COVID-19 em profissionais de enfermagem no Maranhão (2020-2021): características clínico-epidemiológicas dos casos e fatores associados aos óbitos / COVID-19 in nursing professionals in Maranhão (2020-2021): clinical-epidemiological characteristics of cases and factors associated with deaths / COVID-19 en profesionales de enfermería en Maranhão (2020-2021): características clínico-epidemiológicas de casos y factores asociados a muerte

Objetivo: descrever características clínico-epidemiológicas dos casos de COVID-19 em profissionais de enfermagem e analisar fatores associados aos óbitos. Método: estudo transversal realizado com casos e óbitos por COVID-19 em profissionais de enfermagem registrados no período entre abril de 2020 e março de 2021 no estado do Maranhão. Utilizou-se a estatística descritiva e modelos de regressão logística. Resultados: verificaram-se 2.116 casos de COVID-19 em profissionais de enfermagem, a maioria eram técnicos (63,23%), sexo feminino (86,48%), raça/cor preta/parda (48,20%), na faixa etária de 31 a 40 anos (40,69%) e média de idade de 38,11 anos (DP=9,58). A hipertensão arterial sistêmica foi a principal comorbidade apresentada (62,03%). Os fatores de risco para o óbito foram: idade >60 anos, comorbidades como hipertensão arterial sistêmica, diabetes mellitus e obesidade. Conclusão: esses dados podem direcionar intervenções em saúde mais efetivas com intuito de minimizar os riscos de infecção e os danos à saúde desses trabalhadores.

Objective: to identify clinical-epidemiological characteristics of two cases of COVID-19 in nursing professionals and to analyze factors associated with deaths. Method: a cross-sectional study was carried with cases and deaths from COVID-19 in nursing professionals registered between April 2020 and March 2021 in Maranhão. Descriptive statistics and logistic regression models were used. Results: we verified 2,116 cases of COVID-19 in nursing professionals, mostly among technicians (63.23%), females (86.48%), of black/white/brown ethnicity (48.20%), aged from 31 to 40 years (40.69%), and with a mean age of 38.11 years (SD=9.58). Systemic arterial hypertension was the main comorbidity (62.03%). The risk factors for death are age >60 years and comorbidities such as systemic arterial hypertension, diabetes mellitus, and obesity. Conclusion: our findings can support more effective health interventions to minimize the risk of infection and damage to the health of these workers.

Objetivo: identificar las características clínico-epidemiológicas de casos de COVID-19 en profesionales de enfermería y analizar los factores asociados a muertes. Método: se realizó un estudio transversal con casos y muertes por COVID-19 en profesionales de enfermería registrados entre abril de 2020 y marzo de 2021 en Maranhão. Se utilizaron estadísticas descriptivas y modelos de regresión logística. Resultados: verificamos 2.116 casos de COVID-19 en profesionales de enfermería, en su mayoría técnicos (63,23%), del sexo femenino (86,48%), de etnia negra/blanca/morena (48,20%), con edad de 31 a 40 años (40,69%) y edad media de 38,11 años (DE=9,58). La hipertensión arterial sistémica fue la principal comorbilidad presentada (62,03%). Los factores de riesgo de muerte fueron: edad > 60 años y comorbilidades como hipertensión arterial sistémica, diabetes mellitus y obesidad. Conclusión: esos hallazgos pueden respaldar intervenciones de salud más efectivas para minimizar el riesgo de infección y daño a la salud de estos trabajadores.

Factors associated with extubation failure in an intensive care unit: a case-control study / Fatores associados à falha de extubação em unidade de terapia intensiva: estudo de caso-controle / Factores asociados al fracaso de la extubación en unidad de cuidados intensivos: estudio de caso y control

Abstract Objective: to investigate the factors associated with extubation failure of patients in the intensive care unit. Method: unpaired, longitudinal, retrospective and quantitative case-control with the participation of 480 patients through clinical parameters for ventilator weaning. Data were analyzed by: Fisher's exact test or the chi-square test; unpaired two-tailed Student's t test; and Mann-Whitney test. Significant P values lower than or equal to 0.05 were admitted. Results: of the patients, 415 (86.5%) were successful and 65 (13.5%) failed. Success group: the most negative fluid balance, APACHE II in 20 (14-25), weak cough in 58 (13.9%). Failure group: the most positive fluid balance, APACHE II in 23 (19-29), weak cough in 31 (47.7%), abundant amount of pulmonary secretions in 47.7%. Conclusion: positive fluid balance and the presence of inefficient cough or inability to clear the airway were predictors of extubation failure.

Resumo Objetivo: investigar os fatores associados à falha de extubação de pacientes na unidade de terapia intensiva. Método: caso-controle não pareado, longitudinal, retrospectivo e quantitativo com a participação de 480 pacientes por meio de parâmetros clínicos para desmame ventilatório. Dados analisados por: Teste Exato de Fisher ou o teste Qui-quadrado; teste t de Student bicaudal não pareado; e teste de Mann-Whitney. Admitiram-se significantes valores de P menores ou iguais a 0,05. Resultados: dos pacientes, 415 (86,5%) tiveram sucesso e 65 (13,5%) falharam. Grupo sucesso: balanço hídrico mais negativo, APACHE II em 20 (14-25), tosse fraca em 58 (13,9%). Grupo falha: balanço hídrico mais positivo, APACHE II em 23 (19-29), tosse fraca em 31 (47,7 %), quantidade abundante de secreção pulmonar em 47,7 %. Conclusão: o balanço hídrico positivo e a presença de tosse ineficiente ou incapacidade de higienizar a via aérea foram preditores de falhas de extubação.

