ABSTRACT The ethical complexity in sports practice has diverse perspectives that generate dilemmas when applying universal principles, in a competitive environment in constant evolution and with technological, social and cultural advances necessary, to establish a coherent and applicable ethical framework in the field of sports. The objective of this research was to analyze the ethical-sports perspectives and approaches present in bioethics applied to sports practice, in order to understand the emerging ethical dilemmas and current trends in this field. The research was theoretical, through a documentary review, in which the steps of searching and selecting scientific articles were followed; validated information was extracted from academic databases, the findings were systematically organized and finally a narrative synthesis was carried out. The diversity of ethical-sports approaches highlights the constant need to balance competitiveness with fundamental values, of how sport faces dilemmas that require a balance between the pursuit of sporting excellence and respect for integrity, equity and diversity; which challenges all actors to promote a more inclusive sports environment. It was concluded that sport evaluates multiple dimensions, including deontological ethics, equity for athletes and virtue; the importance of regulations to protect integrity, promote an ethical environment and address challenges in emerging sports competition and technology was highlighted.

RESUMEN La complejidad ética en la práctica deportiva tiene diversas perspectivas que generan dilemas al aplicar principios universales, en un entorno competitivo en constante evolución y con avances tecnológicos, sociales y culturales necesarios, para establecer un marco ético coherente y aplicable en el ámbito del deporte. El objetivo de esta investigación consistió en analizar las perspectivas y enfoques éticos-deportivos presentes en la bioética aplicada a la práctica deportiva, con el fin de comprender los dilemas éticos emergentes y las tendencias actuales en este campo. La investigación fue de tipo teórica, a través de una revisión documental, en la que se siguieron los pasos de búsqueda y selección de artículos científicos; se extrajo información validada de bases de datos académicos, se organizaron sistemáticamente los hallazgos y finalmente se realizó una síntesis narrativa. La diversidad de enfoques ético-deportivos subraya la necesidad constante de equilibrar la competitividad con los valores fundamentales, de cómo el deporte enfrenta dilemas que requieren un equilibrio entre la búsqueda de la excelencia deportiva y el respeto por la integridad, equidad y diversidad; lo que desafía, a todos los actores, a promover un entorno deportivo más inclusivo. Se concluyó que el deporte evalúa múltiples dimensiones, incluidos la ética deontológica, la equidad para atletas y la virtud; se destacó la importancia de normativas para proteger la integridad, promover un ambiente ético y abordar los desafíos, en la competencia y tecnología deportivas emergentes.

RESUMO A complexidade ética na prática do esporte tem diversas perspectivas que geram dilemas ao aplicar princípios universais, em um ambiente competitivo em constante evolução e com os avanços tecnológicos, sociais e culturais necessários para estabelecer uma estrutura ética coerente e aplicável no campo do esporte. O objetivo desta pesquisa foi analisar as perspectivas e abordagens ético-esportivas presentes na bioética aplicada ao esporte, a fim de compreender os dilemas éticos emergentes e as tendências atuais nesse campo. A pesquisa foi de natureza teórica, por meio de uma revisão documental, na qual foram seguidas as etapas de busca e seleção de artigos científicos; informações validadas foram extraídas de bancos de dados acadêmicos, as descobertas foram sistematicamente organizadas e, por fim, foi realizada uma síntese narrativa. A diversidade de abordagens éticas no esporte destaca a necessidade constante de equilibrar a competitividade com os valores fundamentais, como o esporte enfrenta dilemas que exigem um equilíbrio entre a busca da excelência esportiva e o respeito à integridade, equidade e diversidade, e desafia todos os atores a promover um ambiente esportivo mais inclusivo. Concluiu-se que o esporte avalia várias dimensões, inclusive a ética deontológica, a equidade para os atletas e a virtude; destacou-se a importância das regulamentações para proteger a integridade, promover um ambiente ético e enfrentar os desafios das competições e tecnologias esportivas emergentes.

