Ancient Literature Analysis and Modern Clinical Application of Famous Classical Formula Huagaisan / 中国实验方剂学杂志

ObjectiveTo sort out the historical evolution， prescription evolution and modern clinical application of Huagaisan. MethodHuagaisan and its synonym Huagaitang are used as keywords to search the databases of Traditional Chinese Medicine Think Tank， Chinese Medical Dictionary， Airusheng Chinese Medical Database and China National Knowledge Infrastructure（CNKI）. According to the inclusion and exclusion criteria， we obtained the information of ancient books and modern clinical research literature related to Huagaisan， and systematically reviewed and analyzed the historical origin， prescription composition， preparation method， dosage， efficacy， medicinal material origin， processing method and modern clinical application of Huagaisan. ResultA total of 198 pieces of ancient book information were included， involving 93 ancient Chinese medicine books. Huagaisan was composed of fried Perillae Fructus， red Poria， fried Mori Cortex， Citri Eoxcarpium Rubrum， stir-fried Armeniacae Semen Amarum， Ephedrae Herba and fried Glycyrrhizae Radix et Rhizoma， which had the efficacy of promoting the lungs and relieving epidemiological symptoms， expelling phlegm and relieving cough， and treating cough with wind-cold bundled epidemiological symptoms and stagnation of phlegm and Qi. The preparation method was suggested as boiling powder， crushing the seven herbs into coarse particles， the dosage of each drug was fried Perillae Fructus of 1.27 g， red Poria of 1.27 g， fried Mori Cortex of 1.27 g， Citri Eoxcarpium Rubrum of 1.27 g， stir-fried Armeniacae Semen Amarum of 1.27 g， Ephedrae Herba of 1.27 g and fried Glycyrrhizae Radix et Rhizoma of 0.64 g， taking 8.26 g when decocting， adding 300 mL of water， decocting to 210 mL， removing the dregs， and taking it warmly after meals. Twenty-one clinical research papers were included to analyze the modern clinical application of Huagaisan， which was mainly used in the treatment of respiratory diseases such as pneumonia， asthma， bronchitis and so on. ConclusionThis paper has verified and summarized the key information of the famous classical formula Huagaisan， which can provide a detailed reference basis for the development and clinical application of its compound preparation.

Historical Evolution and Modern Research Progress of Processing of Scutellariae Radix / 中国实验方剂学杂志

By consulting ancient herbal books and modern literature， this paper systematically sorted out and researched the processing history， relevant processing norms in recent years， modern processing technology， chemical composition changes of processed products and their pharmacological mechanism of Scutellariae Radix， in order to provide a basis for the further development of Scutellariae Radix decoction pieces. According to the textual research of ancient books， there were many kinds of processing auxiliary materials of Scutellariae Radix， such as wine， vinegar， salt， honey， pig bile and so on， among which the wine processing was the most diverse and detailed， and the processed products such as raw products， stir-fried products， wine-processed products， fried charcoal products were still in use. The modern processing techniques of Scutellariae Radix mainly focus on the processing aspects of softening and slicing， wine processing and charcoal frying， and the research methods are relatively unified. At present， it is found that the changed chemical constituents of Scutellariae Radix after processing are flavonoids， polysaccharides， volatile oils and trace elements， etc. Pharmacological effects of processed products are hemostasis， antibacterial， anti-inflammatory， antioxidant， analgesic and antipyretic， treatment of lung diseases， treatment of colitis， etc. However， in the studies of Scutellariae Radix processing， there is a lack of research on the structural changes of chemical components caused by processing and a comprehensive comparative study on the pharmacological effects of various processed products. Based on this， it is suggested to carry out systematic research on the processing technology to processing mechanism， further explore the relationship between the change rule of material basis and pharmacological action before and after processing of Scutellariae Radix， and deepen the exploration of molecular mechanism and clinical application of processed products of Scutellariae Radix， in order to clarify the scientific connotation of the processing mechanism of Scutellariae Radix， and lay a foundation for the subsequent expansion of the application of Scutellariae Radix decoction pieces and the formulation of processing standards.

Phylogenetic relationship between rabies virus (Lyssavirus rabies) variants from two different species / Relações filogenéticas do vírus da raiva (Lyssavirus rabies) em duas diferentes espécies / Relaciones filogenéticas del virus de la rabia (Lyssavirus rabies) en dos especies diferentes

Rabies is a fatal zoonotic disease that affects several mammals. Hematophagous bats are recognized hosts of the rabies virus, and their main food source is the blood of other mammals, particularly cattle. During feeding, bats transmit the virus to cattle, which are victims of the disease, contributing to economic losses and increasing the risk of infection for humans. Based on this affinity in the rabies cycle between bats and cattle, the objective of this study was to analyze the phylogenetic relationships of rabies virus samples in cattle and bats. The G gene of the rabies virus was chosen for this study because it is directly related to the infection process. Nucleotide sequences of the viral G gene were selected from GenBank for samples obtained from infected cattle and bats. Maximum parsimony analyses were conducted using the Molecular Evolutionary Genetics Analysis software. The Maxima Parsimony tree indicated a phylogenetic relationship between the G genes of both hosts, indicating that the virus evolved from bats to cattle. Analysis of parsimoniously informative sites revealed that the viral G gene carried specific mutations in each host. Knowledge of the evolutionary relationships between the rabies virus and its hosts is critical for identifying potential new hosts and the possible routes of infection for humans.

A Raiva é uma zoonose fatal que infecta várias espécies de mamíferos. Os morcegos hematófagos são reconhecidos como hospedeiros do vírus da Raiva e sua principal fonte de alimento é o sangue de outros mamíferos, especialmente os bovinos. Quando se alimentam, os morcegos transmitem o vírus para o bovino os quais são vítimas da doença, contribuindo para perdas econômicas e riscos de infecção para humanos. Baseado nesta afinidade do ciclo da Raiva entre morcegos e bovinos, o objetivo deste estudo foi analisar as relações filogenéticas de amostras do vírus da Raiva em ambos os hospedeiros, bovinos e morcegos. O gene G do vírus da Raiva foi escolhido para esta pesquisa porque ele está diretamente relacionado ao processo de infecção. Sequências de nucleotídeos do gene G viral foram selecionadas no GenBank a partir de amostras obtidas de bovinos e morcegos infectados. Análises de Máxima Parcimônia foram conduzidas utilizando o software Molecular Evolutionary Genetics Analysis. A árvore de Máxima Parcimônia indicou uma relação filogenética entre o gene G de ambos os hospedeiros, indicando que o vírus evoluiu dos morcegos para os bovinos. A análise dos sítios parcimoniosamente informativos revelou que o gene G viral apresentou mutações específicas em cada hospedeiro. O conhecimento sobre as relações evolutivas do vírus da Raiva e seus hospedeiros é crucial para identificar nos hospedeiros potenciais e novas rotas possíveis de infecção para humanos.

