Towards stronger tobacco control policies to curb the smoking epidemic in Spain.

Smoking and exposure to secondhand smoke pose a significant risk to the health of populations. Although this evidence is not new, the commitment of countries to implement laws aimed at controlling consumption and eliminating exposure to secondhand smoke is uneven. Thus, in North America or in Europe, locations like California or Ireland, are pioneers in establishing policies aimed at protecting the population against smoking and secondhand smoke. Identifying measures that have worked would help control this important Public Health problem in other countries that are further behind in tobacco control policies. In Spain, there has been almost 15 years of little political action in legislation oriented to control the tobacco epidemic. If we want to achieve the tobacco endgame, new legislative measures must be implemented. In this paper, we have elucidated tobacco control policies that could be implemented and show how different countries have done so.

An overview on the relationship between residential radon and lung cancer: what we know and future research.

We aim to provide an overview of the research available on indoor radon and lung cancer, with a special focus on Spanish investigations. Early studies on underground miners established the link between radon and lung cancer, which was later confirmed for the general population by residential case-control studies. Spain contributed with extensive evidence, including 5 multicentric, hospital-based, case-control studies in the last 30 years, exploring diverse aspects, such as radon's effect on never-smokers, molecular pathways linking radon exposure to lung cancer risk, survival rates, mortality burden, and occupational exposure. There is a well-established causal association between radon with lung cancer. Despite pioneering research performed in our country by the Galician Radon Laboratory, particularly on driver genes, the evidence on the potential molecular pathways which makes radon a carcinogen is sparse. Also, relevant questions on the potential association of radon exposure with the induction of other diseases are still pending.

Association between duration of smoking abstinence before non-small-cell lung cancer diagnosis and survival: a retrospective, pooled analysis of cohort studies.

BACKGROUND: The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. METHODS: In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. FINDINGS: Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1-3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87-0·97), patients with 3-5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83-0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87-0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81-0·93). Results were consistent across age, sex, histology, and disease-stage distributions. INTERPRETATION: In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. FUNDING: The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.

[Attributable mortality to tobacco consumption in Brazil, 1996-2019]. / Mortalidad atribuida al consumo de tabaco en Brasil, 1996-2019.

OBJECTIVE: To analyze the burden of tobacco consumption on mortality and years of life expectancy lost in population ≥35 years in Brazil in the period 1996-2019 and to identify trend changes in smoking-attributable mortality. METHOD: An independent prevalence method using the lung cancer mortality rate as a proxy for cumulative smoking risk was used to estimate smoking-attributable mortality. Smoking-attributable mortality is estimated from the lung cancer mortality rate and applying relative risks from 5 US cohorts. Smoking-attributable mortality, crude and standardized attributed mortality rates are presented overall, by sex, age and causes of death. Trend analysis was performed by applying joinpoint regression models. Years of life expectancy lost due to tobacco were calculated. RESULTS: Tobacco consumption caused 2,389,831 deaths in Brazil between 1996-2019. Cardiometabolic diseases were the leading cause of death in women throughout the period and in men until 2015. Since 2006, smoking-attributable mortality rates in men, regardless of age, show a decreasing trend while in females the evolution is different. The years of life expectancy lost show a slight decrease since the first triennia and are higher in men. CONCLUSIONS: In Brazil, the 8.5% of total mortality between 1996-2019 is attributed to tobacco consumption. It is important to monitor the burden of the tobacco consumption on mortality in order to strengthen or implement interventions against smoking in Brazil.

Evolution and characterization of health sciences paper retractions in Brazil and Portugal.

The retraction of health sciences publications is a growing concern. To understand the patterns in a particular country-context and design specific measures to address the problem, it is important to describe and characterize retractions. We aimed to assess the evolution of health science retractions in Brazil and Portugal and to describe their features. We conducted a cross-sectional study including all health sciences retracted articles with at least one author affiliated to a Portuguese or Brazilian institution identified through Retraction Watch database. A total of 182 retracted articles were identified. The number of retractions increased over time, but the proportion related to the whole of publications remained stable. A total of 50.0% and 60.8% of the Portuguese and Brazilian retracted articles, respectively, were published in first and second quartile journals. Scientific misconduct accounted for 60.1% and 55.9% of retractions in Brazil and Portugal. In both countries, the most frequent cause of misconduct was plagiarism. The time from publication to retraction decreases as the journal quartile increases. The retraction of health sciences articles did not decrease over time in Brazil and Portugal. There is a need to develop strategies aimed at preventing, monitoring and managing scientific misconduct according to the country context.

Síndrome de Andersen Tawil en una embarazada con alto riesgo de muerte súbita. Reporte de caso / Andersen Tawil syndrome in a pregnant woman at high risk of sudden death

Resumen ANTECEDENTES: El síndrome de Andersen Tawil es una canalopatía multisistémica genética, muy rara, sin alteración cardiaca estructural, heredada de manera autosómica dominante y causada por mutación en el gen KCNJ2. Este síndrome se caracteriza por una triada de parálisis muscular periódica, cambios en el electrocardiograma y estructurales corporales. El rasgo distintivo es la taquicardia ventricular bidireccional, las contracciones ventriculares prematuras y raramente taquicardia polimórfica tipo torsade de pointes. En la actualidad se carece de guías para el peri y postparto y para la prevención de arritmias. CASO CLÍNICO: Paciente de 21 años, embarazada, con síndrome de Andersen Tawil diagnosticado a esta edad, con base en los antecedentes de síncope de repetición y debilidad en las extremidades desde los 11 años. Recibía tratamiento con un beta-bloqueador y un desfibrilador automático implantable. La ecocardiografía fetal a las 23 y 33 semanas de gestación reportó una comunicación interventricular apical de 1.6 mm. A las 39 semanas de embarazo se practicó una cesárea electiva, con evolución posoperatoria satisfactoria. El estudio molecular dirigido al recién nacido descartó el síndrome de Andersen Tawil congénito. CONCLUSIÓN: En pacientes con síndromes de arritmia congénita, el embarazo puede ser seguro siempre y cuando un grupo de especialistas esté pendiente para tomar decisiones de atención y tratamiento durante todo el proceso del embarazo y puerperio.

