Abstract The predominant approach to digital education at the early childhood level, as expressed in national and jurisdictional curriculum developments, is mainly based on teaching students good uses of technology and the use of technological resources by teachers. Concepts such as computational thinking, digital literacy, or information retrieval configure a rather instrumentalist approach to technology. However, to a lesser extent, some documents address them as a cultural phenomenon, referring to reality as "natural, social, and technological," or using categories such as "digital citizenship" or "responsible use" of the Internet. Here, it is proposed to explore arguments for a comprehensive perspective on digital education that, transcending the instrumentalist vision, delves into the cultural and political challenges they present in relation to childhood. To do this, we draw on curricular sources and analyze three recent precedents of analogous curricular transformations: human rights education (the transition from old moral and civic education to education for citizenship), ‘Educación Sexual Integral’ (where the biologistic bias is overcome), and ‘Educación Ambiental Integral’ (whose approaches complexify a naive approach to the environment).

Resumen El enfoque predominante para la educación digital en el nivel inicial, expresado en los desarrollos curriculares nacionales y jurisdiccionales, se apoya principalmente en la enseñanza de los buenos usos de las tecnologías a los alumnos y en el uso didáctico de recursos tecnológicos por parte de los docentes. Conceptos como pensamiento computacional, alfabetización digital, o búsqueda de información configuran un enfoque más bien instrumentalista de lo tecnológico. También, en menor medida, en algunos documentos se las aborda como fenómeno cultural, al referirse a la realidad como “natural, social y tecnológica” o al emplear categorías como “ciudadanía digital” o “uso responsable” de Internet. Se propone aquí explorar argumentos para una perspectiva integral de la educación digital que, trascendiendo la visión instrumentalista, se adentre en los desafíos culturales y políticos que éstas presentan en relación con las infancias. Para ello, se echa mano de fuentes curriculares y se analizan tres antecedentes de transformaciones curriculares análogas recientes: la educación en derechos (el paso de la vieja educación moral y cívica a la educación para la ciudadanía), la Educación Sexual Integral (donde se supera el sesgo biologicista) y la Educación Ambiental Integral (cuyos planteos complejizan y des-ingenuizan el abordaje del ambiente).

Este estudo objetiva organizar, a partir de uma revisão narrativa da literatura, uma cronologia da mineração industrial como projeto de desenvolvimento para a Amazônia brasileira, com foco no período de 1964 a 1997, incluindo antecedentes na década de 1940. Resultados preliminares indicam que a institucionalização da mineração industrial na Amazônia Legal foi impulsionada por marcos regulatórios e grandes projetos minerários, viabilizados por decisões estatais balizadas por uma lógica de ocupação e integração subordinada aos interesses de capital nacional e internacional. A análise histórica demonstra como, no pós-guerra, as jazidas amazônicas foram consideradas estratégicas para a segurança nacional, embora coexistissem com associações empresariais estrangeiras. Durante a ditadura militar, aprofundou-se essa ambivalência: a retórica de “integração para não entregar” articulou-se a megaprojetos de infraestrutura e abriu a região ao capital privado, sobretudo minerador, consolidando um processo de territorialização seletiva sustentado por regimes de exceção normativa. Exemplos incluem o Polamazônia, a proibição da garimpagem artesanal e a implementação do Projeto Grande Carajás. A criação da RENCA, sobreposta a territórios indígenas, evidencia o apagamento sistemático de populações e saberes locais. Nos anos 1990, as reações sociais e políticas, com a demarcação de Terras Indígenas, a implantação de Unidades de Conservação e a governança ambiental global (Rio-92), mostram que o território amazônico é também espaço de disputas e resistências. Reconhecer as desigualdades estruturais geradas por esse modelo é fundamental para repensar profundamente o futuro regional, exigindo o fortalecimento de direitos territoriais, o reconhecimento de saberes tradicionais e estratégias para relações socioambientais mais justas.

Through a narrative review of specialized literature, this study aims to organize a chronology of industrial mining as a development project for the Brazilian Amazon, focusing on the period from 1964 to 1997 and including antecedents from the 1940s. Preliminary findings indicate that the institutionalization of industrial mining in the Legal Amazon was driven by regulatory milestones and large-scale mining projects, enabled by state decisions aligned with an occupation and integration logic subordinated to national and international capital interests. The historical analysis shows how, in the post-war context, Amazonian mineral deposits were deemed strategic for national security, although they coexisted with foreign corporate partnerships. During the military dictatorship, this ambivalence intensified: the rhetoric of “integration to avoid surrender” was coupled with major infrastructure projects and the opening of the region to private, particularly mining, capital, consolidating a selective territorialization process supported by normative exception regimes. Examples include Polamazônia, the ban on artisanal mining, and the implementation of the Grande Carajás Project. The creation of RENCA, overlapping Indigenous territories, illustrates the systematic erasure of local populations and knowledge. In the 1990s, social and political responses, including Indigenous land demarcation, the establishment of Conservation Units, and global environmental governance efforts (Rio-92), reveal that the Amazon territory is also a space for disputes and resistance. Recognizing the structural inequalities generated by this mining model is crucial to profoundly rethinking the region’s future, requiring the strengthening of territorial rights, the acknowledgement of traditional knowledge, and the pursuit of more equitable socio-environmental relations.

