Basal or stimulated thyroglobulin in evaluating response to treatment in papillary thyroid carcinoma? A retrospective cohort study.

OBJECTIVE: It is not clear whether response to initial treatment in papillary thyroid carcinoma (PTC) patients is best evaluated by measuring thyroglobulin (Tg) in the presence of levothyroxine (BTg) or when stimulated by elevated TSH (STg). The aim of this study was to evaluate whether response to therapy 1 year after initial treatment changes with the use of STg in relation to BTg in PTC patients treated with total thyroidectomy (TT) and radioiodine (131I), and, if observed, to assess which response is better associated with clinical course. SUBJECTS AND METHODS: This is a retrospective study of 148 PTC patients submitted to TT and 131I. We analyzed the response to therapy (excellent, biochemical incomplete, or indeterminate) at 1 year after initial treatment, using BTg or STg, and compared which method was better associated with "excellent response at final evaluation." RESULTS: Twenty-eight patients (20.4%) presented change in response to therapy, with 17 of these (60.7%) presenting a worse response. Response using STg was 1.6 times better associated with proposed outcome [odds ratio (OR) = 4.61; confidence interval 95% (IC95%): 2.13-9.98] than with BTg (OR = 2.84; IC95%: 1.33-6.06). CONCLUSION: Response to therapy at 1 year using STg was altered in approximately 20% of cases and therefore proved to be a better predictor of excellent response in the last evaluation.

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

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

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

[Analysis of cardiac surgeries and operative mortality at the National Cardiovascular Institute during 2022]. / Análisis de las cirugías cardíacas y mortalidad operatoria en el Instituto Nacional Cardiovascular durante el 2022.

Objective: To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. Materials and methods: A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo". Results: During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an overall mortality rate of 4.5%. The mortality rate for elective surgeries was 2.8%, while for emergency surgeries, it was 14.3%. The most common complication was paroxysmal atrial fibrillation (14.0%), followed by surgical site infection with 52 cases (10.3%). Conclusions: Valvular surgery, whether isolated or combined with other procedures, was the most frequently performed. The obtained mortality rate is considered acceptable for a reference center.

Síndrome neuroléptico maligno

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

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

Patients Air Medical Transport During the COVID-19 Pandemic: A Retrospective Cohort Study.

INTRODUCTION: Air medical transport during the coronavirus disease 2019 pandemic was essential for transferring critically ill patients. This study aimed to comparatively analyze air-transported patients with and without coronavirus disease 2019 according to their clinical condition and complications that occurred during the flight. METHODS: This was a retrospective cohort study that analyzed the digital records of adult patients transported by fixed-wing aircraft from the interior of the state of Amazonas to the state capital Manaus, Brazil, from June 2019 to May 2021. Pearson's chi-squared, Fisher exact, and Wilcoxon-Mann-Whitney tests were applied (significance level of P < .05). RESULTS: The sample consisted of 741 patients (60.59% men, median age 54 years). The incidence of complications during the flight was 7.28%, with emphasis on dyspnea, psychomotor agitation, and pain. There was a significant difference between patients with (n = 466) and without coronavirus disease 2019 (n = 275) regarding the variables age (P < .001), comorbidities (P < .001), body mass index (P < .001), impact (P < .001) and priority (P = .002) of the transfer, physiological severity (P < .001), use of vasoactive drugs when boarding the aircraft (P = .033), and occurrence of respiratory complications during air medical transport (P = .003). DISCUSSION: Patients with coronavirus disease 2019 were older, had more comorbidities and were severely ill, and had higher body mass index, frequency of vasoactive drug use, and respiratory complications. Although there are minimal differences among these patients, the role that interhospital transfer plays in reducing burden on local, less well-equipped hospitals is a primary role of medical transport, particularly during pandemics.

Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish simple.

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

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

Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study.

INTRODUCTION: The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. METHOD: We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. RESULTS: Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. CONCLUSIONS: The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.