Resumen Objetivo: investigar los factores asociados al fracaso de la extubación de pacientes en la unidad de cuidados intensivos. Método: caso y control no apareado, longitudinal, retrospectivo y cuantitativo con la participación de 480 pacientes mediante parámetros clínicos para el destete de la ventilación. Datos analizados por: Prueba Exacta de Fisher o prueba de Chi-cuadrado; prueba t de Student de dos colas para datos no apareados; y prueba de Mann-Whitney. Se admitieron valores de P significativos menores o iguales a 0,05. Resultados: de los pacientes, 415 (86,5%) tuvieron éxito y 65 (13,5%) fracasaron. Grupo de éxito: balance hídrico más negativo, APACHE II en 20 (14-25), tos débil en 58 (13,9%). Grupo de fracaso: balance de líquidos más positivo, APACHE II en 23 (19-29), tos débil en 31 (47,7%), abundante cantidad de secreciones pulmonares en 47,7%. Conclusión: el balance hídrico positivo y la presencia de tos ineficaz o incapacidad para higienizar la vía aérea fueron predictores de fracaso de la extubación.

Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature / Fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica: revisão integrativa / Factores de riesgo para el desarrollo de infección del sitio quirúrgico en cirugía bariátrica: una revisión integradora

Abstract Objective: to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery. Method: integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner. Results: surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted. Conclusion: conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.

Resumo Objetivo: avaliar as evidências sobre os fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica. Método: revisão integrativa. A busca dos estudos primários foi realizada em quatro bases de dados. A amostra foi composta por 11 pesquisas. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. A análise e a síntese dos dados foram realizadas de maneira descritiva. Resultados: as taxas de infecção de sítio cirúrgico variaram de 0,4% até 7,6%, considerando os resultados dos estudos primários, cujos pacientes foram submetidos à cirurgia por via laparoscópica. Nas pesquisas com os participantes submetidos aos procedimentos cirúrgicos com diferentes abordagens (aberta, via laparoscópica ou robótica), as taxas de infecção variaram de 0,9% até 12%. Com relação aos fatores de risco para o desenvolvimento deste tipo de infecção, ressaltam-se antibioticoprofilaxia, sexo feminino, Índice de Massa Corporal elevado e hiperglicemia perioperatória. Conclusão: a condução da revisão gerou corpo de evidências que reforça a importância na implementação de medidas efetivas para prevenção e controle de infecção de sítio cirúrgico pelos profissionais de saúde após cirurgia bariátrica, promovendo a melhoria da assistência e da segurança do paciente no perioperatório.

Resumen Objetivo: evaluar las evidencias sobre los factores de riesgo para el desarrollo de infección de sitio quirúrgico en cirugía bariátrica. Método: revisión integradora. La búsqueda de estudios primarios se realizó en cuatro bases de datos. La muestra estuvo compuesta por 11 investigaciones. La calidad metodológica de los estudios incluidos se evaluó mediante herramientas propuestas por el Joanna Briggs Institute. El análisis y la síntesis de los datos se realizaron de manera descriptiva. Resultados: las tasas de infección del sitio quirúrgico oscilaron entre 0,4% y 7,6%, considerando los resultados de los estudios primarios, en los que los pacientes fueron sometidos a cirugía mediante laparoscopia. En investigaciones con participantes que se sometieron a procedimientos quirúrgicos con diferentes enfoques (abierto, laparoscópico o robótico), las tasas de infección oscilaron entre el 0,9 % y el 12 %. En cuanto a los factores de riesgo para el desarrollo de este tipo de infección, se destacan la profilaxis antibiótica, el sexo femenino, el Índice de Masa Corporal elevado y la hiperglucemia perioperatoria. Conclusión: la realización de la revisión generó un cuerpo de evidencia que refuerza la importancia de implementar medidas efectivas para la prevención y el control de la infección de sitio quirúrgico, por parte de los profesionales de la salud, después de la cirugía bariátrica, promoviendo la mejora de la atención y la seguridad del paciente en el período perioperatorio.

Factores asociados con la conversión a técnica abierta en la colecistectomía laparoscópica / Factors associated with conversion to open technique in laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es el estándar de oro para el manejo de la patología de la vesícula biliar con indicación quirúrgica. Durante su ejecución existe un grupo de pacientes que podrían requerir conversión a técnica abierta. Este estudio evaluó factores perioperatorios asociados a la conversión en la Clínica Central OHL en Montería, Colombia. Métodos. Estudio observacional analítico de casos y controles anidado a una cohorte retrospectiva entre 2018 y 2021, en una relación de 1:3 casos/controles, nivel de confianza 95 % y una potencia del 90 %. Se caracterizó la población de estudio y se evaluaron las asociaciones según la naturaleza de las variables, luego por análisis bivariado y multivariado se estimaron los OR, con sus IC95%, considerando significativo un valor de p<0,05, controlando variables de confusión. Resultados. El estudio incluyó 332 pacientes, 83 casos y 249 controles, mostrando en el modelo multivariado que las variables más fuertemente asociadas con la conversión fueron: la experiencia del cirujano (p=0,001), la obesidad (p=0,036), engrosamiento de la pared de la vesícula biliar en la ecografía (p=0,011) y un mayor puntaje en la clasificación de Parkland (p<0,001). Conclusión. La identificación temprana y análisis individual de los factores perioperatorios de riesgo a conversión en la planeación de la colecistectomía laparoscópica podría definir qué pacientes se encuentran expuestos y cuáles podrían beneficiarse de un abordaje mínimamente invasivo, en búsqueda de toma de decisiones adecuadas, seguras y costo-efectivas

