ABSTRACT: The invasive chinese slug Meghimatiumpictum (Stoliczka, 1873) (Stylommathophora: Philomycidae) is originally from Asia, and it has been introduced in Latin American countries like Argentina and Brazil, where it is considered a critical horticultural pest. This species also became an intermediate host for the nematode AngiostrongyluscostaricensisMorera&Cespedes, 1971(Strongylida: Metastrongylidae), which can cause abdominal angiostrongyliasis in humans when ingested molluscs or their mucus containing larvae released on fruit and vegetables. This research aimed to investigate the biological parameters of the life cycle of M. pictum and evaluate its food preference to understand the species’ behavior and provide information on the choice of safer pest management and control methods. We observed that 68 and 75% of the grouped and isolated slugs, respectively, survived 26 weeks (180 days) under laboratory conditions. In addition, the individuals kept isolated had higher body mass (2.8 ± 0.6 g), length (3.3 ± 0.8 cm), and width (0.37 ± 0.3 cm) than grouped specimens. We also found that M. pictum has indeterminate growth and an annual reproductive cycle. Concerning food preference, slugs better accepted lettuce at different developmental stages (neonate, juvenile, and adult). Our study presents the first description of the M. pictum life cycle. We concluded that M. pictum has undefined biological parameters, which hampers its laboratory rearing. However, we also demonstrate its potential as a pest for different horticultural crops, which will require the development of management strategies. ABSTRACT Stoliczka, Stoliczka (Stoliczka 1873 Stylommathophora (Stylommathophora Philomycidae Asia Brazil AngiostrongyluscostaricensisMoreraCespedes AngiostrongyluscostaricensisMorera Cespedes AngiostrongyluscostaricensisMorera&Cespedes 1971Strongylida Strongylida 1971 1971(Strongylida Metastrongylidae, Metastrongylidae , Metastrongylidae) vegetables M methods 6 75 respectively 2 180 (18 days conditions addition 2.8 28 8 (2. 06 0 0. g, g g) 3.3 33 3 (3. 08 cm, cm 0.37 037 37 (0.3 03 specimens neonate, neonate (neonate juvenile adult. adult . adult) rearing However crops strategies 187 197 7 18 (1 2. (2 3. (3 (0. 19 1 ( (0

RESUMO: A lesma invasora Meghimatium pictum (Stoliczka, 1873) (Stylommathophora: Philomycidae) é originária da Ásia e foi introduzida em países latino-americanos como Argentina e Brasil, onde é considerada uma praga hortícola severa. Esta espécie também se tornou um hospedeiro intermediário do nematoide Angiostrongylus costaricensis Morera & Céspedes, 1971 (Strongylida: Metastrongylidae), que pode causar a infecção angiostrongilíase abdominal em humanos quando ingerido o molusco ou frutas e vegetais contendo o seu muco contaminado com larvas. Esta pesquisa teve como objetivo investigar os parâmetros biológicos do ciclo de vida de M. pictum e avaliar sua preferência alimentar para entender o comportamento da espécie e fornecer informações sobre a escolha futura de métodos mais seguros de manejo e controle desta praga. Observamos que 68 e 75% das lesmas agrupadas e isoladas, respectivamente, sobreviveram 26 semanas (180 dias) em condições de laboratório. Além disso, os indivíduos mantidos isolados apresentaram maior massa corporal (2,8 ± 0,6 g), comprimento (3,3 ± 0,8 cm) e largura (0,37 ± 0,3 cm) do que os espécimes agrupados. Também descobrimos que M. pictum tem crescimento indeterminado e ciclo reprodutivo anual. Com relação à preferência alimentar, a alface foi bem aceita pelas lesmas em diferentes estágios de desenvolvimento (recém-nascido, juvenil e adulto). Nosso estudo apresenta a primeira descrição do ciclo de vida de M. pictum. Concluímos que M. pictum possui parâmetros biológicos indefinidos, com ciclo de vida longo o que dificulta sua criação em laboratório. No entanto, também demonstramos seu potencial como praga para diferentes culturas hortícolas, o que exigirá o desenvolvimento de estratégias de manejo. RESUMO Stoliczka, Stoliczka (Stoliczka 1873 Stylommathophora (Stylommathophora Philomycidae latinoamericanos latino americanos Brasil severa Céspedes 197 Strongylida (Strongylida Metastrongylidae, Metastrongylidae , Metastrongylidae) larvas M 6 75 isoladas respectivamente 2 180 (18 dias laboratório disso 2,8 28 8 (2, 06 0 0, g, g g) 3,3 33 3 (3, 08 cm 0,37 037 37 (0,3 03 agrupados anual recémnascido, recémnascido recém nascido, nascido (recém-nascido adulto. adulto . adulto) indefinidos entanto hortícolas 187 19 7 18 (1 2, (2 3, (3 (0, 1 ( (0

