Oclusión intestinal en paciente renal crónico secundario a bezoar de telas Reporte de un caso clínico / Intestinal Occlusion in a Chronic Renal Patient Secondary to Textile Bezoar. Clinical Case Report

Resumen Los "bezoar" son conglomerados de materiales no comestibles ingeridos voluntaria o involuntariamente, no digeridos e incapaces de transitar por el tracto intestinal. Principalmente afectan a jóvenes mujeres o adolescentes que presentan el fenómeno llamado "pica", y a pesar de que se ha registrado una alta prevalencia de este fenómeno en pacientes con enfermedad renal crónica (ERC), ha sido poco estudiado. Caso clínico: Paciente del sexo masculino de 35 años de edad que cursa con ERC KDIGO-5 en tratamiento con diálisis peritoneal; se obtiene el hallazgo de "bezoar plástico" transoperatorio (laparotomia por oclusión intestinal) a 10 cm de la válvula ileocecal. El paciente fallece por complicaciones de la patología de origen. Se plantea la necesidad de realizar la búsqueda de comportamientos en pacientes con ERC, que indiquen al cirujano la sospecha, dado que los pacientes generalmente ocultan u omiten referir sobre la ingesta de material extraño.

Abstract The "bezoar" are conglomerates of inedible materials ingested voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called "pica", despite the fact that a high prevalence of this phenomenon of "pica" has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 undergoing peritoneal dialysis treatment, which was found to have a transoperative "plastic bezoar" (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia.

Simpatectomía torácica para hiperhidrosis focal: una revisión de alcance / Thoracic sympathectomy for focal hyperhidrosis: a Scoping Review

La hiperhidrosis focal primaria (HH) es un trastorno que consiste en sudoración que excede lo requerido para la termorregulación y afecta a 3 de cada 100 personas en la población general. Es considerada una enfermedad con alto impacto en la calidad de vida. La fisiopatología involucra el eje hipotálamo- sistema nervioso autónomo. A lo largo de la historia se han descrito múltiples terapias médicas y quirúrgicas con resultados variables. En la literatura se evidencia un vacío en el conocimiento acerca de la simpatectomía torácica (ST) y su utilidad en el contexto de HH. En miras a mejorar la calidad de vida de estos pacientes, realizamos una revisión cuidadosa de la literatura disponible actualmente, encontrando que la ST es un procedimiento seguro y efectivo, con altas tasas de éxito y satisfacción en estos pacientes.

Primary focal hyperhidrosis (HH) is a disorder consisting of sweating in excess of that required for thermoregulation and affects 3 out of 100 people in the general population. It is considered a disease with a high impact on quality of life. Pathophysiology involves the hypothalamic-autonomic nervous system axis. Throughout history, multiple medical and surgical therapies have been described with variable results. The literature shows a gap in knowledge about thoracic sympathectomy and its usefulness in the context of HH. To improve the quality of life of these patients, we carried out a careful review of the currently available literature, finding that ST is a safe and effective procedure, with high rates of success and satisfaction in these patients.

Necroadministración y juventudes: aniquilamiento penitenciario documentado por medios hemerográficos en El Salvador

(analítico) Los ejercicios de la violencia institucional en El Salvador se han hecho tácitos desde los aniquilamientos, las ejecuciones, los encierros y persecución de jóvenes adscritos a grupos identitarios como la mara Salvatrucha y la pandilla Barrio 18; no obstante, su muestra más cruda se ha dado en los espacios penitenciarios en donde la necro-administración se emplea bajo todos los mecanismos institucionales. Así, con el fin de dilucidar su continuum en la consolidación de las políticas de exterminio institucional y legitimadas por el Estado punitivo, se realizó una revisión documental de las notas periodísticas respecto al estado de excepción y agravamiento de las violaciones a los derechos humanos en las cárceles de El Salvador, articulando este esfuerzo con categorías como necropolíticas, olvido-abandono social y festival de las violencias.

(analytical) Acts of institutional violence in El Salvador have involved annihilations, executions, confinements and precarization of the lives of young people who identify as members of groups such as the Mara Salvatrucha and the Barrio 18 gang. However, the crudest examples of this state-sponsored violence have occurred in penitentiary spaces where the so-called necroadministration approach is used in all institutional mechanisms. with the goal of elucidating its continuum in the consolidation of necropolicies by the State, we carry out a documentary review of mediate coverage regarding the declaration of the State of Exception and aggravation of human rights violations in prisons in El Salvador. The analysis of these media reports is articulated with categories including necropolitics, social oblivionabandonment and festival of violence.

