ABSTRACT: Nerium oleander, also known as “espirradeira” in Brazil, is a shrub or small tree widely used as an ornamental plant in temperate and subtropical regions of the world. Ingestion of N. oleander can cause intoxication due to the presence of cardioactive glycosides, in both humans and animals. This study aims to report the epidemiological, clinical, postmortem, and immunohistochemical features of an outbreak of natural intoxication by N. oleander in cattle and the use of immunohistochemistry (IHC) for troponin C, for the first time, in this intoxication in the species. Twenty-eight cattle had access to pruned branches of N. oleander and 20 animals started presenting clinical signs of apathy, anorexia, ataxia, tachypnea, tremors, and recumbency ten hours after the consumption. Eight cattle progressed to death 48 hours after the clinical progression and one was submitted for necropsy. Macroscopic findings included petechiae and ecchymosis on the epicardium and endocardium. Histologically, there were multifocal areas of necrosis of individual or multiple cardiomyocytes, mainly in the left ventricular papillary muscle. Immunohistochemistry for troponin C revealed decrease or absence of cytoplasmic immunolabeling in necrotic cardiomyocytes. Although intoxication by N. oleander is uncommon in cattle, it should be considered as a differential diagnosis for other conditions that cause sudden or acute death in livestock and IHC for troponin C is an auxiliary tool in the identification of peracute and acute cardiac lesions.

RESUMO: Nerium oleander, conhecido popularmente como “espirradeira” no Brasil, é um arbusto amplamente utilizado como planta ornamental em regiões temperadas e subtropicais do mundo. A ingestão de N. oleander pode causar intoxicação devido à presença de glicosídeos cardioativos, tanto em humanos, quanto em animais. Este trabalho tem como objetivo relatar os achados epidemiológicos, clínicos, patológicos e imuno-histoquímicos de um surto de intoxicação natural por N. oleander em bovinos e o uso da imuno-histoquímica (IHQ) para troponina C pela primeira vez nesse tipo de intoxicação na espécie. Vinte e oito bovinos tiveram acesso a galhos de N. oleander após poda e 20 desses bovinos apresentaram sinais clínicos de apatia, anorexia, ataxia, taquipneia, tremores e decúbito dez horas após a ingestão. Oito bovinos morreram 48 horas após o início do curso clínico e um animal foi submetido à necropsia. Os achados macroscópicos incluíram petéquias e equimoses no epicárdio e no endocárdio. Histologicamente, havia áreas multifocais de necrose de cardiomiócitos individuais ou múltiplos, principalmente no músculo papilar do ventrículo esquerdo. A IHQ para troponina C revelou uma acentuada diminuição ou ausência na imunomarcação citoplasmática em cardiomiócitos necróticos. Embora a intoxicação por N. oleander seja incomum em bovinos, ela deve ser considerada como diagnóstico diferencial para outras condições que induzam morte súbita ou aguda em rebanhos e a IHQ para troponina C é uma ferramenta complementar na identificação de lesões hiperagudas e agudas cardíacas.

ABSTRACT Introduction: Adherence to treatment and level of knowledge in patients with arterial hypertension are key factors to control this condition and avoid complications. Objectives: To determine the degree of adherence to treatment, the level of knowledge and comorbidities in patients with arterial hypertension in an urban area of Asunción, Paraguay, in 2022. Methodology: An observational, descriptive, cross-sectional design was applied. Men and women over 18 years of age, known carriers of arterial hypertension, residing in Sajonia neighborhood between May and October 2022, were included. The data were obtained through house-to-house interviews. Demographic variables, the level of adherence with the Morisky Green test and the level of knowledge about the disease with the Batalla test were measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: Four hundred twenty-five subjects participated in the study, predominantly female (61.1%). Diabetes mellitus was referred to by 28.9% of the interviewees. The Morisky Green test detected that 60% of the subjects forget to take their medication, 25% do not take it at the indicated time, 29% take it if they feel well, and 44% stop taking it if they feel undesirable effects. The Batalla test found that 7% believe that arterial hypertension is not for life, 9% believe that the condition is not controlled with diet and medication, and 5.8% could not refer to at least one target organ. Conclusion: Adherence to the treatment of arterial hypertension and the level of knowledge about this condition was not adequate.

