RESUMEN Theobroma cacao (cacao) en República Dominicana es uno de los principales rubros de exportación, registrando un crecimiento sostenido en los últimos cinco años. Son más de 36.000 productores en el país, beneficiando indirectamente a más de 300 mil personas. El país tiene un gran potencial para la producción de cacao, pero debido a la falta de fertilización de las plantaciones combinado con la falta de información sobre el aporte de nutrientes provenientes de la mineralización de biomasa en los sistemas de producción, se presentan bajos rendimientos. El estudio se desarrolló en la provincia Duarte en el período de julio 2016 a junio 2017, con el objetivo de cuantificar la producción de biomasa en cuatros sistemas agroforestales: cacao en monocultivo (C), cacao más Erythrina spp. (C+ Am), cacao más Persea americana (C+Ag), y cacaos más cítricos (C+Ci). Se usó un diseño experimental en arreglo multifactorial 4x15x12: con cuatro sistemas agroforestales, en quince localidades y doce fechas de muestreo, donde se consideró a cada finca como una repetición. Se instalaron cuatro trampas de tubo y maya de saco por finca, con un área de 1 m2. La biomasa promedio por ubicación y fecha se analizó mediante análisis de varianza y prueba de Duncan (P=0,05 %). La mayor producción promedio de biomasa se obtuvo en C+Am con 49,3 T ha-1año-1 (41,08 % del total). Le siguió el sistema C con 27,02 T ha-1año-1, C+Ag con 22,2 T ha-1año-1 y C+Ci con 17,2 T ha-1año-1. La producción neta anual fue de 120 T ha-1año-1, siendo 115,2 T ha-1año-1 atribuible a la especie en estudio, y 4,2 T ha-1año-1 a otras especies. Los valores demuestran una alta producción de biomasa en los sistemas agroforestales asociados al cacao.

RESUMO O cacau (Theobroma cacao L.) na República Dominicana é um dos principais itens de exportação, registrando crescimento sustentado nos últimos cinco anos. São mais de 36 mil produtores no país, beneficiando indiretamente mais de 300 mil pessoas. O país tem grande potencial para a produção de cacau, mas devido à falta de fertilização das plantações aliada à falta de informações sobre a contribuição dos nutrientes provenientes da mineralização da biomassa nos sistemas de produção, ocorrem baixos rendimentos. O estudo foi desenvolvido na província Duarte no período de julho de 2016 a junho de 2017, com o objetivo de quantificar a produção de biomassa em quatro sistemas agroflorestais: cacau em monocultura (C), cacau mais papoula (Erythrina spp. Walp.) (C+ Am ), cacau mais abacate (Persea Americana Mill.) (C+Ag) e cacau mais cítricos (C+Ci). Foi utilizado um delineamento experimental em arranjo multifatorial 4x15x12: com quatro sistemas agroflorestais, em quinze localidades e doze datas de amostragem, onde cada fazenda foi considerada uma repetição. Foram instaladas quatro armadilhas com tubo de PVC e tela de saco por fazenda, com área de 1 m2. A biomassa média por local e data foi analisada por análise de variância e teste de Duncan (p=0,05 %). A maior produção média de biomassa foi obtida em C+Am com 49,3 T/ha/ano (41,08 % do total). Seguiu-se o sistema C com 27,02 T/ha/ano, C+Ag com 22,2 T/ha/ano e C+Ci com 17,2 T/ha/ano. A produção líquida anual foi de 120 T/ha/ano, sendo 115,2 T/ha/ano atribuíveis às espécies em estudo e 4,2 T/ha/ano às demais espécies. Os valores demonstram uma elevada produção de biomassa nos sistemas agroflorestais associados ao cacau.

ABSTRACT Theobroma cacao (cocoa) in the Dominican Republic is one of the main export items, registering a sustained growth in the last five years. There are more than 36,000 producers in the country, indirectly benefiting more than 300 thousand people. The country has great potential for cocoa production, but due to the lack of fertilization of the plantations combined with the lack of information on the contribution of nutrients from the mineralization of biomass in the production systems, low yields are presented. The study was carried out in the Duarte province in the period from July 2016 to June 2017, with the objective of quantifying the biomass production in four agroforestry systems: cocoa in monoculture (C), cocoa plus Erythrina spp (C+ Am), cocoa plus Persea americana (C+Ag ), and cocoa plus citrus (C+Ci). A multifactorial experimental design 4x15x12 was used: with four agroforestry systems, in fifteen locations and twelve sampling dates, where each farm was considered as a replicate. Four pipe and sack mesh traps were installed per farm, with an area of 1 m2. The average biomass by location and date was analyzed by analysis of variance and Duncan test (P = 0.05 %). The highest average biomass production was obtained in C + Am with 49.3 T ha-1 year-1 (41.08% of the total). It was followed by system C with 27.02 T ha-1 year-1, C + Ag with 22.2 T ha-1 year-1 and C + Ci with 17.2 T ha-1 year-1. The annual net production was 120 T ha-1 year-1, of which 115.2 T ha-1 year-1 was attributable to the species under study, and 4.2 T ha-1 year-1 to other species. The values demonstrate a high biomass production in agroforestry systems associated with cocoa.

