Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks.

BACKGROUND: Diarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries. METHODS: Data from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality. RESULTS: This analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81-4.50), female sex (OR = 1.18; 95% CI, 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01-3.25), no vomiting (OR = 1.13; 95% CI, .98-1.30), severe dehydration (OR = 3.79; 95% CI, 3.01-4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72-422.73), whereas cases from the European Region had the lowest odds of death. CONCLUSIONS: Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.

Embolization of renal tumor bone metastasis: case report.

Primary or secondary bone tumors can manifest in different ways, from simple bone pain to possible pathological fractures. Hypervascularized tumors are of greatest concern, with increased incidence of complications. Preoperative embolization of the bone tumor is an effective measure for reducing blood loss during open surgery to excise the tumor. With appropriate experience, the risks of the procedure are minimal and final outcomes are highly satisfactory. The purpose of this paper is to describe the case of a 43-year-old male patient with a metastatic renal cell tumor in the left proximal femur (seen on lower limb computed tomography) who underwent selective preoperative embolization. The procedure resulted in a remarkable absence of bleeding and successful response to subsequent onco-orthopedic surgery.

Os tumores ósseos, primários ou secundários, podem se manifestar de várias formas, desde dor óssea até fraturas patológicas. A preocupação maior repousa sobre tumores hipervascularizados, com maior incidência de complicações. A embolização pré-operatória do tumor ósseo é uma medida eficaz para reduzir a perda sanguínea durante a exérese tumoral em cirurgia aberta. Com uma experiência apropriada, os riscos do procedimento são mínimos, com resultados finais bastante satisfatórios. O presente artigo tem por finalidade descrever o caso de um paciente do sexo masculino, de 43 anos, com tumor metastático de células renais em fêmur proximal esquerdo (visualizado por angiotomografia de membro inferior), submetido à embolização arterial seletiva pré-operatória. O procedimento resultou em ausência de sangramento e ótima resposta à cirurgia onco-ortopédica realizada.

Incidental cardiovascular findings on chest CT scans requested for suspected COVID-19.

BACKGROUND: Computed tomography scans of the chest are often requested as a complementary examination to investigate a clinical suspicion of pulmonary disease caused by the novel coronavirus 19 (COVID-19). OBJECTIVES: Our objective was to analyze the prevalence of incidental cardiovascular findings on chest CT scans requested to assess radiological signs suggestive of COVID-19 infection. METHODS: This cross-sectional, descriptive, and retrospective study reviewed 1,444 chest tomographies conducted in the Radiology department of the Hospital de Clínicas Gaspar Vianna, from March 1 to July 30, 2020, describing the prevalence of images suggestive of viral pneumonia by COVID-19 and incidental pulmonary and cardiovascular findings. RESULTS: The mean age of the patients was 50.6 ± 16.4 years and female sex was more frequent. Computed tomography without contrast was the most frequently used method (97.2%). Aortic and coronary wall calcification and cardiomegaly were the most prevalent cardiovascular findings. CT angiography revealed aortic aneurysms (9.7%), aortic dissection (7.3%) and thoracic aortic ulcers (2.4%). CONCLUSIONS: Incidental cardiovascular findings occurred in about half of the chest CT scans of patients with suspected COVID-19, especially aortic calcifications, cardiomegaly, and coronary calcification.

Experiences and challenges of a street team in Portugal with vulnerable populations: phenomenological study.

OBJECTIVE: To understand the experiences and challenges faced by professionals working on a street team in Portugal in caring for the vulnerable population from the phenomenological perspective of Alfred Schutz. METHOD: Qualitative approach in the light of the theoretical framework of phenomenological Sociology, developed in a street team in the central region of Portugal from phenomenological interviews with five professionals in the months of June and July 2021. The interpretation of the results was analyzed through theoretical conceptions of Alfred Schutz's phenomenological sociology and related literature. RESULTS: Three categories emerged: Conflicts experienced by the street team; Frustration in the daily care provided by the street team; and, Limits in the social relationship with the vulnerable population. CONCLUSION: The street team in Portugal faces challenges in caring for the vulnerable population served,requiring team skills for conflict mediation combined with an understanding of the influences of relationships, in social action.

Organ Preservation Solutions in Transplantation: A Literature Review.

