RESUMO Objetivos: À medida que a utilização de equipamentos digitais no emprego aumenta, a avaliação do seu efeito na saúde visual necessita de ferramentas válidas e robustas. Este estudo teve como objetivo traduzir, adaptar culturalmente e validar para português o Questionário da Síndrome Visual do Computador (CVS-Q©). Métodos: O procedimento foi realizado em 5 fases: tradução direta, síntese da tradução, tradução inversa, consolidação por um painel de especialistas, e pré-teste. Para fazer o pré-teste foi realizado um estudo piloto transversal aplicado a uma amostra de 26 participantes que completaram a versão pré-final da versão portuguesa do CVS-Q©, questionando por dificuldades, compreensão e sugestões de melhoria do questionário. Para avaliar a confiança e validade da versão portuguesa do CVS-Q© foi realizado um estudo transversal de validação em uma amostra diferente (280 funcionários). Resultados: No préteste, 96.2% dos participantes não apresentaram dificuldades no preenchimento do questionário, enquanto 84.0% indicaram que era claro e compreensível. Obteve-se, então, o CVS-Q© em português (Questionário da Síndrome Visual do Computador, CVS-Q PT©). A sua validação revelou uma boa consistência interna da sua escala (Cronbach’s alpha=0.793), boa estabilidade tem poral (coeficiente de correlação interclasse=0.847; 95% CI 0.764-0.902, kappa=0.839), sensibilidades e especificidades adequadas (78.5% e 70.7%, respetivamente), boa capacidade de discriminação (área abaixo da curva=0.832; 95% CI 0.784-0.879), e uma adequada validade da convergência com o índice de doença da superfície ocular (ocular surface disease index - OSDI; coeficiente de correlação de Spearman=0.728, p<0.001). A análise fatorial revelou um único fator responsável por explicar a variância comum em 37.7%. Um funcionário com uma pontuação ≥7 pontos sofria de síndrome visual do computador. Conclusão: O CVS-Q PT© pode ser considerada uma ferramenta intuitiva, de fácil interpretação e com boas pro priedades psicométricas para avaliar a síndrome visual do computador em funcionários portugueses expostos a ecrãs digitais. Este questionário facilitará as decisões sobre medidas preventivas, intervenções e tratamento, e a comparação entre as populações expostas em diferentes países de língua portuguesa. Objetivos aumenta robustas traduzir CVSQ©. CVSQ CVS Q© . Q (CVS-Q©) Métodos fases direta inversa especialistas préteste. préteste pré teste. teste 2 préfinal final CVSQ©, Q©, CVSQ© 280 (28 funcionários. funcionários) Resultados 962 96 96.2 840 84 0 84.0 compreensível Obtevese, Obtevese Obteve se, se Obteve-se então PT©. PT PT©) Cronbachs Cronbach s alpha=0.793, alpha0793 alpha alpha=0.793 , 793 alpha=0.793) interclasse=0.847 interclasse0847 interclasse 847 95 0.7640.902, 07640902 0.764 0.902, 764 902 0.764-0.902 kappa=0.839, kappa0839 kappa kappa=0.839 839 kappa=0.839) 78.5% 785 78 (78.5 707 70 7 70.7% respetivamente, respetivamente respetivamente) área curva=0.832 curva0832 curva 832 0.7840.879, 07840879 0.784 0.879 784 879 0.784-0.879) OSDI Spearman0728 Spearman 728 Spearman=0.728 p<0.001. p0001 p p<0.001 001 p<0.001) 377 37 37.7% ≥ Conclusão intuitiva preventivas tratamento (CVS-Q© 28 (2 9 96. 8 84. alpha079 alpha=0.79 79 interclasse=0.84 interclasse084 7640 0.7640.902 0764090 0764 0.76 0902 0.902 76 90 0.764-0.90 kappa083 kappa=0.83 83 78.5 (78. 70.7 curva=0.83 curva083 7840 0.7840.879 0784087 0784 0.78 0879 0.87 87 0.784-0.879 Spearman072 72 Spearman=0.72 p000 p<0.00 00 3 37.7 (CVS-Q ( alpha07 alpha=0.7 interclasse=0.8 interclasse08 0.7640.90 076409 076 0.7 090 0.90 0.764-0.9 kappa08 kappa=0.8 78. (78 70. curva=0.8 curva08 0.7840.87 078408 078 087 0.8 0.784-0.87 Spearman07 Spearman=0.7 p00 p<0.0 37. alpha0 alpha=0. interclasse=0. interclasse0 0.7640.9 07640 07 0. 09 0.9 0.764-0. kappa0 kappa=0. (7 curva=0. curva0 0.7840.8 07840 08 0.784-0.8 Spearman0 Spearman=0. p0 p<0. alpha=0 interclasse=0 0.7640. 0.764-0 kappa=0 curva=0 0.7840. 0.784-0. Spearman=0 p<0 alpha= interclasse= 0.7640 0.764- kappa= curva= 0.7840 0.784-0 Spearman= p< 0.784-