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

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

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

Evolução clínica e sobrevida de pacientes vítimas de traumatismo cranioencefálico / Clinical evolution and survival of patients victims of head trauma / Evolución clínica y supervivencia de pacientes víctimas de trauma cerebral

Introdução: Trauma cranioencefálico é causa importante de morbimortalidade e incapacidades, principalmente em indivíduos com idade inferior a 45 anos. Doenças neurológicas possuem um processo de recuperação lenta, requerem internação prolongada e, consequentemente, predispõem os pacientes a complicações. Objetivo: Descrever a evolução clínica e a sobrevida de pacientes vítimas de traumatismo crânioencefálico internados em uma Unidade de Terapia Intensiva. Método: Estudo transversal com delineamento descritivo e abordagem quantitativa. Resultados: No período do estudo, foram internadas 33 pessoas diagnosticadas com traumatismo cranioencefálico numa Unidade de Terapia Intensiva Neurológica Adulta de um hospital de ensino no Noroeste Paulista. Em relação ao perfil, 75,7% dos pacientes eram do sexo masculino e a faixa etária predominante de 31 a 59 anos (51,5%). Quanto à causa do trauma, o principal motivo foi a queda, com valor equivalente a 57,58%. Quanto à classificação da lesão, 57,58% foram traumas graves e 66,67% receberam tratamento cirúrgico. O tempo médio de permanência na Unidade de Terapia Intensiva foi superior a 7 dias (42,4%). Sobre a evolução clínica, 42,42% necessitaram de cateter para monitoração da pressão intracraniana, 63,64% foram submetidos à ventilação mecânica invasiva e 78,79% fizeram uso de drogas vasoativas sendo a mais utilizada a Noradrenalina em 67,65% dos casos, seguida do Nitroprussiato de sódio (Nipride®) em 17,65% e a Vasopressina em 14,70%, associada a Noradrenalina. Complicações ocorreram em 54,5% dos pacientes, sendo mais frequente a pneumonia, com 47,83%. O desfecho clínico foi a alta hospitalar para 75,76%, enquanto 12% apresentaram sequelas neurológicas. Conclusão: A maioria dos pacientes necessitou de monitoração da pressão intracraniana, ventilação mecânica e drogas vasoativas. Por ocasião da alta hospitalar, se observou uma pequena porcentagem de pacientes com sequelas neurológicas, reforçando a importância, expertise e competência da equipe multiprofissional no trabalho assistencial em unidades de neurointensivismo.

Introduction: Cranioencephalic trauma is an important cause of morbidity, mortality and disability, especially in individuals under the age of 45. Neurological diseases have a slow recovery process, require prolonged hospitalization and, consequently, predispose patients to complications. Objective: To describe the clinical evolution and survival of patients suffering from traumatic brain injury admitted to an Intensive Care Unit. Method: Cross-sectional study with a descriptive design and quantitative approach. Results: During the study period, 33 people diagnosed with traumatic brain injury were admitted to an Adult Neurological Intensive Care Unit of a teaching hospital in the Northwest of São Paulo. Regarding the profile, 75.7% of patients were male and the predominant age range was 31 to 59 years old (51.5%). As for the cause of the trauma, the main reason was the fall, with a value equivalent to 57.58%. Regarding the classification of the injury, 57.58% were severe traumas and 66.67% received surgical treatment. The average length of stay in the Intensive Care Unit was more than 7 days (42.4%). Regarding clinical evolution, 42.42% required an catheter to monitor intracranial pressure, 63.64% underwent invasive mechanical ventilation and 78.79% used vasoactive drugs, with Noradrenaline being the most used in 67.65% of cases, followed by sodium nitroprusside (Nipride®) in 17.65% and vasopressin in 14.70%, associated with noradrenaline. Complications occurred in 54.5% of patients, with pneumonia being the most common, with 47.83%. The clinical outcome was hospital discharge for 75.76%, while 12% had neurological sequelae. Conclusion: Most patients required intracranial pressure monitoring, mechanical ventilation and vasoactive drugs. At the time of hospital discharge, a small percentage of patients with neurological sequelae were observed, reinforcing the importance, expertise and competence of the multidisciplinary team in care work in neurointensive care units

