Resumo Amostras biológicas obtidas de uma pequena lagoa temporária do norte da Colômbia proporcionaram o primeiro registro de Coronatella undata Sousa, Elmoor-Loureiro e Santos, 2015 e do macho de Coronatella monacantha (Sars, 1901) na Colômbia. Neste estudo, foi descrita a morfologia de fêmeas de C. undata e de fêmeas e machos de C. monacantha, comparando-a com outras espécies do gênero. Coronatella undata foi descrita originalmente no Brasil e, entre as espécies do complexo C. monacantha, parece estar intimamente relacionada com Coronatella acuticostata (Sars, 1903). Coronatella undata apresenta algumas semelhanças com C. monacantha, mas pode ser identificada por seus principais caracteres, tais como: 1) ângulo posterior ventral da valva com dois dentículos; 2) cerda rudimentar no exopodito do ramo do tronco II; 3) filtro da gnatobase do apêndice torácico II com seis cerdas; 4) cerda ODL do membro do tronco I mais curta que a cerda mais longa do IDL. Coronatella monacantha é a espécie mais relatada na região neotropical, e o macho se assemelha mais a Coronatella paulinae Sousa, Elmoor-Loureiro & Santos em relação à/ao: (i) razão comprimento / largura do pós-abdômen, (ii) espinho basal quase reto e (iii) espinho basal longo com a metade do comprimento do espinho basal. No entanto, eles podem ser separados pelo/pela: (i) número de cerdas laterais na antênula, (ii) ângulo postanal, (iii) posição do gonóporo e (iv) presença de dentículo no canto ventral posterior da valva.

Abstract Biological samples obtained from a small temporary pond of northern Colombia yielded the first record Coronatella undata Sousa, Elmoor-Loureiro and Santos, 2015 and of the male of C. monacantha (Sars, 1901) for Colombia. In this study, the morphology of female of Coronatella undata and female and male of C. monacantha was described and compared to other species within the genus. C. undata was originally described from Brazil and, among the species of the Coronatella monacantha complex, seems to be closely related to C. acuticostata (Sars, 1903). C. undata shows some similarities with C. monacantha, but it can be identified by important diagnostic characters such as: 1) posterior-ventral corner of valve with two denticles, 2) seta on exopodite of trunk limb II rudimentary, 3) filter comb of trunk limb II with six setae, 4) ODL seta of trunk limb I shorter than longest seta of IDL. C. monacantha is the most reported species in the Neotropical region and the male most resemble C. paulinae Sousa, Elmoor-Loureiro & Santos, 2015 in relation to (i), length/wide of postabdomen ratio (ii) basal spine almost straight and (iii)) long basal spine reaching the mid-length of basal spine. However, they can be separated by (i) number of lateral seta on the antennule, (ii) postanal angle, (iii) position of gonopore (iv) presence of a denticle on posterior-ventral corner of valve

Abstract Post-heart transplant patient care is a challenging task for multidisciplinary teams. Thus, patient rehabilitation is of paramount importance. Phase I of cardiac rehabilitation helps prevent the pulmonary and functional sequelae found in patients whilst in ICU and during hospitalisation. Functional progression based on the global muscle strength, mobility, and exercise tolerance seem to be a good alternative for this population. The role of physiotherapy in critical care is crucial for the proper treatment of these patients.

SUMMARY Seeds germination and crop productions depend mostly on the planting methods used, initial soil mechanical conditions and soil moisture. The main objective of this work was to quantify the agricultural traffic effects on soil compaction, sunflower (Helianthus annuus L.) seed emergence and yield under two different soil mechanical conditions: No-tillage (NT) and conventional tillage (CT). The trial was located in the western Pampas region during three cropping seasons on an Entic Hapludoll. The parameters measured were: (1) seed emergence, (2) dry bulk density, (3) cone index, (4) water infiltration and (5) crop yields. The main results showed that the emergence was 17.3 % earlier in LC than in NL and the cone index and bulk density values were lower for the CT up to 450 mm. The average yields for the 3 cropping seasons were 3.23 tons ha-1 and 1.99 tons ha-1 for CT and NT, respectively. The main conclusion is that the soil worked under CT is a soil with a low compaction level up to 150 mm. This, in turn, led to a higher plant emergence count and to a more uniform crop establishment and distribution than in the soil worked under NT.

