Abstracto Introducción: En el 2008, el perfil de salud neurológico ecuatoriano presentaba importantes déficits, escasez de neurólogos e inaccesibilidad a residencias en neurología. Ese año una nueva constitución introdujo atención médica universal. Ninguna publicación ha analizado la capacidad de atención neurológica del Sistema de Salud Pública (SSP) del Ecuador. Un análisis actualizado del número de neurólogos y residencias neurológicas es necesario. Objetivo: Determinar el número de programas en neurología y si el SSP ecuatoriano cumple con el ratio ideal mínimo recomendado por la Organización Mundial de la Salud de 1 neurólogo por cada 100.000 habitantes. Métodos: Análisis transversal de datos hasta noviembre, 2022 del SSP y del Consejo de Educación Superior del Ecuador. Los ratio se calcularon acorde al Instituto Nacional de Estadística y Censos. Resultados: El SSP cuenta con noventa y cuatro neurólogos. Mayormente en Pichincha (37/39,4%) y Guayas (24/25,5%). Hay uno por provincia en cinco provincias; ninguno en ocho provincias. Dos provincias cumplieron el ratio ideal. Existen 0,54:100.000 neurólogos/habitantes y una residencia de neurología en Quito. Conclusión: El SSP ecuatoriano tiene escasez de neurólogos, incumpliendo el ratio ideal mínimo, y déficit de residencias en neurología. La descentralización de servicios neurológicos, soporte atención primaria, y financiamiento gubernamental para creación de residencias en neurología son necesidades urgentes.

Abstract Introduction: In 2008, Ecuador's neurologic healthcare profile displayed significant needs, a lack of neurologists, and neurology training accessibility. In that year, a new constitution introduced universal health care. No publication analyzes Ecuador's neurological Public Healthcare capacity. Hence, an up-to-date analysis of the number of neurologists and neurology training programs is required. Objective: Determine if Ecuador's public healthcare meets the minimum ideal ratio recommended by the World Health Organization of 1 neurologist per 100,000 population and the number of neurology training programs in Ecuador. Methods: Cross-sectional analysis of public data until November 2022 from Ecuador's Public Health System (PHS) and the Council of Higher Education. Ratios were calculated using the National Institute of Statistics and Censuses' information. Results: The public health network had ninety-four neurologists. Most found in Pichincha (37/39.4%) and Guayas (24/25.5%). There was one per province in five provinces. No neurologists were available in eight provinces. Two provinces met the ideal ratio. Ecuador’s ratio was 0.54:100,000 neurologists per population. One neurology training program was found in Quito. Conclusion: Ecuador's PHS has a shortage of neurologists, unfulfilling the minimum ideal ratio, and a severe lack of neurology training. Decentralizing neurological services, primary care support, and governmental funding for neurology training are an urgent need.

RESUMEN Introducción: El cistoadenocarcinoma biliar es un tumor quístico poco frecuente, que se origina a partir del epitelio hepatobiliar, cuyo crecimiento es lento y sus síntomas son variables e inespecíficos. Objetivo: Presentar el caso de un paciente portador de un cistoadenocarcinoma biliar. Presentación del caso: Se presenta el caso de una paciente femenina de 56 años de edad que acude a la institución por presentar dolor en el hipocondrio derecho, fiebre y pérdida de peso. Al examen físico se constata una masa palpable en dicha zona abdominal, de bordes lisos, no dolorosa, dura, de escasa movilidad y relacionada con el hígado. Conclusiones: El cistoadenocarcinoma biliar es una neoplasia quística maligna poco frecuente del hígado. La mayoría de los pacientes presentan dolor abdominal, masa palpable y pérdida de peso. El tratamiento quirúrgico es la norma y la resección con márgenes libres se considera la variante de tratamiento más empleada.

