ABSTRACT Introduction: the two conditions that cause blindness and that can frequently coexist in the same patient are glaucoma and cataract. Cataract surgery plus trabeculectomy is very useful in Latin American countries due to its good visual results and low cost for patients with limited economic resources. Being a cost-effective alternative for this type of population. Objective: to describe the results of small incision cataract surgery combined with trabeculectomy in patients with glaucoma refractory to maximum therapy at Fundación Visión. Methodology: a retrospective observational study was carried out that included patients who underwent combined cataract and glaucoma surgery at Fundación Visión from May 2021 to April 30, 2022. The following variables were analyzed; visual acuity, intraocular pressure (IOP), number of hypotensive medications, pre and post surgery, in addition to operative complications. Results: before surgery, 51 % of patients had an IOP between 21 to 30 mmHg, and 57 % used triple drug therapy. After surgery, 98 % of patients had IOP <20 mmHg and 41 % did not need to use hypotensive medications. IOP was significantly reduced (p <0.001) from 28.59 mmHg pre-surgery to 11.18 mmHg post-surgery. In 41% of patients (n = 21) the success was complete, in 57% (n = 29) the success was partial and in one patient there was no success. There was only one case of intraoperative complication with zonulodialysis and the postoperative complications were choroidal detachment and flat bulla, with two cases each. Conclusion: small-incision cataract surgery combined with trabeculectomy is a safe, effective, and lower-cost treatment for people suffering from cataract and glaucoma.

RESUMEN Introducción: las dos condiciones que causan ceguera y que pueden frecuentemente coexistir en el mismo paciente son glaucoma y catarata. La cirugía de catarata más trabeculectomía es de gran utilidad en países de América Latina por los buenos resultados visuales y el bajo costo para pacientes de escasos recursos económicos. Siendo una alternativa costo efectiva para este tipo de población. Objetivo: describir los resultados de la cirugía de catarata por pequeña incisión combinada con trabeculectomía en pacientes con glaucoma refractario a terapia máxima en la Fundación Visión. Métodología: se realizó un estudio observacional retrospectivo que incluyó a pacientes intervenidos con una cirugía combinada de catarata y glaucoma en la Fundación Visión de mayo del 2021 al 30 de abril del 2022. Se analizaron las siguientes variables; agudeza visual, presión intraocular (PIO), número de medicamentos hipotensores, pre y post cirugía, además de las complicaciones operatorias. Resultados: previo a la cirugía, el 51 % de los pacientes tenía una PIO entre 21 a 30 mmHg, y el 57 % usaba una triple terapia medicamentosa. Posterior a la cirugía, el 98 % de los pacientes presentaron PIO <20 mmHg y el 41 % no necesitó usar medicamentos hipotensores. La PIO se redujo significativamente (p <0.001) de 28,59 mmHg en la pre cirugía a 11,18 mmHg en la post cirugía. En el 41 % de los pacientes (n = 21) el éxito fue completo, en el 57 % (n = 29) éxito fue parcial y en un paciente no hubo éxito. Solo hubo un caso de complicación intraoperatoria con zonulodiálisis y las complicaciones postoperatorias fueron el desprendimiento coroideo y ampolla plana, con dos casos cada uno. Conclusión: la cirugía de catarata por incisión pequeña combinada con trabeculectomía es un tratamiento seguro, eficaz y de menor costo para personas que padecen catarata y glaucoma.

Abstract Through a careful and personal reading of the Divine Comedy and the Monarchy of Dante, supported by a part of the extensive bibliography on the theme and other sources, I try to analyze the concept of the supreme command that developed the greatest poet between the 13th and 14th centuries. How does Dante’s political thΩought take shape? How is the conflict resolved between practical and theoretical politics? Dante deprecated the discords Italy was suffering and from these important considerations it is possible to redefine Dante’s political theory and attempt to give answers to these questioners.

Resumen A través de una atenta y personal lectura de la Comedia y la Monarquía de Dante, sustentada por una parte de la amplia bibliografía sobre el tema y otras fuentes, se procura analizar el concepto de mando supremo que desarrolló el sumo poeta entre los siglos XIII y XIV. ¿Cómo se configura el pensamiento político de Dante? ¿Cómo se soluciona el “dilema” entre práctica y teórica políticas? Dante lamentaba las discordias de que era víctima Italia y de estas importantes consideraciones es posible redibujar la teoría política dantesca e intentar dar respuestas a estos interrogantes.

