Composición química de intestinos de pollos pre-secados con harinas vegetales: proteína alternativa para la acuicultura

RESUMEN Objetivo. Caracterizar la composición química de intestinos de pollos procesados con harinas vegetales (HV), como fuente alternativa de proteína para la acuicultura. Materiales y métodos. Los intestinos de pollos, molidos, cocidos y desgrasados (IPMCD), se mezclaron de forma individual con harinas vegetales (HV): polvo de arroz (PA), salvado de trigo (ST), harinas de palmiste (HPa), maíz (HM) y soya (HS), en proporciones (p:p): 80:20, 70:30, 60:40, 50:50 y 40:60 (IPMCD:HV), con 20 tratamientos y diseño completamente aleatorizado. Se evaluó materia seca, proteína cruda, lípidos, fibra, cenizas, energía bruta (MJ kg-1) y costos. Se aplicó análisis de componentes principales (PCA) para verificar la interacción entre proporciones. Resultados. Las mayores proporciones con IPMCD, incrementaron el contenido de proteína y lípidos (p<0.05) y redujeron el costo (p<0.05). Las mezclas con 50:50 y 40:60% (IPMCD:HV) mostraron mayores niveles de fibra y cenizas (p<0.05). Además, el empleó de HS en las mezclas, incrementó el porcentaje de proteína, energía y costos (p<0.05), efecto contrario con HPa que mostró los menores costos (p<0.05). Conclusiones. Las proporciones de IPMCD:HV alcanzaron altos niveles de materia seca, que facilitó el proceso de deshidratación. El contenido nutricional y costos de las mezclas, las acredita como posibles alimentos acuícolas, para reemplazar la proteína en las dietas, según la especie, fin productivo y requerimientos del mercado. El PCA con matriz de covarianza, sugiere que los tratamientos IPMCD:HS (80:20), IPMCD:HS (70:30) y IPMCD:HS (60:40) tienen mejores características nutricionales, aunque, IPMCD:HPa (80:20) mostró altos niveles de proteína y fue la más económica.

ABSTRACT Objective. Characterizing the chemical composition of pre-dried chicken intestines with vegetable meal (VM), as an alternative source of protein for aquaculture. Materials and methods. Chicken intestines, grounded, cooked and defatted (CIGCD), were mixed individually with VM : rice powder (RP), wheat bran (WB), palm kernel cake (PKC), cornmeal (CM) and soybean meal (SBM), in proportions (w:w): 80:20, 70:30, 60:40, 50:50 and 40:60 (CIGCD:VM), for a total of 20 experimental treatments, according to a completely randomized design. Dry matter, crude protein, lipid, fiber, ashes, gross energy (MJ kg-1) and costs were evaluated. The principal component analysis (PCA) was applied to verify the interaction between proportions. Results. The proportions with higher levels of CIGCD, protein and lipid content increased (p<0.05), with reduced cost (p<0.05). Those with higher values of VM, fiber and ash showed high values (p<0.05). The mixtures with SBM, high figures of protein, energy and costs (p<0.05) and with PKC the lowest costs (p<0.05). Conclusions. The proportions of CIGCD:VM reached high levels of dry matter, which facilitated the dehydration process. The content of protein, lipid, energy and costs, obtained in the different mixtures, accredits them as possible aquaculture feed, to replace conventional protein in diets, according to the species, productive purpose and market requirements. The PCA with covariance matrix suggests that the mixtures CIGCD:VM, the treatments CIGCD:SBM (80:20), CIGCD:SBM (70:30) and CIGCD:SBM (60:40) have better nutritional characteristics, although, the CIGCD:PKC (80:20) ratio showed high protein levels and was the most economical.

Evolución de la pérdida sanguínea en la prótesis total de rodilla con recuperador de sangre vs drenaje convencional / Evolution of blood loss in total knee prosthesis with blood recovery system vs conventional drainage

Resumen: Introducción: la cirugía protésica total de rodilla (PTR) se puede asociar a pérdidas sanguíneas (PS) significativas. El objetivo es analizar la evolución de la PS tras PTR con recuperador sanguíneo vs drenaje convencional. Material y métodos: estudio prospectivo de dos grupos de 30 pacientes intervenidos de PTR, uno control (GC) y otro estudio con recuperador (GR). Se analizó la PS, hematocrito (Hcto), hemoglobina (Hb), tensión arterial sistólica (TAS) y diastólica (TAD) y frecuencia cardíaca (FC) a las tres, 24, 48, 72 y 96 horas postquirúrgicas, la necesidad de transfusión, el porcentaje de altas en 72 horas y las complicaciones. Resultados: la mayor PS y porcentaje de cambio de Hcto y Hb se produjo a las tres horas postquirúrgicas e inició su recuperación a las 72 horas en el GR (Hcto, p = 0.02) (Hb, p = 0.04) y a las 96 horas en el GC. La TAS, TAD y FC empezó su recuperación a las 72 horas en ambos grupos. El descenso de TAS fue mayor en el GC a las tres horas (p = 0.02), 24 horas (p = 0.02) y 48 horas (p = 0.01) postquirúrgicas. Veinte y 33% de los pacientes fueron transfundidos, además 20 y 74% fueron dados de alta a las 72 horas en el GC y GR, respectivamente. Conclusión: la mayor PS y porcentaje de cambio de Hcto y Hb se produce a las tres horas postquirúrgicas y empieza su recuperación a las 72-96 horas. El recuperador favorece la recuperación del Hcto, Hb y TAS, disminuye la necesidad de transfusión y favorece el alta precoz.

Abstract: Introduction: knee prosthetic surgery can be associated with significant blood loss that can account for up to 20% of blood volume. The objective of our study is to analyze blood loss (BL) after total knee replacement (TKR), with the use of a blood recovery system vs a normal drain. Material and methods: prospective, comparative, and observational study of two groups of 30 patients who underwent TKR, one control (CG) and another study group with a recovery system (RG). We analyzed PS, hemoglobin (Hb), hematocrit (Htc), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) at 3-, 24-, 48-, 72- and 96-hours post-surgery, the need for transfusion, and the percentage of discharges in 72 hours and complications. Results: the highest percentage of change in Htc and Hb occurred in the first 3 hours post-surgery and recovery began at 72 hours in the RG (p = 0.02) and at 96 hours in the CG (p = 0.04). The decrease in Hb and Htc began his recovery at 72 hours in the RG and at 96 hours in the CG. The TAS, TAD and FC began their recovery at 72 hours in both groups. The decrease in SBP was greater in the CG at 3 hours (p = 0.02), 24 hours (p = 0.02) and 48 hours (p = 0.01) post-surgery. Six patients were transfused in RG and 10 in CG (p = 0.22). 20% and 74% of the patients were discharged at 72 hours in the CG and RG, respectively. Conclusion: the greatest BL occurs in the first 3 hours post-surgery and recovery begins at 72-96 hours. Recovery blood system decreases BL during the first 3 hours, enhance the recuperation of Hb and SBP, decreases the need for transfusion and favors early discharge.

