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Abstract: Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia in patients with heart failure (HF), regardless of ejection fraction, leading to a greater risk of thromboembolic complications. Anticoagulation is one of the fundamental pillars in the treatment of AF, and prior to this, it is recommended to evaluate the embolic risk using the CHA2DS2-VASc score and the bleeding risk with the HAS-BLED score. There are two pharmacological groups of oral anticoagulants (OACs), vitamin K antagonists (VKAs), and direct oral anticoagulants (DOACs). Both groups have advantages and disadvantages in their use. VKAs require frequent monitoring to achieve INR levels within range, a greater number of drug and dietary interactions, leading to lower adherence, satisfaction, and quality of life. Likewise, scientific evidence supports the non-inferiority of DOACs versus VKAs, being recommended in recent clinical practice guidelines for the prevention of thrombotic events in all patients with AF except in cases where moderate to severe mitral stenosis or mechanical valve replacement coexist. To date, there are no published studies that assess adherence and impact on quality of life with the use of DOACs in HF with AF. Therefore, the objective of this research is to observe changes in adherence and quality of life of patients who were switched from VKA to DOAC, describing the occurrence of thrombotic or hemorrhagic events. Methodology: Quasi-experimental, prospective, longitudinal study. All patients over 18 years of age with AF without mechanical valve prosthesis or moderate/severe mitral stenosis, anticoagulated with warfarin with therapeutic range time (TTR) ≤65% and SAMe-T2R ≥2 were included. The Morisky questionnaire was administered to evaluate adherence, and the Anti-Clot Treatment Scale was used to evaluate satisfaction and quality of life. Thrombotic and hemorrhagic risk was evaluated by CHA2DS2-VASc and HAS-BLED. The questionnaires were applied using warfarin and the same questionnaires were repeated after replacing with DOAC for convenience, specifically apixaban. Statistical analysis was performed using the Kolmogorov-Smirnov test, Cochrane Q test, ANOVA, and STATAv.15.0. Results: 43 patients, 31 of whom were male, 100% had CHA2DS2-VASC >2, 37% had HAS-BLED >3, and 62.8% had SAMe-TT2R2 >2. There was a statistically significant difference (p<0.001) in relation to the use of apixaban in quality of life, disease burden, and positive impact. No thrombotic or hemorrhagic events were observed with the use of apixaban. Conclusions: A statistically significant difference was observed in adherence, satisfaction, and quality of life with the use of apixaban, without thrombotic or hemorrhagic events.

Resumo: Introdução: A fibrilação atrial (FA) é a arritmia cardíaca mais comum em pacientes com insuficiência cardíaca (IC), independentemente da fração de ejeção, o que leva a um maior risco de complicações tromboembólicas. A anticoagulação é um dos pilares fundamentais no tratamento da FA e, antes disso, é recomendado avaliar o risco embólico usando o escore CHA2DS2-VASc e o risco de sangramento com o escore HAS-BLED. Existem dois grupos farmacológicos de anticoagulantes orais (AOs): os antagonistas da vitamina K (AVKs) e os anticoagulantes orais diretos (DOACs). Ambos os grupos têm vantagens e desvantagens em seu uso. Os AVKs exigem monitoramento frequente para alcançar níveis de RNI dentro da faixa, um maior número de interações medicamentosas e alimentares, levando a menor adesão, satisfação e qualidade de vida. Da mesma forma, a evidência científica suporta a não inferioridade dos DOACs em relação aos AVKs, sendo recomendados nas diretrizes recentes de prática clínica para a prevenção de eventos trombóticos em todos os pacientes com FA, exceto nos casos em que coexistem estenose mitral moderada a grave ou substituição valvar mecânica. Até o momento, não há estudos publicados que avaliem a aderência e o impacto na qualidade de vida com o uso de DOACs em IC com FA. Portanto, o objetivo desta pesquisa é observar mudanças na adesão e qualidade de vida de pacientes que mudaram de AVK para DOAC, descrevendo a ocorrência de eventos trombóticos ou hemorrágicos. Metodologia: Estudo quase-experimental, prospectivo e longitudinal. Foram incluídos todos os pacientes com mais de 18 anos de idade com FA sem prótese valvar mecânica ou estenose mitral moderada/grave, anticoagulados com varfarina com tempo de alcance terapêutico (TTR) ≤65% e SAMe-T2R ≥2. O questionário Morisky foi administrado para avaliar a adesão, e a Escala de Tratamento Anticoagulante foi usada para avaliar a satisfação e qualidade de vida. O risco trombótico e hemorrágico foi avaliado pelo escore CHA2DS2-VASc e HAS-BLED. Os questionários foram aplicados usando varfarina e os mesmos questionários foram repetidos após a substituição por DOAC por conveniência, especificamente apixabana. A análise estatística foi realizada usando o teste de Kolmogorov-Smirnov, teste Q de Cochrane, ANOVA e STATAv.15.0. Resultados: Foram incluídos 43 pacientes, sendo 31 do sexo masculino. Todos os pacientes apresentavam CHA2DS2-VASC >2, 37% tinham HAS-BLED >3 e 62,8% tinham SAMe-TT2R2 >2. Foi observada uma diferença estatisticamente significativa (p<0,001) no que diz respeito ao uso de apixabana na qualidade de vida, carga da doença e impacto positivo. Não foram observados eventos tromboembólicos ou hemorrágicos com o uso de apixabana. Conclusões: Foi observada uma diferença estatisticamente significativa na adesão, satisfação e qualidade de vida em relação ao uso de apixabana, sem eventos tromboembólicos ou hemorrágicos.

