Religiosity and alcohol use in adolescents with orofacial cleft: correlational study / Religiosidade e uso de álcool em adolescentes com fissura orofacial: estudo correlacional

ABSTRACT Objective: To evaluate the correlation between religiosity and alcohol use among adolescents with orofacial clefts. Methods: Cross-sectional study, developed in a Brazilian public and tertiary hospital, between December 2021 and March 2022. Data collection was hybrid, and three instruments were used: Sociodemographic Questionnaire, Durel Religiosity Scale, and the Alcohol Use Disorders Identification Test. For statistical analysis, the following tests were used: χ2, Fisher's Exact, Mann-Whitney and Spearman's Correlation Coefficient, in addition to analyses of linear correlation strength and bivariate logistic regression. The significance level adopted for all tests was 5% (p≤0.05). Results: 370 adolescents participated, with a mean age of 15.2 years (±1.8). Among them, 23 (5.4%) used alcohol riskly or harmfully, being more frequent among male adolescents (p=0.001), those of mixed race (p=0.046), attending high school (p=0.011), with no religion (p<0.001), or who did not attend religious services (p<0.001). Levels of organizational, non-organizational and intrinsic religiosity were significantly lower among adolescents with risky or harmful alcohol use (p=0.005; p<0.001 and p=0.002, respectively). There was a moderate correlation between risky or harmful alcohol use and non-organizational (r=0.31; p=0.002) and intrinsic (r=0.36; p<0.001) religiosity. Male adolescents (p<0.001; OR=6.58), closest in age to 18 years (p<0.001; OR=1.37), and non-practitioners of religion (p<0.001; OR=6. 48) presented higher odds of risky or harmful alcohol use. Conclusions: Adolescents with higher levels of organizational and intrinsic religiosity used less alcohol, while males, closest in age to 18 years, and non-practitioners of religion presented higher odds of using alcohol riskly or harmfully.

RESUMO Objetivo: Avaliar a correlação entre a religiosidade e o uso de álcool em adolescentes com fissura orofacial. Métodos: Estudo transversal, desenvolvido em um hospital público e terciário brasileiro entre dezembro de 2021 e março de 2022. A coleta de dados foi híbrida, e foram utilizados três instrumentos: Questionário Sociodemográfico, Escala de Religiosidade de Durel e o Alcohol Use Disorders Identification Test. Para a análise estatística foram empregados os testes: qui-quadrado, exato de Fisher, Mann-Whitney e o coeficiente de correlação de Spearman, além das análises de forças de correlação linear e de regressão logística bivariada. O nível de significância adotado para todos os testes foi de 5% (p≤0,05). Resultados: Participaram 370 adolescentes, com média de idade de 15,2 anos (±1,8). Entre eles, 23 (5,4%) usavam o álcool de forma arriscada ou prejudicial. A religiosidade organizacional, não organizacional e a intrínseca foram significativamente menos frequentes entre adolescentes que utilizavam o álcool de forma arriscada ou prejudicial (p=0,005; p<0,001 e p=0,002, respectivamente). Evidenciou-se correlação moderada entre o uso arriscado ou prejudicial do álcool e a religiosidade não organizacional (r=0,31; p=0,002) e a intrínseca (r=0,36; p<0,001). Apresentaram maiores chances de usar o álcool adolescentes do sexo masculino (p<0,001; odds ratio — OR=6,58), com idade mais próxima aos 18 anos (p<0,001; OR=1,37) e que não praticavam a religião (p<0,001; OR=6,48). Conclusões: Adolescentes com maiores níveis de religiosidade organizacional e intrínseca utilizaram menos frequentemente álcool de forma arriscada ou prejudicial, enquanto ser homem, possuir idade mais próxima aos 18 anos e não praticar a religião aumentou a chance de utilizar álcool.

Instruções em bulas destinadas ao uso de medicamentos para dispepsia e constipação durante a lactação / Instructions in package inserts intended for the use of medicines for dyspepsia and constipation during lactation / Instrucciones en prospectos destinados al uso de medicamentos para la dispepsia y el estreñimiento durante la lactancia

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

Implementing cardiac POCUS in obstetric patients during the preanesthetic period. Narrative review / Implementación del POCUS cardiaco en pacientes obstétricas durante el periodo preanestésico. Revisión narrativa

Abstract During the preanesthetic assessment of the obstetric patient, it is critical to assess the patient's cardiovascular baseline condition, identify any potential risks, and facilitate behavioral modification to develop an individualized management strategy aimed at minimizing complications. Cardiac point-of-care ultrasound (POCUS) is a valuable instrument for assessing the morphology and function of the heart prior to surgery. Cardiac POCUS is not designed to replace comprehensive transthoracic echocardiography, which is the realm of cardiovascular anesthesiology and cardiology. However, when used in conjunction with anamnesis, physical examination, electrocardiogram, and previous laboratory results, cardiac POCUS is a valuable adjunct in the diagnostic toolbox of anesthesiologists. It allows for direct visualization of the heart and great vessels, with added benefits of speed, availability, and low risk for the patient. The purpose of this manuscript is to explore and describe the advantages of cardiac POCUS in the preanesthetic period of obstetric patients and its potential value for anesthesiologists through the identification of potentially hazardous conditions that may require individualized preoperative management.

