ABSTRACT Background: Chagasic cardiomyopathy (CC) differs from other heart failure causes in multiple aspects, highlighting the risk of systemic embolisms. However, few studies have evaluated the risk of embolic events in anticoagulated patients with CC compared with other cardiomyopathies. Objective: We aimed to analyze the incidence of systemic embolisms in a cohort of anticoagulated patients diagnosed with atrial fibrillation (AF) with and without CC. Methods: A retrospective cohort study was carried out at a fourth level hospital in Colombia during the period 2014-2020. All patients diagnosed with cardiomyopathy of any etiology and AF, who were on an anticoagulation regimen were included. The primary outcome was the incidence of embolic events. A survival analysis was performed using adjusted Cox proportional hazard models. A p-value <0.05 was considered significant. All statistical tests were two-tailed. Results: A total of 149 anticoagulated patients with cardiomyopathy were evaluated (median age: 71 years; women: 30.20%). The cumulative incidence of embolic events was significantly higher in patients with CC (17.50%) compared with those presenting other cardiomyopathies (4.95%), despite that the latter had a significantly higher CHA2DS2-VASc score (p=0.013). After multivariate analysis, patients with CC had a significantly higher risk of embolic events regardless of the CHA2DS2-VASc score and the type of anticoagulant prescribed (HR 5.65; 95% CI 1.46-21.83; p=0.012). Conclusions: Chagasic cardiomyopathy was associated with a significantly higher risk of embolic events, despite anticoagulation therapy in both groups. More research is required to understand the origin of the risk observed in order to translate this knowledge into specific indications for anticoagulation in patients with CC.

RESUMEN Introducción: La miocardiopatía chagásica (MC) difiere de otras causas de insuficiencia cardíaca en múltiples aspectos, destacándose el riesgo de embolias sistémicas. Sin embargo, pocos estudios han evaluado el riesgo de eventos embólicos en pacientes anticoagulados con MC en comparación con otras miocardiopatías. Objetivo: Nuestro objetivo fue analizar la incidencia de embolias sistémicas en una cohorte de pacientes anticoagulados con diagnóstico de fibrilación auricular (FA) con y sin MC. Material y métodos: Se realizó un estudio de cohorte retrospectivo en hospital de cuarto nivel en Colombia durante el periodo 2014-2020. Se incluyeron todos los pacientes con diagnóstico de miocardiopatía de cualquier etiología y FA que estuvieran en régimen de anticoagulación. El resultado primario fue la incidencia de eventos embólicos. Se realizó un análisis de supervivencia mediante modelos de riesgos proporcionales de Cox ajustados. Un valor de p <0,05 se consideró significativo. Todas las pruebas estadísticas fueron de dos colas. Resultados: Se evaluaron 149 pacientes anticoagulados con miocardiopatía (mediana de edad: 71 años; mujeres: 30,20%). La incidencia acumulada de eventos embólicos fue significativamente mayor en los pacientes con MC (17,50%) en comparación con aquellos con otras miocardiopatías (4,95%), a pesar de que estos últimos tenían una puntuación CHA2DS2-VASc significativamente mayor (p=0,013). Tras el análisis multivariado, los pacientes con MC tuvieron un riesgo significativamente mayor de eventos embólicos independientemente de la puntuación CHA2DS2-VASc y del tipo de anticoagulante prescrito (HR 5,65; IC 95% 1,46-21,83; p=0,012). Conclusiones: La MC se asoció con un riesgo significativamente mayor de eventos embólicos, a pesar del tratamiento anticoagulante en ambos grupos. Se requiere más investigación para comprender el origen de este riesgo observado y traducir este conocimiento en indicaciones específicas de anticoagulación para pacientes con MC.

Abstract In the upper basin of the Medellín River (Colombia) a hydrologic study was carried out to analyze the rainfall-runoff relationships in an event-scale, for the estimation of the maximum streamflow regime associated with different return periods in the basin and its tributary sub-basins, through hydrological modeling that considers the existence of climate change. This study is composed of the characterization of the basin of the study area, as well as the hydrological characterization, which includes the analysis of measured data with high temporal resolution of precipitation and the river levels. Different methods were considered to obtain the necessary information for the execution of a semi-distributed hydrological modeling activities, using the HEC-HMS. The model was calibrated by the simulation of 5 maximum streamflow events of the year 2021 and then it was run with different configurations of the antecedent moisture condition, rainfall-runoff models and stationary and non-stationary conditions (in rainfall), the latter to assess potential effects of the climate change. According to the results, the relative differences between the modeling cases with stationary and non-stationary conditions are, on average, negligible, with values between 3 and 5% in the considered cases, with the non-stationary cases having higher magnitudes of streamflow.