ABSTRACT Introduction: Biliary cystadenocarcinoma is a rare cystic tumor, which originates from the hepatobiliary epithelium, whose growth is slow, and whose symptoms are variable and nonspecific. Objective: To present the case of a patient with a biliary cystadenocarcinoma. Case presentation: The case is presented of a 56-year-old female patient who came to our institution with pain in the right hypochondrium, fever and weight loss. Physical examination revealed a palpable mass in such abdominal area, with smooth edges, nonpainful, hard, with low mobility and related to the liver. Conclusions: Biliary cystadenocarcinoma is a rare malignant cystic neoplasm of the liver. Most patients present with abdominal pain, a palpable mass and weight loss. Surgery is the standard treatment and margin-free resection is considered the most commonly employed treatment variant.

Resumen Objetivo: Describir 6 casos de cáncer de pene y examinar su manejo quirúrgico en un hospital de tercer nivel. Métodos: Estudio retrospectivo y descriptivo de casos de cáncer de pene desde abril de 2020 a mayo de 2022 en el Hospital de Especialidades Eugenio Espejo de la ciudad de Quito, Ecuador. Se incluyeron solo casos que contaban con historia clínica completa, diagnóstico histopatológico confirmatorio y controles postquirúrgicos. Resultados: Se describen 6 pacientes con cáncer de pene con edad promedio de 69 años. En el estudio histopatológico cinco pacientes presentaron diagnóstico de carcinoma de células escamosas y uno de melanoma nodular. La localización más frecuente fue en el glande en cuatro individuos. De acuerdo con la clasificación TNM, dos pacientes fueron estratificados como T3Nx, uno como T3N1, uno como T3N2, uno como T4 y uno como T4bN3b. En la mitad de los casos, el tratamiento de elección fue la penectomía total más linfadenectomía inguinal bilateral. Conclusiones: A pesar de que el cáncer de pene es una patología poco frecuente, la identificación de factores de riesgo y lesiones primarias pueden ayudar al diagnóstico precoz del cáncer, evitando así una metástasis a estructuras anexas al pene y la consecuente penectomía.

Abstract Objective: To describe 6 cases of penile cancer and examine their surgical management in a tertiary level hospital. Methods: Retrospective and descriptive study of penile cancer cases from april 2020 to may 2022 at the Hospital de Especialidades Eugenio Espejo in the city of Quito. Only cases with complete clinical history, confirmatory histopathological diagnosis and post-surgical controls were included. Results: We describe 6 patients with penile cancer with an average age of 69 years. In the histopathological study, five patients were diagnosed with squamous cell carcinoma and one with nodular melanoma. The most frequent location was on the glans penis in four individuals. According to TNM classification, two patients were stratified as T3Nx, one as T3N1, one as T3N2, one as T4 and one as T4bN3b. In half of the cases, the treatment of choice was total penectomy plus bilateral inguinal lymphadenectomy. Conclusions: Although penile cancer is a rare pathology, the identification of risk factors and primary lesions can help in the early diagnosis of cancer, thus avoiding metastasis to structures adnexal to the penis and consequent penectomies.

Abstract Background In patients with rheumatic diseases, the use of biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) after discontinuation of tumor necrosis factor inhibitors (TNFi) is known to be effective. However, data on the use of TNFi after discontinuation of non-TNFi bDMARDs or tsDMARDs (non-TNFi) are scarce. This study assessed the 4-years golimumab retention in patients with rheumatic diseases when used after discontinuation of non-TNFi. Methods Adults with rheumatoid arthritis (RA; n = 72), psoriatic arthritis (PsA; n = 30) or axial spondyloarthritis (axSpA; n = 23) who initiated golimumab after discontinuation of non-TNFi from the Spanish registry of biological drugs (BIOBADASER) were analyzed retrospectively. The retention rate (drug survival or persistence) of golimumab up to 4 years was evaluated. Results The golimumab retention rate was 60.7% (51.4–68.8) at year 1, 45.9% (36.0–55.2) at year 2, 39.9% (29.8–49.7) at year 3 and 33.4% (23.0–44.2) at year 4. Retention rates did not differ significantly whether golimumab was used as second, third, or fourth/subsequent line of therapy (p log-rank = 0.462). Golimumab retention rates were higher in axSpA or PsA patients than in RA patients (p log-rank = 0.002). When golimumab was administered as third or fourth/subsequent line, the 4-years retention rate after discontinuation of non-TNFi was similar to that after discontinuation of TNFi. Conclusion In patients who discontinued non-TNFi, most of whom received golimumab as third/subsequent line of therapy, one-third of patients remained on golimumab at year 4. Retention rates were higher in patients with axSpA and PsA than in those with RA.

