Abstract This essay responds to the contributions of Vicente Palermo and Roy Hora present in this same issue. issue

Resumen El presente ensayo responde a las contribuciones de Vicente Palermo y Roy Hora presenten en este mismo número. número

ABSTRACT Introduction: Fabry disease (FD) is an inborn error of metabolism characterized by α-galactosidase A deficiency. The primary objective was to evaluate the genetic and phenotypic profile of Fabry disease in hemodialysis. Methods: Observational cohort study to determine the incidence of genetic variations and phenotypic changes for FD in hemodialysis patients in the Paraiba Valley and Eastern São Paulo. Genetic testing for the GLA gene was performed for men and women over 12 years of age at the hemodialysis clinics between January 2016 and December 2019 as a screening protocol. Results: The cases came from screening exams of the index case among patients with chronic kidney disease, resulting in 17 families and totaling 82 patients under study. The classification of the most prevalent variant was that of uncertain significance (54%), followed by the pathogenic variant (46%). Five patients in two families were described with two types of variants not previously described in the literature, with pathogenic behavior. Comparing the types of variants, the presence of a pathogenic variant was associated with higher levels of lysoGB3, lower values for alpha-GAL activity and higher frequency of symptoms related to FD. Conclusion: We characterized an extensive population of patients with FD variants with rich genetic, clinical and biomarker details. We believe that this study can help to better characterize the Brazilian population with FD and the most frequent types of variants.

RESUMO Introdução: A doença de Fabry (DF) é um erro inato do metabolismo caracterizado pela deficiência da enzima α-galactosidase A. O objetivo primário foi avaliar o perfil genético e fenotípico da doença de Fabry em hemodiálise. Métodos: Estudo de coorte observacional para determinar a incidência de variações genéticas e alterações fenotípicas para DF em pacientes em hemodiálise no Vale do Paraíba e Zona Leste de São Paulo. O teste genético para o gene GLA foi realizado para homens e mulheres em todos os pacientes das clínicas de hemodiálise maiores de 12 anos entre janeiro de 2016 a dezembro de 2019 como protocolo de rastreio. Resultados: Os casos foram provenientes de exames de triagem do caso índice entre pacientes portadores de doença renal crônica, resultando em 17 famílias e totalizando 82 pacientes em estudo. A classificação da variante mais prevalente foi a de significado incerto (54%), seguida da variante patogênica (46%). Foram descritos 5 pacientes em duas famílias com dois tipos de variantes ainda não previamente descritos na literatura com comportamento patogênico. Na comparação entre os tipos de variantes, a presença de variante patogênica foi associada a maiores níveis de lysoGB3, menores valores da atividade da alfa-GAL e maior frequência de sintomas relativos à DF. Conclusão: Caracterizamos uma extensa população de pacientes com variantes para DF com riqueza de detalhes de genética, clínica e de biomarcadores. Acreditamos que este estudo possa auxiliar na melhor caracterização da população brasileira com DF e nos tipos mais frequentes de variantes.

ABSTRACT: Objective: To compare and validate diagnostic systems for the severity of Osteoarthrosis (OA) of the temporomandibular joints (TMJ) in computed tomography (CT) images. Method: An observational, retrospective, analytical, blinded, retrospective study was performed. Ninety-nine patients (198MSCT-ATM) were evaluated, applying the criteria of seven different diagnostic systems. A calibrated clinician (K=0.7) performed the evaluations. Content validity was performed under the Ahmad criteria. Internal consistency was determined with Cronbach’s Alpha. Data were correlated with Spearman’s Rho. Results: For condylar erosion severity, there was a high positive correlation between Alexiou/Arayasantiparb (rho=0.986) and a low one between Cömert/Alexiou (rho=0.421) and Cömert/Arayasantiparb (rho=0.422) classifications. For condylar sclerosis, we found a strong correlation between Cömert/Alexiou, Masilla/Alexiou and Cömert/Masilla classifications (rho=857; rho=0.853; rho=0.998). The data presented high internal consistency (Cronbach’s alpha=0.897) and low content validation (36.2%). Conclusions: The measurements of the 7 systems have a high reliability. Bone erosion, sclerosis and osteophytes are measured at four levels of severity and with a similar scale in three diagnostic systems (Alexiou, Arayasantiparb and Cömert). We suggest to complement it with the determination of joint space and condylar mobility, as proposed by RDC/TMD. Content validity was low, only the Cömert and Alexiou diagnostic systems were higher than 50%.