Resumen OBJETIVO: Determinar la relación entre el nivel de conocimiento y la adhesión al régimen prescrito de sulfato ferroso y ácido fólico para prevenir o tratar la anemia gestacional en pacientes atendidas en un hospital público del Perú. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, de serie de casos, transversal y prospectivo llevado a cabo entre febrero y abril de 2022 en pacientes en el puerperio inmediato con diagnóstico de anemia gestacional establecido dos meses antes del término del embarazo. Se evaluaron los conocimientos mediante un cuestionario y la adhesión mediante la prueba de Morisky-Green-Levine, ambos instrumentos validados y fiables. El análisis estadístico se procesó en el programa STATA; se utilizaron χ2 de Pearson y el modelo lineal generalizado de la familia de Poisson con varianza robusta y nivel de confianza del 95%. RESULTADOS: Se estudiaron 217 pacientes; 2 de cada 10 tenían diagnóstico de anemia gestacional y cumplían el tratamiento. En conjunto, el 71.89% de las participantes tenía un conocimiento adecuado de la importancia del tratamiento con sulfato ferroso y ácido fólico, y el 23.96% alcanzó un nivel intermedio. La relación entre el nivel de conocimientos y el apego se aproximó a la significación estadística (p = 0.05 RPa:1.63; IC95%: 0.99-2.71), establecida mediante análisis ajustado. El conocimiento de la importancia del tratamiento antianémico para la madre multiplicó por tres la prevalencia de la adherencia (p = 0.04; RPa: 3.17; IC95%: 1.04-9.72). CONCLUSIÓN: El conocimiento por parte de las madres de la importancia del tratamiento antianémico aumentó significativamente la adherencia.

Abstract OBJECTIVE: To determine the relationship between the level of knowledge and adherence to the prescribed regimen of ferrous sulfate and folic acid to prevent or treat gestational anemia in patients attended in a public hospital in Peru. MATERIALS AND METHODS: Observational, descriptive, case series, cross-sectional and prospective study carried out between February and April 2022 in patients in the immediate postpartum period with a diagnosis of gestational anemia established two months before the end of pregnancy. Knowledge was assessed by means of a questionnaire and adherence by means of the Morisky-Green-Levine test, both validated and reliable instruments. Statistical analysis was performed with the STATA program; Pearson’s χ2 and the generalized linear model of the Poisson family with robust variance and 95% confidence level were used. RESULTS: A total of 217 patients were studied; 2 out of 10 had a diagnosis of gestational anemia and were compliant with treatment. Overall, 71.89% of the participants had adequate knowledge of the importance of treatment with ferrous sulfate and folic acid, and 23.96% reached an intermediate level. The relationship between the level of knowledge and adherence was close to statistical significance (p = 0.05 RPa:1.63; 95%CI: 0.99-2.71), established by adjusted analysis. Understanding the importance of antianemic treatment for the mother increased the prevalence of adherence threefold (p = 0.04; RPa: 3.17; 95%CI: 1.04-9.72). CONCLUSION: Mothers’ knowledge of the importance of antianemic treatment significantly increased adherence.

Abstract OBJECTIVE: To describe the sociodemographic, clinical and pathological characteristics and results of the patent blue sentinel lymph node technique in early breast cancer surgery. And to report the experience in identifying the sentinel lymph node in early breast cancer using the 2.5% patent blue technique. MATERIALS AND METHODS: Retrospective and analytical study consisting of the evaluation of the clinical records of patients diagnosed with early breast cancer, without clinical or radiological suspicion of axillary involvement, seen between June 2022 and June 2023 at the Oncological Gynaecology Service of the UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente of the IMSS. The dye injection site was subdermal periareolar, and the identified lumps were examined in the transoperative period. The percentage of identification, false negative rates and negative predictive value of the method were analysed. RESULTS: Ninety-five sentinel node biopsies were analysed. Axillary lymphadenectomy was performed only in patients with sentinel lymph node metastasis confirmed at surgery and in those in whom no stained nodes were identified due to non-migration of the dye. The mean age of the patients was 57.1 years range 25 to 78 years. The tumour size was less than 3 cm. Sixty-four patients 67% underwent mastectomy, compared with 31 who underwent breast-conserving surgery 33%. Fifty-seven of the 95 patients were staged as AI; the most common molecular subtype was compatible with luminal A in 49%. CONCLUSIONS: Sentinel lymph node biopsy with patent blue is a rapid, simple, accurate and inexpensive technique for identifying axillary disease in early breast cancer. The results reported here represent an initial evaluation of the technique in our service.

