Resumen El embarazo ectópico se considera un problema de salud pública a nivel mundial, se hizo una investigación con el objetivo de establecer los fundamentos acerca del embarazo ectópico y las políticas de salud que se requieren para su mitigación. Esta revisión bibliográfica integrativa incluyó diversos textos, artículos, materiales impresos y digitales relacionados con el embarazo ectópico, consultando además en las bases de datos y directorios: SciELO, LILACS, Latindex, Medline; el proceso se realizó mediante el uso de palabras clave en español, quedando seleccionados 18 artículos publicados entre 1990 y 2023. Desde un enfoque histórico social del embarazo ectópico, se determinó que de la toma de decisiones clínicas oportunas, depende el diagnóstico temprano de esa patología; así como de la identificación de factores de riesgo y la actuación pertinente en consecuencia.

Abstract Ectopic pregnancy is considered a public health problem worldwide. This research aimed to establish the foundations of ectopic pregnancy and the health policies required for its mitigation. This bibliographic review included various texts, articles, printed and digital materials related to ectopic pregnancy, consulting databases and directories such as SciELO, LILACS, Latindex, and Medline; through the use of keywords in Spanish, 18 articles published between 1990 and 2023 were selected. Based on a social-historical approach to ectopic pregnancy, it was determined that timely clinical decision-making depends on the early diagnosis of this pathology, the identification of risk factors, and the relevant action accordingly.

RESUMEN El estudio propone evaluar los beneficios sociales de las actividades recreativas en diferentes comunidades mexicanas y resalta su importancia en el fomento de beneficios sociales positivos. Estos hallazgos respaldan la promoción y el desarrollo de programas recreativos en comunidades para mejorar la calidad de vida y el bienestar social. Los resultados revelaron que las actividades recreativas generaban beneficios sociales, como el fortalecimiento de las relaciones sociales, el aumento de la cohesión comunitaria, la mejora de la salud mental y el bienestar general. Además de las diferencias significativas en la percepción de los beneficios sociales según la edad y el nivel socioeconómico de los participantes. Se llevó a cabo un diseño de investigación cualitativo que incluyó la recopilación de datos para obtener una comprensión completa de los efectos sociales de dichas actividades. La muestra de participantes incluyó a niños y jóvenes de diferentes edades y trasfondos socioeconómicos de una colonia del municipio de Huimanguillo, Tabasco, México; quienes participaron en diversas actividades durante un período de cuatro meses. Se utilizaron métodos del nivel teórico y empírico para la labor de muestreo intencional garantizó la representación de una amplia gama de experiencias y perspectivas de las políticas y planificadores urbanos para diseñar programas y espacios recreativos en beneficio de la sociedad.

ABSTRACT The study proposes to evaluate the social benefits of recreational activities in different Mexican communities and highlights their importance in promoting positive social benefits. These findings support the promotion and development of recreational programs in communities to improve quality of life and social well-being. The results revealed that recreational activities generated social benefits, such as strengthening social relationships, increasing community cohesion, improving mental health and general well-being. In addition to the significant differences in the perception of social benefits according to the age and socioeconomic level of the participants. A qualitative research design was conducted that included data collection to gain a full understanding of the social effects of such activities. The sample of participants included children and young people of different ages and socioeconomic backgrounds from a neighborhood in the municipality of Huimanguillo, Tabasco, Mexico; who participated in various activities during a period of four months. Theoretical and empirical methods were used for the purposeful sampling effort, ensuring the representation of a wide range of experiences and perspectives of urban policies and planners to design programs and and planners to design programs and recreational spaces for the benefit of society.

Resumo Introdução: A Revista Portuguesa de Medicina Geral e Familiar (RPMGF) tem acompanhado a evolução da medicina geral e familiar (MGF) em Portugal. A avaliação do seu impacto verifica os artigos e seus autores quanto a referências bibliográficas, sua distribuição geográfica, número de citações de artigos já publicados na RPMGF e avalia a citação de outros artigos nacionais, bem como o tempo entre submissão e aceitação para publicação, comparando com números anteriores da RPMGF. Métodos: Estudo observacional, transversal, das citações dos artigos publicados entre 2016 e 2021 (ambos inclusive), analisando todos os artigos quanto a tipo, número, qualidade e origem geográfica dos autores, número total de referências bibliográficas de artigos já publicados na RPMGF e em Portugal, bem como o tempo entre submissão e edição. Resultados: Analisaram-se 409 artigos, 45,6% de autores da ARS Norte. Para 68,4% houve envolvimento de um especialista de MGF e para 62,7% um interno como autor, sendo 24,8% de autores externos à MGF. O tempo médio de edição foi de 357 dias. A média de referências totais foi de 17,25, de artigos publicados em Portugal de 4,09 e de artigos publicados na RPMGF de 2,20. Verificou-se dinâmica de crescimento de +13,8 (na média de referências portuguesas) e de +32,1 (na média de referências totais) e de 0,0 para as referências da RPMGF. Discussão e Conclusões: A distribuição geográfica dos autores poderá ser um reflexo de realidades formativas diferentes. O tempo de edição parece ser longo para queles que precisam de publicação em tempo curto, o que será fator de não submissão. Os valores de citação mantém-se baixos quanto a referências da RPMGF com dinâmica de crescimento nula. A RPMGF deverá considerar alternativas táticas que levem ao aumento da sua citação em novos trabalhos submetidos.