Plasma rico en plaquetas autólogo en la cicatrización de heridas por cirugía electiva, ¿mito o realidad? Estudio prospectivo experimental / Autologous platelet rich plasma in the healing of wounds by elective surgery, myth or reality? Experimental prospective study

El plasma rico en plaquetas es un producto biológico definido como parte de la fracción plasmática de sangre autóloga con concentración plaquetaria por encima de la línea de base, considerándose como tecnología terapéutica endógena con potencial para estimular y acelerar la cicatrización de los tejidos.Objetivo : Evaluar el uso del plasma rico en plaquetas autólogo en la cicatrización de heridas quirúrgicas de pacientes intervenidos por colecistectomía convencional electiva en el Hospital General Nacional "Dr. Ángel Larralde".Métodos : Estudio cohorte, observacional y analítico, con diseño experimental, prospectivo, de corte longitudinal. Muestra no probabilística, intencional, conformada por pacientes ajustados a criterios de inclusión. Ficha de Recolección de Datos diseñada con las escalas de Vancouver y de Evaluación Objetiva de Paciente y Observador. Los resultados obtenidos se tabularon en una matriz de datos realizada con Microsoft®Excel y, posteriormente, presentados por medio de tablas de distribución de frecuencias y gráficos. Para el análisis e interpretación de los resultados, se recurrió al programa SPSS 26®, de licencia libre. Se utilizó el estadístico Chi Cuadrado.Resultados : Total de 26 pacientes: grupo de estudio con 11 pacientes, grupo control con 15 pacientes. Se calculó valor de p para ambas escalas, resultando˂ 0.05 en todas las observaciones. Conclusión : Se observó una evolución satisfactoria evidente en los pacientes a los cuales se les aplicó el PRP respecto al grupo control, de manera que apoya la premisa de que el PRP contribuye a una cicatrización rápida, sin complicaciones y de fácil obtención(AU)

Platelet-rich plasma is a biological product defined as part of the plasmatic fraction of autologous blood with platelet concentration above the baseline, being considered as an endogenous therapeutic technology with the potential to stimulate and accelerate tissue healing.Objective : To evaluate the use of autologous platelet-rich plasma in the healing of surgical wounds in patients undergoing elective conventional cholecystectomy at the National General Hospital "Dr. Angel Larralde.Methods : Cohort, observational and analytical study, with an experimental, prospective design, longitudinal cut. Non-probabilistic, intentional sample, made up of patients adjusted to inclusion criteria. Data Collection Sheet designed with the Vancouver scales and the Objective Assessment of Patient and Observer. The results obtained were tabulated in a data matrix made with Microsoft®Excel and, later, presented by means of frequency distribution tables and graphs. For the analysis and interpretation of the results, the free license program SPSS 26® was used. The Chi Square statistic was used.Results : Total of 26 patients: study group with 11 patients, control group with 15 patients. The p value was calculated for both scales, resulting in˂ 0.05 in all observations. Conclusion : An evident satisfactory evolution was observed in the patients to whom the PRP was applied compared to the control group, so that it supports the premise that the PRP contributes to rapid healing, without complications and easy to obtain(AU)

Resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá / Results of bariaric surgery in obese patients admitted to Itauguá National Hospital

Introducción: La obesidad es la segunda causa de muerte susceptible de prevención. El tratamiento quirúrgico es el único tratamiento eficaz y demostrado para pacientes con obesidad grave (índice de masa corporal > 40 kg/m²). Las operaciones bariátricas prolongan la supervivencia y corrigen las enfermedades asociadas con la obesidad grave. Objetivos: Caracterizar los resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá de marzo a diciembre del año 2019. Materiales y métodos: Estudio observacional, descriptivo de corte transversal, retrospectivo con muestreo no probabilístico a conveniencia. Se incluyeron pacientes de ambos sexos, mayores a 16 años con obesidad sometidos a cirugía bariátrica en el Servicio de Cirugía General del Hospital Nacional de Itauguá. Resultados: Se incluyeron a 24 pacientes, cuyo promedio de peso fue de 117,5 kg y un promedio del IMC de 43,5. El 67% presentó obesidad grado III y el 70% un ASA III. La técnica quirúrgica empleada con mayor frecuencia fue gastrectomía vertical en manga laparoscópica. El promedio de pérdida de exceso de peso post quirúrgico a los 12 meses fue de 56,4 kg. La estancia hospitalaria post quirúrgico en promedio fue de 48 horas. En el 96% de los casos no se presentaron complicaciones. Conclusión: El resultado de nuestro estudio sugiere que la cirugía bariátrica ha demostrado ser una alternativa con excelentes resultados para el tratamiento de la obesidad, mejorando así no solo patologías clínicas crónicas sino también la calidad de vida del paciente.

Introduction: Obesity is the second cause of death susceptible to prevention. Surgical treatment is the only effective and proven treatment for severely obese patients (body mass index > 40 kg/m²). Bariatric operations prolong survival and correct diseases associated with severe obesity. Objectives: To determine the short-term and long-term results of bariatric surgery in obese patients admitted to the National Hospital of Itauguá from March to December 2019. Materials and methods: Observational, descriptive cross-sectional, retrospective study with non-probabilistic sampling at convenience. We included patients of both sexes, over 16 years of age with obesity who underwent bariatric surgery and were admitted to the General Surgery Service of the Hospital Nacional de Itauguá in 2019. Results: Twenty-four patients were followed up in the study, with an average weight of 117.5 kg and a mean BMI of 43.5. 67% presented with grade III obesity and 70% with ASA III. The most frequently used surgical technique was vertical gastrectomy in the laparoscopic sleeve. The average postoperative weight loss at 12 months was 56.4 kg. The average postoperative hospital stay was 48 hours. There were no complications in 96% of cases. Conclusion: The result of our study suggests that bariatric surgery has proven to be an alternative with excellent results for the treatment of morbid obesity, , thus improving not only chronic clinical pathologies but also the quality of life of the patient with increased life expectancy.