Abstract BACKGROUND: Andersen Tawil syndrome is a very rare genetic multisystemic channelopathy without structural cardiac alteration, inherited in an autosomal dominant manner and caused by mutation in the KCNJ2 gene. This syndrome is characterised by a triad of periodic muscle paralysis, electrocardiogram and body structural changes. The hallmark is bidirectional ventricular tachycardia, premature ventricular contractions and rarely polymorphic torsade de pointes tachycardia. Currently there is a lack of guidelines for peri- and postpartum and arrhythmia prevention. CLINICAL CASE: 21-year-old pregnant patient with Andersen-Tawil syndrome diagnosed at this age, based on a history of repeated syncope and weakness in the extremities since the age of 11. She was being treated with a beta-blocker and an implantable cardioverter defibrillator. Fetal echocardiography at 23 and 33 weeks gestation reported an apical ventricular septal defect of 1.6 mm. Elective caesarean section was performed at 39 weeks of pregnancy, with satisfactory postoperative evolution. Molecular study of the newborn ruled out congenital Andersen-Tawil syndrome. CONCLUSION: In patients with congenital arrhythmia syndromes, pregnancy can be safe as long as it is managed by a group of experts to make decisions and optimise care throughout the pregnancy and postpartum period.

Anomalías congénitas disruptivas asociadas con misoprostol. Reporte de un caso / Disruptive congenital anomalies associated with misoprostol. Case report

Resumen ANTECEDENTES: La exposición prenatal al misoprostol puede asociarse con un espectro de defectos congénitos que varían desde anomalías del sistema nervioso central, secuencia de Moebius, defectos en la pared abdominal, defectos transversales en las extremidades hasta alteraciones fetales. Esos defectos se observan más comúnmente con esquemas de solo misoprostol para inducción del aborto. Por esos antecedentes es importante que la historia clínica de toda paciente obstétrica sea exhaustiva para permitir identificar el antecedente de la exposición prenatal luego de un aborto fallido. CASO CLINICO: Paciente de 21 años, con 32 semanas de embarazo, con diagnóstico de feto con ventriculomegalia. En la evaluación ecográfica destacó la ventriculomegalia triventricular severa, simétrica y la angulación de ambas extremidades inferiores en varo. La resonancia magnética reportó: ventriculomegalia no comunicante severa, bilateral, simétrica, por probable estenosis del acueducto de Silvio. Cariotipo 46,XY y perfil TORCH negativo. El embarazo finalizó mediante cesárea, por indicación fetal a las 35 semanas. La evaluación al nacimiento reportó: parálisis facial bilateral, macrocefalia y pie equino varo bilateral. Al volver a interrogar a la paciente refirió haber sido tratada con misoprostol en el primer trimestre del embarazo, con fines abortivos. Al descartar las alteraciones cromosómicas e infecciosas se estableció el diagnóstico de secuencia Moebius. CONCLUSIONES: La exposición prenatal al misoprostol está relacionada con la aparición de defectos vasculares en algunos fetos expuestos. Aún no se ha determinado el espectro preciso ni la estimación potencial de teratogenicidad. La historia clínica es el pilar para la asociación en estos casos.

Abstract BACKGROUND: Prenatal misoprostol exposure can be associated with a spectrum of birth defects, ranging from central nervous system abnormalities, Moebius sequence, abdominal wall defects, as well as transverse limb defects, fetal abnormalities are more commonly seen with the use of the misoprostol-only regimen for induction of abortion, such that a thorough medical history is essential to detect a history of prenatal exposure after a failed abortion. CLINICAL CASE: A 21-year-old patient, with a 32-week pregnancy, who attended the institute with a diagnosis of a fetus with ventriculomegaly, the ultrasound evaluation highlighted severe symmetric triventricular ventriculomegaly and angulation of both lower extremities in varus, magnetic resonance imaging reported severe non-communicating ventriculomegaly Symmetric bilateral, due to probable stenosis of the aqueduct of Silvio, the karyotype reported 46, XY, as well as a negative TORCH profile, however, a cesarean section was performed for fetal indication at 35 weeks, the evaluation at birth showed bilateral facial paralysis, macrocephaly and foot Bilateral equinus varus, upon re-examination the patient referred the use of misoprostol in the first trimester of pregnancy for abortive purposes, so as there were no chromosomal or infectious alterations, a Moebius sequence was suggested. CONCLUSIONS : Prenatal exposure to misoprostol is related to the appearance of vascular disruption defects in some exposed fetuses, the precise spectrum and potential estimation of teratogenicity have not yet been determined, the clinical history is the mainstay for the association in these cases.