Este estudio pretende organizar, a partir de una revisión narrativa de la literatura, una cronología de la minería industrial como proyecto de desarrollo para la Amazonia brasileña, centrándose en el período comprendido entre 1964 y 1997, incluyendo antecedentes en la década de 1940. Los resultados preliminares indican que la institucionalización de la minería industrial en la Amazonia Legal fue impulsada por marcos regulatorios y grandes proyectos mineros, posibilitados por decisiones estatales basadas en una lógica de ocupación e integración subordinada a los intereses del capital nacional e internacional. El análisis histórico muestra cómo, en la posguerra, los yacimientos amazónicos fueron considerados estratégicos para la seguridad nacional, aunque coexistieran con asociaciones empresariales extranjeras. Durante la dictadura militar, esta ambivalencia se profundizó: la retórica de «integración y no rendición» se vinculó a megaproyectos de infraestructura y abrió la región al capital privado, especialmente minero, consolidando un proceso de territorialización selectiva sustentado en regímenes de excepción normativa. Ejemplos de ello son Polamazônia, la prohibición de la minería artesanal y la implantación del Proyecto Grande Carajás. La creación de la RENCA, que se superpone a los territorios indígenas, pone de manifiesto la eliminación sistemática de las poblaciones y los conocimientos locales. En la década de 1990, las reacciones sociales y políticas, con la demarcación de las Tierras Indígenas, la implantación de las Unidades de Conservación y la gobernanza ambiental global (Río-92), mostraron que el territorio amazónico es también un espacio de disputas y resistencias. Reconocer las desigualdades estructurales generadas por este modelo es fundamental para repensar en profundidad el futuro regional, exigiendo el fortalecimiento de los derechos territoriales, el reconocimiento de los conocimientos tradicionales y estrategias para relaciones socioambientales más justas.

Abstract Consumers are increasingly interested in second-hand clothing. This research analyzes how perceived benefits and risks influence the perceived value of second- hand clothing. In addition, we analyze the impact of perceived value on trust and recommendations to wear second-hand clothing. The empirical application uses structural equation modeling on a sample of 310 centennial consumers of second-hand clothing in Chetumal, Mexico. The results show that perceived benefits positively influence the perceived value of second-hand clothing, whereas perceived risks do not affect perceived value. Perceived value positively influences trust, and trust has a positive impact on consumer recommendations to wear second-hand clothing. The main findings suggest that the benefits perceived by consumers are an antecedent of the perceived value of second-hand clothing.

Resumen Los consumidores están cada vez más interesados en adquirir ropa de segunda mano, por ello, esta investigación analiza cómo influyen los beneficios y riesgos percibidos en el valor percibido de la ropa de segunda mano. Además, analizamos el impacto del valor percibido sobre la confianza y la recomendación a que otros usen ropa de segunda mano. La aplicación empírica utiliza modelos de ecuaciones estructurales sobre una muestra de 310 consumidores centennials de ropa de segunda mano en Chetumal, México. Los resultados muestran que los beneficios percibidos influyen positivamente en el valor percibido de la ropa de segunda mano, aunque los riesgos percibidos no afectan al valor percibido. Asimismo, el valor percibido influye positivamente sobre la Confianza, y esta repercute positivamente en la Recomendación del Consumidor a utilizar ropa de segunda mano. El principal hallazgo de esta investigación es que sólo los beneficios percibidos por los consumidores son un antecedente del valor percibido de la ropa de segunda mano.

Abstract Introduction : SARS-CoV-2 can cause mild upper re spiratory tract involvement to pulmonary disease of varying severity, as well as cardiovascular complications with increased mortality. The prevalence is similar in men and women, although there are sex differences in disease characteristics and outcome. In this study, we analyze the clinical characteristics, progression, and in-hospital outcome by sex of patients included in the RACCOVID-19 registry. Materials and methods : We included data from 2750 patients consecutively admitted to 50 centers in 11 provinces of the country, from May 18 to October 31, 2020. Results : A total of 1541 men (60.2%) and 1018 women (39.8%) were included (p<0.001). The prevalence of car diovascular risk factors (because of current smoking) was higher in men. During hospitalization, men had a higher incidence of cardiovascular complications (17.9% vs. 12.5%; p=0.0002) and mortality (20.8% vs. 16.8%; p=0.01). Poor performance status on hospital admission was more common in men (53.9% vs. 42.6%, p<0.0001). On multivariate analysis, male sex, the presence of hypertension and diabetes, and a history of other medical conditions were independent predictors of in-hospital mortality. Discussion : In the RACCOVID-19 registry, men had worse performance status and higher incidence of cardiovascular complications with higher in-hospital mortality. Male sex, hypertension, diabetes, and his tory of other diseases were independent predictors of in-hospital mortality.

Resumen Introducción : SARS-CoV-2 puede causar desde afec ción leve de la vía área superior hasta enfermedad pulmonar con diferentes niveles de gravedad, así como también complicaciones cardiovasculares, con mayor mortalidad. La prevalencia es similar en hombres y mu jeres, aunque existen diferencias en cuanto a las carac terísticas de la enfermedad y su evolución según el sexo. En este trabajo, se analizan las características clí nicas, evolución y pronóstico intrahospitalario de los pacientes incluidos en el registro RACCOVID-19, de acuerdo al sexo. Materiales y métodos : Se incluyen datos de 2750 pacientes ingresados consecutivamente en 50 centros de 11 provincias del país, desde el 18 de mayo hasta el 31 de octubre de 2020. Resultados : Se incluyeron 1541 hombres (60.2%) y 1018 mujeres (39.8%) (p<0.001). Se observó en el sexo masculino una mayor prevalencia de factores de riesgo cardiovascular, en especial el tabaquismo. En la evolución intrahospitalaria, los varones pre sentaron mayor incidencia de complicaciones cardio vasculares (17.9% vs. 12.5%; p=0.0002) así como una mayor mortalidad (20.8% vs. 16.8%; p=0.01). El estado clínico comprometido fue mayor en varones (53.9 vs. 42.6%; p<0.0001). En el análisis multivariado, el sexo masculino, la presencia de hipertensión arterial, diabetes y otros ante cedentes patológicos fueron predictores independientes de mortalidad hospitalaria. Discusión : Los hombres en el RACCOVID-19 pre sentaron peor estado clínico y más complicaciones cardiovasculares con una mayor mortalidad intrahos pitalaria. El sexo masculino, la hipertensión arterial, la diabetes y la presencia de otros antecedentes patoló gicos fueron predictores independientes de mortalidad hospitalaria.

