Examining surgeon stress in robotic and laparoscopic surgery.

Robotic surgery may decrease surgeon stress compared to laparoscopic. To evaluate intraoperative surgeon stress, we measured salivary alpha-amylase and cortisol. We hypothesized robotic elicited lower increases in surgeon salivary amylase and cortisol than laparoscopic. Surgical faculty (n = 7) performing laparoscopic and robotic operations participated. Demographics: age, years in practice, time using laparoscopic vs robotic, comfort level and enthusiasm for each. Operative data included operative time, WRVU (surgical "effort"), resident year. Saliva was collected using passive drool collection system at beginning, middle and end of each case; amylase and cortisol measured using ELISA. Standard values were created using 7-minute exercise (HIIT), collecting saliva pre- and post-workout. Linear regression and Student's t test used for statistical analysis; p values < 0.05 were significant. Ninety-four cases (56 robotic, 38 laparoscopic) were collected (April-October 2022). Standardized change in amylase was 8.4 ± 4.5 (p < 0.001). Among operations, raw maximum amylase change in laparoscopic and robotic was 23.4 ± 11.5 and 22.2 ± 13.4; raw maximum cortisol change was 44.21 ± 46.57 and 53.21 ± 50.36, respectively. Values normalized to individual surgeon HIIT response, WRVU, and operative time, showing 40% decrease in amylase in robotic: 0.095 ± 0.12, vs laparoscopic: 0.164 ± 0.16 (p < 0.02). Normalized change in cortisol was: laparoscopic 0.30 ± 0.44, robotic 0.22 ± 0.4 (p = NS). On linear regression (p < 0.001), surgeons comfortable with complex laparoscopic cases had lower change in normalized amylase (p < 0.01); comfort with complex robotic was not significant. Robotic may be less physiologically stressful, eliciting less increase in salivary amylase than laparoscopic. Comfort with complex laparoscopic decreased stress in robotic, suggesting laparoscopic experience is valuable prior to robotic.

Laparoscopic vs. robotic colectomy for left-sided diverticulitis.

Diverticulitis is a prevalent gastrointestinal disease that often warrants surgical intervention. However, the optimal approach between traditional laparoscopy (LC) and robotic-assisted laparoscopy (RAC) for diverticulitis remains unclear. Our research compares these techniques in patients diagnosed with left-sided diverticulitis treated at a single, tertiary referral center from 2019 to 2022. Among the 134 patients, 86 underwent laparoscopic and 48 robotic-assisted surgeries. The surgeries included in this analysis are left colectomy, sigmoid colectomy, low anterior resection, and Hartmann's procedure. Primary outcomes were major morbidity and 30-day mortality. Secondary outcomes were operative time, conversion to open, length of stay, unplanned return to the operating room, 30-day readmission rate, and overall morbidity. While demographics and comorbidities were similar for both groups, the robotic-assisted group displayed a statistically significant longer operative time (198.0 ± 84.4 LC vs. 264.8 ± 78.5 min RAC, p < 0.001). When investigated further, there was a significant difference in operative time for uncomplicated diverticulitis cases favoring the LC approach (169.17 ± 58.1 LC vs. 244.82 ± 58.79 min RAC, p < 0.001). This significant difference, however, was not present in complicated diverticulitis cases. Other factors, such as overall and major morbidity, rate of conversion to open approach, ostomy creation, estimated blood loss, time to return of bowel function, length of stay, and 30-day readmission rate, did not significantly differ between the groups. There was no 30-day mortality in either group. Favorable patient outcomes, lack of significant difference in operative time compared with traditional laparoscopy, and absence of differences in morbidities or efficacy, raises an interesting question in the world of minimally invasive surgery: is the robotic-assisted approach emerging as the advantageous approach for complicated diverticulitis cases? We encourage additional, multi-center analysis of specifically complicated diverticulitis managed with both surgical approaches to investigate if these findings are replicated outside of our institution.

Trends in Micronutrient Interventions, Anemia, and Iron Deficiency among Women and Children in Guatemala, 2009-2019.

