Educational disparities in brain health and dementia across Latin America and the United States.

BACKGROUND: Education influences brain health and dementia. However, its impact across regions, specifically Latin America (LA) and the United States (US), is unknown. METHODS: A total of 1412 participants comprising controls, patients with Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD) from LA and the US were included. We studied the association of education with brain volume and functional connectivity while controlling for imaging quality and variability, age, sex, total intracranial volume (TIV), and recording type. RESULTS: Education influenced brain measures, explaining 24%-98% of the geographical differences. The educational disparities between LA and the US were associated with gray matter volume and connectivity variations, especially in LA and AD patients. Education emerged as a critical factor in classifying aging and dementia across regions. DISCUSSION: The results underscore the impact of education on brain structure and function in LA, highlighting the importance of incorporating educational factors into diagnosing, care, and prevention, and emphasizing the need for global diversity in research. HIGHLIGHTS: Lower education was linked to reduced brain volume and connectivity in healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). Latin American cohorts have lower educational levels compared to the those in the United States. Educational disparities majorly drive brain health differences between regions. Educational differences were significant in both conditions, but more in AD than FTLD. Education stands as a critical factor in classifying aging and dementia across regions.

Brain clocks capture diversity and disparity in aging and dementia.

Brain clocks, which quantify discrepancies between brain age and chronological age, hold promise for understanding brain health and disease. However, the impact of multimodal diversity (geographical, socioeconomic, sociodemographic, sex, neurodegeneration) on the brain age gap (BAG) is unknown. Here, we analyzed datasets from 5,306 participants across 15 countries (7 Latin American countries -LAC, 8 non-LAC). Based on higher-order interactions in brain signals, we developed a BAG deep learning architecture for functional magnetic resonance imaging (fMRI=2,953) and electroencephalography (EEG=2,353). The datasets comprised healthy controls, and individuals with mild cognitive impairment, Alzheimer's disease, and behavioral variant frontotemporal dementia. LAC models evidenced older brain ages (fMRI: MDE=5.60, RMSE=11.91; EEG: MDE=5.34, RMSE=9.82) compared to non-LAC, associated with frontoposterior networks. Structural socioeconomic inequality and other disparity-related factors (pollution, health disparities) were influential predictors of increased brain age gaps, especially in LAC (R2=0.37, F2=0.59, RMSE=6.9). A gradient of increasing BAG from controls to mild cognitive impairment to Alzheimer's disease was found. In LAC, we observed larger BAGs in females in control and Alzheimer's disease groups compared to respective males. Results were not explained by variations in signal quality, demographics, or acquisition methods. Findings provide a quantitative framework capturing the multimodal diversity of accelerated brain aging.

Addition of Polyphenols to Drugs: The Potential of Controlling "Inflammaging" and Fibrosis in Human Senescent Lung Fibroblasts In Vitro.

The combination of a polyphenol, quercetin, with dasatinib initiated clinical trials to evaluate the safety and efficacy of senolytics in idiopathic pulmonary fibrosis, a lung disease associated with the presence of senescent cells. Another approach to senotherapeutics consists of controlling inflammation related to cellular senescence or "inflammaging", which participates, among other processes, in establishing pulmonary fibrosis. We evaluate whether polyphenols such as caffeic acid, chlorogenic acid, epicatechin, gallic acid, quercetin, or resveratrol combined with different senotherapeutics such as metformin or rapamycin, and antifibrotic drugs such as nintedanib or pirfenidone, could present beneficial actions in an in vitro model of senescent MRC-5 lung fibroblasts. A senescent-associated secretory phenotype (SASP) was evaluated by the measurement of interleukin (IL)-6, IL-8, and IL-1ß. The senescent-associated ß-galactosidase (SA-ß-gal) activity and cellular proliferation were assessed. Fibrosis was evaluated using a Picrosirius red assay and the gene expression of fibrosis-related genes. Epithelial-mesenchymal transition (EMT) was assayed in the A549 cell line exposed to Transforming Growth Factor (TGF)-ß in vitro. The combination that demonstrated the best results was metformin and caffeic acid, by inhibiting IL-6 and IL-8 in senescent MRC-5 cells. Metformin and caffeic acid also restore cellular proliferation and reduce SA-ß-gal activity during senescence induction. The collagen production by senescent MRC-5 cells was inhibited by epicatechin alone or combined with drugs. Epicatechin and nintedanib were able to control EMT in A549 cells. In conclusion, caffeic acid and epicatechin can potentially increase the effectiveness of senotherapeutic drugs in controlling lung diseases whose pathophysiological component is the presence of senescent cells and fibrosis.