Ácidos grasos omega-3 y función endotelial en pacientes con síndrome coronario agudo / Omega-3 fatty acids and endothelial function in patients with acute coronary syndrome

Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial, manifestándose principalmente como enfermedad isquémica coronaria. El pronóstico y desenlace del Síndrome Coronario Agudo (SCA) depende en gran proporción de la disfunción endotelial asociado a este cuadro. Objetivo:Evaluar el efecto de los ácidos grasos omega­3, sobre la función endotelial en el Síndrome Coronario Agudo (SCA). Métodos: Se realizó estudio con 16 pacientes con síndrome coronario agudo (SCA) tratados con Omega-3 a dosis de 3 gramos/día+Terapia Convencional (O3+Tc) durante 30 días. Se les realizó a las 12 horas del ingreso y los a 30 días, perfil lipídico, proteína C reactiva ultrasensible (PCRus), Endotelina 1 (ET-1), y Péptido Natriurético cerebral (NTproBNP). Resultados: Durante 4 semanas de seguimiento, el uso de 3 gramos/día de ácidos grasos omega-3, añadido a la terapia convencional en el Síndrome Coronario Agudo, mostró una reducción significativa de la concentración plasmática de NTproBNP (p = 0,000), PCRus (p =0,000) y triglicéridos (p = 0,004). Conclusión: Tres gramos al día de ácidos grasos omega-3 contribuye a la reducción de la concentración plasmática de Triglicéridos y NTproBNP en pacientes con síndrome coronario agudo(AU)

Mainly as coronary ischemic disease. the prognosis and outcome of Acute Coronary Syndrome (ACS) depend largely on the endothelial dysfunction associated with this condition. Objective: To evaluate the effect of omega-3 fatty acids on endothelial function in Acute Coronary Syndrome (ACS). Method: A study was conducted with 16 patients with acute coronary syndrome (ACS) treated with Omega-3 at a dose of 3 grams/day+Conventional erapy (O3+Tc) for 30 days. Lipid profile, ultrasensitive C-reactive protein (usCRP), Endothelin 1 (ET-1), and Brain Natriuretic Peptide (NTproBNP) were performed 12 hours aer admission and 30 days later. Results: During 4 weeks of follow-up, the use of 3 grams/day of omega-3 fatty acids, added to conventional therapy in Acute Coronary Syndrome, showed a significant reduction in the plasma concentration of NTproBNP (p = 0.000), hsCRP (p =0.000) and Triglycerides (p = 0.004). Conclusion: three grams a day of omega-3 fatty acids contributes to the reduction of the plasmatic concentration of Triglycerides and NTproBNP in patients with acute coronary syndrome(AU)

Hiperparatiroidismo primario: experiencia en cirugía por mini abordaje unilateral / Primary hyperparathyroidism: experience in surgery by unilateral mini-approach

INTRODUCCIÓN: En el hiperparatiroidismo primario el origen del trastorno, como su nombre lo indica, está en la propia glándula paratiroides, la cual genera una secreción autónoma y excesiva. La cirugía de las glándulas paratiroides evolucionó en forma considerable en los últimos 30 a 40 años, pasamos de exploraciones cervicales exhaustivas, hasta una época en que gracias al desarrollo tecnológico y sobre todo medicina nuclear, podemos localizar en forma preoperatoria el tejido patológico; siendo esta a su vez la base fundamental en la realización de procedimientos más selectivos. OBJETIVO: mostrar la casuística de cirugía por mini abordaje de la glándula paratiroides en el hiperparatiroidismo primario en un centro mutual de Montevideo. MATERIAL Y MÉTODOS: Realizamos un estudio observacional descriptivo y retrospectivo. Se estudió una muestra de 18 pacientes con diagnóstico de hiperparatiroidismo primario y con sospecha de lesión única los cuales fueron intervenidos en un centro mutual de la ciudad de Montevideo entro julio de 2017 y enero de 2020. CONCLUSIÓN: La cirugía por mini abordaje de la glándula paratiroides puede ser aplicada en el hiperparatiroidismo primario en pacientes seleccionados con las ventajas de; tener un menor tiempo quirúrgico, ser ambulatoria (reintegro al hogar en pocas horas), indemnidad de la logia tiroidea contralateral, mejor resultado estético con similar tasa de éxito que la cirugía convencional.

BACKGROUND: In primary hyperparathyroidism, the origin of the disorder, as its name indicates, is in the parathyroid gland itself, which generates excessive and autonomous secretion. Parathyroid gland surgery has evolved dramatically in the last 30 to 40 years, from exhaustive cervical examinations, to nowadays when, thanks to technological development and especially nuclear medicine, we can locate pathological tissue preoperatively; this, in fact, is the fundamental basis for the performance of more selective procedures. OBJECTIVE: to show the casuistry of mini-approach surgery of the parathyroid gland in primary hyperparathyroidism in a mutual center in Montevideo. METHODS: We carried out a descriptive and retrospective observational study. We studied a sample of 18 patients diagnosed with primary hyperparathyroidism and a single suspicious lesion, who underwent surgery in a private center in the city of Montevideo from July 2017 to January 2020. CONCLUSION: Mini-approach surgery of the parathyroid gland can be applied in primary hyperparathyroidism in selected patients, with the advantages of a shorter surgical time, ambulatory (return home in a few hours), keeping the indemnity of the contralateral thyroid loggia, a better cosmetic result with a similar success rate than conventional surgery.

Processing tomato waste as a potential bioactive compounds source: phenolic compounds, antioxidant capacity and bioacessibility studies / Resíduo do processamento do tomate como potencial fonte de compostos bioativos: compostos fenólicos, capacidade antioxidante e bioacessibilidade

A comparative study was perfomed with conventional and ultrasound assisted extraction on tomato processing waste. Ultrasound extraction exhibited slightly higher phenolic and flavonoids content, as well as higher ABTS + radical scavenging capacity (4.63 mg GAE.g-1, 0.96 mg RUE.g-1 and 27.90 µmol TE.g -1 respectively). On both extracts, a high percentage of flavonoids was lost during simulated digestion, resulting on a bioacessibility of approximately 13 %. Extracts presented good stability during storage conditions, which indicates a possible technological application.