Abstract Introduction: Acute kidney injury (AKI) occurs frequently in COVID-19 patients and is associated with greater morbidity and mortality. Knowing the risks of AKI allows for identification, prevention, and timely treatment. This study aimed to identify the risk factors associated with AKI in hospitalized patients. Methods: A descriptive, retrospective, cross-sectional, and analytical component study of adult patients hospitalized with COVID-19 from March 1 to December 31, 2020 was carried out. AKI was defined by the creatinine criteria of the KDIGO-AKI guidelines. Information, regarding risk factors, was obtained from electronic medical records. Results: Out of the 934 patients, 42.93% developed AKI, 60.59% KDIGO-1, and 9.9% required renal replacement therapy. Patients with AKI had longer hospital stay, higher mortality, and required more intensive care unit (ICU) admission, mechanical ventilation, and vasopressor support. Multivariate analysis showed that age (OR 1.03; 95% CI 1.02–1.04), male sex (OR 2.13; 95% CI 1.49–3.04), diabetes mellitus (DM) (OR 1.55; 95% CI 1.04–2.32), chronic kidney disease (CKD) (OR 2.07; 95% CI 1.06–4.04), C-reactive protein (CRP) (OR 1.02; 95% CI 1.00–1.03), ICU admission (OR 1.81; 95% CI 1.04–3.16), and vasopressor support (OR 7.46; 95% CI 3.34–16.64) were risk factors for AKI, and that bicarbonate (OR 0.89; 95% CI 0.84–0.94) and partial pressure arterial oxygen/inspired oxygen fraction index (OR 0.99; 95% CI 0.98–0.99) could be protective factors. Conclusions: A high frequency of AKI was documented in COVID-19 patients, with several predictors: age, male sex, DM, CKD, CRP, ICU admission, and vasopressor support. AKI occurred more frequently in patients with higher disease severity and was associated with higher mortality and worse outcomes. Introduction (AKI COVID19 COVID 19 COVID-1 identification prevention treatment Methods descriptive retrospective crosssectional, crosssectional cross sectional, sectional cross-sectional 31 202 out KDIGOAKI KDIGO guidelines Information records Results 93 4293 42 42.93 6059 60 59 60.59 KDIGO1, KDIGO1 1, KDIGO-1 99 9 9.9 therapy stay (ICU ventilation OR 1.03 103 03 95 1.02–1.04, 102104 1.02–1.04 , 02 04 1.02–1.04) 2.13 213 2 13 1.49–3.04, 149304 1.49–3.04 49 3 1.49–3.04) DM (DM 1.55 155 55 1.04–2.32, 104232 1.04–2.32 32 1.04–2.32) CKD (CKD 2.07 207 07 1.06–4.04, 106404 1.06–4.04 06 4 1.06–4.04) Creactive C reactive CRP (CRP 1.02 102 1.00–1.03, 100103 1.00–1.03 00 1.00–1.03) 1.81 181 81 1.04–3.16, 104316 1.04–3.16 16 1.04–3.16) 7.46 746 7 46 3.34–16.64 3341664 34 64 0.89 089 0 89 0.84–0.94 084094 84 94 oxygeninspired inspired 0.99 099 0.98–0.99 098099 98 Conclusions predictors outcomes COVID1 COVID- 20 429 42.9 605 6 5 60.5 KDIGO- 9. 1.0 10 10210 1.02–1.0 2.1 21 14930 1.49–3.0 1.5 15 10423 1.04–2.3 2.0 10640 1.06–4.0 10010 1.00–1.0 1.8 18 8 10431 1.04–3.1 7.4 74 3.34–16.6 334166 0.8 08 0.84–0.9 08409 0.9 09 0.98–0.9 09809 42. 60. 1. 1021 1.02–1. 2. 1493 1.49–3. 1042 1.04–2. 1064 1.06–4. 1001 1.00–1. 1043 1.04–3. 7. 3.34–16. 33416 0. 0.84–0. 0840 0.98–0. 0980 1.02–1 149 1.49–3 104 1.04–2 106 1.06–4 100 1.00–1 1.04–3 3.34–16 3341 0.84–0 084 0.98–0 098 1.02– 14 1.49– 1.04– 1.06– 1.00– 3.34–1 334 0.84– 0.98– 1.49 1.04 1.06 1.00 3.34– 33 0.84 0.98 1.4 3.34 3.3 3.

RESUMO Introdução: Lesão renal aguda (LRA) ocorre frequentemente em pacientes com COVID-19 e associa-se a maior morbidade e mortalidade. Conhecer riscos da LRA permite a identificação, prevenção e tratamento oportuno. Este estudo teve como objetivo identificar fatores de risco associados à LRA em pacientes hospitalizados. Métodos: Realizou-se estudo descritivo, retrospectivo, transversal e de componente analítico de pacientes adultos hospitalizados com COVID-19 de 1º de março a 31 de dezembro, 2020. Definiu-se a LRA pelos critérios de creatinina das diretrizes KDIGO-LRA. Informações sobre fatores de risco foram obtidas de prontuários eletrônicos. Resultados: Dos 934 pacientes, 42,93% desenvolveram LRA, 60,59% KDIGO-1 e 9,9% necessitaram de terapia renal substitutiva. Pacientes com LRA apresentaram maior tempo de internação, maior mortalidade e necessitaram de mais internações em UTIs, ventilação mecânica e suporte vasopressor. A análise multivariada mostrou que idade (OR 1,03; IC 95% 1,02–1,04), sexo masculino (OR 2,13; IC 95% 1,49–3,04), diabetes mellitus (DM) (OR 1,55; IC 95% 1,04–2,32), doença renal crônica (DRC) (OR 2,07; IC 95% 1,06–4,04), proteína C reativa (PCR) (OR 1,02; IC 95% 1,00–1,03), admissão em UTI (OR 1,81; IC 95% 1,04–3,16) e suporte vasopressor (OR 7,46; IC 95% 3,34–16,64) foram fatores de risco para LRA, e que bicarbonato (OR 0,89; IC 95% 0,84–0,94) e índice de pressão parcial de oxigênio arterial/fração inspirada de oxigênio (OR 0,99; IC 95% 0,98–0,99) poderiam ser fatores de proteção. Conclusões: Documentou-se alta frequência de LRA em pacientes com COVID-19, com diversos preditores: idade, sexo masculino, DM, DRC, PCR, admissão em UTI e suporte vasopressor. LRA ocorreu mais frequentemente em pacientes com maior gravidade da doença e associou-se a maior mortalidade e piores desfechos. Introdução (LRA COVID19 COVID 19 COVID-1 associase associa se identificação oportuno Métodos Realizouse Realizou descritivo retrospectivo º 3 dezembro 2020 Definiuse Definiu KDIGOLRA. KDIGOLRA KDIGO LRA. KDIGO-LRA eletrônicos Resultados 93 4293 42 42,93 6059 60 59 60,59 KDIGO1 1 KDIGO- 99 9 9,9 substitutiva internação UTIs OR 1,03 103 03 95 1,02–1,04, 102104 1,02–1,04 , 02 04 1,02–1,04) 2,13 213 2 13 1,49–3,04, 149304 1,49–3,04 49 1,49–3,04) DM (DM 1,55 155 55 1,04–2,32, 104232 1,04–2,32 32 1,04–2,32) DRC (DRC 2,07 207 07 1,06–4,04, 106404 1,06–4,04 06 4 1,06–4,04) PCR (PCR 1,02 102 1,00–1,03, 100103 1,00–1,03 00 1,00–1,03) 1,81 181 81 1,04–3,16 104316 16 7,46 746 7 46 3,34–16,64 3341664 34 64 0,89 089 0 89 0,84–0,94 084094 84 94 arterialfração arterial fração 0,99 099 0,98–0,99 098099 98 proteção Conclusões Documentouse Documentou COVID19, 19, preditores associouse associou desfechos COVID1 COVID- 202 429 42,9 605 6 5 60,5 9, 1,0 10 10210 1,02–1,0 2,1 21 14930 1,49–3,0 1,5 15 10423 1,04–2,3 2,0 20 10640 1,06–4,0 10010 1,00–1,0 1,8 18 8 1,04–3,1 10431 7,4 74 3,34–16,6 334166 0,8 08 0,84–0,9 08409 0,9 09 0,98–0,9 09809 42, 60, 1, 1021 1,02–1, 2, 1493 1,49–3, 1042 1,04–2, 1064 1,06–4, 1001 1,00–1, 1,04–3, 1043 7, 3,34–16, 33416 0, 0,84–0, 0840 0,98–0, 0980 1,02–1 149 1,49–3 104 1,04–2 106 1,06–4 100 1,00–1 1,04–3 3,34–16 3341 0,84–0 084 0,98–0 098 1,02– 14 1,49– 1,04– 1,06– 1,00– 3,34–1 334 0,84– 0,98– 1,49 1,04 1,06 1,00 3,34– 33 0,84 0,98 1,4 3,34 3,3 3,

