La marihuana de hoy no es la que fumaba tú abuela

Johnny Stack, como nos lo relata Isabella Backman, se inició en la marihuana en una fiesta de la escuela a sus 14 años, cuando apenas se había legalizado su uso medicinal en Colorado. Esa marihuana la había obtenido el hermano mayor de unos de sus amigos, quien tenía una tarjeta para marihuana medicinal. A los 19 años, después de 5 años de estar luchando contra adicción y psicosis, Johnny muere por suicidio. Tres días antes, nos dice Backman, le dijo a su madre que la marihuana le había arruinado su mente y su vida. Nunca se probó, a pesar de múltiples pruebas de laboratorio, que usara ninguna otra droga. (provisto por Infomedic International)

Johnny Stack, as Isabella Backman tells us, was introduced to marijuana at a school party when he was 14 years old, when its medical use had just been legalized in Colorado. That marijuana had been obtained by the older brother of one of her friends, who had a medical marijuana card. At 19, after five years of struggling with addiction and psychosis, Johnny died by suicide. Three days earlier, Backman tells us, he told his mother that marijuana had ruined his mind and his life. It was never proven, despite multiple lab tests, that he used any other drug. (provided by Infomedic International)

Association between fractional exhaled nitric oxide and therapeutic adherence to controller management in pediatric asthma patients.

OBJECTIVES: Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children. MATERIALS AND METHODS: Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller. RESULTS: Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19). CONCLUSIONS: FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.

La calificación Apgar

En 1949, la estudiante de Medicina, que no encontró el acceso para hacerse cirujano, se convertía en la primera mujer en ser profesora de tiempo completo en Columbia's College of Physicians and Surgeons, y tres años más tarde, en 1952, presentaba ante la reunión conjunta de la Sociedad Internacional de Investigación en Anestesia y el Colegio de Anestesiólogos -publicada al año siguiente una de las más logradas contribuciones clínicas, la forma de evaluar el estado de vigor del recién nacido a partir de 5 signos, que llevaría su nombre: la calificación Apgar

In 1949, the medical student, who did not find access to become a surgeon, became the first woman to be a full-time professor at Columbia's College of Physicians and Surgeons, and three years later, in 1952, she presented before the meeting joint effort of the International Society for Research in Anesthesia and the College of Anesthesiologists - published the following year[1] - one of the most successful clinical contributions, the way of evaluating the state of health of the newborn based on 5 signs, which would lead its name: the Apgar score

Hacia una ética menos restrictiva en Salud Pública

La incertidumbre, más que una debilidad es un desafío. Un desafío a la humildad, a la prudencia, a la honestidad. En la Medicina, la incertidumbre crea la obligación de encontrar la verdad, de primero no hacer daño, pero, antes que todo, de aceptarla como origen de la búsqueda y reflexión sobre lo actuado. Eso no indica que entre los pasos que se dan, se comentan errores o infortunadas decisiones.

Uncertainty, more than a weakness is a challenge. A challenge to humility, prudence, honesty. In Medicine, uncertainty creates the obligation to find the truth, first to do no harm, but, above all, to accept it as the origin of the search and reflection on what has been done. This does not indicate that among the steps that are taken, mistakes or unfortunate decisions are made.

Analysis of the implementation of an AIDS mortality committee through municipal health indicators / Análise da implantação de um comitê de mortalidade por AIDS mediante indicadores de saúde municipais / Análisis de la implantación de un comité de mortalidad por SIDA a través de indicadores municipales de salud

Background and objective: the acquired immunodeficiency syndrome (AIDS) has high rates of detection and death in the state of Rio Grande do Sul. In order to better understand such deaths, in December 2017, the Uruguaiana Municipal Department of Health implemented the AIDS Mortality Committee (CMaids). This study aimed to analyze the impact of an CMaids implementation in Uruguaiana through municipal health indicators. Methods: an ecological time-series study that used secondary data from the official platforms of the Ministry of Health from 2008 to 2020. Results: a reduction in the indicators number of deaths (from 28 in 2008 to 9 in 2020), mortality rate (from 22.0 in 2008 to 7.1 deaths/100,000 inhabitants in 2020), and fatality rate (from 46.74 in 2008 to 9.61 deaths/1,000 inhabitants in 2020) was observed. Moreover, trend lines were verified between 2017-2020 through the logarithmic regression model with join points. A relevant Annual Percent Change in mortality and fatality indicators was verified, with a reduction of 59.1% and 73.4%, respectively, in 2020, when comparing the observed and expected values. Conclusion: the findings enable us to conjecture that CMaids contributed to health indicator improvement, evidencing this as a relevant strategy to handle HIV/AIDS endemic at the local level.(AU)