RESUMEN Introducción: la adherencia al tratamiento y el nivel de conocimientos en pacientes con hipertensión arterial son factores claves para controlar esta afección y evitar complicaciones. Objetivos: determinar el grado de adherencia al tratamiento, el nivel de conocimientos y comorbilidades en pacientes con hipertensión arterial de un área urbana de Asunción, Paraguay, en 2022. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyeron varones y mujeres mayores de 18 años, conocidos portadores de hipertensión arterial, que residen en el barrio Sajonia entre mayo y octubre del 2022. Los datos fueron obtenidos con entrevistas realizadas casa por casa. Se midieron variables demográficas, el nivel de adherencia con el cuestionario de Morisky Green y el de conocimientos sobre la enfermedad con el cuestionario de Batalla. La investigación fue aprobada por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: participaron del estudio 425 sujetos, con predominio del sexo femenino (61,1%). La diabetes mellitus fue referida en 28,9% de los entrevistados. El cuestionario de Morisky Green detectó que 60% de los sujetos olvida de tomar su medicación, 25% no la toma en el horario indicado, 29% de la toma si se siente bien y 44% deja de tomarla si siente efectos indeseables. El cuestionario de Batalla halló 7% cree que la hipertensión arterial no es para toda la vida, 9% cree que la afección no se controla con dieta y medicación, y 5,8% no pudo referir al menos un órgano blanco. Conclusión: la adherencia al tratamiento de la hipertensión arterial y el nivel de conocimientos sobre esta afección no fue adecuada.

Resumen: Introducción: la fenocopia de Brugada es un fenómeno electrocardiográfico que presenta un patrón de Brugada tipo 1 o tipo 2 desencadenado por diversas condiciones clínicas subyacentes. Caso clínico: paciente masculino de 23 años que ingresó por ingesta de fosfuro de aluminio. Al ingreso, el electrocardiograma mostró patrón de Brugada tipo 1 con un ecocardiograma transtorácico que mostró una fracción de eyección del ventrículo izquierdo del 34% y discinesia apical. Se realizó un segundo electrocardiograma 24 horas después con taquicardia sinusal y sin evidencia del patrón de Brugada. Luego de 72 horas de mejoría clínica se reportó la contractilidad apical como normal. Conclusión: esta miocardiopatía aguda inducida por estrés por intoxicación con fosfuro de aluminio cumplió con los criterios para ser considerada como fenocopia de Brugada tipo 1 clase B.

Abstract: Introduction: Brugada phenocopy is an electrocardiographic phenomenon that presents a type 1 or 2 Brugada pattern triggered by various underlying clinical conditions. Case report: a 23-year-old male patient was admitted due to the ingestion of aluminum phosphide. At admission, an electrocardiogram showed a Brugada type 1 pattern with a transthoracic echocardiogram showing a left ventricular ejection fraction of 34% and apical dyskinesia. A second electrocardiogram was performed 24 hours later with sinus tachycardia and no evidence of the Brugada pattern. After 72 hours of clinical improvement, the apical contractility was reported as normal. Conclusion: this acute stress-induced cardiomyopathy by Aluminum phosphide intoxication met the criteria to be regarded as a type 1 class B Brugada phenocopy.

RESUMO Objetivo: Apresentar reflexões teórico-metodológicas sobre elaboraçõo, tipos e funções dos modelos teóricos, bem como suas estruturas conceituais e de análise. Métodos: Trata-se de um ensaio cujo processo de coleta do material foi realizado de forma não sistemática, eleito exclusivamente e baseado na linha de argumentaçõo e reflexão que os autores pretendem submeter à apreciaçõo e ao debate público. Resultados: Este trabalho apresenta reflexões sobre tipos e funções dos modelos teóricos, fundamentaçõo teórica nas pesquisas e reflexões sobre a importância dos modelos teóricos para as pesquisas em saúde pública e sua relaçõo com o processo de elaboraçõo, desenvolvimento e relato nos estudos científicos. Além disso, são descritos tipos de modelos teóricos referentes aos planos conceitual e empírico, e a importante elaboraçõo e descriçõo da junçõo de ambos para o fazer científico. Conclusão: Espera-se que este artigo levante discussões e reflexões sobre os métodos atuais que permeiam o fazer científico e fomentem a utilizaçõo dos modelos teóricos como base das pesquisas científicas em seu processo de elaboraçõo, desenvolvimento e relato.