Resumen Durante la valoración preanestésica de la paciente obstétrica, es fundamental evaluar la condición cardiovascular basal de la paciente, identificar riesgos potenciales y facilitar modificaciones conductuales para desarrollar una estrategia de manejo individualizada, dirigida a minimizar las complicaciones. La ecografía cardíaca a la cabecera del paciente (POCUS) es un instrumento valioso para evaluar la morfología y la función del corazón antes de un procedimiento quirúrgico. El POCUS cardiaco no está diseñado para sustituir a la ecocardiografía transtorácica formal, que corresponde al área de anestesiología cardiovascular y a la cardiología. Sin embargo, cuando se usa en conjunto con la anamnesis, el examen físico, el electrocardiograma y los resultados de exámenes de laboratorio previos, el POCUS cardiaco es un complemento valioso dentro del arsenal diagnóstico de los anestesiólogos. Permite la visualización directa del corazón y de los grandes vasos, con beneficios adicionales de velocidad, disponibilidad y bajo riesgo para la paciente. El objetivo del presente manuscrito es explorar y describir las ventajas del POCUS cardiaco durante el periodo preanestésico en pacientes obstétricas y su valor potencial para los anestesiólogos, a través de la identificación de condiciones eventualmente peligrosas que pudieran requerir un manejo preoperatorio individualizado.

Efectos cardiovasculares de la exposición ocupacional a pesticidas / Cardiovascular effects of occupational exposure to pesticides

Resumen Los trabajadores agrícolas se exponen frecuentemente a los pesticidas, los cuales pueden afectar el sistema cardiovascular. El objetivo de la investigación fue revisar la asociación entre la exposición ocupacional a pesticidas, el desarrollo de enfermedades cardiovasculares y los biomarcadores utilizados en la vigilancia de la salud de los trabajadores. Para ello se realizó una revisión no sistemática de la literatura en tres bases de datos: Pubmed, Embase y Scopus, con ecuaciones de búsqueda elaboradas con los términos "agrochemicals", "myocardial infarction", "occupational exposure" y "farmers", y se incluyeron artículos publicados entre 2007 y 2022. Se encontró que los pesticidas causan elevación de las cifras de presión arterial en trabajadores expuestos y en mujeres embarazadas se relaciona con hipertensión gestacional y preeclampsia. Respecto al infarto agudo de miocardio (IAM), el contacto con los pesticidas clorpirifós, coumafós, carbofurano, pendimetalina, trifluralina y acilalanina aumentan el riesgo de IAM en mujeres, y entre los trabajadores masculinos la exposición a dibromuro de etileno, maneb/mancozeb y dimetil-ditiocarbamato de zinc se asoció con mayor mortalidad. La vigilancia epidemiológica se realiza principalmente con la medición de la actividad de la acetilcolinesterasa eritrocitaria (AChE). Se puede concluir que la exposición a pesticidas puede desencadenar enfermedades cardiovasculares agudas y crónicas, como elevación de las cifras de presión arterial, IAM fatal y no fatal. Los pesticidas dimetil ditiocarbamato de zinc, clorpirifós, coumafós, carbofurano, paratión y malatión son las sustancias que tienen mayor relación con el desarrollo de enfermedad cardiovascular.

Abstract Farmworkers are frequently exposed to pesticides, which can affect the cardiovascular system. The objective of the research was to review the association between occupational exposure to pesticides and the development of cardiovascular diseases, and the biomarkers used in monitoring the health of workers. For this, a non-systematic review of the literature was carried out in three databases: Pubmed, Embase and Scopus, with search equations prepared with the terms "agrochemicals", "myocardial infarction", "occupational exposure" and "farmers". Articles published between 2007 and 2022 were included. Pesticides were found to cause elevated blood pressure levels in exposed workers, and in pregnant women it is related to gestational hypertension and preeclampsia. Regarding acute myocardial infarction (AMI), contact the pesticides chlorpyrifos, coumaphos, carbofuran, pendimethalin, trifluralin, and acylalanine increased the risk of AMI in women, and among male workers exposure to ethylene dibromide, maneb/mancozeb, and zinc dimethyldithiocarbamate was associated with increased mortality. Epidemiological surveillance is mainly carried out by measuring erythrocyte acetylcholinesterase (AChE) activity. It can be concluded that exposure to pesticides can trigger acute and chronic cardiovascular diseases, such as elevated blood pressure, fatal and non-fatal AMI. Zinc dimethyl dithiocarbamate, chlorpyrifos, coumafos, carbofuran, parathion and malathion pesticides are the substances most closely related to the development of cardiovascular disease.

Percepções e ações da equipe multiprofissional em saúde sobre a medicina tradicional indígena / Perceptions and actions of the multi-professional health team on traditional indigenous medicine / Percepciones y acciones del equipo multidisciplinario de salud sobre la medicina tradicional indígena

Objetivo: compreender as percepções e as ações de uma equipe multiprofissional em saúde quanto à prática da medicina tradicional indígena em uma Casa de Atenção à Saúde Indígena. Método: estudo qualitativo descritivo, realizado em uma de Casa de Apoio à Saúde Indígena em um município do Pará, que incluiu oito profissionais de uma equipe multiprofissional. A coleta de dados foi realizada no ano de 2018 e estes foram examinados pelo método da análise de conteúdo. Resultados: inserção e prática do cristianismo; ritos e lideranças xamânicas; e postura da equipe de multidisciplinar foram as categorias elencadas, que apontam os entendimentos e atuações da equipe multiprofissional e da organização espacial da Casa de Saúde do município. Considerações finais: há novos costumes e valores entre as etnias, em virtude da aproximação de grupos religiosos, cujas ações foram registradas e apreendidas pela equipe de trabalhadores em saúde.