(analítico) Os exercícios de violência institucional em El Salvador tornaram-se tácitos através de aniquilações, execuções, prisões e precariedade das vidas de jovens pertencentes a grupos de identidade como a Mara Salvatrucha e o Bairro 18 gangue; contudo, o seu exemplo mais grosseiro tem sido nas prisões, onde a chamada necroadministration é utilizada sob todos os mecanismos institucionais. Assim, a fim de elucidar a sua continuidade na consolidação da política de morte pelo Estado, estamos a preparar uma revisão documental de artigos jornalísticos sobre o estado de excepção e o agravamento das violações dos direitos humanos nas prisões de El Salvador, articulando este esforço com categorias como a necropolítica, o esquecimento-abandono social e o festival da violência.

Cistadenoma mucinoso del apéndice cecal en paciente con cuadro clínico de apendicitis aguda operado de apendicetomía por laparoscopia / Report of a Patient Case with a Clinical Picture of Acute Appendicitis, Underwent Emergency Surgery due to Laparoscopic Appendectomy

Resumen Los mucoceles del apéndice son raros, predominan en mujeres y suelen presentarse como una masa palpable en el cuadrante inferior derecho. La mayoría de los pacientes son asintomáticos. El mucocele se define como una dilatación quística de la luz apendicular causada por la acumulación de mucina. Se presenta el caso de un paciente del sexo masculino en la séptima década de la vida, con cuadro clínico de abdomen agudo con sospecha de apendicitis aguda. Se realizó intervención quirúrgica laparoscópica de hemicolectomía tras encontrar hallazgos de tumoración dependiente de colon ascendente (región de ciego), indurada de 80 × 100 mm aproximadamente, realizando hemicolectomía derecha más anastomosis ilecolónica lateroterminal con adecuada evolución postquirúrgica.

Abstract Mucoceles of the appendix are rare, predominate in women and usually present as a palpable mass in the right lower quadrant. Most patients are asymptomatic. The mucocele is defined as a cystic dilatation of the appendicular lumen caused by mucin accumulation. We present the case of a male patient in his seventh decade with clinical symptoms of acute abdomen with suspicion of acute appendicitis, laparoscopic hemicolectomy surgery was performed after finding findings of tumor dependent on ascending colon (blind region), indurated 80 × 100 mm approximately, performing right hemicolectomy plus ileocolonic lateroterminal anastomosis with adequate postoperative evolution.

Significant Rise in SARS-CoV-2 Reinfection Rate in Vaccinated Hospital Workers during the Omicron Wave: A Prospective Cohort Study

ABSTRACT Background: Relatively low SARS-CoV-2 reinfection rates have been reported in vaccinated individuals, but updates considering the Omicron variant are lacking. Objective: The objective of the study was to provide a current estimate of the SARS-CoV-2 reinfection rate in a highly immunized population. Methods: A prospective cohort of Mexican hospital workers was followed (March 2020-February 2022). Reinfection was defined as the occurrence of two or more episodes of COVID-19 separated by a period of ≥ 90 days without symptoms. The reinfection rate was calculated as the number of reinfection episodes per 100,000 persons per day. Results: A total of 3732 medical consultations were provided to 2700 workers, of whom 1388 (51.4%) were confirmed COVID-19 cases. A total of 73 reinfection cases were identified, of whom 71 (97.3%) had completed their primary vaccination series and 22 (30.1%) had had a booster dose before the second episode. The overall reinfection rate was 23.1 per 100,000 persons per day (as compared to a rate of 1.9 per 100,000 persons per day before the Omicron wave). Conclusions: The SARS-CoV-2 reinfection rate rose significantly during the Omicron wave despite a high primary vaccination coverage rate. Almost one-third of reinfected workers had a vaccine booster ≥ 14 days before the last COVID-19 episode.

Prevención de eventos de superpropagación de COVID-19 en autobuses que transportaron pacientes presintomáticos / Prevention of COVID-19 superspreader events in buses boarded by presymptomatic patients

