Resumen Introducción: la anorexia nerviosa (AN) es una patología psiquiátrica grave que posee una de las tasas de mortalidad más altas dentro de las enfermedades mentales, estimándose en 5,1 muertes por 1000 personas/año, y se asocia a una alta comorbilidad tanto psiquiátrica como somática. Objetivos: caracterizar a adolescentes hospitalizados y su rehabilitación nutricional mediante el uso de un protocolo estandarizado. Métodos: estudio descriptivo-retrospectivo de pacientes adolescentes hospitalizados en la Clínica San Carlos de Apoquindo de Chile con diagnóstico de AN, hemodinámicamente estables y sin criterios de síndrome de realimentación, entre el año 2015 y 2021. Se analizaron los datos epidemiológicos, clínicos y nutricionales de los pacientes. Resultados: de 46 pacientes estudiados, 37 eran de sexo femenino; el tiempo de estadía promedio fue de 45,4 (DE ± 36,1) días. Un 53,8 % de los pacientes presentaban como comorbilidad psiquiátrica un trastorno del ánimo; el rasgo de personalidad más habitual fue el obsesivo-compulsivo (36,9 %) y la comorbilidad somática más frecuente fue la patología tiroidea (19,2 %). El aporte calórico inicial por vía oral fue de 1467 (DE ± 479) kcal, con un incremento promedio semanal de 400 kcal, llegando a 2430 (DE ± 457) kcal al alta. Se obtuvo un cambio porcentual del índice de masa corporal promedio (IMC%) de 7,8 % (DE ± 6,1). Conclusión: este es el primer estudio chileno que describe la rehabilitación nutricional de adolescentes con AN y el tiempo de hospitalización que se requiere para lograrla.

Abstract Background: anorexia nervosa (AN) is a severe psychiatric pathology that has one of the highest mortality rates among mental illnesses, estimated at 5.1 deaths per 1,000 people/year, and is associated with high comorbidity, both psychiatric and somatic. Aim: to characterize hospitalized adolescents and their nutritional rehabilitation using a standardized protocol. Methods: a descriptive-retrospective study of adolescent patients hospitalized at the San Carlos of Apoquindo Clinic with a diagnosis of AN, hemodynamically stable and without refeeding syndrome criteria, between 2015 and 2021. Epidemiological, clinical, and nutritional data of the patients were analyzed. Results: of 46 patients studied, 37 were female; the average length of stay was 45.4 (SD ± 36.1) days; 53.8 % of the patients had mood disorder as psychiatric comorbidity, and the most common personality trait was obsessive-compulsive (36.9 %); the most frequent somatic comorbidity was thyroid pathology (19.2 %). The initial oral caloric intake was 1467 (SD ± 479) kcal, with an average weekly increase of 400 kcal, reaching 2430 (SD ± 457) kcal at discharge. An average percentage median body mass index (BMI%) of 7.8 % (SD ± 6.1) was obtained. Conclusions: this is the first study done in Chilean adolescents hospitalized with AN that describes nutritional rehabilitation and length of stay.

Abstract Classical sociology tends to present religion and addictive processes as factors of alienation, opposed to agency. Violence, for its part, has been analyzed in a broad spectrum that ranges from an instrument of domination –for those who suffer it– to an instrument of action –on the part of those who exercise it. However, there are few analyses that observe how religion, addictions and violence are empirically interrelated in the subjective experience of victims and perpetrators of violent acts. Using a qualitative study based on narrative interviews and participant observation, we analyze the way in which violence is re-signified through religion in three rehabilitation centers for drug addicts located in the northern border region of Mexico. We conclude that spiritual warfare is a central resource for re-semanticizing suffering and violence, and constitutes a central aspect of the evangelical model of rehabilitation.