Introduction. Laparoscopic cholecystectomy is the gold standard for the management of gallbladder pathology with surgical indication. During its execution, there is a group of patients who may require conversion to the open technique. This study evaluated perioperative factors associated with conversion at the OHL Central Clinic in Montería, Colombia. Methods. Observational analytical case-control study nested in a retrospective cohort between 2018 and 2021, in a 1:3 case/control ratio, 95% confidence level and 90% power. The study population was characterized and the associations were evaluated according to the nature of the variables, then the OR were estimated by bivariate and multivariate analysis, with their 95% CI, considering a value of p<0.05 significant, controlling for confounding variables. Results. The study included 332 patients, 83 cases and 249 controls, showing in the multivariate model that the variables most strongly associated with conversion were: the surgeon's experience (p=0.001), obesity (p=0.036), gallbladder wall thickening on ultrasonography (p=0.011), and a higher score in the Parkland classification (p<0.001). Conclusions. Early identification and individual analysis of the perioperative risk factors for conversion in the planning of laparoscopic cholecystectomy could define which patients are exposed, and which could benefit from a minimally invasive approach, in search of making safe, cost-effective, and appropriate decisions

Exposição a agrotóxicos e o risco de tumores do Sistema Nervoso Central em crianças: revisão sistemática com metanálise / Pesticide exposure and risk of Central Nervous System tumors in children: a systematic review with meta-analysis

Resumo Os tumores do Sistema Nervoso Central (SNC) representam mais da metade das neoplasias infantis malignas que acometem crianças. Objetivou-se analisar o risco de exposição a agrotóxicos relacionado com o desenvolvimento de tumores do SNC em crianças. Realizou-se uma revisão sistemática da literatura nas bases de dados PubMed/MEDILINE, Embase, Web of Science, Scopus e CINAHL. Foram incluídos estudos de coorte e caso-controle sobre o desenvolvimento de tumores do SNC (todos os tipos histológicos do grupo III Classificação de Câncer Infantil) decorrentes da exposição a agrotóxicos em crianças de 0-14 anos. Na metanálise utilizou-se o modelo de efeito aleatório e o método estatístico de Mantel-Haenszel. A Razão de Chances (RC) ou Odds Ratio (OR) foi a medida de associação aplicada. A revisão foi registrada no International Prospective Register of Systematic Reviews (PROSPERO) sob o número CRD42021209354. A busca identificou 1.158 estudos, dos quais 14 compuseram a revisão. Verificou-se evidência de associação entre o desenvolvimento de astrocitomas e a exposição a todas as classes de pesticidas (OR 1,50; IC95% 1,15-1,96; p=0,03). A síntese dos resultados apontou para uma relação da exposição aos agrotóxicos com o desfecho de alguns tipos histológicos de tumores do SNC na infância.

Abstract Central Nervous System (CNS) tumors represent more than half of all childhood malignant neoplasms. The aim of this study was to determine the relationship between environmental exposure to pesticides and the development of CNS tumors in children. We conducted a systematic review of the literature in the PubMed/MEDILINE, Embase, Web of Science, Scopus, and CINAHL databases. The inclusion criteria were cohort and case-control studies investigating the association between exposure to pesticides and CNS tumors (all histological types included in group III of the WHO Classification of Childhood Cancer) in children aged 0-14 years. The meta-analysis was performed using a random effects model and the Mantel-Haenszel method. Strength of association was measured using odds ratios (OR). The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42021209354. The search identified 1,158 studies, 14 of which were included in the review. There was evidence of an association between the development of astrocytomas and exposure to all classes of pesticides (OR 1.50; 95%CI 1.15-1.96; p=0.03). The synthesis of the evidence pointed to a relationship between exposure to pesticides and some histological types of CNS tumors in childhood.

EGFR inhibitors: clinical aspects, risk factors and biomarkers for acneiform eruptions and other mucosal and cutaneous adverse effects

Abstract The frequency of the use of drugs that act on the epidermal growth factor receptor (EGFR) is increasing, with the consequent onset of cutaneous toxicity, specifically acneiform eruption. The authors extensively review the topic, focusing on describing how these drugs can affect the skin and its appendages, that is, the pathophysiology that encompasses the cutaneous toxicity related to the use of EGFR inhibitors. In addition, it was possible to list the risk factors that may be associated with adverse effects of these drugs. Based on this recent knowledge, the authors expect to aid in the management of patients who are more vulnerable to toxicity, reduce morbidities, and improve the quality of life of patients undergoing treatment with EGFR inhibitors. Other issues related to the toxicity of EGFR inhibitors, such as the clinical aspects of the acneiform eruption grades, and other different types of cutaneous and mucosal reactions, are also included in the article.

Fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama / Factors associated with time-to-treatment initiation of breast cancer

Resumo Este estudo retrospectivo investigou fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama entre 12.100 casos assistidos em estabelecimentos de saúde habilitados para a alta complexidade em oncologia no âmbito do SUS localizados no Rio de Janeiro entre 2013 e 2019. Regressão logística multivariada estimou razões de chances e intervalos de 95% de confiança. Foram submetidos ao primeiro tratamento em tempo >60 dias 82,1% dos casos. Entre aqueles sem histórico de diagnóstico anterior, alta escolaridade e estadiamento III e IV exibiram menor probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto tratamento em estabelecimento de saúde não localizado na capital exibiu probabilidade maior. Entre aqueles com histórico de diagnóstico anterior, idade ≥50 anos, raça/cor da pele não branca e estadiamento I exibiram maior probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto alta escolaridade, tratamento em estabelecimento de saúde não localizado na capital e estadiamento IV exibiram probabilidade menor. Em suma, fatores sociodemográficos, clínicos e relacionados ao estabelecimento de saúde estão associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

Abstract The present retrospective study investigated factors associated with time-to-treatment initiation of breast cancer of a cohort of 12,100 cases of health facilities qualified for high complexity in oncology within the scope of the Brazilian Public Health System (SUS) of Rio de Janeiro between 2013 and 2019. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Of all cases, 82.1% were submitted to the first treatment >60 days. Patients without previous diagnosis history, higher education and in stages III and IV were less likely to have their first treatment >60 days, while treatment at a health facility outside the capital showed a higher probability. Patients with a previous diagnosis history, aged ≥50, non-white race/skin color and in stage I were more likely to be submitted to their first treatment >60 days, while subjects with higher education, treated in a health facility outside the capital and in stage IV showed a lower probability. To summarize, sociodemographic, clinical and health facility-related factors are associated with time-to-treatment initiation of breast cancer.