Chilean consensus by expert panel using the Delphi technique for primary and secondary prevention of gastric cancer. / Estrategias para la prevención primaria y secundaria del cáncer gástrico: consenso chileno de panel de expertos con técnica Delfi.

INTRODUCTION: Gastric cancer (GC) is the first cause of cancer-related death in Chile and 6th in Latin America and the Caribbean (LAC). Helicobacter pylori (H. pylori) is the main gastric carcinogen, and its treatment reduces GC incidence and mortality. Esophageal-gastro-duodenoscopy (EGD) allows for the detection of premalignant conditions and early-stage GC. Mass screening programs for H. pylori infection and screening for premalignant conditions and early-stage GC are not currently implemented in LAC. The aim of this study is to establish recommendations for primary and secondary prevention of GC in asymptomatic standard-risk populations in Chile. METHODS: Two on-line synchronous workshops and a seminar were conducted with Chilean experts. A Delphi panel consensus was conducted over 2 rounds to achieve>80% agreement on proposed primary and secondary prevention strategies for the population stratified by age groups. RESULTS: 10, 12, and 12 experts participated in two workshops and a seminar, respectively. In the Delphi panel, 25 out of 37 experts (77.14%) and 28 out of 52 experts (53.85%) responded. For the population aged 16-34, there was no consensus on non-invasive testing and treatment for H. pylori, and the use of EGD was excluded. For the 35-44 age group, non-invasive testing and treatment for H. pylori is recommended, followed by subsequent test-of-cure using non-invasive tests (stool antigen test or urea breath test). In the ≥45 age group, a combined strategy is recommended, involving H. pylori testing and treatment plus non-invasive biomarkers (H. pylori IgG serology and serum pepsinogens I and II); subsequently, a selected group of subjects will undergo EGD with gastric biopsies (Sydney Protocol), which will be used to stratify surveillance according to the classification Operative Link for Gastritis Assessment (OLGA); every 3 years for OLGA III-IV and every 5 years for OLGA I-II. CONCLUSION: A "test-and-treat" strategy for H. pylori infection based on non-invasive studies (primary prevention) is proposed in the 35-44 age group, and a combined strategy (serology and EGD) is recommended for the ≥45 age group (primary and secondary prevention). These strategies are potentially applicable to other countries in LAC.

Prevalence of COVID-19 Among 8000 Patients at a Hospitalized and Mortality in Old Age.

BACKGROUND: COVID-19 created a general challenge to healthcare systems throughout the world and was an important cause of mortality. AIM: The aim of the present study was to report the general evolution of patients with COVID-19 at a teaching hospital and analyze differences by age group and sex considering mortality rates in the years 2020 and 2021 among patients older than 60 years of age. METHODS: A cross-sectional study was conducted with patients hospitalized with a diagnosis of COVID-19 confirmed by RT-PCR at the São Jose do Rio Preto university hospital between March 2020 and March 2022. The patients were male and female patients, of varying ages belonging to the region of Sao Jose do Rio Preto, were accommodated in the wards or intensive care units (ICUs). Overall mortality was analyzed for the hospital as well as in the ICUs and wards. This analysis was performed separately in two years considering age group, sex, and main comorbidities in patients older than 60 years of age. RESULTS: A total of 8032 patients with COVID-19 were hospitalized between March 2020 and March 2022: 2866 patients with 658 deaths (22.92%) in 2020; 4324 patients with 1168 deaths (27.01%) in 2021; and 842 patients with 205 deaths (24.35 %) in 2022 up to the month of March. More than half (53.60%) of the patients were hospitalized in the ICUs and 46.39% were hospitalized in the wards. Differences in the mortality rate were found for the different age groups in the comparison of the years, with more deaths occurring among individuals up to 90 years of age in the second year (p <0.05). Men were affected more and had a higher mortality rate (p <0.0001). The main comorbidities were cardiovascular disease (70.93%), diabetes (37.76%), and obesity (23.68%). CONCLUSION: The mortality rate of older people hospitalized with COVID-19 was higher than the average, it was higher in 2021 compared to 2020 and increased with age. Cardiovascular disease, diabetes, and obesity were the main comorbidities.