ABSTRACT Purpose: As digital devices are increasingly used at work, valid and reliable tools are needed to assess their effect on visual health. This study aimed to translate, cross-culturally adapt, and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Portuguese. Methods: A 5-phase process was followed: direct translation, synthesis of translation, back-translation, consolidation by an expert committee, and pretest. To run the pretest, a cross-sectional pilot study was conducted with 26 participants who completed the prefinal Portuguese version of the CVS-Q© and were asked about difficulties, comprehensibility, and suggestions to improve the questionnaire. To evaluate the reliability and validity of the Portuguese version of the CVS-Q©, a cross-sectional validation study was performed in a different sample (280 workers). Results: In the pretest, 96.2% had no difficulty in completing it, and 84.0% valued it as clear and understandable. CVS-Q© in Portuguese (Questionário da Síndrome Visual do Computador, CVS-Q PT©) was then obtained. Validation revealed the scale’s good internal consistency (Cronbach’s alpha=0.793), good temporal stability (intraclass correlation coefficient=0.847; 95% CI 0.764-0.902, kappa=0.839), adequate sensitivity and specificity (78.5% and 70.7%, respectively), good discriminant capacity (area under the curve=0.832; 95% CI 0.784-0.879), and adequate convergent validity with the ocular surface disease index (Spearman correlation coefficient=0.728, p<0.001). The factor analysis provided a single factor accounting for 37.7% of the explained common variance. A worker who scored ≥7 points would have computer vision syndrome. Conclusions: CVS-Q PT© can be considered an intuitive and easy-to-understand tool with good psychometric properties to measure computer vision syndrome in Portuguese workers exposed to digital devices. This questionnaire will assist in making decisions on preventive measures, interventions, and treatment and comparing exposed populations in different Portuguese-speaking countries. Purpose work health translate crossculturally cross culturally adapt CVSQ© CVSQ CVS Q© Q (CVS-Q© Methods 5phase phase 5 followed translation backtranslation, backtranslation back back-translation committee pretest crosssectional sectional 2 difficulties comprehensibility CVSQ©, Q©, 280 (28 workers. . workers) Results 962 96 96.2 840 84 0 84.0 understandable Questionário Computador PT obtained scales scale s Cronbachs Cronbach alpha=0.793, alpha0793 alpha alpha=0.793 , 793 alpha=0.793) intraclass coefficient=0.847 coefficient0847 coefficient 847 95 0.7640.902, 07640902 0.764 0.902, 764 902 0.764-0.902 kappa=0.839, kappa0839 kappa kappa=0.839 839 kappa=0.839) 78.5% 785 78 (78.5 707 70 7 70.7% respectively, respectively respectively) area curve=0.832 curve0832 curve 832 0.7840.879, 07840879 0.784 0.879 784 879 0.784-0.879) Spearman coefficient0728 728 coefficient=0.728 p<0.001. p0001 p p<0.001 001 p<0.001) 377 37 37.7 variance ≥ Conclusions easytounderstand easy understand measures interventions Portuguesespeaking speaking countries (CVS-Q 28 (2 9 96. 8 84. alpha079 alpha=0.79 79 coefficient=0.84 coefficient084 7640 0.7640.902 0764090 0764 0.76 0902 0.902 76 90 0.764-0.90 kappa083 kappa=0.83 83 78.5 (78. 70.7 curve=0.83 curve083 7840 0.7840.879 0784087 0784 0.78 0879 0.87 87 0.784-0.879 coefficient072 72 coefficient=0.72 p000 p<0.00 00 3 37. ( alpha07 alpha=0.7 coefficient=0.8 coefficient08 0.7640.90 076409 076 0.7 090 0.90 0.764-0.9 kappa08 kappa=0.8 78. (78 70. curve=0.8 curve08 0.7840.87 078408 078 087 0.8 0.784-0.87 coefficient07 coefficient=0.7 p00 p<0.0 alpha0 alpha=0. coefficient=0. coefficient0 0.7640.9 07640 07 0. 09 0.9 0.764-0. kappa0 kappa=0. (7 curve=0. curve0 0.7840.8 07840 08 0.784-0.8 p0 p<0. alpha=0 coefficient=0 0.7640. 0.764-0 kappa=0 curve=0 0.7840. 0.784-0. p<0 alpha= coefficient= 0.7640 0.764- kappa= curve= 0.7840 0.784-0 p< 0.784-