Objective: understanding the perceptions and actions of a multi-professional health team regarding the practice of traditional indigenous medicine in an Indigenous Health Care Center. Method: this is a descriptive qualitative study carried out in an Indigenous Health Support Center in a municipality in the state of Pará, which included eight professionals from a multi-professional team. Data was collected in 2018 and examined using the content analysis method. Results: insertion and practice of Christianity; shamanic rites and leadership; and the attitude of the multidisciplinary team were the categories listed, which point to the understandings and actions of the multi-professional team and the spatial organization of the Health Center in the municipality. Final considerations: there are new customs and values among ethnic groups, due to the approach of religious groups, whose actions were recorded and apprehended by the team of health workers.

Objetivo: comprender las percepciones y acciones de un equipo multidisciplinario de salud sobre la práctica de la medicina tradicional indígena en una Casa de Atención para la Salud Indígena. Método: estudio descriptivo cualitativo, realizado en una Casa de Apoyo a la Salud Indígena de un municipio de Pará, que incluyó ocho profesionales de un equipo multidisciplinario. La recolección de datos se realizó en 2018 y los datos fueron sometidos al método de análisis de contenido. Resultados: inserción y práctica del cristianismo; ritos y líderes chamánicos; y actitud del equipo multidisciplinario fueron las categorías enumeradas, que indican la percepción y las acciones del equipo multidisciplinario y la organización espacial de la Casa de Salud del municipio. Consideraciones finales: existen nuevas costumbres y valores entre las etnias, debido a la presencia de grupos religiosos, el equipo de los trabajadores de la salud registró y aprendió las acciones de los indígenas.

Supporting evidence-based judicial decisions on health care in Brazil: an experience report / Apoio técnico-científico à tomada de decisão judicial em saúde no Brasil: um relato de experiência / Apoyo técnico-científico a la toma de decisiones judiciales en salud en Brasil: un relato de experiencia

Objective: The main objective of this study is to report on the implementation and results of the "Supporting Health-Related Judicial Decisions in Brazil" project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês through the "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde", in Brazil. Methods: This study is an experience report of a project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês. Results: The activities of the project occurred in 2023 and included two online training courses on primary studies and systematic reviews, 11 one-day workshops with technical-scientific content for members of the Technical Support Centers for the Judiciary (NATJus), 40 online technical-scientific consultations for magistrates on a digital platform, 11 technical-scientific reports addressing the most legally claimed technologies in Brazil; two methodological tools, a national forum (hybrid event), 10 chat-based mentorships for NATJus members; and the maintenance of an open-access blog, by publishing news on relevant topics on law and health. Discussion and conclusion: This project has contributed to the improvement of the judicial decision-making process by providing a range of activities aimed at aiding the prioritization of health technologies that are clearly effective and safe over those that are ineffective, harmful, or have uncertain effects.

Objetivo: O objetivo principal deste estudo é relatar a implementação e os resultados do projeto "Apoio técnico-científico à tomada de decisão judicial em Saúde no Brasil" realizado no Hospital Sírio-Libanês por meio do "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde". Métodos: Este estudo é um relato de experiência de um projeto realizado no Núcleo de Avaliação de Tecnologias em Saúde do Hospital Sírio-Libanês. Resultados: As atividades do projeto ocorreram em 2023 e incluíram dois cursos de formação online sobre estudos primários e revisões sistemáticas, 11 oficinas de um dia com conteúdo técnico-científico para membros dos Núcleos de Apoio Técnico ao Judiciário (NATJus), 40 consultas on-line técnico-científicas para magistrados em plataforma digital, 11 relatórios técnico-científicos abordando as tecnologias mais reivindicadas judicialmente no Brasil; duas ferramentas metodológicas, um fórum nacional (evento híbrido), 10 mentorias via chat para membros do NATJus; e a manutenção de um blog de acesso aberto, com publicação de notícias sobre temas relevantes de direito e saúde. Discussão e conclusão: Este projeto contribuiu para a melhoria do processo de tomada de decisão judicial, fornecendo uma série de atividades destinadas a ajudar na priorização de tecnologias de saúde que sejam claramente eficazes e seguras em detrimento daquelas que são ineficazes, prejudiciais ou têm efeitos incertos.

Objetivo: El objetivo principal de este estudio es informar sobre la implementación y los resultados del proyecto "Apoyo a las Decisiones Judiciales Relacionadas con la Salud en Brasil" realizado en el Centro de Tecnología en Salud del Hospital Sírio-Libanês a través del "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde", en Brasil. Métodos: Este estudio es un informe de experiencia de un proyecto realizado en el Centro de Tecnología en Salud del Hospital Sírio-Libanês. Resultados: Las actividades del proyecto ocurrieron en 2023 e incluyeron dos cursos de capacitación en línea sobre estudios primarios y revisiones sistemáticas, 11 talleres de un día de contenido técnico-científico para miembros de los Centros de Apoyo Técnico al Poder Judicial (NATJus), 40 consultas técnico-científicas en línea para magistrados en plataforma digital, 11 informes técnico-científicos que abordan las tecnologías más reclamadas legalmente en Brasil; dos herramientas metodológicas, un foro nacional (evento híbrido), 10 mentorías basadas en chat para miembros de NATJus; y el mantenimiento de un blog de acceso abierto, mediante la publicación de noticias sobre temas relevantes en derecho y salud. Discusión y conclusión: Este proyecto ha contribuido a mejorar el proceso de toma de decisiones judiciales proporcionando actividades para priorizar las tecnologías sanitarias claramente eficaces y seguras frente a aquellas que son ineficaces, nocivas o de efectos inciertos.