La rabia es una zoonosis fatal que infecta a varias especies de mamíferos. Los murciélagos hematófagos son reconocidos como huéspedes del virus de la rabia y su principal fuente de alimentación es la sangre de otros mamíferos, especialmente del ganado. Al alimentarse, los murciélagos transmiten el virus al ganado que es víctima de la enfermedad, contribuyendo a pérdidas económicas y riesgos de infección para los humanos. Basado en esta afinidad del ciclo de la rabia entre murciélagos y ganado, el objetivo de este estudio fue analizar las relaciones filogenéticas de las muestras de virus de la rabia tanto en huéspedes, ganado y murciélagos. El gen G del virus de la rabia fue elegido para esta investigación porque está directamente relacionado con el proceso de infección. Las secuencias de nucleótidos del gen G viral se seleccionaron en GenBank a partir de muestras obtenidas de bovinos y murciélagos infectados. Los análisis de parsimonia máxima se realizaron utilizando el software Molecular Evolutionary Genetics Analysis. El árbol de Máxima Parsimônia indicó una relación filogenética entre el gen G de ambos huéspedes, indicando que el virus evolucionó de murciélagos a bovinos. El análisis de los sitios parsimoniosamente informativos reveló que el gen G viral presentaba mutaciones específicas en cada huésped. El conocimiento sobre las relaciones evolutivas del virus de la rabia y sus huéspedes es crucial para identificar huéspedes potenciales y nuevas posibles rutas de infección para humanos.

Evolución de la virulencia de SARS-CoV-2 en Chile

Introducción: La evolución de la virulencia ha despertado el interés de la biología evolutiva por décadas. Se trata de co-evolución entre agentes patógenos y sus hospederos. Se han planteado diferentes hipótesis para la evolución de la virulencia, entre ellas la evolución con un compromiso virulencia-transmisión. Objetivo: Estudiar la evolución de la letalidad y la transmisión del SARS CoV-2 en Chile, con la hipótesis que ha existido un compromiso con disminución de la letalidad y aumento de la transmisión de esta durante la epidemia. Resultados: La letalidad diaria en Chile disminuyó claramente. Aunque no se encontró correlación entre la letalidad diaria y el número reproductivo efectivo, el número reproductivo efectivo máximo asociado a cada variante viral, presentó un aumento claro desde la aparición de la variante γ en adelante (δ y O) en Chile. Conclusión: Este estudio muestra una evolución de la virulencia con un compromiso virulenciatransmisión. Esto puede ser explicado en gran parte por la evolución viral, pero el cambio en letalidad también puede ser afectado por las intervenciones no farmacológicas y farmacológicas realizadas por la población humana.

Background: The evolution of virulence has aroused the interest of evolutionary biology for decades. It is about co-evolution between pathogens and their hosts. Different hypotheses have been put forward for the evolution of virulence, including evolution with a virulence-transmission trade-off. Aim: To study the evolution of the fatality rate and transmission of SARS CoV-2 in Chile, with the hypothesis that there has been a trade-off to a decrease in lethality and an increase in its transmission during the epidemic. Results: The daily fatality rate in Chile clearly decreased. Although no correlation was found between daily fatality rate and effective reproductive number, the maximum effective reproductive number associated with each viral variant showed a clear increase from the appearance of the γ variant onwards (δ and O) in Chile. Conclusion: This study shows an evolution of virulence with a virulence-transmission trade-off. This can be largely explained by viral evolution, but the change in lethality can also be affected by non-pharmacological and pharmacological interventions carried out by the human population.

Epilepsy in art: a historical exploration of representations across eras / Epilepsia na arte: uma exploração histórica de representações através de épocas

This narrative review explores the diverse representations of epilepsy in art across different historical periods, examining the intersection of artistic expression with evolving cultural, medical, and societal perceptions. Beginning with ancient and medieval depictions intertwined with religious symbolism, the paper progresses through the Renaissance, and Baroque, and transitions into modern and avant-garde movements. Each period reflects changing attitudes towards epilepsy, from divine interpretations, and religious concerns to anatomical realism and, later, explorations of psychological themes. The contemporary lens focuses on inclusive and empathetic portrayals, utilizing digital media to challenge stigmas and foster understanding.

Esta revisão narrativa explora as diversas representações da epilepsia na arte em diferentes períodos históricos, examinando a intersecção da expressão artística com a evolução das percepções culturais, médicas e sociais. Começando com representações antigas e medievais entrelaçadas com simbolismo religioso, o artigo avança através da Renascença e do Barroco, e transita para movimentos modernos e de vanguarda. Cada período reflete mudanças de atitudes em relação à epilepsia, desde interpretações divinas e preocupações religiosas até o realismo anatômico e, mais tarde, explorações de temas psicológicos. A lente contemporânea centra-se em representações inclusivas e empáticas, utilizando meios digitais para desafiar estigmas e promover a compreensão.

Concordância da avaliação da via alimentar entre fonoaudiólogo e médico baseado na escala FOIS: coorte retrospectiva / Agreement in the assessment of the food pathway between speech therapists and physicians based on the FOIS scale: a retrospective cohort study / Concordancia en la evaluación de la vía alimentaria entre fonoaudiólogos y médicos basada en la escala FOIS: un estudio de cohorte retrospectivo

Introdução: A avaliação fonoaudiológica hospitalar tem um importante papel na prevenção e manejo de pacientes com risco de broncoaspiração. No entanto, nem sempre cabe ao fonoaudiólogo a primeira avaliação e definição da via alimentar nos pacientes hospitalares. Objetivo: Comparar as decisões fonoaudiológicas e médicas quanto à viabilidade da via alimentar em um hospital geral e identificar fatores associados com a melhora da deglutição. Métodos: Trata-se de um estudo retrospectivo de pacientes internados em hospital em Joinville durante março a agosto de 2018. A via alimentar foi considerada com base na Functional Oral Intake Scale (FOIS) sendo a primeira decisão comparada entre o fonoaudiólogo e o médico para o mesmo paciente. Resultados: Dos 171 pacientes, houve maior concordância entre as condutas médica e fonoaudiológica para alimentação por sonda nasoenteral (SNE) (88,7%) e alimentação oral livre (81,9%). No entanto, houve apenas 35% de concordância na definição de dieta adaptada, sendo a concordância geral moderada (Kappa 0,486). Houve evolução na alimentação por via oral em 62 pacientes (36%). Maior limitação da via alimentar, verificado pela necessidade de SNE (OR = 3,17; p = 0,025) e o maior número de atendimentos fonoaudiológicos intra-hospitalares (OR = 1,09; p = 0,020) foram associados com a melhora da disfagia. Conclusão: Encontrou-se concordância entre a avaliação dietética de casos para uso de SNE ou dieta livre entre o fonoaudiólogo e médico. Uso de SNE, como indicador de gravidade do paciente, e o maior número de sessões de fonoterapia foram associados com a melhora da disfagia durante a internação. (AU)