ABSTRACT Objective: To present theoretical-methodological reflections on the elaboration, types, and functions of theoretical models as well as their conceptual and analytic frameworks. Methods: This is an essay, whose material collection was carried out in a non-systematic way, by electing studies exclusively based on the line of argument and reflection that the authors intend to submit to appreciation and public debate. Results: We present reflections on the types and functions of theoretical models, theoretical foundations in research, and reflections on the importance of theoretical models for public health research and their relation with the process of elaboration, development, and reporting in scientific studies. In addition, we describe types of theoretical models referring to the conceptual and empirical levels and the important elaboration and description of their combination for scientific practice. Conclusion: With this article, our intention is to stimulate discussions and reflections on current methods that permeate scientific practice and encourage the use of Theoretical Models as a basis for scientific research in its elaboration, development, and reporting process.

Abstract The aim of this study was to investigate the association between chronic Anaplasma marginale and Babesia spp. infection and hematological parameters of pregnant and non-pregnant taurine heifers. Blood samples from 94 females were collected on the first day (D-10) of timed artificial insemination (TAI) protocol and on pregnancy diagnosis (D+34). Hematological parameters were determined and compared between pregnant (PG) and non-pregnant (NPG) heifers, and within group at different sampling days. Real-time PCR (qPCR) was used to determine A. marginale and Babesia bovis infection, and for absolute quantification of Babesia spp. between PG and NPG groups. Correlation analysis was performed between the number of gDNA copies (CN) of Babesia spp. and hematological parameters. On D-10, mean hemoglobin concentration was higher for NPG, and hematocrit and total plasma protein were higher on D+34 for both groups. There was no difference in Babesia spp. CN between groups. In the first qPCR, all heifers were positive for A. marginale and B. bovis. Significant correlations were found between hemoglobin and erythrocyte and between hemoglobin and hematocrit (r = 0.8082 and r = 0.3009, respectively). Low levels of A. marginale and Babesia spp. did not affect hematological parameters of chronically infected pregnant and non-pregnant taurine heifers.

Resumo O objetivo deste estudo foi investigar a associação entre infecção crônica por Anaplasma marginale e Babesia spp. e parâmetros hematológicos de novilhas taurinas prenhes e não prenhes. Sangue de 94 fêmeas foi coletado no primeiro dia (D-10) do protocolo de inseminação artificial em tempo fixo (IATF) e no diagnóstico de gestação (D+34). Parâmetros hematológicos foram comparados entre novilhas prenhes (PG) e não prenhes (NPG) e dentro dos grupos entre dias de coleta. Usando-se PCR em tempo real (qPCR), determinou-se a infecção por A. marginale e Babesia bovis e quantificação absoluta de Babesia spp. Entre os grupos PG e NPG. A análise de correlação foi realizada entre o número de cópias (CN) de Babesia spp. e parâmetros hematológicos. No D-10, a concentração de hemoglobina foi maior para NPG e hematócrito, e proteína plasmática total foram maiores em D+34 para ambos os grupos. Não houve diferença para CN de Babesia spp. entre os grupos. Na primeira qPCR, todas as novilhas foram positivas para A. marginale e B. bovis. Correlações significativas foram encontradas entre hemoglobina/eritrócito e hemoglobina/hematócrito (r=0,8082 e r=0,3009, respectivamente). Baixos níveis de A. marginale e Babesia spp. não afetaram os parâmetros hematológicos de novilhas taurinas prenhes e não prenhes cronicamente infectadas.

RESUMO Objetivo: Apresentar reflexões teórico-metodológicas sobre elaboraçõo, tipos e funções dos modelos teóricos, bem como suas estruturas conceituais e de análise. Métodos: Trata-se de um ensaio cujo processo de coleta do material foi realizado de forma não sistemática, eleito exclusivamente e baseado na linha de argumentaçõo e reflexão que os autores pretendem submeter à apreciaçõo e ao debate público. Resultados: Este trabalho apresenta reflexões sobre tipos e funções dos modelos teóricos, fundamentaçõo teórica nas pesquisas e reflexões sobre a importância dos modelos teóricos para as pesquisas em saúde pública e sua relaçõo com o processo de elaboraçõo, desenvolvimento e relato nos estudos científicos. Além disso, são descritos tipos de modelos teóricos referentes aos planos conceitual e empírico, e a importante elaboraçõo e descriçõo da junçõo de ambos para o fazer científico. Conclusão: Espera-se que este artigo levante discussões e reflexões sobre os métodos atuais que permeiam o fazer científico e fomentem a utilizaçõo dos modelos teóricos como base das pesquisas científicas em seu processo de elaboraçõo, desenvolvimento e relato. Objetivo teóricometodológicas teórico metodológicas análise Métodos Tratase Trata se sistemática público Resultados científicos disso empírico Conclusão Esperase Espera

