Resumo: O trabalho apresentado pretende visualizar a importância e o papel desempenhado pelo Tribunal de Justiça da União Europeia na evolução e consolidação do sistema de integração comunitário como guardião da legalidade e garante da segurança jurídica da UE. É explorado o papel essencial da jurisprudência do TJUE no processo de integração europeia, centrando-se, mais especificamente, em sua contribuição para a construção do Direito Comunitário, na sua função na garantia dos direitos dos cidadãos e nas polémicas que tem suscitado. São também abordados conceitos jurídicos que são e foram fundamentais,desde o início, no processo de integração, como o do efeito direto ou a primacía do Direito da União sobre o Direito nacional. Para compreender o potencial jurídico do TJUE, é necessário abordar inúmeras sentenças, resoluções e documentos que emitiu, e que o tornam garante da aplicação uniforme das leis, garantindo a coesão da ordem jurídica da União Europeia como um todo.

Abstract: The work presented aims to visualize the importance and role played by the Court of Justice of the European Union in the evolution and consolidation of the community integration system as guardian of legality and guarantor of the legal security of the EU. The essential role of the jurisprudence of the TJUE in the European integration process is explored, focusing, more specifically, on its contribution to the construction of Community Law, its function in guaranteeing the rights of citizens and the controversies it has raised. Legal concepts that are and have been fundamental, from the beginning, in the integration process are also addressed, such as that of direct effect or that of the primacy of Union Law over national Law. To understand the legal potential of the TJUE it is necessary to address the numerous sentences, resolutions and documents it has issued, which make it a guarantor of the uniform application of laws, guaranteeing the cohesion of the legal order of the European Union as a whole.

Resumo: El trabajo presentado pretende visualizar la importancia y el rol que cumple el Tribunal de Justicia de la Unión Europea en la evolución y consolidación del sistema de integración comunitario como guardián de la legalidad y garante de la seguridad jurídica de la UE. Se explora el papel esencial de la jurisprudencia del TJUE en el proceso de integración europea, enfocándose, más específicamente, en su contribución a la construcción del Derecho Comunitario, su función en la garantía de los derechos de los ciudadanos y las controversias que ha suscitado. Se abordan también conceptos legales que son y han sido fundamentales, desde el origen, en el proceso de integración, tales como el de efecto directo o el de la primacía del Derecho de la Unión sobre los Derecho nacionales. Con la finalidad de comprender el potencial jurídico que significa el TJUE se aborda numerosas sentencias, resoluciones y documentos emitidos por él, que lo hace garante de la aplicación uniforme de las leyes asegurando la cohesión del orden jurídico de la Unión Europea en su conjunto.

Resumo: Dado que existe um ambiente económico globalizado e essencialmente em mudança, tanto as pessoas singulares como as pessoas colectivas mudam de domicílio, residência ou sede, e com isso, levanta-se esta polémica para estas últimas, incluindo a sua nacionalidade. A grande questão é se noções como nacionalidade ou domicílio são comparáveis entre os dois tipos de pessoas. E embora a partir de ambientes de integração como os patrocinados pelo MERCOSUL e outras regiões latino-americanas, bem como pela União Europeia (UE), o processo facilitador de movimentos de pessoas jurídicas com fins lucrativos tenha atingido níveis de grande intensidade (alcançando até mesmo o nível europeu caso a aspectos antes impensáveis, como mudanças totais de sede ou perda de personalidade no país de fundação ou origem), os Estados participantes nas áreas acima mencionadas, e em contraste com outros aspectos do Direito Internacional Privado que foram unificados (no UE através dos Regulamentos, os únicos responsáveis por esta gestão), existem incógnitas significativas a revelar em ambos os lados do Oceano Atlântico, nomeadamente, a adopção de regras comuns para determinar a sede ou nacionalidade dessas mesmas empresas comerciais na mobilidade. . Isto constitui uma tarefa pendente tanto para as iniciativas de integração da UE como da América Latina, como o MERCOSUL, de modo que é necessário um estudo calmo para encontrar resultados partilhados promissores que vislumbrem o quadro reflexivo necessário no que diz respeito a um problema tão complexo.