Foi realizado um estudo comparativo com a extração convencional e assistida por ultrassom em resíduos do processamento de tomate. A extração ultrassônica exibiu teor de fenólicos e flavonóides ligeiramente maiores, bem como maior capacidade antioxidante ABTS + (4,63 mg AG.g-1, 0,96 mg RUE.g-1 e 27,90 µmol TE.g -1, respectivamente). Em ambos os extratos, uma alta porcentagem de flavonóides foi perdida durante a digestão simulada, resultando em uma bioacessibilidade de aproximadamente 13%. Os extratos apresentaram boa estabilidade durante as condições de armazenamento, o que indica uma possível aplicação tecnológica.

Simulador de fosa ilíaca derecha para la adquisición de habilidades básicas en apendicectomía convencional / RIGHT ILIAC FOSSA SIMULATOR FOR THE ACQUISITION OF BASIC SKILLS IN CONVENTIONAL APPENDICECTOMY

Introducción: La simulación quirúrgica es un método de enseñanza que cada día va abarcando más terreno, dejando de lado al modelo tradicional de aprendizaje en los servicios de cirugía. El proceso inflamatorio del apéndice cecal es todavía una de las patologías más prevalentes en el área del cirujano general, quien debe tener varias estrategias para poder resolver la misma. Aquí presentamos un simulador de fosa iliaca derecha para la adquisición de habilidades básicas en apendicetomía convencional. Material y Métodos: se desarrolló un simulador de fosa iliaca derecha de la siguiente manera: se recorta el centro la tapa de una caja de aglomerado, y tanto los foamy como el papel crepé en rectángulos del tamaño de la tapa de la caja; se crea un preparado cadavérico utilizando el intestino vacuno; se coloca el preparado y por encima una compresa teñida en la bolsa de polietileno, dentro de la caja; se cierra la caja y se colocan las láminas de foamy y el papel crepé encima de la tapa, fijadas con los tornillos y tuercas, representando la pared abdominal. Resultado: Simulador reproducible, económico y de fácil elaboración. Tiempo total de armado: 1 hora. Conclusiones: Se puede utilizar para simular la técnica quirúrgica de apendicectomía convencional y sus variantes

Introduction: Surgical simulation is a teaching method that covers more ground every day, leaving aside the traditional apprenticeship model in surgery services. The inflammatory process of the cecal appendix is still one of the most prevalent pathologies in the area of the general surgeon, who must have several strategies to solve it. Here we present a right iliac fossa simulator for the acquisition of basic skills in conventional appendectomy. Material and Methods: We cut the center of the lid of the chipboard box, then cut the foamy and the crepe paper into rectangles the size of the lid of the box. We create a cadaveric preparation using the bovine intestine. Then put the preparation with a dyed compress above it in the polyethylene bag, inside the box. We close the box and place on the lid the foamy and crepe paper, fixed with bolts and nuts. Result: Cheap and easy-made simulator. We can armed de simulator in one hour. Conclusions: It can be used to simulate the conventional appendectomy surgical technique and its different variants.

Exploración de las vías biliares como tratamiento de la litiasis coledociana: manejo laparoscópico vs. convencional. Estudio prospectivo y comparativo / Common bile duct exploration as treatment of choledocal lithiasis: laparoscopic vs conventional approach. Prospective and comparative study

La litiasis coledociana es una complicación poco frecuente asociada a la litiasis vesicular. Puede ser resuelta mediante colangiopancreatografía retrógrada endoscópica (CPRE) o en su defecto, una exploración de las vías biliares por abordaje convencional (cirugía abierta) o laparoscópico. Objetivos: Determinar la efectividad del abordaje laparoscópico versus el convencional en la exploración de las vías biliares como tratamiento de la litiasis coledociana. Métodos : Se realizó un estudio prospectivo y comparativo con una muestra de 31 pacientes con litiasis coledociana seleccionados de manera no aleatoria. Resultados : Ambos grupos fueron comparables en edad, sexo, frecuencia de litiasis vesicular y CPRE preoperatoria. El tiempo quirúrgico promedio fue 4,52 versus 3,49 horas para los abordajes laparoscópico y convencional respectivamente. En el grupo laparoscópico se usó tubo de Kehr en 21% de los pacientes y en 79 % sutura primaria. En el grupo convencional se usó tubo de Kehr en 29% de los pacientes y en 71 % sutura primaria. La fuga biliar fue la complicación más frecuente. La estancia hospitalaria fue 3,14 días en el grupo laparoscópico versus 5,23 días en el grupo convencional, sin diferencia estadísticamente significativa. Conclusión : No se logró demostrar una superioridad evidente de alguno de los grupos estudiados, sin embargo nuestros pacientes podrían beneficiarse de las ventajas del abordaje laparoscópico en términos de tener menor dolor postoperatorio y una reincorporación más rápida a sus actividades habituales. Estudios similares con mayor número de casos son necesarios para llegar a datos más concluyentes(AU)

Common bile duct (CBD) lithiasis are an unusual complication associated to gallbladder stones. It can be resolved by endoscopic retrograde cholangiopancreatography (ERCP) or, alternatively, a CBD exploration by conventional (open surgery) or laparoscopic approach.Objectives : To determine the effectiveness of laparoscopic approach versus conventional approach in CBD exploration as a treatment for choledochal lithiasis.Methods : A prospective and comparative study was carried out with a non-random intentionally selected sample consisting of 31 patients with CBD stones.Results : Both groups had no statistical differences regarding age, sex, frequency of gallbladder stones, and preoperatory ERCP. The average surgical time was 4.52 versus 3.49 hours for the laparoscopic and conventional approaches, respectively. In laparoscopic group, Kehr tube was used in 21% of patients and primary closure in 79%. In conventional group, Kehr tube was used in 29% of patients versus 71% of patients with primary closure. Biliary leak was the most frequent complication. Hospital stay was 3.14 days in the laparoscopic group versus 5.23 days in the conventional group, with no statistically significant difference.Conclusion : It was not possible to demonstrate an evident superiority of any of the groups studied, however our patients could benefit from the advantages of the laparoscopic approach in terms of less postoperative pain and faster return to their usual activities. Similar and larger studies are necessary to achieve stronger and conclusive data(AU)

Accuracy of Intraoral Scanners and Conventional pressions in Full-Arches: a Systematic Review / Exactitud de Escáneres Intraorales e Impresiones Convencionales en Arcadas Completas: una Revisión Sistemática

The aim of this study was to evaluate intraoral scanners accuracy in full-arches, comparing them with conventional impressions. A scientific research performed in MEDLINE, EBSCOhost, and SciELO databases was conducted to analyze articles published between 2015 and 2020. Clinical and in vitro studies that evaluated accuracy (precision and trueness) from intraoral scanners and conventional impressions in full-arches were included. Two tests were applied to evaluate the methodological bias from the studies. Out of the 191 articles found, seven of them were selected for a qualitative analysis. In clinical studies,intraoral scanners CEREC Omnicam and 3Shape TRIOS Colorhad the highest precision compared to conventional irreversible hydrocolloid impressions. In in vitro studies, conventional polyvinyl siloxane impressions showed the highest accuracy, followed by intraoral scanners Cadent iTero and CEREC Omnicam, while irreversible hydrocolloid impressions showed the lowest accuracy. Digital intraoral impression systems do not show superior accuracycompared to highly accurate conventional impression techniques. However, they provide excellent clinical results and both methods are clinically accepted.