Abstract: The functions that guarantee or control courts must fulfill in adversarial accusatory models are crucial for the proper protection of the rights and guarantees of all participants, especially the defendant and the accused. These functions are critical to the debates regarding the appropriateness of personal precautionary measures and require the judge to strictly observe the principles governing such measures and to justify how these principles are applied in each case. Supervisory courts must define and clearly state the standards required for each type of personal precautionary measure requested by the litigants and must reproduce in their rulings the criteria employed and the reasoning used to either confirm or dismiss the requirements of the personal precautionary measures, such as their material prerequisites and the necessity for caution

Resumen: Las funciones que los tribunales de garantía o de control deben cumplir en los modelos acusatorios de corte adversarial son fundamentales para la debida protección de los derechos y las garantías de todos los intervinientes, en especial del imputado y el acusado. Estas funciones resultan críticas para los debates en torno a la procedencia de las medidas cautelares personales y suponen por parte del juez la estricta observancia de los principios que regulan tales medidas y la fundamentación acerca del modo en que estos principios son aplicados en cada caso. Los tribunales de garantía deben definir y explicitar los estándares exigibles para cada tipo de medida cautelar personal solicitada por los litigantes, y reproducir en sus resoluciones los criterios empleados y los fundamentos utilizados para dar por acreditados o desestimados los requisitos de las medidas cautelares personales, como son los presupuestos materiales de estas y la necesidad de cautela

Resumo: As funções que os tribunais de garantias ou de controle devem cumprir nos modelos acusatórios de corte adversarial são fundamentais para a devida proteção dos direitos e garantias dos intervenientes, especialmente do imputado e do acusado. Essas funções são críticas para os debates sobre a procedência das medidas cautelares pessoais e implicam, por parte do juiz, a estrita observância dos princípios que regulam tais medidas e a fundamentação sobre a maneira como esses princípios são aplicados em cada caso. Os tribunais de garantia devem definir e explicitar os padrões exigíveis para cada tipo de medida cautelar pessoal solicitada pelos litigantes, e reproduzir em suas resoluções os critérios empregados e os fundamentos utilizados para considerar comprovados ou rejeitados os requisitos das medidas cautelares pessoais, como são os pressupostos materiais dessas medidas e a necessidade de cautela

Abstract Background: Ascending aortic aneurysms are rare pathologies in childhood, especially in the absence of previous diseases such as Marfan syndrome. Objective: Present the possibility of successful endovascular management of large vessel aneurysms, using stents and microcatheters with embolization of the aneurysm sac. Method: We present the case of a previously healthy ten-year-old patient, in whom a pseudoaneurysm was documented between the origin of the left common carotid artery and left subclavian artery, successfully managed endovascularly, initially with a stent covering the neck of the aneurysm to remodel it and later with embolization of the aneurysm sac using a microcatheter. Results: Aneurysms of large vessels, such common carotid artery and subclavian artery, are at risk of rupture with devastating complications; endovascular management is considered a minimally invasive management option, with favorable results. Conclusion: The endovascular management of large vessel aneurysms using stents and microcatheters with embolization of the aneurysmal sac is a novel management option that achieves successful results.

Resumen Antecedentes: Los aneurismas de la aorta ascendente son patologías poco frecuentes en la infancia, sobre todo en ausencia de enfermedades previas como el síndrome de Marfan. Objetivo: Dar a conocer la posibilidad del manejo endovascular exitoso de los aneurismas de grandes vasos, usando stent y micro catéter con embolización del saco aneurismático. Método: Presentamos el caso de una paciente de 10 años y 2 meses, previamente sana, en quien se documentó un pseudoaneurisma entre el origen de la arteria carótida común izquierda y la arteria subclavia izquierda, que logró manejarse de forma endovascular, inicialmente con un stent cubriendo el cuello del aneurisma con el fin de remodelarlo y posteriormente por medio de microcatéter se realizó embolización del saco del aneurisma con coils, con resultado exitoso. Resultados: Los aneurismas de los grandes vasos, como la arteria carótida común y la arteria subclavia, tienen riesgo de ruptura con complicaciones devastadoras; el manejo endovascular se plantea como una opción poco invasiva de manejo, con resultados favorables. Conclusión: El manejo de aneurismas de grandes vasos, por vía endovascular usando stent y microcatéter con embolización del saco aneurismático, es una opción novedosa de manejo que logra resultados exitosos.

RESUMEN Introducción: El estudio aborda la formación espontánea de competencias quirúrgicas, a través de un currículo estructurado en habilidades y técnicas quirúrgicas. Se asume la competencia como configuración psicológica que garantiza la obtención de un resultado compartido por un grupo social. Objetivo: Describir de forma parcial el proceso espontáneo en residentes de Cirugía General, según sus opiniones y percepciones individuales, para identificar potencialidades y limitaciones que permitan construir otro proceso en el que el desarrollo de dichas competencias sea intencional. Métodos: Se sigue un enfoque cuantitativo con un alcance descriptivo. Se aplican tres encuestas a 21 residentes de Cirugía General, acerca de 12 competencias definidas de forma preliminar. Resultados: Se obtuvieron criterios que infieren en el proceso espontáneo supuesto, así como potencialidades y debilidades que permiten su mejora futura. Conclusiones: Se reveló la formación de competencias quirúrgicas de forma espontánea, aun cuando se sigue un currículo estructurado en habilidades y técnicas quirúrgicas. Se extrajeron regularidades didácticas que permitieron trazar pautas para futuras investigaciones.