RESUMEN: Objetivo: Comparar y validar sistemas diagnósticos de severidad de Osteoartrosis (OA) de las articulaciones temporomandibulares (ATM) en imágenes de tomografía computada (TAC). Método: Se efectuó un estudio observacional, retrospectivo, analítico y ciego. Se evaluaron 99 pacientes (198TAC-ATM), aplicando los criterios de siete diferentes sistemas diagnósticos. Un clínico calibrado (K=0,7) efectuó las evaluaciones. La validez de contenido se efectuó bajo los criterios Ahmad. La consistencia interna se determinó con Alpha de Cronbach. Se correlacionaron los datos con Rho de Spearman. Resultados: La severidad de la erosión condilar presenta alta correlación positiva entre las clasificaciones Alexiou/Arayasantiparb (rho=0,986) y baja entre Cömert/Alexiou (rho=0,421) y Cömert/Arayasantiparb (rho=0,422). La esclerosis condilar presentó fuerte correlación entre las clasificaciones de Cömert/Alexiou, Masilla/Alexiou y Cömert/Masilla (rho=857;rho=0,853;rho=0,998). Los datos presentaron alta consistencia interna (Alfa Cronbach=0,897) y baja validación de contenido (36,2%). Conclusiones: Las mediciones de los 7 sistemas presentan alta fiabilidad. La erosión ósea, esclerosis y osteofitos son medidos en cuatro niveles de severidad y con similar escala en tres sistemas de diagnóstico (Alexiou, Arayasantiparb y Cömert), sugiriendose complementar con determinación del espacio articular y movilidad condilar, como propone RDC/TMD para TTM. La validación de contenido fue baja, solo los sistemas diagnósticos de Cömert y Alexiou superaron el 50%.

Resumen Uno de los vectores del paradigma de la modernización es que una sociedad sólo es moderna si desaparecen costumbres y prácticas tradicionales para dar lugar al desarrollo económico. En ese marco, resulta difícil entender la realidad de sectores productivos como la agricultura familiar, que se sustentan sobre conocimientos y formas tradicionales de producción. El objetivo del trabajo es analizar un caso a partir del enfoque de estilos agrícolas que permite captar las prácticas llevadas a cabo por los actores en un contexto moderno teniendo en cuenta la capacidad productiva y el grado de incorporación a los mercados. La metodología combina técnicas cuantitativas y cualitativas de investigación, y las conclusiones son dos: primero, la caracterización de los estilos atiende a aspectos que son más representativos de la realidad; segundo, permite identificar circuitos agroalimentarios alternativos locales, lo que posibilita en los agricultores una manera particular de integrarse al sistema moderno globalizado.

Abstract One of the vectors of the paradigm of modernization is that a society is only modern if traditional customs and practices disappear to give way to economic development. Within this framework, it´s difficult to understand the reality of productive sectors such as family farming that are based on knowledge and traditional forms of production. The aim of the work is to analyze a case from the approach of farming styles that allows capturing practices carried out by the actors in a modernization context taking into account the productive capacity and the degree of incorporation into the markets. The methodology combines quantitative and qualitative research techniques and the conclusions are two: first, that the characterization of the styles addresses aspects that are more representative of reality and second, it makes it possible to identify alternative local agri-food circuits, enabling farmers to have a particular way of integrate into the modern globalized system.

