Resumen Introducción: El grado de conocimiento de los pacientes sobre sus medicamentos está altamente asociado a la mejora de su uso racional y de los resultados de la farmacoterapia. El objetivo fue evaluar el conocimiento y cumplimiento del tratamiento farmacológico en pacientes hipertensos y diabéticos tipo 2 en una unidad de salud de la familia de la ciudad de Luque. Método: Estudio observacional, descriptivo, de corte transverso. La selección se realizó por conveniencia y la información se obtuvo a través de entrevistas, durante las visitas domiciliarias de mayo a junio 2021, utilizando un cuestionario estructurado que incluía datos sociodemográficos, y preguntas de la metodología de Dáder y del test de Morisky-Green modificado. Resultados: De los 50 pacientes entrevistados, el 80 % fueron mujeres, con una edad promedio de 63,04 ± 11,39 años, y con un bajo nivel de estudios. El 100 % eran hipertensos y el 38 % también diabéticos. Los antihipertensivos más prescriptos, ya sea solo o combinados, fueron losartán potásico (50 %), y enalapril maleato (18 %). El 42 % de los diabéticos utilizaban antidiabéticos orales y el 58 % insulina. El 100 % de los pacientes desconoce su tratamiento, y el cumplimiento no superó el 22 %, para ambas patologías. Conclusiones: Los pacientes no son conocedores adecuados de su tratamiento, y el cumplimiento es muy bajo, por lo que es necesaria la intervención del farmacéutico y la implementación de estrategias educativas que puedan ayudar a mejorar el grado de conocimiento y la adherencia a su tratamiento.

Abstract Introduction: The level of patients’ knowledge about their medications is highly related to the improvement of their rational use and the results of the pharmacotherapy. The aim of this study was to assess the knowledge and the compliance with the pharmacological treatment in hypertensive and type 2 diabetic patients in a family health unit of the city of Luque. Method: It was carried out an observational, descriptive and cross-sectional study. The selection was done by convenience and the information was obtained through interviews which took place during the home visits from May to June, 2021. A structured questionnaire was used and included social demographic data and questions of the Dader method and the Morisky-Green test modified. Results: Among the 50 interviewed patients, 80% were women, with an average age of 63,04 ± 11.39 years with a low level of education. 100% were hypertensive and 38% were diabetic too. The most prescribed antihypertensive, both, alone or combined, were Ioasartan Potassium (50%) and Enalapril Maleate (18%). 42% of the diabetic patients used oral antidiabetics and 58% insulin. 100% of the patients ignored their treatment and the compliance did not exceed 22% for both diseases. Conclusions: The patients do not know their treatment and the compliance is very low. Thus, it is necessary the intervention of a pharmacist and the implementation of educational strategies that can help to improve the level of knowledge and the adherence to treatment.

ABSTRACT Research related to vehicle routing and its applications reveals the interest in supporting the authorities in solving society’s problems. In this way, a bi-objective model of mixed integer linear programming and metaheuristics based on genetic algorithm and local search, applied to reverse logistics by green open vehicle routing, is presented. The process consists of collecting solid urban waste at collection points, contributing to urban sustainability through the route plan determined by the proposal, optimizing distances and costs as well; it also measures the fuel consumption of the vehicles from their departure from the depot to the last collection point, as well as the CO2 emissions during routing. The proposals, implemented in GLPK and Python, obtain results in various scenarios. The model generates solutions quickly in scenarios between 5 and 25 collection points. For larger scenarios it does not find solutions within the time limit of 7200 seconds. The metaheuristics have greater potential as for 31 collection points, the processing time was 2.3 seconds which is a good indication for larger scenarios. Three Sectors of Trujillo city are tested to evaluate our proposal.

ABSTRACT Cystic fibrosis (CF) is an inherited disorder of the exocrine secretion glands, considered the most frequent cause of exocrine pancreatic insufficiency (EPI) in childhood. This review summarizes the landscape of enzyme replacement therapy in PEI associated with CF, the available formulations, their dosage and mode of administration, as well as the current limitations and challenges and potential areas for future development.