Introduction: Hospital-based speech-language pathology plays a crucial role in preventing and managing patients at risk of bronchoaspiration. However, the initial evaluation and determination of the feeding route in hospitalized patients may not always fall under the responsibility of the speech-language pathologist. Objective: To compare the decisions of speech-language pathologists and medical professionals regarding the feasibility of the feeding route in a general hospital and identify factors associated with swallowing improvement. Methods: This is a retrospective study of patients admitted to a hospital in Joinville from March to August 2018. The feeding route was assessed based on the Functional Oral Intake Scale (FOIS), with the initial decision compared between the speech-language pathologist and the physician for the same patient. Results: Among 171 patients, there was higher agreement between medical and speech-language pathology decisions for nasoenteral tube feeding (88.7%) and oral unrestricted intake (81.9%). However, there was only 35% agreement in defining an adapted diet, with overall moderate agreement (Kappa 0.486). Oral feeding improved in 62 patients (36%). The presence of nasoenteral tube feeding (OR = 3.17; p = 0.025) and a higher number of in-hospital speech-language pathology appointments (OR = 1.09; p = 0.020) were identified as independent predictors for dysphagia improvement. Conclusion: Concordance was found in the dietary assessment for the use of nasoenteral tube feeding or oral unrestricted intake between speech-language pathologists and physicians. The use of nasoenteral tube feeding as an indicator of patient severity and a higher number of speech-language pathology sessions were associated with dysphagia improvement during hospitalization. (AU)

Introducción: La evaluación fonoaudiológica hospitalaria desempeña un papel crucial en la prevención y el manejo de pacientes con riesgo de broncoaspiración. Sin embargo, no siempre corresponde al fonoaudiólogo la primera evaluación y definición de la vía alimentaria en los pacientes hospitalizados.Objetivo: Comparar las decisiones fonoaudiológicas y médicas sobre la viabilidad de la vía alimentaria en un hospital general e identificar factores asociados con la mejora de la deglución. Métodos: Se trata de un estudio retrospectivo de pacientes hospitalizados en un hospital de Joinville durante marzo a agosto de 2018. La vía alimentaria se evaluó según la Escala Funcional de Ingesta Oral (FOIS), siendo la primera decisión comparada entre el fonoaudiólogo y el médico para el mismo paciente. Resultados: De 171 pacientes, hubo una mayor concordancia entre las decisiones médicas y fonoaudiológicas para la alimentación por sonda nasoenteral (SNE) (88,7%) y la alimentación oral libre (81,9%). Sin embargo, solo hubo un 35% de concordancia en la definición de una dieta adaptada, siendo la concordancia general moderada (Kappa 0,486). La alimentación oral mejoró en 62 pacientes (36%). Una mayor limitación de la vía alimentaria, indicada por la necesidad de SNE (OR = 3,17; p = 0,025), y un mayor número de sesiones fonoaudiológicas intrahospitalarias (OR = 1,09; p = 0,020) se asociaron con la mejora de la disfagia.Conclusión: Se encontró concordancia en la evaluación dietética para el uso de SNE o dieta libre entre el fonoaudiólogo y el médico. El uso de SNE, como indicador de la gravedad del paciente, y un mayornúmero de sesiones de fonoterapia se asociaron con la mejora de la disfagia durante la hospitalización. (AU)

Germenectomía de los terceros molares con cefalometría predictiva de brote

Introducción: Las complicaciones, asociadas al brote anormal de los terceros molares, es posible evitarlas con la germenectomía de estos dientes. Objetivo: Caracterizar la evolución de la germenectomía de terceros molares en pacientes con diagnóstico cefalométrico de brote anormal. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Servicio de Cirugía Maxilofacial del Hospital Provincial "Saturnino Lora Torres", desde febrero de 2019 hasta marzo de 2021. Se estudiaron 32 pacientes de 13 a 15 años de edad, interviniéndose quirúrgicamente 78 terceros molares. Las variables fueron edad, sexo, color de la piel, localización y posición del tercer molar; así como las complicaciones trans y posoperatorias y la evolución. Resultados: Entre los 32 pacientes incluidos en el estudio predominó el sexo femenino (62,5 por ciento) y la edad de 14 años (40,6 por ciento). Las complicaciones ocurridas durante la germenectomía fueron más frecuentes en la arcada inferior. Aunque no fueron detectadas diferencias estadísticamente significativas según localización (valor de p>0,05); con 30 transoperatorias para un 38,4 por ciento y 75 posoperatorias para un 96,2 por ciento. Conclusiones: Se evidencia una evolución marcadamente favorable posterior a la germenectomía de terceros molares en la población de pacientes con diagnóstico cefalométrico de brote anormal. En ellos el sangrado transoperatorio y el dolor posoperatorio constituyen las complicaciones a considerar en este tipo de procedimiento quirúrgico(AU)

Introduction: Complications associated with the abnormal eruption of third molars can be avoided with germenectomy of these teeth. Objective: To characterize the evolution of third molar germenectomy in patients with a cephalometric diagnosis of abnormal bud. Methods: An observational, descriptive and cross-sectional study was carried out in the Maxillofacial Surgery Service at Saturnino Lora Torres Provincial Hospital, from February 2019 to March 2021. Thirty two patients aged 13 to 15 years were studied, with 78 third molars undergoing surgery. The variables were age, sex, skin color, location and position of the third molar; as well as trans and postoperative complications and evolution. Results: Among the 32 patients included in the study, the female sex (62.5 percent) and the age of 14 years (40.6 percent) predominated. Complications that occurred during germenectomy were more frequent in the lower arch. Although no statistically significant differences were perceived according to location (p value > 0.05); with 30 intraoperative for 38.4 percent and 75 postoperative for 96.2 percent. Conclusions: There is evidence of a markedly favorable evolution after germenectomy of third molars in the population of patients with cephalometric diagnosis of abnormal bud. In them, transoperative bleeding and postoperative pain are the complications to consider in this type of surgical procedure(AU)

Percepción temporal de síntomas de disfagia en una cohorte de pacientes con disfagia orofaríngea neurogénica

Introducción: La disfagia resulta de varios mecanismos fisiopatológicos donde sus síntomas no son estáticos ni homogéneos en las personas, especialmente cuando existe disfagia orofaríngea neurogénica. Objetivo: Conocer la percepción y comportamiento en el tiempo de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10 (EAT-10) en pacientes con disfagia orofaríngea neurogénica, con el fin de visualizar la dinámica clínica de esta forma de disfagia. Metodología: Estudio observacional tipo cohorte en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares, con seguimiento a tres y seis meses y diligenciamiento del EAT-10 al momento basal, tercer y sexto mes. Resultados: Un total de 90 personas con evaluación basal, de las cuales el 56,7 % (51/90) lograron seguimiento al tercer mes y 25,6 % (23/90) al sexto mes. Los síntomas de disfagia con mayor autopercepción en los tres momentos fueron la dificultad para tragar sólidos, sensación de comida pegada en garganta y tos al comer. La odinofagia no fue un síntoma habitualmente percibido. La puntuación total del EAT-10 estuvo entre 16,61 ± 9 y 18,1 ± 9,5 puntos en general. En pacientes con seguimiento completo se observó variación en la autopercepción para tragar líquidos y pastillas. Se observó variación del puntaje al ajustarlo por recepción de terapias. Discusión: Las enfermedades neurológicas y neuromusculares impactan directamente la deglución con gravedad entre leve a profunda, donde la autopercepción de síntomas deglutorios es dinámica, pero con síntomas cardinales de disfagia orofaríngea en el tiempo. Conclusiones: El reconocimiento y seguimiento de síntomas de disfagia deben ser aspectos usuales en la atención de pacientes con enfermedades neurológicas y neuromusculares.