RESUMEN La germinación de semillas y la producción de cultivos dependen del sistema de siembra, las condiciones mecánicas y el contenido de agua del suelo. El objetivo principal de este trabajo fue cuantificar los efectos del tráfico agrícola sobre la compactación del suelo, la emergencia y el rendimiento del girasol (Helianthus annuus L.)en dos condiciones de suelo: no-labranza (NL) y labranza convencional (LC). El ensayo se localizó en el oeste de la región pampeana durante tres años sobre suelo Hapludol éntico. Los parámetros medidos fueron: (1) emergencia de semillas, (2) densidad aparente seca, (3) índice de cono, (4) infiltración de agua y (5) rendimiento del cultivo. Los principales resultados mostraron que la emergencia fue 17,3 % más temprana en LC que NL y los valores de índice de cono y densidad aparente fueron menores para el suelo en LC hasta los 450 mm. Los rendimientos promedios fueron de 3,23 ton ha-1 y 1,99 ton ha-1 para LC y NL, respectivamente. La principal conclusión es que el suelo bajo LC posee bajos niveles de compactación hasta los 150 mm, esto resultó en un mayor número de brotes de plantas logrando una distribución del cultivo más uniforme que NL.

Resumen Se realizaron recolectas de mosquitos (Diptera: Culicidae) en el intradomicilio y peridomicilio a lo largo de la frontera Chiapas-Guatemala durante octubre-noviembre del 2018. Se recolectaron 4,439 especímenes pertenecientes a 2 subfamilias, 18 géneros y 41 especies, una de ellas Mansonia dyari (Belkin, Heinemann y Page, 1970) es un nuevo registro estatal para Chiapas. De las 41 especies recolectadas, 21 tienen importancia en salud pública, siendo algunas de ellas los principales vectores de malaria, dengue, fiebre amarilla, chikungunya, zika, mayaro, encefalitis equina venezolana, encefalitis equina del oeste y fiebre del valle del Rift. Culex quinquefasciatus y Aedes aegypti mostraron ser las más abundantes. En algunos casos, los municipios con mayor número de especies e individuos no fueron los más diversos y equitativos, con una alta disimilitud en la composición de sus especies. El intradomicilio obtuvo las mayores abundancias de mosquitos, sin embargo, su diversidad y equitatividad fue baja a diferencia del peridomicilio, presentándose una disimilitud ligeramente alta entre sus especies. Los resultados obtenidos tienen importancia para el establecimiento de programas de vigilancia y control en los municipios fronterizos en el estado de Chiapas, ya que brindan información base de la presencia y distribución de la fauna de mosquitos.

Abstract Mosquito collection was conducted intradomiciliary and peridomiciliary along the Chiapas-Guatemala international border during October-November 2018. We collected 4,439 specimens belonging to 2 subfamilies, 18 genera and 41 species, one of which Mansonia dyari (Belkin, and Page, 1970) is a new record for Chiapas, and 21 species with medical importance were found. Culex quinquefasciatus and Aedes aegypti were the most common species. Some municipalities with the highest number of species and individuals were not the most diverse and equitable, with a high dissimilarity in species composition. The intradomiciliary collections obtained the highest abundances of species, however the diversity and evenness were low in contrast with the peridomiciliary collections, where obtained slightly high dissimilarity among species. The results obtained have importance for the establishment of surveillance and mosquito control programs in the state of Chiapas, since they provide basic information on the occurrence and distribution of mosquito fauna.

