Resumen Objetivo: Describir y analizar la exposición a radiación ionizante de los residentes de ortopedia. Método: Se realizó un estudio prospectivo para evaluar el grado de exposición a radiación ionizante con un dosímetro de placa colocado debajo del mandil plomado a médicos residentes, por 10 meses. Mediante una encuesta en línea se midió el grado de conocimientos sobre seguridad radiológica. Resultados: Participaron 54 médicos residentes. El 55.6% refiere tener conocimiento de la existencia de equipo de protección radiológica y el 40.7% refiere que tuvo entrenamiento previo en su uso. El 77.8% utiliza el mandil plomado y el 31.5% la protección tiroidea. El 81.5% se posicionó a menos de 1 metro de la fuente de producción de rayos X del arco en C. La exposición a la radiación media total fue de 2.9 ± 2.17 mSv (intervalo de confianza del 95%: 1.25-14.28; p = 0.424). Conclusiones: Los médicos residentes de ortopedia presentan dosis de radiación menores que el límite recomendado por la International Commission on Radiological Protection. Sin embargo, existe una falta de conocimientos sobre protección radiológica, así como falta de interés e ignorancia de los efectos adversos de la radiación.

Abstract Objective: To describe and analyze the exposure to ionizing radiation of orthopedic residents. Method: A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety. Results: 54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424). Conclusions: Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation.

ABSTRACT A feeding trial was performed to assess dietary protein:lipid ratios for the grow-out phase of the bullfrog (Lithobates catesbeianus). Nine balanced isoenergetic diets were formulated, combining three different protein levels (300, 400, and 500 g kg−1) with three different lipid levels (50, 100, and 200 g kg−1), designated as P300/50L, P300/100L, P300/200L, P400/50L, P400/100L, P400/200L, P500/50L, P500/100L, and P500/200L. Additionally, a commercial fish feed, commonly used in Mexico to feed bullfrogs, was also tested during the experiment. Growth performance, animal performance parameters, carcass composition, and fatty acid profiles in muscle and liver were evaluated. The feeding trial results showed that all the experimental diets enhanced growth, feed conversion ratio, and frog-leg weight compared with the commercial diet. Bullfrogs had higher growth with 400 and 500 g kg−1 of dietary protein regardless of dietary lipid content. It was also notable that with the P500/200L diet, frogs doubled the weight of those fed the commercial diet. DHA, EPA, and total omega-3 fatty acids were double in muscle and two to eight times higher in the liver compared with the commercial diet. In all cases, the final proximal composition of carcass reflected the diet composition. It is suggested that a diet containing 400 g kg−1 of protein and 50 g kg−1 lipids (protein/lipid ratio: 7.4; gross energy: 18.2 MJ kg−1) is adequate for bullfrog performance during the grow-out phase to achieve market size in a shorter period, thus, reducing farming risks and production costs.

Resumen El artículo se propone abordar la reclamación instaurada por el negociante extranjero Manuel Cortissoz por perjuicios sufridos en la guerra de 1884-85, buscando identificar sus conexiones con el grupo regenerador santandereano, las cuales le ubicarían como uno de los grandes triunfadores luego del final de la guerra. Haciendo uso del método prosopográfico y los postulados analíticos de la microhistoria, indagará por tales relaciones con actores de la Regeneración en Santander durante el citado momento histórico (1886 - 1898), e intentará acercarse a la implementación de este proyecto político en las regiones. La documentación permitirá plantear como hipótesis que en efecto la cercana relación de Cortissoz con el bando regenerador no solo significó que saliera indemne de la guerra, sino que también fue crucial a la hora de fallar su reclamación, que fue concedida a pesar de incontables defectos en su trámite.

Résumé Cet article se propose d'explorer le plaidoyer du commerçant étranger Manuel Cortissoz suite à des préjudices soufferts dans la guerre de 1884-85, afin d'identifier ses connexions avec le groupe régénérateur du Santander, lesquelles connexions feront de lui un des grands vainqueurs suite à la guerre. Faisant appel à la méthode de la prosopographie et les postulats analytiques de la microhistoire, on s'interroge sur le rapport de Cortissoz avec la Regeneración à Santander pendant le moment cité (1886 - 1898) pour comprendre la mise en œuvre de ce projet dans les régions. Les documents permettent d'envisager l'hypothèse selon laquelle les liens de Cortissoz avec la Regeneración lui ont permis de sortir indemne de la guerre et de mener à bien sa réclamation, malgré les problèmes divers que l'on constate dans ladite procédure.