RESUMO Introdução: A doença de Fabry (DF) é um erro inato do metabolismo caracterizado pela deficiência da enzima α-galactosidase A. O objetivo primário foi avaliar o perfil genético e fenotípico da doença de Fabry em hemodiálise. Métodos: Estudo de coorte observacional para determinar a incidência de variações genéticas e alterações fenotípicas para DF em pacientes em hemodiálise no Vale do Paraíba e Zona Leste de São Paulo. O teste genético para o gene GLA foi realizado para homens e mulheres em todos os pacientes das clínicas de hemodiálise maiores de 12 anos entre janeiro de 2016 a dezembro de 2019 como protocolo de rastreio. Resultados: Os casos foram provenientes de exames de triagem do caso índice entre pacientes portadores de doença renal crônica, resultando em 17 famílias e totalizando 82 pacientes em estudo. A classificação da variante mais prevalente foi a de significado incerto (54%), seguida da variante patogênica (46%). Foram descritos 5 pacientes em duas famílias com dois tipos de variantes ainda não previamente descritos na literatura com comportamento patogênico. Na comparação entre os tipos de variantes, a presença de variante patogênica foi associada a maiores níveis de lysoGB3, menores valores da atividade da alfa-GAL e maior frequência de sintomas relativos à DF. Conclusão: Caracterizamos uma extensa população de pacientes com variantes para DF com riqueza de detalhes de genética, clínica e de biomarcadores. Acreditamos que este estudo possa auxiliar na melhor caracterização da população brasileira com DF e nos tipos mais frequentes de variantes.

ABSTRACT Introduction: Fabry disease (FD) is an inborn error of metabolism characterized by α-galactosidase A deficiency. The primary objective was to evaluate the genetic and phenotypic profile of Fabry disease in hemodialysis. Methods: Observational cohort study to determine the incidence of genetic variations and phenotypic changes for FD in hemodialysis patients in the Paraiba Valley and Eastern São Paulo. Genetic testing for the GLA gene was performed for men and women over 12 years of age at the hemodialysis clinics between January 2016 and December 2019 as a screening protocol. Results: The cases came from screening exams of the index case among patients with chronic kidney disease, resulting in 17 families and totaling 82 patients under study. The classification of the most prevalent variant was that of uncertain significance (54%), followed by the pathogenic variant (46%). Five patients in two families were described with two types of variants not previously described in the literature, with pathogenic behavior. Comparing the types of variants, the presence of a pathogenic variant was associated with higher levels of lysoGB3, lower values for alpha-GAL activity and higher frequency of symptoms related to FD. Conclusion: We characterized an extensive population of patients with FD variants with rich genetic, clinical and biomarker details. We believe that this study can help to better characterize the Brazilian population with FD and the most frequent types of variants.

SUMMARY OBJECTIVE: This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS: A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS: The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION: The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.

Abstract The present work aimed to characterize and compare the catalytic properties of amylases from Cunninghamella echinulata and Rhizopus microsporus. The highest production of amylase by C. echinulata, 234.94 U g-1 of dry substrate (or 23.49 U mL-1), was obtained using wheat bran as a substrate, with 50–55% initial moisture and kept at 28 °C for 48 h. The highest production of amylases by R. microsporus, 224.85 U g-1 of dry substrate (or 22.48 U mL-1), was obtained cultivating wheat bran with 65% initial moisture at 45 °C for 24 h. The optimal activity of the amylases was observed at pH 5.0 at 60 °C for C. echinulata enzymes and at pH 4.5 at 65 °C for R. microsporus. The amylases produced by C. echinulata were stable at pH 4.0–8.0, while the R. microsporus enzymes were stable at pH 4.0–10.0. The amylases produced by C. echinulata remained stable for 1 h at 50 °C and the R. microsporus amylases maintained catalytic activity for 1 h at 55 °C. The enzymatic extracts of both fungi hydrolyzed starches from different plant sources and showed potential for liquefaction of starch, however the amylolytic complex of C. echinulata exhibited greater saccharifying potential.

