Resumen Es posible que exista tolerancia al virus de la mancha anular del papayo (PRSV-p) en plantas nativas de Carica papaya. Se evaluó la respuesta de 13 accesiones (Acc) de papayo nativo y la variedad Maradol roja respecto a la incidencia y severidad del PRSV-p, inoculado con el insecto vector Aphis nerii, y su relación con el manejo de la planta observado durante su colecta. Las Acc se colectaron en estado silvestre, en traspatio o cultivadas. A los tres meses de edad se inocularon las plantas con el virus. Se evaluó semanalmente la incidencia y severidad en nueve ocasiones. Las Acc 203 y 205 mostraron el menor índice de severidad (1.0), seguidas de 147a y 60 (con 1.7), 94a (2.0) y 197a (2.2); las Acc 64a (2.5) y 150 (2.8) alcanzaron una severidad intermedia, seguidas de la 65 y 210b (con 3.3), y de 80, 169 y 188a (con 4.3). La var. Maradol roja presentó el mayor índice de severidad (4.8). La severidad promedio en las Acc colectadas en manejo silvestre fue significativamente menor (P = 0.032) que en Maradol roja, aunque no fue diferente en las Acc que provenían de manejo de plantaciones cultivadas o de traspatio. Es posible que entre las Acc silvestres se encuentren genes de tolerancia al PRSV-p.

Abstract Tolerance to the papaya ring spot virus (PRSV-p) may exist in native Carica papaya plants. The response of 13 native papaya accessions (Acc) and the commercial variety Red Maradol to the incidence and severity of the PRSV-p, inoculated with the vector insect Aphis nerii, and their relation with the observed plant management during their collection were evaluated. Acc were collected in the wild, in backyards or in production fields. Three months old-plants were infected with the virus. Disease incidence and severity were measured nine times weekly. Acc 203 and 205 showed the lowest disease severity index (1.0), followed by 147a and 60 (both with 1.7), 94a (2.0) and 197a (2.2); Acc 64a (2.5) and 150 (2.8) reached intermediate severity, followed by 65 and 210b (with 3.3), and by 80, 169 and 188a (with 4.3). Red Maradol variety showed the highest severity index (4.8). In relation to the management in which plants were collected, mean severity in Acc coming from the wild was significantly lower (P=0.032) than in Red Maradol, although they were not different from Acc coming from cultivated orchards or from backyards. It is possible that PRSV-p tolerance genes might be found in wild Acc.

Resumo Objetivo Comparar o efeito de alta dose de vitamina A (VitA) no seguimento pósmolar de pacientes com gonadotrofina coriônica humana (hCG) sérica apresentando valoresbaixoseem platô(L&P). Métodos Estudo retrospectivo de série de casos comparando duas coortes não simultâneas. Grupo controle (CG): 34 pacientes com títulos de hCG sérico L&P submetidos a manejo expectante por 6 meses após o esvaziamento uterino, de 1992 a 2010; Grupo de Estudo (SG): de 2011 a 2017, 32 pacientes em condições semelhantes de hCG receberam Vit-A na dose de 200.000 IU por dia, do momento da identificação dohCG em platôate o primeirohCG normaloudiagnóstico de progressão para neoplasia trofoblástica gestacional (NTG). O presente estudo foi aprovado pelo Comitê de Ética da Instituição na qual foi desenvolvido. Resultados Em ambososgrupos, aprevalência de hCGL&P foi < 5%. No SG, os níveis de hCGemplatô forammaiores (CG = 85.5 versus SG = 195 IU/L; p = 0,028), e foram significantemente menores tanto a prevalência de NTG pós-molar (CG = 29.4% versus SG = 6.3%, p = 0,034) como o tempo de seguimento (CG = 14 versus SG = 10 meses, p < 0.001). Na evolução para NTG não houve diferença no estadiamento da Interna tional Federation of Gynecology and Obstetrics (FIGO, na sigla em inglês) ou na agressividade do tratamento. Com altas doses de Vit-A não houve qualquer efeito tóxico relevante. Não houve casos de recidiva de NTG ou de óbito. Conclusão O uso limitado de altas doses de Vit-A parace ser seguro e apresenta efeitos significativos na evolução de pacientes em controle pós-molar com títulos de hCG sérico L&P, e pode diminuir o desenvolvimento de NTG pós-molar nessa população.