Abstract The article proposes to approach the complaint made by the foreign businessman Manuel Cortisol over damages suffered in the war of 1884-85, seeking to identify his connections with the Santander Regenerator group, which made him into one of the great victors after the end of the war. Making use of the prosopographical method and the analytic postulates of microhistory, it will investigate those relationships with the actors of the Regeneration in Santander during this historic moment (1886 - 1898) and attempt to understand the implementation of this political project in the regions. The documentation will permit the proposal of the hypothesis that, in effect, the close relationship Cortissoz had with the regenerator group not only meant that he would emerge unscathed from the war, but it was also crucial at the time of his complaint, which was accepted, despite the many errors in its execution.

Resumen Introducción: Las enfermedades cardiovasculares son la primera causa de muerte en el mundo. Su incidencia depende de factores de riesgo, los cuales pueden ser evaluados mediante escalas de riesgo cardiovascular que, de acuerdo con este, permiten establecer estrategias de prevención. Sin embargo, están dirigidas principalmente a áreas urbanas de Colombia donde se ha estudiado la carga de la enfermedad, y muy poco a las áreas rurales. Objetivo: Describir las características clínicas de una población rural que asiste a un programa rural de riesgo cardiovascular. Método: Estudio transversal en 540 participantes de un programa de riesgo cardiovascular de nivel primario. Se obtuvieron los datos sociodemográficos, clínicos y bioquímicos. Se estimó el riesgo cardiovascular mediante la escala de Framingham. Resultados: La hipertensión arterial fue el factor de riesgo de mayor prevalencia entre los participantes (95.5%); de ellos, el 70% presentaba un control adecuado de las cifras de presión arterial. En segundo lugar, se encontró sobrepeso/obesidad, con una proporción mayor en mujeres que en hombres (56.4% vs. 70.7%, p = 0.001). El tabaquismo fue de muy baja prevalencia (0.09%), al igual que las complicaciones en órgano blanco (hombres 8% vs. mujeres 2.2%, p = 0.001). El 75% de la población (n = 409) se estratificó como riesgo bajo de acuerdo con la escala de Framingham. Conclusiones: En esta población, la hipertensión arterial, el sobrepeso/obesidad y la coexistencia de diabetes mellitus tipo 2 tienen una prevalencia similar a la de otras poblaciones rurales y urbanas. El estrato de bajo riesgo cardiovascular agrupa a la mayoría de individuos y el tabaquismo es de muy baja prevalencia.

Abstract Introduction: Cardiovascular diseases are the leading cause of death in the world. Its presentation depends on risk factors, which can be evaluated using cardiovascular risk scores and according to its risk establish preventive strategies. However, these strategies have been mainly addressed to urban areas, where the burden of disease has been studied, and not so much to rural areas of Colombia. Objective: To describe the clinical characteristics of a rural population that attends a rural cardiovascular risk program. Method: It was performed a cross-sectional study in 540 participants in a primary-level cardiovascular risk program. Sociodemographic, clinical, and biochemical data were collected. Cardiovascular risk was estimated using the Framingham score. Results: High blood pressure was the highest risk factor in prevalence among the participants (95.5%), of whom 70% had adequate blood pressure values. Overweight/obesity was the second more prevalent risk factor, with a higher proportion in women respect to men (56.4 vs. 70.7%, p = 0.001). Smoking had a low prevalence (0.09%), as well as target organ dysfunction (men 8% vs. women 2.2%, p = 0.001). The 75% of the population (n = 409) was classified in low risk, according to the Framingham score. Conclusions: In this population hypertension, overweight/obesity and the coexistence of type 2 diabetes mellitus had similar prevalence respect to other rural and urban populations. The lower cardiovascular risk stratum grouped most of the participants and smoking had a very low prevalence.

ABSTRACT Introduction: Industrially, the use of enzymes has increased over time, as their production processes, stabilization and operating conditions have been optimized. Meanwhile associated with their use are minimized with environmental sustainability. The use of mathematical modeling has been a key factor in this advance, making it an great scientific interest area. Objective: To know the state of the art in this area of knowledge, highlighting the most successful and promising findings at present. Materials and Methods: A systematic search of recent high-impact publications between 2015 and 2021 was carried out in internationally recognized databases. A qualitative/comparative analysis of the approaches and contributions of the selected literature was carried out. Results and Discussion: It was evidenced that most of the mathematical models was developed from the Michaelis-Menten kinetic equation, but the simplifications assumed, the operating conditions and the mathematical methods used to solve these systems define the singularity and complexity of each investigation, which makes complex their comparison or implementation in a standardized way. Conclusions: In all cases, the proposed models were adjusted to experimental results or they agreed when different mathematical resolution methods were used. These results can provide valuable information for processes improvement and for equipment design, minimizing costs and time of experimentation and being more friendly to the environment.

