Abstract Introduction: Bio bays in Puerto Rico play an important socio-economic role and declines in dominant bioluminescent dinoflagellate Pyrodinium bahamense are concerning. Studies show erratic blooms with is weak correlation to in situ environmental factors. Our study examines shorter field and longer proxy records on dinoflagellate density at Laguna Grande de Fajardo (LGF). Objectives: To quantify temporal changes in dinoflagellate density in a long-term monitoring study, understand how the marine environment modulates those changes, and determine the wider impacts of a fluctuating climate and extreme events on proxies for dinoflagellate density. Methods: Bimonthly samples were collected from 2016 to 2021 at three sampling sites in LGF. Dinoflagellates density was estimated by Sedgewick Rafter counting cells. Environmental conditions were obtained from Rio Fajardo 5007100 station and NOAA buoy 41056. Marine climate and biotic proxies were obtained from remote sensing measurements. Kruskal Wallis, Spearman correlations and cross-correlations in the shorter field and longer proxy records were used to evaluate environmental controls on LGF dinoflagellate blooms. Results: Six years of field monitoring densities found a low period in 2016-2017, frequent and intense blooms in 2018-2021 punctuated by hurricanes. Generally low values were recorded in late winter in contrast with higher values in late summer (Aug-Nov). Light winds and mixed layer response to seasonal warming in the form of high tides and low salinity, were found to sustain dinoflagellate reproduction. Conclusions: Bioluminescent dinoflagellates are vital to coastal tourism and require resource management. LGF results show that: 1) dinoflagellate counts fluctuate widely, 2) fluorescing dinoflagellates are sensitive to environmental conditions because of limited seasonality and narrow physiological range, 3) hurricanes play a role by ‘raking and refreshing’ the coastal lagoon for subsequent biotic reproduction, and 4) intra-seasonal fluctuations of density and proxies relate to air-sea thermodynamic conditions, the salinity budget and sea level.

Resumen Introducción: Las bahías bioluminiscentes en Puerto Rico desempeñan un papel socioeconómico importante y disminuciones del dinoflagelado bioluminiscente dominante Pyrodinium bahamense son preocupantes. Los estudios muestran proliferaciones erráticas débilmente correlacionadas con factores ambientales locales. Objetivos: Cuantificar cambios en la densidad de dinoflagelados a largo plazo en la Laguna Grande de Fajardo (LGF), comprender cómo el ambiente marino modula esos cambios y determinar los impactos de eventos climáticos extremos en la densidad de dinoflagelados. Métodos: Se recolectaron muestras bimestrales del 2016-2021 en tres sitios de la LGF. La densidad se estimó mediante el conteo de células de Sedgewick Rafter. Condiciones ambientales se obtuvieron de la estación Río Fajardo 5007100 y de la boya NOAA 41056. El clima marino y los indicadores bióticos se obtuvieron por mediciones de teledetección. Se utilizaron correlaciones Kruskal Wallis, Spearman y las correlaciones cruzadas en los registros de campo corto y proxy largos para evaluar los controles ambientales en las proliferaciones de dinoflagelados LGF. Resultados: En seis años de monitoreo se encontraron densidades bajas entre el 2016-2017 y proliferaciones frecuentes e intensas en 2018-2021 marcadas por huracanes. Se registraron valores bajos a finales del invierno, en contraste con valores más altos a finales del verano (agosto-noviembre). Vientos ligeros y la respuesta de capas mixtas al calentamiento estacional en forma de mareas altas y baja salinidad, mantienen la reproducción de los dinoflagelados. Conclusiones: Los dinoflagelados bioluminiscentes son vitales para el turismo costero y requieren manejo de los recursos. En general: 1) los recuentos de dinoflagelados fluctúan ampliamente, 2) los dinoflagelados fluorescentes son sensibles a las condiciones ambientales debido a su estacionalidad limitada y estrecho rango fisiológico, 3) los huracanes juegan un rol de rastrillar y refrescar la laguna costera para su posterior reproducción, y 4) fluctuaciones intra-estacionales se relacionan con las condiciones termodinámicas aire-mar, el balance de salinidad y el nivel del mar.

Abstract This case report describes the clinical and therapeutic approach used in a 32-year-old female patient with a tooth fracture in tooth 22. The patient, with no history of systemic disease, presented with a chronic periapical lesion and a cervical fracture in the affected tooth. Treatment included atraumatic extraction of the tooth, followed by placement of a 3.75 x 10mm post-extraction implant with immediate loading and guided bone regeneration. The minimally invasive surgical technique was employed using the Dentoflex® drilling sequence. The primary stability of the implant, measured in 37 Newtons of torque, allowed the placement of a prefabricated metal abutment for the subsequent cemented crown. Bone regeneration of the interimplant space was successfully performed, supplemented by connective grafting due to the patient's thin gingival phenotype. Postoperative follow-up, including controls at 7, 14 days and four months, showed a satisfactory conformation of the gingival margin and papillary tissue, consolidating the success of the treatment.