ABSTRACT Objective: To present theoretical-methodological reflections on the elaboration, types, and functions of theoretical models as well as their conceptual and analytic frameworks. Methods: This is an essay, whose material collection was carried out in a non-systematic way, by electing studies exclusively based on the line of argument and reflection that the authors intend to submit to appreciation and public debate. Results: We present reflections on the types and functions of theoretical models, theoretical foundations in research, and reflections on the importance of theoretical models for public health research and their relation with the process of elaboration, development, and reporting in scientific studies. In addition, we describe types of theoretical models referring to the conceptual and empirical levels and the important elaboration and description of their combination for scientific practice. Conclusion: With this article, our intention is to stimulate discussions and reflections on current methods that permeate scientific practice and encourage the use of Theoretical Models as a basis for scientific research in its elaboration, development, and reporting process. Objective theoreticalmethodological methodological frameworks Methods essay nonsystematic non systematic way debate Results development addition Conclusion article

Resumen Objetivo: Caracterizar la epidemiología de la discapacidad de origen vial e identificar factores asociados a la dependencia funcional, participación en actos familiares, educativos y laborales en Medellín, Colombia 2004-2017. Métodos: Estudio longitudinal, con fuente de información secundaria, colectada con encuesta voluntaria y aplicada durante valoración clínica. Se analizó el total de registros de personas con discapacidad de origen vial y se desarrollaron cuatro modelos de regresión logística para identificar factores asociados con dependencia funcional, participación familiar, académica y laboral, con un error p = 0,05. Resultados: Entre 2004-2017, Medellín tenía registradas 63 848 personas con discapacidad. La causa que más la generó fue la enfermedad general con 21 444 (33,3%) registros. Los incidentes viales ocuparon el primer lugar entre eventos externos con 3092 (39,3%) casos: 2181 hombres (70,5%) y 911 mujeres (29,5%). Tener dos o más dificultades permanentes incrementó el riesgo de dependencia funcional (OR = 2,15; IC95%: 1,75-2,65). La no participación en actos familiares era reducida en personas con nivel académico superior (OR = 0,71; IC95%: 0,53-0,96). No participación en educación aumentó al no recibir ingresos (OR = 1,71; IC95%: 1,40-2,09). No participación laboral incrementó por barreras personales (OR = 1,61; IC95%: 1,10-2,34). Conclusión: La discapacidad de origen vial empuja familias en Medellín a mayor pobreza económica. La reintegración y participación en actos familiares y comunitarios de víctimas viales se restringe por factores físicos, ambientales y actitudinales.

Abstract Objective: To characterize the epidemiology of disability of road origin and to identify factors associated with functional dependence, participation in family, educational, and labor events in Medellin, Colombia 2004-2017. Methods: Longitudinal study, with a secondary information source for analysis of related factors. The information was collected via a voluntary survey, applied during clinical assessment to identify physical and psychological deficiencies and participation restrictions. The total records of people with disabilities of road origin were analyzed and four logistic regression models were developed to identify factors associated with functional dependence, family, academic and work participation, with an error P = 0.05. Results: Between 2004-2017 Medellin had registered 63,848 people with disabilities. The cause that most generated it was general disease with 21,444 (33.3%) records; road incidents ranked first among incidents with 3,092 (39.3%) cases. Men with disabilities of road origin were 2,181 (70.5%) and women 911 (29.5%). Having two or more permanent difficulties increased the risk of functional dependence (OR = 2.15; CI 95%: 1.75-2.65). Non-participation in family events was reduced in people with a higher academic level (OR = 0.71; CI 95%: 0.53-0.96). Non-participation in education increased due to not receiving economic income (OR = 1.71; CI95%: 1.40-2.09). Non-participation in work increased due to personal barriers (OR=1.61, CI95%: 1.10-2.34). Conclusion: Road origin disability pushes families in Medellin towards greater economic poverty. The reintegration and participation in family and community events of road victims is restricted by physical, environmental, and attitudinal.

