Preliminary study of the population and reproductive dynamics of Echinaster sepositus (Spinulosida: Echinasteridae) in Cala del Racó / Estudio preliminar de la población y dinámica reproductiva de Echinaster sepositus (Spinulosida: Echinasteridae) en Cala del Racó

Abstract Introduction: The red starfish (Echinaster sepositus) is one of the most common asteroid species in the Mediterranean Sea. However, information about their biology or their role in benthic communities is scarce. Objective: This study aims to provide new information on the ecology of this species through the temporal characterization of the population of E. sepositus in Cala del Racó (Alicante, Spain) and the in situ monitoring of its reproductive cycle. Methods: For this purpose, three study areas were established at different depths. For each of the recorded starfish, data about the size, the substrate on which it was found, the area, the depth and the sex in the case of observing the reproduction were collected. Results: A total of 19 samplings have been carried out throughout a year of study. In this way, it has been possible to observe that the density of individuals increases in the shallower zone during autumn and winter, when the temperature drops to 14.13 ºC, while it decreases in spring and summer when the temperature rises to 27.17 ºC. Those results are reversed in the deepest part of the study. The highest density of individuals (0.51 ind/m2) occurred in October. Arborescent photophilic algae and crustose coralline algae were the substrates with the highest number of E. sepositus recorded. Medium to large specimens are located preferably on crustose coralline algae or arborescent photophilic algae, while smaller individuals were mostly located on Posidonia oceanica. No specimens of E. sepositus were observed spawning. Conclusions: Data leads to assume that there is a migration of starfishes towards more superficial areas when the water is at colder temperature and towards deeper areas when the temperature increases. It is valued the possibility that there is a change in the nutritional needs of E. sepositus throughout its development. According to our observations, the future reproduction studies should be concentrated between late-summer and early-autumn.

Resumen Introducción: La estrella de mar roja (Echinaster sepositus) es una de las especies de asteroideos más comunes del mar Mediterráneo. Sin embargo, la información sobre su biología o su papel en las comunidades bentónicas es escasa. Objetivo: Este estudio pretende aportar nueva información sobre la ecología de esta especie mediante la caracterización temporal de la población de E. sepositus en la Cala del Racó (Alicante, España) y el monitoreo in situ de su ciclo reproductivo. Métodos: Con este fin se establecieron tres zonas de estudio a distintas profundidades. Para cada una de las estrellas registradas se tomaron datos de tamaño, el sustrato sobre el que se encuentra, la zona, la profundidad y el sexo en caso de observar la reproducción. Resultados: A lo largo de un año de estudio se han realizado un total de 19 muestreos. De esta forma se ha podido observar que la densidad de individuos aumenta en la zona menos profunda durante otoño e invierno, cuando la temperatura del agua baja hasta los 14.13 ºC, mientras que se reduce en primavera y verano, cuando la temperatura se eleva hasta los 27.17 ºC. Este resultado se invierte en la zona más profunda del estudio. La mayor densidad de individuos ha sido observada en octubre (0.51 ind/m2). Las algas fotófilas arborescentes y las algas coralinales costrosas han sido los sustratos con un mayor número de E. sepositus registrados. Los ejemplares de tamaños medianos a grandes se localizan preferentemente sobre algas coralinales costrosas o algas fotófilas arborescentes, mientras que los individuos de menor tamaño se sitúan mayormente sobre Posidonia oceanica. No se observaron ejemplares de E. sepositus reproduciéndose. Conclusiones: Los datos permiten presuponer que existe una migración entre las zonas más superficiales, cuando la temperatura del agua es menor, y zonas más profundas cuando la temperatura aumenta. Se valora la posibilidad de la existencia de un cambio en los requerimientos nutricionales de E. sepositus a lo largo de su desarrollo. De acuerdo con nuestras observaciones, los estudios futuros sobre la reproducción de esta especie deben concentrarse entre finales de verano y principios de otoño.

Spatial-temporal Distribution and Influencing Factors of Late Diagnosis of HIV/AIDS Based on Bayes Spatial-temporal Model / 中山大学学报(医学科学版)

ObjectivesTo analyze the spatial and temporal clustering characteristics and related influencing factors of late diagnosis of HIV/AIDS in Lanzhou， to identify its high-risk areas and time trends in Lanzhou， and to provide a theoretical basis for developing targeted HIV/AIDS prevention and control strategies in Lanzhou. MethodsThe subjects of this study were adult HIV/AIDS cases reported in Lanzhou City between 2011 and 2018. Data used in the study were sourced from the Lanzhou Center for Disease Control and Prevention and the Lanzhou Statistical Yearbook. To analyze the spatial distribution characteristics and influencing factors of the relative risk （RR） of late HIV/AIDS diagnosis， Bayes spatial-temporal model was used. ResultsA total of 1984 new HIV/AIDS cases were reported in Lanzhou from 2011 to 2018， with an mean age of 37.51 years and predominantly male （91.8%）. The number of late diagnosis cases was 982， with an mean age of 39.67 years and a predominance of males （91.8%）. Late diagnosis was more common in older individuals and women with HIV/AIDS. Chengguan District （51.1%）， Anning District （50.3%） and Yuzhong County （51.9%） had an above-average proportion of late diagnosis of HIV/AIDS. The proportion of late diagnosis cases in Lanzhou showed a fluctuating upward trend from 2011 to 2018. The results of Bayes spatial-temporal model showed that the risk of late HIV/AIDS diagnosis in Lanzhou had fluctuated from 2011 to 2015， and then increased rapidly after 2015 ［RR （95% credibility interval， 95%CI） increased from 1.01 （0.84， 1.23） to 1.11 （0.77， 1.97）］； the trends of risk of late diagnosis in Honggu district and three counties were similar to the overall trend in Lanzhou city， while the risk of late diagnosis in Chengguan District and Qilihe District showed a decreasing trend. The regions with the RR for late diagnosis greater than 1 included Yongdeng County （RR=1.07， 95% CI： 0.55， 1.96）， Xigu District （RR=1.04， 95% CI： 0.67， 1.49）， Chengguan District （RR=2.41， 95% CI： 0.85， 6.16）， and Qilihe District （RR=2.03， 95% CI： 1.10， 3.27）. Besides， the heatmap analysis showed that Chengguan District and Qilihe District were the hot spots. The influencing factors analysis showed that the higher GDP per capita （RR=0.65， 95% CI： 0.35， 0.90） and the larger proportion of males with HIV/AIDS cases （RR=0.53， 95% CI： 0.19， 0.92） could lead to the lower the relative risk of late HIV/AIDS diagnosis. However， the higher the population density （RR=1.35， 95% CI： 1.01， 1.81） caused the higher the risk of late diagnosis. ConclusionOur study shows the risk of late diagnosis of HIV/AIDS in Lanzhou was on the rise， and there are significant regional differences. GDP per capita， the proportion of males in HIV/AIDS cases and population density are influencing factors in the late diagnosis of HIV/AIDS. Therefore， for regions with a high risk of late diagnosis or related risk factors， targeted HIV screening and prevention services should be given priority in order to reduce the proportion and risk of late diagnosis of HIV/AIDS.