OBJECTIVES: Renal transplant with ABO-incompatible donors expands the donor pool. Earlier studies have focused the use of protocol biopsies in ABOincompatible transplant patients. Our study described outcomes of indication (for cause) renal biopsies and clinical outcomes in patients with ABO-incompatible renal transplant. MATERIALS AND METHODS: This retrospective study included 164 patients from January 2012 to June 2019. Biochemical parameters, serial immunoglobulin G anti-ABO titers, and class I and II donor-specific antibody findings were obtained from hospital records, and renal graft biopsies were reviewed according to the Banff 2017 update. RESULTS: We analyzed the results of 65 biopsies from 54 patients. Biopsy-proven acute antibody-mediated rejection (12.8%) was found to be more prevalent than acute cellular rejection (1.8%). Patients with antibodymediated rejection all had microvascular inflammation (g+ptc score of 2 or more, where g+ptc is the sum of the glomerulitis and peritubular capillaritis scores) and were positive for C4d. Acute tubular injury per se was seen in 10.3% of patients; 65% of these patients had C4d positivity in peritubular capillaries, and only 1 patient developed chronic active antibody-mediated rejection on follow-up. Patient and death-censored graft survival rates were 92% and 98% at 1 year after transplant and 88% and 91% at 3 years, respectively. Patients with an episode of antibody-mediated rejection had lower rates of patient (76.5%) and deathcensored graft survival (84.6%) at 1 year. CONCLUSIONS: The microvascular inflammation score (g+ptc score of 2 or higher) is more reliable than diffuse C4d positivity to determine antibody-mediated rejection in ABO-incompatible transplants because diffuse C4d positivity may also be seen in etiologies unrelated to antibody-mediated rejection. Acute tubular injury with C4d positivity without microvascular injury does not confirm antibody-mediated rejection. We suggest that Banff classification be updated in ABOincompatible transplants to include diagnostic criteria for the diagnosis of antibody-mediated rejection.

When basic supplies are missing, what to do? Specific demands of the local street population in times of coronavirus - a concern of social psychiatry.

BACKGROUND: Homeless experts and some federal housing officials are sounding the alarm that the patchwork of government efforts to address the coronavirus outbreak risks leaving out one group of acutely vulnerable people: the homeless. In terms of isolation, it is too unclear what that looks like if you normally sleep on the streets. In this tough moment, when people should be turned away, not only it feels inhumane, but it is also a big public health risk, because where are they going to go? METHOD: The studies were identified using large-sized newspapers with international circulation RESULTS: With more cities suspecting community transmission of the novel coronavirus, people who sleep in shelters or hunker down outside already have a lower life expectancy and often have underlying health conditions that put them at greater risk if they develop COVID-19 (Global News, 2020). These people face lack of sleep, malnutrition, and "extreme stress levels just to meet their daily needs", all of which weakens the immune system. Along with mental illness or substance abuse disorders, they are "incredibly vulnerable to this virus". CONCLUSIONS: Health organizations are well aware of the risks involved in mental health. A large population of homeless people experience their pain and psychological distress intermittently. For low-income patients, the various borderline situations related to health/illness involve growing expectations regarding the basic needs. This is a serious concern when linked to the pandemic.

Theory of Mind (ToM) Performance in High Functioning Autism (HFA) and Schizotypal-Schizoid Personality Disorders (SSPD) Patients.

The similarities between high functioning autism (HFA) and schizotypal-schizoid personality disorder (SSPD) in terms of social cognition and interpersonal deficits may lead to confusion in symptom interpretation, and consequently result in misdiagnosis. Thus, this study aims to investigate differences in mentalizing with particular interest on the socio-cognitive and socio-affective dimensions. Three Advanced Theory of Mind (ToM) tests were applied in 35 patients with HFA, 30 patients with SSPD and 36 healthy controls. Individuals with HFA showed greater impairment and no dissociation between affective and cognitive ToM components. Conversely, SSPD individuals displayed less difficulties but greater impairments on the cognitive component. Beyond the replicability of ToM impairment in HFA individuals, our findings suggest more impaired cognitive ToM in SSPD participants which further support the sequence of mentalizing development build upon different chronological stages.

Health teams' role in disaster risk management / Desempeño de los equipos de salud en el manejo de riesgos de desastres naturales / Atuação de equipes de saúde na gestão de riscos de desastres

ABSTRACT Objective: to understand the perceptions of Primary Health Care and Psychosocial Care professionals regarding their role in addressing the psychosocial impacts following hydrological natural disasters in southern Brazil. Method: a multiple-case, descriptive and integrated study with a qualitative approach. The participants were professionals and managers from Primary Health Care and Psychosocial Care in municipalities from southern Brazil. Data collection was carried out during the conduction of a funded project, including narrative interviews between January and May 2018. Data analysis followed the stages of Fritz Schütze's method. Results: interpretation of the narratives of the cases and their units of analysis comprised the following categories: 1) Health teams' performance in disasters; and 2) Cultural meanings and training for risk and disaster reduction. Demands for pre-flooding care, demands during the disaster event, and post-flooding demands: care in psychosocial support and territory surveillance were identified. Conclusion: the study identified actions perceived by health team professionals and municipal managers regarding disasters in a context of recurrent events. While recognizing cultural aspects for a resilient response, there are operational and training gaps for an effective management of the response and recovery plan at the community level.