Resumen: La intervención coronaria percutánea (ICP) es actualmente el método de revascularización prevalente durante los últimos 40 años debido a su eficacia, baja tasa de complicaciones y mínima invasión, con el inconveniente de la restenosis. La estrategia dominante para mejorar la ICP para obtener beneficios a largo plazo es la utilización de stents liberadores de fármacos, aunque la tasa actual de restenosis intrastent es ≈10%, aparte de otros inconvenientes como la inserción de cuerpo extraño, riesgo de trombosis, hemorragia en pacientes de alto riesgo, potencial de atrapamiento de ramas y posibilidad de múltiples capas de metal después del tratamiento de la restenosis intrastent. El balón recubierto de fármaco puede reducir la restenosis sin dejar un cuerpo extraño ni agregar capas de metal, su uso está respaldado por declaraciones de consenso de grupos de expertos y actualizaciones de publicaciones de informes durante casi una década. El presente artículo es de la declaración del Colegio Mexicano de Cardiología Intervencionista y Terapia Endovascular (COMECITE) con respecto a la utilización actual del balón medicado coronario y recomendaciones en restenosis intrastent, vasos pequeños, bifurcaciones, descendente anterior izquierda/coronaria principal izquierda e infarto agudo de miocardio.

Abstract: Percutaneous coronary intervention (PCI) is currently the prevalent revascularization method for the last forty years due to its efficacy, low complication rate, and minimal invasion with still pending restenosis solution. The dominant strategy to improve PCI for long-lasting benefits is the utilization of drug-eluting stents (DES), even though the current in-stent restenosis (ISR) rate is ≈10%, plus the inconvenience of foreing body insertion, thrombosis risk, bleeding in high-risk patients, jailing branches potential and possible multiple metal layers after ISR treatment. Drug coated-balloon (DCB) may reduce restenosis without leaving a foreign body and adding metal layers. Several expert group consensus statements and updating report publications, support their utilization for almost a decade. The present paper is from the Mexican College of Interventional Cardiology and Endovascular Therapy (COMECITE) statement regarding current DCB utilization and recommendations in ISR, small vessels, bifurcations, left anterior descendent/left main coronary and acute myocardial infarction.

Resumen. La reorientación hacia la lucha contraguerrillas en la estrategia militar en la década de 1950, así como la alineación con los Estados Unidos como potencia dominante en el hemisferio occidental después de la Segunda Guerra Mundial, enriquecieron la doctrina del Ejército Nacional de Colombia. Este artículo estudia los antecedentes que permitieron implementar en la doctrina militar del Ejército colombiano un concepto militar que se abrió paso en el mundo en esos años: la aeromovilidad, para complementar la actuación en el marco de las maniobras terrestres ejecutadas por las tropas. El artículo analiza el Plan Lazo de 1962 y el reglamento EJC 3-10 de 1969 para establecer sus avances conceptuales, su influencia norteamericana, así como las circunstancias que impulsaron estos elementos nuevos, como la participación colombiana en la Guerra de Corea.

Abstract. The redirection of military strategy towards counter-guerrilla warfare in the 1950s and the United States’ positioning as the dominant power in the Western Hemisphere after World War II enriched the Colombian National Army’s doctrine. This article examines the background that enabled implementing the military concept of air mobility -prevalent worldwide in those years- in the Colombian Army’s military doctrine to complement the troops’ ground maneuver performance. To this end, the article analyzes the 1962 Lazo Plan and the 1969 EJC 3-10 regulation to establish their conceptual advances, American influence, and the circumstances that prompted these new elements, such as Colombia’s participation in the Korean War.