RESUMEN La fibrosis quística (FQ) es un trastorno hereditario, de las glándulas de secreción exocrina, considerada la causa más frecuente de insuficiencia pancreática exocrina (IPE) en la infancia. Esta revisión resume el panorama del tratamiento de reposición enzimática en la IPE asociada a la FQ, las formulaciones disponibles, su dosificación y modo de administración, así como las limitaciones y desafíos actuales y las posibles áreas del desarrollo futuro.

Abstract At present there is a great advance in the use of organic substances as fertilizers; humic substances are one of them with various forms of extraction. This article evaluates the extraction yield of humic substances (humic acid and fulvic acid) from three raw materials and different basic extractants and acids. In the basic extraction of humic substances, the type of raw material significantly influences, to a p value equal to 5 %. The maximum extraction volumes of humic substances are with garden waste. The fractionation stage of the humic and fulvic acids (acid extraction) depends on the type of basic extractant. The alternative Vermicompost - NaOH - HCl is the most economic and technically feasible, with 38.53 % of extraction yield value of humic acid and 64.90 $/h of gross profit.

Resumen En la actualidad existe un gran avance en la utilización de sustancias orgánicas como fertilizantes; las sustancias húmicas son una de ellas con diversas formas de extracción. En este artículo se valora el rendimiento de extracción de sustancias húmicas a partir de tres materias primas y diferentes extractantes básicos y ácidos. En la etapa de extracción básica de las sustancias húmicas influye significativamente el tipo de materia prima, para un valor P igual 5 %. Los mayores volúmenes de extracción de sustancias húmicas son con el residuo de jardinería. El fraccionamiento de ácidos húmicos y fúlvicos depende del tipo de extractante básico. La alternativa Humus de lombriz - NaOH - HCl es la más factible desde el punto de vista técnico y económico, con un 38.53 % de rendimiento de extracción de ácido húmico y un beneficio bruto igual a 64.90 $/h.

ABSTRACT Castor bean (Ricinus communis L.) is an oleaginous plant of economic importance due to its different industrial applications. Edaphic characteristics are used to determine the viability of places considered as suitable to obtain castor oil. The objectives of this study were to determine the edaphic characteristics and oil content of R. communis, and to evaluate elicitation with salicylic acid (SA) in El Marqués, Querétaro, Mexico. Sampling was carried out in a direct way, selecting sites where castor bean plants were found. Samples of 1.5 kg of soil were taken and 3 clusters of castor bean in a mature state were collected from 21 accessions. The physicochemical characteristics of the soil and oil content of seeds were determined. Finally, 300 plants of the Guanajuatoil variety were planted and elicitated with different SA concentrations under greenhouse conditions in order to determine oil content. The physical analysis of the soil samples indicated dark-colored soils, Mollisol and Vertisol types, with different textures: clay, clay loam, sandy clay loam and sandy loam. Soil chemical analyses showed the following soil characteristics: pH 7.22; electrical conductivity 0.52 dS m-1; organic matter 7.17%; cation exchange capacity 26.77; calcium 38.62, magnesium 6.81, sodium 13.41and potassium 6.97 cmol kg-1; and nitrogen and phosphorus contents of 16.32 and 54 mg kg-1, respectively. Castor oil content was higher in clay soils (41.46%). The plants elicited with SA presented oil contents ranging from 28.99% to 52.9%, obtained with 100 and 900 ^M. In conclusion, elicitation with SA is an adequate method to increase oil content in castor bean seeds. The locality of El Marqués has good potential for the production of castor oil.

ABSTRACT Background: one of the most widely used instruments in the medical literature for evaluating cognitive functions in older adults is the Clock Drawing test. Objective: to evaluate the normative values of the Clock Drawing test, version of Cacho and García, in healthy elderly who attend grandparents' homes. Methods: a descriptive study was carried out from the quantitative approach. The universe was made up of 84 older adults who attend grandparents' homes in the Holguín municipality, in the period between May 2019 and March 2020. 60 older adults were selected through a probabilistic sampling. Socio-demographic, cognitive functioning and the normative values of the Clock Drawing test were considered as variables. The semi-structured interview, the Mini-examination of the mental state, the Katz index, the Lawton scale and the Clock Drawing test were used. The results were processed with the EPIDAT 3.1 and MedCal packages. Results: the age range of the older adults was 61-93 years. There was the same percentage value for the female and male sex. Primary education level predominated. The elderly obtained in the Clock test a minimum score of 6.5 and a maximum of 10. The average value reached was 9.21. Conclusions: the minimum scores achieved by the elderly are within the normative values of the qualification of the Clock test, for cognitively healthy elderly.