Perfil de óbitos associados à trauma abdominal submetidos ao instituto médico-legal do município de Toledo ­ Pr / Profile of deaths associated with abdominal trauma submitted to the medical-legal institute of the municipality of Toledo ­ Pr / Perfil de muertes asociadas a trauma abdominal presentado al instituto médico-legal del municipio de Toledo ­ Pr

Introdução: Os traumas abdominais representam notável importância dentre as causas predominantes de morbi-mortalidade no mundo. Em se tratando de óbitos relacionados a essas lesões, estão na categoria de causas externas, as quais no Brasil representam a segunda causa geral de mortalidade, principalmente na população em idade ativa. Notadamente, traumas estão fortemente relacionados a acidentes automobilísticos, cujas taxas vêm crescendo nos últimos anos. Neles, ocorrem os politraumas, cuja região abdominal é inclusa de forma prevalente. Objetivo: a presente pesquisa tem como objetivo apresentar o perfil de óbitos os quais sejam associados a trauma abdominal e submetido ao Instituto Médico-Legal, entre os anos de 2019 até 2021. Metodologia: estudo retrospectivo, do tipo transversal, de caráter fundamentalmente quantitativo, no qual foram avaliados os laudos de óbitos decorrentes de trauma abdominal necropsiados no IML de Toledo (PR), no período de 2019 a 2021. Foram avaliadas as variáveis sexo, idade, tipo de lesão, circunstância dos óbitos e órgão mais acometido. Resultados e discussão: dos 916 óbitos trazidos à Polícia Científica de Toledo (PR) advindos de causas externas, os inclusos dentre os traumas abdominais representaram um percentual de 51,05% (n=462), no período de 2019 a 2021. Observou-se maior prevalência de óbitos por acidentes automobilísticos (68,61%), cuja causa principal foi o politrauma (37,45%). O sexo masculino fora o mais prevalente, com 84,85% (n=392), cuja faixa etária teve concentração entre os 18 aos 29 anos. Os órgãos mais lesionados foram o fígado (69,31%) e o baço (33,66%). Considerações finais: nesta amostra houve predominância de óbitos por acidentes, principalmente associados ao trauma contuso, em homens na faixa entre 18 e 29 anos, cujo órgão mais lesado fora o fígado. O conhecimento acerca do perfil de óbitos é uma importante ferramenta epidemiológica frente a possíveis intervenções, além de servir como fonte estatística para outros trabalhos do âmbito médico-legal.

Introduction: Trauma represents a notable importance among the predominant causes of morbidity and mortality in the world. When it comes to deaths related to these injuries, they are in the category of external causes, since in Brazil they represent the second general cause of mortality, especially in the working-age population. Notably, traumas are strongly related to car accidents, whose rates have been increasing in recent years. In them, polytraumas occur, whose abdominal region is prevalently included. Objective: this research aims to present the profile of deaths which are associated with abdominal trauma and hospitalized at the Instituto Médico-Legal, between the years 2019 to 2021. Methodology: retrospective, cross-sectional study, fundamentally quantitative, in which the reports of deaths resulting from abdominal trauma necropsied at the IML of Toledo (PR), from 2019 to 2021, were evaluated. The variables were gender, age, type of injury, injuries of the deaths and most affected organ. Results and removal: Of the 916 deaths brought to the Scientific Police of Toledo (PR) from external causes, those included among abdominal traumas represented a percentage of 51.05% (n=462), in the period from 2019 to 2021. there was a higher prevalence of deaths from car accidents (68,61%), whose main cause was polytrauma (37.45%). Males were the most prevalent, with 84.85% (n=392), whose age group was concentrated between 18 and 29 years. The most injured organs were the liver (69.31%) and the spleen (33.66%). Final considerations: in this sample there was a predominance of deaths from accidents, mainly associated with blunt trauma, in men aged between 18 and 29 whose most injured organ outside the liver. Knowledge about the profile of deaths is an important epidemiological tool in the face of possible interventions, in addition to serving as a statistical source for other studies in the medical-legal field.

