Introdução: Metástase óssea é a neoplasia maligna mais comum do esqueleto, e a tomada de decisão cirúrgica depende de múltiplos fatores, incluindo as complicações pós-operatórias e a expectativa de vida. A identificação de novos fatores prognósticos pode auxiliar na tomada de decisão. Objetivo: Analisar em metástases de ossos longos, a incidência de complicações e sobrevida pós-operatórias até 1 ano correlacionando-as com NLR e PLR. Método: Revisão de 160 prontuários de operados por metástase óssea no esqueleto apendicular. Além de características epidemiológicas, foram determinados os valores de NLR e PLR correlacionando-os com sobrevida e complicações. Resultado: Mulheres representaram 64,5% com tumor primário na mama em 62,6%; o fêmur proximal foi o mais acometido; sobrevida média foi 13,2 meses e a de 1 ano 34,7%; ressecção tumoral com endoprótese foi mais comum. A taxa de complicação pós-cirúrgicas foi de 10% e o tempo médio para a ocorrência de complicações pós-operatórias foi de 27,9 dias (0-140). Foi encontrada associação da variável neutrófilos com a complicação pós-operatória (p=0,04). A cada 100 unidades a mais de neutrófilos houve aumento de 1% nas chances de complicações pós-cirúrgicas. Valores médios do NLR e PLR foram, respectivamente, 5,3 (0,2-30,7) e 199,7 (32,1-676,7).  Os pacientes com NLR ≥ 2 (p<0,001) apresentaram diminuição na sobrevida de 92,3% para 62,5% no 3° mês e de 61,5% para 31,3% em 1 ano. Aqueles com PLR ≥209 (p<0,001) apresentaram diminuição na sobrevida de 69% para 59,3% no 3° mês, e de 40,2% para 25,9% em 1 ano. Conclusão: Não foi verificada associação positiva entre o NLR e o PLR com complicações pós-operatórias, mas com sobrevida fortemente sim, a partir do 3° mês de pós-operatório.

Introduction: Bone metastasis is the most common malignant neoplasm of the skeleton, and surgical decision-making depends on multiple factors, including postoperative complications and life expectancy. The identification of new prognostic factors can assist in decision making. Objective: In long bones metastases, to analyze the incidence of complications and postoperative survival up to 1 year, correlating them with NLR and PLR. Method: Review of 160 medical records of patients who underwent surgery for bone metastasis in the appendicular skeleton. In addition to epidemiological characteristics, NLR and PLR values were determined, correlating them with survival and complications. Result: Women represented 64.5% with a primary breast tumor in 62.6%; the proximal femur was the most affected; median survival was 13.2 months and in 1 year 34.7%. Tumor resection with endoprosthesis was more common. The post-surgical complication rate was 10% and the average time for post-operative complications to occur was 27.9 days (0-140). An association between the neutrophil variable and postoperative complications was found (p=0.04). For every 100 more units of neutrophils there was a 1% increase in the chances of post-surgical complications. Mean NLR and PLR values were, respectively, 5.3 (0.2-30.7) and 199.7 (32.1-676.7). Patients with NLR NLR ≥ 2 (p<0,001) showed a decrease in survival from 92,3% to 62,5% at the 3rd month, and from 61,5% to 31,3% at 1 year. Those with PLR ≥209 (p<0.001) showed a decrease in survival from 69% to 59.3% at the 3rd month, and from 40.2% to 25.9% at 1 year. Conclusion: There was no positive association between NLR and PLR with postoperative complications, but strongly yes with survival from the 3rd month after surgery.

Introduction: In general, inflammation stimulates the production and release of neutrophils and, at the same time, decreases the production of lymphocytes. Lymphopenia reflects that cell-mediated immunity is impaired, while neutrophilia represents a response to systemic inflammation in these cancers. Objective: To review the incidence of complications and postoperative survival rates in patients with bone metastases in long bones, correlating them with markers NLR and PLR. Method: Narrative review carried out collecting information published on virtual platforms in Portuguese and English, initially carried out by searching for descriptors related to the topic, which were: “lower extremity, surgery, metastasis, epidemiology, postoperative complications, neutrophils, lymphocytes, platelets”. The extension incorporated AND or OR, by title and/or summary, and full reading of the texts most related to the topic. Result: 21 articles were included. Conclusion: The higher both the NLR and PLR are associated with lower survival in patients with bone metastases when undergoing surgical treatment, especially after 3 months postoperatively. However, there is still no confirmation that they signal any outcome, favorable or not, in relation to postoperative complications.