Abstract: Background and Aims: Sclerocactus (Cactaceae) is a genus that comprises 27 taxa mainly distributed in the southern United States of America and northern Mexico. Sclerocactus papyracanthus is a very distinctive species due to its flattened papyraceous central spines and its growth form, which is similar to that of some grasses. Its currently known distribution is in the states of Arizona, New Mexico, and Texas in the southern USA close to the border with Mexico. However, we detected an observation of a putative individual of this species in Chihuahua on the Naturalista platform. Therefore, we set out to find individuals of S. papyracanthus in Mexico, describe their morphology, its ecological preferences, and document their occurrence in this country with herbarium specimens, photographs, and illustrations. Methods: Using the location indicated in the Naturalista observation, we carried out two explorations in early 2023 to the state of Chihuahua in search of the species. A cactus population that resembled S. papyracanthus was found. We took photographs, measured and described the morphological characters of the found individuals, and prepared herbarium specimens. The obtained morphological and ecological data were compared with those reported in the scientific literature and with other available herbarium vouchers. Key results: The morphological comparisons corroborated that the Sclerocactus population found corresponded to S. papyracanthus and the presence of the species in Mexico was confirmed. A total of 38 plants of different sizes were found. Also, two young individuals flowering were documented. Conclusions: In Mexico, S. papyracanthus is now known from a single grassland locality in the municipality of Ascensión, Chihuahua. Further exploration and investigation are needed to understand its ecological preferences and its distribution in Mexico.

Resumen: Antecedentes y Objetivos: Sclerocactus (Cactaceae) es un género que comprende 27 taxones principalmente distribuidos en el sur de los Estados Unidos de América y el norte de México. Sclerocactus papyracanthus es una especie muy distintiva debido a sus espinas centrales papiráceas y aplanadas, y a su forma de crecimiento similar a la de algunos pastos. Su distribución actual conocida es en los estados de Arizona, Nuevo México y Texas en el sur de los Estados Unidos de América, cerca de la frontera con México. Sin embargo, detectamos una posible observación de esta especie en Chihuahua en la plataforma Naturalista. Derivado de esto, nuestros objetivos fueron encontrar individuos de S. papyracanthus en México, describir su morfología, sus preferencias ecológicas y documentar la ocurrencia de la especie en México con ejemplares de herbario, fotografías e ilustraciones. Métodos: Usando la ubicación reportada en la observación de Naturalista, se realizaron dos exploraciones en el estado de Chihuahua a principios de 2023 para buscar la especie. Se encontró una población de cactus similares a S. papyracanthus. Se tomaron fotografías, mediciones morfológicas y datos del hábitat y se prepararon ejemplares de herbario. Los datos ecológicos y morfológicos obtenidos fueron comparados con aquellos reportados en literatura científica y en otros ejemplares de herbario disponibles. Resultados clave: Las comparaciones morfológicas corroboraron que la población de Sclerocactus encontrada corresponde a S. papyracanthus y la presencia de la especie en México fue confirmada. Se encontraron un total de 38 plantas de varios tamaños. Además, se documentaron dos individuos juveniles floreciendo. Conclusiones: Actualmente en México, S. papyracanthus se conoce solo de una localidad de pastizales en el municipio de Ascensión, Chihuahua. Se necesitan más exploración e investigación para complementar el conocimiento de las preferencias ecológicas y la distribución de la especie en México.