Resumen OBJETIVO: Describir las características sociodemográficas, clínicas y patológicas y los resultados obtenidos con la técnica de ganglio centinela con azul patente en la cirugía de cáncer de mama temprano. Además, reportar la experiencia en la identificación del ganglio centinela en cáncer de mama temprano con la técnica con azul patente al 2.5%. MATERIALES Y MÉTODOS: Estudio retrospectivo y analítico consistente en la evaluación de los expedientes clínicos de pacientes diagnosticadas con cáncer de mama temprano, sin sospecha clínica o radiológica de afectación axilar, atendidas entre junio de 2022 y junio de 2023 en el servicio de Ginecología Oncológica de la UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente del IMSS. El sitio de inyección del colorante fue subdérmico periareolar, los ganglios identificados se estudiaron en el transoperatorio. Se analizaron el porcentaje de identificación, las tasas de falsos negativos y el valor predictivo negativo del método. RESULTADOS: Se analizaron 95 procedimientos de biopsia de ganglio centinela. Solo se practicó la linfadenectomía axilar en las pacientes con metástasis en el ganglio centinela comprobada en el estudio transoperatorio y en las que no se identificaron ganglios teñidos por no migración del colorante. La edad promedio de las pacientes fue de 57.1 años límites 25 y 78 años. El tamaño del tumor fue menor a 3 cm. A 64 67% pacientes se les hizo la mastectomía en comparación con 31 a quienes se efectuó cirugía conservadora de mama 33%. Se estadificaron como IA 57 de las 95 pacientes; el subtipo molecular más frecuente fue compatible con luminal A en 49%. CONCLUSIONES: La biopsia del ganglio centinela, con azul patente, es una técnica rápida, sencilla, precisa y de bajo costo para identificar daño axilar en etapas tempranas del cáncer de mama. Lo aquí reportado son resultados que corresponden a una primera evaluación de la técnica en nuestro servicio.

RESUMEN Introducción: El uso de catéteres venosos centrales para hemodiálisis se relaciona con un mayor desarrollo de complicaciones infecciosas, por lo que las Guías de Práctica Clínica recomiendan diferentes estrategias para disminuir dichas complicaciones, sin indicación clara sobre el apósito a utilizar en la cura del orificio de salida. Objetivos: Comparar la tasa de infecciones relacionadas con el catéter de dos pautas de cura del orificio de salida del catéter venoso central de hemodiálisis: apósito con gluconato de clorhexidina al 2% frente a clorhexidina en solución al 2%, cubierta con apósito de poliuretano semipermeable autoadhesivo. Material y Método: Estudio experimental, controlado, aleatorizado en pacientes en hemodiálisis a través de catéter venoso central para comparar dos pautas de cura, grupo control: clorhexidina en solución al 2% cubierta con apósito de poliuretano semipermeable autoadhesivo y grupo intervención: apósito con gluconato de clorhexidina al 2%. Se recogieron datos socioclínicos y relacionados con las complicaciones infecciosas. Se realizó un análisis descriptivo e inferencial.. Resultados: Se estudiaron 50 pacientes, 25 en cada grupo. El grupo intervención presentó dos infecciones del orificio de salida y el grupo control, presentó doce casos (OR: 0,176, IC 95%: 0,039-0,790; p=0,013). El grupo intervención presentó un caso de bacteriemia frente a dos episodios del grupo control (OR: 0,533, IC 95%: 0,048-5,892; p=ns). Conclusión: La cura con apósito con gluconato de clorhexidina al 2% es una medida protectora frente a la infección del orificio de salida en comparación con la cura con clorhexidina en solución al 2% y apósito de poliuretano.

ABSTRACT Introduction: The use of central venous catheters for hemodialysis is associated with a higher incidence of infectious complications, leading Clinical Practice Guidelines to recommend various strategies to reduce such complications, with no clear indication of the dressing to use for catheter exit site care. Objectives: To compare the infection rate related to the catheter exit site using two different protocols: dressing with 2% chlorhexidine gluconate versus 2% chlorhexidine solution, both covered with self-adhesive semi-permeable polyurethane dressing for central venous catheters used in hemodialysis. Material and Method: An experimental, controlled, randomized study was conducted in hemodialysis patients with central venous catheters to compare two care protocols. The control group received a 2% chlorhexidine solution covered with a self-adhesive semi-permeable polyurethane dressing, while the intervention group received a dressing with 2% chlorhexidine gluconate. Socio-clinical and infection-related data were collected, and descriptive and inferential analyses were performed. Results: A total of 50 patients were studied, with 25 in each group. The intervention group had two exit site infections, while the control group had twelve cases (OR: 0.176, 95% CI: 0.039-0.790; p=0.013). The intervention group had one case of bacteremia compared to two cases in the control group (OR: 0.533, 95% CI: 0.048-5.892; p=ns). Conclusion: Dressing with 2% chlorhexidine gluconate is a protective measure against exit site infection compared to dressing with 2% chlorhexidine solution and polyurethane dressing.