Abstract Introduction: Positive mental health involves a mix of personal and psychosocial resources, as well as attitudes, affections, and positive behaviors that allow the person to face the challenges that arise in life, at a personal, family, social, and school level. Objective: Determine the association between personal factors and positive mental health in high school students during COVID-19. Methodology: Descriptive correlational study. Intentional non-probabilistic sampling. The sample consisted of 210 students of both sexes, ages 15 to 19, enrolled in cycle 2022-1 of the morning shift. Adolescents with visual conditions were excluded. A personal factors study and Positive Mental Health Scale were applied, with prior assent and informed consent. The statistical analysis was descriptive and inferential Results: The students were 64.8% female, 76.1% were under 17 years of age, 53.3% were in the sixth semester, 42% presented COVID-19 and 45% reported losses due to COVID-19. Global positive mental health was low in 50.5% of students. There was a significant positive statistical association in overall positive mental health with sex p=0.01, and a negative one with suffering from a mental illness p=0.01 and having family members who suffered from a mental illness p=0.05. Conclusion: Mental health of young people was not very positive. It needs to be studied to generate nursing interventions for promotion and prevention of school health to result in effective stress management of young people who are in high school when considering the family, society, and the educational field.

Abstrato Introdução: A saúde mental positiva envolve um conjunto de recursos pessoais e psicossociais, atitudes, afetos e comportamentos positivos que permitem à pessoa enfrentar os desafios que surgem na vida, a nível pessoal, familiar, social e escolar. Objetivo: Determinar a associação entre fatores pessoais e saúde mental positiva em estudantes do ensino médio em tempos de COVID-19. Metodologia: Estudo descritivo, preditivo e correlacional. Amostragem não probabilística intencional, amostra 210 estudantes de ambos os sexos, com idades entre 15 e 19 anos, matriculados no ciclo 2022-1 do turno da manhã. Foram excluídos os adolescentes com problemas visuais. Foram aplicados inquérito de fatores pessoais e Escala de Saúde Mental Positiva, com prévio assentimento e consentimento informado. A análise estatística foi descritiva e inferencial. Resultados: Os alunos eram 64,8% do sexo feminino, 76,1% tinham menos de 17 anos, 53,3% estavam no sexto semestre, 42% apresentaram COVID-19 e 45% relataram perdas por COVID-19. A saúde mental positiva global foi baixa em 50,5% dos estudantes. Houve associação estatística positiva significativa na saúde mental geral positiva com sexo p=0,01, e negativa com sofrer de doença mental p=0,01 e ter familiares que sofriam de doença mental p=0,05. Conclusão: A saúde mental positiva dos jovens foi baixa, necessita ser estudada para gerar intervenções de enfermagem na promoção e prevenção da saúde escolar para promover o enfrentamento eficaz do manejo do estresse dos jovens que estão no ensino médio quando se considera a família, a sociedade e o campo educacional.

Resumen Introducción: La salud mental positiva involucra una mezcla de recursos personales y psicosociales, actitudes, afectos y comportamientos positivos que permiten a la persona enfrentar los retos que se le presentan en la vida, a nivel personal, familiar, social y escolar. Objetivo: Determinar la asociación entre factores personales y la salud mental positiva en estudiantes de bachillerato en tiempos de COVID-19. Metodología: Estudio descriptivo correlacional. Muestreo intencional no probabilístico, en una muestra de 210 estudiantes de ambos sexos, edades de 15 a 19 años, inscritos en ciclo 2022-1 del turno matutino. Se excluyeron adolescentes con afecciones visuales. Se aplicó encuesta de factores personales y Escala de Salud Mental Positiva, previo asentimiento y consentimiento informado. El análisis estadístico fue descriptivo e inferencial. Resultados: Los estudiantes fueron 64.8 % del sexo femenino, 76.1 % eran menores de 17 años, 53.3 % cursaban sexto semestre, 42 % presentó COVID-19 y 45 % manifestó pérdidas por Covid-19. La salud mental positiva global fue baja en 50.5 % de los estudiantes. Hubo asociación estadística significativa positiva en salud mental positiva global con sexo p=0.01, y negativa con padecer alguna enfermedad mental p=0.01 y contar con familiares que padecían alguna enfermedad mental p=0.05. Conclusión: La salud mental positiva de los jóvenes fue baja, se requiere ser estudiada para generar intervenciones de enfermería en promoción y prevención de la salud escolar para favorecer un afrontamiento efectivo del manejo el estrés de los jóvenes que cursan bachillerato al considerar a la familia, la sociedad y al ámbito educativo.

