Abstract Among the trends in literary contemporaneity in Brazil, critics have identified the presence of new realisms and the return to subjectivity SCHØLLHAMMER, 2009, 2020), the reiteration of the fractured narrative and the thematization of violence in big cities RESENDE, 2008), among others. Considering these findings, we recognize the recurrence of several traits present in the modern novel revisited in the contemporary. The present work proposes the analysis of one of these traits - multiperspectivity HARTNER, 2019; NIEDERHOFF, 2019) - in Meia-noite e vinte (Twenty After Midnight) (2016) by Daniel Galera, Pontos de fuga (2019) by Milton Hatoum, and Torto arado (2019) by Itamar Vieira Junior. We aim to analyze how multiple perspectives are articulated in authors and works with different aesthetic projects, seeking to understand the different effects achieved, and how each work touches on fundamental issues for Brazilian society today, such as violence.

Resumen Entre las corrientes que componen la literatura contemporánea en Brasil, la crítica ha identificado la presencia de nuevos realismos y el retorno a la subjetividad (SCHØLLHAMMER, 2009, 2020), la reiteración de la narrativa fracturada y el tema de la violencia en las grandes ciudades (RESENDE, 2008), entre otros. Teniendo en cuenta estos hallazgos, identificamos la recurrencia de varios rasgos presentes en la novela moderna revisitada en la época contemporánea. Este artículo propone el análisis de una de estas características - el multiperspectivismo (HARTNER, 2019; NIEDERHOFF, 2019) - en Meia-noite e vinte (2016), de Daniel Galera, Pontos de fuga (2019), de Milton Hatoum, y Torto arado (2019), de Itamar Vieira Junior. El objetivo es analizar cómo se articulan múltiplas perspectivas en autores y obras con diferentes propuestas, buscando comprender los diferentes efectos logrados, y cómo cada obra aborda cuestiones fundamentales para la sociedad brasileña actual, como la violencia.

Resumo Entre as tendências que compõem a contemporaneidade literária no Brasil, a crítica tem identificado a presença de novos realismos, o retorno à subjetividade (SCHØLLHAMMER, 2009, 2020), a reiteração da narrativa entrecortada e a tematização da violência nas grandes cidades (RESENDE, 2008), entre outras. Considerando tais constatações, identificamos a recorrência de diversos traços presentes ainda no romance moderno revisitados no contemporâneo. O presente trabalho propõe a análise de um desses traços - o multiperspectivismo (HARTNER, 2019, NIEDERHOFF, 2019) - em Meia-noite e vinte (2016), de Daniel Galera, Pontos de fuga (2019), de Milton Hatoum, e Torto arado (2019), de Itamar Vieira Junior. O objetivo é analisar de que formas as perspectivas múltiplas se articulam em autores e obras de propostas distintas, buscando compreender os diferentes efeitos alcançados, e como cada obra tangencia questões fundamentais para a sociedade brasileira na atualidade, como a violência.

Resumen El objetivo general de esta investigación fue conocer la relación entre el involucramiento parental escolar en casa (IPE-C) y la autoeficacia parental escolar (AP-E) durante el confinamiento por la COVID-19. Participaron 349 madres de alumnas(os) de escuelas primarias, públicas y privadas, que respondieron las escalas construidas para este estudio. Los resultados mostraron una relación positiva moderada entre IPE-C y AP-E y la mayoría de las participantes obtuvo puntajes altos en ambos aspectos; asimismo, madres con mayor escolaridad (licenciatura/posgrado) puntuaron más alto tanto en el involucramiento como en la autoeficacia parentales; aquellas con expectativas altas de rendimiento escolar de sus hijas(os), presentaron mayor AP-E comparadas con el grupo con expectativas bajas a regulares, y madres con hijas(os) de 9 a 12 años presentaron menor IPE-C comparadas con el grupo de 6 a 8 años.

Abstract The general objective of this research was to discover the relationship between parents' involvement in home schooling and their self-efficacy during the COVID-19 lockdown. The participants-349 mothers of students in public and private elementary schools-responded to scales constructed for the study. The results show a moderate positive relation between involvement in home schooling and self-efficacy and most of the respondents obtained high scores in both aspects. In addition, mothers with higher educational levels (undergraduate/graduate studies) scored higher in both involvement and self-efficacy. Those with higher expectations for their child's/children's academic achievement had higher self-efficacy compared with the groups of mothers with low to average expectations. Mothers of children aged nine to twelve had lower involvement in home schooling compared with the mothers of children aged six to eight.