RESUMEN Fundamento: dentro de los instrumentos más utilizados en la literatura médica para la evaluación de las funciones cognitivas en los adultos mayores se encuentra el test del Reloj. Objetivo: evaluar los valores normativos del test del Reloj, versión de Cacho y García a la orden, en ancianos sanos que asisten a las casas de abuelos. Métodos: desde el enfoque cuantitativo se realizó un estudio descriptivo. El universo estuvo constituido por 84 adultos mayores que asisten a las casas de abuelos del municipio Holguín, en el periodo comprendido entre mayo de 2019 y marzo de 2020.Se seleccionaron a través de un muestreo probabilístico 60 adultos mayores. Se plantearon como variables las sociodemográficas, el funcionamiento cognitivo y los valores normativos del test del Reloj. Se utilizaron la entrevista semiestructurada, el mini-examen del estado mental, el índice de Katz, la escala de Lawton y el test del Reloj a la orden. Los resultados se procesaron con los paquetes EPIDAT 3.1 y MedCal. Resultados: el rango de edad de los adultos mayores fue de 61-93 años. Existió igual valor porcentual para el sexo femenino y masculino. Predominó el nivel de escolaridad primario. Los ancianos obtuvieron en el test del Reloj una puntuación mínima de 6,5 y una máxima de 10. El valor medio alcanzado fue de 9.21. Conclusiones: las puntuaciones mínimas alcanzadas por los adultos mayores se encuentran dentro de los valores normativos de la calificación del test del Reloj, a la orden, para ancianos cognitivamente sanos.

ABSTRACT Background: depression in older adults has been associated with cognitive impairment as a result of the possible negative effects of emotional symptoms on cognition. Objective: to determine the impact of depression on the cognitive functioning of older adults who attend grandparents' homes numbers 2 and 3 of the Holguín municipality. Methods: from the quantitative approach, a descriptive study was carried out between May 2019 and March 2020. The universe was made up of 50 older adults who attend grandparents' homes numbers 2 and 3 of the Holguín municipality. The sample was selected probabilistically and consisted of 26 older adults. Socio-demographic, depression and cognitive functioning were considered as variables. The semi-structured interview, the mental state mini-test, the Clock Test, the Montreal Cognitive Assessment and the Yesavage scale of geriatric depression were used in the evaluation. The results were processed in the EPIDAT 3.1 and MedCalc packages. Results: there were significant differences between the groups in the mental state mini-test and in the Montreal Cognitive Assessment. Participants with depression had significantly lower scores on the cognitive domains of the Montreal Cognitive Assessment. Conclusions: depression had a negative influence on the cognitive functioning of older adults. The presence of depression affected the interpretation of the Montreal Cognitive Assessment.

RESUMEN Fundamento: la depresión en los adultos mayores ha sido asociada con el deterioro cognitivo como resultado de los posibles efectos negativos de síntomas emocionales sobre la cognición. Objetivo: determinar el impacto de la depresión en el funcionamiento cognitivo de adultos mayores que asisten a las casas de abuelos números dos y tres del municipio Holguín. Métodos: desde el enfoque cuantitativo se realizó un estudio descriptivo, entre mayo de 2019 y marzo de 2020. El universo estuvo constituido por 50 adultos mayores que asisten a las casas de abuelos números dos y tres del municipio Holguín. La muestra se seleccionó de forma probabilística y la constituyeron 26 adultos mayores. Se consideraron como variables las sociodemográficas, la depresión y el funcionamiento cognitivo. Se utilizó en la evaluación la entrevista semiestructurada, el mini-examen del estado mental, el Test del Reloj, el Montreal Cognitive Assessment y la escala de depresión geriátrica de Yesavage. Los resultados se procesaron en los paquetes EPIDAT 3.1 y MedCalc. Resultados: se evidenciaron diferencias significativas entre los grupos en el mini-examen del estado mental y en el Montreal Cognitive Assessment. Los participantes con depresión obtuvieron puntuaciones significativamente más bajas en los dominios cognitivos del Montreal Cognitive Assessment. Conclusiones: la depresión influyó de forma negativa en el funcionamiento cognitivo de los adultos mayores. La presencia de depresión afectó la interpretación del Montreal Cognitive Assessment.