Introduction: Dysphagia results from several pathophysiological mechanisms where its symptoms are not static or homogeneous in people, especially when there is neurogenic oropharyngeal dysphagia. Objective: To know the perception and behavior over time of symptoms of dysphagia using the Eating Assessment Tool-10 (EAT-10) in patients with neurogenic oropharyngeal dysphagia to visualize the clinical dynamics of this form of dysphagia. Methodology: Observational cohort study in patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes with, follow-up at three and six months, and completion of the EAT-10 at baseline, third and sixth month. Results: A total of 90 people with baseline evaluation were included, of whom 56.7% (51/90) achieved follow-up at the third month and 25.6% (23/90) at the sixth month. Symptoms of dysphagia with greater self-perception at all three moments were difficulty swallowing solids, sensation of food stuck in the throat and coughing when eating. Odynophagia was not a commonly perceived symptom. The total score of the EAT-10 was between 16.61±9 and 18.1±9.5 points in general. In patients with complete follow-up, variation in self-perception of swallowing liquids and pills was observed. Variation of the score when adjusting for the reception of therapies. Discussion: Neurological and neuromuscular diseases directly impact swallowing with mild to profound severity, where self-perception of swallowing symptoms is dynamic, but with cardinal symptoms of oropharyngeal dysphagia over time. Conclusions: The recognition and monitoring of dysphagia symptoms should be usual aspects in the care of patients with neurological and neuromuscular diseases.

Síndrome neuroléptico maligno

El síndrome neuroléptico maligno (SNM) es una reacción adversa medicamentosa potencialmente fatal asociada comúnmente a medicamentos antipsicóticos. Este artículo presenta una revisión actualizada sobre el SNM, aborda su epidemiología, factores de riesgo, presentación clínica, posibles mecanismos subyacentes y tratamiento. Se busca mejorar el reconocimiento temprano, diagnóstico y manejo del SNM en el ámbito clínico para reducir su morbimortalidad. La búsqueda de literatura se realizó en PubMed, fueron priorizados ensayos aleatorizados, revisiones sistemáticas, estudios retrospectivos y reportes de caso. La incidencia del SNM ha disminuido en los últimos años, posiblemente debido a una mejor prescripción y titulación de la medicación. Los factores de riesgo incluyen el uso de antipsicóticos de alta potencia, dosis elevadas, incremento rápido de la dosis y uso de antipsicóticos inyectables de depósito. Se han identificado factores ambientales como la deshidratación, sujeción mecánica y temperaturas extremas. Algunas características psicopatológicas, como la agitación psicomotriz y la confusión, también se han asociado al SNM. Los factores hereditarios y los polimorfismos genéticos pueden influir en la susceptibilidad al SNM, pero se requieren estudios adicionales. La fisiopatología del SNM se relaciona con el bloqueo excesivo de los receptores dopaminérgicos, pero otros cofactores y sistemas neurotransmisores también podrían estar involucrados. El cuadro clínico del SNM se caracteriza por cambios en el estado mental, rigidez muscular, hipertermia, síntomas catatónicos y sudoración profusa. Existen diversas formas de tratamiento, desde medidas generales hasta intervenciones farmacológicas.

The Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse drug reaction commonly associated with antipsychotic medications. This article presents an updated review of NMS, addressing its epidemiology, risk factors, clinical presentation, possible underlying mechanisms, and treatment. The aim is to improve early recognition, diagnosis, and management of NMS in the Peruvian clinical setting to reduce morbidity and mortality. The literature search was conducted in PubMed, prioritizing randomized studies, systematic reviews, retrospective studies, and case reports. The incidence of NMS has decreased in recent years, possibly due to better medication prescription and titration. Risk factors include the use of high-potency antipsychotics, high doses, rapid dose escalation, and the use of depot injectable antipsychotics. Environmental factors such as dehydration, mechanical restraint, and extreme temperatures have been identified. Some psychopathological characteristics, such as psychomotor agitation and confusion, have also been associated with NMS. Genetic factors and genetic polymorphisms may influence susceptibility to NMS, but further studies are needed. The pathophysiology of NMS is related to excessive blockade of dopaminergic receptors, but other cofactors and neurotransmitter systems may be involved. The clinical presentation of NMS is characterized by changes in mental status, muscle rigidity, hyperthermia, catatonic symptoms, and profuse sweating. There are various treatment approaches ranging from general measures to pharmacological interventions.

Origen y evolución de la optometría y la óptica en Cuba y en el mundo

Al revisar la historia de la optometría y la óptica se encuentra que ha tenido procesos de cambio y evolución, debido a la preocupación por la salud visual que ha venido deteriorándose al transcurrir de los años. Para mostrar dichos cambios se realizó una revisión teórica-histórica del origen y la evolución de la optometría y la óptica. Se tuvo en cuenta los datos que han sido de avance científico, tecnológico y humanístico, no solo en la antigüedad sino también en la actualidad, los cuales han servido para mejorar el desarrollo de nuestra actividad profesional y consecuentemente al mejoramiento del bienestar social. Fueron innumerables los hombres que enriquecieron nuestros conocimientos con sus aportes, por lo cual se ha necesitado de muchos siglos de lenta y progresiva evolución para llegar a ser lo que es hoy en día, una ciencia con todas las bases de la óptica, la anatomía y la fisiología de la visión la cual se rige por leyes que nos permiten un conocimiento más exacto de ella. El objetivo es valorar el proceso de origen y evolución de la optometría y la óptica en Cuba y el mundo.

When reviewing the history of optometry and optics, it is found that it has undergone processes of change and evolution, due to the concern for visual health that has been deteriorating over the years. In order to show these changes, a theoretical-historical review of the origin and evolution of optometry and optics was carried out. We took into account the data that have been of scientific, technological and humanistic progress, not only in ancient times but also at present, which have served to improve the development of our professional activity and consequently to the improvement of social welfare. There were countless men who enriched our knowledge with their contributions, so it has taken many centuries of slow and progressive evolution to become what it is today, a science with all the bases of optics, anatomy and physiology of vision which is governed by laws that allow us a more accurate knowledge of it. The objective is to evaluate the process of origin and evolution of optometry and optics in Cuba and the world.

Taxonomía de los hongos: un rompecabezas al que le faltan muchas piezas

Los hongos son organismos polifacéticos presentes en casi todos los ecosistemas de la tierra, donde establecen diversos tipos de simbiosis con otros seres vivos. A pesar de ser reconocidos por los humanos desde la antigüedad -y de la cantidad de trabajos que han profundizado sobre su biología y ecología-, aún falta mucho por conocer sobre estos organismos. Algunos de los criterios que clásicamente se han utilizado para su estudio, hoy resultan limitados y hasta cierto punto permiten un agrupamiento de los aislamientos según algunas características, pero generan confusión en su clasificación y, más aún, cuando se pretende comprender sus relaciones genealógicas. Los caracteres fenotípicos no son suficientes para identificar una especie de hongos y, menos aún, para construir una filogenia amplia o de un grupo particular. Hay grandes vacíos que hacen que los árboles generados sean inestables y fácilmente debatidos. Para los profesionales de la salud, parece que la identificación de los hongos hasta niveles inferiores como género y especie es suficiente para elegir el tratamiento más adecuado para su control, comprender la epidemiología de los cuadros clínicos asociados y reconocer los brotes y los factores determinantes de la resistencia a los antimicrobianos. No obstante, la ubicación taxonómica dentro del reino permitiría establecer relaciones filogenéticas entre los taxones fúngicos, facilitando la comprensión de su biología, su distribución en la naturaleza y la evolución de su potencial patogénico. Los avances de las técnicas de biología molecular y las ciencias de la computación en los últimos 30 años han permitido cambios importantes dirigidos a establecer los criterios para definir una especie fúngica y alcanzar una construcción filogenética más o menos estable. Sin embargo, el camino por recorrer aún es largo, y supone un trabajo mancomunado de la comunidad científica a nivel global y el apoyo a la investigación básica.