RESUMEN Introducción: A nivel industrial la utilización de enzimas se ha ido incrementando a medida que se han optimizado sus procesos de producción, estabilización y condiciones operativas de la mano de la minimización de los costos asociados a su uso y de la sustentabilidad ambiental. El uso de la modelación matemática ha sido un factor clave para este avance, por lo que es un área de gran interés científico. Objetivo: Conocer el estado del arte en esta área del conocimiento, resaltando los hallazgos más exitosos y promisorios publicados recientemente. Materiales y Métodos: Se realizó una búsqueda sistemática de publicaciones recientes de alto impacto entre el 2015 y el 2021 en bases de datos reconocidas internacionalmente, y se llevó a cabo un análisis cualitativo/comparativo de los enfoques y contribuciones de la literatura seleccionada. Resultados y Discusión: Se evidenció que la mayoría de los modelos matemáticos desarrollados parten de la ecuación cinética de Michaelis-Menten pero las simplificaciones asumidas, las condiciones operativas evaluadas y los métodos utilizados para la resolución de estos sistemas, definen la singularidad y complejidad de cada investigación, lo que hace compleja su comparación o implementación de manera estandarizada. Conclusiones: En todos los casos, los modelos planteados se ajustaron a resultados experimentales o se observó concordancia al utilizar diferentes métodos de resolución matemática, lo que puede aportar valiosa información en la mejora de procesos y en el diseño de equipos, minimizando costos y tiempo de experimentación, a través de estrategias más amigables con el medio ambiente.

ABSTRACT Objective: The academic performance influences academic desertion. The literature points out several factors of cognitive development that determine everyday life achievements, particularly in academic life. This paper aims at exploring academic reasoning levels at a sample of university students. Methods: The author relies on an abstract reasoning test and a quasi-experimental analysis given to 571 students of nine areas of knowledge at the University of Cuenca, Ecuador, who agreed to take part in the study. Results: No significant differences were found between levels of abstract reasoning between students of different knowledge areas. The most outstanding finding was that 68.5% of the sample would not pass the abstract reasoning exam. Conclusion: These findings show that on the basis of the relationship between abstract reasoning and academic performance highlighted in the specialized literature, it since recommendable to reinforce the development of abstract reasoning in initial stages of institutionalized Education.

RESUMEN Objetivo: El rendimiento académico influye en la deserción académica. La literatura apunta a ciertos factores de desarrollo cognitivo que determinan el desenvolvimiento en la vida cotidiana y, precisamente, en la vida académica (en el rendimiento). Este artículo tiene como objetivo determinar el grado de razonamiento abstracto en una muestra de estudiantes universitarios. Métodos: La exploración del nivel de razonamiento abstracto del estudiante universitario se realizó mediante la aplicación cuasi-experimental de la Prueba de Analogías Figurales (Blum, Galibert, Abal, Lozzia y Attorresi, 2011) a una muestra de 571 alumnos de nueve áreas del conocimiento de la Universidad de Cuenca, Ecuador, que expresaron previamente su voluntariedad de formar parte del estudio. Resultados: No se encontraron diferencias significativas entre el nivel de razonamiento abstracto entre áreas de conocimiento. Como dato más destacable, se comprobó que un 68.5% de la muestra no aprobaría el examen de razonamiento abstracto. Conclusión: Los resultados de este estudio confirman la relación descrita en la literatura entre razonamiento abstracto y rendimiento académico, unos y otros apuntan hacia la necesidad del reforzamiento del desarrollo del razonamiento abstracto en etapas iniciales de la educación institucionalizada.

Abstract: The work managed to simulate the hydrological behavior of the basin in an area where there are no studies of this type. The intensity-duration-frequency (IDF) curves were used for the construction of hietograms. With this information, a hydrological modeling system was applied with the HEC-HMS tool (version 4.6.1), and the QGIS 3.4 MADEIRA program to determine the morphological characteristics of the basin. Peak flows were obtained for return periods of 25, 50 and 100 years, respectively. This analysis is of great help for other hydrographic basins throughout the Ecuadorian region, since they have an important function in the ecosystem and they do not have hydrometeorological information.