ABSTRACT: Necrotizing fasciitis (NF) is a rare, rapidly progressing, and severe infection of subcutaneous tissues and muscle fascia that can be fatal. It causes rapid tissue necrosis through pathogen-induced vasoconstriction and thrombosis. While commonly found in the torso, abdomen, and limbs, it rarely affects the head and neck. Effective treatment includes early diagnosis, surgery, antibiotics, and hyperbaric oxygen therapy, though mortality remains high. A 40-year-old man with a history of uncontrolled diabetes mellitus (DM) presented with increased volume, erythema, and cramps in the cervical and upper thoracic area. The main diagnosis was NF, requiring surgical debridement of the affected tissue. Despite therapeutic efforts, the patient succumbed to sepsis and multiple organ failure. NF is a life-threatening infection with a very low incidence but a high mortality rate. Cervical NF often arises from odontogenic infections and is associated with systemic factors like diabetes and obesity. Early diagnosis is challenging, but Computed tomography (CT) and the Laboratory risk indicator score for necrotizing fasciitis (LRINEC) score are essential. Effective treatment includes surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy. NF remains a critical condition with high mortality, underscoring the need for early recognition and aggressive treatment strategies to improve patient outcomes.

RESUMEN: La fascitis necrosante (FN) es una infección rara, de rápida progresión y grave de los tejidos subcutáneos y la fascia muscular que puede ser fatal. Causa necrosis tisular rápida a través de la vasoconstricción y trombosis inducidas por patógenos. Aunque se encuentra comúnmente en el torso, abdomen y membros, rara vez afecta la cabeza y el cuello. El tratamiento efectivo incluye un diagnóstico temprano, cirugía, antibióticos y terapia de oxígeno hiperbárico, aunque la mortalidad sigue siendo alta. Un hombre de 40 años con antecedentes de diabetes mellitus (DM) no controlada se presentó con aumento de volumen, eritema y calambres en la zona cervical y torácica superior. El diagnóstico principal fue FN, requiriendo desbridamiento quirúrgico del tejido afectado. A pesar de los esfuerzos terapéuticos, el paciente sucumbió a sepsis y falla multiorgánica. La FN es una infección potencialmente mortal con una incidencia muy baja pero una alta tasa de mortalidad. La FN cervical a menudo surge de infecciones odontogénicas y está asociada con factores sistémicos como la diabetes y la obesidad. El diagnóstico temprano es un desafío, pero la tomografía computarizada (TC) y el puntaje de indicadores de riesgo de laboratorio para fascitis necrosante (LRINEC) son esenciales. El tratamiento efectivo incluye desbridamiento quirúrgico, antibióticos de amplio espectro y terapia de oxígeno hiperbárico. La FN sigue siendo una condición crítica con alta mortalidad, lo que subraya la necesidad de un reconocimiento temprano y estrategias de tratamiento agresivas para mejorar los resultados de los pacientes.

Resumo Introdução: Em Portugal verificou-se um decréscimo do número de interrupções voluntárias da gravidez (IVG) entre 2011 e 2021, com um discreto aumento desde 2022. A percentagem de interrupções realizadas em mulheres com menos de 20 anos tem vindo a diminuir, variando entre 8,3 e 9,1%. Objetivo: Caracterizar as IVG realizadas em adolescentes num hospital distrital português. Desenho de Estudo, População e Métodos: Estudo observacional retrospetivo descritivo que incluiu todas as jovens com idade inferior a 20 anos que realizaram IVG entre 2010 e 2023. Foram analisados aspetos sociodemográficos, antecedentes obstétricos, contraceção, características da IVG e orientação subsequente. Resultados: Durante o período de estudo foram realizadas 712 IVG em 669 adolescentes, observando-se uma tendência decrescente entre 2010 e 2021, seguida por um aumento nos dois últimos anos. A idade mínima foi de 13 anos (mediana 18 anos), e 88,9% das adolescentes eram solteiras. 85,9% eram portuguesas e, das estrangeiras, 61,7% eram naturais de Países Africanos de Língua Oficial Portuguesa (PALOP). A maioria (68,3%) eram estudantes e, das trabalhadoras, 49,1% estavam desempregadas. Cerca de metade (47,5%) não usava contraceção e o principal método, quando utilizado, foi o preservativo (29,2%). Adicionalmente, 10,1% tinha realizado pelo menos uma IVG previamente e 8% tinha pelo menos um filho. Em 56,6% dos casos houve encaminhamento para consulta de planeamento familiar ao nível dos Cuidados de Saúde Primários e os principais métodos contracetivos escolhidos após a IVG foram os hormonais (95,2%), sendo os métodos de longa duração preferidos em 44,8% dos casos. Conclusão: A recente tendência crescente de IVG na adolescência, período de particular vulnerabilidade, exige intervenção. É essencial a otimização de estratégias educativas, de sensibilização e promoção da acessibilidade a métodos contracetivos mais eficazes, nomeadamente métodos de longa duração, bem como o reforço do encaminhamento e seguimento destas jovens.