RESUMO A esclerose múltipla (EM) é a doença desmielinizante mais comum do sistema nervoso central. A cognição não é rotineiramente avaliada nos pacientes apesar da ocorrência frequente de queixas ou disfunção cognitivas. Objetivo: Comparar o perfil de pacientes com EM com controles pareados por idade, sexo e escolaridade e investigar a potencial influência de parâmetros clínicos na cognição. Métodos: Trinta e cinco pacientes com EM (idade média±desvio padrão [DP] 37,9 anos±11,44, H/M: 12/23) e 33 controles saudáveis (idade média±DP 38,8 anos±12,6, H/M: 12/21) foram incluídos neste estudo. Todos os participantes passaram por avaliação clínica estruturada e por testagem cognitiva com os seguintes instrumentos: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span e testes de fluências verbais (letras F, A e S e categoria-animais). A psicopatologia foi investigada com a Mini International Neuropsychiatric Interview e com o Beck Depression Inventory (BDI). A Expanded Disability Status Scale (EDSS) foi aplicada nos pacientes. Resultados: Pacientes tiveram desempenho pior que os controles na maioria dos testes — 70% deles tiveram déficit cognitivo. A função cognitiva mais frequentemente afetada foi memória episódica (45,7%), seguida por fluência verbal (42,8%) e velocidade de processamento (22,8%). A pontuação no SDMT correlacionou-se inversamente com a gravidade da doença, medida pela EDSS. A depressão não influenciou o desempenho cognitivo nesta série de pacientes. Conclusões: Declínio cognitivo é comum em pacientes com EM. Enquanto o déficit motor se associou com a velocidade de processamento, a depressão não influenciou o desempenho cognitivo.

ABSTRACT Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Cognition is not routinely assessed in patients with MS though they frequently have cognitive complaints or dysfunction. Objective: The aim of this study was to compare the cognitive status of patients with MS with age, sex, and schooling matched controls and to evaluate the potential influence of clinical parameters on cognition. Methods: A total of 35 patients with MS (mean±SD age 37.9 years±11.44, M/F: 12/23) and 33 healthy controls (mean±SD age 38.8 years±12.6, M/F: 12/21) were enrolled in this study. All subjects underwent a structured clinical assessment and the cognitive tools are as follows: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span, and Verbal Fluency Tests (letters F, A, and S and animal category). Psychopathology was assessed with the Mini International Neuropsychiatric Interview and the Beck Depression Inventory (BDI). The Expanded Disability Status Scale (EDSS) was used for patients. Results: Patients performed worse than controls in almost all tests, with approximately 70% of patients presenting cognitive impairment. The most affected cognitive domain was episodic memory (45.7%), followed by verbal fluency (42.8%) and information processing speed (22.8%). SDMT was inversely correlated with disease severity, as assessed by the EDSS. Depression did not influence cognitive performance in this cohort. Conclusions: Cognitive dysfunction is common among patients with MS. While motor impairment was associated with information processing speed, depression did not influence cognitive performance.

Paro cardiaco en salas de recuperación posanestésica, entidad poco frecuente en esterilizacion tubaria. Factores descencadenantes como sobresedación, bloqueo espinal alto, uso de opioides, toxicidad sistémica por anestésicos locales. La ligadura tubárica como prevención de embarazo definitivo, se realiza preferentemente con bloqueo raquídeo. Paciente de 35 años en su puerperio de 12 horas, se somete a salpingoclasia bilateral bajo anestesia raquidea, con dosis de fentanil de 20 mcg y bupivacaina pesada de 12 mg. Nivel de dermatoma alcanzado de T6 (ideal para el procedimiento quirúrgico), sin ninguna otra administración medicamentosa. En la unidad de recuperación posanestésica presenta paro cardiaco con inicio inmediato soporte vital avanzado con buenos resultados posteriores. Se le practican los exámenes complementarios e interconsultas correspondientes. Paciente con alta hospitalaria sin secuelas neurológicas a los 4 días posteriores al evento. Se recomienda prevenir y tratar la causa de todo evento cardiaco.