Abstract Background: The Revista Portuguesa de Medicina Geral e Familiar (RPMGF) has been following the evolution of general and family medicine (GFM) in Portugal. It is important to evaluate the preference of articles and authors about bibliographic references, their geographical distribution, measure the bibliographic citation of articles already published in the RPMGF and evaluate the bibliographic citation of Portuguese articles and the time between submission and acceptance for publication, compared to previous papers in the RPMGF. Methods: Observational and cross-sectional study of citations of articles published between 2016 and 2021 (both inclusive), analyzing all articles in terms of type, number, quality, and geographical origin of authors, the total number of bibliographic references, articles published in Portugal and articles already published in RPMGF and time between submission and editing. Results: A total of 409 articles were analyzed, 45.6% of authors from ARS Norte. For 68.4% there was involvement of a specialist in GFM and for 62.7% an intern was the author, with 24.8% of authors external to the MGF. The average editing time was 357 days. The average of total references was 17.25, of articles published in Portugal 4.09, and of articles published in the RPMGF 2.20. There was a growth dynamic of +13.8 (in the average of Portuguese references), +32.1 (in the average of total references), and 0.0 for the RPMGF references. Discussion and Conclusions: The geographical distribution of the authors reflects territorial inequality, which may reflect different educational realities. The editing time seems to be long for those who need publication in a short time, which could constitute a factor of non-submission. Citation values remain low to RPMGF references and their growth dynamics were null. The journal should consider strategic alternatives that allow an increase in the citation of the RPMGF in support of new works carried out.

ABSTRACT Introduction: Intersectorality still shows potential for perfecting its conceptualization in the managerial and technological context to achieve improvements in programs. Objective: Design and evaluate a strategy for intersectoral technological management improvement, to improve the family medicine program. Methods: A quasi-experimental before and after intervention study was carried out, through an intersectoral improvement strategy. From the universe of 771 health users, a sample of 389 was chosen by proportional stratified sampling; It was made up of 330 from health, 38 community actors and 21 from other sectors. It was carried out in 4 stages: diagnosis, design and validation, implementation and evaluation. The variables were studied: level of knowledge, organizational climate and intersectoral actions. Absolute frequencies and percentages were used for the analysis of qualitative data and the McNemar test for the results of the intervention. Results: The application of the strategy in social practice was pertinent due to the results of the expected effectiveness (9.5). The level of knowledge of professionals improved (92.5%), the organizational climate in the 3 dimensions (8.1, 8.2 and 9.3). 90% (9) of the intersectoral actions were satisfactory with a significant association between the intervention and the results (p= 0.001). Conclusions: The designed strategy optimizes managerial technological intersectorality, and improves the family medicine program in the level of knowledge of professionals, the organizational climate and intersectoral actions.

RESUMEN Introducción: La intersectorialidad aún muestra potencial para el perfeccionamiento de su conceptualización en el contexto gerencial y tecnológico, para alcanzar mejoras en los programas de salud. Objetivo: Diseñar y evaluar una estrategia de perfeccionamiento intersectorial tecnológica gerencial para mejorar el programa de medicina familiar. Métodos: Se realizó un estudio cuasiexperimental de intervención de tipo antes y después, a través de una estrategia perfeccionamiento intersectorial. Del universo de 771 usuarios de la salud se escogió una muestra de 389 por muestreo estratificado proporcional; quedó constituida por 330 de la salud, 38 actores de la comunidad y 21 de otros sectores. Fue realizado en 4 etapas: diagnóstico, diseño y validación, implementación y evaluación. Se estudiaron las variables: nivel de conocimientos, clima organizacional y acciones intersectoriales. Se emplearon frecuencias absolutas y porcentajes para el análisis de los datos cualitativos y la prueba de McNemar para los resultados de la intervención. Resultados: Resultó pertinente la aplicación de la estrategia en la práctica social por los resultados de la efectividad esperada (9,5). Mejoró el nivel de conocimientos de los profesionales (92,5 %), el clima organizacional en las 3 dimensiones (8,1, 8,2 y 9,3). El 90 % (9) de las acciones intersectoriales resultaron satisfactorias con una asociación significativa entre la intervención y los resultados (p= 0,001). Conclusiones: La estrategia diseñada optimiza la intersectorialidad tecnológica gerencial y mejora el programa de medicina familiar en el nivel de conocimiento de los profesionales, el clima organizacional y las acciones intersectoriales.