Researching New Drug Combinations with Senolytic Activity Using Senescent Human Lung Fibroblasts MRC-5 Cell Line.

Therapeutically targeting senescent cells seems to be an interesting perspective in treating chronic lung diseases, which are often associated with human aging. The combination of the drug dasatinib and the polyphenol quercetin is used in clinical trials as a senolytic, and the first results point to the relief of physical dysfunction in patients with idiopathic pulmonary fibrosis. In this work, we tested new combinations of drugs and polyphenols, looking for senolytic activity using human lung fibroblasts (MRC-5 cell line) with induced senescence. We researched drugs, such as azithromycin, rapamycin, metformin, FK-506, aspirin, and dasatinib combined with nine natural polyphenols, namely caffeic acid, chlorogenic acid, ellagic acid, ferulic acid, gallic acid, epicatechin, hesperidin, quercetin, and resveratrol. We found new effective senolytic combinations with dasatinib and ellagic acid and dasatinib and resveratrol. Both drug combinations increased apoptosis, reduced BCL-2 expression, and increased caspase activity in senescent MRC-5 cells. Ellagic acid senolytic activity was more potent than quercetin, and resveratrol counteracted inflammatory cytokine release during senolysis in vitro. In conclusion, dasatinib and ellagic acid and dasatinib and resveratrol present in vitro senolytic potential like that observed for the combination in clinical trials of dasatinib and quercetin, and maybe they could be future alternatives in the senotherapeutic field.

CAG and GGN repeat polymorphisms in the androgen receptor gene of a Chilean pediatric cohort with idiopathic inguinal cryptorchidism.

BACKGROUND: Cryptorchidism is one of the most common congenital disorders in boys and it is associated with a higher risk of sub-fertility and testicular cancer. Testicular descent occurs during embryo-fetal development in two phases, transabdominal and inguino-scrotal. In the latter process, androgens play a leading role. The androgen receptor has in its N-terminal domain, two aminoacidic repeats encoded by polymorphic nucleotide repetitions: (CAG)nCAA and GGN. The number of repetitions of these trinucleotides has been associated with different transactivation capacities and sensitivities of the androgen receptor response. OBJECTIVE: To determine whether pediatric Chilean individuals with idiopathic inguinal cryptorchidism have a different number of CAG and/or GGN repeats polymorphisms compared with controls. MATERIALS AND METHODS: A total of 109 cases with idiopathic inguinal cryptorchidism (26 bilateral and 83 unilateral) were studied by polymerase chain reaction amplification from DNA extracted from peripheral blood, followed by fragment size analysis by capillary electrophoresis, which were compared with 140 controls. RESULTS: The CAG26 repeats allele was increased in the total cases (8.3% vs. 1.4%; p = 0.012; odds ratio = 6.21, 95% confidence interval 1.31-29.4), and in bilateral cases compared to controls (11.5% vs. 1.4%; p = 0.028; odds ratio = 9 CI 95% 1.43-56.8). Similarly, CAG > 22 alleles were increased in the total cases (62.4% vs. 49.3%, p = 0.041), and more significantly in bilateral cases (73.1% vs. 49.3%; p = 0.032; odds ratio = 2.79, 95% confidence interval 1.1-7.1). In addition, CAG < 18 alleles were not observed among cases, but were present in 5.7% of controls (p = 0.01). Regarding the GGN repeats, no differences were observed between cases and controls either when analyzing separately unilateral and bilateral cryptorchidism. The joint analysis of the distribution of CAG and GGN alleles showed that the CAG26 allele was present with GGN23, hence the combination CAG26/GGN23 alleles was equally increased in bilateral cases compared with controls (11.5% vs. 1.4%). In contrast, CAG < 18 was preferably observed in the combination CAG < 18/GGN≠23 and was absent in the total cases (4.3% vs. 0%; p = 0.037). DISCUSSION: These results suggest that greater lengths of CAG alleles may contribute to a diminished androgen receptor function. The CAG26 allele alone or in combination with GGN23 was associated with a higher risk of bilateral cryptorchidism. On the other hand, CAG < 18 and the CAG < 18/GGN≠23 allele combination may reduce the probability of cryptorchidism.

