ABSTRACT Leptospirosis is an important zoonosis. The World Health Organization recommends the use of microscopic soroagglutination in the diagnosis of the disease. However, this is a time-consuming technique that offers a risk of contamination to the performer and requires a trained professional. The indirect enzyme-linked immunosorbent assay (ELISA) test presents less risk, is faster, and has lower cost benefit for high sampling. In view of the advantages of using the test, and the importance of the development of techniques that facilitate and make the diagnosis more efficient, the objective of this study was to standardize an indirect ELISA technique using an immunogenic protein of Leptospira spp. for the diagnosis of canine leptospirosis. The standardized test obtained a cut off of 0.314, 76% of sensitivity, 34% of specificity, 53.52% of positive predictive value, 58.62 of negative predictive value, and 55% of accuracy. The protein extraction technique was efficient for antigen production, and the standardized test can be used in the diagnosis of canine leptospirosis.

Resumo Este ensaio aborda, à luz da bioética, a transformação do currículo médico no Brasil de um modelo multidisciplinar para um inter ou transdisciplinar. Em revisão narrativa, discutem-se a teoria da complexidade e a transdisciplinaridade, estabelecendo analogia entre a maneira como bioéticas latino-americanas usufruem dessa teoria para a compreensão da realidade, formulando bases conceituais de um currículo médico que supere a fragmentação na formação. Para as bioéticas do sul global, o pensamento complexo e a transdisciplinaridade são fundamentais para compreender uma realidade não reducionista, aberta à construção de conhecimentos que não se isolem na explicação biomédica do mundo. De maneira semelhante, para a formação de médicos com visão de saúde ampliada, que valorizem os determinantes sociais e subjetivos do processo saúde-doença, o currículo deve proporcionar a religação dos saberes. A introdução do pensamento complexo no currículo médico pode estimular o ensino não reducionista.

Abstract Adopting bioethics as the framework, this essay discusses the transformation of medical curricula in Brazil from a multidisciplinary model to an inter- or transciplinary one. The narrative review method is used to discuss the theory of complexity and transdiciplinarity, establishing an analogous understanding between how Latin American bioethics views use this theory to understand reality, creating conceptual framework of a medical curricula that goes beyond fragmentation in training. Complex thought and transdiciplinarity are fundamental for the bioethics views of the global south to understand a non-reductionist reality, one that is open to constructing knowledge that is not isolated in a biomedical understanding of the world. Likewise, to train physicians with a broader view of health and who value the social and subjective determinant aspects in the health-disease process, the curriculum must provide a rekindling of pieces of knowledge. The introduction of complex though in medical curricula can stimulate non-reductionist teaching.

Resumen Este ensayo muestra, basándose en la bioética, la transformación del currículo de medicina en Brasil del modelo multidisciplinar al modelo inter- o transdisciplinar. Desde una revisión narrativa se discute la teoría de la complejidad y la transdisciplinariedad bajo una analogía de cómo las bioéticas latinoamericanas utilizan esa teoría para comprender la realidad, sentando bases conceptuales para un currículo de medicina que supere una formación fragmentaria. Para las bioéticas del sur global, el pensamiento complejo y la transdisciplinariedad son claves para comprender una realidad no reduccionista, abierta a la construcción de saberes que no se restringen a la explicación biomédica de mundo. Asimismo, para una formación médica con visión amplia de la salud y que valora los determinantes sociales y subjetivos del proceso salud-enfermedad, el currículo debe propiciar la reconexión de saberes. La introducción del pensamiento complejo en el currículo de medicina puede fomentar una enseñanza no reduccionista.

Resumo Este artigo tem como objetivo identificar competências médicas marcadas pelo estigma contra pessoas com transtornos mentais, analisando, a partir do conceito de habitus de Pierre Bourdieu, a interferência da formação médica no pensamento e na ação dos médicos da atenção básica para a condução de casos de pessoas com esses transtornos. Utilizou-se o recurso metodológico da observação participante e uma aula aplicada por um psiquiatra para médicos da atenção básica em atividade de matriciamento. Descrevemos a estratégia pedagógica desenvolvida que, quando analisada, foi capaz de demonstrar estigmas nas competências de médicos com potencial consequência negativa no atendimento dos usuários, sendo identificados generalizações, reducionismos, desesperança e outros sentimentos negativos associados com barreiras de acesso ao cuidado.

