Reference intervals for serum immunoglobulins G, M and E levels in Brazilian children aged 1 to 10 years: a population-based study

Abstract Objective: To determine the reference intervals (RI) for serum levels of IgG, IgM, and IgE in healthy children aged 1-10 years living in central Brazil. Method: A sample of 1743 healthy children was randomly selected from kindergartens and public schools. Reference intervals were defined by non-parametric rank (Clinical Laboratory Standards Institute, USA), bootstrapping, and Horn's robust methods. Results: By the rank method, the IgG RI was 792-1771 mg/dL for children of both sexes aged 1-10 years. IgM RI were different for gender and age groups, being 45-196 mg/dL and 34-190 mg/dL for boys aged 1-2 years and 3-10 years, respectively. For girls, the IgM RI were 50-212 mg/dL and 39-212 mg/dL, for ages 1-4 and 5-10 years, respectively. The IgE RI for both sexes and ages 1-10 years was 6-1005 mg/dL. The bootstrap method showed RI similar to the rank method but with slightly different confidence intervals. Horn's robust method determined RI different from those obtained by previous methods. Conclusion: RI for serum concentrations of IgG, IgM, and IgE were established for Brazilian children aged 1-10 years. This definition will be useful for Brazilian physicians, who will have more adequate parameters for their clinical decision-making.

Flowers vs. Devils: plants used against witchcraft in the urbanized Sonora Market, Mexico City / Flores vs Demonios: plantas usadas contra la brujería en el urbanizado Mercado de Sonora, Ciudad de México

Mexican markets embody cultural diversity and offer a wide range of products, serving as hubs for local exchange.In our study at Mexico City's Sonora Market, the country's prominent medicinal market, we explored the use of plant remedies against witchcraft in an urban environment. Through interviews with plant vendors and extensive data collection, we identified 21 plant species from 16 botanical families renowned for their effectiveness in combating sorcery, attracting good luck, and promoting success. Additionally, we documented 14 ailments associated with envy and negative emotions. These remedies involved practices and applications such as cleansings, decoctions, baths, and incense burning, aimed at alleviating afflictions and fostering positive outcomes. Notably, the Sonora Market continues to uphold the tradition of using plant remedies against witchcraft, even in the bustling setting of one of the world's largest cities. This highlights the enduring significance of these practices within Mexican society

Los mercados mexicanos encarnan diversidad cultural y ofrecen numerosos productos, sirviendo como centros de intercambio local. En nuestro estudio en el Mercado de Sonora en la Ciudad de México, el sitio de plantas medicinales más relevante del país, exploramos el uso de plantas contra la brujería en un entorno urbano. A través de entrevistas con locatarios, identificamos 21 especies de plantas pertenecientes a 16 familias botánicas usadas en la lucha contra la brujería, atrayendo buena suerte y promoviendo el éxito. Además, documentamos 14 enfermedades asociadas con la envidia y emociones negativas. Los remedios involucraban prácticas y aplicaciones como limpias, decocciones, baños, incienso, con el objetivo de aliviar dolencias y fomentar resultados positivos. En el Mercado deSonora persiste la tradición de utilizar plantas contra la brujería, incluso en el marco de una de las mayores ciudades del mundo, resaltando la importancia de estas prácticas dentro de la sociedad mexicana.

Gravidade dos sintomas da covid-19 e qualidade de vida na covid longa: qual a relação em adultos e idosos? / Severity of covid-19 symptoms and quality of life in long covid: what is the relationship between adults and the elderly? / Gravedad de los síntomas de covid-19 y calidad de vida en long covid: ¿cuál es la relación entre adultos y ancianos?

Avaliar a relação entre gravidade dos sintomas da Covid-19 e qualidade de vida na Covid Longa em adultos e idosos. Trata-se de estudo transversal, prospectivo e multicêntrico, realizado com indivíduos com idade superior á 18 anos com Covid Longa, de ambos os sexos, acompanhados nas Clínicas Escolas da Universidade Paulista ­ UNIP. Foi aplicado uma ficha de avaliação, no qual foram coletadas informações como, dados pessoais, história clínica da Covid-19, e manejos da doença em relação a necessidade de oxigenoterapia, ventilação mecânica não invasiva (VNI) e invasiva (VM) e traqueostomia (TQT), bem como o questionário SF36 versão Brasileira. A pesquisa foi submetida e aprovada pelo CEP da Universidade Paulista ­ UNIP, parecer 4.894.652. Os adultos e idosos que foram internados tiveram pior qualidade de vida nos domínios capacidade funcional, vitalidade e saúde mental. Aqueles que utilizaram oxigenoterapia, VM e TQT, tiveram maior acometimento no domínio saúde mental e os indivíduos que utilizaram a VNI, tiveram pior pontuação no domínio capacidade funcional. Conclui-se que adultos e idosos com Covid Longa apresentaram pior qualidade de vida à longo prazo, sobretudo naqueles com maior gravidade dos sintomas da Covid-19, ou seja, que necessitaram de internação, oxigenoterapia, VNI, VM e traqueostomia.

To evaluate the relationship between the severity of Covid-19 symptoms and quality of life adults and elderly with Long Covid in. This is a cross-sectional, prospective and multicenter study, carried out with individuals aged over 18 years with Long Covid, of both gender, followed at the Clinic School of Universidade Paulista - UNIP. Infor-mations such as personal data, clinical history of Covid-19, and disease management in relation to used of oxygen therapy, non-invasive (NIV) and invasive mechanical ventila-tion and tracheostomy was collected. SF36 questionnaire version Brazilian was aplied to assess quality of life . Adults and elderly people who were hospitalized had a worse quality of life in functional capacity, vitality and mental health domains. Furthermore, those who used oxygen therapy, intubation and tracheostomy, had worse mental health. The individuals who used NIV had worse scores in domain capacity works. It is con-cluded that adults and elderly people with Long Covid had a worse quality of life in the long term, especially in those with more severe symptoms of Covid-19, that is, those who required hospitalization, oxygen therapy, invasive and non-invasive mechanical ventilation and tracheostomy.

