Abstract: The purpose of this study was to obtain evidence of validity and reliability of the questionnaire for the evaluation of the tutor's competences, through the application of procedures that included unidimensionality analysis, confirmatory factor analysis and a set of techniques indicated for optimization of the measurement of complex constructs. The results indicate evidence of acceptable validity and reliability that allow it to become a measure useful for its large-scale application in the Mexican context. With respect to optimization stage, a reduced scale is supported that contributes to the simplification of application processes. The importance of the evaluation of the tutoring and its contribution to the formative process of the student body with instruments reliable and that allow an appropriate institutional instrumentation.

Resumen: El presente estudio tuvo como propósito obtener evidencia de validez y confiabilidad del cuestionario para la evaluación de competencias del tutor(a), mediante la aplicación de procedimientos que incluyeron análisis de unidimensionalidad, análisis factorial confirmatorio y un conjunto de técnicas indicadas para la optimización de la medida de constructos complejos. Los resultados indican evidencia de validez y confiabilidad aceptables que le permiten constituirse en una medida útil para su aplicación a gran escala en el contexto mexicano. Con respecto a la etapa de optimización, se sostiene una escala reducida que aporta a la simplificación de procesos de aplicación. Se discute la importancia de la evaluación de la tutoría y su contribución al proceso formativo del estudiantado con instrumentos confiables y que permitan una instrumentación institucional apropiada.

Resumen Introducción: La fluorosis dental es una patología endémica causada por la ingestión excesiva de fluoruros que pueden producir una alteración durante el desarrollo del esmalte, y es considerado un importante problema de salud pública porque afecta la salud bucal y sistémica de la población. Objetivo: Este estudio tuvo como idea principal determinar la frecuencia y los niveles de fluorosis dental en escolares de 12 a 15 años pertenecientes a dos instituciones educativas de Lima - Perú. Método: Se realizó un estudio descriptivo de tipo transversal, la muestra estuvo conformada por 252 estudiantes, entre 12 y 15 años de dos centros educativos de Lima. El muestreo fue por selección sistemática de elementos muestrales. La fluorosis dental se evalúo mediante el Índice de Dean. Para determinar la frecuencia y los niveles de fluorosis dental, se realizó un examen clínico bucal y se desarrolló un cuestionario validado previamente. Resultados: La frecuencia de fluorosis dental fue de 44,8% (n=113) afectando más a los varones en un 27,39% (n=69) y a los adolescentes de 13 años (15,1%). En relación con los niveles de fluorosis, predominó el tipo “muy leve” (34,9%). También se encontró una asociación entre la presencia y el nivel de fluorosis con el número de aplicaciones de flúor (p<0,05). Además, se dijo que el índice comunitario de fluorosis de Dean fue de 0,43. Conclusiones: En la población escolar evaluada, la frecuencia de fluorosis fue de 44,8% y el nivel predominante de fluorosis fue muy leve. Además, el índice comunitario fue de 0,43, el cual mostró un nivel límite de importancia para la salud pública. Por lo que se puede considerar que el número de aplicaciones tópicas de flúor recibido por la población sin una planificación adecuada se podría convertir en un factor de riesgo para causar fluorosis dental.

Abstract Introduction: Dental fluorosis is an endemic pathology caused by the excessive ingestion of fluorides that can produce an alteration during the development of the enamel and is considered an important public health problema because it affects the oral and systemic health of the population. Objective: The objective of this study was to determine the frequency and levels of dental fluorosis in school children between 12 and 15 years of age belonging to two educational institutions in Lima, Peru. Method: A descriptive cross-sectional study was carried out, the sample consisted of 252 students between 12 and 15 years of age from two educational centers in Lima. Sampling was by systematic selection of sample elements. Dental fluorosis was evaluated using the Dean Index. To determine the frequency and levels of dental fluorosis a clinical oral examination was carried out and a previously validated questionnaire was developed. Results: The frequency of dental fluorosis was 44.8% (n=113) affecting more males by 27.39% (n=69) and adolescents aged 13 years (15.1%). In relation to the levels of fluorosis, the “very mild” type predominated (34.9%). An association was also found between the presence and level of fluorosis with the number of fluoride applications (p<0.05). In addition, Dean's community fluorosis index was reported to be 0.43. Conclusions: In the school population evaluated, the frequency of fluorosis was 44.8% and the predominant level of fluorosis was very mild. In addition, the community index was 0.43, which indicated a borderline level of public health importance. Therefore, it can be considered that the number of topical fluoride applications received by the population without adequate planning could become a risk factor for causing dental fluorosis.