Caracterización del consumo de tabaco en población adulta en Colombia: propuestas de mejora / Characterization of tobacco consumption in the adult population in Colombia: proposals for improvement

En Colombia, los estudios y encuestas poblacionales han incorporado preguntas sobre consumo de tabaco en adultos, aunque no existe un cuestionario estandarizado. Se buscó identificar los estudios o encuestas que han caracterizado el consumo de tabaco en adultos en Colombia y analizar las variables que se incluyen con ese fin, según su utilidad. Se revisaron las páginas web de organismos oficiales y se realizó una revisión narrativa de los estudios y encuestas publicados hasta febrero de 2022. Se identificaron 11 estudios o encuestas que incluyeron un número variable de preguntas sobre consumo de tabaco, todos permitieron estimar prevalencias de fumadores actuales pero no las de exfumadores. La edad objetivo del estudio no es homogénea, el ámbito es nacional en la mayoría y muestran una enorme variabilidad en las preguntas. Estandarizar los instrumentos que permiten estimar la prevalencia de consumo de tabaco debería ser una prioridad en Colombia.

In Colombia, population studies and surveys have incorporated questions on tobacco consumption in adults, although no standardized questionnaires exist. This article aimed to identify the studies or surveys that have characterized tobacco consumption in adults in Colombia and analyze the variables included for this purpose according to their usefulness. The web pages of official organizations were reviewed, and a narrative review of the studies and surveys published until February 2022 was carried out. Eleven studies or surveys were identified that included a variable number of questions on tobacco consumption, all of which allowed estimating the prevalence of current smokers but not that of ex-smokers. The target age of the study is not homogeneous; the scope is national in the majority, and there is enormous variability in the questions. Standardizing the instruments that help estimate the prevalence of tobacco consumption should be a priority in Colombia

O programa saúde na escola como ferramenta para a construção da educação sexual na adolescência: um relato de experiência / The health in school program as a tool for the construction of sex education in adolescence: an experience report / El programa salud en la escuela como herramienta para la construcción de la educación sexual en la adolescencia: relato de una experiencia

Introdução: O Programa Saúde na Escola (PSE), instituído no ano de 2007, tem o objetivo de promover saúde através do processo educacional, oferecendo o conhecimento adequado e possibilitando a redução de vulnerabilidades que podem vir a comprometer o desenvolvimento de crianças e adolescentes, valorizando a parceria entre profissionais de saúde no contexto escolar. Objetivo: Descrever a experiência de acadêmicas de enfermagem atuando no PSE através de uma abordagem sobre sexualidade na adolescência e enfatizar a importância do papel da enfermeira para promoção da saúde por meio da educação. Metodologia: Estudo descritivo e qualitativo, do tipo relato de experiência, realizado durante as atividades do Estágio Supervisionado I, do curso de Bacharelado em Enfermagem, de uma universidade do interior da Bahia, em uma escola pública municipal do interior da Bahia, no mês de junho de 2022. Principais resultados: Os estudantes não demonstraram constrangimento acerca da temática e estavam participativos, porém, alguns estudantes apresentaram uma postura de desinteresse no que se refere à seriedade do assunto abordado. Percebeu-se que estes possuem conhecimento prévio acerca da temática de saúde sexual e reprodutiva. Todavia, ainda apresentam dúvidas acerca da transmissão das Infecções Sexualmente Transmissíveis (IST), o que contribui para o aumento da ocorrência dessas doenças nessa população. Conclusão: Portanto, destaca-se a importância do PSE e da atuação da enfermeira para educação sexual, o que reflete na qualidade de vida dos adolescentes, bem como na prevenção dos riscos e agravos à sua saúde.

Introduction: The School Health Program (PSE), established in 2007, aims to promote health through the educational process, offering adequate knowledge and enabling the reduction of vulnerabilities that may compromise the development of children and adolescents, valuing the partnership between health professionals in the school context. Objective: To describe the experience of nursing students working in the PSE through an approach on sexuality in adolescence and to emphasize the importance of the nurse's role for health promotion through education. Methodology: Descriptive and qualitative study, of the type of experience report, carried out during the activities of Supervised Internship I, of the Bachelor of Nursing course, of a university in the interior of Bahia, in a municipal public school in the interior of Bahia, in June 2022. Main results: The students did not show embarrassment about the theme and were participative, however, some students presented a posture of disinterest regarding the seriousness of the subject addressed. It was noticed that they have previous knowledge about the theme of sexual and reproductive health. However, they still have doubts about the transmission of Sexually Transmitted Infections (STIs), which contributes to the increase in the occurrence of these diseases in this population. Conclusion: Therefore, the importance of the PSE and the nurse's performance for sexual education is highlighted, which reflects on the quality of life of adolescents, as well as in the prevention of risks and injuries to their health.

Introducción: El Programa Salud en la Escuela (PSE), creado en 2007, tiene como objetivo promover la salud a través del proceso educativo, ofreciendo conocimientos adecuados y posibilitando la reducción de vulnerabilidades que puedan comprometer el desarrollo de niños y adolescentes, valorizando la asociación entre profesionales de salud en el contexto escolar. Objetivo: Describir la experiencia de los estudiantes de enfermería que trabajan en el PSE a través de un abordaje sobre la sexualidad en la adolescencia y destacar la importancia del papel de la enfermera para la promoción de la salud a través de la educación. Metodología: Estudio descriptivo y cualitativo, del tipo relato de experiencia, realizado durante las actividades de Práctica Supervisada I, del curso de Licenciatura en Enfermería, de una universidad del interior de Bahía, en una escuela pública municipal del interior de Bahía, en junio de 2022. Principales resultados: Los alumnos no mostraron vergüenza con el tema y se mostraron participativos, sin embargo, algunos alumnos presentaron una postura de desinterés en relación a la seriedad del tema abordado. Se notó que tienen conocimientos previos sobre el tema de la salud sexual y reproductiva. Sin embargo, aún tienen dudas sobre la transmisión de Infecciones de Transmisión Sexual (ITS), lo que contribuye al aumento de la ocurrencia de estas enfermedades en esta población. Conclusiones: Por lo tanto, se destaca la importancia de la PSE y de la actuación de la enfermera para la educación sexual, lo que se refleja en la calidad de vida de los adolescentes, así como en la prevención de riesgos y daños a su salud.