Resumen Este reporte de caso describió el enfoque clínico y terapéutico utilizado en una paciente de 32 años de edad con una fractura dentaria en el diente 22. La paciente, sin antecedentes de enfermedad sistémica, presentaba una lesión periapical crónica y una fractura cervical en el diente afectado. El tratamiento incluyó la extracción atraumática del diente, seguida de la colocación de un implante postextracción de 3,75 x 10mm con carga inmediata y regeneración ósea guiada. Se empleó la técnica quirúrgica mínimamente invasiva utilizando la secuencia de fresado Dentoflex®. La estabilidad primaria del implante, medida en 37 Newtons de torque, permitió la colocación de un pilar metálico prefabricado para la posterior corona cementada. Se realizó con éxito la regeneración ósea del espacio interimplantario, complementada con injerto conectivo debido al fenotipo gingival delgado de la paciente. El seguimiento postoperatorio, incluyendo controles a los 7, 14 días y cuatro meses, mostró una conformación satisfactoria del margen gingival y del tejido papilar, consolidando el éxito del tratamiento.

ABSTRACT The gold and silver deposits of the Vetas-California mining district are hosted in Paleozoic gneisses and Mesozoic granites of the Santander massif in the Eastern Cordillera of Colombia, far from the northern Andean volcanic arc. In the California area, there is ambiguity in defining the epithermal-type metallogenic model with high to intermediate sulfidation due to the presence of Late Triassic-Early Jurassic and Miocene magmatism. The best-known hydrothermal episodes comprise two early porphyritic-style phases: a) characterized by a propylitic alteration with molybdenite of the ∼10.1 Ma-old La Mascota breccia, related to granodiorite porphyries and smaller-volume rhyodacitic dykes; and b) attributed to a magmatic-hydrothermal system due to phyllic alteration associated with quartz-pyrite veins with hydrothermal sericite dated at ∼3.4 Ma. These two hydrothermal episodes were followed by four epithermal phases related to the development of multiphase hydrothermal breccias and quartz-alunite alteration, defined by bornite, covellite, and chalcopyrite, alongside wolframite, enargite, and sphalerite, with gold and silver mineralization between ∼2.6 and ∼ 1.6 Ma. To understand the relationship of the emplacement of the porphyries and the subsequent auro-argentiferous enrichments to the deformation front observed in the Pamplona buttress, to the east of the Santander Massif, a 4D structural model of the mineralization is formulated here. This model is based on the spatial analysis of the stresses responsible for the La Baja-Angostura dextral fault in terms of the regional kinematics of the Bucaramanga sinistral fault. It is considered that the SW sector of the deposit area corresponds to a well-defined, tabular, sub-vertical body of the La Mascota breccia. On the other hand, the NE sector in the La Baja-Angostura fault is expressed as a topographically elevated right horsetail splay, which controls the more disseminated distribution of the mineralization by means of veinlet swarms arranged in an ∼E-W direction. The disseminated mineralization of Vetas-California was probably favored by late thermal expansion-contraction events in the gneissic sockets, which allowed the accumulation and precipitation of boiling solutions rich in volatiles and elements of economic interest.

RESUMEN Los depósitos auroargentíferos del distrito minero Vetas-California están alojados en gneises paleozoicos y rocas ígneas mesozoicas del Macizo de Santander en la cordillera Oriental de Colombia, a cientos de kilómetros del volcanismo septentrional Norandino. En el área de California, existe ambigüedad en la definición del modelo metalogénico de tipo epitermal con sulfuración alta a intermedia debido a la presencia de magmatismo del Triásico tardío-Jurásico temprano y Mioceno. Los episodios hidrotermales mejor conocidos comprenden dos fases tempranas de estilo porfirítico: a) una caracterizada por una alteración propilítica con molibdenita de la Brecha La Mascota, de edad ∼10,1 Ma, relacionada con pórfidos de granodiorita y diques riodacíticos de menor volumen; b) otra atribuida a un sistema magmático-hidrotermal con alteración fílica asociada a filones y vetas de cuarzo-pirita con sericita hidrotermal de edad ∼3,4 Ma. A estos episodios le suceden cuatro fases de estilo epitermal relacionadas con el desarrollo de brechas hidrotermales multifásicas y con alteración de cuarzo-alunita, definidas por bornita, covelina y calcopirita, además de wolframita, enargita y esfalerita, con mineralización de oro y plata entre los ∼2,6 y ∼1,6 Ma. En la presente contribución se formula una hipótesis del modelo 4D del control estructural de las mineralizaciones para comprender la relación del emplazamiento de los pórfidos y los subsecuentes enriquecimientos auroargentíferos con respecto al frente de deformación reconocido en el Contrafuerte de Pamplona, al oriente del Macizo de Santander. Para ello, se analizan los esfuerzos responsables de la falla dextral La Baja-Angostura a partir de la cinemática regional de la falla sinistral de Bucaramanga. Se establece que el sector SO del área de mineralización corresponde a un cuerpo bien definido, tabular, subvertical, de la Brecha La Mascota. En el sector NE, en cambio, la Falla La Baja-Angostura se expresa como una cola de caballo (horsetail) derecha, topográficamente más elevada, la que controla la distribución diseminada de la mineralización mediante enjambres de vetillas subordinadas dispuestas en dirección principal ∼E-O. La mineralización diseminada de las Vetas-California fue favorecida probablemente por fenómenos tardíos de dilatación-contracción térmica de los encajantes gnéisicos, que permitieron la acumulación y precipitación de soluciones en ebullición ricas tanto en volátiles como en sustancias de interés económico.