Resumen Introducción: El trauma es una importante causa de mortalidad a nivel mundial y la cuarta causa de muerte en Colombia. Esta condición genera morbilidad y discapacidad, impactando sustancialmente sobre los años de vida potencialmente perdidos, sobre todo, en las edades más tempranas donde es más prevalente. Objetivo: Caracterizar epidemiológica y clínicamente pacientes con trauma abdominal penetrante manejados quirúrgicamente. Materiales y métodos: Estudio observacional de corte transversal y linealidad retrospectiva de pacientes con trauma abdominal penetrante, manejados quirúrgicamente en un hospital de alto nivel de complejidad entre 2016 y 2018, que incluye variables sociodemográficas y clínicas relacionadas con el trauma, el tipo de intervención quirúrgica y complicaciones asociadas. Resultados: Se identificaron 115 pacientes, el 94,8% de sexo masculino. El mecanismo de lesión predominante fue por arma corto-punzante con 67,8%. Se encontró consumo de drogas y sustancias embriagantes relacionado en el 43,7% de los casos. Los principales órganos lesionados fueron el intestino delgado 39.1%, pequeños vasos con 20% e hígado con 16.5%. Los tipos de reparo realizados más frecuentemente fueron la rafia de intestino delgado (22,6 %), y la anastomosis de intestino delgado (20,9%). El Penetrating Abdominal Trauma Index >25 mostró mayor hiperlactatemia (80%) y sepsis (50%). La mortalidad fue del 3.4%, asociado a reintervención y sepsis. Conclusión: La mortalidad por trauma abdominal penetrante en la costa del caribe colombiano es baja. 9 de cada 10 casos son hombres, casi la mitad de los casos se relaciona a consumo de sustancias psicoactivas y las principales complicaciones son la hiperlactatemia y sepsis.

Abstract Introduction: Trauma is an important cause of mortality worldwide and the fourth cause of death in Colombia. This condition generates morbidity and disability, having a substantial impact on the years of life potentially lost, especially in the younger ages where it is more prevalent. Objective: To characterize epidemiologically and clinically patients with penetrating abdominal trauma managed surgically. Materials and methods: Observational cross-sectional retrospective study of patients with penetrating abdominal trauma, surgically managed in a high complexity level hospital between 2016 and 2018, including sociodemographic and clinical variables related to trauma, type of surgical intervention and associated complications. Results: A total of 115 patients were identified, 94.8% of whom were male. The predominant mechanism of injury was a short stabbing weapon (67.8%). Drug and intoxicant use were found in 43.7% of the cases. The main organs injured were the small intestine (39.1%), small vessels (20%) and liver (16.5%). The most frequent types of repair performed were small bowel raffia (22.6%) and small bowel anastomosis (20.9%). The Penetrating Abdominal Trauma Index >25 showed higher hyperlactatemia (80%) and sepsis (50%). Mortality was 3.4%, associated with reoperation and sepsis. Conclusion: Mortality due to penetrating abdominal trauma in the Colombian Caribbean coast is low. Nine out of ten cases are men, almost half of the cases are related to the consumption of psychoactive substances and the main complications are hyperlactatemia and sepsis.

ABSTRACT Introduction: diabetes mellitus has increased considerably in recent times and constitutes an important health problem. A high number of patients are diagnosed late, even with risk factors, which are not properly identified. Objective: to identify the hidden morbidity of diabetes mellitus in a population of 20 years old and over with risk factors. Methods: an observational, descriptive study was carried out in 102 patients 20 years old and older with risk factors for diabetes mellitus belonging to the “Ramón López Peña” Polyclinic between June and October 2020, who underwent fasting glucose measurement and glucose tolerance test when necessary. Age, sex, risk factors and the presence of symptoms and signs of the disease were studied. Descriptive and health statistics techniques were used. Results: 70.6% were women and 49% were 60 years of age or older. Among the risk factors, excess body weight (84.3%), arterial hypertension (52.9%) and family history of the disease (22.5%) predominated. Metabolic alteration was found in 26 patients, 19 (18.6%) were diagnosed as diabetic, for an incidence of 1.97%. Conclusions: the existence of hidden morbidity of diabetes mellitus in the population at risk was demonstrated, in addition, other people with disorders in glucose metabolism should be closely monitored, which shows the importance of active screening to achieve an early diagnosis and avoid complications of the disease.