Background: Food fortification and micronutrient supplementation are public health strategies to improve micronutrient status in Guatemala; their population effectiveness has not been evaluated in recent years. Objective: We evaluated trends in food fortification, micronutrient supplementation, anemia, and iron deficiency among nonpregnant women aged 15-49 y [women of reproductive age (WRA)] and children 6-59 aged mo [preschool age children (PSC)]. Method: Nationally representative serial cross-sectional surveys were used to assess changes in hemoglobin, anemia, ferritin, iron deficiency, iron deficiency anemia, and self-reported consumption of fortifiable foods and micronutrient supplements during 2008/2009, 2013, 2015, 2016, 2017/2018, and 2018/2019. Predictors of hemoglobin and ferritin were assessed using generalized linear mixed models adjusted for survey year as random effects, and the consumption of fortifiable foods, supplements, and other potential confounders were fixed effects. Results: Multiple micronutrient powder consumption among PSC during the previous 3 mo was 53.3% (95% CI: 49.4, 57.2) in 2013 and 33.6% (28.8, 38.4) in 2018/2019. Anemia among PSC was 11.3% (8.0, 14.5) in 2008/2009 and 6.1% (3.6, 8.6) in 2018/2019. Anemia among WRA was 10.7% (7.2, 14.2) in 2008/2009 and 3.9% (2.7, 5.2) in 2018/2019. Iron deficiency among PSC was 15.5% (12.1, 19.0) in 2008/2009 and 10.9% (7.4, 14.5) in 2016 (lowest), but 17.1 (13.3, 21.0) in 2017/2018 (highest). Iron deficiency among WRA was 14.9% (11.6, 18.2) in 2008/2009, 13.8% (11.8, 15.8) in 2013 (lowest), and 18.9% (16.3, 21.6) in 2017/2018 (highest). Wheat flour/bread consumption was positively associated with hemoglobin among PSC, and sugar consumption was positively associated with hemoglobin among WRA. The reported consumption of fortifiable foods was not associated with ferritin among PSC or WRA. Conclusions: Guatemala has implemented multiple food fortification strategies, and anemia has declined. Increases in iron deficiency in 2017-2019 warrant further attention. Secular trends toward poverty alleviation, education, and development might be responsible for changes not explained by the micronutrient interventions evaluated.

An Overview of the Role of MicroRNAs on Carcinogenesis: A Focus on Cell Cycle, Angiogenesis and Metastasis.

In recent years, the importance of epigenetic markers in the carcinogenesis of different malignant neoplasms has been demonstrated, also demonstrating their utility for understanding metastatic spread and tumor progression in cancer patients. Among the different biomarkers, microRNAs represent a set of non-coding RNAs that regulate gene expression, having been involved in a wide variety of neoplasia acting in different oncogenic pathways. Both the overexpression and downregulation of microRNAs represent a complex interaction with various genes whose ultimate consequence is increased cell proliferation, tumor invasion and interaction with various driver markers. It should be noted that in current clinical practice, even though the combination of different microRNAs has been shown to be useful by different authors at diagnostic and prognostic levels, there are no diagnostic kits that can be used for the initial approach or to assess recurrences of oncological diseases. Previous works have cited microRNAs as having a critical role in several carcinogenic mechanisms, ranging from cell cycle alterations to angiogenesis and mechanisms of distant metastatic dissemination. Indeed, the overexpression or downregulation of specific microRNAs seem to be tightly involved in the modulation of various components related to these processes. For instance, cyclins and cyclin-dependent kinases, transcription factors, signaling molecules and angiogenic/antiangiogenic products, among others, have been recognized as specific targets of microRNAs in different types of cancer. Therefore, the purpose of this article is to describe the main implications of different microRNAs in cell cycle alterations, metastasis and angiogenesis, trying to summarize their involvement in carcinogenesis.

Persistently expressed human chorionic gonadotropin induces premature luteinization and progressive alterations on the reproductive axis in female mice.

The hypothalamic-pituitary-gonadal axis plays a fundamental role in the endocrine regulation of the reproductive function in mammals. Any change in the function of the participating hormones or their receptors can lead to alterations in sexual differentiation, the onset of puberty, infertility, cancer development, and other dysfunctions. In this study, we analyzed the influence of persistently elevated levels of the human chorionic gonadotropin hormone (hCG), a powerful agonist of pituitary luteinizing hormone (LH), on the reproductive axis of female mice. As a consequence of chronic hCG hypersecretion through a global expression of the hCGbeta-subunit in transgenic (TG) female mice, a series of events perturbed the prepubertal to juvenile transition. The imbalance in gonadotropin action was first manifested by precocious puberty and alterations in gonadal hormone production, with the consequent ovarian function disruption and infertility in adulthood. The expansion of cumulus cells in vivo and in vitro, ovulatory capacity, and gene expression of ovulation-related marker genes after hormone stimulation were normal in 3-week-old TG females. However, the expression of genes related to steroidogenesis and luteinization such as Lhcgr, Prlr, and the steroidogenic enzymes Cyp11a1, Cyp17a1, and Cyp19a1 were significantly elevated in the TG females. This study demonstrates that the excessive secretion of hCG in concert with high prolactin, induced premature luteinization, and enhanced ovarian steroidogenesis, as was shown by the up-regulation of luteal cell markers and progesterone synthesis in the TG mice. Furthermore, progressively impaired reproductive function of the TG females occurred from the peripubertal stage to adulthood, thus culminating in infertility.

Burden of overweight and obesity in Mexico from 1990 to 2021.

BACKGROUND: Overweight and obesity (OW/OB) represent a serious challenge in Mexico, with effects on health, society and economy. Demographic, epidemiological, nutritional, social and economic factors have exacerbated this problem. OBJECTIVE: To analyze mortality and years of healthy life lost in Mexico due to OW/OB in the 1990-2021 period. MATERIAL AND METHODS: The Global Burden of Disease and Risk Factors 2021 study was used to analyze data on elevated body mass index (BMI) as a risk factor and its evolution in Mexico. RESULTS: In 2021, 118 thousand deaths attributable to high BMI were recorded, which accounted for 10.6% of total deaths and more than 4.2 million disability-adjusted life years lost. CONCLUSIONS: The obesogenic environment, influenced by social determinants of health, has had a significant impact on mortality, burden of disease, and economic costs. Addressing OW/OB requires multisector interventions to strengthen the Mexican health system.