Introdução : De um modo geral, a inflamação estimula a produção e liberação de neutrófilos e, ao mesmo tempo, diminui a produção de linfócitos. A linfopenia reflete que a imunidade mediada pelas células é prejudicada, enquanto a neutrofilia representa resposta à inflamação sistêmica nesses cânceres. Objetivo : Revisar nos pacientes com metástase óssea em ossos ao longo da incidência de complicações e taxas de sobrevida pós-operatória correlacionando-as com os marcadores NLR e PLR. Método : Revisão narrativa feita colhendo informações publicadas em plataformas virtuais em português e inglês inicialmente realizada por busca dos descritores relacionados ao tema que foram: “extremidade inferior, cirurgia, metástase, epidemiologia, complicações pós-operatórias, neutrófilos, linfócitos, plaquetas” e seus equivalentes em inglês “ extremidade inferior, cirurgia, metástase, epidemiologia, sobrevivência, complicações, neutrófilos, linfócitos, plaquetas sanguíneas ”. A extensão incorporou AND ou OR, pelo título e/ou resumo, e leitura na íntegra dos textos mais relacionados ao tema.  Resultado : Foram incluídos 21 artigos. Conclusão : Quanto maiores, tanto o NLR quanto o PLR estão associados à menor sobrevida em pacientes com MO quando submetidos ao tratamento cirúrgico, especialmente após 3 meses de pós-operatório. Contudo, ainda não há confirmação de que eles sinalizam algum estágio, positivo ou não, em relação às complicações pós-operatórias.

AbstractLupinus synthesizes quinolizidine alkaloids (AQ) as a defense strategy against herbivores. These compounds have a wide variety of applications; however, it is necessary to have a sufficient amount of raw material to satisfy market needs. The species rich in these compounds are wild species, which limits the obtaining of the raw material. One of the strategies for obtaining raw material and producing secondary metabolites is the use of biotechnological tools such as plant tissue culture. In this work we report the characterization of germination, callus induction of Lupinus bilineatus and L. montanus and the characterization of in vitro growth and AQ production. The culture medium and seed scarification protocol allowed the germination of seeds of both species with percentages at 12 days of 100% for L. bilineatus and 74% for L. montanus. With respect to callus induction, a sweep of indolbutyric acid (2,4-D) and cinetin (CIN) concentrations was employed using leaf, stem and root as explants. The best response for callus induction for both species was presented using root with a combination of 2 mg L-1 of 2,4-D and 1 mg L-1 of CIN for L. bilineatus and 1 mg L-1 of 2,4-D and 0.5 mg L-1 of CIN for L. montanus, in both cases friable callus was obtained with two colorations: green and beige. Growth and AQ production were characterized for green callus, since AQ are synthesized in photosynthetic tissues. The growth kinetics shows a characteristic three-phase curve, an adaptation phase extending to day seven, the fastest growth phase and finally a senescence phase starting on day 18. AQ production was observed on day 21. This work contributes to the knowledge of germination behavior, the induction of dedifferentiated tissue and the growth and production of alkaloids in a callus culture in two species of Lupinus, L. montanus and L. bilineatus, both with potential in the chemical and agrochemical industry.

Resumen Lupinus sintetiza alcaloides quinolizidínicos (AQ) como estrategia de defensa en contra de herbívoros. Estos compuestos tienen una amplia variedad de aplicaciones; sin embargo, es necesario contar con la suficiente cantidad de materia prima para satisfacer las necesidades del mercado. Las especies ricas en estos compuestos son especies silvestres, lo que limita la obtención de la materia prima. Una de las estrategias para la obtención de materia prima y la producción de metabolitos secundarios es el uso de herramientas biotecnológicas como el cultivo de tejidos vegetales. En este trabajo se reporta la caracterización de la germinación, la inducción de callo de Lupinus bilineatus y L. montanus y la caracterización del crecimiento in vitro y producción de AQ. El medio de cultivo y el protocolo de escarificación permitieron la germinación de las semillas de ambas especies a los 12 días con porcentajes de 100% para L. bilineatus y de 74% para L. montanus. Con respecto a la inducción de callo, se empleó un barrido de concentraciones de ácido 2,4-diclorofenoxiacético (2,4-D) y cinetina (CIN) utilizando como explante cotiledón, hipocótilo y raíz. La mejor respuesta para la inducción de callo para ambas especies se presentó usando raíz con una combinación de 2 mg L-1 de 2,4-D y 1 mg L-1 de CIN para L. bilineatus y 1 mg L-1 de 2,4-D y 0.5 mg L-1 de CIN para L. montanus, en ambos casos se obtuvo callo friable con dos coloraciones: verde y beige. El crecimiento y la producción de AQ se caracterizaron para el callo verde, pues los AQ se sintetizan en tejidos fotosintéticos. La cinética de crecimiento muestra una característica curva de tres fases, una fase de adaptación que se alarga hasta el día siete, la fase de crecimiento más rápido y finalmente una fase de senescencia que inicia el día 18. La producción de AQ se observó el día 21. Este trabajo contribuye al conocimiento del comportamiento de la germinación, la inducción de tejido desdiferenciado y el crecimiento y producción de alcaloides en un cultivo de callo de dos especies de Lupinus, L. montanus y L. bilineatus, ambas con potencial en la industria química y de agroquímicos.