Abstract Introduction: In Portugal, there was a decrease in the number of induced abortion (IA) between 2011 and 2021, with a slight increase since 2022. The percentage of abortion by women request performed in women under 20 years old has been decreasing, ranging between 8.3% and 9.1%. Aim: To characterize the IA performed in adolescents in a Portuguese district hospital. Study Design, Population and Methods: Retrospective descriptive observational study that included all young women under the age of 20 who underwent IA between 2010 and 2023. Sociodemographic aspects, obstetric and contraceptive history, characteristics of the abortions, and subsequent counseling were analyzed. Results: During the study period, 712 IA were performed on 669 adolescents, with a decreasing trend observed between 2010 and 2021, followed by an increase in the last two years. The minimum age was 13 years (median age 18 years) and 88.9% of the adolescents were single. 85.9% were Portuguese and, among the foreigners, 61.7% were from Portuguese-speaking African countries. The majority (68.3%) were students and, among those who worked, 49.1% were unemployed. Roughly half (47.5%) did not use contraception, and the main method, when used, was the condom (29.2%). Additionally, 10.1% had previously undergone at least one IA and 8% had at least one child. In 56.6% of the cases, there was a referral to a family planning appointment at primary health care, and the main contraceptive methods chosen after abortion were hormonal (95.2%), with long-acting methods preferred in 44.8% of cases. Conclusions: The recent increasing trend of IA in adolescence, a period of particular vulnerability, should prompt intervention. It is crucial to optimize strategies that involve education, awareness, and promotion of accessibility to more effective contraceptive methods, particularly long-acting methods, as well as to reinforce referrals and ensure follow-up of these young women.

Abstract Cardiovascular diseases are increasing every day in the world population and are the first cause of death. The current situation shows that failures occur in the community after medical discharge that do not promote a quick and sustainable recovery of these patients. The article presented aims to socialize a theoretical conception of physical-therapeutic orientation for Chronic Ischemic Heart Patients in Phase III, in which the analytical-synthetic theoretical methods have been used to deepen the theoretical foundations, inductive-deductive to know in its essence the studied process and deduce its most specific particularities, the historical-logical to look for the background of how this problem has been addressed previously and the systemic-structural-functional due to the system character that was given to the conception. Among the empirical methods and techniques used were document analysis, which allowed the study of instruments involved in the process, observation and interviews that made it possible to approach the process in practice, and the criteria of specialists that allowed the assessment of the feasibility and importance of the theoretical concept provided. In addition, mathematical-statistical methods were used, fundamentally in the diagnosis carried out prior to the creation of the theoretical concept of physical-therapeutic orientation for Chronic Ischemic Heart Patients in Phase III. This theoretical concept contributes to the reintegration of these patients into work and all social activities, with a healthy lifestyle and responsible behavior. In this way, it is possible to reduce mortality and morbidity due to this cause.

Resumen Las enfermedades cardiovasculares se incrementan cada día en la población mundial y constituyen la primera causa de muerte. La situación actual evidencia que ocurren fallas en la comunidad después del alta médica que no propician una recuperación rápida y sostenible de esos enfermos. El artículo que se presenta tiene como objetivo socializar una concepción teórica de orientación físico-terapéutica para Cardiópatas Isquémicos Crónicos en la Fase III, en el que han sido utilizados como métodos teóricos el analítico-sintético para profundizar en los fundamentos teóricos, inductivo-deductivo para conocer en su esencia el proceso estudiado y deducir sus particularidades más específicas, el histórico-lógico para buscar los antecedentes de cómo ha sido abordada esta problemática anteriormente y el sistémico-estructural-funcional por el carácter de sistema que se otorgó a la concepción. Entre los métodos y técnicas empíricas se emplearon el análisis de documentos, que permitió el estudio de instrumentos implicados en el proceso, la observación y entrevista que hicieron posible acercarse al proceso en la práctica y el criterio de especialistas que permitió valorar la factibilidad e importancia de la concepción teórica aportada. Además, se utilizaron métodos matemático-estadísticos, fundamentalmente en el diagnóstico realizado previo a la creación de la concepción teórica de orientación físico-terapéutica para Cardiópatas Isquémicos Crónicos en la Fase III. Esta concepción teórica contribuye a la reinserción de estos pacientes al trabajo y a todas las actividades sociales, con un estilo de vida saludable y una conducta responsable. Así es posible reducir la mortalidad y la morbilidad por esta causa.

Resumo As doenças cardiovasculares estão aumentando a cada dia na população mundial e são a principal causa de morte. A situação atual mostra que ocorrem falhas na comunidade após a alta médica que não favorecem uma recuperação rápida e sustentável desses pacientes. O objetivo deste artigo é socializar uma concepção teórica de orientação físico-terapêutica para Cardiopatas Isquêmicos Crônicos em Fase III, na qual os métodos teóricos analítico-sintéticos foram utilizados para aprofundar os fundamentos teóricos, indutivo-dedutivo para compreender a essência do processo estudado e deduzir suas particularidades mais específicas, histórico-lógico para buscar os antecedentes de como esse problema foi abordado anteriormente e sistêmico-estrutural-funcional devido ao caráter sistêmico dado à concepção. Entre os métodos e técnicas empíricos utilizados estão a análise de documentos, que permitiu o estudo dos instrumentos envolvidos no processo, a observação e as entrevistas, que possibilitaram a abordagem do processo na prática, e os critérios de especialistas, que permitiram avaliar a viabilidade e a importância da concepção teórica apresentada. Além disso, foram utilizados métodos matemático-estatísticos, fundamentalmente no diagnóstico realizado antes da criação da concepção teórica de orientação físico-terapêutica para Cardiopatas Isquêmicos Crônicos na Fase III. Essa concepção teórica contribui para a reintegração desses pacientes ao trabalho e a todas as atividades sociais com um estilo de vida saudável e um comportamento responsável. Dessa forma, é possível reduzir a mortalidade e a morbidade por essa causa.