Justificativa e objetivo: a síndrome da imunodeficiência adquirida (aids) apresenta elevadas taxas de detecção e óbito no estado do Rio Grande do Sul. A fim de compreender melhor tais óbitos, em dezembro de 2017, a Secretaria Municipal de Saúde de Uruguaiana implementou o Comitê de Mortalidade por aids (CMaids). O objetivo deste estudo é analisar o impacto da implantação do CMaids de Uruguaiana por meio de indicadores de saúde municipais. Métodos: estudo ecológico de série temporal, utilizando dados secundários das plataformas oficiais do Ministério da Saúde entre o período de 2008 a 2020. Resultados: observou-se redução dos indicadores número de óbitos (de 28 em 2008 para 9 em 2020), taxa de mortalidade (de 22,0 em 2008 para 7,1 óbitos/100.000 habitantes em 2020) e taxa de letalidade (de 46,74 em 2008 para 9,61 óbitos/1.000 habitantes em 2020). Ainda, verificaram-se linhas de tendência entre 2017-2020 por meio do modelo de regressão logarítmica com pontos de junção. Averiguou-se relevante mudança percentual anual nos indicadores de mortalidade e letalidade, com redução de 59,1% e 73,4%, respectivamente, em 2020, ao comparar-se o valor observado e o esperado. Conclusão: os achados permitem conjecturar que o CMaids contribuiu para melhorias dos indicadores de saúde, evidenciando essa como uma estratégia relevante para o enfrentamento do HIV/aids em nível local.(AU)

Justificación y objetivo: el síndrome de inmunodeficiencia adquirida (sida) presenta altas tasas de detección y muerte en el estado de Rio Grande do Sul. Para entender mejor esas muertes, en diciembre de 2017, la Secretaría Municipal de Salud de Uruguaiana implementó el Comité de Mortalidad por SIDA (CMaids). El objetivo de este estudio es analizar el impacto de la implementación del CMaids de Uruguaiana a través de los indicadores de salud municipales. Métodos: estudio ecológico de series temporales, utilizando datos secundarios de las plataformas oficiales del Ministerio de Salud desde 2008 hasta 2020. Resultados: se observó la reducción de los indicadores de número de óbitos (de 28 en 2008 a 9 en 2020), tasa de mortalidad (de 22,0 en 2008 a 7,1 muertes/100.000 habitantes en 2020) y tasa de letalidad (de 46,74 en 2008 a 9,61 muertes/1.000 habitantes en 2020). Además, se verificaron líneas de tendencia entre 2017-2020 a través del modelo de regresión logarítmica con puntos de unión. Se verificó un cambio porcentual anual relevante en los indicadores de mortalidad y letalidad, con una reducción de 59,1% y 73,4%, respectivamente, en 2020, al comparar los valores observados y esperados. Conclusión: los resultados permiten conjeturar que el CMaids contribuye a mejorar los indicadores de salud, evidenciando que es una estrategia relevante para la lucha contra el VIH/SIDA a nivel local.(AU)

Entre persecuciones y crímenes, los códigos de ética

Jurar y aceptar códigos de conducta, que no son otra cosa que códigos de ética, constituyen la entrada a la profesionalidad médica como a la dedicación a la investigación. "Los profesionales de la Medicina tienen deberes, obligaciones, privilegios y un status protegido, pero también se rigen por los más altos estándares éticos", nos dice Phalen. El Colegio Médico de Panamá lo recuerda en su Código de Ética, cuando trae la frase de Rabelais, médico y filósofo del siglo XVI: "la ciencia sin conciencia es la ruina del alma", para resaltar lo "indispensable de una permanente reflexión ética que fortalezca la conciencia y nos recuerde el núcleo de vocación y servicio al prójimo".   Los humanos más tempranos ya practicaron especializaciones profesionales relacionadas con la salud, como lo revelan hallazgos arqueológicos y estudios antropológicos. Los primeros médicos en la historia, ambos nacidos en Egipto, Imhotep, varón y Merit Ptah, mujer, declararon juramentos a sus dioses, nos sigue relatando Robert F. Phalen, basados en varios atributos éticos: no mentir, no matar, no engañar. (provisto por Infomedic International)