Resumen Objetivo: Mostrar las estrategias agroecológicas desplegadas por agroecosistemas de la agricultura campesina, tendientes a captar el trabajo/energía producido por la naturaleza y transformarlo en valor, con la participación escasa o nula del capital en tales procesos. Metodología: El estudio del caso responde a un método de investigación cualitativa a partir de entrevistas y observaciones directas Resultados: Los procesos de no mercantilización, la condición bifacética de la mano de obra familiar, los tiempos del capital y los de la naturaleza, el capital como cosa y como proceso, la inmediatez tanto del proceso de trabajo, del producto de trabajo y de la realización del valor de uso conjuntamente con formas de apropiación y gestión comunal de la tierra y recursos asociados, son aspectos que sientan la base para pensar en la agroecología contrahegemónica. Limitaciones: Más estudios de caso permitirían abordar estas perspectivas que tienen una fuerte mirada capitalocentrico e integrar y complementar con otras miradas y disciplinas. Conclusiones: Comprender la lógica del capital desde su relación con la naturaleza y como la naturaleza puede trabajar para ciertos agroecosistemas, disminuyendo el carácter disciplinador del capital en tales procesos, constituye un tema a considerar para el diseño de políticas por parte de los movimientos sociales.

Abstract Objective: To show the agroecological strategies deployed by agroecosystems of peasant agriculture, tending to capture the work/energy produced by nature and transform it into value, with little or no participation of capital in such processes. Methodology: The case study responds to a qualitative research method based on interviews and direct observations. Results: The processes of non-commodification, the bifaceted condition of family labor, the times of capital and those of nature, capital as a thing and as a process, the immediacy of both the work process, the work product, and the realization of use value together with forms of appropriation and communal management of the land and associated resources, all of it are aspects that lay the groundwork for thinking about counter-hegemonic agroecology. Limitations: More case studies would allow us to address these perspectives that have a strong capitalocentric perspective and integrate and complement other perspectives and disciplines. Conclusions: Understanding the logic of capital from its relationship with nature and how nature can work for certain agroecosystems, reducing the disciplining nature of capital in such processes, is an issue to consider for the design of policies by social movements.

Resumen En el presente artículo se estudian los conceptos de imagen y representación en la filosofía de Ernst Cassirer. En este texto se hace patente el valor simbólico con el cual el neokantiano define a las imágenes. A partir de ello, se explica cómo éstas pueden presentarse como una relación de identidad entre un objeto definido y el concepto construido por un agente epistémico. Para ilustrar dicha teoría, se considera el funcionamiento del Tomógrafo Axial Computarizado (TAC) para mostrar que la finalidad de las imágenes médicas es representar la realidad de forma digital, para lo cual se requiere únicamente simbolizar la forma del cuerpo. Finalmente, se sugiere el uso del Efecto Doppler como método alternativo a considerar en el funcionamiento del TAC.

Abstract This article studies the concepts of image and representation in Ernst Cassirer’s philosophy. In this text the symbolic value with which the neo-Kantian defines images becomes evident. Based on this, it is explained how these can be presented as a relationship of identity between a defined object and the concept constructed by an epistemic agent. To illustrate such theory, the operation of the Computed Axial Tomography (CAT) is considered to show that the purpose of medical images is to represent reality digitally, for which it is only required to symbolize the shape of the body. Finally, the use of the Doppler Effect is suggested as an alternative method to consider in the operation of the CAT.

Abstract: The south of Mendoza province has been characterized as the southern frontier of South American pre-Hispanic agriculture on the eastern slope of the Andes. This characterization has been based on the presence of crops at the archaeological sites and adopting a dichotomic perception of hunter-gatherers and farmers. During the last few decades, the archaeological record has shown a complex and shifting situation both at a spatial and temporal level in relation to the dependence of human groups on this type of resource. Based on a biogeographic model, we evaluated different lines of analysis from the archaeological record to assess the impact of environmental factors on the emergence of agriculture within the region. The results obtained confirm the low importance of agriculture among human groups as well as their flexibility in facing different environmental and demographic scenarios. Finally, we propose that the environmental structure of Patagonia would have played a central role in limiting the spread of domesticated plant use in this region of South America.