Abstract Objective To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5IU/L). Methods The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted. Results In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths. Conclusion The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Abstract Background Adherence to antihypertensive medication is a major challenge in the management of hypertension, and non-adherence is an important barrier to effective management of hypertension. Objectives To determine the adherence rate to hypertensive drug treatment and the factors that influence non-adherence in a cohort of the Argentinean population. Methods A multicenter cross-sectional study was conducted in eight cities of Argentina. Consecutive hypertensive patients seen in general practice offices, receiving pharmacological treatment for at least six months were included. Blood pressure measurements were performed by physicians during the patient visit. The level of adherence was assessed using the Morisky questionnaire, and patients were divided into non-adherent and adherent. Continuous variables were compared using independent t-test. Categorical variables were compared using the χ2 test. To identify the variables independently associated with non-adherence, a forward stepwise binary regression logistic model was performed, and the results expressed as odds ratio (OR) with 95% of confidence interval. All tests were two-tailed, and p-values < 0.05 were considered statistically significant. Results A total of 852 individuals (52% women, 62 ± 13 years) were included. The main reason for lack of adherence was forgetfulness of medication intake and errors in the time of intake (~ 40% in both). Individuals with more cardiovascular risk factors (smoking, diabetes, dyslipidemia and previous cardiovascular events) had lower adherence to antihypertensive treatment, and considerably younger (~ five years younger). Conclusions Adherence rate to antihypertensive drug treatment in our study group was higher than the one reported in previous studies, and the main reason for non-adherence was forgetfulness of medication intake. (Int J Cardiovasc Sci. 2020; 33(3):272-277)

ABSTRACT Objective. To identify the food industry’s arguments against front-of-package nutrition labels in Uruguay. Methods. Content analysis and inductive coding were applied to the comments made by the food industry during the public consultation on the draft decree regulating the inclusion of front-of-package nutrition labels (warnings) in Uruguay. Results. Most of the comments expressed concern about the high prevalence of obesity and noncommunicable diseases in the country and emphasized a commitment to implementing actions to help combat these health problems. However, 81% of the comments disagreed with the draft decree presented for public consultation; these included general criticisms of its validity. The content of the comments related to seven areas: lack of rationale for the measure; violation of international commitments; criticisms of the warning system; discrimination against industrialized packaged food; criticisms of the nutrient profile model; other criticisms of aspects specific to the draft decree; and adverse economic effects. For each area, there is discussion of the technical and normative relevance and consistency of the content presented by the industry representatives. Conclusions. Despite apparent agreement about the need to adopt measures, it is clear that the food industry is strongly opposed to the policy and, in particular, to the warning system. The results of this analysis may help to facilitate the process of implementing similar regulations in other countries.

RESUMO Objetivo. Identificar os argumentos da indústria alimentícia contra a rotulagem frontal de advertência nutricional no Uruguai. Métodos. Realizou-se uma análise do conteúdo dos comentários de representantes da indústria alimentícia obtidos em uma consulta pública conduzida no Uruguai durante o processo de elaboração do decreto para regulamentar a inclusão de rotulagem frontal de advertência nutricional com uso de códigos indutivos. Resultados. Os comentários, na sua maioria, revelaram preocupação com a alta prevalência de obesidade e doenças crônicas não transmissíveis no país e destacaram o compromisso com a implementação de ações para combater estes problemas de saúde. No entanto, verificou-se que, em 81% dos comentários, os participantes discordavam da proposta do decreto apresentada na consulta pública e teceram críticas gerais quanto à sua validade. Observaram-se sete dimensões distintas no conteúdo dos comentários: falta de justificação da medida, descumprimento de compromissos internacionais, críticas ao sistema de advertência, discriminação de alimentos industrializados em embalagens, críticas ao modelo de perfil nutricional, outras críticas relativas a aspectos específicos do projeto do decreto e repercussão econômica negativa. Para cada dimensão, foram discutidas a relevância e a coerência técnica e normativa do conteúdo dos comentários feitos pelos representantes da indústria. Conclusões. Apesar de uma suposta concordância quanto à necessidade de adotar medidas, observou-se uma firme oposição da indústria alimentícia à política e, em particular, ao sistema de advertência nutricional propostos. Os resultados desta análise servem para facilitar o processo de implementação de regulamentações semelhantes em outros países.