Position of Correct Option and Distractors Impacts Responses to Multiple-Choice Items: Evidence From a National Test.

Even though the impact of the position of response options on answers to multiple-choice items has been investigated for decades, it remains debated. Research on this topic is inconclusive, perhaps because too few studies have obtained experimental data from large-sized samples in a real-world context and have manipulated the position of both correct response and distractors. Since multiple-choice tests' outcomes can be strikingly consequential and option position effects constitute a potential source of measurement error, these effects should be clarified. In this study, two experiments in which the position of correct response and distractors was carefully manipulated were performed within a Chilean national high-stakes standardized test, responded by 195,715 examinees. Results show small but clear and systematic effects of options position on examinees' responses in both experiments. They consistently indicate that a five-option item is slightly easier when the correct response is in A rather than E and when the most attractive distractor is after and far away from the correct response. They clarify and extend previous findings, showing that the appeal of all options is influenced by position. The existence and nature of a potential interference phenomenon between the options' processing are discussed, and implications for test development are considered.

Treatment of Elephantiasis with Physiological Retraction of the Skin to Clinical Standards of Normality.

Stage III lymphedema, also known as elephantiasis, is the most advanced stage and involves the occurrence of large deformities. This article reports the case of a 30-year-old woman with bilateral stage III lymphedema who weighed 109 kg. The largest circumference measurements below the knee were 97 cm on the right leg and 76 cm on the left leg. Intensive treatment was performed, involving 8 hour per day of mechanical lymphatic therapy with the RAGodoy® device, which performs passive plantar flexion and extension, 15 min of cervical lymphatic therapy per day, and the use of non-elastic laced compression stockings. Treatment resulted in a considerable loss of edema as well as the occurrence of folds of excess skin, which were resolved by continuing treatment in a slower, non-intensive manner. Folds of excess skin are common during the treatment of large lymphedemas until reaching standards of normality or near normality but can be resolved with further clinical treatment.

Intervenciones parentales para el desarrollo lingüístico- comunicativo en preescolares con Trastornos del Neurodesarrollo: una revisión sistemática / Parental interventions for linguistic-communicative development in preschoolers with Neurodevelopmental Disorders: a systematic review

Resumen En el actual escenario sociosanitario enfrentado a raíz de la pandemia por SARS-CoV-2, múltiples actividades se han visto mermadas, e incluso, suspendidas por los largos periodos de aislamiento social y las medidas de cuidado para evitar contagios. En este sentido, muchas personas han dejado de recibir con la misma regularidad, o bajo las mismas circunstancias, sus tratamientos, incluyendo a niños con Trastornos del Neurodesarrollo (TND). Es así como surgen las intervenciones Parentales. Estas son programas donde los padres o cuidadores primarios son entrenados para llevar a cabo acciones terapéuticas con el niño y cuyo objetivo puede estar orientado a promover múltiples habilidades. El objetivo de la presente revisión sistemática fue determinar el efecto de estas intervenciones para promover el lenguaje y la comunicación en niños con diagnóstico de TND de entre 2 y 5 años. Se realizó una búsqueda sistemática en las bases de datos ERIC, MEDLINE y PubMed, considerando publicaciones de entre enero del 2010 y marzo de 2022. De las 9885 referencias iniciales, y posterior a las etapas de tamizaje y elegibilidad, 5 fuentes primarias cumplieron con los criterios de selección. Los resultados indican que las intervenciones parentales para habilidades de comunicación serían efectivas e incluso se mantendrían los efectos en medidas de seguimiento. En cuanto a las habilidades de lenguaje, los resultados a través de los estudios son contradictorios. Por otra parte, ninguno de los estudios reporta efectos adversos para los niños. En cuanto a efectos beneficios o adversos para padres o cuidadores primarios, ninguno de los estudios incluidos reporta medidas asociadas.