RESUMEN Introducción: la diabetes mellitus ha aumentado considerablemente en los últimos tiempos y constituye un importante problema de salud. Una elevada cifra de pacientes se diagnostica tardíamente, aún con factores de riesgo, que no son debidamente identificados. Objetivo: identificar la morbilidad oculta de diabetes mellitus en población de 20 años y más con factores de riesgo. Métodos: se realizó un estudio observacional, descriptivo, en 102 pacientes de 20 años y más con factores de riesgo de diabetes mellitus pertenecientes al Policlínico “Ramón López Peña” entre junio y octubre de 2020, a los que se les realizó medición de glucosa en ayunas y prueba de tolerancia a la glucosa en casos necesarios. Se estudiaron la edad, el sexo, los factores de riesgo y la presencia de síntomas y signos de la enfermedad. Se utilizaron técnicas de estadística descriptiva y de salud. Resultados: el 70,6% eran mujeres y 49% tenía 60 años o más. Entre los factores de riesgo predominaron el exceso de peso corporal (84,3%), la hipertensión arterial (52,9%) y los antecedentes familiares de la enfermedad (22,5%). Se encontró alteración metabólica en 26 pacientes, 19 (18,6%) fueron diagnosticados como diabéticos, para una incidencia de 1,97%. Conclusiones: se demostró la existencia de morbilidad oculta de diabetes mellitus en la población de riesgo, además, otras personas con trastornos en el metabolismo de la glucosa que deben vigilarse estrechamente, lo que evidencia la importancia de la pesquisa activa para lograr un diagnóstico precoz y evitar complicaciones de la enfermedad.

Resumen Existen diferentes métodos para evaluar la seguridad de las aplicaciones Web, principalmente basados en algún técnico automatizado de escaneo El objetivo de la presente investigación refiere de los conceptos básicos necesarios para entender temas de seguridad informática en sistemas de información y servicios, con el propósito de enfocarlos en pruebas de penetración en las aplicaciones web, se abordan metodologías que pueden aplicarse y marcos de referencia que deben ser tomados en cuenta en el ciclo de vida de desarrollo de aplicaciones, así mismo, se aporta con tablas descriptivas de las metodologías utilizadas en pruebas de Pentesting llegando finalmente a abarcar la familia de ISO/IEC 27 000 dejando plasmado en la discusión una breve descripción de las mismas y el uso que da en las implantaciones de SGSI, evaluaciones y auditorias de seguridad de la información.

Abstract There are various methods for evaluating the security of Web applications, most of which rely on automated scanning technicians. The goal of this research is to address the fundamental concepts required to understand computer security issues in information systems and services, with a focus on penetration tests in web applications. Methodologies that can be applied and reference frameworks that must be taken into account in the application development life cycle are addressed; additionally, descriptive tables of the methodologies used in pen-testing tests are provided, finally reaching the ISO/IEC 27000 family, leaving a brief description of the same and the use it gives in ISMS implementations, information security evaluations and audits.