Abstract: Since there is a globalized and essentially changing economic environment, both natural and legal persons change their domicile, residence or headquarters, and with this, this controversy is being raised for the latter, including their nationality. The big question is whether notions such as nationality or domicile are comparable between both types of people. And although from integration environments such as those sponsored by MERCOSUR and other Latin American regions, as well as by the European Union (EU), the facilitating process of movements of for-profit legal entities has reached levels of great intensity (even reaching the European case to previously unthinkable aspects such as total changes of headquarters or the loss of personality in the country of founding or origin), the participating States in the aforementioned areas, and in contrast to other aspects of Private International Law that have been unified (in the EU through Regulations, the only ones in charge of this management), there are significant unknowns to be revealed on both sides of the Atlantic Ocean, specifically, the adoption of common rules to determine the headquarters or nationality of those same commercial companies. in mobility. This constitutes a pending task for both the EU and Latin American integration initiatives such as MERCOSUR, so that a calm study is required to find promising shared results that glimpse the necessary reflective framework with respect to such a complex problem.

Resumen: Desde que existe un entorno económico globalizado y por esencia cambiante, las personas tanto físicas como jurídicas cambian su domicilio, residencia o sede, y con ello, cuestión esta polémica para las segundas, inclusive su nacionalidad. La gran cuestión es saber si son equiparables nociones como nacionalidad o domicilio entre ambos tipos de personas. Y si bien desde entornos de integración como son los auspiciados desde MERCOSUR y otras regiones latinoamericanas, así como por la Unión Europea (UE), el proceso facilitador de movimientos las personas jurídicas con ánimo de lucro ha alcanzado cotas de gran intensidad (llegando inclusive en el caso europeo a aspectos antes impensable como los cambios totales de sede o la pérdida de personalidad en el país de fundación u origen), los Estados participantes en los referidos ámbitos, y en contraste a otros aspectos de Derecho Internacional Privado que se han venido unificando (en la UE mediante Reglamentos, los únicos al frente de esta gestión), quedan significativas incógnitas por desvelar a uno y otro lado del Océano Atlántico, en concreto, la adopción de unas reglas comunes para determinar la sede o nacionalidad de esas mismas sociedades mercantiles en movilidad. Ello constituye una tarea pendiente tanto para la UE y las iniciativas integradoras latinoamericanas como es la de MERCOSUR, de manera que se impone el estudio sosegado para hallar resultados prometedores compartidos que atisben el necesario marco reflexivo con respecto a tan compleja problemática.

Resumen En el marco de la organización supranacional que es la Unión Europea, el presente artículo pretende estudiar y analizar la lucha de las instituciones europeas en favor de la democracia y, más concretamente, de los esfuerzos llevados a cabo por el Parlamento Europeo. La petición de revisar la transparencia de las instituciones europeas proviene en tiempo reciente del Parlamento Europeo, tras las investigaciones, detenciones y noticias derivadas de la coyuntura del asunto denominado como Qatargate. En efecto, así es como se conoce actualmente a las presiones políticas y económicas relacionadas con la organización y celebración en Qatar del Mundial de fútbol de 2022. En esta línea, se abordarán las repercusiones que plantea la nueva Resolución del Parlamento Europeo, con fecha de 16 de febrero de 2023, en la que se disponen nuevas herramientas con el objetivo de incrementar la integridad de las instituciones europeas. La hipótesis que seguiremos se encuentra fundamentada en el hecho de que, la corrupción y vulneración de los valores europeos, por parte de las instituciones, hace que los ciudadanos se desvinculen de la propia y progresiva construcción de la Unión Europea. Para refutar dicha hipótesis, se ha llevado a cabo una investigación que proporcione explicación a la cuestión planteada, y lo realice a través de una metodología cuantitativa, todo ello con la finalidad de alcanzar una idea general de la realidad social. Pues bien, en base a todo lo analizado, se ha podido confirmar que, la confianza de la ciudadanía en las instituciones se ve mermada cuando aumentan los casos de corrupción y/o vulneración de los derechos.