RESUMO Este artigo apresenta o contexto e os modos de construção da versão brasileira do Guia da Gestão Autônoma da Medicação (Guia GAM-BR), comparativamente ao Guia originário do Quebec. O Guia GAM-BR foi resultado de parceria estabelecida entre Brasil e Canadá que, por meio de uma pesquisa multicêntrica, transpôs ao contexto brasileiro o instrumento quebequense, a serviço dos usuários da saúde mental, visando ao aumento do seu poder de negociação em seus tratamentos medicamentosos. Tal transposição implicou mais do que ‘adaptação’: tratou-se da ‘transformação’ do Guia originário em um instrumento brasileiro. Entre essas transformações, destacam-se: substituição do ‘eu’ pelo ‘você’ como sujeito do enunciado das questões apresentadas pelo Guia; maior desenvolvimento do tema dos direitos; supressão das orientações para retirada progressiva da medicação. Além disso, o dispositivo grupal fez-se imanente à estratégia GAM brasileira. Longe de significar traição, tais transformações mantêm-se fiéis à forma participativa e cogestiva que orientou a elaboração da GAM na sua origem, como encarnação da experiência democrática e cidadã própria ao Quebec. Assim, o artigo busca colocar em análise a produção dos efeitos da estratégia GAM em solo brasileiro, na consideração à experiência democrática e ao processo de reforma psiquiátrica no Brasil.

ABSTRACT This article presents the context and construction of the Brazilian version of the Gaining Autonomy & Medication Management Guide (GAM-BR) compared to Quebec’s original Guide. The GAM-BR Guide resulted from a partnership between Brazil and Canada, which transposed the Quebec instrument to the Brazilian context through multicenter research to empower mental health users in the negotiation of their drug treatment. This process was more than an adaptation as it transformed the original Guide into a Brazilian instrument. The main changes were replacing ‘I’ with ‘you’ as the subject of the statements in the Guide, further developing the theme of rights, suppressing the guidelines for the progressive withdrawal of medication. Additionally, the group device became immanent to the Brazilian GAM strategy. Far from being a betrayal, this set of changes remains loyal to the participatory and co-managerial process that oriented the elaboration of the GAM at its origin as an embodiment of Quebec’s typical democratic and citizen experience. Therefore, this article aims to analyze the production of the GAM strategy’s effects of in Brazil, considering its democratic experience and the psychiatric reform in the country.

RESUMO Este artigo apresenta o contexto e os modos de construção da versão brasileira do Guia da Gestão Autônoma da Medicação (Guia GAM-BR), comparativamente ao Guia originário do Quebec. O Guia GAM-BR foi resultado de parceria estabelecida entre Brasil e Canadá que, por meio de uma pesquisa multicêntrica, transpôs ao contexto brasileiro o instrumento quebequense, a serviço dos usuários da saúde mental, visando ao aumento do seu poder de negociação em seus tratamentos medicamentosos. Tal transposição implicou mais do que ‘adaptação’: tratou-se da ‘transformação’ do Guia originário em um instrumento brasileiro. Entre essas transformações, destacam-se: substituição do ‘eu’ pelo ‘você’ como sujeito do enunciado das questões apresentadas pelo Guia; maior desenvolvimento do tema dos direitos; supressão das orientações para retirada progressiva da medicação. Além disso, o dispositivo grupal fez-se imanente à estratégia GAM brasileira. Longe de significar traição, tais transformações mantêm-se fiéis à forma participativa e cogestiva que orientou a elaboração da GAM na sua origem, como encarnação da experiência democrática e cidadã própria ao Quebec. Assim, o artigo busca colocar em análise a produção dos efeitos da estratégia GAM em solo brasileiro, na consideração à experiência democrática e ao processo de reforma psiquiátrica no Brasil.