Resumo Introdução: O estudo examina a prevalência e os fatores associados à fragilidade em idosos, destacando a escassez de pesquisas na América Latina e a necessidade de uma abordagem abrangente de cuidados de saúde para enfrentar essa preocupação epidemiológica crescente. Objetivo: O objetivo deste estudo descritivo correlacional transversal com uma fase multivariada foi determinar as variáveis de aptidão física que predizem a fragilidade em idosos de 60 a 64 anos. Foi realizado em Sabaneta, Antioquia, durante o primeiro semestre de 2021 com 125 indivíduos saudáveis com idades entre 60 e 64 anos. Metodologia: Para as variáveis qualitativas, sexo e fragilidade estavam relacionados estatisticamente de forma significativa. Para as variáveis quantitativas, “força das pernas”, “força dos braços direito e esquerdo”, “agilidade ao caminhar” e “endurance aeróbico ao caminhar” foram significativas em relação à fragilidade. Resultados: No modelo de regressão linear, constatou-se que a variável “agilidade ao caminhar” foi o preditor de fragilidade em idosos. Prevalência de condições frágeis em 85.6% dos casos, dos quais 48% tinham condições pré-frágeis. Variáveis como força dos braços, força das pernas, agilidade ao caminhar e endurance aeróbico ao caminhar foram estatisticamente significativas. Conclusões: A agilidade ao caminhar é um fator de risco preditivo para fragilidade em idosos. Indivíduos com agilidade ao caminhar diminuída têm uma probabilidade 26% maior de serem frágeis.

Abstract Introduction: The study examines the prevalence and factors associated with frailty in older adults, highlighting the scarcity of research in Latin America and the need for a comprehensive healthcare approach to address this growing epidemiological concern. Purpose: The aim of this cross-sectional correlational descriptive study with a multivariate phase was to determine the physical fitness variables that predict frailty in older adults aged 60-64 years. It was conducted in Sabaneta, Antioquia during the first semester of 2021 with 125 healthy individuals aged 60-64 years. Methodology: For the qualitative variables, sex and frailty were statistically significantly related. For the quantitative variables, “leg strength”, “right and left arm strength”, “walking agility”, and “aerobic walking endurance” were significant in relation to frailty. Results: In the linear regression model, it was found that the variable “walking agility” was the predictor of frailty in older adults. Prevalence of frail conditions in 85.6% of the cases, of which 48% had pre-frail conditions. Variables such as arm strength, leg strength, walking agility, and aerobic walking endurance were statistically significant. Conclusions: Walking agility is a predictive risk factor for frailty in older adults. Individuals with decreased walking agility have a 26% higher probability of being frail.

Resumen Introducción: El estudio examina la prevalencia y los factores asociados con la fragilidad en personas adultas mayores, destacando la escasez de investigaciones en América Latina y la necesidad de un enfoque integral de atención de salud para abordar esta creciente preocupación epidemiológica. Propósito: El objetivo de este estudio descriptivo transversal correlacional con fase multivariada fue determinar las variables de la condición física que predicen la fragilidad en las personas adultas mayores de entre 60 y 64 años del municipio de Sabaneta, Antioquia durante el primer semestre del 2021 con 125 personas sanas. Metodología: Para las variables cualitativas, el sexo y la fragilidad se relacionan de forma estadísticamente significativa. En las variables cuantitativas, “fuerza muscular de las piernas”, “fuerza muscular de los brazos derecha e izquierda”, “agilidad de marcha” y “resistencia aeróbica en marcha” se asociaron de forma estadísticamente significativa con la fragilidad. Resultados: En el modelo de regresión lineal, se evidenció que la variable “agilidad de la marcha” fue la predictora de fragilidad en la persona adulta mayor. Prevalencia de fragilidad en el 85.6 % de los casos, de los cuales el 48 % presentan condiciones de prefragilidad. Variables como la fuerza de los brazos, fuerza de las piernas, agilidad de la marcha y resistencia aeróbica en la marcha fueron estadísticamente significativas. Conclusiones: La agilidad de la marcha es un factor predictivo de riesgo de fragilidad en la persona adulta mayor. Las personas con disminución en la agilidad de la marcha tienen un 26 % más de probabilidades de ser frágiles.