Resumen: En el trabajo se logró realizar la simulación del comportamiento hidrológico de la cuenca en una zona donde no existen estudios de este tipo. Se utilizó las curvas intensidad-duración-frecuencia (IDF) para la construcción de hietogramas. Con esta información, se aplicó un sistema de modelamiento hidrológico con la herramienta HEC-HMS (versión 4.6.1), y el programa QGIS 3.4 MADEIRA para determinar las características morfológicas de la cuenca. Se obtuvieron los caudales de punta para períodos de retorno de 25, 50 y 100 años respectivamente. Este análisis es de gran ayuda para otras cuencas hidrográficas en toda la región ecuatoriana, ya que tienen una función importante en el ecosistema y que no cuentan con información hidrometeorológica.

Abstract Introduction: Selective logging of forests has significantly diminished the densities of Handroanthus chrysantha Jacq. in Colombia. Therefore, there is a need for studies that contribute to its management. Objective: We aimed to evaluate seed germination and the growth of seedlings under nursery conditions. Methods: Four pre-germinative, four organic substrates and two luminosity conditions were tested. We used a random multifactorial experimental design composed of 32 controlled factors. The main components were immersion of seeds in water at room temperature at different times, combinations of organic substrates and exposure of the factors to shade and sun. Results: We recorded 395 and 290 germinated seeds, corresponding to 51 and 38% of the total sown under shade and sun, respectively. The factors with the best germination values were immersion for 24 hours with alluvial sand and immersion for 24 hours with river sand of mixed with ant soil (2:1) under shade and, without immersion with alluvial sand+ground of ant 2:1 and immersion for 24 hours with chicken manure+ant soil 2:1 under sun. The highest growth in height, vigour and survival was observed in seedlings exposed to full sunlight in any of the combinations of organic substrates. Conclusion: The propagation of H. chrysantha should germinate the seeds under shadow and then expose them to the sun to stimulate their growth.

Resumen Introducción: La tala selectiva de los bosques ha reducido las densidades de Handroanthu chrysantha Jacq. en Colombia, por lo que se hace necesarios estudios que aporten a su manejo. Objetivo: Evaluar la germinación de las semillas y el crecimiento de las plántulas de H. chrysantha en vivero. Metodología: Probamos cuatro tratamientos pre-germinativos, cuatro sustratos orgánicos y dos condiciones de luminosidad. Se utilizó un diseño experimental multifactorial aleatorizado integrado por 32 factores controlados. Los componentes principales fueron: inmersión de semillas en agua a temperatura ambiente en diferentes horas, combinaciones de diferentes sustratos orgánicos y exposición de los factores a sombra y sol. Resultados: Registramos 395 y 290 semillas germinadas, que corresponden al 51 y 38% del total sembrado bajo sombra y sol, respectivamente. Los factores con mejor germinación fueron inmersión por 24 horas con arena aluvial e inmersión por 24 horas con arena de río+tierra de hormiga 2:1 bajo sombra y, sin inmersión con arena aluvial+tierra de hormiga 2:1 e inmersión por 24 horas con gallinaza+tierra de hormiga 2:1 en sol. Los mejores resultados en altura, vigor y supervivencia fueron de plántulas expuestas a plena luz solar en cualquiera de las combinaciones de sustratos orgánicos utilizados. Conclusión: Para la propagación de H. chrysantha se deben germinar las semillas en sombra y después exponerlas al sol para estimular su crecimiento.

Resumen El propósito de este trabajo fue profundizar en la necesidad de la formación didáctica en educación física de los docentes de la básica primaria en las escuelas colombianas; para lo cual se realizó una revisión teórica conceptual de los aspectos básicos del manejo de la educación física para los niños de primaria y sus beneficios a nivel de desarrollo corporal y emocional. Metodológicamente se utilizó la revisión documental basada en los niveles monográficos y hermenéuticos como técnicas para la revisión y análisis de fuentes bibliográficas. Los resultados inducen a afirmar que los docentes de la básica primaria de las escuelas colombianas no poseen la formación didáctica en educación física para desarrollar procesos de enseñanza acordes con las características de la asignatura, lo cual limita los beneficios biopsicosociales que deberían ser adquiridos durante la formación del niño en esta etapa escolar.

Resumo 0 objetivo deste trabalho foi aprofundar a necessidade de formação didática em educação física para professores do ensino fundamental em escolas colombianas; para o qual foi realizada urna revisão teórica conceitual dos aspectos básicos da gestao da educação física para criancas do ensino fundamental e seus beneficios ao nivel do desenvolvimento corporal e emocional. Metodológicamente, a revisão documental baseada nos níveis monográfico e hermenêutico foi utilizada como técnica para a revisão e análise de fontes bibliográficas. Os resultados levam a afirmar que os professores do ensino fundamental ñas escolas colombianas não possuem a formação didática em educação física para desenvolver processos de ensino de acordó com as características da disciplina, o que limita os beneficios biopsicossociais que devem ser adquiridos durante a formação. Da criança nesta fase escolar.

