RESUMEN Introducción: La cirugía mínimamente invasiva de estrabismo ha revolucionado el concepto de la cirugía tradicional de estrabismo. Este procedimiento se realiza con mínima disrupción anatómica entre el músculo y el tejido perimuscular. Objetivo: Describir una propuesta de modificación a la técnica de cirugía mínimamente invasiva de estrabismo. Métodos: Se revisó la literatura en español e inglés, sin restricciones de fecha, para investigar modificaciones reportadas a la técnica de cirugía mínimamente invasiva de estrabismo. En las modificaciones revisadas, coexiste la posibilidad de que ocurra la complicación de músculo deslizado o músculo perdido. Para realizar una técnica quirúrgica segura se identificaron los aspectos que pueden influir en esta, que son el agarre muscular y su fijación escleral, sin ampliar las microincisiones. Resultados: En la técnica modificada se emplearon pinzas curvas de Moody-Castroviejo, para ampliar el campo operatorio. Se utilizó una sola sutura no reabsorbible de ácido poliglicólico para el agarre muscular; se pasa primero por el espesor muscular y después por los extremos superior e inferior de la inserción muscular, lo cual ofrece seguridad al procedimiento. Se propone el uso del Dardenne, instrumento oftalmológico utilizado en la realización de pupiloplastias, para traer el extremo opuesto de la sutura y realizar un nudo de Siepser; al cortar la sutura, quedan los cabos por debajo del túnel conjuntival, sin ampliar las microincisiones. Conclusiones: Las modificaciones a la técnica de cirugía mínimamente invasiva de estrabismo, que propone este trabajo, permiten mejor agarre y fijación del músculo.

ABSTRACT Introduction: Minimally invasive strabismus surgery has revolutionized the concept of traditional strabismus surgery. This procedure is performed with minimal anatomical disruption between the muscle and perimuscular tissue. Objective: To describe a proposed modification to the minimally invasive strabismus surgery technique. Method: The literature in Spanish and English was reviewed, without date restrictions, to investigate reported modifications to the minimally invasive strabismus surgery technique. In the revised modifications, the possibility of the complication of slipped muscle or lost muscle coexists. To perform a safe surgical technique, the aspects that can influence it are identified, which are muscle grip and scleral fixation, without expanding the microincisions. Results: In the modified technique, curved Moody-Castroviejo forceps were used to expand the operating field. A single nonabsorbable polyglycolic acid suture was used for muscle attachment; it is passed first through the muscle thickness and then through the upper and lower ends of the muscle insertion, which offers safety to the procedure. The use of the Dardenne, an ophthalmological instrument used in performing pupilloplasties, is proposed to bring the opposite end of the suture and make a Siepser knot. When cutting the suture, the ends remain below the conjunctival tunnel, without expanding microincisions. Conclusions: Proposed modifications to the minimally invasive strabismus surgery technique, allow better grip and fixation of the muscle.

Resumen: Desde el año 2007 en Uruguay los cuidados paliativos (CP) son parte de las prestaciones de salud que todos los ciudadanos que los necesitan tienen derecho a recibir y, desde entonces, ha aumentado significativamente la accesibilidad a estos. Objetivo: describir la situación actual del desarrollo organizativo de servicios de cuidados paliativos pediátricos (CPP) en el país y los pacientes por ellos asistidos desde el inicio de sus actividades hasta el 31/12/2020, las principales fortalezas y desafíos percibidos por los profesionales de dichos equipos. Metodología: se realizó una consulta mediante encuesta online auto administrada enviada a los coordinadores de servicios de CPP del Uruguay. Resultados: se confirmaron 19 equipos en 9/19 departamentos, 5/19 están integrados por profesionales de las cuatro disciplinas básicas recomendadas, el resto por distintas combinaciones de disciplinas, con cargas horarias muy variables. Brindan asistencia en: hospitalización 19/19, policlínica 18/19, atención domiciliaria coordinada 13/19 y retén telefónico 10/19. Fueron asistidos 2957 niños, 23% de los mismos fallecieron. 16/19 equipos reportan como principales fortalezas los valores compartidos y el trabajo en equipo interdisciplinario y 15/19 como principal desafío los déficits de recursos humanos. Conclusiones: persisten importantes inequidades en el acceso a los CPP. Se constató gran variabilidad en la integración de los equipos y la carga horaria de los profesionales. Es necesario que las autoridades sanitarias continúen promoviendo y exigiendo el desarrollo de equipos de CPP en las instituciones y departamentos que no los tienen y el cumplimiento de estándares mínimos de calidad en los ya existentes.