Relacionar la gravedad de los síntomas de Covid-19 y la calidad de vida en adultos y ancianos con Largo Covid. Métodos: Se trata de un estudio transversal, prospectivo y multicéntrico, realizado con individuos mayores de 18 años con Largo Covid, de ambos sexos, seguidos en las Clínicas Escolas de la Universidade Paulista - UNIP. Se aplicó un formulario de evaluación, en el cual se recolectó información como datos personales, antecedentes clínicos de Covid-19 y manejo de la enfermedad en relación a la necesidad de oxigenoterapia, ventilación mecánica no invasiva e invasiva y traqueotomía, así como la Cuestionario SF36 versión brasileña. Resultados: Los adultos y ancianos hospitalizados tenían peor calidad de vida en los dominios capacidad funcional, vitalidad y salud mental. De los cuales usaban oxigenoterapia, intubación y traqueotomía, tenían peor salud mental. Los individuos que usaban ventilación mecánica no invasiva tenían peores puntuaciones en el domínio del la capacidad funcional. Conclusión: Se concluye que los adultos y ancianos con Covid Largo tuvieron una peor calidad de vida a largo plazo, especialmente en aquellos con síntomas más severos de Covid-19, es decir, aquellos que requirieron hospitalización, oxigenoterapia, invasiva y no invasiva. ventilación mecánica y traqueotomía.

Empoderamento estrutural de enfermeiros nos serviços de emergências: revisão integrativa / Empoderamiento estructural de enfermeros en los servicios de emergencias: revisión integradora / Structural empowerment of nurses in emergency services: an integrative review

Resumo Objetivo Sintetizar e analisar as evidências científicas acerca do empoderamento estrutural dos enfermeiros, especificamente no contexto da emergência. Métodos Revisão integrativa da literatura realizada nas bases de dados eletrônicas: Lilacs, PubMed, Scopus, Web of Science e Embase. Foram identificados 174 artigos nas bases de dados, considerando-se os critérios de inclusão e exclusão: estudos originais, nos idiomas português, inglês e espanhol, publicados a partir de 1996 e cujo escopo fossem os trabalhos acerca do empoderamento estrutural de enfermeiros atuantes nos diversos cenários da emergência. Após a avaliação e os refinamentos dos trabalhos por intermédio dos critérios estabelecidos, obteve-se um total de seis estudos para análise. Resultados Foram estabelecidas duas categorias temáticas para sintetizar o conhecimento: "as dimensões do empoderamento estrutural dos enfermeiros da emergência" e "a relação do empoderamento estrutural dos enfermeiros com outras variáveis e seu impacto no contexto da emergência". Essas categorias temáticas permitiram evidenciar que a oportunidade é fundamental para o empoderamento do enfermeiro nesse contexto, além disso, observou-se a relevância da liderança e o ambiente de trabalho como componentes importantes que influenciam no empoderamento e na prática profissional do enfermeiro. Conclusão O empoderamento estrutural é significativo para prática profissional do enfermeiro no contexto da emergência, pois ter acesso às dimensões de empoderamento resulta em autonomia no trabalho, níveis maiores de autoeficácia e melhoria na qualidade e segurança da assistência prestada.

Resumen Objetivo Sintetizar y analizar las evidencias científicas sobre el empoderamiento estructural de los enfermeros, específicamente en el contexto de emergencias. Métodos Revisión integradora de la literatura realizada en las bases de datos electrónicas Lilacs, PubMed, Scopus, Web of Science y Embase. Se identificaron 174 artículos en las bases de datos, con los siguientes criterios de inclusión y exclusión: estudios originales, en portugués, inglés y español, publicados a partir de 1996, cuyo alcance eran los trabajos sobre el empoderamiento estructural de enfermeros que trabajan en diferentes escenarios de emergencias. Después de la evaluación y la refinación de los trabajos mediante los criterios establecidos, se obtuvo un total de seis estudios para el análisis. Resultados Se establecieron dos categorías temáticas para sintetizar el conocimiento: "las dimensiones del empoderamiento estructural de los enfermeros de emergencias" y "la relación del empoderamiento estructural de los enfermeros con otras variables y el impacto en el contexto de emergencias". Estas categorías temáticas permitieron evidenciar que la oportunidad es fundamental para el empoderamiento de los enfermeros en este contexto. Además, se observó la relevancia del liderazgo y del ambiente de trabajo como componentes importantes que influyen en el empoderamiento y en la práctica profesional de los enfermeros. Conclusión El empoderamiento estructural es significativo para la práctica profesional de los enfermeros en el contexto de emergencias, ya que tener acceso a las dimensiones del empoderamiento tiene como resultado la autonomía en el trabajo, mayores niveles de autoeficacia y una mejora de la calidad y seguridad de la atención brindada.

Abstract Objective to synthesize and analyze the scientific evidence on the structural empowerment of nurses, specifically in the context of the emergency room. Methods An integrative literature review was carried out using the electronic databases Lilacs, PubMed, Scopus, Web of Science and Embase. 174 articles were identified in the databases, considering the inclusion and exclusion criteria: original studies, in Portuguese, English and Spanish, published from 1996 onwards and whose scope was work on the structural empowerment of nurses working in the various emergency scenarios. After evaluating and refining the studies using the established criteria, a total of six studies were obtained for analysis. Results Two thematic categories were established to synthesize the knowledge: "the dimensions of structural empowerment of emergency nurses" and "the relationship between nurses' structural empowerment and other variables and their impact in the emergency context". These thematic categories made it clear that opportunity is fundamental to nurses' empowerment in this context, as well as the relevance of leadership and the work environment as important components that influence nurses' empowerment and professional practice. Conclusion Structural empowerment is significant for nurses' professional practice in the context of emergencies, since having access to the dimensions of empowerment results in autonomy at work, higher levels of self-efficacy and an improvement in the quality and safety of the care provided.