Resumen Introducción. La rentabilidad del sistema de doble propósito (SDP) está afectada por baja eficiencia productiva y altos costos de producción generados en el manejo tradicional. Estudios en función de la reducción de costos e incremento de los ingresos, podría sugerir estrategias para mejorar la eficiencia económica. Objetivo. Determinar la eficiencia técnica y rentabilidad de tres alternativas de producción del SDP bovino en Meta, Colombia. Materiales y métodos. El estudio se llevó a cabo durante el periodo 2016-2017, en una finca del departamento de Meta, Colombia. Se seleccionaron 72 vacas Bos taurus x Bos indicus, que iniciaban lactancia, alimentadas bajo pastoreo, las vacas seleccionadas y sus crías se distribuyeron en tres grupos: alternativa 1 (MA1): ordeño dos veces por semana hasta el destete a 100 días, alternativa 2 (MA2): ordeño dos veces por semana hasta el destete a 240 días y alternativa 3 (MT): ordeño diario (tradicional), hasta el destete a 240 días. En los terneros se midió el peso al nacimiento y a los 252 días de vida (P252), y se estimó la ganancia de peso diaria (GPD). En las vacas se midió la tasa de terneros nacidos por vaca/año (TN) y la leche producida por lactancia (LPL). Para el análisis económico, los resultados en cada tratamiento se proyectaron para un pie de cría de 100 vacas. Resultados. El P252 y la GPD de los grupos MA1 (189,30 kg; 0,64 kg/animal/día) y MA2 (186,10 kg; 0,63 kg/animal/día) fue similar (p>0,05), pero superiores (p<0,05) a los del MT (155,10 kg; 0,54 kg/animal/día). La TN fue mayor para MA1 (0,84 terneros/vaca/año), seguida por la del MA2 (0,74 terneros/vaca/año) y MT (0,68 terneros/vaca/año). La LPL fue de 1204,36 kg para MT, 303,74 kg para MA2 y 158,75 kg para MA1. La rentabilidad de MA1 superó en 9,5 y 9,2 % a MA2 y MT, respectivamente. Conclusiones. El ordeño dos veces por semana hasta el destete (MA1) reflejó mayor eficiencia económica por efecto del incremento en la tasa de terneros nacidos por vaca/año (TN) y disminución en los costos de producción.

Abstract Introduction. The profitability of the dual-purpose system (DPS) is affected by low production efficiency and high production costs generated in traditional management. Studies based on the reduction of expenses and increase of income, could suggest strategies to improve economic efficiency. Objective. Determine the technical and profitable efficiency of three production alternatives for bovine DPS in Meta, Colombia. Materials and methods. The study was conducted during 2016-2017, on a farm in the department of Meta, Colombia. Seventy-two Bos taurus x Bos indicus cows were selected, starting lactation, fed under grazing, during the period 2016-2017, in a farm in Meta, Colombia. The selected cows and their calves were distributed in three groups; alternative 1 (MA1): milking 2 times a week until weaning at 100 days, alternative 2 (MA2): milking 2 times a week until weaning at 240 days, and traditional (MT): milking daily (traditional) until weaning at 240 days. In the calves, the weight at birth and at 252 days of age (W252) were measured, and the daily weight gain (DWG) was estimated. In the cows, the birth rate (BR) and the milk produced per lactation (MPL) were measured. The productive response fed the economic analysis projected for a breeding stock of 100 cows. Results. The W252 and DWG between MA1 (189.30 kg; 0.64 kg/animal/day) and MA2 (186.10 kg; 0.63 kg/animal/day) groups were similar (P>0.05), but higher (p<0.05) than those of the MT (155.10 kg; 0.54 kg/animal/day). BR presented the highest benefit for MA1 (0.84 calves/cow/year), followed by MA2 (0.74 calves/cow/year), and MT (0.68 calves/cow/year). The MPL was 1204.36 kg for MT, 303.74 kg for MA2 and 158.75 kg for MA1. MA1's profitability outperformed MA2 and MT by 9.5 and 9.2 %, respectively. Conclusions. The MA1 reflected the greater economic efficiency mainly due to the effect of the increase in the BR and the decrease in production costs.