Spatio-temporal analysis of the visceral leishmaniasis in the state of Alagoas, Brazil / Análise espacial-temporal da leishmaniose visceral no estado de Alagoas

Visceral leishmaniosis is a neglected tropical disease. We evaluated the spatial distribution of cases of visceral leishmaniosis in the state of Alagoas, Brazil. All cases of VL, registered by the health department, were analyzed and georeferenced. Results: Between 2008 and 2017, 97.1% of the municipalities presented sporadic classification of transmission. With temporal evolution, the incidence of cases of visceral leishmaniosis was concentrated in most municipalities in the microregion of Santana do Ipanema-AL. Space-time analysis, if considered, may promote the improvement of surveillance and control actions of visceral leishmaniosis.

A leishmaniose visceral é uma doença tropical negligenciada. Foram avaliadas a distribuição espacial dos casos de leishmaniose visceral no estado de Alagoas. Todos os casos de LV, registrados pela secretaria de saúde, foram analisados e georreferenciados. Entre 2008 e 2017, 97,1% dos municípios apresentaram classificação esporádica de transmissão. Com a evolução temporal, a incidência de casos de leishmaniose visceral se concentrou na maioria dos municípios da microrregião de Santana do Ipanema-AL. A análise espaço-tempo, se considerada, pode promover o aprimoramento das ações de vigilância e controle da leishmaniose visceral.

Spatio-temporal analysis of the visceral leishmaniasis in the state of Alagoas, Brazil

Abstract Visceral leishmaniosis is a neglected tropical disease. We evaluated the spatial distribution of cases of visceral leishmaniosis in the state of Alagoas, Brazil. All cases of VL, registered by the health department, were analyzed and georeferenced. Results: Between 2008 and 2017, 97.1% of the municipalities presented sporadic classification of transmission. With temporal evolution, the incidence of cases of visceral leishmaniosis was concentrated in most municipalities in the microregion of Santana do Ipanema-AL. Space-time analysis, if considered, may promote the improvement of surveillance and control actions of visceral leishmaniosis.

Resumo A leishmaniose visceral é uma doença tropical negligenciada. Foram avaliadas a distribuição espacial dos casos de leishmaniose visceral no estado de Alagoas. Todos os casos de LV, registrados pela secretaria de saúde, foram analisados e georreferenciados. Entre 2008 e 2017, 97,1% dos municípios apresentaram classificação esporádica de transmissão. Com a evolução temporal, a incidência de casos de leishmaniose visceral se concentrou na maioria dos municípios da microrregião de Santana do Ipanema-AL. A análise espaço-tempo, se considerada, pode promover o aprimoramento das ações de vigilância e controle da leishmaniose visceral.

Tendência Temporal no Implante Percutâneo de Bioprótese Aórtica: Análise de 10 Anos do Registro TAVIDOR / Temporal Trends in Transcatheter Aortic Valve Implantation: 10-Year Analysis of the TAVIDOR Registry

Resumo Fundamento O implante percutâneo de bioprótese valvar aórtica (TAVI) consolidou-se como opção terapêutica da estenose aórtica de grau importante. Dados sobre as características evolutivas dos procedimentos e dos resultados obtidos com a técnica ao longo da última década, em escala nacional, são desconhecidos. Objetivos Analisar a tendência temporal referente ao perfil demográfico, características dos procedimentos e desfechos hospitalares de pacientes submetidos a TAVI na Rede D'Or São Luiz. Métodos Registro observacional envolvendo 29 instituições nacionais. Comparou-se características dos procedimentos realizados de 2012 a 2017 (Grupo 1) e de 2018 a 2023 (Grupo 2). Foram considerados significantes os resultados com valor de p < 0,05. Resultados Foram analisados 661 casos, 95 pertencentes ao Grupo 1 e 566 ao Grupo 2. A média de idade foi 81,1 anos. Observou-se no Grupo 1 maior prevalência de pacientes em classe funcional III ou IV e escore de risco > 8%. Foi mais frequente o emprego de anestesia geral, monitorização ecocardiográfica transesofágica e via de acesso por dissecção. Maior taxa de sucesso do procedimento (95,4% versus 89,5%; p = 0,018) foi aferida em implantes efetivados a partir de 2018, assim como menor mortalidade (3,9% versus 11,6%; p = 0,004) e necessidade de marcapasso definitivo (8,5% versus 17,9%; p = 0,008). Conclusões A análise temporal de 10 anos do Registro TAVIDOR demonstra uma queda na complexidade clínica dos pacientes. Além disso, o avanço para técnicas de implante minimalistas, somadas à evolução tecnológica dos dispositivos, podem ter contribuído para desfechos favoráveis dentre aqueles cujo implante ocorreu no último quinquênio.

Abstract Background Transcatheter aortic valve implantation (TAVI) has established itself as the preferential strategy to approach severe aortic stenosis. Information on procedural improvements and nationwide results obtained with the technique throughout the past decade are unknown. Objectives To assess the temporal variation of the demographic profile, procedural characteristics, and in-hospital outcomes of patients undergoing TAVI procedures at the Rede D'Or São Luiz. Methods Observational registry comprising 29 national institutions, comparing the characteristics of the TAVI procedures performed from 2012 to 2017 (Group 1) to those performed from 2018 to 2023 (Group 2). The statistical significance level adopted was p < 0.05. Results This study assessed 661 patients, 95 in Group 1 and 566 in Group 2, with a mean age of 81.1 years. Group 1 patients had a higher prevalence of New York Heart Association functional class III or IV and STS risk score > 8%. In addition, they more often underwent general anesthesia, transesophageal echocardiographic monitoring, and access through femoral dissection. Group 2 patients had a higher success rate of the TAVI procedure (95.4% versus 89.5%; p = 0.018), lower mortality (3.9% versus 11.6%; p = 0.004), and less often needed permanent pacemaker implantation (8.5% versus 17.9%; p = 0.008). Conclusions The 10-year temporal trends analysis of the TAVIDOR Registry shows a reduction in patients' clinical complexity over time. Furthermore, the advance to minimalistic implantation techniques, added to the technological evolution of the devices, may have contributed to the favorable outcomes observed among those whose implantation occurred in the last 5 years studied.

