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Background: Coxiella burnetii is an obligate intracellular bacterium that causes Q fever, a worldwide contagious and zoonotic disease. Q fever is primarily transmitted to humans by infected cattle, sheep, and goats. Ruminants do not always develop clinical signs, except for pregnant females, which can present reproductive failure such as abortions and stillbirths. Regardless of its worldwide distribution, in Mexico this is considered an exotic disease, although serological evidence of C. burnetii has been demonstrated and at least six confirmed human cases have been reported. Objective: To assess the presence of C. burnetii in cattle in Mexico. Methods: Genomic DNA was extracted from 153 vaginal swabs obtained from cattle dwelling in 12 Mexican states and analyzed by PCR. Results: The C. burnetii IS1111 insertion sequence was identified by endpoint PCR in 33.33% (51/153) of the vaginal swabs. We obtained two nucleotide sequences that confirmed the genetic material of C. burnetii. Conclusion: Our results constitute a first step to elucidate the current epidemiology of Q fever in our country, and they indicate that cattle may be a reservoir of C. burnetii. To the best of our knowledge, this report provides the first molecular proof that this pathogen exists among cattle in Mexico. [ABSTRACT FROM AUTHOR]

Industrializing coffee is an important aspect for the country because. in addition to generating an added value to the raw material at the time of production, it strengthens the Ecuadorian industrial sector. The objective of this research is to diagnose coffee production in the canton of Jipijapa, province of Manabí, Ecuador. For this purpose, research was conducted on the national and international theoretical foundations of administrative management, the characterization of coffee production, its importance, evaluation and inadequacies. The main theoretical aspects on which the management of coffee microenterprises is based were investigated and a diagnosis was made of the current situation in Jipijapa, as well as the management system in this canton. [ABSTRACT FROM AUTHOR]

The present article explores the evolution of the models used in the medical field, from the biomedical model to the model offered by the framework of 4E Cognition. Additionally, the diagnosis and treatment of illness through the biomedical focus is critiqued due to its reductionist view of the complexity of the health-illness continuum and the human experience. The 4E Cognition model is proposed as a possibility for the practical application of the biopsychosocial model - be it that one of the principle critiques of this model is the difficulty of applicability - given so that the development of concrete interventions from an integrative perspective in the medical sciences are permitted. This article explores the application of the 4E Cognition model in the field of psychiatry and psychology, highlighting the potential role of Mobile Brain-Body Imaging (MoBI) technology for the diagnosis and treatment of diverse neuropsychiatric diagnoses from an integrative perspective that considers physiological, social, psychological, environmental, and structural elements. Finally, possible future directions in terms of research and the applicability of the development of interventions and treatments that are implementing these technologies are explored. [ABSTRACT FROM AUTHOR]

Introduction: The Sacroiliac joint (SIJ) serves as a crucial connection between the sacrum and ilium, playing a vital role in transferring forces during physical activity. Its biomechanical function is essential for stability, supported by ligaments and pelvic floor muscles. However, SIJ dysfunction can contribute to lower back pain, a condition affecting 70-85 % of Western society. Causes: SIJ dysfunction can stem from various factors, including abnormal motion or malalignment, triggered by arthritis, trauma, or atypical gait patterns. Diagnosis: Diagnosis SIJ dysfunction involves physical examinations such as FABER, compression, distraction, thigh thrust, and Gaenslen tests. Typically, three positive provocative test results are required for diagnosis, supplemented by imaging techniques like X-rays, MRIs, and joint injections. Misdiagnosis: Despite the availability of diagnostic methods, SIJ dysfunction is frequently misdiagnosed due to symptoms overlap with other conditions and overlooked etiology. Treatment: Upon diagnosis, SIJ dysfunction can be managed with conservative measures like physical therapy and NSAIDs, or more invasive interventions such as surgery. Conclusion: SIJ dysfunction is a prevalent yet often misdiagnosed condition, emphasizing the importance of raising awareness among both the public and clinicians to ensure accurate diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

The current trend in tourism in Cuba shows a customer motivated by culture and heritage, which demands a professional training designed to manage a cultural tourist destination. Upon graduation, they enter into a job market evaluated by a competency-based job profile. This leads to the conception of a methodological proposal from the teachinglearning process of the Bachelor's Degree in Tourism. Therefore, it is necessary to characterize the current state of cultural competency training in these students at the University of Havana. The purpose of this article is to diagnose the formation of this competency in a sample of third-year students in the day regular course based on the impact of the subject Cultural Heritage of Cuba, which is taught in the second year. [ABSTRACT FROM AUTHOR]