El objetivo de este estudio fue evaluar la exactitud de escáneres intraorales en impresiones digitales de arco completo en comparación con las impresiones convencionales. Se realizó una revisión sistemática en las bases de datos MEDLINE, EBSCOhost y SciELO para analizar artículos publicados entre los años 2015 y 2020. Se incluyeron estudios clínicos e in vitro que evaluaran exactitud (precisión y/o veracidad) de escáneres intraorales impresiones convencionales en arcos completos. Dos pautas se aplicaron para evaluar el riesgo de sesgo de los estudios. De 191 artículos encontrados, 7 fueron seleccionados para un análisis cualitativo. En los estudios clínicos, los escáneres intraorales CEREC Omnicam y 3Shape TRIOS Color presentaron la mayor precisiónen comparación con las impresiones convencionales de hidrocoloide irreversible. En los estudios in vitro, las impresiones de polivinil siloxano presentaron la mayor exactitud seguido por los escáneres intraorales CadentiTero y CEREC Omnicam, mientras quelas impresiones de hidrocoloide irreversible presentaron la menor exactitud. Los sistemas de impresión digital intraoral no mostraron tener una exactitud superior comparados con las técnicas de impresión convencional de gran exactitud. Sin embargo, proveen excelentes resultados clínicos y ambos métodos son clínicamente aceptables.

Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional? / Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one?

Resumen La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Abstract Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

Avaliação de ressecção de mucosa endoscópica sob imersão d'água de pólipos colorretais em um centro ambulatorial no Brasil / Evaluation of underwater endoscopic mucosal resection for colorectal polyps in an outpatient clinic in brazil

ABSTRACT BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.

RESUMO CONTEXTO: Desde 2012, uma nova técnica para ressecção de pólipos grandes tem sido descrita, a ressecção da mucosa endoscópica sob imersão d'água (REMS). Algumas vantagens que surgem desta técnica são evitar a injeção na camada submucosa e a maior chance de captura completa do pólipo. Objetivo - Há poucos estudos com REMS no Brasil. Nosso objetivo é avaliar a segurança e a eficácia da técnica em um centro brasileiro. MÉTODOS: Esta série de casos foi conduzida de fevereiro a dezembro de 2020. Pólipos colorretais maiores que 9 mm sem sinais endoscópicos de invasão de submucosa foram ressecados utilizando RMES. RESULTADOS: Vinte e quatro pólipos foram ressecados com RMES em 24 pacientes diferentes. O tamanho médio dos pólipos era de 19 mm, variando de 12 a 35 mm. Todas as lesões foram ressecadas e 66% (16/24) foram ressecadas em monobloco. Na análise histológica, a maioria era adenoma (70.8%) e apenas uma havia invasão profunda da submucosa. CONCLUSÃO: O uso de REMS é um procedimento seguro e factível. Com o aumento de dados relativos ao procedimento, esta parece ser uma excelente ferramenta na prevenção do câncer colorretal e sua aplicabilidade deve ser encorajada para fora dos centros de referência.

Instrumental piezoeléctrico comparado con sierra convencional en cirugía ortognática / Piezoelectric bone surgery compared to conventional saw in orthognathic surgery

RESUMEN: Introducción: La utilización de instrumental piezoeléctrico en cirugía ortognática ha ido en aumento con el fin de minimizar el riesgo de daño a tejidos blandos en comparación al uso de sierra convencional. Sin embargo, aún existe incertidumbre respecto a las complicaciones asociadas a cada instrumental. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 10 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con la sierra convencional podría disminuir el riesgo de daño nervioso grave y disminuir el sangrado grave (>500 mL), pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría presentar poca o nula diferencia en el dolor postoperatorio, pero la certeza de la evidencia es baja. Finalmente no es posible establecer con claridad si el uso de instrumental piezoeléctrico disminuye la pérdida de sangre intraoperatoria (variable continua), la inflamación postoperatoria o el tiempo operatorio, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: The use of piezoelectric bone surgery in orthognathic surgery has been increasing to minimize the risk of soft tissue damage compared to conventional saws. However, there is still uncertainty regarding the complications associated with each instrument. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed primary studies' data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified four systematic reviews that included 10 primary studies, four of which corresponded to randomized trials. We conclude that the use of piezoelectric instrumentation compared to the conventional saw may reduce the risk of severe nerve damage and decrease severe bleeding (>500 mL), but the certainty of the evidence is low. On the other hand, the use of piezoelectric bone surgery may make little or no difference in postoperative pain, but the certainty of the evidence is low. Finally, we are uncertain whether piezoelectric bone surgery reduces intraoperative blood loss (continuous variable), postoperative inflammation, and operative time, as the certainty of the evidence has been assessed as very low.

Comparison of automated breast ultrasound and hand-held breast ultrasound in the screening of dense breasts / Comparação entre a ultrassonografia automatizada e a ultrassonografia convencional no rastreio de mamas densas

Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.