ABSTRACT Introduction: In 2008, Ecuador’s mental health profile displayed deficiencies due to the lack of psychiatrists and psychiatry residency programs. The same year, access to universal health care, was instituted as a right in the Constitution. There are no studies on the Public Health System’s capacity to provide mental health services, hence an updated analysis of the number of psychiatrists and psychiatry training programs available is required. Objective: To determine the number of psychiatrists available through the Public Health System and to calculate the ratio of psychiatrist per 10,000 population; to establish the number of residency programs available. Methods: Cross-sectional analysis of the data available from the Ecuadorian Public Health System and the Higher Education Council of Ecuador. Ratios were calculated using data from the National Institute of Statistics and Censuses. Results: Ecuador’s psychiatrists ratio is 0.08:10,000 and the adjusted ratio (psychiatrists and psychologists) is 0.65:10,000. The Public Health System has 138 psychiatrists, concentrated in Pichincha (n=51) and Guayas (n=27). Three provinces had no psychiatrists available. There are two psychiatry training programs in Quito. Conclusion: Ecuadorian Public Healthcare holds a shortage of psychiatrists which inhibit the minimum ideal ratio fulfillment, along with a noticeable lack of psychiatric training programs availability.

RESUMEN Introducción: En 2008, el perfil de salud mental del Ecuador exhibió falencias por la falta de psiquiatras y entrenamiento psiquiátrico. Ese año, se instituyó la salud como derecho en la constitución. No existen publicaciones que estudien la capacidad para proveer salud mental del Sistema Público, por lo que, análisis actualizados del número de psiquiatras y programas de entrenamiento son requeridos. Objetivo: Determinar el número de psiquiatras y calcular su ratio por cada 10,000 habitantes en la red de salud pública ecuatoriana; describir la oferta actual nacional de posgrados psiquiátricos. Métodos: Análisis transversal de datos públicos de la Red Integral Pública de Salud y del Consejo de Educación Superior. Para calcular el ratio usamos datos del Instituto Nacional de Estadística y Censos. Resultados: El ratio total en Ecuador es 0.08:10,000 y el ratio ajustado (psiquiatras y psicólogos) es 0.65:10,000. El país cuenta con 138 psiquiatras en la red de salud pública, concentrados en Pichincha (n=51) y Guayas (n=27). Tres provincias no cuentan con servicio de psiquiatría. Al momento sólo existen dos programas de residencia, ambos en Quito. Conclusión: El estudio evidenció que Ecuador no cumple la relación ideal establecida para suplir la demanda de psiquiatras eficientemente, además de una notable escasez de posgrados para la especialidad.

SUMMARY OBJECTIVE: This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city. METHODS: This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model. RESULTS: The average age of participants was 34 years (Q1 32.1–Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters). CONCLUSION: The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Abstract The challenges that Latin America faces in health are deeply related to others, such as access to clean water, the right to education, and housing. Health professionals that work in an environment where the population faces constant barriers to accessing care in the public health system or has limited resources to pay for it in a private sector will face an ethical dilemma, the question of how to honor the call to care for patients when there is not enough support system or infrastructure to do so. Within the schools of medicine and health sciences, the question is how to train students to face or resolve these conflicts. The social responsibility approach is a proposal that allows the alignment of education for health professionals and health systems to contribute to the creation of an effective, equitable, and sustainable system. The present article aims to discuss this problem from the importance of training health professionals, ethical and committed to their communities, that have the skills and attitudes to implement a patient-centered vision. The involvement of universities and training institutions of the next generation of health professionals cannot be postponed.

Resumo Os desafios que a América Latina enfrenta em matéria de saúde estão profundamente relacionados a outros, como o acesso à água limpa, o direito à educação e à moradia. Os profissionais de saúde que trabalham em um ambiente onde a população enfrenta constantes barreiras ao acesso aos cuidados no sistema público de saúde ou tem recursos limitados para pagá-los em um setor privado enfrentarão um dilema ético, a questão de como honrar o chamado para cuidar dos pacientes quando não há sistema de apoio ou infraestrutura suficiente para fazê-lo. Dentro das escolas de medicina e ciências da saúde, a questão é como treinar os estudantes para enfrentar ou resolver estes conflitos. A abordagem da responsabilidade social é uma proposta que permite o alinhamento da educação dos profissionais de saúde e dos sistemas de saúde para contribuir para a criação de um sistema eficaz, equitativo e sustentável. O presente artigo visa discutir este problema a partir da importância de formar profissionais de saúde, éticos e comprometidos com suas comunidades, que tenham as habilidades e atitudes necessárias para implementar uma visão centrada no paciente. O envolvimento de universidades e instituições de treinamento da próxima geração de profissionais de saúde não pode ser adiado.