Group A beta-hemolytic Streptococcus (GABHS) or Streptococcus pyogenes is considered the leading causative agent (15%) of acute bacterial pharyngotonsillitis. In the community, especially among school children, it is the age of maximum incidence for this agent. The prediction scales are supportive and are not recommended in children under three. The first-line antibiotics continues to be the penicillin since its resistance has not yet been demonstrated. Short regimens are currently suggested in the dosage. Some basic and practical concepts about said pathology are reviewed. To avoid the abuse of antibiotics when the etiology of pharyngotonsillitis is generally viral. [ABSTRACT FROM AUTHOR]

The clinical case of a 15-year-old male with a final diagnosis of schizophrenia is presented, through which an analysis of the fundamentals of classical psychiatry is carried out, particularly in relation to authors who phenomenologically approached psychosis cases initiated in youth, specifically hebephrenia. Although the concept of hebephrenia is no longer recognized as a separate subtype of schizophrenia in current classifications, the classical approach is examined to contextualize and substantiate the clinical approach to a recent case. The clinical characteristics of the classical concept of hebephrenia will be described, including early onset in puberty, the succession of oscillating affective states, rapid cognitive decline, and the presence of productive phenomena such as accessory delusions and hallucinations that change in relation to mood states. In addition, the autistic variant of hebephrenia is mentioned, characterized by isolation, apathy, brief and inadequate responses, lack of initiative, and depressive symptoms such as dysthymia with agitation. While it is important to bear in mind that the concept of hebephrenia is not recognized as a subtype in current classifications such as those of the DSM-5 or the ICD-11, this analysis allows us to understand historical perspectives and phenomenological approaches used in the past, which can assist us in the present. [ABSTRACT FROM AUTHOR]

Meckel’s diverticulum is the most common congenital gastrointestinal malformation and is caused by partial or total involution of the omphalomesenteric duct during embryonic development, resulting in a true diverticulum, since it contains all the layers of the small intestine. It has an incidence of 0.6-4% in the general population and is the main cause of lower gastrointestinal bleeding in pediatric patients. Most of them remain asymptomatic until adulthood, and may present clinical symptoms suggestive of acute appendicitis, intestinal obstruction and lower gastrointestinal bleeding. The finding of the diverticulum is usually incidental and only 4-6% of the time it is found as a directed study of this abnormality. There are multiple diagnostic studies available, including computed tomography (CT), Technetium-99m pertechne)tate (Tc-99m) scintigraphy, video capsule endoscopy, and laparoscopy/laparotomy. The management of Meckel’s diverticulum is surgical, especially due to its multiple complications, which are detailed in this article. The use of minimally invasive techniques and the best technologies and detection methods have made it possible to reduce the mortality of Meckel’s diverticulum complications. Finally, this pathology is a challenge for any specialist, since the low incidence and symptoms similar to diverticular diseases pose a greater challenge both in diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Presacral tumors are frequent entities with different etiologies, without an established surgical management or approach, having relatively little experience in management and follow-up and postoperative results. Objective: To report the result in a descriptive way of the management of this type of lesions in the Clinical Hospital of the University of Chile. Material and Method: Observational, descriptive and retrospective study of case series, analyzing the database of surgeries of the Clinical Hospital of the University of Chile in the last 15 years, excluding patients with bone tumors and operated by other units. Simple and descriptive statistics were used for the analysis. Results: 23 patients were operated on in the last 15 years, 12 transabdominally. 9 resolved by open fashion and 3 laparoscopically. The remaining 11 patients was resolved with posterior approach, being the kraske used in all patients. The average follow-up was 16 months with 4 patients showing recurrence. Conclusions: The presacral tumors represent a challenge in terms of diagnosis and surgical management, being the preoperative study with images plus physical examination, determinant in the surgical management of the same. We recommend considering transabdominal approaches in those tumors larger than 10 cm and in those that strongly suspect malignancy, which does not contraindicate the laparoscopic route. In case of subsequent management, never rule out incidental lesions of the rectum, so the intraoperatory anorectal examination should be the rule. [ABSTRACT FROM AUTHOR]

Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings. Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany. Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants. Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample. Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical, biochemical, and radiologic findings of girls with early puberty (EP) attended at a public hospital in Lima, Peru. Methods: This is a case series study that results from the review of clinical charts of girls diagnosed of (EP). Patients with peripheral EP, isolated thelarche and malformations were excluded. The Z-IMC, Z-genetic height, Z-height, and projected adult final height (PAFH) were calculated. The t-Student, Wilcoxon and Shapiro-Wilk tests were calculated using STATA version 17, a p values < 0.05 was considered statistically significant, the study was approved by the IRB of UPCH and HCH. Results: We reviewed 86 charts; mean age was 8,16±1.09 years and mean bone age was 10.33±1.27 years (p<0.001). We found M2(19.7%), M3(59.3%) and M4(20.9%). Normal weight (27.9%), overweight (30.2%) and obesity (41.8%). Median LH was 0.6 (RIQ:0.4-1.8) and median FSH was 3.4 (RIQ:2.1-5.2). Conclusion: Chronologic age at diagnosis was late with a bone age higher than chronologic age. Height of girls compared to genetic height was higher. PAFH was lower than genetic height. Most of the girls presented with advanced breast development, overweight and obesity. [ABSTRACT FROM AUTHOR]

Mechanization is of great relevance in the development of the agricultural sector, as a tool that facilitates agricultural activities with quality and speed and a significant increase in the productivity and competitiveness of this sector, in the case of the province of Manabí in Ecuador this aspect becomes more relevant because this sector has a substantial weight in its economic and social life. The objective of the research was to carry out a diagnosis of agricultural mechanization competencies in the cantons of the central zone of Manabí. The methodology used consisted of several stages, which made it possible to evaluate the factors that characterize the competencies of agricultural mechanization in the area under study: human factor, machinery, operating conditions and infrastructure and financing. For the collection of information, surveys based on the factors under analysis were prepared and applied to agricultural producers and owners/entrepreneurs who provide mechanization services in the central zone of Manabí. The results of the diagnosis in the selected sample show that only 41% of the agricultural activities are being carried out with the use of agricultural machinery and that 20% of the producers have their own means to carry out agricultural activities, among other relevant aspects. As a whole, the results allowed concluding that the agricultural mechanization skills in the central zone of the province of Manabí present undesirable low levels that limit its productivity. [ABSTRACT FROM AUTHOR]

Introduction: lymphomatoid granulomatosis is a very rare disease; This is the first case reported in the hospital. Patient information: 44-year-old male, with a health history and no toxic habits, who began with respiratory symptoms, dermatological lesions, constitutional syndrome and flaccid paraplegia. Complementary examinations showed pancytopenia, and the chest xray and tomography showed an image suggestive of lung metastasis; An MRI showed a compressive lesion at the dorsal level. The anatomopathological studies of the skin and lung showed a lymphomatoid granulomatosis with medullary invasion. The patient was treated with chemotherapy and died abruptly one month after it began. Conclusions: lymphomatoid granulomatosis is a rare disease currently considered a lymphoid neoplasm associated with Epstein-Barr virus and large B cell lymphoma. It occurs in this patient accompanied by neurological injury; The diagnosis was only possible by anatomopathological studies. It was impossible to perform an autopsy due to family refusal. [ABSTRACT FROM AUTHOR]

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La polimialgia reumática (PMR) es una enfermedad inflamatoria de las articulaciones que se presenta en pacientes mayores de 50 años con dolor y rigidez matutina prolongada en las cinturas del hombro y la cadera y en el cuello. La falta de hallazgos clínicos específicos, signos de laboratorio, biomarcadores y métodos de imagen establecidos dificulta el diagnóstico de los pacientes con esta enfermedad. La 18F-FDG PET/TC es una técnica de imagen funcional que constituye una herramienta consolidada en Oncología y que también ha demostrado su utilidad en el campo de las enfermedades inflamatorias. El objetivo de este trabajo es presentar evidencia bibliográfica sobre el uso de métodos de imagen molecular como la PET/TC para el diagnóstico precoz, la evaluación de la actividad de la enfermedad y la respuesta terapéutica en la PMR. Al mismo tiempo, se consideran las ventajas, las desventajas y las contraindicaciones de otros métodos. Polymyalgia rheumatica (PMR) is an inflammatory joint disease that presents in patients older than 50 years with prolonged morning pain and stiffness in the shoulder and hip joints and neck. The lack of specific clinical findings, laboratory signs, biomarkers and established imaging methods makes it difficult to diagnose patients with this disease. 18F-FDG PET/CT is a functional imaging technique that is an established tool in oncology and has also proven useful in the field of inflammatory diseases. The aim of this paper is to present literature evidence on the use of molecular imaging methods such as PET/CT for early diagnosis, assessment of disease activity and therapeutic response in PMR. At the same time, the advantages, disadvantages and contraindications of other methods are considered. [ABSTRACT FROM AUTHOR]