ABSTRACT Both systemic lupus erythematosus and antiphospholipid syndrome are autoimmune diseases with thromboembolic potential, especially due to the presence of thrombogenic antibodies. The lung is a common place where a thrombus usually settles and generates a thromboembolism, sometimes with subsequent infarction and cavitation. There are few studies reporting cavitary pulmonary infarction in a patient with lupus associated with antiphospholipid syndrome. We present the case of a 24-year-old woman with general symptoms and cavitated right lung lesion. She was initially treated as tuberculous or fungal infection. Laboratory tests and images guided and diagnosed lupus associated with antiphospholipid syndrome, complicated by pulmonary thromboembolism that later became cavitated. The patient improved considerably with anticoagulants, corticosteroids, and cyclophosphamide.

RESUMEN Tanto lupus eritematoso sistémico como el síndrome antifosfolípido son enfermedades autoinmunes con potencial tromboembólico, sobre todo por la presencia de anticuerpos trombogénicos. El pulmón es un lugar común donde suele asentarse un trombo y generar una tromboembolia, a veces con posterior infarto y cavitación. Existen pocos estudios que informen un infarto pulmonar cavitado en un paciente con lupus asociado a síndrome antifosfolípido. Presentamos el caso de una mujer de 24 años con síntomas generales y lesión pulmonar derecha cavitada. Fue tratada inicialmente como infección tuberculosa o fúngica. La analítica y las imágenes orientaron y diagnosticaron lupus asociado a síndrome antifosfolípido, complicado con tromboembolismo pulmonar que luego pasó a cavitarse. La paciente mejoró considerablemente con anticoagulantes, corticoides y ciclofosfamida.

Abstract Objective: To identify how the implementation of a peripheral pharmaceutical intervention program influences the prevention of anemia in children from 0 to 5 years of age. Materials and methods: A quantitative, descriptive and comparative study was conducted with a purposive nonprobability sampling. The study population consisted of 40 children and the sample included 28 children from 0 to 5 years of age, of both sexes, living in the Carlos Manuel Cox shanty town, located in the district of Ancón, province of Lima, Peru. Hematological tests were performed to measure the hemoglobin level in the children, and questionnaires were administered to their caregivers or parents. An awareness program on anemia, parasitosis, nutritious food, good hygiene practices, medical control, and medical and pharmacological treatment was undertaken. A Likert scale was used to determine the prevention of iron deficiency anemia. For blood analysis, a microhematocrit test was performed to measure the hemoglobin levels, prior to the awareness of anemia. The sampling was carried out by a medical technologist together with the researchers. Data processing was conducted using IBM SPSS Statistics V25.0 and Microsoft Excel programs. Correlations between variables were determined using Pearson’s correlation coefficient. Results: Concerning the results of knowledge about anemia, a mean of 7.6 and a standard deviation of 2.5 were found in the pretest, and a mean of 18.0 and a standard deviation of 0.0 were found in the posttest, thus there was no increase in knowledge. Conclusions: The pharmaceutical intervention program positively influences the knowledge of mothers about the prevention of iron deficiency anemia in their children.

