Resumen Caso 1: Femenino de cuatro años de edad con absceso cervical izquierdo recurrente por fístula del seno piriforme izquierdo tratada finalmente con electrocoagulación endoscópica sin recidivas en más de siete meses. Caso 2: Masculino de seis años de edad con absceso cervical izquierdo recurrente por fístula del seno piriforme izquierdo tratado con electrocoagulación endoscópica sin recidivas en más de 6 meses. Discusión: Las fistulas del seno piriforme son poco comunes, resueltas en forma quirúrgica con amplias disecciones cervicales y en ocasiones con hemitiroidectomías. No suelen sospecharse sino hasta la recurrencia del cuadro. Aunque no todos los abscesos cervicales son por fístulas del seno piriforme, recomendamos descartarla en casos de recidiva sobre todo en el lado izquierdo del cuello; acompañando el drenaje con exploración endoscópica. De confirmarse el diagnóstico se ofrece tratamiento por electrocoagulación en la misma intervención con mejores resultados al evitar los riesgos que implica la resección extensa del tratamiento convencional. En nuestros casos usamos endoscopía flexible y electrocoagulación con resultados superiores en relación con el tratamiento quirúrgico convencional. Limitaciones: Solo se trata de dos casos, pero corresponden a una entidad poco frecuente. Valor: Se muestra como alternativa el tratamiento endoscópico con electrocoagulación con mejores resultados en relación con el manejo tradicional para los casos de fístula del seno piriforme en niños.

Abstract Case 1: A 4-year-old female with a recurrent left cervical abscess due to a left piriform sinus fistula finally treated with endoscopic electrocoagulation without recurrences for more than 7 months. Case 2: 6-year-old male with recurrent left cervical abscess due to left piriform sinus fistula treated with endoscopic electrocoagulation without recurrences for more than 6 months. Discussion: Piriform sinus fistulas are rare and are surgically corrected with extensive cervical dissections and occasionally hemithyroidectomies. They are not usually noticed as such until the recurrence. Although not all cervical abscesses are due to piriform sinus fistulas, we recommend ruling out in cases of recurrence, especially on the left side of the neck, accompanying by drainage with endoscopic exploration. If the suspicion is confirmed, electrocoagulation treatment is offered in the same intervention with better results by avoiding the risks involved in an extensive resection with conventional treatment. In our cases we use flexible endoscopy and electrocoagulation with better results compared to conventional surgical treatment. Limitations: These are only two cases, but they are rare. Value: Endoscopic treatment with electrocoagulation is shown as an alternative with better results in relation to traditional management for cases of piriform sinus fistula in children.

ABSTRACT The welding of dissimilar steels such as duplex and superaustenitic stainless steels is often used in industrial applications. The effect of welding energy on the heat-affected zone (ZTA) and fusion zone (ZF) presents knowledge gaps to be researched in relation to the metallurgical and mechanical properties of these steels. Variations in the application of welding energy can favor the presence of a greater volume of the ferritic or austenitic phases, and in more critical cases, cause the formation of precipitates harmful to corrosion. This work aims to evaluate the metallurgical, mechanical properties and corrosion resistance of dissimilar welding composed of duplex stainless steel S32205, as base metal, and superaustenitic stainless steel as weld metal, verifying the effects on microstructural, sensitization and anisotropies with the application of different heat inputs. In the microstructural analysis, the formation of first phase constituents, such as grain boundary austenite (GBA), witmanstatten austenite (WA), intragranular austenite (IGA) and secondary austenite (γ2) was verified. The microhardness values found were higher than those reported in the literature. In the corrosion tests, in environments with oxidizing chlorides, the samples showed pitting corrosion, with a high loss of mass in the specimens being detected. It is concluded that in the ZTA the metallurgical characteristics were maintained after the variation of the thermal input and in the ZF there was an increase in the loss of mass in the corrosion test in the analyzed samples.

