Resumen Introducción: La Organización Mundial de la Salud considera que la universidad debe ser un espacio social en el que se promueva la salud para mejorar o prevenir enfermedades en la comunidad escolar. En los diversos escenarios clínico-educativos en los cuales los médicos residentes realizan su especialización ocurren situaciones que trasgreden su salud física y mental. El sentido de coherencia es su capacidad para percibir que son competentes y manejar cualquiera de estas situaciones, independientemente de lo que suceda en su vida, es una habilidad para seleccionar el estilo de afrontamiento que mejor se ajuste a una situación dada. Objetivo: Determinar la relación entre bienestar mental, sentido de coherencia y factores sociodemográficos de interés en médicos residentes de la especialidad en medicina familiar adscritos a una unidad de medicina familiar. Método: Se ejecutó estudio predictivo transversal, en el que previo consentimiento informado participaron médicos residentes de la especialidad en medicina familiar, se recuperaron factores sociodemográficos, se midió su sentido de coherencia y bienestar mental auto aplicando instrumentos válidos y confiables. Mediante un modelo lineal generalizado se estimó la relación entre estas variables ajustándose por grado académico, se consideró valores p ≤ 0.05 como estadísticamente significativos. Resultados: Sentido de coherencia se asoció significativamente con bienestar mental (B = 0.223, IC 95% [0.137, 0.309], p = 0.000), en residentes de primer grado (B = -7.573, IC 95% [-12.637, -2.508], p = 0.003) y en residentes de segundo grado (B = -6.336, IC 95% [-11.925, -0.748], p = 0.026). El análisis de devianza (D2 = 0.6427) indica que sentido de coherencia y grado académico revelan 64% de la variabilidad de bienestar mental. Conclusiones: El sentido de coherencia tuvo una relación significativa con el bienestar mental en médicos residentes de la especialidad en medicina familiar; por ello, intervenciones orientadas a favorecer el sentido de coherencia pueden diseñarse y utilizarse para mitigar su bienestar mental.

Abstract Introduction: The World Health Organization considers that the university should be a social space in which health is promoted to improve or prevent diseases in the school community. In the various clinical-educational settings in which medical residents carry out their specialization, situations occur that affect their physical and mental health. The sense of coherence is their ability to perceive that you are competent and to handle any of these situations, regardless of what is going in their life, is an ability to select the coping style that best fits a given situation. Objective: To determine the relationship between mental wellness, sense of coherence and sociodemographic factors of interest in resident physicians specializing in family medicine. Method: A cross-sectional predictive study was carried out, with the participation of family medicine residents, with prior informed consent, sociodemographic factors were collected, their sense of coherence and mental wellness were measured by applying valid and reliable instruments. Using a generalized linear model, the relationship between these variables was estimated, adjusting for academic grade, p ≤ 0.05 values were considered statistically significant. Results: Sense of coherence was significantly associated with mental wellness (B = 0.223, CI 95% [0.137, 0.309], p = 0.000), in first-degree residents (B = -7.573, CI 95% [-12.637, -2.508], p = 0.003) and in second-degree residents (B = -6.336, CI 95% [-11.925, -0.748], p = 0.026). The deviance analysis (D2 = 0.6427) indicates that sense of coherence and academic degree reveal 64% of the variability of mental well-being. Conclusions: The sense of coherence had a significant relationship with the mental well-being in resident physicians specializing in family medicine; therefore, interventions aimed at promoting a sense of coherence can be designed and used to mitigate their mental well-being.

Abstract Objective: The classic triad, which defines IFAP syndrome, is ichthyosis follicularis, alopecia, and photophobia. It is a rare X-linked genetic disorder characterized by multiple congenital anomalies with variable severity, caused by pathogenic variants in the MBTPS2 gene, which encodes a zinc metalloprotease that is essential for normal development. This study aimed to report a case of a Brazilian patient with IFAP syndrome presenting skeletal anomalies, which is a rare finding among patients from different families. Case description: We describe a male proband with IFAP syndrome showing severe ichthyosis congenita, cryptorchidism, limb malformation, and comprising the BRESHECK syndrome features. Using whole-exome sequencing, we identified a rare missense variant in hemizygosity in the MBTPS2 gene, which had not been identified in other family members. Comments: This is the first diagnosis of IFAP syndrome in Brazil with a molecular investigation. The present case study thus expands our knowledge on the mutational spectrum of MBPTS2 associated with IFAP syndrome.