RESUMEN Objetivo: conocer las percepciones de los profesionales de equipos de Atención Primaria de la Salud y de Atención Psicosocial con respecto a su desempeño frente a los efectos psicosociales posteriores a desastres naturales hidrológicos en el sur do Brasil. Métodos: estudio de casos múltiples, descriptivo, integrado y con enfoque cualitativo. Los participantes fueron profesionales y gerentes de Atención Primaria de la Salud y de Atención Psicosocial de municipios del sur de Brasil. Los datos se recolectaron mientras se ejecutaba un proyecto financiado, por medio de entrevistas narrativas entre enero y mayo de 2018. El análisis de datos siguió las etapas del método de Fritz Schütze. Resultados: la interpretación de las narrativas de los casos y sus unidades de análisis dieron lugar a las siguientes categorías: 1) Desempeño de los equipos de salud en los desastres; y 2) Significados culturales y capacitación para reducir riesgos y desastres. Se identificaron requerimientos de atención previos a una inundación; al igual que requerimientos durante el desastre, y posteriores a una inundación: cuidado en la atención psicosocial y vigilancia del territorio. Conclusión: el estudio identificó acciones percibidas por profesionales de equipos de salud y gerentes municipales en relación con los desastres en un contexto de eventos recurrentes. Aunque reconocen aspectos culturales para ofrecer una respuesta resiliente, se evidencian brechas operativas y de capacitación para que la administración del plan de respuesta y recuperación sea efectiva al nivel de la comunidad.

RESUMO Objetivo: conhecer as percepções dos profissionais de equipes de atenção primária à saúde e de atenção psicossocial quanto a atuação frente aos impactos psicossociais pós-desastres naturais hidrológicos no sul do Brasil. Método: abordagem qualitativa, tipo estudo de múltiplos casos, descritivo e integrado. Participaram profissionais e gestores da Atenção Primária à Saúde e da Atenção Psicossocial de municípios do Sul do Brasil. Coleta de dados durante execução de projeto financiado, com entrevistas narrativas entre janeiro e maio de 2018. Análise dos dados seguiu etapas do método de Fritz Schütze. Resultados: a interpretação das narrativas dos casos e suas unidades de análise, compuseram as categorias: 1) Atuação das equipes de saúde nos desastres e 2) Significados culturais e capacitação à redução de riscos e desastres. Foram identificadas demandas de atenção pré-inundação; demandas durante o evento do desastre; e demandas após inundação: cuidado na atenção psicossocial e vigilância do território. Conclusão: o estudo identificou ações percebidas por profissionais de equipes de saúde e de gestores municipais com relação aos desastres em um contexto de recorrentes eventos. Embora reconheçam aspectos culturais para a resposta resiliente, há lacunas operacionais e de capacitação para que a gestão do plano de resposta e de recuperação seja efetiva em nível de comunidade.

Cumprimento das demandas articuladas no plano de parto entre usuárias do sistema público de saúde / Compliance with articulated demands in the childbirth plan among users of the public health system / Cumplimiento de las demandas articuladas en el plan de parto entre usuarios del sistema de salud pública

Objetivo: Avaliar o cumprimento do PP entre usuárias de Unidades Básicas de Saúde (UBS), do Sistema Único de Saúde (SUS), no município de Montes Claros, Minas Gerais, entre os meses de março a setembro de 2014. Métodos: Estudo transversal, descritivo, realizado entre os meses de março a setembro de 2014, com 48 gestantes participantes de rodas de conversas em Unidades Básicas de Saúde. Os dados foram analisados através de frequências absolutas e relativas. Resultados: 41 (85,4%) mulheres não possuíam conhecimento prévio acerca do plano de parto, 28 (58,3%) relataram que ele ajudou no trabalho de parto, 11 (22,9%) o apresentaram na admissão e 17 (35,4%) informaram suas escolhas à equipe verbalmente. As demandas mais cumpridas foram a presença do acompanhante, livre movimentação e uso de métodos não farmacológicos para alívio da dor. Conclusão: Os resultados do presente estudo são evidências importantes para a promoção de políticas públicas voltadas à assistência obstétrica. (AU).

Objective: Evaluate the fulfillment of the PP among users of Basic Health Units (UBS), of the Unified Health System (SUS), in the municipality of Montes Claros, Minas Gerais, between March and September 2014. Methods: Cross-sectional, descriptive study, carried out between March and September 2014, with 48 pregnant women participating in conversation circles at Basic Health Units. Data were analyzed using absolute and relative frequencies. Results: 41 (85.4%) women had no prior knowledge about the birth plan, 28 (58.3%) reported that it helped in labor, 11 (22.9%) presented it on admission and 17 ( 35.4%) informed their choices verbally to the team. The most fulfilled demands were the presence of the companion, free movement and use of non-pharmacological methods for pain relief. Conclusion: The results of the present study are important evidence for the promotion of public policies aimed at obstetric care. (AU).