Resumen La sociología clásica suele presentar a la religión y a los procesos adictivos como factores de alienación, contrarios a la capacidad de agencia. Por su parte, la violencia ha sido analizada en un amplio espectro, desde un instrumento de dominación –para quien la sufre– o uno de acción –por parte de quien la ejerce–. Sin embargo, existen pocos análisis que observen cómo religión, adicciones y violencia se interrelacionan empíricamente, en la experiencia subjetiva de víctimas y perpetradores de actos violentos. A partir de un estudio cualitativo basado en entrevistas narrativas y observación participante, analizamos la forma en que la violencia es resignificada a través de la religión en tres centros de rehabilitación para fármacodependientes, ubicados en la región fronteriza del norte de México. Concluimos que la guerra espiritual es un recurso central para resemantizar el sufrimiento y la violencia, y constituye un aspecto medular del modelo evangélico de rehabilitación.

Background: SARS-CoV-2 affects all age groups, but higher mortality rates are recorded in older people, men and with comorbidities, mainly hypertension, diabetes and obesity. Aim: To describe the main clinical characteristics, evolution and prognostic factors for death in older patients hospitalized for COVID-19. Materials and Methods: Retrospective analysis of 128 patients aged 73 years, 66% men, hospitalized at a clinical hospital, with a diagnosis of COVID-19, admitted from May 1 to August 1, 2020. Data were collected from the clinical records, a description of the study population was made, and a univariate analysis and logistic regression were performed. Results: Seventy-two percent of patients had two or more comorbidities, mainly arterial hypertension in 66%, diabetes mellitus in 34% and cardiovascular disease in 19%. Forty-one percent were admitted to intensive care and 31% were connected to mechanical ventilation. In-hospital mortality was 26.6%. A multivariate analysis was performed in two blocks, finding in the first that arterial hypertension and older age significantly predict mortality. However, when previous institutionalization and immuno-suppression were included as variables in the second block, age ceased to be a significant predictor. Conclusions: Prognostic factors associated with death in this age group are arterial hypertension and previous institutionalization.

Background: Alarms about mistreatment in medical education have been raised for almost 30 years. Aim: To describe the frequency of abuse reports among medical students at a university in Chile, investigating their association with age, sex, and educational level. Material and Methods: The Mistreatment by Teachers Questionnaire was applied to 264 first to seventh year medical students (54% males). An exploratory factorial analysis of the instrument was performed, a descriptive analysis was made and its relationship with age, sex and level of training were evaluated. Results: Ninety eight percent of respondents reported having been mistreated at least once. Mistreatment was grouped into three factors with a confidence ranging between α = 0.79 and 0.93, namely demoralization, deregulated demands and physical aggression. The first two were associated with age and level of education. There were no differences by sex. Conclusions: Mistreatment is common in undergraduate medical education, as it has been found in other universities around the world.

SUMMARY Objective: To describe prenatal and post-natal clinical features of neonates born from mothers with COVID-19 including 14-day follow-up post discharge. Methods: Case series of neonates attended at Hospital Guillermo Almenara born from mothers infected with COVID-19 during the lockdown implemented by the Peruvian government. Neonates were divided in two groups based on positivity of the nasopharyngeal PCR test. Results: 201 pregnant women with COVID-19 diagnosed by rapid tests who delivered 206 neonates were identified; 4 of these neonates had positive nasopharyngeal PCR tests. Pregnants infected with COVID-19 were younger than non-infected, but no differences were observed in route of delivery, sex of the newborn and body weight at birth. Two hundred and five neonates were discharged one week after birth ;181 neonates with negative nasopharyngeal negative PCR tests and 4 neonates with a positive PCR test were followed for 14 days, none presented symptoms and received mixed lactation. Conclusions: Neonates born from mother infected with COVID-19 had minimal risk of getting the infection and their pre and post-natal development will not be affected despite of having a positive PCR test.

