Resumen Introducción: El 15% de los promocionales de la industria farmacéutica (IF) incluyen información que no se fundamenta con los resultados del artículo original. Objetivo: Evaluar la validez de los artículos científicos originales que sustentan la información de los promocionales de la IF dirigidos a internistas y cardiólogos y conciliar la información del artículo científico original con la del promocional. Método: Los promocionales se obtuvieron en los congresos nacionales de Medicina Interna (MI) y Cardiología (C) realizados en México; aleatoriamente se seleccionaron 10 de cada especialidad; tres investigadores evaluaron la calidad de las referencias bibliográficas, la validez de los artículos originales y realizaron la conciliación de la información. Se realizó análisis descriptivo. Resultados: Se recolectaron 57 promocionales de MI y 16 de C; la calidad de las referencias bibliográficas de 4 promocionales de MI se evaluaron como evidencia “moderada” y las referencias de 4 promocionales de C como evidencia “no científica”. Los ensayos clínicos controlados de MI y C fueron válidos, un estudio observacional de C se catalogó sin validez. La conciliación de la información del promocional con la del artículo original reveló diferencias en cuatro promocionales de cada especialidad y de acuerdo con los criterios éticos para la promoción de medicamentos de la Organización Mundial de la Salud (OMS) predominó la falta de exactitud, en algunos casos la información no fue fidedigna y/o verdadera. Conclusiones: Es importante capacitar al médico en lectura crítica, para que evalúe objetivamente la información e identifique la promoción de medicamentos inefectivos y/o inseguros.

Abstract Introduction: It has been reported that 15% of the promotional products from the pharmaceutical industry (PI) include information not supported by the results of the original research. Objective: Evaluate the validity of the scientific information that supports the data included in the pharmaceutical industry promotional brochures for internists and cardiologists and reconcile the information. Method: Promotional brochures were collected during national conferences of Internal Medicine (IM) and Cardiology (C), and 10 promotional brochures of each medical specialty were randomly selected. Three researchers evaluated the quality of the references, and the validity of the original research and compared the information from the promotional brochure and the original publication. Descriptive statistical analysis was performed. Results: 57 IM and 16 C promotional brochures were collected; the quality of the references of 4 promotional brochures from IM was classified as “moderate” evidence and the references of 4 promotional from C were identified as “non-scientific” evidence. Clinical trials of IM and C were evaluated as valid and an observational study of C was classified as invalid. Comparison between promotional information and the original study detected differences in four IM and four C promotions, according to the ethical criteria for the promotion of medicines by the World Health Organization (WHO) the lack of accuracy predominated, and in some cases, the information was not reliable and/or true. Conclusions: Training in critical lectures is crucial for medical doctors. This will allow them a critical review of promotional information from PI, to identify the ones that may lead to inappropriate prescription.

ABSTRACT Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

Objective: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. Methods: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. Results: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. Conclusion: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression. Clinical trial registration: ClinicalTrials.gov (NCT04123301).

Resumen: La amiloidosis es una enfermedad de depósito, donde un precursor proteico específico se pliega inadecuadamente desde su estructura terciaria a una de forma más plana, generando depósitos multisistémicos que comprometen la función de múltiples órganos. Se realizó una búsqueda no sistemática de la literatura, encontrando múltiples reportes de amiloidosis cardiaca en población estadounidense y europea, pero no se encontraron reportes de caso de amiloidosis cardiaca como presentación aguda de falla cardiaca en paciente anciano en Latinoamérica. Se presenta el caso clínico de una paciente de edad avanzada, quien debuta con falla cardiaca aguda de novo donde se pudo evidenciar un compromiso cardiaco por depósitos amiloides. La sospecha clínica es fundamental, ya que el compromiso cardiovascular ha aumentado en frecuencia en los últimos años, y un diagnóstico oportuno muchas veces determina el pronóstico.

Abstract: Amyloidosis is a deposit disease, in which a specific protein precursor inadequately folds from its tertiary structure to a flatter one, generating multisystemic deposits that affect the organs’ function. A non-systematic review of the literature was performed, and multiple reports of cardiac amyloidosis in the American and European populations were found. However, no cases of cardiac amyloidosis with acute heart failure were exhibited in elderly patients in Latin America. The case of an elderly patient who debuted with acute heart failure in which cardiac compromise due to amyloid deposits was evidenced is presented below. Clinical suspicion is fundamental, as cardiovascular involvement has increased in frequency in recent years, and a timely diagnosis often determines the prognosis.