Swearing and accepting codes of conduct, which are nothing more than codes of ethics, constitute the gateway to medical professionalism as well as dedication to research. Medical professionals have duties, obligations, privileges and a protected status, but they are also governed by the highest ethical standards, Phalen tells us. The Panamanian Medical Association reminds us of this in its Code of Ethics, when it brings the phrase of Rabelais, physician and philosopher of the 16th century: science without conscience is the ruin of the soul, to emphasize the indispensability of a permanent ethical reflection that strengthens the conscience and reminds us of the core of vocation and service to others.   The earliest humans already practiced professional specializations related to health, as revealed by archaeological findings and anthropological studies. The first physicians in history, both born in Egypt, Imhotep, male, and Merit Ptah, female, declared oaths to their gods, Robert F. Phalen continues, based on several ethical attributes: not to lie, not to kill, not to deceive. (provided by Infomedic International)

Risk factors for intensive care unit admission and death from COVID-19 in fully vaccinated patients hospitalized for severe COVID-19, Brazil, 2021-2022.

Objectives: To assess factors associated with admission to an intensive care unit (ICU) and death from coronavirus disease 2019 (COVID-19) in fully vaccinated patients with severe COVID-19 in Brazil and the association between ICU admission and death from COVID-19. Methods: This was retrospective study of patients hospitalized for COVID-19 from February 12, 2021 to January 10, 2022 across Brazil who were fully vaccinated against COVID-19 before hospitalization. Outcomes were admission in an ICU for COVID-19 and death from COVID-19. Variables evaluated were: sex; age; self-reported skin color; macroregion; comorbidities; time between full vaccination and onset of symptoms; and time between onset of symptoms and hospitalization. A Poisson regression model was used to estimate crude and adjusted risk ratios. Results: Of 74 991 patients hospitalized for severe COVID-19, 67.28% were ≥ 70 years and 68.32% had at least one comorbidity. Men, patients aged 60-69 years, and patients aged 18-39 years with obesity had the greatest risk of ICU admission. Patients aged 18-39 years with obesity, diabetes, or renal diseases had the highest risk of death from COVID-19. When age and time between onset of symptoms and hospitalization were considered effect modifiers, patients admitted to an ICU 9-13 days after symptom onset in each age category had the greatest risk of death from COVID-19. Conclusion: Although older patients were at greatest risk of ICU admission and death from COVID-19, the difference in the risk of dying from COVID-19 between patients admitted to an ICU and those not admitted was greatest for young adults.

Risk factors for intensive care unit admission and death from COVID-19 in fully vaccinated patients hospitalized for severe COVID-19, Brazil, 2021–2022

[ABSTRACT]. Objectives. To assess factors associated with admission to an intensive care unit (ICU) and death from corona- virus disease 2019 (COVID-19) in fully vaccinated patients with severe COVID-19 in Brazil and the association between ICU admission and death from COVID-19. Methods. This was retrospective study of patients hospitalized for COVID-19 from February 12, 2021 to Jan- uary 10, 2022 across Brazil who were fully vaccinated against COVID-19 before hospitalization. Outcomes were admission in an ICU for COVID-19 and death from COVID-19. Variables evaluated were: sex; age; self-re- ported skin color; macroregion; comorbidities; time between full vaccination and onset of symptoms; and time between onset of symptoms and hospitalization. A Poisson regression model was used to estimate crude and adjusted risk ratios. Results. Of 74 991 patients hospitalized for severe COVID-19, 67.28% were ≥ 70 years and 68.32% had at least one comorbidity. Men, patients aged 60–69 years, and patients aged 18–39 years with obesity had the greatest risk of ICU admission. Patients aged 18–39 years with obesity, diabetes, or renal diseases had the highest risk of death from COVID-19. When age and time between onset of symptoms and hospitalization were considered effect modifiers, patients admitted to an ICU 9–13 days after symptom onset in each age category had the greatest risk of death from COVID-19. Conclusion. Although older patients were at greatest risk of ICU admission and death from COVID-19, the difference in the risk of dying from COVID-19 between patients admitted to an ICU and those not admitted was greatest for young adults.