Abstract: Within the multi-objective (static) optimization field, various works related to the adaptive selection of genetic operators can be found. These include multi-armed bandit-based methods and probability-based methods. For dynamic multi-objective optimization, finding this type of work is very difficult. The main characteristic of dynamic multi-objective optimization is that its problems do not remain static over time; on the contrary, its objective functions and constraints change over time. Adaptive operator selection is responsible for selecting the best variation operator at a given time within a multi-objective evolutionary algorithm process. This work proposes incorporating a new adaptive operator selection method into a Dynamic Multi-objective Evolutionary Algorithm Based on Decomposition algorithm, which we call DMOEA/D-SL. This new adaptive operator selection method is based on a reinforcement learning algorithm called State-Action-Reward-State-Action Lambda or SARSA (λ). SARSA Lambda trains an Agent in an environment to make sequential decisions and learn to maximize an accumulated reward over time; in this case, select the best operator at a given moment. Eight dynamic multi-objective benchmark problems have been used to evaluate algorithm performance as test instances. Each problem produces five Pareto fronts. Three metrics were used: Inverted Generational Distance, Generalized Spread, and Hypervolume. The non-parametric statistical test of Wilcoxon was applied with a statistical significance level of 5% to validate the results.

Abstract: The main contribution of this paper is the implementation of a multi-objective evolutionary algorithm based on decomposition with adaptive adjustment of control parameters applied to the bi-objective problem of Internet shopping (MOEA/D-AACPBIShOP). For this variant of the IShOP, the minimization of the cost and shipping time of the shopping list is considered. The proposed MOEA/D-AACPBIShOP algorithm produces an approximate Pareto set on a total of nine of instances with real-world data classified as small, medium, and large. The instances are obtained using the Web Scraping technique, extracting some information attributes of technological products from the Amazon site. This optimization problem is a very little studied variant of the Internet Shopping Problem (IShOP). The proposed algorithm is compared with two multi-objective algorithms: A Non-dominated Sorting Genetic Algorithm II (NSGA-II) and the basic MOEA/D version. The results demonstrate that the three algorithms studied have a similar statistical performance with respect to the quality of the solutions they provide. To make a comparison, these algorithms are evaluated using three metrics: Hypervolume, Generalized Dispersion, and Inverted Generational Distance. On the other hand, the Wilcoxon and Friedman non-parametric tests validate the obtained results with a 5% significance level.

Abstract Introduction: Syphilis is a notifiable infection, mostly sexually acquired, caused by the bacterium Treponema pallidum. Clinical manifestations vary on the stage of the disease: early syphilis, (primary and secondary disease) and late syphilis (latent or tertiary). The secondary disease is systemic and develops within weeks or a few months, in approximately 1/4 of individuals with untreated primary infection. At this stage, the illness may appear as constitutional symptoms, adenopathies, macular or papular rash including palms and soles, and hepatic, renal, or neurological manifestations, among others. Serologic testing provides a presumptive diagnosis, therefore nontreponemal and treponemal-specific tests are needed for the diagnosis of syphilis. The difficult interpretation of the serologic findings allied to a wide variety of signs and symptoms and an increasing incidence in the last years challenge the diagnosis of this disease. Case description: The authors describe a clinical case of an adult who appears with swollen lower limbs, fatigue, and the perception of abdominal distension. Objectively, exhibits erythematous maculopapular lesions, with peripheral desquamation, non-pruritic, on the palms and soles. After a complete clinical interview, the hypothesis of decompensation of liver disease in the context of secondary syphilis/syphilitic hepatitis is raised and the patient is sent to the Emergency Department, where the infection is confirmed. Comment: This case report demonstrates the challenge of diagnosing syphilis due to the wide variety of clinical manifestations. Once the diagnosis of syphilis, treatment is curable simply with an only-dose injection of penicillin, preventing severe consequences due to systemic disease. In summary, a family doctor must be capable of recognizing this infection and acquainted with the serologic tests that may be used and the recommended treatment.