ANTECEDENTES: El sobrepeso y la obesidad constituyen un grave desafío en México, con efectos en la salud, sociedad y economía. Factores demográficos, epidemiológicos, nutricionales, sociales y económicos han agravado esta problemática. OBJETIVO: Analizar la mortalidad y los años de vida saludable perdidos en México por sobrepeso y obesidad en el período de 1990 a 2021. MATERIAL Y MÉTODOS: Se utilizó el Global Burden of Disease 2021 para analizar los datos sobre índice de masa corporal elevado como factor de riesgo y su evolución en México. RESULTADOS: En 2021 se registraron 118 mil muertes atribuibles a índice de masa corporal elevado, que representaron 10.6 % del total de muertes y más de 4.2 millones de años de vida perdidos ajustados por discapacidad. CONCLUSIONES: El ambiente obesogénico, influido por determinantes sociales, ha tenido un impacto significativo en la mortalidad, la carga de enfermedad y los costos económicos. Abordar el sobrepeso y la obesidad requiere intervenciones multisectoriales para fortalecer el sistema de salud mexicano.

Joint International SILACO, SICCMII, ISASS Symposium as a Model for a Collaborative Framework to Create Literature on Advances in Spine Surgery, Patient Care, and Policy.

International collaborations can be the key to overcoming innovation implementation hurdles. The authors report on a joint symposium between the International Society For The Advancement of Spine Surgery (ISASS) and La Sociedad Iberolatinoamerica de Columna (SILACO), and La Sociedad Interamericana de Cirurgia de columna de Minima invasión (SICCMII) aimed at improving joint surgeon education programs. The symposium highlighted that patient-related spine care issues are similar across geographical, cultural, and language barriers. The sustainability of such programs depends on funding and mutually respectful relationships orchestrated by multi-lingual leaders who will bridge gaps created by geographical, cultural, and language barriers to effectively develop clinical research content focused on advancing surgeon education and improving patient outcomes across the Americas.

Beyond autophagy: LC3-associated phagocytosis and endocytosis.

Noncanonical functions of the autophagy machinery in pathways including LC3-associated phagocytosis and LC3-associated endocytosis have garnered increasing interest in both normal physiology and pathobiology. New discoveries over the past decade of noncanonical uses of the autophagy machinery in these distinct molecular mechanisms have led to robust investigation into the roles of single-membrane LC3 lipidation. Noncanonical autophagy pathways have now been implicated in the regulation of multiple processes ranging from debris clearance, cellular signaling, and immune regulation and inflammation. Accumulating evidence is demonstrating roles in a variety of disease states including host-pathogen responses, autoimmunity, cancer, and neurological and neurodegenerative pathologies. Here, we broadly summarize the differences in the mechanistic regulation between autophagy and LAP and LANDO and highlight some of the key roles of LAP and LANDO in innate immune function, inflammation, and disease pathology.

Eficacia y seguridad de antipsicóticos y antidepresivos en el tratamiento de la anorexia nerviosa: revisión sistemática / Efficacy and Safety of Antipsychotics and Antidepressants in the Treatment of Anorexia Nervosa: a Systematic Review

RESUMEN Introducción: Las recomendaciones de las guías vigentes están basadas en evidencia de baja calidad. Se requiere su actualización periódica considerando la evidencia reciente. Objetivo: Sintetizar la mejor evidencia clínica disponible sobre eficacia y seguridad de antidepresivos y antipsicóticos de segunda generación en pacientes con anorexia nerviosa. Métodos: Revisión sistemática (CRD42020150577). Se buscaron en PubMed, SCOPUS, Ovid(Cochrane), EMBASE y LILACS los ensayos clínicos aleatorizados realizados en pacientes con anorexia nerviosa que evaluasen el uso de antipsicóticos de segunda generación o antidepresivos orales a cualquier dosis y por cualquier tiempo en el tratamiento ambulatorio y/u hospitalario tomando como resultados el peso (índice de masa corporal), las entidades psicopatológicas y la seguridad. Resultados: Se incluyeron 5 estudios, 4 catalogados como con alto riesgo de sesgo. La evidencia indica que los pacientes que reciben tratamiento con olanzapina o fluoxetina tienden a mantenerse por más tiempo dentro de los programas de tratamiento. La olanzapina mostró resultados favorables (un estudio) en cuanto al aumento de peso, pero no mostró los mismos resultados en psicopatología, donde la evidencia es contradictoria. Conclusiones: En concordancia con las revisiones anteriores, nuestro trabajo permite concluir que hay información contradictoria sobre la eficacia de los psicofármacos para la anorexia nerviosa. El trabajo futuro debe enfocarse en desarrollar ensayos clínicos de alta calidad metodológica.