Resumen El objetivo de esta investigación fue analizar la relación entre la presencia de trastornos emocionales y el acoso escolar en los estudiantes de sexto a noveno grado de las instituciones educativas públicas de la ciudad de Floridablanca (Colombia). El diseño del estudio fue cuantitativo correlacional. Los instrumentos utilizados fueron la prueba de tamizaje cyberbullying y el Sistema de Evaluación de Niños y Adolescentes (SENA). Se evaluaron 76 menores que cumplen el rol de víctima o agresor, y los resultados obtenidos indicaron que un alto porcentaje de los involucrados en el acoso escolar como víctimas o agresores cara a cara o en línea presentan desajustes emocionales. Los datos descriptivos muestran que en Floridablanca (Colombia) aún hay fracciones de acoso escolar por debajo de la prevalencia internacional; sin embargo, existe una alta proporción de estudiantes en riesgo de asumir algún rol en el acoso escolar. Se concluyó que la Psicología es una disciplina científica que aporta herramientas para abordar los trastornos emocionales adscritos al acoso escolar. Que deben recibir tratamiento psicológico todos los involucrados en el acoso escolar en cualquiera de sus roles. Esta investigación puede considerarse como insumo para futuros trabajos que pretendan formular acciones de intervención para el acoso escolar y el trabajo de los trastornos emocionales qu e genera este problema.

Abstract The main goal for this research was to analyze the relationship between emotional disorders and bullying in schoolchildren. Participants were recruited from sixth to ninth grade in public schools from Floridablanca, Colombia. The design method was quantitative and correlational. We administered an online test called Cyberbullying to detect students involved in bullying and cyberbullying and emotional disorders were assessed using the test Sistema de Evaluación de Niños y Adolescentes (SENA). Participants were 76 schoolchildren with high scores as victims and/or aggressors. Results show a high percentage of schoolchildren involved in bullying and cyberbullying either as victims and/or aggressors that are suffering from emotional problems. Descriptive data also shows that Floridablanca still maintains a lower prevalence of bullying compared to international standards, but there’s a high risk for children getting involved in these behaviors. This research can be taken as an input for future work that intends to formulate intervention actions, both for school acoso and for the work of the emotional disorders that this problem generates.

ABSTRACT. Article 43 of Law 1258, 2008 refers to the abuse of the rights of majority, parity, and minority, allowing to sue requesting both the nullification of corporate decisions and damages. Such a rule has triggered a voluminous case law. Nonetheless, such success has been pyrrhic, since while claimants obtain a judgment annulling some decisions and granting damages, they continue as prisoners in the company and defenseless against new oppressions. For the action for abuse of voting rights to be effective, this text proposes suspending some voting rights of the abusing shareholder or granting them to the shareholder suffering the oppression.

RESUMEN. La Ley 1258 de 2008 consagra los abusos de voto de mayoría, paridad y minoría, permitiendo demandar la nulidad de decisiones sociales y solicitar perjuicios. Esta norma ha generado una amplia jurisprudencia. Con todo, las victorias de los accionistas oprimidos han sido pírricas, ya que, si bien obtienen la nulidad de ciertas decisiones sociales y una condena monetaria a favor, siguen presos en la compañía e inermes frente a nuevas conductas abusivas. Para que la acción por abuso del derecho al voto sea eficaz, se propone suspender votos del accionista que abusa de ellos u otorgarlos a su víctima.