Resumen Objetivo: El objetivo fue identificar cómo la aplicación de un programa de intervención farmacéutica periférica influye en la prevención de la anemia en niños de 0 a 5 años. Materiales y métodos: El estudio se aplicó bajo un enfoque cuantitativo y fue descriptivo y comparativo. Se realizó un muestreo no probabilístico de tipo intencional. La población fue de 40 niños, con una muestra de 28 niños (de 0 a 5 años) de ambos sexos pertenecientes al asentamiento humano Carlos Manuel Cox, en el distrito de Ancón en la provincia de Lima, Perú. Se aplicaron pruebas hematológicas para medir el nivel de hemoglobina en los niños, así como cuestionarios que resolvieron sus cuidadores o padres. Se sensibilizó sobre la anemia, así como acerca de la parasitosis, alimentos nutritivos, hábitos de higiene control y tratamiento médico y farmacológico. Se aplicó una escala de Likert para la prevención de la anemia ferropénica. Para el análisis de sangre, se procedió con una prueba de microhematocrito para medir la hemoglobina, previa sensibilización sobre la anemia, en la que la toma de muestras estuvo a cargo de un tecnólogo médico junto con las investigadoras. El procesamiento de datos se realizó con los programas SPSS 25.0 y Microsoft Excel. Las correlaciones entre las variables se determinaron mediante el coeficiente de correlación de Pearson. Resultados: Respecto a los resultados de conocimientos sobre anemia, en el pretest se encontró una media de 7,6, con una desviación estándar de 2,5, que después, en el postest, se presentó como 18,0 y 0,0, respectivamente; por lo tanto, no representa un aumento en el conocimiento. Conclusiones: Se determinó que el programa de intervención farmacéutica influye positivamente en el conocimiento de las madres sobre la prevención de la anemia ferropénica en sus hijos.

This study aims to identify and analyze factors associated with Food Insecurity (FI), trends and spatial distributions for geographical strata. The hypothesis of worsening of the outcome of severe FI, measured by the Brazilian Food Insecurity Scale (EBIA), in households as an effect of the crisis and/or the austerity policy, was investigated. The article involves studies with cross-sectional design and mixed ecological of spatio-temporal trends, based on 4 national IBGE surveys. It was adopted a weight calibration procedure according to population distribution by gender and age group, as well as estimation and modeling methods that incorporate effects of the sample design. Poisson regression with robust estimation of variance was used to estimate prevalence ratios of severe FI at the etiological level. For the ecological level, two multilevel modeling approaches were employed for repeated measures of strata: multiple log-log regression for associations; and, modeling of splines for trend estimation. The findings point to impacts of the current austerity, with changes in trends in the Bolsa Família Program and reflections on the increase in severe FI. It is projected an increase in FI and distance from the achievement of the SDG nº 2 in 2030 by Brazil, despite the success obtained in 2014 for MDG nº 1.

Este estudio tiene como objetivo identificar y analizar los factores asociados a la Inseguridad Alimentaria (IF), tendencias y distribución espacial por estratos geográficos. Se investigó la hipótesis de empeoramiento del resultado de la IF severa, medida por la Escala Brasileña de Inseguridad Alimentaria (EBIA), en los hogares como efecto de la crisis y/o de la política de austeridad. El artículo trata de estudios con diseño transversal para análisis ecológicos transversales y mixtos de tendencias espacio-temporales, a partir de 4 encuestas nacionales del IBGE. Se adoptó un procedimiento de calibración de peso de acuerdo con la distribución por sexo y grupo de edad y métodos de estimación y modelado que incorporan efectos del diseño de la muestra. Se utilizó la regresión de Poisson con estimación robusta de la varianza para estimar los índices de prevalencia de la IA grave a nivel etiológico. Para el nivel ecológico, se emplearon dos enfoques de modelado multinivel para medidas repetidas de estratos: regresión logarítmica múltiple para asociaciones; y modelado de splines para la estimación de tendencias. Los hallazgos apuntan a impactos de la actual austeridad, con cambios de tendencia en el Programa Bolsa Família y reflejos sobre el aumento de la IF severa. Se proyecta un aumento de la IA y distancia de la consecución del objetivo nº 2 de los ODS en 2030 por parte de Brasil, a pesar del éxito obtenido en 2014 para el ODM nº 1.