Resumen En la cuenca alta del río Medellín (Colombia) se realizó un estudio hidrológico con el fin de analizar las relaciones lluvia-escorrentía a escala de eventos en esta zona, para la estimación del régimen de caudales máximos asociados a diferentes períodos de retorno en la cuenca del río y subcuencas tributarias, mediante modelación hidrológica considerando cambio climático. Este estudio está compuesto por la caracterización de la cuenca de la zona de estudio, así como la caracterización hidrológica, la cual abarca el análisis de datos medidos con alta resolución temporal de precipitación y niveles del río. Se tienen en cuenta también diferentes métodos para la obtención de la información necesaria para la correcta ejecución de actividades de modelación hidrológica semidistribuida, utilizando el software HEC-HMS. El modelo fue calibrado simulando 5 eventos máximos de caudal del año 2021, y luego ejecutado con distintas configuraciones de condición de humedad antecedente, modelos lluvia-escorrentía y la consideración de condiciones estacionarias y no estacionarias (en la precipitación), estas últimas con el fin de evaluar potenciales efectos debido al cambio climático. Según los resultados obtenidos, las diferencias relativas entre los caudales máximos obtenidos simulando las curvas IDF estacionarias y no estacionarias (estos últimos siendo usados como proxy para condiciones de cambio climático) no presentan diferencias significativas y oscilan entre 3-5%,obteniéndose las mayores magnitudes en los casos no estacionarios.

Abstract The present study determines the prevalence of eggs of Fasciola hepatica and Calicophoron spp. and of mixed infection in grazing cattle from six cattle ranches in the district of Florida, Department of Amazonas (Peru). Using the natural sedimentation technique, 358 fecal samples were examined. The prevalence of F. hepatica was 69.83 % (95% CI 65.08 - 74.59), followed by Calicophoron spp. 60.34 % (95% CI 55.27 - 65.40) and a prevalence of mixed infection 41.62 % (95% CI 36.51 - 46.73). The presence of F. hepatica eggs did not differ among farms, breeds, and age groups (P>0.05). The presence of Calicophoron spp. and mixed infection with F. hepatica showed differences between towns and breeds (P<0.05), unlike the age groups, which were statistically similar (P>0.05). A high prevalence of fecal eggs of F. hepatica and spp. was found, a situation that could be due to the environmental conditions that allow the optimal development of the intermediate host and the cattle grazing system.

Resumen El presente estudio determina la prevalencia de los huevos de Fasciola hepatica, Calicophoron spp. y la infección mixta en vacunos de crianza al pastoreo de seis poblados ganaderos del distrito de Florida, Amazonas (Perú). Mediante la técnica de sedimentación natural se examinaron 358 muestras fecales. La prevalencia de F. hepatica fue 69.83 % (IC 95% 65.08 - 74.59), seguido de Calicophoron spp. 60.34 % (IC 95% 55.27 - 65.40) y una prevalencia de infección mixta 41.62 % (IC95% 36.51 - 46.73). La presencia de huevos de F. hepatica no tuvo diferencias entre los poblados, las razas y el grupo etario (P>0.05). La presencia de Calicophoron spp. y la infección mixta con F. hepatica presentaron diferencias entre poblados y la raza (P<0.05), a diferencia del grupo etario que fueron similares estadísticamente (P>0.05). Se halló una alta prevalencia de huevos fecales de F. hepatica y Calicophoron spp., situación que podría estar dado por las condiciones ambientales que permiten el óptimo desarrollo del hospedador intermediario y del sistema de crianza al pastoreo de los vacunos.

Abstract The term diverticular disease or diverticulosis is used to describe the presence of diverticula that do not exhibit inflammation or any other complications. Diverticular disease is a growing problem in developing countries mainly by changes in diet becoming more like industrialized countries. The management of diverticulitis has evolved in recent years toward more conservative strategies or minimally invasive techniques. This review focuses in minimally invasive management of perforated diverticulitis and purulent peritonitis. In appropriately selected and classified patients, this alternative reduces morbidity and mortality of laparotomy and allows management of complications.