RESUMEN Se presenta la evolución histórica de la certificación de especialistas en medicina familiar en México, a 35 años de su fundación. Asimismo, se abordan brevemente los procesos de evaluación de los sustentantes y la importancia de mantener la «vigencia de la certificación». Se realiza el benchmarking de la certificación en otros países con procesos de certificación bien definidos y consolidados. Al final, se presentan los retos más inmediatos de la certificación en México para esta especialidad.

ABSTRACT: The historical evolution of the Certification of Specialists in Family Medicine in Mexico is presented, 35 years after its foundation. Likewise, the evaluation processes of the applicants and the importance of maintaining the “Certification Validity” are briefly addressed. Certification benchmarking is carried out in other countries with well-defined and consolidated certification processes. At the end, the most immediate challenges of the Certification in Mexico for this specialty are presented.

Abstract Objectives To evaluate neonatal autopsy rates at a tertiary hospital in southern Brazil ascertain the level of agreement between premortem and postmortem diagnosis. Methods The authors reviewed all neonatal autopsies performed over a 10-year period and described the percentage of neonates who died and underwent autopsy. The authors tested for agreement between autopsy findings and the cause of death as defined by the neonatologist. Agreement between clinical diagnosis and autopsy findings was classified using the modified Goldman criteria. Additional findings at autopsy were grouped by organ system. Linear regression and multiple comparisons were used for statistical analyses. Results During the study period, 382 neonates died at the Neonatal Intensive Care Unit (NICU). Consent to perform an autopsy was obtained for 73 (19.1%). The complete agreement between autopsy findings and the neonatologist's premortem diagnosis was found in 48 patients (65.8%). Additional findings were obtained at autopsy in 25 cases (34.2%). In 5 cases (6.9%), the autopsy findings contributed to subsequent genetic counseling. Seven autopsies (9.6%) revealed a diagnosis that would have changed patient management if established premortem. The autopsy rate increased by an average of 1.87% each year. Conclusion Despite a high level of agreement between clinical diagnosis and pathological findings, autopsies provided relevant data regarding the cause of death, providing additional clinical information to neonatologists and allowing genetic counseling of family members.

Resumo O gênero Pouteria apresenta várias aplicações terapêuticas e, dentre elas, grande potencial antiflamatório. Os efeitos do gel de Pouteria ramiflora sobre a cicatrização de feridas na pele de ratos diabéticos foram avaliados pela histomorfometria. A estreptozotocina foi administrada por via intraperitoneal em animais após jejum de 12 horas, a confirmação de indução da diabetes foi confirmada pelo índice glicêmico (˃ 240 mg dL-1). Foi realizada uma incisão no dorso do animal e foram criados 3 grupos de tratamento: controle (gel carbopol), extrato etanólico (Ext) e Gel + extrato etanólico à 2% (Ext+gel); a avaliação histopatológica foi realizada no 7º, 14º, 21º e 30º dias após o período pós operatório. Os resultados da prospecção fitoquímica dos extratos de P. ramiflora demonstraram majoritariamente a presença de compostos fenólicos e flavonóides; o infiltrado inflamatório avaliado no 7º dia foi maior para animais do grupo controle em relação aos grupos Ext (p<0.05) e Ext+gel 2% (p<0.05); no 14º dia o controle e Exp (p<0.05) apresentaram aumento significativo dos infiltrados inflamatórios. A presença de fibroblastos foi elevada no 7º dia em todos os tratamentos. O processo da angiogênese mostrou um maior número de vasos sanguíneos entre os grupos Ext e Ext+gel (p<0.05) no 7º dia; no 14º dia o grupo controle, Ext (p<0.05), Control e Ext+gel (p<0.05) apresentaram aumento de vascularização, e no 21º dia apenas os grupos controle e Ext (p<0.05). Os resultados histopatológicos mostraram que a formulação gel carbopol + extrato etanólico a 2% foi eficiente na reparação de tecidos e na diminuição de células inflamatórias nos animais diabéticos.