Thermal variation in human temporal bone using rigid endoscope

Abstract Objective Compare thermal variation in the region of the External Acoustic Canal (EAC) and the Round Window (RW) using different rigid endoscopes and light sources in human temporal bones. Method This is an analytical experimental study using human temporal bones. Thermal variation was assessed during ten minutes, using a thermometer in the region of the EAC and the RW of two temporal bones, right and left. We used three different endoscopes (0° 4-mm, 0° 3-mm and 30° 4-mm) and five intensity/type light source (Halogen 100%, LED 50%, LED 100%, Xenon 50% and Xenon 100% with the same endoscope light fiber. Results We found temperature elevations in the EAC and RW in all measurements. Larger caliber endoscopes (4-mm) and light sources at 100% intensity generated higher temperatures, slightly higher in halogen and xenon. The 30° endoscopes tended to put more heat on structures, with little difference in most measurements. We identified greater temperature variations in the EAC of the right and left temporal bones compared to the RW overall. The highest temperature acquired in the present study was in the EAC of the temporal bone with a 4-mm and 30° endoscope, using xenon light source (intensity of 100%), with an increase of 4.51 °C. Conclusion The type of endoscope and light source can influence the thermal variation and the risk of tissue injury during endoscopic ear surgery. Larger endoscopes with xenon and halogen light sources at maximum intensity generate more heat. Level of evidence: 5.

The variations of osseous structure of the ınternal acoustic canal: an anatomical study

Abstract Objectives The internal acoustic meatus is an osseous canal that connects the inner ear to the posterior cranial fossa. It is located in the petrous portion of the temporal bone. A thin cribriform osseous plate known as the fundus is situated at the lateral end of the canal. This study assesses the structural and numerical variations of the fundus formations. Methods Fifty-four temporal bones of unknown gender and age were examined with the surgical microscope. Results The temporal bones analyzed were 46.2% right-sided and 53.7% left-sided. Only one temporal bone had two parallel transverse crests, while three had a single anterior crest that split into two branches posteriorly. The number of foramina at the transverse crest varied, with 29.6% having none, 48.1% having a single foramen, and 22.2% having several foramina. An anterior crest structure was seen in 53.7% of the temporal bones, with 5% having a slightly constricted entry to the facial canal. In cases with a single nerve foramen, 48.1% had one, while 51.8% had more than one, including examples with three or four foramina. A crest was found between the foramina of the single nerve in 7% of patients. Furthermore, a crest between the saccular nerve foramen and the high fiber foramina was seen in 25.9% of cases, and 5% had two saccular nerve foramina. Conclusion We think that revealing the anatomical, structural and numerical variations in the fundus will be useful in explaining the disease-symptom relationship. Level of evidence: Level 4.

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020 / Qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil: análise de tendência de 2001 a 2020

ABSTRACT Objective: To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period. Methods: This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated. Results: In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (β=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (β=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (β=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (β=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (β=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (β=0.019; p<0.001; AAGR=0.5) showed an increasing trend. Conclusion: Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

RESUMO Objetivo: Analisar a tendência temporal dos indicadores de qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil, no período de 20 anos. Métodos: Trata-se de um estudo epidemiológico de tendência temporal, cujos dados foram extraídos do Sistema de Informação de Agravos de Notificação (SINAN). Foram construídos indicadores a partir do Manual Técnico-Operacional, que apresenta as Diretrizes para Vigilância, Atenção e Eliminação da Hanseníase como Problema de Saúde Pública do Ministério da Saúde. Para análise de tendência dos indicadores selecionados, utilizou-se o modelo de Prais-Winsten e calculou-se a Taxa de Incremento Anual (TIA). Resultados: Na série temporal de 20 anos aqui investigada, foram notificados no Brasil 732.959 casos de hanseníase. A tendência mostrou-se estacionária para cura de hanseníase entre os casos novos (β=-0,000; p=0,196; TIA=-0,2); casos de hanseníase em abandono de tratamento entre os casos novos (β=-0,001; p=0,147; TIA=-0,4); contatos examinados de casos novos de hanseníase (β=-0,001; p=0,112; TIA=1,6); casos novos de hanseníase com grau de incapacidade física avaliado no diagnóstico (β=-0,000; p=0,196; TIA=-0,2); e casos curados no ano com grau de incapacidade física avaliada (β=0,002; p=0,265; TIA=0,5); enquanto o indicador casos de recidiva entre os casos notificados no ano (β=0,019; p<0,001; TIA=0,5) apresentou tendência crescente. Conclusão: Com base na avaliação dos indicadores para mensurar a qualidade dos serviços de atenção à saúde para redução da hanseníase, ficou evidente que o Brasil possui grandes desafios para sua execução plena, sendo necessárias melhorias na qualidade do serviço ofertado à população.

Socioeconomic factors increase the risk of teenage pregnancy: spatial and temporal analysis in a Brazilian municipality / Fatores socioeconômicos aumentam o risco de gravidez na adolescência: análise espacial e temporal em um município brasileiro

ABSTRACT Objective: To evaluate the distribution of the proportion of teenage mothers (PTM) in time and space and its relationship with socioeconomic indicators and social vulnerability. Methods: An ecological study was carried out with teenage mothers living in 322 census tracts in Foz do Iguaçu (state of Paraná, Brazil) between 2013 and 2019. Spatial clusters of teenage mothers were identified by spatial scanning and grouped into strata with different prevalence. The association between these strata and the individual social vulnerability of the mothers was evaluated using the Pearson's Chi-square test. Linear regression models were adjusted to evaluate the association between PTM and socioeconomic factors by census tract and temporal trend in PTM in different strata. Results: We identified five high prevalence clusters in peripheral regions and six with low prevalence in the central region of the municipality. Proportionally, there were more teenage mothers with a worse vulnerability index in the high prevalence stratum than in the low prevalence stratum. Places with worse socioeconomic conditions present higher PTM, a profile that did not change over time. For the increase of one unit in the Brazilian Deprivation Index and proportion of women responsible for the household, the PTM increased, respectively, by 3.8 (95%CI 3.1-4.4) and 0.086% (95%CI 0.03-0.14). There was a reduction in the global PTM in part of the period, which occurred later in the higher prevalence strata, but the proportions were stable again in the last years of study. Conclusion: Teenage pregnancy is concentrated in regions with worse socioeconomic conditions and greater maternal vulnerability and its behavior over time occurred differently in these areas.