Resumen: El sur de la Provincia de Mendoza ha sido caracterizado como el límite meridional de la agricultura prehispánica sudamericana, específicamente en la vertiente oriental de los Andes. Dicha caracterización ha estado basada en la presencia de plantas domesticadas en los sitios arqueológicos, utilizando una mirada dicotómica entre cazadores-recolectores y agricultores. Los trabajos arqueológicos de las últimas décadas han mostrado una situación compleja y cambiante tanto a nivel espacial como temporal en relación a la dependencia de los grupos humanos sobre este tipo de recursos. A partir de un modelo biogeográfico, se utilizan distintas líneas de análisis del registro arqueológico con el fin de evaluar la incidencia del contexto ambiental en el ingreso de la agricultura a la región. Los resultados obtenidos confirman la escasa importancia de los recursos domesticados entre los grupos humanos de la región y la flexibilidad mostrada por los mismos para enfrentar distintos escenarios ambientales y demográficos. Finalmente, se propone que, en el sur de Mendoza, la estructura ambiental del área biogeográfica de Patagonia habría tenido un rol central en los límites para la dispersión de las plantas domesticadas en esta región de América del Sur.

ABSTRACT The goal of this paper is to describe an archaeological burial site with commingled skeletal remains, named Cañada Seca-1 (MNI= 24), located in the Atuel River valley and dating from ca.1500yearsBP. This isperformedby integrating well-known and recently developed lines of inquiry.Based on this record, we discuss interpretations related to cultigen presence and its implicationsin human subsistence and mobility, in an area traditionally characterized as the pre-Hispanicagricultural limit, ca. 2200 years BP. Results show that the individuals did not developed a farmingstrategy, although maize seems to have been part of their diet. In turn, the new information aboutmortuary behavior in the Atuel River valley provides new insights regarding mobility, as well asthe use of utilitarian (lithics) and nonutilitarian (lithic and malacological ornaments) technologythat went beyond these peoples' life into their death.

RESUMEN Este trabajo tiene como objetivo caracterizar el sitio Cañada Seca-1, un entierro múltiple (NMI=24) localizado en el valle del Atuel y fechado en ca. 1500 años AP, a través de la integración de diferentes líneas de evidencia. A partir de este registro se discuten las interpretacionesen torno a la presencia de cultígenos y sus implicancias para la subsistencia humana en unárea caracterizada tradicionalmente como el límite de la dispersión agrícola sudamericana,ca. 2200 años AP. Los resultados destacan que los individuos inhumados en el sitio no habríandesarrollado una estrategia fundamentalmente agrícola, aunque el maíz formó parte de su dieta.Además, la nueva información sobre los comportamientos mortuorios en la zona del valle delAtuel, ofrece evidencias tanto sobre movilidad como sobre el uso de tecnologías utilitarias (líti-cas) y no utilitarias (ornamentos líticos y malacológicos) que trascendieron la vida cotidiana ylos acompañaron en la muerte.

Resumen Antecedentes: La malformación adenomatoidea quística y el secuestro broncopulmonar son malformaciones que se pueden diagnosticar prenatalmente. Los adecuados controles prenatales ayudan a un diagnóstico temprano y su manejo. Objetivo: Presentar el caso de un recién nacido con diagnóstico parental de una malformación pulmonar y su desenlace posterior. Reporte de caso: Recién nacido a término con diagnóstico antenatal de malformación pulmonar, el cual se confirmó tras su nacimiento. Discusión: Estas dos malformaciones son entidades cuya incidencia viene aumentando, razón por la cual es importante el conocimiento del curso clínico, ayudas diagnósticas, complicaciones y las posibilidades de manejo con las que se cuenta.

Abstract Background: Cystic adenomatoid malformation and bronchopulmonary sequestration are malformations that can be diagnosed prenatally. Appropriate prenatal controls helps to early diagnosis and management. Objective: To present the case of a newborn with a parental diagnosis of a pulmonary malformation and its subsequent outcome. Case report: Newborn at term with antenatal diagnosis of pulmonary malformation which was confirmed postnatal. Discussion: These two malformations are entities whose incidence is increasing, which is why knowledge of the clinical course, diagnostic aids, complications, and the management possibilities that are available are important.