ABSTRACT This article presents the context and construction of the Brazilian version of the Gaining Autonomy & Medication Management Guide (GAM-BR) compared to Quebec’s original Guide. The GAM-BR Guide resulted from a partnership between Brazil and Canada, which transposed the Quebec instrument to the Brazilian context through multicenter research to empower mental health users in the negotiation of their drug treatment. This process was more than an adaptation as it transformed the original Guide into a Brazilian instrument. The main changes were replacing ‘I’ with ‘you’ as the subject of the statements in the Guide, further developing the theme of rights, suppressing the guidelines for the progressive withdrawal of medication. Additionally, the group device became immanent to the Brazilian GAM strategy. Far from being a betrayal, this set of changes remains loyal to the participatory and co-managerial process that oriented the elaboration of the GAM at its origin as an embodiment of Quebec’s typical democratic and citizen experience. Therefore, this article aims to analyze the production of the GAM strategy’s effects of in Brazil, considering its democratic experience and the psychiatric reform in the country.

ABSTRACT Introduction: WHO recommends that during the first six months of life, infants should be fed exclusively with breast milk. From that moment, they should receive adequate and safe complementary foods, without abandoning breastfeeding at least until two years of age. Pharmacological treatment is one of the reasons for abandoning breastfeeding despite the fact that most current medications are compatible with breastfeeding. Objective: To determine the causes of the interruption of breastfeeding in women participants of two national virtual platforms. Method: Observational, descriptive study using a virtual survey of 33 women who have suspended breastfeeding from April 2015 to April 2017, participants of two virtual breastfeeding and maternity support platforms in Paraguay. Sampling not probabilistic for convenience. Results: The average age of 28 ± 4.2 years, mostly university, residents in the Central department. 30.3% of weaning was detected before 6 months, and only 9.0% reached 24 months of breastfeeding recommended by WHO. The causes of the most frequent interruption of breastfeeding were medication (36.4%), followed by a feeling of lack of milk (27.3%) and that the child was left hungry (18.2%). Conclusions: The medication represented the major cause of involuntary weaning, being compatible with breastfeeding drugs in more than half of the cases reported. The pharmacist, a professional with greater knowledge of information sources on medications, could have contributed in these cases to the preservation of breastfeeding

RESUMEN Introducción: La OMS recomienda que durante los seis primeros meses de vida, los lactantes debieran ser alimentados exclusivamente con leche materna. A partir de ese momento, deberían recibir alimentos complementarios adecuados e inocuos, sin abandonar la lactancia natural al menos hasta los dos años de edad. El tratamiento farmacológico es una de las razones de abandono de la lactancia materna a pesar de que la mayoría de los medicamentos actuales son compatibles con la lactancia. Objetivo: Determinar las causas de la interrupción de la lactancia materna en mujeres participantes de dos plataformas virtuales nacionales. Método: Estudio observacional, descriptivo utilizando una encuesta virtual en 33 mujeres que hayan suspendido la lactancia materna de abril 2015 a abril 2017, participantes de dos plataformas virtuales de apoyo a la lactancia y maternidad del Paraguay. El muestreo no probabilístico por conveniencia. Resultados: La edad promedio de 28±4,2 años, la mayoría universitarias, residentes en el departamento Central. Se detectó 30,3% de destetes antes de los 6 meses, y solo 9,0% alcanzaron los 24 meses de lactancia materna recomendada por la OMS. Las causas de la interrupción de la lactancia más frecuente fue la medicación (36,4%), seguida de sensación de falta de leche (27,3%) y de que el niño se quedaba con hambre (18,2%). Conclusiones: La medicación representó la mayor causa de destete involuntario, siendo medicamentos compatibles con la lactancia en más de la mitad de los casos reportados. El farmacéutico, profesional con mayor conocimiento de fuentes de información sobre medicamentos, podría haber contribuido en estos casos para la preservación de la lactancia.