Abstract This article aims to identify medical competencies marked by stigma against people with mental disorders. We analyzed, based on Pierre Bourdieu's concept of habitus, the interference of medical training in the thinking and action of primary care doctors to manage cases of people with those disorders. This research used features of participant observation on a lesson applied by a psychiatrist for primary care physicians in matrix support activities. We describe the pedagogical strategy developed that, when analyzed, was able to demonstrate stigmas in the competencies of doctors, with a potential negative consequence for healthcare, like generalizations, reductionisms, hopelessness and other feelings associated with barriers to access to care giving of that population.

Resumo Este artigo tem como objetivo identificar competências médicas marcadas pelo estigma contra pessoas com transtornos mentais, analisando, a partir do conceito de habitus de Pierre Bourdieu, a interferência da formação médica no pensamento e na ação dos médicos da atenção básica para a condução de casos de pessoas com esses transtornos. Utilizou-se o recurso metodológico da observação participante e uma aula aplicada por um psiquiatra para médicos da atenção básica em atividade de matriciamento. Descrevemos a estratégia pedagógica desenvolvida que, quando analisada, foi capaz de demonstrar estigmas nas competências de médicos com potencial consequência negativa no atendimento dos usuários, sendo identificados generalizações, reducionismos, desesperança e outros sentimentos negativos associados com barreiras de acesso ao cuidado.

Abstract This article aims to identify medical competencies marked by stigma against people with mental disorders. We analyzed, based on Pierre Bourdieu's concept of habitus, the interference of medical training in the thinking and action of primary care doctors to manage cases of people with those disorders. This research used features of participant observation on a lesson applied by a psychiatrist for primary care physicians in matrix support activities. We describe the pedagogical strategy developed that, when analyzed, was able to demonstrate stigmas in the competencies of doctors, with a potential negative consequence for healthcare, like generalizations, reductionisms, hopelessness and other feelings associated with barriers to access to care giving of that population.

RESUMO: Objetivou-se neste trabalho avaliar o perfil de ácido graxo e a qualidade físico-química do óleo de buriti em condições de armazenamento. O óleo foi analisado durante 70 dias avaliando as características físico-química índice de acidez, índice de refração, densidade aparente, viscosidade absoluta, índice de peróxidos, oxidação lipídica pelo método de TBARS, parâmetros de cor (L*, a*, b*, C* e h*) e carotenoides (α-caroteno e β-caroteno) a cada 10 dias de armazenamento, além do sistema β-caroteno/ácido linoléico e perfil de ácidos graxos. As variáveis se mantiveram estáveis durante os períodos de análises e os carotenoides totais variaram entre 836,91 a 1036,96 µg/g. O ácido graxo com maior teor foi o ácido oleico com valor de 78,06 g/100 g de ácidos graxos e relação ω6/ω3 de 1,95. O óleo de buriti apresenta qualidade nutricional que justifica o estímulo ao consumo devido aos ácidos graxos que apresenta, necessitando dos órgãos reguladores a elaboração de um protocolo de extração do óleo da polpa do fruto.

ABSTRACT: The objective of this research was to evaluate the fatty acid profile and physicochemical properties of buriti oil under storage conditions. The oil was analyzed for 70 days by evaluating the physicochemical characteristics of acidity index, refractive index, bulk density, absolute viscosity, peroxide index, lipid oxidation by TBARS method, color parameters (L *, a *, b *, C * e h *) and carotenoid profile (α-carotene and β-carotene) for every 10 days of storage, in addition to the β-carotene/linoleic acid system and fatty acid profile. Variables remained stable over the analysis periods and the total carotenoids ranged from 836.91 to 1036.96 µg/g. Oleic acid accounted for the highest content among fatty acids, with a value of 78.06 g/100 g of fatty acids and a ω6/ω3 ratio of 1.95. Buriti oil has a nutritional quality and a fatty acid profile that justifies recommendations for its consumption, suggesting the need for regulatory bodies to draw up a standardized protocol for extracting oil from the fruit pulp.