Prevalência de ingestão hídrica e fatores associados entre idosos não institucionalizados do Sul do Brasil / Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil

Resumo O objetivo deste estudo foi descrever a prevalência de idosos com uma ingestão adequada de água e seus fatores associados. Estudo transversal de base populacional realizado em 2014 com idosos (≥ 60 anos) participantes do estudo "COMO VAI?". Investigou-se o número de copos de água ingeridos/dia pelos entrevistados, considerando-se adequada a ingestão de pelo menos oito copos/dia. As variáveis independentes foram características sociodemográficas, comportamentais e de saúde. A regressão de Poisson foi utilizada para a investigação das associações. Foram entrevistados 1.451 idosos, sendo observado que uma baixa percentagem, 12,6% (IC95% 10,8; 14,7) referiu consumo adequado de água. Maior percentagem de consumo adequado de água foi observada nos idosos mais jovens, com excesso de peso, que apresentaram cinco ou mais doenças e que eram mais dependentes quanto à capacidade funcional. A tendência decrescente de ingestão de água em relação à idade torna essencial o desenvolvimento de ações voltadas para essa população de maior risco acerca da importância de uma ingestão hídrica adequada e das possíveis consequências do seu consumo inadequado.

Abstract The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

DIGITAL GAMING ADDICTION AMONG ADOLESCENTS STUDENTS OF ST. COLUMBA'S COLLEGE, HAZARIBAGH.

Digital gaming addiction has become a growing concern among adolescents, with potential gender differences in prevalence, risk factors, and consequences. The aims of the study to provide an outcome of existing tools on digital gaming addiction among adolescents, focusing specifically on gender differences. By examining key tools, the study explores the prevalence of gaming addiction among male and female adolescents, gender-related risk factors, and the differential impact of gaming addiction on various domains of well-being. The findings highlight the importance of considering gender-specific factors in understanding and addressing digital gaming addiction among adolescents.

Análisis clínicos en pediatría: la necesidad de minimizar las horas de ayuno / Clinical analysis in pediatrics: the need to minimize fasting hours

Los informes de laboratorio tienen impacto en las decisiones médicas. El ayuno es un factor preanalítico "controlable" que influye en los distintos parámetros bioquímicos. El objetivo del presente trabajo es poner en discusión la realización en pediatría de análisis clínicos con la indicación de un ayuno fisiológico , analizando resultados obtenidos por diferentes autores y evaluando las diferencias clínicas encontradas según los criterios de calidad establecidos por el laboratorio de Química Clínica. La mayoría de los individuos durante el día se encuentran en estado postprandial. Los resultados del perfil lipídico en ayunas no representan las concentraciones reales promedios de los lípidos plasmáticos de un paciente. El ayuno no sería crítico en la etapa de pesquisa , pero puede ser relevante para establecer un diagnóstico certero o inicio de tratamiento. En el caso de la glucemia si se indica en el control rutinario del paciente, y no hay sospecha de alteraciones en el metabolismo de los hidratos de carbono la glucemia sin ayuno puede ser solicitada comparando la misma con valores de corte adecuado. Las diferentes guías nacionales e internacionales recomiendan que la elección de la métrica para la evaluación, control y seguimiento de pacientes con diagnóstico de diabetes se realicen según el objetivo terapéutico. En los trabajos analizados, observamos que varios parámetros bioquímicos presentaron diferencias estadísticas, aunque las diferencias clínicas no fueron relevantes y permanecieron dentro de los intervalos de referencia. El factor limitante para evaluar parámetros bioquímicos sin ayuno es la falta de valores de referencia adecuados. Hay evidencia suficiente para que tanto el perfil lipídico, la glucemia como el resto de los parámetros bioquímicos del laboratorio de química clínica, sean solicitados con la indicación de un ayuno fisiológico de 2, 4 o 6 horas, dependiendo siempre del motivo de consulta y/o la edad del paciente. Es esencial extender la evaluación a otros analitos en población pediátrica, así como evaluar nuevos puntos de corte para parámetros bioquímicos sin ayuno (AU)

Laboratory reports have an impact on medical decision-making. Fasting is a "controllable" preanalytical factor that influences the different biochemical parameters. The aim of this study is to discuss the performance of clinical analyses in pediatrics with the indication of physiological fasting, analyzing results obtained in different disciplines, and evaluating the clinical differences found according to the quality criteria established by the clinical chemistry laboratory. During the day, most patients are in a postprandial state. Fasting lipid profile results do not represent the actual average plasma lipid concentrations of a patient. Fasting would not be critical in the screening stage, but it may be relevant to establish an accurate diagnosis or initiate treatment. Regarding glycemia, if it is indicated in the routine control of the patient and there is no suspicion of alterations in carbohydrate metabolism, non-fasting glycemia can be requested, comparing it with adequate cut-off values. Different national and international guidelines recommend that the choice of metrics for the evaluation, control, and follow-up of patients with diabetes should be made according to the therapeutic objective. In the studies analyzed, we found that several biochemical parameters presented statistical differences, although the clinical differences were not relevant and remained within the reference range. The limiting factor in the evaluation of biochemical parameters without fasting is the lack of adequate reference values. There is sufficient evidence that the lipid profile, glycemia, and the remaining biochemical parameters of the clinical chemistry laboratory should be requested with the indication of a physiological fast of 2, 4, or 6 hours, always depending on the reason for consultation and/or the patient's age. It is essential to extend the evaluation to other analytes in the pediatric population, as well as to evaluate new cut-off points for biochemical parameters without fasting (AU)