Abstract Introduction. The COVID-19 infection drastically affected health care worldwide, creating challenges for primary care. In order to mitigate and manage infection, telemedicine has become an emerging and effective modality in several medical specialties, including head and neck surgery. Methods. Retrospective cross-sectional analysis of patients seen in virtual consultation over 18 months. Absolute and relative frequencies were estimated, univariate analysis was done with chi-square, and bivariate analysis with binary logistic regression. Variables such as primary diagnosis, the resolution power of the consultation, the need for an in-person appointment, the platform, and its difficulties were included. Results. 2485 patients from 11 departments were included. Thyroid pathology was the most frequent (62.9%), followed by aerodigestive tract pathology (10.8%). The consultation was efficient in 99% of cases, with a resolution capacity of 96.4%. 1.4% had difficulties on the platform and 8.3% of patients required an in-person. When there was difficulty in reviewing exams or an inadequate functional inspection, it was 30 times more likely to not be able to efficiently be resolved. Conclusion. Telemedicine provides an efficient alternative for care in head and neck surgery, especially in thyroid pathology controls, avoiding unnecessary travel. In the aerodigestive tract, where the physical examination is essential, its usefulness is limited to the possibility of performing a subsequent endoscopic examination that allows adequate staging and facilitates in-person assessment.

Resumen Introducción. La infección por COVID-19 afectó drásticamente la atención en salud a nivel mundial, generando retos para la atención primaria. En orden de mitigar y manejar el contagio, la telemedicina se convirtió en una modalidad emergente y efectiva en varias especialidades médicas, incluida la cirugía de cabeza y cuello. Métodos. Estudio de corte transversal con análisis retrospectivo de pacientes atendidos en la consulta virtual durante 18 meses. Se estimaron frecuencias absolutas y relativas, y bivariado con regresión logística binaria. Se incluyeron las variables de diagnóstico primario, poder resolutivo de la consulta, necesidad de cita presencial, plataforma y dificultades de la misma. Resultados. Se incluyeron 2485 pacientes provenientes de 11 departamentos. La patología tiroidea fue la más frecuente (62,9 %), seguida de la aerodigestiva (10,9 %). La consulta fue eficiente en el 99 % de los casos, con una capacidad resolutiva del 96,4 %. El 1,4 % tuvo dificultades en la plataforma y el 8,3 % de los pacientes requirió cita presencial. Cuando hubo dificultad para la revisión de exámenes o una inadecuada inspección funcional, fue 30 veces más probable no poder resolver eficientemente la consulta. Conclusión. La telemedicina provee una alternativa eficiente de atención en cirugía de cabeza y cuello, especialmente en los controles de patología tiroidea, evitando desplazamientos innecesarios. En el tracto aerodigestivo, donde el examen físico es primordial, su utilidad está limitada a la posibilidad de realizar un examen endoscópico posterior que permita una adecuada estadificación y facilite la valoración presencial.

Abstract Tea is identified as the second most consumed drink in the world, and its frequent intake is related to several benefits to human health, considering its antimutagenic, anticarcinogenic, antimicrobial, anti-inflammatory, antihistamine, diuretic, calming, and above all, antioxidant effects. These effects are often associated with the action of the phenolic compounds contained in these infusions. In Brazil, among the most consumed infusions are the teas of chamomile (Matricaria chamomilla L.), lemongrass (Cymbopogon citratus (D.C.) Stapf), lemon balm (Melissa officinalis L.), anise (Pimpinella anisum L.), yerba mate (Ilex paraguariensis A. St.-Hil), peppermint (Mentha piperita L.), and green/black tea (Camellia sinensis L.). Therefore, said popularity is the reason why the mentioned species were chosen to be evaluated on inflammatory enzymes. The activity of phospholipases A2 was reduced by more than 25% after treatment with black tea and yerba mate. The most significant inhibition of protease activity was observed after incubation with black tea (40.74%), green tea (31.48%) and yerba mate (25.93%). Infusions of black and green tea reduced hemolysis in semisolid and liquid media, and for the latter, reductions of up to 50% of hemolytic activity were observed, indicating an anti-inflammatory potential of the samples. Plasma incubations with green tea, black tea and lemon balm and subsequent addition of venom (1:10 ratio; tea:PBS, v:v) prolonged the coagulation time of citrated plasma by approximately twice compared to the positive control. All controls with pure tea had a thrombolytic character, in higher proportions than the venom control, especially chamomile (273.55% dissolution). Phenolic compounds derived from phenolic acids, flavonoids, and tannins are identified as the main agents that promote the biological effects observed in this study. This is mainly due to their anti-catalytic properties exerted on inflammatory enzymes and as chelating agents of enzymatic co-factors. The evaluated teas showed potential for nutraceutical use, thus pointing to the possibility of use as an adjuvant in the treatment of diseases linked to hemostasis. world health antimutagenic anticarcinogenic antimicrobial antiinflammatory, antiinflammatory anti inflammatory, antihistamine diuretic calming all Brazil Matricaria L., L L. , L.) Cymbopogon D.C. DC D C (D.C. Stapf, Stapf Stapf) Melissa Pimpinella Ilex A St.Hil, StHil St. Hil St St.-Hil) Mentha greenblack Camellia L.. . Therefore 25 40.74%, 4074 40.74% 40 74 (40.74%) 31.48% 3148 31 48 (31.48% 25.93%. 2593 25.93% 93 (25.93%) media latter 50 samples 110 1 10 (1:1 ratio teaPBS, teaPBS PBS, PBS tea:PBS vv v v:v control character 273.55% 27355 273 55 (273.55 dissolution. dissolution dissolution) acids flavonoids study anticatalytic catalytic cofactors. cofactors co factors. factors co-factors hemostasis D.C (D.C St.Hil St.-Hil 2 407 40.74 4 7 (40.74% 31.48 314 3 (31.48 259 25.93 9 (25.93% 5 11 (1: 273.55 2735 27 (273.5 40.7 (40.74 31.4 (31.4 25.9 (25.93 (1 273.5 (273. 40. (40.7 31. (31. 25. (25.9 ( 273. (273 (40. (31 (25. (27 (40 (3 (25 (2 (4