RESUMO Objetivo Analisar se existe associação entre a presença, a intensidade e o tipo de desvio vocal e as medidas cepstrais em amostras de indivíduos com queixa vocal. Método Foram utilizadas 376 amostras da vogal /ε/ de indivíduos de ambos os gêneros, com queixa vocal. Utilizou-se uma escala analógico-visual para análise perceptivo-auditiva das vozes quanto à intensidade do desvio vocal (GG), graus de rugosidade (GR), soprosidade (GS) e tensão (GT), incluindo-se a determinação da qualidade vocal predominante (rugosa, soprosa ou tensa). Foram extraídas as medidas relacionadas ao Cepstral Peak Prominence-Smoothed (CPPS) e o declínio espectral das amostras vocais. Resultados Houve diferença dos valores do CPPS entre os grupos com e sem desvio vocal, assim como entre as diferentes intensidades e tipos de desvio vocal. Os valores do CPPS foram mais reduzidos em função da presença e intensidade do desvio vocal. Os valores do CPPS diferenciaram vozes rugosas x soprosas, rugosas x tensas e soprosas x tensas. O declínio espectral apenas diferenciou vozes soprosas x tensas. O CPPS se correlacionou de modo positivo e forte com os GG e GS, de modo negativo moderado com o GR, e de forma negativa fraca com o GT. O declínio espectral apresentou correlação positiva moderada com o GT e correlação negativa fraca com o GS. Conclusão Existe associação entre a presença de desvio vocal, o GG, a qualidade vocal predominante e o CPPS. De modo especial, o GG é fortemente correlacionado ao CPPS. O declínio espectral está associado apenas aos parâmetros de soprosidade e tensão.

ABSTRACT Purpose To analyze whether there is an association between the presence, intensity and type of voice disorder and the cepstral measures in samples of individuals with voice complaints. Methods We used 376 vowel /Ɛ/ samples from individuals of both genders that had voice complaints. An analogue-visual scale was used for the auditory-perceptual analysis of voices regarding the overall grade of dysphonia (G) and the grades of roughness (R), breathiness (B), and strain (S), including a determination of voice quality (rough, breathy or strained). Measures related to cepstral peak prominence smoothed (CPPS) and spectral decline of vocal samples were extracted. Results There were differences in the CPPS values between the groups with or without voice disorders as well as between the different intensities and types of voice disorder. CPPS values were lower because of the presence and intensity of voice disorders. The CPPS values differentiated the following voices: rough x breathy, rough x strained, and breathy x strained. The spectral decline only differentiated breathy x strained voices. CPPS correlated positively and strongly with G and B; moderately and negatively with R, and negatively and weakly with S. The spectral decline had a moderate positive correlation with S and a weak negative correlation with B. Conclusion There is association between voice disorder, G, predominant voice quality, and CPPS. In particular, G is strongly correlated with CPPS. Spectral decline is associated only with the parameters B and S.

Abstract Introduction This research investigates the applicability of a relatively new estimator of mutual information, KSG estimator, to find the reconstruction delay of phase space in dynamical systems. There are evidences that the KSG estimator is more accurate than the naive method commonly used. Methods In this paper we estimated mutual information between the voice signals and their delayed versions, with KSG method. The voice signals were obtained from a disordered voice database. Then, we found the reconstruction delay where mutual information reached its first minimum. We applied the encountered value of reconstruction delay in linear discriminant analysis, in order to discriminate between healthy and pathological voices or to discriminate between pathologies. Discrimination between voice pathologies using nonlinear measurements is still not much explored. Moreover, in this paper we used a single nonlinear measurement: reconstruction delay. Results The results show that the reconstruction delay obtained with KSG method has increased classification rates in most cases, in terms of accuracy, sensitivity and specificity, when compared to the naive estimator usually adopted. Conclusion The KSG estimator is a promising technique to improve the diagnosis of voice related pathologies.

RESUMO Objetivo Investigar a acurácia das medidas acústicas, isoladas e combinadas, na discriminação da intensidade do desvio vocal (GG) e da qualidade vocal predominante (QVP) em pacientes disfônicos. Método Participaram 302 pacientes do gênero feminino, com queixa vocal. A partir da vogal /ɛ/ sustentada, foram extraídas as medidas acústicas de média e desvio padrão (DP) da frequência fundamental (F0), o jitter, o shimmer e o Glottal to noise excitation (GNE) e a média dos três primeiros formantes (F1, F2, F3). A avaliação perceptivo-auditiva do GG e QVP foi realizada por três fonoaudiólogos especialistas em voz. Resultados Isoladamente, apenas o GNE obteve desempenho satisfatório na discriminação do GG e da QVP. Houve uma melhora na classificação do GG e QVP com a combinação das medidas acústicas. A média de F0, F2 e GNE (saudável × desvio leve a moderado), DP de F0, F1 e F3 (leve a moderado × desvio moderado), Jitter e GNE (moderado × desvio intenso) foram as melhores combinações para discriminar o GG. As melhores combinações para discriminação da QVP foram média de F0, Shimmer e GNE (saudável × rugosa), F3 e GNE (saudável × soprosa), média de F0, F3 e GNE (rugosa × tensa), média de F0, F1 e GNE (soprosa × tensa). Conclusão De forma isolada, o GNE mostrou-se o único parâmetro acústico capaz de discriminar o GG e a QVP. Houve um ganho no desempenho da classificação com a combinação das medidas acústicas tradicionais e formânticas, tanto para a discriminação do GG como da QVP.