ABSTRACT Introduction: The study addresses the spontaneous formation of surgical competences through a structured curriculum in surgical competences and techniques. Competence is assumed as a psychological configuration that guarantees obtaining a result shared by a social group. Objective: To partially describe the spontaneous process in general surgery residents, considering their individual opinions and perceptions, to identify potentialities and limitations that allow the construction of another in which the development of these competences is intentional. Methods: A quantitative approach is followed with a descriptive scope. Three surveys are applied to 21 General Surgery residents, regarding twelve previously defined competences. Results: Criteria were obtained that infer the supposed spontaneous process, as well as potentialities and weaknesses that allow its future improvement. Conclusions: The formation of surgical skills was revealed spontaneously, even when a structured curriculum in surgical competences and techniques is followed. Didactic regularities were extracted that allowed to draw up guidelines for future research.

Abstract This article reconstructs the action “AIDS: for love, use a condom” carried out by a group of artists and activists in Buenos Aires in 1994 when Argentina was approaching the historical peak of mortality and transmission of this epidemic. The action consisted of massive graffiti on the walls of the city. It was aimed at counteracting the state discourse of the first prevention campaigns, marked by a frightening tone regarding sexuality, the lack of mention of the use of condoms to avoid the transmission of HIV/AIDS, and the pressure of the Catholic Church. Methodologically, interviews were conducted with the organizers, and personal archives, journalistic material, and official documents (laws, parliamentary bills, epidemiological bulletins) were used. In conclusion, it is pointed out that this experience made it possible to move different dimensions of the public sphere: the urban space, the dominant discourse, and the State’s response. Likewise, the analysis of this action seeks to contribute to the debates on the relationship between emotions and politics. AIDS “AIDS love condom 199 epidemic city campaigns sexuality HIVAIDS HIV HIV/AIDS Church Methodologically organizers archives material laws, laws (laws bills bulletins used conclusion sphere space States State s response Likewise politics 19 1

Resumo Este artigo reconstrói a ação “AIDS: por amor, use camisinha”, realizada por um grupo de artistas e ativistas em Buenos Aires, em 1994, quando a Argentina se aproximava ao pico histórico de mortalidade e transmissão dessa epidemia. A ação consistiu em uma ação massiva de grafite nos muros da cidade e teve como objetivo contrapor o discurso estatal das primeiras campanhas de prevenção, que era marcado por um tom de medo em relação ao exercício da sexualidade, pela falta de menção ao uso de preservativos para evitar a transmissão do HIV/AIDS e pela pressão da Igreja Católica. Metodologicamente, foram realizadas entrevistas com os organizadores, utilizados arquivos pessoais, material jornalístico e documentos oficiais (leis, projetos parlamentares, boletins epidemiológicos). Como conclusões, destaca-se que essa experiência permitiu movimentar diferentes dimensões da esfera pública: o espaço urbano, o discurso dominante, a resposta do Estado. Da mesma forma, a análise dessa ação busca contribuir para os debates sobre a relação entre afeto e política. AIDS “AIDS amor camisinha, camisinha , camisinha” Aires 1994 epidemia prevenção sexualidade HIVAIDS HIV Católica Metodologicamente organizadores pessoais leis, leis (leis parlamentares epidemiológicos. epidemiológicos . epidemiológicos) conclusões destacase destaca pública urbano dominante Estado forma política 199 19 1

Resumen Este artículo reconstruye la acción “SIDA: por amor usá preservativo” realizada por un grupo de artistas y activistas en Buenos Aires en 1994, cuando Argentina se aproximaba al pico histórico de transmisión y mortalidad por esta epidemia. La acción consistió en una masiva grafiteada en paredes de la ciudad y tuvo por objeto contrarrestar el discurso estatal de las primeras campañas de prevención, signado por el tono atemorizante en torno al ejercicio de la sexualidad, la falta de mención al uso del preservativo para evitar la transmisión del VIH/sida y la presión de la Iglesia Católica. Metodológicamente, se realizaron entrevistas a organizadores, se recurrió a archivos personales, material periodístico y documentos oficiales (leyes, proyectos parlamentarios, boletines epidemiológicos). Como conclusiones se señala que esta experiencia posibilitó conmover diferentes dimensiones de lo público: el espacio urbano, el discurso dominante, la respuesta del Estado. Asimismo, el análisis de esta acción busca abonar a los debates atentos a la relación entre afectos y política. SIDA “SIDA 1994 epidemia prevención sexualidad VIHsida VIH sida Católica Metodológicamente organizadores personales leyes, leyes (leyes parlamentarios epidemiológicos. epidemiológicos . epidemiológicos) público urbano dominante Estado Asimismo política 199 19 1