Objetivo: Evaluar el cumplimiento del PP entre usuarios de Unidades Básicas de Salud (UBS), del Sistema Único de Salud (SUS), en el municipio de Montes Claros, Minas Gerais, entre marzo y septiembre de 2014. Métodos: Estudio transversal, descriptivo, realizado entre marzo y septiembre de 2014, con 48 gestantes participantes de ruedas de conversación en Unidades Básicas de Salud. Los datos se analizaron utilizando frecuencias absolutas y relativas. Resultados: 41 (85,4%) mujeres no tenían conocimiento previo sobre el plan de parto, 28 (58,3%) informaron que ayudó en el parto, 11 (22,9%) lo presentaron al ingreso y 17 ( 35,4%) informaron verbalmente sus elecciones al equipo. Las demandas más cumplidas fueron la presencia del acompañante, la libre circulación y el uso de métodos no farmacológicos para el alivio del dolor. Conclusión: Los resultados del presente estudio son evidencia importante para la promoción de políticas públicas dirigidas a la atención obstétrica. (AU).

[Pap smear screening for the control of cervical cancer in Minas Gerais State, Brazil, 2002]. / Perfil de produção do exame citopatológico para controle do câncer do colo do útero em Minas Gerais, Brasil, em 2002.

This article analyzes the implementation of Pap smears by the Cervical Cancer Control Program in 2002 in women 25-59 years of age residing in 850 municipalities (counties) in Minas Gerais State, Brazil. Cluster analysis was performed to classify municipalities by: number of Pap smears performed; test findings; and adequacy of slides. The variable "satisfactory slide, but limited by" was the principal factor for classifying municipalities into 5 clusters. Spatial representation of clusters indicated a more critical situation in the North, Jequitinhonha, Vale do Mucuri, and Vale do Rio Doce "meso-regions" of Minas Gerais and identified operational problems resulting from inadequate collection of material, with more "desiccated" slides observed in the North of the State and more slides with "absent endocervical cells" in the Center and South. The methodology allowed identifying clusters of municipalities with problems in the screening process, related to quality of sampling and fixing and reading of slides.

Efetividade da versão portuguesa do Fume na literacia em saúde de adolescentes acerca do tabaco / Effectiveness of the Portuguese version of Fume in adolescents' health literacy about tobacco / Efectividad de la versión portuguesa de Fume en la alfabetización en salud de los adolescentes sobre el tabaco

Resumo Objetivo Avaliar a efetividade da versão traduzida para português europeu do mobile health game Fume (No Fume), no que diz respeito à literacia em saúde de adolescentes em contexto escolar sobre as questões relacionadas com o tabaco. Método Estudo quantitativo, quase-experimental, com avaliação pré-teste e pós-teste, com uma amostra por conveniência de 144 adolescentes, dividida por um grupo experimental e um grupo de controle, realizado em duas escolas públicas do 2º e 3º ciclo do ensino básico de uma cidade do distrito de Coimbra, região centro de Portugal. Resultados Verificou-se, nos adolescentes que utilizaram o No Fume (grupo experimental), uma evolução favorável, estatisticamente significativa, nas expetativas negativas sobre fumar (p = 0,033). Conclusão O No Fume revelou um efeito positivo nas expetativas negativas sobre fumar dos adolescentes. Deve investir-se no desenvolvimento do No Fume para maximizar o seu potencial de utilização pois, enquanto tecnologia educativa baseada na gamificação, poderá contribuir para o alargamento e disseminação de intervenções inovadoras promotoras da saúde mental dos adolescentes

Abstract Objective To evaluate the effectiveness of the version translated into European Portuguese of the Fume mobile health game (No Fume), with regard to the health literacy of adolescents in the school context on tobacco-related issues. Method A quantitative and quasi-experimental study, with pre-test and post-test evaluation, conducted with a convenience sample of 144 adolescents, divided into an experimental group and a control group, carried out in two public schools serving the 2nd and 3rd cycles of elementary education from a city in the district of Coimbra, central region of Portugal. Results Among the adolescents who used No Fume (experimental group), a statistically significant and favorable evolution was verified in the negative expectations about smoking (p = 0.033). Conclusion No Fume revealed a positive effect on the negative expectations about smoking among the adolescents. Investments should be made in developing No Fume in order to maximize its potential for use since, as an educational technology based on gamification, it may come to contribute to the expansion and dissemination of innovative interventions that promote adolescents' mental health.