Resumo Introdução: A sífilis é uma infeção de notificação obrigatória, maioritariamente transmitida por via sexual, causada pela bactéria Treponema pallidum. As manifestações clínicas variam conforme o estadio da doença: sífilis precoce (doença primária e secundária) e sífilis tardia (latente ou terciária). A doença secundária é sistémica e desenvolve-se, após semanas ou meses, em aproximadamente 1/4 dos indivíduos com infeção primária não tratada. Neste estadio, a doença pode manifestar-se através de sintomas constitucionais, adenopatias, erupções cutâneas maculopapulares palmoplantares, manifestações hepáticas, renais ou neurológicas, entre outras. A serologia fornece um diagnóstico presuntivo, sendo necessários testes não treponémicos e treponémicos para estabelecer o diagnóstico de sífilis. A difícil interpretação dos achados serológicos associada a uma grande variedade de manifestações clínicas e a uma incidência crescente nos últimos anos torna o seu diagnóstico um desafio. Descrição do caso: Os autores descrevem o caso clínico de um adulto que apresenta um quadro de edema inaugural dos membros inferiores, cansaço e noção de distensão abdominal. Objetivamente apresenta lesões maculopapulares eritematosas, com descamação periférica, não pruriginosas, nas palmas das mãos e plantas dos pés. Após entrevista clínica completa coloca-se a hipótese de descompensação de doença hepática em contexto de sífilis secundária/hepatite sifilítica e envia-se o doente ao serviço de urgência, onde é confirmada a infeção. Comentário: Este caso demonstra que a grande variedade de manifestações clínicas torna o diagnóstico de sífilis um desafio. Uma vez feito o diagnóstico deve ser instituído tratamento com dose única de penicilina intramuscular, evitando potenciais consequências graves decorrentes da doença sistémica. Em suma, um médico de família deve ser capaz de reconhecer esta infeção, interpretando corretamente os testes serológicos e instituindo o tratamento recomendado.

ABSTRACT Objective. To identify the presence of the SARS-CoV-2 virus in wastewater from hospitals in Peru. Materials and methods. Water samples were collected from the effluents of nine hospitals in Peru during March and September 2022. SARS-CoV-2 was identified by using Illumina sequencing. Variant, lineage and clade assignments were carried out using the Illumina and Nextclado tools. We verified whether the SARS-CoV-2 variants obtained from wastewater were similar to those reported by the National Institute of Health of Peru from patients during the same period and region. Results. Eighteen of the 20 hospital wastewater samples (90%) provided sequences of sufficient quality to be classified as the Omicron variant according to the WHO classification. Among them, six (30%) were assigned by Nextclade to clades 21K lineage BA.1.1 (n=1), 21L lineage BA.2 (n=2), and 22B lineages BA.5.1 (n=2) and BA .5.5 (n=1). Conclusions. SARS-CoV-2 variants were found in hospital wastewater samples and were similar to those reported by the surveillance system in patients during the same weeks and geographic areas. Wastewater monitoring could provide information on the environmental and temporal variation of viruses such as SARS-CoV-2.

RESUMEN Objetivo. Identificar la presencia del virus SARS-CoV-2 en aguas residuales de hospitales en Perú. Materiales y métodos. Se recolectaron muestras de agua en los efluentes de nueve hospitales del Perú durante marzo y septiembre de 2022 y se realizó la identificación de SARS-CoV-2 mediante secuenciación Illumina. Las asignaciones de variantes, linajes y clados se llevaron a cabo con las herramientas Illumina y Nextclado. Verificamos si las variantes de SARS-CoV-2 obtenida de las aguas residuales fueron similares a las reportadas por el Instituto Nacional de Salud del Perú procedentes de pacientes durante el mismo período y región. Resultados. Dieciocho de las 20 muestras de aguas residuales hospitalarias (90%) proporcionaron secuencias con la calidad suficiente para ser clasificadas como variante Ómicron según la clasificación de la OMS. Entre ellos, seis (30%) fueron asignados por Nextclade a los clados 21K linaje BA.1.1 (n=1), 21 L linaje BA.2 (n=2) y 22B linajes BA.5.1 (n=2) y BA.5.5 (n=1). Conclusiones. Se encontraron variantes del SARS-CoV-2 en muestras de aguas residuales hospitalarias y que fueron similares a las reportadas por el sistema de vigilancia en pacientes durante las mismas semanas y áreas geográficas. El monitoreo de aguas residuales podría proporcionar información sobre la variación ambiental y temporal de virus como el SARS-CoV-2.

ABSTRACT Myasis is an ectoparasitic infection caused by human (as well as some domestic and wild animals) tissue and cavity infestation by _Diptera_ larvae, generally flies. This condition is more frequent in tropical areas, and it may also occur in places with deficient sanitary conditions. We present the case of a patient from a tropical area, a farmer who reported exposure to dead animals, wild animals, and flies, in whom forunculoid type cutaneous myasis in the scrotum region was diagnosed, which also had superimposed infection. This patient received therapy with intravenously administered antibacterial agents, a single dose of oral ivermectin. Locally, orifices were occluded with basil. This was followed by the forceps-aided extraction of 20 larvae in two sessions. The patient had good progression. We consider this case is an original contribution, given that genitalia infection by fly larvae is unfrequently reported, even in endemic areas. Two cases of genital myasis have been reported in the national literature: one in a young woman, and the other in an elderly woman. Nonetheless, as far as we know, scrotal myasis has never been reported in Peru.