Resumen Objetivo: Aplicar un modelo de análisis de redes neuronales artificiales (RNA) para identificar las variables que predicen el liderazgo asignado y el éxito académico en egresados de seis generaciones de la carrera de Medicina. Método: Estudio analítico, retrospectivo y comparativo. Participaron 1434 egresados. Se envió un cuestionario por correo electrónico que incluyó el consentimiento de participación voluntaria. Se realizó análisis estadístico multivariado mediante RNA del tipo perceptrón multicapa, árboles de decisión y análisis de impulsores. Resultados: Las RNA identificaron siete variables independientes que predijeron el éxito profesional y ocho para el liderazgo en los médicos egresados. Los árboles de decisión identificaron diferencias significativas en las variables desempeño profesional (p = 0.000), edad (p = 0.005) y actividades de educación continua (p = 0.034) relacionadas con el éxito profesional, y para el liderazgo las variables sexo (p = 0.000), promedio en el bachillerato (p = 0.042), realizar práctica clínica en el servicio social (p = 0.002) y actividades de educación continua (p = 0.011). Conclusiones: Las RNA identificaron las principales variables independientes predictoras del éxito profesional y el liderazgo de los egresados. El estudio abre dos líneas de investigación poco estudiadas con las técnicas de RNA en el área de la medicina.

Abstract Objective: To apply an artificial neural networks analysis (ANN) model to identify variables that predict assigned leadership and academic success in graduates of six generations of medical school. Method: Analytical, retrospective, comparative study. A total of 1434 graduates participated. A questionnaire was sent to them by e-mail including a voluntary participation consent. A multivariate statistical analysis using multi-layer perceptron ANN, decision trees and driver analysis was performed. Results: The ANN identified seven independent variables that predicted professional success and eight for leadership in medical graduates. The decision trees identified significant differences in the variables professional performance (p = 0.000), age (p = 0.005) and continuing education activities (p = 0.034) related to professional success, and for leadership the variables gender (p = 0.000), high school grades (p = 0.042), performing clinical practice during the social service year (p = 0.002) and continuing education activities (p = 0.011). Conclusions: The ANN identified the main independent predictor variables of professional success and leadership of the graduates. This study opens up two new lines of research little studied with the techniques of in the area of medicine.

Resumen Objetivo: Examinar la problemática y retos que enfrentan los productores de baja escala, tras la inserción y auge de la cadena de mango en los mercados internacionales y analizar las estrategias que han desarrollado para integrarse de manera dinámica con la actividad. Metodología: Se realizó un análisis longitudinal retrospectivo de integración, se empleó información propia, obtenida en campo a través de entrevistas a informantes clave (n=18) y una encuesta aplicada (n=132), entre las temporadas de 2020 y 2021, cuyo tamaño de muestra se obtuvo a través de la fórmula para variables cualitativas con población finita. Resultados: Se encuentra que a medida en que la actividad exportadora se ha posicionado en la región Istmo-Costa, los procesos de producción se han hecho cada vez más rigurosos y estandarizados, a fin de cumplir con el conjunto de normas y estándares nacionales e internacionales que regulan la actividad, y cuyo cumplimiento es determinante para poder participar y competir en estos mercados. Limitaciones: El estudio se centra en el papel de los productores a pequeña escala, la dinámica, problemática y retos presentes en productores de mayor escala podrían analizarse en abordajes posteriores. Conclusiones: Los pequeños productores de mango son actores con capacidad de agencia y organización que han sabido construir redes y alianzas, a partir de las cuales pugnan, negocian y crean mecanismos que les permiten hacer frente a dichos retos, e incluso, aprovechar las oportunidades del difícil y complejo entorno agroexportador global.

Abstract Objective: To examine the problems and challenges faced by these small-scale producers, after the insertion and boom of the mango chain in international markets, and on the other, the strategies they have developed to dynamically integrate with activity. Methodology: A retrospective longitudinal analysis of integration was carried out, using own information, obtained in the field through interviews with key informants (n=18) and an applied survey (n=132), between the 2020 and 2021 seasons, whose size of sample was obtained through the formula for qualitative variables with finite population. Results: It is found that as the activity has positioned itself in the Isthmus-Coast region, the production processes have become increasingly rigorous and standardized to comply with the set of national and international norms and standards that regulate the activity, and compliance with which is decisive to be able to participate and compete in these markets. Limitations: This study is focused on the role of small-scale producers, however, the dynamics, problems and challenges present in larger-scale producers could be analyzed in later studies. Conclusions: Despite their status as subordinates’ units, these small producers are relevant actors with the capacity for agency and organization, who know how to build networks and alliances, from which they fight, negotiate, and create mechanisms that allow them to face these challenges, and even take advantage of opportunities offer the hard and complex global agro-export system.

ABSTRACT The application of artificial intelligence based on the multiple linear regression model with stochastic descending gradient is described in order to determine the quality of the white Huacaya alpaca fibre. In total, 1200 fibres corresponding to six alpaca samples were analysed. The fibres were characterized by optical microscopy and with the optical fibre diameter analyser (OFDA100) equipment. Fibre diameter, medulla diameter, percentage of medullation by volume, comfort factor, and objectionable fibres were considered as independent variables, and the "Soft" factor was considered as a response variable. This last variable resulting from the difference in the comfort factor and objectionable fibres served to give a logical order to the data matrix and obtain an accurate prediction model. The average values were 26.80 ± 6.95 for the fibre diameter, 14.10 ± 5.92 for the medulla diameter, 24.75 ± 13.20 µm for the percentage of medullation by volume and 71.56 ± 13.04% for the comfort factor. The machine learning multiple linear regression modelling fitted a small sample size with high precision, showing minimal errors, and optimized with the stochastic gradient descent algorithm predicted a Soft factor very close to the observed Soft factor. It is concluded that the multiple linear regression technique with the stochastic approach satisfies the prediction of the new factor called "soft" and that it represents the appropriate modelling for the prediction of fibre quality in the textile industry.