RESUMEN El propósito de esta investigación es identificar las problematizaciones predominantes en cuentas feministas colombianas de Instagram, sobre las violencias basadas en género durante el primer año de la pandemia de covid-19. Desde un enfoque cualitativo, se realizó una etnografía digital basada en los preceptos de la netnografía, como alternativa para detallar los mundos sociales construidos a partir de los grupos en línea. A partir de las observaciones realizadas en el marco del trabajo de campo en línea se seleccionaron 50 contenidos de @lainsumisa y 20 contenidos de @feministasenconstrucción, publicados entre marzo de 2020 y marzo de 2021, los cuales se analizaron mediante técnicas de análisis del discurso. Entre los hallazgos se discuten las siguientes categorías emergentes: el trabajo no remunerado en el hogar, el acoso romantizado, la gordofobia y la vulneración a las mujeres negras y racializadas. Al respecto, se plantea el ciberactivismo como una oportunidad para el surgimiento de colectivos y redes de apoyo para las mujeres que luchan por la equidad de género y por sus derechos, hacia el cuestionamiento de ideas patriarcales que atentan contra su bienestar.

ABSTRACT The purpose of this research is to identify predominant problematizations in Colombian feminist Instagram accounts regarding gender-based violence during the first year of the COVID-19 pandemic. Employing a qualitative approach, a digital ethnography based on the principles of netnography was conducted as an alternative to detail the social worlds constructed from online groups. Fifty pieces of content from @lainsumisa and twenty pieces of content from @feministasenconstrucción, published between March 2020 and March 2021, were selected based on observations made within the online fieldwork framework. These were analyzed using discourse analysis techniques. The findings discuss the following emerging categories: unpaid household work, romanticized harassment, fatphobia, and the violation of Black and racialized women’s rights. In this context, cyberactivism is presented as an opportunity for the emergence of collectives and support networks for women advocating for gender equality and their rights, towards questioning patriarchal ideas that jeopardize their well-being.

RESUMEN El propósito de esta investigación es identificar las problematizaciones predominantes en cuentas feministas colombianas de Instagram, sobre las violencias basadas en género durante el primer año de la pandemia de covid-19. Desde un enfoque cualitativo, se realizó una etnografía digital basada en los preceptos de la netnografía, como alternativa para detallar los mundos sociales construidos a partir de los grupos en línea. A partir de las observaciones realizadas en el marco del trabajo de campo en línea se seleccionaron 50 contenidos de @lainsumisa y 20 contenidos de @feministasenconstrucción, publicados entre marzo de 2020 y marzo de 2021, los cuales se analizaron mediante técnicas de análisis del discurso. Entre los hallazgos se discuten las siguientes categorías emergentes: el trabajo no remunerado en el hogar, el acoso romantizado, la gordofobia y la vulneración a las mujeres negras y racializadas. Al respecto, se plantea el ciberactivismo como una oportunidad para el surgimiento de colectivos y redes de apoyo para las mujeres que luchan por la equidad de género y por sus derechos, hacia el cuestionamiento de ideas patriarcales que atentan contra su bienestar.

ABSTRACT The purpose of this research is to identify predominant problematizations in Colombian feminist Instagram accounts regarding gender-based violence during the first year of the COVID-19 pandemic. Employing a qualitative approach, a digital ethnography based on the principles of netnography was conducted as an alternative to detail the social worlds constructed from online groups. Fifty pieces of content from @lainsumisa and twenty pieces of content from @feministasenconstrucción, published between March 2020 and March 2021, were selected based on observations made within the online fieldwork framework. These were analyzed using discourse analysis techniques. The findings discuss the following emerging categories: unpaid household work, romanticized harassment, fatphobia, and the violation of Black and racialized women’s rights. In this context, cyberactivism is presented as an opportunity for the emergence of collectives and support networks for women advocating for gender equality and their rights, towards questioning patriarchal ideas that jeopardize their well-being.

Abstract Although the terms "rare diseases" (RD) and "orphan diseases" (OD) are often used interchangeably, specific nuances in definitions should be noted to avoid misconception. RD are characterized by a low prevalence within the population, whereas OD are those inadequately recognized or even neglected by the medical community and drug companies. Despite their rarity, as our ability on discovering novel clinical phenotypes and improving diagnostic tools expand, RD will continue posing a real challenge for rheumatologists. Over the last decade, there has been a growing interest on elucidating mechanisms of rare autoimmune and autoinflammatory rheumatic diseases, allowing a better understanding of the role played by immune dysregulation on granulomatous, histiocytic, and hypereosinophilic disorders, just to name a few. This initiative enabled the rise of innovative targeted therapies for rheumatic RD. In this review, we explore the state-of-the art of rare RD and the critical role played by rheumatologists in healthcare. We also describe the challenges rheumatologists may face in the coming decades. diseases (RD orphan (OD interchangeably misconception population companies rarity expand decade granulomatous histiocytic disorders few review stateofthe state healthcare decades