Abstract In the current socio-sanitary scenario that we are facing as a result of the SARS-CoV-2 Pandemic, there have been many activities that have been reduced and even suspended due to long periods of social isolation and care measures to avoid contagion. In this sense, many people have stopped receiving their treatments with the same regularity or under the same circumstances, including children with Neurodevelopmental Disorders. This is how parental interventions correspond to programs where parents or primary caregivers are trained to carry out therapeutic actions with the child and whose objective may be aimed at promoting multiple skills. The objective of this systematic review was to determine the effect of these interventions to promote language and communication in children diagnosed with Neurodevelopmental Disorders between 2 and 5 years of age. A systematic search was carried out in the ERIC, MEDLINE and PubMed databases including publications between January 2010 and March 2022. Of the 9885 initial references, and after the screening and eligibility stages, 5 primary sources met the selection criteria. The results indicate that parental interventions for communication skills would be effective, and the effects would even be maintained in follow-up measures. Regarding language skills, the results across studies are contradictory. On the other hand, none of the studies reported adverse effects for children. Regarding beneficial or adverse effects for parents or primary caregivers, none of the included studies reported associated measures.

Validation of the Spanish version of the Pediatric Symptom Checklist (PSC) to identify and assess psychosocial problems among early adolescents in Chile.

BACKGROUND: The high prevalence of mental disorders in early adolescents, and their consequences, encourage the need for validated instruments to identify and assess psychosocial problems. OBJECTIVES: i) To evaluate the psychometric properties of the Spanish version of the Pediatric Symptom Checklist (PSC) questionnaires (PSC-Y, 35 items, and PSC-17-Y) and its subscales (Attention, Internalizing and Externalizing subscales), including the assessment of the item structure, concurrent validity, and reliability; and ii) To assess possible associations between bullying experiences, school climate and school membership with psychological problems identified by the PSC questionnaire. METHODS: A cross-sectional study was carried out in 39 schools in Santiago, Chile. The sample consisted of 3,968 adolescents aged between 10 and 11 years. A descriptive analysis of the Pediatric Symptom Checklist was performed along with measures of dimensionality, reliability, and correlations with a validated questionnaire exploring similar constructs, the Strengths and Difficulties Questionnaire. Finally, associations of bullying, school climate, and school membership with the three subscales of the PSC were explored. RESULTS: Both versions of PSC had problems with item #7 (Act as if driven by motor), which did not load in any of the latent factors. It was removed from later analyses. The three-factor structure of PSC was confirmed. All remaining items had high factor loadings in their corresponded latent factors, and the reliability was high for the total scales (PSC-34-Y, ω = 0.78; PSC-16-Y, ω = 0.94) and the subscales of PSC-16-Y (Attention, ω = 0.77; Internalizing, ω = 0.79; Externalizing, ω = 0.78). The goodness of fit was adequate, and the correlation between PSC subscales and SDQ subscales was high. Victimization and perpetration were associated with all PSC subscales, and higher school climate and stronger school memberships were negatively associated with PSC symptoms. CONCLUSIONS: The current findings seem to demonstrate that the Spanish version of the PSC is a valid and reliable instrument for identifying and assessing psychosocial problems in early adolescents.

Synthesis and Physiological Remodeling of CD34 Cells in the Skin following the Reversal of Fibrosis through Intensive Treatment for Lower Limb Lymphedema: A Case Report.

A novel type of cell underwent identification between 2005 and 2008 and was denominated the "telocyte" in 2010. In 2012, transmission electron microscopy revealed the presence of telocytes in the dermis. The aim of the present study was to report important changes in immunostained CD34 cells following the treatment of lower limb lymphedema using a specific lymphatic therapy technique. A clinical trial involving the evaluation of changes in immunostained CD34 cells in the epidermis and dermis (10 randomly selected histological fields) of a patient before and after intensive treatment for clinical stage II lymphedema was conducted using the Godoy Method, which was adapted to the treatment of skin fibrosis. The evaluation involved the use of the Weibel multi-point morphometric method. Comparisons were performed using the t-test with a 95% significance level. An important increase in CD34 cells was found with redistribution occurring following treatment. The treatment of primary lymphedema of the lower limbs resulted in the clinical reversal of fibrosis and an increase in the number of immunomarked CD34 cells.