ABSTRACT In the development, considerations about human aging are addressed, the objective focused on the analysis of the theoretical ideas that underpin human aging, establishing the position taken from the personal considerations emanating from the study of the concepts of healthy, physiological, satisfactory aging. or healthy, active life expectancy, of the consequences that an increase in life expectancy would bring, but without quality of life, health promotion in the aging process and self-care in older adults. The result of carrying out the task is presented in the position taken and the considerations of the subject, analyzing that the concepts of healthy, satisfactory or healthy, physiological, successful aging, active life expectancy, complement each other, then, the expectation o Life expectancy is related to the quality of life from the physical, social, emotional, spiritual, intellectual and occupational well-being that allows the individual to appropriately satisfy their individual and collective needs and in this, health promotion must start from an early age , enabling healthy and healthy lifestyles, which influence the aging process, by applying good practices, is considered timely and necessary in older adults to promote their self-care, which will not be possible in those with physical or metal limitations.

RESUMEN En el desarrollo se abordan consideraciones acerca del envejecimiento humano, el objetivo centró el análisis de las ideas teóricas que fundamentan el envejecimiento humano, estableciendo la toma de posición a partir de las consideraciones personales emanadas del estudio de los conceptos de envejecimiento sano, fisiológico, satisfactorio o saludable, expectativa de vida activa, de las consecuencias que traería el incremento de la expectativa de vida, pero sin calidad de vida, la promoción de salud en proceso de envejecimiento y el autocuidado en los adultos mayores. El resultado de la realización de la tarea se presenta en la toma de posición y las consideraciones del tema, analizándose que los conceptos envejecimiento sano, satisfactorio o saludable, fisiológico, exitoso, expectativa de vida activa, se complementen entre sí, luego, la expectativa o esperanza de vida se relaciona con la calidad de vida desde el bienestar físico, social, emocional, espiritual, intelectual y ocupacional que le permite al individuo satisfacer apropiadamente sus necesidades individuales y colectivas y en ello, la promoción de salud debe iniciarse desde edades tempranas, posibilitando estilos de vida sanos y saludables, que influyen en el proceso de envejecimiento, al aplicar buenas prácticas, así se considera oportuna y necesaria en los adultos mayores para favorecer su autocuidado, que no será posible en aquellos que presentan limitaciones físicas o metales.

RESUMEN En Colombia, la producción avícola es una fuente importante de alimento aportando proteína de origen animal de buena calidad como huevos y carne, sin embargo, al presentarse altos costos en los concentrados se ha generado la necesidad de búsqueda de alternativas de alimentación. El objetivo de este trabajo fue determinar el efecto del consumo de forrajes verdes de Alfalfa (Medicago sativa), Morera (Morus alba) y Botón de oro (Tithonia diversifolia) en parámetros productivos y calidad de huevo. Se establecieron cuatro tratamientos con una alimentación base de concentrado balanceado comercial y agua a voluntad; T1: suplementación con Alfalfa, T2: con Morera, T3: Botón de oro y T4: grupo control. Los parámetros evaluados fueron peso, porcentaje de postura, consumo de alimento, peso del huevo, pigmentación y peso de la yema, peso y densidad de la albumina, peso y espesor de la cascara y las unidades Haugh. Las aves del T2, mostraron diferencias estadísticamente significativas (p<0,05) en el peso corporal en el primer intervalo de estudio y en la pigmentación de la yema en los tres intervalos con valores levemente superiores. La suplementación con morera mejora significativamente la pigmentación de la yema sin afectar negativamente los parámetros productivos.

ABSTRACT In Colombia, poultry production is an important source of food, providing protein of good quality animal origin such as eggs and meat; however, due to the high costs of concentrates, the need to search for food alternatives has been generated. The objective of this work was to determine the effect of the consumption of green forages of Alfalfa (Medicago sativa), Mulberry (Morus alba) and Buttercup (Tithonia diversifolia) in productive parameters and egg quality. Four treatments were established with a base feed of commercial balanced concentrate and water ad libitum; T1: supplementation with Alfalfa, T2: with Mulberry, T3: Buttercup and T4: control group. The parameters evaluated were weight, percentage of laying, feed consumption, egg weight, pigmentation and weight of the yolk, weight and density of albumin, weight and thickness of the shell and Haugh units. The T2 birds showed statistically significant differences (p<0,05) in body weight in the first study interval and in yolk pigmentation in the three intervals with slightly higher values. Mulberry supplementation significantly improves bud pigmentation without negatively affecting productive parameters.

Abstract Introduction: Acute kidney injury (AKI) occurs frequently in COVID-19 patients and is associated with greater morbidity and mortality. Knowing the risks of AKI allows for identification, prevention, and timely treatment. This study aimed to identify the risk factors associated with AKI in hospitalized patients. Methods: A descriptive, retrospective, cross-sectional, and analytical component study of adult patients hospitalized with COVID-19 from March 1 to December 31, 2020 was carried out. AKI was defined by the creatinine criteria of the KDIGO-AKI guidelines. Information, regarding risk factors, was obtained from electronic medical records. Results: Out of the 934 patients, 42.93% developed AKI, 60.59% KDIGO-1, and 9.9% required renal replacement therapy. Patients with AKI had longer hospital stay, higher mortality, and required more intensive care unit (ICU) admission, mechanical ventilation, and vasopressor support. Multivariate analysis showed that age (OR 1.03; 95% CI 1.02–1.04), male sex (OR 2.13; 95% CI 1.49–3.04), diabetes mellitus (DM) (OR 1.55; 95% CI 1.04–2.32), chronic kidney disease (CKD) (OR 2.07; 95% CI 1.06–4.04), C-reactive protein (CRP) (OR 1.02; 95% CI 1.00–1.03), ICU admission (OR 1.81; 95% CI 1.04–3.16), and vasopressor support (OR 7.46; 95% CI 3.34–16.64) were risk factors for AKI, and that bicarbonate (OR 0.89; 95% CI 0.84–0.94) and partial pressure arterial oxygen/inspired oxygen fraction index (OR 0.99; 95% CI 0.98–0.99) could be protective factors. Conclusions: A high frequency of AKI was documented in COVID-19 patients, with several predictors: age, male sex, DM, CKD, CRP, ICU admission, and vasopressor support. AKI occurred more frequently in patients with higher disease severity and was associated with higher mortality and worse outcomes.