ABSTRACT Introduction: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. Objective: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. Methods: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. Results: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. Conclusions: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Factores legales, de imagen, sociales y económicos que determinan la contratación de personas con discapacidad en empresas de la ciudad de Chillán / Legal, image, social and economic factors that determine hiring of people with disabilities into companies in the city of Chillán

Introducción: La baja contratación de personas con discapacidad, falta de oportunidades y discriminación, en un país post inclusión, está condicionada por diversas barreras, factores o preocupaciones de las empresas y empleadores, las cuales dificultan la inclusión laboral debido a diferentes apreciaciones de índole personal y cultural. Objetivo: La presente investigación tiene por objetivo describir factores legales, de imagen, sociales y económicos que determinan la contratación de personas con discapacidad, según la percepción de los gerentes, administradores y jefes de recursos humanos de empresas de la ciudad de Chillán. Metodología: Para llevar a cabo dicho análisis, se consideró a 50 representantes de 50 empresas de la ciudad, pertenecientes a los rubros del comercio, servicios básicos y otros rubros, los cuales entregaron la percepción sobre los factores a través de una encuesta de auto aplicación. Resultados: Los análisis de los resultados demostraron una tendencia generalizada de la muestra sobre el factor social, identificándolo como un determinante sobre la contratación de personas con discapacidad. Discusión: Se concluyó que el factor social seguido del factor económico, mayormente determinan la contratación de personas con discapacidad, independiente del rubro empresarial, tamaño de las empresas y experiencias previas en la contratación de personas discapacitadas.

Introduction: The low hiring, lack of opportunities and discrimination of people with disabilities, in a post-inclusion country, is conditioned by various barriers, factors or concerns in companies and employers, which hinder labor inclusion, due to different views from a personal and cultural nature. Aim: To describe legal, image, social and economic factors that determine the hiring of people with disabilities, according to the perception of managers, chief of staff and human resources manager of companies in the city of Chillán. Methods: To carry out this analysis, 50 representatives of 50 companies in the city, belonging to the trade, basic services and other items were considered. Participants gave their perception of the factors, through a self-application survey. Results: The analysis of the results showed a general trend in the sample, regarding the social factor, identifying it as a determining factor in hiring people with disabilities. Discussion: It was concluded that the social factor followed by the economic factor, mainly determine the hiring of people with disabilities, regardless the business category, size of the companies and previous experiences in hiring people with disabilities.

Clinical significance of baseline Pan-Immune-Inflammation Value and its dynamics in metastatic colorectal cancer patients under first-line chemotherapy.

Pan-Immune-Inflammation Value (PIV) has been recently proposed as a new blood-based prognostic biomarker in metastatic colorectal cancer (mCRC). Herein we aimed to validate its prognostic significance and to evaluate its utility for disease monitoring in patients with mCRC receiving first-line chemotherapy. We conducted a single-centre retrospective study involving 130 previously untreated mCRC patients under first-line standard chemotherapy in a real-world scenario. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count at three different time-points: baseline, week 4 after therapy initiation, and at disease progression. We analyzed the influence of baseline PIV on overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and overall response rate (ORR). We also explored the utility of PIV dynamics for disease monitoring. Baseline PIV high was significantly associated with worse OS in univariate [hazard ratio (HR) = 2.10, 95% CI, 1.41-3.15; p = 0.000299] and multivariate (HR = 1.82, 95% CI, 1.15-2.90; p = 0.011) analyses. Baseline PIV was also associated with worse PFS in univariate (HR = 2.04, 95% CI, 1.40-2.97; p = 0.000187) and multivariate (HR = 1.56, 95% CI, 1.05-2.31; p = 0.026) analyses. Baseline PIV was not correlated either with DCR or ORR. Regarding PIV dynamics, there was a statistically significant increase from week 4 to disease progression (p = 0.0003), which was at the expense of cases with disease control as best response (p < 0.0001). In conclusion, this study validates the prognostic significance of baseline PIV in patients with mCRC receiving first-line standard chemotherapy in a real-world scenario. Moreover, it suggests the potential utility of PIV monitoring to anticipate the disease progression among those patients who achieve initial disease control.

Influence of Nursing in Health Economics: an Integrative Review of Literature

In times of great socio-sanitary conjunctures, such as these, to identify the influence of nursing in the complex dynamics of the health economy and health management becomes vital. Objective: To determine the implications of nursing on health economics as seen in the literature. Methodology: To integrative a review of the literature, in OVID, Pubmed, Clinikal Key, Scielo databases, published in the 2000 - 2018 period in English, Portuguese, and Spanish languages, following the recommendations of the SALSA review method and adjusted to modified PRISMA requirements. Of a total of 26 retrieved articles, 18 were eligible for review, after applying the inclusion and exclusion criteria. The data were summarized using a narrative-qualitative-descriptive synthesis. Results: 44% of the publications were made between 2005 and 2009; 78% were made in the United States; 56% were obtained from PUBMED; and 44% are of quantitative design. The categorical analysis shows a clear tendency to reveal the economic cost related to the impact of the nursing professional's work in various areas, rather than considerations of quality of care or effectiveness of the work. Conclusion: Links were observed between nursing actions and health economics in three main aspects: quality of care, costs, and effectiveness.