RESUMEN Objetivo: Describir las características clínicas prenatales y post natales de los neonatos hijos de madres con la Covid-19, y seguimiento hasta los 14 días post alta. Material y métodos: Estudio tipo observacional, serie de casos, censal de los neonatos nacidos en el Hospital Guillermo Almenara Irigoyen, hijos de madres con la Covid-19, que nacieron durante la cuarentena decretada por el gobierno peruano. Los neonatos se dividieron en 2 grupos: con la prueba PCR nasofaríngea positiva o no y se observó si alguna de estas características estuvieron asociadas con la presentación de esta prueba positiva. Resultados: Hubieron 201 gestantes con diagnóstico de Covid-19 por prueba rápida y que tuvieron 206 neonatos. De ellos, 4 neonatos tuvieron la PCR nasofaríngea positiva y 202, negativa. La edad materna fue menor en el grupo con la prueba positiva, pero no hubo diferencia respecto al tipo de parto: césarea, fueron a termino, con adecuado peso al nacer y ningún sexo predominó. Doscientos cinco (99,51%) neonatos salieron de alta en la primera semana de vida; 181 (90,05%) neonatos con PCR nasofaríngea negativa y los 4 neonatos con prueba positiva fueron seguidos por 2 semanas; ninguno presentó síntomas y el tipo de lactancia fue mixta. Conclusiones: Los neonatos hijos de madres con la Covid-19, tendrían una mínima posibilidad de contraer esta enfermedad. Y su desarrollo prenatal y post natal no se vería afectado, a pesar de incluso tener la prueba PCR nasofaríngea positiva.

Resumen La vertiente del Pacífico mexicano en el suroeste de Oaxaca alberga una gran diversidad de aves que ha sido poco estudiada. Presentamos un inventario y análisis de la avifauna de esa región, mediante transectos, redes de niebla y observaciones no sistemáticas, en 12 localidades repartidas en cuatro tipos de vegetación (selva mediana subcaducifolia, ve getación ribereña, áreas sujetas a manejo agropecuario y selva baja caducifolia). Contabilizamos 120 especies, correspondientes a 39 familias y 19 órdenes. Del total de especies, 72% fueron residentes todo el año y 24%, de invierno. Por el tipo de alimentación, las terrestres insectívoras (52%) fueron las más abundantes, seguidas de las carnívoras (20%) y terrestres herbívoras (15%). El mayor número de especies (68%) estuvo asociado a ve getación ribereña. Esta región de Oaxaca alberga 16% de la riqueza de aves de México, entre ellas a nueve especies endémicas o cuasiendémicas de México y 12 en categorías de riesgo a nivel nacional o internacional, como el pato real (Cairina moschata), loro corona lila (Amazona finschi), loro cabeza amarilla (Amazona oratrix) y vireo de Bell (Vireo bellii). Recomendamos la protección de la vegetación ribereña y de las selvas como la mejor estrategia para la conservación de la avifauna.

Abstract The Mexican Pacific watershed in southwest Oaxaca is home to a great diversity of birds that has been little studied. We present an inventory and analysis of the birdlife of that region, collected through transects, mist nets and non-systematic observations, in 12 locations distributed in four vegetation types (sub-deciduous forest, riparian vegetation, areas subject to agricultural management and dry deciduous forest). We counted 120 species, corresponding to 39 families and 19 orders. Of the total number of species 72% were permanent residents and 24% winter residents. Categorized by their diet terrestrial insectivores (52%) were more abundant, followed by carnivores (20%) and terrestrial herbivores (15%). The highest number of species (68%) was associated with riparian vegetation. In this region of Oaxaca occurs 16% of the bird richness of Mexico, including nine species endemic or quasiendemic to Mexico, and 12 species that are classified into national or international risk categories, such as the Muscovy Duck (Cairina moschata), Lilac-crowned Parrot (Ama zona finschi), Yellow-headed Parrot (Amazona oratrix) and Bell’s Vireo (Vireo bellii). We recommend the protection of riparian vegetation and forests as the best strategy for the conservation of the avifauna.

ABSTRACT The present study aimed to investigate the morphology and morphometry of progenitor cells from the bone marrow through cytological examination during foetal development of the alpaca (Vicugna pacos). Bone marrow samples were collected from 18 culled and clinically healthy alpaca foetuses in Pasco, Peru. The eighth and ninth ribs were removed using the cost-chondral junction as reference and smears were made with the bone marrow samples, and then stained with Wright. The percentages of cellularity for each third of pregnancy were 16 ± 0.2 (n= 3), 35 ± 0.16 (n= 5) and 78 ± 0.12 (n=10), respectively, showing the first hematopoietic cells from 201.5 days old. Through the differential count of 500 cells, the myeloid: erythroid ratio was established, being 0.47 ± 0.27 and 0.69 ± 0.19 for the first, second and last third of pregnancy, respectively. In the second third of pregnancy 10.17% of erythroid cells, 5.03% of myeloid cells and 84.80% of other cell types were detected, while in the last third it was 39.99% of erythroid cells, 26.99% of myeloid cells and 33.21% of other cell types. In the morphometric examination, hematopoietic cells revealed characteristics like those found in other species.