RESUMO Introdução: Lesão renal aguda (LRA) ocorre frequentemente em pacientes com COVID-19 e associa-se a maior morbidade e mortalidade. Conhecer riscos da LRA permite a identificação, prevenção e tratamento oportuno. Este estudo teve como objetivo identificar fatores de risco associados à LRA em pacientes hospitalizados. Métodos: Realizou-se estudo descritivo, retrospectivo, transversal e de componente analítico de pacientes adultos hospitalizados com COVID-19 de 1º de março a 31 de dezembro, 2020. Definiu-se a LRA pelos critérios de creatinina das diretrizes KDIGO-LRA. Informações sobre fatores de risco foram obtidas de prontuários eletrônicos. Resultados: Dos 934 pacientes, 42,93% desenvolveram LRA, 60,59% KDIGO-1 e 9,9% necessitaram de terapia renal substitutiva. Pacientes com LRA apresentaram maior tempo de internação, maior mortalidade e necessitaram de mais internações em UTIs, ventilação mecânica e suporte vasopressor. A análise multivariada mostrou que idade (OR 1,03; IC 95% 1,02–1,04), sexo masculino (OR 2,13; IC 95% 1,49–3,04), diabetes mellitus (DM) (OR 1,55; IC 95% 1,04–2,32), doença renal crônica (DRC) (OR 2,07; IC 95% 1,06–4,04), proteína C reativa (PCR) (OR 1,02; IC 95% 1,00–1,03), admissão em UTI (OR 1,81; IC 95% 1,04–3,16) e suporte vasopressor (OR 7,46; IC 95% 3,34–16,64) foram fatores de risco para LRA, e que bicarbonato (OR 0,89; IC 95% 0,84–0,94) e índice de pressão parcial de oxigênio arterial/fração inspirada de oxigênio (OR 0,99; IC 95% 0,98–0,99) poderiam ser fatores de proteção. Conclusões: Documentou-se alta frequência de LRA em pacientes com COVID-19, com diversos preditores: idade, sexo masculino, DM, DRC, PCR, admissão em UTI e suporte vasopressor. LRA ocorreu mais frequentemente em pacientes com maior gravidade da doença e associou-se a maior mortalidade e piores desfechos.

RESUMEN La utilización de forrajes en la alimentación de los cerdos trae consigo ventajas nutricionales y fisiológicas que favorecen el comportamiento porcino, la morera presenta una excelente calidad nutritiva y fue utilizada con cabras, ovinos y vacunos; el objetivo de esta investigación consistió en evaluar la respuesta productiva en la etapa de ceba en cerdos cruzados de razas Pietrain y Landrace, al emplear el follaje de morera (Morus alba), como sustituto parcial del concentrado comercial. La investigación se desarrolló en la Facultad de Ciencias Zootécnicas, extensión Chone, y se conformó por 16 cerdos, los tratamientos estudiados fueron T0 como testigo, T1, T2 y T3 corresponderán al 3, 6 y 9% de harina de morera en la alimentación de los cerdos, distribuidos en cuatro tratamientos con cuatro repeticiones y un individuo. Las principales variables evaluadas fueron: ganancia diaria de peso, consumo diario de alimento, conversión alimentaria y mortalidad. El pesaje de los cerdos se realizó cada 15 días, con la determinación del peso vivo promedio, la ganancia media diaria y la conversión alimentaria. Se realizó un análisis estadístico utilizando el procedimiento del (ANOVA) Análisis de Varianza de Clasificación Simple o Totalmente al Azar, donde se obtuvo un intervalo de confianza del 95%. La inclusión de harina de morera al 3% puede mejorar los parámetros productivos de cerdos cruzados de razas Pietrain y Landrace.

ABSTRACT The use of forages in pig feeding brings with it nutritional and physiological advantages that favor pig behavior. Mulberry has excellent nutritional quality and was used with goats, sheep and cattle; The objective of this research was to evaluate the productive response in the fattening stage in crossbred pigs of Pietrain and Landrace breeds, when using mulberry (Morus alba) foliage as a partial substitute for commercial concentrate. The research was developed in the Faculty of Animal Sciences, Chone extension, and was made up of 16 pigs, the treatments studied were T0 as a control, T1, T2 and T3 will correspond to 3, 6 and 9% of mulberry flour in the feeding of pigs, distributed in four treatments with four repetitions and one individual. The main variables evaluated were: daily weight gain, daily feed intake, feed conversion and mortality. Pigs were weighed every 15 days, determining the average live weight, average daily gain and feed conversion. Statistical analysis was performed using the Simple or Totally Random Classification Analysis of Variance (ANOVA) procedure, where a 95% confidence interval was obtained. The inclusion of mulberry flour at 3% can improve the productive parameters of crossbred pigs of Pietrain and Landrace breeds.

Abstract Sericulture, often known as silk farming is the practice of rearing silkworms for production of raw silk. One of the major impediments faced by the sericulture community is the silkworm diseases that cause significant crop losses. In the present study, the efficacy of phototrophic bacteria as feed supplements in improving the economic traits as well as disease resistance in mulberry silkworm, Bombyx mori L. was assessed. A total of three phototrophic bacteria were isolated and identified as belonging to the genera Marichromatium, Rhodobacter and Rhodopseudomonas based on 16S rRNA gene sequencing analysis. Their morphological, physiological and biochemical characters were studied, grown under ambient conditions and biomass was harvested. Mulberry fortified with the aforementioned phototrophic bacteria in solitude and combinations at varying concentrations (0.5, 1, 2 and 5%) were found to be innocuous to the mulberry silkworm. The best results were observed when mulberry leaf was supplemented with Rhodopseudomonas sp. at 2% concentration which improved survival, cocoon weight, shell weight, shell%, filament length and non-breakable filament length by 5.18, 0.27, 3.86, 3.5, 1.5 and 1.2%, respectively under normal rearing conditions. Under Staphylococcus sp. infected conditions, the aforesaid diet also enhanced survival in silkworms by 16%. On the other hand, the same diet didn’t exhibit any discernible influence on survival against fungal, viral, or microsporidian infections in silkworm.