RESUMEN Objetivo. Identificar los argumentos de la industria alimentaria en contra del etiquetado frontal de advertenciasnutricionales en Uruguay. Métodos. Se realizó un análisis de contenido de los comentarios de la industria alimentaria recibidos durante la consulta pública implementada durante el proceso de diseño del decreto que reglamenta la inclusión de rotulación nutricional frontal basada en advertencias en Uruguay mediante una codificación inductiva. Resultados. La mayoría de los comentarios manifestaron la preocupación por la elevada prevalencia de obesidad y enfermedades no transmisibles en el país y destacaron el compromiso con la implementación de acciones que contribuyan a combatir esta problemática de salud. Sin embargo, 81% de los comentarios planteó desacuerdo con la propuesta de decreto elevada a consulta pública y realizó críticas generales sobre su validez. El contenido de los comentarios se relacionó con siete dimensiones: falta de justificación de la medida, violación de compromisos internacionales, críticas al sistema de advertencias, discriminación a alimentos industrializados envasados, críticas al modelo de perfil de nutrientes, otras críticas a aspectos específicos del proyecto de decreto y efectos económicos negativos. En cada dimensión se discute la pertinencia y consistencia técnica y normativa de los contenidos vertidos por los representantes de la industria. Conclusiones. Bajo un aparente acuerdo con la necesidad de adoptar medidas, se evidenció, sin embargo, una fuerte oposición a la política y en particular al sistema de advertencias por parte de la industria alimentaria. Los resultados del análisis aportan insumos para facilitar el proceso de implementación de regulaciones similares en otros países.

Resumen: El objetivo de este artículo es determinar la importancia del metamizol como analgésico en México, al conocer la frecuencia de su uso y los mecanismos de acción y así clasificar adecuadamente al medicamento dentro de la farmacopea de analgésicos. Pocos fármacos generan discusión sobre su filiación, pero el metamizol, desde que salió al mercado en 1922 hasta el día de hoy, se mantiene sin definirse claramente. Comúnmente cuando se busca una clasificación de los antiinflamatorios no esteroideos (AINE), se clasifica al metamizol dentro de los mismos como derivados de la pirazolona. Se debe comenzar entonces con los aspectos farmacológicos para relacionar las semejanzas y diferencias con otros AINEs y poder sacar conclusiones adecuadas. Aun así, el medicamento es de los más utilizados por los médicos en los hospitales de segundo y tercer nivel (82%), aunque la mayoría no sabe en realidad cuál es su mecanismo de acción (91%), por ello, la importancia de conocer el mecanismo de acción de este fármaco.

Abstract: The aim of this article is to know the importance of metamizol as analgesic in Mexico, knowing the frequency of their use and the mechanisms of action and to adequately classify the drug in the pharmacopoeia of painkillers. Few drugs generate discussion about their parentage but metamizol from that hits the market in 1922 until today, it has no clearly defined. Commonly when NSAIDs rated seeks to metamizol is classified within the same as pyrazolone derivatives. We then start with the pharmacological aspects and later to know the similarities and differences with other NSAIDs and can draw appropriate conclusions. Even so, the medicine is one of the most used by physicians in second and third level hospitals (82%), although most do not really know what their mechanism of action is (91%), so the importance of knowing the mechanism of action of this drug.

Resumen: En los últimos años, se ha visto un incremento en el interés por los pacientes con enfermedad por reflujo gastroesofágico que presentan reflujo no ácido o duodenogástrico. Su importancia se debe a las consecuencias patológicas que conlleva, ya que se ha asociado con gastritis alcalina, esofagitis severa, mayor riesgo de esófago de Barrett y de progresión a cáncer, reflujo duodenogástrico (RDG) sintomático sin lesiones y síntomas atípicos. Sin embargo, el papel que tiene esta patología como una enfermedad independiente del reflujo gastroesofágico no es nada claro. La mayoría de los estudios se enfocan en los síntomas y trastornos que presenta este reflujo a nivel del esófago, y existe escasa información sobre el impacto que tiene a nivel gástrico independientemente de lo que sucede en el esófago. Presentamos una guía para el correcto uso de las definiciones relacionadas con el reflujo no ácido y el reflujo duodenogástrico, así como una clasificación basada en sus causas.

