RESUMEN La enfermedad de Parkinson (EP) es el segundo trastorno neurodegenerativo más común después de la demencia tipo Alzheimer. Produce un declive significativo en la calidad de vida (CdV) de las personas que la sufren y sus familiares. Comprender los efectos físicos y psicosociales de esta enfermedad contribuye a la toma de decisiones clínicas. El presente estudio tiene como objetivo examinar la evidencia actual respecto al impacto de los trastornos fonoaudiológicos de origen motor sobre la CdV en personas con EP. Se realizó una revisión sistemática de la literatura buscando artículos en las siguientes bases de datos: PUBMED, SCIELO Y WoS, entre junio y julio del año 2020, con antigüedad máxima de 10 años, obteniendo una muestra de 10 trabajos. Las publicaciones analizadas describen aspectos de la CdV afectados en personas con EP con disfagia o disartria a través de cuestionarios. Los resultados indican un descenso en la CdV de las personas con EP en relación con su alimentación y comunicación, reportando fatiga al comer o hablar, vergüenza en actividades sociales, periodos extensos de alimentación, entre otros. Lo anterior pone de manifiesto la importancia de considerar como objetivos dentro de la intervención en EP componentes de la calidad de vida.

ABSTRACT Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s-type dementia. It is known that these types of diseases cause a significant decline in the quality of life of the people who suffer from them and in their next of kin. Understanding the physical and psychosocial effects of neurodegenerative diseases contributes to clinical decision-making. It is for the above mentioned that the present study aims to examine the current evidence regarding the direct impact that phonoaaudiological disorders of motor origin generate on the quality of life in people with PD. A systematic review of the literature was carried out. The articles were searched in the following databases: PUBMED, SCIELO and WOS, during the months of June and July of the year 2020, constituting a sample of 12 works, with a maximum age of 10 years. The analysed publications mainly describe the aspects of quality of life that are affected in people with PD, who suffer dysphagia or dysarthria, all this through the application of different questionnaires which evaluate different aspects of this concept. The results of the review show the importance of considering within the intervention process the component of quality of life in people with E.P, since the scores obtained according to the instruments applied indicate a decrease of this component and even more with the progress of the disease, which translates into worse quality of life related to food and speech.

Abstract: Introduction: medical education has evolved from a topic-focused programs to one focused on the quality of outcomes and competencies. Different models and educational contents have been suggested for the training of doctors specializing in general surgery around the world. However, in our country there is no single program for all training venues for specialists in general surgery, which has resulted in a wide heterogeneity of levels of educational quality as well as clinical results in our country. Objective: to structure an academic program that serves as a reference for all academic institutions in our country training medical doctors specializing in general surgery. Material and methods: the development of the proposal of the reference program for the training of general surgeons (PRFCG) consisted of 5 phases: 1) review and integration of national and international programs better structured by a committee; 2) review and consensus by academic professors, experts and associates of the initial program; 3) review and consensus through the Delphi methodology (consensus > 75%) by working groups that worked remotely prior to the XVIII National Meeting of the Surgeon; 4) Presentation and discussion of the results of these Tables in the XVIII Meeting and 5) Presentation and dissemination of the PRFCG in the XLVI International Congress of Surgery that took place in the city of Mérida, Yucatán. Results: the final product of this process was consolidated with the support and participation of more than 200 professors and experts on surgical education, 620 associates, 14 coordinators and 54 experts who worked for the creation of a program with 27 cognitive units, 9 transversal competencies, 8 attitudinal competencies, 21 rotations, 92 surgical procedures proposed in logbook as well as 5 APROCs as part of the PRFCG. The complete program is contemplated for a 4-year training with a flexible academic structure. Conclusions: PRFCG is herein presented as a reference with the intention of “standardizing” the minimum necessary academic elements for the training of a specialist in general surgery. The mission of this project is not to impose a program, but to facilitate through different means a surgical education of the highest quality and available to all Mexicans with the support of the Mexican Association of General Surgeons, A.C. (AMCG).