ABSTRACT Dogs are considered to be the main domestic reservoir associated with the transmission of Leishmania (L.) infantum chagasi to humans in endemic areas of visceral leishmaniasis in America. However, little is known about the role of canines as a source of infection in endemic areas of nonulcerated cutaneous leishmaniasis (NUCL). Therefore, the objective of the present study was to investigate the role of dogs as a possible reservoir of the parasite in Southern Honduras. Dogs (n = 107) living with individuals affected by NUCL were clinically examined and biological material was collected for parasitological and immunological diagnosis. Most animals showed a healthy appearance and a few presented slight weight loss (64%), alopecia (7%), onychogryphosis (5%) and skin lesions (1%). The overall seroprevalence of Leishmania infection based on the DDP ® quick test and/or in-house ELISA serological test was 41%. The presence of the parasite’s DNA was confirmed in 94% of the dogs; however, the average parasite load in the buffy coat was low at 6.09 parasites/µL, ranging between 0.221 and 50.2. The skin of seropositive dogs examined by histopathology using paraffin sections stained by hematoxylin and immunohistochemistry did not show cutaneous lesions or parasite amastigotes. Based on the absence of parasites in the skin and the low parasite load detected in the buffy coat, it seems that the dog does not represent a good source of infection for the vector in the endemic area of NUCL transmission in Southern Honduras. Other domestic and/or wild animals should be investigated.

ABSTRACT Purpose To compare the time of food transition and the form of oral feeding at hospital discharge, between premature newborns diagnosed with bronchopulmonary dysplasia and premature newborns without the diagnosis. Methods Cross-sectional, retrospective study based on data collection from medical records. Data were collected from 78 newborns, in a reference maternity hospital, in which the sample was stratified into two groups according to the presence or absence of the diagnosis of bronchopulmonary dysplasia. The time of food transition and the feeding method at hospital discharge were analyzed for both groups. Results There was a significant difference in the time of food transition and in the feeding method at hospital discharge between the groups. Preterm newborns with bronchopulmonary dysplasia had an average of 18.03 (± 5.5) transition days and left using a bottle. Conclusion The group with bronchopulmonary dysplasia required a longer time of food transition and fewer ( of its ) infants had exclusive breastfeeding compared to the group without the diagnosis.

RESUMO Objetivo Comparar o tempo de transição alimentar e a forma de alimentação por via oral na alta hospitalar, entre recém-nascidos prematuros com diagnóstico de displasia broncopulmonar e prematuros sem o diagnóstico. Métodos Estudo transversal, retrospectivo com base na coleta de dados nos prontuários. Foram coletados dados de 78 recém-nascidos, em uma maternidade de referência. A amostra foi estratificada em dois grupos, de acordo com a presença do diagnóstico de displasia broncopulmonar, sendo um grupo de prematuros com displasia broncopulmonar e outro sem. Foram analisados o tempo de transição alimentar e o método de alimentação na alta hospitalar de ambos os grupos. Resultados Houve diferença significativa no tempo de transição alimentar e no método de alimentação na alta hospitalar entre os grupos. Os recém-nascidos pré-termo com displasia broncopulmonar apresentaram média de 18,03 (± 5,5) dias de transição e saíram em uso de mamadeira. Conclusão O grupo com displasia broncopulmonar necessitou de maior tempo de transição alimentar e teve menor frequência de aleitamento materno exclusivo, em relação ao grupo sem o diagnóstico.