Este estudo visa identificar e analisar fatores associados à Insegurança Alimentar (IA), tendências e distribuição espacial para estratos geográficos. Investigou-se a hipótese de piora do desfecho de IA grave, medido pela Escala Brasileira de Insegurança Alimentar (EBIA), nos domicílios como efeito da crise e/ou da política de austeridade. O artigo envolve estudos com desenho transversal para análises seccionais e ecológico misto de tendências espaço-temporais, a partir de 4 inquéritos nacionais do IBGE. Adotou-se procedimento de calibração dos pesos segundo distribuição por sexo e faixa etária e métodos de estimação e modelagem que incorporam efeitos do desenho amostral. A regressão de Poisson com estimação robusta de variância foi empregada para estimar razões de prevalências de IA grave em nível etiológico. Para o nível ecológico, empregou-se duas abordagens de modelagem multinível para medidas repetidas de estratos: regressão múltipla log-log para associações; e, modelagem de splines para estimação de tendências. Os achados apontam impactos da austeridade vigente, com mudanças de tendências no Programa Bolsa Família e reflexos sobre o aumento da IA grave. Projeta-se o aumento da IA e afastamento do alcance do objetivo nº 2 dos ODS em 2030 pelo Brasil, a despeito do sucesso obtido em 2014 para o ODM nº 1.

Abstract: Tourism is experiencing static growth; however, the decrease in transportation costs and technological development can make it a more dynamic industry; therefore, the purpose of the study was to evaluate two tourist destinations in Mexico, one in the northwest (Guaymas, Sonora) and the other in the southeast of the country (Bahías de Huatulco, Oaxaca) in order to establish the correlation between financial performance factors and technology resources in tourism companies' strategic management. The research was exploratory based on the organizational theoretical perspective called TOE: Technology, Organization and Environment framework, non-parametric statistics were used, quantifying the intensity and direction of the interdependence between the variables. It can be concluded that the tourism companies that presented a systematic financial performance and an efficient use of technological resources, generated greater opportunities to grow in the market and the ability to face the competition by improving their strategic management, in contrast to those that do not adequately present their financial statements, as well as null or low use of Information Technologies due to lack of knowledge, which has prevented them from obtaining real value from the organization and a management focused on profitability and its permanence in the future.

ABSTRACT Air traffic management has become increasingly complex due to the increasing use of air transport. One of the main management bottlenecks is planning the efficient use of runways for takeoff and landing. This paper aims to investigate the Aircraft Landing Problem, which seeks to minimize earliness and tardiness in aircraft landing time, assigning them to a runway to land and sequencing them. A new mathematical formulation based on Job Shop was proposed for the problem, comparing it with four mathematical formulations in the literature; three directly comparable and another containing a particularity that does not allow a direct comparison with the other formulations. Computational tests were performed on 49 instances of the literature using the Gurobi Optimizer optimization package. These mathematical formulations commonly used for the ALP present difficulties in finding the optimal solution when the number of aircraft to land is large, i.e., more than 50 aircraft. Therefore, we proposed a matheuristic to solve instances with a greater number of aircraft than the Gurobi Optimizer cannot solve optimally. This matheuristic first finds an initial solution using relax-and-fix (RF) and then fix-and-optimize (FO) improves the found solution. Comparisons were also made using the first feasible solution obtained by Gurobi and then was improved with FO. Among the matheuristic variations, the one that obtained the best result was the combination of RF with FO and this also showed efficiency in relation to the work in the literature that uses FO.

Abstract Objective: The objective of our study is to find out the data regarding the appearance of renal lithiasis and its characteristics in kidney transplant patients with functioning grafts in our centre. Design: A retrospective study was undertaken of the transplants performed in our centre between January 1981 and December 2019. The transplants with functioning grafts and in which lithiasic pathology had been diagnosed were selected. The characteristics of these transplants were collected (location, composition, form of presentation and treatment carried out). Results: 2658 patients with a functioning graft were identified in our centre. A rate of lithiasic pathology of 1.8% was reported. Among them, 44% were located in the lower calyx. Regarding the composition, calcium was observed in 45.4% of cases. Limitations: It is important to highlight that our study is observational and retrospective, with all the limitations on validity that this entails. Originality: Our series is the largest study reported to date of lithiasic pathology in kidney transplantation. It is also important to highlight that the data was extracted taking only functioning grafts into account. Conclusions: The incidence of appearance of lithiasis is small, but it is a pathology that should be taken into account due to the complications that it can entail. The most frequently observed location in our series was in the lower calyx. Although these results are supported by a large number of cases, more robust studies are needed to confirm them.