Objective: We investigated whether social skills are impaired in patients with obsessive-compulsive disorder (OCD), whether they changed over the course of treatment, and whether OCD severity, age of onset, and illness duration were associated with social skills deficit. Methods: A total of 41 treatment-naïve patients with OCD and 34 healthy controls were assessed using the Social Skills Inventory. Patients were reevaluated 12 weeks after standardized treatment. Group differences and the effects of treatment on OCD symptomatology over time were analyzed with independent and paired tests, respectively. OCD severity, age at illness onset, and illness duration were tested as predictors of social skills. Results: The patient group had lower overall social skill scores than controls (p < 0.001). After treatment, although OCD symptomatology (p < 0.001) improved, there was no significant difference in social skills (p = 0.673). Earlier age of symptom onset predicted lower social skill scores (p = 0.016). Conclusion: Our results suggest that, despite improved OCD symptoms, social skills did not change after treatment. Subsequent investigations with larger sample sizes and longer follow-up periods could determine whether social skills are likely to increase over time. Objective obsessivecompulsive obsessive compulsive OCD, , (OCD) severity deficit Methods 4 treatmentnaïve naïve 3 Inventory 1 tests respectively Results p 0.001. 0001 0.001 . 0 001 0.673. 0673 0.673 673 0.673) 0.016. 0016 0.016 016 0.016) Conclusion that symptoms followup follow up (OCD 000 0.00 00 067 0.67 67 0.01 01 0.0 06 0.6 6 0.

ABSTRACT The use of Stizolobium aterrimum (velvet bean) as green manure has been encouraged in agriculture as a source of nitrogen-rich phytomass for incorporation into the soil to enhance subsequent crop yield. The nitrogen-fixing capacity of this legume can be optimized through symbiosis with selected strains of rhizobia. The aim of this study was to evaluate the effectiveness of new strains of Bradyrhizobium in promoting the growth of velvet bean plants, both in potted soil and in the field. The study involved three experiments (two in pots and one in the field) with four replications of each in an Oxisol. An additional experiment was carried out to estimate the native rhizobial community in the experimental soil. The efficiency of the strains was estimated by compared plant growth with them to plant growth in two non-inoculated controls (one without mineral N and the other with mineral N) and plant growth with the strain BR2811, which is approved as an inoculant for velvet bean plants. Evaluations of velvet bean were performed at 60 and 100 days after emergence in non-sterile soil pots, and at 170 days after sowing (at flowering) in the field. Native rhizobia are efficient in symbiosis with velvet bean, as they were similar to BR2811 and to the control with mineral N, but they had lower biological nitrogen fixation efficiency than the new strains tested–UFLA05-18 and UFLA05-20. The new strains increased velvet bean yield and accumulation of N in velvet bean phytomass and, therefore, have potential for being used as inoculants for this species. nitrogenrich rich nitrogenfixing fixing plants field Oxisol noninoculated non inoculated BR 6 10 nonsterile sterile 17 flowering BR281 tested–UFLA0518 testedUFLA0518 testedUFLA tested–UFLA05 18 tested UFLA05 UFLA tested–UFLA05-1 UFLA0520. UFLA0520 20. 20 UFLA05-20 therefore species 1 BR28 UFLA0518 tested–UFLA051 testedUFLA051 testedUFLA05 tested–UFLA0 UFLA0 tested–UFLA05- UFLA052 2 UFLA05-2 BR2 UFLA051 testedUFLA0 tested–UFLA UFLA05-