Abstract The purpose of this work was to deepen the need for didactic training in physical education for elementary school teachers in Colombian schools; for which a conceptual theoretical review of the basic aspects of physical education management for primary school children and its benefits at the level of body and emotional development was carried out Methodologically, the documentary review based on the monographic and hermeneutical levéis was used as techniques for the review and analysis of bibliographic sources. The results lead to affirm that the teachers of elementary school in Colombian schools do not have the didactic training in physical education to develop teaching processes in accordance with the characteristics of the subject, which limits the biopsychosocial benefits that should be acquired during training of the child in this school stage.

Resumen El artículo aborda la problemática de las soberanías locales, su emergencia como resultado de la eclosión juntera, y su relación con la otrora cabecera del poder virreinal: Santafé. El objetivo es identificar los puntos centrales de la confrontación entre las soberanías locales y los postulados unitarios surgidos de un sector de la élite santafereña. A partir de ello, se interpretan, principalmente, cartas y publicaciones periódicas que se refieren a nociones como soberanía, representación y provincia. Fueron relevantes las contribuciones de Thibaud y Calderón a la concepción de soberanía, y las de Palti en torno a la representación. Así, se concluye que la fragilidad de las soberanías locales obedece a problemas internos como la conformación de cuerpos representativos y la preponderancia de algunos centros poblados que se denominaron "cabeceras provinciales". Finalmente, se señala que las soberanías locales son un tema poco estudiado, tratado en particular desde el papel de los cabildos y juntas, por lo cual se deja de lado numerosos conflictos, que hacen de las soberanías locales una alternativa política inviable frente al unitarismo promocionado desde el centro del virreinato.

Abstract The article addresses the problem of local sovereignty, its emergence as a result of the hatching, and its relationship with the former head of the viceregal power: Santafé. The objective is to identify the central points of the confrontation between local sovereignty and unitary postulates arising from a sector of the elite of Santa Fe. From this, they are interpreted, mainly, letters and periodicals that refer to notions such as sovereignty, representation and province. The contributions of Thibaud and Calderón to the conception of sovereignty were relevant, and those of Palti regarding representation. Thus, it is concluded that the fragility of local sovereignty is due to internal problems such as the conformation of representative bodies and the preponderance of some populated centers that were called "provincial headers". Finally, it is pointed out that local sovereignty is a little studied topic, dealt with in particular from the role of the councils and boards, so that numerous conflicts are left aside, which make local sovereignty an unfeasible political alternative against promoted unitarianism from the center of the viceroyalty.

Resumo O artigo aborda a problemática das soberanias locais, sua emergência como resultado da eclosão de conselhos, e sua relação com a outrora cabeceira do vice-reinado: Santafé. O objetivo é identificar os pontos centrais da confrontação entre as soberanias locais e os postulados unitários surgidos de um setor da elite de Santafé. A partir disto, são interpretadas, principalmente, cartas e publicações periódicas que fazem referência a noções como soberania, representação e província. Foram relevantes as contribuições de Thibaud e Calderón à conceição de soberania, e as de Palti em torno à representação. Desta forma, concluiu-se que a fragilidade das soberanias locais obedece a problemas internos como a conformação de corpos representativos e a preponderância de alguns centros povoados que foram denominados "cabeceiras provinciais". Finalmente, aponta-se que as soberanias locais são um tema pouco estudado, tratado em particular desde o papel dos cabildos e conselhos, pelo qual se deixa de lado numerosos conflitos, que fazem das soberanias locais uma alternativa política inviável perante o unitarismo promovido desde o centro do vice-reinado.

RESUMO O ácido docosahexaenóico (DHA) é o ácido graxo ômega-3 mais importante e menos disponível na dieta humana ocidental. Atualmente, a fonte de ácidos graxos poliinsaturados de cadeia longa ômega-3 (LC-PUFA) depende principalmente da pesca extrativista, tornando esse recurso insustentável em um futuro próximo. Nos últimos anos, uma alta taxa de biossíntese e acúmulo de DHA foi descoberta em uma espécie de água doce (Chirostoma estor) pertencente à família Atherinopsidae. Deste modo, surgiu o interesse em avaliar a composição de ácidos graxos em outros membros da família. Portanto, este estudo compila dados originais da composição de carne de oito espécies de aterinopsídeos de ambientes de água doce e salobra, selvagens ou cultivadas. Altos níveis de DHA (16 a 31%) foram encontrados em todos os membros da família analisados, exceto em C. grandocule, independentemente de seu habitat ou origem. As espécies analisadas do grupo Jordani (C. estor, C. promelas e C. humboldtianum) apresentaram altos níveis de DHA e EPA baixos (<0,5%), como relatado anteriormente para C. estor cultivado. O baixo nicho trófico desses aterinopsídeos e sua capacidade de acumulação de ácidos graxos são fatores que tornam essas espécies notáveis candidatas à aquicultura sustentável.