Importance of so called "novel cardiovascular risk factors" in severity of coronary artery calcification; how serious they should be taken: a systematic review and metaanalysis / Importancia de los denominados "factores novedosos de riesgo cardiovascular" en la severidad de la calcificación de las arterias coronarias; qué tan serios deben tomarse: una revisión sistemática y un metaanálisis

Abstract Cardiovascular diseases are among important causes of death. Atherosclerosis is an important etiology for coronary artery diseases in which coronary artery calcification plays a principal role. Recently novel cardiovascular risk factors in coronary calcification are under attention. In this study, we investigated possible association between novel cardiovascular risk factors and coronary calcification. This is a prospectively registered systematic review and meta-analysis in PROSPERO and was performed in accordance with PRISMA guidelines. Medical databases were searched. Primary papers were screened and studies reporting our outcomes of interest were selected for data extraction. Quantitative data syntheses were performed using Comprehensive Meta-analysis Ver.3. In this study, 5252 papers were screened and finally 28 papers including 31241 patients underwent data extraction. Based on our findings, neutrophil/lymphocyte ratio (8 out of 10), red cell distribution width (r = 0.250, p < 0.0001), and interleukin 6 (odds ratio [OR]: 1.101 [95% confidence interval (CI): 1.001-1.210], p = 0.047) were associated with severity of coronary calcification while C-reactive protein (one out of eight) was not associated with coronary calcification. Results of lymphocyte/monocyte ratio (r = -0.120, p < 0.001), platelet/lymphocyte ratio (OR: 1.47 [95% CI: 0.89-2.41, p = 0.124]), and MPV (r = 0.017, p = 0.814 vs. OR: 1.91 [95% CI: 1.28-2.85, p = 0.002]) remained controversial due to few number of included studies or contrary results. We can conclude that neutrophil/lymphocyte ratio, red cell distribution width, and interleukin-6 are significantly associated with coronary calcification and C-reactive protein is not significantly associated with severity of coronary calcification. Our results about mean platelet volume, platelet/lymphocyte ratio, and lymphocyte/monocyte ratio are not reliable and require further investigations.

Resumen Las enfermedades cardiovasculares se encuentran entre las primeras causas de mortalidad. La aterosclerosis es una etiología importante de las enfermedades de las arterias coronarias en la que la calcificación de las arterias coronarias juega un papel principal. Recientemente, se están prestando atención a factores novedosos de riesgo cardiovascular en la calcificación coronaria. En este estudio investigamos la asociación posible entre los factores novedosos de riesgo cardiovascular y la calcificación coronaria. Esta es una revisión sistemática y metaanálisis registrados de forma prospectiva en PROSPERO y se realizó de acuerdo con las pautas de PRISMA. Se realizaron búsquedas en bases de datos médicas. Se examinaron los artículos primarios y se seleccionaron para la extracción de datos los estudios cuyos resultados fueron de nuestro interés. Las síntesis de datos cuantitativos se realizaron utilizando Comprehensive Meta-analysis Ver.3. En este estudio se seleccionaron 5252 artículos y finalmente se extrajeron los datos de 28 artículos que incluían 31241 pacientes. Según nuestros hallazgos, la proporción de neutrófilos/linfocitos (8 de 10), el ancho de distribución de glóbulos rojos (r = 0,250, valor de p < 0.0001) y la interleucina 6 (OR: 1.101 [IC del 95%: 1.001-1.210], valor p = 0.047) se asociaron con la gravedad de la calcificación coronaria, mientras que la proteína C reactiva (1 de 8) no se asoció con la calcificación coronaria. Resultados de la proporción linfocitos/monocitos (r = -0,120, valor p < 0,001), la proporción plaquetas/linfocitos (OR: 1,47 [IC 95%: 0.89-2.41, valor p = 0.124]) y el volumen plaquetario medio (r = 0.017, valor p = 0.814 C. OR: 1.91 [IC 95%: 1.28-2.85, valor p = 0.002]) siguieron siendo polémicos debido al escaso número de estudios incluidos o resultados contrarios. Podemos concluir que la proporción de neutrófilos/linfocitos, el ancho de distribución de los glóbulos rojos y la interleucina 6 se asocian significativamente con la calcificación coronaria y la proteína C reactiva no se asocia significativamente con la gravedad de la calcificación coronaria. Nuestros resultados sobre el volumen plaquetario medio, la proporción de plaquetas/linfocitos y la proporción de linfocitos/monocitos no son confiables y requieren más investigaciones.

Epidemiology and severity of traumatic dental injuries in permanent teeth: A 20-year retrospective study

Abstract This study aimed to assess the traumatic dental injuries (TDIs) in permanent dentition among patients who attended at the outpatient clinic of a Brazilian dental school, during the last 20 years, and to investigate factors associated with the severity of these injuries. Clinical records of patients who attended a specialized center for dental trauma care in Brazil presenting at least one TDI in a permanent tooth, between the years 2000 and 2019, were reviewed. The data recorded were sex, age, affected arch, etiology, number, and type of the teeth affected, and classification and severity of the TDIs. The diagnosis and classification of the TDIs were based on the guidelines of the International Association of Dental Traumatology (IADT). The severity of each patient's injuries was defined as mild, moderate, or severe. Descriptive statistics, chi-square and multinomial regression analyses were used to evaluate the results. The significance level was set at 5%. A total of 837 clinical records were included, totaling 2357 teeth. Males were more prevalent than females. The patients' age ranged from 5 to 71 years. The most common traumas were avulsion (n=512) and uncomplicated enamel-dentin fracture (n=488). Univariate analyses showed that there was a statistically significant association between age group (p=0.004), etiology (p=0.000) and number of teeth affected (p=0.000) with severity of dental trauma. In conclusion, TDIs that occurred in Piracicaba and region are epidemiologically similar to those found worldwide, and that more severe injuries are related to age range, etiology and number of teeth affected.