Resumen Usando las representaciones anatómicas de Cristy-Eckerman (C-E) / Segars y el formalismo MIRD, se estiman las dosis absorbidas en pulmones de pacientes recién nacidos explorados con radiofarmacos 133Xe (Ventilación) y 99mTc (MAA) (perfusión). Estas representaciones son fantomas utilizados en los cálculos de Monte Carlo en la determinación de fracciones absorbidas específicas, que asociadas al tiempo de residencia farmacéutica determinan la dosis absorbida. Preocupaciones sobre el impacto dosimétrico de usar estos agentes ventilación /perfusión, así como el uso de diferentes fantomas, se exploraron en pacientes recién nacidos. Cuando a los pulmones se exploran con 99mTc(MAA), la diferencia relativa en la dosis total entre las representaciones anatómicas de C-E/Segars fue de 1,0 %. Cuando a los pulmones se exploran con 133 Xe, la diferencia relativa en la dosis total entre las representaciones antropomórficas de C-E/Segars fue de 0,5 %. Independientemente del radiofármaco utilizado para los estudios pulmonares de un paciente recién nacido, la sustitución de la representación de C-E por la de Segars no refleja cambios muy significativos en el cálculo de la dosis absorbida en los pulmones, donde la mayor contribución dosimétrica es su autodosis que es suministrada principalmente por los electrones producidos a lo largo de la desintegración del 99mTc y 133Xe.

Abstract Using the Cristy-Eckerman (C-E)/Segars anatomical representations and the MIRD formalism, the Absorbed doses in lungs of newborn patients scanned with radiopharmaceuticals 133Xe (ventilation) and 99mTc (MAA) (perfusion) are estimated. These representations are phantoms used in Monte Carlo calculations to determine specific absorbed fractions, which, associated with the pharmaceutical residence time, determine the absorbed dose. Concerns about the dosimetric impact of using these ventilation / perfusion agents, as well as the use of different phantoms, were explored in newborn patients. When the lungs were scanned with 99mTc (MAA), the relative difference in total dose between the C-E / Segars anatomical representations was 1.0%. When the lungs were scanned with 133Xe, the relative difference in total dose between the anthropomorphic representations of C-E / Segars was 0.5%. Regardless of the radiopharmaceutical used for the pulmonary studies of a newborn patient, the substitution of the C-E representation for that of Segars does not reflect very significant changes in the calculation of the absorbed dose in the lungs, where the greatest dosimetric contribution is its self-dose, which is supplied mainly by the electrons produced during the 99mTc and 133 Xe decay.

Abstract Negative impacts of climate change are expected in the production of Coffea arabica L. one of the most commercialized tropical agroproducts in the world. However, most studies work with global circulation models, being of little use in making decisions on the scale of farm management. Given this, the objective of this study was to identify the suitability for the cultivation of C. arabica in the face of climate change and how tree cover mitigates the impacts of climate change in an agroforestry plot. The indices of climatic extremes were calculated (1961 to 2016 for Coatepec; 1985 to 2016 for Briones) and a trend analysis was carried out (Mann-Kendall). The temperature inside a plot, and on an open site, was monitored for two years (2017-2019). This was related to the climatic requirements of C. Arabica. Trends of increase (p < 0.05) of the minimum and minimum extreme annual temperatures were identified in the two stations near the plot (0.24 and 0.69 °C·decade-1 in Coatepec and 0.46 and 0.79 °C·decade-1 in Briones). The maximum temperature did not present significant increases, reducing the thermal amplitude. Both annual and seasonal precipitation shows trends of increase in intensity. All these conditions are still suitable for the cultivation of C. arabica. At the plot scale, the importance of tree cover is demonstrated, which in this agroforestry system allows to reduce the maximum temperature by 1.9 °C compared to an open site. Tree cover has also made it possible to mitigate extreme events.

Resumen Se prevén impactos negativos del cambio climático en la producción de Coffea arabica L. uno de los agroproductos tropicales más comercializados en el mundo. Sin embargo, la mayoría de los estudios trabajan con modelos de circulación global, siendo poco útiles en la toma de decisiones a escala de manejo de una finca. Ante ello, el objetivo de este estudio fue identificar la aptitud para el cultivo de C. arabica ante el cambio climático y cómo la cobertura arbórea mitiga los impactos del cambio climático en una parcela agroforestal. Se calcularon los índices de extremos climáticos (1961 a 2016 para Coatepec; 1985 a 2016 para Briones) y se realizó un análisis de tendencias (Mann-Kendall). Se monitoreó la temperatura en el interior de una parcela, y en un sitio abierto, durante dos años (2017-2019). Esto se relacionó con los requerimientos climáticos de C. arabica. Se identificaron tendencias de incremento (p<0,05) de las temperaturas mínima y mínima extrema anual en las dos estaciones cercanas a la parcela (0,24 y 0,69 °C·década-1 en Coatepec y 0,46 y 0,79 °C·década-1 en Briones). La temperatura máxima no presentó incrementos significativos, reduciendo la amplitud térmica. Tanto la precipitación anual y estacional muestran tendencias de incremento en intensidad. Todas estas condiciones siguen siendo aptas para el cultivo de C. arabica. A escala de parcela, se demuestra la importancia de la cobertura arbórea, que en este sistema agroforestal permite reducir la temperatura máxima 1,9 °C en comparación con un sitio abierto. Asimismo, la cobertura arbórea ha permitido mitigar eventos extremos.