En momentos de grandes coyunturas socio sanitarias actuales, se vuelve vital identificar la influencia de enfermería en las dinámicas complejas de la economía de la salud y la gestión sanitaria. Objetivo: Determinar las implicancias evidenciadas en la literatura que enfermería posee en la economía de la salud. Metodología: Revisión integrativa de la literatura, en bases de datos OVID, Pubmed, Clinikal Key, Scielo publicados entre 2000 - 2018 en idiomas inglés, portugues y español, siguiendo las recomendaciones del método SALSA de revisión y ajustada a requerimientos PRISMA modificado. De un total de 26 artículos recuperados, 18 fueron elegibles para revisión, luego de aplicar los criterios inclusión y exclusión. Los datos fueron resumidos mediante síntesis narrativa-cualitativa- descriptiva. Resultados: Un 44% de las publicaciones se realizaron entre 2005 al 2009; el 78% fueron hechas en Estados Unidos; un 56% se obtuvieron de PUBMED y el 44% son de diseño cuantitativo. El análisis categorial muestra una clara tendencia por relevar el costo económico relacionado al impacto del trabajo del profesional de enfermería en diversas áreas del quehacer, más que consideraciones de calidad del cuidado o efectividad del trabajo. Conclusión: Se observaron vinculaciones entre el actuar de enfermería y la economía de la salud, en tres aristas principales: calidad de atención, costos y efectividad.

Resultados del sistema de puntuación del Concurso Nacional de Ingreso a los Servicios de Salud entre 2016 y 2020 / Scores obtained by physicians in the national health services admission contest between 2016 and 2020

BACKGROUND: Medical specialists are an essential resource for the functioning of the health system and in Chile there is a growing deficit of these specialists. To address this shortage, the government has strategies for training health professionals, such as a national public contest for medical scholarships, named CONISS, which stands out for its high capacity to produce medical specialists. The scoring system of this contest is used for the allocation of training resources to the best candidates. AIM: To describe the results of the CONISS scoring system between 2016 and 2020. MATERIAL AND METHODS: Analysis of public registries of physicians participating in the CONISS contest between 2016 and 2020. RESULTS: During the study period 7,373 physicians participated in this contest (49% females). Annual participation increased progressively. The participants graduated from 21 Chilean universities and a variable number from foreign universities. The scores obtained by participants improved by 1.47 points between the first and last year of the study period. CONCLUSIONS: Interpretation of these results is complicated by the characteristics and limitations of the measurements of the CONISS scoring system. This precludes establishing whether this system effectively filters out the best candidates for medical specialization programs.

Infancias y colecho en la Argentina: factores sociodemográficos, socioeconómicos y de salud familiar / Bedsharing and childhood: socio-demographic, socio-economic and family health factors / Co-leito na infância: fatores sócio-demográficos, socioeconômicos e de saúde familiar

Resumen (analítico) Se caracteriza el fenómeno del colecho en términos sociodemográficos, socioeconómicos y en relación con las vulnerabilidades específicas de los hogares, tales como la violencia intrafamiliar y los consumos nocivos. A través de la Encuesta de la Deuda Social Argentina y un análisis multivariado cuantitativo, se abordan los siguientes interrogantes: ¿el colecho es una práctica asociada únicamente a los bebés?, ¿resulta más frecuente en contextos de pobreza o se trata de una práctica que atraviesa a diferentes infancias? Se concluye que el colecho no es un fenómeno exclusivo de los y las bebés; que en la adolescencia es más regresivo para las mujeres y que el factor socio-económico remite a un «colecho forzoso¼ que se especifica en interacción con el hacinamiento, la monoparentalidad, los consumos nocivos y la violencia intrafamiliar.

Abstract (analytical) This paper analyses the phenomenon of bed-sharing in terms of sociodemographic and socioeconomic variables, but also considers specific vulnerabilities like domestic violence and addictions. It is worth examining whether this practice is associated only with babies, or else if vulnerable contexts also have an impact on children's and adolescent's co-sleeping. The information was obtained through Social Debts in Argentina Survey, and this quantitative research concludes that in this country not only early years bed-share, the phenomenon impairs teenage girls more often and that the socio-economic factor plays a decisive role. For this reason, we propose the term "forced-bed-sharing", which refers to when co-sleeping is intensified by variables like overcrowding, single-parent family type, addictions and domestic violence.