Introducción: El trauma craneoencefálico es una causa importante de morbilidad, mortalidad y discapacidad, especialmente en individuos menores de 45 años. Las enfermedades neurológicas tienen un proceso de recuperación lento, requieren hospitalización prolongada y, en consecuencia, predisponen a los pacientes a sufrir complicaciones. Objetivo: Describir la evolución clínica y supervivencia de pacientes con traumatismo craneoencefálico ingresados en una Unidad de Cuidados Intensivos. Método: Estudio transversal con diseño descriptivo y enfoque cuantitativo. Resultados: Durante el período de estudio, 33 personas diagnosticadas con lesión cerebral traumática fueron internadas en una Unidad de Cuidados Intensivos Neurológicos de Adultos de un hospital universitario del Noroeste de São Paulo. En cuanto al perfil, el 75,7% de los pacientes fueron del sexo masculino y el rango de edad predominante fue de 31 a 59 años (51,5%). En cuanto a la causa del traumatismo, el motivo principal fue la caída, con un valor equivalente al 57,58%. En cuanto a la clasificación de la lesión, el 57,58% fueron traumatismos graves y el 66,67% recibió tratamiento quirúrgico. La estancia media en la Unidad de Cuidados Intensivos fue superior a 7 días (42,4%). En cuanto a la evolución clínica, el 42,42% requirió catéter para monitorizar la presión intracraneal, el 63,64% recibió ventilación mecánica invasiva y el 78,79% utilizó fármacos vasoactivos, siendo la noradrenalina la más utilizada en el 67,65% de los casos, seguida del nitroprusiato de sodio (Nipride®) en 17,65% y vasopresina en 14,70%, asociada a noradrenalina. Las complicaciones ocurrieron en el 54,5% de los pacientes, siendo la neumonía la más común, con el 47,83%. El resultado clínico fue el alta hospitalaria para el 75,76%, mientras que el 12% tuvo secuelas neurológicas. Conclusión: La mayoría de los pacientes requirieron monitorización de la presión intracraneal, ventilación mecánica y fármacos vasoactivos. Al momento del alta hospitalaria se observó un pequeño porcentaje de pacientes con secuelas neurológicas, lo que refuerza la importancia, experiencia y competencia del equipo multidisciplinario en el trabajo asistencial en las unidades de cuidados neurointensivos

Sources of social support and clinical and functional evolution of people with schizophrenia.

PURPOSE: The impact of social support on comprehensive measures of results (clinical and functional) of the course of schizophrenia was studied, understood and evaluated as a multidimensional construct differentiating sources of support (family vs. nonfamily). METHODS: One hundred fifty-two patients diagnosed with schizophrenia were assessed with the Mannheim Interview on Social Support (MISS) and the Social Functioning Scale (SFS). The hypotheses were explored in a prospective longitudinal design, using a causal correlational analysis for their evaluation by applying structural equation models. RESULTS: The only explanatory factor of social functioning was Nonfamily social support, while the only explanatory factor of clinical result measurements was Family social support, observing a clearly differentiated impact of the different sources of support on the schizophrenia result measurements. It was also found that while Family social support explained 6.8% of the variance in the clinical result measurements, Nonfamily social support explained 13.7% of the variance in social functioning. CONCLUSION: The results confirmed the differential importance of social support variables (family vs. nonfamily) in the clinical and functional result measurements of people with schizophrenia.

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units.

Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Caracterización del dengue con bradicardia en adolescentes

Introducción: El dengue es una enfermedad infecto contagiosa de variada intensidad, oriunda de climas tropicales como los que predominan en la región de las Américas. Es trasmitida por el mosquito Aedes aegypti y afecta a la población pediátrica. Su espectro clínico incluye alteraciones de la conducción cardíaca y de bradicardia. Objetivo: Caracterizar el dengue con bradicardia en adolescente. Métodos: Se realizó un estudio observacional descriptivo, longitudinal y retrospectivo en el Hospital Pediátrico Provincial Universitario Dr. Eduardo Agramonte Piña de la provincia Camagüey en el periodo comprendido desde enero a diciembre de 2021. El universo quedó conformado por 28 pacientes con diagnóstico de dengue que presentaron bradicardia. Los datos se recogieron en un formulario y se procesaron en una base de datos creada con SPSS versión 22. Resultados: Los resultados mostraron predominio de los pacientes del sexo masculino, del municipio Camagüey, entre los síntomas iniciales más frecuentes fue el dengue sin signos de alarma, el inicio de la bradicardia es durante la hospitalización, la bradicardia sinusal se presenta en todos los pacientes, en la mayoría de los casos la duración es en la etapa de recuperación. Conclusiones: Entre los síntomas encontrados predominaron los pacientes que no presentaron signos de alarma de dengue, la aparición de estos signos se asoció con bradicardia sinusal en la etapa de recuperación.