RESUMO Objetivo: A clássica tríade de ictiose folicular, alopecia e fotofobia dá nome a uma síndrome rara de origem genética com herança ligada ao cromossomo X (síndrome IFAP, do inglês Ichthyosis Follicularis, Alopecia, and Photophobia). Esta é uma síndrome caracterizada por múltiplas anomalias congênitas de expressividade variável, causada por variantes patogênicas no gene MBTPS2, que codifica uma zinco-metaloprotease essencial para o desenvolvimento normal humano. O objetivo deste estudo é apresentar o relato de caso de um paciente brasileiro com síndrome IFAP que apresentou anomalias esqueléticas, um achado raro entre os pacientes de diferentes famílias. Descrição do caso: Apresentamos um probando do sexo masculino com síndrome IFAP, com ictiose congênita grave, criptorquidia, malformação de membros e as características da síndrome de BRESHECK. Por meio do sequenciamento do exoma completo, identificamos uma variante rara do tipo missense, em hemizigose, no gene MBTPS2, não identificada em outros membros da família. Comentários: Este é o primeiro diagnóstico de síndrome IFAP no Brasil com investigação molecular. A análise molecular e a descrição de uma variante rara no gene MBPTS2 expandem nosso conhecimento sobre o espectro mutacional desse gene associado à síndrome IFAP.

ABSTRACT Objective To analyze the short, medium and long-term efficacy and stability in 46 eyes with keratoconus, operated with Ferrara intrastromal corneal ring segments. Methods The primary endpoint was the mean keratometry of total corneal refractive power. We also studied the effects of age, degree of keratoconus and clinical phenotype on the results, as well as the following keratometry variations and aberrometry variations: flattest, most curved, mean, maximum, astigmatism, root mean square of primary coma aberration and root mean square of secondary coma aberration. Results The immediate postoperative reduction in mean keratometry of total corneal refractive power was 3.08±1.51 diopters (D) (p<0.001). At 4 years, the mean keratometry of total corneal refractive power increased to 0.57±0.96D (p=0.005). Between 4 and 7 years, there was no change in mean keratometry of total corneal refractive power (p=0.727). The degree of keratoconus was a factor affecting the efficacy of the intrastromal corneal ring segments, achieving a greater effect in those with a greater degree of keratoconus (p=0.012 between groups). The immediate postoperative reduction was 1.77±1.88D for the flattest, 3.91±2.30D for the most curved, 2.76±1.63D for the mean, 4.42±3.26D for the maximum, 2.15±2.68D for astigmatism, 1.03±0.83µm for root mean square of primary coma aberration and root mean square of secondary coma aberration (p<.001 in all cases). At 4 years, most curved increased by 0.42±0.78D (p=0.001), mean increased by 0.54±0.64 (p<0.001) and root mean square of primary coma aberration decreased 0.14±0.27µm (p=0.020). Conclusion Ferrara intrastromal corneal ring segment implantation is an effective and stable long-term treatment for patients with keratoconus. There is, however, partial regression in the medium term.

RESUMO Objetivo Analisar a eficácia e a estabilidade a curto, médio e longo prazo em 46 olhos com ceratocone, operados com segmentos de anel intrastromal corneano de Ferrara. Métodos A meta primária foi a ceratometria média de poder refrativo total da córnea. Também estudamos os efeitos da idade, grau de ceratocone e fenótipo clínico nos resultados, bem como as seguintes variações de ceratometria e variações de aberrometria: mais plana, mais curva, média, máxima, astigmatismo, raiz quadrada média da aberração comática primária e raiz quadrada média da aberração comática secundária. Resultados A redução pós-operatória imediata da ceratometria média do poder refrativo total da córnea foi de 3,08±1,51 dioptrias (D) (p<0,001). Aos 4 anos, a ceratometria média do poder refrativo total da córnea aumentou para 0,57±0,96D (p=0,005). Entre 4 e 7 anos, não houve mudança na ceratometria média da potência refrativa total da córnea (p=0,727). O grau de ceratocone foi um fator que afetou a eficácia dos segmentos do anel intrastromal da córnea, alcançando um efeito maior naqueles com maior grau de ceratocone (p=0,012 entre grupos). A redução pós-operatória imediata foi de 1,77±1,88D para a mais plana, 3,91±2,30D para a mais curva, 2,76±1,63D para a média, 4,42±3,26D para a máxima, 2,15±2,68D para o astigmatismo, 1,03±0,83µm para a raiz quadrada média da aberração comática primária e raiz quadrada média da aberração comática secundária (p<0,001 em todos os casos). Aos 4 anos, a maioria das curvas aumentou 0,42±0,78D (p=0,001), a média aumentou 0,54±0,64 (p<0,001) e a raiz quadrada média da aberração comática primária diminuiu 0,14±0,27µm (p=0,020). Conclusão O implante de anel intrastromal corneano Ferrara é um tratamento eficaz e estável a longo prazo para pacientes com ceratocone. Há, no entanto, uma regressão parcial a médio prazo.