Resumen La sericultura, a menudo conocida como cultivo de la seda, es la práctica de criar gusanos de seda para la producción de seda cruda. Uno de los principales impedimentos a los que se enfrenta la sericultura son las enfermedades de los gusanos de seda que causan importantes pérdidas en la cosecha. En el presente estudio, se evaluó la eficacia de las bacterias fototróficas como suplementos alimenticios para mejorar los rasgos económicos así como la resistencia a las enfermedades en el gusano de seda de morera, Bombyx mori L. Se aislaron tres bacterias fototróficas y se identificaron como pertenecientes a los géneros Marichromatium, Rhodobacter y Rhodopseudomonas, basándose en el análisis de secuenciación del gen 16S rRNA. Se estudiaron sus caracteres morfológicos, fisiológicos y bioquímicos, se cultivaron en condiciones ambientales y se cosechó la biomasa. Se comprobó que la morera enriquecida con las mencionadas bacterias fototróficas en soledad y en combinaciones a distintas concentraciones (0, 5, 1, 2 y 5%) era inocua para el gusano de seda de la morera. Los mejores resultados se observaron cuando se complementó la hoja de morera con Rhodopseudomonas sp. a una concentración del 2%, que mejoró la supervivencia, el peso del capullo, el peso de la cáscara, el porcentaje de cáscara, la longitud del filamento y la longitud del filamento no rompible en un 5,18, 0,27, 3,86, 3,5, 1,5 y 1,2%, respectivamente, en condiciones normales de cría. En condiciones de infección por Staphylococcus sp., la citada dieta también aumentó la supervivencia de los gusanos de seda en un 16%. Por otra parte, la misma dieta no mostró ninguna influencia discernible en la supervivencia contra las infecciones fúngicas, víricas o de microsporidios en los gusanos de seda.

ABSTRACT Introduction: Transplantation is the most favorable therapeutic option for people with chronic renal failure. The donor can be a cadaveric or living donor, related or not. Transplant outcomes are related to various immunological and non-immunological factors. Objective: To characterize Cuban cadaveric donors for renal transplantation Materials and methods: A cross-sectional and descriptive study of cadaveric donors was carried out during the year 2019. The region of origin, sex, skin color and age ranges of the donors were analyzed, as well as ABO and Rhesus Rh blood groups; serology for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV), and toxic habits. Results: A total of 95 cadaveric donors were studied, 62 from the West and 33 from the Center of the country. 63.2% were male and 36.8% female due to the most frequent age group being 40-60 years and the mean age of 49.45 years. 58.95% of the patients were of blood group O, 30.53% group A and groups B and AB had 5.26% prevalence; and only 8 were Rh negative. All had negative serology for HIV, HBV and HCV. The most frequent associated diseases were arterial hypertension and diabetes mellitus. Conclusions: The cadaveric donors during the year 2019 showed characteristics similar to those reported by other studies. The increase in the age of the donors affects the appearance of associated diseases and this could affect the result of the transplant.

RESUMEN Introducción: El trasplante es la opción terapéutica más favorable para las personas con insuficiencia renal crónica. El donante puede ser cadavérico o donante vivo, emparentado o no. Los resultados del trasplante están en relación con varios factores inmunológicos y no inmunológicos. Objetivo: Caracterizar inmunogenéticamente a los donantes cadavéricos cubanos para trasplante renal. Métodos: Se realizó un estudio transversal y descriptivo de los donantes cadavéricos durante el año 2019. Se analizó la región de procedencia, sexo, color de la piel y rangos de edades de los donantes, así como, grupo sanguíneos ABO y Rhesus Rh; serología para VIH, Virus de hepatitis B(VHB) y Virus de hepatitis C (VHC); y hábitos tóxicos. Resultados: Se estudió un total de 95 donantes cadavéricos, 62 provenientes del occidente y 33 del centro del país. El 63,2 % fueron masculinos y 36,8 % femenino. El grupo de edad de mayor frecuencia fue 40 - 60 años y la edad media de 49,45 años. El 58,95 % de los pacientes fueron de grupo sanguíneo O; 30,53 % grupo A y los grupos B y AB tuvieron 5,26 % de prevalencia; y solo 8 fueron Rh negativos. Todos tuvieron serología para VIH, VHB y VHC negativas. Las enfermedades asociadas más frecuentes fueron la hipertensión arterial y la diabetes mellitus. Conclusiones: Los donantes cadavéricos durante el año 2019 mostraron características similares a las reportadas por otros estudios. El aumento de las edades de los donantes incide en la aparición de enfermedades asociadas y esto pudiera repercutir en el resultado del trasplante.

ABSTRACT Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3%). The average level of schooling 61.5%, married marital status 52.0%. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4%. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4%) there was permanence of the results over time. Complications occurred in 4 patients (14.3%). There were 19 patients treated as outpatients (67.9%), with a hospital stay of one day (32.1%). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles.

RESUMEN Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 %). El nivel medio de escolaridad 61,5 %, estado civil casado 52,0 %. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 %. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 %) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 %). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 %), con estancia hospitalaria de un día (32,1 %). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares.

ABSTRACT Introduction: Palmer's disease (or Palmer's syndrome) is poorly understood and is due to traumatic rupture of the internal collateral ligament of the knee at the femoral insertion. Objective: to present three patients suffering from Palmer's disease as a consequence of a traumatic internal collateral ligament injury of the knee at another time. Methods: study of multiple cases of patients treated by arthroscopy in the period from January 2002 to January 2020. Aspects such as age, sex, cause, time to operation and procedure performed were analyzed. The results were evaluated using the visual analog scale for pain and the Lysholm assessment scale. Results: all are young active males, two with right knee injury, two with history of sports trauma and one work-related. Pain, block, knee extension limitation and Böhler, Mc Murray and Apley maneuvers were positive in all patients. There was a significant improvement in the visual analog scale for pain and in the Lysholm scale postoperatively. Conclusions: Palmer's disease is secondary to internal collateral ligament injury that simulates an internal meniscus injury; its diagnosis and resolution are possible with arthroscopy and intensive rehabilitation.