Introduction: Papillary carcinomas are the most prevalent and least aggressive thyroid carcinomas (PTC). In some cases, the diagnosis is doubtfull and the prognosis is poor. The search for tissue biomarkers that ensure both the diagnosis for indeterminate cases and the prognosis, identifying the most aggressive cases, has been studied in recent decades. Objective: To review the literature in search of cyclin D1 as a marker of papillary thyroid carcinomas and multinodular goiters and evaluate whether its expression correlates with the clinicopathological characteristics of papillary thyroid carcinomas. Methods: Narrative review carried out by collecting information for reading and analysis from online research on virtual platforms. Initially, a search was carried out from MESH descriptors related to the topic, using the following terms: “papillary thyroid carcinoma, cyclin D1, immunohistochemistry, diagnosis, prognosis.” with AND or OR search, considering the title and/or abstract and those chosen were read in full. Results: The search included 77 articles that were compiled in this review. Conclusion: Cyclin D1 was expressed in the vast majority of PTCs, with diffuse distribution being predominant. There was no correlation between its expression and any clinicopathological characteristic of PTC.

Racional - Os carcinomas papilíferos são os mais prevalentes e menos agressivos de tireoide (CPT). Em alguns casos, o diagnóstico é duvidoso e o prognóstico ruim. A busca de biomarcadores teciduais que permitam assegurar tanto o diagnóstico para casos indeterminados, quanto o prognóstico, identificando os casos de maior agressividade, têm sido estudadas nas últimas décadas. Objetivo: Revisar na literatura na busca da ciclina D1 como marcador dos carcinomas papilíferos de tireoide e nos bócios multinodulares, e avaliar se a expressão dela apresenta correlação com as características clínico-patológicas dos carcinomas papilíferos de tireoide. Métodos: Revisão narrativa feita colhendo informações para leitura e análise a partir de pesquisa online em platoformas virtuais. Inicialmente foi realizada busca por descritores DECs relacionados ao tema, utilizando os seguintes termos: “carcinoma papilífero de tireoide, ciclina D1, imunoistoquímica, diagnóstico, prognóstico.” com busca AND ou OR, considerando o título e/ou resumo e os escolhidos foram lidos na íntegra. Resultados: A busca incluiu 77 artigos que foram compilados nesta revisão.  Conclusão: A ciclina D1 foi expressa na grande maioria dos CPT sendo a distribuição difusa predominante. Não houve correlação entre a expressão dela com qualquer característica clinicopatológica dos CPT.

Summary: The floodplain of the San Pedro River, a fluvial-delta formation, is one of the coastal areas affected by marine intrusion during the last glaciation. In this region, agriculture is the main economic activity; however, intensive agricultural practices, the geological past, current interactions with the marine system and the transport of salts through sediments and water make this area susceptible to soil salinization. To characterize the salinity of the agricultural area of the San Pedro River floodplain, two soil samplings were carried out at 91 sites over a period of two years. Samples were taken from depths of 0.0 to 0.3 m and from 0.0 to 0.1 m to depths of 1 m and 3 m. Fifty groundwater samples were collected. Saturation extracts were obtained (1: θsat) from the soil samples. For the soil and groundwater extracts, the pH, EC, and major cations and anions were determined, the sodium adsorption ratio was calculated in the original and adjusted formulations (SAR or and SAR adj ), and the exchangeable sodium percentage (ESP) was ascertained. The pH, EC and SAR or of the groundwater ranged from 6.94 to 8.37, 199 to 4660 µS cm-1 and 0.16 to 32.30 (mmolc L-1)1/2, while in the saturation extracts, the pH, EC and SAR or ranged from 4.81 to 8.58, 0.08 to 72.4 dS m-1 and 0.11 to 33.09 (mmolc L-1)1/2, respectively. The salinity problems in the study area are closely related to the intrusion of salts from the marine system.