Introducción: El traumatismo abdominal representa notable importancia entre las causas predominantes de morbimortalidad en el mundo. Cuando se trata de muertes relacionadas con estas lesiones, se encuentran en la categoría de causas externas, que en Brasil representan la segunda causa general de mortalidad, especialmente en la población en edad de trabajar. En particular, el trauma está fuertemente relacionado con los accidentes automovilísticos, cuyas tasas han aumentado en los últimos años. En ellos se producen politraumatismos, cuya región abdominal está predominantemente incluida. Objetivo: esta investigación tiene como objetivo presentar el perfil de las muertes asociadas a traumatismo abdominal y presentadas al Instituto Médico Legal, entre los años 2019 y 2021. Metodología: estudio retrospectivo, transversal, de carácter fundamentalmente cuantitativo, en el que se analizaron los reportes de muertes. resultantes de trauma abdominal autopsiado en el IML de Toledo (PR), de 2019 a 2021. Se evaluaron las variables sexo, edad, tipo de lesión, circunstancias de las muertes y órgano más afectado. Resultados y discusión: de las 916 muertes aportadas a la Policía Científica de Toledo (PR) por causas externas, las incluidas dentro de los traumatismos abdominales representaron un porcentaje del 51,05% (n=462), en el periodo 2019 a 2021. observado- hubo mayor prevalencia de muertes por accidentes automovilísticos (68,61%), cuya principal causa fue el politraumatismo (37,45%). El sexo masculino fue el de mayor prevalencia, con 84,85% (n=392), cuyo grupo etario se concentró entre 18 y 29 años. Los órganos más lesionados fueron el hígado (69,31%) y el bazo (33,66%). Consideraciones finales: en esta muestra hubo predominio de muertes por accidentes, principalmente asociados a traumatismos cerrados, en hombres con edades entre 18 y 29 años, cuyo órgano más lesionado fue el hígado. El conocimiento sobre el perfil de defunciones es una importante herramienta epidemiológica de cara a posibles intervenciones, además de servir como fuente estadística para otros trabajos médico-legales.

La Pregunta de Investigación y su Asociación con los Niveles de Evidencia y Grados de Recomendación en Estudios de Investigación Clínica / The Research Question and its Association with the Levels of Evidence and Grades of Recommendation in Clinical Research Studies

La mayoría de las preguntas de investigación (PI), conducirán a un proyecto que apunta a generar nuevo conocimiento, sin embargo el escenario, la población a estudio y la metodología pueden ser muy diferentes, lo que determinará que los resultados obtenidos y por ende, el nivel de evidencia (NE) y el grado de recomendación (GR) puedan variar notablemente. El objetivo de este artículo fue proporcionar recomendaciones para formular una PI asociada al NE y respectivos GR que se pueden desprender a partir de los resultados generados. Este artículo entregará algunos conocimientos sobre la PI y su relación con los NE y GR de la evidencia generada a partir de resultados obtenidos por un proceso de investigación en diferentes escenarios de investigación.

SUMMARY: Most research questions (RQ) will lead to a project that aims to generate new knowledge. However, the setting, study population and methodology may be very different, which will determine the results obtained and therefore, the level of evidence (LOE) and the grade of recommendation (GOR) may vary significantly. The aim of this study was to provide recommendations to formulate a RQ associated with the LOE and respective GOR that can be derived from the generated results. This article will provide some knowledge about the RQ and its relationship with the LEO and GOR of the generated evidence from results obtained by a research process in different research scenarios.

Gingivitis espongiótica. Manejo clínico no quirúrgico. Reporte de un caso / Spongiotic gingivitis. Non-surgical clinical management. Report of a case

Objetivo: La gingivitis espongiótica es una patología benigna poco común y una entidad clínica patológica poco frecuente que los odontólogos pueden observar durante la atención odontológica. Es importante conocer la misma para poder diagnosticarla adecuadamente, describir sus características clínicas y elaborar un plan para su tratamiento. El objetivo de este artículo es presentar un caso clínico de esta patología poco conocida, describir sus características y su manejo clínico. Caso clínico: Un niño de 7 años que ingresó derivado por su odontólogo a la cátedra de Estomatología de la Facultad de Odontología de la Universidad Nacional de Córdoba, Argentina, presentaba en la encía libre e insertada del maxilar superior una lesión con ausencia de sintomatología y evolución crónica, benigna y con cambios estéticos notorios. Se deriva a la cátedra de Periodoncia para realizar un tratamiento interdisciplinario. Tuvo una respuesta favorable al tratamiento de la lesión, y se realizó un seguimiento periódico de la misma evitando la técnica quirúrgica convencional para su tratamiento.(AU)

Aim: Spongiotic gingivitis is a rare benign pathology and a rare clinical pathological entity that dentists can observe during dental care. It is important to know it to be able to properly diagnose it, describe its clinical characteristics and develop a plan for its treatment. The aim of this article is to present a clinical case of this little-known pathology and describe its characteristics as well as its clinical management. Clinical case: A 7-yeard-old child who was referred by his dentist to the Department of Stomatology of the Faculty of Dentistry of the National University of Córdoba, Argentina, presented a lesion in the free and inserted gingiva of the upper jaw, with absence of symptoms and chronic, benign evolution with notable aesthetic changes. He is referred to the Periodontics department to perform interdisciplinary treatment. He had a favorable response to the treatment of the lesion, and a periodic follow-up was carried out, avoiding the conventional surgical technique for its treatment.(AU)

A study on household medicine wastage and disposal practices with screening of water samples for antibiotic presence in a South Indian district

Background: Pharmaceuticals in the environment is known since last two decades. As hospitals and pharma industries, household medicines also need proper disposal otherwise they will gradually find their way into environment. So, we did a survey of residents in major metro city to understand their medicine wastage as well as disposal practices. Methods: Pharmaceuticals in the environment is known since last two decades. As hospitals and pharma industries, household medicines also need proper disposal otherwise they will gradually find their way into environment. So, we did a survey of residents in major metro city to understand their medicine wastage as well as disposal practices. Results: The water samples screened for antibiotic presence were all negative from 10 locations. A total population of 749 people, from 165 houses were included in the study. Leftover medicines were found in 75.8% houses, of which 5.36% houses had leftover antibiotics. Garbage disposal (58.2%) was the most commonly observed method of medicine disposal. Good attitude towards proper antibiotic disposal was independently significant with higher education (OR=2.5, 95% CI= 1.05-6.17), employment (OR=2.1, 95% CI= 1.05-4.3), and upper middle-class families (OR=2.4, 95% CI= 1.08-5.21). Conclusions: Lack of proper guidelines for household medicine disposal across the country is reflected in our community too. Although this study could not detect antibiotics in the canal water, the emerging resistance pattern across the state reflects it could be there. Therefore, immediate action on medicine waste collections needs to be implemented.