RESUMO A soldagem de aços dissimilares, como os aços inoxidáveis duplex e superausteníticos é muitas vezes utilizada em aplicações industriais. O efeito da energia de soldagem na zona termicamente afetada (ZTA) e zona de fusão (ZF) apresenta lacunas de conhecimento a serem pesquisadas em relação às propriedades metalúrgicas e mecânicas destes aços. Variações na aplicação da energia da soldagem podem favorecer a presença de maior volume das fases ferrítica ou austenítica, e em casos mais críticos, ocasionar a formação de precipitados deletérios à resistência a corrosão. Este trabalho tem o objetivo avaliar as propriedades metalúrgicas, mecânicas e a resistência à corrosão da soldagem dissimilar composta de aço inoxidável duplex S32205, como metal de base, e aço inoxidável superaustenítico como metal de solda. Verificou-se os efeitos na microestrutura, sensitização e anisotropias com aplicação de diferentes aportes térmicos. Na análise microestrutural foi verificado a formação de constituintes de primeira fase, como a austenita de contorno de grãos (GBA), austenita de witmanstatten (WA), austenita intragranular (IGA) e austenita secundária (γ2). Os valores de microdureza encontrados foram superiores aos referenciados na literatura. Nos ensaios de corrosão, em ambientes com cloretos oxidantes, as amostras apresentaram corrosão por pitting, sendo detectada elevada perda de massa nos corpos de prova. Conclui-se que na ZTA as características metalúrgicas se mantiveram após a variação do aporte térmico e na ZF houve incremento da perda de massa no ensaio de corrosão nas amostras analisadas.

Resumen Introducción: La cuantificación de SARS-CoV-2 en aguas residuales es una herramienta que permite determinar la tendencia de la circulación viral en un área geográfica determinada. Objetivo: Cuantificar el virus SARS-CoV-2 en 15 plantas de tratamiento de aguas residuales en diferentes ciudades de Chile para establecer una comparación con las variables de: i) casos activos por cada 100.000 habs.; ii) positividad diaria (casos nuevos); y iii) fases del plan de confinamiento. Metodología: SARS-CoV-2 se concentró a partir de muestras de aguas residuales. Para obtener el número de genomas del virus por litro se realizó una cuantificación absoluta utilizando qRT-PCR. Resultados: Entre enero y junio de 2021 se procesaron 253 muestras, siendo todas positivas para la presencia del virus. Asimismo, se logró determinar que la tasa de casos activos por cada 100.000 habs. es la variable que mejor se ajusta a las tendencias obtenidas con la cuantificación de la carga viral en las aguas residuales. Conclusiones: La cuantificación de SARS-CoV-2 en las aguas residuales de manera permanente es una herramienta eficiente para determinar la tendencia del virus en un área geográfica determinada y, en conjunto con una vigilancia genómica, puede constituirse en una vigilancia centinela ideal generando alertas sobre futuros brotes.

Abstract Background: The quantification of SARS-CoV-2 in wastewater is a tool that allows determining the trend of viral circulation in a particular geographical area. Aim: To quantify the SARS-CoV-2 virus in 15 wastewater treatment plants in different Chilean cities to establish a comparison with the variables of: i) Active cases per 100,000 inhabitants; ii) daily positivity (novel cases); and iii) phases of the lockdown strategy. Methods: SARS-CoV-2 was concentrated from wastewater samples. To obtain the number of virus genomes per liter, absolute quantification was performed using qRT-PCR. Results: Between January and June 2021, 253 samples were processed, all of which were positive for the presence of the virus. Likewise, it will be determined that the rate of active cases per 100,000 inhabitants is the variable that best fits the trends obtained with the quantification of the viral load in wastewater. Conclusions: The quantification of SARS-CoV-2 in wastewater as a continuous strategy is an efficient tool to determine the trend of the viral circulation in a delimited geographical area and, combined with genomic surveillance, it can constitute an ideal sentinel surveillance alert on future outbreaks.

Abstract Considerable differences exist in the quantification and clinical significance of both supraventricular and ventricular extrasystoles found in Holter recordings. Usually extrasystoles were classified as rare, occasional, frequent and very frequent. Current publications were analyzed regarding the frequency and clinical significance or these arrhythmias, especially in in relation to prior myocardial infarction, ventricular dysfunction, atrial fibrillation and cerebro vascular events. Tables showing limits to define the severity of supraventricular and ventricular extrasystoles are included.

Resumen En la actualidad existen diferencias en la interpretación y cuantificación de los extrasístoles supraventriculares y ventriculares en el Holter de ritmo cardíaco y no existe siempre una misma definición e interpretación de lo que se denomina como “escaso”, “ocasional”, “frecuente” o “muy frecuente”. El objetivo del presente trabajo ha sido revisar las evidencias actuales y sus fundamentos en relación a la cuantificación o carga de la extrasistolía supraventricular y ventricular en un Holter de ritmo cardíaco, lo que debiera contribuir a una mayor precisión y mejor interpretación de la información cuantitativa en la práctica clínica diaria con este examen. Se revisa en la literatura el concepto de carga de extrasístoles supraventriculares y ventriculares y su relación con eventos clínicos: fibrilación auricular y accidente cerebrovascular en el caso de la extrasistolía supraventricular y mortalidad post infarto y deterioro de la función ventricular en el caso de la extrasistolía ventricular. De esta manera se cuantifica en base a la evidencia la extrasistolía supraventricular y ventricular.