ABSTRACT Objective. Chagas disease poses a public health problem in Latin America, and the electrocardiogram is a crucial tool in the diagnosis and monitoring of this pathology. In this context, the aim of this study was to quantify the change in the ability to detect electrocardiographic patterns among healthcare professionals after completing a virtual course. Materials and Methods. An asynchronous virtual course with seven pre-recorded classes was conducted. Participants answered the same questionnaire at the beginning and end of the training. Based on these responses, pre and post-test results for each participant were compared. Results. The study included 1656 participants from 21 countries; 87.9% were physicians, 5.2% nurses, 4.1% technicians, and 2.8% medical students. Initially, 3.1% answered at least 50% of the pre-test questions correctly, a proportion that increased to 50.4% after the course (p=0.001). Regardless of their baseline characteristics, 82.1% of course attendees improved their answers after completing the course. Conclusions. The implementation of an asynchronous online course on electrocardiography in Chagas disease enhanced the skills of both medical and non-medical personnel to recognize this condition.

Abstract Objectives To analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. Methods Observational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p < 0.05 was considered significant. Results A sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p = 0.001) as well as the multiple spaces involvement, (p = 0.001) the presence of air corpuscles, (p = 0.001) compromise of the retropharyngeal space (p = 0.001) and age greater than 55 years (p = 0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p = 0.001, 95% CI 0.856-0.984). Conclusions The clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. Level of evidence: IV. Observational analytical crosssectional cross sectional study 1 old genders 1st st 201 31th th 2021 https//7414519.shinyapps.io/ClinicalRiskScore/. https7414519shinyappsioClinicalRiskScore httpsshinyappsioClinicalRiskScore https //7 414 5 19.shinyapps.io/ClinicalRiskScore/ . 7 19 shinyapps io ClinicalRiskScore (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/) outcomes 005 0 05 0.0 significant 21 obtained 12 56.8% 568 56 8 (56.8% men 23.5% 235 23 (23.5% 0.001 0001 001 involvement corpuscles 0.001. account 97 65 95 0.8560.984. 08560984 0.856 0.984 856 984 0.856-0.984) evidence IV 20 202 7414519 https//7414519.shinyapps.io/ClinicalRiskScore/ shinyappsioClinicalRiskScore // 41 19shinyappsioClinicalRiskScore 19.shinyapps.io/ClinicalRiskScore (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/ 00 0. 2 56.8 (56.8 23.5 (23.5 0.00 000 9 6 8560 0.8560.984 0856098 0856 0.85 0984 0.98 85 98 0.856-0.984 741451 https//7414519.shinyapps.io/ClinicalRiskScore / 4 (https://7-414-5-19.shinyapps.io/ClinicalRiskScore 56. (56. 23. (23. 0.8560.98 085609 085 0.8 098 0.9 0.856-0.98 74145 (56 (23 0.8560.9 08560 08 09 0.856-0.9 7414 (5 (2 0.8560. 0.856-0. 741 ( 0.8560 0.856-0 74 0.856-

Abstract Background Alcohol, a widely abused drug, significantly diminishes life quality, causing chronic diseases and psychiatric issues, with severe health, societal, and economic repercussions. Previously, we demonstrated that non-voluntary alcohol consumption increases the opening of Cx43 hemichannels and Panx1 channels in astrocytes from adolescent rats. However, whether ethanol directly affects astroglial hemichannels and, if so, how this impacts the function and survival of astrocytes remains to be elucidated. Results Clinically relevant concentrations of ethanol boost the opening of Cx43 hemichannels and Panx1 channels in mouse cortical astrocytes, resulting in the release of ATP and glutamate. The activation of these large-pore channels is dependent on Toll-like receptor 4, P2X7 receptors, IL-1β and TNF-α signaling, p38 mitogen-activated protein kinase, and inducible nitric oxide (NO) synthase. Notably, the ethanol-induced opening of Cx43 hemichannels and Panx1 channels leads to alterations in cytokine secretion, NO production, gliotransmitter release, and astrocyte reactivity, ultimately impacting survival. Conclusion Our study reveals a new mechanism by which ethanol impairs astrocyte function, involving the sequential stimulation of inflammatory pathways that further increase the opening of Cx43 hemichannels and Panx1 channels. We hypothesize that targeting astroglial hemichannels could be a promising pharmacological approach to preserve astrocyte function and synaptic plasticity during the progression of various alcohol use disorders.