Resumen: Introducción: el déficit de hierro es la causa más común de anemia debido a carencia nutricional. Su tratamiento consiste en proporcionar alimentos ricos en hierro biodisponible junto con la administración de hierro oral. En circunstancias definidas puede utilizarse el hierro intravenoso. Objetivo: describir el abordaje diagnóstico y terapéutico de un niño portador de anemia ferropénica severa secundaria a mala adherencia al hierro oral en el que se utilizó hierro intravenoso. Caso clínico: niño de 21 meses, raza blanca. Antecedente de anemia ferropénica severa, con repercusión hemodinámica que a los 14 meses requirió transfusión de sangre desplasmatizada. Sin controles de hemoglobina posteriores. Sin adherencia a profilaxis con hierro vía oral. Alto consumo de leche de vaca y bajo consumo de alimentos ricos en hierro. En el contexto de infección respiratoria aguda baja se constata anemia clínica con marcado decaimiento y anorexia, sin repercusión hemodinámica. Se confirma la anemia microcítica, hipocrómica severa, con ancho de distribución eritrocitaria elevado, con metabolismo de hierro alterado. Recibe hierro sacarato, intravenoso, por seis días con buena tolerancia y evolución. Discusión: se identificaron múltiples factores de riesgo para anemia ferropénica. La pobre respuesta al tratamiento con hierro oral debido a efectos adversos y olvidos de administración, junto al antecedente de anemia ferropénica severa, que requirió transfusión de sangre desplasmatizada, motivaron la indicación de hierro intravenoso. Su administración fue programada y monitorizada, sin complicaciones. Es necesario fortalecer la prevención en todos los controles pediátricos y abordar este problema de salud desde una mirada interdisciplinaria.

Summary: Introduction: iron deficiency is the most common cause of anemia due to nutritional deficiency. Its treatment consists of providing bioavailable iron rich food together with oral iron. In specific circumstances, intravenous iron may be used. Objective: of this study is to describe the diagnostic and therapeutic approach used with a child with severe iron deficiency anemia secondary to poor adherence to oral iron, in which intravenous iron was used. Clinical case: 21 month-old white patient. History of severe iron deficiency anemia, with hemodynamic repercussions that at 14 months of age required transfusion of deplasmatized blood. Without subsequent hemoglobin controls. No adherence to oral iron prophylaxis. High consumption of cow’s milk and low of iron-rich foods. Within the context of acute lower respiratory infection, a clinical anemia with marked decline and anorexia were observed, without hemodynamic repercussions. Severe hypochromic microcytic anemia was confirmed, with an elevated erythrocyte distribution width and altered iron metabolism. He received iron saccharate, intravenously for 6 days with good tolerance and evolution. Discussion: multiple risk factors for iron deficiency anemia were identified. The poor response to treatment with oral iron resulting from adverse effects and lack of proper administration, together with a history of severe iron deficiency anemia, which required transfusion of deplasmatized blood, led to the prescription of intravenous iron. This administration was scheduled and monitored, occurring without complications. It is necessary to strengthen prevention of this condition in all pediatric check-ups and address this health problem from an interdisciplinary perspective.

Resumo: Introdução: a deficiência de ferro é a causa mais comum de anemia por deficiência nutricional. Seu tratamento consiste no fornecimento de alimentos ricos em ferro biodisponível, juntamente com a administração de ferro por via oral. Em circunstâncias especificas, pode ser utilizado ferro intravenoso. Objetivo: descrever a abordagem diagnóstica e terapêutica de uma criança com anemia ferropriva grave secundária a sua má adesão ao ferro oral, e o uso de ferro intravenoso. Caso clínico: 21 meses, raça branca. História de anemia ferropriva grave, com repercussão hemodinâmica que requiriu de transfusão de sangue desplasmatizada aos 14 meses. Não houve nenhum controle de hemoglobina subsequente. Nenhuma adesão à profilaxia oral com ferro. Alto consumo de leite de vaca e baixo consumo de alimentos ricos em ferro. No contexto de infecção respiratória inferior aguda, observa-se anemia clínica com acentuado emagrecimento e anorexia, sem repercussões hemodinâmicas. É confirmada anemia microcítica e hipocrômica grave, com largura de distribuição eritrocitária elevada e metabolismo alterado do ferro. Recebeu sacarose férrica intravenosa por 6 dias com boa tolerância e evolução. Discussão: foram identificados múltiplos fatores de risco para anemia ferropriva. A má resposta ao tratamento com ferro oral devido aos efeitos adversos e ao esquecimento da administração, aliás da história de anemia ferropriva grave, que exigiu transfusão de sangue desplasmatizada, motivaram a indicação do ferro intravenoso. Sua administração foi programada e monitorada, e aconteceu sem intercorrências. É preciso fortalecer a prevenção em todos os controles pediátricos e abordar este problema de saúde numa persectiva interdisciplinar.