Abstract Objective: To determine the prevalence of blood eosinophilia in adults with chronic obstructive pulmonary disease (COPD) according to different cut-off points. Methods: A cross-sectional study was carried out in patients with COPD. The frequency of blood eosinophilia was determined by absolute (cells/ µL) and relative (%) eosinophil count. Multivariate methods were used in order to identify the associated factors. Results: 81 patients were included; the mean age was 71.9 ± 9.8 years; 46 (57%) of the patients were men. The prevalence of eosinophilia for the cut-off points of ≥ 100, ≥ 150, ≥ 200, ≥ 300, and ≥ 400 cells/µL was of 64.2%, 37.0%, 16.1%, and 9.9% respectively. Out of 81 patients, 34 (42%) had a relative eosinophil concentration of ≥ 2%; 21 (25.9%) ≥ 3%; 14 patients (17.3%) had ≥ 4%; and 10 patients (12.3%) had ≥ 5%. Eosinophilia of ≥ 100 cells/µL was associated with age of ≥ 80 years (OR = 6.04, p = 0.026), and with the exacerbation of COPD (OR = 9.40, p = 0.038); in contrast, eosinophilia of ≥ 2% was associated only with age of ≥ 80 years (OR = 3.73, p = 0.020). In addition, the eosinophil count of ≥ 100 and < 300 cells/µL was associated with the exacerbation of COPD (OR = 11.00, p = 0.026). Conclusions: Our results suggest that the frequency of eosinophilia in the context of COPD shows substantial variations according to the used definition.

Resumen Objetivo: Establecer la prevalencia de eosinofilia en sangre en adultos con enfermedad pulmonar obstructiva crónica (EPOC) según varios puntos de corte. Métodos: Se realizó un estudio transversal en pacientes con EPOC. La frecuencia de eosinofilia en sangre se determinó a partir de la concentración absoluta (células/µL) y relativa (%) de eosinófilos. Fueron realizados modelos multivariados para identificar factores asociados. Resultados: En 81 pacientes incluidos, la edad promedio fue de 71.9 ± 9.8 años; de los cuales, 46 (57 %) fueron hombres. La prevalencia de eosinofilia para los puntos de corte ≥ 100, ≥ 150, ≥ 200, ≥ 300 y ≥ 400 células/µL fue de 64.2, 43.2, 37.0, 16.1 y 9.9 %, respectivamente. De 81 pacientes, 34 (42 %) tuvieron una concentración ≥ 2 %; 21 (25.9 %) ≥ 3 %; 14 (17.3 %) ≥ 4 %; y 10 (12.3 %) ≥ 5 %. La eosinofilia ≥ 100 células/µL se asoció con la edad ≥ 80 años (RM = 6.04, p = 0.026) y con la exacerbación de la EPOC (RM = 9.40, p = 0.038); en cambio, la eosinofilia ≥ 2 %, lo hizo con solamente la edad ≥ 80 años (RM = 3.73, p = 0.020). Complementariamente, la concentración de eosinófilos ≥ 100 y < 300 células/µL se asoció con la exacerbación de la EPOC (RM = 11.00, p = 0.026). Conclusiones: Nuestros resultados sugieren que la frecuencia de eosinofilia en EPOC muestra variaciones sustanciales según la definición adoptada.

Resumen Introducción. La mastitis granulomatosa crónica es una enfermedad inflamatoria poco frecuente y con mayor incidencia en el sexo femenino. Su sintomatología y su presentación clínica causan gran ansiedad tanto en el paciente como en el personal médico, debido a su comportamiento similar al de la patología mamaria maligna. No hay una etiología clara ni un manejo terapéutico definido. El objetivo de este estudio fue determinar las características clínico-patológicas, el tratamiento y la evolución de las pacientes con mastitis granulomatosa, durante el periodo de estudio. Métodos. Estudio retrospectivo en el que se revisaron las historias clínicas de pacientes con diagnóstico y manejo de trastorno inflamatorio de la mama no especificado (N61X), entre enero de 2010 y diciembre de 2019. Se encontraron 236 pacientes, se excluyeron 176 por no cumplir con el diagnóstico de mastitis granulomatosa crónica o por no tener un seguimiento adecuado. Se evaluaron las características sociodemográficas, clínicas y de evolución, comparando la respuesta que se obtuvo con cada tratamiento. Resultados. Se incluyeron 60 pacientes femeninas que presentaron manifestaciones variadas. El 38,3 % (n=23) recibieron manejo antibiótico, el 30 % (n=18) fue tratado con corticoides, el 8,3 % (n=5) recibió antibióticos más corticoides y se realizó manejo expectante en el 16,6 % (n=10). El 6,6 % (n=4) de los pacientes fueron llevados a cirugía. Discusión. La mejor respuesta y la menor tasa de recidiva se encontró en las pacientes que fueron sometidas a observación y en aquellas que recibieron corticoides.