Resumen: La planicie del río San Pedro, que tiene una formación fluvio-deltaica, es una de las superficies costeras que fueron afectadas por la intrusión marina durante la última glaciación. En esta zona, la agricultura es la principal actividad económica, sin embargo, las actividades agrícolas intensivas, su pasado geo-morfológico, la actual interdependencia con el sistema marino y el transporte de sales a través de los sedimentos y aguas, hacen que esta región sea susceptible a la acumulación de sales en los suelos. Con el objetivo de caracterizar la salinidad de la superficie agrícola de la planicie del río San Pedro, se hicieron dos muestreos de suelos en 91 sitios en un periodo de dos años. Se tomaron muestras de 0.0 a 0.3 m y de 0.0 a cada 0.1 m hasta profundidades de 1 m y 3 m. Se recolectaron 50 muestras de agua freática, además se obtuvieron extractos de saturación (1: θsat) de las distintas muestras de suelos. A los extractos de suelo y aguas freáticas, se les determinó el pH, CE, cationes y aniones mayoritarios, se calculó el parámetro relación de adsorción de sodio en su formulación original y ajustada (RAS or , RAS aj ) y el porciento de sodio intercambiable (PSI). El pH, CE y RAS or del agua freática estuvieron dentro de los intervalos de 6.94-8.37, 199-4660 µS cm-1 y 0.16-32.30 (mmolc L-1)1/2, mientras que en los extractos de saturación entre 4.81-8.58, 0.08-72.4 dS m-1 y 0.11-33.09 (mmolc L-1)1/2 respectivamente. Los problemas de salinidad en la zona de estudio están estrechamente relacionados con la intrusión de sales provenientes del sistema marino.

Resumen El objetivo de este estudio experimental fue determinar el efecto de terapia de fotobiomodulación sobre la reparación ósea en un modelo de osteotomía de tibia de rata a los 15 y 30 días. La muestra estuvo compuesta por 36 ratas Holtzman macho que se aleatorizaron en 6 grupos iguales. Grupos A1 y A2: osteotomía + energía láser de 1 Joule. Grupos B1 y B2: osteotomía + energía láser 3 Joule. Grupos C1 y C2 (controles): solo osteotomía. La reparación ósea fue analizada por evaluación histológica de osteoblastos y osteocitos tanto a los 15 días (grupos A1, B1 y C1) como a los 30 días (grupos A2, B2 y C2). Como resultados se encontró que en todos los grupos hubo mayor número de osteoblastos a los 15 días vs. 30 días (p<0,05), y mayor número de osteocitos en B1 y C2 vs B2 y C1, respectivamente (p<0,05). Al evaluar a los animales a los 15 días, se observó mayor número de osteoblastos en A1 y C1 vs B1 (p<0.001); y mayor número de osteocitos en A1 y B1 vs C1 (p<0,001). Al evaluar a los ratones a los 30 días hubo mayor cantidad de osteoblastos en C2 vs A2 y B2 (p<0,05) y de osteocitos en C2 vs B2 (p<0,05). Se concluye que la terapia de fotobiomodulación con 1 Joule mejoró la reparación ósea a los 15 días; sin embargo, dicha mejora no se observó a los 30 días porque no hubo diferencias entre los grupos irradiados y el control.

Abstract The aim of this experimental study was to determine the effect of photobiomodulation therapy on bone repair in a rat tibia osteotomy model at 15 and 30 days. The sample consisted of 36 male Holtzman rats that were randomized into 6 equal groups. Groups A1 and A2: osteotomy + 1 J laser energy. Groups B1 and B2: osteotomy + 3 J laser energy. Groups C1 and C2 (controls): osteotomy only. The bone repair was analyzed by histological evaluation of osteoblasts and osteocytes both at 15 days (groups A1, B1, and C1) and at 30 days (groups A2, B2, and C2). Within the results, in all groups a greater number of osteoblasts was found at 15 days vs 30 days (p<0.05), and a greater number of osteocytes in B1 and C2 vs B2 and C1, respectively (p<0.05). When evaluating the 3 groups worked up to 15 days, more osteoblasts were found in A1 and C1 vs B1 (p<0.001); and osteocytes predominated in A1 and B1 vs C1 (p<0.001). At 30 days there was a greater quantity of osteoblasts in C2 vs A2 and B2 (p<0.05) and of osteocytes in C2 vs B2 (p<0.05). It is concluded that 1 J photobiomodulation therapy improved bone repair at 15 days; however, this improvement was not observed at 30 days because there were no differences between the irradiated groups and the control.

RESUMEN Introducción: Los tumores fibrosos solitarios (TFS) son neoplasias raras de origen mesenquimal que, aunque generalmente se desarrollan en la pleura visceral, ocasionalmente se presentan en la cavidad intracraneal. Además, se caracterizan por altas tasas de metástasis y recurrencia. Caso clínico: Se presenta el caso de un paciente masculino de 59 años con cuadro de 3 meses de cefalea y bradipsiquia. La tomografía reveló una tumoración neoformativa que infiltra cavidad nasal, celdillas etmoidales, y fosa craneal anterior, comprometiendo lóbulo frontal izquierdo. El paciente fue sometido a dos craniectomías exploratorias donde se realizaron los diagnósticos sugestivos de neoplasia glial de alto grado y TFS. Para la precisión diagnóstica se realizó inmunohistoquímica que fue compatible con tumor fibroso solitario. Se analiza el caso centrándose particularmente en los aspectos histopatológicos, localización inusual de este tumor y sus manifestaciones clínicas variables.