Abstract Fifteen polar extracts from leaf, seed, pod, stem, flower and root of Crotalaria spectabilis were prepared using aqueous systems, based on the principles of green chemistry, and showed different protease inhibitor (PI) activities on trypsin, papain, pepsin and the extracellular L. amazonensis serine protease (LSPIII). The most pronounced inhibitory effect on LSPIII was observed in leaf (CS-P), root, stem, flower (CS-FPVPP) and pod (CS-VA) extracts. Crotalaria extracts exhibited low cytotoxicity on macrophages; however, they decreased the viability of L. amazonensis promastigotes and amastigotes, as observed in leaf (CS-AE, CS-P, CS-T and CS-PVPP), seed (CS-ST), flower and root (CS-RA) extracts. CS-P was chosen to study PI and secondary metabolites and a 10-12 kDa protein, analyzed by mass spectrometry, was identified as a serine PI homologous with papaya latex serine PI. Glycosylated flavonoids, such as quercetins, vitexin and tricin were the major secondary metabolites of CS-P. The presence of PIs in C. spectabilis is a new finding, especially in other organs than seeds since PIs have been reported only in seed legumes. Besides, this is the first report of antileishmanial activity of C. spectabilis extracts and the identification of serine polypeptide PI and glycosylated flavonoids from leaf.

Abstract Cognitive impairment and depression are common conditions during aging and may be associated with age, however, several studies indicate that they usually occur together and the coexistence of these two pathologies decrease the quality of life in the elderly. The objective of this study was to analyze the relationship between depression and cognitive impairment in older adults. For which a bibliographic review was carried out through the analysis of research published in journals that are part of the Scopus, ScienceDirect, Elsevier and PubMed database, from 2015 to 2021. The studies reviewed showed that depression and deterioration have both a direct (one intervenes in the other) and an indirect relationship, there are common associated factors such as age, concomitant diseases, psychosocial and biological factors. All this affects the well-being of the elderly and currently it is about mitigating this effect with protection and help programs for the elderly.

Resumen El deterioro cognitivo y la depresión son padecimientos frecuentes durante el envejecimiento y pueden estar asociados a la edad; sin embargo, varios estudios indican que suelen presentarse de manera conjunta y la coexistencia de estas dos patologías disminuyen la calidad de vida en la tercera edad. El objetivo del presente trabajo fue analizar la relación entre depresión y deterioro cognitivo en los adultos mayores, para lo cual se efectuó una revisión bibliográfica mediante el análisis de investigaciones publicadas en revistas que son parte de la base de datos como Scopus, ScienceDirect, Elsevier y PubMed, desde el año 2015 hasta el 2021. Los estudios revisados mostraron que la depresión y el deterioro tienen una relación, tanto directa (una interviene en la otra), como indirecta, y que a su vez, existen factores asociados en común como la edad, enfermedades concomitantes, factores psicosociales y biológicos. Todo esto afecta el bienestar del adulto mayor y en la actualidad se trata de mitigar este efecto con programas de protección y ayuda en la tercera edad.

SUMMARY: The leg muscles are organized in anterior, lateral and posterior compartments. The posterior compartment is usually divided in two layers: superficial and deep. The deep muscles of the posterior compartment of the leg are known to mainly plantar flexion and toes flexion. In comparison to the other leg compartments, variations of the posterior one are rare. These variants often involve the presence or absence of one or more muscles, and they have differences among origin and insertion, which leads to confusion between anatomists. We aim to describe a case of a male cadaver that possessed three supernumerary muscles in the lateral and posterior compartments of both legs: the peroneus quartus muscle and two accessory bellies of the flexor digitorum longus. This presentation seems to be very rare and scarcely reported in the literature. These variants have the potential of causing nervous or vascular compression, thus leading to tarsal tunnel syndrome or a symptomatic peroneus quartus. The clinical and surgical implications of this abnormal presentation is discussed.

RESUMEN: Los músculos de la pierna están organizados en compartimentos anterior, lateral y posterior. El compartimento posterior por lo general es dividido en dos capas: superficial y profunda. Se sabe que los músculos profundos del compartimento posterior de la pierna se caracterizan principalmente por participar de la flexión plantar y la flexión de los dedos de los pies. En comparación con los otros compartimentos de la pierna, las variaciones musculares en el compartimiento posterior son raras. Estas variantes suelen implicar la presencia o ausencia de uno o más músculos y presentan diferencias en el origen y en la inserción, lo que conduce a confusión entre los anatomistas. Nuestro objetivo fue describir el caso de un cadáver masculino que poseía tres músculos supernumerarios en los compartimentos lateral y posterior de ambas piernas: el músculo fibular cuarto y dos vientres accesorios del músculo flexor largo de los dedos. Esta presentación parece ser muy rara y escasamente reportada en la literatura. Estas variantes musculares tienen el potencial de causar compresión nerviosa o vascular, lo que conduce al síndrome del túnel del tarso o un cuarto músculo fibular sintomático. Se discuten las implicaciones clínicas y quirúrgicas de esta presentación anormal.