RESUMO Objetivo: Avaliar a distribuição da proporção de mães adolescentes (PMA) no tempo e espaço e sua relação com indicadores socioeconômicos e vulnerabilidade social. Métodos: Realizou-se estudo ecológico com mães adolescentes residentes em 322 setores censitários de Foz do Iguaçu (PR) entre 2013 e 2019. Aglomerados espaciais de mães adolescentes foram identificados por varredura espacial e agrupados em estratos com diferentes prevalências. Avaliou-se a associação entre esses estratos e a vulnerabilidade social individual das mães pelo teste qui-quadrado de Pearson. Ajustaram-se modelos de regressão linear para avaliar associação entre a PMA e fatores socioeconômicos por setor censitário e tendência temporal da PMA nos diferentes estratos. Resultados: Identificaram-se cinco aglomerados de alta prevalência nas regiões periféricas e seis de baixa na região central do município. Proporcionalmente houve mais mães adolescentes com pior índice de vulnerabilidade no estrato de alta prevalência do que no de baixa. Locais com piores condições socioeconômicas apresentaram maior PMA, perfil que não mudou ao longo do tempo. Para o aumento de uma unidade do Índice Brasileiro de Privação e da proporção de mulheres responsáveis por domicílio, a PMA aumentou respectivamente 3,8 (IC95% 3,1-4,4) e 0,086% (IC95% 0,03-0,14). Houve uma redução na PMA global em parte do período, que ocorreu mais tardiamente nos estratos de maior prevalência, mas as proporções voltaram a ficar estáveis nos últimos anos de estudo. Conclusão: A gravidez na adolescência se concentra em regiões de pior condição socioeconômica e com maior vulnerabilidade materna e seu comportamento no tempo ocorreu, nessas áreas, de modo distinto.

Epilepsia do lobo temporal com esclerose hipocampal mesial / Temporal lobe epilepsy with mesial hippocampal sclerosis / Epilepsia del lóbulo temporal con esclerosis del hipocampo mesial

Objetivo:Compreender o cenário atual da ELT-HS, caracterizado por sua fisiopatologia, manifestações clínicas, métodos diagnósticos e tratamentos. Método:Trata-se de uma revisão integrativa da literatura, com caráter descritivo, de artigos indexados no Sistema de Análise e Recuperação da Literatura Médica Online MEDLINE/Pubmed, Literatura Latino-Americana e do Caribe em Ciências da Saúde LILACS, e nas bases de dados Científicas Electronic Library Online (SciELO), pesquisados na período compreendido entre outubro de 2022 e março de 2023. Foram incluídos artigos em português e inglês que contemplassem os objetivos da revisão, publicados nos últimos dez anos (2011-2021).Resultados: Inicialmente foram encontrados 144 artigos nas bases de dados, que após a leitura, foramselecionados na pesquisa 40 artigos que correspondiam ao objetivo proposto. Os artigos analisados correspondem aos anos de 2011 a 2021. Conclusão:O tratamento cirúrgico da ELT-HS tem se mostrado eficaz para resolução completa das crises na maioria dos pacientes. O conhecimento sobre sua fisiopatologia, manifestações clínicas, diagnóstico e tratamentos são de fundamental importância para os médicos que atendem pacientes com epilepsia.

Objective: To understand the current scenario of TLE-HS, characterized by its pathophysiology, clinical manifestations, diagnostic methods and treatments. Method:This is an integrative literature review with descriptive character, of articles indexed in the Medical Literature Analysis And Retrieval System Online MEDLINE/Pubmed, Latin American and Caribbean Literature in Health Sciences LILACS, and Scientic databases Electronic Library Online (SciELO), researched in the period between october 2022 and march 2023. Articles in Portuguese and English that contemplated the objectives of the review, published in the last ten years (2011-2021), were included. Results:Initially, 144 articles were found in the databases, which after reading, 40 articles were selected in the research that corresponded to the proposed objective. The articles analyzed are equivalent to the years 2011 to 2021. Conclusion:The surgical treatment of TLE-HS has been shown to be effective for the complete resolution of crises in most patients. Knowledge about its pathophysiology, clinical manifestations, diagnosis and treatments are of fundamental importance for physicians who treat patients with epilepsy

Objetivo: Comprender el escenario actual de la TLE-HS, caracterizado por su fisiopatología, manifestaciones clínicas, métodos diagnósticos y tratamientos. Método: Se trata de una revisión bibliográfica integradora con carácter descriptivo, de artículos indexados en el Sistema de Análisis y Recuperación de Literatura Médica en Línea MEDLINE/Pubmed, Literatura Latinoamericana y del Caribe en Ciencias de la Salud LILACS, y bases de datos Scientic Electronic Library Online (SciELO), investigados en el período comprendido entre octubre de 2022 y marzo de 2023. Se incluyeron artículos en portugués e inglés que contemplaran los objetivos de la revisión, publicados en los últimos diez años (2011-2021). Resultados:Inicialmente se encontraron 144 artículos en las bases de datos, de los cuales luego de la lectura se seleccionaron 40 artículos en la investigación que correspondía al objetivo propuesto. Los artículos analizadoscorresponden a los años 2011 a 2021. Conclusión:El tratamiento quirúrgico del ELT-HS se ha mostrado eficaz para la resolución completa de las crisis en la mayoría de los pacientes. El conocimiento sobre su fisiopatología, manifestaciones clínicas, diagnóstico y tratamientos es de fundamental importancia para los médicos que tratan pacientes con epilepsia

Was the COVID-19 epidemic synchronous in space? An analysis in the health regions of the Rio de Janeiro state, 2020-2022 / A epidemia de COVID-19 foi síncrona no espaço? Uma análise nas regiões de saúde do estado do Rio de Janeiro, 2020-2022

ABSTRACT Objective: To analyze the spatio-temporal dynamics of COVID-19 in the Rio de Janeiro state within the nine health regions, between March 2020 and December 2022. Methods: The Poisson model with random effects was used to smooth and estimate the incidence of COVID-19 hospitalizations reported in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) to verify the synchronicity of the epidemic in the state. Results: The COVID-19 epidemic in the state is characterized by the presence of seven peaks during the analyzed period corresponding to seven found. An asynchrony in hospitalizations was identified, varying according to the different virus variants in the nine health regions of the state. The incidence peaks of hospitalizations ranged from 1 to 12 cases per 100,000 inhabitants during the pandemic. Conclusion: This spatio-temporal analysis is applicable to other scenarios, enabling monitoring and decision-making for the control of epidemic diseases in different areas.