Summary: Since 2007, palliative care (PC) has been a part of the health benefits that all Uruguayan citizens are entitled to receive and, since then, accessibility has increased significantly. Objective: to describe the present development of pediatric palliative care services (PPC) in Uruguay and the patients assisted by health providers since the beginning of their services until 12/31/2020 and the key strengths and challenges perceived by these palliative care teams. Methodology: a consultation was carried out through a self-administered online survey and sent to the PPC service coordinators in Uruguay. Results: 19 teams were confirmed in 9/19 departments, 5/19 are integrated by professionals from the four recommended basic disciplines, the rest by different combinations of disciplines, with highly variable workloads. They provide assistance in: hospitalization 19/19, clinics 18/19, coordinated home care 13/19 and telephone assistance 10/19. 2957 children were assisted, 23% of them died. 16/19 teams report shared values and interdisciplinary teamwork as their main strengths, and 15/19 report human resource shortage as their main challenge. Conclusions: significant inequality persist regarding access to PPCs. We confirmed a high variability in teams’ integration and professional workload. It is necessary for the health authorities to continue to promote and demand the development of PPC teams in the institutions and departments that do not yet have them and the compliance with minimum quality standards in those that already operate.

Resumo: Desde 2007, os cuidados paliativos (CP) fazem parte dos benefícios de saúde que todos os cidadãos têm direito a receber no Uruguai e, desde então, a acessibilidade a eles tem aumentado significativamente. Objetivo: descrever a situação atual do desenvolvimento organizacional dos serviços de cuidados paliativos pediátricos (CPP) no Uruguai e dos pacientes atendidos desde o início de suas atividades até 31/12/2020 e as principais fortalezas e desafios percebidos pelos profissionais das referidas equipes. Metodologia: foi realizada uma consulta por meio de uma pesquisa online autoaplicável enviada aos coordenadores dos serviços do CPP no Uruguai. Resultados: 19 equipes foram confirmadas em 19/09 departamentos, 19/05 compostas por profissionais das quatro disciplinas básicas recomendadas, o restante por diferentes combinações de disciplinas, com cargas horárias altamente variáveis. Elas atendem em: internação 19/19, policlínica 18/19, atendimento domiciliar coordenado 13/19 e posto telefônico 19/10. 2.957 crianças foram atendidas, 23% delas faleceram. 16/19 equipes relatam valores compartilhados e trabalho em equipe interdisciplinar como suas principais fortalezas, e 15/19 relatam déficits de recursos humanos como seu principal desafio. Conclusões: persistem desigualdades significativas no acesso aos CPP. Verificou-se: grande variabilidade na integração das equipes e na carga de trabalho dos profissionais. É necessário que as autoridades de saúde continuem promovendo e exigindo o desenvolvimento de equipes de CPP nas instituições e departamentos que não as possuem e o cumprimento de padrões mínimos de qualidade nas que já existem.