Introduction: Dengue is a contagious infectious disease of varying intensity that originates from tropical climates such as those that predominate in the region of the Americas. It is transmitted by the Aedes aegypti mosquito and affect the pediatric population. Its clinical spectrum includes alterations in cardiac conduction and bradycardia. Objective: To characterize dengue with bradycardia in adolescents. Methods: A descriptive, longitudinal and retrospective observational study was carried out at the Dr. Eduardo Agramonte Piña University Provincial Pediatric Hospital in Camagüey province in the period from January to December 2021.The universe was made up of 28 patients diagnosed with dengue who presented bradycardia. The data was collected in a from and processed in a database created with SPSS version 22. Results: The results grouped in the form of tables, showed a predominance of male patients, from the municipality of Camagüey, among the most frequent initial symptoms is dengue without warning signs, the onset of bradycardia is during hospitalization, it occurs in all patients, in most cases the duration is in the recovery stage. Conclusions: Among the symptoms found, patients who did not present dengue alarm signs was associated with sinus bradycardia during recovery.

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

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

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

Profil épidémiologique et mortalité due à la tuberculose dans la zone de Santé de Kamina, Province du Haut-Lomami, en Démocratique du Congo / Epidemiological profile and deaths related to TB disease in the Kamina´s Health Zone, Haut-Lomami Province, Democratic Republic of the Congo

Introduction: Était de décrire le profil épidémiologique, clinique et évolutif des patients tuberculeux suivis dans le milieu urbano-rural de Kaminaen République Démocratique du Congo (RDC). Méthodes: il s´agit d´une étude transversale par analyse rétrospective de dossiers des patients suivis pour tuberculose sur une période allant du 1er Janvier 2018 au 31 Décembre 2021. Résultats: sur un total de 612 échantillons analysés, 216 cas de tuberculose ont été confirmés par le laboratoire, soit une fréquence de 35,3 %. Notre échantillon était constitué de 138 hommes et 78 femmes, soit un sex-ratio de 1,77. L´âge moyen était de 35,37±18,14 années. La majorité des patients était dans la tranche d´âge comprise entre 21-40 ans. La profession libérale représentait 94,4 % de notre effectif, soit 204 patients. Il y a eu 63,4% des patients souffraient d´une tuberculose pulmonaire dont 70,9 % était guéris. La sérologie VIH était positive chez 6 patients, soit un taux de séroprévalence VIH de 2,77 %. Au total, 27 malades sont décédés sur les 612, soit un taux de mortalité de 4,41 %. C´est la tranche d´âge de malades ages de plus de 60 ans qui a connu une mortalitéélévée, soit 5 cas sur 20 (25 %), suivie de celle des malades ages de moins de 20 ans, 11 cas sur 49 (22,4 %). D´autre part, le résultat a montré un taux de mortalité plus élévé chez les tuberculeux séropositif, 33,3 %, contre 11.9 % chez les séronégatifs. Conclusion: ce rapport montre un taux élevé de tuberculose dans la zone de santé de Kamina ; il confirme le fait que la TB est endémique dans la région. Il est nécessaire d'améliorer les conditions de vie de la population et le système de santé local en ce qui concerne la prévention et la gestion de la TB afin de réduire sa morbi-mortalité.