ABSTRACT Purpose Investigate the accuracy of isolated and combined acoustic measurements in the discrimination of voice deviation intensity (GD) and predominant voice quality (PVQ) in patients with dysphonia. Methods A total of 302 female patients with voice complaints participated in the study. The sustained /ɛ/ vowel was used to extract the following acoustic measures: mean and standard deviation (SD) of fundamental frequency (F0), jitter, shimmer, glottal to noise excitation (GNE) ratio and the mean of the first three formants (F1, F2, and F3). Auditory-perceptual evaluation of GD and PVQ was conducted by three speech-language pathologists who were voice specialists. Results In isolation, only GNE provided satisfactory performance when discriminating between GD and PVQ. Improvement in the classification of GD and PVQ was observed when the acoustic measures were combined. Mean F0, F2, and GNE (healthy × mild-to-moderate deviation), the SDs of F0, F1, and F3 (mild-to-moderate × moderate deviation), and mean jitter and GNE (moderate × intense deviation) were the best combinations for discriminating GD. The best combinations for discriminating PVQ were mean F0, shimmer, and GNE (healthy × rough), F3 and GNE (healthy × breathy), mean F 0, F3, and GNE (rough × tense), and mean F0 , F1, and GNE (breathy × tense). Conclusion In isolation, GNE proved to be the only acoustic parameter capable of discriminating between GG and PVQ. There was a gain in classification performance for discrimination of both GD and PVQ when traditional and formant acoustic measurements were combined.

Abstract Drugs used in the treatment of depression can cross the placenta giving rise to questions regarding the effects these drugs exert on the fetus. Hypericum perforatum L., Hypericaceae, is a natural product used to treat depression. However, information about its toxicity and the occurrence of alterations in the central nervous system development of the offspring is scarce. This work assessed the behavior of adult male rats born from mothers treated with Hypericum extract during gestation and analyzed the fluorescence of the extract in different organs of mothers and fetuses. Male pups were divided into three treated groups, corresponding to the administration of the Hypericum extract to mothers at the dose levels of 36 mg/kg, 72 mg/kg and 144 mg/kg, and one control group in which the mothers received distilled water. At 90 days of age, the offspring underwent the following tests: rotarod, pentobarbital-induced sleep time, elevated plus maze, hole-board and forced swimming test. The observed fluorescence indicated the presence of the extract in all tissues analyzed. The obtained results suggest lasting changes in the performances displayed in the CNS, depression and anxiety tests, indicating that the use of Hypericum during gestation could interfere with the behavioral development of the offspring reducing anxiety and depression when they become adults. We suggest that these alterations are associated with the reprogramming of the brain regions related to changes in emotional reactivity.

Abstract Non-state actors contribute with inputs to the elaboration of the national interest in trade negotiations, thus enhancing its legitimacy. Nevertheless, does the participation of those actors necessarily equal influence on the part of all segments of civil society on policymaking? To answer the question, I argue that procedural legitimacy should be evaluated not only in relation to the inputs society provides to the State, but should also consider whether officials actually analyse societal contributions in decision-making. I demonstrate the empirical application of the model based upon Brazil's experience in multilateral trade negotiations during the 2000s, using Mexico as a shadow case. I conclude that foreign trade policymaking can only be democratised if, in procedural legitimacy, the State attributes equal weight to contributions from all types of societal actors, including civil society organisations and organised social movements, which tend to have less material resources and power than interest groups such as business associations and labour unions.

Gestational depression is detrimental to the health of the mother and the offspring and contributes to the appearance of depressive and anxiety symptoms during the postnatal period. Traditional antidepressants have undesirable side effects when utilised during gestation, but Hypericum perforatum has been characterised as an efficient and safe antidepressant that prevents the recurrence of symptoms. This study verified the effects of Hypericum perforatumon the behaviour of Wistar rats that were treated during gestation and evaluated 10 and 60 days post-treatment. Pregnant Wistar rats were divided into four groups of ten animals each: one control group that received distilled water and three treatment groups that were treated orally with 36, 72 or 144 mg/kg Hypericum perforatumextract. At 10 and 60 days after parturition and post-treatment, the rats were submitted to the holeboard, the tail suspension, and the forced swim tests. The animals treated with 144 mg/kg Hypericum perforatumexhibited greater head-dipping activity in the hole-board test and reduced immobility in the tail suspension and forced swim tests, suggesting less anxiety and depression 10 and 60 days post-treatment.The results indicated that treating rats with Hypericum perforatumduring the gestational period decreased depressive behaviour and anxiety 10 and 60 days post-treatment.