RESUMO A contemporaneidade e a docência nas áreas de saúde e formação profissional, tem se transformado e evoluído nos últimos tempos, com a introdução das metodologias ativas no processo ensino-aprendizagem, nas instituições de ensino superior no Brasil. Essas metodologias ativas de aprendizagem, como a ABP, Aprendizagem Baseada em Problemas, são utilizadas com a finalidade de que estudantes da área da saúde adquiram o conhecimento de forma significativa, em relação ao ensino tradicional. A educação médica no Brasil tem sido assunto de muitas discussões sobre a formação profissional em saúde e vem passando por significativas mudanças nos últimos anos. O presente artigo tem por objetivo relatar uma experiência docente no ensino de graduação em Medicina, nos componentes curriculares Mecanismo de Agressão e Defesa I e II (MADs), na Universidade do Estado da Bahia – Campus I. MADs é um componente curricular atualmente presente em diferentes cursos da área de saúde do Brasil. Este componente é composto pelas disciplinas microbiologia, parasitologia, imunologia e patologia, lecionado de forma integrada. Foram aplicadas metodologias ativas de ensino, do tipo aprendizagem baseada em problemas (ABP), que abrangeram sessões tutoriais, atividades em laboratórios, apresentações científicas e o uso de filmes. Além disto, foram utilizados recursos lúdicos e a ferramenta MOODLE no campus virtual. Esta proposta teve início no ano de 2012 e vem sendo aplicada a partir desta data até os dias atuais. A experiência vivenciada nas MADs, com a utilização de variadas formas de metodologias de ensinagem, tem permitido “romper” com o tradicional, isto é, tem levado o discente a desenvolver habilidades, competências e construção dos saberes. Estas novas alternativas de ensino nos permitiu uma interação mais ampla entre a relação discente-docente e nos fez refletir e avançar no processo avaliativo, que tem sido realizado de forma ampla e processual. Além disso, um impacto positivo para sua formação pode ser observado. No que se refere ao processo de ensino, aprendizagem e avaliações, novas propostas pedagógicas devem ser inseridas priorizando o caráter formativo e de desenvolvimento dos discentes, para que haja a construção de competências necessárias ao perfil estabelecido pelas DCNs, Diretrizes Curriculares Nacionais, do curso de Graduação em Medicina e demais cursos de saúde.

ABSTRACT Changes are occurring in health teaching and professional training, due to the introduction of active methodologies to the teaching-learning process in Brazilian higher education institutions. These active learning methodologies, such as PBL (Problem-Based Learning), are used to help medical students acquire knowledge in a more relevant way, compared to traditional teaching. Medical education in Brazil has been the subject of much discussion, and has undergone significant changes in recent years. The objective of the present work is to report the teaching experience in the curricular components Mechanisms of Aggression and Defense I (MAD I) and Mechanisms of Aggression and Defense II (MAD II) of Universidade do Estado da Bahia [State University of Bahia] - Campus I in undergraduate teaching in Medicine. These subjects are composed of the disciplines microbiology, parasitology, immunology (MAD I and II) and pathology (MAD II), taught in an integrated way. Active teaching methodologies were applied, such as problem-based learning, laboratory activities, scientific presentations and the use of film. In addition, the MOODLE tool was used in the virtual campus. This proposal began in 2012 and has been applied since then. The experience of the MADs, with the use of different forms of teaching methodologies, has led to a transformation of traditional teaching, leading students to develop their skills and competencies and build knowledge. These new teaching alternatives allow for a broader interaction between the students and the teacher and led us to reflect and advance in the evaluation process, which has been carried out in a broad and procedural way. Moreover, a positive impact on the students’ training was observed. As for the processes of teaching, learning and evaluation, new pedagogical proposals should be introduced, prioritizing the formative and developmental character of students so that the necessary competences can be built into the profile established by the National Curricular Guidelines (DCNs) of the Undergraduate Medicine course and other courses in the area of health.