Resumo Esse estudo objetivou avaliar as injúrias dentárias traumáticas (IDTs) na dentição permanente entre os pacientes que compareceram ao ambulatório de uma faculdade de odontologia brasileira, durante os últimos 20 anos, e investigar fatores associados à severidade dessas lesões. Os registros clínicos dos pacientes que compareceram a um centro especializado de atendimento em traumatismo dentário no Brasil apresentando pelo menos uma IDT em dente permanente, entre os anos de 2000 e 2019, foram revisados. Os dados registrados foram sexo, idade, arco dental afetado, etiologia, número e tipo dos dentes afetados, e classificação e severidade das IDTs. O diagnóstico e a classificação das IDTs foram baseados nas diretrizes da Associação Internacional de Traumatologia Dentária (AITD). A gravidade das lesões de cada paciente foi definida como leve, moderada ou severa. Estatísticas descritivas, teste qui-quadrado e análises de regressão multinomial foram usadas para avaliar os resultados. O nível de significância foi fixado em 5%. Um total de 837 registros clínicos foi incluído, totalizando 2357 dentes. O sexo masculino foi mais prevalente que o feminino. A idade dos pacientes variou de 5 a 71 anos. Os traumas mais comuns foram avulsão (n=512) e fratura não-complicada do esmalte-dentina (n=488). As análises univariadas mostraram que houve associação estatisticamente significativa entre a faixa etária (p=0,004), etiologia (p=0,000) e número de dentes afetados (p=0,000) com a gravidade do traumatismo dentário. Em conclusão, as IDTs que ocorreram em Piracicaba e região são epidemiologicamente semelhantes aos encontrados em todo o mundo, e que lesões mais graves estão relacionadas à faixa etária, etiologia e número de dentes afetados.

Clinical characteristics, etiological profile, treatment and long term outcomes in patients with non ischemic systolic heart failure; Himachal Pradesh heart failure registry (HP–HF registry)

Background: The data on clinical characteristics, treatment practices and out comes in patients with Nonischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment

Assessment of Risk Factors for Primary Open-angle Glaucoma

Introduction: primary open-angle glaucoma (POAG) is a chronic and progressive anterior optic neuropathy characterized by perimetric alterations and pathological excavation of the optic disc in the absence of other ocular pathologies or congenital anomalies. It is usually accompanied by an increase in intraocular pressure. Gonioscopic examination confirms that the iridocorneal angle is open. The term "risk factor" is defined as a condition statistically leading to an increased risk of occurrence of an event. The purpose of our work is to list the main risk factors of POAG.Patients and Methods: This is a retrospective study carried out in our ophthalmology department over a period of 4 years between January 2018 and December 2021, involving one hundred patients with POAG followed in glaucoma consultation.Results: These are 100 cases, with an average age of 64.27, with a male predominance. The most found risk factors in our series are: age, intraocular hypertension (IOH), thin cornea, arterial hypertension, diabetes and family history of glaucoma.Conclusion: The identification of the main risk factors of POAG at the individual level is a major data of the management. Knowing these factors helps to monitor patients at risk more carefully and to adjust the treatment more appropriately in patients likely to develop glaucoma or to aggravate already known glaucoma. More efforts are required for early screening and education on POAG in communities, especially in a POAG high-risk population

Severe acute respiratory syndrome for COVID-19 by RT-PCR test during its intensifying phase, Gujarat, India

Background: The COVID-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) originated from Wuhan, China, a pandemic. By knowing different demographic and clinical data, one can have a better idea about the progress and fate of disease, which will help others to plan accordingly to manage patients in terms of decreasing morbidity and mortality caused by it. Aims and Objectives: The study was done to describe the RT-PCR diagnostic profiles of SARS-CoV-2 patients in Gujarat from three districts (Arvalli, Sabarkantha, and Gandhinagar) and their correlation with respect to age, sex, travel history, symptoms, and underlying conditions. Materials and Methods: This was a retrospective cohort study of patients with COVID-19, who were screened for SARS-CoV-2 from April 16 to May 25, 2020, from three districts of Gujarat (Arvalli, Sabarkantha, and Gandhinagar). Positive cases were confirmed by qRT-PCR and analyzed for epidemiological, demographic, and clinical characterization among different groups. Results: Of 4000 suspects screened, a total of 199 patients were confirmed with SARS-CoV-2 infection. Among them, middle-aged group (5.4%) and young adult patients (4.3%) were infected with SARS-CoV-2. The median age was 33 years, including 143 males and 56 females. The positivity rate from breathlessness was 8 (28.5%), nasal discharge 2 (25%), and nausea/vomiting 2 (25%) followed by fever 28 (20%) among total cases in respective categories. Among asymptomatic 3536 patients, 146 patients were confirmed for SARS-CoV. Among 256 patients with comorbidities, 14 patients were confirmed for SARS-CoV. Conclusion: Clinical investigation in initial SARS-CoV-2 patients in the western Indian region revealed that young adult male was more susceptible than female. Symptoms such as fever, cough, and sore throat reports are useful for screening the SARS-CoV-2.