RESUMEN La miasis es una ectoparasitosis que se produce por la infestación de los tejidos y cavidades de seres humanos, así como de algunos animales domésticos y silvestres, por larvas de dípteros, generalmente moscas. Esta condición es más frecuente en áreas tropicales, aunque también puede presentarse en lugares con condiciones sanitarias deficientes. Presentamos el caso de un paciente procedente de una zona tropical, agricultor, con antecedentes de exposición a animales muertos, animales silvestres y moscas, a quien se le diagnosticó miasis cutánea de tipo forunculoide en la región escrotal sobreinfectada. El paciente recibió tratamiento con antibióticos endovenosos, una dosis única de Ivermectina oral y, a nivel local, se realizó la oclusión de los orificios con albahaca, seguida de la extracción con pinzas de 20 larvas en dos sesiones. La evolución del paciente fue satisfactoria. Consideramos que este caso constituye una contribución original, dado que la infestación genital por larvas de mosca se reporta infrecuentemente, incluso en zonas endémicas. En la literatura nacional, existen dos casos de miasis genital: uno en una mujer joven y otro en una anciana. Sin embargo, hasta donde tenemos conocimiento, no se ha reportado la presencia de miasis escrotal en el Perú.

Resumen Antecedentes La medición de la hemoglobina glucosilada A1c (HbA1c) con un valor por debajo del 7% indica un adecuado control glucémico. Los esquemas farmacológicos están basados en cinco clases terapéuticas. Objetivo Describir los esquemas de tratamiento utilizados y hacer una comparación indirecta de ellos, con respecto al control de la glucosa determinada por la HbA1c, en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos Estudio descriptivo, transversal y retrospectivo, con muestreo sistemático. Fue aprobado con número de registro R-2022-2402-046. Información basada en expedientes entre enero de 2019 y diciembre de 2022. Se incluyeron pacientes con DM2, mayores de 18 años, de ambos sexos, con Hb1Ac reciente, parámetro de control 7% o menos, y con el mismo tratamiento farmacológico por lo menos 3 meses. Se excluyeron pacientes con diabetes mellitus tipo 1 y con diabetes gestacional. Análisis con estadística descriptiva. Resultados Se incluyeron 180 mujeres (64.1%) y 101 hombres (35.9%). Se utilizaron 58 esquemas farmacológicos diferentes. Porcentajes de control de HbA1c: monoterapia 50%, terapia dual 45%, terapia triple 48% y esquema cuádruple 28%. Conclusiones El porcentaje de control glucémico varía según el tipo de tratamiento farmacológico y existe poco uso de fármacos nuevos. El gran número de esquemas utilizados revela que no se estandarizan tratamientos, sino que se considera la individualidad del paciente.

Abstract Background The glicated hemoglobin A1c(HbA1c) measurement, whose value is below 7% indicates adequate glycemic control. The pharmacological regimens are based on five therapeutic classes. Objective Describe the treatment schemes used and make an indirectly compare them concerning glucose control, determined by HbA1c, in patients with type 2 diabetes mellitus (DM2). Materials and methods Descriptive, cross-sectional and retrospective study, with systematic sampling. Registration number R-2022-2402-046 was approved. Information based on records between January 2019 and December 2022. Patients with DM2, over 18 years of age, both sexes, with recent Hb1Ac, control parameter 7% or less and with the same pharmacological treatment for at least 3 months were included. Type 1 and gestational diabetes were excluded. Analysis with descriptive statistics. Results 180 women (64.1%) and 101 men (35.9%) were included. 58 pharmacological regimens were used (58). HbA1c control percentages: monotherapy 50%, dual therapy 45%, triple therapy 48% and quadruple regimen 28% were used. Conclusions The percentage of glucose control varies about the type of pharmacological treatment and there is little use of new drugs. The large number of schemes used reveals not standardizing treatments, but rather considering the individuality of the patient.