Ethnobotanical knowledge on non-conventional food plants and medicinal plants in Extractivist Reserve in the Brazilian Amazon / Conocimiento etnobotánico sobre plantas alimenticias no convencionales y plantas medicinales en una Reserva Extractivista en la Amazonía Brasileña

Information on the knowledge and ways of using food and medicinal plants by traditional populations, family farmers and Brazilian native population in the Amazon is essential to guarantee the food sovereignty of these groups. This study was conducted using semi-structured interviews applied to local respondents. A total of 269 species of both non-conventional food plants and medicinal plants were identified, distributed in 83 botanical families and 198 genera. The Arecaceae and Lamiaceae families had the highest species richness (11 and 7, respectively). The Shannon-Wiener (H') and Pielou (J') diversity indices were considered high (5.02 and 0.9, respectively) when compared to other ethnobotanical works. In the environment in which these families are found, these species become the only food and medicinal resources available.

La información sobre los saberes y formas de uso de las plantas alimenticias y medicinales por parte de las poblaciones tradicionales, agricultores familiares e indígenas brasileños en la Amazonía es fundamental para garantizar la soberanía alimentaria de estos grupos. Este estudio se realizó utilizando entrevistas semiestructuradas aplicadas a encuestados locales. Se identificaron un total de 269 especies tanto de plantas alimenticiasno convencionales como de plantas medicinales, distribuidas en 83 familias botánicas y 198 géneros. Las familias Arecaceae y Lamiaceae tuvieron la mayor riqueza de especies (11 y 7, respectivamente). Los índices de diversidad de Shannon-Wiener (H') y Pielou (J') fueron considerados altos (5,02 y 0,9, respectivamente) en comparación con otros trabajos etnobotánicos. En el ambiente en que se encuentran estas familias, estas especies se convierten en los únicos recursos alimenticios y medicinales disponibles.

Exploring the potential of omics technologies in medicinal plant research: a review in Colombia / Explorando el potencial de las tecnologías ómicas en la investigación de plantas medicinales: una revisión en Colombia

This review presents advances in the implementation of high - throughput se quencing and its application to the knowledge of medicinal plants. We conducted a bibliographic search of papers published in PubMed, Science Direct, Google Scholar, Scopus, and Web of Science databases and analyzed the obtained data using VOSviewer (versi on 1.6.19). Given that medicinal plants are a source of specialized metabolites with immense therapeutic values and important pharmacological properties, plant researchers around the world have turned their attention toward them and have begun to examine t hem widely. Recent advances in sequencing technologies have reduced cost and time demands and accelerated medicinal plant research. Such research leverages full genome sequencing, as well as RNA (ribonucleic acid) sequencing and the analysis of the transcr iptome, to identify molecular markers of species and functional genes that control key biological traits, as well as to understand the biosynthetic pathways of bioactive metabolites and regulatory mechanisms of environmental responses. As such, the omics ( e.g., transcriptomics, metabolomics, proteomics, and genomics, among others) have been widely applied within the study of medicinal plants, although their usage in Colombia is still few and, in some areas, scarce. (185)

El extracto de cloroformo (CE) y las fracciones obtenidas de las raíces de Aldama arenaria se evaluaron para determinar su actividad antiproliferativa in vitro contra 10 líneas ce lulares tumorales humanas [leucemia (K - 562), mama (MCF - 7), ovario que expresa un fenotipo resistente a múltiples fármacos (NCI/ADR - RES), melanoma (UACC - 62), pulmón (NCI - H460), próstata (PC - 3), colon (HT29), ovario (OVCAR - 3), glioma (U251) y riñón (786 - 0)]. CE presentó actividad antiproliferativa débil a moderada (log GI 50 medio 1.07), mientras que las fracciones 3 y 4, enriquecidas con diterpenos de tipo pimarane [ent - pimara - 8 (14), ácido 15 - dien - 19 - oico y ent - 8(14),15 - pimaradien - 3 ß - ol], presentaron activid ad moderada a potente para la mayoría de las líneas celulares, con un log GI 50 medio de 0.62 y 0.59, respectivamente. Los resultados mostraron una acción antiproliferativa in vitro prometedora de las muestras obtenidas de A. arenaria , con los mejores resul tados para NCI/ADR - RES, HT29 y OVCAR - 3, y valores de TGI que van desde 5.95 a 28.71 µg.mL - 1, demostrando que los compuestos de esta clase pueden ser prototipos potenciales para el descubrimiento de nuevos agentes terapéuticos

Assessment of demographic attributes and health profile of schedule caste of 5 villages of Aligarh District, Uttar Pradesh, India