Resumen: Introducción: la educación médica ha evolucionado desde programas centrados en tópicos hasta la enfocada en la calidad de los resultados y competencias. Diferentes modelos y contenidos educativos han sido sugeridos para la formación de médicos especialistas en cirugía general en todo el mundo. Sin embargo, en nuestro país no existe un programa único para todas las sedes formadoras de especialistas en cirugía general, lo que ha dado pie a una amplia heterogeneidad de niveles de calidad educativa, así como de resultados clínicos en nuestro país. Objetivo: estructurar un programa académico que sirva como referencia para todas las instituciones académicas formadoras de médicos especialistas en cirugía general de nuestro país. Material y métodos: el desarrollo de la propuesta del programa de referencia para la formación de cirujanos generales (PRFCG) constó de cinco fases: 1) revisión e integración de los programas nacionales e internacionales mejor estructurados por un comité; 2) revisión y consenso por profesores académicos, expertos y asociados del programa inicial; 3) revisión y consenso mediante la metodología Delphi (consenso > 75%) por mesas de trabajo que trabajaron a distancia previo al XVIII Encuentro Nacional del Cirujano; 4) presentación y discusión de los resultados de estas mesas en el XVIII Encuentro; y 5) presentación y difusión del PRFCG en el XLVI Congreso Internacional de Cirugía que se llevó a cabo en la ciudad de Mérida, Yucatán, así como ante las autoridades competentes de la Universidad Nacional Autónoma de México para proponer su integración en el programa único de especialidades médicas. Resultados: el producto final de este proceso se consolidó con el apoyo y participación de más de 200 profesores y expertos, 620 asociados, 14 coordinadores y 54 expertos que trabajaron para la creación de un programa con 27 unidades cognitivas, nueve competencias transversales, ocho actitudinales, 21 rotaciones, 92 procedimientos quirúrgicos propuestos en bitácora, así como cinco actividades profesionales confiables (APROC) como parte del PRFCG. El programa completo está contemplado para un entrenamiento de cuatro años con una estructura académica flexible. Conclusiones: se presenta este PRFCG como una referencia con la intención de “estandarizar” los elementos académicos mínimos necesarios para la formación del especialista en cirugía general. La misión de este proyecto no es imponer un programa, sino facilitar a través de diferentes medios una educación quirúrgica de la más alta calidad al alcance de todos los mexicanos con el apoyo de la Asociación Mexicana de Cirugía General, A.C. (AMCG).

ABSTRACT The article investigates, historiographically and ethnographically, three large-circulation Mozambican newspapers published between 1975 and 2007 in order to understand how the media used to address the homosexuality since independence. Based on the theoretical approach provided by the Anthropology of the Media, firstly it contextualizes the debate related to homosexuality in other African countries' press, secondly it provides a historical background of the discussion in the Mozambican media. Chronologically it approaches the main themes developed by the country's press regarding sexual and gender dissidence. As conclusion, by publicizing the homosexuality of foreigners and not engaging in hate speech, the local media reinforced the idea of the exogeny of homosexuality in Africa and, unlike other neighboring African nations, contributed to produce an environment of tolerance towards the theme in Mozambique.

RESUMO No presente artigo, investigo historiográfica e etnograficamente, três jornais moçambicanos de grande circulação entre os anos de 1975 e 2007, no intuito de perceber como a imprensa do país tratou a questão da homossexualidade desde a independência. A partir da abordagem teórica proporcionada pela Antropologia da mídia, começo por uma contextualização da questão homossexual na imprensa de outros países africanos e pela contextualização histórica da imprensa moçambicana. Abordo cronologicamente os principais temas que foram desenvolvidos pela imprensa do país no tocante à dissidência sexual e de gênero. Concluo que a imprensa local, ao publicizar a homossexualidade de estrangeiros e não engajar em um discurso de ódio, reforçou a ideia da exogenia da homossexualidade em África e, diferente de outras nações africanas vizinhas, contribuiu para produzir um ambiente de tolerância para com a questão em Moçambique.