RESUMEN Se describe la aplicación de inteligencia artificial basada en el modelo de regresión lineal múltiple con gradiente descendiente estocástica con la finalidad de determinar la calidad de la fibra de alpaca Huacaya de color blanco. Se analizaron 1200 fibras correspondientes a seis muestras de alpaca. Las fibras se caracterizaron mediante microscopía óptica y con el equipo analizador óptico de diámetro de fibra (OFDA 100). Se consideraron como variables independientes al diámetro de fibra, diámetro de médula, porcentaje de medulación por volumen, factor de confort, fibras objetables y como variable de respuesta al factor "Soft". Esta última variable resultante de la diferencia del factor de confort y fibras objetables sirvió para darle un ordenamiento lógico a la matriz de datos y obtener un modelo de predicción preciso. Los valores promedio fueron 26.80±6.95 para el diámetro de fibra, 14.10±5.92 en diámetro de médula, 24.75±13.20 ìm para el porcentaje de medulación por volumen y 71.56± 13.04% para el factor de confort. El modelamiento de regresión lineal múltiple de machine learning se adaptó con gran precisión a un tamaño muestral pequeño, mostrando errores mínimos, y optimizado con el algoritmo de gradiente descendiente estocástico predijo un factor Soft muy cercano al factor Soft observado. Se concluye que la técnica de regresión lineal múltiple con el enfoque estocástico satisface la predicción del nuevo factor denominado "soft" y que representa el modelamiento adecuado para la predicción de calidad de fibras en la industria textil.

Abstract The rhizoma peanut (Arachis glabrata Benth., section Rhizomatosae) is a tetraploid perennial legume. Although several A. glabrata cultivars have been developed as forage and ornamental turf, the origin and genomic constitution of this species are still unknown. In this study, we evaluated the affinity between the genomes of A. glabrata and the probable diploid donors of the sections Rhizomatosae, Arachis, Erectoides and Procumbentes by genomic in situ hybridization (GISH). Single GISH analyses detected that species of the sections Erectoides (E2 subgenome) and Procumbentes (E3 subgenome) were the diploid species with the highest degree of genomic affinity with A. glabrata. Based on single GISH experiments and DNA sequence similarity, three species -A. duranensis, A. paraguariensis subsp. capibarensis, and A. rigonii-, which showed the most uniform and brightest hybridization patterns and lowest genetic distance, were selected as probes for double GISH experiments. Double GISH experiments showed that A. glabrata is constituted by four identical or very similar chromosome complements. In these assays, A. paraguariensis subsp. capibarensis showed the highest brightness onto A. glabrata chromosomes. Thus, our results support the autopolyploid origin of A. glabrata and show that the species with E2 subgenome are the most probable ancestors of this polyploid legume forage.

ABSTRACT Purpose: Peribulbar injection of triamcinolone is an alternative treatment for thyroid eye disease; however the safety profile of this therapeutic option remains controversial. The aim of this study was to describe the occurrence of local and systemic adverse effects after peribulbar injection of triamcinolone in patients with thyroid eye disease. Methods: This was a retrospective case series. Medical records of patients with thyroid eye disease treated with peribulbar injections of triamcinolone at a single academic institution between 2007 and 2019 were analyzed. Local and systemic complications were documented. Results: A total of 123 patients were treated. Only 11 patients (8.9%) developed local complications. The most frequent complication was the presence of superficial eyelid ecchymosis (nine patients; 7.3%). Notably, systemic complications (hyperglycemic and suprarenal inhibition after stop treatment) occurred in two patients (1.6%). All complications were transient, and the patients did not have any long-term sequelae. Conclusions: Peribulbar injection of triamcinolone for the treatment of thyroid eye disease is linked to a very low rate of local or systemic complications. Prospective studies are warranted to delve into this topic.

RESUMO Objetivo: A injeção peribulbar de triancinolona é um tratamento alternativo para doenças oculares da tireoide; no entanto, a segurança desse procedimento continua controversa. O objetivo deste artigo é descrever os efeitos adversos locais e sistêmicos de injeções peribulbares de triancinolona em pacientes com doença ocular da tireoide. Métodos: Estudo retrospectivo de uma série de casos. Foram analisados os prontuários médicos dos pacientes com doença ocular da tireoide tratados com injeções de triancinolona peribulbar em uma única instituição acadêmica entre 2007 e 2019. Foram documentadas as complicações locais e sistêmicas. Resultados: Um total de 123 pacientes foram tratados. Apenas 11 (8,9%) pacientes apresentaram complicações locais, sendo a mais frequente a presença de equimoses palpebrais superficiais (7,3%), enquanto 2 (1,6%) pacientes apresentaram complicações sistêmicas (hiperglicemia e inibição da suprarrenal após a interrupção do tratamento). Todas estas complicações foram transitórias e nenhum paciente apresentou sequelas de longo prazo. Conclusões: As injeções peribulbares de triancinolona nas doenças oculares da tireoide têm uma taxa muito baixa de complicações, tanto locais quanto sistêmicas. São necessários estudos prospectivos para aprofundar este tópico.