ABSTRACT Introduction: ectopic pregnancy is currently a world of health problem. The increase in its incidence is attributed to the difficulties in the diagnosis that are often presented and to the morbidity and mortality that derive from it. It is one of the first causes of death in the first quarter of pregnancy. Objective: assess ectopic pregnancy as a clinical dilemma for diagnosis. Methods: a narrative bibliographic review was carried out that included various texts, articles, printed and digital materials related to ectopic pregnancy. The databases and directories Scielo, Lilacs, Latindex, Medline and Scopus were consulted, through the keywords in Spanish and Bollean operators to expand the results: “Hemorrhages” and “Ectopic pregnancy”. 22 original and review articles were selected, in the national and international context, published between 2000 and 2020. Development: in every nosological illness a good interrogation and a physical examination favor the diagnosis, however difficult it may be. Following the steps of the clinical method helps to obtain an appropriate and timely diagnosis. It is transcendental that the doctor knows the pathophysiology and the clinical elements in ectopic pregnancy, which can go to look in an exquisite interrogation and a detailed physical examination. Conclusions: the diversity of possible clinical presentations has led to "the great simulator of gynecology", so it constitutes a clinical dilemma its diagnosis in the different levels of health care.

RESUMEN Introducción: el embarazo ectópico es en la actualidad un problema de salud a nivel mundial. El aumento de su incidencia se atribuye a las dificultades en el diagnóstico que muchas veces se presentan y a la morbilidad y la mortalidad que de él se derivan. Es una de las primeras causas de muerte en el primer trimestre de la gestación. Objetivo: valorar el embarazo ectópico como un dilema clínico para el diagnóstico. Métodos: se realizó una revisión bibliográfica narrativa que incluyó diversos textos, artículos, materiales impresos y digitales relacionados con el embarazo ectópico. Se consultaron las bases de datos y directorios SciELO, LILACS, Latindex, Medline y Scopus, mediante las palabras clave en español y operadores boléanos para ampliar los resultados: “hemorragias” AND “embarazo ectópico”. Fueron seleccionados 22 artículos originales y de revisión, en el contexto nacional e internacional, publicados entre 2000 y 2020. Desarrollo: en toda enfermedad nosológica un buen interrogatorio y un examen físico favorecen el diagnóstico, por muy difícil que este sea. Seguir los pasos del método clínico ayuda a obtener un diagnóstico certero y oportuno. Es de trascendental importancia que el médico conozca la fisiopatología y los elementos clínicos en el embarazo ectópico, lo que puede ir a buscar en un interrogatorio exquisito y un examen físico detallado. Conclusiones: la diversidad de presentaciones clínicas posibles ha llevado a considerarlo “el gran simulador de la Ginecología”, por lo que constituye un dilema clínico su diagnóstico en los diferentes niveles de atención de salud.

ABSTRACT Introduction: most corrective surgeries in patients with craniosynostosis are performed without major complications; Despite this, there are factors that negatively influence its correct evolution. Objective: to describe the postsurgical complications in patients operated on for craniosynostosis in the Province of Villa Clara. Methods: a retrospective, descriptive cross-sectional study was carried out from January 2018 to December 2022 in the Province of Villa Clara, the study population was made up of all patients operated on for craniosynostosis in the center during this period. The variables studied were the complications presented, the classification of the malformation according to the affected suture, the age at which the surgical intervention was performed, the surgical technique performed and the surgical time used. Results: the main complication was superficial infection of the surgical wound; Complications predominated in patients with scaphocephaly and in those in whom the surgical intervention occurred after 12 months of life. Patients who underwent craniectomy, morcellation and suturectomy as surgical techniques had a higher rate of complications, as did those whose surgical time was greater than one hour and 30 minutes. Conclusions: most complications were mild. The factors associated with the appearance of these complications were scaphocephaly-type deformities, surgical interventions in patients over 12 months of age and the performance, in all patients, of cranial remodeling techniques, which imply a longer surgical time.

RESUMEN Introducción: la mayoría de las cirugías correctivas en pacientes con craneosinostosis se realizan sin complicaciones mayores; a pesar de esto existen factores que influyen negativamente en su correcta evolución. Objetivo: describir las complicaciones postquirúrgicas en pacientes operados de craneosinostosis en la Provincia de Villa Clara. Métodos: se realizó un estudio retrospectivo, descriptivo de corte transversal desde enero de 2018 a diciembre de 2022 en la Provincia de Villa Clara, la población en estudio estuvo compuesta por la totalidad de los pacientes intervenidos de craneosinostosis en el centro durante este período. Las variables estudiadas fueron las complicaciones presentadas, la clasificación de la malformación según la sutura afectada, la edad en que se realiza la intervención quirúrgica, la técnica quirúrgica realizada y el tiempo quirúrgico empleado. Resultados: la principal complicación fue la infección superficial de la herida quirúrgica; las complicaciones predominaron en pacientes con escafocefalia y en los que la intervención quirúrgica ocurrió después de los 12 meses de vida. Los pacientes a los que se les realizaron como técnicas quirúrgicas la craniectomía, la morcelación y la suturectomía presentaron mayor índice de complicaciones, igual que en los que el tiempo quirúrgico empleado fue mayor de una hora y 30 minutos. Conclusiones: la mayoría de las complicaciones fueron leves. Los factores asociados a la aparición de estas complicaciones fueron las deformidades tipo escafocefalia, las intervenciones quirúrgicas en pacientes mayores de 12 meses de edad y la realización, en la totalidad de los pacientes, de técnicas de remodelado craneal, que implican un mayor tiempo quirúrgico.