[RESUMEN]. Objetivos. Evaluar los factores asociados con el ingreso en la unidad de cuidados intensivos (UCI) y la muerte por la enfermedad del coronavirus del 2019 (COVID-19) en pacientes con el esquema completo de vacunación que presentan un cuadro grave de COVID-19, así como la relación entre el ingreso en la UCI y la muerte por esta enfermedad en Brasil. Métodos. Se realizó en Brasil un estudio retrospectivo de pacientes hospitalizados con COVID-19 del 12 de febrero del 2021 al 10 de enero del 2022 que habían recibido el esquema completo de vacunación contra la COVID-19 antes de ser hospitalizados. Los resultados fueron el ingreso en la UCI debido a la COVID-19 y la muerte por esta enfermedad. Las variables evaluadas fueron sexo, edad, color de piel autonotificado, mac- rorregión, comorbilidades, período entre el esquema completo de vacunación y la aparición de los síntomas y período entre el inicio de los síntomas y la hospitalización. Se utilizó un modelo de regresión de Poisson para estimar los cocientes de riesgo crudo y ajustado. Resultados. De los 74 991 pacientes hospitalizados con un cuadro grave de COVID-19, 67,28% tenía 70 años o más y 68,32% tenía al menos una comorbilidad. Los varones, los pacientes de 60 a 69 años y los paci- entes de 18 a 39 años con obesidad presentaron el mayor riesgo de ingreso en la UCI. Los pacientes de 18 a 39 años con obesidad, diabetes o enfermedades renales presentaban el mayor riesgo de muerte por esta enfermedad. Cuando la edad y el período entre el inicio de los síntomas y la hospitalización se consideraron modificadores del efecto, los pacientes ingresados en la UCI entre 9 y 13 días después del inicio de los sín- tomas en cada categoría de edad presentaron el mayor riesgo de muerte debido a la COVID-19. Conclusión. Aunque los pacientes de mayor edad presentaron el mayor riesgo de ingreso en la UCI y muerte debido a la COVID-19, la diferencia en el riesgo de morir por esta enfermedad entre pacientes ingresados en la UCI y pacientes no ingresados fue más elevada en adultos jóvenes.

[RESUMO]. Objetivos. Avaliar fatores associados à admissão em unidade de tratamento intensivo (UTI) e óbito por doença do coronavírus 2019 em pacientes com COVID-19 grave, totalmente vacinados, no Brasil, bem como a relação entre a entrada na UTI e a morte por COVID-19. Métodos. Estudo retrospectivo de pacientes hospitalizados com COVID-19, de 12 de fevereiro de 2021 a 10 de janeiro de 2022, em todo o Brasil, que tinham o esquema vacinal completo contra a COVID-19 antes da hospitalização. Os desfechos foram a admissão em UTI devido à COVID-19 e a morte em decorrência da doença. As variáveis avaliadas foram sexo, idade, cor da pele autodeclarada, macrorregião, comorbidades, tempo entre a vacinação completa e o início dos sintomas, e tempo entre o início dos sintomas e a internação. Para estimar os coeficientes de risco bruto e ajustado foi usado um modelo de regressão de Poisson. Resultados. Dos 74.991 pacientes internados com quadro de COVID-19 grave, 67,28% tinham ≥ 70 anos e 68,32% apresentavam pelo menos uma comorbidade. Os homens, pacientes entre 60-69 anos e pacientes entre 18-39 anos com obesidade tinham o maior risco de internação na UTI. Os pacientes de 18-39 anos de idade com obesidade, diabetes ou doenças renais apresentavam o maior risco de morte por COVID-19. Quando a idade e o intervalo entre o início dos sintomas e a hospitalização foram considerados modificadores de efeito, os pacientes admitidos em UTI entre 9 e 13 dias após o início dos sintomas em cada categoria de idade tinham o maior risco de morte devido à COVID-19. Conclusão. Embora os pacientes mais velhos tivessem maior risco de admissão na UTI e morte por COVID- 19, a diferença no risco de óbito pelo coronavírus entre os pacientes admitidos em uma UTI e aqueles não admitidos foi maior para os adultos jovens.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Disparidad en la provisión de servicios de salud

Para algunos, "el final del orden liberal traería el caos, su continuación, significaría el sufrimiento económico inacabable" La polarización conceptual no se queda allí, frente a las realidades que cada día se dan en los 5 continentes. Entregarle todo al mercado, no lleva al bienestar, sino que lo frustra. El mercado necesita de la rectoría del Estado con responsabilidad social. La disponibilidad de servicios, atención de la enfermedad, la promoción de la salud, la mortalidad por enfermedades, la optimización de los estándares de vida, en las democracias socialistas, está íntimamente ligada a la promoción de los derechos humanos; en los autoritarismos, a la no observación de esos derechos, a la capitalización de la ciudadanía, al secuestro de la sociedad civil por el partido único. (provisto por Infomedic International)