RESUMO: A amoreira-preta faz parte do grupo das pequenas frutas e sua área de cultivo está em plena expansão, sendo uma opção importante para os pequenos agricultores que usam o sistema de produção agroecológico. Os ácaros destacam-se dentre as principais pragas da cultura em nível mundial, pois eles podem comprometer desde o crescimento das plantas até sua frutificação. O objetivo desta pesquisa foi estudar a ocorrência de ácaros fitófagos e predadores em diferentes genótipos de amoreira preta no município de Pelotas, RS, Brasil. Este estudo foi realizado no período novembro de 2015 a outubro de 2016, totalizando 14 amostragens. Um total de 11.158 ácaros coletou-se (5.940 ácaros fitófagos, 323 ácaros predadores, e 4.895 ácaros de alimentação variada), que estavam distribuídos em oito famílias. As espécies Neotetranychus asper (Feres & Flechtmann, 2000), Diptacus rubuscolum (Trinidad, Duarte & Navia, 2018), e Acalitus orthomerus (Keifer, 1951) tiveram maior ocorrência. De acordo com a classificação faunística, a espécie fitófaga N. asper é predominante nos genótipos 128 e 178, enquanto a espécie D. rubuscolum é predominante no genótipo 132. Monitorar esses genótipos é recomendado para detectar possíveis danos à cultura.

ABSTRACT: Blackberry is part of the small-fruit group and the blackberry cultivation area is expanding as an important option for small farmers using the agroecological production system. Mites are prominent among the world’s major crop pests, as they can affect plants from growth to fruiting. The objective of this study was to evaluate the occurrence of phytophagous and predatory mites in different blackberry genotypes in the municipality of Pelotas, RS, Brazil. This study was carried out in the period Nov. 2015 - Oct. 2016, totaling 14 samples. A total of 11,158 mites were collected [phytophagous (5940) and predatory (323) mites, and those with varied feeding habits (4895)], which were distributed in 8 families. The species Neotetranychus asper (Feres & Flechtmann, 2000), Diptacus rubuscolum (Trinidad, Duarte & Navia, 2018), and Acalitus orthomerus (Keifer, 1951) had highest occurrence. According to the faunistic classification, the N. asper phytophagous species is predominant in genotypes 128 and 178; whereas, D. rubuscolum is predominant in genotype 132. Monitoring of these genotypes is recommended to detect possible damage to the crop.

Objective: to determine the risk factors that have an impact on failing to achieve binocular vision in patients operated on from congenital esotropia. Methods: a case-series study conducted in patients operated on from congenital esotropia at the Pediatric Ophthalmology service of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology from January 2007 through May 2010. The following variables were analyzed: fusion, stereopsis, stability of the ocular alignment, surgical age, number of surgeries, amblyopia, and refractive defect. Results: in this group, 57.7 % of the patients reached fusion and 30.8 % achieved stereopsis, in a range of 3000 to 400 arc seconds. The risk of not developing fusion and the risk of not developing stereopsis in operated children aged over 18 months were 5 times higher and 4 times higher, respectively, than in children operated on before that surgical age. Those patients who lose the ocular alignment after one year of surgery were 3 times more likely to fail to achieve fusion than those who kept orthotopia. The probabilities of not developing stereopsis were almost twice greater in amblyopic children. Conclusions: the early surgery is important to improve the visual functional results in those operated on from congenital esotropia. The loss of ocular parallelism and amblyopia were associated to unsuccessful development of fusion and stereopsis.

Objetivo: determinar los factores de riesgos que influyen en la no obtención de visión binocular en los pacientes operados de esotropía congénita. Métodos: estudio de serie de casos en pacientes operados de esotropía congénita en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período comprendido de enero de 2007 a mayo de 2010. Se analizaron las variables siguientes: fusión, estereopsis, edad quirúrgica, estabilidad del alineamiento ocular, número de cirugías, ambliopía y defecto refractivo. Resultados: el 57,7 % de los pacientes alcanzó fusión y el 30,8 % logró estereopsia, en un rango de 3 000 a 400 segundos de arco. Los niños operados tuvieron después de los 18 meses un riesgo cinco veces mayor de no desarrollar fusión y cuatro veces mayor de no desarrollar estereopsis que los operados antes de esa edad. Los pacientes que perdieron el alineamiento ocular tuvieron al año de la cirugía casi tres veces mayor probabilidad de no alcanzar fusión que aquellos que mantuvieron la ortotropía. La probabilidad de no desarrollar estereopsis fue casi dos veces mayor en los niños ambliopes. Conclusiones: la cirugía temprana resulta importante para mejorar los resultados funcionales visuales en los operados de esotropía congénita. La pérdida del paralelismo ocular y la ambliopía estuvieron asociadas al no desarrollo de fusión y estereopsis.