Resumen Conocer el contenido de biomasa aérea de árboles individuales es importante en los esfuerzos para determinar la contribución de los bosques en el secuestro de carbono. Los datos LiDAR (Light Detection and Ranging) son una alternativa a las imágenes satelitales para estimar características del arbolado. Dada la importancia de los bosques de la vertiente oriental de la Cuenca del ex Lago de Texcoco para la captura de carbono, el objetivo del presente estudio fue evaluar modelos de regresión para la estimación de biomasa aérea en árboles individuales de Pinus hartwegii Lindl. a partir de datos LiDAR. En campo se midió el diámetro normal (Dn), la altura total (AT), altura de fuste limpio (AF) y el diámetro de copa (DC) de 60 árboles. Sobre un conjunto de datos LiDAR aerotransportados se identificaron esos árboles y se midieron las mismas variables (ATL, AFL y DCL, donde la letra L hace referencia a LiDAR), excepto el diámetro normal, ya que no es posible su medición directa con el LiDAR. Para conocer la biomasa aérea de los árboles se usó el Dn y una ecuación alométrica generada previamente por otros autores. Mediante la técnica de regresión se ajustaron siete modelos lineales y cinco no lineales eligiendo aquel con menor raíz del cuadrado medio del error, mayor R2adj y menor valor del criterio de información de Akaike, además de cumplir con los supuestos de regresión. El modelo seleccionado es de tipo exponencial, con las variables ATL y DCL para estimar la biomasa: RMSE = 406.70, R2adj = 0.8107 y AIC = 723.88.

Summary Knowing the aboveground biomass content of individual trees is important in efforts to determine forests contribution to carbon sequestration. LiDAR (Light Detection and Ranging) data are an alternative to satellite images to estimate tree attributes. Considering the importance of forestland on the eastern slopes of the former Texcoco Lake basin for carbon capture, this study aimed to assess regression models for the estimation of above-ground biomass in individual Pinus hartwegii Lindl. trees from LiDAR data. In the field the breast-height diameter (Dn), total height (AT), stem height (AF) and crown diameter (DC) of 60 trees were measured. Those trees were identified on an air-borne LiDAR dataset and the same variables were measured (namely ATL, AFL and DCL, where L stands for LiDAR), except for Dn since it is not possible to measure it directly from LiDAR. Above-ground tree biomass was determined based on Dn and an allometric equation previously developed by other authors. Using the regression technique seven linear and five nonlinear models were adjusted, choosing the one with the lowest mean square root of the error (RMSE), the largest R2adj and the lowest value of the Akaike information criterion, in addition to the compliance of regression assumptions. The selected model is exponential with ATL and DCL variables to estimate biomass: RMSE = 406.70, R2adj = 0.8107 and AIC = 723.88.

ABSTRACT. The communication between doctor and patient is highly relevant as it can influence patients’ health outcomes, their adoption of treatment, their decision to continue or discontinue it, and their satisfaction with the care provided by physicians. On the other hand, defensive medicine encompasses medical attention that does not increase patient benefits and results in the overuse of medical services, driven by the physician’s fear of being sanctioned and/or preventing litigation risks. This research aimed to explore the relationship between the lack of training in communication skills among physicians and defensive medicine. The design was non-experimental, correlational; using a logical deductive method and a quantitative approach. The population studied consisted of physicians from Mexico and Peru, with a sample of 350 professionals (175 from each country). It reaffirmed the importance of training in communication skills for physicians; however, it was evident that a high percentage did not receive such training or received it in a very basic manner. Their behaviors indicated the practice of defensive medicine (although not all were familiar with the concept) and suggested that better communication training could influence a change in attitude.