Resumen La sociedad requiere ciudadanos reflexivos y críticos que sepan resolver de forma efectiva los problemas actuales que plantean aspectos científico-tecnológicos. Para ello, es necesario que desde la educación se forme al alumnado en las competencias necesarias para que sepan actuar de forma responsable ante estos problemas. Así, la argumentación basada en pruebas es esencial, ya que permitirá tomar decisiones fundamentadas, constituyendo los debates una herramienta adecuada para fomentarla en el aula. Este trabajo plantea un debate sobre el problema socio-científico de la prohibición de plásticos de un solo uso en la formación inicial del profesorado de ciencias de secundaria en España. Los participantes actúan como oyentes del debate entre dos compañeros, una a favor y otra en contra de la prohibición, y deben tomar una decisión argumentada ante el problema antes y después del debate. Los resultados muestran cambios importantes en la decisión adoptada, predominando antes del debate posturas a favor y ambas posiciones después, sustentadas en distintos tipos de pruebas, inicialmente ambientales, sociales y relativas a propiedades de materiales y, finalmente, sociales en muchos casos.

Abstract The society requires reflective and critical citizens who know how to effectively solve current problems posed by scientific-technological aspects. To this end, it is necessary that students to be trained in the necessary skills so that they know how to act responsibly in the face of these problems. Thus, evidence-based argumentation is essential as it will allow informed decisions to be made, and debates are an appropriate tool to promote it in the classroom. This paper raises a debate on the socio-scientific problem of the ban on single-use plastics in the initial training of secondary science teachers in Spain. The participants act as listeners to the debate between two classmates, one for and one against the ban, and must make an informed decision on the problem before and after the debate. The findings show important changes in the decision adopted, with a predominance of positions in favor before the debate and both positions after, supported by different types of evidence, initially environmental, social and related to material properties, and finally social in many cases.

Resumo O artigo propõe uma discussão sobre o papel da imagem em diferentes teorias psicológicas a partir de uma leitura do romance Dias de abandono, de Elena Ferrante. Os aspectos míticos e cotidianos da figura da “pobre coitada” [poverella] tal como aparece no texto são abordados em sua ambivalência, considerando tanto a pertinência e as dificuldades de uma abordagem psicanalítica clássica quanto a eventual adequação da teoria dos arquétipos de C. G. Jung para a compreensão do fenômeno no contexto da narrativa. O artigo propõe, então, a psicologia arquetípica de James Hillman, Patricia Berry e Rafael López-Pedraza como a referência teórica mais apropriada para a análise, na medida em que reconhece a dimensão transpessoal e transgeracional da imagem sem submetê-la a uma interpretação estruturalista. abandono Ferrante pobre coitada poverella [poverella ambivalência C G narrativa então Hillman LópezPedraza López Pedraza análise submetêla submetê la estruturalista

Abstract The article proposes a discussion on the role of images in different psychological theories from a reading of the novel The Days of Abandonment, by Elena Ferrante. The mythical and mundane aspects of the figure of the “poor thing” [la poverella] as it appears in the text are approached in their ambivalence, considering both the pertinence of a classical psychoanalytic approach and the adequacy of C. G. Jung's theory of archetypes to understand the phenomenon in the context of the narrative. The article then projects the archetypal psychology of James Hillman, Patricia Berry, and Rafael López-Pedraza as the most appropriate theoretical reference for the analysis, recognizing transpersonal dimension of the image, but without submitting it to a structuralist interpretation. Abandonment Ferrante poor thing la poverella ambivalence C G Jungs Jung s narrative Hillman Berry LópezPedraza López Pedraza analysis image interpretation

Riassunto L’articolo propone una discussione sul ruolo dell’immagine in diverse teorie psicologiche partendo da una lettura del romanzo I Giorni dell’abbandono, di Elena Ferrante. Gli aspetti mitici e quotidiani della figura della “poverella”, così come compare nel testo, sono affrontati considerando tanto la pertinenza e le difficoltà di un approccio psicanalitico classico, quanto l’eventuale adeguamento della teoria degli archetipi di C.G. Jung ai fini della comprensione del fenomeno nel contesto della narrativa. L’articolo propone dunque la psicologia archetipica di James Hillman, Patricia Berry e Rafal López-Predaza quale riferimento teorico più appropriato per l’analisi, nella misura in cui riconosce la dimensione transpersonale e transgenerazionale dell’immagine senza sottoporla ad un’interpretazione strutturalista. Larticolo L articolo dellimmagine dell immagine dellabbandono, dellabbandono abbandono, abbandono dell’abbandono Ferrante poverella, poverella , “poverella” testo classico leventuale l eventuale CG C G C.G narrativa Hillman LópezPredaza López Predaza lanalisi, lanalisi analisi, analisi l’analisi uninterpretazione interpretazione strutturalista “poverella