Resumen Objetivo: El objetivo de nuestro estudio es conocer los datos de aparición de litiasis renal y sus características en los pacientes trasplantados renales con injertos funcionantes en nuestro centro. Diseño: Se llevó a cabo un estudio retrospectivo de los trasplantes realizados en nuestro centro desde enero de 1981 hasta diciembre de 2019. Se seleccionaron aquellos con injertos funcionantes y en los que se haya diagnosticado patología litiásica. Se recogen las características de esta (localización, composición, forma de presentación y tratamiento realizado). Resultados: Se encontraron 2658 pacientes con injerto funcionante en nuestro centro. Se reporta una incidencia de patología litiásica del 1.8%. De entre ellos, el 44% se localizaban en el cáliz inferior. En cuanto a la composición, en el 45.4% fue observada la cálcica. Limitaciones: Es importante destacar que nuestro estudio es observacional y retrospectivo con todas las limitaciones de validez que eso entraña. Originalidad: Nuestra serie es la más numerosa reportada hasta la fecha en el estudio de la patología litiásica en el trasplante renal. Es también importante resaltar que los datos se extrajeron teniendo sólo en cuenta injertos funcionantes. Conclusiones: La incidencia de aparición de litiasis es pequeña, pero es una patología a tener en cuenta por las complicaciones que puede conllevar. La localización más frecuentemente observada en nuestra serie fue el cáliz inferior. Aunque estos resultados están respaldados por un gran número de casos, son necesarios estudios de mayor solidez que los refrenden.

Resumen Introducción/objetivo: El presente estudio tiene como objetivo examinar la rela ción entre el liderazgo transformacional del entrenador y las características de resiliencia y la vulnerabilidad bajo presión, así como analizar si los factores del conflicto intragrupo (social y tarea) y de la cohesión grupal (social y tarea), pudieran mediar la relación entre dichas variables. Método: A través de un diseño longitudinal, se incluyó a un total de 301 depor tistas inscritos en los JUDEX, pertenecientes a 34 equipos de fútbol y voleibol, con edades comprendidas entre 13 y 18 años (M = 15.72; DT = 1.33). Resultados: Los resultados mostraron una relación positiva entre el liderazgo transformacional del entrenador y las características de resiliencia, y una asociación negativa respecto a la vulnerabilidad bajo presión. Además, el conflicto intragrupo (social y tarea) actuó como mediador entre la relación del liderazgo trans formacional del entrenador y la resiliencia de equipo. En cuanto al papel mediador de la cohe sión grupal, solo la cohesión tarea actuó como mediadora entre el liderazgo transformacional del entrenador y la resiliencia de equipo. Conclusiones: La presente investigación muestra la importancia del liderazgo del entrenador para mejorar la resiliencia del equipo en categorías de formación, y la influencia positiva que tiene la reducción de los conflictos intragrupo y el aumento de la cohesión tarea durante la temporada.

Abstract Introduction/objective: The present study aimed to examine the relationship be tween transformational coach leadership with the characteristics of resilience and vulnerability under pressure, as well as to analyze whether the factors of intra-group conflict (social and task) and group cohesion (social and task) could mediate the relationship between these variables. Method: Through a longitudinal design, a total of 301 athletes enrolled in the JUDEX, belong ing to 34 soccer and volleyball teams, and aged between 13 and 18 years (M = 15.72; SD = 1.33). Results: The results showed a positive relationship between transformational leadership of the coach and resilience characteristics, and a negative association with respect to vulnerability under pressure. In addition, intra-group conflict (social and task) acted as mediators between the relationship between transformational coach leadership and team resilience. Regarding the mediating role of group cohesion, only task cohesion acted as a mediator between trans formational coach leadership and team resilience. Conclusions: This research draws as main conclusion the importance of the coach’s leadership to improve team resilience in youth cate gories, and the positive influence of the reduction of intragroup conflicts and the increase of task cohesion during the season.