Abstract Introduction. Chronic granulomatous mastitis is a rare inflammatory disease with a higher incidence in females. Its symptoms and its clinical presentation cause great anxiety both in the patient and in the medical personnel, due to its behavior similar to that of malignant breast disease. There is no clear etiology or defined therapeutic management. The objective of this study was to determine the clinical-pathological characteristics, treatment and evolution of the patients with granulomatous mastitis, during the study period. Methods. Retrospective study in which the medical records of patients with diagnosis and management of unspecified inflammatory disorder of the breast (N61X) were reviewed, between January 2010 and December 2019. Two-hundred-thirty-six patients were found, 176 were excluded for not complying with the diagnosis of chronic granulomatous mastitis or for not having an adequate follow-up. The sociodemographic, clinical and evolution characteristics were evaluated, comparing the response obtained with each treatment. Results. Sixty female patients who presented varied manifestations were included, of which 38.3% (n=23) received antibiotic treatment, 30% (n=18) were treated with steroids, 8.3% (n=5) received antibiotics plus steroids, expectant management was performed in 16, 6% (n = 10), and 6.6% (n=4) of the patients were taken to surgery. Discussion. The best response and the lowest recurrence rate were found in patients who were observed and in those who received steroids.

ABSTRACT Facing global and local environmental problems from individual action has motivated the emergence of studies on pro-environmental behavior. Juliaca-Perú, being threatened before imminent environmental risks such as the crisis of production, collection and segregation of garbage, contamination of water sources and depredation of the natural landscape, requires this type of study. The objective of the research was to explore the pro-environmental behavior of university students from the city of Juliaca, from a qualitative approach. The study was based on a grounded theory design. We worked with information provided by an intentional qualitative sample of 28 students from the National University of Juliaca. The data was collected through an online form with open questions, and analyzed with the Atlas.ti 7 software. Two emerging behavioral structures that describe environmental behavior were identified: Avoidance actions (reduction of garbage generation, energy and water savings) and charitable actions (recycling, reuse and segregation). Students tend to be more inclined towards charitable actions. In conclusion, university students perform beneficial and avoidant actions that configure a low-impact pro-environmental behavior.

RESUMEN Enfrentar los problemas ambientales globales y locales desde la acción individual ha motivado el surgimiento de estudios acerca del comportamiento pro ambiental. Juliaca -Perú, al estar amenazada antes riesgos ambientales inminentes como la crisis de la producción, recojo y segregación de la basura, contaminación de fuentes de agua y depredación del paisaje natural, requiere este tipo de estudios. El objetivo de la investigación fue explorar el comportamiento proambiental de estudiantes universitarios de la ciudad de Juliaca, desde un enfoque cualitativo. El estudio estuvo basado en un diseño con teoría fundamentada. Se trabajó con información proporcionada por una muestra cualitativa intencional de 28 estudiantes de la Universidad Nacional de Juliaca. Los datos fueron recogidos mediante un formulario en online con preguntas abiertas, y analizados con el software Atlas.ti 7. Se identificaron dos estructuras conductuales emergentes que describen el comportamiento ambiental: Acciones evitativas (reducción de generación de basura, ahorro de energía y agua) y acciones benéficas (reciclaje, reutilización y segregación). Los estudiantes tienden a inclinarse más por las acciones benéficas. En conclusión, los estudiantes universitarios realizan acciones benéficas y evitativas que configuran un comportamiento pro ambiental de bajo impacto.