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

Resumo Neste artigo discute-se a arquitetura de um estado de exceção de novo tipo no Brasil, na qual a força de lei foi utilizada como arma política (lawfare). Aponta que a 4.ª Vara Federal, em Curitiba, atuou como um tribunal de exceção a partir de uma série de práticas que ferem a Constituição Nacional e o devido processo legal, e que interferiram na normalidade do processo político. Como exemplos, analisa o processo do Mensalão, o impeachment da Presidenta Dilma e as ações da Lava Jato, que culminaram na prisão de Lula e pavimentaram o caminho para a eleição de Bolsonaro. Conclui-se que parte do judiciário brasileiro agiu como agente político utilizando a lei como arma.

Abstract This article discusses the architecture of a state of exception in Brazil, in which the force of law was used as a political weapon (Lawfare). It points out that the 4th Federal Court, in Curitiba, acted as a court of exception from a series of practices that hurt the national constitution and due process of law, and which interfered with the normality of the political process. As examples, he analyses the process of monthly, the impeachment of President Dilma and Lava Jato’s actions, which culminated in Lula’s arrest and paved the way to Bolsonaro’s election. It is concluded that part of the Brazilian judiciary acted as a political agent using the law as a weapon.

RESUMO RACIONAL: A hérnia incisional é caracterizada por um abaulamento da parede abdominal causada por um prolapso das estruturas intracavitárias, como um segmento do intestino delgado, através de um orifício de trocarte. A ultrassonografia e o exame físico são usados no diagnóstico da hérnia incisional. OBJETIVOS: Avaliar a diferença entre o exame físico e a ultrassonografia abdominal no diagnóstico da hérnia incisional em pacientes submetidos a cirurgia bariátrica por videolaparoscopia. MÉTODOS: O total de 123 pacientes submetidos à cirurgia bariátrica, tipo derivação gástrica em Y de Roux, foram avaliados para a presença ou ausência de hérnia incisional por exame físico e ultrassonografia, nos sítios incisionais de cada trocarte. RESULTADOS: O total de sete hérnias foram detectados por exame físico, enquanto a ultrassonografia detectou um total de 56 hérnias em pelo menos um sítio incisional. A análise de concordância de Lin mostrou que os testes empregados não são concordantes. A associação entre o Índice de Massa Corpórea e a detecção de hérnia foi observada (p=0.04, para exame físico, p=0.052 para ultrassonografia). A ultrassonografia detectou mais hérnias incisionais em trocartes de 10 mm ou mais do que em trocartes de 5 mm (p<0,0001, p<0.05). Não foi observada diferença entre os tipos de trocartes empregados. CONCLUSÕES: A ultrassonografia abdominal demonstrou ter acurácia mais elevada que o exame físico, resultando em um aumento substancial na detecção de hérnia incisional nos locais de inserção dos trocartes.

ABSTRACT BACKGROUND: Incisional hernia is characterized by a bulging of the abdominal wall caused by the prolapse of intracavitary structures, such as a segment of the small intestine, through the trocar orifice. Ultrasonography and physical examination are used in the diagnosis of incisional hernia. AIMS: This study aimed to evaluate the difference between physical examination and abdominal ultrasonography at the diagnosis of incisional hernia in patients who underwent laparoscopic bariatric surgery. METHODS: A total of 123 patients who underwent Roux-en-Y gastric bypass type bariatric surgery performed by laparoscopy were analyzed for the presence or absence of hernia by physical and ultrasonography examination at each trocar incision site. RESULTS: In our results, a total of 7 hernias were detected by physical examination, while ultrasonography detected a total of 56 hernias in at least one of the incision sites. Lin's concordance analysis showed that the tests are not concordant. The association between body mass index and hernia detection (p=0.04 for physical examination and p=0.052 for ultrasonography) was observed. Ultrasonography detected more incisional hernias in 10-mm or larger trocars than in 5-mm trocars (p<0.0001, p<0.05). No differences were noted among the trocar types that were used. CONCLUSIONS: Abdominal ultrasonography showed to have a higher accuracy than physical examination, resulting in a substantial increase in incisional hernia detection at the trocar sites.