Abstract The genus Pouteria has been studied because it presents various activities, among which is its anti-inflammatory potential. The effects of Pouteria ramiflora Carbopol gel on the healing of skin wounds in diabetic rats were evaluated by microscopic imaging. Streptozotocin was administered intraperitoneally in animals that had fasted for 12 hours, a situation confirmed by the glycemic index (˃ 240 mg dL-1). An excision on the back of the animals was performed and three groups were formed: Control (Gel), Ethanolic extract (Ext) and Gel + extract 2% (Ext+gel); the histopathological evaluation occurred on the 7th, 14th, 21st and 30th days after the post-operative period. The results of the phytochemical prospecting of P. ramiflora extract demonstrated the major presence of phenolic compounds and flavonoids; the assessment of the inflammatory infiltrate on the 7th day was higher on group Ext and Ext+gel when compared to group Control; on the 14th day control and Ext (p<0.05). The quantification of fibroblasts was higher on the 7th day among the three treatments, control and Ext (p<0.05), on the 21st day. Angiogenesis showed a higher number of vessels in Ext+gel group (p<0.05) on the 7th day; in Control, Ext and Ext+gel (p<0.05) on the 14th day; and Control and Ext (p<0.05)on the 21st day. The histopathological results showed that the formulation Ext+gel was efficient in tissue reparation and decrease in inflammatory cells on the diabetic’s animals.

Background: Healthcare-associated infections (HAIs) are important adverse events that must be prevented. Objective: The objective of the study was to report and study possible changes in HAI rates as well as their causes after the COVID-19 hospital surge capacity response (HSCR) in an academic referral center. Methods: This was a before-after observational study. The Infection Prevention and Control (IPC) program (prospective surveillance, prevention bundles, antibiotic stewardship, continuing education, and feedback) was transiently disrupted after the start of HSCR (March 2020). HAI rates were compared before (January 2019-February 2020) and after (April-July 2020) HSCR, and plausible predisposing factors in affected patients were compared. Results: An increase in the HAI rate from 6.2 to 11.8 cases/1000 patient-days was noted between periods due to increases in ventilator-associated pneumonia and bloodstream infection (BSI) rates. More critically ill patients were admitted during HSCR, and use of invasive devices increased. Prone positioning and infusion of muscle relaxants became commonplace. The nurse-to-patient ratio in the intensive care unit decreased, and 4 h shifts were introduced to avoid fatigue. The BSI rate decreased after the IPC program with additional measures was reintroduced in May 2020. Conclusions: The strain on the workforce and modifications to the IPC program very possibly underlay the findings. IPC programs continue to be essential during the pandemic.

ABSTRACT To develop an in vitro selection protocol, it is necessary to differentiate between tolerant and susceptible cultivars to the studied factor. The present work was carried out with the objective of selecting the temperature that allows to in vitro differentiating the response of the Phaseolus vulgaris cultivars 'ICA Pijao' (susceptible) and 'Tío Canela-75' (tolerant) to high temperatures. Different temperatures (30, 35, 40, 45 and 50 °C) were applied to seeds of the two cultivars. In vitro seed germination percentage, radicle and plumule length, number of explants that formed callus and number of shoots per callus were evaluated. It was possible to differentiate between cv. ‘ICA Pijao’ (susceptible) and ‘Tío Canela- 75’ (tolerant) with the variables radicle length, plumule length, percentage of calli formed and number of regenerated shoots. It was selected 35 °C as the selective agent.