ABSTRACT Docosahexaenoic acid (DHA) is the most critical and least available omega-3 fatty acid in the Western human diet. Currently, the source of omega-3 long chain polyunsaturated fatty acids (LC-PUFA) is mainly dependent on wild fisheries, making this resource unsustainable in the foreseeable future. In recent years, a high rate of biosynthesis and accumulation of DHA has been discovered in a freshwater species (Chirostoma estor) belonging to the Atherinopsidae family. Interest in evaluating fatty acid composition in other members of the family has emerged, so this study compiles original data of flesh composition of eight atherinopsid species from freshwater and brackish environments, either wild or cultured. High levels of DHA (16 to 31%) were found in all analyzed members of the family, except in C. grandocule, independently of their habitat or origin. The analyzed species of the Jordani group (C. estor, C. promelas and C. humboldtianum) showed high DHA and low EPA levels (<0.5%) as previously reported for cultured C. estor. The low trophic niche of these atherinopsids and their fatty acid accumulation capabilities are factors that make these species noteworthy candidates for sustainable aquaculture.

Resumen: El melanoma cutáneo es el tumor que más ha aumentado en incidencia en los últimos años. Presenta alta letalidad en estadios avanzados. En nuestro país el promedio anual de casos sería de 129 en hombres, 117 en mujeres, con 50 y 30 muertes anuales respectivamente. Objetivo: describir y analizar el perfil clínico-epidemiológico y sobrevida de una cohorte de pacientes portadores de melanoma cutáneo asistidos en dos centros de referencia en Montevideo en el período comprendido entre 2008 y 2017. Método: se realizó un estudio descriptivo, retrospectivo, observacional de cohortes históricas en base a revisión de historias clínicas de los pacientes con diagnóstico de melanoma cutáneo asistidos en el Servicio de Oncología del Hospital de Clínicas y en la Unidad de Oncología cutánea del Instituto Nacional del Cáncer en el período comprendido entre 2008 y 2017, con un seguimiento de los casos hasta el 31 de julio de 2018. Resultados: se analizaron 173 pacientes, mediana de edad 61,2 años (14-89), 50,3% de sexo masculino y 49,7% de sexo femenino. La forma anátomo-clínica nodular fue la más frecuente (32,7%), seguida de la extensiva superficial (28,9%), siendo el resto menos frecuentes. No fue alcanzada la mediana de sobrevida global (SVG), siendo la tasa de SVG a cinco años de 68,5% y a diez años de 54,5%. La mediana de SVG en EIV fue de 12 meses (IC 95% 8,5-21,5). Conclusiones: los resultados de nuestra serie en SVG son similares a los reportados a nivel mundial, al igual que en la mayoría de las características clínico-epidemiológicas. Se trata del primer trabajo con reporte de sobrevida en melanoma cutáneo en nuestro país.

Summary: Cutaneous melanoma is the tumour whose incidence has increased the most in recent years. This condition is highly lethal in advanced stages. In our country the annual average of cases adds up to 129 in men and 117 in women, there being 50 and 30 respectively, every year. Objective: to describe and analyse the clinical and epidemiological profile and survival in a cohort of patients who are carriers of cutaneous melanoma and were assisted in two reference centers in Montevideo between 2008 and 2017. Methods: we conducted a descriptive, retrospective, observational study of historical cohorts, based on a review of the medical records in patients with a diagnosis of cutaneous melanoma assisted in the Oncology Service of the University Hospital and the Skin Oncology Unit of the National Cancer Institute between 2008 and 2017, with a follow-up until March 31, 2018. Results: 173 pacientes were analysed, median age was 61.2 years old (14-89), 50.3% were men and 49.7% were women. Nodular anatomo-clinical presentation was the most frequent form (32.7%), followed by superficial spreading (28.9%), other forms being less frequent. Median global survival was not achieved, global survival after 5 years being 68.5% and 54.5% after 10 years. Median global survival in Stage 4 was 12 months (IC 95% 8.5-21.5). Conclusions: the results in our series are similar to those reported internationally, in terms of global survival, the same as in most of the clinical an epidemiological characteristics. This is the first study with a cutaneous melanoma survival report in our country.