Resumo (analítico) O artigo caracteriza o fenómeno do coleito considerando variáveis sócio demográficas e socioeconómicas, mas também vulnerabilidades específicas como a violência doméstica ou vícios. Neste contexto, perguntamo-nos: associa-se só aos bebés? Tem mais frequência em condições de vulnerabilidade? Esta prática tem um impacto ou motivações diferentes em relação ás características das crianças? A informação foi obtida através do Questionário da Dívida Social Argentina, e o desenho de pesquisa quantitativo conclui que não é somente um fenómeno exclusivo da primeira infância, na adolescência é mais frequente em meninas e que o fator socioeconómico é decisivo. Por isso, propomos o termo "coleito forçoso", que refere a quando a regularidade da cama compartilhada se intensifica por variáveis como a superlotação, o tipo de família monoparental, vícios e violência doméstica.

Is hepatitis C direct-acting antiviral therapy a risk factor for the development and recurrence of hepatocellular carcinoma? Narrative literature review and clinical practice recommendations.

The development of direct-acting antivirals (DAAs) has been a turning point in chronic hepatitis C treatment. With an efficacy rate on viral eradication close to 100% and an excellent safety profile, they have replaced interferon-based treatments as first-line therapy for hepatitis C virus (HCV). Following the encouraging results observed during the first years with these treatments, new publications suggested an unexpectedly high incidence of hepatocellular carcinoma (HCC) in patients previously treated with DAAs as well as a higher HCC recurrence rate in them. The possible interaction between DAAs and HCC and its impact on HCC incidence and recurrence still remains controversial. The aim of the present work is to review the current state of the matter by analyzing studies that evaluate the association between chronic hepatitis C treatment with DAAs and the development of HCC either de novo or as a recurrence. Following this, clinical practice recommendations are done.

Percepciones que tienen trabajadores chilenos sobre el impacto del teletrabajo en el entorno de covid-19

RESUMEN La pandemia ha generado diversos cambios que han llevado a las empresas a buscar estrategias para continuar sus procesos productivos y proteger la salud de los trabajadores; entre estas, la más destacada es el Teletrabajo. Objetivo: Analizar las percepciones que tienen los trabajadores chilenos sobre el impacto del teletrabajo en términos de Estrés laboral, Balance Vida-Trabajo y Satisfacción, en ambiente de contingencia producto del COVID-19. Material y Método: Investigación de tipo cuantitativa, tipo relacional y de corte transversal que utilizó un muestreo por conveniencia y se obtuvieron datos de 225 trabajadores chilenos que estaban realizando teletrabajo producto del COVID-19 y respondieron la encuesta on-line. Se utilizó un instrumento con 26 reactivos, que se aplicó a trabajadores mayores de edad que estuvieran realizando actividades desde casa, entre los meses de septiembre a octubre de 2020, logrando obtener 181 respuestas útiles. Resultados: Los trabajadores que se encuentran en modalidad telemática corresponden mayormente a mujeres, solteras, entre 24 a 40 años, del ámbito educativo, del sector público y tienen experiencia laboral mayor a diez años; existe una relación positiva entre la satisfacción laboral y el teletrabajo (r= 0,381), mientras que para las variables Estrés laboral y Balance vida-trabajo sucede lo contrario, es decir, una relación negativa (r= -0,408). Conclusión: Las actividades telemáticas producen a los trabajadores sintomatología de estrés, como tensión y/o ansiedad, pero a pesar de esto, tienen una actitud positiva ante este cambio en la modalidad laboral, tratando de vivir el día a día y buscando cómo apoyar a otros.

ABSTRACT The pandemic has caused several changes that have led companies to look for strategies to continue their production processes and protect the health of workers. Among these strategies, the most important is Teleworking. Objective: To analyze the perceptions that Chilean workers have on the impact of teleworking in terms of work stress, work-life balance and satisfaction, in a contingency environment as a result of COVID-19. Material and Method: Quantitative, relational and cross-sectional research using convenience sampling and data from 225 Chilean workers who were teleworking as a result of COVID-19 and responded to the on-line survey. An instrument with 26 items was applied to workers of legal age who were carrying out activities from home, between the months of September to October 2020, collecting 181 useful responses. Results: People working from home correspond mostly to single women, between 24 to 40 years old, who work in the field of education or the public sector and have work experience of more than ten years; there is a positive relationship between job satisfaction and teleworking (r= 0.381), while for the variables work stress and work-life balance a negative relationship was observed (r= -0.408). Conclusion: Teleworking produces stress symptoms among workers, such as tension and/or anxiety. Nevertheless, workers have a positive attitude towards this modality, trying to adapt and seeking support from other people.