Introduction: the purpose of this study was to describe the epidemiological, clinical and evolutionary profile of patients with tuberculosis followed in the urban-rural area of Kamina, Democratic Republic of the Congo (DRC). Methods: we conducted a cross-sectional study based on a retrospective analysis of the medical records of patients followed for tuberculosis over the period January 1, 2018 -December 31, 2021. Results: out of 612 samples analysed, 216 cases had received lab confirmation of tuberculosis, reflecting a rate of 35.3%. Our sample consisted of 78 women and 138 men (sex ratio 1.77). The average age of patients was 35,37±18.14 years. The majority of patients were in the age range 21-40 years. Self-employed people accounted for 94.4% of our workforce (204 patients); 63.4% of patients suffered from pulmonary tuberculosis, 70.9% of whom were cured. Serology test for HIV was positive in 6 patients (i.e. an HIV seroprevalence rate of 2.77%). In total, 27 patients out of 612 died, (i.e. a mortality rate of 4.41%). Patients aged over 60 had higher mortality rates (5 out of 20 cases; 25%), followed by patients under 20 (11 out of 49 cases; 22.4%). On the other hand, our results showed a higher mortality rate among HIV-positive patients with tuberculosis (33.3%, compared to 11.9% among HIV-negative patients). Conclusion: this study shows a high rate of tuberculosis in the Kamina health zone, confirming the fact that TB is endemic in the region. There is a need to improve the living conditions of the population and the local health system with regard to the prevention and management of TB in order to reduce morbidity and mortality

JUXTACORTICAL OSTEOSARCOMA: CLINICAL EVOLUTION AND DEDIFFERENTIATION RELATED FACTORS.

Objective: Evaluate risk factors related to clinical evolution and dedifferentiation of parosteal (juxtacortical) osteosarcoma to high-grade osteosarcoma. Methods: Retrospective cohort study performed over a period of 25 years, using data from medical records of patients diagnosed with parosteal osteosarcoma. The data were submitted to statistical analysis by Fisher's exact test and Student's t-test. Results: Of the 326 patients treated for osteosarcoma, we identified 17 patients diagnosed with parosteal osteosarcoma. Of these, 4 (23.5%) were not actually diagnosed with parosteal osteosarcoma and 4 did not have the minimum data required for analysis, being excluded from the study. Of the 9 patients studied, we observed that 3 (33.3%) evolved with tumor dedifferentiation to high-grade osteosarcoma. Moreover, 2 (66.7%) had local recurrence and 2 (66.7%) metastases. Conclusion: Age, sex, and the tumor size were not directly related to the dedifferentiation from parosteal osteosarcoma to high-grade osteosarcoma. The most aggressive clinical evolution - presence of local recurrences and metastasis - in parosteal osteosarcoma occurred in tumors with dedifferentiation, however, we cannot associate each other as cause and effect, but as related factors. Level of Evidence IV, Case Series.

Objetivo: Avaliar fatores de risco relacionados à evolução clínica e à desdiferenciação do osteossarcoma justacortical (parosteal, paraosteal) em osteossarcoma de alto grau. Métodos: Estudo de coorte retrospectiva realizado num período de 25 anos. Foram utilizados dados de prontuários de pacientes com diagnóstico de osteossarcoma parosteal que, em seguida, foram submetidos à análise estatística pelo Teste Exato de Fisher e pelo Teste t de Student. Resultados: Foram tratados 326 pacientes com diagnóstico de osteossarcoma, dos quais 17 (5,21%) receberam diagnóstico de osteossarcoma parosteal, 4 (1,22%) foram diagnosticados com osteossarcoma convencional e 4 (1,22%) não tinham dados mínimos necessários para análise, sendo excluídos do estudo. Dos 9 (2,76%) pacientes estudados, 3 (0,92%) evoluíram com desdiferenciação do tumor para osteossarcoma de alto grau. Dois (0,84%) pacientes apresentaram recidiva local e 2 (0,84%%) apresentaram metástases. Conclusão: Os fatores idade, sexo e volume do tumor não estão diretamente relacionados com a desdiferenciação do osteossarcoma parosteal para osteossarcoma de alto grau. Apesar de a evolução clínica mais agressiva - presença de recidivas locais e metástase - no osteossarcoma parosteal ter ocorrido nos tumores com desdiferenciação, não é possível estabelecer uma relação de causa e efeito, apenas considerá-las como fatores relacionados. Nível de Evidência IV, Série de Casos.