Resumen Objectivo Evaluar la efectividad de la versión traducida al portugués europeo del mobile health game Fume (No Fume) en la alfabetización en salud de los adolescentes en un contexto escolar sobre temas relacionados con el tabaco. Método Estudio cuantitativo, cuasiexperimental, con evaluación pretest y postest, con una muestra por conveniencia de 144 adolescentes dividida en un grupo experimental y un grupo de control, realizado en dos escuelas públicas del segundo y tercer ciclo de educación básica de una ciudad en el distrito de Coímbra, región central de Portugal. Resultados Los adolescentes que utilizaron No Fume (grupo experimental), tuvieron una evolución favorable estadísticamente significativa en las expectativas negativas sobre fumar (p = 0,033). Conclusión No Fume reveló un efecto positivo sobre las expectativas negativas sobre fumar en los adolescentes. Se debe invertir en el desarrollo de No Fume para maximizar su potencial de uso porque, como tecnología educativa basada en la gamificación, puede contribuir a la expansión y difusión de intervenciones innovadoras que promuevan la salud mental de los adolescentes.

Experiences and challenges of a street team in Portugal with vulnerable populations: phenomenological study / Experiencias y desafíos de un equipo de calleen Portugal con poblaciones vulnerables: estudio fenomenológico / Experiências e desafios de uma equipe de rua em Portugal com populações vulneráveis: estudo fenomenológico

ABSTRACT Objective: To understand the experiences and challenges faced by professionals working on a street team in Portugal in caring for the vulnerable population from the phenomenological perspective of Alfred Schutz. Method: Qualitative approach in the light of the theoretical framework of phenomenological Sociology, developed in a street team in the central region of Portugal from phenomenological interviews with five professionals in the months of June and July 2021. The interpretation of the results was analyzed through theoretical conceptions of Alfred Schutz's phenomenological sociology and related literature. Results: Three categories emerged: Conflicts experienced by the street team; Frustration in the daily care provided by the street team; and, Limits in the social relationship with the vulnerable population. Conclusion: The street team in Portugal faces challenges in caring for the vulnerable population served,requiring team skills for conflict mediation combined with an understanding of the influences of relationships, in social action.

RESUMEN Objetivo: Comprender las experiencias y desafíos de dos profesionales de un equipo de calle en Portugal que no atienden poblaciones vulnerables en la perspectiva fenomenológica de Alfred Schutz. Método: Enfoque cualitativo a la luz del marco teórico de la sociología fenomenológica desarrollado en un equipo de calle ubicado en la región central de Portugal a partir de entrevistas fenomenológicas con cinco profesionales durante los meses de junio y julio de 2021. Los datos fueron analizados a través de la sociología fenomenológica por Alfred Schutz y literatura relacionada. Resultados: Surgieron tres categorías: conflictos vividos por el equipo de calle; Frustración no diaria de cuidar al equipo de calle; y, Límites a las relaciones sociales con poblaciones vulnerables. Conclusión: El equipo de calle en Portugal enfrenta desafíos en la atención de las poblaciones vulnerables atendidas, lo que requiere habilidades de equipo para la mediación de conflictos y las relaciones sociales.

RESUMO Objetivo: Compreender as experiências e desafios dos profissionais de uma equipe de rua de Portugal no cuidado à população vulnerável na perspectiva fenomenológica de Alfred Schutz. Método: Abordagem qualitativa à luz do referencial Teórico da Sociologia fenomenológica desenvolvido em uma Equipe de rua localizada na região centro de Portugal a partir de entrevistas fenomenológicas com cinco profissionais nos meses de junho e julho de 2021. Os dados foram interpretados por meio da análise compreensiva conforme a sociologia fenomenológica de Alfred Schutz e de literatura correlata. Resultados: Emergiram três categorias: conflitos vivenciados pela equipe de rua; Frustração no cotidiano do cuidar pela equipe de rua; e, Limites na relação social com a população vulnerável. Conclusão: A equipe de rua de Portugal enfrenta desafios no cuidado a população vulnerável atendida sendo necessário habilidades da equipe para mediação de conflitos aliada a compreensão das influências das relações, no agir social.

Surgical Repair of a Ruptured Giant Abdominal Aortic Aneurysm in a 16-Year-Old with Takayasu's Arteritis: Case Report and Etiological Review

Abstract Takayasu's arteritis is a type of primary systemic vasculitis that affects medium and large arteries, including the aorta and its main branches, as well as the pulmonary and coronary arteries. Although rare in children, it is the third most common vasculitis in the pediatric population, often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. This is a case of a 16-year-old girl with a giant ruptured abdominal aortic aneurysm, who needed surgery on an emergency basis. The etiological aspects involved in aneurysms in young patients are also addressed.