Classification of Alzheimer's disease and frontotemporal dementia using routine clinical and cognitive measures across multicentric underrepresented samples: A cross sectional observational study.

Background: Global brain health initiatives call for improving methods for the diagnosis of Alzheimer's disease (AD) and frontotemporal dementia (FTD) in underrepresented populations. However, diagnostic procedures in upper-middle-income countries (UMICs) and lower-middle income countries (LMICs), such as Latin American countries (LAC), face multiple challenges. These include the heterogeneity in diagnostic methods, lack of clinical harmonisation, and limited access to biomarkers. Methods: This cross-sectional observational study aimed to identify the best combination of predictors to discriminate between AD and FTD using demographic, clinical and cognitive data among 1794 participants [904 diagnosed with AD, 282 diagnosed with FTD, and 606 healthy controls (HCs)] collected in 11 clinical centres across five LAC (ReDLat cohort). Findings: A fully automated computational approach included classical statistical methods, support vector machine procedures, and machine learning techniques (random forest and sequential feature selection procedures). Results demonstrated an accurate classification of patients with AD and FTD and HCs. A machine learning model produced the best values to differentiate AD from FTD patients with an accuracy = 0.91. The top features included social cognition, neuropsychiatric symptoms, executive functioning performance, and cognitive screening; with secondary contributions from age, educational attainment, and sex. Interpretation: Results demonstrate that data-driven techniques applied in archival clinical datasets could enhance diagnostic procedures in regions with limited resources. These results also suggest specific fine-grained cognitive and behavioural measures may aid in the diagnosis of AD and FTD in LAC. Moreover, our results highlight an opportunity for harmonisation of clinical tools for dementia diagnosis in the region. Funding: This work was supported by the Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat), funded by NIA/NIH (R01AG057234), Alzheimer's Association (SG-20-725707-ReDLat), Rainwater Foundation, Takeda (CW2680521), Global Brain Health Institute; as well as CONICET; FONCYT-PICT (2017-1818, 2017-1820); PIIECC, Facultad de Humanidades, Usach; Sistema General de Regalías de Colombia (BPIN2018000100059), Universidad del Valle (CI 5316); ANID/FONDECYT Regular (1210195, 1210176, 1210176); ANID/FONDAP (15150012); ANID/PIA/ANILLOS ACT210096; and Alzheimer's Association GBHI ALZ UK-22-865742.

Avaliação das estratégias de promoção da saúde e prevenção ao uso de drogas na rede psicossocial / Evaluación de estrategias de promoción de la salud y prevención del consumo de drogas en la red psicosocial / Assessment of health promotion and drug use prevention strategies in the psychosocial network

Resumo Objetivo avaliar as estratégias de promoção da saúde e prevenção ao uso de drogas na Rede de Atenção Psicossocial. Método estudo qualitativo, fundamentado na avaliação de empoderamento, desenvolvido em 2017 na Rede de Atenção Psicossocial (RAPS) de um município do Rio Grande do Sul, Brasil. Os grupos de interesse foram 42 trabalhadores e gestores representativos dos componentes da RAPS municipal. Foram utilizadas técnicas de observação participante, entrevistas e Fórum Aberto. Resultado avaliou-se que as ações de promoção da saúde e prevenção ao uso de drogas são precárias e necessitam de investimentos, constituindo-se a missão dos trabalhadores e gestores. Identificou-se como dificuldade a atuação da atenção primária, devido às fragilidades nas políticas públicas e à falta de apoio dos serviços especializados. Como potencialidade, elencou-se o matriciamento em saúde mental. Sugere-se investimento na Atenção Primária por meio de treinamento e suporte a essas equipes. Conclusão e implicações para a prática a pauta da promoção da saúde e prevenção ao uso abusivo de drogas é urgente e deve ser incluída na estruturação de políticas públicas e práticas no âmbito das redes.