[Lung cancer mortality trends in Colombia, 1985-2018Tendências na mortalidade por câncer de pulmão na Colômbia de 1985 a 2018]. / Tendencias en la mortalidad por cáncer de pulmón en Colombia, 1985-2018.

Objective: To determine lung cancer mortality trends in Colombia during the period 1985-2018 in the population aged 35 years and over and identify changes in the trend. Methods: Analysis of mortality time series. The specific standardized rates by sex and age group were calculated. Using joinpoint regression, the annual percentage change in the rates was estimated and points of change were identified. Results: During the period 1985-2018, 105 553 deaths from lung cancer were reported in the population aged 35 and over. The standardized rates exhibit a downward trend during the period 1985-2005, except in people over the age of 64. Conclusions: Lung cancer death rates in Colombia are trending downward. Primary and secondary prevention measures with respect to tobacco use need to be enhanced and other risk factors, such as residential radon or occupation, monitored.

Objetivo: Determinar a evolução da mortalidade por câncer de pulmão na Colômbia no período de 1985 a 2018, na população com 35 anos de idade ou mais, e identificar mudanças na tendência. Métodos: Análise de séries temporais de mortalidade. Foram calculadas taxas específicas e padronizadas por sexo e faixa etária. Por meio da regressão joinpoint, estimou-se o percentual de variação anual das taxas e foram identificados os pontos de variação. Resultados: No período de 1985 a 2018, foram registradas 105.553 mortes por câncer de pulmão na população com 35 anos de idade ou mais. As taxas padronizadas demonstram tendência decrescente no período de 1985 a 2005, exceto para maiores de 64 anos. Conclusões: A tendência das taxas de mortalidade por câncer de pulmão na Colômbia é descendente. É necessário promover medidas de prevenção primária e secundária acerca do consumo de tabaco e monitorar outros fatores de risco, como a exposição ao radônio residencial ou a ocupação.

Tendencias en la mortalidad por cáncer de pulmón en Colombia, 1985-2018

[RESUMEN]. Objetivo. Determinar la evolución de la mortalidad por cáncer de pulmón en Colombia en el período 1985- 2018 en la población de 35 años y más e identificar cambios en la tendencia. Métodos. Análisis de series temporales de mortalidad. Se calcularon las tasas específicas y estandarizadas por sexo y grupos de edad. Mediante la regresión joinpoint se estimó el porcentaje de cambio anual de las tasas y se identificaron puntos de cambio. Resultados. En el período 1985-2018 se registraron 105 553 muertes por cáncer de pulmón en la población de 35 años y más. Las tasas estandarizadas muestran una tendencia decreciente en el período 1985-2005, excepto en mayores de 64 años. Conclusiones. La tendencia de las tasas de mortalidad por cáncer de pulmón es decreciente en Colombia. Es necesario potenciar medidas de prevención primaria y secundaria sobre el consumo de tabaco y vigilar otros factores de riesgo como el radón residencial o la ocupación.

[ABSTRACT]. Objective. To determine lung cancer mortality trends in Colombia during the period 1985-2018 in the popula- tion aged 35 years and over and identify changes in the trend. Methods. Analysis of mortality time series. The specific standardized rates by sex and age group were cal- culated. Using joinpoint regression, the annual percentage change in the rates was estimated and points of change were identified. Results. During the period 1985-2018, 105 553 deaths from lung cancer were reported in the population aged 35 and over. The standardized rates exhibit a downward trend during the period 1985-2005, except in people over the age of 64. Conclusions. Lung cancer death rates in Colombia are trending downward. Primary and secondary preven- tion measures with respect to tobacco use need to be enhanced and other risk factors, such as residential radon or occupation, monitored.

[RESUMO]. Objetivo. Determinar a evolução da mortalidade por câncer de pulmão na Colômbia no período de 1985 a 2018, na população com 35 anos de idade ou mais, e identificar mudanças na tendência. Métodos. Análise de séries temporais de mortalidade. Foram calculadas taxas específicas e padronizadas por sexo e faixa etária. Por meio da regressão joinpoint, estimou-se o percentual de variação anual das taxas e foram identificados os pontos de variação. Resultados. No período de 1985 a 2018, foram registradas 105.553 mortes por câncer de pulmão na popu- lação com 35 anos de idade ou mais. As taxas padronizadas demonstram tendência decrescente no período de 1985 a 2005, exceto para maiores de 64 anos. Conclusões. A tendência das taxas de mortalidade por câncer de pulmão na Colômbia é descendente. É necessário promover medidas de prevenção primária e secundária acerca do consumo de tabaco e monito- rar outros fatores de risco, como a exposição ao radônio residencial ou a ocupação.