RESUMO A pandemia gerou várias mudanças que levaram as empresas a procurar estratégias para continuar os seus processos de produção e proteger a saúde dos trabalhadores; entre estas, a mais relevante é o Teletrabalho. Objetivo: Analisar as percepções dos trabalhadores chilenos sobre o impacto do teletrabalho em termos de Estresse no trabalho, Equilíbrio Vida-Trabalho e Satisfação, em um ambiente de contingência resultante da COVID-19. Material e Método: Pesquisa quantitativa, do tipo relacional e corte transversal utilizando amostragem de conveniência e obtendo dados de 225 trabalhadores chilenos que estavam realizando teletrabalho como resultado da COVID-19 e responderam ao questionário online. Foi utilizado um instrumento com 26 reativos, que foi aplicado a trabalhadores adultos que realizavam atividades desde casa, entre setembro e outubro de 2020, obtendo 181 respostas úteis. Resultados: Os trabalhadores que estão no modo telemático, correspondem maioritariamente a mulheres, solteiras, entre 24 e 40 anos, do campo educativo, do sector público e têm mais de dez anos de experiência de trabalho; existe uma relação positiva entre a satisfação profissional e o teletrabalho (r= 0,381), enquanto para as variáveis Estresse no trabalho e Equilíbrio Vida-Trabalho acontece o contrário, ou seja, uma relação negativa (r= -0,408). Conclusão: As atividades telemáticas produzem sintomas de estresse nos trabalhadores, tais como tensão e/ou ansiedade, mas apesar disso, têm uma atitude positiva em relação a esta mudança na modalidade de trabalho, tentando viver dia após dia e procurando formas de apoiar os outros.

Diálogos entre o método da cartografia e alguns pressupostos filosóficos de Hannah Arendt na pesquisa em educação / Diálogos entre el método de la cartografía y algunas presuposiciones filosóficas de Hannah Arendt en la investigación en educación / Dialogs between the cartography method and some philosophical assumptions of Hannah Arendt in educational research

O artigo aventura-se nas fronteiras do método cartográfico e dos escritos de Hannah Arendt sobre ação, política e educação. Desse encontro, busca-se construir posições para uma pesquisa feita em campo no âmbito da educação, tendo em vista a implicação do pesquisador no processo da pesquisa, reconhecendo-se como parte desse processo e rompendo com sua suposta neutralidade; a aceitação da imprevisibilidade no percurso de criação da pesquisa; e, por fim, o compromisso político com o coletivo com o qual se trabalha e com o mundo que nós, pesquisadores e pesquisados, habitamos. Apresentam-se também questões suscitadas a partir da relação de uma das autoras, como pesquisadora, com o seu campo de pesquisa, tomando a experiência como produtora de pensamento sobre os desafios metodológicos de trabalhos pautados na cartografia. (AU)

El artículo se aventura en las fronteras del método cartográfico y de los escritos de Hannah Arendt sobre acción, política y educación. A partir de ese encuentro, se busca construir posiciones para una investigación realizada en el campo en el ámbito de la educación: la implicación del investigador en el proceso de la investigación, reconociéndose como parte de ese proceso y rompiendo con su supuesta neutralidad. La aceptación de la imprevisibilidad en el recorrido de creación de la investigación; y, finalmente, el compromiso político con el colectivo con el que se trabaja y con el mundo que nosotros, investigador e investigados, habitamos. También se presentan cuestiones suscitadas a partir de la relación de una de las autoras como investigadora, con su campo de investigación utilizando la experiencia como productora de pensamiento sobre los desafíos metodológicos de trabajo pautados en la cartografía. (AU)

The article explores the cartography method and the writings of Hannah Arendt on action, politics and education. Based on the articulation between these two universes, the authors aim to build the following positions for a field research in the sphere of education: the researcher's implication in the research process, recognizing themselves as part of the process and breaking with their alleged neutrality; acceptance of unpredictability during the development of the research; and, finally, the political commitment to the collective with which the researcher works and to the world we, researcher and participants, inhabit. Furthermore, the study presents questions about the relationship of one of the authors, as a researcher, with her research field, taking into consideration her experience as a producer of thoughts about the methodological challenges faced by works grounded on cartography. (AU)

Análise de custo por desfecho das novas terapias de combinação tripla com lenalidomida para o mieloma múltiplo recidivado/refratário no Brasil / Cost by outcomes analysis of novel triplecombination therapies with lenalidomide for relapsed/refractory multiple myeloma in Brazil

Objetivo: Estimar o custo de tratamento das novas terapias de combinação tripla com lenalidomida no manejo dos pacientes com mieloma múltiplo recidivado/refratário (MMRR) sob a perspectiva do sistema de saúde privado brasileiro. Métodos: Os custos associados da combinação de lenalidomida + dexametasona com carfilzomibe (KRd), daratumumabe (DRd), elotuzumabe (ERd) e ixazomibe (IRd) foram comparados. Para cada terapia, a duração de tratamento foi estimada pela média do tempo de sobrevida livre de progressão (SLP) restrita a três anos a partir de dados de SLP dos estudos pivotais das respectivas terapias. Os custos de tratamento foram estimados para a duração de tratamento, considerando a posologia específica dos regimes terapêuticos. Os preços dos medicamentos foram baseados no preço fábrica de abril de 2020. Não foi considerado o compartilhamento de doses. O custo total do tratamento, o custo médio por ciclo e o custo por taxa de resposta objetiva (TRO) em três anos foram comparados. Resultados: A duração de tratamento no período de três anos foi de 23,3, 27,6, 20,3 e 20,9 meses para KRd, DRd, ERd e IRd, respectivamente. O custo médio total de tratamento foi estimado em 975.557 reais (BRL) para KRd, 1.507.544 BRL para DRd (+55% versus KRd), 1.207.899 BRL para ERd (+24% versus KRd) e 983.917 para IRd (+1% versus KRd). KRd teve o menor custo médio por mês de SLP (horizonte de três anos) entre as terapias, 41.957 BRL versus 54.709 BRL para DRd (+30% versus KRd), 59.635 BRL para ERd (+42% versus KRd) e 47.147 para IRd (+12% versus KRd). Similarmente, o custo por TRO foi 31% menor para KRd (1.119.770 BRL), comparado ao DRd (1.621.015 BRL), 27% menor, comparado ao ERd (1.528.986 BRL), e 11% menor, comparado ao IRd (1.256.064). Conclusões: Resultados da presente análise indicam que KRd está associado a um menor custo médio de tratamento, acompanhado de maior previsibilidade, menor custo por TRO e por mês de SLP, comparado ao DRd, ERd e IRd no horizonte de três anos sob a perspectiva do sistema de saúde privado brasileiro. Os resultados estão associados com alguma incerteza em razão das diferenças nas populações dos estudos, desenho dos estudos (duração fixa de carfilzomibe vs. tratamento até a progressão para daratumumabe, elotuzumabe e ixazomibe) e porque a duração de tratamento é tipicamente menor do que a SLP.