Resumen El cuento es uno de los recursos educativos más utilizados en las aulas de educación infantil. Con el objetivo de evaluar la adecuación de este tipo de literatura en contextos de coeducación, se presenta un estudio comparado desde una perspectiva de género. Se diseñó un instrumento de análisis de contenido exprofeso para comparar 40 cuentos (20 clásicos y 20 actuales) con el programa de análisis cualitativo Atlas.ti. Los resultados indican que siguen existiendo elementos sexistas en los cuentos que se utilizan en las aulas. No obstante, en la literatura infantil actual existe una evolución positiva hacia la equidad, ya que ahora presta mayor atención a la perspectiva de género, a la diversidad de tipologías familiares o a la igualdad en las tareas, lo cual marca una línea de evolución deseable, aunque todavía existen ciertos aspectos que no reflejan una imagen igualitaria. Se ofrecen recomendaciones para usar en el aula de infantil.

Abstract Children’s tales are one of the most used educational resources in early childhood education classrooms. With the aim of evaluating the adequacy of this type of literature in coeducation contexts, we developed a comparative study from a gender perspective. We designed a content analysis instrument expressly to compare 40 children’s tales (20 classics and 20 contemporary stories) using the qualitative analysis program Atlas.ti. The results indicate that there are still sexist elements in the stories used in childhood education. However, in current children’s literature there is a positive evolution towards equity, since it now pays more attention to gender perspective, to the diversity of family typologies and to task equality, which marks a desirable line of evolution, although there are still certain aspects that do not reflect an egalitarian image. Finally, we present a series of recommendations for childhood educations courses.

Abstract: The objective of this work is to describe the current situation and the projections of forensic voice comparison in Chile, in the light of international standards that focus on the production of reliable evidence that can be used in the courts of justice. To do this, first, the scientific foundations that characterize this branch of forensic sciences are disclosed and, then, on that basis, the situation in Chile and its projections are analyzed and discussed, both in practice and in the forensic research.

Resumen: El objetivo de este trabajo es describir la situación actual y las proyecciones de la comparación forense de la voz en Chile, a la luz de los estándares internacionales que se enfocan en la producción de evidencia confiable, que pueda ser utilizada en los tribunales de justicia. Para ello, en principio, se dan a conocer los fundamentos científicos que caracterizan esta rama de las ciencias forenses y, luego, sobre esa base se analiza y comenta la situación de Chile y sus proyecciones, tanto en la práctica como en la investigación forense.

Resumen Los anfibios y los reptiles han ganado popularidad como mascotas y el número de especies que se ofrecen a la venta va en aumento. Se ha reconocido la necesidad de realizar estudios que analicen los delitos contra la vida silvestre a nivel mundial para tener una mejor comprensión del fenómeno. Con el objetivo de conocer cuantas especies y cuáles son las que se venden en la Ciudad de México, realizamos 14 visitas a tres importantes mercados y realizamos un análisis de los grupos de anfibios y reptiles vendidos como mascotas y animales ornamentales. Registramos un total de 31, 919 individuos de 90 especies diferentes (14 de anfibios, 76 de reptiles) y encontramos que el 92.8% de los anfibios y el 76.9% de los reptiles están protegidos por la Norma mexicana NOM059, la Lista Roja de la UICN y/o CITES. Se encontraron diferencias significativas (W = 3.14, p < 0.05) en el número de organismos registrados de las especies de anfibios, así como en el número de individuos registrados por especie de reptiles (W = 7.52, p < 0.001). Consideramos necesario evaluar todas las especies nativas de anfibios y reptiles en los mercados que podrían ser incluidos en programas de aprovechamiento sustentable como una herramienta para su manejo.