Background: Demography is the scientific study of human populations. It takes into account the quantitative aspects of their general characteristics. In this paper health profile and different attributes of demography like age, gender, caste, marital status, educational status, temperament and occupation etc of scheduled caste people of 5 villages of Aligarh district were assessed and documented. Methods: A pretested, predesigned questionnaire containing the demographic attributes was filled by researchers by face-to-face examination of the population through scheduled caste sub plan mobile health care OPD’s. Surveys were conducted from 2nd June to 25th September 2022. Results: Collected and analyzed data exhibits that there were marked difference with the age groups 0-15, 26-45 and 66-85, gender, caste, with religion of Hindu (90.83%) and Muslim (7.33%), educational status regarding illiterate (59.81) and graduate or above (1.65%), Mizaj, dietary habit and there were no significant differences regarding marital status, occupation and addiction behavior were noticed. Conclusions: It can be concluded that majority of the scheduled caste population was living in interiors of rural areas with low socio-economic and health status. Most visited gender were females which indicate poor nutrition, lack of immunity and excessive burden on them. Majority of the population belongs to Balghami Mizaj. Most preferred diets were mixed and main occupation of the scheduled caste population was agriculture. This study will make policy makers and health workers derive practical conclusions which will help in the upliftment of the scheduled caste populations.

Application of models of behavior change communication in various stages of healthcare

A resource-limited country like India calls for a deeper focus on preventive health than it is now. So far, behaviour change communication (BCC) has been more or less limited to campaigns and awareness activities. Treating physicians applying BCC interventions in their clinics is particularly rare. This article aims to describe the role of BCC at the primary healthcare level in preventing diseases. The article also attempts to highlight the importance of BCC in helping cure and rehabilitate patients. Evidence-based interventions can be derived from BCC models that help physicians handle their patients better. Health education an already defined domain of health promotion will be the key to achieving the said goal. It promises to be one of the cheap and effective tools in achieving the vision of universal healthcare. It provides room for flexibility and customised care for each patient. After a thorough understanding of various models and theories of BCC, a physician should be able to apply them on a regular basis in their day-to-day interaction with patients in the most scientific manner possible.

Combination therapy for hypertension management: insights from the Indian experts

Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.

Digital therapeutics for cardiovascular diseases in India- a low-middle income country’s perspective: a systematic review

Cardiovascular disease acts as a predominant cause for death in India. Digital technology has shown great potential in delivering cardiac rehabilitation remotely to patients with minimal cost implications. The main aim of this study was to analyze the comprehensiveness and effectiveness of digital cardiac rehabilitation intervention for cardiovascular patients on the Indian Cardiology Continuum. A comprehensive literature search was performed in Pubmed, Springer-link, Elsevier, Embase and Google Scholar. The selected tenure for this review was 10 years (16 January 2014 to 16 January 2024). Authors separately conducted the assessment of the selected studies by using the quality assessment of diagnostic accuracy studies. Microsoft excel 2020 was used for statistical analysis and graphical designs. A total of 3 articles were included in the review. The median sample size of the included studies is 153 (30-304), mean study timeline is 7.67 months (3-17), and median follow-up period is 6 months (3-12). Digital therapeutics showed significant reduction in Systolic Blood Pressure (34.67 mmHg) and Diastolic Blood Pressure (21.97 mmHg) in stage III hypertensive patients. Medication adherence of patients using digital therapeutics was 90%, while 10% patients remained non-adherent/dropped out of the trial. Digital therapeutics builds a lucrative bridge to help cardiovascular patients cross over into improved QoL, in place of traditional face-to-face CR regimes. Further research is required to improve comprehensiveness and clinical effectiveness of the digital cardiac rehab programs on a long-term basis in India.

Examining the Role and Efficiency of Personalized Medicine in the Diagnosis, Prevention, and Treatment of Diseases

Personalized medicine refers to a set of diagnostic, treatment, and prevention activities and approaches based on which patients are classified according to their personal characteristics and medical procedures are performed for them. The purpose of this article is to investigate the importance of personalized medicine, the factors that cause people to differ in their response to treatment, the methods and techniques used to achieve the goals of personalized medicine, and finally to use this method to investigate the possible differences of people in the answer is treatment. Based on this method, either drugs that have been made before are personalized for each person, or recombinant protein drugs are used. Based on the type of factor that has made a person different in response to treatment and medicine, the right type of medicine and the necessary and sufficient dose are prescribed for the person. According to the available reports, regarding the COVID-19 disease, the differences mentioned in different people can be effective in the growing course of the disease, and the use of a personal medical approach leads to the introduction of a safe, effective, and accurate treatment method for different people. But we can say that the most important goal in personal medicine is prevention. Such a way that before contracting the disease, enduring the pain, and finally enduring the side effects of different drugs for treatment, the probability of the occurrence of the disease with the continuous monitoring of the biological indicators of various diseases, which are also identified through personal medicine, in people be checked for health.

Epidemiology of Injuries and Their Implications in Jiu-Jitsu Practitioners: An Integrative Systematic Review / Epidemiologia das lesões e suas implicações em praticantes de jiu-jitsu: Uma revisão sistemática integrativa

Abstract Objective To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the question: "What are the characteristics and prevalence of musculoskeletal injuries in Jiu-Jitsu practitioners?". Methods Since the beginning of the study, in August 2020, we conducted a search on the MEDLINE, LILACS, and SciELO electronic databases. We included cross-sectional studies published between 2018 and 2023 on the epidemiology of the types of injuries among jiu-jitsu practitioners that compared their incidence regarding different levels of ability and experience. Two independent researchers performed the data extraction and assessed the risk of bias. Results Seven studies were included. The common outcomes involved 2,847 jiu-jitsu practitioners. A high prevalence in the knee joint and chest and rib areas was reported. Considering the difference in experience level among the practitioners, we could observe that most of the individuals included were beginners. Among the age groups observed, male practitioners older than 30 years of age were the ones who presented the highest rate of musculoskeletal injury, especially during training sessions. Conclusion There is a high prevalence of musculoskeletal injuries among jiu-jitsu practitioners. The most affected anatomical segments are the knee joint, the chest, and the rib region, followed by the shoulder joint. The related factors change according to certain variables, being more common during training in male individuals over 30 years of age and beginners in the sport.