Resumen: Los desórdenes de disfunción del surfactante pulmonar se producen por defectos genéticos que alte ran el metabolismo del surfactante pulmonar. Son trastornos poco frecuentes y causan morbi-mortalidad significativa en la población neonatal y pediátrica. Objetivo: Describir los hallazgos clínicos, histopatológicos y ultraestructura del cuerpo lamelar que orientan hacia disfunción de la proteína surfactante C (SP-C), en lugares donde no se disponen de estudios genéticos confirmatorios. Caso Clínico: Reportamos tres casos pediátricos de desórdenes de disfunción del surfactante pulmonar procedentes de un hospital pediátrico de Perú. En todos los casos se realizó biopsia pulmonar video asistida. Los estudios de ultraestructura del cuerpo lamelar fueron compatibles con disfunción del surfactante pulmonar tipo C. El tratamiento utilizado fueron pulsos de metilprednisolona mensual mente por seis meses, luego cada dos meses, variando la duración según la evolución clínica. También recibieron hidroxicloroquina diario y azitromicina tres veces por semana. Se realizaron evaluaciones clínicas, fondo de ojo, ecocardiograma, electrocardiograma y bioquímica periódicas. Al seguimiento hubo buena respuesta al tratamiento y no se observaron efectos adversos. Un caso falleció a pesar de las terapias recibidas. Conclusiones: En 3 pacientes con disfunción del surfactante tipo C el trata miento con corticoides, hidroxicloroquina y azitromicina fue exitoso en 2 de ellos. Este es una de las primeras series de casos reportados en Perú que contribuye al estudio de estas enfermedades especial mente en países de bajos y medianos recursos.

Abstract: Pulmonary surfactant dysfunction disorders are caused by genetic defects that alter pulmonary surfactant metabolism. They are rare disorders and cause significant morbidity and mortality in the neonatal and pediatric populations. Objective: To describe the clinical, histopathological, and ultrastructural findings of the lamellar body that suggest surfactant protein C (SP-C) dysfunction, where confirmatory genetic studies are not available. Clinical Case: We report three pediatric cases of pulmonary surfactant dysfunction disorders from a pediatric hospital in Peru. Video-assisted lung biopsy was performed in all cases. Ultrastructural studies of the lamellar body were compatible with type- C pulmonary surfactant dysfunction. The treatment used was methylprednisolone pulses monthly for six months, then every two months, varying the duration according to the clinical evolution. They also received daily hydroxychloroquine and azithromycin three times a week. Clinical evaluations, eye fundus, echocardiogram, electrocardiogram, and biochemistry were performed periodically. At follow-up, there was a good response to treatment and no adverse effects were observed. One case died despite the therapies received. Conclusions: In 3 patients with type-C surfactant dysfunction, treatment with corticosteroids, hydroxychloroquine, and azithromycin was successful in 2 of them. This is one of the first case series reported in Peru that contributes to the study of these diseases, especially in low- and medium-income countries.

ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) for temporary cardiopulmonary support is one of the most intense and technologically complex therapies offered in medicine. It is a high-risk procedure that requires specific knowledge and technical skills to perform it with good results. Objective: The main goal of this study is to describe our extracorporeal membrane oxygenation (ECMO) training program based on the study of specialized nurses and physicians of a simulation teaching experience, conducted in a pediatric cardiac intensive care unit. The program was developed as a theoretical-practical course with final exam and annual maintenance training sessions, caring for ECMO patients, its implementation and results. Methods: A descriptive study for registered nurses, intensivists, and cardiac surgeons. A self-administered, anonymous, and voluntary survey was conducted to assess the long-term perception about the program. Demographic data to describe the population was required, and questions about satisfaction and confidence in acquired skills and competences were asked. A descriptive statistical analysis was performed; patient survival and complications were compared before and after ECMO program using chi-square test, and P<0.05 was considered statistically significant. Results: Twenty-four training courses were performed for 68 professionals. More than 88% of the professionals considered the course components to be adequate and complete; and 94% felt trained to manage the ECMO circuit. Most valued activities were workshops and clinical cases. Since the implementation of the training program, 88 patients were assisted, with a survival rate at discharge of 58%, higher than in the previous period (P=0.03). Conclusion: More than 80% of the professionals considered the workshops and simulations as the most useful components. Reliance on the circuit care was higher than in training problem scenarios. Since 2013 we assisted 88 patients on ECMO, with a survival rate at discharge of 58%, within international standards results.