RESUMO A poliangeíte microscópica é uma doença autoimune rara de etiologia desconhecida, caracterizada por inflamação e necrose dos vasos sanguíneos. Faz parte das vasculites associadas a anticorpos citoplasmáticos antineutrófilos - um grupo heterogêneo de doenças caracterizadas por vasculite. É uma doença sistêmica que afeta vários órgãos. Os pacientes podem apresentar uma grande variedade de sintomas. As manifestações oculares podem apresentar-se como seus sintomas clínicos iniciais, necessitando de abordagem multidisciplinar para redução da morbimortalidade. O diagnóstico precoce ajuda na formulação do tratamento adequado e na prevenção de complicações futuras. O tratamento agressivo, incluindo cirurgia, muitas vezes é necessário para limitar o dano estrutural e preservar a função visual. Apresentamos o caso de uma mulher de 82 anos que inicialmente apresentou ceratite ulcerativa periférica que levou ao diagnóstico de poliangite microscópica.

ABSTRACT Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis.

Abstract: The Santa Ana de Vuelta Larga’s parish, located in the Portoviejo’s basin river of the province of Manabi, Ecuador, is one of the most affected areas by inundations. For this reason, in this recent study it was analyzed its global vulnerability, through physical, social, economic and ecological elements. For this was used direct observation of aspect as the location, conservation and building materials for the construction of housing, also personal and descriptive polls to provide information about risk management and economic lost, and the Geographic Information Systems for the cartographic analysis of environmental aspects of the parish. Quizzes were realized randomly for social groups of 378 people, this is the result of finite population, with a margin error of 5% and a confidence level of 95%. The results show that global vulnerability is average (55%) where the social aspect is more influent, since there is a lack of preparation upon the risk of local governmental institutions and population. Followed by the physical aspect, because of the geographic proximity of households to the river, the ecological factor, for the vegetative cover reduction and the sealed soil, and in a minor proportion of the economic factor because of the location of the commercial zone in places with inferior slopes of 2.5°. Finally, the parish vulnerability is linked to its geographical location, lack of land development planes, preparation for risk and change of soil use and vegetation cover.

Resumen: La parroquia Santa Ana de Vuelta Larga, localizada en la cuenca del río Portoviejo de la provincia de Manabí, Ecuador, es una de las más afectadas por inundaciones. Por ello, en el presente estudio se analizó su vulnerabilidad global mediante componentes físicos, sociales, económicos y ecológicos, para lo cual se emplearon: observación directa de aspectos como ubicación, conservación y material de construcción de las viviendas; encuestas personales y descriptivas con el fin de recabar información acerca de la gestión de riesgos y pérdidas económicas, y Sistemas de Información Geográfica (SIG) para el análisis cartográfico de los aspectos ecológicos de la parroquia. Las encuestas se realizaron aleatoriamente, por estratos, a 378 personas, resultado de la fórmula de poblaciones finitas, con un margen de error de 5% y un nivel de confianza de 95%. Los resultados arrojaron que la vulnerabilidad global es media (55%), en la que influye más el aspecto social por la falta de preparación ante el riesgo de parte de las instituciones gubernamentales locales y habitantes; le sigue el aspecto físico, por la cercanía de gran parte de viviendas al río; el ecológico, por la disminución de la cobertura vegetal y el sellado de suelo, y, en menor proporción, el económico, por la ubicación de la zona comercial sobre el área con pendientes inferiores a 2.5º. Se concluye que la vulnerabilidad de la parroquia está ligada a su ubicación geográfica, a la falta de un ordenamiento territorial y de preparación ante el riesgo y al cambio del uso de suelos y cobertura vegetal.