Resumen Introducción: Ha ocurrido superpropagación de COVID-19 cuando individuos sintomáticos sin uso de cubrebocas abordaron autobuses. Objetivo: Reportar el riesgo de superpropagación cuando individuos presintomáticos abordaron autobuses junto con pasajeros no vacunados, pero se mantuvieron intervenciones preventivas no farmacológicas. Métodos: Estudio prospectivo de personal de salud transportado durante dos semanas en autobuses a un centro de vacunación contra COVID-19. Fue obligatorio llevar ventanas abiertas, uso correcto de cubrebocas y exclusión de personas con síntomas. La vigilancia prospectiva identificó a trabajadores con COVID-19 los 14 días siguientes a la vacunación. Cada pasajero asintomático de autobuses donde se detectaron casos fue vigilado durante un periodo similar. Los resultados de tamizaje voluntario estuvieron disponibles para los trabajadores que se realizaron prueba el mes previo o el siguiente a la vacunación. Resultados: 1879 trabajadores abordaron 65 autobuses. El tiempo a bordo varió de tres a ocho horas. Veintinueve casos de COVID-19 y cuatro casos asintomáticos fueron identificados entre 613 pasajeros de 21 autobuses. La mediana de tiempo entre la vacunación y el inicio de síntomas de COVID-19 fue de seis días. Fue identificado un caso de transmisión sospechada en autobús. Conclusiones: Las intervenciones preventivas no farmacológicas estrictas redujeron sustancialmente el riesgo de superpropagación de COVID-19 en autobuses ocupados por individuos presintomáticos.

Abstract Introduction: COVID-19 superspreader events have occurred when symptomatic individuals without wearing face masks boarded buses. Objective: To report the risk of superspreader events when presymptomatic individuals boarded buses together with unvaccinated passengers, but with non-pharmacological preventive interventions being maintained. Methods: Prospective study of health personnel transported in buses to a COVID-19 vaccination center for two weeks. Open windows, correct use of face masks and exclusion of symptomatic individuals were mandatory. Prospective surveillance identified workers with COVID-19 within 14 days after vaccination. Each asymptomatic passenger of buses where cases were identified was monitored for a similar time period. Voluntary screening results were available for workers who were tested in the month before or after vaccination. Results: 1,879 workers boarded 65 buses. On-board time ranged from three to eight hours. Twenty-nine cases of COVID-19 and four asymptomatic cases were identified among 613 passengers of 21 buses. Median time between vaccination and COVID-19 symptoms onset was six days. One case of suspected transmission on a bus was identified. Conclusions: Strict nonpharmacological preventive interventions substantially reduced the risk of COVID-19 superspreader events in buses boarded by presymptomatic individuals.

Técnica minimalista para valvuloplastía aórtica percutánea / Minimally invasive balloon aortic valve valvuloplastyBackground

RESUMEN: ANTECEDENTES: La valvuloplastía aórtica es un procedimiento paliativo o como puente al reemplazo aórtico percutáneo o quirúrgico. Nuestro abordaje incluye una técnica minimalista y la utilización de balones de mayor tamaño que lo estándar. OBJETIVO: Evaluar los resultados clínicos inmediatos y alejados de pacientes tratados mediante esta técnica modificada. MÉTODOS: Se incluyó a todos los pacientes sometidos a balonplastía aórtica entre Julio del 2012 y Agosto del 2019 en nuestro centro. El procedimiento se realizó bajo sedación consciente mediante un único acceso femoral y sin instalación de un marcapasos transitorio. El éxito de la intervención se definió como caída de gradiente basal en 50% o más en ausencia de complicación mayor. RESULTADOS: Se realizaron un total de 52 procedimientos en 49 pacientes. La edad promedio fue 76 ± 9,9 años. Un tercio de los pacientes tenía una fracción de eyección del ventrículo izquierdo ≤35% y similar proporción tenía un perfil de riesgo STS score > 10 puntos. La duración total promedio fue de 31,1 + 10,0 min. Se utilizó un balón #28 en el 84.6% de los casos. El éxito del procedimiento se alcanzó en 94,2% de los casos. Ocurrieron 2 muertes intraoperatorias (3,9%), ambas en pacientes de muy alto riesgo y 2 (3,9%) complicaciones vasculares mayores. La sobreviva en el seguimiento alejado fue 32,7%. CONCLUSIÓN: La valvuloplastia aórtica percutánea con técnica modificada, utilizando balones de mayor tamaño que lo habitual, es una técnica segura que logra óptimos resultados hemodinámicos.

ABSTRACT: Aortic balloon valvuloplasty (ABV) is a palliative procedure or a bridge to percutaneous or surgical aortic valve replacement. Our group proposes a minimalist approach that reduces the use of resources and also stands out for using larger balloons. AIM: To assess the safety and the immediate results of patients undergoing aortic balloon valvuloplasty using a minimally invasive procedure. METHODS: All patients who underwent ballon aortic valvuloplasty (BAV) between July 2012 and Au- gust 2019 were included. The procedure was performed under conscious sedation using a single femoral access and without the installation of a temporary pacemaker. Success was defined as a 50% drop in the mean aortic gradient plus the absence of major complications. RESULTS: 52 procedures in 49 patients were performed; the average age was 76 ± 9,9 years. A third of patients included had a left ventricular ejection fraction ≤35% and a similar proportion had a high risk profile with an STS score> 10 points. A 28 mm balloon was used in 84.6% of cases. The procedure was successful in 94,2% of cases. There were 2 (3,85%) intraoperative deaths in very high-risk patients and 2 (3,85%) major vascular complications. The survival rate at late follow up was 32,7%. CONCLUSION: Aortic balloon valvuloplasty with a minimally invasive technique using larger than usual balloons is a safe technique that achieves optimal hemodynamic results.