Antecedentes: La educación en bioética es esencial para desarrollar competencias éticas en profesionales de la salud. Sin embargo, existe evidencia limitada sobre su implementación en programas de ciencias de la salud, particularmente en países en desarrollo. Objetivo: Evaluar la integración de la educación en bioética en programas de ciencias de la salud mediante el examen de los niveles de formación docente y la implementación curricular en una universidad privada de Paraguay. Métodos: Este estudio transversal analizó registros académicos de 105 docentes (tasa de respuesta del 34.7 %) y planes de estudio de siete programas de pregrado en ciencias de la salud durante 2020–2021. La recolección de datos incluyó demografía docente, formación en bioética, contenido curricular, metodologías de enseñanza y estrategias de evaluación. El análisis cuantitativo empleó estadística descriptiva y pruebas de chi-cuadrado, mientras que el análisis cualitativo examinó documentos curriculares. Resultados: Solo el 2 % de los docentes tenía calificaciones formales en bioética, mientras que el 24 % reportó formación no formal. El programa de Enfermería mostró tasas significativamente más altas de docentes con formación en bioética (71 %) en comparación con otros programas (0–22 %, P=0.03). Todos los programas, excepto Psicología, incluyeron principios éticos en sus declaraciones de misión, pero la implementación se limitó a cursos únicos obligatorios (34–85 horas) con métodos de enseñanza tradicionales basados en clases magistrales. Se encontraron variaciones significativas en el momento de la educación en bioética entre programas, desde el segundo hasta el décimo semestre. Conclusiones: Los hallazgos revelan brechas sustanciales entre las aspiraciones institucionales y la implementación real de la educación en bioética, caracterizada por una limitada formación docente y una integración curricular fragmentada. Los resultados sugieren la necesidad de mejorar el desarrollo docente, revisar el plan de estudios e implementar estrategias de enseñanza innovadoras para fortalecer la educación en bioética en los programas de ciencias de la salud.

Background: Bioethics education is essential for developing ethical competencies in healthcare professionals. However, limited evidence exists regarding its implementation in health sciences programs, particularly in developing countries. Objective: To assess the integration of bioethics education in health sciences programs by examining faculty training levels and curricular implementation at a private university in Paraguay. Methods: This cross-sectional study analyzed academic records from 105 faculty members (34.7% response rate) and curricula from seven undergraduate health sciences programs during 2020-2021. Data collection included faculty demographics, bioethics training, curricular content, teaching methodologies, and assessment strategies. Quantitative analysis employed descriptive statistics and chi-square tests, while qualitative analysis examined curricular documents. Results: Only 2% of faculty held formal bioethics qualifications, while 24% reported non-formal training. The Nursing program showed significantly higher rates of faculty with bioethics training (71%) compared to other programs (0-22%, P=0.03). All programs, except Psychology, included ethical principles in their mission statements, but implementation was limited to single mandatory courses (34–85 hours) with traditional lecture-based teaching methods. Significant variations were found in the timing of bioethics education across programs, ranging from second to tenth semester. Conclusions: Findings reveal substantial gaps between institutional aspirations and actual implementation of bioethics education, characterized by limited faculty training and fragmented curricular integration. Results suggest the need for enhanced faculty development, curriculum revision, and innovative teaching strategies to strengthen bioethics education in health sciences programs.

Abstract: This study presents the results of the redesign of the diploma program for elementary school teachers in Panama, with the purpose of providing solid professional training to teach mathematical content in a way that is relevant to the teacher's job context. The teaching of mathematical content at the preschool and elementary level is crucial since it fosters creativity and critical thinking among students. In this 2018-2022 study, a virtual diploma course is offered to 277 teachers with diverse educational backgrounds and work experiences. The results show that the implementation of appropriate pedagogical strategies facilitates the transfer of mathematical knowledge in the classroom while strengthening teacher didactic knowledge, allowing teachers to significantly improve their educational practice. In conclusion, this approach is an effective tool for enhancing the teaching of mathematics since it promotes meaningful and lasting learning in students.

Resumen: Este estudio presenta los resultados del rediseño del programa de diplomado dirigido a maestros de primaria en Panamá, con el propósito de proporcionar una formación profesional sólida que permita enseñar contenidos matemáticos de manera relevante para el contexto laboral del docente. La enseñanza de los contenidos matemáticos en el nivel preescolar y primaria es crucial, ya que fomenta la creatividad y el pensamiento crítico en los estudiantes. En este estudio 2018-2022, se ofrece un diplomado virtual a 277 docentes con diversos antecedentes educativos y experiencias laborales. Los resultados muestran que la implementación de estrategias pedagógicas adecuadas facilita la transferencia de conocimientos matemáticos en el aula y fortalece el conocimiento didáctico de los maestros, lo que les permite mejorar significativamente su práctica educativa. En conclusión, este enfoque es una herramienta efectiva para potenciar la enseñanza de las matemáticas, ya que promueve un aprendizaje más significativo y duradero en los estudiantes.