Abstract This article aims to study and analyse the European struggle for democracy as a supranational organisation. The request to review the transparency of European institutions comes from the European Parliament, following the investigations, arrests and news of the Qatargate affair, as the political and economic pressures related to the 2022 World Cup are currently known. In this vein, it will address the implications of the European Parliament's new resolution, dated 16 February 2023, which provides for new tools aimed at increasing the integrity of the European institutions. The hypothesis to be followed will be that corruption and the violation of European values by the institutions causes citizens to disengage from the European Union. In order to refute this hypothesis, an explanatory research has been carried out, using a quantitative methodology, with the aim of reaching a general idea of the social reality. On the basis of all that has been analysed, it has been possible to confirm that citizens' trust in institutions is diminished when cases of corruption and/or violation of rights increase.

Abstract: The proposal to regulate the use of data in the European Union has been a priority for some years. Since the European Data Strategy was presented by the European Commission in 2020, work has been under way on a Regulation on a European Data Governance Act to help complete the regulatory framework initiated with the General Data Protection Regulation in 2016. Last April 2022, the European Parliament made public its amendments to the proposal on this proposal for a Regulation and its position on it, welcoming it as a great necessity for the development of the European market. We will dedicate the following lines to the review of some aspects of the proposal and its analysis.

Resumen: La propuesta para regular el uso de los datos en la Unión Europea lleva siendo una prioridad desde hace unos años. Desde que se presentó por la Comisión Europea la Estrategia Europea de Datos en 2020, se ha estado trabajando en un Reglamento sobre una Ley de Gobernanza Europea de Datos que ayude a completar el marco normativo iniciado con el Reglamento General de Protección de Datos en 2016. El pasado abril de 2022, el Parlamento Europeo hizo públicas sus enmiendas a la propuesta sobre esta propuesta de Reglamento y su posición al respecto, acogiéndola como una gran necesidad para el desarrollo del mercado europeo. A la revisión de algunos aspectos de la propuesta y a su análisis dedicaremos las líneas siguientes.

Abstract Background: Vulvar diseases are common in the general population and have a negative impact on the quality of life. Objectives: To describe our experience as dermatologists in the management of vulvar dermatosis consultations. Methods: A retrospective observational study was conducted with patients who attended monographic vulvar consultations over a 5-year period. Clinical information was obtained from the patient’s charts. Results: 148 women were studied. Their mean age was 43.24 years (standard deviation: 15.15 years), with ages ranging from 4 months to 80 years. 53.4% of patients took between 2 and 5 years to seek medical attention for the first time. The most frequent diagnosis was lichen sclerosus (41.9%), irritative eczema of the vulva (14.9%), and lichen simplex chronicus (10.1%). 83.8% reported anogenital itching, 66.2% pain, and 45.9% dyspareunia. The most frequently prescribed treatment was ultra-potent topical corticosteroids (clobetasol propionate; 41.2%). Patients with lichen sclerosus were significantly older than those who presented with any of the other diseases. No differences were found in terms of either the time of disease evolution or in symptom presentation. Study limitations: Retrospective study. Vulvar diseases with an infectious cause are usually managed in primary care, therefore, were not included. All patients were recruited from a single private hospital which limits the comparisons with the public health system. Conclusions: Vulvar diseases frequently occur and are associated with high morbidity. It is essential to promote the development of specific vulvar consultations in hospitals. Specialties such as dermatology, gynecology, urology, or physiotherapy must be part of these units.