Resumen: Introducción: el bloqueo de plexo braquial con abordaje costoclavicular, ofrece ventajas como sitio de inyección único, sitio adecuado para colocación de catéter de analgesia continua. Objetivo: identificar la visibilidad de los tres cordones del plexo braquial en el espacio costoclavicular según la angulación del brazo. Material y métodos: se realizó un estudio observacional descriptivo y transversal; se incluyeron 99 pacientes entre 18 a 90 años de edad, en un período de dos meses. Se describieron variables continuas, se aplicó la prueba no paramétrica de Friedman para K muestras relacionadas, una regresión lineal para confirmar la correlación entre la distancia de la piel a plexo braquial, peso e índice de masa corporal (IMC). Resultados: se encontró una menor profundidad en relación piel plexo bajo abducción del brazo a una angulación de 90o y 110o, que permite la visualización sonoanatómica del plexo braquial a nivel costoclavicular con significancia estadística. El peso es un factor independiente que determina la distancia entre la profundidad piel plexo. Conclusiones: se determinó que el abordaje del bloqueo costoclavicular ecoguiado es anatómicamente factible con elevada eficacia clínica, el cual concluye ser un sitio anatómico innovador y seguro.

Abstract: Introduction: the brachial plexus block with a costoclavicular approach offers advantages as a single injection site, being a suitable site for continuous analgesia catheter placement. Objective: to identify the visibility of the 3 brachial plexus cords in the costoclavicular space according to the angulation of the arm. Material and methods: a descriptive and cross-sectional observational study was carried out; 99 healthy patients between 18 and 90 years of age were included, in a period of two months. Continuous variables were described, the nonparametric Friedman test was applied for K related samples, a linear regression was performed to confirm the correlation between the distance from the skin to the brachial plexus, weight and body mass index (BMI). Results: a smaller depth was found in relation to the skin plexus under abduction of the arm at an angulation of 90o and 110o, which allows an adequate sonoanatomical visualization of the brachial plexus at the costoclavicular level with statistical significance. Weight is an independent factor that determine the distance between the skin plexus depth. Conclusions: it was determined that the ultrasound-guided costoclavicular block approach is anatomically feasible with greater clinical efficacy, which concludes to be an innovative and safe anatomical site.

SUMMARY Vaccines prevent millions of deaths each year, and their efficacy and safety have been widely established. In economic terms, vaccination is one of the most cost-effective health interventions, generating significant savings and long-term economic growth. Adult vaccination has been shown to decrease morbidity and mortality associated with preventable Infectious diseases, reducing complications and hospitalizations, including admissions to intensive care units. We have prepared this consensus document in order to design a pragmatic, accessible and standardized vaccination scheme for adults, according to risk category and age, based on the available evidence of available vaccines and new vaccines, having used the third consensus of the Paraguayan Infectious Diseases Society of 2019 as a basis for the final recommendations.

RESUMEN Las vacunas previenen millones de muertes cada año y su eficacia y seguridad han sido ampliamente establecidas. En términos económicos, la vacunación es una de las intervenciones sanitarias más costo efectivas, generando un importante ahorro y crecimiento económico que supone a largo plazo. Se ha demostrado que la vacunación de adultos disminuye la morbilidad y la mortalidad asociadas a enfermedades infecciosas prevenibles, reduciendo las complicaciones y las hospitalizaciones, incluidos los ingresos a las unidades de cuidados intensivos. Hemos elaborado este documento de consenso con el objeto de diseñar un esquema de vacunación pragmático, accesible y estandarizado del adulto, según categoría de riesgo y edad, sobre la base de la evidencia disponible de vacunas accesibles y nuevas vacunas habiendo utilizado el Tercer Consenso de la Sociedad Paraguaya de Infectología del 2019 como base para las recomendaciones finales.

ABSTRACT Objective. In 2021, Mexico launched the HEARTS program to improve the prevention and control of cardiovascular disease (CVD) risk factors in 20 primary care facilities in the states of Chiapas and Yucatán. This study projects the annual cost of program implementation and discusses budgetary implications for scaling up the program. Methods. We obtained district-level data on treatment protocols, medication costs, and other resources required to prevent and treat CVD. We used the HEARTS Costing Tool to estimate total and per-patient costs. A “partial implementation” scenario calculated the costs of implementing HEARTS if existing pharmacological treatment protocols are left in place. The second scenario, “full implementation,” examined costs if programs use HEARTS pharmacological protocol. Results. Respectively in the partial and full implementation scenarios, total annual costs to implement and operate HEARTS were $260 023 ($32.1 per patient/year) and $255 046 ($31.5 per patient/year) in Chiapas, and $1 000 059 ($41.3 per patient/year) and $1 013 835 ($43.3 per patient/year) in Yucatán. In Chiapas, adopting HEARTS standardized treatment protocols resulted in a 9.7 % reduction in annual medication expenditures relative to maintaining status-quo treatment approaches. In Yucatán, adoption was $12 875 more expensive, in part because HEARTS hypertension treatment regimens were more intensive than status quo regimens. Conclusion. HEARTS in the Americas offers a standardized strategy to treating and controlling CVD risk factors. In Mexico, approaches that may lead to improved program affordability include adoption of the recommended HEARTS treatment protocols with preferred medications and task shifting of services from physicians to nurses and other providers.