Abstract Here we sequenced and characterized the complete plastome of Bactris riparia, a species closely related to B. gasipaes and widely distributed in Western Amazonia. We performed a comparative genomic analysis with B. riparia and the other four Bactridinae species retrieved from GenBank. The plastome of B. riparia was 156,715 bp with a quadripartite structure. Gene content included 86 protein-coding genes (CDS), 38 tRNAs, and 8 rRNAs. Bactris riparia has 69 more base pairs than B. gasipaes, with identical numbers in IR, and more in LSC and SSC. The comparative analysis indicated that structure, collinearity, and IR/SSC borders of plastomes within subtribe Bactridinae are, in general, conserved. We predicted 69 SSRs in B. riparia plastome. Among them, ~80% consisted of A/T homopolymers. Among the 52 variable CDS, rbcL showed the highest non-synonymous rate, while the rps15 gene had the highest synonymous rate. Three genes (ccsA, cemA, and rpoC1) presented evidence of positive selection and 22 genes showed evidence of purifying selection. The phylogenetic tree based on plastome sequences set Bactris as more closely related to Astrocaryum than to Acrocomia. These new plastome data of B. riparia will contribute to studies about the diversity, evolutionary history, and conservation of palms.

ABSTRACT Introduction: Difficulties are frequently identified in the organization of bibliographic references by the Vancouver Standards. Objective: To develop the Vancouver Rules-APK application for mobile devices for the organization of bibliographic references. Method: HTML5, CSS3, JavaScript, Java, Visual Studio Code, Android Studio and Adobe Photoshop were used for its construction. Results: This work shows the Vancouver Standards-APK application prototype for mobile devices, its advantages, the electronic address where it can be downloaded, and the user manual to generate and retrieve bibliographic references by filling in the form according to the type of document used. Conclusions: The application contributes to the organization of the bibliographic references by the Vancouver Standards in an easier way for the one who writes it.

RESUMEN Introducción: Frecuentemente se identifican dificultades en la organización de las referencias bibliográficas por las Normas de Vancouver. Objetivo: Desarrollar la aplicación para dispositivos móviles Normas de Vancouver-APK para la organización de las referencias bibliográficas. Método: Se utilizó HTML5, CSS3, JavaScript, Java, Visual Studio Code, Android Studio y adobe Photoshop. Resultados: En este trabajo se muestra el prototipo de aplicación Normas de Vancouver-APK para dispositivos móviles, sus ventajas, la dirección electrónica donde se puede descargar, y el manual de usuario para generar y recuperar las referencias bibliográficas a través del llenado del formulario según el tipo de documento utilizado. Conclusiones: La aplicación contribuye a la organización de las referencias bibliográficas por las Normas de Vancouver de una manera más fácil, limitando la complejidad para el que lo redacta.

Abstract Aging represents a critical life change followed by a loss of functional and neuropsychological abilities, as well as significant processes like coping with death. It is important to study the way older adults deal with the meaning of death and the anxiety it generates. Through a cross-sectional, correlational study the Folstein Mini Mental, Yesavage Scale, Templer's Fear of Death, Collet Lester's Death Anxiety and a supportive social network questionnaire were applied in a non-probabilistic sample of 63 older adults who attend institutional support groups. The results indicate cognitive impairment prevalence of 9.5%, with 17% of women reporting depression. There was an association between continuing to work and fear of death, as well as anxiety about death and having chronic-degenerative disease. Results also suggest a correlation between depression and end of life fear and the process and occurrence of the death of a relative, which is the highest indicators of anxiety. The results are discussed in relation to various aspects of gender, the situation of support from the family and social support network, as well as access to health and social security services.