Abstract: In recent years, there has been a growing interest in duodenogastric or non-acid reflux in patients with GERD (gastroesophageal reflux disease). This is due to the association of this disease with alkaline gastritis, severe esophagitis, Barrett’s esophagus and high risk of cancer. However, the role of this disease as an independent entity from GERD is not clear. Most studies focus on symptoms and problems caused by this kind of reflux in the esophagus, ignoring the impact on the gastric level. We present a guide for the proper use of the definitions related to non-acid and duodenogastric reflux and a cause-based classification.

RESUMEN Existe amplia evidencia de los efectos de la ansiedad precompetitiva (e.g. Bueno, Capdevila y Fernández- Castro, 2002; Caracuel y Jaenes, 2015) en las prácticas y pruebas deportivas, así como del rol protector de las estrategias de afrontamiento que emplean los deportistas (e.g., Soto, 2003). Sin embargo, debido a que las prácticas deportivas competitivas se diferencian, entre otras cosas, en su carácter colectivo o individual, tanto la ansiedad competitiva como las estrategias de afrontamiento involucradas pudiesen diferenciarse según dicha condición (e.g., Simón y Martens,1979). El presente estudio corresponde a una exploración sobre posibles efectos diferenciales del tipo de práctica sobre la ansiedad precompetitiva, las estrategias de afrontamiento y la relación entre ambas. El diseño fue transversal de tipo correlacional, en el cual se aplico el Inventario de Ansiedad Competitiva en el Deporte (CSAI-2) y el Cuestionario de Aproximación al Afrontamiento en el Deporte (ACSQ-1) a 22 nadadores individuales y 28 jugadores de waterpolo, minutos antes de una competición oficial. Los resultados indican que existen diferencias solo en los niveles de autoconfianza, pero que la relación entre estrategias de afrontamiento y ansiedad precompetitiva es distinta entre grupos. Finalmente, se sugieren modelos diferenciados de intervención, el alcance de los resultados, las limitaciones del estudio y se sugieren nuevas investigaciones.

ABSTRACT There is extensive evidence of the effects of precompetitive anxiety (e.g. Bueno, Capdevila,& Fernández-Castro, 2002; Caracuel and Jaenes, 2015) in sports practices and events, as well as the protective role of coping strategies employed by athletes (e.g., Soto, 2003). However, because competitive sports practices differ, among other things, in their collective or individual character, both competitive anxiety and the coping strategies involved could be differentiated according to that condition (e.g., Simon and Martens, 1979). This study corresponds to an exploration of possible differential effects of the type of practice on precompetitive anxiety, coping strategies and the relationship between both. The design was transversal and correlational kind, in which the Inventory of Competitive Anxiety in Sport (CSAI-2) and the Questionnaire of Approach to Facing in Sport (ACSQ-1) were applied to 22 individual swimmers and 28 water polo players, minutes before an official competition. Results indicate that there are differences only in levels of self-confidence, but that the relationship between coping strategies and precompetitive anxiety is different between groups. Finally, differentiated models of intervention, the scope of the results, the limitations of the study, and new research are suggested.

ECMO (Extracorporeal Membrane Oxygenation) is an extracorporeal life support system in catastrophic lung failure, shock and cardiopulmonary resuscitation, in different age groups, with multiple physiologic features. When the candidate to be submitted is too unstable to be transported to a hospital with ECMO, cannulation before transfer allows stabilization and subsequent transport. The aim of this article is to review the current concepts of extracorporeal support, its indications, national and international experience, and its possible role in the SARS-Cov2 pandemic.