Abstract. The transformation of agricultural waste into activated carbon represents an attractive approach as new and alternative source, but also as a reduction of pollution associated to the degradation of precursors. The organic residues sugarcane (Saccharum officinarum) bagasse-shell, orange (Citrus sinensis) peel-bagasse, and eucalyptus (Eucalyptus globulus) leaves, obtained from a biodrying process were transformed into activated carbons using phosphoric acid as activating agent. The resulting materials were physicochemically characterized and after that, carbonaceous electrodes were prepared to test the feasibility of using them in a discoloration electro-Fenton wastewater treatment process. Orange peel-bagasse biodried precursor transformed into activated carbon showed the highest efficiency when used as the modifier in a carbon paste electrode due to its highest porosity, electroactive area (24.9x10-2 cm2), and roughness (1.21 a.u.), also to its chemical affinity for anionic molecules. These properties, in addition to the capability of electro-sorb iron ions on the surface during the Fenton reaction, allowed a 44 % methyl orange discoloration efficiency. Sugarcane bagasse-peel and eucalyptus leaves biodried residues were also evaluated with efficiencies under 30 %, mainly attributed to intrinsic composition of the precursor materials.

Resumen. La transformación de los residuos agrícolas en carbón activado representa un enfoque atractivo y novedoso, además de que representa una alternativa a la reducción de la contaminación asociada a la degradación de residuos orgánicos. Los residuos orgánicos de bagazo de caña de azúcar (Saccharum officinarum), bagazo y cáscara de naranja (Citrus sinensis), y hojas de eucalipto (Eucalyptus globulus), que fueron obtenidos de un proceso de biosecado, se transformaron en carbón activado utilizando ácido fosfórico como agente activante. Los materiales resultantes se caracterizaron fisicoquímicamente y después de eso, se prepararon electrodos de pasta de carbón modificados con estos materiales, para estudiar la viabilidad de utilizarlos en un proceso de tratamiento de aguas residualesmediante electro-Fenton. El precursor biosecado de bagazo y cáscara de naranja transformado en carbón activado mostró la mayor eficiencia cuando se usó como modificador en un electrodo de pasta de carbón, debido a su mayor porosidad, área electroactiva (24.9x10-2 cm2) y rugosidad (1.21), también debido a su mayor afinidad química por moléculas aniónicas. Estas propiedades, aunadas a la capacidad de electro-sorber iones de hierro en la superficie durante la reacción de Fenton, permitieron una eficiencia de decoloración del naranja de metilo del 44 %. También se evaluaron residuos biosecados de bagazo de caña de azúcar y hojas de eucalipto, con eficiencias inferiores al 30 %, atribuidas principalmente a la composición intrínseca de los materiales precursores.

Abstract Background: Colorectal cancer (CRC) is the second cause of cancer death in the world and is estimated to have been responsible for almost 935,000 deaths during 2020. Objective: Describe clinicopathological features, overall survival (OS) and progression-free survival (PFS) in CRC patients under 30 years. Method: This is a retrospective cohort study in patients under 30 years diagnosed with CRC. Results: From 2017 to 2021, 1823 patients were diagnosed with CRC, of which 54 (2.96%) were under 30 years. The OS, during 4 years, was 41.5%. The clinical stage found IV (hazard ratio [HR]: 6.212; 95% confidence interval [95% CI]: 2.504-15.414; p < 0.001), giving neoadjuvant therapy (HR: 0.705; 95% CI: 0.499-0.996; p = 0.047) and no medical history of Lynch syndrome (HR: 3.925; 95% CI: 1.355-11.364; p = 0.012) are independent predictors of mortality. The PFS, during 4 years, was 21.3%. Clinical stage IV (HR: 2.418; 95% CI: 1.000-5.850; p < 0.050), and no diagnosis of Lynch syndrome (HR: 3.800; 95% CI: 1.398-10.326; p = 0.009) are independent predictors. Conclusions: Younger patients are usually diagnosed with CRC in advanced stages. Early symptoms and evaluation, irrespective of age, are crucial.