Resumo Os desafios que a América Latina enfrenta em matéria de saúde estão profundamente relacionados a outros, como o acesso à água limpa, o direito à educação e à moradia. Os profissionais de saúde que trabalham em um ambiente onde a população enfrenta constantes barreiras ao acesso aos cuidados no sistema público de saúde ou tem recursos limitados para pagá-los em um setor privado enfrentarão um dilema ético, a questão de como honrar o chamado para cuidar dos pacientes quando não há sistema de apoio ou infraestrutura suficiente para fazê-lo. Dentro das escolas de medicina e ciências da saúde, a questão é como treinar os estudantes para enfrentar ou resolver estes conflitos. A abordagem da responsabilidade social é uma proposta que permite o alinhamento da educação dos profissionais de saúde e dos sistemas de saúde para contribuir para a criação de um sistema eficaz, equitativo e sustentável. O presente artigo visa discutir este problema a partir da importância de formar profissionais de saúde, éticos e comprometidos com suas comunidades, que tenham as habilidades e atitudes necessárias para implementar uma visão centrada no paciente. O envolvimento de universidades e instituições de treinamento da próxima geração de profissionais de saúde não pode ser adiado.

Abstract The challenges that Latin America faces in health are deeply related to others, such as access to clean water, the right to education, and housing. Health professionals that work in an environment where the population faces constant barriers to accessing care in the public health system or has limited resources to pay for it in a private sector will face an ethical dilemma, the question of how to honor the call to care for patients when there is not enough support system or infrastructure to do so. Within the schools of medicine and health sciences, the question is how to train students to face or resolve these conflicts. The social responsibility approach is a proposal that allows the alignment of education for health professionals and health systems to contribute to the creation of an effective, equitable, and sustainable system. The present article aims to discuss this problem from the importance of training health professionals, ethical and committed to their communities, that have the skills and attitudes to implement a patient-centered vision. The involvement of universities and training institutions of the next generation of health professionals cannot be postponed.

Resumo Introdujo: Baixa visáo e cegueira tém alta prevaléncia global, com categorías de incapacidade comuns na Colombia. Sao necessários estudos que caracterizem a etiologia das deficiencias visuais permanentes. Objetivo: Identificar e caracterizar as diferentes causas de baixa visao e cegueira em sete centros de referéncia para a populagáo deficiente visual na Colombia, atendidos entre 2012 e 2017 em seis capitais. Materiais e métodos: estudo retrospectivo, série de casos, descritivo e multicéntrico. Resultados: Uma amostra de 879 registros de pacientes com deficiéncia visual estava disponível. 54% (478/879) homens. A baixa visao é mais prevalente para todas as faixas etárias. 70% (612/879) baixa visao e 30% (267/879) cegueira. A etiologia mais comum em pacientes com baixa visáo foi a degenerado macular relacionada a idade (DMAE) (24%, 144/612); em pacientes com cegueira foi glaucoma (17%, 45/267). Discussao: Possivelmente na Colombia as causas da baixa visáo e cegueira váo além da catarata, erros refrativos náo corrigidos e cegueira infecciosa. Condusdes: As etiologias mais comuns encontradas sáo condigóes oculares crónicas e diversas, que requerem intervengóes específicas para diminuir sua prevaléncia e prevenir casos de baixa visáo e cegueira.