RESUMEN Para desarrollar un protocolo de selección in vitro se hace necesario lograr la diferenciación entre cultivares tolerantes y susceptibles al factor estudiado. El presente trabajo se realizó con el objetivo de seleccionar la temperatura que permita diferenciar in vitro la respuesta de los cultivares de Phaseolus vulgaris ‘ICA Pijao’ (susceptible) y ‘Tío Canela- 75’ (tolerante) a altas temperaturas. Se aplicaron diferentes temperatura (30, 35, 40, 45 y 50 °C) a semillas de los dos cultivares. Se evaluó in vitro, el porcentaje de germinación de las semillas, longitud de la radícula y la plúmula, número de explantes que formaron callos y número de brotes por callo. Se logró diferenciar entre el cv. ‘ICA Pijao’ (susceptible) y ‘Tío Canela- 75’ (Tolerante) con las variables longitud de la radícula, longitud de la plúmula, porcentaje de callos formados y número de brotes regenerados. Se seleccionó 35 °C como agente selectivo.

Abstract: The spatio-temporal routing in episodically connected vehicular networks es a communication pattern where the destination nodes is a set of vehicles that transit the destination región during the specified destination región. The spatio-temporal routing is well suited to support Smart City and Intelligent Transportation Systems applications (i.e. road safety, crowdsensing, entertainment). In this paper, we present Oportunistic Greedy Routing over Street-layout Graph (OGRoSG), a novel spatio-temporal routing protocol for episodically connected vehicular networks. Unlike previous works in the literature, OGRoSG takes advantage of information available in modern navigation systems, such as the streets map and the geographic position. The protocol performs greedy geographic routing, the notion of being closer to the destination área is based on the progress towards the destination región on the streets-map graph and the direction of the vehicles. In order to achieve this, the vehicles process the destination región and the street graph to generate a shortest-paths tree with an extended destination región as root. This extended destination región guarantees that it covers the entire destination región and the paths that interconnect it. We evaluate the performance of the OGRoSG protocol using simulations in NS-3, using mobility traces generated in a map based in the city of Murcia, Spain. Our results show that OGRoSG outperforms a set of Spatio-Temporal variants of the Epidemic, Spray & Wait and Binary Spray & Wait routing protocols in terms of delivery ratio and overhead induced in the network.

Resumen: El enrutamiento de tráfico con ámbito espacio-temporal para redes vehiculares episódicamente conectadas es un patrón de comunicación en el cual los nodos destino son un conjunto de vehículos que transitan en una región destino durante un intervalo de tiempo predefinido. El enrutamiento de ámbito espacio-temporal es apropiado para dar soporte a aplicaciones de Smart City y de Intelligent Tranportation System (ITS), tal como seguridad en el camino, crowdsensing, entretenimiento y negocios. En este artículo se presenta Oportunistic Greedy Routing over Street-layout Graph (OGRoSG), un novedoso protocolo de comunicación de ámbito espacio-temporal para redes vehiculares episódicamente conectadas. A diferencia de propuestas existentes en la literatura, OGRoSG aprovecha la información disponible en sistemas de navegación modernos, tal como el mapa de las calles y la posición geográfica. En el enrutamiento geográfico voraz (greedy) que realiza el protocolo, la noción de cercanía está basada en el progreso sobre el grafo vial que considera la trayectoria en la que viajan los vehículos. Con este propósito, OGRoSG procesa la región destino y el grafo de calles para crear un árbol de caminos más cortos con una región destino extendida como raíz. Esta región destino extendida garantiza que está formada de un componente conectado de que incluye a todos los nodos que representan intersecciones ubicadas dentro de la región destino. Se evaluó el desempeño de OGRoSG usando simulaciones en NS-3 usando trazas de movilidad generadas en un mapa basado en la ciudad de Murcia, España. Nuestros resultados muestran que OGRoSG supera a variantes espacio-temporales de los protocolos de enrutamiento Epidemic, Spray & Wait y Binary Spray & Wait en términos de porcentaje de entrega y sobrecarga producida en la red.

Abstract: Introduction: The latest joint H. pylori NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conduc ted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the “degree of agreement” among a panel of SLAGHNP ex perts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylori in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recom mendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylori infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxi cillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the pa tient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or se cond degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.