Fungi are multifaceted organisms found in almost all ecosystems on Earth, where they establish various types of symbiosis with other living beings. Despite being recognized by humans since ancient times, and the high number of works delving into their biology and ecology, much is still unknown about these organisms. Some criteria classically used for their study are nowadays limited, generating confusion in categorizing them, and even more, when trying to understand their genealogical relationships. To identify species within Fungi, phenotypic characters to date are not sufficient, and to construct a broad phylogeny or a phylogeny of a particular group, there are still gaps affecting the generated trees, making them unstable and easily debated. For health professionals, fungal identification at lower levels such as genus and species, is enough to select the most appropriate therapy for their control, understand the epidemiology of clinical pictures associated, and recognize outbreaks and antimicrobial resistance. However, the taxonomic location within the kingdom, information with apparently little relevance, can allow phylogenetic relationships to be established between fungal taxa, facilitating the understanding of their biology, distribution in nature, and pathogenic potential evolution. Advances in molecular biology and computer science techniques from the last 30 years have led to crucial changes aiming to establish the criteria to define a fungal species, allowing us to reach a kind of stable phylogenetic construction. However, there is still a long way to go, and it requires the joint work of the scientific community at a global level and support for basic research.

Evolución de menores diagnosticados con trastorno de déficit de atención e hiperactividad. Estudio de seguimiento en una muestra española / Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish sample

Resumen Antecedentes: El trastorno de déficit de atención e hiperactividad (TDAH) constituye una condición crónica con riesgos asociados a largo plazo. Objetivo: Analizar el estado clínico, la ocupación y las dificultades de la vida diaria de dos cohortes de niños con diagnóstico de TDAH (2004 y 2009) después cinco y 10 años. Material y método: Estudio descriptivo y longitudinal de la base de datos WOMI correspondiente a Oviedo, Asturias, España. Se incluyeron niños detectados con TDAH por su pediatra de atención primaria. Se solicitó una entrevista telefónica voluntaria de seguimiento. Las variables de resultado fueron estado clínico y ocupacional al momento de la entrevista, síntomas de TDAH según SNAP-IV y Cuestionario de Fortalezas y Dificultades (SDQ). Resultados: La muestra entrevistada estuvo formada por 95 sujetos, de los cuales 71 respondieron a los cuestionarios SNAP-IV y SDQ; 60.7 % de la muestra no recibía tratamiento en el momento del seguimiento, 4.7 % no tenía ninguna ocupación, 25.4 % mantenía síntomas globales de TDAH en nivel superior al punto de corte clínico y 66.2 % presentaba dificultades con interferencia moderada. Conclusiones: Los síntomas del TDAH disminuyen conforme las personas crecen. Las comorbilidades de salud mental y el abandono académico no se confirmaron en la muestra.

Abstract Background: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks. Objective: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years. Material and method: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). Results: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference. Conclusions: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample.

Comparative histological analysis of cerebellum of representative species of elasmobranchii

SUMMARY: In elasmobranch fishes, variations in gross structural organization of cerebellum has been extensively explored. The basic histological features of cerebellum although conserved in the group but the comparative account on subtle cellular variations is largely underestimated. The present study aims to explore the histological and cellular variations in different layers of cerebellar cortex of the representative elasmobranchs' species belonging to different habitat. Our findings showed that the histological architecture of cerebellar granular layer between the examined species varies noticeably. By and large increase cellular density were observed in all the layers of cerebellum in the representative species of shark compared to ray. The findings were then compared and discussed with reference to their habitat and behavior.

En los peces elasmobranquios, las variaciones en la organización estructural general del cerebelo se han explorado ampliamente. Las características histológicas básicas del cerebelo, aunque se conservan en el grupo, pero la descripción comparativa de las variaciones celulares sutiles es limitada. El presente estudio tiene como objetivo explorar las variaciones histológicas y celulares en diferentes capas de la corteza cerebelosa de las especies representativas de elasmobranquios pertenecientes a diferentes hábitats. Nuestros hallazgos mostraron que la arquitectura histológica de la capa granular del cerebelo entre las especies examinadas varía notablemente. Se observó un gran aumento de la densidad celular en todas las capas del cerebelo en las especies representativas de tiburón en comparación con la raya. Luego, los hallazgos se compararon y discutieron con referencia a su hábitat y comportamiento.

Proteína C reactiva y su progresión en el tiempo para la detección de las fugas anastomóticas / C-reactive protein and its progression over time for the detection of anastomotic leaks

Introducción. Las fugas anastomóticas son una complicación común y crítica en cirugía gastrointestinal, por lo que su identificación y tratamiento temprano son necesarios para evitar resultados adversos. El uso convencional con un valor límite de la proteína C reactiva ha demostrado una utilidad limitada. El objetivo de este estudio fue determinar la utilidad de la medición seriada de la proteína C reactiva en la detección de fugas anastomóticas. Métodos. Revisión prospectiva de base de datos retrospectiva de pacientes sometidos a cirugía abdominal mayor con al menos una anastomosis intestinal. Se midió la proteína C reactiva al tercer y quinto día posoperatorio. Las complicaciones se categorizaron según la clasificación de Clavien-Dindo. La precisión diagnóstica fue evaluada por el área bajo la curva. Resultados. Se incluyeron 157 pacientes, el 52 % mujeres. La edad promedio fue de 63,7 años. El mayor número de cirugías correspondió a gastrectomía (36,3 %), resección anterior de recto (15,3 %) y hemicolectomía derecha (13,4 %). El 25,5 % tuvieron alguna complicación postoperatoria y el 32,5 % (n=13) presentaron fuga en la anastomosis. El aumento de la proteína C reactiva tuvo un área bajo la curva de 0,918 con un punto de corte de aumento en 1,3 mg/L, sensibilidad de 92,3 % (IC95% 78 ­ 100) y una especificidad de 92,4 % (IC95% 88 ­ 96). Conclusiones. El aumento de 1,3 mg/L en la proteína C reactiva entre el día de la cirugía y el quinto día fue un predictor preciso de fugas anastomóticas en pacientes con cirugía abdominal mayor