Resumen El envejecimiento implica un cambio muy importante que va acompañado de pérdida de capacidades funcionales y neuropsicológicas, así como de procesos significativos como el manejo de la muerte. Es importante estudiar la manera en la que los adultos mayores enfrentan el significado de la muerte y la ansiedad generada. Mediante un estudio transversal y de alcance correlacional, se aplicó el mini mental de Folstein, la escala de Yesavage, la de miedo a la muerte de Templer y la de ansiedad a la muerte de Collet Lester, así como un cuestionario de redes sociales de apoyo en una muestra no probabilística de 63 adultos mayores que asisten a grupos de apoyo institucionales. Los resultados indican prevalencia de deterioro cognitivo de 9.5 %; 17 % de mujeres reporta depresión. Hay asociación entre continuar laborando y miedo a la muerte, así entre ansiedad a la muerte y tener enfermedad crónica-degenerativa, asimismo, existe correlación entre depresión y miedo al término de la vida, y al proceso y ocurrencia de la muerte de un familiar, que son los indicadores más altos de ansiedad. Los resultados se discuten con relación a diversos aspectos de género, situación del apoyo de red familiar y red social, así como acceso a los servicios de salud y de seguridad social.

Resumo Introdução: A nevralgia do pudendo define-se como uma dor ao longo do dermátomo do nervo pudendo e pode ocorrer em ambos os sexos. Sendo uma patologia capaz de mimetizar muitas outras condições orgânicas, o seu diagnóstico surge geralmente após meses de sintomatologia. O presente relato de caso pretende enfatizar uma patologia rara, alguns dos seus aspetos clínicos e critérios de diagnóstico, demonstrando um exemplo de como o atraso no diagnóstico pode conduzir a um excessivo gasto de recursos em saúde, bem como a um sofrimento físico e psicológico significativos. Descrição do caso: Utente do sexo feminino, de 73 anos, recorre à consulta aberta da Unidade de Saúde Familiar (USF), em agosto 2016, por queixas de ardência vulvar e desconforto na região suprapúbica com três semanas de evolução. Realizou antibioterapia empírica, sem melhoria da sintomatologia. Por manutenção das queixas recorre a várias consultas de medicina geral e familiar na USF e a várias especialidades em regime público e privado, sendo medicada com vários antibióticos, antifúngicos, corticoides, entre outros. Foram realizados vários exames auxiliares de diagnóstico e levantadas inúmeras hipóteses diagnósticas até que, mais de um ano desde o surgimento dos primeiros sintomas, se chega ao diagnóstico mais provável de nevralgia do pudendo. Apesar do diagnóstico, a doente continuou com a dor mal controlada, tendo mesmo de recorrer às opções de último recurso para o tratamento desta patologia. Comentário: A nevralgia do pudendo é uma patologia cujo diagnóstico se alcança habitualmente após muito tempo do início da sintomatologia do doente, com muito sofrimento físico e psicológico associado. Por este motivo, o relato de caso apresentado pretende sensibilizar o profissional de saúde para este diagnóstico e para a importância do médico de família enquanto elemento integrador dos cuidados do doente.

Abstract Introduction: Pudendal neuralgia is defined as pain along the dermatome of the pudendal nerve and can occur in both sexes. Being a pathology capable of mimicking many other organic conditions, its diagnosis usually appears after months of symptoms. The present case report aims to emphasize a rare pathology, some of its clinical aspects, and diagnostic criteria, demonstrating an example of how the delay in the diagnosis can lead to excessive spending of health resources as well as to significant physical and psychological suffering. Case description: A 73-year-old female patient resorts to a medical appointment in the Family Health Unit in August 2016 for complaints of vulvar burning and discomfort in the suprapubic region with three weeks of evolution. Empirical antibiotic therapy was performed, with no improvement in symptoms. Because of the complaints’ persistence, she resorts to several appointments at the Family Health Unit and various medical specialties in the public and private regime, being medicated with various antibiotics, antifungals, corticosteroids, among others. Several auxiliary diagnostic tests have been carried out and numerous diagnostic hypotheses have been raised until more than a year since the appearance of the first symptoms, the most probable diagnosis of pudendal neuralgia is established. Despite the diagnosis, the patient continued to have poorly controlled pain, having to resort to options of the last resource for the treatment of this pathology. Comments: Pudendal neuralgia is a condition whose diagnosis is usually reached long after the patient's symptoms have started, with a lot of associated physical and psychological suffering. For this reason, the case report presented pretends to sensitize the health professional to this diagnosis and to the importance of the family doctor as an integrating element of the patient's care.