Resumen Este trabajo aborda el diseño optimizado del filtro LCL y el controlador del lazo interno de corriente (PI) para un inversor trifásico de puente completo de un sistema de generación distribuida (GD). El objetivo es mejorar el desempeño y la calidad de la energía que suministran estos sistemas en su interconexión con la red eléctrica. En ese sentido, las variables de optimización son los parámetros del filtro y del controlador y se plantean dos funciones objetivo, una relacionada con la razón de atenuación armónica del filtro y otra con el desempeño del control, específicamente, la integral del error absoluto por el tiempo (ITAE, por sus siglas en inglés). Se resalta que la primera función objetivo depende de los parámetros del filtro, mientras que la segunda depende de los parámetros del controlador y también del filtro (planta); por lo cual, a diferencia de otros trabajos, la solución se aborda de manera conjunta y se resuelve utilizando optimización por enjambre de partículas (PSO, por sus siglas en inglés) a través de MatLab. Para la optimización, en primer lugar, se obtiene el modelo matemático del filtro y del controlador de corriente. Las restricciones, en el caso del filtro, se imponen en los parámetros de inductancia total, frecuencia de resonancia y resistencia de amortiguamiento; mientras que, en el controlador las restricciones buscan asegurar que las ganancias seleccionadas respeten el factor de amortiguamiento y ancho de banda propuesto. Derivado del proceso de optimización, en la parte final del documento se muestra la validación de los resultados obtenidos a nivel simulación, utilizando el esquema eléctrico de un inversor implementado en el software PSIM® de PowerSim®, donde se prueba el controlador y filtro diseñado ante cambios de potencia activa y reactiva. Con ello se demuestra la efectividad del diseño optimizado basado en PSO.

Abstract This work addresses the optimized design of the LCL filter and the internal current controller (PI), for a three-phase full-bridge inverter, of a distributed generation (DG) system. The objective is to improve the performance and quality of the energy supplied by these systems in their interconnection with the electrical grid. In this regard, the optimization variables are the filter and controller parameters; and two objective functions are established, one related with the filter harmonic attenuation ratio and other with the control performance, specifically, the integral time absolute error (ITAE). It is highlighted that the first objective function depends on the filter parameters, while the second one depends on the parameters of both the controller and the filter (plant); this is why, different to other proposals, here the solution is addressed in a combined way and is solved using particle swarm optimization (PSO) by means of MatLab. For the optimization, first, the mathematical model of the filter and the current controller is obtained. The constraints, in the case of the filter, are in the following parameters: total inductance, resonant frequency and damping resistance; while, in the controller, the constraints allow the selected gains to fulfill the proposed damping factor and bandwidth. As a result of the optimization process, in the final part of the document, the validation of the obtained results is shown, using the electrical schematic of an inverter implemented in the PSIM® software by PowerSim®, where the controller and filter designed is tested under active and reactive power changes; showing the effectiveness of the optimized design based on PSO.

Resumo A partir de pesquisa etnográfica realizada nos últimos anos no sul de Moçambique, o presente artigo responde antropologicamente à pergunta colocada por um telespectador moçambicano sobre o porquê da inexistência de sujeitos homossexuais em contextos rurais locais. O argumento central aqui apresentado é de que ainda que o desejo (homo)erótico preceda e prescinda da linguagem, a constituição de um sujeito propriamente homossexual não. Logo, as cidades oferecerão não apenas um ambiente propício para a vivência de experiências eróticas e identitárias desse sujeito, mas também a episteme necessária para que ele se constitua como tal.

Abstract Based on an ethnographic research carried out in recent years in southern Mozambique, this article answers anthropologically the question posed by a Mozambican viewer about why there are no homosexual subjects in local rural contexts. The central argument presented here is that although the (homo)erotic desire precedes and dispenses with language, the constitution of a subject that is properly homosexual does not. Therefore, cities will provide not only an environment conducive to the experience of erotic and identity experiences of this subject but will offer the necessary episteme for such subject to be constituted as such.

RESUMO No presente artigo, fruto de pesquisa histórica e etnográfica, apresento alguns arquivos coloniais portugueses e estrangeiros no que concerne à vida (homo)sexual pretérita dos homens do sul de Moçambique. Ao trazer tais dados, que vão desde a literatura de viagem até os boletins oficiais da Província, argumento pela escassez de registros sobre o homoerotismo na história colonial de Moçambique até o século XX. Ao analisar os casamentos entre homens moçambicanos nas minas sul-africanas, e os processos - até agora inéditos - sobre a penalização das práticas homossexuais no período tardo-colonial em Moçambique, argumento que o silêncio sobre a sexualidade, atribuído aos bantus desta região, pode ser também efeito do pudor do colonizador português, ainda que tenha sido ele o instaurador, naquele território, de uma nova categoria: a “homossexualidade”.