Objective: To estimate treatment costs for novel triple-combination therapies with lenalidomide in the management of relapsed/refractory multiple myeloma (RRMM) patients from the Brazilian private healthcare perspective. Methods: Treatment costs associated with lenalidomide + dexamethasone combinations with carfilzomib (KRd), daratumumab (DRd), elotuzumab (ERd) and ixazomib (IRd) were compared. For each therapy, treatment duration was estimated as the mean progression-free survival (PFS) time restricted to three years using published PFS data from pivotal trials available for these treatments. Treatment costs were estimated for the modeled treatment duration considering therapy-specific dosing schedules. Drug prices were based on April 2020 Brazilian list prices. No vial sharing was assumed. Total treatment costs, average cost per cycle, and cost per overall response rate (ORR) over the three-year period were compared. Results: Modeled treatment duration over the three-year period was 23.3, 27.6, 20.3 and 20.9 months for KRd, DRd, ERd and IRd respectively. Corresponding average total treatment costs were estimated to be 975,557 Brazilian Real (BRL) for KRd; 1,507,544 BRL for DRd (+55% versus KRd); 1,207,899 BRL for ERd (+24% versus KRd) and 983,917 for IRd (+1% versus KRd). KRd had the lowest average cost per month of restricted PFS (3-year time frame) among the therapies, 41,957 BRL versus 54,709 BRL for DRd (+30% versus KRd); 59,635 BRL for ERd (+42% versus KRd); and 47,147 for IRd (+12% versus KRd). Similarly, the cost per achieved ORR was lower for KRd (1,119,770 BRL) than that for DRd (1,621,015 BRL); ERd (1,528,986 BRL); and IRd (1,256,064) by 31%, 27% and 11%, respectively. Conclusions: Results of the present analysis indicate that KRd is associated with lower mean treatment costs and more predictable costs, lower cost per ORR and per month in PFS than DRd, ERd and IRd over a relevant three-year time horizon from the Brazilian private healthcare perspective. The results are associated with some uncertainty due to differences in trial populations, trial design (fixed duration for carfilzomib vs treatment till progression for daratumumab, elotuzumab and ixazomib) and because treatment duration is typically shorter than PFS.

Transforaminal Endoscopic Discectomy Combined With an Interspinous Process Distraction System for Spinal Stenosis.

BACKGROUND: The combination of the percutaneous transforaminal endoscopic decompression (PTED) with an interspinous process distraction system (IPS) may offer additional benefit in the treatment of spinal stenosis in patients who have failed nonsurgical treatment. METHODS: We retrospectively reviewed the medical records of 33 patients diagnosed with lumbar stenosis and radiculopathy and treated them with transforaminal endoscopic lumbar decompression between 2013 and 2017. Primary outcome measures were modified Macnab as well as preoperative and postoperative visual analog scale (VAS) criteria and the Oswestry Disability Index (ODI). Only patients with a minimum follow-up of 2 years were included. RESULTS: A total of 28 patients were treated with a combination of PTED and percutaneous IPS (group A), and 5 patients were treated with PTED and mini-open IPS (group B). In group A patients, there was a 4.48 reduction in the VAS score. The ODI changed from 50.25 preoperatively to 18.2 postoperatively, and excellent and good Macnab outcomes were obtained in 78% of patients. In group B patients, the mean VAS reduction was 5.2 points. The ODI changed from 44.34 preoperatively to 14.62 postoperatively, and 80% of group B patients achieved excellent and good Macnab outcomes. No complications related to PTED or IPS were observed throughout the 2-year follow-up. CONCLUSIONS: The addition of IPS to the PTED procedure in select patients may offer additional benefits to patients being treated for lumbar lateral stenosis and foraminal stenosis with low-grade spondylolisthesis. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Feasibility study.