Resumen Una Red Neuronal Artificial (RNA) es un paradigma de aprendizaje y procesamiento automático inspirado en el comportamiento biológico de las neuronas y en la estructura del cerebro. El cerebro es un sistema altamente complejo; su unidad básica de procesamiento son las neuronas, las cuales se encuentra distribuidas de forma masiva compartiendo múltiples conexiones entre ellas. Las RNAs intentan emular ciertas características propias de los humanos, pueden ser vistas como un sistema inteligente que lleva a cabo tareas de manera distinta a como lo hacen las computadoras actuales. Las RNAs pueden emplearse para realizar actividades complejas, por ejemplo: reconocimiento y clasificación de patrones, predicción del clima, predicción de valores genéticos, etc. Los algoritmos utilizados para entrenar las redes, son en general complejos, por lo cual surge la necesidad de contar con alternativas que permitan reducir de manera significativa el tiempo necesario para entrenar una red. En este trabajo se presenta una propuesta de algoritmos basados en la estrategia “divide y conquista” que permiten entrenar las RNAs de una sola capa oculta. Parte de los sub problemas del algoritmo general de entrenamiento se resuelven utilizando técnicas de cómputo paralelo, lo que permite mejorar el desempeño de la aplicación resultante. El algoritmo propuesto fue implementado utilizando el lenguaje de programación C++, así como las librerías Open MPI y ScaLAPACK. Se presentan algunos ejemplos de aplicación y se evalúa el desempeño del programa resultante. Los resultados obtenidos muestran que es posible reducir de manera significativa los tiempos necesarios para ejecutar el programa que implementa el algoritmo para el ajuste de la RNA.

Abstract An Artificial Neural Network (ANN) is a learning paradigm and automatic processing inspired in the biological behavior of neurons and the brain structure. The brain is a complex system; its basic processing unit are the neurons, which are distributed massively in the brain sharing multiple connections between them. The ANNs try to emulate some characteristics of humans, and can be thought as intelligent systems that perform some tasks in a dierent way that actual computer does. The ANNs can be used to perform complex activities, for example: pattern recognition and classification, weather prediction, genetic values prediction, etc. The algorithms used to train the ANN, are in general complex, so therefore there is a need to have alternatives which lead to a significant reduction of times employed to train an ANN. In this work, we present an algorithm based in the strategy “divide and conquer” which allows to train an ANN with a single hidden layer. Part of the sub problems of the general algorithm used for training are solved by using parallel computing techniques, which allows to improve the performance of the resulting application. The proposed algorithm was implemented using the C++ programming language, and the libraries Open MPI and ScaLAPACK. We present some application examples and we asses the application performance. The results shown that it is possible to reduce significantly the time necessary to execute the program that implements the algorithm to train the ANN.

Spiny lobster Panulirus gracilis is a fishing resource of high commercial importance in Ecuador. Studies of fecundity and reproductive potential of population are fundamental and ensures sustainable use for the fishery, because it is intimately related with the renewal capacity of population. We analyzed size distribution and reproductive potential of spiny lobsters P. gracilis catched by nets in Santa Rosa, Manabí, Ecuador. Data was collected during July 2011, August, September and November 2012, and a sample of 273 females was obtained. Size of lobsters varied between 58 and 102 mm of carapace length (CL), with an average of 83 mm CL ± 7.1; only 2% of lobsters had legal size (> 103 mm LC). Thirty percent of females were ovigerous stage III. Fecundity varied between 123,255 and 805,632 eggs, with an average of 397,115 ± 148,069 eggs; relative fecundity was 1193 ± 236 eggs for each gram of weight. Reproductive potential analysis showed that females with size < 80 mm CL contribute only with 17.8% of total egg production while females between 90 and 100 mm CL provide 38.2% of total eggs production.