ABSTRACT The objective of the study was to identify the resistance of Mycobacterium tuberculosis to drugs in Paraguay, 2014 to 2017. A retrospective observational study was carried out. The data from the National Tuberculosis Program of Paraguay between the years 2014 to 2017 were used. All patients with a diagnosis of Tuberculosis who underwent a resistance test were included. Data were extracted in Excel and analyzed with Stata 17.0. 3429 tuberculosis patients who had a result of at least one sensitivity test were included. Resistance was found in 2.1% of patients. Resistance to Rifampicin was present in 0.3% of cases while to Izionazide in 0.6% of cases. The prevalence of resistance was higher in men 3.4 (95% CI 2.2 - 4.8) p = 0.003, who resided in the Chaco 6.0 (95% CI 3.4 - 9.7) p = 0.000, previously treated 2.7 (95% CI 1.1 - 5.1) p = 0.010. In the model, it was observed that a previously treated patient has a greater chance of having resistance OR 2.62 (95% CI 1.1 - 6.24). The prevalence of resistance of Mycobacterium tuberculosis to drugs was related to having been previously treated.

RESUMEN El objetivo del estudio fue identificar la resistencia del Mycobacterium tuberculosis a los fármacos en Paraguay, 2014 a 2017. Se realizó un estudio observacional retrospectivo. Se utilizaron los datos del Programa Nacional de Tuberculosis del Paraguay comprendidos entre los años 2014 a 2017. Se incluyeron todos los pacientes con diagnóstico de Tuberculosis que se realizaron un test de resistencia. Se extrajeron los datos en Excel y fueron analizados con Stata 17.0. Se incluyeron 3429 pacientes con tuberculosis que contaban con resultado de al menos una prueba de sensibilidad. La resistencia se encontró en 2.1% de los pacientes. La resistencia a la Rifampicina estuvo presente en el 0.3% de los casos mientras que a la Izionazida en el 0.6% de los casos. La prevalencia de resistencia fue más alta en hombres 3.4 (IC 95% 2.2 - 4.8) p=0.003, que residían en el chaco 6.0 (IC 95% 3.4 - 9.7) p=0.000, previamente tratados 2.7 (IC 95% 1.1 - 5.1) p=0.010. En el modelo se pudo observar que un paciente previamente tratado tiene mayores posibilidades de tener resistencia OR 2.62 (IC 95% 1.1 - 6.24). La prevalencia de resistencia del Mycobacterium tuberculosis a fármacos estuvo relacionada con haber sido previamente tratado.

Abstract Background: The estimated tuberculosis (TB) mortality rate in Paraguay in 2019 was 3.9 per 100,000 people. Indigenous communities are at high risk for TB. Aim: To determine the factors associated with mortality in indigenous people with a diagnosis of TB in Paraguay, 2014-2019. Methods: A retrospective observational study was done. sociodemographic data and risk factors data from the National TB Program of Paraguay between the years 2014 to 2019 were used. Results: A total of 2,210 indigenous people with a diagnosis of TB were included, 53,8% were male, between 20 to 39 (32.3%) and 0 to 19 years old (30.2%), the localization of TBC was majority pulmonary (92.3%). During 2014 to 2019 the were 217 deaths (9.8%). The factors associated to mortality in TB patients were the age (adOR = 13.95; CI: 7.07-27.55 older than 80 years), (adOR = 4.20; CI: 2.59-6.82 older than 60 years), and (adOR = 3.30; CI: 2.06 - 5.2840 to 59 years), HIV co-infection (adOR = 7.07; CI 3.74-13.87), and localization of TB (adOR = 3.60; CI: 1.88-6.90 for disseminated TB). Conclusion: Older age, HIV co-infection and disseminated localization of TBC are associated with a higher risk of death in indigenous people with TB.

Resumen Introducción: La tasa de mortalidad estimada de tuberculosis (TBC) en Paraguay en 2019 fue de 3,9 por 100.000 habs. Las comunidades indígenas presentan un elevado riesgo de padecer TBC. Objetivo: Determinar los factores asociados a la mortalidad en personas de origen indígena con diagnóstico de TBC en Paraguay, 2014-2019. Métodos : Se realizó un estudio observacional retrospectivo. Se utilizaron los datos del Programa Nacional de Control de la TBC del Paraguay comprendidos entre los años 2014 y 2019. Se registraron los datos sociodemográficos y factores de riesgo. Resultados: Se incluyeron 2.210 personas de origen indígena con diagnóstico de TBC, el 53,8% fue de sexo masculino, entre 20 y 39 años (32,3%) y 0 a 19 años de edad (30,2%), la localización de la TBC fue mayoritariamente pulmonar (92,3%). Durante el 2014 a 2019 se observaron 217 muertes (9,8%). Los factores asociados a mortalidad en pacientes con TBC fueron la edad (adOR = 13,95; CI: 7,07-27,55 mayor a 80 años), (adOR = 4,20; CI: 2,59-6,82 mayor a 60 años) y (adOR = 3,30; CI: 2,06-5,28 para 40 a 59 años), la co-infección VIH (adOR =), y la localización de la TBC (adOR = 3,60; CI: 1,88-6,90 para TBC diseminada). Conclusión: La mayor edad, el diagnóstico de co-infección VIH y localización de la TBC diseminada, están asociados a un mayor riesgo de muerte en población indígena con TBC.

