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OBJECTIVE: To describe an effective two-step surgical approach for the management of cesarean scar ectopic pregnancies (CSEPs). CSEPs occur at an estimated frequency of 1 in 1,800 pregnancies, constituting approximately 6% of ectopic pregnancies in women with a history of prior cesarean delivery [1, 2]. Despite numerous recommended therapeutic approaches, the most effective treatment strategy remains uncertain [3]. DESIGN: We present an innovative double-step technique for the management of a patient with a CSEP involving hysteroscopic subchorionic injection of methotrexate (MTX), followed by laparoscopic resection of the residual gestational sac and simultaneous repair of the uterine defect. SETTING: Academic tertiary hospital. PATIENT: A 34-year-old G2P1001 with a history of prior cesarean section presented at 10 weeks of gestation. Ultrasound revealed a gestational sac within the niche of the previous cesarean scar, confirming the diagnosis of a CSEP. The patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, and Scopus, among others), and other applicable sites. INTERVENTION: The initial treatment involved hysteroscopic administration of MTX within the placental intervillous spaces, ensuring precise medication delivery. The administered dose of MTX was 1 mg/kg. Following the normalization of beta-human chorionic gonadotrophin (ß-hCG) levels, laparoscopic resection of the remaining gestational sac and reconstruction of the uterine wall defect were performed. MAIN OUTCOME MEASURES: We have implemented a management strategy focusing on ectopic pregnancy removal and addressing defect revision. The hysteroscopic approach allows for a clear assessment of the ectopic pregnancy and facilitates precise MTX administration, enhancing its effectiveness by increasing drug concentration within the placental intervillous space. Delaying surgical repair until after the ß-hCG levels have decreased reduces the risk of excessive bleeding during the procedure, as lower ß-hCG levels are associated with reduced vascularity at the ectopic site. Subsequent laparoscopic resection allows for complete removal of the remaining products of conception and repair of the defect, preserving the uterus and restoring normal anatomy. Compared to other surgical approaches, our two-step approach enables a more precise evaluation of placental implantation, making it a highly effective surgical method. RESULTS: We successfully managed a CSEP using a double-step technique. This involved hysteroscopic injection of subchorionic MTX, followed by laparoscopic resection of the residual gestational sac. Concurrently, we repaired the uterine defect. Both procedures were performed in an outpatient setting without complications detected during or after treatment. At the follow-up visit, the patient reported good health, and subsequent ultrasound confirmed an empty isthmocele. CONCLUSION: This sequential hysteroscopic and laparoscopic approach represents a definitive and effective minimally invasive surgical option for the treatment of CSEP.

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Introducción: La mayoría de los pacientes con enfermedades graves y progresivas como el VIH/SIDA se enfrentan a una variedad de desafíos psicológicos, es por eso que en esta investigación nos preguntamos cual es el estado psicológico de pacientes con la enfermedad del síndrome de inmunodeficiencia adquirida, internados en el Instituto de Medicina Tropical en el año 2022. Objetivo: Evaluar el estado psicológico de pacientes con la enfermedad del síndrome de inmunodeficiencia adquirida, internados en el Instituto de Medicina Tropical en el año 2022. Metodología: Estudio descriptivo, prospectivo de enfoque mixto con diseño no experimental en el que se incluyeron a 100 pacientes con diagnóstico de VIH/SIDA internados en el IMT en el periodo de enero a julio de 2022, encontrando los siguientes resultados: 30 a 44 años en el 66% del total, procedentes de Asunción (31%), y del área Central (53%). Con respecto al estado cognitivo el 61% estaba lúcido, ubicado en tiempo y espacio, la memoria y atención se ven afectadas en el 51% de los pacientes; estado afectivo: el miedo o temor fueron los estadíos principales, seguido de la preocupación e impotencia. Analizando el estado somático se vio que el descanso fue malo, al igual que la alimentación. En relación al estado interpersonal el 87% contaba con apoyo familiar, el estado conductual mostró incoherencias en cuanto al afrontamiento de los síntomas y la adherencia. Conclusión: Los factores sociodemográficos y psicosociales la percepción de apoyo social, las creencias relacionadas con la enfermedad, los rasgos de personalidad, las habilidades sociales, los estilos de afrontamiento, entre otras, pueden permitir a los pacientes con VIH/ SIDA afrontar la enfermedad para lograr la adaptación y el bienestar de su salud general