RESUMEN El presente estudio tuvo como objetivo investigar la morfología y morfometría de las células progenitoras de la médula ósea a través del examen citológico durante el desarrollo fetal de la alpaca (Vicugna pacos). Se colectaron muestras de médula ósea provenientes de 18 fetos de alpacas clínicamente sanas y destinadas a beneficio en Pasco, Perú. Se seccionaron la octava y novena costillas tomando como referencia la unión costo-condral y se hicieron frotis con las muestras de médula ósea, que fueron coloreadas con la tinción Wright. Los porcentajes de celularidad para cada tercio de gestación fueron 16 ± 0.2 (n=3), 35 ± 0.16 (n=5) y 78 ± 0.12 (n=10), respectivamente, evidenciándose las primeras células hematopoyéticas a partir de los 201.5 días de edad. Mediante el conteo diferencial de 500 células se estableció la relación mieloide:eritroide, siendo de 0, 0.47 ± 0.27 y 0.69 ± 0.19 para el primer, segundo y tercer tercio de gestación, respectivamente. En el segundo tercio de gestación se detectó 10.17% de células eritroides, 5.03% de células mieloides y 84.80% de otros tipos celulares, mientras que en el último tercio fue de 39.99% de células eritroides, 26.99% de células mieloides y 33.21% de otros tipos celulares. En el examen morfométrico, las células hematopoyéticas revelaron características similares a las encontradas en otras especies.

ABSTRACT Objective: To determine the incidence and the clinical, bacteriological and cerebrospinal fluid characteristics of neonatal meningitis in Lima hospitals. Materials and methods: An observational, multicenter study was conducted in six hospitals in the city of Lima during 1 year of epidemiological surveillance. Results: The cumulative hospital incidence was 1.4 cases per 1000 live births. A total of 53 cases of neonatal meningitis were included, 34% (18/53) were early and 66% (35/53) late. The associated maternal factors were meconium-stained amniotic fluid and urinary tract infection. Insufficient prenatal check-ups were found in 58.8% (30/51). The most associated neonatal factor was sepsis. The main symptoms were fever, irritability, hypoactivity and respiratory distress. Pleocytosis in cerebrospinal fluid (CSF) was significant, without predominance of polymorphonuclear lymphocytes (PMN), hypoglycorrhagia and proteinorrhagia. The most frequent pathogens isolated were Escherichia coli and Listeria monocytogenes. Conclusions: The hospital incidence of neonatal meningitis was 1.4 per 1000 live births, being ten times higher in preterm infants. Breathing difficulty was the most frequent symptom in the early stage, while fever and irritability in the late stage. CSF showed pleocytosis without predominance of PMN. The most frequent germs were Escherichia coli and Listeria monocytogenes. Ventriculitis and hydrocephalus were the most common neurological complications.

RESUMEN Objetivo: Determinar la incidencia y las características clínicas, bacteriológicas y del líquido cefalorraquídeo de la meningitis neonatal en hospitales de Lima. Materiales y métodos: Se realizó un estudio observacional, multicéntrico en seis hospitales de la ciudad de Lima, con una vigilancia epidemiológica durante un año. Resultados: La incidencia acumulada hospitalaria fue de 1,4 casos por mil nacidos vivos. Fueron incluidos 53 casos de meningitis neonatal, 34% (18/53) fueron tempranos y 66% (35/53) tardíos. Los factores maternos asociados fueron líquido amniótico meconial e infección de tracto urinario. El 58,8% (30/51) presentó controles prenatales insuficientes. El factor neonatal más asociado fue sepsis. Los principales síntomas fueron fiebre, irritabilidad, hipoactividad y dificultad respiratoria. En el líquido cefalorraquídeo (LCR) se destacó la pleocitosis, sin predominio de polimorfonucleares (PMN), hipoglucorraquia y proteinorraquia. Los patógenos aislados con mayor frecuencia fueron Escherichia coli y Listeria monocytogenes. Conclusiones: La incidencia hospitalaria de meningitis neonatal fue de 1,4 por mil nacidos vivos, siendo diez veces mayor en prematuros. La dificultad respiratoria fue el síntoma más frecuente en la forma temprana, mientras que la fiebre e irritabilidad en la forma tardía. El LCR mostró pleocitosis sin predominio de PMN. Los gérmenes más frecuentes fueron Escherichia coli y Listeria monocytogenes. La ventriculitis e hidrocefalia fueron las complicaciones neurológicas más comunes.