Resumen Antecedentes: El cáncer colorrectal (CCR) es la segunda causa de muerte por cáncer en el mundo y se estima que fue responsable de casi 935,000 muertes durante el año 2020. Objetivo: Describir las características clinicopatológicas, la supervivencia global (SG) y la supervivencia libre de progresión (SLP) en pacientes con CCR menores de 30 años. Método: Estudio de cohorte retrospectivo en pacientes con diagnóstico de CCR menores de 30 años. Resultados: Entre 2017 y 2021 se diagnosticaron 1823 pacientes con CCR, de los cuales 54 (2.96%) eran menores de 30 años. La SG a 4 años fue del 41.5%. Se encontró que la etapa clínica IV (hazard ratio [HR]: 6.212; intervalo de confianza del 95% [IC95%]: 2.504-15.414; p < 0.001), recibir tratamiento neoadyuvante (HR: 0.705; IC95%: 0.499-0.996; p = 0.047) y no tener antecedente de síndrome de Lynch (HR:3.925; IC95%: 1.355-11.364; p = 0.012) son predictores de mortalidad independientes. La SLP a 4 años fue del 21.3%. La etapa clínica IV (HR: 2.418; IC95%: 1.000-5.850; p < 0.050) y el no contar con diagnóstico de síndrome de Lynch (HR: 3.800; IC95%: 1.398-10.326; p = 0.009) son predictores independientes. Conclusiones: Los pacientes jóvenes son diagnosticados con CCR en etapas avanzadas. Los síntomas iniciales, junto con la evaluación, independientemente de la edad, son cruciales.

Resumen Introducción: El abdomen abierto es una alternativa para manejar al paciente traumatizado, y una variante para instituirlo es la terapia de presión negativa de la herida con el dispositivo VAC®. Aunque tiene ventajas técnicas, no está exento de riesgos y una complicación crítica es la formación de fístulas enteroatmosféricas (FEA). Objetivo: Analizar el papel de la duración de la terapia de presión negativa y del número de cambios del dispositivo VAC® sobre la aparición de FEA en pacientes traumatizados manejados con abdomen abierto. Método: Se establecieron puntos de corte con curva de características operacionales del receptor. Los valores se compararon con la prueba t de Student o U de Mann-Whitney, considerando p < 0.05 como valor estadísticamente significativo. Resultados: La FEA se presentó en 39 casos (5.9%). Hubo una diferencia significativa en la aparición de FEA en pacientes con duración de la terapia de presión negativa de la herida ≥ 11.2 días (46.9 vs 1.3%; riesgo relativo [RR]: 3.67; intervalo de confianza del 95% [IC95%]: 2.4-6.68; p = 0.017) y cuando se practicaron ≥ 2.6 cambios del dispositivo VAC® (34.6 vs. 0.5%; RR: 6.92; IC95%: 1.1-4.3; p < 0.001). Conclusiones: En nuestra institución, la práctica de más de tres cambios del dispositivo VAC® y el mantenimiento de la terapia por más de 11 días debe ser cuidadosamente considerado para reducir el riesgo de formación de FEA.

Abstract Background: Open abdomen is an alternative for the management of trauma patient, and negative pressure therapy of the wound using VAC® device is a genuine sort of treatment. Although the device poses technical advantages, risks are present and a critical complication is the enteroatmospheric fistula formation (EAF). Objective: To analize the role of negative pressure therapy length and VAC® device number of changes on the EAF formation in trauma patients udergoing open abdomen. Method: Cut-off points were calculated using receiver operational characteristics curve. Values were compared with Student's t or Mann-Withney U tests, considering statistically significant p < 0.05. Results: EAF were present in 39 cases (5.9%). A significant difference in the presence of EAF was present in patients with negative pressure therapy of the wound length ≥ 11.2 days (46.9 vs. 1.3%; relative risk [RR]: 3.67; 95% confidence interval [95% IC]: 2.4-6.68; p = 0.017) and when ≥ 2.6 VAC® device changes were performed (34.6 vs. 0.5%; RR: 6.92; 95% IC: 1.1-4.3; p < 0.001). Conclusions: At our institution, the practice of >3 VAC® device changes and length of therapy > 11 days should be carefully considered leading to reduce the risk of EAF formation.