ABSTRACT The objective of the present investigation was to propose an alternative solution to the problem of lack of hours of underground water supply for human consumption in the district of Ite, carrying out the treatment with ferric chloride for the removal of arsenic (0,4930 ± 0,0642 mgL-1) of natural origin from the Locumba river; which will be used as an additional source of water. Methodology: a jug testing equipment was used to study the operating conditions. A fractional factorial analysis was applied and then a response surface analysis to study the operating variables: their influence, linearity and the appropriate operating conditions. Additionally, speciation and analysis of arsenic (As+3) were performed using solid phase extraction (SFS) and voltammetry. Results: It was possible to reduce the number of operation variables from five to three variables (FeCl3 dose, flocculation speed, sedimentation time); The response surface design was applied to the latter, determining that the samples that were filtered after the treatment process; in all operating conditions they showed arsenic concentrations lower than 0,01 mgL-1. In the unfiltered samples, concentrations below 0,01 mgL-1 were achieved in two operating conditions. The results of the unfiltered arsenic samples were fitted to a quadratic model, obtaining an r2-adjusted value of 94%. The found quadratic model was shown to be a saddle point. The best operating conditions for the greatest removal of arsenic (0,00924 mgL-1) in the unfiltered samples were: 40 mgL-1 of FeCl dose, 60 rpm as flocculation speed, 80 minutes of sedimentation time, pH =7 and a flocculation time of 25 minutes. Conclusions: It is possible to remove arsenic from Locumba river water to levels suitable for human consumption using ferric chloride as coagulant under the operating conditions found in this study. It should be kept in mind that pH is one of the most important variables in this type of treatment process and the use of sulfuric acid to regulate it is one of the best alternatives due to the cost and proximity of Ite to the Southern Copper Corporation mining company, which produces this chemical input.

RESUMEN El objetivo de la presente investigación fue proponer una alternativa de solución al problema de falta de horas de abastecimiento de agua subterránea para consumo humano del distrito de Ite, realizando el tratamiento con cloruro férrico para la remoción de arsénico (0,4930±0,0642 mgL-1) de origen natural del río Locumba; que será utilizado como fuente adicional de agua. Metodología: se utilizó un equipo probador de jarras para el estudio de las condiciones de operación. Se aplicó un análisis factorial fraccionado y luego un análisis de superficie respuesta para estudiar en las variables de operación: su influencia, linealidad y las condiciones adecuadas de operación. Adicionalmente se realizó la especiación y el análisis del arsénico (As+3) utilizando la extracción por fase sólida (EFS) y voltamperometría. Resultados: Se logró reducir el número de variables de operación de cinco a tres variables (dosis de FeCl3, velocidad de floculación, tiempo de sedimentación); a estas últimas se les aplico el diseño de superficie respuesta determinando que las muestras que fueron filtradas luego del proceso de tratamiento; en todas las condiciones de operación mostraron concentración de arsénico menores a 0,01 mgL-1. En las muestras no filtradas se logró concentraciones por debajo de 0,01 mgL-1 en dos condiciones de operación. Los resultados de las muestras de arsénico sin filtrar se ajustaron a un modelo cuadrático, obteniendo un valor de r2-ajustado de 94%. El modelo cuadrático encontrado mostró ser punto silla. Las mejores condiciones de operación para la mayor remoción de arsénico (0,00924 mgL-1) en las muestras sin filtrar fueron: 40 mgL-1 de dosis de FeCl3, 60 rpm como velocidad de floculación, 80 minutos de tiempo de sedimentación, pH=7 y un tiempo de floculación de 25 minutos. Conclusiones: Es posible remover el arsénico del agua del río Locumba a niveles aptos para el consumo humano utilizando como coagulante el cloruro férrico en las condiciones de operación encontradas en el presente estudio. Debe tenerse presente que el pH es una de las variables más importantes en este tipo de procesos de tratamiento y el uso de ácido sulfúrico para regularlo una de las mejores alternativas por el costo y la cercanía de Ite a la compañía minera Southern Copper Corporation quien produce este insumo químico.