RESUMO Objetivo: A proporção entre pressão venosa central menos arterial de dióxido de carbono e conteúdo de oxigênio arterial menos venoso central (Pcv-aCO2/Ca-cvO2) é frequentemente usada como substituta para a oxigenação tecidual. O objetivo deste estudo foi identificar e sintetizar a literatura e a qualidade das evidências que suportam a Pcv-aCO2/Ca-cvO2 como um preditor de mortalidade em comparação com o lactato em pacientes críticos. Métodos: Pesquisamos vários bancos de dados procurando estudos que tivessem medido a Pcv-aCO2/Ca-cvO2 em pacientes críticos. Pesquisadores independentes realizaram a triagem dos artigos e a extração de dados. Uma metanálise de efeitos aleatórios foi realizada. Diferenças médias padronizadas agrupadas foram usadas para comparar a capacidade prognóstica da Pcv-aCO2/Ca-cvO2 e do lactato. Resultados: Inicialmente, obtivemos 172 estudos; 17 foram incluídos para descrição qualitativa, e dez foram incluídos para síntese quantitativa. A média de Pcv-aCO2/Ca-cvO2 foi maior nos não sobreviventes do que nos sobreviventes (diferença média padronizada agrupada de 0,75; IC95% 0,34 - 1,17; I2 = 83%), assim como os níveis de lactato (diferença média padronizada agrupada = 0,94; IC95% 0,34 - 1,54; I2 = 92%). Ambos os testes foram preditores estatisticamente significativos de mortalidade, embora com sobreposição de IC95% entre eles. Conclusão: Evidências de qualidade moderada mostraram pouca ou nenhuma diferença na capacidade da Pcv-aCO2/Ca-cvO2, em comparação com o lactato, em predizer mortalidade. No entanto, nossas conclusões são limitadas pela considerável heterogeneidade entre os estudos. Registro no PROSPERO:CRD42019130387

ABSTRACT Objective: The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate. Methods: We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate. Results: We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I2 = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I2 = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them. Conclusion: Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies. PROSPERO registration:CRD42019130387

ABSTRACT Introduction: The role of the tutor in virtual medical education seems to be that of a transmitter of knowledge to a facilitator of learning. WhatsApp application is one of the resources that is used for this purpose. Objective: Describe the results of the use of WhatsApp application for computers as a tool for educational interaction in the Anesthesiology Service of “Manuel Ascunce Domenech” University Hospital. Methods: Observational, descriptive and cross-sectional study to determine the usefulness of WhatsApp, as a communication tool between the tutor and a group of students of the Specialty of Anesthesiology and Resuscitation, from June 2020 to June 2021. The population was of 40 students and the sample was of 15, who met the inclusion criteria. Weekly teaching communication was carried out or at the request of the student, without a fixed schedule, through WhatsApp. A questionnaire based on the objectives of the research was applied after one year. Results: All students were under 30 years of age, but the ages between 23-26 years (60%) predominated, the female sex represented 66.66% of the participants, 73.33% established a connection through a smartphone, the main advantages referred to were: immediacy (93.33%), the link with the tutor and physical distancing (86.66%), and privacy (80%). The main disadvantages were: high cost of connectivity (100%), small screen to read (46.66%), inappropriate hours (40%). The majority reported a high degree of satisfaction (86.66%). Conclusions: The use of WhatsApp offers multiple advantages for the relationship between the tutor and the students, and promotes a successful outcome in the learning process.

RESUMEN Introducción: La función del tutor en la educación médica virtual deja de ser la de un transmisor de conocimiento a un facilitador del aprendizaje. La aplicación WhatsApp es uno de los recursos que se utiliza para este fin. Objetivo: Describir los resultados del uso de la aplicación informática WhatsApp como herramienta de interacción educativa en el servicio de Anestesiología del Hospital Universitario “Manuel Ascunce Domenech”. Métodos: Estudio observacional, descriptivo y transversal para determinar la utilidad de WhatsApp, como herramienta de comunicación entre el tutor y un grupo de alumnos de la Especialidad de Anestesiología y Reanimación, desde junio del año 2020 hasta junio del año 2021. La población fue de 40 estudiantes y la muestra de 15, los cuales cumplieron los criterios de inclusión. Se realizó comunicación docente semanal o a demanda del alumno, sin horario fijo, mediante WhatsApp. Al año se aplicó un cuestionario basado en los objetivos de la investigación. Resultados: Todos los alumnos tenían menos de 30 años, pero predominaron las edades entre 23-26 años (60 %), el sexo femenino representó el 66,66 % de los participantes, el 73,33 % estableció conexión mediante un teléfono inteligente, las principales ventajas referidas fueron la inmediatez (93,33 %), el vínculo con el tutor y distanciamiento físico (86,66 %), y la privacidad (80 %). Las principales desventajas fueron: alto costo de conectividad (100 %), pantalla pequeña para leer (46,66 %), horario inapropiado (40 %). La mayoría reportó alto grado de satisfacción (86,66 %). Conclusiones: El uso de WhatsApp ofrece múltiples ventajas para la relación entre el tutor y los estudiantes, y propicia un desenlace exitoso en el proceso de aprendizaje.