For some, the end of the liberal order would bring chaos, its continuation would mean endless economic suffering The conceptual polarization does not stop there, in the face of the realities that occur every day in the 5 continents. Surrendering everything to the market does not lead to welfare, but rather frustrates it. The market needs the stewardship of the State with social responsibility. The availability of services, disease care, health promotion, disease mortality, optimization of living standards, in socialist democracies, is closely linked to the promotion of human rights; in authoritarianisms, to the non-observance of these rights, to the capitalization of citizenship, to the kidnapping of civil society by the single party. (provided by Infomedic International)

P2Y12 receptor antagonism inhibits proliferation, migration and leads to autophagy of glioblastoma cells.

Glioblastoma (GBM) is the most aggressive and lethal among the primary brain tumors, with a low survival rate and resistance to radio and chemotherapy. The P2Y12 is an adenosine diphosphate (ADP) purinergic chemoreceptor, found mainly in platelets. In cancer cells, its activation has been described to induce proliferation and metastasis. Bearing in mind the need to find new treatments for GBM, this study aimed to investigate the role of the P2Y12R in the proliferation and migration of GBM cells, as well as to evaluate the expression of this receptor in patients' data obtained from the TCGA data bank. Here, we used the P2Y12R antagonist, ticagrelor, which belongs to the antiplatelet agent's class. The different GBM cells (cell line and patient-derived cells) were treated with ticagrelor, with the agonist, ADP, or both, and the effects on cell proliferation, colony formation, ADP hydrolysis, cell cycle and death, migration, and cell adhesion were analyzed. The results showed that ticagrelor decreased the viability and the proliferation of GBM cells. P2Y12R antagonism also reduced colony formation and migration potentials, with alterations on the expression of metalloproteinases, and induced autophagy in GBM cells. Changes were observed at the cell cycle level, and only the U251 cell line showed a significant reduction in the ADP hydrolysis profile. TCGA data analysis showed a higher expression of P2Y12R in gliomas samples when compared to the other tumors. These data demonstrate the importance of the P2Y12 receptor in gliomas development and reinforce its potential as a pharmacological target for glioma treatment.

Lecturas de Bioética: Escuela de Medicina / Bioethics Readings: Medicine School

La escuela de Medicina hoy debe formar líderes, líderes que escuchan, que revelan sinceridad cuando lo hacen, que conocen el dolor, las restricciones que estorban la felicidad del hombre común, del Otro, la abundancia del egoísmo y la pobreza de la solidaridad entre nosotros, médicos que perciben las preguntas, que no tienen todas las respuestas, pero las exploran, y que sienten los temblores del temor y de la muerte, no solamente en los enfermos sino en ellos mismos.

Medical school today must train leaders, leaders who listen, who reveal sincerity when they do so, who know the pain, the restrictions that hinder the happiness of the common man, of the Other, the abundance of selfishness and the poverty of solidarity among us, physicians who perceive the questions, who do not have all the answers, but explore them, and who feel the tremors of fear and death, not only in the sick but in themselves.

Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study.

BACKGROUND: Spinal instrumentation using transpedicular screws has been used for decades to stabilize the spine. In October 2018, an intraoperative CT system was acquired in the Neurosurgery service of the University Hospital Complex of Vigo, this being the first model of these characteristics in the Spanish Public Health System, so we began a study from January 2015 to December 2019 to assess the precision of the transpedicular screws implanted with this system compared with a control group performed with the classical technique and final fluoroscopic control. METHODS: The study was carried out in patients who required transpedicular instrumentation surgery, in total 655 screws were placed, 339 using the free-hand technique (Group A) and 316 assisted with intraoperative CT navigation (Group B) (p>0.05). Demographic characteristics, related to surgery and the screw implantation grades were assessed using the Gertzbein-Robbins classification. RESULTS: 92 patients were evaluated, between 12 and 86 years (average: 57.1 years). 161 thoracic screws (24.6%) and 494 lumbo-sacral screws (75.4%) were implanted. Of the thoracic screws, 33 produced a pedicle rupture. For the lumbo-sacral screws, 71 have had pedicle violation. The overall correct positioning rate for the free-hand group was 72.6% and for the CT group it was 96.5% (p<0.05). CONCLUSION: The accuracy rate is higher in thoracic-lumbar instrumentation in the navigation group versus free-hand group with fluoroscopic control.