Resumen Objetivo evaluar las estrategias de promoción de la salud y prevención de drogas en la Red de Atención Psicosocial. Método estudio cualitativo, basado en la evaluación de empoderamiento, desarrollado en 2017 en la Red de Atención Psicosocial (RAPS) de un municipio de Rio Grande do Sul, Brasil. Los grupos de interés fueron 42 trabajadores y directivos representantes de los componentes de la RAPS municipal. Se utilizaron técnicas de observación participante, entrevistas y Foro Abierto. Resultado se evaluó que las acciones de promoción de la salud y prevención del uso de drogas son precarias y requieren inversiones, constituyendo la misión de trabajadores y gestores. La actuación de la atención primaria fue identificada como una dificultad, debido a las debilidades de las políticas públicas y la falta de apoyo de los servicios especializados. Como potencialidad, se enumeró el apoyo matricial en salud mental. Se sugiere invertir en Atención Primaria a través de la formación y el apoyo a estos equipos. Conclusión e implicaciones para la práctica la agenda de promoción de la salud y prevención del abuso de drogas es urgente y debe ser incluida en la estructuración de políticas públicas y prácticas en redes.

Abstract Objective to assess health promotion and drug use prevention strategies in the Psychosocial Care Network. Method this is a qualitative study based on empowerment evaluation, developed in 2017 in the Psychosocial Care Network of a municipality in Rio Grande do Sul, Brazil. The interest groups were 42 workers and managers representing the municipal RAPS components. Participant observation techniques, interviews and Open Forum were used. Results it was assessed that health promotion and drug use prevention actions are precarious and require investments, constituting the mission of workers and managers. Primary care was identified as a difficulty due to weaknesses in public policies and lack of support from specialized services. As a potentiality, matrix support in mental health was listed. Investment in Primary Care is suggested through training and support for these teams. Conclusion and implications for practice health promotion and drug abuse prevention agenda are urgent and must be included in the structuring of public policies and practices within the networks.

Mortality and Deep Vein Thrombosis in the Gamma Variant of Covid 19 and Lung Injury.

Purpose: The SARS-CoV-2 disease predisposes infected individuals to thrombosis, the underlying mechanisms of which are not fully understood. The balance between pro-coagulant factors and natural coagulation inhibitors in critically ill patients with Covid-19 is fundamental to the prevention and treatment of complications. The aim of the present study was to investigate the pulmonary injury patterns in Covid-19 having higher mortality in the presence of deep vein thrombosis in comparison to patients without venous thrombosis and determine the Gamma variant. Methods: A retrospective study was conducted involving the evaluation of 200 medical records of patients with Covid-19 and a clinical suspicion of deep vein thrombosis (DVT) at the intensive care unit of a public hospital. The sample was divided into two groups of patients were formed - those positive and those negative for DVT. Statistical analysis involved the use of Fisher's exact test, the paired t-test and chi-square test. Results: Patients with DVT had more severe lung injuries (greater than 70%) compared to those without DVT (p = 0.003). Lesions affecting 50% to 70% of the lung area occurred in little more half of the group with DVT and just under half in the group without DVT (p = 0.5). Pulmonary lesions affecting less than 50% of the lung occurred more in patients without DVT (p = 0.0001). The Gamma variant increased prevalence of the both DVT and mortality (p=0.0001). Conclusion: Deep vein thrombosis is an aggravating factor of mortality in patients with SARS-CoV-2, and the Gamma variant is an aggravating factor of both thrombotic events and mortality.

Lipedema in Male Progressing to Subclinical and Clinical Systemic Lymphedema.

The aim of the present case study was to report the 3-year follow-up of a male patient with lipedema and subclinical systemic lymphedema evaluated using multi-segment bioimpedance. The report describes the case of a 53-year-old male with a history of oncological surgery involving lymph node clearance in the right inguinal region followed by radiotherapy and chemotherapy. The physical examination revealed lipedema and lymphedema in the right lower limb. The patient was submitted to multi-segment bioimpedance, circumference measurements and volumetry, with the detection of clinical lymphedema of the limb. The patient underwent intensive treatment for lymphedema using the Godoy Method®, which resulted in a substantial reduction in the edema. However, at the 1-year follow-up, the patient had progressed to subclinical systemic lymphedema, followed a year later by clinical systemic lymphedema evaluated using multi-segment bioimpedance. Lipedema is less frequent in men compared to women, but the increase in weight is an aggravating factor in both sexes. This condition initially affects the lower limbs, progressing to subclinical systemic lymphedema, followed by clinical systemic lymphedema determined using multi-segment bioimpedance, demonstrating that edema in patients with lipedema may be systemic.