Resumo: O melanoma cutâneo é o tumor cuja incidência mostrou o maior incremento nos últimos anos. Nos estádios avançados apresenta alta letalidade. No Uruguai a média anual de casos seria de 129 em homens, 117 em mulheres, com 50 e 30 casos anuais respectivamente. Objetivo: descrever e analisar o perfil clínico-epidemiológico e a sobrevida de uma coorte de pacientes portadores de melanoma cutâneo atendidos em dois centros de referência em Montevidéu no período 2008- 2017. Métodos: um estudo descritivo, retrospectivo, observacional de coortes históricas foi realizado baseado na revisão dos prontuários dos pacientes com diagnóstico de melanoma cutâneo atendidos no Serviço de Oncologia do Hospital de Clínicas e na Unidade de Oncologia cutânea do Instituto Nacional del Cáncer no período 2008-2017, com um seguimento até 31/07/2018. Resultados: foram analisados 173 pacientes, com mediana de idade 61,2 anos (14-89), sendo 50,3% do sexo masculino e 49,7% feminino. A forma anátomo-clínica nodular foi a mais frequente (32,7%) seguido pela extensiva superficial (28,9%), as demais formas foram menos frequentes. Não foi possível alcançar a mediana de sobrevida global, sendo a taxa de SVG a 5 anos 68,5% e a 10 anos 54,5%. A mediana de SVG em EIV foi de 12 meses (IC 95% 8,5-21,5). Conclusões: os resultados da série estudada em sobrevida global são similares aos descritos internacionalmente, assim como a maioria das características clínico-epidemiológicas. Este é o primeiro trabalho que informa sobre a sobrevida em melanoma cutâneo no Uruguai.

RESUMO Objetivo: Identificar os fatores de base que afetam a ressuscitação com fluidos em pacientes sépticos. Métodos: Estudo de caso-controle com 181 pacientes consecutivos admitidos a uma unidade de terapia intensiva clínica entre 2012 e 2016 com diagnóstico de sepse. Analisaram-se os dados demográficos, clínicos, radiológicos e laboratoriais. Resultados: Receberam volume ≥ 30mL/kg de fluidos por via endovenosa quando da admissão 130 pacientes (72%). Nas análises univariadas, histórico pregresso de doença arterial coronária e insuficiência cardíaca se associou com menor volume de terapia com fluidos. Nas análises multivariadas, um histórico de insuficiência cardíaca (RC = 2,31; IC95% 1,04 - 5,14) permaneceu significantemente associado com o recebimento de menor volume de fluidos por via endovenosa. A fração de ejeção ventricular esquerda, a função sistólica/diastólica, hipertrofia ventricular esquerda e hipertensão pulmonar não se associaram com a quantidade de fluidos por via endovenosa. A quantidade de fluidos administrados por via endovenosa não se associou com diferenças em termos de mortalidade. Durante as primeiras 24 horas, pacientes com antecedentes de insuficiência cardíaca receberam 2.900mL de fluidos endovenosos (1.688 - 4.714mL) em comparação com 3.977mL (2.500 - 6.200mL) recebidos pelos pacientes sem histórico de insuficiência cardíaca (p = 0,02). Conclusão: Pacientes sépticos com história pregressa de insuficiência cardíaca receberam 1L de fluidos por via endovenosa a menos nas primeiras 24 horas, sem diferenças em termos de mortalidade.

ABSTRACT Objective: To identify the underlying factors that affect fluid resuscitation in septic patients. Methods: The present study was a case-control study of 181 consecutive patients admitted to a Medical Intensive Care Unit between 2012 and 2016 with a diagnosis of sepsis. Demographic, clinical, radiological and laboratory data were analyzed. Results: One hundred-thirty patients (72%) received ≥ 30mL/kg of IV fluids on admission. On univariate analyses, a past history of coronary artery disease and heart failure was associated with less fluid therapy. On multivariate analyses, a history of heart failure (OR = 2.31; 95%CI 1.04 - 5.14) remained significantly associated with receiving less IV fluids. Left ventricular ejection fraction, systolic/diastolic function, left ventricular hypertrophy and pulmonary hypertension were not associated with IV fluids. The amount of IV fluids was not associated with differences in mortality. During the first 24 hours, patients with a past history of heart failure received 2,900mLof IV fluids [1,688 - 4,714mL] versus 3,977mL [2,500 - 6,200mL] received by those without a history of heart failure, p = 0.02. Conclusion: Septic patients with a past history of heart failure received 1L less IV fluids in the first 24 hours with no difference in mortality.