Risk factors for intensive care unit admission and death from COVID-19 in fully vaccinated patients hospitalized for severe COVID-19, Brazil, 2021-2022 / Factores de riesgo para el ingreso en la unidad de cuidados intensivos y la muerte debido a la COVID-19 en pacientes con el esquema completo de vacunación hospitalizados por COVID-19 grave en Brasil, 2021-2022 / Fatores de risco para admissão em unidade de terapia intensiva e óbito pelo coronavírus em pacientes totalmente vacinados, internados por COVID-19 grave no Brasil, 2021-2022

ABSTRACT Objectives. To assess factors associated with admission to an intensive care unit (ICU) and death from coronavirus disease 2019 (COVID-19) in fully vaccinated patients with severe COVID-19 in Brazil and the association between ICU admission and death from COVID-19. Methods. This was retrospective study of patients hospitalized for COVID-19 from February 12, 2021 to January 10, 2022 across Brazil who were fully vaccinated against COVID-19 before hospitalization. Outcomes were admission in an ICU for COVID-19 and death from COVID-19. Variables evaluated were: sex; age; self-reported skin color; macroregion; comorbidities; time between full vaccination and onset of symptoms; and time between onset of symptoms and hospitalization. A Poisson regression model was used to estimate crude and adjusted risk ratios. Results. Of 74 991 patients hospitalized for severe COVID-19, 67.28% were ≥ 70 years and 68.32% had at least one comorbidity. Men, patients aged 60-69 years, and patients aged 18-39 years with obesity had the greatest risk of ICU admission. Patients aged 18-39 years with obesity, diabetes, or renal diseases had the highest risk of death from COVID-19. When age and time between onset of symptoms and hospitalization were considered effect modifiers, patients admitted to an ICU 9-13 days after symptom onset in each age category had the greatest risk of death from COVID-19. Conclusion. Although older patients were at greatest risk of ICU admission and death from COVID-19, the difference in the risk of dying from COVID-19 between patients admitted to an ICU and those not admitted was greatest for young adults.

RESUMEN Objetivos. Evaluar los factores asociados con el ingreso en la unidad de cuidados intensivos (UCI) y la muerte por la enfermedad del coronavirus del 2019 (COVID-19) en pacientes con el esquema completo de vacunación que presentan un cuadro grave de COVID-19, así como la relación entre el ingreso en la UCI y la muerte por esta enfermedad en Brasil. Métodos. Se realizó en Brasil un estudio retrospectivo de pacientes hospitalizados con COVID-19 del 12 de febrero del 2021 al 10 de enero del 2022 que habían recibido el esquema completo de vacunación contra la COVID-19 antes de ser hospitalizados. Los resultados fueron el ingreso en la UCI debido a la COVID-19 y la muerte por esta enfermedad. Las variables evaluadas fueron sexo, edad, color de piel autonotificado, macrorregión, comorbilidades, período entre el esquema completo de vacunación y la aparición de los síntomas y período entre el inicio de los síntomas y la hospitalización. Se utilizó un modelo de regresión de Poisson para estimar los cocientes de riesgo crudo y ajustado. Resultados. De los 74 991 pacientes hospitalizados con un cuadro grave de COVID-19, 67,28% tenía 70 años o más y 68,32% tenía al menos una comorbilidad. Los varones, los pacientes de 60 a 69 años y los pacientes de 18 a 39 años con obesidad presentaron el mayor riesgo de ingreso en la UCI. Los pacientes de 18 a 39 años con obesidad, diabetes o enfermedades renales presentaban el mayor riesgo de muerte por esta enfermedad. Cuando la edad y el período entre el inicio de los síntomas y la hospitalización se consideraron modificadores del efecto, los pacientes ingresados en la UCI entre 9 y 13 días después del inicio de los síntomas en cada categoría de edad presentaron el mayor riesgo de muerte debido a la COVID-19. Conclusión. Aunque los pacientes de mayor edad presentaron el mayor riesgo de ingreso en la UCI y muerte debido a la COVID-19, la diferencia en el riesgo de morir por esta enfermedad entre pacientes ingresados en la UCI y pacientes no ingresados fue más elevada en adultos jóvenes.