RESUMO Objetivo. Em 2021, o México lançou o programa HEARTS para melhorar a prevenção e o controle dos fatores de risco de doenças cardiovasculares (DCV) em 20 unidades básicas de saúde nos estados de Chiapas e Yucatán. Este estudo projeta o custo anual de implementação do programa e discute as implicações orçamentárias para sua expansão. Métodos. Foram obtidos dados de nível distrital sobre protocolos de tratamento, custos de medicamentos e outros recursos necessários para prevenir e tratar a DCV. A ferramenta de cálculo de custos do HEARTS foi usada para estimar os custos totais e por paciente. Um cenário de “implementação parcial” calculou os custos de implementação do HEARTS se os protocolos de farmacoterapia existentes forem mantidos em vigor. O segundo cenário, “implementação plena”, examinou os custos se os programas utilizassem o protocolo de farmacoterapia do HEARTS. Resultados. Respectivamente nos cenários de implementação parcial e plena, os custos anuais totais para implementar e operar o HEARTS foram de US$ 260 023 (US$ 32,1 por paciente/ano) e US$ 255 046 (US$ 31,5 por paciente/ano) em Chiapas, e $1 000 059 (US$ 41,3 por paciente/ano) e US$ 1 013 835 (US$ 43,30 por paciente/ano) em Yucatán. Em Chiapas, a adoção de protocolos de tratamento padronizados do HEARTS resultou em uma redução de 9,7% nos gastos anuais com medicamentos em relação à manutenção das condutas atuais (status quo). Em Yucatán, a adoção foi US$ 12 875 mais cara, em parte porque os regimes de tratamento de hipertensão do HEARTS eram mais intensivos do que os regimes atuais. Conclusão. A HEARTS nas Américas oferece uma estratégia padronizada para tratar e controlar os fatores de risco de DCV. No México, abordagens que podem levar a uma melhor acessibilidade do programa incluem a adoção dos protocolos de tratamento recomendados do HEARTS com medicamentos preferidos e a realocação de tarefas de médicos para enfermeiros e outros profissionais.

RESUMEN Objetivo. En el año 2021, México puso en marcha el programa HEARTS para mejorar la prevención y el control de los factores de riesgo de las enfermedades cardiovasculares en 20 centros de atención primaria en los estados de Chiapas y Yucatán. En este estudio se estima el costo anual de la ejecución del programa y se abordan las implicaciones presupuestarias para su ampliación. Métodos. Se obtuvieron datos a nivel de distrito sobre los protocolos de tratamiento, los costos de los medicamentos y otros recursos necesarios para prevenir y tratar las enfermedades cardiovasculares. Se empleó la herramienta HEARTS para el cálculo de costos con el fin de estimar los costos totales y por paciente. En una situación de “implementación parcial”, se calcularon los costos de ejecutar HEARTS si se mantienen los protocolos de tratamiento farmacológico existentes. En un segundo escenario de “implementación completa”, se examinaron los costos de los programas que emplean el protocolo farmacológico de HEARTS. Resultados. En los escenarios de implementación parcial y total, respectivamente, los costos anuales totales para implementar y poner en marcha el paquete de medidas HEARTS fueron de US$ 260 023 (US$ 32,1 por paciente al año) y US$ 255 046 (US$ 31,5 por paciente al año) en Chiapas, y US$ 1 000 059 (US$ 41,3 por paciente al año) y US$ 1 013 835 (US$ 43,3 por paciente al año) en Yucatán. En Chiapas, la adopción de los protocolos de tratamiento estandarizados de HEARTS supuso una reducción de 9,7% en los gastos anuales de medicamentos en comparación con el mantenimiento de los enfoques de tratamiento ya establecidos. En Yucatán, la adopción fue US$ 12 875 más cara, en parte porque los esquemas de tratamiento para la hipertensión que se proponen en HEARTS fueron más intensivos que los esquemas ya establecidos. Conclusiones. El programa HEARTS en la Región de las Américas ofrece una estrategia estandarizada para tratar y controlar los factores de riesgo de las enfermedades cardiovasculares. En México, los enfoques que pueden conducir a una mayor asequibilidad del programa incluyen la adopción de los protocolos de tratamiento recomendados de HEARTS con medicamentos de preferencia y la distribución de tareas de los servicios para que pasen del personal médico al personal de enfermería y otros prestadores de atención de salud.