Desfecho clínico e fatores associados em pacientes comCOVID-19 internados em uma Unidade de Terapia Intensiva / Clinical outcome and associated factors in patients with COVID-19 admittedto an Intensive Care Unit

Introdução: O Corona Virus Disease (COVID-19) é umainfecção de elevada transmissibilidade e está associada commaior suscetibilidade ao desenvolvimento de desnutrição.Desta forma, a terapia nutricional enteral deve estar inte-grada ao tratamento global deste agravo. Objetivo: Analisar os fatores clínicos, nutricionais e bioquí-micos associados ao desfecho clínico de pacientes com COVID-19 internados em uma Unidade de Terapia Intensiva (UTI). Métodos: Trata-se de uma série de casos, realizado no pe-ríodo de março a julho de 2020, com os dados registrados nasfichas de acompanhamento nutricional dos pacientes interna-dos com COVID-19. As variáveis analisadas foram: demográ-ficas (idade e sexo); clínicas (comorbidades, doença de basee desfecho), antropométricas, bioquímicas e de suporte nu-tricional. Resultados: A amostra foi composta por 102 pacientes,65,7% apresentaram síndrome respiratória aguda grave, aprincipal doença de base observada foi as doenças cardíacas(23,5%) e 69,3% dos pacientes evoluíram para a alta da UTI.Com relação às variáveis nutricionais, aproximadamente 50%dos pacientes receberam alimentação por via enteral e 73,3%iniciaram de forma precoce. No que se refere aos marcadores bioquímicos, os pacientes que foram a óbito, apresentarammaiores valores das razões proteína C reativa (PCR) /albu-mina (p=0,024) e das concentrações de PCR (p=0,012)quando comparado com os que evoluíram para alta da UTI.Além disso, observa-se que os idosos (HR ajustada =3,62;IC95% 1,19 – 10,97) e o início precoce da terapia nutricionalenteral (HR ajustada = 10,62; IC95% 2,41 – 46,87) foram fa-tores relacionados com a alta da UTI. Conclusão: O acompanhamento do processo inflamatórioatravés de diferentes marcadores parece ser um bom parâ-metro de evolução clínica desses pacientes. Além disso, osbenefícios da terapia de nutrição enteral precoce podem es-tar associados à melhor evolução clínica e redução de com-plicações durante internamento.(AU)

ntroduction: The Corona Virus Disease (COVID-19) is ahighly transmissible infection and is associated with greatersusceptibility to the development of malnutrition. Thus, en-teral nutritional therapy must be integrated into the globaltreatment of this condition. Objective: To analyze the clinical, nutritional and biochem-ical factors associated with the clinical outcome of patientswith COVID-19 admitted to an Intensive Care Unit (ICU). Methods: This is a case series, carried out from March toJuly 2020, with data recorded in the nutritional monitoringrecords of patients hospitalized with COVID-19. The variablesanalyzed were: demographic (age and sex); clinical (comor-bidities, underlying disease and outcome), anthropometric,biochemical and nutritional support. Results: The sample consisted of 102 patients, 65.7% hadthe severe acute respiratory syndrome, the main underlyingdisease observed was heart disease (23.5%) and 69.3% ofpatients were discharged from the ICU. Regarding nutritionalvariables, approximately 50% of patients received enteralfeeding and 73.3% started early. Concerning biochemicalmarkers, patients who died had higher C-reactive protein(CRP)/albumin ratios (p=0.024) and CRP concentrations(p=0.012) when compared to those who progressed to dis-charge from the ICU. In addition, it is observed that the eld-erly (adjusted HR = 3.62; 95%CI 1.19 – 10.97) and early ini-tiation of enteral nutritional therapy (adjusted HR = 10.62;95%CI 2.41 – 46 .87) were factors related to ICU discharge. Conclusion: Monitoring the inflammatory process usingdifferent markers seems to be a good parameter for theclinical evolution of these patients. In addition, the benefitsof early enteral nutrition therapy may be associated withbetter clinical outcomes and reduced complications duringhospitalization.(AU)