Autism Spectrum Disorders-A Review on The Preventive Aspects

Autism Spectrum disorder (ASD) is a neurodevelopmental disorder presenting with defects in social commu-nication skills and repetitive sensory motor behaviour. There has been increasing concern regarding this dis-order due to its increase in incidence and prevalence in recent years. Since it stays for lifelong and has no spe-cific pharmacological treatment, many studies are being conducted to find ways of preventing this disorder. Better understanding of the causative factors will lead to better development of prevention strategies. This review aims at highlighting the methods of prevention of ASD which are mostly focussed on the environmen-tal factors causing ASD as well as the ongoing researches on development of drugs and genetic modification using animal models. Some studies have shown preventive effects of factors such as nutrition supplements such as Vitamin D and folate, breastfeeding and avoiding exposure to harmful chemicals and drugs. The aim is to prevent the occurrence of the disorder and preventing the severity of symptoms wherever possible. Still more studies are needed to establish the exact association between the possible causative factors and ASD so that clinical trials can be done to establish the preventive effects in future.

Fenotipos hipertrigliceridemia e hipertensión-cintura abdominal alterada y su asociación con factores de riesgo cardiovascular en mujeres atendidas en Consulta Provincial de Climaterio

Fundamento: la presencia de fenotipos hipertensión- circunferencia abdominal aumentada se considera un índice pronóstico de deterioro cardiometabólico. Objetivo: determinar la frecuencia de mujeres con fenotipos cintura alterada y establecer la asociación entre estos y los principales factores de riesgo cardiovascular, así como estimar el riesgo cardiovascular global a los 10 años. Métodos estudio descriptivo, correlacional, transversal, que incluyó a 100 mujeres que asistieron a Consulta Provincial de Climaterio, del Hospital Gustavo Aldereguìa, de Cienfuegos, desde marzo 2016 a 2020. Variables analizadas: edad, color de piel, tabaquismo, hipertensión arterial, obesidad, actividad física, diabetes mellitus, índice de masa corporal, circunferencia abdominal, colesterol total, ácido úrico y triglicéridos. Se determinó la razón de prevalencia con un nivel de significación del 95 %. Resultados: la razón de probabilidad demostró mayor riesgo de presentar el fenotipo en mayores de 45 años (1,47), obesas (5,57), hipertensas (3,71) y diabéticas (1,67). Se evidenció asociación significativa entre hábito de fumar y actividad física con razón de probabilidad de 5,80 y 18 respectivamente. Conclusiones: existe una relación significativa entre fenotipos cintura abdominal alterada y los principales factores de riesgo cardiovasculares, como incremento de la edad, riesgo cardiovascular, diabetes mellitus, hipertensión arterial, tabaquismo, inactividad física y obesidad.

Background: the presence of hypertension-increased abdominal circumference phenotypes is considered a cardiometabolic deterioration prognostic index. Objective: to determine the frequency of women with altered waist phenotypes and to establish the association between these and the main cardiovascular risk factors, as well as to estimate the global cardiovascular risk at 10 years. Methods: descriptive, correlational, cross-sectional study, which included 100 women who attended the Provincial Climacteric Consultation, at the Gustavo Aldereguía Lima Cienfuegos Hospital, from March 2016 to 2020. The analyzed variables were: age, skin color, smoking, arterial hypertension, obesity, physical activity, diabetes mellitus, body mass index, abdominal circumference, total cholesterol, uric acid, and triglycerides. The prevalence ratio was determined with a significance level of 95%. Results: the likelihood ratio showed a higher risk of presenting the phenotype in people over 45 years of age (1.47), obese (5.57), hypertensive (3.71) and diabetic (1.67). A significant association was found between smoking and physical activity with a probability ratio of 5.80 and 18, respectively. Conclusions: there is a significant relationship between altered abdominal waist phenotypes and the main cardiovascular risk factors, such as increased age, cardiovascular risk, diabetes mellitus, arterial hypertension, smoking, physical inactivity and obesity.

Alteraciones del metabolismo glucídico y factores de riesgo aterogénico en familiares de primera línea de pacientes diabéticos

Fundamento la diabetes mellitus es una de las enfermedades con mayor morbilidad y mortalidad entre las afecciones crónicas no trasmisibles y su prevalencia en individuos con antecedentes familiares de primer grado es elevada. Objetivo: describir las alteraciones del metabolismo glucídico y los factores de riesgo aterogénicos presentes en familiares de primera línea de pacientes diabéticos de un consultorio médico Método: se realizó un estudio descriptivo de corte transversal entre los meses de enero de 2020 a enero de 2022, que incluyó a los familiares de primera línea de los pacientes diabéticos tipo 2, dispensarizados en el consultorio No. 10 perteneciente al Policlínico Universitario Héroes del Moncada del municipio Plaza de la Revolución. Se estudiaron 122 pacientes mayores de 19 años. Se analizaron como variables: edad, sexo y color de la piel, factores de riesgo aterogénico y las alteraciones del metabolismo de los hidratos de carbono. Resultados: predominaron los pacientes del sexo femenino y el grupo de edad 19 y 39 años. El factor de riesgo más frecuente fue la dislipemia, presente en el 43,4 % seguido de la hipertensión arterial y del sobrepeso/obesidad. Las alteraciones del metabolismo glucídico se presentaron en 74,6 % de los pacientes, con predominio de la glucemia en ayunas alterada en el 30,3 % y en 11,5 % se diagnósticó diabetes mellitus. Conclusiones: las alteraciones del metabolismo glucídico y los factores de riesgo aterogénicos detectadas ponen de manifiesto la asociación entre factores genéticos y ambientales en el desarrollo de la enfermedad y la importancia de trazar estrategias de prevención desde edades tempranas de la vida.