ABSTRACT Objective: To determine the incidence and the clinical, bacteriological and cerebrospinal fluid characteristics of neonatal meningitis in Lima hospitals. Materials and methods: An observational, multicenter study was conducted in six hospitals in the city of Lima during 1 year of epidemiological surveillance. Results: The cumulative hospital incidence was 1.4 cases per 1000 live births. A total of 53 cases of neonatal meningitis were included, 34% (18/53) were early and 66% (35/53) late. The associated maternal factors were meconium-stained amniotic fluid and urinary tract infection. Insufficient prenatal check-ups were found in 58.8% (30/51). The most associated neonatal factor was sepsis. The main symptoms were fever, irritability, hypoactivity and respiratory distress. Pleocytosis in cerebrospinal fluid (CSF) was significant, without predominance of polymorphonuclear lymphocytes (PMN), hypoglycorrhagia and proteinorrhagia. The most frequent pathogens isolated were Escherichia coli and Listeria monocytogenes. Conclusions: The hospital incidence of neonatal meningitis was 1.4 per 1000 live births, being ten times higher in preterm infants. Breathing difficulty was the most frequent symptom in the early stage, while fever and irritability in the late stage. CSF showed pleocytosis without predominance of PMN. The most frequent germs were Escherichia coli and Listeria monocytogenes. Ventriculitis and hydrocephalus were the most common neurological complications.

RESUMEN Objetivo: Determinar la incidencia y las características clínicas, bacteriológicas y del líquido cefalorraquídeo de la meningitis neonatal en hospitales de Lima. Materiales y métodos: Se realizó un estudio observacional, multicéntrico en seis hospitales de la ciudad de Lima, con una vigilancia epidemiológica durante un año. Resultados: La incidencia acumulada hospitalaria fue de 1,4 casos por mil nacidos vivos. Fueron incluidos 53 casos de meningitis neonatal, 34% (18/53) fueron tempranos y 66% (35/53) tardíos. Los factores maternos asociados fueron líquido amniótico meconial e infección de tracto urinario. El 58,8% (30/51) presentó controles prenatales insuficientes. El factor neonatal más asociado fue sepsis. Los principales síntomas fueron fiebre, irritabilidad, hipoactividad y dificultad respiratoria. En el líquido cefalorraquídeo (LCR) se destacó la pleocitosis, sin predominio de polimorfonucleares (PMN), hipoglucorraquia y proteinorraquia. Los patógenos aislados con mayor frecuencia fueron Escherichia coli y Listeria monocytogenes. Conclusiones: La incidencia hospitalaria de meningitis neonatal fue de 1,4 por mil nacidos vivos, siendo diez veces mayor en prematuros. La dificultad respiratoria fue el síntoma más frecuente en la forma temprana, mientras que la fiebre e irritabilidad en la forma tardía. El LCR mostró pleocitosis sin predominio de PMN. Los gérmenes más frecuentes fueron Escherichia coli y Listeria monocytogenes. La ventriculitis e hidrocefalia fueron las complicaciones neurológicas más comunes.