ABSTRACT In this article, which is the result of historical and ethnographic research, I present some Portuguese and foreign colonial archives in which concerns the past (homo)sexual lives of men from southern Mozambique. By bringing such data, ranging from travel literature to the official bulletins of the Province, I argue for the scarcity of records on homoeroticism in the colonial history of Mozambique until the 20th century. When analyzing marriages between Mozambican men in South African mines, as well as unpublished Mozambican processes regarding the penalization of homosexual practices in the late colonial period, I argue that the silence about sexuality attributed to Bantus in this region can be also the effect of the Portuguese colonizer’s decency, even though the Portuguese were the responsible for establishing in Mozambique a new category: “homosexuality”.

Resumo Maríyarapáxjis é um neologismo (proveniente da expressão portuguesa maria-rapaz) encontrado na língua materna de meus interlocutores moçambicanos (a língua changana) para dar conta, entre outros, de homens que a princípio demonstram certa afeminação, mas que nas últimas décadas passou também a nomear os homossexuais. Apesar de analisar outros vocábulos, escolho-o como título deste artigo porque, além de ser uma das palavras mais ouvidas no sul do país para nomear esses sujeitos, ela parece ser o epítome de uma série de processos históricos de institucionalização das homossexualidades masculinas nas classes populares do sul de Moçambique. O presente artigo, fruto de investigação etnográfica e linguística, busca analisar o léxico das línguas changana e portuguesa dentro do campo semântico da homossexualidade no sul de Moçambique e colocá-las em diálogo com as teorias feministas africanas.

Abstract Maríyarapáxjis is a neologism (derived from the Portuguese expression maria-rapaz) found in the mother tongue of my interlocutors (the Changana language). The expression is mostly applied to men who at first demonstrate some effeminacy, but in recent decades it has also come to name the homosexuals. Although I also analyze other expressions, I choose it as the title of this article because besides being one of the most heard words in the south of the country to name these subjects, it seems to be the epitome of a series of historical processes of institutionalization of male homosexualities in the popular classes of southern Mozambique. This article, the result of ethnographic and linguistic research, seeks to analyze the lexicon of the Changanan and Portuguese languages within the semantic field of homosexuality in southern Mozambique and put them in dialogue with African feminist theories.

Abstract Maríyarapáxjis es un neologismo (proveniente de la expresión portuguesa maria-rapaz) encontrado en la lengua materna de mis interlocutores mozambiqueños (la lengua changanana) para dar cuenta, entre otros, de hombres que en un principio demuestran cierto afeminamiento, pero que en las últimas décadas también es utilizado para nombrar a los homosexuales. Aunque también analizo otras palabras, la elijo como título de este artículo porque además de ser una de las palabras más escuchadas en el sur del país para nombrar a estos sujetos, parece ser el epítome de una serie de procesos históricos de institucionalización de los varones homosexuales en las clases populares del sur de Mozambique. Este artículo, resultado de una investigación etnográfica y lingüística, busca analizar el léxico de las lenguas changanana y portuguesa dentro del campo semántico de la homosexualidad en el sur de Mozambique y ponerlas en diálogo con las teorías feministas africanas.

Resumo O presente artigo busca compreender o processo de “institucionalização” (Douglas, 2007) da homossexualidade em Moçambique, a partir do caso etnográfico do programa radiofônico Café Púrpura, patrocinado pela LambdaMoz - a maior organização LGBT do país - e transmitido em cadeia nacional no segundo semestre de 2018. Ao analisar cinco de seus episódios, chegamos à conclusão que o movimento LGBT moçambicano busca não somente institucionalizar a homossexualidade através de discursos, símbolos e valores, mas o faz a partir de uma perspectiva política específica, qual seja, uma política de “base” de não confrontação violenta contra a sociedade mais ampla. Nesse sentido, os dados conduzem à reflexão sobre uma importante categoria nativa na semântica homossexual local, a “tolerância”.

Abstract This article aims to understand the process of “institutionalization” (Douglas, 2007) of homosexuality in Mozambique, based on the ethnographic case of the Café Púrpura radio program sponsored by LambdaMoz - the largest LGBT organization in the country - and broadcast nationally in 2018. Analyzing five of its episodes, we concluded that the Mozambican LGBT movement seeks not only to institutionalize homosexuality through discourses, symbols and values, but also from a specific political perspective, namely, a politics of “base” of non-violent confrontation against the wider society. In this sense, the data lead to reflection on an important native category in local homosexual semantics, “tolerance”.