Resumo Objetivo Comparar a ultrassonografia convencional das mamas (US) com a ultrassonografia automatizada das mamas (ABUS) no rastreio do câncer. Métodos Realizamos um estudo transversal com pacientes com mamas mamograficamente densas, sendo avaliadas pela US e pela ABUS. A US foi realizada por radiologistas e a ABUS por técnicos de mamografia e analisada por radiologistas especializados em mama. A classificação Breast Imaging Reporting and Data System (BIRADS) do exame e das lesões o tempo de leitura e de aquisição foram avaliados. A análise estatística foi realizada através de medidas de tendência central, dispersão e frequências, teste t de Student e regressão logística univariada, através do odds ratio, com intervalo de confiança de 95%, e com p<0,05 sendo considerado estatisticamente significante. Resultados Foram avaliadas 440 pacientes. Em relação às lesões, a US detectou 15 (7,7%) BI-RADS 2, 175 (89,3%) BI-RADS 3 e 6 (3%) BI-RADS 4, das quais 3 foram confirmadas, por biópsia, como carcinomas ductais invasivos e 3 falso-positivos. A ABUS identificou 12 (12,9%) BI-RADS 2, 75 (80,7%) BI-RADS 3 e 6 (6,4%) BI-RADS 4, incluindo 3 lesões detectadas pela US e confirmadas como carcinomas ductais invasivos, além de 1 carcinoma lobular invasivo e 2 lesões de alto risco não detectadas pela US. O tempo de leitura dos exames da ABUS foi estatisticamente inferior ao tempo do radiologista para realizar a US (p<0,001). A concordância foi de 80,9%. Um total de 219 lesões foram detectadas, das quais 70 por ambos os métodos, 126 observadas apenas pela US (84,9% não eram lesões suspeitas no ABUS) e 23 apenas pela ABUS. Conclusão Comparado à US, a ABUS permitiu adequado estudo complementar no rastreio do câncer de mamas heterogeneamente densas e extremamente densas.

Comparación de Brackets de Autoligado y Brackets Convencionales basada en la evidencia / Comparação baseada em evidências de colchetes autoligáveis ​​e colchetes convencionais / Evidence-based comparison of self-ligating and conventional brackets

Resumen Los brackets de autoligado son aquellos que incorporan un mecanismo de cierre que mantiene el arco en el interior de la ranura del bracket. Fueron creados principalmente para crear un sistema de menor fricción, permitiendo una mecánica de deslizamiento más eficiente y disminuir el tiempo de tratamiento. Objetivo: El objetivo de esta revisión es presentar de manera más estructurada y ordenada toda la información disponible respecto de los distintos aparatos de autoligado, ya sea activo o pasivo, comparando las cualidades entre sí y con los aparatos convencionales. Método: Se realizó una búsqueda mediante PubMed y Epistemonikos, sin importar idioma o año de publicación. Resultados: Se establecieron comparaciones tanto de brackets de autoligado activos con pasivos, como de brackets de autoligado con brackets convencionales en distintas situaciones clínicas. Conclusiones: Para la gran mayoría de situaciones clínicas, no existe una diferencia estadísticamente significativa, a excepción de la expresión de torque, en donde los brackets convencionales tienen una mayor ventaja.

Resumo Os braquetes autoligáveis são aqueles que incorporam um mecanismo de fechamento que mantém o fio dentro da ranhura do braquete. Eles foram criados principalmente para criar um sistema de menor atrito, permitindo uma mecânica de deslizamento mais eficiente e reduzindo o tempo de tratamento. Objetivo: O objetivo desta revisão é apresentar de forma mais estruturada e ordenada todas as informações disponíveis sobre os diferentes dispositivos autoligáveis, sejam eles ativos ou passivos, comparando as qualidades entre si e com os dispositivos convencionais. Método: A busca foi realizada usando PubMed e Epistemonikos, independentemente do idioma ou ano de publicação. Resultados: Foram comparadas braquetes autoligáveis ativos e passivos e braquetes autoligáveis convencionais em diferentes situações clínicas. Conclusões: Para a grande maioria das situações clínicas, não há diferença estatisticamente significativa, exceto para a expressão do torque, onde os braquetes convencionais apresentam maior vantagem.

Abstract Self-ligating brackets include a locking mechanism that holds the archwire in the bracket slot. They were created primarily to create a lower friction system, allowing for more efficient sliding mechanics and reducing treatment time. Objective: This review aims to present all the information available on different self-ligating devices, whether active or passive, in a structured and organized way. This paper sets out to compare their qualities with each other and with conventional devices. Method: A search was conducted in PubMed and Epistemonikos, regardless of language or year of publication. Results: Comparisons were made of both active and passive self-ligating brackets and self-ligating brackets with conventional brackets in different clinical situations. Conclusions No statistically significant difference was found in most clinical situations, except for torque expression, where conventional brackets have a more significant advantage.

Soil phosphorus availability and uptake by mycorrhizal and non-mycorrhizal plants in an onion no-tillage system / Disponibilidade e absorção de fósforo no solo por plantas micorrízicas e não micorrízicas em sistema de plantio direto de cebola

ABSTRACT: Onion is an important vegetable crop, predominantly grown under conventional tillage system management. Alternatively, the vegetable no-tillage system uses cover crops to form a residue layer, which improves soil physical, chemical, and biological attributes. Aiming to understand the interaction of mycorrhizal and non-mycorrhizal cover crops, phosphatase activity, and soil phosphorus availability and uptake by plants, a no-tillage vegetable production system experiment with onion was carried out in Ituporanga, Southern Brazil. The treatments were black oats (Avena strigosa); rye (Secale cereale); oilseed radish (Raphanus sativus); rye + oilseed radish; black oats + oilseed radish, and a control with spontaneous plants. Additionally, two plots, a conventional tillage system area and a forest, both adjacent to the experiment, were evaluated. We measured cover crop biomass, onion yield, acid phosphatase activity, and resin-extracted phosphorus in the soil, shoot and root phosphorus content, and root colonization in cover crops, spontaneous plants, and onions. The treatments with cover crops had the highest plant biomass in winter and onion yield. Available soil phosphorus and acid phosphatase activity were higher in no-tillage plots than in the conventional tillage system area. The presence of non-mycorrhizal oilseed radish was associated with decreased colonization of rye and onion roots by arbuscular mycorrhizal fungi. No-tillage areas with cover crops or spontaneous plants in winter accumulated more phosphorus than conventional tillage system areas. The conventional tillage system showed adverse effects on most soil attributes, as shown by a Principal Component Analysis.