Resumen Se realizó una revisión de literatura acerca de los aportes investigativos de la resiliencia en el deporte entre los años de 2010 y 2020 en una muestra de 239 artículos que respondieron a criterios de inclusión como: artículos originales, de revisión de literatura, estudios cualitativos, cuantitativos o mixtos publicados; tesis o trabajos de grado y capítulos de libro. La búsqueda se realizó en las bases de datos de PubMed, Ebsco Host, Science Direct, Scopus, PsyINFO. Se encontró que la investigación y aportes de la resiliencia en el deporte son numerosos y aplicados a una gran diversidad de modalidades deportivas y a nivel de actividad física, deporte formativo y competitivo. Se encontraron predominantemente estudios cuantitativo-descriptivos; sin embargo se destacan diversos enfoques metodológicos. Se observó además que los estudios se orientaron hacia las poblaciones de adultos y adolescentes, y un tercer foco de interés son las revisiones de literatura. Los campos en los que se exploró la resiliencia en el deporte se asociaron al desempeño en competencia, afrontamiento de la adversidad, situaciones estresantes, o de burn out, como dimensión motivacional. Se concluye con la necesidad de realizar estudios específicos por práctica deportiva, tipos de deporte y fenómenos psico-sociales relacionados como la influencia de la recuperación de lesiones, estados anímicos y situaciones adversas extradeportivas y extra-competición.

Abstract A literature review was conducted on the research contributions on resilience in sports between 2010 and 2020 in a sample of 239 articles, which responded to inclusion criteria such as original articles; literature reviews; qualitative, quantitative, or mixed published studies; thesis or degree works; and book chapters. The search was carried out in PubMed, Ebsco Host, Science Direct, Scopus, and PsycINFO databases. It was found that research and contributions on resilience in sports are numerous and applied to a great diversity of sports modalities and at the level of physical activity and formative and competitive sports. Quantitative-descriptive studies were predominantly found; however, different methodological approaches are highlighted. It was also observed that the studies were oriented towards adult and adolescent populations, and a third focus of interest is literature reviews. The fields in which resilience in sports was explored were associated with performance in competition, coping with adversity, stressful situations, or burnout, as a motivational dimension. It is concluded that it is necessary to carry out specific studies by sports practice and types of sports, and the related psycho-social phenomena, such as the influence of injury recovery, moods, and adverse extra-sports and extra-competition situations.

Resumen La investigación biomédica en seres humanos en los países con mediano o bajo ingreso ha despertado el interés de la bioética por cómo lograr una distribución equitativa de los beneficios. Las cuestiones de justicia se han abordado bajo el concepto de «disponibilidad razonable» o «distribución justa de los beneficios». Sin embargo, la insuficiencia de este enfoque radica en que las cuestiones públicas se han abordado desde los principios bioéticos de beneficencia, no maleficencia y justicia. Recientemente se ha abordado el tema desde la justicia social, pero el enfoque propio de la ética referida a las poblaciones o ética pública es una asignatura pendiente de profundizar. Este trabajo quiere señalar la importancia de este enfoque complementario. Se pretende, desde la ética pública, ver la necesidad de enfocarse en el valor social del conocimiento generado, y ofrecer algunos criterios orientadores para ser detectados por los Comités de Ética de la Investigación.

Abstract Biomedical research on human subjects in Middle-Low and Low Income Countries (LMICs or LICs) has aroused the interest of bioethics in how to achieve an equitable distribution of benefits. Questions of justice have been addressed under the concept of «reasonable availability» or «fair benefit sharing». However, the inadequacy of this approach lies in the fact that public issues have been addressed from the bioethical principles of beneficence, non-maleficence and justice. Recently, the subject has been approached from the standpoint of social justice, but the approach of ethics referring to populations or public ethics is a pending subject to be studied in greater depth. This paper aims to point out the importance of this complementary approach. It is intended, from public ethics, to see the need to focus on the social value of the knowledge generated, and to offer some guiding criteria to be detected by Research Ethics Committees.