Resumo O presente é um estudo etnográfico de um projeto de cooperação internacional entre uma organização internacional de luta contra a epidemia do HIV/AIDS e a organização LAMBDA, a maior ONG LGBT de Moçambique. Os objetivos deste artigo são demonstrar, primeiramente, como, devido ao fluxo internacional de recursos financeiros ligados a certos conceitos/agendas, esses projetos acabam de alguma forma institucionalizando um projeto de homossexualidade em Moçambique, além de reavivar práticas potencialmente neocoloniais. O trabalho também procura demonstrar como as práticas burocráticas externas podem entrar em choque com as práticas culturais locais, no que tem sido chamado de ‘ONGização.’

Abstract The current paper is an ethnographic study of an international cooperation project between an international organisation for the fight against the HIV/AIDS epidemic and the organisation LAMBDA, the largest LGBT NGO in Mozambique. The objectives of this paper are, firstly, to demonstrate how due to the international flow of financial resources attached to certain concepts and agendas, these projects end up somehow institutionalising a homosexuality project in Mozambique, in addition to reviving potentially neo-colonial practices. It also seeks to demonstrate how external bureaucratic practices can clash with local cultural practices, in what has been called ‘NGOisation.’

Abstract The species Anastrepha zacharyi Norrbom has recently been recorded in the Amazon, however the species is subsampling in the biome. In this research, we report a new occurrence of A. zacharyi in the state of Pará and, through climate suitability modelling, present new possible distribution areas of the species in the Brazilian eastern Amazon.

Resumen El aumento de la temperatura corporal se asocia a exacerbación de déficits neurológicos en pacientes con esclerosis múltiple (EM) que se corrigen con la resolución de la hipertermia, proceso denominado fenómeno de Uhthoff. Una paciente de 65 años con EM primaria progresiva, hospitalizada por fractura de cadera, presentó un cuadro de insuficiencia respiratoria aguda en relación al aumento de temperatura corporal (38 °C) debido a un incremento en la temperatura ambiental. Las pruebas complementarias descartaron patología infecciosa, tromboembolismo pulmonar y otros procesos intercurrentes. La paciente presentó mejoría respiratoria tras modificar la temperatura de la habitación y recibir tratamiento farmacológico para la hipertermia. Al tercer día de ingreso fue operada bajo anestesia general con control estricto de temperatura corporal, sin incidencias. Es importante el manejo anestésico en pacientes con EM, siendo el control estricto de la temperatura corporal necesario para evitar comorbilidad y complicaciones perioperatorias.

Abstract Increase in body temperature is associated with neurological deficit exacerbations in patients with multiple sclerosis (MS). These are corrected with the resolution of hyperthermia, in what is known as Uhthoff's phenomenon. A 65-year-old patient with primary progressive MS, admitted because of hip fracture, developed acute respiratory failure in association with elevation in body temperature (38 °C) due to an increase in room temperature. Additional tests ruled out infection, pulmonary thromboembolism, or other concomitant processes. The patient's respiratory condition improved following a change in room temperature and the use of pharmacological treatment for hyperthermia. She was taken to surgery under general anesthesia 3 days after admission, with tight temperature monitoring, and surgery proceeded uneventfully. Anesthetic management in patients with MS is important, requiring close control of body temperature to avoid comorbidities and perioperative complications.

ABSTRACT The cleft lip and palate is one of the congenital pathologies with greater prevalence in the world. In the present work, there is an analysis of 12 SNP's located in genomic sequences of ABCA4, BMP4, MSX1, SUMO1, VAX1 andIRF6, under an epidemiological perspective, molecular genetics, genomics and population genetics. All of the above applied to a population of Queretaro, Mexico, of mixed genetic origin. Material and methods: A study was conducted of observation, analytic and descriptive study with samples from 93 triads (study subjects and their parents). When you select SNP's that can be differentiated by RFLP (Restriction Fragment Length Polymorphism)we hope to distinguish between genetic markers that: 1)comply with the equation of balance of Hardy-Weiner and 2) Validate them as potential genetic markers to be used in studies of association in closed populations of genetic origin mixed with cleft lip and palate in Amealco, Queretaro, Mexico. If so subsequently raises test the frequencies obtained with a selected population genetically closed in Amealco, Queretaro. Results: After performing the RFLP analysis of 12 SNP's located in the sequence of genes ABCA4, BMP4, MSX1, SUMO1, VAX1 and IRF6, we find the same allele for SNP analyzed which is located in the 100% of the population. Conclusion: Of the 12 SNP's analyzed in this report, for the fi rst time 5 of them are mentioned their frequency. The rest of them had the same frequency reported in the literature. Although the SNP's selected were not useful as a genetic markers due to the same allele is present in 100% of the general population. The fact of having found in the same genotype of all samples indicates that the population of the city of Queretaro is genetically closed and on the basis of this extremely useful for future validations of other SNP's as potential genetic markers.