Introduction: Most patients with serious and progressive diseases such as HIV/AIDS face a variety of psychological challenges, which is why in this research we ask ourselves what is the psychological state of patients with the acquired immunodeficiency syndrome disease interned at the Institute of Tropical Medicine in the year 2022. Objective: To evaluate the psychological state of patients with acquired immunodeficiency syndrome, admitted to the Institute of Tropical Medicine in 2022. Methodology: Descriptive, prospective study of a mixed approach with a non-experimental design in which 100 patients with a diagnosis of HIV/AIDS admitted to the IMT in the period from January to July 2022 were included, finding the following most relevant results: 30 to 66% of the total were 44 years old, coming from Asunción (31%), and Central area (53%). Regarding the cognitive state, 61% were lucid, located in time and space, memory and attention were affected in 51% of the patients; affective state: fear or apprehension were the main stages, followed by worry and impotence. Analyzing the somatic state, it was seen that the rest was bad, as was the diet. In relation to the interpersonal state, 87% had family support, the behavioral state showed inconsistencies in coping with symptoms and adherence. Conclusion: Sociodemographic and psychosocial factors, the perception of social support, beliefs related to the disease, personality traits, social skills, coping styles, among others, may allow patients with HIV/AIDS to face the disease in order to achieve adaptation and well-being of your general health.

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BACKGROUND: The instructions of manufacturers of methodologies for anti-HIV-1/2 antibodies screening tests re-commend avoiding analyzing blood samples with hemolysis or lipemia, but they do not mention references about scientific studies evaluating their interference. The increased need for an opportune detection of HIV infection to avoid its spread has led to public health institutions including routine HIV screening even in internal medicine and emergency rooms. Nevertheless, these blood samples are usually associated with the presence of lipemia and/ or hemolysis, leaving doubt for probable misinterpretations. This fact highlights the need for applying verification techniques, established under the internal methodological conditions of each laboratory, in order to increase the coverage of HIV screening and to ensure the reliability of their results. METHODS: Following the ethics committee approval and patient's informed consent, a confirmed anti-HIV-1 positive human serum (undetectable viral load and p24 antigen, and stable total lymphocytes > 30%) was obtained. This work describes techniques for the semiquantitative analysis of anti-HIV antibodies of three commercial HIV-screening methodologies (immunochromatography, enzyme-immunoassay and chemiluminescence) and to deter-mine the detection limit of these screening tests, as well as evaluating the maximum concentration of total lipids and of free hemoglobin that do not interfere in the detection limits. RESULTS: The highest analyzed concentration of total lipid (870 mg/dL) did not interfere with the detection limits of anti-HIV-1 antibodies in any of the evaluated methodologies. Free hemoglobin presented interference at different concentrations depending on the methodology: immunochromatography (0.57 g/dL)), enzyme-immunoassay (8.6 g/dL), and chemiluminescence (11.5 g/dL)). CONCLUSIONS: Concentrations of lipemia above postprandial levels or hemolysis induced by experimental manipulation might not interfere with HIV-serological screening. Determining the maximum permissible limits of lipemia and hemolysis by each manufacturer or laboratory based on an internal evaluation of their serological methodology would increase the reliability of HIV-diagnosis in internal medicine and emergency rooms and in patients with dyslipidemia or physiological hemolysis.