RESUMO Introdução: a pré-eclâmpsia pode estar associada à doença renal no futuro. Objetivos: medir mudanças na função renal ao longo do tempo em pacientes com pré-eclâmpsia. Métodos: amostras de urina e soro de onze pacientes com pré-eclâmpsia e oito pacientes com gravidez normal foram obtidas durante a gravidez, pós-parto e 3 anos após o parto. Medimos podocalixina na urina, proteína e creatinina sérica. Resultados: após 3 anos, não houve diferenças significativas na podocalixina urinária em pacientes com ou sem pré-eclâmpsia: 4,34 ng/mg [2,69, 8,99] versus 7,66 ng/mg [2,35, 13], p = 0,77. O mesmo se aplicou à excreção urinária de proteínas: 81,5 mg/g [60,6, 105,5] vs. 43,2 mg/g [20,9, 139,3] p = 0,23. A creatinina sérica foi de 0,86 mg/dL [0,7, 0,9] vs. 0,8 mg/dL [0,68, 1] p = 0,74 naqueles com e sem pré-eclâmpsia. Em pacientes normais, a podocalixina urinária diminuiu de 54,4 ng/mg [34,2, 76,9] durante a gestação para 7,66 ng/mg [2,35, 13] três anos após a gravidez, p = 0,01. A proteinúria diminuiu de 123,5 mg/g [65,9, 194,8] para 43,2 mg/g [20,9, 139,3], p = 0,12. Em pacientes com pré-eclâmpsia, a podocalixina urinária diminuiu de 97,5 ng/mg [64,9, 318,4] durante a gravidez para 37,1 ng/mg em uma semana de pós-parto [21,3, 100,4] p = 0,05 e 4,34 ng/mg [2,69, 8,99] três anos depois, p = 0,003. A proteinúria foi de 757,2 mg/g [268.4, 5031.7] durante a gravidez vs. 757,2 mg/g [288.2, 2917] pós-parto, p = 0.09 vs. 81.5 mg/g [60.6, 105.5] três anos depois, p = 0.01. Dois pacientes ainda apresentavam proteinúria após 3 anos. Conclusões: em pacientes com pré-eclâmpsia, a podocalixina urinária pós-parto diminuiu antes da proteinúria. Após três anos, a creatinina sérica, a podocalixina urinária e a proteína tenderam a se normalizar, embora alguns pacientes ainda tivessem proteinúria.

ABSTRACT Introduction: preeclampsia can be associated with future renal disease. Objectives: To measure changes in renal function overtime in patients with preeclampsia. Methods: urine and serum samples from eleven patients with preeclampsia and eight patients with a normal pregnancy were obtained during pregnancy, postpartum, and 3 years after delivery. Urine podocalyxin, protein, and serum creatinine were measured. Results: after 3 years, there were no significant differences in urinary podocalyxin in patients with or without preeclampsia: 4.34 ng/mg [2.69, 8.99] vs. 7.66 ng/mg [2.35, 13], p = 0.77. The same applied to urinary protein excretion: 81.5 mg/g [60.6, 105.5] vs. 43.2 mg/g [20.9, 139.3] p = 0.23. Serum creatinine was 0.86 mg/dL [0.7, 0.9] vs. 0.8 mg/dL [0.68, 1] p = 0.74 in those with and without preeclampsia. In normal patients, urinary podocalyxin decreased from 54.4 ng/mg [34.2, 76.9] during pregnancy to 7.66 ng/mg [2.35, 13] three years after pregnancy, p = 0.01. Proteinuria decreased from 123.5 mg/g [65.9, 194.8] to 43.2 mg/g [20.9, 139.3], p = 0.12. In preeclampsia patients, urinary podocalyxin decreased from 97.5 ng/mg [64.9, 318.4] during pregnancy to 37.1 ng/mg within one week post-partum [21.3, 100.4] p = 0.05 and 4.34 ng/mg [2.69, 8.99] three years after, p = 0.003. Proteinuria was 757.2 mg/g [268.4, 5031.7] during pregnancy vs. 757.2 mg/g [288.2, 2917] postpartum, p = 0.09 vs. 81.5 mg/g [60.6, 105.5] three years later, p = 0.01. Two patients still had proteinuria after 3 years. Conclusions: in preeclampsia patients, postpartum urinary podocalyxin decreased before proteinuria. After three years, serum creatinine, urinary podocalyxin, and protein tended to normalize, although some patients still had proteinuria.