Resumo Introdução: A hipertensão é uma condição que pode ter várias entidades diagnósticas como causa secundária. O seu estudo é fundamental dada a possibilidade de algumas destas causas, apesar de raras, serem potencialmente fatais, com impacto no indivíduo e na família. Descrição do caso: Utente do sexo feminino, 26 anos de idade, sem antecedentes patológicos de relevo, recorreu a consulta na sua Unidade de Saúde Familiar (USF) por cefaleia e pressão arterial elevada. Na sequência do estudo de causas secundárias foi detetada uma massa na glândula suprarrenal, que veio a revelar tratar-se de carcinoma adrenocortical produtor de cortisol e androgénios, localmente avançado, e com metastização hepática. A utente foi proposta para quimioterapia paliativa, que não chegou a realizar. Foi acompanhada no Centro Hospitalar do Porto e simultaneamente no centro de saúde até ao seu falecimento. Comentário: Este caso clínico pretende ilustrar uma causa rara de hipertensão secundária diagnosticada nos cuidados de saúde primários e alertar para a importância do médico de família na sua correta identificação e orientação.

Abstract Introduction: Hypertension is a multifaceted condition, often attributed to several secondary causes. Understanding these causes is crucial due to the potential lethality of some conditions, although rare, that affect both the individual and their family. Case description: A 26-year-old female patient, without any significant past medical history, presented at her Family Health Unit (FHU) with a headache and high blood pressure. Following the study of secondary causes, a mass was detected in the adrenal gland, which turned out to be an adrenocortical carcinoma producing cortisol and androgens, locally advanced, and with liver metastasis. The patient was proposed for palliative chemotherapy, which she did not complete. She was monitored at the Porto Hospital Center and simultaneously with the family doctor until her death. Comment: This clinical case aims to illustrate a rare cause of secondary hypertension diagnosed in primary health care and emphasizes the importance of the family doctor in its correct identification and guidance.

Resumo Introdução: A galactorreia é um sintoma raro na infância. O diagnóstico diferencial é vasto e é necessária uma investigação cuidada, através de uma história clínica detalhada e um exame objetivo adequado. Descrição do caso: Criança de quatro anos do sexo masculino, com antecedentes de perturbação do comportamento e impulsividade (PCI), medicado com risperidona 0,20 mg/dia há quatro meses. Foi observado em consulta de doença aguda na sua Unidade de Saúde Familiar (USF) por apresentar corrimento mamilar bilateral esbranquiçado com cerca de uma semana de evolução, sem outra sintomatologia associada. Ao exame objetivo observou-se galactorreia bilateral, sem outras alterações. Solicitou-se estudo analítico (EA) que revelou aumento da prolactina e função tiroideia normal. Optou-se pela suspensão da terapêutica, repetição posterior do EA e referenciação para consulta de endocrinologia pediátrica (EP). Após duas semanas da suspensão do fármaco ficou assintomático e manteve-se em vigilância na USF. Em consulta de EP repetiu estudo analítico, que evidenciou valores normais de prolactina. Por manutenção da PCI iniciou paliperidona 3 mg/dia, mas quatro meses depois apresentou novamente galactorreia bilateral. Optou-se pelo incentivo à psicoeducação e suspensão da paliperidona. Comentário: Os autores pretendem alertar que os fármacos antipsicóticos são uma das principais causas de galactorreia, incluindo em idade pediátrica. Apesar da existência de outros diagnósticos diferenciais com maior gravidade, a suspensão de fármacos predisponentes a alterações hormonais pode ser uma prova terapêutica válida, evitando numa primeira fase exames de imagem desnecessários.

Abstract Introduction: Galactorrhea is a rare symptom in childhood. The differential diagnosis is extensive, and further investigation is necessary, aided by a detailed anamnesis and physical examination. Case description: A 4-year-old boy with a history of impulsive behavior had been taking risperidone 0.20 mg/day for four months. He was observed at his primary health care facility (PHCF) due to a bilateral whitish nipple discharge within one week of evolution. No other symptoms were reported. On physical examination, bilateral galactorrhea was observed. The remaining physical examination was normal. A blood test revealed normal thyroid hormone levels but an increased serum prolactin. Risperidone was discontinued, additional blood tests were scheduled, and the patient was referred to a pediatric endocrinology (PE) consultation. He became asymptomatic after two weeks of discontinuing risperidone. He maintained reassessment appointments at his PHCF. At PE consultation, he repeated blood tests which revealed normalized prolactin levels. For the management of persistent impulsive behavior, paliperidone was initiated at a dosage of 3 mg/day. However, after four months, bilateral galactorrhea recurred. Paliperidone was also discontinued and psychoeducation measures were emphasized. Comment: The authors aim to emphasize that antipsychotic drugs are among the main causes of galactorrhea, even in children. Despite the serious differential diagnosis of galactorrhea, suspending imbalance-predisposing hormonal drugs can be a valid therapeutic test, avoiding unnecessary imaging exams in the initial phase of the investigation.