Abstract Amphibians and reptiles have gained popularity as pets, and the number of species offered for sale is increasing. The need to carry out studies that analyze wildlife crime within countries has been recognized in order to have a better understanding of the phenomenon. In order to know how many species and which ones are sold in Mexico City, we conducted 14 visits to three major markets in Mexico City and conducted an analysis of the groups of amphibians and reptiles sold as pets and ornamental animals. We recorded a total of 31,919 individuals comprising 90 different species (14 amphibians, 76 reptiles) and found that 92.8% of the amphibians and 76.9% of the reptiles are protected by the Mexican government NOM-059, IUCN Red List and/or CITES. Significant differences (W = 3.14, p < 0.05) were found in the number of registered organisms of the amphibian species, as well as in the number of registered individuals per reptile species (W = 7.52, p < 0.001). We consider it necessary to evaluate all native species of amphibians and reptiles in the markets that could be included in sustainable use plans as a tool for their management.

Background: Transcatheter aortic-valve implantation (TAVI) was introduced in 2002 and the first implants in our country were performed in 2010. Aim: To review the TAVI experience in our hospital, considering the technology improvements and gained experience throughout this period. Material and Methods: All patients undergoing TAVI in our center were included. Results and complications were adjudicated according to the Valve Academic Research Consortium-2 (VARC-2) criteria. Patients were divided in 3 groups, according to procedural year: Period 1: 2010-2015 (n = 35); Period 2: 2016-2018 (n = 35); Period 3: 2019-2021 (n = 41). Mortality up to one year after the procedure was recorded. Results: Between 2010 and 2021, 111 TAVI procedures were performed. The mean age of patients was 82 years and 47% were women. Risk scores for in-hospital mortality were STS 6.7%, EUROSCORE II 8.0% and ACC/STS TAVR Score 4.9%. The trans-femoral route was used in 88% and a balloon-expandable valve was chosen in 82% of patients. A successful implant was achieved in 96%, with an in-hospital mortality of 1.8%. Mortality at 30 days and 1-year were 2.7 and 9.0%, respectively. During period 3, 100% of implants were successful, with no in-hospital mortality, less vascular complications (p < 0.01), less stroke (p = 0.04), less severe paravalvular leak (p = 0.01) and significantly lower rate of acute complications (p < 0.01). Conclusions: TAVI achieves excellent results. With greater experience and better available technologies, these results are even more favorable.

Abstract Objective: To know the epidemiological behavior and associations of AF in Mexican population. Material and methods: 8,686 patients from 38 cardiologists participating in REMECAR were analyzed. They were divided by gender and age, the comorbidities studied were obesity, chronic kidney disease (CKD), high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia, stroke, chronic obstructive pulmonary disease (COPD), hypothyroidism, heart failure (HF) and ischemic heart disease (IHD). Program used: IBM SPSS Statistic. Results: AF was diagnosed in 498 patients (5.7%), with higher prevalence in men (6.1% vs. 5.3%) and older age in women (74.3 ± 12.1 vs. 70.5 + -12.3 years, p<0.0001). In those under 60 years, AF was associated in women with HF, in men with CKD, DM, stroke, hypothyroidism and HF. In women older than 60 years, AF was associated with CKD, dyslipidemia, stroke, chronic COPD and HF, in men with CKD, stroke, COPD, hypothyroidism, HF and IHD. AF in women increase the probability 1.13 for obesity, 1.13 for HBP, 2.8 for CKD, 2.9 for COPD, 4.3 for stroke and 6.5 for HF, in men increase the probability 1.05 for HBP, 1.4 for DM, 2.1 for CKD, 2.4 for COPD, 3.0 for hypothyroidism, 4.7 for stroke and 6.0 for HF. Conclusions: AF is a very common arrhythmia, with a higher prevalence in patients attending the cardiology consultation, in men and with an older age of presentation in women. The older the age, the higher the prevalence of AF and comorbidities, HF is the most frequent condition associated with AF.