RESUMEN ¿Por qué no se soluciona la crisis carcelaria en Ecuador? Esta pregunta lleva a explorar la problemática penitenciaria desde sus orígenes hasta llegar al contexto ecuatoriano actual. El objetivo es reflexionar y demostrar que las prisiones y la privación de libertad han mantenido la misma dinámica desde sus orígenes, causando sufrimiento y dolor a los reclusos, en contraposición a la finalidad resocializadora de la pena; el contexto actual demuestra que la gestión penitenciaria no ha evolucionado, pese al desarrollo científico y normativo de esta rama. El enfoque cualitativo y socio-jurídico son la base de la investigación porque a través del diseño narrativo se describe de forma secuencial la historia del sistema penitenciario, el avance normativo y se compara con la realidad social; es decir, se hace un acercamiento del derecho a la sociedad a través de la revisión documental de fuentes secundarias. En definitiva, se concluye que no existe la voluntad política del Estado para abordar el problema de forma técnica y con el personal especializado, tal como sugiere la doctrina; al contrario, la crisis carcelaria en Ecuador tiene un tinte anacrónico, deshumanizante y alejado de la finalidad de la pena; es decir, no hay rehabilitación ni resocialización.

ABSTRACT Why is the prison crisis in Ecuador not solved? is the question that leads us to explore the penitentiary problem from its origins to the current Ecuadorian context. The objective is to reflect and demonstrate that prisons and deprivation of liberty have maintained the same dynamic since their origins, causing suffering and pain to inmates, in contrast to the resocializing purpose of punishment; The current context shows that prison management has not evolved, despite the scientific and regulatory development of this branch. The qualitative and socio-legal approach is the basis of the research because through the narrative design the history of the penitentiary system, the regulatory advance, and are compared with social reality are sequentially described; That is, an approach to the right to society is made through the documentary review of secondary sources. In short, it is concluded that there is no political will of the State to address the problem technically and with specialized personnel as suggested by the doctrine; on the contrary, the prison crisis in Ecuador has an anachronistic, dehumanizing tone and is far from the purpose of the sorrow; That is, there is no rehabilitation or resocialization.

Abstract In this work, the economic branches related to design were analyzed, under the assumption that design can help the competitiveness of products, this is done due to the facts derived from the economic crises that emerged in 2004 and 2008, and that only in 2016 a recovery could be observed at the aggregate level of the state economy. With the objective of highlighting the industrial dynamism, the findings/results highlight that some branches related to traditional and technology industries present an economic restructuring towards expansion, while others are suffering a setback, this under the scenario of the effects caused by the economic openings and the new agreements with China, which resulted in a competitive confrontation between Chinese products and Mexican products and added to this only those industries that manage to be more flexible to change and manage to restructure their companies will survive.

Resumen En este trabajo se analizaron las ramas económicas relacionadas con el diseño, bajo el supuesto de que el diseño puede ayudar a la competitividad de los productos, esto se hace por los hechos derivados de las crisis económicas que surgieron en el 2004 y en el 2008, y que apenas en el 2016 se pudo observar una recuperación a nivel agregado de la economía estatal. Con el objetivo de resaltar el dinamismo industrial, los hallazgos/resultados destacan que algunas ramas relacionadas con las industrias tradicionales y de tecnología presentan una reestructuración económica hacia la expansión, mientras que otras están sufriendo un retroceso, esto bajo el escenario de los efectos causados por la aperturas económica y los nuevos acuerdos con China, que dieron como resultado una confrontación competitiva entre los productos chinos y los productos de México y aunado a esto solo sobrevivirán aquellas industrias que logren ser más flexibles al cambio y logren reestructurar su empresas.

Resumo: Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

Abstract: Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

resumen está disponible en el texto completo

ABSTRACT The service manager plays a relevant role in the administration of subjective interrelationships within the team and with the users, as well as in preserving the mental health of these professionals. The aim of this article is to analyze and discuss the mental suffering of professionals in mental health teams, as well the management strategies for handling, care, and prevention, based on the perceptions of the managers of the Psychosocial Care Centers (CAPS). The research was conducted in 2022, with nine managers from CAPS III and Alcohol and Drug units in the city of Campinas-SP. Narratives were analyzed and systematized into thematic categories: management skills, manager-team conflicts, signs of mental distress, psychosocial factors related to work, work processes, collective and individual management, and administrative difficulties. The results highlighted the challenges of management, and the strategies adopted, such as the need for attentive listening to the workers, critical analysis of work processes, and the maintenance of spaces for dialogue, to prevent or identify signs of distress in the team. This research contributes to the understanding of the mental distress faced by mental health professionals and emphasizes the role of management in promoting health and addressing the challenges experienced by these professionals.