ABSTRACT Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that, although typically develop in the visceral pleura, occasionally occur in the intracranial cavity. Furthermore, they are characterized by high rates of metastasis and recurrence. Case Report: We present the case of a 59-year-old male patient with a 3-month history of headache and bradyphrenia. Computed tomography revealed a neoformative tumor infiltrating the nasal cavity, ethmoid sinuses, and anterior cranial fossa, involving the left frontal lobe. The patient underwent two exploratory craniectomies, during which diagnoses suggestive of high-grade glial neoplasia and SFT were made. For precise diagnosis, immunohistochemistry was performed, which was consistent with solitary fibrous tumor. The case is analyzed, focusing particularly on histopathological aspects, the unusual location of this tumor, and its variable clinical manifestations.

Resumen Antecedentes: El síndrome de Down es la anomalía cromosómica más frecuente y se asocia con defectos cardiacos congénitos, elementos clínicos de una alta morbilidad y mortalidad infantil. Objetivo: Describir los desenlaces clínicos de los pacientes con síndrome de Down sometidos a cirugía e intervencionismo como tratamiento de las cardiopatías congénitas en esta institución. Material y métodos: Estudio retrospectivo que incluyó pacientes menores de 18 años con síndrome de Down y patología cardiaca asociada durante los últimos 10 años. Las variables estudiadas fueron: peso, talla, sexo, edad, tipo de cardiopatía, procedimiento correctivo, tiempo de estancia intrahospitalaria y en unidad de terapia intensiva, morbilidad y mortalidad. Resultados: 368 pacientes pediátricos fueron llevados a corrección quirúrgica o intervencionista, de los cuales 197 (54%) pertenecían al sexo femenino, la mediana de edad fue de 24 meses (rango intercuartílico [RIQ]: 14-48) en el grupo quirúrgico y de 36 meses (RIQ: 17-85) en el intervencionista. Las cardiopatías congénitas más frecuentes fueron: persistencia del conducto arterioso (31%), comunicación interventricular (28%), canal atrioventricular (CAV) (20%), comunicación interauricular (16%) y tetralogía de Fallot con el 4% respectivamente. La estancia hospitalaria fue de 9 días (RIQ: 7-15) en el grupo quirúrgico y de 3 días (RIQ: 2-5) en el hemodinámico. Las morbilidades fueron infección postoperatoria en 30 pacientes (14%) y en 19 pacientes (9%) bloqueo atrioventricular completo. La mortalidad global incluyendo tanto el quirúrgico como el intervencionista fue del 2%. Conclusiones: Los resultados terapéuticos, quirúrgicos e intervencionistas, en los niños con síndrome de Down y cardiopatías congénitas han mejorado en forma muy satisfactoria. Es de destacar la menor prevalencia del CAV en la población mexicana. Es indispensable realizar evaluación cardiológica a los niños con síndrome de Down y aquellos con cardiopatías congénitas llevarlos a corrección de manera oportuna para favorecer la sobrevida y calidad de vida.

Abstract Background: Down syndrome is the most common chromosomal abnormality, it is associated with a wide variety of congenital heart defects, being considered as clinical elements of high infant morbidity and mortality. Objective: To describe the clinical outcomes of patients with Down syndrome undergoing surgery and interventionism as treatment for congenital heart disease at this Institution. Material and methods: 368 patients with Down syndrome and associated congenital heart disease were diagnosed. The variables studied were weight, stature, sex, age, type of heart disease, corrective procedure, length of stay in the hospital and intensive care unit, morbidity and mortality. Results: 368 pediatric patients underwent surgical or interventional correction. Of which 197 (54%) were female, the median age was 24 months (interquartile range [IQR]: 14-48) in the surgical group and 36 months (IQR: 17-85) in the interventional group. The most frequent congenital heart diseases were: PCA (31%), IVC (28%), CAV (20%), ASD (16%) and tetralogy of Fallot with 4% respectively. Hospital stay was 9 days (IQR: 7-15) in the surgical group and 3 days (IQR: 2-5) in the hemodynamic group. Morbidities were postoperative infection in 30 patients (14%) and complete atrioventricular block in 19 patients (9%). Overall mortality including both surgical and interventional was 2%. Conclusions: The therapeutic, surgical and interventional results in children with Down syndrome and congenital heart disease have improved very satisfactorily. The lower prevalence of the atrioventricular canal in the Mexican population is noteworthy. It is essential to carry out a cardiological evaluation of children with Down syndrome and those with congenital heart disease to correct them in a timely manner to promote survival and quality of life.