Facilitators and barriers in the organization of physiotherapists' work in a specialized rehabilitation center / Facilitadores e barreiras na organização do trabalho de fisioterapeutas em um centro especializado em reabilitação

Abstract Introduction: Physiotherapy is part of the multidiscipli-nary team of specialized rehabilitation centers and seeks to offer users comprehensive care from a biopsychoso-cial perspective. Objective: To get to know facilitators and obstacles related to the physiotherapists' work orga-nization in a specialized rehabilitation center present in their care practices provided and recommended for persons with disabilities. Methods: We conducted a qualitative, descriptive study, taking the case study as a guiding model, developed and analyzed from methodological resources of ethnography. Three data collection strategies were used: documentary research, direct observation and interviews with physiotherapists. Data were analyzed through the reconstruction of scenes, articulating the elements captured in the data production process. Results: The findings regarding the reception and welcoming pointed out how the aspects of demand and overloaded agenda make it difficult to adopt the embracement, however, welcoming practices are perceived during the assistance provided by the physiotherapist. Assessments and reassessments need to be reformulated, taking a common language base as a reference and for that it is necessary to induce manage-ment with an impact on the organization of work. The singular therapeutic project is not yet a reality in the institution, as its adoption also leads to changes and the dismantling of the established culture of assistance through productivity pressured by demand. Conclusion: Our study made it possible to identify the contribution of knowledge about the organization of work in the specialized center for the implementation or not of an approach that is closer to what is desired in terms of care in the biopsychosocial perspective.

Resumo Introdução: A fisioterapia integra a equipe multidisciplinar de centros especializados em reabilitação e busca ofertar um cuidado integral na perpectiva biopsicosso-cial aos usuários. Objetivo: Conhecer facilitadores e obstáculos relacionados à organização do trabalho do fisioterapeuta em um centro especializado em reabilita-ção, presente em suas práticas de cuidado prestadas e preconizadas à pessoa com deficiência. Métodos: Trata-se de um estudo qualitativo, descritivo, tomando como modelo condutor o estudo de caso, desenvolvido e analisado a partir de recursos metodológicos da etnografia. Utilizaram-se três estratégias de coleta de dados: pesquisa documental, observação direta e entre-vistas com os fisioterapeutas. Os dados foram analisa-dos por meio da reconstrução de cenas, articulando os elementos capturados no processo de produção dos dados. Resultados: Os aspectos de demanda e agenda sobrecarregada dificultam a adoção do acolhimento, contudo percebem-se práticas acolhedoras durante a assistência prestada pelo fisioterapeuta. As avaliações e reavaliações precisam ser reformuladas, tomando como referencial uma base de linguagem comum e, para isso, é preciso uma indução da gestão com impacto sobre a organização do trabalho. O projeto terapêutico singular ainda não é realidade na instituição, visto que a adoção do mesmo também remete a mudanças e ao desmonte da cultura estabelecida de assistência por produtivi-dade pressionada pela demanda. Conclusão: O estudo permitiu identificar a contribuição do conhecimento sobre a organização do trabalho no centro especializado para a efetivação ou não de uma abordagem que se aproxime do que se almeja em termos de cuidado na perspectiva biopsicossocial.

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática da literatura / Chest physiotherapy in children with pneumonia: a systematic literature review / Fisioterapia respiratoria en niños con neumonía: revisión sistemática de la literatura

Objetivo: Avaliar a atuação da fisioterapia respiratória no tratamento da pneumonia em crianças. Métodos: Trata-se de uma revisão sistemática baseada no método Preferred Reporting Items for Sistematic Reviews and Meta-Análises (PRISMA). Neste estudo foram incluídos artigos originais relacionados com objetivo que aplicaram a fisioterapia respiratória no tratamento de crianças com pneumonia, escritos na língua portuguesa e inglesa, publicados no site da Biblioteca Virtual em Saúde (BVS), nas bases de dados Literatura Latino-Americana e do caribe em ciências da saúde (LILACS), Scientific-Electronic-Library-Online (SciELO), no Physioterapia Evidence Database (PEDro) e PubMed, utilizando os descritores (pneumonia, respiratory physiotherapy, chest therapy, pediatric e child*). Resultados: Inicialmente foram identificados 273 artigos publicados e, de acordo com os critérios de inclusão, exclusão e elegibilidade, ao final cinco foram selecionados para análise qualitativa. Dos artigos selecionados para o estudo, três mostraram que fisioterapia respiratória proporcionou melhorias significativas entre os pacientes de grupo de controle e intervenção, usando técnicas e equipamentos que auxiliavam na desobstrução das vias aéreas e diminuição das internações decorrentes da pneumonia. Contudo, não houve estudos que qualificassem as intervenções fisioterapêuticas como principal recurso para o tratamento dessa doença. Conclusão: Dessa forma, conclui-se que a utilização da fisioterapia respiratória pode ser um adjuvante importante para a melhora dos quadros e funções respiratórias de crianças com pneumonia.

Objective: To evaluate the performance of respiratory physical therapy in the treatment of pneumonia in children. Methods: This is a systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. This study included original articles related to the objective that applied respiratory physiotherapy in the treatment of children with pneumonia, written in Portuguese and English, published on the Virtual Health Library (VHL) site, in the Latin American and Caribbean Health Sciences Literature (LILACS), Scientific-Electronic-Library-Online (SciELO), Physiotherapy Evidence Database (PEDro) and PubMed databases, using the descriptors (pneumonia, respiratory physiotherapy, chest therapy, pediatric and child*). Results: Initially 273 published articles were identified and according to the inclusion, exclusion and eligibility criteria, at the end five were selected for qualitative analysis. Of the articles selected for the study, three showed that respiratory physiotherapy provided significant improvements among control and intervention group patients using techniques and equipment that aided in airway clearance and decreased hospitalizations due to pneumonia. However, there were no studies qualifying physical therapy interventions as the main resource for the treatment of this disease. Conclusion: Therefore, we concluded that chest physiotherapy can be an important adjuvant for the improvement of respiratory function in children with pneumonia.

Objetivo: Evaluar el papel de la fisioterapia respiratoria en el tratamiento de la neumonía en niños. Métodos: Esta es una revisión sistemática basada en el método Preferred Reporting Items for Sistematic Reviews and Meta-Análises (PRISMA). Este estudio incluyó artículos originales relacionados con el objetivo de aplicar la fisioterapia respiratoria en el tratamiento de niños con neumonía, escritos en portugués e inglés, publicados en el sitio web de la Biblioteca Virtual en Salud (BVS), en las bases de datos de Literatura Latinoamericana y del Caribe en ciencias de la salud. (LILACS), Scientific-Electronic-Library-Online (SciELO), no Physioterapia Evidence Database (PEDro) e PubMed, utilizando los descriptores (pneumonia, respiratory physiotherapy, chest therapy, pediatric e child*). Resultados: Inicialmente se identificaron 273 artículos publicados y, según los criterios de inclusión, exclusión y elegibilidad, finalmente se seleccionaron cinco para el análisis cualitativo. De los artículos seleccionados para el estudio, tres mostraron que la fisioterapia respiratoria proporcionó mejoras significativas entre los pacientes de los grupos de control e intervención, utilizando técnicas y equipos que ayudaron a despejar las vías respiratorias y reducir las hospitalizaciones por neumonía. Sin embargo, no hubo estudios que calificaran las intervenciones fisioterapéuticas como principal recurso para el tratamiento de esta enfermedad. Conclusíon: Por lo tanto, se concluye que el uso de fisioterapia respiratoria puede ser un coadyuvante importante para mejorar las condiciones y funciones respiratorias de los niños con neumonía.