RESUMO Objetivo: Analisar a dinâmica espaço-temporal de COVID-19 no estado do Rio de Janeiro nas nove regiões de saúde, entre março de 2020 e dezembro de 2022. Métodos: Utilizou-se o modelo de Poisson com efeitos aleatórios para suavizar a curva de incidência de hospitalizações por COVID-19 notificadas no Sistema de Informação da Vigilância Epidemiológica da Gripe (Sivep-Gripe) para verificar a sincronicidade da epidemia no estado. Resultados: A epidemia de COVID-19 no estado é caracterizada pela presença de sete picos no período analisado correspondentes a sete variantes encontradas. Identificou-se uma assincronicidade nas hospitalizações, variando de acordo com as diferentes variantes do vírus nas nove regiões de saúde do estado. Os picos de incidência das hospitalizações variaram de 1 a 12 casos por 100 mil habitantes no decorrer da pandemia. Conclusão: Essa análise espaço-temporal é extensível em outros cenários, sendo possível o monitoramento e a tomada de decisões de controle de doenças epidêmicas em várias áreas.

Detailed analysis of inner ear malformations in CHARGE syndrome patients - correlation with audiological results and proposal for computed tomography scans evaluation methodology

Abstract Objectives The aim was to describe the spectrum of inner ear malformations in CHARGE syndrome and propose a Computed Tomography (CT) detailed scan evaluation methodology. The secondary aim was to correlate the CT findings with hearing thresholds. Methods Twenty ears of ten patients diagnosed with CHARGE syndrome were subjected to CT analysis focusing on the inner ear and internal acoustic canal. The protocol used is presented in detail. ASSR results were analyzed and correlated with inner ear malformations. Results Cochlear hypoplasia type III was the most common malformation found in 12 ears (60%). Cochlear hypoplasia type II, aplasia with a dilated vestibule, and rudimentary otocyst were also identified. In 20%, no cochlear anomaly was found. The lateral Semicircular Canal (SCC) absence affected 100% of ears, the absence of the posterior SCC 95%, and the superior SCC 65%. Better development of cochlea structures and IAC correlated significantly with the lower hearing thresholds. Conclusion This study demonstrated that rudimentary SCC or a complete absence of these SCCs was universally observed in all patients diagnosed with CHARGE syndrome. This finding supports the idea that inner ear anomalies are a hallmark feature of the CHARGE, contributing to its distinct clinical profile. The presence of inner ear malformations has substantial clinical implications. Audiological assessments are crucial for CHARGE syndrome, as hearing loss is common. Early detection of these malformations can guide appropriate interventions, such as hearing aids or cochlear implants, which may significantly improve developmental outcomes and communication for affected individuals. Recognizing inner ear malformations as a diagnostic criterion presents implications beyond clinical diagnosis. A better understanding of these malformations can advance the knowledge of CHARGE pathophysiology. It may also help guide future research into targeted therapies to mitigate the impact of inner ear anomalies on hearing and balance function. Level of evidence: 4.

Heterogeneidade espaço-temporal dos indicadores de imunização da vacina tríplice viral em crianças no Brasil / Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from Brazil / Heterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil

RESUMO Objetivo. Avaliar a cobertura vacinal e as taxas de abandono da vacina tríplice viral nas macrorregiões brasileiras. Métodos. Este estudo ecológico, com abordagem espaço-temporal, utilizou dados do Programa Nacional de Imunizações e do Sistema de Informação sobre Nascidos Vivos. Estimou-se a variação anual (2014 a 2021) da cobertura vacinal e da taxa de abandono da vacina tríplice viral em crianças de 12 meses e 15 meses de idade nos 5 570 municípios brasileiros. A análise estatística foi realizada para o conjunto de municípios de cada macrorregião brasileira usando a técnica de varredura espaço-temporal, considerando o modelo probabilístico de Poisson e a hipótese de que os municípios com menores coberturas vacinais ou altas taxa de abandono formariam aglomerados (clusters) espaço-temporais. Resultados. De 2014 a 2021, 38,3% e 12,9% dos municípios alcançaram cobertura da vacina tríplice viral ≥ 95,0% na primeira e segunda doses, respectivamente; 53,6% dos municípios tiveram alta taxa de abandono (20,0% a 49,9%) e 37,2% tiveram altíssima taxa de abandono. O Nordeste apresentou os clusters primários para baixa cobertura da primeira (2018 a 2021) e da segunda doses (2020 a 2021) da vacina tríplice viral com maiores riscos relativos (RR) em relação aos demais clusters primários. O RR para alta taxa de abandono foi elevado em todas as macrorregiões brasileiras (1,57 a 26,23). Conclusões. Em algumas macrorregiões, a taxa de abandono era alta desde 2014, sinalizando risco de ressurgimento do sarampo. Por sua vez, a análise espaço-temporal indicou mais baixas coberturas vacinais em 2020, sugerindo influência da pandemia de covid-19.

ABSTRACT Objective. To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. Methods. This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. Results. From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). Conclusions. In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of measles resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

RESUMEN Objetivo. Evaluar la cobertura de vacunación y las tasas de incumplimiento del esquema de vacunación triple viral en las macrorregiones de Brasil. Métodos. En este estudio ecológico, con un enfoque espaciotemporal, se utilizaron datos del Programa Nacional de Inmunización y del Sistema de Información sobre Recién Nacidos Vivos. Se estimó la variación anual de la cobertura de vacunación y la tasa de incumplimiento del esquema de vacunación triple viral en niños de 12 y 15 meses en 5570 municipios brasileños (en el período 2014-2021). El análisis estadístico se realizó en el conjunto de municipios de cada macrorregión brasileña mediante la técnica de barrido espaciotemporal, con un modelo probabilístico de Poisson y con la hipótesis de que los municipios con menor cobertura de vacunación o tasas altas de incumplimiento formarían conglomerados espaciotemporales. Resultados. En el período 2014-2021, el 38,3% y el 12,9% de los municipios alcanzó una cobertura ≥95,0% para la primera y la segunda dosis de la vacuna triple viral, respectivamente; el 53,6% de los municipios tuvo una tasa de incumplimiento alta (del 20,0% al 49,9%) y el 37,2% una tasa extremadamente alta. En la zona del nordeste se observaron los conglomerados primarios de cobertura baja de la primera y la segunda dosis de la vacuna triple viral (administradas en los períodos 2018-2021 y 2020-2021, respectivamente) con un mayor riesgo relativo (RR), en comparación con los demás conglomerados primarios. Se observó un RR alto de tener una tasa elevada de incumplimiento en todas las macrorregiones de Brasil (de entre 1,57 y 26,23). Conclusiones. En algunas macrorregiones, la tasa de incumplimiento había sido elevada desde el 2014, lo cual indica un riesgo de resurgimiento del sarampión. A su vez, en el análisis espaciotemporal se observó una menor cobertura de vacunación en el 2020, lo que denota la influencia de la pandemia de COVID-19.