Resumo Objetivo Investigar a epidemiologia dos tipos de lesões entre praticantes de jiu-jitsu e sua incidência em diferentes níveis de habilidade e experiência por meio da questão: "Quais as características e a prevalência das lesões musculoesqueléticas em praticantes de jiu-jitsu?" Métodos Desde o início do estudo, em agosto de 2020, foram pesquisados os bancos de dados MEDLINE, LILACS e SciELO. Foram incluídos estudos transversais, publicados entre 2018 e 2023, que investigaram a epidemiologia dos tipos de lesões ocorridas entre praticantes de jiu-jitsu e compararam sua incidência em diferentes níveis de habilidade e experiência. Para tanto, dois pesquisadores independentes realizaram a extração dos dados e avaliaram o risco de viés. Resultados Sete estudos foram incluídos. Os resultados comuns envolveram 2.847 praticantes de jiu-jitsu. Houve uma alta prevalência de lesão na articulação do joelho e nas áreas do tórax e das costelas. Considerando a diferença de nível de experiência entre os praticantes, pôde-se observar que a maioria dos indivíduos incluídos eram iniciantes. Entre as faixas etárias observadas, homens acima de 30 anos de idade foram os que mais apresentaram lesões musculoesqueléticas, principalmente durante os treinos. Conclusão Houve uma alta prevalência de lesões musculoesqueléticas entre os praticantes de jiu-jitsu. Os segmentos anatômicos mais acometidos foram a articulação do joelho, o tórax e a região das costelas, seguidos da articulação do ombro. Os fatores relacionados mudaram de acordo com algumas variáveis, sendo mais comuns durante o treinamento em indivíduos do sexo masculino com mais de 30 anos e iniciantes na modalidade.

Orthopedic Injuries in Beach Tennis Players in Brazil / Lesões ortopédicas nos praticantes de beach tennis no Brasil

Abstract Objective To analyze the epidemiological data of orthopedic injuries in beach tennis players. Methods We conducted a cross-sectional study, through a questionnaire, with 185 beach tennis players during tournaments and training sessions in two cities. The questionnaire comprised anthropometric data, as well as data on length of time practicing the sport and reported orthopedic injuries. Results We excluded 25 of the 185 interviewees. Of the 160 players studied, 51.9% were male and 48.1%, female. The average age was of 40.4 years, the average height was of 1.73 m, the average weight was of 75.6 kg, and the average body mass index (BMI) was of 25.2 kg/m2. Orthopedic injuries were reported by 48.8% of the participants, 30.0% in the lower limbs, 11.3% in the spine, and 25.0% in the upper limbs, with an incidence of 0.82 per one thousand hours of practice. Correlating the incidence of injuries with age, weight, height, and BMI, we only found relevance between the higher average age in patients with lower- and upper-limb injuries. Players who had no previous experience with other racket sports had fewer injuries. Other parameters, such as gender, use of the two-handed backhand, dominant side, participation in competitions, and practice of other sports did not show statistically significant differences. Conclusion Orthopedic injuries were found in almost half of the beach tennis players, primarily in the lower limbs. Age, experience with other racket sports, category, hours of training per week, and length of time playing the sport influenced the incidence of orthopedic injuries.

Resumo Objetivo Analisar os dados epidemiolügicos das lesões ortopédicas nos praticantes de beach tennis. Métodos Foi realizado um estudo transversal, por meio de questionário, em 185 praticantes de beach tennis, durante torneios e treinos, em duas cidades. O questionário consistiu na coleta de dados antropométricos, além de dados relativos ao tempo de prática do esporte e às lesões ortopédicas referidas. Resultados Excluímos 25 dos 185 entrevistados. Dos 160 praticantes estudados, 51,9% eram do sexo masculino, e 48,1%, do feminino. A média de idade foi de 40,4 anos, a média da estatura foi de 1,73 m, a média do peso, de 75,6 kg, e a média do índice de massa corporal (IMC), de 25,2 kg/m2. A presença de lesões ortopédicas foi relatada por 48,8% dos praticantes, sendo 30,0% nos membros inferiores (MMII), 11,3% na coluna, e 25,0% nos membros superiores (MMSS), com incidência de 0,82 a cada mil horas de prática. Correlacionando a incidência de lesões com idade, peso, altura e IMC, encontramos relevância apenas entre a média de idade maior nos pacientes com lesão nos MMII e MMSS. Os jogadores que não tinham experiência prévia com outros esportes com raquete tiveram menos lesões. Demais parâmetros, como sexo, uso do backhand com duas mãos, lado dominante, participação em competições e prática de outros esportes não obtiveram diferenças estatisticamente significantes. Conclusão Lesões ortopédicas foram encontradas em quase a metade dos praticantes de beach tennis, preferencialmente nos MMII. Idade, experiência com outros esportes de raquete, categoria, horas de treino por semana e tempo de prática do esporte influenciaram na incidência de lesões ortopédicas.