ABSTRACT: The latest Casen survey applied in Chile shows alarming numbers of school dropouts, nearly 5 million students between the ages of 14 and 17 have dropped out of school. It is these young people who need a strengthened Education for Young People and Adults and with the ability to offer them opportunities to finish their formal education. This research is of a quantitative, descriptive and inferential nature, which aims to know the degree of contribution of Initial Teacher Training from the perspective of students in training, through a questionnaire structured in three dimensions. The results of this research indicate medium to null knowledge in the area, prejudices attributed to the students who attend these establishments, low job expectations in the area and less preparation depending on the career.

RESUMEN: La última encuesta Casen aplicada en Chile muestra cifras alarmantes de deserción escolar, cerca de 5 millones de estudiantes entre 14 y 17 años han abandonado sus estudios. Son estos jóvenes quienes necesitan de una Educación para Personas Jóvenes y Adultas (EPJA) fortalecida y con la capacidad de ofrecerles oportunidades de finalizar con su educación formal. Esta investigación es de carácter cuantitativo, descriptivo e inferencial, que tiene por objetivo conocer el grado de contribución de la Formación Inicial Docente desde la perspectiva de los estudiantes en formación, mediante un cuestionario estructurado en tres dimensiones. Los resultados de esta investigación señalan conocimientos en el área de medio a nulo, prejuicios atribuidos a los estudiantes que asisten a estos establecimientos, bajas expectativas laborales en el área y menor preparación dependiendo de la carrera.

ABSTRACT Agricultural science in Chile began in 1881 with the establishment of the Agronomic Station of the National Society of Agriculture (SNA). In this article we described the history and evolution of research and development (R+D) and human capital training in this field. The main research institution, in terms of territory coverage and human resources, is the Instituto de Investigaciones Agropecuarias (INIA), along with five regional research centers, specialized in different aspect of agricultural science, and 20 schools of agriculture and 11 doctoral programs associated to different universities. Public investment in agricultural R+D is provided by the Ministry of Agriculture, Ministry of Science and Technology, Ministry of Economy and Regional Governments, reaching around US$200 million in the last decade. The number of researchers in agricultural science is ~ 40 per million of inhabitants (~ 800 in total). An average of 140 projects per year are financed in agriculture R+D by different funding agencies. The scientific productivity was estimated in ~ 0.45 articles (Scopus) per researcher. It is concluded that, although significant progress has been made the last decades, there is still a reduced number of researchers and insufficient investment to face urgent challenges of the agricultural sector in Chile.

Abstract: Element of flexibility as well as controversial, assessments made by the EU Court of Justice regard-ing preliminary rulings referred to it constitute an expression of distinctive judicial independence. Such positions have led in some cases to a refusal to answer the doubts submitted from national administrative departments. Faced with such disturbing examples, this study proposes a scientific methodology for a better understanding, by taking into account one of the most recently produced, which precisely affects a Spanish administrative body.