Development and validation of the Salt Intake-Related Knowledge, Attitude, and Practice Questionnaire for Malaysian adults

@#Introduction: Malaysian adults consume excessive amounts of salt daily, which could lead to hypertension. Understanding knowledge, attitudes, and practices (KAP) surrounding salt intake is crucial for designing effective interventions to reduce excessive consumption and its associated health risks. Therefore, this study aimed to adapt an existing salt intake-related KAP questionnaire that was previously employed in a local population-based survey and to validate and test its reliability. Methods: This cross-sectional study comprised two phases: (1) adaptation, content validation (CV), and face validation (FV); (2) pilot testing and reliability testing. CV and FV involved a total of seven experts and ten Malaysian adults from the Klang Valley, respectively. Pilot testing involved 139 Malaysian adults to determine the questionnaire’s reliability. Content validity index (CVI) and Face validity index (FVI) values were calculated to analyse CV and FV. Reliability of each domain was analysed by obtaining Cronbach’s alpha (α) values. Results: A self-administered questionnaire comprising six items each for knowledge, attitude, and practice was developed. The questionnaire demonstrated acceptable item-level CVI (I-CVI) and item-level FVI (I-FVI) values of at least 0.83, indicating that the items were relevant, clear, non-ambiguous, and simple. Reliability test showed acceptable α values of at least 0.70 for each domain, suggesting that the questionnaire was reliable. Conclusion: This tool could be considered valid and reliable for assessing the level of KAP towards salt intake among adults in Malaysia.

Increased Osteoblastic and Osteocytic in Vitro Cell Viability by Yerba Mate (Ilex paraguariensis)

Background@#Yerba mate (YM, Ilex paraguariensis) consumption beneficially affects the bones. However, whether YM components exert their effect on bone cells directly remains elusive. @*Methods@#We evaluated how main YM components affect osteoblastic (MC3T3-E1) and osteocytic (MLO-Y4) cells in vitro when administered separately or in an aqueous extract. MC3T3-E1 and MLO-Y4 cells were exposed to three different experimental conditions: (1) Caffeine, chlorogenic acid, and their combinations; (2) Caffeine, rutin, and their combinations; (3) Aqueous YM extract. @*Results@#All polyphenol and caffeine concentrations as well as that of their tested combinations significantly increased MC3T3-E1 cell viability from 16.6% to 34.8% compared to the control. In MLO-Y4 cells, the lowest rutin and the two highest caffeine concentrations significantly increased cell viability by 11.9, 14.9, and 13.7%, respectively. While rutin and caffeine combinations tended to increase MLO-Y4 cell viability, different chlorogenic acid and caffeine combinations did not affect it. Finally, the aqueous YM extract significantly increased MLO-Y4, MC3T3-E1, and differentiated MC3T3-E1 cell viability compared to the control without treatment. @*Conclusions@#YM components (rutin, chlorogenic acid, and caffeine) positively affected bone cells, mainly pre-osteoblast cells. Moreover, the aqueous YM extract significantly increased MLO-Y4, MC3T3-E1, and differentiated MC3T3-E1 cell viabilities indicating an additional relevant nutritional property of YM infusion. Further studies would be required to elucidate the underlying effector mechanism of YM on the bones and its relationship with previously described in vivo positive effects.

Effects of Residential Proximity to Industrial Zone on Respiratory Symptoms among Residents in Parit Raja, Batu Pahat

@#Introduction: The industrial park in the district of Parit Raja, Batu Pahat resulted in rapid growth of the town during the last 20 years and has been a reason of concern that this park also has contributed greatly to the problem of air pollution. The aim of this study was to evaluate the association between industrial air pollution and respiratory symptoms in adults living in the Parit Raja. Methods: A comparative cross-sectional study was undertaken among residents in the district of Parit Raja, Batu Pahat, Johor, Malaysia. A total of 110 residents aged between 19 and 65 years were randomly selected and information on personal characteristics and respiratory symptoms was obtained through a validated questionnaire. The prevalence of respiratory symptoms was compared between residents recruited from the areas situated about 5km radius of the industrial park (exposed) and >5km radius from the industrial park (comparative). Results: A total of 34.5% and 25.5% of adults from the exposed group reported experiencing coughing for the last 3 months and chest tightness for the last 3 years. The logistic regression models showed that symptoms of coughing was associated with the exposed group (aOR=6.34, 95% CI=2.08-19.35), male respondents (aOR=3.18, 95% CI=1.10-9.16) and who stay in Part Raja for more than 14 years (aOR=3.16, 95% CI=1.14-8.79). Conclusion: This study demonstrated that long-term air pollution exposures are consistently associated with respiratory symptoms in residents living in the proximity of industrial parks. Therefore, public health initiatives that aim to provide more conducive environment are needed, especially for residents living near industrial parks.

Cardiocerebral infarction presenting as Opalski Syndrome: A case report

Introduction@#Opalski Syndrome is a rare type of stroke variant presenting with signs of lateral medullary syndrome plus ipsilateral hemiparesis. A confirmed myocardial infarction simultaneously occurring with this acute ischemic stroke syndrome makes this an even more challenging case of Cardiocerebral infarction.@*Case@#The patient is a 48-year-old female, a known diabetic and asthmatic, and was seen due to a 3-day history of sudden onset of non-rotatory dizziness associated with diplopia, non-projectile vomiting, numbness of the left side of the face and lingual dysarthria. She was initially admitted in a primary hospital wherein she developed chest pain, dyspnea and diaphoresis. She was transferred and was received with findings of miosis of the left eye, rotational nystagmus, left dysmetria, decreased pain and temperature sensation on the right extremities, left central facial palsy, tongue deviation to the left side, left hemiparesis and upward Babinski on the left. We localize this lesion on the left lateral medullary area with involvement of the caudal left corticospinal tract. Hence, a clinical impression of Opalski Syndrome was made. This was confirmed with cranial MRI findings of T2/FLAIR hyperintense focus involving the left lateral aspect of the medulla. The patient’s Troponin I was also elevated and she was managed as a case of acute coronary syndrome - NSTEMI. Hence, a diagnosis of Type III Cardiocerebral infarction was made. Medical intervention was started with dual antiplatelet therapy and anticoagulation with noted clinical improvement. @*Conclusion@#This case report highlights the diagnosis of Opalski Syndrome in a patient also presenting with Cardiocerebral infarction. There should be prompt recognition of the following disease entities to have an effective treatment, avoid cardiac and neurologic sequelae, and achieve an overall favorable prognosis.