Caracterización clínica y tratamiento de pacientes ingresados por la COVID-19 en terapias intensivascubanas

RESUMEN Introducción: La pandemia por la COVID-19 fue declarada emergencia de salud pública internacional. El conocimiento de los síntomas, comorbilidades y el riesgo según el tratamiento recibido puede contribuir a una mejor clasificación y atención de los pacientes. Objetivo: Caracterizar clínicamente a los pacientes de COVID-19 atendidos en las unidades de terapia intensiva cubanas. Métodos: Estudio observacional retrospectivo de todos los pacientes atendidos en las unidades de terapia intensiva de Cuba en el periodo comprendido entre el 11 de marzo y el 30 de julio de 2020. Se recolectaron datos demográficos, clínicos y de resultados. Se compararon los pacientes fallecidos y recuperados de acuerdo a la prevalencia de las covariables a través de una prueba estándar de chi-cuadrado. Se realizó regresión logística para evaluar las variables predictoras de la mortalidad hospitalaria. Resultados: Se atendieron 175 pacientes, de ellos 106 graves y 69 críticos. Predominó el sexo masculino (52,0 %), mayores de 60 años (67,2 %) con hipertensión arterial (57,0 %). La edad (mayores de 80 años, OR= 9,62, IC95%: 3,16-29,2), el estado al ingreso (OR= 8,32, IC95%: 2.30-30,10) y la inestabilidad hemodinámica (OR=6,9, IC95%:2,96-16,37), se asociaron a un mayor riesgo de fallecimiento. Los pacientes tratados con kaletra, cloroquina, itolizumab o jusvinza incrementaron la supervivencia. El riesgo de fallecimiento en los críticos disminuyó de 80 a 25% con el uso de jusvinza. Conclusiones: La caracterización clínica realizada demuestra la efectividad de los protocolos clínicos empleados en las unidades de terapia intensiva del país.

ABSTRACT Introduction: COVID-19 pandemic was declared an international public health emergency. The knowledge of the symptoms, comorbidities, and the risk associated with the treatment received could contribute to better classification and care of patients. Objective: To clinically characterize COVID-19 patients admitted to the Cuban intensive care units Methods: A retrospective observational study of all patients treated in the Cuban intensive care units from March 11 to July 30, 2020. Demographic, clinical and outcome data were collected. The prevalence of fatal and recovery cases was compared by covariables using the standard chi-square test. A logistic regression was performed to evaluate the predictor variables for in-hospital mortality. Results: A total of 175 patients were treated, including 106 acutely ill and 69 critically ill. Patients were predominantly male (52.0%), over 60 years old (67.2%) and had hypertension (57.0%). Age (over 80 years old, OR= 9.62, 95% CI: 3.16-29.2), health status at admission (OR= 8.32, 95% CI: 2.30-30.10), and hemodynamic instability (OR=6.9, 95% CI: 2.96-16.37) were associated with an increased risk of death. Patients treated with Kaletra, chloroquine, Itolizumab, or Jusvinza increased survival. Mortality risk in critically ill patients decreased from 80% to 25% with the use of Jusvinza. Conclusions: The clinical characterization performed demonstrates the effectiveness of the clinical protocols used in the country's intensive care units.

Representações do cuidado em saúde bucal de crianças em vulnerabilidade em uma cidade do nordeste do Brasil / Representations of child oral health care in northeastern Brazil

Resumo O cuidado em saúde bucal com enfoque na integralidade em saúde de crianças em vulnerabilidade social auxilia a desenvolver indivíduos com uma maior consciência de si. Uma das suas dependências está no potencial modelador das ações, atitudes e intenções dos sujeitos em relação à saúde ou doenças bucais e seus modos de cuidar circulantes na sociedade. O objetivo central foi analisar as representações sociais do cuidado em saúde bucal de crianças em vulnerabilidade. Realizou-se uma pesquisa qualitativa e exploratória, cuja amostra foram 26 crianças entre cinco e 12 anos, numa unidade de atenção primária em saúde de Fortaleza, CE, entre maio e julho de 2021. Foi aplicada a técnica do desenho-estória com tema e realizada análise interpretativa das informações, utilizando elementos da teoria salutogênica e revisão narrativa, evocados através de representações sociais, por meio de análise temática do conteúdo. As crianças retratam a prática da escovação dentária enquanto hábito rotinizado ou coercitivo, como cuidado oral. Práticas de autocuidado oral, expressando ludicidade, associando a assistência odontológica e elencando variedade de elementos para a atividade foram pontuais. Nas representações da boca, o significado é atrelado aos dentes e aos lábios, desejos e idealizações para com eles, experiência de cárie e da perda do dente decíduo.