Resumo: Elemento de flexibilidade e também polémico, as apreciações do Tribunal de Justiça da União Européia sobre as questões prejudiciais que lhe são submetidas são expressão de uma marcada independência judicial. Estas posições o levaram, em alguns casos, a recusar-se a responder às dúvidas enviadas pelas autoridades administrativas nacionais. Diante de exemplos tão preocupantes, este estudo propõe uma metodologia científica para melhor compreendê-los, focalizando-se especialmente em um dos (casos) mais recentes produzidos, e que afeta especificamente um órgão administrativo espanhol.

Resumen: Elemento de flexibilidad a la par que polémico, las apreciaciones pronunciadas por el Tribunal de Justicia de la UE en cuanto a las cuestiones prejudiciales que le son remitidas constituyen expresión de una acentuada independencia judicial. Estos posicionamientos le han llevado en algunos casos a rechazar contestar a las dudas remitidas desde instancias administrativas nacionales. Ante tan inquietantes ejemplos, este estudio propone una metodología científica para comprenderlos mejor, centrándose con carácter especial uno de los más recientemente producidos, y que afecta a precisamente un órgano administrativo español.

Abstract: The world economy was seriously affected by the COVID-19 pandemic, which caused the paralysis of most sectors in Ecuador, one of these was the automotive industry. The objective of the investigation was to determine how COVID-19 has impacted the liquidity of importing companies of automotive parts that operate in Santo Domingo. A descriptive scope was applied, the same one that had a qualitative-quantitative mixed modality. The research design is non-experimental cross-sectional, the method of knowledge was of documentary and field analysis. Concluding that the pandemic has caused a notable decrease in the size, level of sales and jobs in automotive companies, thus affecting their liquidity.

Resumen: La economía mundial sufrió graves afectaciones, debido a la pandemia COVID-19, que provocó, la paralización de la mayoría de los sectores en Ecuador, uno de estos fue el automotriz. El objetivo de la investigación fue, determinar como la COVID-19 ha impactado la liquidez de las empresas importadoras de repuestos automotrices que operan en Santo Domingo. Se aplicó un alcance descriptivo, el mismo que tuvo una modalidad mixta cuali-cuantitativa. El diseño de la investigación es no experimental transversal, el método de conocimiento fue de análisis documental y de campo. Concluyendo que la pandemia ha provocado una disminución notable en el tamaño, nivel de ventas y plazas de trabajo en las empresas automotrices afectando de esta manera a la liquidez de las mismas.

Resumen El presente trabajo tiene por finalidad analizar la Nota Conjunta del Consejo de Europa y la Agencia de Derechos Fundamentales de la Unión Europea, como documento aclaratorio sobre el uso de normas internacionales en concordancia con los derechos universales para la correcta aplicación de estas en la coyuntura del COVID-19. Para ello, se ha estudiado la actualidad en las fronteras, la protección de la salud en la práctica y la vulnerabilidad de los menores.

Resumen The purpose of this work is to analyse the Joint Note of the Council of Europe and the European Union Agency for Fundamental Rights, as a explanatory document on the use of international regulations in line with universal rights for the proper application of these at the juncture of COVID-19. To this end, the current situation in frontiers, the protection of health in practice and the vulnerability of minors have been studied.

Abstract Aim: The aim of the study was to evaluate urgent care practice with regard to anorectal abscesses (AA) in a tertiary-level referral hospital. Materials and methods: this was retrospective and unicentric study. Patients who underwent surgery for AA between 2016 and 2017 were included in the study. Demographic variables were analyzed as well as the treatment performed, the need for hospitalization, use of antibiotics, and referral to the coloproctology outpatient department (COD). The recurrence risk factors were also evaluated. Results: A total of 220 evaluations under anesthesia were performed, corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years). The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD. The only risk factor associated with recurrence was the presence of an associated anal fistula. Conclusions: Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.