Resumen Introducción Los Programas de Recuperación Mejorada (PRM) en cirugía colorrectal disminuyen las complicaciones y acortan la estadía hospitalaria. La implementación de un PRM representa un desafío en nuestro sistema de salud público, dado la alta demanda y recursos limitados. Objetivo Evaluar el efecto en la estadía hospitalaria (EH) posterior a la implementación de un PRM en cirugía colorrectal electiva en un hospital público. Materiales y Método Estudio retrospectivo, que incluyó pacientes entre 15 y 85 años operados electivamente de resecciones colorrectales en un hospital público entre 1 de enero de 2015 y 31 de diciembre de 2016. Se compararon dos grupos: 1) total de pacientes operados electivamente 1 año posterior a la implementación del PRM (post-PRM) y 2) total de pacientes operados electivamente un año previo a la implementación de PRM (pre-PRM), en términos de EH, reingresos, complicaciones y mortalidad a 30 días. Se realizó análisis de tiempo a evento para comparar la EH entre ambos grupos. Resultados Un total de 144 pacientes fueron incluidos: 92 en el grupo post-PRM y 52 en el grupo pre-PRM. No hubo diferencias clínicas entre ambos grupos. La mediana de EH en el grupo post-PRM fue 2 días menor que en el grupo control (5 vs 7 días, test de log-rank, p = 0,03). No hubo diferencia en complicaciones, reingresos ni mortalidad. Conclusión La implementación de un PRM en cirugía colorrectal electiva en un hospital público se asocia a una disminución de la EH sin aumento de morbimortalidad.

Background Enhanced Recovery Programs (ERP) in colorectal surgery has proved to decrease complications and shorten hospital stay. The implementation of an ERP could be a difficult task in a high-demanding public health system with limited resources. Aim Evaluate the effect on length of stay (LOS) after the implantation of an ERP for colorectal surgery in a resource-limited public hospital. Materials and Method This retrospective study included patients aged 15-85 years who underwent elective colorectal surgery at a resource-limited public hospital in Chile between January 1, 2015 and December 31, 2016. We compared two groups: (1) total number of patients operated electively after 1-year of ERP implementation (post-ERP group) and (2) total number of patients electively operated 1-year previous ERP (pre-ERP group) in terms of LOS, readmissions, complications, and 30-day mortality. A time to event analysis was performed to evaluate differences in LOS. Results A total of 144 patients were included in this study: 92 in the post-ERP group and 52 in the pre-ERP group. There were no clinical differences between groups. The median LOS in the post-ERP group was 2 days lower than that in the control group (5 vs 7 days, log-rank test p = 0.03). There were no differences in complications, readmissions, and 30-day mortality. Conclusions The implementation of an ERP for colorectal surgery in a resource-limited hospital was associated with decreased LOS without increasing morbidity.

Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.

Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.

ABSTRACT Background: The functional fitness of older people may be associated with their nutritional status. Aim: To assess the association between of anthropometric measures with functional fitness in older people. Material and Methods: Cross-sectional study conducted in 75 participants aged 65 to 89 years. Body mass index (BMI), waist-to-height ratio (WHtR), fat mass (FM) and skeletal muscle mass index (SMI) were calculated from anthropometric measures. The functional fitness was determined using the Senior Fitness Test battery. Results: BMI and FM indicated obesity, and WHtR indicated cardiometabolic risk in 49%, 55% and 83% of participants, respectively. SMI indicated a low muscle mass in 91% of females. Performance standards of chair stand, arm curl, 2-min step test and 8-foot up-and-go tests were met in 1%, 8%, 1% and 89% of participants, respectively. Significant negative correlations were found between 2-min step test and BMI, WHtR and FM (r = −0.26, −0.31 and −0.48 respectively). Back scratch had a negative correlation with BMI (r = −0.23) and SMI (rho = −0.28). Significant positive correlations were found between 8-foot up-and-go, WHtR (rho = 0.28) and FM (rho = 0.23), and between 2-min step test and SMI (rho = 0.28). The coefficient of determination (R2) between 2-min step test with BMI, WHtR and FM were 0.05, 0.08 and 0.22, respectively, while the R2 between back scratch and BMI was 0.04. Multiple regression models indicated that FM affected the 2-min step test independently of BMI and WHtR (adjusted R2 = 0.22), however age and sex negatively influenced these associations. Conclusions: Functional fitness of older adults is influenced by nutritional anthropometric measures, particularly BMI, WHtR and FM for aerobic capacity, and BMI for upper limb flexibility.