Instrumentos de avaliação da literacia em saúde acerca do tabaco: tradução e adaptação para português europeu / Instrumentos para evaluar la alfabetización en salud sobre el tabaco: traducción y adaptación al portugués europeo / Instruments for assessing tobacco-related health literacy: translation and adaptation to european portuguese

RESUMO Objetivo traduzir e adaptar culturalmente para português europeu os instrumentos de avaliação da literacia em saúde acerca do tabaco Attitudes Towards Tobacco Use, Tobacco-Use Motives e Motivation to Decline Tobacco Use in the Future, e Smoking Outcome Expectation Scale e Anti-Smoking Self-Efficacy Scale, e realizar validação preliminar Método tradução e adaptação transcultural de acordo com as recomendações do Institute for Work and Health e validação preliminar em 144 adolescentes de duas escolas públicas da região central de Portugal, em abril e maio de 2019 Resultados foram retirados itens relativos a snus, por não apresentarem relevância no contexto português. Assim, dois instrumentos passaram a ser constituídos apenas por um item. Os valores de alfa de Cronbach das versões em português europeu foram 0,799, 0,673, 0,905 e 0,890 Conclusão contribui para a existência de instrumentos de avaliação da literacia em saúde acerca do tabaco, adaptados para português europeu, para a população dos adolescentes

RESUMEN Objetivo traducir y adaptar culturalmente al portugués europeo los instrumentos de evaluación de la alfabetización en salud sobre el tabaco Attitudes Towards Tobacco Use, Tobacco-Use Motives y Motivation to Decline Tobacco Use in the Future, y Smoking Outcome Expectation Scale y Anti-Smoking Self-Efficacy Scale, y realizar una validación preliminar Método traducción y adaptación transcultural según las recomendaciones del Institute for Work and Health y validación preliminar en 144 adolescentes de dos escuelas públicas de la región central de Portugal, en abril y mayo de 2019 Resultados se eliminaron los artículos relacionados con la snus, ya que no eran relevantes en el contexto portugués. De este modo, dos instrumentos se componen de un solo ítem. Los valores del alfa de Cronbach de las versiones en portugués europeo fueron 0,799, 0,673, 0,905 y 0,890 Conclusión contribuye a la existencia de instrumentos de evaluación de la alfabetización en salud sobre el tabaco, adaptados al portugués europeo, para la población adolescente

ABSTRACT Objectives To translate and culturally adapt to European Portuguese the tobacco-related health literacy assessment instruments "Attitudes Towards Tobacco Use," "Tobacco-Use Motives," "Motivation to Decline Tobacco Use in the Future," "Smoking Outcome Expectation Scale," and "Anti-Smoking Self-Efficacy Scale"; and to conduct the preliminary validation of the translated versions Methodology Translation and cross-cultural adaptation in accordance with the Institute for Work & Health recommendations and preliminary validation study using a sample of 144 adolescents from two public schools in central Portugal in April and May 2019 Results Snus-related items were removed due to their lack of relevance in the Portuguese context. Thus, two instruments consisted of only one item each. The European Portuguese versions of the instruments presented Cronbach's alpha scores of 0.799, 0.673, 0.905, and 0.890 Conclusion The present study contributed to developing European Portuguese versions of instruments for assessing tobacco-related health literacy among adolescents

Adolescentes em território de grande circulação de substâncias psicoativas: uso e prejuízos / Adolescents in a wide-circulation territory of psychoactive substances: use and losses

Objetivou descrever o perfil de problemas associados ao uso de substâncias entre adolescentes, estudantes de ensino fundamental de uma escola situada em território de intensa circulação de drogas, e verificar as relações com uso e características sociodemográficas. Estudo transversal e correlacional preditivo, com 109 estudantes do nono ano, que responderam ao questionário contendo informações sociodemográficas e o Drug Use Screening Inventory (DUSI). Os dados foram analisados por estatísticas descritivas, testes de associação e cálculo de densidades de problemas investigadas pelo DUSI. Houve maior densidade de problemas para todas as áreas de vida investigadas dentre os escolares que já haviam feito uso de substâncias psicoativas. "Praticar a religião" foi identificado como fator de proteção para o uso de substâncias psicoativas e "trabalhar" como fator de risco para o uso de álcool. Evidenciou-se a necessidade de estratégias preventivas direcionadas ao uso de substâncias e orientadas a esse público.