Cardiac arrest in post-anesthetic recovery period, a rare entity in sterilization tubal . Descending factors such as over-sedation, high spinal block, use of opioids, systemic toxicity from local anesthetics. Tubal ligation as prevention of definitive pregnancy, is preferably performed under spinal anesthesia. A 35-year-old patient in his 12-hour puerperium, undergoes Sterrilization Tubal under spinal anesthesia, with fentanyl doses of 20 mcg and hiperbaric bupivacaine of 12 mg. Dermatome level reached of T6 (ideal for the surgical procedure), without any other drug administration. In the post-anesthesia recovery period, she presented cardiac arrest with immediate initiation of advanced life support with good later results. Complementary exams and corresponding consultations are given. Patient released from hospital with no neurological sequelae 4 days post the incident. It is recommended to prevent and treat the cause of all cardiac events.

El taponamiento cardiaco es la acumulación de líquido dentro del saco pericárdico, lo que conlleva a un aumento de la presión intrapericardica, permitiendo el deterioro de la capacidad del corazón para llenarse y actuar como bomba. Entre sus causas tenemos a la tuberculosis, las colagenopatías, y el cáncer. En el embarazo se pueden enmascarar los signos y síntomas del taponamiento cardiaco por los cambios fisiológicos propios del embarazo. El Gold estándar para su detección es la ecocardiografía. El tratamiento del taponamiento cardiaco es la pericardiocentesis o el drenaje quirúrgico. Se presenta el caso de una paciente de 26 años con: embarazo de 32,6 semanas, trabajo de parto pretérmino, taponamiento cardiaco y post pericardiocentesis de 2 horas, para culminación de embarazo. El manejo anestésico es complejo tanto para la madre y el recién nacido, basándose en mantener estabilidad hemodinámica y posterior traslado a unidad de terapia intensiva.

Cardiac tamponade is the accumulation of fluid within the pericardial sac, which leads to an increase in intrapericardial pressure, allowing the deterioration of the heart’s ability to fill and act as a pump. Among its causes are tuberculosis, collagen disease, and cancer. In pregnancy, the signs and symptoms of cardiac tamponade can be masked by the physiological changes of pregnancy. The gold standard of detection is echocardiography. Treatment of cardiac tamponade is pericardiocentesis or surgical. The case of a 26-year-old patient is presented with: a 32.6 for week pregnancy in preterm labor, cardiac tamponade and 2-hour post-pericardiocentesis, for culminate of pregnancy. Anesthetic management is complex for both the mother and the newborn, basing on maintaining hemodynamic stability and subsequent transfer to the intensive care unit.

Abstract The golden mussel is an aquatic invasive species that was introduced in South America in the ‘90s, including Brazil, and was firstly registered in 2001 in the Paraná state. This bivalve causes macrofouling issues because adhere in substrates and form dense aggregations, affecting especially hydroelectric power plants, and water treatment facilities, apart from the native biodiversity. The present research aimed to diagnose the distribution of Limnoperna fortunei in the Paraná state using environmental DNA (eDNA) from 174 sites from 12 basins, and scientific and technical previous records. L. fortunei eDNA was found in 90 sites from 11 hydrographic basins sampled. Most of the positive samples were detected in Iguaçu (42), Tibagi (15), and Ivaí (10) rivers basins. We also registered the first occurrence for five basins: Cinzas, Itararé, Ivaí, Pirapó e Ribeira rivers. Together, our and previous data recorded L. fortunei in 118 sites, between adult, larvae, and eDNA detection. Moreover, the results evidenced that eDNA is a low coast and reliable tool, and it may be very recommended for L. fortunei early detection and diagnosis. The present research was the greatest and most widespread survey for golden mussel prospection in a state in Brazil, supported a worrying scenario for Parana, with the urgent need for intense and continuous monitoring and prevention actions for controlling and mitigation of the L. fortunei impacts.