RESUMEN El labio y paladar hendido es una de las patologías congénitas con mayor prevalencia en el mundo. En el presente trabajo se hace un análisis de 12 PNU localizados en las secuencias genómicas de ABCA4, BMP4, MSX1, SUMO1, VAX1 y IRF6, bajo una perspectiva epidemiológica, de genética molecular, genómica y de genética de poblaciones; todo lo anterior aplicado a una población de Querétaro, México, de origen genético mixto. Material y métodos: Se realizó un estudio observacional, analítico y descriptivo a partir de muestras de 93 tríadas (sujetos de estudio y sus padres). Al seleccionar PNU que puedan ser diferenciados por medio de RFLP esperamos distinguir entre marcadores genéticos que: 1) cumplan con la ecuación de equilibrio de Hardy-Weinberg y 2) validarlos como potenciales marcadores genéticos para ser empleados en estudios de asociación en poblaciones cerradas de origen genético mixto con labio y paladar hendido (Amealco, Querétaro, México). De ser así, posteriormente se plantea probar las frecuencias obtenidas con una población seleccionada genéticamente cerrada de Amealco, Querétaro. Resultados: Después de realizar el análisis RFLP de 12 PNU localizados en la secuencia de genes ABCA4, BMP4, MSX1, SUMO1, VAX1 y IRF6, hallamos el mismo alelo para PNU analizado, el cual se encuentra en el 100% de la población. Conclusión: De los 12 PNU analizados, en este reporte, por primera vez se menciona la frecuencia de cinco de ellos. Los restantes siete presentaron la misma frecuencia reportada en la literatura. Aunque los PNU seleccionados no fueron de utilidad como marcadores genéticos debido a que el mismo alelo está presente en el 100% de la población general. El hecho de haberlos encontrado en el mismo genotipo de todas las muestras indica que la población de la ciudad de Querétaro es genéticamente cerrada y con base en esto extremadamente útil para futuras validaciones de otros PNU como posibles marcadores genéticos.

Abstract Background: Necrotizing fasciitis is a rare soft tissue infection, distinguised by an aggressive and rapidly expanding infectious process, that it results in necrosis of the skin, subcutaneous cellular tissue and muscular fascia. Clinical case: A 25 years-old patient, with 41 weeks of pregnancy; entered the hospital due to delivery labor. Despite the good evolution of the dilation cervical, the pregnancy was completed by caesarean section. During the postoperative were observed signs of moderate anemia; iron and vitamin C were indicated orally; however, on the third postoperative day, the surgical wound with signs was evidenced of intense inflammation and serous exudate. Observed fever of 38.1 ºC in the last hours; his general condition worsened significantly. Laboratory studies reported: leukocytosis, severe anemia, thrombocytopenia, hyponatremia, hyperglycemia, acidosis compensated metabolism and hypoxemia. The culture of exudate from a surgical wound confirmed an infection by Pseudomonas aeruginosa and Staphylococcus aureus. We established the diagnosis of necrotizing fasciitis. The treatment consisted of reopening of the wound, asepsis and debridement of the skin, subcutaneous cellular tissue and fascia muscular. The patient stayed five more days in the intensive care unit, with complementary oxygen, inotropic support, intravenous antibiotics (imipenem, clindamycin, amikacin) and parenteral nutrition. The evolution was favorable; do not observed complications and the surgical wound closed completely. Conclusions: The prognosis of patients with necrotizing fasciitis varies according of timely diagnosis and treatment. The morbimortality rate it is estimated, even, at 76%.