ABSTRACT Introduction: The incidence of hepatitis B in Cuba has decreased significantly since incorporation of Cuban vaccine Heberbiovac HB. Objective: To determine the prevalence of hepatitis B virus markers in blood donors from three provinces and the persistence of antibodies against surface antigen of this virus in blood donors born after introduction of Cuban vaccine in the National Immunization Program. Methods: The design of a prevalence study was applied. We included 433 donors who attended the blood banks of the provinces of Havana, Villa Clara and Santiago de Cuba, between January and December 2018.The HBsAg, anti-HBc and anti-HBs markers were detected; the latter was detected in donors aged 18-26 years. The real-time analysis of C-reactive protein (CRP) was performed to identify viral replication in individuals positive to HBsAg-positive and to anti-HBc. Results: The prevalence of HBsAg and anti-HBc was 1.15% (5/433) and 7.85% (38/433), respectively. In individuals born after introduction of the vaccine, the prevalence of HBsAg and anti-HBc was 0% and 0.95%, respectively. 36.19% (38/105) of these donors had protective levels of anti-HBs (≥10UI/L). Viral DNA was detected in a donor positive to HBsAg and to anti-HBc. Hidden infection with the hepatitis B virus was not identified. Conclusions: The prevalence of HBsAg is low among Cuban blood donors, with a tendency to be null in donors born after application of Cuban vaccine Heberbiovac HB.

RESUMEN Introducción: La incidencia de la hepatitis B en Cuba se redujo notablemente desde la incorporación de la vacuna cubana Heberbiovac HB. Objetivo: Determinar la prevalencia de marcadores del virus de la hepatitis B en donantes de sangre de tres provincias y la persistencia de los anticuerpos contra el antígeno de superficie de este virus en donantes nacidos posterior a la introducción de la vacuna cubana en el Programa Nacional de Inmunización. Métodos: Se aplicó el diseño de un estudio de prevalencia. Se incluyeron 433 donantes que acudieron a los bancos de sangre de las provincias La Habana, Villa Clara y Santiago de Cuba, entre enero y diciembre de 2018. Se detectaron los marcadores HBsAg, anti-HBc y anti-HBs; este último en donantes con edades entre 18 a 26 años. Se realizó la proteína C reactiva (PCR) en tiempo real para identificar la replicación viral en individuos positivos al HBsAgo al anti-HBc. Resultados: La prevalencia de HBsAg y de anti-HBc fue de 1,15 % (5/433) y 7,85 % (38/433), respectivamente. En los individuos nacidos después de la introducción de la vacuna, la prevalencia de HBsAg y anti-HBc fue 0 % y 0,95 %, respectivamente. El 36,1 9 % (38/105) de estos donantes tenían niveles protectores de anti-HBs (≥ 10 UI/L). El ADN viral se detectó en un donante positivo al HBsAg y anti-HBc; no se identificó infección oculta por el virus de la hepatitis B. Conclusiones: La prevalencia del HBsAg es baja en donantes de sangre cubanos, con tendencia a ser nula en donantes nacidos después de la aplicación de la vacuna cubana Heberbiovac HB.

RESUMEN: En esta investigación se evalúa la relación entre el crédito otorgado al sector privado y variables institucionales considerando países en diferente nivel de desarrollo. El análisis se implementa a través de un ejercicio empírico que utiliza un panel de datos para un universo de 126 países durante el periodo 2004-2013. Los resultados sugieren que la eficiencia institucional es determinante en el desempeño del mercado de crédito, tanto en países desarrollados como en países en vías de desarrollo. Este resultado es contrario a lo que se ha señalado en la literatura: que el impacto de las instituciones es significativo típicamente cuando las economías han alcanzado un nivel umbral de desarrollo.

RÉSUMÉ: Cette recherche évalue la relation entre les crédits accordés au secteur privé et les variables institutionnelles en tenant compte des pays à différents niveaux de développement. L'analyse est mise en ceuvre par le biais d'un exercice empirique utilisant un panel de données pour un univers de 126 pays au cours de la période 2004-2013. Les résultats suggèrent que l'efficacité institutionnelle est un facteur déterminant de la performance du marché du crédit, non seulement dans les pays développés mais aussi dans les pays en développement. Ce résultat est contraire à ce qui a été souligné dans la littérature: le fait que l'impact des institutions est généralement important lorsque les économies ont atteint un seuil de développement.