Dexmedetomidina un α-agonista, de amplio uso y popular nivel mundial, que poco conocimiento se tiene sobre su uso de forma intratecal en la población boliviana, de manera especial en pacientes obstétricas. Objetivos: evaluar el efecto de dexmedetomidina intratecal en anestesia obstétrica y observar los efectos secundarios del medicamento. Métodos: ensayo clínico aleatorizado y simple ciego. La muestra fue de 123 pacientes, cada grupo de 41 pacientes cumpliendo ambos criterios. Grupo B (bupivacaina + fentanil); grupo D2 (bupivacaina + fentanil+ dexmedetomidina 2 µg) y grupo B3 (bupivacaina + fentanil+ dexmedetomidina 3 µg). Análisis estadístico: se utilizó el software SPSS® 25 y Excel® 2016. Con un nivel de confianza del 95 % y error muestral del 13 %. Resultados: duración del bloqueo motor fue de 106,5 ± 16 minutos en el grupo B; 142,3 ± 28,2 minutos en el grupo D2 y 145,6 ± 16,7 minutos en el grupo D3. Siendo significativo entre los grupos de estudio (valor p < 0,000). PAM con significancia estadística antes y después del nacimiento. Frecuencia cardiaca significativo a los 15, 30 y 45 minutos (valor p < 0,000; 0,001; 0,004; 0,000 y 0,002). Etilefrina en el grupo B fue de 3,44 ± 1,8 ml; para el grupo D3 fue de 1,8 ± 2,7 ml y grupo D2 fue de 0,85 ± 1,6 ml. Conclusiones: mejor estabilidad hemodinámica con 2 µg dexmedetomidina, menor incidencia de hipotensión, uso de vasopresores, las complicaciones escasas y un excelente estado de sedación materna.

Dexmedetomidine an α-agonist, widely used and popular worldwide, with little knowledge about its use intrathecally in the Bolivian population, especially in obstetric patients. Objectives: evaluate the effect of spinal dexmedetomidine in obstetric anesthesia and observe the side effects of the medication. Methods: randomized and simple blind clinical trial. The sample consisted of 123 patients, each group of 41 patients meeting both criteria. Group B (bupivacaine + fentanyl); group D2 (bupivacaine + fentanyl + 2 µg dexmedetomidine) and group B3 (bupivacaine + fentanyl + 3 µg dexmedetomidine). Statistical analysis: it was carried out in SPSS® 25 and Microsoft Excel® 2016. With a confidence level of 95% and sampling error of 13%. Results: duration of the motor block was 106,5 ± 16 minutes in group B; 142,3 ± 28,2 minutes in group D2 and 145,6 ± 16,7 minutes in group D3. Being significant among the study groups (p value <0,000). MAP with statistical significance before and after birth. Significant heart rate at 15, 30 and 45 minutes (p value <0,000; 0,001; 0,004; 0.000 and 0,002). Ethylephrine in group B was 3,44 ± 1,8 ml; for group D3 it was 1,8 ± 2,7 ml and group D2 was 0,85 ± 1,6 ml. Conclusions: better hemodynamic stability with 2 µg dexmedetomidine, lower incidence of hypotension, use of vasopressors, limited complications and an excellent state of maternal sedation.

Resumo Hans Keilson faz parte do numeroso grupo de escritores de língua alemã que publicou entre as décadas de 1930 e 1950 obras sobre a Segunda Guerra Mundial e temas tangentes. Reconhecido tardiamente, Keilson escreveu romances, autobiografia e ensaios em que se confundem suas experiências, seu conhecimento técnico como psicanalista e a ficção. Neste artigo propomos uma leitura da novela Comédia em tom menor (Komödie in Moll), destacando a empatia como chave fundamental para leitura da obra, a focalização como expediente narrativo para alcançá-la, e a presença de elementos cômicos imiscuídos à realidade grave e por vezes trágica que é construída no conto.

Abstract Hans Keilson is one of the numerous German-speaking writers who published works about World War II and tangent themes between the 1930s and 1950s. Recognized only later, Keilson wrote an autobiography, novels, and essays in which his experiences, fiction, and his technical knowledge as a psychoanalyst are all present. In this article we interpret the novel Komödie in Moll, regarding empathy as a fundamental key for reading the work, focalization as a narrative resource to reach empathy, and analyzing the presence of comic elements involved in the serious and sometimes tragic reality that is built in the short story.