RESUMO O gestor do serviço de saúde tem papel relevante na administração das inter-relações subjetivas da equipe com os usuários, bem como preservação da saúde mental destes profissionais. O objetivo deste artigo é analisar e discutir o sofrimento mental dos profissionais das equipes de saúde mental, estratégias de gestão para manejo, cuidado e prevenção, a partir das percepções dos gestores dos Centros de Atenção Psicossocial (Caps). A pesquisa foi realizada no ano de 2022, com nove gestores dos Caps III e de Álcool e Drogas do município de Campinas-SP. As narrativas foram analisadas e sistematizadas em categorias temáticas: competências de gestão, conflitos gestor-equipe, sinais de sofrimento mental, fatores psicossociais relacionados ao trabalho, processos de trabalho, gestão do coletivo e do individual e dificuldades da administração. Os resultados evidenciaram as dificuldades da gestão e as estratégias adotadas, tais como a necessidade da escuta dos trabalhadores, da análise crítica dos processos de trabalho e manutenção de espaços de diálogo coletivo para evitar ou identificar sinais de sofrimento na equipe. Esta pesquisa contribui para a compreensão do sofrimento mental enfrentado pelos profissionais de saúde mental e destaca a participação da gestão na promoção da saúde e no enfrentamento dos desafios vivenciados por esses profissionais.

Abstract Perinatal palliative care emerged as an essential measure to comprehensively address the treatment of neonatal patients with prenatal or perinatal diagnoses of severe life-threatening illnesses. This care is aimed at newborns suffering from conditions that prevent them from surviving beyond a few minutes or hours, or in cases where they are born lifeless. The focus is not only on the neonatal patient, but also on supporting the mother and close relatives. The primary goal is to preserve the dignity of newborns and to provide them with the greatest possible comfort during their transition to the end of life.

Resumen Los cuidados paliativos perinatales surgieron como una medida esencial para abordar integralmente el tratamiento de pacientes neonatales con diagnósticos prenatales o perinatales de enfermedades graves que puedan poner en riesgo su vida. Estos cuidados están dirigidos a recién nacidos que padecen condiciones que les impiden sobrevivir más allá de unos pocos minutos u horas, o en casos en los que naces sin vida. Los mismos, no se centran solo en el paciente neonatal, sino también en apoyar a la madre y a los familiares cercanos. El objetivo primordial es preservar la dignidad de los recién nacidos y proporcionarles el mayor confort posible durante su transición hacia el final de la vida.

Abstract: End-of-life care management presents significant ethical challenges, especially in complex clinical cases such as that of a patient with severe head trauma and multiple complications. Ethical decision-making involves considering the rights, dignity, and preferences of the patient and his or her family, as well as quality of life and relief from suffering. The objective of this research is to design and implement a comprehensive methodology to provide a care plan that respects the dignity and improves the quality of life of patients at the end of life, aligned with their wishes and those of their family. The approach used was the Comprehensive Methodology of Clinical-Ethical Analysis (CMECA), which included a continuous evaluation, pain and symptom management, supportive care, limitations of medical interventions, and preparation for the end of life, with the active participation of the family from a palliative care approach. The resolution of the case was achieved through a shared decision between the parents and the medical team, proceeding with a gradual disconnection of life support. The importance and relevance of the Comprehensive Methodology of Ethical-Clinical Analysis (CMECA) is highlighted, due to its comprehensive approach focused on the patient and in accordance with medical ethics. This method stands out for considering legal and ethical aspects, empathy, and respect for human dignity at all times.