RESUMO: A cebola é uma importante cultura vegetal, cultivada predominantemente sob sistema de preparo convencional. Como alternativa, o sistema de plantio direto de hortaliças utiliza culturas de cobertura para formar uma camada de biomassa, o que melhora os atributos físicos, químicos e biológicos do solo. Com o objetivo de entender a interação de culturas de cobertura micorrízicas e não-micorrízicas, atividade da fosfatase ácida e disponibilidade e absorção de fósforo do solo pelas plantas, foi realizado um experimento em sistema de plantio direto de hortaliças com a cultura da cebola em Ituporanga, sul do Brasil. Os tratamentos foram: aveia preta (Avena strigosa); centeio (Secale cereale); nabo forrageiro (Raphanus sativus); centeio + nabo forrageiro; aveia preta + nabo forrageiro e um controle com vegetação espontânea. Além disso, duas outras parcelas, uma área em sistema de preparo convencional e uma floresta, ambas adjacentes ao experimento, foram avaliadas. Medimos a biomassa da cultura de cobertura, o rendimento de cebola, a atividade de fosfatase ácida e o fósforo extraído por resina no solo, bem como o conteúdo de fósforo da parte aérea e da raiz e a colonização das raízes em plantas de cobertura, plantas espontâneas e cebolas. Os tratamentos com plantas de cobertura apresentaram a maior biomassa de culturas de cobertura e rendimento de cebola. A atividade de fosfatase ácida e fósforo disponível no solo foram maiores nas parcelas de plantio direto do que na área convencional. A presença de nabo forrageiro, uma planta não micorrízica, foi associada a reduções na colonização de raízes de centeio e cebola por fungos micorrízicos arbusculares. As áreas de plantio direto com plantas de cobertura ou plantas espontâneas no inverno acumularam mais fósforo do que as áreas com preparo convencional. O sistema convencional de lavoura mostrou efeitos adversos para a maioria dos atributos do solo, como mostra a Análise de Componentes Principais.

Evaluation of the influence of the impression technique, scanning direction and type of scanner on the accuracy of the final model / Avaliação da influência da técnica de impressão, direção de digitalização e tipo de scanner na precisão do modelo final

Objective: The purpose of this study is to evaluate the influence of the type of scanner and scanning direction on the accuracy of the final cast. Material and Methods: A partial master cast was used as a reference. A total of 128 scans were obtained and divided into two groups: the conventional method and the digital method. The digital group was divided into three groups: TRIOS 3, Omnicam and CS 3600. Each of these groups was subdivided according to the scanning direction, and each scan was overlaid on the digital reference cast to measure the trueness and precision of the procedures. Results: The overall precision values for the type of impression were 59.89 ± 13.08 µm for conventional and 13.42 ± 4.28 µm for digital; the values for trueness were 49.37 ± 19.13 µm for conventional and 53.53 ± 4.97 µm for digital; the scanning direction trueness values were 53.05 ± 4.36 µm for continuous and 54.03 ± 5.52 µm for segmented; and the precision values were 14.18 ± 4.67 µm for continuous and 12.67 ± 3.75 µm for segmented (p> 0.05). For the scanner type, the trueness values were 50.06 ± 2.65 µm for Trios 3, 57.45 ± 4.63 µm for Omnicam, and 52.57 ± 4.65 µm for Carestream; and those for precision were 11.7 ± 2.07 µm for Trios 3, 10.09 ± 2.24 µm for Omnicam, and 18.49 ± 2.42 µm for Carestream (p <0.05). Conclusions: The digital impression method is the most favorable method regarding precision; in terms of trueness, there are no differences between the types of impressions. (AU)

Objetivo: O objetivo deste estudo é avaliar a influência do tipo de técnica de moldagem, tipo de escâner intraoral e direção do escaneamento na precisão do modelo final. Material e Métodos: Um modelo parcial mestre foi usado como referência. Um total de 128 escaneamentos foi obtido e dividido em dois grupos: o método convencional (n = 32) e o método digital (n = 96). O grupo digital foi dividido em três grupos: TRIOS 3 (n = 32), Omnicam (n = 32) e CS 3600 (n = 32). Cada um desses grupos foi subdividido de acordo com a direção do escaneamento (n = 16), e cada escaneamento foi sobreposto ao modelo de referência digital para medir a veracidade e precisão dos procedimentos. Resultados: Os valores gerais de precisão para o tipo de impressão foram 59,89 ± 13,08 µm para convencional e 13,42 ± 4,28 µm para digital; os valores de veracidade foram 49,37 ± 19,13 µm para convencional e 53,53 ± 4,97 µm para digital; os valores de veracidade para a direção de digitalização foram 53,05 ± 4,36 µm para contínua e 54,03 ± 5,52 µm para segmentada; e os valores de precisão foram 14,18 ± 4,67 µm para contínua e 12,67 ± 3,75 µm para segmentada (p> 0,05). Para o tipo de scanner, os valores de veracidade foram 50,06 ± 2,65 µm para Trios 3, 57,45 ± 4,63 µm para Omnicam e 52,57 ± 4,65 µm para Carestream; e os de precisão foram 11,7 ± 2,07 µm para Trios 3, 10,09 ± 2,24 µm para Omnicam e 18,49 ± 2,42 µm para Carestream (p <0,05). Conclusões: O método de moldagem digital é o método mais favorável em relação à precisão; em termos de veracidade, não há diferenças entre os tipos de impressão (AU)

Quando comer não é suficiente: tríade, cuidado/educação, desenvolvimento e uso dos objetos durante as refeições em duas creches do DF / Cuando comer no es suficiente: triada, cuidado/educación, desarrollo y uso de los objetos durante momentos de alimentación en dos escuelas infantiles de Brasilia

Resumo O presente estudo caracteriza o uso de objetos e de práticas alimentares e descreve as qualidades das interações na tríade cuidadora-objeto-criança (12 a 24 meses) durante as refeições em duas creches em Brasília. A análise enfoca ações, diálogos e aspectos metacomunicativos expressos pelas tríades ao longo da ação pedagógica. A pesquisa utilizou análise microgenética, com observação não participante, filmagem, fotos e registros escritos. Identificouse, por meio deste estudo, como o uso de objetos e a relação triádica são desenvolvidos nas refeições e os aspectos relacionais/educacionais emergentes nesses momentos. Com base nas análises microgenéticas, ficou evidente que os objetos, relações e formas de comunicação na relação triádica estão relacionados com a apropriação e compreensão do uso de objetos, ações de tempo de refeição e práticas contextuais em sala de aula. Os resultados identificam a necessidade de trazer à tona aspectos de significado e sentido durante as refeições em contextos educacionais da primeira infância. O envolvimento da tríade mediante as tentativas de criar cânones das ações, o papel da ação intencional da cuidadora e a dinâmica variegada da semiótica da tríade salientam nas conclusões da pesquisa.

Abstract This paper addresses the use of objects within mealtime practices of 12-14 months old children in two day-care centers in Brasilia. It aims at understanding the qualities of the triadic interactions of teacher-object-child. A research was conducted in order to favor such interactions during everyday school routine. Empirical data collection consisted in non-participant observation, video recording of mealtime episodes, written notes and photos. Microgenetic analyses focused on actions, dialogues and meta-communicative aspects which allowed the identification of the emergence of triadic relationships during mealtime. Special emphasis was drawn on a variety of engagements with food and eating utensils during the educational settings. Results suggest that objects, engagements, and ways of communication in the triadic relationships are related with actions, appropriation and understanding of the use of objects, mealtime actions and cultural practices. Conclusions reveal that important aspects related to meaning making during mealtime in early childhood education and show how the triadic engagement allow the emergence of canonical actions, and the role of the caregiver's leadership, as well as, the variegated semiotic dynamics into the triadic relations.