La arritmia y taquicardia son muy comunes en las embarazadas, aunque el bloqueo espinal pueda ser una técnica anestésica segura, la taquicardia grave, la parada cardiaca y otras arritmias son relatadas durante las prácticas de raquianestesia. La bupivacaina y levobupivacaina pueden aumentar el intervalo PR y la duración del QRS y prolongar la conducción cardiaca. La dexmedetomidina tiene propiedades simpaticolíticas, sedativas, estabilidad respiratoria sin depresión ventilatoria, amnésicas y analgésicas, los efectos adversos de la dexmedetomidina son la hipertensión inicial, hipotensión, naúseas, bradicardia, fibrilación atrial, edema pulmonar, oliguria y sed. Paciente de 33 años de edad con embarazo de 39,2 sem. Sin antecedentes patológicos. Recibe anestesia espinal y a los 10 min bradicardica de 39 corregida con atropina y posterior con arritmia sinusal. En conclusión, la presencia de arritmias cardiacas puede deberse a varios factores, es trascendental la vigilancia y monitoreo continuo del electrocardiograma para reconocer y corregir de manera oportuna.

Arrhythmia and tachycardia are very common in pregnant women, although spinal block may be a safe anesthetic technique, severe tachycardia, cardiac arrest and other arrhythmias are reported during spinal anesthesia practices. Bupivacaine and levobupivacaine can increase the PR interval and the duration of QRS and prolong cardiac conduction. Dexmedetomidine with sympatholytic, sedative, respiratory stability without ventilatory depression, amnesic and analgesic properties, the adverse effects of dexmedetomidine are initial hypertension, hypotension, nausea, bradycardia, atrial fibrillation, pulmonary edema, oliguria and thirst. 33-year-old patient with a pregnancy of 39.2 weeks. No pathological history she received spinal anesthesia and at 10 min bradycardia of 39 corrected with atropine and later with sinus arrhythmia. In conclusion, the presence of cardiac arrhythmias can be due to several factors, the continuous monitoring and monitoring of the electrocardiogram to recognize and correct in a timely manner is transcendental.

Objetivos: evaluar el uso de la dexmedetomidina intranasal como coadyuvante para sedación en LUI y AMEU asociado al sistema de infusión controlado por objetivo. Métodos: ensayo clínico no controlado, prospectivo y simple ciego. Muestra de 48 pacientes que cumplen los criterios de inclusión. Grupo CD se administró Dexmedetomidina IN a dosis de 0,9 µg/kg y otro grupo de control. Para el análisis estadístico de variables continuas se usó media y DE; para variables ordinales se calculó frecuencia. Además de prueba T de Student y Chi χ2. Nivel de confianza de 95 % y margen de error 12%. Resultados: edad media de 32 ± 7 años; en el grupo CD la dosis de inducción y mantenimiento de remifentanil fue de 2 ± 0,7 ng/ml y en el grupo SD la dosis de inducción fue de 4,1 ± 0,7 ng/ml y de mantenimiento 3,9 ± 0,5 ng/ml; para el propofol la dosis de inducción y mantenimiento fue 3,7 ± 0,5 mcg/ml en el grupo SD mientras que, en el grupo CD la dosis de inducción y mantenimiento fue de 2,1 ± 0,5 mcg/ml. La frecuencia cardiaca de 64 - 62 y en el grupo SD fue de 70 - 67 latidos/min. La PAM asociado al dexme está por 73 mmHg y el grupo de SD es de 78 mmHg. No se verifico complicaciones por la administración de la Dexmedetomidina. Conclusiones: la dexmedetomidina IN permite disminuir la dosis de los fármacos, con estabilidad de los cambios hemodinámicos, la dosis utilizada no produce complicaciones.

Objectives: to evaluate the use of intranasal dexmedetomidine as an adjunct for sedation in LUI and AMEU associated with the objective controlled infusion system. Methods: uncontrolled, prospective, single-blind clinical trial. Sample of 48 patients who meet the inclusion criteria. Group CD was administered Dexmedetomidine IN a dose of 0.9 µg / kg and another control group. For the statistical analysis of continuous variables, mean and SD were used; For ordinal variables, frequency was calculated. In addition to Student’s T-test and Chi χ2. 95% confidence level and 12% margin of error. Results: age of 32 ± 7 years; in the CD group the induction and maintenance dose of remifentanil was 2 ± 0.7 ng / ml and in the SD group the induction dose was 4.1 ± 0.7 ng / ml and maintenance dose 3.9 ± 0.5 ng / ml; for propofol the induction and maintenance dose was 3.7 ± 0.5 mcg / ml in the SD group, while in the CD group the induction and maintenance dose was 2.1 ± 0.5 mcg / ml. The heart rate was 64-62 and in the SD group it was 70-67 beats / min. The MAP associated with dexme is 73 mmHg and the SD group is 78 mmHg. No complications were verified by the administration of Dexmedetomidine. Conclusions: dexmedetomidine IN allows to decrease the dose of drugs, with stability of hemodynamic changes, the dose used does not cause complications.