RESUMEN La investigación tiene como objetivo identificar las estrategias metacognitivas para la inclusión educativa de estudiantes universitarios con discapacidad auditiva y/o visual en la Universidad Estatal de Milagro, desde el enfoque de los educadores. Para ello se desarrolla una investigación cuali-cuantitativa por medio de entrevistas a profundidad y encuestas direccionas a docentes, llevadas a cabo entre abril y mayo de 2023. Los resultados del estudio permitieron conocer que los educadores ponen en práctica acciones estratégicas con fundamentos metacognitivos que favorecen la inclusión de los educandos tales como el trabajo con pares, clases invertidas, proyectos, diálogos, análisis críticos, debates, actividades grupales, entre otros. Además, recurren a acciones para que los estudiantes logren sus aprendizajes como las tutorías, incentivo al autoconocimiento, así como la atención y concentración, e incluso incurren en apoyos extra como el darles soporte para el manejo de emociones, pensamientos positivos, identificación de problemas en sus aprendizajes. Pese a ello destacan la necesidad de formación respecto a la educación inclusiva y la incorporación de material para trabajar con estudiantes con discapacidad visual y/o auditiva. Finalmente se plantea una propuesta de estrategias metacognitivas que contribuirán en la inclusión educativa de los estudiantes universitarios.

ABSTRACT The objective of the research is to identify metacognitive strategies for the educational inclusion of university students with hearing and/or visual disabilities at the State University of Milagro, from the perspective of educators. For this, a qualitative-quantitative investigation is developed through in-depth interviews and directed surveys to teachers, carried out between April and May 2023. The results of the study allowed us to know that educators put into practice strategic actions with metacognitive foundations that favor the inclusion of students such as work with peers, flipped classes, projects, dialogues, critical analysis, debates, group activities, among others. In addition, they resort to actions for students to achieve their learning such as tutorials, encouragement of self-knowledge, as well as attention and concentration, and even incur extra support such as giving them support for managing emotions, positive thoughts, identification of problems in their learnings. Despite this, they highlight the need for training regarding inclusive education and the incorporation of material to work with students with visual and/or hearing disabilities. Finally, a proposal of metacognitive strategies that will contribute to the educational inclusion of university students is proposed.

ABSTRACT Phosphorus (P) is one of the fundamental elements for the development of soybean. An inadequate supply in the plant could seriously limit production. In the experimental field of the Faculty of Agrarian Sciences, Pedro Juan Caballero Branch of the National University of Asunción, located in the Cerro Corá District, on an Alfisol, an experiment was installed to evaluate the effects of the application of different simple superphosphate dose in soybean yield and damages. Significant differences were found between the control and the fertilized treatments in terms of yield parameters, with an increase in grain yield according to the increase in the applied phosphorus dose, adjusting to a linear equation. The average production of grains in kg ha-1 was 3,837.50, 4,148.61, 4,290.28, and 4,455.56 kg ha-1 for doses of 30, 60, 90, and 120 kg ha-1 of P2O5 respectively, being the mean obtained in the control equal to 3,527.78 kg ha-1. Significant differences were found between the control and the fertilized treatments in terms of the percentage variable of pods attacked by bedbugs and healthy pods. Healthy plants have been verified, without attack or punctures in higher doses of P2O5.

RESUMEN El fósforo (P) es unos de los elementos fundamentales para el desarrollo de la soja. Un suministro inadecuado en la planta podría limitar considerablemente el rendimiento. En el campo experimental de la Facultad de Ciencias Agrarias, Filial Pedro Juan Caballero de la Universidad Nacional de Asunción, situado en el Distrito de Cerro Corá, sobre un Alfisol, se instaló un experimento con el objetivo de evaluar los efectos de la aplicación de diferentes dosis de superfosfato simple en el rendimiento productivo de la soja y los danos. Se encontraron diferencias significativas entre el testigo y los tratamientos fertilizados en cuanto a los parámetros de rendimiento, existiendo un aumento del rendimiento de granos de acuerdo al aumento de la dosis de fósforo aplicado, ajustándose a una ecuación lineal. La producción media de granos en kg ha-1 fueron de 3.837,50, 4.148,61, 4.290,28, y 4.455,56 kg ha-1 para dosis de 30, 60, 90, y 120 kg ha-1 de P2O5 respectivamente, siendo la media obtenida en el testigo igual a 3.527,78 kg ha-1. Se encontraron diferencias significativas entre el testigo y los tratamientos fertilizados en cuanto a la variable de porcentaje de vainas atacadas por chinches y vainas sanas. Se ha verificado plantas sanas, sin ataque o puncturas en mayores dosis de P2O5.