Effects of the Use of Beta-Blockers on Chronic Obstructive Pulmonary Disease Associated with Cardiovascular Comorbities: Systematic Review and Meta-analysis / 결핵및호흡기질환

Cardiovascular comorbidity is common in individuals with chronic obstructive pulmonary disease (COPD). This factor interferes with pharmacological treatment. The use of β-blockers has been proposed for their known cardioprotective effects. However, due to their adverse reactions, and the risk of causing bronchospasm, there is reluctance to use them. To summarize existing evidence on the effects of β-blocker use in COPD associated with cardiovascular comorbidities in relation to disease severity, exacerbation, and mortality outcomes. EMBASE, Medline, Lilacs, Cochrane Library, and Science Direct databases were used. Observational studies that evaluated the effects of β-blockers on individuals with COPD and cardiovascular comorbidities, and related disease severity, exacerbations, or mortality outcomes were included. Studies that did not present important information about the sample and pharmacological treatment were excluded. Twenty studies were included. Relevance to patient care and clinical practice: The use of β-blockers in individuals with COPD and cardiovascular disease caused positive effects on mortality and exacerbations outcomes, compared with the results of individuals who did not use them. The severity of the disease caused a slight change in forced expiratory volume in 1 second. The odds ratio for mortality was 0.50 (95% confidence interval [CI], 0.39 to 0.63; p<0.00001), and for exacerbations, 0.76 (95% CI, 0.62 to 0.92; p=0.005), being favorable to the group that used β-blockers. Further studies are needed to study the effect of using a specific β-blocker in COPD associated with a specific cardiovascular comorbidity.

Panorama clínico, epidemiológico e espacial da ocorrência de Leishmaniose visceral no estado do Pará, Amazônia brasileira / Clinical, epidemiological and spatial overview of visceral Leishmaniasis in the state of Pará, brazilian amazonia / Panorama clínico, epidemiológico y espacial de la Leishmaniasis visceral en el estado de Pará, amazonia brasileña

Objetivo: Essa pesquisa teve como objetivo determinar o perfil clínico, epidemiológico e espacial daLeishmaniose Visceral, bem como, sua associação com o desmatamento nos municípios pertencentesao 12º centro regional de saúde no Sudeste do Estado do Pará, Brasil de 2016 a 2020. Método: Trata-se de um estudo analítico ecológico, realizado com dados provenientes de 15 municípios do 12º Centro Regional de Saúde, obtidos por meio do banco de dados do Data-SUS-TABNET, através do SINAN. Resultados: Para o período do estudo foram notificados 415 casos de LV nos municípios analisados, o que correspondeu a uma média anual de 83 casos. O ano com maior número de notifi- cações foi 2017, apresentando 34,7%, sendo o município de Redenção com o maior número de casos.Conclusões: Portanto, há necessidade de ampliação das medidas de controle e vigilância da LV, comfoco na notificação de casos, a fim de realizar a obtenção do panorama fidedigno da LV e elaborar estratégias mais assertivas para seu controle e mitigação.

Objective: This research aimed to determine the clinical, epidemiological and spatial profile of Vis- ceral Leishmaniasis, as well as its association with deforestation in the municipalities belonging to the 12th regional health center in the Southeast of Pará State, Brazil from 2016 to 2020. Method: Thisis an ecological analytical study, conducted with data from 15 municipalities of the 12th Regional Health Center, obtained through the Data-SUS-TABNET database, through SINAN. Results: For thestudy period, 415 cases of VL were reported in the analyzed municipalities, corresponding to an an-nual average of 83 cases. The year with the highest number of notifications was 2017, present- ing 34.7%, being the municipality of Redenção with the highest number of cases. Conclu- sion: Therefore,there is a need to expand VL control and surveillance measures, focusing on the notification of casesin order to obtain a reliable picture of VL and develop more assertive strategies for its control and mitigation.

Objetivo: Esta investigación tuvo como objetivo determinar el perfil clínico, epidemiológico y espacial de la Leishmaniasis Visceral, así como su asociación con la deforestación en municipios pertenecientes al 12º Centro Regional de Salud del Sudeste del Estado de Pará, Brasil, de 2016 a 2020. Método: Trata-se de um estudo analítico ecológico, realizado com dados provenientes de 15 municípios do 12º Centro Regional de Saúde, obtidos por meio do banco de dados do Data-SUS-TABNET, através do SINAN. Resultados: Durante el período de estudio, fueron notificados 415 casos de LV en los municipios analizados, correspondiendo a una media anual de 83 casos. El año con mayor número de notificaciones fue 2017, 34,7%, y el municipio de Redenção presentó el mayor número de casos. Conclusiones: Por lo tanto, es necesario ampliar las medidas de control y vigilancia de la LV, centrándose en la notificación de casos con el fin de obtener una imagen fiable de la LV y desarrollar estrategias más asertivas para su control y mitigación.