Cobertura algal en dos sitios del Parque Nacional de Guanahacabibes, plataforma suroccidental de Cuba

Introducción: Las comunidades de macroalgas marinas del Parque Nacional Guanahacabibes no han sido estudiadas desde el punto de vista cuantitativo, a pesar de la influencia que la vegetación submarina tiene sobre la estructura y el funcionamiento de los ecosistemas costeros, componente que hasta ahora ha sido subestimado en la región. Objetivo: Evaluar la variación temporal y espacial de los géneros de macroalgas en dos sitios de María La Gorda, sur del Parque Nacional de Guanahacabibes, y evaluar la salud del arrecife de acuerdo con la cobertura de los diferentes morfo-tipos de macroalgas predominantes. Metodología: El muestreo fue cuatrimestral entre febrero 2014 y marzo 2017 en Yemayá y Laberinto, mediante buceo autónomo a una profundidad de 10 m. La cobertura algal fue estimada siguiendo la metodología AGRRA. Se usaron ocho transectos de 20 m por sitio de muestreo de acuerdo con las condiciones del arrecife y la forma del fondo. Cada cinco metros se colocó un cuadrante de 25 x 25 cm. Se calculó el porcentaje de cobertura que aporta cada género y de los grupos morfofuncionales a la cobertura total. Resultados: Los géneros dominantes durante el periodo de estudio fueron: Dictyota, Lobophora y Halimeda. Las algas carnosas y calcáreas mostraron mayor cubrimiento en Laberinto (carnosas= 57.8 ±15.6; calcáreas = 8.3 ± 6.8) que en Yemayá, (carnosas = 47.3 ± 23.1; calcáreas = 8.5 ± 9.3). Las formas costrosas son más abundantes en Yemayá (17.1 ± 15.1) que en Laberinto (7.7 ± 10). El índice de las carnosas fue superior en Laberinto (225.7 ± 110.2). Conclusión: La disminución en los niveles de cobertura de algas costrosas y la dominancia de formas carnosas como Dictyota y Lobophora en la zona de estudio, evidencian el deterioro en ambos sitios, a pesar de las políticas de conservación de parques nacionales.

Introduction: The macroalgal communities of the Guanahacabibes National Park have been poorly studied from the quantitative point of view, despite the influence that underwater vegetation has on the structure and functioning of coastal ecosystems, a component that until now has been underestimated in the Cuba region. Objetive: To evaluate the temporal and spatial variation of the macroalgal genera in two sites of María La Gorda, south of the Guanahacabibes National Park, and evaluate the reef health according to the coverage of the different predominant macroalgal morphotypes. Methodology: Sampling took place quarterly between February 2014 and March 2017, in Laberinto and Yemayá by SCUBA diving at a depth of 10 m. The algal coverage was estimated following the AGRRA methodology. Eight 20 m transects per sampling site were used according to reef conditions and bottom shape. Every five meters a 25 x 25 cm square was placed. The coverage (%) contributed per genus and morpho-functional group to the total coverage found was calculated. Results: The dominant genera during the study period were: Dictyota, Lobophora and Halimeda. Fleshy and calcareous algae showed greater coverage in Laberinto (fleshy= 57.8 ± 15.6; calcareous = 8.3 ± 6.8) than in Yemayá (fleshy = 47.3 ± 23.1; calcareous = 8.5 ± 9.3). Crustose algae were more abundant in Yemayá (17.1 ± 15.1) than in Laberinto (7.7 ± 10). The fleshy index was higher in Laberinto (225.7 ± 110.2). Conclusion: The decrease in the levels of crustose algal cover, as well as the dominance of fleshy forms Dictyota and Lobophora in the study area, shows the deterioration in both sites, despite the conservation policies of national parks.

Distribution of cases of congenital heart disease in a hospital in Oeste Paulista / Distribuição dos casos de cardiopatias congênitas em um hospital do Oeste Paulista

The aim of this research was to conduct a comprehensive spatial-temporal analysis of the population affected by congenital heart anomalies assisted at the Pediatric Cardiology Outpatient Department at the distinguished Western Paulista reference hospital. We conducted a retrospective study involving the analysis of electronic database records and patient medical charts for individuals diagnosed with congenital heart disease during the period from July 2013 to July 2018. A total of 298 medical records were selected for the analysis of variables encompassing the ICD-10 codes, gender, spatial distribution, and temporal trends. It was possible to observe that septal defects were the most prevalent congenital heart abnormalities, and there was no gender-based difference. An increase in diagnoses was noted from 2014, coinciding with the implementation of the "heart test," and 51% of the cases were from Presidente Prudente, with a higher concentration of cases in the industrial park area. There is an association between cardiac congenital malformations and an adverse environmental context. The findings can inform public health policies aimed at reducing the exposure of the most vulnerable population in pursuit of improving health indicators (AU).

O objetivo deste trabalho foi analisar a distribuição espaço-temporal dos pacientes com cardiopatias congênitas aten-didos no Ambulatório de Cardiologia Pediátrica do Hospital de referência do Oeste Paulista. Realizamos um estudo retrospectivo com análise de dados de base eletrônica e prontuários dos pacientes diagnosticados com cardiopatia congênita entre os períodos de julho de 2013 a julho de 2018. Foram selecionados 298 prontuários para análise das variáveis de CID-10, gênero, distribuição espacial e série temporal. Foi possível observar que os defeitos septais foram as cardiopatias mais prevalentes, não houve diferença entre os gêneros. Notou-se aumento do diagnóstico a partir de 2014, com implementação do teste do coraçãozinho e 51% dos casos eram da cidade de Presidente Prudente, com maior concentração de casos na região do parque industrial. Há uma relação na incidência das malformações cardíacas com o meio ambiente desfavorável. Os resultados encontrados podem guiar políticas de saúde pública, visando reduzir a exposição da população mais vulnerável, na busca da melhora nos índices de saúde (AU).

Evaluation of the Radiological Anatomy of the Temporal Bone Air Spaces and Morphometric Analysis in Turkish Healthy Adults / Evaluación de la Anatomía Radiológica de los Espacios Aéreos del Hueso Temporal y Análisis Morfométrico en Adultos Turcos Sanos

SUMMARY: The temporal bone is a complicate structure which located on the lateral skull. The objective of the present study was to determine the temporal bone air spaces' morphometry, morphology, and pneumatization in Turkish healthy adult people. This retrospective observational study was carried out from 82 subjects (47 males, 35 females) aged 18-69 years. The external auditory canal and related structures' diameters and the volume of these areas were evaluated. The means and standard deviations of the Meatus acusticus externus length (MAEL), meatus acusticus externus pars cartilaginea length (MAEcL), meatus acusticus externus pars ossea length (MAEoL), meatus acusticus externus pars cartilaginea surface (MAEcS), meatus acusticus externus pars ossea surface (MAEoS), meatus acusticus externus volume (MAEV), meatus acusticus externus pars cartilaginea volume (MAEcV), meatus acusticus externus pars ossea volume (MAEoV), processus mastoideus air cells volume (PMACV), cavum tympani volume (CTV), and temporale pneumatic spaces volume (OTPSV) were found as 23.21±3.70 mm, 12.69±3.72 mm, 7.80±3.70 mm, 669.89±107.7 mm2, 267.50±30.51 mm2, 743.50±119.6 mm3, 971.97±156.69 mm3, 419.51±48.67 mm3, 5915.93±650.34 mm3, 673.48±91.93 mm3, 7813.34±717.49 mm3 have found in 82 subjects, respectively. In this paper, the morphometric and volume properties of the temporal bone cavities measurements were significantly higher in males than females. These results may both provide reference values of Turkish healthy population, and lead to decrease potential surgical complications about temporal and mastoid regions.