Abstract Introduction: Low vision and blindness have high global prevalence, with categories of disability common in Colombia. Studies that characterize the etiology of permanent visual impairments are required. Objective: To identify and characterize the different causes of low vision and blindness in seven reference centers for the visually impaired population in Colombia, attended between 2012 and 2017 in six capital cities. Materials and methods: retrospective, case series, descriptive and multicenter study. Results: A sample of 879 records of visually impaired patients was available. Low vision is more prevalent for all age groups. 70% (612/879) low vision and 30% (267/879) blindness. The most common etiology in patients with low vision was age-related macular degeneration (DMAE) (24%, 144/612); in patients with blindness it was glaucoma (17%, 45/267). Discussion: Possibly in Colombia the causes of low vision and blindness go beyond cataracts, un corrected refractive errors and infectious blindness. Conclusions: The most common etiologies found are chronic and diverse eye conditions, which require specific interventions to decrease their prevalence and prevent cases of low vision and blindness.

Resumen Introducción: La baja visión y la ceguera tienen alta prevalencia mundial, siendo categorias de discapacidad frecuentes en Colombia. Se requieren estudios que caractericen la etiologia de las deficiencias visuales permanentes. Objetivo: Identificar y caracterizar las diferentes causas de baja visión y ceguera en siete centros de referencia para la población con discapacidad visual en Colombia, atendida entre los años 2012 a 2017 en seis ciudades capitales. Materiales y métodos: estudio retrospectivo, serie de casos, descriptivo y multicéntrico. Resultados: Se contó con una muestra de 879 registros de pacientes con discapacidad visual. El 70% (612/879) con baja visión y 30% (267/879) con ceguera. Para todos los grupos de edad es más prevalente la baja visión. La etiologia más frecuente en pacientes con baja visión fue la degeneración macular asociada a la edad (DMAE) (24%, 144/612); en pacientes con ceguera fue el glaucoma (17%, 45/267). Discusión: Posiblemente en Colombia las causas de baja visión y ceguera van más allá de las cataratas, errores de refracción no corregidos y ceguera infecciosa. Conclusiones: las etiologias más frecuentes encontradas son condiciones oculares crónicas y diversas, que requieren intervenciones especificas para disminuir su prevalencia y prevenir casos de baja visión y ceguera.

ABSTRACT Rendu-Osler-Weber´s disease, also known as hereditary hemorrhagic telangiectasia, is a genetic disease of autosomal dominant inheritance with incomplete penetrance. It affects both sexes equally and symptoms usually begin between the ages of 20 and 40, but it is considered that the disease is underdiagnosed. Typically, the clinical forms and the onset of this disease are associated with the organs and tissues that are most frequently affected: mucosal and skin telangiectasias, epistaxis, gastrointestinal, pulmonary and intracerebral bleeding. In contrast, the clinical case that is presented is characterized because the first clinical manifestations that motivated the medical consultation were crises of pain and bone inflammation in the right upper limb, which is unusual and is inscribed as an element of novelty in the disease. The objective of this publication is to present a case of hereditary hemorrhagic telangiectasia with an atypical presentation in a female teenager.

RESUMEN La enfermedad de Rendu-Osler-Weber, también conocido como telangiectasia hemorrágica hereditaria, es una enfermedad genética de herencia autosómica dominante con penetrancia incompleta. Afecta por igual a ambos sexos y los síntomas se inician habitualmente entre los 20 y 40 años, pero se considera que la enfermedad está infradiagnosticada. Típicamente las formas clínicas y el debut de esta enfermedad se asocian a los órganos y tejidos que se afectan con mayor frecuencia: telangiectasias en mucosas y en piel, epistaxis, sangramiento gastrointestinal, pulmonar e intracerebral. En contraste, el caso clínico que se presenta se caracteriza porque las primeras manifestaciones clínicas que motivaron la consulta médica fueron crisis de dolores e inflamación ósea en el miembro superior derecho, lo cual es inusual y se inscribe como un elemento de novedad en la enfermedad. Es el objetivo de esta publicación exponer un caso de telangiectasia hemorrágica hereditaria con una forma de presentación atípica en una adolescente. Al alta hospitalaria, la paciente estaba estable, sin complicaciones. Se recomendó seguimiento hospitalario fundamentalmente por la especialidad de Neumología, por ser los pulmones los órganos más afectados.

At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative “Un respiro para Chile” brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.