Abstract Iodine (I) is a non-essential element for plants; however, the application of the element has shown positive effects on plants grown in optimal conditions or under stress. The objective of this experiment was to evaluate the impact of iodine on the concentration of phenolic compounds, antioxidant capacity and photosynthetic pigments in leaves of three fig cultivars subjected to salt stress. Eight-month-old fig plants were established under a completely randomized experimental design with a 3x2x2 factorial arrangement: three fig cultivars (Ficus carica L.): Brown Turkey, Kadota and Black Mission; two levels of NaCl (0 and 100 mmol L-1) and two levels of iodine (0 and 10 mg L-1). The analyses of variance showed the impact of the main factors (cultivars, NaCl and I) and the interaction between them. The application of iodine on fig seedlings increased the concentration of chlorophyll a, regardless of the cultivar and the concentration of NaCl. The number of new leaves and their dry weight were affected by the interaction between NaCl and I, these variables increased with the presence of I in saline condition. The relative content of total phenols, total flavonoids, antioxidant capacity by DPPH and photosynthetic pigments (chlorophylls and carotenoids) showed interaction between the cultivars, the levels of NaCl and the concentration of I, where the values of these variables were increased by the presence of I under salinity conditions. Due to the above, iodine could be considered as an alternative to mitigate the stress caused by NaCl in Ficus carica L. plants.

Resumen El yodo (I) es un elemento no esencial para las plantas; sin embargo, la aplicación del elemento ha demostrado efectos positivos en plantas cultivadas en condiciones óptimas o bajo estrés. El objetivo de este experimento fue evaluar el impacto del yodo sobre la concentración de compuestos fenólicos, capacidad antioxidante y pigmentos fotosintéticos en hojas de tres cultivares de higuera sometidas a estrés salino. Plantas de higuera de ocho meses de edad fueron establecidas bajo un diseño experimental completamente al azar con arreglo factorial 3x2x2: tres cultivares de higuera (Ficus carica L.): Brown Turkey, Kadota y Black Mission; dos niveles de NaCl (0 y 100 mmol L-1) y dos niveles de yodo (0 y 10 mg L-1). Los análisis de varianza mostraron impacto de los factores (cultivares, NaCl y I) y la interacción entre ellos. La aplicación de yodo en plántulas de higuera incrementó la concentración de clorofila a, independiente del cultivar y la concentración de NaCl. El número de hojas nuevas y el peso seco fue impactado por la interacción entre NaCl y I, incrementándose estás variables con la presencia de I en condición salina. El contenido relativo de fenoles totales, flavonoides totales, capacidad antioxidante por DPPH y pigmentos fotosintéticos (clorofilas y carotenoides) mostraron interacción entre los cultivares, los niveles de NaCl y la concentración de I, donde los valores de las variables fueron incrementados por la presencia de I en condiciones salinas. Por lo anterior, el I podría considerarse como alternativa para mitigar el estrés provocado por NaCl en plantas de Ficus carica L.

ABSTRACT Introduction: In the ICU, 19% have fungi, 23% develop septic shock. Candida albicans the most frequent. The most commonly used antifungal is fluconazole. Objectives: In high altitude residents with septic shock (SS) we will describe: Characteristics, evolution and sensitivity of invasive fungal infection (IFI) and we will contrast them with those published at sea level. The study: Retrospective and transversal. We analyzed blood cultures of adults with SS and IFIs in an ICU at 3,250 meters of altitude, for 7 years. Findings: 123 samples. The IFIs increased 3.6 for candida albicans. Women with 74 years was frequent. BGN represented 52.88%, BGP 37.9% and fungi 9.22%. Candida albicans 79.67% with sensitivity greater than 90% for Voriconazole, Amphotericin B and Fluconazole. Conclusions: IFIs with SS were caused by candida albicans, IFIs increased, there is adequate sensitivity to antifungals. At high altitudes there is a higher frequency of females, higher average age, and good sensitivity to fluconazole.

RESUMEN Introducción: En UCI, 19% tienen hongos, 23% desarrollan shock séptico. Cándida albicans el más frecuente. Antimicótico más utilizado es fluconazol. Objetivos: En residentes de la altitud con shock séptico (SS) describiremos: Características, evolución y sensibilidad de la infección fúngica invasiva (IFI) y los contrastaremos con los publicados a nivel del mar. El estudio: Retrospectivo y transversal. Analizamos hemocultivos de adultos con SS y IFIs en una UCI a 3,250 metros de altitud, durante 7 años. Hallazgos: 123 muestras. Las IFIs aumentaron 3.6 para candida albicans. Mujeres con 74 años fue frecuente. BGN representaron 52.88%, BGP 37.9% y hongos 9.22%. Cándida albicans 79.67% con sensibilidad mayor al 90% para Voriconazol, Anfotericina B y Fluconazol. Conclusiones: IFIs con SS fueron causadas por cándida albicans, IFIs aumentaron, existe adecuada sensibilidad a los antimicóticos En la altitud existe mayor frecuencia del sexo femenino, mayor promedio de edad y una buena sensibilidad al fluconazol.