Background: COVID-19 pandemic disturbed mental health of healthcare personnel. Residents of the specialization programs could be at risk, since they were reassigned in their functions. Aim: To describe the impact of COVID-19 pandemic on symptoms of depression, stress, anxiety and resilient coping in residents of Anesthesiology, Internal Medicine and Emergency Medicine Material and Methods: Residents were invited to answer an online survey containing the DASS-21 scale for anxiety, stress and depression symptoms and the Brief Resilient Coping Scale (BRCS) for resilience skills. Results: Fifty four out of 90 residents answered the survey. Eighteen to 24% of respondents had symptoms of depression, anxiety and stress at severe and extremely severe levels. Those with severe and extremely severe symptoms had also the lowest score on the BRCS resilience scale. We did not find an association between severity of symptoms and gender. Discussion: A proportion of respondent residents had severe psychological symptoms and lower resilience scores during the COVID-19 pandemic.

Abstract: The identification of multiple risk factors that predispose to bleeding during the obstetric event, such as acquired hemophilia, which is a disorder that develops due to the generation of autoantibodies that inhibit coagulation factors, the objective interpretation of routine laboratory tests , the development of systematized thinking in diagnostic-therapeutic integration by health personnel, and the provision of hospital pharmacological resources, is what frequently determines the prognosis in obstetric patients with extreme morbidity who require multidisciplinary care in the different hospital units of the health sector of our country. The objective is to present a clinical case of extreme morbidity due to acquired hemophilia, its clinical presentation, evolution and fatal outcome. A case referred from another unit of the ISEM (Instituto de Salud del Estado de México) Health Sector, treated at the Obstetric Intensive Care Unit of the «Mónica Pretelini Sáenz» Hospital, is presented, highlighting the importance of diagnostic-therapeutic integration, and the multifactorial interaction of variables related to its fatal outcome. Conclusions: Ignorance of the pathology, delay in diagnosis, multiple conditioning procedures of iatrogenic hemorrhage and the limitation in therapeutic resources are factors that contribute to a fatal outcome.

Resumen: La identificación de múltiples factores de riesgo que predisponen a la hemorragia durante el evento obstétrico, como la hemofilia adquirida que es un trastorno que se desarrolla por la generación de autoanticuerpos inhibidores de factores de la coagulación, la interpretación objetiva de las pruebas de laboratorio rutinarias, el desarrollo de un pensamiento sistematizado en la integración diagnóstico-terapéutica por parte del personal de salud, y la disposición de los recursos farmacológicos hospitalarios, es lo que determina frecuentemente el pronóstico en pacientes obstétricas con morbilidad extrema que requieren atención multidisciplinaria en las diferentes unidades hospitalarias del sector salud de nuestro país. El objetivo es presentar un caso clínico de morbilidad extrema por hemofilia adquirida, su presentación clínica, evolución y desenlace fatal. Se presenta un caso referido de otra unidad del Sector Salud ISEM (Instituto de Salud del Estado de México), atendido en la Unidad de Cuidados Intensivos Obstétricos del Hospital «Mónica Pretelini Sáenz», resaltando la importancia en la integración diagnóstico-terapéutica y la interacción multifactorial de variables relacionadas con su desenlace fatal. Conclusiones: Desconocimiento de la patología, retraso en el diagnóstico, múltiples procedimientos condicionantes de hemorragia iatrógena y la limitación en recursos terapéuticos son factores que contribuyen a un desenlace fatal.