Introduction. Anastomotic leaks are a common and critical complication in gastrointestinal surgery. Their identification and early treatment are necessary to avoid adverse results, and conventional use with a cutoff value of C-reactive protein has shown limited utility. The objective of this study was to determine the usefulness of serial measurement of C-reactive protein in the detection of anastomotic leaks. Methods. Prospective review of a retrospective database of patients undergoing major abdominal surgery with at least one intestinal anastomosis. C-reactive protein was measured on the third and fifth postoperative days. Complications were classified according to the Clavien-Dindo classification. Diagnostic accuracy was evaluated by the area under the curve.Results. 157 patients were included, 52% were females. The average age was 63.7 years. The largest number of surgeries corresponded to gastrectomies (36.3%), anterior resection of the rectum (15.3%) and right hemicolectomies (13.4%). 25.5% had some postoperative complication and 32.5% (n=13) had anastomosis leaks. The increase in C-reactive protein had an area under the curve of 0.918 with an increase cut-off point of 1.3 mg/L, sensitivity of 92.3% (95% CI 78-100) and specificity of 92.4%. (95% CI 88-96). Conclusions. The 1.3 mg/L increase in C-reactive protein between the day of surgery and the fifth day was an accurate predictor of anastomotic leaks in patients with major abdominal surgery

Evaluation of the follow-up of children treated for congenital syphilis in a municipality in the state of Espírito Santo, when it lacked crystalline penicillin / valiação do acompanhamento de crianças tratadas para sífilis congênita em município do estado do espírito santo em época de falta de penicilina cristalina

Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. In Brazil, its incidence has increased, along with the lack of penicillin, the antibiotic of choice for congenital syphilis, from 2014 to 2017. During this period, children were treated with alternative drugs, but to date, data from the scientific literature do not recommend another antibiotic. Objective: To compare the progression, according to the established treatment, and evaluate the follow-up in health care facilities in Vila Velha (Espírito Santo) of children with congenital syphilis aged up to two years, born in Hospital Infantil e Maternidade Alzir Bernardino Alves ­ a reference in neonatology and low-risk pregnancy in the state at the time ­ from 2015 to 2016, when the hospital experienced a greater lack of penicillin. Methods: This is a retrospective cross-sectional observational study based on data from medical records of the hospital and other healthcare facilities in the city. We performed statistical analyses, per health district, of epidemiological and sociodemographic data, as well as those related to visits, their frequency, and clinical profile, according to the follow-up parameters proposed by the Ministry of Health at the time. Results: Medical records of 121 children were evaluated, presenting as the main findings: only 35% of the children completed the follow-up; among those treated with ceftriaxone, 55.2% completed the follow-up, and 100% of the children whose venereal disease research laboratory was greater than that of their mother at birth completed the follow-up. Of the symptomatic children at birth who remained or became symptomatic at follow-up, 58.8% used ceftriaxone. Conclusion: Among symptomatic children at birth, most of those treated with ceftriaxone remained symptomatic at follow-up. The Counseling and Testing Center was the most successful facility in the follow-up of these children. District 5 had the lowest success rate in the follow-up of these patients, and districts 1 and 2 showed the lowest rates of appropriate approach to congenital syphilis during follow-up. (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível causada pela bactéria Treponema pallidum. No Brasil, sua incidência vem aumentando, acompanhada da falta de penicilina, antibiótico de escolha para a sífilis congênita, no período de 2014­2017. Nesse período, as crianças foram tratadas com medicamentos alternativos, porém dados da literatura científica até o momento não recomendam outro antibiótico. Objetivo: Comparar a evolução, de acordo com o tratamento instituído, e avaliar o acompanhamento nas unidades de saúde em Vila Velha (ES), até os dois anos de idade, das crianças com sífilis congênita nascidas no Hospital Infantil e Maternidade Alzir Bernardino Alves ­ referência em neonatologia e gravidez de baixo risco no estado na época ­ de 2015 a 2016, período em que houve maior falta de penicilina no hospital. Métodos: Estudo observacional do tipo transversal, retrospectivo, baseado em dados dos prontuários do hospital e outras Unidades de Saúde do município. Foram analisados estatisticamente, por região de saúde, dados epidemiológicos, sociodemográficos, bem como relativos às consultas, sua periodicidade e ao perfil clínico, de acordo com os parâmetros de seguimento propostos pelo Ministério da Saúde na época. Resultados: Avaliaram-se os prontuários de 121 crianças, obtendo-se como principais achados: somente 35% das crianças tiveram seguimento completo; das crianças tratadas com ceftriaxona, 55,2% tiveram seguimento completo, e 100% das crianças que tiveram VDRL maior que o da mãe no parto completaram o seguimento. Das crianças sintomáticas ao nascimento e que permaneceram ou ficaram sintomáticas no seguimento, 58,8% fizeram uso de ceftriaxona. Conclusão: Das crianças sintomáticas ao nascimento, as tratadas com ceftriaxona, em sua maioria, mantiveram-se sintomáticas no seguimento. O Centro de Testagem e Aconselhamento teve maior êxito no acompanhamento dessas crianças. A região 5 teve a menor taxa de êxito no seguimento desses pacientes, e as regiões 1 e 2 menor taxa de abordagem correta para sífilis congênita durante o seguimento. (AU)

ICF and perception of functioning according to children/adolescents in follow-up with speech/language disorders / CIF e percepção da funcionalidade segundo crianças/adolescentes em acompanhamento por alterações de fala/linguagem

ABSTRACT Purpose To characterize changes in the functioning aspects, in the perception of children and adolescents with speech and language disorders under speech-language follow-up, using the ICF. Methods Descriptive, analytical and longitudinal research, with a qualitative and quantitative approach, whose sample consisted of 60 children and adolescents: 30 with speech and language disorders and 30 with typical speech and language development. Data collection was carried out in two moments: beginning of the research and six months later. A semi-structured questionnaire was administered to the participants, and a medical records analysis was performed. From these data, functioning was classified using he ICF categories. The Wilcoxon test and thematic content analysis were used to compare the interviews. Results The use of ICF allowed characterizing changes resulting from speech-language follow-up. Participants with speech and language disorders presented a decrease in the magnitude of the qualifiers in the categories: articulation and fluency, social relationships, daily activities, engagement in play, people's attitude barriers, and how to handle stress. Conclusion The findings show changes in components of Body Functions, Activities and Participation, and the influence of Environmental Factors after speech-language follow-up, in the perception of the studied group, which brings relevant subsidies for a greater understanding of functioning and therapeutic intervention. The use of the ICF enabled the longitudinal analysis in a biopsychosocial approach, contemplating, in addition to biological aspects, the social impact of speech and language disorders in the lives of these children and adolescents.

RESUMO Objetivo Caracterizar mudanças nos aspectos de funcionalidade, segundo a percepção de crianças e adolescentes com alterações de fala e linguagem em acompanhamento fonoaudiológico, utilizando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Método Pesquisa de delineamento descritivo-analítico, longitudinal e de abordagem qualitativa-quantitativa, cuja amostra se constituiu de 60 crianças e adolescentes: 30 com alteração de fala e linguagem e 30 com desenvolvimento típico de fala. Coleta foi realizada em dois momentos: início da pesquisa e seis meses depois. Foi realizada entrevista com questionário semiestruturado com os participantes, e análise de prontuário. A partir desses dados, a funcionalidade foi caracterizada com as categorias da CIF. Para comparação entre as entrevistas utilizou-se o Teste Wilcoxon e análise de conteúdo temática. Resultados O uso da CIF possibilitou caracterizar mudanças ocorridas com o acompanhamento fonoaudiológico. Os participantes com alterações de fala e linguagem apresentaram diminuição na magnitude dos qualificadores nas categorias de funções de articulação e fluência, relacionamentos sociais, atividades do cotidiano, envolvimento no brincar, atitudes barreiras das pessoas, modo de lidar com o estresse. Conclusão Os achados mostram mudanças nos componentes de Funções do Corpo, Atividades e Participação e a influência dos Fatores Ambientais após o acompanhamento fonoaudiológico na percepção do grupo estudado, o que traz subsídios relevantes quanto à funcionalidade para maior compreensão e intervenção terapêutica. A utilização da CIF possibilitou estudo e análise longitudinal em uma abordagem biopsicossocial, contemplando além dos aspectos biológicos, o impacto social das alterações de fala e linguagem na vida dessas crianças e adolescentes.