Abstract: Objective. To retrospectively assess the diagnostic capacity of quantitative elastography to determine the odds between benign and malignant thyroid nodules, and determine its usefulness in deciding which nodules should be subjected to fine needle aspiration puncture (FNA). Patients and methods. 203 thyroid nodules from 195 patients referred by the Endocrinology Service for cytological study during the year 2018 were analyzed. All of them underwent conventional ultrasound, quantitative elastography and FNA. A statistical analysis was performed using logistic regression that relates the probability that a nodule is suspected of malignancy and the elasticity value measured inkilopascals (kPa) and the elastographic ratio. Results. There is a significant and positive relationship between the cytological result of Bethesda V / VI and the kPas / elastographic ratio. FNA is recommended for those nodules with values greater than 25kPa and / or elastographic ratio greater than 1.5. Conclusion. Quantitative elastography is a useful tool that, together with other ultrasound parameters, would help to predict the malignancy of a thyroid nodule and to better select for FNA.

Resumen: Objetivo. Evaluar retrospectivamente la capacidad diagnóstica de la elastografía cuantitativa para determinar la posibilidad de malignidad o benignidad de los nódulos tiroideos benignos y malignos, y determinar su utilidad para así decidir qué nódulos deberán ser sometidos a punción aspirativa con aguja fina (PAAF). Pacientes y métodos. Se analizaron 203 nódulos tiroideos de 195 pacientes remitidos por el Servicio de Endocrinología para estudio citológico durante el año 2018. A todos ellos se les realizó ecografía convencional, elastografía cuantitativa y PAAF. Se realizó un análisis estadístico mediante regresión logística, que pone en relación la probabilidad de que un nódulo sea sospecho de malignidad y el valor de la elasticidad medido en kilopascales (kPa) y el ratio elastográfico. Resultados. Existe una relación significativa y positiva entre el resultado citológico de Bethesda V/VI y los kPas/ratio elastográfico. Se recomienda realizar PAAF a aquellos nódulos con valores superiores a 25kPa y/o ratio elastográfico superior a 1,5. Conclusión. La elastografía cuantitativa es una herramienta útil que, junto a otros parámetros ecográficos, ayudaría a predecir o sospechar la malignidad de un nódulo tiroideo y a una mejor selección para la PAAF.

Summary: Chemical mineral fertilization (CF) in soybean (Glycine max L.) is a regular practice and depends on the availability of moisture in soil. The increase in cost of agricultural inputs and loss of soil fertility drive the search for sustainable strategies. The objective of this experiment was to use biological fertilization alternatives (FB) in this crop with the Huasteca 400 variety. Treatments were (1) control, 18-46-00 (100% CF); (2) arbuscular mycorrhizal Biogea® + 50% CF; (3) arbuscular mycorrhizal INIFAP + 50% CF; (4) Biogea + poultry manure (1 Mg ha-1) + 50% CF; (5) Biogea + gypsum (0.5 Mg ha-1) + 50% CF; and (6) Bradyrhizobium japonicum (Cel Tech®) + arbuscular mycorrhiza INIFAP (Rhizophagus intraradices). Soil plant analysis development (SPAD) index was measured in stages V1, V5, and R2, and plant height in V5 and R5. Yield, grain protein, and oil percentage were quantified at harvest. The economic production analysis was determined by profitability. No statistical differences were recorded between alternative treatments and the control group. The combination between B. japonicum and R. intraradices showed the best profitability with a benefit-cost ratio of 2.6 and a profit of USD 11 890 per hectare. This alternative management of soybean nutrition can promote greater profitability and decrease due to contamination in the agroecological environment.

Resumen: La fertilización química mineral (FQ) en soya (Glycine max L.) es una práctica regular y está en función de la disponibilidad de humedad en el suelo. El incremento en el costo de los insumos agrícolas y la perdida de la fertilidad del suelo, impulsan la búsqueda de estrategias sustentables. El objetivo de este experimento fue usar alternativas de fertilización biológica (FB) en este cultivo con la variedad Huasteca 400. Los tratamientos fueron: 1) testigo, 18-46-00 (100% FQ); 2) micorriza arbuscular Biogea® + 50% FQ; 3) micorriza arbuscular INIFAP + 50% FQ; 4) Biogea + gallinaza (1 Mg ha-1) + 50% FQ; 5) Biogea + yeso (0.5 Mg ha-1) + 50% FQ; y 6) Bradyrhizobium japonicum (Cel Tech® + micorriza arbuscular INIFAP (Rhizophagus intraradices). Se midió el índice SPAD, en las etapas V1, V5 y R2, altura de planta en V5 y R5. El rendimiento, porcentaje de aceite y proteína del grano se cuantificaron a la cosecha. El análisis económico de la producción, se determinó por la rentabilidad. No hubo diferencias estadísticas entre los tratamientos alternativos y el testigo. La combinación entre B. japonicum y R. intraradices demostró la mejor rentabilidad con una relación beneficio-costo de 2.6 y una ganancia de $11 890 por hectárea. Este manejo alternativo de nutrición de la soya puede promover mayor rentabilidad y disminución por contaminación en el entorno agroecológico.