ABSTRACT Objective: To analyze the perception of renal nurses in Spain regarding the organizational environment for evidence-based clinical practice (EBCP), and to determine what professional and context factors influence such perception. Material and Method: A cross-sectional observational multicenter study was carried out in 15 nephrology services from different Spanish hospitals and 2 dialysis centers. The Practice Environment Scale of Nursing Work Index (PES-NWI) and Evidence-Based Practice Questionnaire (EBPQ) tools were used. A descriptive, bivariate statistical analysis (ANOVA, Kruskall-Wallis) and logistic regression were performed with the EBPQ total score as the dependent variable. Results: A total of 397 surveys were received (participation rate: 84.28%), and after processing the surveys 382 were valid (81.1% of the population): 82.7% were women, with a mean age of 42 years, a mean of 18.2 years of professional experience as a nurse (12.2 years in nephrology), 94.8% were clinical nurses, and 81.9% worked in hemodialysis. The average PES-NWI score was 62.35±15.10 (95% CI:60.78-48.06). Nurses in centers with more than 500 nurses, those who worked in hemodialysis, and those with more than 11 years of professional experience had lower scores on some PES-NWI factors. Nurse managers had higher scores in all PES-NWI factors. The average EBPQ score was 81.05±21.92 (95% CI:78.70-83.4). Nurses with less professional experience the better PES-NWI scores; also, postgraduate nurses had higher scores on several EBPQ factors. Conclusions: Factors that most influence the perception of Spanish renal nurses are professional experience, role within the organization, a favorable context, and postgraduate education.

RESUMEN Objetivo: Analizar la percepción de las enfermeras renales en España en relación con el entorno organizacional para la práctica clínica basada en la evidencia (PCBE); y determinar qué factores profesionales y del contexto influyen en esta percepción. Material y Método: Estudio observacional transversal multicéntrico, en 15 servicios de nefrología de distintos hospitales en España y 2 centros de diálisis. Se utilizaron los instrumentos Practice Environment Scale of Nursing Work Index (PES-NWI) y Evidence Based Practice Questionnarie (EBPQ). Se realizó un análisis estadístico descriptivo, bivariado (ANOVA, Kruskall-Wallis), y regresión logística con la puntuación total del EBPQ como variable dependiente. Resultados: Se recibieron 397 encuestas (participación 84,28%), tras depuración encuestas, fueron válidas 382 (81,1% población): 82,7% mujeres, edad media 42 años, media de experiencia profesional como enfermera 18,2 años (12,2 años en nefrología), 94,8% clínicas, 81,9% de hemodiálisis. Puntuación media PES-NWI 62,35±15,10 (IC 95%: 60,78-48,06). Presentaron menores puntuaciones en algunos factores del PES-NWI las enfermeras de centros >500 enfermeras, que trabajan en hemodiálisis y >11 años de experiencia profesional. Las enfermeras gestoras presentaron mayores puntuaciones en todos los factores del PES-NWI. Puntuación media EBPQ 81,05±21,92 (IC 95%: 78,70-83,4). Presentaron mayores puntuaciones en varios factores del EBPQ las enfermeras con menor experiencia profesional, mejor puntuación en PES-NWI y que poseían estudios de postgrado. Conclusiones: Los factores que más influyen en la percepción de las enfermeras renales en España son la experiencia profesional, el rol dentro de la organización, un contexto favorable y la formación de postgrado.

Abstract: Background and Aims: Ricciocarpos natans is one of the few species of truly aquatic hepatics. It has a subcosmopolitan distribution and appears to be more common in temperate areas. The species has been considered to be very rare in Central America where it was known only from Panama. The objective of this study is to report the presence of this species in Costa Rica and to survey its current distribution in Latin America. Methods: We provide an overview of the distribution of the floating aquatic liverwort Ricciocarpos natans in Latin America based on literature, herbarium specimens and unequivocal photographic records across the region, as well as field work in Costa Rica. Key results: Ricciocarpos natans is reported as new for Costa Rica. We provide the most complete survey to date of the geographic distribution of the species in Latin America. Conclusions: Our survey shows that Ricciocarpos natans appears to be more common and widely distributed in the Neotropics than previously assumed. Its assumed rarity seems to be the result of insufficient collection efforts.

Resumen: Antecedentes y Objetivos: Ricciocarpos natans es una de las pocas especies de hepáticas verdaderamente acuáticas. Tiene una distribución subcosmopolita y parece ser más común en áreas templadas. La especie ha sido considerada muy rara en América Central, donde solo se conocía de Panamá. El objetivo de este estudio es reportar la presencia de esta especie en Costa Rica y revisar su distribución en América Latina. Métodos: Brindamos una descripción general de la distribución de la hepática acuática flotante Ricciocarpos natans en América Latina con base en la literatura, especímenes de herbario y registros fotográficos inequívocos en toda la región, así como trabajo de campo en Costa Rica. Resultados clave: Ricciocarpos natans se reporta como nueva para Costa Rica. Brindamos el estudio más completo hasta la fecha de la distribución geográfica de la especie en América Latina. Conclusiones: Nuestro estudio muestra que Ricciocarpos natans parece ser más común y más ampliamente distribuida en el Neotrópico de lo que se suponía anteriormente. Su supuesta rareza parece ser el resultado de esfuerzos de recolección insuficientes.