Caracterização dos pacientes internados em uti- covid com evolução a óbito / Characterization of patients admitted to uti-covid and evolution to death / Caracterización de pacientes ingresados en uti-covid y evolución a muerte

A infecção humana pelo SARS-CoV-2 desencadeia alterações respiratórias altamente patogênicas e contagiosas e já culminou em mais de 15 milhões de mortes no mundo. Mesmo com o desenvolvimento de vacinas específicas, o COVID-19 persiste até o momento, devido fatores como o surgimento de variantes virais e o declínio da imunidade. O objetivo foi determinar as caraterísticas clínicas, laboratoriais e de imagem dos pacientes que foram a óbito por COVID-19 hospitalizados em um hospital do Meio Oeste de Santa Catarina, entre 2020 e 2022. Trata-se de um estudo observacional descritivo, com coleta de dados secundários e abordagem quantitativa, no período de 2022 a 20223. Foram incluídos prontuários de pacientes da população alvo registrados nos sistemas de informação do hospital. Com isso, foram incluídos na pesquisa 62 pacientes com média de idade de 79 anos, do sexo feminino (55%), branco (80%), com baixa escolaridade (61%), com comorbidades (84%) sendo a principal comorbidade hipertensão, seguido por dislipidemia e cardiopatia. A causa da morte mais frequente foi insuficiência respiratória aguda (27,9%), após uma média de 5 dias de internação, sendo que antes disso, a média de dias desde o surgimento dos sintomas até a internação foram de 6 dias. A ocorrência de vidro fosco na avaliação tomográfica inicial foi de 67%. Laboratorialmente, os exames; d-dímero, creatinina, ureia e leucócitos apresentaram elevação com a progressão da doença, enquanto os valores médios das hemácias, hemoglobina, linfócitos e de albumina tiveram valores reduzidos. Concluindo, é importante conhecer o perfil do paciente e estudar os preditores que apresentam possíveis mecanismos de progressão da doença, para o desenvolvimento de estratégias de prevenção e de tratamento do COVID-19 com foco nos grupos com maior risco de evolução desfavorável, nesse estudo representado pelo sexo feminino, com idade elevada, com doenças crônicas e que usam medicamentos para estas comorbidades e que apresentaram acometimento tomográfico e laboratorial precoce.

Human infection by SARS-CoV-2 triggers highly pathogenic and contagious respiratory changes and has already led to over 15 million deaths worldwide. Even with the development of specific vaccines, COVID-19 persists to date, due to factors such as the emergence of viral variants and declining immunity. The aim was to determine the clinical, laboratory and imaging characteristics of patients who died from COVID-19 hospitalized in a hospital in the Midwest of Santa Catarina between 2020 and 2022. This is a descriptive observational study, with secondary data collection and quantitative approach, in the period from 2022 to 20223. Patient charts of the target population recorded in the hospital's information systems were included. With this, 62 patients were included in the research with a mean age of 79 years, female (55%), white (80%), with low education (61%), with comorbidities (84%) being the main comorbidity hypertension, followed by dyslipidemia and heart disease. The most frequent cause of death was acute respiratory failure (27.9%), after a mean of 5 days of hospitalization, and before that, the mean number of days from onset of symptoms to hospitalization was 6 days. The occurrence of ground glass on initial CT evaluation was 67%. Laboratory tests; d-dimer, creatinine, urea and leukocytes showed elevation with disease progression, while mean values of RBCs, hemoglobin, lymphocytes and albumin had reduced values. In conclusion, it is important to know the patient's profile and study the predictors that present possible mechanisms of disease progression, for the development of prevention and treatment strategies for COVID-19 focusing on groups at higher risk of unfavorable evolution, in this study represented by female, aged, with chronic diseases and who use medications for these comorbidities and who presented early tomographic and laboratory involvement.

La infección humana por SARS-CoV-2 desencadena alteraciones respiratorias altamente patógenas y contagiosas y ya ha provocado más de 15 millones de muertes en todo el mundo. Incluso con el desarrollo de vacunas específicas, el COVID- 19 persiste hasta la fecha, debido a factores como la aparición de variantes virales y la disminución de la inmunidad. El objetivo fue determinar las características clínicas, de laboratorio y de imagen de los pacientes fallecidos por COVID-19 hospitalizados en un hospital del Centro-Oeste de Santa Catarina entre 2020 y 2022. Se trata de un estudio observacional descriptivo, con recolección de datos secundarios y abordaje cuantitativo, en el período de 2022 a 20223. Fueron incluidas las historias clínicas de los pacientes de la población objetivo registradas en los sistemas de información del hospital. Con esto, 62 pacientes fueron incluidos en la investigación con edad media de 79 años, sexo femenino (55%), raza blanca (80%), con baja escolaridad (61%), con comorbilidades (84%) siendo la principal comorbilidad la hipertensión, seguida de dislipidemia y cardiopatía. La causa más frecuente de muerte fue la insuficiencia respiratoria aguda (27,9%), tras una media de 5 días de hospitalización, y antes de eso, la media de días desde el inicio de los síntomas hasta la hospitalización fue de 6 días. La aparición de vidrio deslustrado en la evaluación inicial por TC fue del 67%. Las pruebas de laboratorio; d-dímero, creatinina, urea y leucocitos mostraron elevación con la progresión de la enfermedad, mientras que los valores medios de GR, hemoglobina, linfocitos y albúmina presentaron valores reducidos. En conclusión, es importante conocer el perfil del paciente y estudiar los predictores que presentan posibles mecanismos de progresión de la enfermedad, para el desarrollo de estrategias de prevención y tratamiento de la COVID- 19 con enfoque en los grupos de mayor riesgo de evolución desfavorable, en este estudio representados por el sexo femenino, de edad avanzada, con enfermedades crónicas y que utilizan medicamentos para estas comorbilidades y que presentaron compromiso tomográfico y laboratorial precoz.