Resumen La cardiomiopatía hipertrófica apical es una forma poco común de cardiomiopatía hipertrófica que se caracteriza por un compromiso, casi exclusivo, del ápice ventricular izquierdo, y se distingue por la morfología de as de picas en la ventriculografía. La heterogeneidad y la variabilidad en la presentación de esta patología y de su curso clínico hacen que sea un diagnóstico fácilmente omitido. Describimos el caso clínico de un paciente con cardiomiopatía hipertrófica apical que debutó con dolor precordial típico y síncope de origen cardiogénico. El propósito de este reporte es revisar las características principales de una afección poco frecuente, incluyendo su epidemiologia, diagnóstico, pronóstico y tratamiento, y así facilitar al personal médico el momento en que se enfrente a ella en la práctica clínica.

Abstract Apical hypertrophic cardiomyopathy is an uncommon form of hypertrophic cardiomyopathy characterized by a compromise of the left ventricular apex and is distinguished by the ace morphology in the ventriculography. The heterogeneity and variability in the presentation of this pathology and the clinical course, make a diagnosis easily omitted. We describe a clinical case of a patient with apical hypertrophic cardiomyopathy that debuted with precordial pain and syncope of cardiogenic origin. The purpose of this report is to review the main characteristics of a rare pathology, epidemiology, diagnosis, prognosis and treatment and thus, to provide medical personnel with the approach of this pathology in clinical practice.

Resumen La contaminación de aguas superficiales y subterráneas por herbicidas como la atrazina ocurre por lixiviación a través del perfil del suelo. El objetivo del estudio fue evaluar la movilidad de atrazina en parcelas dedicadas al cultivo de maíz, cada una con un tipo de suelo distinto ubicadas en los municipios de San Nicolás Buenos Aires (Regosol) y Los Reyes de Juárez (Calcisol), Puebla, México. Se realizaron experimentos de desplazamiento en columnas empacadas de suelo (8.5 cm de diámetro y 30 cm de longitud). Sobre cada columna se aplicó una concentración acuosa de 6.25 g L-1 de atrazina (Gesaprim®). Se empleó, primero, un volumen de poro de una solución reconstituyente del suelo (sin atrazina) y posteriormente, se aplicaron 30 volúmenes de poro de agua de riego que contenía atrazina. Se analizaron los lixiviados y tres profundidades de las columnas de suelo (0-2 cm, 2-10 cm y 10-20 cm, respectivamente). Los resultados de correlación de Pearson mostraron que la materia orgánica, textura y la capacidad de intercambio catiónico fueron las características fisicoquímicas del suelo que afectan a la movilidad de la atrazina. La atrazina presentó un coeficiente de retardo de 1.08 en Regosol y de 1.03 en Calcisol. El transporte del herbicida fue nueve veces mayor velocidad en el Regosol con respecto al Calcisol. La atrazina se mantuvo retenida en una mayor cantidad en los dos centímetros de las columnas de suelo. El porcentaje de masa degradada de atrazina fue de 94% para el Regosol y 69% para el Calcisol.

Abstract Surface and groundwater contamination by herbicides such as atrazine occurs by leaching through the soil profile. The objective of the study was to evaluate the mobility of atrazine in plots dedicated to maize cultivation, each with a different type of soil located in the municipalities of San Nicolás Buenos Aires (Regosol) and Los Reyes de Juárez (Calcisol), Puebla, Mexico. Displacement experiments were conducted on soil packed columns (8.5 cm in diameter and 30 cm in length). An aqueous concentration of 6.25 g L-1 of atrazine (Gesaprim®) was applied to each column. First, a pore volume of a soil restorative solution (without atrazine) was used and subsequently, 30 volumes of irrigation water pore containing atrazine were applied. The leachates and three depths of the soil columns (0-2 cm, 2-10 cm and 10-20 cm, respectively) were analyzed. Pearson’s correlation results showed that organic material, texture and cation exchange capacity were the physicochemical characteristics of the soil that affect the mobility of atrazine. Atrazine had a delay coefficient of 1.08 in Regosol and 1.03 in Calcisol. The transport of the herbicide was nine times faster in the Regosol compared to Calcisol. Atrazine was retained in a greater amount in the first two centimeters of soil columns. The degraded mass percentage of atrazine was 94% for Regosol and 69% for Calcisol.