Resumen Introducción: El trasplante renal es el tratamiento de elección de la enfermedad renal en etapa terminal (ERT). Desde marzo de 2020, la actividad de trasplantes en México se ha visto afectada debido a la pandemia de COVID-19. Objetivo: Determinar el impacto en la mortalidad de pacientes en lista de espera (LE) para trasplante renal de donante cadavérico en un hospital de referencia en Yucatán, por suspensión de actividades debido a la pandemia. Material y métodos: Pacientes > 18 años en LE para trasplante renal en este hospital. En caso de muerte de un paciente, se investigó la causa, especialmente si estaba asociada a COVID-19. Un valor de p de dos colas ≤ 0.05 se consideró significativo en todos los análisis. Resultados: La razón de probabilidad de muerte por COVID-19 en un paciente con ERT en la LE en 2020 fue OR = 5.04 (IC 95%: 1.65-7.14, p = 0.023). La razón de probabilidad de morir con ERT en la LE con retraso en las consultas de seguimiento fue de OR = 6.59 (IC 95%: 2.7-16.28, p = 0.008). Conclusión: La probabilidad de muerte de un paciente con ERT en la LE con retraso en las consultas de seguimiento y retención del trasplante es estadísticamente más alta que la probabilidad de muerte por COVID-19.

Abstract Introduction: Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Since March 2020, transplant activity in Mexico has been affected due to the COVID-19 pandemic. Objective: The aim of the study was to determine the impact on mortality of patients on the waiting list (WL) for cadaveric donor kidney transplantation in a referral hospital in Yucatán, due to suspension of activities due to the pandemic. Material and methods: Patients over 18 years of age on the waiting list for kidney transplantation at this hospital. In the event of a patient's death, the cause was investigated, especially if it was associated with COVID-19. A two-tailed p ≤ 0.05 was considered significant in all analyzes. Results: The odds ratio (OR) of death from COVID-19 in a patient with ESRD in the WL in 2020 was OR = 5.04 (95% CI: 1.65-7.14, p = 0.023). The OR of dying with ESRD in the WL with a delay in the follow-up visits was OR = 6.59 (95% CI: 2.7-16.28, p = 0.008). Conclusion: The probability of death of a patient with ESRD with delayed follow-up visits and transplant retention is statistically higher than the probability of death from COVID-19.

Resumen Antecedentes: El cáncer de células pequeñas (CPCP) representa el 13-15% del total de neoplasias primarias de pulmón. Se caracteriza por su rapidez en la tasa de crecimiento y en el desarrollo de metástasis a distancia. Objetivos: Orientar y estandarizar el tratamiento del CPCP enfermedad extensa en México basado en evidencia clínica nacional e internacional. Material y métodos: Este documento se desarrolló como una colaboración del Instituto Nacional de Cancerología y la Sociedad Mexicana de Oncología en cumplimiento con estándares internacionales. Se integró un grupo conformado por oncólogos médicos, cirujanos oncólogos, cirujanos de tórax, radio-oncólogos y metodólogos con experiencia en revisiones sistemáticas de la literatura y guías de práctica clínica. Resultados: Se consensaron, por el método Delphi y en reuniones a distancia, las recomendaciones en CPCP enfermedad extensa, producto de preguntas de trabajo. Se identificó y evaluó la evidencia científica que responde a cada una de dichas preguntas clínicas antes de incorporarla al cuerpo de la guía. Conclusión: Esta guía proporciona recomendaciones clínicas para el manejo de la enfermedad extensa del CPCP y durante el proceso de toma de decisiones de los clínicos involucrados con su manejo en nuestro país para mejorar la calidad de la atención clínica para estos pacientes.