Resumen: La gestión de cuidados al final de la vida presenta desafíos éticos significativos, especialmente en casos clínicos complejos como el de un paciente con severo trauma craneoencefálico y múltiples complicaciones. La toma de decisiones éticas involucra considerar los derechos, la dignidad y las preferencias del paciente y su familia, así como la calidad de vida y el alivio del sufrimiento. El objetivo de esta investigación es diseñar e implementar una metodología integral para brindar un plan de cuidado que respete la dignidad y mejore la calidad de vida de pacientes al final de la vida, alineado con sus deseos y los de su familia. El enfoque utilizado fue la Metodología Integral de Análisis Ético-Clínico (MIAEC), en el que se incluyó una evaluación continua, manejo del dolor y síntomas, cuidados de soporte, limitaciones de intervenciones médicas y preparación para el final de la vida, con la participación activa de la familia desde un enfoque de cuidados paliativos. La resolución del caso se logró a través de una decisión compartida entre los padres y el equipo médico, procediendo con una desconexión paulatina del soporte vital. Se resalta la importancia y pertinencia de la Metodología Integral de Análisis Ético-Clínico (MIAEC) por su enfoque integral centrado en el paciente y en conformidad con la ética médica. Este método se destaca por considerar aspectos legales y éticos, la empatía, y el respeto por la dignidad humana en todo momento.

Resumo: La gestão de cuidados ao final da vida apresenta desafios éticos significativos, especialmente em casos clínicos complexos como o de um paciente com severo trauma cranioencefálico e múltiplas complicações. A tomada de decisões éticas envolve considerar os direitos, a dignidade e as preferências do paciente e de sua família, assim como a qualidade de vida e o alívio do sofrimento. O objetivo desta investigação é desenhar e implementar uma metodologia integral para oferecer um plano de cuidado que respeite a dignidade e melhore a qualidade de vida de pacientes ao final da vida, alinhado com seus desejos e os de sua família. O enfoque utilizado foi a Metodologia Integral de Análise Ético-Clínica (MIAEC), na qual incluiu-se uma avaliação contínua, manejo da dor e de sintomas, cuidados de suporte, limitação de intervenções médicas e preparação para o final da vida, com a participação ativa da família desde um enfoque de cuidados paliativos. Alcançou-se a resolução do caso através de uma decisão compartilhada entre os pais e a equipe médica, procedendo-se uma desconexão paulatina do suporte vital. Ressalta-se a importância e pertinência da Metodologia Integral de Análise Ético-Clínica (MIAEC) por seu enfoque integral centrado no paciente e em conformidade com a ética médica. Este método se destaca por considerar aspectos legais e éticos, a empatia e o respeito pela dignidade humana em todos os momentos.

A vigilância em saúde, como vigilância de agravos e doenças, tem um escopo bastante amplo. Discutiremos aqui a face mais conhecida, que é a vigilância de doenças transmissíveis, e assumiremos como mote a pandemia causada pelo vírus SARS-CoV-2. No desenvolvimento do texto, a abordagem se amplia para uma reflexão sobre tecnologias, modelo e organização do sistema. A mais grave epidemia de nossa época, classificada como pandemia, por atingir simultaneamente todo o planeta, tem obrigado a reflexões que envolvem múltiplos campos do conhecimento. O sofrimento decorrente deve inibir a tentação de associá-la a qualquer imagem positiva, ainda que tenha havido oportunidade para aprender e, em algumas circunstâncias, testemunhar a capacidade humana de agir solidariamente. Poucas coisas são tão didáticas como tragédias e erros. Cabe explorá-los cuidadosamente e extrair a necessária retroalimentação para corrigir rumos da atuação em saúde. Neste texto, trataremos das condições que levaram a vigilância em saúde no Brasil a falhar fragorosamente em sua missão frente à emergência desencadeada pela doença do novo coronavírus 2019 e levantaremos pontos que merecem atenção em uma reestruturação do sistema de vigilância em saúde.

The term "health surveillance" encompasses a wide range of activities, including the monitoring and observation of illnesses and diseases. In this section, we will examine the most well-known aspect of health surveillance, namely the monitoring of communicable diseases. To illustrate our discussion, we will use the ongoing pandemic caused by the SARS-CoV-2 virus as a case study. As the text progresses, the focus shifts to an examination of technologies, models, and the structure of the system. The most severe epidemic of our era, classified as a pandemic due to its global impact, has compelled us to reflect on a multitude of disciplines. The resulting suffering should preclude any association with positive images, despite the opportunity to learn and, in some instances, observe the capacity of humans to act in solidarity. It is often observed that few things are as didactic as tragedies and mistakes. It is therefore important to explore them carefully to extract the necessary feedback to correct the course of action in health. In this text, we will discuss the conditions that led health surveillance in Brazil to fail miserably in its mission in the face of the emergency triggered by the novel coronavirus disease 2019. We will also present points that deserve attention in a restructuring of the health surveillance system.