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A apendicite é a emergência cirúrgica mais comum em pediatria, estando presente em 1% a 8% das crianças com dor abdominal aguda. O quadro clínico clássico é caracterizado pela presença de dor abdominal aguda migratória em fossa ilíaca direita. Entretanto, em pacientes com situs inversus totalis, a dor se manifesta na fossa ilíaca esquerda, o que pode retardar o diagnóstico e predispor ao desenvolvimento de complicações. Dessa forma, o objetivo deste trabalho é relatar um caso de apendicite em um adolescente com situs inversus totalis. Este estudo trata-se de um relato de caso de apendicite em um adolescente portador de situs inversus totalis. A pesquisa foi submetida ao Comitê de Ética em Pesquisa em Seres Humanos e aprovado sob o número do CAAE 53591321.0.0000.5237. A incidência de apendicite em portadores de situs inversus totalis é de 0,016% a 0,024%. Em função da apresentação clínica atípica nesses pacientes, tem-se uma tendência ao retardo no diagnóstico da apendicite, especialmente quando o situs inversus totalis não foi previamente identificado. Com isso, existe um maior risco de desenvolvimento de complicações graves, como a perfuração intestinal e a sepse, o que eleva consideravelmente a morbimortalidade. Portanto, ressalta-se a importância de elencar a apendicite como um possível diagnóstico em pacientes com dor abdominal aguda em fossa ilíaca esquerda pela possibilidade de situs inversus totalis.

Resumo: Este artigo busca problematizar como o discurso sobre a depressão, nas três primeiras edições do Manual diagnóstico e estatístico de transtornos mentais , efetuou a apropriação da contradição sofrimento-patologia. Para tanto, a análise foi orientada pelos princípios da análise de discurso francesa, de Michel Pêcheux, desenvolvida, no Brasil, por Eni Orlandi. O estudo salienta que: 1) as duas primeiras edições do manual apresentavam a depressão como efeito; a partir da terceira há um entendimento da depressão enquanto causa; 2) nas duas primeiras edições do manual, sofrimento e patologia são um único e mesmo objeto, já na terceira edição ocorre uma cisão entre essas esferas; 3) o mecanismo discursivo da antecipação pode contribuir para a compreensão do processo de apagamento do sujeito da enunciação pelo sujeito do enunciado nos manuais diagnósticos.

Objetivos: Apresentar o protocolo desenvolvido para diagnóstico e tratamento de Transtorno de Compulsão Alimentar (TCA) em pacientes adultos no Hospital Universitário Walter Cantídio (HUWC). Metodologia: Uma revisão de literatura foi realizada, a fim de buscar informações atualizadas sobre o tema e de construir um protocolo que possa facilitar o diagnóstico e o tratamento do transtorno. Foram utilizadas referências clássicas, como o DSM-5, o CID-10 e o CID-11, bem como artigos publicados, nos últimos seis anos, por grupos de estudo do tema. Resultados: Com base nas evidências levantadas, foi elaborado um fluxograma, contemplando recomendações para diagnóstico e tratamento de TCA em adultos. Conclusões: O protocolo elaborado pode auxiliar a equipe assistencial do HUWC no diagnóstico e no tratamento de pacientes com TCA, melhorando a resposta ao tratamento de comorbidades potencialmente severas, associadas e agravadas pelo referido transtorno.

La educación cubana está centrada en una serie de transformaciones, nombradas como Tercer Perfeccionamiento del Sistema Nacional de Educación. El Preuniversitario no es la excepción por la importancia que reviste como antesala de la universidad, se hace necesario la preparación de sus docentes con énfasis en la formación de la competencia investigativa para lograr el fin y los objetivos del nivel educativo. El artículo tiene como objetivo socializar el diagnóstico sobre la formación de la competencia investigativa en el Instituto Preuniversitario Urbano "Eduardo García Delgado", en el municipio Trinidad, provincia Sancti Spíritus. El resultado del diagnóstico sobre la formación de la competencia investigativa en el Consejo Técnico del Preuniversitario se basó en el estudio teórico y la sistematización de experiencias vividas acerca de cómo se concibió la labor investigativa de los docentes y sus habilidades para cumplir su función científico-investigativa. El contexto educativo en que tuvo lugar el estudio diagnóstico fue el Instituto Preuniversitario Urbano "Eduardo García Delgado", municipio Trinidad, de la provincia Sancti Spíritus. Se emplearon los métodos teóricos como el analítico"sintético e inductivo"deductivo y los empíricos como la revisión de documentos, sistematización de experiencias, la encuesta y la entrevista. Además, se empleó el método de estadística descriptiva para procesar los datos obtenidos de la aplicación de los instrumentos del diagnóstico. Los resultados obtenidos permitieron identificar las fortalezas y debilidades del Consejo Técnico del Preuniversitario sobre la formación de la competencia investigativa y diseñar propuestas de solución, a través del empleo del método científico.