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El testimonio infantil en delitos sexuales ha sido un tema investigado. Esta investigación tiene como objetivo, analizar las preguntas del interrogatorio y contrainterrogatorio, realizadas a niños(as) cuando rinden testimonio presumiéndose víctimas de delitos sexuales, bajo un estudio cualitativo con un diseño narrativo. Las unidades de análisis fueron las preguntas que hicieron la Fiscalía, Defensa, ministerio público y el juez en interrogatorio y contrainterrogatorio a niños(as) como víctimas en audiencias de juicio oral. Se contabilizaron 1126 preguntas, clasificadas en dos categorías orientadoras: tipos de preguntas y elementos de apoyo. Respecto a la primera, se generaron los siguientes códigos: preguntas frecuentes y necesarias, de hechos específicos, prohibidas e inadecuadas, aclaratorias del juez, preguntas de opinión del niño(a) y objetadas; la segunda categoría se codificó en los medios electrónicos, los juegos, dibujos anatómicos, láminas y videos. Los datos se analizaron con el software ATLAS.ti 7.5.4. La investigación demuestra que los actores judiciales deben considerar la forma en que hacen las preguntas para cumplir con los mínimos estándares legales, además de preservar el bienestar integral de los niños, niñas y adolescentes (NNA), por lo que se sugiere fomentar la formación en quienes interrogan.

The testimony of children in sexual crimes has been a subject investigated, but its study is not frequent when children are called as witnesses. The objective of this investigation was to analyze the interrogation and cross-examination questions made to children when they testify presuming victims of sexual crimes. It is a qualitative study, under a Narrative Design. The questions were obtained from eight videos of children giving testimony in oral hearing. The units of analysis were the questions asked by the Office of the Prosecutor, Defense, Public Pros ecutor and the Judge in the practice of the cross-examination and cross-examination. There were 1126 questions, classified into two guiding categories: types of questions and support elements. The data was analyzed with Atlas Ti software. Regarding the types of questions, the following codes were generated: Frequent and necessary questions, questions of specific facts, forbidden and inadequate questions, clarifying questions of the Judge, questions of opinion of the child and questions objected. And regarding the support elements, electronic media, games, anatomical drawings, pictures and videos. The investigation shows that judicial actors must not only consider the way in which they ask questions, in order to comply with the minimum legal standards, but that the children be considered as a psychological subject, whose integral welfare should be preserved, so it is suggested to encourage training in those who question.

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RESUMEN Se presenta caso de mujer de 22 años que presenta una celulitis en la región del muslo lado derecho por lo que recibe antibióticos por vía oral en un principio con amoxicilina y luego por vía parenteral con quinolona más clindamicina y consulta a nuestro Servicio por diarrea y dolor abdominal. La rectosigmoidoscopía detecta colitis pseudomembranosa. Las toxinas por C. difficile resultaron positivas en heces. Se inició tratamiento antibiótico específico con lo que el cuadro diarreico cesó.

ABSTRACT The case of a 22-year-old woman with cellulitis on the right side of the thigh region is presented. She receives oral antibiotics initially with amoxicillin and then parenterally quinolone plus clindamycin and consults our service for diarrhea and abdominal pain. Rectosigmoidoscopy detects pseudomembranous colitis. Toxins of C. difficile were positive in feces. Specific antibiotic treatment was started and then the diarrheic symptoms stopped.

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Eight years after the enactment of the National Mental Health Law (26.657), we consider it necessary to build spaces for debate on the potentialities and challenges in its practical implementation. This research addresses the mental health practices in the general public hospitals of the city of Rosario and Gran Rosario, Argentina, from the workers' perspective. Through a qualitative and exploratory / descriptive approach, semi-structured interviews were conducted with 23 mental health workers (nurses, psychiatrists, psychologists, social workers and therapeutic companions). The analysis of the results allowed to stablish that the sanction of the law legitimized and strengthened already existing conceptions and practices, making possible its extension and the creation of new devices. Political, management, building, training and human resources limitations were analyzed. The scarcity of substitute devices to the psychiatric hospital, in addition to previously mentioned limitations, points to the importance of a Mental Health Plan, with clear resources, objectives and guidelines that may enable changes in the paradigm of care.

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