RESUMEN El cáncer pulmonar es la principal causa de muerte por cáncer en el mundo y en Chile, especialmente en mujeres jóvenes debido al aumento del consumo de tabaco. En Chile, la incidencia y mortalidad por esta enfermedad han aumentado en los últimos años. La mayoría de los casos se diagnostican en etapas avanzadas, limitando las opciones de tratamiento a paliativas. Objetivo: Se realizó un estudio para caracterizar a los pacientes adultos con cáncer pulmonar confirmado histológicamente en el Hospital Regional de Temuco entre octubre de 2019 y junio de 2023, y analizar factores como tabaquismo, exposición a biomasa, síntomas al diagnóstico, y mutaciones moleculares. Material y Métodos: Se realizó un estudio transversal de pacientes adultos con cáncer pulmonar confirmado histológicamente en el Hospital Regional de Temuco entre octubre de 2019 y junio de 2023. Se recolectaron datos sobre características biosociodemográficas, antecedentes médicos, tabaquismo, exposición a biomasa, síntomas al diagnóstico, performance status, tipo de biopsia, resultados anatomopatológicos y estudios moleculares de mutaciones. Resultados: De 256 pacientes diagnosticados con cáncer pulmonar, 220 cumplieron los criterios de inclusión de confirmación histológica. El 55,3% eran hombres con una media de edad de 68±9,5 años. El 67,7% tenía antecedentes de tabaquismo y el 30,1% estuvo expuesto a biomasa. El 98,6% presentó síntomas al diagnóstico, siendo la tos el más frecuente. La mayoría (81,9%) estaba en etapas avanzadas (III-IV). El 63,9% de los diagnósticos fueron adenocarcinomas, con mutaciones EGFR en el 13,6% y ALK en el 2,1%. La expresión PDL-1 se encontró en el 18,8% de los casos. Se encontraron asociaciones significativas entre las mutaciones EGFR y ALK predominantes en pacientes no fumadores, y entre la expresión PDL-1 con la exposición a biomasa. Conclusiones: El cáncer pulmonar afecta principalmente a hombres con una edad media de diagnóstico similar a la reportada en otras series. El tabaquismo sigue siendo el principal factor de riesgo. La exposición a biomasa también contribuye al riesgo en la región. La mayoría de los pacientes estaban en etapas avanzadas al momento del diagnóstico. El adenocarcinoma fue el tipo más frecuente, con mutaciones EGFR y ALK encontradas en porcentajes menores que en otras series nacionales. La expresión PDL-1 mostró una asociación significativa con la exposición a biomasa y etapas avanzadas de la enfermedad.

ABSTRACT Lung cancer is the leading cause of cancer-related death worldwide and in Chile, especially among young women due to increased tobacco consumption. In Chile, the incidence and mortality of this disease have risen in recent years. Most cases are diagnosed at advanced stages, limiting treatment options to palliative care. Aim: characterize adult patients with histologically confirmed lung cancer at the Regional Hospital of Temuco between October 2019 and June 2023, and to analyze factors such as smoking, biomass exposure, symptoms at diagnosis, and molecular mutations. Material and Methods: A cross-sectional study was conducted on adult patients with histologically confirmed lung cancer at the Regional Hospital of Temuco between October 2019 and June 2023. Data was collected on biosociodemo-graphic characteristics, medical history, smoking, biomass exposure, symptoms at diagnosis, performance status, biopsy type, pathological results, and molecular mutation studies. Results: Out of 256 patients diagnosed with lung cancer, 220 met the inclusion criteria for histo-logical confirmation. 55.3% were male, with a mean age of 68 ± 9.5 years. 67.7% had a history of smoking, and 30.1% were exposed to biomass. 98.6% presented symptoms at diagnosis, with cough being the most common. The majority (81.9%) were diagnosed at advanced stages (III-IV). 63.9% of diagnoses were adenocarcinomas, with EGFR mutations found in 13.6% and ALK mutations in 2.1%. PDL-1 expression was detected in 18.8% of cases. Significant associations were found between EGFR and ALK mutations, which were more predominant in non-smokers, and between PDL-1 expression and biomass exposure. Conclusions: Lung cancer primarily affects men, with a mean age at diagnosis similar to that reported in other studies. Smoking remains the main risk factor, while biomass exposure also contributes to risk in the region. Most patients were diagnosed at advanced stages of the disease. Adenocarcinoma was the most frequent subtype, with EGFR and ALK mutations found at lower rates than in other national studies. PDL-1 expression showed a significant association with bio-mass exposure and advanced stages of the disease.

Resumen Paciente sexo masculino de 64 años, con antecedentes de hipertensión arterial y dislipemia en tratamiento, consulta por dermatosis asintomática en escroto de aproximadamente 30 años de evolución. Al examen físico se observan lesiones tumorales blanco-amarillentas, sólidas, de consistencia dura, sin adherencia a planos profundos, de tamaño variado, sin adenopatías asociadas, localizadas en escroto. Se solicita laboratorio de rutina, sin particularidades, con resultados normales de paratohormona,calcemia, fosfatemia y vitamina D. Se solicita radiografía de tórax, que informa ausencia de imágenes patológicas,y serealiza toma de biopsiapara anatomía patológica,compatible con calcinosis de escroto. Se propone tratamiento quirúrgico, al cual el paciente se niega. Interés del caso: Surge al tratarse de una patología poco frecuente, y por lo tanto con escasa bibliografía al respecto, además de la importancia de la posible comorbilidad que puede acompañarla.

Abstract A 64-year-old male patient, with a history of high blood pressure and dyslipidemia under treatment, presents an asymptomatic dermatosis in the scrotum of approximately 30 years of evolution. On physical examination, white-yellowish tumors of different sizes were observed at the scrotum. These lesions or tumors were solid and seemed to be superficial. No lymphadenopathy was found. A routine laboratory was requested without any particularities, with normal results of parathormone, calcium, phosphatemia and vitamin D. A chest x-ray was also requested, which showed no abnormalities. Finally, a biopsy was performed with pathological results compatible with scrotal calcinosis. Surgical treatment was proposed, which the patient refuses. Case interest: infrequent pathology, scarcebibliography, important the search for associated diseases.