Resumen Objetivo: Evaluar el manejo de los abscesos perianales por parte del servicio de cirugía de urgencias. Método: Estudio unicéntrico retrospectivo. Se incluyeron pacientes que requirieron manejo quirúrgico de abscesos perianales de 2016 a 2017. Se analizaron variables demográficas, tratamientos realizados, necesidad de ingreso hospitalario, uso de antibióticos y necesidad de derivación a la consulta externa de coloproctología. Así mismo, se evaluaron los factores relacionados con la recurrencia del absceso. Resultados: Durante el periodo de estudio se realizaron 220 exploraciones, correspondientes a 190 pacientes (129 hombres) con una edad media de 46 ± 14.9 años. El tratamiento quirúrgico más frecuentemente realizado fue el drenaje simple (75.8%). Se prescribieron antibióticos en el 62.9% de los casos. El 41.1% de los pacientes fueron remitidos a consulta externa de coloproctología. El único factor de riesgo asociado a la recurrencia fue la presencia de una fístula perianal asociada. Conclusiones: Los abscesos perianales son frecuentes en los servicios de urgencias. Hay una gran variabilidad clínica en su manejo, sobre todo en lo relativo a la realización de cultivos, la prescripción de antibióticos y la derivación a unidades de coloproctología especializadas, sin que ninguna de estas medidas tenga un claro impacto en la recurrencia.

Resumen La enfermedad por SARS-CoV-2 (COVID-19) ha aumentado drásticamente desde marzo 2020 y en la actualidad no existen datos suficientes para establecer el riesgo de contagio de este virus en receptores de trasplante renal en comparación con la población general. El objetivo de este reporte de caso fue presentar las características del curso clínico y terapéutico de una paciente trasplantada renal en terapia de mantenimiento que presentó neumonía por COVID-19 y fue atendida en un hospital no trasplantador. La paciente era una mujer de 47 años con antecedente de insuficiencia renal no filiada que recibió trasplante renal de donante por muerte encefálica en el año 2006. Las características clínicas (síntomas, exámenes de laboratorio e imágenes radiológicas) de la mujer fueron similares a las de otros pacientes con COVID-19 de la población general, por lo que fue tratada con hidroxicloroquina, lopinavir/ritonavir, antibioticoterapia profiláctica y dosis única de tocilizumab. La triple terapia inmunosupresora de mantenimiento que recibía se discontinuó al no poder monitorizar los niveles sanguíneos de algunos fármacos inmunosupresores; asimismo se indicaron dosis bajas de metilprednisolona y 5 dosis de flebogama. La neumonía por COVID-19 en esta paciente inmunodeprimida evolucionó favorablemente sin necesidad de respiración mecánica asistida, y la función renal mejoró a sus valores basales, mantenien- do moderada proteinuria. Al alta se reinició la dosis previa de su medicación inmunosupresora habitual. La experiencia descrita en el presente caso puede ser útil para en tratamiento de pacientes trasplantados y con COVID-19 en hospitales no trasplantadores y que no disponen de la capacidad de verificar los niveles de medicación inmunosupresora.

Abstract SARS-CoV-2 disease (COVID-19) has dramatically increased since March 2020. There is insufficient data to establish the risk of acquiring the infection in kidney transplant recipients in comparison with the general population. The objective of this case is to report here the clinical features and therapeutic course of the renal transplant recipient with confirmed COVID-19 pneumonia in a non-transplant hospital. This is a 47-year-old woman with end stage renal disease (ESRD) of unknown cause who received kidney transplantation 14 years ago. Her clinical characteristics (symptoms, laboratory test results, and chest x-ray images) were similar to those of non-transplanted COVID-19 patients. She was treated with hydroxychloroquine, lopinavir/ritonavir, prophylactic antibiotic therapy, and a single dose of tocilizumab for COVID-19. The triple maintenance immunosuppressive therapy she was receiving was temporarily suspended due to the inability to monitor immunosuppressive drugs levels in our hospital, and low dose methylprednisolone plus five doses of flebogamma were administered instead. The COVID-19 pneumonia in this long-term immunosuppressed patient was successfully recovered without the need to assisted mechanical respiration. The renal function improved to its baseline values, maintaining moderate proteinuria. At discharge, the previous dose of his usual immunosuppressive medication was restarted. We conclude that the experience described with our case may be useful for non-transplant hospitals, which do not have the capacity to perform immunosuppressive medication titration.