ABSTRACT Introduction: Burns are devastating injuries associated with high morbidity and mortality. A disruption of the immune system is developed, affecting the function of neutrophils and lymphocytes, first defensing line against pathogens. In order to evaluate the association between the Neutrophil to Lymphocyte Ratio, and the prognosis of the burn injurie, the investigation was performed. Methods: . A descriptive, longitudinal, prospective investigation was developed at the Burn Unit of Calixto García Hospital, from January 2022nd to December 2022nd. All severely burned patients admitted, with ages between 19 and 60 years old, and less than 24 hours from the onset of the accident were included. Patients suffering from chronic conditions were excluded. To determinate the levels of Neutrophil to Lymphocyte Rates, blood samples were taken at the first 72 hours after injury and during the 6th day. A relationship between the levels of Neutrophil to Lymphocyte Ratio, and the prognosis of the trauma was established. Of a total of 134 patients admitted, 36th were included. Results: Male patients were the majority. Fire the main etiological agent, and accidents the first production mode. High levels of Neutrophil to Lymphocyte Ratio were detected since the first 72 hours after trauma, and stayed high during the 6th day of evolution. Patients with poorest life prognosis, showed higher levels of Neutrophil to Lymphocyte Ratio. Conclusion: A direct relationship was found between the levels of Neutrophil- to Lymphocyte Ratio and the severity of the burn injury, and the survival rate.

RESUMEN Introducción: Las quemaduras son lesiones devastantes que se asocian a alta morbilidad y mortalidad. Se produce desbalance inmunológico, afectando los leucocitos, primera línea de defensa ante cualquier noxa, fundamentalmente los neutrófilos y linfocitos. Con el objetivo de evaluar el Índice Neutrófilos-Linfocitos en los lesionados severamente quemados, se realiza éste estudio. Método: . Estudio descriptivo, longitudinal y prospectivo, en el servicio de Caumatología del Hospital Universitario Calixto García, desde enero 2022 a diciembre 2022.Se incluyó a todos los ingresados clasificados como Grandes Quemados, con menos de 24 horas de evolución de la lesión, entre 19 a 60 años. Se excluyó a pacientes con enfermedades crónicas no transmisibles descompensadas. Se tomaron muestras de sangre venosa a las 72 horas y al 6to día post trauma, para determinar valores de Índice Neutrófilos Linfocitos. Se relacionaron dichos valores con el estado al egreso y con el Pronóstico de Vida. De un total de 134 ingresados, 36 cumplieron los criterios de inclusión. Resultados: . Predominaron los lesionados masculinos, el fuego directo el principal agente causal, y los accidentes prevalecieron sobre otros mecanismos de producción. El Índice Neutrófilos Linfocitos se elevó desde las primeras 72 horas de evolución, con valores mayores en los lesionados con peor pronóstico de vida, y en los egresados fallecidos. Conclusión: . Existió una asociación lineal entre los valores de Índice Neutrófilos/Linfocitos en lesionados egresados vivos y los que fallecieron, así como relación directamente proporcional con la gravedad de la lesión.