Abstract Background and objective. Peripheral nerve injury, in all its mechanisms, is a frequent event in the general population. There are diferent methods of repairing it, however there is not enough research on the most effective graft. The objective of this study is to determine the superiority of the combination of polyethylene glycol in polytetrafluoroethylene tubes as a graft versus its isolated use and an autograft. Methods. Experimental study of cases and controls using Wistar rats that were induced, under sedation, nerve injury by extracting a nerve graft from the sciatic nerve and its subsequent repair, divided into 3 groups: autograft, polytetrafluoroethylene graft and polytetrafluoroethylene graft with polyethylene glycol. Results. Eight histopathological variables were analyzed and a total axon count was made, finding a greater number in the autograft samples. Among the clinical variables, limb deformity, macroscopic muscular atrophy and walking disturbance were analyzed, showing the group of the combination of materials an excellent evolution in the 3 categories. Conclusions. The clinical recovery of the operated limb in the group where the combination of the studied materials was used was notably superior, in addition to the observation of much better axonal organization, indicating a superiority of this combination with respect to the other groups evaluated.

Resumen Introducción y objetivo. La lesión de nervio periférico, en todos sus mecanismos, es un evento frecuente entre la población en general. Existen distintos métodos de reparación de la misma, sin embargo, no hay suficiente investigación sobre el injerto más eficaz. El objetivo de este estudio es determinar la superioridad de la combinación de polietilenglicol en tubos de politetrafluoroetileno como injerto sobre el uso aislado del mismo y de un autoinjerto. Material y método. Estudio experimental de casos y controles utilizando ratas Wistar a las que se les indujo, bajo sedación, lesión nerviosa mediante extracción de injerto nervioso de nervio ciático y su posterior reparación, divididas en 3 grupos: autoinjerto, injerto de politetrafluoroetileno e injerto de politetrafluoroetileno con polietilenglicol. Resultados. Analizamos 8 variables histopatológicas con conteo total de axones, encontrando mayor número en las muestras de autoinjerto. Entre las variables clínicas, analizamos la deformidad de la extremidad, la atrofia muscular macroscópica y la alteración en la marcha. El grupo de la combinación de materiales mostró una evolución excelente en las 3 categorías. Conclusiones. La recuperación clínica de la extremidad intervenida en el grupo donde se utilizó la combinación de los materiales en estudio fue notablemente superior; observamos además mucha mejor organización axonal, indicando una superioridad de esta combinación respecto a los otros grupos evaluados.

Resumen El aumento de la resistencia a los antimicóticos y la toxicidad de los actualmente disponibles ha estimulado el desarrollo de nuevos compuestos con acción antifúngica de origen natural. Numerosos estudios científicos dan cuenta de las propiedades biomédicas y farmacológicas de los de-rivativos de Ilexparaguariensis (Yerba mate). Sobre sus frutos, hay muy pocos estudios científicos realizados respecto a sus propiedades fitoquímicas y/o farmacológicas; y prácticamente nulos sobre su capacidad antimicrobiana. El objetivo de este estudio fue evaluar la capacidad antifúngica in vitro de extractos acuosos de frutos de I. paraguariensis sobre hongos dermatofitos. Se trabajó con cepas aisladas de muestras clínicas de las especies Trichophytonmen-tagrophytescomplex, Trichophytonrubrum, Microsporumcanis, Trichophytontonsurans y Nannizziagypsea. Para evaluar la capacidad antifúngica del extracto acuoso de yerba mate (EAFYM), se preparó una solución madre de 500 mg/ml. Se aplicó el método cuantitativo de microdilución en caldo RPMI. Se utilizó un inóculo fúngico de 1-3 x103 UFC/ml. Se realizaron controles de crecimiento fúngico, esterilidad y antifúngicos comerciales de referencia. Los cultivos se incubaron durante 96 h a 35 ºC, la concentración mínima de EAFYM que produjo la inhibición completa del crecimiento fúngico se determinó por observación visual y posterior punción en medio sólido. Se concluye que EAFYM tiene actividad antifúngica in vitro contra las cepas de dermatofitos estudiadas, en un rango entre 31,25 y 125 mg/ml.

Abstract Increasing resistance to antifungal agents and the toxicity of currently available antifungal agents has stimulated the development of new compounds with antifungal action of natural origin. Numerous scientific studies have reported on the biomedical and pharmacological properties of the de-rivatives of Ilex paraguariensis (Yerba mate). Very few scientific studies have been conducted on the phytochemical and/or pharmacological properties of its fruits, and practically none on its antimicrobial capacity. The aim of this study was to evaluate the in vitro antifungal capacity of aqueous extracts of I. paraguariensis fruits on dermatophyte fungi. Strains isolated from clinical samples of Trichophyton men-tagrophytes complex, Trichophyton rubrum, Microsporumcanis, Trichophyton tonsurans and Nannizziagypsea were used. To evaluate the antifungal capacity of the aqueous extract of yerba mate (EAFYM), a stock solution of 500 mg/ml was prepared. The quantitative microdilution method was applied in RPMI broth. A fungal inoculum of 1-3 x103 CFU/ml was used. Controls for fungal growth, sterility and commercial reference antifungals were performed. Cultures were incubated for 96 h at 35 °C. The minimum concentration of EAFYM that produced complete inhibition of fungal growth was determined by visual observation and subsequent puncture on solid medium. It is concluded that EAFYM has in vitro antifungal activity against the dermatophyte strains studied, ranging from 31.25 to 125 mg/ml.