Physical exercise in the control of pain or fatigue associated with viral infections: systematic review / Exercícios físicos no controle de dor ou fadiga associadas às infecções virais: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Individuals after viral infections remain with persistent symptoms such as pain and fatigue. Physical exercises have been described as a promising alternative for the control of these symptoms, but there are no systematic reviews that verify the effectiveness of this therapy and that assess the quality of these studies. The aim of this study was to investigate the effect of physical exercise on pain or fatigue associated with viral infections. METHODS: Systematic review registered with PROSPERO (CRD42021265174). Data collection was carried out between July 2021 and January 2022. Randomized clinical trials that addressed the practice of exercises, in individuals over 18 years of age, diagnosed with viral infection associated with the presence of pain or fatigue for more than 3 months were included. The search was carried out in the Pubmed, EMBASE, LILACS and Scielo databases, and the paired selection was carried out in the software (rayyan.ai); risk of bias analysis was assessed using the Cochrane risk-of-bias tool for randomized trials 2; certainty of evidence through GRADE; and for the construction of the meta-analysis, the Review Manager software. RESULTS: Eleven clinical trials were selected in populations with acquired immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), chikungunya and poliomyelitis. For both pain and fatigue, the combination of aerobic exercise with resistance training, lasting 40 to 60 minutes, two to three times a week, was effective and safe. The methodological quality of the studies showed a high risk of bias in six studies due to the following domains: bias due to deviations from the intended interventions, bias due to lack of outcome data and bias in the selection of the reported outcome; rated as some concerns in one study due to the domain bias due to deviations from intended interventions; and the others were assessed as low risk of bias. The meta-analysis showed a result in favor of the intervention group on pain intensity in the studies for Chikungunya and in a study for HTLV, which points to a positive effect in favor of the active groups. CONCLUSION: Exercises for the treatment of fatigue have very low evidence, while resistance exercises have moderate evidence for pain outcome. These are low-risk, low-cost resources with promising effects that should be better tested in people after viral infections.

RESUMO JUSTIFICATIVA E OBJETIVOS: Indivíduos após infecções virais permanecem com sintomas persistentes, como a dor e a fadiga. Exercícios físicos têm sido descritos como alternativa promissora para o controle desses sintomas, porém não há revisões sistemáticas que verifquem a eficácia dessa terapêutica e que avaliem a qualidade destes estudos. O objetivo deste estudo foi investigar o efeito de exercícios físicos na dor ou fadiga associados a infecções virais. MÉTODOS: Revisão sistemática registrada na PROSPERO (CRD42021265174). A coleta de dados foi realizada entre julho de 2021 a janeiro de 2022. Foram incluídos ensaios clínicos randomizados que abordaram a prática de exercícios, em indivíduos com idade superior a 18 anos, com diagnóstico de infecção viral associada à presença de dor ou fadiga por mais de três meses. A busca foi realizada nas bases de dados Pubmed, EMBASE, LILACS e Scielo e, a seleção por pares foi realizada no software (rayyan.ai); a análise de risco de viés foi avaliada através da ferramenta Cochrane risk-of-bias tool for randomized trials 2; a certeza da evidência por meio da GRADE; e para a construção da meta-análise, o software Review Manager. RESULTADOS: Foram selecionados 11 ensaios clínicos nas populações com Vírus da Imunodeficiência Adquirida (HIV), Virus Linfotrópico da Célula T Humana (HTLV), Chikungunya e Poliomielite. Tanto para dor quanto para a fadiga, a conjunção de exercícios aeróbicos com treino resistido, com duração de 40 a 60 minutos, de duas a três vezes por semana, foram eficazes e seguros. A qualidade metodológica dos estudos demonstrou em seis estudos alto risco de viés, devido aos domínios: viés devido a desvios das intervenções pretendidas, viés devido à falta de dados de resultado e viés na seleção do resultado relatado; classificado como algumas preocupações em um estudo devido o domínio viés devido a desvios das intervenções pretendidas; e os demais foram avaliados como baixo risco de viés. Na meta-análise foi demonstrado resultado a favor do grupo intervenção sobre a intensidade da dor nos estudos para Chikungunya e em um estudo para HTLV, o que aponta para efeito positivo a favor dos grupos ativos. CONCLUSÃO: Os exercícios físicos no tratamento da fadiga apresentam evidências muito baixas, enquanto para o desfecho dor os exercícios resistidos apresentam moderada evidência. São recursos de baixo risco e custo, com efeitos promissores, que devem ser melhor testados em pessoas após infecções virais. DESTAQUES O treinamento aeróbico combinado com o treinamento de resistência mostra resultados promissores para reduzir a dor e a fadiga nesta população após a infecção viral. O Pilates é um método que reduz significativamente a intensidade da dor após infecções por HTLV-1 e Chikungunya. O exercício pode beneficiar pessoas com sintomas persistentes de dor e fadiga após infecções

Calidad del sueño y satisfacción laboral en médicos residentes

RESUMEN Introducción: La calidad del sueño es fundamental para lograr el buen funcionamiento mental y físico, siendo más importante en médicos residentes, donde son sometidos a exigencias laboral y académica por lo que se ven afectados el rendimiento profesional y académico. Objetivo: Determinar la relación entre la calidad del sueño y la satisfacción laboral en médicos residentes del Hospital Militar Central en el periodo 2021. Metodología: Estudio observacional, descriptivo, corte transversal. No probabilístico por conveniencia. Se incluyeron médicos residentes del Hospital Militar Central en el periodo 2021. Para el cruce de variables nominales entre sí se utilizó la prueba de chi cuadrado. Para la determinación de la correlación entre las variables nominales y cuantitativas se utilizó el coeficiente de correlación de Pearson y se consideró una p0,05) y Odds Ratio= 5,5. Conclusión: Existe una asociación significativa para la calidad del sueño y la satisfacción laboral de los médicos residentes. Se encontró que la calidad del sueño mejora con la mayor cantidad de horas trabajadas; sin embargo, se analizó que, a mayores horas de trabajo, aumenta la insatisfacción laboral para los médicos residentes.