Introducción: El estado nutricional y la condición física funcional (CFF) pueden estar relacionados en adultos mayores. Objetivo: Analizar la influencia de medidas antropométricas nutricionales sobre CFF. Material y Método: Estudio transversal realizado en 75 adultos de 65 a 89 años. Las variables antropométricas fueron índice de masa corporal (IMC), razón cintura-talla (RCT), masa adiposa (MA) e índice de masa muscular esquelética (IMME). La evaluación de CFF se efectuó con la batería Senior Fitness Test. Resultados: El IMC y MA indicaron obesidad, y RCT indicó riesgo cardiometabólico en 49%, 55% y 83% de los participantes, respectivamente. IMME indicó una baja masa muscular en 91% de las mujeres. El estándar de rendimiento para las pruebas sentarse-levantarse, flexión-codo, paso-2-minutos y levantarse-caminar-sentarse se logró en 1%, 8%, 1% y 89% de los participantes, respectivamente. Se encontraron correlaciones significativas negativas entre paso-2-minutos con IMC, RCT y MA (r = −0.26,-0.31 y-0.48 respectivamente. La misma asociación se observó entre juntar-manos-espalda con IMC (r = −0.23) e IMME (rho = −0.28). Se encontraron correlaciones significativas positivas entre levantarse-caminar-sentarse con RCT (rho=0.28) y MA (rho = 0.23), y entre paso-2-minutos con IMME (rho = 0.28). Los R2 entre paso-2-minutos e IMC, RCT y MA fueron 0.05, 0.08 y 0.22, respectivamente, mientras que el R2 entre juntar-manos-espalda e IMC fue 0.04. Los modelos de regresión múltiple indicaron que MA afectó la prueba paso-2-minutos independientemente de IMC y RCT (R2 ajustado = 0.22), aunque la edad y sexo afectaron negativamente estas asociaciones. Conclusiones: La CFF de adultos mayores es influenciada por alteraciones evidenciadas por medidas antropométricas nutricionales, particularmente IMC, RCT y MA sobre la capacidad aeróbica, e IMC sobre la flexibilidad de extremidad superior.

ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.

Abstract: This paper analyzes the relationship between custom, one of the main sources of public international law, and the need of consent of the State to which the customary rule should apply. The two main answers that the authors gave in connection to that relationship are reviewed: on the one hand, the authors who require consent as a condition for enforceability of the customary law and, on the other hand, the authors who deny the need of such consent. We adopt the doctrinal opinion that international customary law is compulsory only for those States that had, expressly or tacitly, consented to it.

Resumen: El presente trabajo analiza la relación existente entre una de las principales fuentes del Derecho Internacional Público, la costumbre y el consentimiento de los Estados. En particular, se repasarán las dos grandes respuestas que los autores han intentado ensayar al respecto, agrupándose a los mismos entre los consensualistas y aquellos que niegan la necesidad de contar con el consentimiento del Estado al cual se pretende obligar mediante la norma consuetudinaria. Finalmente, se concluye adoptando la posición doctrinal según la cual la norma consuetudinaria internacional es únicamente obligatoria para aquellos Estados que, en forma expresa o tácita, la han consentido.

Resumo: Este artigo analisa a relação entre uma das principais fontes do Direito Internacional Público, o costume e o consentimento dos Estados. Em particular, serão revisadas as duas grandes respostas que os autores tentaram ensaiar a esse respeito, agrupando-as entre os consensualistas e aqueles que negam a necessidade de ter o consentimento do Estado ao qual pretendem dar por meio da norma costumeira. Finalmente, conclui-se adotando a posição doutrinária segundo a qual a norma internacional consuetudinária é obrigatória apenas para os Estados que, expressa ou tacitamente, a consentiram.

Abstract: Rodrigo Lira’s poetry is marked by the use of black humor and polyphony, both to refer to the poetic voice and its literary, cultural, social and political context. These strategies for the configuration of their identity and discursive positioning, of a fragmentary nature are used to conjure his sense of belonging, loneliness and guilt of being.

Resumen: La poesía de Rodrigo Lira está marcada por el uso del humor negro y la polifonía, tanto para referirse a la voz poética como a su contexto literario, cultural, social y político. Estas estrategias para la configuración de su identidad y posicionamiento discursivo, de carácter fragmentario, se utilizan para conjurar su sentido de despertenencia, soledad y culpa de ser.