Efecto del entrenamiento funcional, en comparación al entrenamiento tradicional de fuerza, sobre la condición física de adultos mayores: revisión sistemática / Effects of Functional Training, Compared to Traditional Strength Training, on Physical Fitness in Older Adults: A Systematic Review / Efeito do treinamento funcional, comparado ao treinamento de força tradicional, sobre a aptidão física em adultos idosos: uma revisão sistemática

Resumen Introducción: Las personas adultas mayores (AM) representan un grupo creciente de la población, los cuales son especialmente susceptibles a sufrir una pérdida de la condición física asociada a la funcionalidad. El entrenamiento tradicional de fuerza (ETF) ha demostrado ser efectivo, mejorando o limitando la pérdida de masa muscular y fragilidad. El entrenamiento funcional (EF) ha surgido como una alternativa accesible de prevención en los cambios físicos provocados por la vejez. Sin embargo, existe escasa evidencia respecto a la efectividad del EF, versus el ETF, sobre la condición física en AM. Propósito: Evaluar sistemáticamente la efectividad del EF, en comparación con el ETF, sobre la mejora de la condición física en los adultos mayores. Metodología: Se consultaron las bases de datos Pubmed, SPORTDiscus (EBSCO), SCOPUS, PEDro y Web of Science empleando los términos "resistance training", "aged", "physical fitness" y "functional training". Resultados: Se identificaron un total de 5 artículos que cumplieron con los criterios de inclusión. Se observa que, tanto EF como el ETF son efectivos en la mejora de diversas manifestaciones de fuerza. Por otra parte, el EF presenta una proporción de mayor efectividad sobre elementos de la condición física funcional, tales como: la capacidad cardiorrespiratoria (3.3 veces), agilidad (2.7 veces) y fuerza de tren inferior funcional (1.7 a 2.8 veces) en comparación al ETF. Conclusión: Tanto el EF como el ETF pueden ser alternativas válidas para mejorar la condición física general en los AM. Por otra parte, el EF presenta una mayor efectividad sobre parámetros vinculados a la funcionalidad del AM.

Introduction: Older adults (OA) represent a growing population group that is especially susceptible to a loss of physical fitness associated with functional impairment. Traditional resistance training (TRT) has proven to be effective, improving or limiting the loss of muscle mass and frailty. Functional training (FT) has emerged as an affordable alternative to prevent physical changes caused by aging. However, there is little evidence regarding the effectiveness of functional training, versus traditional resistance training, on physical capacity in older adults. Purpose: To systematically review the effectiveness of FT, compared to TRT, on improving physical fitness in OA. Methodology: Pubmed, SPORTDiscus (EBSCO), SCOPUS, PEDro, and Web of Science databases were consulted. In addition, search strategies were performed, including the terms "resistance training," "aged," "physical fitness," and "functional training." Results: Five articles meeting inclusion criteria were identified. From the qualitative analysis conducted, it was observed that both FT and TRT training are effective in improving various manifestations of strength. In addition, compared to TRT, FT presents a higher proportion of effectiveness on functional fitness elements such as cardiorespiratory capacity (3.3 times), agility (2.7 times), and functional lower body strength (1.7 to 2.8 times). Conclusion: Both FT and TRT can be valid alternatives to improve general physical fitness in OA. Likewise, EF is more effective on parameters related to functionality in OA.

Resumo Introdução: Os adultos idosos (AM) representam um grupo crescente da população, que são particularmente suscetíveis a uma perda de aptidão física associada à funcionalidade. O treinamento de força tradicional (TFT) demonstrou ser eficaz para melhorar ou limitar a perda de massa muscular e fragilidade. O treinamento funcional (TFT) surgiu como uma alternativa acessível para evitar as mudanças físicas causadas pelo envelhecimento. Entretanto, há poucas evidências a respeito da eficácia da EF, em comparação com a ETF, na aptidão física em MA. Objetivo: Avaliar sistematicamente a eficácia da EP, em comparação com a ETF, na melhoria da aptidão física em adultos mais velhos. Metodologia: Pubmed, SPORTDiscus (EBSCO), SCOPUS, PEDro e Web of Science foram consultados usando os termos "treinamento de resistência", "envelhecido", "aptidão física" e "treinamento funcional". Resultados: Foi identificado um total de 5 artigos que preenchiam os critérios de inclusão. Observa-se que tanto a EF quanto a ETF são eficazes para melhorar as diversas manifestações de força. Por outro lado, a EF tem uma proporção maior de eficácia nos elementos de aptidão funcional, tais como aptidão cardiorrespiratória (3,3 vezes), agilidade (2,7 vezes) e força corporal funcional inferior (1,7 a 2,8 vezes) em comparação com a ETF. Conclusão: Tanto a EF quanto a ETF podem ser alternativas válidas para melhorar a aptidão física geral nos MA. Por outro lado, o EF é mais eficaz nos parâmetros ligados à funcionalidade do MA.

Percepciones de profesores y estudiantes acerca de la utilización del portafolios en la asignatura Prevención en Salud

Fundamento: en el ámbito de la pedagogía universitaria, el modelo docente adopta una nueva visión, el aprendizaje desarrollador y la evaluación educativa; en este contexto ha surgido, en los últimos años, el portafolios. Objetivo valorar la percepción de profesores y estudiantes sobre la utilización del portafolio como herramienta de aprendizaje en la asignatura Prevención en Salud. Métodos: investigación educacional, realizada en la Universidad de Ciencias Médicas de Cienfuegos en el primer período del curso 2022, sobre un universo constituido por el total de estudiantes de segundo año que cursaron la asignatura y los profesores que fungieron como tutores. La muestra fue seleccionada al azar, 64 estudiantes y 36 profesores, que aceptaron participar en la investigación respetando los principios éticos. Se empleó la técnica de la entrevista, se diseñó un cuestionario semiestructurado para explorar la opinión de estudiantes y profesores. Resultados: los docentes consideraron de utilidad el portafolio para el aprendizaje, al permitir objetivar y documentar las competencias, logrando dinamismo y estímulo para la reflexión; alegaron inconformidad en la evaluación refiriendo que requiere de mucho tiempo. Los estudiantes recibieron orientaciones sobre el portafolio, que les permitieron prepararse para su profesión, organizarse y autoevaluarse. Como debilidad destacaron la laboriosidad al considerarlo estresante, refiriéndose a la responsabilidad y al tiempo disponible e insuficiente motivación que brindan los tutores. Conclusiones: el portafolio es un instrumento centrado en el aprendizaje de competencias, con participación del estudiante y un tipo de evaluación que estimula la responsabilidad aplicando los conocimientos de la vida real en la práctica médica.