Abstract Background: Small cell lung cancer (SCLC) represents 13-15% of all primary lung neoplasms and is characterized by its rapid growth rate and the rapid development of distant metastases. Objectives: To guide and standardize the treatment of extensive disease small cell lung cancer in Mexico based on national and international clinical evidence. Material and methods: This document was developed as a collaboration between the National Cancer Institute and the Mexican Society of Oncology in compliance with international standards. An interdisciplinary group was formed, including medical oncologists, oncological surgeons, thoracic surgeons, radiation oncologists, and methodologists with experience in systematic reviews of the literature and clinical practice guidelines. Results: A consensus was reached, both by the Delphi method and in remote meetings, of extensive disease recommendations resulting from work questions. The scientific evidence that answers each of these clinical questions was identified and critically evaluated, before being incorporated into the body of evidence of the Guide. Conclusions: This Clinical Practice Guide provides clinical recommendations for the management of extensive disease of SCLC to contribute to the decision-making process of the clinicians involved with its management in our country, hoping that this will contribute to improving the quality of clinical care in these patients.

RESUMEN Introducción En México, esta indagación hasta donde se tiene conocimiento representa el primer trabajo multicéntrico que estudia el grado de desarrollo de la aptitud clínica en cuatro Unidades de medicina familiar del Sector Salud. Por consiguiente, la interrogante de investigación es ¿Cuál es el grado de desarrollo de la aptitud clínica en tres instituciones de salud?. Este estudio proveerá conocimientos que permitirán emprender investigaciones en las cuales se ensayen estrategias educativas que propicien el desarrollo de esta aptitud. Objetivo Determinar el grado de desarrollo de la aptitud clínica en residentes de medicina familiar de cuatro sedes académicas. Método Diseño prospectivo, transversal, observacional y multicéntrico. Se estudió toda la matrícula del ciclo académico 2019-2020 con consentimiento informado. Se construyó un instrumento que evaluó la variable “aptitud clínica” mediante ocho indicadores y 182 ítems; la validez conceptual, de contenido y confiabilidad se valoró por cinco médicos familiares con experiencia docente y en investigación educativa. Resultados De las cuatro sedes, las calificaciones globales más altas en los indicadores fueron alcanzadas por los R1 de la Unidad de Medicina Familiar # 20 del Instituto Mexicano del Seguro Social (UMF20 IMSS), R2 y R3 del Hospital General de Zona # 1 (HGZMF1 IMSS). Los R1 de la UMF20 alcanzaron los más altos puntajes en 3/8 indicadores. Los R2 y R3 del HGZMF1 lograron las más altas puntuaciones en 2/8 indicadores. Se estimaron diferencias entre R1 (n=46), entre R2 (n=47) y entre R3 (n=40) de las cuatro sedes por indicador y no se encontraron diferencias estadísticas significativas en ningún caso. Conclusiones El grado de desarrollo de la aptitud clínica se puede considerar de nivel medio en las cuatro sedes académicas. Esto en parte se puede explicar a que el instrumento exploró situaciones clínicas problematizadas, que exigieron del residente la reflexión crítica de su experiencia clínica antecedente.

ABSTRACT Introduction In Mexico, this inquiry to the best of our knowledge represents the first multicenter work that studies the degree of development of clinical aptitude in four Family Medicine Units of the Health Sector. Therefore, the research question is : What is the degree of development of clinical aptitude in three health institutions? This study will provide knowledge that will allow undertaking researches in which educational strategies that propitiate the development of this aptitude are tested. Objective To determine the degree of development of clinical aptitude in family medicine residents from four academic sites. Method Prospective, cross-sectional, observational and multicenter design. The entire enrollment of the 2019-2020 academic year was studied with informed consent. An instrument was constructed that assessed the variable "clinical aptitude" by means of eight indicators and 182 items; conceptual, content and reliability validity was assessed by five family physicians with teaching and educational research experience. Results Of the four sites, the highest overall scores on the indicators were achieved by the R1 of the Family Medicine Unit # 20 of the Mexican Social Security Institute (UMF20 IMSS), R2 and R3 of the General Zone Hospital # 1 (HGZMF1 IMSS). UMF20 R1s achieved the highest scores on 3/8 indicators. The R2s and R3s of HGZMF1 achieved the highest scores on 2/8 indicators. Differences were estimated between R1s (n=46), between R2s (n=47) and between R3s (n=40) of the four sites by indicator and no significant statistical differences were found in any case. Conclusions The degree of development of clinical aptitude can be considered medium level in the four academic sites. This can be partly explained by the fact that the instrument explored problematic clinical situations, which required the resident to reflect critically on his previous clinical experience.

Abstract Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. Methods: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. Results: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusion: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.

Resumen Objetivo: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. Métodos: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. Resultados: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusión: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.