RESUMO Objetivos. Avaliar fatores associados à admissão em unidade de tratamento intensivo (UTI) e óbito por doença do coronavírus 2019 em pacientes com COVID-19 grave, totalmente vacinados, no Brasil, bem como a relação entre a entrada na UTI e a morte por COVID-19. Métodos. Estudo retrospectivo de pacientes hospitalizados com COVID-19, de 12 de fevereiro de 2021 a 10 de janeiro de 2022, em todo o Brasil, que tinham o esquema vacinal completo contra a COVID-19 antes da hospitalização. Os desfechos foram a admissão em UTI devido à COVID-19 e a morte em decorrência da doença. As variáveis avaliadas foram sexo, idade, cor da pele autodeclarada, macrorregião, comorbidades, tempo entre a vacinação completa e o início dos sintomas, e tempo entre o início dos sintomas e a internação. Para estimar os coeficientes de risco bruto e ajustado foi usado um modelo de regressão de Poisson. Resultados. Dos 74.991 pacientes internados com quadro de COVID-19 grave, 67,28% tinham ≥ 70 anos e 68,32% apresentavam pelo menos uma comorbidade. Os homens, pacientes entre 60-69 anos e pacientes entre 18-39 anos com obesidade tinham o maior risco de internação na UTI. Os pacientes de 18-39 anos de idade com obesidade, diabetes ou doenças renais apresentavam o maior risco de morte por COVID-19. Quando a idade e o intervalo entre o início dos sintomas e a hospitalização foram considerados modificadores de efeito, os pacientes admitidos em UTI entre 9 e 13 dias após o início dos sintomas em cada categoria de idade tinham o maior risco de morte devido à COVID-19. Conclusão. Embora os pacientes mais velhos tivessem maior risco de admissão na UTI e morte por COVID-19, a diferença no risco de óbito pelo coronavírus entre os pacientes admitidos em uma UTI e aqueles não admitidos foi maior para os adultos jovens.

Coraje para enfrentar el COVID-19 / Courage to face COVID-19

Los llamados a la solidaridad, a la justicia social, a la beneficencia, y, a la no maleficencia, son todos y han sido, llamados de los valores de la bioética para la enseñanza y para la práctica médicas, ayer, durante la pandemia de COVID-19, y siempre. Son pocos en estas lides, como mentores o como profesionales de la medicina, que no hayan honrado ese llamado. A veces pareciera no ser así, porque el ruido de los pocos es, no solo detestable, sino asfixiante. Pero comenzamos a ver resultados de ese cumplimiento, no con el Juramento Hipocrático, sino con el Otro, con el prójimo, con quien busca conocer cómo preservar la salud y con quién recuperarla. Precisamente con aquel y aquellos que en la confidencialidad ponen su vida y su bienestar en manos de la ciencia y en el calor de una práctica humanista

The calls to solidarity, to social justice, to charity, and, to non-maleficence, are all and have been, calls of the values ​​of bioethics for teaching and medical practice, yesterday, during the pandemic of COVID-19, and always. Few in these struggles, as mentors or as medical professionals, have not honored that call. Sometimes it seems not to be so, because the noise of the few is not only detestable, but suffocating. But we begin to see results of that fulfillment, not with the Hippocratic Oath, but with the Other, with the neighbor, with whom he seeks to know how to preserve health and with whom to recover it. Precisely with those and those who, in confidentiality, put their lives and well-being in the hands of science and in the warmth of a humanistic practice.

P2Y12 Purinergic Receptor and Brain Tumors: Implications on Glioma Microenvironment.

Gliomas are the most common malignant brain tumors in adults, characterized by a high proliferation and invasion. The tumor microenvironment is rich in growth-promoting signals and immunomodulatory pathways, which increase the tumor's aggressiveness. In response to hypoxia and glioma therapy, the amounts of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) strongly increase in the extracellular space, and the purinergic signaling is triggered by nucleotides' interaction in P2 receptors. Several cell types are present in the tumor microenvironment and can facilitate tumor growth. In fact, tumor cells can activate platelets by the ADP-P2Y12 engagement, which plays an essential role in the cancer context, protecting tumors from the immune attack and providing molecules that contribute to the growth and maintenance of a rich environment to sustain the protumor cycle. Besides platelets, the P2Y12 receptor is expressed by some tumors, such as renal carcinoma, colon carcinoma, and gliomas, being related to tumor progression. In this context, this review aims to depict the glioma microenvironment, focusing on the relationship between platelets and tumor malignancy.