Efectividad de la ozonopuntura en pacientes con artrosis cervical / Effectiveness of ozonepuncture in patients with cervical osteoarthritis

Introducción: La artrosis vertebral es frecuente. Las causas y procesos fisiopatológicos que contribuyen a su avance son variados. Se plantea que 80 % de las personas mayores de 55 años de edad presentan alteraciones en la columna cervical. Objetivo: Evaluar la efectividad de la ozonopuntura para el alivio de síntomas y signos en pacientes con artrosis cervical. Métodos: Se realizó un estudio de intervención terapéutica en 80 pacientes con artrosis cervical, atendidos en la Consulta de Ortopedia y remitidos al Servicio de Medicina Tradicional y Natural del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde mayo del 2017 hasta marzo del 2019. Se dividieron aleatoriamente en 2 grupos: de estudio y de control, con 40 integrantes cada uno. Resultados: La enfermedad prevaleció en los pacientes de 50-59 años de edad, tanto del grupo de estudio como de control (35,0 y 30,0 %, respectivamente) y en el sexo femenino (85,0 % en el primero y 82,5 % en el segundo). La evolución fue buena y excelente en casi la totalidad de los integrantes del grupo de estudio. Conclusiones: La ozonopuntura fue efectiva en los pacientes con artrosis cervical y no se presentaron reacciones secundarias relacionadas con su aplicación. La evolución resultó satisfactoria y se observó una respuesta mayor en la desaparición de los síntomas y signos clínicos con la terapéutica acupuntural que con la convencional.

Introduction: The vertebral osteoarthritis is frequent. The pathophysiological causes and processes that contribute to its advance are varied. It is said that the 80 % of people over 55 years present cervical spine disorders. Objective: To evaluate the effectiveness of the ozonepuncture for the relief of symptoms and signs in patients with cervical osteoarthritis. Methods: A study of therapeutic intervention in 80 patients with cervical osteoarthritis was carried out, they were assisted in the Orthopedics Service and referred to the Traditional and Natural Medicine Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from May, 2017 to March, 2019. They were divided at random in 2 groups: study and control groups, with 40 members each one. Results: The disease prevailed in the 50-59 age group, in both groups (35.0 and 30.0 %, respectively) and in the female sex (85.0 % in the first one and 82.5 % in the second). The clinical course was good and excellent in almost all the members of the study group. Conclusions: The ozonepuncture was effective in the patients with cervical osteoarthritis and adverse reactions related to its application were not presented. The clinical course was satisfactory and a higher response was observed in the disappearance of the symptoms and clinical signs with the acupuntural therapeutic than with the conventional one.

Can agroecological management increase functional diversity of birds in rice fields? / ¿Puede el manejo agroecológico incrementar la diversidad funcional de aves en campos de arroz?

Introduction: Recognition of the variety of ecosystem services that biodiversity performs in agroecosystems is one of the basic principles of agroecology. Because indices of functional diversity may be directly related with ecosystem services, an assessment of functional diversity can be useful for evaluating ecosystem services provided under agroecological management. Objective: We compared functional diversity of birds found in rice fields under conventional and agroecological management in the rice zone of Santa Fe Province, Argentina. Our objective was to determine whether agroecological management of rice is associated with a higher functional diversity and a different functional composition of birds than conventional management. Methods: We surveyed birds eight times, roughly every 15 days between November 2017 and March 2018, from beginning of sowing to before harvest, in both types of rice fields. Birds were sampled by a combined technique of line transects and point counts at four sites in each type of management. We calculated indices of functional diversity and composition based on morphologic and trophic attributes of birds detected in each type of field. Results: Functional richness, divergence and dispersion were higher under agroecological management. Only differences in functional richness between managements reflected differences in species richness. Community-level weighted means of trait values by sample varied between management types. An insectivorous diet, pursuit as a foraging method, and air and shrubs as foraging substrates were traits best represented under agroecological management. Conclusions: Our results suggest that agroecological management of rice crops is related with a higher functional diversity of birds than conventional practices, suggesting that agroecological management may enhance the provision of ecosystem services by birds in rice agroecosystems.

Introducción: El reconocimiento de la variedad de servicios ecosistémicos de la biodiversidad en los agroecosistemas es uno de los principios básicos de la agroecología. Debido a que los índices de diversidad funcional pueden estar directamente relacionados con los servicios ecosistémicos, la evaluación de la diversidad funcional representa una estrategia adecuada para evaluar estos servicios en agroecosistemas bajo manejo agroecológico. Objetivo: Se comparó la diversidad funcional de aves entre arroceras bajo manejo convencional y agroecológico en la zona arrocera de la provincia de Santa Fe, Argentina. El objetivo fue determinar si el manejo agroecológico del arroz se asocia con una mayor diversidad funcional y con una diferente composición funcional de aves en relación con el manejo convencional. Métodos: Se muestrearon las aves mediante 8 conteos repetidos aproximadamente cada 15 días entre noviembre 2017 y marzo 2018, desde el comienzo de la siembra hasta antes de la cosecha, en ambos tipos de arroceras. Los muestreos fueron realizados mediante una técnica mixta combinando transectas de línea y puntos de conteo en cuatro sitios por tipo de manejo. Se calcularon índices de diversidad y composición funcional con base en atributos morfológicos y tróficos de las aves registradas. Resultados: La riqueza, la divergencia y la dispersión funcional fueron más altos bajo manejo agroecológico. Solamente en el caso de la riqueza funcional las diferencias reflejaron únicamente la variación de la riqueza de especies. La media ponderada a nivel de ensamble de los valores de los rasgos por muestra varió entre los tipos de manejo, estando la dieta insectívora, la persecución como método de forrajeo, y el aire y los arbustos como sustrato de forrajeo mejor representados bajo manejo agroecológico. Conclusión: Los resultados sugirieron que el manejo agroecológico del arroz se relaciona con una mayor diversidad funcional de aves que las prácticas de manejo convencional, sugiriendo que el manejo agroecológico puede mejorar la provisión de servicios ecosistémicos por aves en cultivos de arroz.