RESUMEN Introducción: la enfermedad de Palmer (o el síndrome de Palmer) es poco conocida y se debe a la ruptura del ligamento colateral interno de la rodilla de causa traumática hacia la inserción femoral. Objetivo: presentar tres pacientes que padecen la enfermedad de Palmer como consecuencia de una lesión traumática del ligamento colateral interno de la rodilla en otro momento. Métodos: estudio de casos múltiples de pacientes tratados por artroscopia en el período comprendido entre enero de 2002 y enero de 2020. Se analizaron aspectos como la edad, el sexo, la causa, el tiempo transcurrido hasta la operación y el procedimiento realizado. Los resultados se evaluaron mediante la escala visual análoga para el dolor y la escala de evaluación de Lysholm. Resultados: todos son jóvenes activos del sexo masculino, dos con lesión en la rodilla derecha, dos con historia de traumas deportivos y uno laboral. El dolor, el bloqueo, la limitación a la extensión de la rodilla y las maniobras de Böhler, de Mc Murray y de Apley fueron positivos en todos los pacientes. Se constató una significativa mejoría de la escala visual análoga para el dolor y de la escala de Lysholm en el postoperatorio. Conclusiones: la enfermedad de Palmer es secundaria a la lesión del ligamento colateral interno que simula una lesión del menisco interno; su diagnóstico y su solución son posibles con la realización de una artroscopia y con una rehabilitación intensiva.

RESUMEN: El siguiente artículo es una investigación referente a los sistemas de información gerencial y su proceso evolutivo hacia la cuarta revolución industrial. La pregunta de investigación es: ¿Cómo afrontar con inmediatez la administración de las decisiones estratégicas empresariales en un entorno repleto de datos que no necesariamente son información? Para ello, se realizó una revisión bibliográfica actualizada y se llegó a la hipótesis de que la inteligencia artificial no sustituye al ser humano, sino que complementa y facilita la calidad de vida en las personas mediante el aprovechamiento de las ventajas tecnológicas y la erradicación de las actividades de poco valor.

RÉSUMÉ: L'article suivant est une recherche sur les systèmes d'information de gestion et leur processus d'évolution vers la quatrième révolution industrielle. La question de recherche est la suivante : comment faire face, de façon immédiate, à la gestion des décisions stratégiques de l'entreprise dans un environnement rempli de données qui ne sont pas nécessairement des informations ? À cette fin, on a réalisé une analyse documentaire actualisée et l'on a avancé l'hypothèse selon laquelle l'intelligence artificielle ne remplace pas les êtres humains, mais complémente et facilite la qualité de vie des personnes en tirant parti des avantages technologiques et en supprimant les activités de faible valeur.

ABSTRACT: The following article is research about Management Information Systems in evolutionary process towards the fourth industrial revolution; the problem to solve is: How to quickly face all strategic decisions within an environment full of data that might not be a real information? To do this, a current bibliographic review has been prepared to develop the hypothesis about artificial intelligence does not replace the human intelligence, instead of it, complements and facilitates the quality people's life due to the technology's advantages and the reduction in low value-added activities.

RESUMO: O artigo a seguir é uma investigação referente aos Sistemas de Informação Gerencial e o seu processo evolutivo rumo à quarta revolução industrial. O problema a ser resolvido é: Como lidar imediatamente com a administração das decisões estratégicas de negócios em um ambiente repleto de dados que não necessariamente são informações? Para isso, foi realizada uma revisão bibliográfica atual e chegou-se à hipótese de que a inteligência artificial não substitui o ser humano, mas complementa e facilita a qualidade de vida das pessoas aproveitando as vantagens tecnológicas e a erradicação de bens de baixo valor.

ABSTRACT Introduction: Objectives: The primary aim of this work is to study the immunological effectors induced in CIGB-247-vaccinated patients. These effectors include humoral and cellular components of the immune system. Also, the goal of the present investigation is to detect different immunoglobulin classes and subclasses and its specificity for VEGF relevant epitopes, and demonstrate the induction of VEGF-specific and cytotoxic CD8 T lymphocytes. This research has, as an additional objective, the presentation of the first preliminary pieces of evidence of the feasibility to combine CIGB-247 with other anti-cancer treatments. Methods: To investigate the vaccine-induced immunological effectors, ELISA and ELISPOT tests were used for monitoring the immune response elicited in cancer patients from the CENTAURO and CENTAURO-2 clinical trials and also those from the compassionate use program. Results: Immunization with CIGB-247 elicited VEGF-specific IgM and IgA antibodies. Antibody response maturation was detected in some patients with long term overall survival, indicated by the subclass switching from IgG1 to IgG4. This antibody response blocked the interaction of VEGF with its receptors VEGFR2 and VEGFR1. This specific polyclonal antibody response inhibited the binding between VEGF and the monoclonal antibody bevacizumab, for that reason, it was directed to a relevant epitope on VEGF, implicated in the VEGF-induced proangiogenic activity. The vaccination contributed to normalizing platelet VEGF levels, and produced cytotoxic CD8 T lymphocytes. Some experimental evidence indicated the potential use of CIGB-247 in combination with chemotherapy. Conclusions: All these results allowed for the application of CIGB-247 in phase II clinical trials in combination with other cancer therapeutic treatments.

RESUMEN Objetivos: Esta investigación tiene como objetivo estudiar los efectores inmunológicos que se inducen en los pacientes inmunizados con el CIGB-247, que incluyen elementos humorales y celulares. Este estudio pretende detectar las diferentes clases y subclases de inmunoglobulinas, evaluar su especificidad por epítopes relevantes en el VEGF y demostrar la presencia de linfocitos CD8+ citotóxicos específicos. También, este trabajo se propone presentar las primeras evidencias preliminares de la posibilidad de combinar el CIGB-247 con otros regímenes oncoterapéuticos. Métodos: Para el estudio de los efectores inmunológicos, se realizó el seguimiento inmunológico por las técnicas de ELISA y ELISPOT a los pacientes de los estudios CENTAURO, CENTAURO-2 y Programa de Uso Compasional. Resultados: Se demostró que la inmunización induce anticuerpos de clase IgM e IgA específicas al VEGF. En algunos pacientes de larga supervivencia, se produjo una maduración de la respuesta de anticuerpos, representado por el cambio desde IgG1 hacia la subclase IgG4 de mayor afinidad. Se demostró que la repuesta de anticuerpos bloquea la interacción entre el VEGF y los receptores VEGFR2 y VEGFR1. Esta respuesta policlonal específica al VEGF está dirigida a un epítope relevante para su actividad pro-angiogénica, al inhibir su interacción con el anticuerpo monoclonal bevacizumab. Se muestra que la inmunización contribuye a normalizar los niveles de VEGF plaquetario y genera linfocitos T CD8+ citotóxicos. Se obtienen evidencias de la posibilidad de combinar el CIGB-247 con la quimioterapia. Conclusiones: Estos resultados permitieron el avance del CIGB-247 hacia los estudios clínicos fase II en combinación con otros regímenes onco-terapéuticos.