ABSTRACT Edwards’ syndrome, or trisomy 18 syndrome, is an autosomal chromosomal disorder characterized by the presence of an extra chromosome 18, with distinctive clinical features. We present a case with a prenatal diagnosis based on obstetrical morphological ultrasound that led to the performance of a fetal echocardiography with findings of a pulmonary valve dysplasia with double injury and interventricular communication. Subsequently, cordocentesis is performed for karyotyping and genetic counseling.

RESUMEN El síndrome de Edwards o síndrome de trisomía 18 es un trastorno cromosómico autosómico que se caracteriza por la presencia de un cromosoma 18 extra, con rasgos clínicos distintivos. Se presenta un caso con diagnóstico prenatal basados en la ecografía morfológica obstétrica que condujeron a la realización ecocardiografía fetal donde resalta la displasia de la válvula pulmonar con doble lesión y la comunicación interventricular. Posteriormente se realiza cordocentesis para realización del cariotipo y asesoramiento genético.

RESUMO. Déficit de atenção e hiperatividade (TDAH) é uma das mais frequentes condições psiquiátricas da infância. Objetivo: O objetivo deste artigo foi identificar, sintetizar os resultados e avaliar criticamente todas as revisões sistemáticas (RS) da Cochrane sobre as intervenções farmacológicas para crianças e adolescentes (até 18 anos de idade) diagnosticados com transtorno do déficit de atenção com hiperatividade. Métodos: A pesquisa foi realizada na base de dados Cochrane de Revisões Sistemáticas — CDSR (via Wiley) em julho de 2020. Resultados: A estratégia de busca resultou em quatro RS de alta qualidade metodológica, que analisavam 51 ensaios clínicos randomizados (9.013 participantes). Comparado ao placebo, o tratamento com antidepressivos tricíclicos (desipramina), anfetamina e metilfenidato apresentou melhora nos sintomas, como dificuldade de concentração, impulsividade e hiperatividade no curto prazo (até seis meses). Houve aumento na ocorr≖ncia de eventos adversos, como redução do apetite, dificuldade para dormir e dor abdominal. Foram encontradas evid≖ncias insuficientes para apoiar os efeitos da suplementação com ácidos graxos poli-insaturados. Conclusões: Com base nos resultados de revisões sistemáticas Cochrane, o uso de antidepressivos tricíclicos, anfetamina e metilfenidato em crianças e adolescentes com TDAH parece apresentar efeitos positivos e taxas mais elevadas de eventos adversos menores quando comparado ao placebo. Dado o alto risco de viés nos estudos primários incluídos nessas RS, ainda são necessários novos ensaios clínicos randomizados com rigor metodológico para apoiar esses achados.

ABSTRACT. Attention deficit hyperactivity disorder (ADHD) is one of the most frequent childhood psychiatric problems. Objective: The objective of this study was to identify, synthesize the results, and critically evaluate all Cochrane systematic reviews (SRs) on the pharmacological interventions for children and adolescents (up to age 18) diagnosed with ADHD. Methods: The search was performed in the Cochrane Database of Systematic Reviews (via Wiley) in July 2020. Results: The search strategy resulted in four SRs of high methodological quality, analyzing 51 randomized clinical trials (9,013 participants). Compared to placebo, treatment with tricyclic antidepressants (TCAs) (desipramine), amphetamine, and methylphenidate showed improvement in symptoms such as difficulty concentrating, impulsivity, and hyperactivity in the short term (up to 6 months). There was an increase in the occurrence of adverse events, such as reduced appetite, difficulty sleeping, and abdominal pain. Insufficient evidence was found to support the effects of supplementation with polyunsaturated fatty acids. Conclusions: The use of TCAs, amphetamine, and methylphenidate in children and adolescents with ADHD seems to present positive effects and higher rates of minor adverse events when compared to placebo.