RESUMEN El objetivo consiste en describir las características clínicas y epidemiológicas del síndrome de Guillain-Barré (SGB) durante el brote de 2019 en pacientes de un hospital de Chiclayo, Lambayeque, Perú. Se trata de un estudio descriptivo y retrospectivo basado en 36 casos. Los datos se recolectaron mediante análisis documental de fichas de investigación clínico-epidemiológica de vigilancia del SGB proporcionadas por el Ministerio de Salud. La muestra se caracterizó por una mediana de edad de 46,05 años, un predominio del sexo masculino (69,40 %) y una mayor procedencia de la zona de Lambayeque (66,70 %). Asimismo, el 19,40 % de pacientes padecieron enfermedades crónicas, y los antecedentes más frecuentes fueron infecciones respiratorias (45,50 %) y gastrointestinales (36,40 %). La presentación clínica se caracterizó por debilidad (97,20 %), parálisis ascendente (72,20 %), paresia del nervio facial izquierdo (8,30 %), hiporreflexia (91,70 %) y disminución del tono muscular (47,20 %). En conclusión, el sexo masculino, la edad entre 30 y 59 años y los antecedentes de infección gastrointestinal y respiratoria fueron las características epidemiológicas predominantes del SGB en este brote; mientras que la debilidad, la parálisis ascendente, el dolor y la hiporreflexia predominaron entre las características clínicas. Se sugiere la vigilancia activa y el fortalecimiento de capacidades preventivas y de atención de esta enfermedad.

ABSTRACT The objective is to describe the clinical and epidemiological characteristics of Guillain-Barré syndrome (GBS) during the 2019 outbreak in patients treated in a hospital in Chiclayo, Lambayeque, Peru. This is a descriptive and retrospective study conducted on 36 cases. Data were collected through a documentary analysis of clinical-epidemiological surveillance research forms for GBS, provided by the Ministry of Health. The sample was characterized by a median age of 46.05 years, a predominance of male sex (69.40 %) and an origin from Lambayeque (66.70 %). Additionally, 19.40 % of patients had chronic diseases, and the most frequent conditions found in their medical history were respiratory infections (45.50 %) and gastrointestinal infections (36.40 %). The clinical presentation was characterized by weakness (97.20 %), ascending paralysis (72.20 %), paresis of the left facial nerve (8.30 %), hyporeflexia (91.70 %) and decreased muscle tone (47.20 %). We conclude that male sex, an age between 30 and 59 years and a history of gastrointestinal and respiratory infections were the predominant epidemiological characteristics of GBS in this outbreak; while weakness, ascending paralysis, pain and hyporeflexia were among the most common clinical characteristics. Active surveillance and the strengthening of preventive and care capacities for this disease are recommended.

RESUMEN La insuficiencia suprarrenal secundaria, aunque poco común, representa una complicación seria en pacientes que reciben tratamiento con inhibidores de mTOR, como el everolimus. Este medicamento se utiliza comúnmente en la prevención del rechazo en trasplantes de órganos y en el tratamiento de ciertos tipos de cáncer, pero su impacto en la función suprarrenal no siempre es evidente. En el caso presentado, un hombre de 74 años con antecedentes de trasplante hepático y diabetes mellitus tipo 2 asistió a su control médico rutinario sin manifestar síntomas relacionados con la insuficiencia suprarrenal. A pesar de su estado asintomático, el equipo médico decidió investigar la función suprarrenal, dada la duración del tratamiento con everolimus. Las pruebas diagnósticas incluyeron la medición de cortisol en orina de 24 horas, la cual reveló niveles bajos, confirmando así la insuficiencia suprarrenal. Este hallazgo es significativo, ya que la insuficiencia suprarrenal puede llevar a crisis adrenal que, si no se maneja adecuadamente, puede ser potencialmente mortal. Este caso destaca la importancia de la vigilancia endocrina en pacientes inmunosuprimidos, donde la ausencia de síntomas no debe llevar a la complacencia. Un enfoque proactivo para evaluar la función suprarrenal es esencial para identificar complicaciones antes de que se conviertan en emergencias. La detección temprana y el tratamiento adecuado de la insuficiencia suprarrenal pueden mejorar significativamente los resultados clínicos y la calidad de vida de estos pacientes. Por lo tanto, se recomienda que los médicos estén alertas a los riesgos asociados con el uso de inhibidores de mTOR y realicen una evaluación regular de la función adrenal en este grupo de pacientes.

ABSTRACT Although rare, secondary adrenal insufficiency represents a serious complication in patients receiving treatment with mTOR inhibitors, such as everolimus. This drug is commonly used to prevent organ transplant rejection and to treat certain cancer types, but its impact on adrenal function is not always apparent. In the case presented, a 74-year-old man with a history of liver transplant and type 2 diabetes mellitus attended his routine medical check-up with no symptoms related to adrenal insufficiency. Despite his asymptomatic state, the medical team decided to study adrenal function because of the prolonged duration of everolimus treatment. The diagnostic tests included the measurement of 24-hour urine cortisol, which revealed low cortisol levels, thus confirming adrenal insufficiency. This finding is significant, as adrenal insufficiency can result in adrenal crises that, if not properly managed, can be potentially fatal. This case highlights the importance of endocrine surveillance in immunosuppressed patients, where the absence of symptoms should not lead to complacency. A proactive approach to evaluating adrenal function is crucial for identifying complications before they become emergencies. Early detection and appropriate treatment of adrenal insufficiency can significantly improve clinical outcomes and the quality of life for these patients. Therefore, it is recommended that physicians remain vigilant to the risks associated with the use of mTOR inhibitors and conduct regular adrenal function evaluations in this patient group.