Background Educational inclusion, a concept that has changed over time, is becoming relevant. It initially considered only disability and now contemplates education for all people. Educational inclusion has special relevance in health care workers’ training, who will have direct contact with heterogeneous populations, where diversity-oriented treatments are required. Aim To describe how diversity is integrated into health care training in a clinical context. Material and Methods qualitative study, based on Grounded Theory. Two group interviews and thirteen semi-structured interviews were conducted among 11 teachers and 25 students of health careers. Data was analyzed using Atlas-ti 7.5.2. A constant comparison method, reaching an axial coding level, was used. Results The category of training in health careers in the context of diversity emerged. It is a process that operates in cognitive, affective and behavioral dimensions. It accounts for the diversity of system actors and the model of a health professional and teacher facing diversity. Conclusions These dimensions should be understood during clinical training. Socio-cultural diversity encompassing gender, sex, ethnicity, religion and disability should be considered. Therefore, educational inclusion is an important issue to be considered by universities.

Introduction: Learning processes planning is highly complex, both for students and teachers. Prior to decide what to do in the classroom, teachers should consider graduate profile and courses programs. But it is unclear how they finally define their purposes before taking a class. Aim: To analyze the process of purposes definition that underlies teaching activities election for undergraduate health programs. Subjects and methods: Qualitative study, according to the grounded theory. Four experts in medical education and 25 teachers were interviewed, prior informed consent. For data analysis, axial coding was performed. Results: Teachers' purposes are usually expressed in terms related to competency model. They are rooted in the conception of 'what is usually taught'. It is also affected by what is formally established in the curriculum. But its operationalization is strongly affected by personal and professional conceptions and teachers' experiences. For teachers, this increases the relevance of their work, although the guidelines defined by his university are less used. Conclusion: Teachers showed an active role in teaching purposes definition, which is consistent with what is expected by a reflexive teacher. However, the discussion of what problems in formal curricula leads him to make frequent personal adaptations remains open.

Introducción: Los procesos de planificación del aprendizaje son altamente complejos, tanto para estudiantes como para docentes. Para decidir qué hacer en el aula, los docentes deben considerar el perfil de egreso de la carrera y los programas de la asignatura, pero no está claro cómo finalmente definen sus propósitos antes de realizar una clase. Objetivo: Analizar el proceso de definición de propósitos desde los cuales el docente planifica las actividades de enseñanza de programas de pregrado de la salud. Sujetos y métodos: Estudio cualitativo, según la teoría fundamentada. Se entrevistó a cuatro expertos en educación médica y a 25 docentes, previo consentimiento informado. Para el análisis se realizó codificación axial. Resultados: Los propósitos de los docentes suelen expresarse en términos afines al modelo por competencias y están arraigados en la concepción de 'qué se suele enseñar', afectado por lo establecido formalmente en el plan de estudios. Su operacionalización está fuertemente influida por las concepciones personales y profesionales y las experiencias del académico. Para el docente, esto aumenta la relevancia de su labor, aunque ello signifique un menor seguimiento de las directrices definidas por su universidad. Conclusión: El docente ejerce un rol activo en la definición de los propósitos de enseñanza, lo que es coherente con lo esperado por un docente reflexivo. Sin embargo, queda abierta la discusión de cómo los problemas en la definición de los planes de estudio formales lo llevan a realizar frecuentes adaptaciones personales.

ABSTRACT: This study sought to describe the transgender identity construction process from the perspective of transgender adolescents. The aim was to visualize their needs and difficulties during the process, since there is evidence showing that they are a vulnerable group in terms of mental health. A multiple case exploratory study was conducted using qualitative methodology. Participants were 8 purposively selected Chilean teenagers residing in Santiago, Chile, aged between 15 and 19 years, who had revealed their gender identity to their parents and were receiving support from mental health specialists. Semi-structured interviews were conducted and were analyzed using the grounded theory method. Results revealed a trajectory that begins in early childhood with an affinity for and an interest in the activities of the gender not assigned at birth, with family and/or peers displaying reluctance/rejection. This process is associated with contradictory feelings and emotional tension, which compels adolescents to search for information in their sociocultural context in order to name and make sense of what they are experiencing. Afterward, they become able to share their gender identity with those closest to them and begin considering subsequent social changes.