It aimed to describe the profile of problems associated with substance use among adolescents, elementary school students from a school located in a territory with a high circulation of drugs, and to verify the relationships between use and sociodemographic characteristics. Cross-sectional and predictive correlational study, with 109 ninth-year students, who answered the questionnaire containing sociodemographic information and the Drug Use Screening Inventory (DUSI). The data were analyzed by descriptive statistics, association tests, and calculation of problem densities investigated by the DUSI. There was a greater density of problems for all areas of life investigated among students who had already used psychoactive substances. "Practice religion" was identified as a protective factor for the use of psychoactive substances and "work" as a risk factor for the use of alcohol. The need for preventive strategies directed to the use of substances and directed to this public was evidenced.

Embolization of renal tumor bone metastasis: case report / Embolização de metástase óssea de tumor renal: relato de caso

Abstract Primary or secondary bone tumors can manifest in different ways, from simple bone pain to possible pathological fractures. Hypervascularized tumors are of greatest concern, with increased incidence of complications. Preoperative embolization of the bone tumor is an effective measure for reducing blood loss during open surgery to excise the tumor. With appropriate experience, the risks of the procedure are minimal and final outcomes are highly satisfactory. The purpose of this paper is to describe the case of a 43-year-old male patient with a metastatic renal cell tumor in the left proximal femur (seen on lower limb computed tomography) who underwent selective preoperative embolization. The procedure resulted in a remarkable absence of bleeding and successful response to subsequent onco-orthopedic surgery.

Resumo Os tumores ósseos, primários ou secundários, podem se manifestar de várias formas, desde dor óssea até fraturas patológicas. A preocupação maior repousa sobre tumores hipervascularizados, com maior incidência de complicações. A embolização pré-operatória do tumor ósseo é uma medida eficaz para reduzir a perda sanguínea durante a exérese tumoral em cirurgia aberta. Com uma experiência apropriada, os riscos do procedimento são mínimos, com resultados finais bastante satisfatórios. O presente artigo tem por finalidade descrever o caso de um paciente do sexo masculino, de 43 anos, com tumor metastático de células renais em fêmur proximal esquerdo (visualizado por angiotomografia de membro inferior), submetido à embolização arterial seletiva pré-operatória. O procedimento resultou em ausência de sangramento e ótima resposta à cirurgia onco-ortopédica realizada.

Achados cardiovasculares incidentais em tomografias de tórax solicitadas para suspeita de COVID-19 / Incidental cardiovascular findings on chest CT scans requested for suspected COVID-19

Resumo Contexto As tomografias de tórax são frequentemente solicitadas como exames complementares para avaliação de suspeita clínica de afecção pulmonar pelo novo coronavírus 19 (COVID-19). Objetivos Nosso objetivo foi analisar a prevalência dos achados cardiovasculares incidentais em tomografias de tórax solicitadas para avaliar sinais radiológicos sugestivos de COVID-19. Métodos Por meio de um estudo transversal, descritivo e retrospectivo, foram revisadas 1.444 tomografias de tórax realizadas no setor de radiologia do Hospital de Clínicas Gaspar Vianna, no período de 1° de março a 30 de julho de 2020, com a descrição da prevalência de imagens sugestivas de pneumonia viral pelo COVID-19, além de achados pulmonares e cardiovasculares incidentais. Resultados A média de idade dos pacientes foi 50,6±16,4 anos, sendo o sexo feminino o mais frequente. A tomografia sem contraste foi o método mais utilizado (97,2%), e opacidades em vidro fosco foram identificadas em 56,0% dos casos. Achados incidentais cardiovasculares ocorreram em 51,2% (intervalo de confiança 48,7%-53,8%) das tomografias, prevalecendo calcificação da parede aórtica (21,8%), cardiomegalia (10,5%), e calcificação coronária (5,0%). Nas tomografias com contraste, evidenciaram-se aneurismas de aorta (9,7%), dissecção de aorta (7,3%) e úlceras de aorta torácica (2,4%). Conclusões Achados cardiovasculares incidentais ocorreram em aproximadamente metade das tomografias de tórax de pacientes com suspeita de COVID-19, mais especificamente, calcificações da parede da aorta, cardiomegalia e calcificação coronária.

Abstract Background Computed tomography scans of the chest are often requested as a complementary examination to investigate a clinical suspicion of pulmonary disease caused by the novel coronavirus 19 (COVID-19). Objectives Our objective was to analyze the prevalence of incidental cardiovascular findings on chest CT scans requested to assess radiological signs suggestive of COVID-19 infection. Methods This cross-sectional, descriptive, and retrospective study reviewed 1,444 chest tomographies conducted in the Radiology department of the Hospital de Clínicas Gaspar Vianna, from March 1 to July 30, 2020, describing the prevalence of images suggestive of viral pneumonia by COVID-19 and incidental pulmonary and cardiovascular findings. Results The mean age of the patients was 50.6 ± 16.4 years and female sex was more frequent. Computed tomography without contrast was the most frequently used method (97.2%). Aortic and coronary wall calcification and cardiomegaly were the most prevalent cardiovascular findings. CT angiography revealed aortic aneurysms (9.7%), aortic dissection (7.3%) and thoracic aortic ulcers (2.4%). Conclusions Incidental cardiovascular findings occurred in about half of the chest CT scans of patients with suspected COVID-19, especially aortic calcifications, cardiomegaly, and coronary calcification.