Foundation: diabetes mellitus is one of the diseases with the highest morbidity and mortality among non-communicable chronic conditions and its prevalence in individuals with a first-degree family history is high. Objective: to describe the alterations in glucose metabolism and the atherogenic risk factors present in diabetic patients' first-degree relatives of a medical office. Method: a descriptive cross-sectional study was carried out between January 2020 and January 2022, which included first-degree relatives of type 2 diabetic patients, dispensed at medical office No. 10 belonging to the Héroes del Moncada University Policlinic from the Plaza de la Revolución municipality, 122 patients older than 19 years old were studied. The following variables were analyzed: age, sex, and skin color, atherogenic risk factors, and changes in carbohydrate metabolism. Results: female patients and the age group 19 and 39 years old predominated. The most frequent risk factor was dyslipidemia, present in 43,4 % followed by arterial hypertension and overweight/obesity. Alterations in glucose metabolism occurred in 74,6 % of the patients, with a predominance of altered fasting glycemia in 30,3 % and 11,5 % diagnosed with diabetes mellitus. Conclusions: the alterations in glucose metabolism and the atherogenic risk factors detected reveal the association between genetic and environmental factors in the development of the disease and the importance of developing prevention strategies from an early age of life.

Variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey

Fundamento: la infertilidad femenina es un término utilizado para referirse a una mujer que no ha podido quedar embarazada después de haberlo intentado por lo menos en un año al mantener relaciones sexuales desprotegidas. Objetivo: caracterizar algunas variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en el Hospital Docente Ginecobstétrico Provincial Ana Betancourt Mora de Camagüey durante el año 2021. El universo estuvo constituido por 304 pacientes con diagnóstico de infertilidad. Las variables estudiadas incluyeron: grupo etáreo, tipo de infertilidad, municipio de origen, tasa de incidencia, nivel educacional, hábitos tóxicos, factores de riesgo y antecedentes personales. Los datos se expresaron en números y porcientos. Resultados: el 30,9 % correspondió al grupo etáreo de 30 a 34 años, procedentes en su mayoría del municipio Camagüey (43,5 %), mientras Céspedes alcanzó la mayor tasa de incidencia (13,8 %) por cada 1000 mujeres con rango de edad que pudieran ser admitidas en el programa. Un porciento elevado tenía estudios universitarios (45,4 %) y preuniversitarios (24,3 %), predominó el consumo de café (24,0 %) y tabaco (14,5 %) como hábitos tóxicos; así como enfermedades de trasmisión sexual (24,7 %) y el uso de anticonceptivo (21,1 %). La obesidad (13,5 %) resultó ser el principal antecedente personal. Conclusiones: la infertilidad femenina está determinada por varios factores, incluidos los epidemiológicos, como los hábitos tóxicos, el estado nutricional, los antecedentes personales, entre otros, en su mayoría modificables, que pueden ser tratados desde la Atención Primaria de Salud.

Background: female infertility is a term used to refer to a woman who has not been able to get pregnant after trying for at least a year by having unprotected sexual intercourse. Objective: to characterize some socio-epidemiological variables of female infertility in Camagüey province. Methods: a descriptive, cross-sectional study was carried out at the Ana Betancourt Mora Camagüey Provincial Gynecobstetric Teaching Hospital during the year 2021. The universe consisted of 304 patients diagnosed with infertility. The variables studied included: age group, type of infertility, municipality of origin, incidence rate, educational level, toxic habits, risk factors, and personal history. Data were expressed in numbers and percentages. Results: 30.9 % corresponded to the age group of 30 to 34 years, coming mostly from the Camagüey municipality (43.5 %), while Cespedes reached the highest incidence rate (13.8 %) per 1000 women with age range that could be admitted to the program. A high percentage had university studies (45.4 %) and pre-university studies (24.3 %), the consumption of coffee (24.0 %) and tobacco (14.5 %) predominated as toxic habits; as well as sexually transmitted diseases (24.7 %) and the use of contraception (21.1 %). Obesity (13.5 %) turned out to be the main personal history. Conclusions: female infertility is determined by several factors, including epidemiological ones, such as toxic habits, nutritional status, personal history, among others, mostly modifiable, which can be treated from Primary Health

Primer Consenso Nacional Intersociedades de Inmunización del Adulto. 2023

Las vacunas previenen millones de muertes cada año y su eficacia y seguridad han sido ampliamente establecidas. En términos económicos, la vacunación es una de las intervenciones sanitarias más costo efectivas, generando un importante ahorro y crecimiento económico que supone a largo plazo. Se ha demostrado que la vacunación de adultos disminuye la morbilidad y la mortalidad asociadas a enfermedades infecciosas prevenibles, reduciendo las complicaciones y las hospitalizaciones, incluidos los ingresos a las unidades de cuidados intensivos. Hemos elaborado este documento de consenso con el objeto de diseñar un esquema de vacunación pragmático, accesible y estandarizado del adulto, según categoría de riesgo y edad, sobre la base de la evidencia disponible de vacunas accesibles y nuevas vacunas habiendo utilizado el Tercer Consenso de la Sociedad Paraguaya de Infectología del 2019 como base para las recomendaciones finales.

SUMMARY Vaccines prevent millions of deaths each year, and their efficacy and safety have been widely established. In economic terms, vaccination is one of the most cost-effective health interventions, generating significant savings and long-term economic growth. Adult vaccination has been shown to decrease morbidity and mortality associated with preventable Infectious diseases, reducing complications and hospitalizations, including admissions to intensive care units. We have prepared this consensus document in order to design a pragmatic, accessible and standardized vaccination scheme for adults, according to risk category and age, based on the available evidence of available vaccines and new vaccines, having used the third consensus of the Paraguayan Infectious Diseases Society of 2019 as a basis for the final recommendations.