Abstract One century after the first drive tour to detect the effects of urbanization on the local climate (Vienna, Austria, 1927; Karlsruhe, Germany, 1929), the method is still valid, as evidenced by recent research mentioned throughout this article. This method was applied in two data recording campaigns in eastern Mexico: June to September 2012 in a coastal city (Coatzacoalcos, 320 thousand inhabitants) and August to November 2018 in a mountainous site (Emiliano Zapata, 20 thousand inhabitants). In both campaigns, the urban heat island (ICU, for its acronym in Spanish) was detected within the urban canopy, whose intensity depended on the type of surface and the dominant atmospheric circulation systems at the time of data recording. The peak ICU intensity at the coastal site is 8.7 °C in the daytime and 3 °C at night, while it is up to 1.9 °C at the mountainous site. The tours included the urban area and its periphery, with temperature recorded at points representative of the different surfaces or land uses. Gasoline motor vehicles were used. The data recording equipment was calibrated before the campaigns and installed as far away from the engine as possible to avoid data biased by the heat emitted by the engine. Sensors were set to record data at 1-minute intervals. At each recording point, a 10-minute waiting time was allowed to stabilize sensors; then, the temperature corresponding to minute 10 was recorded. We used a HOBO U10-003 data logger in Coatzacoalcos and a Kestrel 4500 portable meteorological station in Emiliano Zapata. Data were recorded outside of the hours when minimum and maximum temperatures occur because around them it is impossible to identify a clear trend to nighttime or evening cooling or morning warming - a trend necessary to know to reproduce simultaneous thermal measurements. In both sites, the temperatures recorded were corrected according to the thermal trend during tours and altitudinal differences between recording points. Eighteen and ten tours were driven for coastal and mountainous sites, respectively. Various weather conditions were considered, for example, clear or partly cloudy skies prior to a cold front or a tropical wave. From the results, it is inferred that the type of surface, the meteorological events during data recording, and the size of the urban area are key factors determining ICU intensity. At the coastal site, an anticyclone seems to promote the development of the ICU, except for significant meteorological disturbances that induce a weak ICU (thermal differences less than 2 °C). Although the mountainous site, Emiliano Zapata, has an area and population 1:10 relative to the coastal site, it does have an ICU, with a higher temperature in the central urban area, compared to its surroundings where vegetated areas predominate. The average ICU intensity is weak, 1.5 ºC. It is worth mentioning that the analysis of atmospheric temperature alone is limited because multiple additional factors, such as wind, atmospheric humidity, and anthropogenic heat emissions, influence the ICU genesis and evolution. Based on the results and experience gathered in this study, we recommend continuing data recording efforts to extend the ICU study period and include other seasons of the year to have a more detailed characterization. While driving tours have proven to be a suitable method for ICU recording in urban areas, setting a relatively dense network of fixed rooftop stations may improve the analysis and yield at least two ICU detection levels (within the urban canopy through drive tours and above it by fixed stations). Infrared satellite images could supplement the analysis to represent the phenomenon at three levels: ground, canopy, and above-canopy.

Resumen A casi un siglo del primer recorrido en vehículo para detectar efectos de la urbanización en el clima local (Viena, Austria, 1927; Karlsruhe, Alemania, 1929) el método sigue vigente como lo evidencian investigaciones recientes. El presente trabajo recupera datos de temperatura atmosférica de dos campañas de mediciones mediante trayectos vehiculares en el oriente de México: de junio a septiembre de 2012 en una ciudad costera (Coatzacoalcos, 320 000 habitantes) y de agosto a noviembre de 2018 en un asentamiento montañoso (Emiliano Zapata, 20 000 habitantes). En ambas campañas se detectó la presencia de la isla de calor urbana, cuya intensidad resultó dependiente del tipo de superficie y de los sistemas de circulación atmosférica predominantes al momento de las mediciones. La intensidad máxima de la isla de calor urbana diurna en el sitio costero es de 8.7 °C y de 3 °C en el periodo nocturno, mientras que en el sitio montañoso fue de hasta 1.9 °C. También se mostró que la intensidad de ambas islas de calor urbana excede a lo estimado estadísticamente para ciudades de Latinoamérica en función de la población.