Resumen Objetivo: Conocer el comportamiento epidemiológico y asociaciones de la FA en población mexicana. Material y métodos: Analizamos 8,686 pacientes de 38 cardiólogos inscritos en REMECAR, divididos por edad y sexo. Comorbilidades estudiadas: obesidad, ERC, HTA, DM, dislipidemia, EVC, EPOC, hipotiroidismo, IC y CI. Programa: IBM SPSS. Resultados: FA en 498 pacientes (5.7%), mayor prevalencia en hombres (6.1 vs. 5.3%), mayor edad en mujeres (74.3 ± 12.1 vs. 70.5 ± 12.3 años, p < 0.0001). En mujeres menores de 60 años la FA se asoció con IC (p = 0.041), en hombres con ERC (p = 0.43), DM (p = 0.009), EVC (p = 0.001), hipotiroidismo (p = 0.001) e IC (p = 0.001). En mujeres mayores de 60 años se asoció con ERC (p = 0.001), dislipidemia (p = 0.001), EVC (p = 0.001), EPOC (p = 0.001) e IC (p = 0.001), en hombres con ERC (p = 0.002), EVC (p = 0.001), EPOC (p = 0.002), hipotiroidismo (p = 0.002), IC (p = 0.001) y CI (p = 0.033). En mujeres la FA se asoció con 1.13 veces mayor probabilidad de obesidad, 1.13 de HTA, 2.8 de ERC, 2.9 de EPOC, 4.3 de EVC y 6.5 de IC, en hombres la FA se asoció con 1.05 veces mas probabilidad de HTA, 1.4 de DM, 2.1 de ERC, 2.4 de EPOC, 3 de hipotiroidismo, 4.7 de EVC y 6 de IC. Conclusiones: La FA es una arritmia muy frecuente, con mayor prevalencia en pacientes que acuden a consulta de cardiología, en hombres y mayor edad de presentación en las mujeres. A mayor edad, mayor prevalencia de FA y de comorbilidades, la IC es la condición más frecuente con la que se asoció la FA.

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

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

Abstract Palliative care is the holistic care of individuais with serious health-related suffering due to severe illness. The improving survival in malignant and non-malignant diseases results in an ageing population who tive with advanced chronic diseases that commonly present to acute care settings. With our improved ability to relief symptoms and treat intercurrent complications, imaging can be an important aspect of modem palliative care. Point-of-care ultrasound (POCUS) is ultrasound used at the bedside to answer directed clinical questions and guide clinical care. The goals of our review are to provide greater understanding about utility and appropriateness of the use of POCUS in palliative care. The use of POCUS in the clinical setting has increased substantially in recent years, and its characteristics make it an attractive diagnostic and therapeutic adjunct in palliative care, namely in home-based care.

Resumo Os cuidados paliativas são cuidados holísticos prestados a indivíduos com sofrimento intenso decorrente de doença grave. A melhoria da sobrevida nas doenças malignas e não malignas levou ao envelhecimento da população, que vive com doenças crónicas avançadas e frequentemente recorre aos serviços de saúde. Os métodos imagiológicos não invasivos podem ter um papel importante nos cuidados paliativas modernos, no controlo sintomático e na abordagem de intercorrências agudas. A ecografiapoint-of-care (POCUS) trata-se da ecografia realizada à cabeceira do doente, para responder a questões clínicas dirigidas, com o objetivo de orientar a abordagem clínica. O objetivo da nossa revisão é contribuir para uma maior compreensão acerca da utilidade e adequação de POCUS em cuidados paliativas. A utilização do POCUS na prática clínica tem vindo a aumentar nos últimos anos e as suas características tornam-no uma ferramenta útil no diagnóstico e terapêutica em cuidados paliativas, nomeadamente em equipas de apoio comunitário.

Resumen Atendiendo a la relevancia de adaptarse y mitigar el cambio climático, las universidades son un escenario clave para el desarrollo de acciones que impacten a nivel social, económico, político y cultural sobre esta problemática. Como un aporte a este propósito, se realizó una investigación para describir los conocimientos y las percepciones sobre cambio climático en estudiantes universitarios de la Región Caribe colombiana. La muestra incluyó 1 275 estudiantes de siete universidades públicas. Los principales hallazgos muestran una marcada tendencia al reconocimiento de causas y efectos del cambio climático, así como de estrategias para su mitigación. Sin embargo, no suele asociarse a efectos relacionados con su cotidianidad y contextos inmediatos. Los resultados evidencian la necesidad de articular explícitamente los procesos de formación profesional al reconocimiento de acciones relacionadas con el cambio climático. Asimismo, esta información permite fortalecer lineamientos contextualizados sobre el abordaje de este fenómeno en la educación superior.

Abstract Adaptation and mitigation of climate change are relevant in current societies. In this way, universities are an important scenario for the development of strategies that contribute to social, economic, political, and cultural factors associated with this topic. As a contribution to this purpose, research was carried out to describe the knowledge and perceptions of climate change among university students in the Colombian Caribbean region. The sample included 1275 students from seven public universities. The main findings show a trend to recognize causes and effects of climate change, as well as mitigation strategies. However, climate change is not usually associated with effects related to their daily lives and immediate contexts. Results indicate that more articulation between professional training processes to the recognition of actions related to climate change is necessary. Likewise, conclusions allow us to strengthen contextualized guidelines on the approach to this phenomenon in higher education.

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

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