El diagnóstico de la sífilis depende del cuadro clínico, la evaluación de las lesiones y de las pruebas serológicas. Las pruebas serológicas son treponémicas y no treponémicas. Las pruebas no treponémicas son empleadas como tamizaje y las pruebas treponémicas, como confirmatorias. Se considera hasta hace pocos años tres pruebas treponémicas estándar, FTA-ABS (fluorescent treponemal antibody absorption test), FTA-ABS de doble coloración y MHA-TP (microhemaglutinación), las que usan al T.pallidum como antígeno y se basan en la detección de anticuerpos contra componentes treponémicos. Las pruebas treponémicas se usan para verificar la reactividad de las pruebas no treponémicas, pueden ser usadas para confirmar una sospecha con evidencia clínica de sífilis, como ocurre en la sífilis tardía, y cuando las pruebas no treponémicas son no reactivas. Pero, las pruebas treponémicas son técnicamente más difíciles y costosas que las pruebas no treponémicas y algunas veces no se pueden usar para monitorear el tratamiento. Actualmente se realizan generalmente tres o más ensayos simultáneos, para el diagnóstico serológico de la sífilis. La tecnología de ADN recombinante ha permitido la purificación de antígenos treponémicos como el TpN15, TpN17, TpN47 y TmpA, su clonación y expresión, que han llevado al desarrollo de pruebas de anticuerpos treponémicos de nueva generación como el enzimoinmunoensayos (EIA), el Western blot (WB), y la reacción en cadena de la polimerasa (PCR). Los EIA son muy apropiados para procesar grandes volúmenes de muestras, porque pueden ser automatizados, y obtenerse una lectura objetiva generando reportes electrónicamente, con lo que se reduce los errores en la trascripción de datos. El EIA específico para IgM contra treponema no detecta sífilis tardía, además no debe usarse como tamizaje. Sin embargo en la sífilis temprana, la prueba que detecta IgM específico, es la más sensible. El WB treponémico, se ha desarrollado como una alternativa a las pruebas FTA-ABS o MHA-TP para la confirmación del diagnóstico de la sífilis. WB se puede usar para detectar tanto IgG como IgM. En los últimos años, se han desarrollado nuevas pruebas basadas en la amplificación de ADN de T.pallidum y la PCR ha incrementado su sensibilidad para detectar T.pallidum a menos de 10 microorganismos, pero es aún una técnica que se realiza básicamente en laboratorios de investigación.

Introducción: El estudio citológico por punción ecoguiada es rápido, confiable, mínimamente invasivo y beneficioso. Permite reducir procedimientos quirúrgicos innecesarios y clasifica a los pacientes con nódulos benignos o malignos para una intervención quirúrgica oportuna. Objetivo: Evaluar la utilidad diagnóstica, para enfermedad nodular, de la punción con aguja fina. Métodos: Estudio observacional, analítico y de corte transversal, basado en el análisis de los resultados de punción aspiración con aguja fina preoperatoria de pacientes sometidos a cirugía tiroidea en el Hospital Hipólito Unánue entre enero 2016 - diciembre 2019. Resultados: 105 pacientes cumplieron con los criterios de inclusión, de los cuales el 95 % (n= 100) fueron de sexo femenino. El rango de edad estuvo entre 13 y 82 años. Del total de pacientes en 64 la citología fue informada como benigna y en 19 como maligna. El diagnóstico citológico mostró una sensibilidad de un 60 %, especificidad de un 98,1 %, y valores predictivos positivo del 94,7 % y negativo del 81,3 %. La precisión de la prueba diagnóstica de citología fue de un 84,3 % (intervalo de confianza de 95 %: 74,7-91,4). Conclusión: La punción aspiración con aguja fina permite un diagnóstico simple, mínimamente invasivo, seguro y rentable, para lesiones tiroideas, con una alta especificidad y precisión. Sin embargo, debido a las posibilidades de resultados falsos negativos encontrados en este estudio, se recomienda que incluso los pacientes con hallazgos citológicos benignos sean sometidos a seguimiento clínico regular.