RESUMEN: El objetivo de este estudio fue describir el proceso de construcción de la identidad transgénero, desde la perspectiva de los adolescentes implicados. El propósito fue visualizar necesidades y dificultades durante el proceso, ya que existe evidencia de que son un grupo vulnerable en el área de la salud mental. El estudio fue exploratorio de casos múltiples, utilizando metodología cualitativa. Los participantes fueron 8 adolescentes chilenos residentes en Santiago de Chile, seleccionados intencionadamente, entre 15-19 años, que han develado su condición a sus padres y reciben apoyo de especialistas en salud mental. Se realizaron entrevistas semiestructuradas y se analizaron con el método de la teoría fundamentada. Los resultados revelaron una trayectoria que se inicia en la temprana infancia con afinidad e interés por actividades del género no asignado al nacer, con reticencia/rechazo de la familia y/o pares. El proceso se acompaña de sentimientos contradictorios y de tensión emocional, que movilizan la búsqueda de información en el medio sociocultural para dar nombre y sentido a lo que sucede. Luego, es posible compartir esta condición con los más significativos e ir pensando en los cambios sociales posteriores.

Abstract The analysis of interments from the burial area of the ancient pre-Hispanic city of Tamtoc, revealed not only the unusual burial pattern of this place but also the differences in the patterns of mortality and their relationship with cultural features present in some of the individuals. Variables such as age at death, sex, presence of corporal modifications, funerary trousseau and disposition of the burials in the sepulchral space were analyzed. The practice of modeling the skull shows non-local variations and there is only one case with dental decoration. These findings are discussed from the archaeological evidence and the role of this site as a regional guiding center.

Resumen El análisis de los entierros procedentes del área funeraria de la antigua ciudad prehispánica de Tamtoc, reveló no solo el inusual patrón de entierro de este lugar sino también las diferencias en los patrones de mortalidad y su relación con rasgos culturales presentes en algunos de los individuos. Se analizaron variables como edad a la muerte, el sexo, presencia de modificaciones corporales, ajuar funerario y disposición de los entierros en el espacio sepulcral. La práctica de modelarse el cráneo muestra variaciones no locales y existe un solo caso con decoración dental. Estos hallazgos se discuten a partir de la evidencia arqueológica y del papel de este sitio como centro rector regional.

Attention Deficit Hyperactivity Disorder (ADHD) is defined as a neuropsychiatric picture of behavioral manifestation, chronic, symptomatically evolutive and of probable genetic transmission (Aboitiz & Carrasco, 2009) that impacts the different areas of development, for the child and his family (Silver, 2010). Research has shown that students with ADHD have a higher educational risk, due not only to academic and learning difficulties, but also to social difficulties, rejection of their peers and a decrease in teaching expectations (Valero, 2013). One of the most notorious characteristics, through out the life cycle, is the frequent association that ADHD presents with other psychiatric disorders; anxious, affective and oppositional disorders (Larson, Russ, Khan & Halfon, 2011), the latter being the most prevalent in children and adolescents (Garrido, 2013). In coherence with the above, the World Health Organization (WHO) has established that psychiatric disorders that begin in childhood or adolescence should be a priority for Public Health (Vicente, Saldivia, De la Barra, Melipillán, Valdivia & Kohn 2012). In Chile, it is approached from an integral and interdisciplinary perspective from Primary Health Care, based on the evidence that multimodal treatment is ideally recommended for its approach, understanding it as a multidisciplinary treatment according to the biopsychosocial model seeks to complement resources psychopharmacological, psychotherapeutic and psychopedagogical. The present investigation seeks to know what is the perception of the effects of a multimodal treatment in mothers with children diagnosed with ADHD, in a Family Health Center. A qualitative design of descriptive type was used, using the focused individual interview as a technique. The sample consisted of four maternal figures, who accessed the interviews after having duly signed an informed consent. An analysis of the conventional content of the interviews was carried out, with triangulation by researchers and experts. The results indicate the perception of the effects on: the individual development of the child, the family dynamics and the school environment. In relation to the individual development of the child, perceptions of the effects of treatment in the emotional, behavioral and social areas have been identified. In the family dynamics, two aspects are recognized, one related to the performance of the role of the parents and the other related to the relationship between mother and child. Regarding paternal roles, they indicate greater participation on the part of the father, changes in the organization of family daily life, in the parenting patterns, in the behavioral management of themselves and a greater satisfaction with their maternal role. Regarding the relationship, mothers perceive a greater level of empathy, the promotion of more autonomy and an improvement in the expression of affects. Regarding the perception of the effects of treatment in the school environment, improvements in school adaptation, performance, interpersonal relationships and school behavior are identified. We mainly discuss the perceived progress in the affective field, where the findings show improvements in self-esteem and emotional maturity, by observing their children more cheerful, expressive, communicative and with greaterself-confidence, better quality social relationships that impact on a better quality of life for both the child and his family. The need for a depathologizing and integral vision of the child in the intervention processes is emphasized, with emphasis on their competences and family interaction, where reorganization processes, changes of roles and parenting patterns are more functional to the needs of the child. Regarding the limitations of this study, we can mention the small number of participants, which could affect the richness of the experiences of the phenomenon studied. Likewise, it is estimated that for future research it would be relevant to know the perception of the child and other significant actors, such as parents and teachers.