Resumen Introducción: El síndrome de Peutz-Jeghers es una enfermedad hereditaria autosómica dominante poco frecuente, caracterizada por el desarrollo de pólipos en el tubo digestivo, pigmentación mucocutánea y riesgo de desarrollar neoplasias malignas. El objetivo de este estudio fue analizar los datos epidemiológicos, clínicos e histopatológicos de los pacientes con SPJ atendidos en un hospital pediátrico de tercer nivel. Métodos: Se llevó a cabo un estudio observacional retrospectivo, para describir las características epidemiológicas, clínicas, endoscópicas e histopatológicas de los pacientes con SPJ atendidos en un hospital pediátrico de tercer nivel de atención en México. Resultados: Se recopilaron 13 casos con una relación masculino-femenino de 1.16:1. El dolor abdominal fue el principal motivo de consulta, seguido por rectorragia. Los pacientes presentaban pigmentación mucocutánea y pólipos en el tubo digestivo, la mayoría del tipo hamartomatoso, aunque también se hallaron pólipos inflamatorios, hiperplasia folicular y adenomatosos. Dentro de las complicaciones se encontró una alta prevalencia de cirugías de emergencia secundarias a procesos obstructivos abdominales, motivo principal de consulta de primera vez en estos pacientes. Conclusiones: Las principales manifestaciones clínicas fueron pigmentación mucocutánea, dolor abdominal y rectorragia. Ante un cuadro de obstrucción intestinal se debe considerar el SPJ en el diagnóstico diferencial. No se debe excluir el diagnóstico de SPJ si no se evidencian pólipos hamartomatosos en la primera endoscopia. Se debe incluir la valoración nutricional por el riesgo de presentar algún grado de desnutrición.

Abstract Background: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disease characterized by the development of polyps in the gastrointestinal tract, mucocutaneous pigmentation, and the risk of developing malignant neoplasms. This study aimed to analyze the epidemiological, clinical, and histopathological data of patients with PJS treated in a tertiary pediatric hospital. Methods: We conducted a retrospective observational study to describe the epidemiological, clinical, endoscopic, and histological characterization of patients with PJS treated in a tertiary pediatric hospital in Mexico. Results: We included 13 cases with a male-female ratio of 1.16:1. Abdominal pain was the main reason for consultation, followed by rectorrhagia. Patients showed mucocutaneous pigmentation and polyps in the gastrointestinal tract, frequently of the hamartomatous type, although inflammatory polyps, follicular hyperplasia, and adenomatous polyps were also found. Among the complications, there was a high prevalence of emergency surgery secondary to abdominal obstructive processes, the main reason for first-time consultation in these patients. Conclusions: The main clinical manifestations were mucocutaneous pigmentation, abdominal pain, and rectorrhagia. PJS should be included in the differential diagnosis in the presence of intestinal obstruction. The diagnosis of PJS should not be excluded if hamartomatous polyps are not evident on the first endoscopy. Nutritional assessment should be included due to the risk of presenting some degree of malnutrition.

Resumen La transferencia del conocimiento a situaciones cotidianas que contenga información de carácter cuantitativo, denominadas situaciones genéricas, es un indicador de lo que es ser competente en el área de las matemáticas; por ello, los obstáculos que puedan presentarse en la observación y comunicación de dichas situaciones interfieren con la cabal comprensión de las mismas y su posterior traducción al lenguaje matemático. En este documento , fruto de la reflexión sobre nuestra experiencia como docentes de matemáticas, se presenta una alternativa de trabajo a partir de promociones en folletos publicitarios, infografías, gráficos o diagramas publicadas en revistas o diarios que permite, mediante la exploración, comprensión y análisis de la situación planteada, trabajar competencias matemáticas para fortalecer del razonamiento cuantitativo, mostrando un camino metodológico que ayude a los estudiantes a superar la paradoja del lenguaje específico, la cual es vista como un obstáculo para la comunicación y el aprendizaje de las matemáticas.

Abstract The transfer of knowledge to everyday situations containing information of a quantitative nature, called generic situations, is an indicator of what it is to be competent in the area of mathematics; therefore, obstacles that may arise in the observation and communication of such situations interfere with the full understanding of them and their subsequent translation into mathematical language. This document presents an alternative work from promotions in advertising brochures, computer graphics, charts or diagrams published in magazines or newspapers that allows, through exploration, for the understanding and analysis of the situation, to work mathematical skills to strengthen quantitative reasoning, showing a methodological path that will help students overcome the paradox of specific language, which is seen as an obstacle to communication and learning in mathematics.

Abstract INTRODUCTIONSARS-CoV-2 infection can produce endothelial injury and microvascular damage, one cause of the multiorgan failure associated with COVID-19. Cerebrovascular endothelial damage increases the risk of stroke in COVID-19 patients, which makes prompt diagnosis important. Endothelial dysfunction can be evaluated by using transcranial Doppler ultrasound to study cerebral hemodynamic reserve, but there are few of these studies in patients with COVID-19, and the technique is not included in COVID-19 action and follow-up guidelines nationally or internationally. OBJECTIVEEstimate baseline cerebral hemodynamic patterns, cerebral hemodynamic reserve, and breath-holding index in recovered COVID-19 patients. METHODWe conducted an exploratory study in 51 people; 27 men and 24 women 20–78 years of age, divided into two groups. One group comprised 25 recovered COVID-19 patients, following clinical and epidemiological discharge, who suffered differing degrees of disease severity, and who had no neurological symptoms or disease at the time they were incorporated into the study. The second group comprised 26 people who had not been diagnosed with COVID-19 and who tested negative by RT-PCR at the time of study enrollment. Recovered patients were further divided into two groups: those who had been asymptomatic or had mild disease, and those who had severe or critical disease. We performed transcranial Doppler ultrasounds to obtain baseline and post-apnea tests of cerebral hemodynamic patterns to evaluate cerebral hemodynamic reserve and breath-holding indices. We characterized the recovered patient group and the control group through simple descriptive statistics (means and standard deviations). RESULTSThere were no measurable differences in baseline cerebral hemodynamics between the groups. However, cerebral hemodynamic reserve and breath-holding index were lower in those who had COVID-19 than among control participants (19.9% vs. 36.8% and 0.7 vs. 1.2 respectively). These variables were similar for patients who had asymptomatic or mild disease (19.9% vs.19.8%) and for those who had severe or critical disease (0.7 vs. 0.7). CONCLUSIONSPatients recovered from SARS-CoV-2 infection showed decreased cerebral hemodynamic reserve and breath-holding index regardless of the disease’s clinical severity or presence of neurological symptoms. These abnormalities may be associated with endothelial damage caused by COVID-19. It would be useful to include transcranial Doppler ultrasound in evaluation and follow-up protocols for patients with COVID-19.