ABSTRACT Introduction: The quality of sleep is essential to achieve good mental and physical functioning, being more important in resident doctors, where they are subjected to work and academic demands for which professional and academic performance are affected. Objective: To determine the relationship between sleep quality and job satisfaction in resident doctors of the Central Military Hospital in the period 2021. Methods: Observational, descriptive, cross-sectional study. Non-probabilistic for convenience. Resident physicians of the Central Military Hospital were included in the 2021 period. The chi-square test was used to cross-match nominal variables. To determine the correlation between the nominal and quantitative variables, Pearson's correlation coefficient was used and p 0.05) and Odds Ratio = 5.5. Conclusion: There is a significant association for the quality of sleep and job satisfaction of resident physicians. It was found that the quality of sleep improves with the greater number of hours worked; however, it was analyzed that, with longer working hours, job dissatisfaction increases for resident physicians.

AZFa, AZFb, AZFc and gr/gr Y-chromosome microdeletions in azoospermic and severe oligozoospermic patients, analyzed from a neural network perspective.

AIM: Analysis of male infertility by molecular methods has increased since recognition of genetic risk factors. The AZFa, AZFb, AZFc, and gr/gr regions on the Y-chromosome can cause male infertility. The aim of this study was to determine the prevalence of Y-chromosome microdeletions in these regions in infertile Mexican patients. MATERIAL AND METHODS: We recruited 57 infertile patients with abnormal sperm count (26 azoospermic and 31 oligozoospermic) and 55 individuals with normal sperm count. Analysis of the regions of interest was performed by PCR. RESULTS: 15.8% of infertile patients presented Y-chromosome microdeletions, whereas no deletions were found in the control group. Deletions were observed in all the analyzed regions except in AZFa. Additionally, the neural network model revealed a mild genotype-phenotype correlation between deletion of the sY1191, sY1291 and sY254 markers with oligozoospermia, azoospermia and cryptozoospermia, respectively. CONCLUSIONS: Our data show that AZFb, AZFc, and gr/gr microdeletions are significantly associated with infertility in Mexican population. In addition, the neural network model revealed a discrete genotype-phenotype correlation between specific deletions and a particular abnormality. Our results reinforce the importance of the analysis of AZF regions as part of the clinical approach of infertile men.

OBJETIVO: La utilización de técnicas moleculares para estudiar la infertilidad masculina se ha incrementado desde el reconocimiento de factores genéticos. Las regiones AZFa, AZFb, AZFc, y gr/gr del cromosoma Y son causa de infertilidad masculina. El objetvo de este estudio fue determinar la prevalencia de microdeleciones en estas regiones en pacientes infértiles Mexicanos. MATERIAL Y MÉTODOS: Reclutamos 57 pacientes infértiles con cuentas espermáticas anormales (26 con azoospermia y 31 con oligozoospermia) y 55 individuos con cuentas espermáticas normales. El análisis de las regiones se realizó mediante PCR. RESULTADOS: 15.8% de los pacientes infértiles presentó microdeleciones, no se encontraron microdeleciones en el grupo control. Las microdeleciones fueron observadas en todas las regiones excepto en AZFa. Adicionalmente, el modelo de red neuronal reveló una leve correlación genotipo-fenotipo entre microdeleciones de los marcadores sY1191, Sy1291 y sY254 con oligozoospermia, azoospermia y criptozoospermia, respectivamente. CONCLUSIONES: Nuestros datos muestran que las microdeleciones en AZFb, AZFc, y gr/gr se asocian significativamente con infertilidad en la población Mexicana. Además, el modelo de red neuronal reveló una discreta correlación genotipo-genotipo entre microdeleciones específicas con una anormalidad en particular. Nuestros resultados refuerzan la importancia del análisis de las regiones AZF en el abordaje de la infertilidad masculina.

Tendencias en la mortalidad por cáncer de pulmón en Colombia, 1985-2018 / Lung cancer mortality trends in Colombia, 1985-2018 / Tendências na mortalidade por câncer de pulmão na Colômbia de 1985 a 2018

RESUMEN Objetivo. Determinar la evolución de la mortalidad por cáncer de pulmón en Colombia en el período 1985-2018 en la población de 35 años y más e identificar cambios en la tendencia. Métodos. Análisis de series temporales de mortalidad. Se calcularon las tasas específicas y estandarizadas por sexo y grupos de edad. Mediante la regresión joinpoint se estimó el porcentaje de cambio anual de las tasas y se identificaron puntos de cambio. Resultados. En el período 1985-2018 se registraron 105 553 muertes por cáncer de pulmón en la población de 35 años y más. Las tasas estandarizadas muestran una tendencia decreciente en el período 1985-2005, excepto en mayores de 64 años. Conclusiones. La tendencia de las tasas de mortalidad por cáncer de pulmón es decreciente en Colombia. Es necesario potenciar medidas de prevención primaria y secundaria sobre el consumo de tabaco y vigilar otros factores de riesgo como el radón residencial o la ocupación.

ABSTRACT Objective. To determine lung cancer mortality trends in Colombia during the period 1985-2018 in the population aged 35 years and over and identify changes in the trend. Methods. Analysis of mortality time series. The specific standardized rates by sex and age group were calculated. Using joinpoint regression, the annual percentage change in the rates was estimated and points of change were identified. Results. During the period 1985-2018, 105 553 deaths from lung cancer were reported in the population aged 35 and over. The standardized rates exhibit a downward trend during the period 1985-2005, except in people over the age of 64. Conclusions. Lung cancer death rates in Colombia are trending downward. Primary and secondary prevention measures with respect to tobacco use need to be enhanced and other risk factors, such as residential radon or occupation, monitored.