Mentir para vacunarse / Lyng to get vaccinated

No hace mucho tiempo, un grupo pequeño pero significativo de ciudadanos nacionales cruzaron las fronteras, surcaron los aires, se mecieron con las olas para vacunarse contra COVID-19 porque en el horizonte nacional, no había señales de protegerse con ellas, por no pertenecer a alguno de los grupos prioritarios. La escasez del recurso financiero y de las vacunas obligó considerar la necesidad de proteger primero con la vacuna a los grupos vulnerables, conocidos en ese momento, como las personas mayores de 70 años y el personal de salud, de las instituciones hospitalarias. Aún con vacunas suficientes, el más frágil no debe hacer filas y esperar porque otros gozan de los privilegios de la familiaridad, la amistad o la posición social. Además, en otras latitudes, las vacunas se empezaban a botar al final del día.

Not long ago, a small but significant group of national citizens crossed the borders, crossed the air, rocked with the waves to get vaccinated against COVID-19 because on the national horizon, there were no signs of protecting themselves with them, because they did not belong to one of the priority groups. The scarcity of financial resources and vaccines made it necessary to consider the need to first protect vulnerable groups, known at that time, such as people over 70 years of age and health personnel, of hospital institutions with the vaccine. Even with sufficient vaccinations, the most fragile should not stand in line and wait because others enjoy the privileges of familiarity, friendship, or social position. In addition, in other latitudes, vaccines began to drop at the end of the day.

Pre-Treatment Neutrophil Count as a Predictor of Antituberculosis Therapy Outcomes: A Multicenter Prospective Cohort Study.

Background: Neutrophils have been associated with lung tissue damage in many diseases, including tuberculosis (TB). Whether neutrophil count can serve as a predictor of adverse treatment outcomes is unknown. Methods: We prospectively assessed 936 patients (172 HIV-seropositive) with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort study from different regions in Brazil, from June 2015 to June 2019, and were followed up to two years. TB patients had a baseline visit before treatment (month 0) and visits at month 2 and 6 (or at the end of TB treatment). Smear microscopy, and culture for Mycobacterium tuberculosis (MTB) were performed at TB diagnosis and during follow-up. Complete blood counts were measured at baseline. Treatment outcome was defined as either unfavorable (death, treatment failure or TB recurrence) or favorable (cure or treatment completion). We performed multivariable logistic regression, with propensity score regression adjustment, to estimate the association between neutrophil count with MTB culture result at month 2 and unfavorable treatment outcome. We used a propensity score adjustment instead of a fully adjusted regression model due to the relatively low number of outcomes. Results: Among 682 patients who had MTB culture results at month 2, 40 (5.9%) had a positive result. After regression with propensity score adjustment, no significant association between baseline neutrophil count (103/mm3) and positive MTB culture at month 2 was found among either HIV-seronegative (OR = 1.06, 95% CI = [0.95;1.19] or HIV-seropositive patients (OR = 0.77, 95% CI = [0.51; 1.20]). Of 691 TB patients followed up for at least 18 months and up to 24 months, 635 (91.9%) were either cured or completed treatment, and 56 (8.1%) had an unfavorable treatment outcome. A multivariable regression with propensity score adjustment found an association between higher neutrophil count (103/mm3) at baseline and unfavorable outcome among HIV-seronegative patients [OR= 1.17 (95% CI= [1.06;1.30]). In addition, adjusted Cox regression found that higher baseline neutrophil count (103/mm3) was associated with unfavorable treatment outcomes overall and among HIV-seronegative patients (HR= 1.16 (95% CI = [1.05;1.27]). Conclusion: Increased neutrophil count prior to anti-TB treatment initiation was associated with unfavorable treatment outcomes, particularly among HIV-seronegative patients. Further prospective studies evaluating neutrophil count in response to drug treatment and association with TB treatment outcomes are warranted.

Lecturas de Bioética: Las víctimas indirectas de la pandemia / Bioethics Readings: The Indirect Victims of the Pandemic

A 15 meses de la pandemia, todavía no conocemos los resultados del cierre de los servicios de salud ni las consecuencias de los manejos de muchas manos en ese plato. Nos preocupa, con razón, la alarmante serie de consecuencias negativas sobre la economía y sobre la educación, pero, en la marcha forzada, la pandemia desnudó las serias y crónicas falencias éticas del sistema de salud nacional

15 months after the pandemic, we still do not know the results of the closure of health services or the consequences of the handling of many hands on that plate. We are rightly concerned about the alarming series of negative consequences on the economy and on education, but, in the forced march, the pandemic exposed the serious and chronic ethical shortcomings of the national health system.