ABSTRACT Background: In severe aortic stenosis (AS), reduced left ventricular ejection fraction (LVEF) (<50%) may be attributed to decreased contractility, afterload mismatch (AM) or a combination of both mechanisms. However, when LVEF is ≥50% some patients may have decreased contractility. Objective: The aim of this study was to assess contractility level (CL), AM and ventricular geometry as determinants of LVEF in patients with severe AS. Methods: Doppler echocardiography was used to study 184 patients with severe AS and 71 normal individuals (N). Contractility was assessed as the difference between measured and predicted midwall fractional shortening (mFS) minus 2 standard errors for an established meridional end-systolic stress (ESS). Patients with AS were divided into 4 groups: LVEF <50% (n = 78), LVEF 50-59% (n = 27), LVEF 60-69% (n = 45), and LVEF ≥70% (n = 34). Results: Decreased CL was observed in approximately half of the patients with LVEF <60% and in a lesser degree in patients with LVEF ≥60%. Afterload mismatch was found in patients with LVEF <50% with decreased (34%) as well as preserved (45%) CL. Conclusions: Half of the patients with LVEF <60% presented decreased CL and to a lesser extent this occurred in the rest of the patients, even with LVEF ≥70%. The overestimation of systolic function using LVEF seems to be related to the degree of concentric hypertrophy..

RESUMEN Introducción: En la estenosis aórtica (EAo) grave la fracción de eyección ventricular izquierda (FEVI) reducida (<50%) puede deberse a una disminución de la contractilidad, exceso de poscarga (EP) o a una combinación de ambos mecanismos. Sin embargo, cuando la FEVI es ≥50% algunos pacientes pueden tener la contractilidad disminuida. Objetivo: Evaluar el nivel de contractilidad (NC), EP y geometría ventricular como determinantes de la FEVI en pacientes con EAo grave. Material y métodos: Se estudiaron 184 pacientes con EAo grave y 71 individuos normales (N) mediante eco-Doppler cardíaco. El NC se determinó mediante la diferencia entre la fracción de acortamiento mesoparietal (FAm) medida (EAo) y la FAm predicha (N) menos 2 errores estándar para un valor determinado de estrés meridional de fin de sístole (EFS). Los pac con EAo fueron divididos en 4 grupos: FEVI <50% (n = 78), FEVI 50-59% (n = 27), FEVI 60-69% (n = 45) y FEVI ≥70% (n = 34). Resultados: El NC estuvo disminuido aproximadamente en la mitad de los pac. con FEVI <60% y en menor grado en los pacientes con FEVI ≥60%. El EP se observó en los pacientes con FEVI <50% con NC disminuido (34%) como así también con NC conservado (45%) Conclusiones: La mitad de los pacientes con FEVI <60% presentó NC disminuido y en menor proporción ello ocurrió en el resto de los pacientes, incluso hasta con FEVI ≥70%. La sobrestimación de la función sistólica utilizando la FEVI parece estar relacionada con el grado de hipertrofia concéntrica

ABSTRACT Preschool Education plays a significant role in the integral formation of school children. Its mission, objectives and perspectives require relevant and creative educational processes. Interdisciplinarity constitutes a transforming vision of knowledge, it is an expression of a renovating and authentic dynamic from the ethical, cultural, political and social support of the context it serves, in a process more and more dialectic where the instructive makes communion with the educational. From this perspective, the development of the language and its linguistic components constitute a prioritized objective at this educational level. Each one reinforces values, attitudes, and ways of acting in accordance with its nature and function. The pragmatic component of language and its social character give a very peculiar stamp to the dialogue between social subjects, since it characterizes the text-context relationship, the social communicative situation, the communicative intention and purpose of the discursive subjects, develops the cognitive dimension and raises the level of creativity of the dialogic actors.

RESUMEN La Educación Preescolar desempeña un papel significativo en la formación integral de los escolares. Su misión, objetivos y perspectivas precisan de procesos formativos pertinentes y creativos. La interdisciplinariedad constituye una visión transformadora del conocimiento, es expresión de una dinámica renovadora y auténtica a partir del sustento ético, cultural, político y social del contexto al que sirve, en un proceso cada vez más dialéctico donde lo instructivo hace comunión con lo educativo. Desde esta perspectiva, el desarrollo del lenguaje y sus componentes lingüísticos constituyen un objetivo priorizado en este nivel educativo. Cada uno afianza valores, actitudes, formas de actuación en consonancia con su naturaleza y función. El componente pragmático del lenguaje y su carácter social imprimen un sello muy peculiar al dialogo entre los sujetos sociales, pues, caracteriza la relación texto-contexto, la situación social comunicativa, la intención y finalidad comunicativas de los sujetos discursivos, desarrolla la dimensión cognoscitiva y eleva el nivel de creatividad de los actores dialógicos.