Este artigo se propõe a delinear, historicamente, o diagnóstico clínico do Transtorno Disruptivo da Desregulação do Humor (TDDH). Com base no método genealógico, essa categoria diagnóstica é desnaturalizada e recontextualizada em sua origem. Analisa-se o conceito de desregulação do humor a partir da escala CBCL (Childhood Behaviour Checklist), sua identificação como um transtorno bipolar da infância, posterior transformação no diagnóstico de TDDH e subsequente crítica deste, com a proposta de englobar os sintomas de desregulação do humor na infância, no diagnóstico de transtorno opositor-desafiante. Como alternativa, o artigo sugere que o humor irritadiço na infância é um estado afetivo primário, constituindo-se, assim, em uma predisposição orgânica primária. Já a regulação emocional é uma construção adaptativa, que se modela ao longo da vida, gerando apresentações subjetivas diversas.

Introducción: el cáncer de mama durante el embarazo es poco frecuente y su incidencia ha aumentado a medida que las mujeres retrasan la maternidad. Objetivo: analizar el manejo del cáncer de mama durante el embarazo. Materiales y métodos: se examinaron las bases electrónicas de datos de literatura científica biomédica para investigar los artículos elegibles en los últimos 15 años, sobre el cáncer de mama en humanos durante el embarazo. Resultados: el diagnóstico de cáncer de mama es un desafío durante el embarazo. El tratamiento debe ajustarse a los protocolos para mujeres no embarazadas disminuyendo los riesgos fetales. La ecografía es el método de imagen ideal, también puede realizarse la mamografía porque la radiación fetal es baja. La mastectomía radical modificada es el tratamiento recomendado durante el primer trimestre. La quimioterapia neoadyuvante o adyuvante puede utilizarse con riesgos fetales mínimos durante el segundo o tercer trimestre. Tanto la radioterapia como la hormonoterapia están contraindicadas. La recurrencia y supervivencia en las pacientes tratadas no se afectan en forma negativa por el embarazo. Conclusión: la incidencia de cáncer de mama asociado con el embarazo ha aumentado. El tratamiento debe intentar seguir las pautas descritas para mujeres no embarazadas, este no parece afectar el pronóstico. El manejo multidisciplinario es obligatorio.

Introducción: la mayoría de las aplicaciones en patología digital se encuentran relacionadas con la oncológica, aunque se han propuesto algunos modelos recientes que permiten evaluar la utilidad en el diagnóstico histológico de microorganismos. Material y métodos: se realizó la siguiente revisión en la que se incluyeron 10 artículos publicados en inglés, que tienen como eje central el diagnóstico histopatológico de microorganismos y diferentes modelos de inteligencia artificial. Discusión: los diseñados se han probado para el diagnóstico de Helicobacter pylori, Mycobacterium tuberculosis, Aspergillus, Mucorales y microorganismos relacionados con onicomicosis. Conclusiones: se recomienda el uso de la inteligencia artificial en el diagnóstico histopatológico de microorganismos como un campo emergente que refuerza la función del patólogo coordinador de los diferentes modelos, optimizando así su función y mejorando los tiempos de trabajo y los niveles de efectividad.

La depresión se ha convertido en un imperio que desde occidente ha colonizado al mundo y desplaza otros lenguajes que dan sentido a la angustia profunda en diferentes culturas. El libro ofrece una historia global de esta aflicción, desde la antigua melancolía hasta la actualidad, a través de rastrear sus múltiples significados, tratamientos y memorias personales para comprender la expansión y el protagonismo que adquiere en nuestros días. En esta historia también aborda las dimensiones sociales de la depresión y evidencia que formar parte de grupos desfavorecidos, oprimidos, estigmatizados o perseguidos incrementa las posibilidades de padecerla. A partir de un abordaje histórico que utiliza herramientas conceptuales interdisciplinarias la obra cuestiona lugares comunes, falsos dilemas, dogmas filosóficos sin sustento empírico y visiones unilaterales sobre la depresión. También aporta una visión compleja de un padecimiento milenario y en crecimiento que contiene, al mismo tiempo, aspectos médicos, sociales, políticos, culturales y del que aún resta mucho por conocer.