La langosta espinosa Panulirus gracilis es un recurso pesquero de gran importancia comercial en Ecuador. Estudios de fecundidad y el potencial reproductivo son fundamentales y garantiza su aprovechamiento sustentable para la pesquería, ya que está relacionado con la capacidad de renovación de la población. En el presente trabajo se analizó la distribución de tallas y el potencial reproductivo de P. gracilis capturadas en Santa Rosa, Manabí, Ecuador. La toma de datos se realizó durante julio 2011, agosto, septiembre y noviembre 2012, se obtuvo una muestra de 273 hembras. La talla varió entre 58 y 102 mm de longitud cefalotorácica (LC) con un valor promedio de 83 mm LC ± 7,1 y sólo el 2% de la captura se encontró dentro de la talla legal permitida (> 103 mm LC). El 30% de las hembras se encontraron en estadio reproductivo III, con una fecundidad absoluta entre 123.255 y 805.632 huevos y un promedio de 397.115 ± 148.069 huevos, la fecundidad relativa promedio fue de 1193 ± 236 huevos por cada gramo de peso del animal. El análisis del potencial reproductivo indica que las hembras menores de 80 mm LC aportan sólo el 17,8% de la producción total de huevos, mientras que las hembras entre 90 y 100 mm LC aportan con el 38,2%.

Cutting tools with mechanical clamping (inserts) are used in high productivity machining processes. The objective of the study was to determine the influence of turning process cutting speed on productivity and costs. Cuban pentagonal cemented carbide inserts were used. The turning of Cr12Mo was performed at various cutting speeds and remained constant feed and depth. The insert´s flank wear behavior and the equation that relates the cutting speed and the insert life were determined. The influence of the cutting speed on machining time and production costs respectively was established too. It was determined that the cutting speed for maximum productivity is 255.45 m/min and for the lowest cost is 120.03 m/min.

Las herramientas de corte con sujeción mecánica (calzos o insertos) son utilizadas en procesos de mecanizado de alta productividad. El objetivo del trabajo consiste en determinar la influencia de la velocidad de corte del proceso de torneado en la productividad y los costos. En el estudio se emplearon calzos pentagonales de carburo cementado de producción nacional. Como material a elaborar fue utilizado el acero Cr12Mo, utilizándose varias velocidades de corte, manteniéndose constante el avance y la profundidad, hasta alcanzar el desgaste límite del flanco del calzo (0,5 mm) para obtener la ecuación que relaciona la velocidad de corte y el tiempo de vida útil del calzo. También fue establecida la influencia de la velocidad de corte sobre los tiempos de maquinado y los costos productivos respectivamente. Por último, la velocidad de corte obtenida para máxima productividad es 255.45 m/min y para el menor costo 120,03 m/min.

Clinical cases: Four cases of patients simulating eye problems are reported. The patients included: an adopted 9 year-old girl complaining of bilateral visual loss, a 10 year-old girl with school and family problems complaining of decreased visual acuity, a 22 year-old female mentioning unilateral visual loss after a car accident, and a 30 year-old female complaining of decreased visual acuity after refractive surgery. Structural and functional tests were performed on all 4 patients and none of the tests revealed any pathological findings. The 4 cases were diagnosed as patients simulating ophthalmological symptoms. Discussion: A non-organic cause of visual loss is a common problem in Ophthalmology. Simulation is the diagnosis used when an adult consciously tries to obtain some kind of benefit without proven pathology. In the case of children, obtaining benefit is not their intention, but psycho-social and psychiatric problems are frequently associated in these cases.

Casos clínicos: Se exponen 4 casos de pacientes simuladores: una niña de 9 años, adoptada, con pérdida visual binocular; una niña de 10 años con baja visión y problemas familiares y escolares; una mujer de 22 años que alegaba pérdida de visión monocular tras un accidente de tráfico, y una mujer de 30 años con afectación de su visión tras cirugía refractiva. En ninguno de los casos las pruebas estructurales y funcionales mostraron alteraciones que justificaran la afectación. A través de exploraciones específicas de la función visual se llegó al diagnóstico de simulación en todos los casos. Discusión: La pérdida visual de causa no orgánica es un problema común en oftalmología. Cuando el sujeto es consciente de la misma y pretende obtener algún beneficio se trata de una simulación. En el caso de los niños no existe dicha intencionalidad, sino posibles problemas psicosociales y psiquiátricos asociados.