El uso de coadyuvantes en anestesia obstétrica es útil para disminuir la dosis de los anestésicos locales. En boga la adición de un nuevo fármaco como es la dexmedetomidina espinal que abarca de 5 μg a 10 μg en el reporte mundial. Objetivos: Comparar el efecto de la administración espinal de la dexmedetomidina y morfina, más bupivacaina pesada en pacientes sometidas a cesárea. Métodos: Ensayo clínico, doble ciego y prospectivo de 99 pacientes randomizados en 3 grupos: grupo D2 (fentanilo 10 μg, bupivacaina 9 mg y dexmedetomidina 2 μg); grupo D3 (fentanilo 10 μg, bupivacaina 9 mg y dexmedetomidina 3 μg) y grupo M (fentanilo 10 μg, bupivacaina 9 mg y morfina 100 μg). Evaluación de parámetros hemodinámicos, duración de bloqueo motor, necesidad de vasopresores y complicaciones. Análisis estadístico: ANOVA para variables cuantitativas, para variables nominales se empleó chi cuadrado. Valor de p <0.05 es significativo. Resultados: La duración más prolongada del bloqueo motor fue en el grupo D2 (140,3 ± 30,7minutos), seguido del grupo de D3 (142,4 ± 16 minutos) y el grupo M (107 ± 14,6). En los grupos con dexmedetomidina se tiene sedación y estabilidad hemodinámica, la necesidad de rescate fue en el grupo M; la cantidad de vasopresores que se utilizó fue de 1 ± 1,7 ml en el grupo D2; 1,8 ± 2,9 ml en el grupo D3 y 1,7 ± 2,1 ml en el grupo M. Hipotensión es la complicación más frecuente. Conclusiones: Dexmedetomidina 2 μg mejor estabilidad hemodinámica con prolongación del bloqueo motor y menor necesidad de vasopresores.

The use of adjuvants in obstetric anesthesia, useful to decrease the dose of local anesthetics. The addition of a new drug such as spinal dexmedetomidine ranging from 5 μg to 10 μg in the world report. Objectives: To compare the effect of spinal administration of dexmedetomidine and morphine plus hiperbaric bupivacaine in patients undergoing cesarean section. Methods: Prospective double-blind clinical trial, 99 randomized patients in 3 groups:group D2 (fentanyl 10 μg , bupivacaine 9 mg and dexmedetomidine 2 μg ); group D3 (fentanyl 10 μg , bupivacaine 9 mg and dexmedetomidine 3 μg ) and group M (fentanyl 10 μg , bupivacaine 9 mg and morphine 100 μg ). Evaluation of hemodynamic parameters, duration of motor block, need for vasopressor and complications. Statistical analysis: ANOVA for quantitative variables. Chi-squared tes was used for nominal variables. P value <0.05 is significant. Results: The duration of the longer Motor Block was in the D2 group (140.3 ± 30.7 minutes), followed by the D3 group (142.4 ± 16 minutes) and the M group of 107 ± 14.6; In the dexmedetomidine groups, it has sedation and hemodynamic stability. The need for rescue was in group M; the amount of vasopressor used was 1 ± 1.7 ml in group D2; 1.8 ± 2.9 ml in group D3 and 1.7 ± 2.1 ml group M. Hypotension is the most frequent complication. Conclusions: Dexmedetomidine 2 μg better hemodynamic stability with prolonged motor block and less need for vasopressor.

Abstract INTRODUCTION: Herein, we aimed to identify the factors associated with adverse drug events (ADEs) in chronic Chagas disease (CD) patients. METHODS: We analyzed 320 medical notes from 295 patients. The Naranjo algorithm was applied to determine the cause of ADEs. Mixed effects logistic regression was performed to evaluate the factors associated with ADEs. RESULTS: ADEs were described in 102 medical notes (31.9%). Captopril was most frequently associated with ADEs. Age (RR 0.96; 95%CI 0.94-0.99) and cardiac C/D stages (RR 3.24; 95%CI 1.30-4.58) were the most important clinical factors associated with ADEs. CONCLUSIONS: Close follow-up is warranted for CD patients.