Resumen El término Industria 4.0 está presente en la academia, el sector empresarial y los medios de comunicación. Se asocia a una nueva revolución tecnológica caracterizada por la interrelación de diversas tecnologías, cuyos principales elementos son los sistemas ciberfísicos, la inteligencia artificial y la conectividad global. Aunque existe abundante literatura sobre el tema, la mayoría está orientada desde una perspectiva técnica y de negocios; halagüeña en cuanto a las ventajas esperadas. Sin embargo, en este artículo se analizan las potencialidades para alterar los términos tradicionales de la relación contradictoria capital-trabajo. Mediante una amplia revisión bibliográfica, se describe a la Industria 4.0 en su contexto histórico-económico resaltando las tendencias que impulsa. Mientras que la generalidad de los autores enfatiza en la conectividad e interacción técnica, en el presente texto se acentúa el aspecto económico distintivo de esta revolución. Se destaca cómo el involucramiento de tecnologías disruptivas para lograr la alta automatización representa una clara tendencia a la desaparición del empleo asalariado, con la excepción de una mínima ocupación de trabajo calificado y de servicios. La unión de este tipo de tecnologías supone un salto cualitativo debido a la eliminación de los tiempos muertos entre empresas individuales y a lo largo de todas las cadenas de producción. Se concluye mostrando la radical alteración en las relaciones laborales de expandirse la Industria 4.0.

Abstract The term industry 4.0 is present in academia, the business sector, and the media. It is associated with a new technological revolution characterized by the interrelation of various technologies, whose main elements are cyberphysical systems, artificial intelligence, and global connectivity. Although there is abundant literature on the subject, most of it is oriented from a technical and business perspective, and it is optimistic in terms of expected advantages. However, this article analyzes the potential for altering the traditional terms of the contradictory capital-labor relationship. Through an extensive literature review, industry 4.0 is described in its historical-economic context, highlighting the trends it drives. While most authors emphasize connectivity and technical interaction, this text emphasizes the distinctive economic aspect of this revolution. It highlights how the involvement of disruptive technologies to achieve high automation represents a clear trend towards the disappearance of salaried employment, with the exception of the minimal occupation of skilled labor and services. The union of this type of technologies represents a qualitative leap due to the elimination of downtime between individual companies and along all production chains. It concludes by showing the radical alteration in labor relations if industry 4.0 expands.

Abstract Objective. The work’s aim was to comprehend the cultural practices of the care by Zenú indigenous mothers to their newborn premature children and those of low birth weight by implementing the Kangaroo-Mother method at home. Methods. Qualitative study of particularistic ethnographic approach, with participation from eight mothers and two key informants trained in the Kangaroo-Mother method, who were interviewed and observed in their homes, in the municipalities of San Andrés de Sotavento, Tuchín, Sampués, and San Antonio de Palmitos from the Departments of Córdoba and Sucre (Colombia), respectively. Ethnographic analysis was performed. The criteria of data saturation and methodological rigor, typical of qualitative research, were applied. Results. Eight Zenú indigenous mothers and two key informants from the family participated in the study. The themes emerging were the context, a different experience, adaptations of the Kangaroo-Mother method at home and care practices, protection and healing based on customs and cultural tradition. Conclusion. The indigenous mothers provide holistic care to their newborn premature children and those with low birth weight, by integrating the knowledge and practices of the Kangaroo-Mother method and with the ancestral practices of care, protection, and healing characteristic of the context and culture; thus, transcending the use of resources available in the environment.

Resumen Objetivo. Comprender las prácticas culturales del cuidado de madres indígenas Zenú a sus hijos recién nacidos de bajo peso al nacer y prematuros al implementar el Método Madre Canguro en el hogar. Métodos. Estudio cualitativo de enfoque etnográfico particularista en el cual participaron ocho madres y dos informantes clave entrenadas en el Método Madre Canguro, quienes fueron entrevistadas y observadas en sus domicilios, en los municipios de San Andrés de Sotavento, Tuchín, Sampués y San Antonio de Palmitos de los Departamentos de Córdoba y Sucre (Colombia), respectivamente. Se realizó análisis etnográfico. Se aplicaron los criterios de saturación de los datos y del rigor metodológico, propios de la investigación cualitativa. Resultados. Participaron ocho madres indígenas Zenú y dos familiares informantes claves. Emergieron temas: el contexto, una experiencia diferente, las adaptaciones del método madre canguro en el hogar y las prácticas de cuidado, protección y curación basada en las costumbres y la tradición cultural. Conclusión. Las madres indígenas brindan cuidado holístico a sus hijos recién nacidos con bajo peso al nacer y prematuros, al integrar el conocimiento y prácticas del Método Madre Canguro y con las practicas ancestrales de cuidado, protección y curación propias del contexto y la cultura; transcendiendo así el uso de recursos disponibles en el medio.