Decrease in Fungizone toxicity induced by the use of Lipofundin as a dilutent: an in vitro study.

The aim of this work was to develop an in vitro experimental protocol for the evaluation of toxicity and efficacy of an amphotericin B (AmB) micelle system, Fungizone, which was previously diluted with a lipid based emulsion for parenteral use, named Lipofundin LCT/MCT-20%. Two cell models were used for the experiments: Red Blood Cells (RBC) from human donnors and Candida tropicalis (Ct). These models were used to perform the toxicity and activity of the Fungizone/ Lipofundin admixture (AmB-LP) and the Fungizone (AmB-M) alone. While potassium (K+) and hemoglobin leakage from RBC were the parameters used to evaluate the acute and chronic toxicity, respectively, the efficacy of AmB-LP and AmB-M were assessed by K+ leakage or cell survival rate (CSR) from Ct. The results show that the toxicity of AmB-LP to RBC was concentration dependent concerning the K+ leakage; while at high concentrations, 5 and 50 mg x mL(-1), the leakage was 50.91 +/- 2.09% and 95.71 +/- 0.64%, respectively, at a concentration of 0.5 mg x mL(-1) this value was 17.16 +/- 1.57% and the value tended to zero for the lowest concentration studied, 0.05 mg x mL(-1). Surprisingly, AmB-LP induced very low hemoglobin leakage for all concentrations studied. At the highest concentration, 50 mg x mL(-1), this value was around 3%. When the cell model was Ct, the results changed completely. Not only high concentrations of AmB-LP, but also lower ones were able to induce a K+ permeability of around 100%. The CSR parameter showed an inverse correlation with the concentration; high values, between 50 and 5 mg x mL(-1), resulted in a CSR of around 8%. On the other hand, for lower concentration values, 0.05 and 0.5 mg x mL(-1), this one was around 80%. The same profile of activity against Ct was found for AmB-M. Only a small variation was found for the K+ leakage at 0.05 mg x mL(-1) that presented a value of 96.99 +/- 2.53%. However, AmB-M seemed to be much more toxic than AmB-LP. Its induction of hemoglobin leakage started at 0.5 mg x mL(-1) and reached the 100% at 5 mg x mL(-1). K+ leakage results were worse. The intermediate concentrations of study, 0.5 and 5 mg x mL(-1), presented a significant increase compared to AmB-LP. All together these results reveal that the activity of AmB is not only concentration dependent, but also depends on the drug carrier in which this compound was inserted. The AmB-LP preparation showed the same efficacy as AmB-M, but with a low toxicity. Therefore, AmB-LP presented a higher therapeutic index that permits the administration of high concentration of AmB without revealing side effects. However, the simple mixture of two complex pharmaceutical entities, as micelles and emulsions, should be analyzed carefully to assure that physicochemical stability is not reduced and thereby cause a different biodistribution in vivo.

[Generalized congenital lipodystrophy: correlation with leptin and other biochemical parameters]. / Lipodistrofia generalizada congênita: correlação com leptina e outros aspectos bioquímicos.

PURPOSE: To correlate serum leptin and insulin levels, and the glucosic profile of 21 patients shared in diabetics and non diabetics with Congenital Generalized Lipodystrophy (CGL). METHODS: In a prospective study, were dosed serum leptin level with radioimmunoassay technique, fasting plasma glucose through of the glucoseoxidase-peroxidase reaction, the hemoglobin glycate using the technique microchromatography for ionic exchange resin and insulin through immunoassay system. The fructosamine concentration serum was determinated for reduction nitroblue tetrazolium method. The Student's test was used to compare results between the groups and the correlation "r" coefficient to analise the relation among the several variants studied, with significant level of 5% (p < 0.05). All the statistical procedures were performed using the Excel by Microsoft and the Statistic program for Windows by StatSoft, Inc. version 5.1 edition 97. RESULTS: Leptin decreased on the most patients, showing no statistically significant difference between the groups. Also there wasn't difference statistically significant (p = 0.9542) of the insulin's value between diabetics and non diabetics. CONCLUSION: The hyperinsulinism and the hypoleptinemia occurred independently of diabetes in the CGL's patients and this can be due to the natural history of disease, in which the raise insulin levels precede the initial diabetes mellitus and the low leptin levels were related to the lipoatrophy.