Introducción: En el postoperatorio de anestesia obstétrica, los temblores representan el 54%. Por lo cual, se pretende evitarlo en la sala de recuperación, usando medicamentos que regulen los temblores como ketamina y meperidina. Objetivos: Determinar la eficacia de la ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional. Métodos: Se realizó un ensayo clínico, simple ciego, aleatorizado y controlado. En el Hospital Obrero N° 2, Ingresaron en el estudio 40 pacientes cumpliendo criterios de inclusión, 20 pacientes por grupo. Las dosis usadas en el grupo Ketamina de 0.25 mg/kg y grupo meperidina de 0.1 mg/Kg. Se usó la escala de Crossley para determinar temblores, medición de temperatura periférica y efectos secundarios maternos y fetales. Para análisis estadístico se usó Chi x2 de Pearson. Resultados: La edad media del estudio es 29,77±3,35 años; Tiempo quirúrgico media de 50 ± 8,8 minutos;Temperatura en quirófano más frecuente se encontraba entre 22° a 23° C; La temperatura periférica se encontró entre 36.6°C a 37.5 °C; en el grupo de meperidina se presentó más nauseas. No existen efectos secundarios en neonatos. Conclusiones: Los temblores redujeron en los pacientes que recibieron ketamina mientras que en los que recibieron meperidina presentaron más nauseas como efecto secundario.

Introduction: The presence of shiviring in obstetric anesthesia in the postoperative period is up to 54%. Therefore, it is intended to avoid in the recovery room, using medications that regulate shiviring such as ketamine and meperidine. Objectives: To determine the efficacy of ketamine and meperidine for the prevention of shivering in patients undergoing cesarean section under regional anesthesia. Methods: A single-blind, randomized, controlled clinical trial was conducted. In Hospital Obrero N ° 2, 40 patients enrolled in the study meeting inclusion criteria, 20 patients per group.The doses used in the Ketamine group of 0.25 mg / kg and meperidine group of 0.1 mg / Kg. The Crossley scale was used to determine shivering, peripheral temperature measurement and maternal and fetal side effects. For statistical analysis, Chi x2 from Pearson was used. Results: The average age of the study is 29.77 ± 3.35 years; Average surgical time of 50 ± 8.8 minutes;Temperature in the most frequent operating room was between 22 ° to 23 ° C;The peripheral temperature was between 36.6 ºC to 37.5 ºC; in the meperidine group there was more nausea; No neonatal side effects. Conclusions: Patients who received ketamine is better at preventing tremors while patients who received meperidine had more nausea as a side effect.

El higroma quístico congénito o linfangioma es un tumor del sistema linfático, es de origen embrionario y se origina por la obstrucción del drenaje de los sacos linfáticos. Su localización en orden de frecuencia es en las regiones cervical, axilar, intraperitoneal e inguinal, y muy raro como alteración única en el mediastino anterior. Paciente de 32 años de edad, con embarazo 16 sem ± 6 días y reporte de ecografía: Embarazo de 15 sem ± 20 días, normohidramnia, higroma quístico, Ausencia de hueso nasal además de una comunicación interventricular. Paciente en sala de legrado bajo sedación profunda, se obtiene producto de sexo masculino con alteraciones faciales y aumento de volumen en región cervical. Podemos concluir que, el control prenatal es importante realizar para obtener un diagnóstico precoz con examen ecográfico seriado, estudio genético, ecocardiografía fetal y para dar tratamiento quirúrgico es necesario conformar un equipo multidisciplinario.

The congenital cystic hygroma or lymphangioma is a tumor of the lymphatic system, is of embryonic origin and is caused by the obstruction of the drainage of the lymphatic sacs. Its location in order of frequency is in the cervical, axillary, intraperitoneal and inguinal regions, and very rare as a single alteration in the anterior mediastinum. A 32-year-old patient with a pregnancy of 16 weeks ± 6 days and an ultrasound report: Pregnancy of 15 weeks ± 20 days, normohydramnia, cystic hygroma, Absence of nasal bone in addition to interventricular communication. Patient in curettage room under deep sedation, male product with facial alterations and volume increase in cervical region is obtained. We can conclude that prenatal control is important to obtain an early diagnosis with serial ultrasound examination, genetic study, fetal echocardiography and to give surgical treatment it is necessary to form a multidisciplinary team.