Resumen La preeclampsia es una patología de origen desconocido, de alta incidencia en la salud materna y neonatal. Caracterizada como una hipertensión gestacional grave multisistémica a partir de las 20 semanas de gestación hasta el parto y posparto, siendo de los trastornos más prevalentes en el mundo y la principal causa de muerte materna en Ecuador durante 2022. El objetivo fue realizar una revisión bibliográfica respecto de los factores de riesgo que predisponen preeclampsia en embarazadas. Mediante una revisión bibliográfica de estudios correspondientes a factores predisponentes al desarrollo de preeclampsia y eclampsia en embarazadas cuyos resultados se enfocaron a pacientes adultas diagnosticadas con dichas patologías mediante estrategia PICO, aplicando criterios de inclusión y exclusión. La preeclampsia conlleva una diversidad de factores de riesgo familiares patológicos como preeclampsia previa, hipertensión o enfermedades renales, diabéticas y obesidad; otros factores incluyen: edad, raza, embarazos gemelares, multiparidad, progenitores de distinta índole. Los factores significativos para presentar la enfermedad fueron en su mayoría factores ginecoobstétricos donde destacaron multiparidad, edad, obesidad, malnutrición, hipertensión previa y factores hereditarios.

Abstract Preeclampsia is a condition of unknown origin, with a high incidence in maternal and neonatal health, characterized as a severe multisystemic gestational hypertension from the 20th week of gestation until childbirth and postpartum. Among the most prevalent disorders worldwide, in Ecuador was the main cause of maternal death during 2022. The objective was to conduct a literature review regarding risk factors that predispose pregnant women to preeclampsia. Through a literature review of studies corresponding to predisposing factors for the development of preeclampsia and eclampsia in pregnant women, whose results were focused on adult patients diagnosed with said pathologies through the PICO strategy, applying inclusion and exclusion criteria. Preeclampsia involves a variety of pathological familial risk factors such as prior preeclampsia, hypertension, renal diseases, diabetes, and obesity; other factors include age, race, twin pregnancies, multiparity, and diverse parental lineage. The significant factors for presenting the disease were mostly gynecobstetric factors, prominently multiparity, age, obesity, malnutrition, prior hypertension, and hereditary factors.

Resumen La enfermedad relacionada con inmunoglobulina (Ig) G4 es una enfermedad de reciente conocimiento que puede comprometer cualquier órgano teniendo preferencias por ciertas regiones del cuerpo, donde la región de cabeza y cuello es uno de sus principales puntos afectados, pudiendo comprometer tanto la órbita, glándulas salivales, glándulas lagrimales, glándula tiroides, cavidades paranasales, hueso temporal, faringe y laringe. Este último órgano es infrecuentemente comprometido, solo existiendo 12 casos registrados en la literatura antes de la publicación de este escrito. Presentamos un caso de una mujer de 49 años con historia de disnea frente a esfuerzo, diagnosticándose una estenosis subglótica la cual fue manejada quirúrgicamente con una reconstrucción laringotraqueal. En el estudio histopatológico se evidenció histología compatible con enfermedad relacionada con IgG4, por lo que se inició tratamiento médico con corticotera- pia oral por un lapso de 2 meses en conjunto con inmunología. Paciente luego de 4 años de seguimiento, no ha presentado recaídas, manteniendo un lumen subglótico adecuado.

Abstract Immunoglobulin (Ig) G4-related disease is a medical condition of recent knowledge that can compromise any organ, having preferences for certain regions of the body, where the head and neck region is one of the main affected points, being able to affect orbit, salivary glands, lacrimal glands, thyroid gland, paranasal cavities, temporal bone, pharynx and larynx. The latter is infrequently compromised, with only 12 cases registered in the literature before the publication of this writing. We present a case of a 49-year-old woman with a history of exertional dyspnea, diagnosed with a sub- glottic stenosis which was managed surgically with laryngotracheal reconstruction. The histopathological study revealed histology compatible with IgG4-related disease, so medical treatment with oral corticosteroid therapy was started for a period of 2 months in conjunction with immunology. After 4 years of follow-up, the patient has not presented relapses, maintaining an adequate subglottic lumen.

RESUMEN Reportamos los dos primeros casos, en Perú, sobre el uso del tratamiento con oxigeno hiperbárico coadyuvante (TOHC) en pacientes con mucormicosis asociado a COVID-19 (MAC). El primer caso es una mujer de 41 años, con dolor en hemicara y región palatina izquierdas con rinorrea purulenta de un mes de evolución. Al examen físico, solo evidencia fístula oroantral. El segundo caso se trata de un varón de 35 años, con disminución de agudeza visual izquierda y dolor palatino con fístula que drena secreción purulenta de cuatro meses de evolución. Ambos pacientes tienen el antecedente de diabetes, tuvieron COVID-19 moderado cuatro meses antes del ingreso, y recibieron corticoterapia por este diagnóstico. Ambos pacientes tuvieron una evaluación tomográfica que mostró compromiso del seno maxilar y tejido óseo circundante, con endoscopia nasal diagnóstica y terapéutica para desbridamiento. Se obtuvieron muestras compatibles con mucormicosis en estudio histológico. Los pacientes fueron tratados con limpieza quirúrgica y anfotericina B desoxicolato, sin embargo, presentaron evoluciones tórpidas. Por lo tanto, se adicionó la TOHC y mostraron una mejoría evidente tras cuatro semanas de tratamiento con controles subsiguientes sin presencia de mucormicosis. Resaltamos la evolución de estos pacientes con TOHC, en una enfermedad con importante morbimortalidad, que ha sido emergente durante la pandemia.