Resumo Antecedentes Devido às medidas de resposta à pandemia de coronavirus disease 2019 (covid-19), a administração de toxina botulínica (TXB) foi adiada para muitos pacientes durante o primeiro confinamento em Portugal. Objetivos Avaliar o impacto do adiamento do tratamento com TXB no controle da enxaqueca. Métodos Estudo retrospectivo unicêntrico. Foram incluídos pacientes com enxaqueca crônica com pelo menos três ciclos prévios de TXB e que tenham sido considerados respondedores. Os pacientes foram divididos em dois grupos, sendo um com atraso do tratamento (grupo P) e outro sem atraso (controles). O protocolo Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) foi utilizado. Dados clínicos relacionados com a enxaqueca foram obtidos na consulta inicial (T0) e nas três consultas subsequentes (T1-3). Resultados O presente estudo incluiu dois grupos, o grupo P (n = 30; 47,0 ± 14,5 anos; 27 mulheres, intervalo T0-1ª visita: 5,5 [4,1-5,8] meses) e o grupo controle (n = 6; 57,7 ± 13,2 anos; 6 mulheres; intervalo T0-1ª visita 3,0 [3,0-3,2] meses). Os grupos não apresentavam nenhuma diferença no início do estudo. Quando comparado à T0, o número de dias/mês com enxaqueca (5 [3-6,2] vs. 8 [6-15], p < 0,001), dias usando triptanos/mês (2,5 [0-6] vs. 3 [0-8], p = 0,027) e intensidade da dor (7 [5,8-10] vs. 9 [7-10], p = 0,012) foram maiores na primeira visita no grupo P, não apresentando os controles variação significativa. A piora dos indicadores relacionados com a enxaqueca diminuiu nas visitas seguintes; porém, mesmo na terceira visita, ainda não haviam retornado ao basal. As correlações foram significativas entre o atraso do tratamento e o aumento de dias/mês com enxaqueca na primeira consulta após o confinamento (r = 0,507; p = 0,004). Conclusão Houve piora clínica da enxaqueca após o adiamento do tratamento em correlação direta com a duração do atraso. 201 covid19, covid19 covid 19 , (covid-19) (TXB Portugal unicêntrico respondedores controles. . (controles) PREEMPT (PREEMPT utilizado T0 T (T0 T13. T13 T1 (T1-3) n 30 470 47 0 47, 145 14 5 14, anos 2 mulheres T01ª Tª 1ª ª 55 5, 4,15,8 4158 4,1 5,8 4 1 [4,1-5,8 meses 577 57 7 57, 132 13 13, 3, 3,03,2 3032 3,2 [3,0-3,2 meses. diasmês mês ( 36,2 362 6,2 [3-6,2 vs 615, 615 15 [6-15] 0,001, 0001 0,001 001 0,001) triptanosmês triptanos 2,5 25 (2, 06 [0-6 08, 08 [0-8] 0,027 0027 027 5,810 5810 10 [5,8-10 710, 710 [7-10] 0,012 0012 012 significativa seguintes porém basal r 0,507 0507 507 0,004. 0004 0,004 004 0,004) 20 covid1 (covid-19 (controles (T (T1-3 4,15, 415 41 4, 58 [4,1-5, 03 3,03, 303 32 [3,0-3, 36 36, 62 6, [3-6, 61 [6-15 000 0,00 00 2, (2 [0- [0-8 0,02 002 02 810 5,81 581 [5,8-1 71 [7-10 0,01 01 0,50 050 50 (covid-1 (T1- 4,15 [4,1-5 3,03 [3,0-3 [3-6 [6-1 0,0 [0 81 [5,8- [7-1 0,5 05 (covid- (T1 [4,1- [3,0- [3- [6- 0, [ [5,8 [7- (covid [4,1 [3,0 [3 [6 [5, [7 [4, [3, [5 [4