Resumo As vantagens da telemedicina incluem observação, diagnóstico, tratamento e monitorização do utente à distância. Devido à pandemia por COVID-19, o recurso à teleconsulta aumentou, pretendendo evitar deslocações desnecessárias e contágios. Com este trabalho, procurou-se avaliar a evidência existente sobre teleconsulta em outcomes de saúde na população seguida nos Cuidados de Saúde Primários e/ou que os procura para resolução de doença aguda, através de uma pesquisa sistemática nas bases de dados de medicina baseada na evidência de estudos que analisem a teleconsulta nos Cuidados de Saúde Primários. Foram incluídas duas revisões sistemáticas. A primeira demonstrou que as consultas telefónicas são uma opção apropriada em determinadas situações, reduzindo a carga de trabalho na prática clínica. A segunda revelou que as intervenções de telemedicina são eficazes e custo-efetivas. Tendo em consideração o limitado número de estudos sobre o tema e o facto de apresentarem limitações, atribuiu-se uma força de recomendação SORT B.

Abstract The rewards of telemedicine include the possibility of patient observation, diagnosis, treatment and monitoring at a distance. Due to the COVID-19 pandemic, the use of teleconsultation increased, aiming at avoiding unnecessary travelling and disease spreading. This work aimed at evaluating the existing evidence regarding teleconsultation and its health outcomes in the Primary Care population, including in the acute setting, through a systematic research in evidence-based medicine databases of studies evaluating teleconsultation in Primary Care. Two systematic reviews were included. The first one showed that telephonic consultations are an appropriate alternative in some settings, reducing workload in clinical practice. The second one revealed that telemedicine is both an effective and cost-effective intervention. Considering the limited number of studies on this subject and their limitations, a B-level SORT strength of recommendation was attributed.

ABSTRACT The purpose of the study was to describe the design, validation and implementation of a virtual teaching-learning environment as a didactic resource for information literacy training. An applied descriptive technological innovation analysis was conducted at Dr. Antonio Luaces Iraola Provincial General University Hospital in Ciego de Avila. Use was made of the technological support in the Moodle platform. The research developed along three stages: facto-perceptible, development and validation of contributions, and application of contributions). The virtual learning environment was validated by expert criteria and applied to 55 participants. The EVEA-health design fostered self-management and skill-developing learning among student participants. Validation by expert criteria not only made it possible to evaluate the feasibility and scientific-methodological relevance of the virtual teaching-learning environment, but also its enrichment. The high percentage of good and excellent scores showed that participants developed information competencies related to the appropriate management of information sources and the use of scientific data. The study contributes new knowledge about the usefulness of implementing a virtual teaching-learning environment as a didactic resource for information literacy training and the development of health information competencies.

RESUMEN Este trabajo tuvo como objetivo describir el diseño, la validación y la implementación de un entorno virtual de enseñanza-aprendizaje como recurso didáctico de la alfabetización informacional. Se realizó una investigación aplicada, de innovación tecnológica, y con un estudio descriptivo en el Hospital Provincial General Docente “Dr. Antonio Luaces Iraola”, de Ciego de Ávila. Se utilizó el soporte tecnológico de la plataforma Moodle. La investigación se realizó en tres fases (facto perceptible, construcción de los aportes y validación y aplicación de los aportes); se validó por criterios de expertos el entorno virtual de aprendizaje y se aplicó en 55 participantes. El diseño del EVEA-salud posibilitó la autogestión y el aprendizaje desarrollador de los participantes en calidad de estudiantes. La validación por criterio de expertos no solo permitió evaluar la factibilidad y la pertinencia científico-metodológica del entorno virtual de enseñanza aprendizaje, sino también su enriquecimiento. El alto porcentaje de aprobados con calificación de bien y excelente demostró que los participantes desarrollaron competencias informacionales en torno al adecuado manejo de las fuentes de información y el uso de la información científica. Esta investigación aporta un conocimiento nuevo sobre la utilidad de la implementación de un entorno virtual de enseñanza aprendizaje como recurso didáctico de la alfabetización informacional para el desarrollo de competencias informacionales en salud.