Case Report: Godoy & Godoy method of cervical lymphatic therapy - indirect evaluation of the effect of the duration of stimulation on ocular edema.

The aim of the present study is to report the indirect evaluation of cervical stimulation considering the effect of the duration of the stimulus on the control of intraocular pressure in a patient with bilateral glaucoma with important ocular edema.  A 47-year-old woman reported the onset of pain and bilateral tearing in the eyes at 35 years of age and was diagnosed with glaucoma. The patient began clinical treatment, but intraocular pressure remained 35 to 40 mmHg even with the use of four eye medications in the form of drops. The patient reported that her vision was always blurred despite the use of the eyedrops. The patient was submitted to the Godoy & Godoy method of cervical lymphatic therapy to reduce the edema. The ophthalmologist measured her intraocular pressure every two and three days. We found that the pressure was maintained below 20 mmHg when lymphatic therapy was performed every two days, but intraocular pressure increased and the vision became blurred when therapy was performed every three days. The Godoy & Godoy method of cervical lymphatic therapy constitutes a novel lymphatic system stimulation strategy that maintains its effect on intraocular pressure for approximately 48 hours, as demonstrated through an indirect evaluation.

Aceptación y factores determinantes en vacunación contra COVID-19 en usuarios del Ambulatorio "El Ujano"

La vacunación contra la COVID-19 es una medida de prevención clave para reducir la tasa de contagios, contribuir con la inmunidad de rebaño y disminuir la severidad del cuadro clínico. Objetivos: Investigar la aceptación a la vacunación contra la COVID-19 y los factores determinantes en usuarios desde 18 años en el Ambulatorio Urbano tipo I "El Ujano" en Barquisimeto, Venezuela. Métodos: Se realizó un estudio descriptivo transversal, con una muestra no probabilística accidental de 276 usuarios en octubre-noviembre de 2021. La técnica de recolección utilizada fue la entrevista guiada y se formuló como instrumento de recolección de datos un cuestionario estructurado. El análisis fue de tipo descriptivo, usando medidas de frecuencia absolutas y relativas. Resultados: El 87,3 % aceptó la vacuna, prevaleciendo en ambos sexos y todos los grupos etarios. Independientemente del grado de instrucción de los encuestados, predominó el alto nivel de conocimiento sobre la COVID-19 y su prevención en un 60,2 %. La principal fuente de información fue la televisión (54,8 %). La presencia del antecedente patológico de infección por la COVID-19 personal, familiar o de conocidos se demostró en 81,2 % de los usuarios, de los cuales 53,3 % reportaron familiares o conocidos fallecidos debido a esta enfermedad. La principal causa de rechazo (12,7 %) a la vacunación fue "las personas enferman de COVID-19 cuando se vacunan" (31,4 %). Conclusiones: Este estudio aporta datos para la elaboración de planes que incentiven la aceptación de la vacunación como medida de prevención y de esta manera influir positivamente en el control de la pandemia.

Vaccination against COVID-19 is a key preventive measure to reduce the rate of infection, contribute to herd immunity and reduce the severity of the clinical presentation. Objectives: To investigate the acceptance of vaccination against COVID-19 and the determining factors in users from 18 years of age in the Urban Ambulatory type I "El Ujano" in Barquisimeto, Venezuela. Methods: A cross-sectional descriptive study was conduced with an accidental non-probabilistic sample made up of 276 users in October-November 2021. The collection technique used was the guided interview and a structured questionnaire was formulated as a data collection tool. The analysis was descriptive, using absolute and relative frequency measures. Results: 87,3 % accepted the vaccine, prevailing in both sexes and all age groups. Regardless of the level of education of the respondents, the high level of knowledge about COVID-19 and its prevention prevailed in 60,2 %. The main source of information was television (54,8 %). The presence of a pathological history of infection by personal, family or known COVID-19 was demonstrated in 81,2 % of users, of which 53,3 % reported relatives or acquaintances who died due to this disease. The main cause of rejection (12,7 %) to vaccination was "people get sick with COVID-19 when they are vaccinated" (31,4 %). Conclusions: this study provides data for the development of plans that encourage the acceptance of vaccination as a prevention measure and thus positively influence the control of the pandemic.