Resumen Establecer la prevalencia de lesiones de la mucosa oral y variaciones de lo normal en una población de adultos mayores. Estudio observacional en 156 participantes de Los Guido (San José, Costa Rica) del 2015 a 2016. Se evaluaron y analizaron de forma descriptiva y cualitativa información sociodemográfica, factores de riesgo, comorbilidad y exploración clínica. Los hallazgos en mucosa oral afectaron preferentemente a las mujeres (n=111; 71%), el rango de edad entre 60 y 69 años (n=65; 42%) y con el tabaco como factor de riesgo (n=67; 43%) e hipertensión arterial (n=101; 65%). Los hallazgos intraorales se presentaron preferentemente de forma conjunta variaciones de lo normal y patologías (n=71; 46%), predominantemente una variación de lo normal (n=67; 33%) y una patología (n=51; 43%). Las variaciones de lo normal más prevalentes fueron lengua saburral, várices linguales y amígdalas criptodónticas. Las enfermedades infecciosas (n=33; 21%), los desórdenes potencialmente malignos (n=30; 19 %) e injurias físicas y químicas (n=18; 12%) fueron los grupos más prevalentes. Las cuatro lesiones más predominantes fueron estomatitis protésica, queilitis actínica, queratosis friccional y glositis atrófica. No hubo diferencia estadísticamente significativa (p=0.392) al comparar la proporción de frecuencia por sexo. Las variaciones de la anatomía normal predominaron; siendo en forma individual la lengua saburral la más frecuente; de las patologías destacaron las enfermedades infecciosas principalmente la estomatitis protésica. Existe poca información en esta área en Costa Rica, es importante generar más estudios que permitan contribuir con la salud oral de la población adulta mayor.

Abstract To establish the prevalence of oral mucosal lesions and normal variations in a population of older adults. This observational study was conducted from 2015 to 2016 and involved 156 participants from Los Guido (San José, Costa Rica). The participants’ sociodemographic information, risk factors, comorbidity, and clinical examination were evaluated and analyzed descriptively and qualitatively. Findings in oral mucosa were found to preferentially affect women (n=111; 71%) and individuals between the ages of 60 and 69 years (n=65; 42%), having smoking as a risk factor (n=67; 43%), and suffering from arterial hypertension (n=101; 65%). Intraoral findings were mainly presented together with variations from normal and pathology (n=71; 46%), predominantly one variation from normal (n=67; 33%) and one pathology (n=51; 43%). The most prevalent normal variations were the saburral tongue, lingual varicose veins, and cryptic tonsils. Infectious diseases (n=33; 21%), potentially malignant disorders (n=30; 19%), and physical and chemical injuries (n=18; 12%) were the most prevalent groups. The four most predominant lesions were prosthetic stomatitis, actinic cheilitis, frictional keratosis, and atrophic glossitis. The differences in pathological groups were not statistically significant (p=0.392) when comparing the frequency ratio by sex. Variations of the normal anatomy are the predominant ones, the saburral tongue being the most prevalent individually; among the pathologies, the most remarkable group was the infectious diseases, and prosthetic stomatitis was the most frequent. The information about this subject in Costa Rica is limited. So it is important to conduct more studies that contribute to the oral health of the elderly population in this area.

Abstract From the perspective of critical animal studies, this text explores the political potential of photographs and films depicting “horror” or containing strong representations of animal pain and suffering. These images are disseminated through social networks on the Internet by various organizations and individuals interested in promoting veganism. This exploration is guided by concepts and reflections present in the works of Didi-Huberman, Rancière, and Sontag, each approaching the political role of images in genocidal historical processes from different perspectives. In doing so, this study critically engages with notions of animal pain and suffering, and connects some of these arguments with animal exploitation. The aim is not only to shed light on questions regarding the political function of images and the gaze in the human-animal relationship, but also to analyze the common structures of thought underlying both material and symbolic violence directed at both human and non-human animals.

Resumen Desde el enfoque de los estudios críticos animales, el texto aborda el potencial político de las fotografías y los audiovisuales del “horror”, o con un fuerte contenido de dolor y sufrimiento animal, difundidas a través de redes sociales en internet por las diversas organizaciones e individuos interesados/as en promover los veganismos, a la luz de ciertos conceptos y reflexiones presentes en Didi-Huberman, Rancière y Sontag, quienes, desde diferentes perspectivas, se ocupan del lugar político de las imágenes en procesos históricos genocidas. Para esto me acerco críticamente a las nociones de dolor y sufrimiento animal y entrecruzo algunos de los argumentos citados con el campo de la explotación animal, con el fin de no solo de iluminar las preguntas sobre el rol político de las imágenes y la mirada en la relación humano-animal, sino también problematizar aquellas estructuras comunes de pensamiento a la base de la violencia material y simbólica tanto hacia los animales humanos como los no humanos.