Resumo Objetivo. Compreender as práticas culturais de cuidado de mães indígenas Zenú para o baixo peso ao nascer e recém-nascidos prematuros na implantação do Método Mãe Canguru no domicílio. Métodos. Estudo qualitativo com abordagem etnográfica particularista, no qual participaram oito mães e dois informantes-chave treinados no Método Mãe Canguru, que foram entrevistados e observados em suas residências, nos municípios de San Andrés de Sotavento, Tuchín, Sampués e San Antonio de Palmitos de los Departamentos de Córdoba e Sucre (Colômbia), respectivamente. Foi realizada análise etnográfica. Foram aplicados os critérios de saturação de dados e rigor metodológico, típicos da pesquisa qualitativa. Resultados. Participaram oito mães indígenas Zenú e dois familiares informantes-chave. Emergiram temas: o contexto, uma experiência diferente, as adaptações do método mãe canguru em casa e as práticas de cuidado, proteção e cura baseadas em costumes e tradição cultural. Conclusão. As mães indígenas prestam cuidados holísticos aos seus recém-nascidos de baixo peso e prematuros, integrando os saberes e práticas do Método Mãe Canguru e com as práticas ancestrais de cuidado, proteção e cura típicas do contexto e da cultura; transcendendo assim o uso dos recursos disponíveis no ambiente

RESUMEN Introducción: Los materiales educativos basados en evidencia y culturalmente aceptables han demostrado ser una herramienta efectiva en el fomento de la alimentación saludable. Objetivo: Diseñar un material educativo impreso en alimentación saludable usando Intervention Mapping para una Clínica del Estilo de Vida. Métodos: Se utilizó la metodología de Intervention Mapping con los pasos 1) evaluación de necesidades, 2) Matrices de objetivos, 3) Métodos teóricos y 4) Diseño. Resultados: Se construyó el Modelo Lógico PRECEDE, la matriz de objetivos de cambio basado en los determinantes conocimiento, identificación, disponibilidad y apoyo y se utilizó el procesamiento de la información como método teórico. Se obtuvo una revista de 22 páginas con contenido, imágenes, texto y redacción basado en los pasos de Intervention Mapping. Conclusiones: El proceso de Intervention Mapping proporcionó insumos basados en evidencia y participativos para el diseño del material educativo de la Clínica del Estilo de Vida en estudio.

ABSTRACT Introduction: Evidence-based and culturally acceptable educational materials have proven to be effective tools for promoting healthy eating. Objective: To design printed educational material depicting healthy eating using Intervention Mapping for use in a Lifestyle Medicine Clinic. Methods: Intervention Mapping methodology was implemented in proceeding order: 1) Establishing needs assessment, 2) Matrix of objectives, 3) Theoretical methods, and 4) Design. Results: The PRECEDE Logic Model was followed along with the matrix of change objectives based on the determinants of knowledge, identification, availability, support, and information processing was used as a theoretical method. A 22-page magazine with content, images, and text was obtained based on the Intervention Mapping steps. Conclusions: The Intervention Mapping process provided evidence-based and participatory inputs for the design of educational material for a Lifestyle Medicine Clinic in this particular study.

Abstract Clinical case description: A 65-year-old male who came to the emergency room due to non-clot-forming holomictional hematuria. Diagnostic approach is started, identifying in the medical history the diagnosis of prostate adenocarcinoma stage 4 without radiotherapy. Due to the patient's symptoms, surgical treatment is performed, where squamous carcinoma of the prostate is reported. Therefore, the evolution and treatment of the patient is monitored Relevance: It is known that patients with squamous cell carcinoma of the prostate have a short survival from the moment of diagnosis. There are few case reports on this entity and its treatment of choice. Clinical implications: There is not a enough data to determine the management of this type of patients. The reported incidence is minimal and there is no specific treatment for these patients. Conclusion: Squamous cell carcinoma of the prostate is a rare entity. There is little information on the possible management and prognosis in this type of cancer is adverse. Therefore, it is of the utmost importance to open new areas of research on this type of cancer.

Resumen Descripción del caso clínico: Hombre de 65 años, que acude a consulta de urgencias, por presentar hematuria holomiccional no formadora de coágulos. Se inicia abordaje diagnóstico, identificando antecedente de adenocarcinoma de próstata EC IV. Sin antecedente de tratamiento con radioterapia. Debido a sintomatología de paciente se realiza tratamiento quirúrgico, donde se reporta carcinoma escamoso de próstata. Por lo que se da seguimiento a evolución y tratamiento de paciente. Relevancia: Se conoce que los pacientes con carcinoma escamoso de próstata tienen una sobrevida corta desde el momento del diagnóstico. Se tienen pocos reportes de casos sobre esta entidad y su tratamiento de elección. Implicaciones clínicas: No se cuenta con una información suficiente que nos determinen el manejo de este tipo de pacientes. La incidencia reportada es mínima y no existe un tratamiento específico para estos pacientes. Conclusiones: El carcinoma de células escamosas de la próstata es una entidad rara. Se cuenta con poca información sobre el manejo y el pronóstico en este tipo de cáncer es desfavorable. Es de suma importancia abrir nuevas vertientes de investigación sobre este tipo de cáncer.