El hueso temporal es una compleja estructura ubicada en el parte lateral del cráneo. El objetivo del presente estudio fue determinar la morfometría, morfología y neumatización de los espacios aéreos del hueso temporal en individuos adultos turcos sanos. Este estudio observacional retrospectivo que se llevó a cabo en 82 sujetos (47 hombres, 35 mujeres) de entre 18 y 69 años. Se evaluaron los diámetros del meato acústico externo y las estructuras relacionadas y el volumen de estas áreas. Las medias y las desviaciones estándar de la longitud del meato acústico externo (MAEL), la longitud de la parte cartilaginosa del meato acústico externo (MAEcL), la longitud de la parte ósea del meato acústico externo (MAEoL), la superficie de la parte cartilaginosa del meato acústico externo (MAEcS), la superficie de la parte ósea del meato acústico externo (MAEoS), volumen del meato acústico externo (MAEV), volumen de la parte cartilaginosa del meato acústico externo (MAEcV), volumen de la parte ósea del meato acústico externo (MAEoV), volumen de las células aéreas del proceso mastoideo (PMACV), volumen del cavum tympani (CTV) y el volumen de los espacios neumáticos temporales (OTPSV) se encontró como 23,21 ± 3,70 mm, 12,69 ± 3,72 mm, 7,80 ± 3,70 mm, 669,89 ± 107,7 mm2, 267,50 ± 30,51 mm2, 743,50 ± 119,6 mm3, 971,97 ± 156,69 mm3, 419,5. 1±48,67 mm3, 5915,93 ± 650,34 mm3, 673,48 ± 91,93 mm3, 7813,34 ± 717,49 mm3, respectivamente. En este artículo, las propiedades morfométricas y de volumen de las mediciones de las cavidades del hueso temporal fueron significativamente mayores en hombres que en mujeres. Estos resultados pueden proporcionar valores de referencia de la población sana turca y conducir a una disminución de las posibles complicaciones quirúrgicas en las regiones temporal y mastoidea.

Temporal trend in the incidence of human visceral leishmaniasis in Brazil / Tendência temporal da incidência de leishmaniose visceral humana no Brasil

Abstract It is an ecological study that analyzed the time trend of visceral leishmaniasis incidence rates in Brazil using segmented time regression by joinpoints. There was a decreasing incidence rate of this disease in the country with an average annual percent change (AAPC) of -5 (CI95%: -9.1; -0.6) and a reduction of 1.69 cases/100 thousand inhabitants in 2007, and 0.91/100 thousand inhabitants in 2020. The Central-West region showed the highest reduction percent (AAPC: -9.1; CI95%: -13.8; -4.3), followed by the Southeast region (AAPC: -8.7; -14.6; -2.5). The North and South regions showed the largest number of joinpoints in the time series. The highest incidences were recorded in the male population, however, stable (AAPC: 2.14; CI95%: -8.3; 0). In the age group analysis, the trend was decreasing for the groups from 0 to 4 years old (AAPC: -7.7; CI95%: -12.6; -2.4), 5 to 9 years old (AAPC: -7.3; CI95%: -13.6; -0,4) and 10 to 14 years old (AAPC: -5.5; CI95%: -10.3; -0.3). It was found that although Visceral Leishmaniasis is an endemic disease in Brazil, there was a decrease in its incidence rate from 2007 to 2020.

Resumo Trata-se de um estudo ecológico que analisou a tendência temporal das taxas de incidência de leishmaniose visceral no Brasil mediante regressão temporal segmentada por pontos de inflexão. Observou-se tendência de decréscimo na taxa de incidência dessa patologia no país, com variação variação percentual média anual (average annual percent change - AAPC) de -5 (IC95%: -9,1; -0,6) e redução de 1,69 casos/100 mil habitantes em 2007, para 0,91/100 mil habitantes em 2020. A região Centro-Oeste apresentou a maior redução do AAPC (AAPC: -9,1; IC95%: -13,8; -4,3), seguida da região Sudeste (AAPC: -8,7; -14,6; -2,5). As regiões Norte e Sul apresentaram o maior número de pontos de inflexão (joinpoint) na série temporal. As maiores incidências foram registradas na população masculina, porém com tendência estacionária (AAPC: 2,14; IC95%: -8,3; 0). Na análise por faixa etária, a tendência foi decrescente nos grupos de 0 a 4 anos (AAPC: -7,7; IC95%: -12,6; -2,4), 5 a 9 anos (AAPC: -7,3; IC95%: -13,6; -0,4) e de 10 a 14 anos (AAPC: -5,5; IC95%: -10,3; -0,3). Verificou-se que, apesar de a leishmaniose visceral se tratar de uma doença endêmica no Brasil, houve declínio na sua taxa de incidência no período de 2007 a 2020.

Descuento sexual y conductas sexuales arriesgadas en una muestra de adultos jóvenes de Colombia / Sexual Discounting and Sexual Risk Behavior in a Sample of Young Adults from Colombia / Desconto sexual e comportamento sexual de risco em uma amostra de jovens adultos da Colômbia

El objetivo del presente trabajo fue describir la tasa de descuento sexual y evaluar la relación entre el autorreporte de conductas sexuales arriesgadas (csa) y el descuento sexual en una muestra de adultos jóvenes en Colombia. Para esto, se realizó una investigación no experimental de corte transversal y correlacional. Ciento treinta y seis participantes fueron sometidos a un cuestionario de autorreporte de conductas de riesgo sexual, a la tarea de descuento sexual (sddt) y al cuestionario de elección monetaria (mcq). Los análisis de la curva de descuento sexual demuestran que el valor de la opción de tener sexo seguro disminuye con el in-cremento en la demora en la obtención de un condón (i. e., descuento sexual). Adicionalmente, se observa que el grado de descuento sexual está asociado con csa, como el número de parejas sexuales y el número de relaciones sexuales en los últimos tres meses, y que hay una diferencia en el patrón de descuento sexual entre hombres y mujeres.