Alterações bioquímicas de pacientes com COVID-19 / Alteraciones bioquímicas de pacientes con COVID-19 / Biochemical changes in patients with COVID-19

Resumo Objetivo identificar as alterações bioquímicas dos pacientes com apresentação moderada e grave da doença Covid-19 e as preditivas de gravidade nos que evoluíram do estagio moderado para o grave. Métodos Estudo de coorte prospectivo com 709 pacientes internados com diagnóstico confirmado de COVID-19 e apresentação moderada e grave da doença. Foi realizado em um hospital universitário de média e alta complexidade do estado de São Paulo, no período de abril de 2020 a dezembro de 2021. Os dados coletados dos prontuários foram exames laboratoriais e evolução clínica dos pacientes. Na análise descritiva, foi utilizado frequência absoluta, percentual, média e desvio padrão. Os Testes do Qui-Quadrado de Pearson, Exato de Fisher, Mann-Whitney ou t de Student foram utilizados para comparar as diferenças entre os grupos dos moderados e graves. O nível de significância adotado foi de 0,05. Resultados A média de idade foi significantemente maior nos pacientes graves em relação aos moderados (p<0,001). Os valores da hemoglobina e plaquetas foram estatisticamente menores na internação no grupo dos pacientes graves, proteína C-reativa e D-Dímero, maiores (p<0,001). O número de óbitos foi significantemente maior nos pacientes que foram internados em estado grave (p<0,001) e verificamos também que a hemoglobina e plaquetas estavam abaixo dos valores de referência na internação deste grupo. Dos 533 pacientes que internaram em estado moderado, 38 evoluiram para quadro grave. Conclusão Os resultados mostram a importância da avaliação clínica das variáveis bioquímicas no momento da internação como preditivas de gravidade. Os achados reportados nesta investigação corroboram com dados da literatura e podem elucidar intervenções precoces para melhor manejo dos pacientes desde o momento da internação.

Resumen Objetivo Identificar las alteraciones bioquímicas de los pacientes con cuadro moderado y grave de la enfermedad de COVID-19 y las predictivas de gravedad en los que evolucionaron de nivel moderado a grave. Métodos Estudio de cohorte prospectivo con 709 pacientes internados con diagnóstico confirmado de COVID-19 y cuadro moderado y grave de la enfermedad. Fue realizado en un hospital universitario de complejidad mediana y alta en el estado de São Paulo, durante el período de abril de 2020 a diciembre de 2021. Los datos obtenidos a partir de las historias clínicas fueron pruebas de laboratorio y evolución clínica de los pacientes. En el análisis descriptivo se utilizó frecuencia absoluta, porcentaje, promedio y desviación típica. Para comparar las diferencias entre los grupos de los moderados y graves se utilizaron las pruebas χ2 de Pearson, exacta de Fisher, Mann-Whitney o t de Student. El nivel de significación adoptado fue de 0,05. Resultados El promedio de edad fue considerablemente más alto en los pacientes graves en relación con los moderados (p<0,001). Los valores de la hemoglobina y de las plaquetas fueron estadísticamente inferiores en la internación en el grupo de los pacientes graves, proteína C reactiva y dímero D, superiores (p<0,001). El número de defunciones fue considerablemente más alto en los pacientes que ingresaron en estado grave (p<0,001) y verificamos también que la hemoglobina y las plaquetas estaban por debajo de los valores de referencia en la internación de este grupo. De los 533 pacientes que ingresaron en estado moderado, 38 evolucionaron hacia cuadros graves. Conclusión Los resultados muestran la importancia de la evaluación clínica de las variables bioquímicas en el momento de la internación como predictivas de gravedad. Los resultados informados en esta investigación confirman los datos de la literatura y pueden esclarecer intervenciones tempranas para un mejor manejo de los pacientes desde el momento de la internación.

Abstract Objective To identify the biochemical alterations of patients with moderate and severe COVID-19 and the predictors of severity in those who progressed from the moderate to the severe stage. Methods This is a prospective cohort study with 709 patients hospitalized with a confirmed diagnosis of COVID-19 and moderate and severe illness. It was carried out in a university hospital of medium and high complexity, in the state of São Paulo, from April 2020 to December 2021. Data collected from medical records were laboratory tests and clinical progression of patients. In the descriptive analysis, absolute frequency, percentage, mean and standard deviation were used. Pearson's chi-square, Fisher's exact, Mann-Whitney or Student's t tests were used to compare the differences between the moderate and severe groups. The significance level adopted was 0.05. Results The mean age was significantly higher in severe patients than in moderate ones (p<0.001). Hemoglobin and platelet values were statistically lower upon admission in the group of critically ill patients, C-reactive protein and D-dimer higher (p<0.001). The number of deaths was significantly higher in patients who were hospitalized in a serious condition (p<0.001) and we also found that hemoglobin and platelets were below the reference values at hospitalization in this group. Of the 533 patients who were hospitalized in a moderate condition, 38 progressed to a severe condition. Conclusion The results show the importance of clinical assessment of biochemical variables at the time of admission as predictors of severity. The findings reported in this investigation corroborate data from the literature and can elucidate early interventions for better management of patients from the moment of hospitalization.

Ongoing HIV-1 evolution and reservoir reseeding in two elite controllers with genetically diverse peripheral proviral quasispecies

BACKGROUND Elite controllers (EC) are human immunodeficiency virus (HIV)-positive individuals who can maintain low viral loads for extended periods without antiretroviral therapy due to multifactorial and individual characteristics. Most have a small HIV-1 reservoir composed of identical proviral sequences maintained by clonal expansion of infected CD4+ T cells. However, some have a more diverse peripheral blood mononuclear cell (PBMC)-associated HIV-1 reservoir with unique sequences. OBJECTIVES To understand the turnover dynamics of the PBMC-associated viral quasispecies in ECs with relatively diverse circulating proviral reservoirs. METHODS We performed single genome amplification of the env gene at three time points during six years in two EC with high intra-host HIV DNA diversity. FINDINGS Both EC displayed quite diverse PBMCs-associated viral quasispecies (mean env diversity = 1.9-4.1%) across all time-points comprising both identical proviruses that are probably clonally expanded and unique proviruses with evidence of ongoing evolution. HIV-1 env glycosylation pattern suggests that ancestral and evolving proviruses may display different phenotypes of resistance to broadly neutralising antibodies consistent with persistent immune pressure. Evolving viruses may progressively replace the ancestral ones or may remain as minor variants in the circulating proviral population. MAIN CONCLUSIONS These findings support that the high intra-host HIV-1 diversity of some EC resulted from long-term persistence of archival proviruses combined with the continuous reservoir's reseeding and low, but measurable, viral evolution despite undetectable viremia.

A brief history of the evolution of lung cancer operation / 中华肿瘤杂志

Surgical operation is one of the significant parts of the comprehensive therapeutic methods of lung cancer. In the history of the development of lung cancer operation, scholars and predecessors at home and abroad have gradually established the current status of lung cancer operation and the framework of comprehensive treatment after continuous understanding of local anatomy of lung, continuous innovation of surgical equipment and continuous reform of surgical methods. In the continuous development and improvement of lung cancer surgical diagnosis and treatment procedures, a set of standardized diagnosis and treatment process of lung cancer screening, early diagnosis and treatment, standardized surgery process, rapid perioperative recovery, postoperative adjuvant treatment and follow-up has been formed. The achievements of lung cancer operation are achieved by scholars standing on the shoulders of giants. In the process of pioneering and innovating, we should go back and review the road that our predecessors have taken, and draw energy from it to continue to create new brilliance in lung cancer operation. In this paper, the evolution history of lung cancer surgery is summarized in order to improve the clinician's understanding of the history of lung cancer surgery.