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Introduction: Thromboangiitis obliterans or Buerger's disease is a non-atherosclerotic, segmental and inflammatory vaso‐occlusive disease that appears mainly in medium and small sized arteries. Clinically, the most common manifestations are consistent with symptoms of ischemia of the lower extremities, intermittent claudication is the earliest onset sign [3]. An arteriography may be performed as a follow-up method in patients with long-standing disease and persistent symptomatology. With technological development, CO2 arteriography, approved by the FDA, has become an alternative to that performed with iodinated contrast, especially in patients hypersensitive to iodine or with compromised renal function as in our patient [6, 7]. Clinical case: A 62-year-old patient with a personal history of arterial hypertension, stage III renal disease and Thromboangiitis obliterans for 20 years. The patient comes to the control of his disease with symptoms characterized by intermittent claudication with a distance of 200 meters in the left lower limb. He continues with his smoking habit and states that he does not plan to stop. On physical examination, palpation of proximal pulses is normal, distal pulses are not palpable, but they are audible with sound Doppler in both extremities. Due to the progressive deterioration of vascular symptomatology, it was decided to perform an arteriography. Due to the reported allergy and renal pathology, CO2 arteriography was chosen, a procedure that was performed without complications. With the arteriographic findings, without the presence of stenosis requiring revascularization, it was decided to continue with the clinical treatment of the pathology and insisting on the elimination of the smoking habit. Conclusions: Treatment of Thromboangiitis Obliterans consists of eliminating the smoking habit; however, in patients who cannot meet this criterion due to different circumstances, periodic follow-up is recommended to determine if there is .......

espanolLas playas turisticas con certificaciones de calidad son recursos de alta importancia economica y ambiental. Las certificaciones en litorales fueron creadas para proteger recursos naturales tan importantes como la playa y para gestionar y promover una calidad turistica de alto nivel. Pese a que, muchas veces dentro de America Latina las playas suelen ser la primera fuente generadora de ingresos para las comunidades en perfiles costeros no se les da el cuidado o no se realza la importancia de estas. El presente trabajo tuvo como objetivos el realizar una propuesta de adaptacion de los criterios Bandera Azul segun la Federacion de Educacion Ambiental enfocados a El Salvador con los criterios minimos a cumplir, asimismo, exponer los beneficios de playas certificadas entre los cuales se enlistan el fortalecimiento de la planta turistica, sostenibilidad ambiental para las comunidades y para el Gobierno al contar con una playa que hace de marca para la oferta nacional e internacional, dentro de la propuesta de adaptacion se consideraron 21 criterios que cumplir de manera obligatoria y aconsejada, la factibilidad del proyecto se dio gracias a las entrevistas realizadas en donde se pudo comprobar la intencion de apoyo de parte de la Corporacion Salvadorena de Turismo y el sector privado junto a academicos de ser participes; finalmente esta trabajo sirve como base investigativa para la puesta en marcha de la certificacion en playas salvadorenas en el futuro. EnglishTourist beaches with quality certifications are resources of high economic and environmental importance. The coastal certifications were created to protect natural resources as important as the beach and to manage and promote a high level of tourism quality. Despite the fact that, many times within Latin America, beaches are usually the first source of income for communities in coastal profiles, they are not cared for or their importance is not highlighted. The objective of this work was to make a proposal to adapt the Blue Flag criteria according to the Federation of Environmental Education focused on El Salvador with the minimum criteria to be met, also, to expose the benefits of certified beaches, among encountered with the strengthening of the tourist plant, environmental sustainability for the communities and for the Government by having a beach that acts as a brand for the national and international offer, within the adaptation proposal, 21 criteria were considered to be fulfilled in a mandatory and recommended way, the feasibility of the project was given thanks to the interviews carried out in which it was possible to verify the intention of support from the Salvadoran Tourism Corporation and the private sector, together with academics to be participants; Finally, this work serves as a research basis for the implementation of certification in Salvadoran beaches in the future.

Las fracturas de clavicula tradicionalmente han sido tratadas de forma conservadora, estas suponen entre 2.6 y 4% de todas las fracturas del adulto y 35% de las lesiones de la cintura escapular. Entre un 70-80% de estas fracturas corresponden al tercio medio de clavicula. Su adecuado diagnostico y tratamiento son fundamentales ya que este hueso contribuye a la fuerza y estabilidad del brazo, actuando como punto de origen e insercion muscular y a su vez, ofreciendo proteccion a estructuras neurovasculares importantes, entre otras funciones. El objetivo fundamental de este estudio es plasmar lo relativo al tratamiento conservador en las fracturas de clavicula. El diseno de investigacion que se llevo a cabo es de tipo documental o bibliografico. El tratamiento de estas fracturas va a depender, en gran medida, de su clasificacion. Historicamente, el manejo conservador o no quirurgico en las fracturas de clavicula es el mas usado, quizas motivado a que la mayoria de estas ocurren en el tramo distal de este hueso, es decir, son de tipo I y presentan caracteristicas que pueden ser sanadas con el uso unico de inmovilizacion. No obstante, existen casos, en donde ciertas condiciones de la fractura la hacen candidata a un manejo quirurgico. El manejo conservador de la fractura de clavicula se realiza basicamente por medio de la inmovilizacion de esta area mediante un cabestrillo (con ferula o tablilla, segun sea el caso), tratamiento medicamentoso de la inflamacion y el dolor, y fisioterapia para recuperar la fuerza y la movilidad del hombro. Este tratamiento a lo largo del tiempo ha generado muy buenos pronosticos y excelente evolucion.