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es abordado bajo una perspectiva integral e interdisciplinaria desde la Atención Primaria de Salud en Chile. La presente investigación buscó conocer cuál es la percepción de los efectos de un tratamiento multimodal en madres con hijos diagnosticados con TDAH, en un Centro de Salud Familiar. Se utilizó un diseño cualitativo de tipo descriptivo, utilizando como técnica la entrevista individual focalizada. La muestra estuvo compuesta por cuatro figuras maternas. Se realizó un análisis de contenido convencional, con triangulación por investigador y expertos. Los resultados señalan la percepción de efectos en: desarrollo individual del niño, dinámica familiar y ámbito escolar. En relación con el desarrollo individual del niño, se han identificado percepciones de los efectos del tratamiento en las áreas emocional, conductual y social. En la dinámica familiar, se reconocen dos aspectos, uno relacionado con el desempeño del rol de los padres y otro referente a la relación vincular padres/hijo. En cuanto a la percepción de los efectos del tratamiento en el entorno escolar, se identifican mejoras en la adaptación escolar, el rendimiento, las relaciones interpersonales y el comportamiento escolar. Se discute, el progreso percibido en el campo afectivo, en el que se observan mejoras en autoestima, madurez emocional, autoconfianza y relaciones sociales de mejor calidad que impactan favorablemente en una mejor calidad de vida del niño y su familia. Se enfatiza la necesidad de una visión despatologizadora e integral del niño en la intervención, con énfasis en sus competencias e interacción familiar.

Abstract Background: Atypical Steven-Johnson syndrome is a rare disease that can be caused by Mycoplasma pneumoniae; it is characterized by respiratory symptoms, mucosal lesions of variable severity and constitutional symptoms, in the absence of cutaneous involvement. Case report: We present the case of a 35-old-man who developed mucositis in the conjunctiva, oral cavity and genitalia after the onset of respiratory symptoms. Mycoplasma pneumoniae infection was confirmed, and treatment with antibiotic and steroids was therefore started, whereby clinical manifestations subsided. Conclusions: Mycoplasma pneumoniae-induced atypical Steven-Johnson syndrome diagnosis can be challenging. The differential diagnosis of fever and oral, genital and conjunctival mucositis associated with respiratory symptoms should include infection with this bacteria in order to provide accurate and timely treatment.

Resumen Antecedentes: El síndrome de Steven-Johnson atípico es una enfermedad poco común que puede ser causada por Mycoplasma pneumoniae; se caracteriza por síntomas respiratorios, lesiones en mucosas de gravedad variable y síntomas constitucionales, en ausencia de compromiso cutáneo. Reporte de caso: Hombre de 35 años quien desarrolló mucositis en conjuntiva, cavidad oral y genitales después de la presentación de síntomas respiratorios. Se confirmó la infección por Mycoplasma pneumoniae, por lo que se inició tratamiento con antibiótico y esteroides, con lo cuales remitieron las manifestaciones clínicas. Conclusiones: El diagnóstico de síndrome de Steven-Johnson atípico inducido por Mycoplasma pneumoniae puede ser difícil. El diagnóstico diferencial de fiebre y mucositis oral, genital y conjuntival asociadas con síntomas respiratorios debe incluir infección por esta bacteria, con el fin de brindar un tratamiento certero y oportuno.