Foundation: in the university pedagogy field, the teaching model adopts a new vision: developer learning and educational evaluation; in this context, the portfolio has emerged in recent years. Objective: to assess the perception of teachers and students about the use of the portfolio as a learning tool in the Health Prevention subject. Methods: educational research, at the Cienfuegos Medical Sciences University in the first period of the 2022 academic year, a universe made up of the total number of second-year students who took the subject and the professors who served as tutors. The sample was randomly selected, 64 students and 36 teachers, who agreed to participate in the research respecting ethical principles. The interview technique was used, a semi-structured questionnaire was designed, exploring the opinion of students and teachers. Results: the teachers considered the portfolio useful for learning, as it allowed objectifying and documenting the competencies, achieving dynamism and stimulating reflection, they claimed disagreement in the evaluation, stating that it requires a lot of time. The students received guidance on the portfolio, which allowed them to prepare for their profession, organize and self-evaluate. As a weakness, they highlighted industriousness, considering it stressful, referring to the responsibility and the time available and insufficient motivation provided by the tutors. Conclusions: the portfolio is an instrument focused on learning competencies, with student participation and a type of evaluation that stimulates responsibility by applying real-life knowledge in medical practice.

Conocimientos sobre infecciones de trasmisión sexual en adolescentes de Parroquia Naiguatá. La Guaira. Venezuela, 2021

Fundamento: las infecciones de trasmisión sexual son un problema que puede perjudicar a los seres humanos, especialmente a los adolescentes. Objetivo: describir el conocimiento sobre infecciones de trasmisión sexual en adolescentes de la Parroquia Naiguatá. La Guaira. Métodos: estudio descriptivo, de corte transversal realizado desde junio a diciembre de 2021. El universo estuvo constituido por 471 adolescentes y se seleccionó una muestra de 142 (30,0 %), mediante el método aleatorio simple. Se aplicó una encuesta estructurada de ocho preguntas. Las variables analizadas fueron: edad, sexo, comienzo de las relaciones sexuales, conocimientos sobre las infecciones de trasmisión sexual: enfermedades consideradas de trasmisión sexual, vías de trasmisión, manifestaciones clínicas, riesgo para adquirirlas, medidas para prevenirlas y sus complicaciones. Resultados: la edad que predominó fue de 16 años y el sexo femenino; el 41, 5 % inició las relaciones sexuales a los 14 años. Predominó el desconocimiento de las infecciones de trasmisión sexual, sus vías de trasmisión y sus manifestaciones clínicas. Se identificó el sida, sífilis y blenorragia como infecciones de trasmisión sexual; reconocieron el uso del condón como forma de prevención y como principales complicaciones de estas enfermedades la muerte (66,9 %) y la inflamación pélvica (53,5 %). Conclusiones: el conocimiento de los adolescentes sobre las infecciones de trasmisión sexual continúa siendo insuficiente.

Foundation: sexually transmitted infections are a problem that can harm human beings, especially adolescents. Objective: to describe the adolescents' knowledge about sexually transmitted infections from the Naiguatá Parish. La Guaira. Methods: descriptive, cross-sectional study carried out from June to December 2021. The universe of 471 adolescents and a sample of 142 (30.0%) was selected, using the simple random method. A structured survey of eight questions was applied. The analyzed variables were: age, sex, beginning of sexual relations, knowledge about sexually transmitted infections: diseases considered to be sexually transmitted, routes of transmission, clinical manifestations, risk of acquiring them, measures to prevent them, and their complications. Results: the prevailing age was 16 years old and the female sex; 41.5% started sexual relations at 14 years of age. Ignorance of sexually transmitted infections, their transmission routes and their clinical manifestations prevailed. AIDS, syphilis and gonorrhea were identified as sexually transmitted infections; recognized the use of condoms as a form of prevention and death (66.9%) and pelvic inflammation (53.5%) as the main complications of these diseases. Conclusions: the adolescents' knowledge about sexually transmitted infections continues to be insufficient.

Faceta Direta de Resina Composta utilizando Pigmentos Opacificadores para Reabilitação Estética Anterior de Dente Escurecido: Relato de Caso / Direct Composite Resin Veneer using Opacifying Pigments for Anterior Aesthetic Rehabilitation of Discolored Teeth: Case Report

O tratamento estético de dentes com alteração de cor é um grande desafio na Odontologia Restauradora. Nesse sentido, a utilização de técnicas de estratificação com resina composta associada ao uso de pigmentos opacificadores permite que seja possível restaurar por meio de uma técnica direta, que resulta em um menor desgaste da estrutura dental durante o preparo. Dessa forma, o presente trabalho apresenta um caso clínico de faceta direta de resina composta utilizando associação de três pigmentos opacificadores. Paciente do sexo masculino, 54 anos, procurou atendimento apresentando alteração de cor severa do dente 21, relato de trauma dental, tratamento endodôntico e contraindicação de novo protocolo de clareamento interno, sendo sugerido, como plano de tratamento, a restauração direta com resina composta. Para a confecção da faceta direta de resina, foi utilizada uma mistura de três opacificadores na consistência fluida. Para verificar o valor da camada aplicada da mistura, foram feitas fotografias em preto e branco. A estratificação prosseguiu com camadas de resina translúcida para a base palatina, resina opaca de dentina e resina acromática translúcida para o esmalte. Como resultado, constatou-se a função e eficácia do uso da associação de pigmentos opacificadores na resolução do caso, em seguida, foi realizada uma reavaliação após 30 dias e 7 meses do procedimento restaurador, quando verificou-se a estabilidade de cor da restauração. Concluiu-se, portanto, que a utilização da técnica de estratificação de resinas compostas associada a utilização de pigmentos opacificadores traz resultados estéticos satisfatórios e favoráveis por meio de uma técnica direta, realizada em sessão clínica única e com alta previsibilidade.

The esthetic treatment of teeth with discoloration is a major challenge in restorative dentistry. In this sense, the use of composite resin veneering techniques associated with the use of opacifying stains allows restorations to be made using a direct technique, which results in less wear to the tooth structure during preparation. Thus, the present study presents a clinical case of a direct composite resin veneer using an association of three opacifying pigments. A 54-year-old male patient presented with severe color change on the central upper left incisor, a report of dental trauma, endodontic treatment, and contraindication for a new internal bleaching protocol. In order to make the direct resin veneer, a mixture of three opacifiers in a fluid consistency was used. To check the value of the applied layer of the mixture, black and white photographs were taken. Layering proceeded with translucent resin layers for the palatal base, opaque dentin resin and translucent achromatic resin for the enamel. As a result, the function and efficacy of the use of the association of opacifying pigments was verified in the resolution of the case. A reevaluation was performed 30 days and 7 months after the restorative procedure, when the color stability of the restoration was verified. This case allows to conclude that using composite resin layering technique associated with the use of opacifying pigments brings satisfactory and favorable aesthetic results through a direct technique, performed in a single clinical session and with high predictability.