This research project demonstrates the problems in the Metropolitan District of Quito, due to the high consumption by the society of plastic materials including polyethylene terephthalate (PET) which does not have an appropriate final destination. In the first place, the project provides favorable factors for sustainable construction, because it tries to mitigate the problem of pollution and the reduction of the use of traditional masonry. The objective is to provide society with construction alternatives through the recycling of high consumption materials to conserve the environment, a way of mitigation is the reuse of plastic bottles of any capacity as building elements of masonry. This new construction must comply with parameters that provide security to its occupants, for this the research will determine through tests in masonry specimens the design bases for the construction with recycled elements, verifying the results with the norms in force in the Country. El presente proyecto investigativo demuestra la problemática en el que se encuentra el Distrito Metropolitano de Quito, esto es debido al alto consumo por parte de la sociedad de materiales plásticos entre ellos el polietileno de tereftalato (PET) los cuales no tiene un destino final apropiado. En primer lugar el proyecto proporciona factores favorables para una construcción sostenible, porque se intenta mitigar el problema de la contaminación y de la disminución de uso de mamposterías tradicionales. El objetivo es brindar a la sociedad alternativas de construcción mediante el reciclaje de materiales de alto consumo logrando conservar el medio ambiente, una forma de mitigación es la reutilización de las botellas plásticas de cualquier capacidad como elementos constructivos de mampostería. Esta construcción novedosa debe cumplir con parámetros que brinden seguridad a sus ocupantes, para ello la investigación determinará a través de ensayos en especímenes de mampostería las bases de diseño para la construcción con elementos reciclados, verificando los resultado con las normas vigentes en el país.

Personal health records (PHRs) are intended to increase patients' access to and ownership over their health care information for self-management purposes. The purpose of this study was to determine the association of graph literacy with adoption of an online PHR and, among adopters with self-reported skills, the frequency of use and intent to return to use the PHR . We conducted a cross-sectional survey of veterans receiving outpatient care. We measured health literacy, numeracy, graph literacy, and Internet and PHR adoption and use. We compared subgroups of veterans using analyses of covariance. We used hierarchical logistic regression models to estimate the effects of the literacy variables on PHR use. A total of 600 veterans (age = 22-94) participated in the survey. After we adjusted for known covariates, we found that adopters of a PHR were more likely to demonstrate higher health and graph literacy than nonadopters. Among PHR adopters, self-reported frequent and skillful users were more likely to have higher graph literacy than lower frequency and less skillful users. Adopters with higher intentions to return to use the PHR were more likely to show lower graph literacy than those less likely to return to use the PHR. Inadequate graph literacy was associated with lower adoption of a PHR and, among users, with lower self-reported frequent use and skills . As PHR use becomes more widespread, stakeholders will need to consider patients' levels of graph literacy when implementing PHRs.

Introducción: La adopción de las pautas ergonómicas en el manejo de la fibromialgia conducen a mejorar la calidad de vida del paciente, en tanto contribuyen a la disminución de los síntomas que caracterizan la enfermedad. Objetivo: reflexionar sobre la correcta observancia de las pautas ergonómicas en el manejo de la fibromialgia. Desarrollo: Para los trabajadores que padecen de fibromialgia, la posibilidad de mantenerse con una vida laboral activa requiere cambios no solamente en ellos como, sino en las condiciones de trabajo, que les son indispensables dada la naturaleza incapacitante de la enfermedad. Estos pacientes, que por demás están obligados a frecuentes justificaciones por su absentismo, se retiran del mercado laboral o finalmente se adaptan a las desfavorables condiciones de trabajo, adoptando estrategias personales que les permiten mantenerse laboralmente activos. Conclusiones: Un elemento de esencial importancia a ser tomado en cuenta en las enfermedades reumáticas, lo constituyen los factores ergonómicos, que deben encaminar sus pasos al fortalecimiento de una cultura de salud laboral y seguridad, por parte de empleadores y pacientes. ABSTRACT Introduction: the adoption of ergonomic guidelines in the management of fibromyalgia leads to improve the quality of life of the patient, as they contribute to the reduction of symptoms that characterize the disease. Objective: to reflect on the correct observance of the ergonomic guidelines in the management of fibromyalgia. Development: for workers suffering from fibromyalgia, the possibility of maintaining an active working life requires changes not only in them but also in the working conditions that are indispensable because of the incapacitating nature of the disease. These patients, who are often forced to frequent justifications for absenteeism, withdraw from the labor market or finally adapt to unfavorable working conditions, adopting personal strategies that allow them to remain active. Conclusions: an element of essential importance to be taken into account in rheumatic diseases, are the ergonomic factors, which should guide their steps towards strengthening a culture of occupational health and safety, by employers and patients.

Resumo: Diante da crise socioambiental e civilizadora atual, é necessário tomar ações que permitam o empoderamento das pessoas e suas comunidades, com o fim de promover as transformações nos seus estilos de vida e avançar para a sociedade do Bom viver. O presente trabalho de pesquisa tem como objetivo divulgar o projeto “Convento Eco-empreende”. Trata-se de uma experiência eco-pedagógica que constitui uma alternativa comunitária através dos processos da educação socioambiental, a construção de um horto agroecológico e a criação de processos de empreendedorismo solidário. Como resultado, são mostrados os processos de capacitação de um grupo de pessoas da comunidade rural do Convento na costa equatoriana. Em suma, conclui-se que a educação socioambiental requer um diálogo de saberes que integre o conhecimento científico com a sabedoria ancestral das comunidades.