Resumen: Introducción: Las últimas guías clínicas conjuntas de NASPGHAN y ESPGHAN en relación a la infección por H. pylori publicadas el año 2016, contienen 20 afirmaciones que han sido cuestionadas en la práctica respecto a su aplicabilidad en Latinoamérica (LA); en particular en relación a la preven ción del cáncer gástrico. Métodos: Se realizó un análisis crítico de la literatura, con especial énfasis en datos de LA y se estableció el nivel de evidencia y nivel de recomendación de las afirmaciones mas controversiales de las Guías Conjuntas. Se realizaron 2 rondas de votación de acuerdo a la técnica Delfi de consenso y se utilizó escala de Likert (de 0 a 4) para establecer el “grado de acuerdo” entre un grupo de expertos de SLAGHNP. Resultados: Existen pocos estudios en relación a diagnóstico, efectividad de tratamiento y susceptibilidad a antibióticos de H. pylori en pacientes pediátricos de LA. En base a estos estudios, extrapolaciones de estudios de adultos y la experiencia clínica del panel de expertos participantes, se realizan las siguientes recomendaciones. Recomendamos la toma de biopsias para test rápido de ureasa e histología (y muestras para cultivo o técnicas moleculares, cuando estén disponibles) durante la endoscopia digestiva alta sólo si en caso de confirmar la infección por H. pylori, se indicará tratamiento de erradicación. Recomendamos que centros regionales seleccio nados realicen estudios de sensibilidad/resistencia antimicrobiana para H. pylori y así actúen como centros de referencia para toda LA. En caso de falla de erradicación de H. pylori con tratamiento de primera línea, recomendamos tratamiento empírico con terapia cuádruple con inhibidor de bomba de protones, amoxicilina, metronidazol y bismuto por 14 días. En caso de falla de erradicación con el esquema de segunda línea, se recomienda indicar un tratamiento individualizado considerando la edad del paciente, el esquema indicado previamente y la sensibilidad antibiótica de la cepa, lo que implica realizar una nueva endoscopía con extracción de muestra para cultivo y antibiograma o es tudio molecular de resistencia. En niños sintomáticos referidos a endoscopía que tengan antecedente de familiar de primer o segundo grado con cáncer gástrico, se recomienda considerar la búsqueda de H. pylori mediante técnica directa durante la endoscopia (y erradicarlo cuando es detectado). Con clusiones: La evidencia apoya mayoritariamente los conceptos generales de las Guías NASPGHAN/ ESPGHAN 2016, pero es necesario adaptarlas a la realidad de LA, con énfasis en el desarrollo de centros regionales para el estudio de sensibilidad a antibióticos y mejorar la correcta selección del tratamiento de erradicación. En niños sintomáticos con antecedente familiar de primer o segundo grado de cáncer gástrico, se debe considerar la búsqueda y erradicación de H. pylori.

Abstract Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine. In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.

Resumen Introducción: La esofagitis inducida por medicamentos es un diagnóstico poco frecuente en pacientes pediátricos. A continuación, se describe una serie de seis casos de pacientes menores de 15 años con esofagitis inducida por L-arginina. Casos clínicos: Los seis casos se encontraban en tratamiento con L-arginina por talla baja e iniciaron con dolor retroesternal, odinofagia y disfagia de rápida instalación. Cuatro de ellos acudieron al servicio de urgencias por la intensidad de los síntomas. Los hallazgos en la endoscopia del tubo digestivo alto fueron úlceras en la mucosa del esófago a la altura del tercio medio, zona de estrechez natural por la compresión del bronquio izquierdo. Conclusiones: En presencia de odinofagia, disfagia, dolor retroesternal y el antecedente de la ingesta de L-arginina, la esofagitis inducida por fármacos debe considerarse como una posibilidad diagnóstica. El tratamiento está basado en el manejo del dolor, sucralfato, omeprazol, así como la suspensión del medicamento y medidas preventivas centradas en la educación del paciente y los familiares sobre los riesgos y beneficios de un medicamento y la forma correcta de administrarlo.