Amblyopia is a neurological disorder resulting from abnormal stimulation of the brain during the critical period of the visual development. Till recently, the only therapeutic option was the optic correction with glasses or ocular lenses, which was the initial indication to carry out visual rehabilitation later. The advances in refractive surgery have revolutionized the treatment of the refractive errors in the adults, but the high prevalence of pediatric refractive defects and the accelerated progress of the refractive surgery in the last few years have aroused great interest among ophthalmologists. The refractive surgery is a controversial topic with advocators and opponents, but it is an alternative treatment for patients that do not respond to the conventional treatment for amblyopia. If an energetic behavior is not assumed in this respect, the children could become amplyopic.

La ambliopía es un desorden neurológico, resultado de una anormal estimulación del cerebro durante el periodo crítico del desarrollo visual. Hasta hace poco tiempo la única opción terapéutica para el tratamiento de los defectos refractivos era la corrección óptica con cristales o lentes de contacto, indicación inicial para después realizar rehabilitación visual. Los avances en cirugía refractiva han revolucionado el tratamiento de los errores refractivos en los adultos, pero la alta prevalencia de defectos refractivos pediátricos y el progreso vertiginoso de la cirugía refractiva en los últimos años, han despertado un gran interés en oftalmólogos. La cirugía refractiva es un tema controversial con defensores y detractores, pero es un tratamiento alternativo para pacientes que no responden al tratamiento convencional de la ambliopía y, de no tomar una conducta enérgica, los niños quedan ambliopes.

Host genetic factors play an important role in mediating resistance to HIV-1 infection and may modify the course of infection. HLA-B alleles (Bw4 epitope; B*27 and B*57) as well as killer cell immunoglobulin-like receptors have been associated with slow progression of HIV-1 infection. OBJECTIVE: To evaluate the association between serological epitopes HLA-Bw4 and HLA-Bw6 and prognostic markers in AIDS. METHODS: 147 HIV-infected individuals in Bahia, Northeast Brazil, were genotyped for HLA class I locus. HLA class I genotyping was performed by hybridization with sequence-specific oligonucleotide probes following amplification of the corresponding HLA-A, HLA-B and HLA-C genes. Statistical analysis was performed using Fisher's exact and ANOVA tests for categorical and continuous variables, respectively. RESULTS: We detected a significant association (χ2 = 4.856; p = 0.018) between the presence of HLA-Bw4 and low levels of viremia. Eighteen out of the 147 HIV-infected individuals presented viremia <1,800 copies/mL and 129 presented viremia > 2,000 copies/mL. Ninety and four percent (17/18) of all individuals with viremia < 1,800 copies/mL carried HLA-Bw4, compared to 67.4% (87/129) of individuals with viremia > 2,000 copies/mL. Additionally, we found a significantly higher frequency of B*57 (OR = 13.94; 95% CI = 4.19-46.38; p < 0.0001) and Cw*18 (OR = 16.15; 95% CI = 3.46-75.43; p < 0.0001) alleles, favoring the group with lower viremia levels, in comparison with those with higher viral load. CONCLUSION: HLA-Bw4-B*57 and Cw*18 alleles are associated with lower level of viral load in HIV-infected Brazilian patients. These findings may help us in understanding the determinants of HIV evolution in Brazilian patients, as well as in providing important information on immune response correlates of protection for such population