Resumen Antecedentes: La fascitis necrotizante es una infección poco frecuente de los tejidos blandos, caracterizada por un proceso infeccioso agresivo y de rápida extensión que resulta en necrosis de la piel, tejido celular subcutáneo y fascia muscular. Caso clínico: Paciente de 25 años, con 41 semanas de embarazo; ingresó a la unidad hospitalaria por trabajo de parto. Pese a la buena evolución de la dilatación cervical, el embarazo finalizó mediante cesárea. Durante el posoperatorio se observaron signos de anemia moderada y para ello se le indicó hierro y vitamina C por vía oral; sin embargo, al tercer día posquirúrgico se evidenció la herida quirúrgica con signos de inflamación intensa y exudado seroso. Tuvo fiebre de 38.1 ºC en las últimas horas; su estado general empeoró significativamente. Los estudios de laboratorio reportaron: leucocitosis, anemia severa, plaquetopenia, hiponatremia, hiperglucemia, acidosis metabólica compensada e hipoxemia. El cultivo del exudado de la herida quirúrgica confirmó una infección por Pseudomonas aeruginosa y Staphylococcus aureus. Se estableció el diagnóstico de fascitis necrotizante. El tratamiento consistió en reapertura de la herida, asepsia y desbridamiento de la piel, tejido celular subcutáneo y fascia muscular. La paciente permaneció cinco días más en la unidad de cuidados intensivos, con oxígeno complementario, apoyo inotrópico, antibióticos por vía intravenosa (imipenem, clindamicina, amikacina) y nutrición parenteral. La evolución fue favorable; no se reportaron complicaciones adicionales y la herida quirúrgica cerró por completo. Conclusiones: El pronóstico de las pacientes con fascitis necrotizante varía en función del diagnóstico y tratamiento oportunos. La tasa de morbilidad y mortalidad se estima, incluso, en 76%.

Resumo Justificativa Os analgésicos orais à base de opioides têm sido usados para o manejo da analgesia nos períodos peri e pós-operatório de pacientes submetidos à linfadenectomia axilar. A região axilar é uma zona difícil de bloquear e não há registro de uma técnica de anestesia regional específica que ofereça o seu bloqueio adequado. Métodos Após a aprovação do Conselho de Ética institucional, estudos anatômicos e radiológicos foram feitos para determinar a deposição e disseminação de azul de metileno e anestésico local, respectivamente injetados na axila via plano interfascial torácico. Exames de ressonância magnética foram então feitos em 15 de 34 pacientes programados para cirurgia de mama unilateral que envolveria qualquer um dos seguintes procedimentos: esvaziamento axilar, biópsia de linfonodo sentinela, biópsia de linfonodo axilar ou mamas supranumerárias, para verificar a deposição e o tempo de propagação da solução dentro do plano interfascial torácico in vivo. Resultados Estudos radiológicos e em cadáveres mostraram que a injeção de anestésico local e azul de metileno via plano interfascial torácico com a técnica guiada por ultrassom resulta em deposição confiável na axila. Nos pacientes, a injeção de anestésico local produziu um bloqueio sensitivo axilar confiável. Esse achado foi corroborado por estudos de ressonância magnética que mostraram sinais hiperintensos na região axilar. Conclusões Esses achados definem as características anatômicas do bloqueio da região axilar e destacam o potencial clínico desses novos bloqueios.

Abstract Background Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. Methods After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Results Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. Conclusions These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block.

ABSTRACT Objective: To assess socio-demographic characteristics of patients undergoing total knee arthroplasty (TKA) in a public university hospital, evaluating the outcome infection and associated factors. Method: A retrospective study was carried out with 78 patients undergoing TKA, from 2013 to 2014. The socio-demographic and clinical characteristics of the patients were collected. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication. Result: Of 81 arthroplasties performed, patients were older (mean age 64 years), women (79%), with primary osteoarthritis as main etiology (87.6%) and most had comorbidities (82.7%). Infection occurred in 16% of patients, and this outcome associated with age older than 65 years (p=0.023) and the occurrence of deep vein thrombosis (p=0.027). Conclusion: Patients undergoing TKA are mostly elderly women with primary osteoarthritis in the knee and comorbidities who developed infection in 16% of cases. More studies need to be conducted aimed at creating specific protocols in order to improve the quality of clinical practice. Level of Evidence III, Retrospective Comparative Study.