RESUMO Objetivo. Determinar a evolução da mortalidade por câncer de pulmão na Colômbia no período de 1985 a 2018, na população com 35 anos de idade ou mais, e identificar mudanças na tendência. Métodos. Análise de séries temporais de mortalidade. Foram calculadas taxas específicas e padronizadas por sexo e faixa etária. Por meio da regressão joinpoint, estimou-se o percentual de variação anual das taxas e foram identificados os pontos de variação. Resultados. No período de 1985 a 2018, foram registradas 105.553 mortes por câncer de pulmão na população com 35 anos de idade ou mais. As taxas padronizadas demonstram tendência decrescente no período de 1985 a 2005, exceto para maiores de 64 anos. Conclusões. A tendência das taxas de mortalidade por câncer de pulmão na Colômbia é descendente. É necessário promover medidas de prevenção primária e secundária acerca do consumo de tabaco e monitorar outros fatores de risco, como a exposição ao radônio residencial ou a ocupação.

COVID-19 Infection in Pregnancy: PCR Cycle Thresholds, Placental Pathology, and Perinatal Outcomes.

(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (CT) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and CT values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between CT values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low CTs (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or CT values (p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.

Utilización de Cannabidiol en un paciente pediátrico con tras-torno del espectro autista y epilepsia: informe de un caso / Cannabidiol use in a pediatric patient with autism spectrum disorder and epilepsy: case report / Uso de Canabidiol em paciente pediátrico com transtorno do espectro do autismo e epilepsia: relato de caso

Introducción: El trastorno del espectro autista constituye un desorden neuropsiquiátrico caracterizado por dificultades en la interacción y comunicación social, al que se asocian actividades e intereses restrictivos y estereotipados. Los medicamentos psicofarmacológicos convencionales suelen ir dirigidos al tratamiento de las conductas asociadas, pero no tratan los déficits centrales del TEA. Caso clínico: Niño de 3 años que acude a consulta de neuropediatría por retraso en la adquisición de lenguaje y conductas inapropiadas para la edad que son compatibles con manifestaciones de TEA; además al realizar el estudio electroencefalograma se evidencian descargas paroxísticas que coinciden con episodios de desconexión del medio. Padres deciden el uso de CBD además de iniciar un programa de intervención terapéutica psicomotora, conductual y fonoaudiológica. Evolución: Tras un año de intervención y seguimiento se evidenciaron avances significativos en el control de las crisis y mejoría en las capacidades empáticas, adaptativas y relacionales. Tolera de mejor manera los espacios cerrados, sigue órdenes y rutinas sencillas. El terapista indica grandes avances y termina su primer año de escolarización con logros significativos. El estudio EEG en mejores condiciones con respecto a los anteriores, con una actividad de base mejor estructurada y disminución de la actividad epileptógena frontal. Conclusión: Este reporte de caso refuerza la idea de que la intervención terapéutica temprana y la utilización de cannabidiol como terapia añadida puede ser capaz de ayudar en el control de las crisis en la epilepsia y también a disminuir los síntomas conductuales relacionados con el trastorno del espectro autista. Se requiere más investigación para dilucidar la efectividad del cannabidiol en los TEA.

Introduction: Autism spectrum disorder (ASD) are made up a neuropsychiatric disorder characterized by difficulties in social interaction and communication, associate with restrictive and stereotyped activities and interests. Conventional psychopharmacological medications are usually directed to the treatment of associated behaviours but do not treat the core deficits of ASD. Clinical case: A 3-year-old boy attended for delayed language acquisition and age inappropriate behaviours compatible with manifestations of ASD; in addition, an electroen-cephalogram showed paroxysmal discharges coinciding with episodes of disconnection from the environment. Parents decided to use cannabidiol and to start a psychomotor, behavioural, and speech therapy intervention program. Evolution: After one year of intervention and follow-up, were evidenced significant advances in seizures control and improvement in empathic, adaptive, and relational skills. He tolerates closed spaces better, follows orders and simple routines. The therapist indicates great pro-gress, and he finishes his first year of schooling with significant achievements. EEG study in better conditions than previous ones, with a better-structured baseline activity and de-creased frontal epileptogenic activity. Conclusion: This case report reinforces the idea that early therapeutic intervention and the use of cannabidiol as an add-on therapy may be able to aid in seizure control in epilepsy and decrease behavioural symptoms related to autism spectrum disorder. Further research is needed to elucidate the effectiveness of cannabidiol in ASD.

Introdução: O transtorno do espectro autista é um transtorno neuropsiquiátrico caracterizado por dificuldades de interação e comunicação social, ao qual estão associados atividades e interesses restritivos e estereotipados. Os medicamentos psicofarmacológicos convencionais geralmente têm como objetivo o tratamento de comportamentos associados, mas não tratam os déficits centrais do TEA. Caso clínico: Menino de 3 anos que procurou uma clínica neurológica pediátrica por atraso na aquisição da linguagem e comportamentos inadequados para a idade compatíveis com manifestações de TEA; Além disso, na realização do estudo eletroencefalograma, evidenciam-se descargas paroxísticas que coincidem com episódios de desconexão do meio ambiente. Os pais decidem usar o CBD, além de iniciar um programa de intervenção psicomotora, comportamental e fonoaudiológica. Evolução: Após um ano de intervenção e acompanhamento, foram evidenciados avanços significativos no controle das crises e melhora nas capacidades empáticas, adaptativas e relacionais. Tolera melhor espaços fechados, segue comandos e rotinas simples. O terapeuta indica grande progresso e termina o primeiro ano de escola com conquistas significativas. Estudo do EEG em melhores condições em relação aos anteriores, com atividade de base mais bem estruturada e diminuição da atividade epileptogênica frontal. Conclusão: Este relato de caso reforça a ideia de que a intervenção terapêutica precoce e o uso de canabidiol como terapia adjuvante podem ajudar no controle das crises epilépticas e também diminuir os sintomas comportamentais relacionados ao transtorno do espectro do autismo. Mais pesquisas são necessárias para elucidar a eficácia do canabidiol em ASDs.