Resumen: Los resultados aportados por la Investigación sobre la Educación Médica analizados desde un enfoque bioético basado en los derechos humanos, han dejado ver que los derechos a una educación médica de calidad, a un empleo digno de los médicos residentes, y a la atención de la salud de los pacientes, quedan en entredicho bajo el sistema educativo actual. Tales falencias han generando una situación de violencia sistémica que se ha estructurado a distintos niveles: violencia subjetiva o aquella directamente ejercida contra los médicos; objetiva o la implícita en las relaciones de dominación que han caracterizado el sistema educativo médico; y violencia simbólica que ha normalizado las relaciones de explotación en el sistema educativo en salud mexicano. Todo lo anterior ha repercutido en mermas en la atención de la salud de los pacientes.

Abstract: The results provided by the Research on Medical Education, analyzed using a bioethical approach based on human rights, have showed that the rights to quality medical education, worthy jobs for resident doctors, and healthcare for patients, are questioned under the current educational system. These failures have generated a situation of systemic violence structured as: subjective, or the violence directly exerted against doctors; objective or the violence that is implicit in the relationships of domination that have characterized the medical education system; and the symbolic violence that has made exploitative relationships in the Mexican health education system seem normal. All of the aforementioned have produced deficiencies in the health care of patients.

Resumen: Introducción: La etiología del derrame pericárdico es altamente variable en diferentes regiones del mundo. Este estudio describe las características clínicas y la etiología del derrame pericárdico severo en una serie de casos atendidos en un hospital de tercer nivel de la ciudad de Medellín, Colombia. Material y métodos: Serie de casos retrospectiva basada en registros clínicos. Se incluyeron todos los pacientes atendidos entre 2006 y 2018 que presentaron derrame pericárdico severo y requirieron intervención para extracción del líquido pericárdico. Los criterios de exclusión fueron la ausencia de más de 50% de los datos en la historia clínica. Para el análisis únicamente se tuvo en cuenta el primer derrame pericárdico y no la recurrencia de éste. Se describen etiología, indicación de drenaje y comorbilidades de los pacientes. Resultados: Se incluyeron 48 pacientes, 50% hombres, edad media 52.4 años (DE 17.5). Las etiologías no infecciosas fueron las más frecuentes (66.7%), seguidas por derrames pericárdicos idiopáticos (20.8%) y etiologías infecciosas (12.5%), la mayoría secundarias a tuberculosis. La principal indicación de drenaje fue búsqueda etiológica (58.0%) y la principal comorbilidad fue hipertensión (40.0%). Conclusiones: Las causas no infecciosas fueron las más comunes, contrario a lo reportado en otras series para países en vía de desarrollo donde las causas infecciosas son las más frecuentes. Aunque la etiología idiopática fue inferior a las reportadas en otras series, continúa siendo un número representativo de pacientes en los que no se logra establecer la etiología.

Abstract: Introduction: The etiology of pericardial effusion is highly variable around the world. The present study describes the clinical features and etiologies of severe pericardial effusion in a series of cases treated at a third-level hospital in Medellín, Colombia. Material and methods: Retrospective case series based on clinical records. All patients treated between 2006 and 2018 with severe pericardial effusion requiring intervention for pericardial fluid drainage were included. The exclusion criteria were the absence of more than 50% of the data in the clinical history and the recurrence of the pericardial effusion after its first drainage. Etiology, indications for pericardial drainage and patient comorbidities are described. Results: 48 patients were included, 50% men with a mean age of 52.4 years (SD 17.5). Non-infectious etiologies were the most common causes of severe pericardial effusion (66.7%), followed by idiopathic (20.8%) and infectious causes (12.5%), being tuberculosis the most important. The main indication for pericardial drainage was to determine its etiology (58.0%) and the most relevant comorbidity was hypertension (40.0%). Conclusions: The main causes of severe pericardial effusion were non-infectious, unlike previous reports from developing countries where infectious diseases are considered the most common. Although, the frequency of idiopathic etiology was lower than that reported in other series, it continues to be a representative number of patients in which the etiology cannot be established.