Resumen Introducción. La morera (Morus alba), planta originaria de China, se utiliza como forraje en algunas granjas. Su alto contenido de proteína estimula la producción de leche en el ganado; sin embargo, se desconoce si sus flavonoides pueden ser incorporados en la leche caprina. Objetivo. Evaluar el efecto de una dieta enriquecida con morera, sobre la concentración de flavonoides y parámetros bromatológicos de leche de cabras alpinas estabuladas. Materiales y métodos. El experimento se realizó en el año 2019, con cabras de una granja particular ubicada en Veracruz, México. Se formaron dos grupos (A con el tratamiento y B control) con cinco cabras de raza alpina cada uno, de características similares (alimentación estabulada, tres partos, sin mastitis, ordeño manual matutino y vespertino). El grupo A recibió forraje sin morera antes y después del tratamiento (días 1-10 y 21-31, respectivamente), y una dieta de forraje modificada con morera (días 11-20, tratamiento); el grupo B se alimentó con forraje sin morera los 31 días de experimentación. Además, se analizó el contenido de flavonoides en la morera y cada tres días en muestras de leche, además de los bromatológicos de contenido de proteína, grasa, lactosa, sólidos no grasos y densidad. Resultados. Durante la dieta modificada con morera, la concentración de flavonoides alcanzó un máximo de 53,45 mg mL-1 EQ en el grupo A al día 20, descendió de forma paulatina durante el periodo posterior al tratamiento; además, mantuvo un 20 % más de flavonoides que el grupo control. Se observó también un incremento significativo del contenido de proteína en el grupo A, sin diferencia significativa en los demás parámetros bromatológicos de la leche entre los dos grupos. Conclusión. Las dietas modificadas con morera favorecieron la incorporación de flavonoides y el incremento de proteína en la leche de cabra, sin modificar los demás parámetros bromatológicos.

Abstract Introduction. Mulberry (Morus alba), a plant native to China, is used as a fodder on some farms. Its high protein content stimulates milk production in cattle; however, it is not known whether its flavonoids can be incorporated into goat milk. Objective. To evaluate the effect of a diet enriched with mulberry-enriched, on flavonoids concentration and bromatological parameters of milk from stabled alpine goats. Materials and methods. The experiment was carried out in 2019, with goats from a particular farm located in Veracruz, Mexico. Two groups were formed (A with the treatment and B control) with five Alpine breed goats each, with similar characteristics (stall feeding, three calving, without mastitis, morning and evening hand milking). Group A received forage without mulberry before and after treatment (days 1-10 and 21-31, respectively), and a modified forage diet with mulberry (days 11-20; group B was fed forage without mulberry on all 31 days of experimentation. Additionally, the flavonoid content in mulberry and every three days in milk samples were analyzed, in addition to the bromatological content of protein, fat, lactose, non-fat solids, and density. Results. During the mulberry-modified diet, the flavonoid concentration reached a maximum of 53.45 mg mL-1 EQ in group A at day 20, it decreased gradually during the post-treatment period; however, it maintained 20 % more flavonoids than the control group. A significant increase in protein content was also observed in group A, with no significant difference in the other bromatological parameters of the milk between the two groups. Conclusions. The diets modified with mulberry favored the incorporation of flavonoids and the increase of protein in goat milk, without modifying the other bromatological parameters.

ABSTRACT Orthodontic care for people with special needs is challenging. The high incidence of malocclusions in these patients threatens their quality of life by generating functional problems in chewing, swallowing and breathing. A bibliographic review was carried out with the objective of describing orthodontic treatment in disabled patients and offering considerations in this regard. It was concluded that malocclusions have a high incidence in disabled patients; the most frequent, generally, are related to the syndrome or condition of these. Orthodontic treatment for these patients must be supported by parents and / or caregivers. Its management will vary according to the disorder it presents; it can be general anesthesia, in the form of drops or intravenous. The goal of treatment must be modified, from trying to pursue orthodontic perfection to seeking a result that is aesthetically and functionally acceptable. For patients with special needs, adherence to and modification of the treatment plan, as necessary, will be the most important for a successful outcome. Disability should not eliminate the possibility of orthodontics as a treatment option.

RESUMEN La atención ortodóncica a personas con necesidades especiales constituye un reto. La elevada incidencia de maloclusiones en estos pacientes atenta contra su calidad de vida al generar problemas funcionales en la masticación, la deglución y la respiración. Se realizó una revisión bibliográfica con el objetivo de describir el tratamiento ortodóncico a pacientes discapacitados y ofrecer consideraciones al respecto. Se concluyó que las maloclusiones tienen una elevada incidencia en pacientes discapacitados; las más frecuentes, generalmente, se relacionan con el síndrome o condición de estos. El tratamiento ortodóncico a estos enfermos debe estar respaldado por los padres y/o cuidadores. Su manejo variará según el trastorno que presente; puede ser anestesia general, en forma de gotas o intravenosa. El objetivo del tratamiento debe ser modificado, desde tratar de perseguir la perfección ortodóncica a buscar un resultado que sea estética y funcionalmente aceptable. Para pacientes con necesidades especiales, el cumplimiento y modificación del plan de tratamiento, según sea necesario, será lo más importante para un resultado exitoso. La discapacidad no debería eliminar la posibilidad de la ortodoncia como una opción de tratamiento.