ABSTRACT Introduction: the revolution in medical training was incorporated into a powerful changing movement for the educational systems of medicine and surgery, which had been occurring since the dawn of the 20th century with the publication of Flexner. It is currently enhanced by research advances in the molecular basis of disease, imaging, instrumentation, nanotechnology, robotic and remote-controlled devices. Objective: to analyze the need to update medical training in the specialty of Surgery by applying the scientific-technical advances that are world references. Methods: a bibliographic review was carried out on the development of competencies in the training of the surgeon, for which several texts were consulted. The following keywords were used: surgery, surgeons, clinical skills, surgical skills, medical education, evaluation process. After reading them, 25 were selected for analysis and preparation of the report: 16 of international authorship and 9 Cubans; with 76% updating and predominance of serial publications. Development: the report was developed from the subtopics: Prevalence of the tutelary model introduced by William Steward Halsted in the training of specialists in Surgery, Relevance of the training of the specialist in Surgery by competencies, Evaluation of competency-based learning, Some definitions of the term competence and On surgical competences in the surgeon's training process, in which positions and diversity of criteria are assumed among the numerous selected authors. Conclusions: the teaching-learning process of the surgeon requires that the integration of abilities and skills be programmed and based on surgical skills, without forgetting clinical skills; all supported by new models of learning and evaluation.

RESUMEN Introducción: la revolución en la formación médica se incorporó a un poderoso movimiento de cambio en los sistemas educativos de la medicina y la cirugía, la cual venía ocurriendo desde los albores del siglo XX con la publicación de Flexner. Está potenciada actualmente con los avances investigativos de las bases moleculares de la enfermedad, la imagenología, instrumentación, la nanotecnología, artefactos robóticos y teledirigidos. Objetivo: analizar la necesidad de actualizar la formación médica en la especialidad de Cirugía aplicando los avances científico-técnicos que constituyen referentes a nivel mundial. Métodos: se realizó una revisión bibliográfica sobre el desarrollo de competencias en la formación del cirujano para lo cual se consultaron varios textos. Se utilizaron como palabras clave: cirugía, cirujanos, competencias clínicas, competencias quirúrgicas, educación médica, proceso de evaluación. Luego de su lectura se seleccionaron 25 para su análisis y conformación del informe: 16 de autoría internacional y 9 cubanos; con un 76 % de actualización y predominio de las publicaciones seriadas. Desarrollo: el informe se desarrolló a partir de los subtemas: Prevalencia del modelo tutelar introducido por William Steward Halsted en la formación de especialistas en Cirugía, Pertinencia de la formación del especialista en Cirugía por competencias, Evaluación del aprendizaje basado en competencias, Algunas definiciones del término competencia y Sobre las competencias quirúrgicas en el proceso de formación del cirujano, en los que se asumen posiciones y diversidad de criterios entre los numerosos autores seleccionados. Conclusiones: el proceso enseñanza aprendizaje del cirujano necesita que la integración de las habilidades y destrezas sea programada y basada en competencias quirúrgicas, sin obviar las competencias clínicas; todo ello apoyado en modelos nuevos de aprendizaje y evaluación.

RESUMO Objetivo: Avaliar a prevalência dos fenótipos eosinofílico e alérgico da asma grave no Brasil e investigar as características clínicas dos pacientes com asma grave no país. Métodos: Estudo transversal com pacientes adultos com diagnóstico de asma grave atendidos em centros especializados no Brasil. O estudo foi realizado em 2019. Resultados: Foram incluídos no estudo 385 pacientes. Destes, 154 apresentavam contagem de eosinófilos no sangue > 300 células/mm3 e 231 apresentavam contagem de eosinófilos no sangue ≤ 300 células/mm3. A mediana da idade foi de 54,0 anos, e a maioria dos pacientes era do sexo feminino, com IMC de 29,0 kg/m2 e história de alergia (81,6%). A prevalência de pacientes com contagem de eosinófilos no sangue > 300 células/mm3 foi de 40,0% (IC95%: 35,1-44,9), e a daqueles com contagem de eosinófilos no sangue > 300 células/mm3 e história de alergia foi de 31,9% (IC95%: 27,3-36,6). A idade e o IMC apresentaram associações positivas com contagem de eosinófilos no sangue > 300 células/mm3 (OR = 0,97, p < 0,0001 e OR = 0,96, p = 0,0233, respectivamente), ao passo que o tempo decorrido desde o início dos sintomas de asma apresentou associação aumentada com contagem de eosinófilos no sangue > 300 células/mm3 (OR = 1,02, p = 0,0011). Conclusões: Este estudo possibilitou a caracterização da população de pacientes com asma grave no Brasil, mostrando a prevalência do fenótipo eosinofílico (em 40% da amostra). Nossos resultados revelam a relevância do fenótipo eosinofílico da asma grave em nível nacional, contribuindo para aumentar a eficácia no manejo da doença e na implantação de estratégias de saúde pública.