RESUMEN. La comunicación entre médico y paciente es muy relevante, pues puede influir en los resultados de salud de los pacientes, en la adopción del tratamiento por parte del enfermo, en su decisión por continuar o dejarlo, y en la satisfacción con la atención brindada por los médicos. Por otro lado, la medicina defensiva es toda atención médica que no aumenta los beneficios para el paciente y se traduce en sobreuso de servicios médicos, motivado por el temor del médico a ser sancionado o prevenir riesgos de litigios. Esta investigación planteó explorar la relación entre la ausencia de formación en habilidades comunicacionales en los médicos y la medicina defensiva. El diseño fue no experimental, correlacional, con un método lógico deductivo y un enfoque cuantitativo. La población fueron médicos de México y de Perú, y la muestra estuvo conformada por 350 profesionales (175 de cada país). Se reafirmó la importancia de la formación en habilidades comunicacionales en los médicos; sin embargo, se evidenció que un alto porcentaje no la recibió o la obtuvo de manera muy elemental. Los comportamientos indicaron que sí practican la medicina defensiva (aunque no todos conocían el concepto) y que una mejor formación comunicacional podría incidir en un cambio de actitud.

RESUMO. A comunicação entre médico e paciente é muito relevante, pois pode influenciar nos resultados de saúde dos pacientes, na adoção do tratamento por parte do enfermo, em sua decisão de continuar ou interromper, e na satisfação com a atenção prestada pelos médicos. Por outro lado, a medicina defensiva consiste em toda atenção médica que não aumenta os benefícios para o paciente e resulta no uso excessivo de serviços médicos, motivado pelo medo do médico de ser sancionado e/ou de evitar riscos de litígios. Esta pesquisa buscou explorar a relação entre a falta de formação em habilidades de comunicação nos médicos e a medicina defensiva. O desenho foi não experimental, correlacional; método lógico dedutivo; e abordagem quantitativa. A população foi composta por médicos do México e do Peru, e a amostra foi de 350 profissionais (175 de cada país). A importância da formação em habilidades de comunicação nos médicos foi reafirmada; no entanto, foi evidenciado que uma parcela significativa não a recebeu ou a obteve de maneira muito básica. Os comportamentos indicaram que eles praticam a medicina defensiva (embora nem todos conhecessem o conceito) e que uma melhor formação em comunicação poderia influenciar uma mudança de atitude.

ABSTRACT Introduction: Containment measures by COVID-19 affect lifestyle and social relationships and it is reasonable to expect psychological effects from the thought of becoming infected. In dental practice, psychological reactions have been diverse. Objective: To identify anxiety and risk perception due to the COVID-19 pandemic, as well as the self-efficacy of dental students to take preventive measures. Methods: Cross-sectional study in students of the School of Dentistry of a public university in northeastern Mexico in May 2020 (n = 412). Online data were collected on anxiety, risk perception and self-efficacy on Likert scale and sociodemographic profile. Descriptive statistics and binary logistic regression multivariate analysis were used. Results: Mean age was 21.8 ± 2.8 years; 72.1% were female. Twenty-two out of 100 dental students reported feeling anxious about the COVID-19 pandemic for at least eight days in the last two weeks; risk perception (OR = 2.46, 95%CI 1.75 - 3.48) and being female (OR = 2.23, 95%CI 1.33-3.76) increased the odds of anxiety. While self-efficacy (OR = 0.71, CI95% 0.51 - 0.99) and history of COVID-19 training (OR = 0.63, CI95% 0.4-0.99) decreased them. Conclusions: High risk perception and being of the female sex are associated with a significant increase in COVID-19 anxiety.

RESUMEN Introducción: Las medidas de contención por el COVID-19 afectan el estilo de vida y las relaciones sociales y es razonable esperar efectos psicológicos por la idea de infectarse. En la práctica odontológica las reacciones psicológicas han sido diversas. Objetivo: Identificar la ansiedad y la percepción de riesgo por la pandemia del COVID-19, así como la autoeficacia de los estudiantes de la carrera de Odontología para tomar medidas preventivas. Métodos: Estudio transversal en alumnos de la Facultad de Odontología de una universidad pública al noreste de México en mayo del 2020 (n = 412). Se colectaron datos en línea sobre ansiedad, percepción de riesgo y autoeficacia en escala de Likert y el perfil sociodemográfico. Se utilizó la estadística descriptiva y el análisis multivariado de regresión logística binaria. Resultados: La media de edad fue 21,8 ± 2,8 años; el 72,1 % era del sexo femenino. Veintidós de cada 100 estudiantes de Odontología reportaron haberse sentido con ansiedad por la pandemia del COVID-19 durante al menos ocho días de las últimas dos semanas; la percepción de riesgo (OR = 2,46, IC95 % 1,75 - 3,48) y el ser mujer (OR = 2,23, IC95% 1,33 - 3,76) incrementaron las probabilidades de ansiedad. Mientras que la autoeficacia (OR = 0,71, IC95 % 0,51 - 0,99) y el antecedente de capacitación en COVID-19 (RM = 0,63, IC95 % 0,4 - 0,99) las disminuyeron. Conclusiones: La alta percepción de riesgo y ser del sexo femenino se asocia con un aumento significativo de la ansiedad ante el COVID-19.