Abstract Background Due to coronavirus disease 2019 (COVID-19) pandemic response measures, the administration of botulinum toxin (BTX) was delayed for many patients during the first lockdown period in Portugal. Objectives To review the impact of postponing BTX treatment on migraine control. Methods This was a retrospective, single-center study. Patients with chronic migraine who had done at least three previous BTX cycles and were considered responders were included. The patients were divided into two groups, one that has had their treatment delayed (group P), and one that has not (controls). The Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol was used. Migraine-related data were obtained at baseline and at three subsequent visits. Results The present study included two groups, group P (n = 30; 47.0 ± 14.5 years; 27 females, interval baseline -1st visit: 5.5 [4.1-5.8] months) and the control group (n = 6; 57.7 ± 13.2 years; 6 females; interval baseline-1st visit 3.0 [3.0-3.2] months). No difference between the groups was present at baseline. When compared to baseline, the number of days/month with migraine (5 [3-6.2] vs. 8 [6-15] p < 0.001), days using triptans/month (2.5 [0-6] vs. 3 [0-8], p = 0.027) and intensity of pain (7 [5.8-10] vs. 9 [7-10], p = 0.012) were greater in the first visit for group P, while controls did not present a significant variation. The worsening of migraine-related indicators decreased in the following visits; however, even in the third visit, it had not returned to baseline. Correlations were significant between the delayed time to treatment and the increase in days/month with migraines at the first visit after lockdown (r = 0.507; p = 0.004). Conclusions There was a deterioration of migraine control after postponed treatments, with a direct correlation between the worsening of symptoms and the number of months that the treatment was delayed. 201 COVID19 COVID 19 (COVID-19 measures (BTX Portugal retrospective singlecenter single center , P) controls. . (controls) PREEMPT (PREEMPT used Migrainerelated related visits n 30 470 47 0 47. 145 14 5 14. years 2 females 1st st 55 5. 4.15.8 4158 4.1 5.8 4 1 [4.1-5.8 577 57 7 57. 132 13 13. baseline1st baselinest 3. 3.03.2 3032 3.2 [3.0-3.2 months. daysmonth month ( 36.2 362 6.2 [3-6.2 vs 615 15 [6-15 0.001, 0001 0.001 001 0.001) triptansmonth triptans 2.5 25 (2. 06 [0-6 08, 08 [0-8] 0.027 0027 027 5.810 5810 10 [5.8-10 710, 710 [7-10] 0.012 0012 012 variation migrainerelated however r 0.507 0507 507 0.004. 0004 0.004 004 0.004) treatments 20 COVID1 (COVID-1 (controls 4.15. 415 41 4. 58 [4.1-5. 03 3.03. 303 32 [3.0-3. 36 36. 62 6. [3-6. 61 [6-1 000 0.00 00 2. (2 [0- [0-8 0.02 002 02 810 5.81 581 [5.8-1 71 [7-10 0.01 01 0.50 050 50 (COVID- 4.15 [4.1-5 3.03 [3.0-3 [3-6 [6- 0.0 [0 81 [5.8- [7-1 0.5 05 (COVID [4.1- [3.0- [3- [6 0. [ [5.8 [7- [4.1 [3.0 [3 [5. [7 [4. [3. [5 [4

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.

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.

Abstract This article examines the regulation of tertiary education in Peru within the context of the pervasiveness of the regulatory state in liberal democracies. Peru’s experience with regulating tertiary serves as a cautionary example of the challenges posed by the regulatory state. Despite a decade of reforms, the outcome for Peruvians has been reduced competition, increased costs, limited access to education, and no discernible enhancement in quality. The article introduces the regulatory state concept and explores its origins and ongoing expansion. It argues that this expansion results from diverse factors such as economic shifts away from free markets and the implementation of welfare policies. The subsequent part outlines strategies for reducing regulatory burden, ranging from straightforward approaches to paradigm-shifting concepts. However, none of these alternatives proves fully effective. Finally, the authors scrutinize a Peruvian case study of tertiary education -in which the state controls half of the education offerings-. The article’s conclusion advocates for strengthening the role of the state to alleviate regulatory pressures. In this sense, a model closer to the Nordic model -wherein state intervention is distinct and strategic within a predominantly free-market economy- is the best way to escape the ubiquity quality of the regulatory state.

BACKGROUND: The South African Noise Induced Hearing Loss (NIHL) Regulations, mandates employers to conduct a noise risk assessment, which records specific variables for determining the status of exposure and the need for implementation of control measures. OBJECTIVES: The study evaluated company noise risk assessment practices for alignment with legal requirements and specific risk assessment guidelines. METHOD: Convenience sampling was used to select the four manufacturing and utilities companies that participated in the study. The participating companies submitted latest noise risk assessment records for evaluation through the READ approach. RESULTS: The noise risk assessment records of three of the four companies omitted the recording of factors such as the reasonable deterioration in or failure of control measures, adequate control and formalisation of hearing conservation programmes (HCPs). When evaluated against the South African National Standard 31000 Risk Assessment guidelines, the risk assessment processes of the respective companies were lacking in addressing aspects related to establishing communication and consultation, evaluation, adapting, continually improving, leadership and commitment, and integration. CONCLUSION: The recorded information on the noise risk assessment reports from the four participating companies were incomplete, negatively affecting subsequent HCP management processes and decision-making. Future studies should investigate other aspects such as the implementation status of recommended noise controls as well as their effectiveness as recorded in the noise risk assessment records. CONTRIBUTION: This study provided firsthand insights of company noise risk assessment practices, specifically identifying functional and technical areas requiring improvement to enhance current efforts directed towards the minimisation of NIHL within HCPs. The study highlighted that the current practices on recording noise risk assessment information remain incomplete, adversely diminishing the impact of the assessment as an important decision-making tool. The identified technical issues specifically, when addressed, will increase trust on the decisions derived from noise risk assessments.