Ultrasound techniques for the detection of developmental dysplasia of the hip: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. OBJECTIVE: To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. DESIGN AND SETTING: A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12-89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. CONCLUSION: All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. REGISTRATION NUMBER: Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema

Purpose: Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. Methods: This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Results: Twenty?seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with <3 months between the two samples – 12 (44.4%). Group 2 included patients with >3 months between the two samples –15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post?dexamethasone in group 1, but not in group 2. Interleukin (IL)?4, IL?6, IL?10, vascular endothelial growth factor (VEGF), IL?1?, interferon?gamma inducible protein?10 (IP?10), monocyte chemoattractant protein?1 (MCP?1), and IL?2 decreased post?injection in group 1. But cytokines increased post?dexamethasone in group 2, except IL?10. When compared to baseline, IL?6 reduced to half in group 1 (P?value 0.814) and it tripled in group 2 ( P?value 0.009). The level of VEGF in the first and second samples was not different in either group. Conclusion: Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL?6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT.

Utilização de banco de dados policiais como perspectiva para redução do sub-registro da violência contra mulheres / Using police databases as a prospect to reduce under-recording of violence against women / Utilizar las bases de datos policiales como perspectiva para reducir el subregistro de la violencia contra las mujeres

Objetivo: buscou-se avaliar a concordância entre o Sistema de Informação de Agravo de Notificação (SINAN) e dados policiais para casos de violência física e sexual contra mulheres, bem como o perfil das mulheres agredidas, das agressões e dos agressores. Método: foi realizado estudo transversal com casos ocorridos em uma cidade de Minas Gerais, notificados no SINAN e/ou identificados na base policial, entre os anos de 2015 e 2016. Criou-se uma base consolidada, composta pelos casos elegíveis das duas fontes, tendo sido realizadas análises descritivas. Em uma base pareada contendo casos comuns aos dois bancos, foi realizada análise de concordância pelo teste Fleiss'Kappa. Resultados: 1.185 casos compuseram a base consolidada e 56 constituíram a base pareada. Houve sub-registro de 83,54% nos dados do SINAN, além de incompletude importante de informações. A base policial apresentou cerca de oito vezes maior captação. A concordância de informações foi elevada/moderada para sete de 11 características avaliadas para os casos comuns. Na base consolidada, as vítimas foram predominantemente negras, solteiras ou viúvas, com idade entre 18 e 39 anos. Os homens, especialmente (ex)parceiros e familiares, foram os principais agressores. Conclusão: o sub-registro e a incompletude de informações sobre violência contra mulher no SINAN é uma realidade que precisa ser tratada. O cruzamento com fontes de dados policiais é uma alternativa para melhorar a qualidade das informações, reduzindo o sub-registro. Apesar dos dados subestimados, percebeu-se que a violência física e doméstica, cometida por (ex)parceiro contra mulheres jovens e negras continua sendo prevalente, atentando para o fato que se deve manter foco de políticas públicas.(AU)

Objective: this study sought to evaluate the agreement between the Information System for Notifiable Health Problems (Sistema de Informação de Agravo de Notificação, SINAN) and Police data for cases of physical and sexual violence against women, as well as the profile of the assaulted women, the aggressions and the aggressors. Method: a cross-sectional study was conducted with cases in a city from Minas Gerais, notified to the SINAN and/or identified in the Police database between 2015 and 2016. A consolidated database was created, comprised by the eligible cases from both sources, with performance of descriptive analyses. An agreement analysis by means of the Fleiss Kappa test was performed in a paired database containing cases common to both databases. Results: a total of 1,185 cases comprised the consolidated database, whereas 56 were included in the paired one. There was 83.54% under-recording in the SINAN data, in addition to important information incompleteness. The Police database presented nearly eight times more recording of cases. Agreement of all the information was high/moderate for seven out of 11 characteristics evaluated for the common cases. In the consolidated databases, the victims were predominantly black-skinned, single or widowed, and aged between 18 and 39 years old. The main aggressors were men, mainly (former) partners and family members. Conclusion: under-recording and incompleteness of diverse information about violence against women in the SINAN is a reality that needs to be dealt with. Cross-referencing with Police data sources represent an alternative to improve quality of the information, reducing under-recording. Despite the underestimated data, it was noticed that physical and domestic violence, perpetrated by (former) partners against young and black-skinned women, continues to be prevalent, pointing to the fact that it should remain as the focus of public policies.(AU)

Objetivo: se buscó evaluar la concordancia entre el Sistema de Informação de Agravo de Notificação (SINAN) y los datos policiales para los casos de violencia física y sexual contra las mujeres, así como el perfil de las mujeres maltratadas, de las agresiones y agresores. Método...(AU)

Reference intervals for serum TSH concentrations of healthy children from the Central Region of Brazil

ABSTRACT Objective: The objective of this study was to determine the serum thyroid-stimulating hormone (TSH) concentration reference intervals (RIs) of healthy children aged 1 to 10 years of both sexes, living in the Central Region of Brazil. Subjects and methods: 1,735 children [869 (50.1%) female; 866 (49.9%) male] enrolled in the morning shift of 47 pre- and 83 public elementary schools in the municipality of Cuiabá, Mato Grosso, were studied by gathering anthropometric and social data and their medical history. A blood sample was collected from each child to determine the TSH concentration using the electrochemiluminescence method on a Cobas® 6000 modular analyzer (Analyzer series, Roche Diagnostics). Results: The RIs were determined using the 2.5 and 97.5 percentile and the mean ± 2 standard deviations methods. After identifying the homoscedastic groups by age and sex, outliers higher or lower than three standard deviations were excluded. The distribution of serum TSH concentrations showed no significant age or sex differences. Based on the percentile method, TSH RI ranged from 0.93 to 5.86 μIU/mL. Based on the mean ± 2 standard deviations, TSH RI ranged from 0.30 to 5.29 μIU/mL. Conclusion: The normal serum TSH concentration of the Brazilian children evaluated in this study differ from those of populations from other countries. Other regional population studies may validate the RIs found in this study and enable its safer use in pediatric clinical practice.