The goal of this study was to describe the rate of sexual discounting and its relation with the self-report of sexual risk behavior in a sample of young adults from Colombia. To achieve this goal, a correlational cross-sectional non-experimental study was done. One hundred thirty six young adult participants responded to a sexual risk behavior self-report questionnaire, a sexual delay discounting task (sddt), and a monetary choice questionnaire (mcq). The results suggest that the value of the safe sex option decreases with the delay to obtain a condom (i. e., sexual discounting). Additionally, it was observed that the sexual discounting rate was associated with the self-report of sexual risk behavior, like, the number of sexual partners and sexual encounters in the last three months. It was also observed a different pattern of sexual discounting between men and women

O objetivo deste estudo foi descrever a taxa de desconto sexual e avaliar a relação entre o autorrelato de com-portamentos sexuais de risco (csr) e o desconto sexual em uma amostra de jovens adultos na Colômbia. Para isso, foi realizada uma investigação não experimental, transversal e correlacional. 136 participantes foram submetidos a um questionário de comportamentos se-xuais de risco autorreferidos, à tarefa de desconto sexual (sddt) e ao questionário de escolha monetária (mcq). As análises da curva de desconto sexual mostram que o valor da opção de praticar sexo mais seguro diminui com o aumento do atraso na obtenção do preservativo (ou seja, desconto sexual). Adicionalmente, observa-se que o grau de desconto sexual está associado à csr, assim como o número de parceiros sexuais e o número de relações sexuais nos últimos 3 meses, e que existe uma diferença no padrão de desconto sexual entre homens e mulheres.

Aspectos electroclínicos de la epilepsia temporal mesial / Neuropsychological risk in temporal lobe epilepsy

Introducción: La epilepsia del lóbulo temporal mesial se considera la más frecuente de las epilepsias focales, con signos y síntomas característicos que ayudan a definir su diagnóstico. Contenidos: Dentro de su historia natural, las crisis pueden iniciar en los primeros años de vida, usualmente como episodios febriles con un periodo de remisión, para reaparecer en la adolescencia o en el adulto joven. La presentación electroencefalográfica tiene un patrón característico, con aparición de puntas y ondas agudas interictales en la región temporal anterior, por lo general unilaterales, y con actividad ictal generalmente theta en la misma localización. La causa más frecuente es la esclerosis del hipocampo. El tratamiento con medicamentos anticrisis puede controlar la epilepsia, aunque algunos casos pueden evolucionar a la farmacorresistencia, en la cual la cirugía de epilepsia está indicada, y tiene buenos resultados. Conclusiones: Esta revisión se centra en la descripción de las características electroclínicas de la epilepsia temporal mesial, para hacer un diagnóstico temprano e iniciar un tratamiento adecuado, a efectos de lograr un mejor pronóstico y una mejor calidad de vida para los pacientes con epilepsia y sus familiares.

Introduction: Mesial temporal lobe epilepsy is considered the most common of the focal epilepsies, with characteristic signs and symptoms that help define its diagnosis. Contents: In the natural history of the disease, seizures can begin in the first years of life, usually as febrile seizures with a period of remission, to reappear in adolescence or in the young adult. The electroencephalographic presentation has a characteristic pattern with the appearance of interictal sharp waves and spikes in the anterior temporal region, usually unilateral, and with generally theta ictal activity in the same location. The most common cause is hippocampal sclerosis. Treatment with antiseizure medication can control epilepsy. However, in some cases evolution of drug resistance can occur, leading to epilepsy surgery as the most appropriate treatment, based on its good results. Conclusions: This review focuses on the description of the electroclinical characteristics of temporal mesial epilepsy, in order to make an early diagnosis and adequate treatment, thus providing a better prognosis and quality of life for patients with epilepsy and their families.

Riesgo neuropsicológico en epilepsia del lóbulo temporal / Neuropsychological risk in temporal lobe epilepsy

Introducción: Los síntomas neuropsicológicos son una preocupación importante para los pacientes con epilepsia y pueden llegar a ser muy influyentes en la percepción de calidad de vida. En el caso de la epilepsia del lóbulo temporal, existen muchas variables que influyen en el desempeño cognitivo de los pacientes, entre las más importantes se encuentran la etiología, la edad de inicio, la duración de la enfermedad y la frecuencia de crisis; sin embargo, una de las variables más importantes es la lateralidad de la epilepsia. Está claramente demostrado que los síntomas cognitivos de la epilepsia del lóbulo temporal varían en función del hemisferio cerebral afectado. Contenido: La epilepsia del lóbulo temporal es una de las principales epilepsias focales que es susceptible de manejo quirúrgico, y, en este sentido, el tipo de procedimiento también tiene una gran importancia en el desenlace cognitivo de estos pacientes. En este artículo, realizamos una revisión narrativa de la literatura, con el objetivo de describir el riesgo neuropsicológico relacionado no solamente con la epilepsia del lóbulo temporal per se, sino también con las intervenciones quirúrgicas que se realizan en pacientes refractarios a la medicación. Conclusiones: Es importante conocer los conceptos sobre las implicaciones del impacto cognitivo en los pacientes con epilepsia del lóbulo temporal antes de tomar decisiones quirúrgicas en pacientes refractarios, así como entender que el tipo de cirugía también influye en su desempeño cognitivo. Se debe buscar un equilibrio entre la libertad de crisis y las posibles secuelas neuropsicológicas posquirúrgicas.

Introduction: Neuropsychological symptoms are a major concern for patients with epilepsy and can highly influence the perception of quality of life. In the case of temporal lobe epilepsy, there are many variables that impact the cognitive performance of these people, among the most important are the etiology, the age of onset, the duration of the disease and the frequency of seizures, however, one of the most important variables is the lateralization of the seizure. It has been demonstrated that the cognitive symptoms of temporal lobe epilepsy vary depending on the affected cerebral hemisphere. Contents of the review: Temporal lobe epilepsy is one of the main focal epilepsies that is susceptible to surgical management, and the type of surgery also has great importance in the cognitive outcomes of these patients. In this article, we carry out a narrative review of the literature in order to describe the neuropsychological risk related not only to temporal lobe epilepsy per se, but also to surgical interventions performed in drug-resistant patients. Conclusions: It is important to know the concepts about the implications of cognitive impact in patients with temporal lobe epilepsy before making surgical decisions in refractory patients and to understand that the type of surgery also influences the cognitive performance of these patients. A balance must be sought between the freedom of seizures and the possible postoperative neuropsychological sequelae.