ABSTRACT We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Resumen Objetivo: Determinar la incidencia de reacciones adversas (RA) tras la primera dosis de la vacuna Pfizer-BioNTech e identificar algunos factores asociados con ellas. Método: Se realizó un estudio de cohorte retrospectiva. Los datos fueron obtenidos mediante una encuesta epidemiológica contestada en línea. Se realizaron análisis multivariados para identificar factores asociados con las RA tempranas (< 2 h) y tardías (≥ 2 h). Resultados: Se incluyeron 2295 trabajadores de la salud; en ellos, la incidencia acumulada de RA fue del 18.2% (intervalo de confianza del 95%: 16.6-19.8%) y la mayoría fueron tardías (78.2%). Las RA tempranas más frecuentes fueron dolor local, cefalea y mareo; en las tardías fueron dolor local, cefalea y fatiga. No se documentaron casos de anafilaxia; sin embargo, en el grupo de RA tempranas y tardías hubo un caso y tres casos, respectivamente, con síntomas sistémicos que afectaron a dos órganos diferentes. Los factores asociados que incrementaron el riesgo de RA tempranas fueron ser mujer (odds ratio [OR]: 2.23; p = 0.002) y pertenecer al personal médico (OR: 1.56; p = 0.041). En las RA tardías fue ser mujer (OR: 1.94; p < 0.0001); por su parte, la diabetes (OR: 0.46; p = 0.021), el asma (OR: 0.53; p = 0.040) y el tabaquismo (OR: 0.44; p = 0.002) fueron factores asociados inversamente. Es interesante que la historia de COVID-19 no se asoció con RA tempranas ni tardías. Conclusiones: El riesgo de presentar algún tipo de RA debido a la vacuna Pfizer-BioNTech en trabajadores de la salud es < 20%.

Abstract Objective: To determine the incidence of adverse reactions (AR) after the first dose of Pfizer-BioNTech vaccine, and to identify some factors associated with AR. Method: A retrospective cohort study was conducted. Data were obtained through an epidemiological survey answered online. Multivariate analyses were performed to identify factors associated with early (< 2 h) and late (≥ 2 h) AR. Results: A total of 2295 health care workers were included; in them, the cumulative incidence of AR was 18.2% (95% confidence interval: 16.6-19.8), where the majority were late (78.2%). The associated factors that increased the risk of early AR were being female (odds ratio [OR]: 2.23, p = 0.002) and belonging to the medical staff (OR: 1.56; p = 0.041). In late AR were being female (OR: 1.94; p < 0.0001); on the other hand, diabetes (OR: 0.46; p = 0.021), asthma (OR: 0.53; p = 0.040) and smoking (OR: 0.44, p = 0.002) were inversely associated factors. Interestingly, history of COVID-19 was not associated with either early or late AR. Conclusions: The risk of presenting some type of AR due to the Pfizer-BioNTech vaccine in health care workers is < 20%.

ABSTRACT We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

RESUMEN Reportamos los dos primeros casos, en Perú, sobre el uso del tratamiento con oxigeno hiperbárico coadyuvante (TOHC) en pacientes con mucormicosis asociado a COVID-19 (MAC). El primer caso es una mujer de 41 años, con dolor en hemicara y región palatina izquierdas con rinorrea purulenta de un mes de evolución. Al examen físico, solo evidencia fístula oroantral. El segundo caso se trata de un varón de 35 años, con disminución de agudeza visual izquierda y dolor palatino con fístula que drena secreción purulenta de cuatro meses de evolución. Ambos pacientes tienen el antecedente de diabetes, tuvieron COVID-19 moderado cuatro meses antes del ingreso, y recibieron corticoterapia por este diagnóstico. Ambos pacientes tuvieron una evaluación tomográfica que mostró compromiso del seno maxilar y tejido óseo circundante, con endoscopia nasal diagnóstica y terapéutica para desbridamiento. Se obtuvieron muestras compatibles con mucormicosis en estudio histológico. Los pacientes fueron tratados con limpieza quirúrgica y anfotericina B desoxicolato, sin embargo, presentaron evoluciones tórpidas. Por lo tanto, se adicionó la TOHC y mostraron una mejoría evidente tras cuatro semanas de tratamiento con controles subsiguientes sin presencia de mucormicosis. Resaltamos la evolución de estos pacientes con TOHC, en una enfermedad con importante morbimortalidad, que ha sido emergente durante la pandemia.