ABSTRACT: This research evaluates the relationship between the credit granted to the private sector and institutional variables, considering countries at different levels of development. The analysis is implemented through an empirical exercise that uses a panel data for a universe of 126 countries during the 2004-2013 period. Results suggest that the institutional efficiency determines the performance of credit market, both in developed and developing countries. This finding is contrary to others shown in the literature, where the impact of institutions is usually significant when economies have reached a development threshold.

RESUMO: Nesta pesquisa, é avaliada a relação entre o crédito dado ao setor privado e as variáveis institucionais considerando países em diferente nivel de desenvolvimento. A análise é implantada por meio de um exercício empírico que utiliza um painel de dados para um universo de 126 países entre 2004 e 2013. Os resultados sugerem que a eficiência institucional seja determinante no desempenho do mercado de crédito, tanto em países desenvolvidos quanto em países em via de desenvolvimento. Esse resultado é contrário ao indicado na literatura: que o impacto das instituições é significativo tipicamente quando as economias atingem um limite de desenvolvimento.

Mucormycosis is a rare, usually fatal, opportunistic infection that mostly affects people with immune deficiency or associated pathologies. There are few reports of this disease in patients without the traditional risk factors, still unknown what could be the real predisposing causes involved. The forms of presentation are rhinocerebral, cutaneous, pulmonary, gastrointestinal and disseminated. This is why, due to the difficult diagnosis, high mortality and uncommon presentation, we report the case of a 4-year-old child without immunodeficiency or background pathologies who developed an esophagogastric mucormycosis.

La mucormicosis es una infección oportunista rara usualmente fatal, que afecta mayoritariamente a personas con déficit inmunológico o patologías asociadas. Hay pocos reportes de esta enfermedad en pacientes sin los factores de riesgo tradicionales, desconociéndose aún cuáles podrían ser las causas predisponentes reales implicadas. Las formas de presentación son rinocerebral, cutánea, pulmonar, gastrointestinal y diseminada. Es por esto que, debido al difícil diagnóstico, alta mortalidad y presentación poco común reportamos el caso de un niño de 4 años sin inmunodeficiencia ni patologías de fondo que desarrolló una mucormicosis esófago-gástrica.

ABSTRACT Fusarium species are a group of fungi that cause superficial infections, locally invasive and disseminated disease, which occur mainly in immunocompromised hosts, and occasionally in immunocompetent individuals. We present three cases that show three different clinical forms of Fusarium spp. disease that affected different types of patients (patients with hematological malignancy, chronic kidney disease in peritoneal dialysis and post-surgical for osteoarticular pathology), each with its own characteristics that merit discussion. These cases show different clinical forms of invasive fusariosis caused by Fusarium solani complex species in patients with different pathologies and therapeutic management that could be risk factors for the development of the disease. The clinical recognition of fusariosis, not only in oncohematological patients, together with a timely diagnosis and treatment contribute to the success of the treatment and a reduction in mortality.

RESUMEN Las especies de Fusarium son un grupo de hongos que causan infecciones superficiales, localmente invasivas y enfermedad diseminada, que ocurren principalmente en huéspedes inmunocomprometidos, y ocasionalmente en individuos inmunocompetentes. Presentamos tres casos que ponen en manifiesto tres diferentes formas clínicas de la enfermedad por Fusarium spp., que afectaron diversos tipos de pacientes (pacientes con malignidad hematológica, enfermedad renal crónica en diálisis peritoneal y post-quirúrgico por patología osteoarticular), cada una con características propias que ameritan su discusión. Estos casos ponen de manifiesto diferentes formas clínicas de fusariosis invasiva causadas por especies del complejo Fusarium solani en pacientes con diferentes patologías y manejo terapéutico que podrían ser factores de riesgo para el desarrollo de la enfermedad. El reconocimiento clínico de la Fusariosis, no solo en pacientes oncohematólogicos, junto con un diagnóstico y tratamiento oportuno contribuyen al éxito del tratamiento y a una reducción en la mortalidad.