O objetivo deste trabalho foi determinar o requerimento hídrico e o coeficiente de cultura (Kc) da cana-de-açúcar irrigada durante o ciclo de soca, variedade RB 92-579, na região semiárida do Submédio do Vale do São Francisco. O experimento foi conduzido em área de cultivo comercial de cana-de-açúcar situada no município de Juazeiro, BA. Obteve-se o requerimento hídrico da cultura por meio do método do Balanço de Energia Razão de Bowen. Foram monitoradas também a biomassa acumulada e a fração da radiação fotossinteticamente ativa interceptada pela cultura (fRFA). Com os resultados constatou-se que a evapotranspiração da cana-de-açúcar atingiu uma taxa média diária de 4,7 mm, em resposta ao acúmulo de biomassa e, mas a fRFA apresentou, entretanto, influência do tombamento da cultura durante a fase de crescimento máximo. O requerimento hídrico total da cana-de-açúcar foi de 1710 mm, e o Kc atingiu o valor médio de 1,10 na fase de crescimento máximo. As equações de estimativa do Kc mensal, tendo graus dias acumulados e dias após o corte como variáveis independentes apresentaram ótimos ajustes (R2 ~ 0,95 e 0,98) e consideram a redução nos valores de Kc devida ao tombamento da cultura.

The objective of this study was to determine the water requirement and crop coefficient of the irrigated sugarcane, variety RB 92-579, in the semi-arid region of the lower middle of São Francisco Valley. The experiment was carried out in a commercial area of sugarcane located in the municipality of Juazeiro in the State of Bahia. The crop water requirement was estimated with the Bowen Ratio Energy Balance method. The accumulated biomass and the photosynthetic active radiation intercepted (fPAR) by the crop were monitored. The sugarcane evapotranspiration reached a mean value of 4.7 mm d-1 in response to fPAR and accumulated biomass; however presented influence of the crop lodging during the maximum growth phase. The total water requirement of the sugarcane ratoon was 1710 mm. Crop coefficient reached a mean value of 1.10 in the phase of maximum growth. The equations adjusted for monthly crop coefficient, using the growing degree days and days after the harvest as independent variables presented good performance (R2 ~ 0.95 and 0.98) and, consider the reduction in the Kc values because of crop lodging.

Este trabalho objetivou realizar uma análise da eficiência do uso de água em um sistema de produção de cana-de-açúcar irrigada no Submédio do Vale do São Francisco, Brasil. Indicadores que consideram a resposta produtiva da cultura e o desempenho de aplicação de água no sistema de produção foram utilizados e calculados por meio de dados de biomassa seca acumulada, rendimento industrial e a partir dos valores de evapotranspiração de referência (ETo), evapotranspiração da cultura (ETc) e do volume de água que entrou no sistema de produção por precipitação e irrigação (P + I). Verificou-se que a maior eficiência do uso de água pela cultura ocorreu entre o sétimo e o oitavo meses produtivos em virtude do aumento da partição de biomassa para os colmos e do suprimento de radiação e, ainda, da redução da ETc em resposta ao tombamento das plantas. Os indicadores utilizados demonstraram que a demanda de água da cultura foi suprida adequadamente em relação à evapotranspiração máxima. A cana-de-açúcar apresentou uma eficiência de produção de 9,49 kg de colmos, 1,22 kg de açúcar e 875,23 mL de álcool por m3 de ETc e 5,36 kg de colmos, 0,69 kg de açúcar e 494,14 ml de álcool por m3 de P+I.

The objective of this work was to accomplish an analysis of the water use efficiency in a production system of irrigated sugarcane located in the Lower-Middle São Francisco river basin, Brazil. Indicators based on the crop yield and the water application performance in the production system were used. These indicators were calculated through accumulated dry biomass, industrial yield data and through the values of reference evapotranspiration, crop evapotranspiration and the water volume that entered in the system by rain and irrigation (P+I). It was verified that, the highest water use efficiency of crop occured between 7th and 8th month, due to increase in the stalk biomass partition and radiation supply, and due to reduction of ETc in response tumbling of the plants. The used indicators demonstrated that the water demand of crop was adequately in relation to maximum evapotranspiration of crop. The irrigated sugarcane presented a production efficiency of 9.49 kg of stalks, 1.22 kg of sugar and 875.23 mL of alcohol per m3 of ETc and of 5.36 kg of stalks, 0.69 kg of sugar and 494.14 mL of alcohol per m3 of P+I.

JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção da dura-máter é a complicação mais freqüente após a raquianestesia ou a sua perfuração acidental durante tentativa de bloqueio peridural. O objetivo deste relato é descrever o uso da hidrocortisona no tratamento e na prevenção da cefaléia pós-punção da dura-máter (CPPD). RELATO DOS CASOS: São relatados três casos em que a hidrocortisona foi utilizada no tratamento e na prevenção da cefaléia pós-punção da dura-máter. O primeiro foi de uma paciente obstétrica submetida à cesariana, que apresentou cefaléia no pós-operatório, não responsiva à medicação convencional e ao tratamento com tampão sangüíneo peridural (TSP), mas que apresentou remissão completa do quadro com hidrocortisona por via venosa. Outras duas pacientes, em quem ocorreu perfuração acidental da dura-máter durante a tentativa de localização do espaço peridural e que tratadas com hidrocortisona, por via venosa, com fins preventivos, não desenvolveram quadro de cefaléia. CONCLUSÕES: Nos casos observados a hidrocortisona mostrou eficácia no tratamento da CPPD após falha das medidas conservadoras e do TSP. A utilização da hidrocortisona em pacientes com perfuração acidental da dura-máter pode ser útil, pois não é técnica invasiva e a incidência e a gravidade das CPPD nesse grupo de pacientes é elevada. São necessários estudos controlados para estabelecer o real papel da hidrocortisona na prevenção e tratamento da CPPD.

BACKGROUND AND OBJECTIVES: Post-dural puncture headache is the most frequent complication after spinal anesthesia or accidental dural perforation during attempted epidural block. This report aimed at describing the use of hydrocortisone to treat and prevent post-dural puncture headache (PDPH). CASE REPORTS: Three cases in which hydrocortisone was used to treat and prevent post-dural puncture headache are reported. The first is an obstetric patient submitted to Cesarean section with postoperative headache not responding to conventional medication and epidural blood patch (EBP), however with total remission after intravenous hydrocortisone. The other two patients, who suffered accidental dural perforation during attempted epidural space location, were preventively treated with intravenous hydrocortisone and have not developed headache. CONCLUSIONS: In our cases, hydrocortisone was effective to treat PDPH after failed conservative measures and EBP. Hydrocortisone for accidental dural perforation patients may be useful since it is a noninvasive technique and the incidence of PDPH in this group of patients is high. Controlled studies are needed to determine the actual role of hydrocortisone in preventing and treating PDPH.

JUSTIFICATIVA Y OBJETIVOS: La cefalea después-punción de la dura-máter es la complicación más frecuente después de la raquianestesia o su perforación accidental durante tentativa de bloqueo peridural. El objetivo de este relato es describir el uso de la hidrocortisona en el tratamiento y en la prevención de la cefalea después-punción de la dura-máter (CPPD). RELATO DE LOS CASOS: Se relatan tres casos en que la hidrocortisona fue utilizada en el tratamiento y en la prevención de la cefalea después-punción de la dura-máter. El primero fue de una paciente obstétrica sometida a cesárea, que presentó cefalea en el postoperatorio, no respondente a la medicación convencional y al tratamiento con tampón sanguíneo peridural (TSP), sin embargo, presentó remisión completa del cuadro con hidrocortisona por vía venosa. Otras dos pacientes, en quien ocurrió perforación accidental de la dura-máter durante la tentativa de localización del espacio peridural y que tratadas con hidrocortisona, por vía venosa, con fines preventivos, no desarrollaron cuadro de cefalea. CONCLUSIONES: En los casos observados la hidrocortisona mostró eficacia en el tratamiento de la CPPD después de falla de las medidas conservadoras y del TSP. La utilización de hidrocortisona en pacientes con perforación accidental de la dura-máter puede ser de utilidad, pues no es una técnica invasiva y la incidencia y la gravedad de las CPPD en ese grupo de pacientes es elevada. Se hacen necesarios estudios controlados para establecer el papel real de la hidrocortisona en la prevención y tratamiento de la CPPD.