Smoking-attributable mortality in South America: A systematic review.

BACKGROUND: Dating from the 1920s and linked to the increase in mortality among smokers, tobacco has become one of the most studied health risk factors. Tobacco-use series, whether for the general population or for specific groups, are unavailable for most South American countries, something that hinders the characterisation of this risk factor. OBJECTIVES: To identify and analyse studies that estimate smoking-attributable mortality (SAM) in South America and provide an overview of the impact of smoking habit on mortality in the region. METHODS: Systematic review using PubMed, Embase, LILACS, Biblioteca Virtual en Salud, Google Scholar and Google, and including all papers published until June 2020 reporting studies in which SAM was estimated. RESULTS: The search yielded 140 papers, 17 of which fulfilled the inclusion criteria. There were SAM estimates for all South American countries, with Argentina having the most. The first estimate covered 1981 and the latest, 2013. The method most used was prevalence-based. Regardless of the country and point in time covered by the estimate, the highest figures were recorded for men in all cases. The burden of attributable vs observed mortality varied among countries, reaching a figure of 20.3% in Argentina in 1986. The highest SAM burden was registered for the group of cardiovascular diseases. CONCLUSIONS: SAM estimates are available for all South American countries but the respective study periods differ and the frequency of the estimates is unclear. For 4 countries, the only estimates available are drawn from reports, something that does not allow for a detailed assessment of the estimates obtained. To help with decision-making targeted at evaluating and enhancing the impact of smoking control policies, further studies are needed in order to update the impact of smoking on all countries across South America.

Prevalence, clinical features, and outcomes of SARS-CoV-2 infection in pregnant women with or without mild/moderate symptoms: Results from universal screening in a tertiary care center in Mexico City, Mexico.

The perinatal consequences of SARS-CoV-2 infection are still largely unknown. This study aimed to describe the features and outcomes of pregnant women with or without SARS-CoV-2 infection after the universal screening was established in a large tertiary care center admitting only obstetric related conditions without severe COVID-19 in Mexico City. This retrospective case-control study integrates data between April 22 and May 25, 2020, during active community transmission in Mexico, with one of the highest COVID-19 test positivity percentages worldwide. Only pregnant women and neonates with a SARS-CoV-2 result by quantitative RT-PCR were included in this study. Among 240 pregnant women, the prevalence of COVID-19 was 29% (95% CI, 24% to 35%); 86% of the patients were asymptomatic (95% CI, 76%-92%), nine women presented mild symptoms, and one patient moderate disease. No pregnancy baseline features or risk factors associated with severity of infection, including maternal age > 35 years, Body Mass Index >30 kg/m2, and pre-existing diseases, differed between positive and negative women. The median gestational age at admission for both groups was 38 weeks. All women were discharged at home without complications, and no maternal death was reported. The proportion of preeclampsia was higher in positive women than negative women (18%, 95% CI, 10%-29% vs. 9%, 95% CI, 5%-14%, P<0.05). No differences were found for other perinatal outcomes. SARS-CoV-2 test result was positive for nine infants of positive mothers detected within 24h of birth. An increased number of infected neonates were admitted to the NICU, compared to negative neonates (44% vs. 22%, P<0.05) and had a longer length of hospitalization (2 [2-18] days vs. 2 [2-3] days, P<0.001); these are potential proxies for illness severity. This report highlights the importance of COVID-19 detection at delivery in pregnant women living in high transmission areas.

Residential Radon in Manizales, Colombia: Results of a Pilot Study.

Radon is a colorless, odorless, and tasteless noble gas, causally related with the onset of lung cancer. We aimed to describe the distribution of radon exposure in the municipality of Manizales, Colombia, in order to estimate the population's exposure and establish the percentage of dwellings that surpass reference levels. A cross-sectional study representing all geographical areas was carried out by measuring indoor radon concentrations. Participants answered a short questionnaire. Alpha-track type radon detectors were installed in all residences for six months. The detectors were subsequently processed at the Galician Radon Laboratory, an accredited laboratory at the University of Santiago de Compostela. A total of 202 homes were measured. Seventy-seven percent of the sampled houses were three stories high, their median age was 30 years, and half were inhabited by three people or fewer. For most dwellings, the building materials of walls and flooring were brick and covered cement, respectively. Results showed a geometric mean of radon concentration of 8.5 Bq/m3 and a maximum value of 50 Bq/m3. No statistically significant differences were found either between the geometric mean of the dwelling's site, the height at which detectors were placed inside the home, or the wall and flooring materials, or between mean 222Rn concentrations in rural and urban areas. No dwelling surpassed the 222Rn reference level established by the WHO. This study shows that residential radon levels in Manizales, Colombia, seem to be low, though a more in-depth approach should be carried out. Despite these results, it is essential to create a national radon program and establish a radon concentration reference level for Colombia in line with international recommendations.