INTROCTION: Listeria monocytogenes shows a special attraction to infect the central nervous system and its meningeals coats. It affects newborn as well as elderly people, patients with deficiencies in their cellular inmune systems, and healthy adults. It presents most commonly as an acute meningitis, although it can present itself as cerebritis, brain stem encephalitis (rhomboencephalitis), and exceptionally as myelitis. PATIENTS: We describe six clinical cases of neurolisterioris, five of which in healthy adults; we also describe the images and cerebrospinal fluid (CSF) findings, RESULTS: Three patients contracted acute meningitis, one of them meningoencephalitis, one cerebritis and the last one rhomboencephalitis. The CSF was turbid or slightly turbid with normal glycorrachia in three patients. The diagnosis was made in five through culture of CSF. The patient with the rhomboencephalitis had brain stem microabscesses in the brain magnetic resonance. All the patients had a good outcome under antibiotics treatment. CONCLUSION: Neurolisteriosis has to be kept in mind as a feasible diagnosis not only in immunocompromised but also in newborn as well as elderly patients. It should also be taken into account in young healthy adults living in regions under poor sanitary conditions where there is no adequate control of food manufacturing.

INTRODUCCION: Listeria monocytogenes tiene una especial predilección por infectar el sistema nervioso central y sus cubiertas meningeas. Afecta a pacientes que se encuentran en edades extremas de la vida, pacientes con deficiencia en su inmunidad celular y adultos sanos. La forma mas común de manifestarse es la meningitis aguda, aunque puede expresarse como cerebritis, encefalitis de tronco (romboencefalitis), y excepcionalmente mielitis. CASUISTICA: Se presentan y comentan seis casos clinicos de neurolisteriosis, cinco en adultos sanos, con sus hallazgos imagenológicos y licuorales. RESULTADOS: Tres de los pacientes se presentaron como meningitis aguda, uno como meningoencefalitis, otro como cerebritis y el restante como romboencefalitis. Se destaca el carácter turbio o ligeramente turbio del líquido cefalo-raquideo (LCR), la glucorraquia normal detectada en tres de los casos y el diagnostico realizado en cinco de los casos por cultivo del LCR. Se comenta la resonancia magnética singular del caso de la romboencefalitis con microabscesos en tronco. Todos los pacientes tuvieron evolución satisfactoria con tratamiento antibiotico. CONCLUSIÓN: La neurolisteriosis debe ser un diagnostico a tener en cuenta no solo en pacientes inmunocomprometidos o en edades extremas de la vida. Debe también tenerse en cuenta en pacientes adultos jóvenes sanos procedentes de regiones donde las condiciones sanitarias son precarias y no existe un adecuado control en la elaboración de alimentos.

Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at riskwas the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

Las alteraciones electrolíticas son frecuentes en el paciente quemado, y en general se presentan enpacientes con quemaduras de mayor gravedad. Es poco conocida la frecuencia y magnitud de la hipomagnesemia, asicomo los factores de riesgo para presentarla en esta situación clínica. Se realizó un estudio retrospectivo observacional de revisión de casos, en 35 pacientes con quemaduras, manejados en el servicio de Cirugía Plástica Reconstructiva del Hospital Central Sur de PEMEX. Se determinó el comportamiento del magnesio sérico y se formaron dos grupos, un grupo de estudio que incluyó a 11 pacientes con quemaduras e hipomagnesemia, y un segundo grupo de 24 pacientes, con quemaduras y sin hipomagnesemia. Se determinaron los principales factores de riesgo relacionados con los episodios de hipomagnesemia. Se encontró que el paciente de mayor riesgo es aquel con quemaduras mayores de 40%de superficie corporal, de segundo y tercer grado, que se encuentra en el cuarto y el décimo día después de la quemadura, y que presenta hipocalemia, hipocalcemia o las dos y que además no ha recibido aporte por vía intravenosa este catión. La mejor manera de prevenirlo es identificar al paciente de alto riesgo o diagnosticar de manera oportuna para evitar mayores complicaciones.