ABSTRACT Objective: To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. Methods: This was a cross-sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. Results: A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm3 and 231 had a blood eosinophil count of ≤ 300 cells/mm3. The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m2 and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.1-44.9), and that of those with a blood eosinophil count > 300 cells/mm3 and a history of allergy was 31.9% (95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm3 (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm3 (OR = 1.02, p = 0.0011). Conclusions: This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.

Abstract Acuña-Castillo, R., J. E. Jiménez, L. E. Bezerra-Silva., J. San Gil-León & M. A. Blanco. 2021. Notes on the distribution of Brasenia schreberi (Cabombaceae) in the Neotropics, with a new country record for Costa Rica. Darwiniana, nueva serie 9(2): 364-374. We studied herbarium specimens of Brasenia schreberi from the Neotropics in order to describe the distribution pattern of the species across the region. Also, we report the first records of B. schreberi for Costa Rica. We confirm that B. schreberi has a sporadic pattern of distribution in the region and also in most neotropical countries where it has been collected. For this reason and because of its apparent disappearance from some localities, we recommend B. schreberi to be considered Vulnerable in the Neotropics.

Resumen Acuña-Castillo, R., J. E. Jiménez, L. E. Bezerra-Silva., J. San Gil-León & M. A. Blanco. 2021. Notas sobre la distribución de Brasenia schreberi (Cabombaceae) en el Neotrópico, con un nuevo registro para Costa Rica. Darwiniana, nueva serie 9(2): 364-374. Estudiamos especímenes de herbario de Brasenia schreberi recolectados en el Neotrópico para describir el patrón de distribución de la especie en la región. Además, registramos aquí por primera vez la presencia de B. schreberi en Costa Rica. Podemos confirmar que B. schreberi tiene un patrón de distribución esporádico en la región y también en la mayoría de los países neotropicales donde se ha recolectado. Por esta razón, y por su aparente desaparición de algunas localidades, recomendamos que B. schreberi se considere como Vulnerable en el Neotrópico.

Resumen Tres objetivos guiaron el trabajo: examinar el impacto de la crisis económica en el financiamiento y gasto público en educación en el Perú, 2020-2021; revisar lo actuado en financiamiento y gasto educativo, 1950-2019; y demostrar los beneficios para el país del desarrollo humano junto a las competencias para la vida. Para lograr los dos primeros objetivos, el diseño es no experimental, longitudinal y de tendencia; y el tercer objetivo, transversal. Los datos, en el caso de las finanzas educativas y el PBI del Perú, corresponden al período 1950-2019; las competencias para la vida (años 2012, 2015 y 2018) y los indicadores de educación, salud, economía y social, recolectados de 55 países, durante 2018 o 2019. Las fuentes de información fueron nacionales e internacionales de reconocido prestigio. El tratamiento de los datos se basó en el uso de técnicas estadísticas inferenciales: mínimos cuadrados ordinarios, test de Chow y correlación. Los resultados de la investigación evidencian lo siguiente: primero, las proyecciones revelan una contracción del gasto público en educación al finalizar 2020 y un crecimiento a 2021; segundo, la tensión por definir la fuente (pública o privada) de financiamiento de la educación, el uso del gasto educativo público como instrumento de política económica y superposición, desde 2001, de las competencias para la vida sobre la tasa de escolaridad; y tercero, a partir de la evidencia internacional, los beneficios de las competencias para la vida en el enfoque escuela eficaz. Finalmente, las recomendaciones se formulan para cada conclusión.

Abstract This study examines the impact of the economic crisis on school funding and spending in Peru during 2020-2021 and reviews actions taken in educational expenditure from 1950-2019 and prove that spending on education benefits the country by fostering human development and teaching life skills. The study was non-experimental, longitudinal and analyzed trends in order to achieve the first two objectives and was cross-cutting in order to attain the third objective. Information regarding Peru´s educational finances and GDP for the 1950-2019 period, life skills, education, health, economy and social data for 2012, 2015 and 2018, was based on 2018-2019 data sources from 55 countries from both national and internationally renowned organizations. Data processing was based on inferential statistical techniques including the OLS (Ordinary Least Square) method, Chow Test and correlation. Research results reveal 1) a contraction in public spending on education towards the end of 2020 and growth in 2021; 2) existing tension in defining the source (public or private) of educational funding, public funding on education as an economic policy tool and the overlap of life skills with school enrollment since 2001; 3) Based on international evidence, the benefits of life skills in an effective school approach. Recommendations for each of the aforementioned results are made in the conclusion.