Abstract Oral health care focused on comprehensive health for vulnerable children helps to develop better self- aware individuals, relying on the shaping potential of the subjects' actions, attitudes and intentions regarding oral health or diseases and their ways of caring in place. This study sought to analyze the social representations of oral health care for vulnerable children. A qualitative and exploratory research was conducted with 26 children between five and 12 years of age, in a primary health care unit in Fortaleza, between May and July 2021. Data were collected by means of thematic drawing-story and investigated by interpretive and content analysis, using elements from salutogenic theory and narrative review evoked by social representations. Children portray toothbrushing as a routine or coercive habit, such as oral care. Oral self-care practices associated with playfulness, dental care and a variety of elements for the activity were punctual. In representations concerning the mouth, meaning is tied to the teeth and lips, related desires and ideals, the experience of caries and loss of primary tooth.

Acerca de la muerte de Hernando de Magallanes: efectos de una flecha envenenada

Ferdinand Magellan's maritime expedition that resulted in the circumnavigation of the Earth and the discovery of the strait that bears his name is among the greatest feats in history. The trip, which took more than three years, was not completed by Magellan, who died on the island of Mactan, Philippines in a scuffle with the locals. As reported in Magellan's voyage journal written by Pigafetta, Magellan died after receiving a poisoned arrow in his right leg. This study reviews the main compounds used by indigenous from the Philippines and Southeast Asian to poison their arrows, their agents, and effects. These poisons are mainly derived from Aconitum and other species, such as Strychnos, Lophopetalum, Beaumontia, and Strophanthus. They contain cardiac alkaloids and glycosides, which can produce neurological and cardiac effects in just a few minutes. We argue that these toxic effects hindered the withdrawal of Magellan from the beach, facilitating his death in hands of the locals.

Fundamentos teóricos de Florencia Nightingale sobre higiene de manos. Apuntes para una reflexión en tiempos de COVID-19 / Theoretical foundations of Florence Nightingale on hand hygiene. Notes for a reflection in times of COVID-19

RESUMEN Se presenta una revisión, desde el paradigma de Florencia Nightingale, sobre su visión teórica acerca de la higiene de manos. Se analizan los principales aspectos teóricos expresados por ella y su relación con la higiene de manos, además de exponer, mediante el análisis de sus aportes teóricos, su contribución al desarrollo de la enfermería no solo en Cuba sino en el mundo, mostrando la importancia que tiene esta praxis para combatir un sin número de enfermedades infecciosas y muy específicamente la COVID-19, pues una de las medidas más importantes para romper su cadena de transmisión es precisamente la higiene de las manos.

ABSTRACT A review is presented, from the paradigm of Florencia Nightingale, on her theoretical vision about hand hygiene. The main theoretical aspects expressed by her and her relationship with hand hygiene are analyzed, in addition to exposing, through the analysis of her theoretical contributions, her contribution to the development of nursing not only in Cuba but in the world, showing the importance that has this practice to combat a number of infectious diseases and very specifically COVID-19, since one of the most important measures to break its chain of transmission is precisely hand hygiene.

Reclamos por atención en salud: experiencia en un centro privado / Analysis of healthcare claims received at an audit unit of a clinical hospital

Background: The resolution of claims at healthcare institutions is an important issue for administrators. Aim: To analyze the causes of healthcare-related claims in a private, clinical health center. Material and Methods: All claims processed at the audit unit of a clinical hospital between 2016 and 2019 were analyzed. Results: In the study period, 602 complaints were recorded, representing a rate of one claim for every 1,000 services provided. The two main causes of complaints were sub-standard interaction with the doctor such as communication or lack of empathy, corresponding to 21% of cases, and complaints related to care costs, quotes, and insurance coverage (21%). The highest number of complaints originated in emergency care, but the highest rate by number of healthcare services provided occurred in hospitalization in the Mental Health and the Adult Critical Care units. Roughly, 75% of the complaints were settled with a phone call to the patient, which allowed to explain what happened and to apologize accordingly. In 21% of the cases, one or more meetings were held with the patient, a family member, or his/her legal representative to settle an agreement. In 3.5% of cases a mediation process through an independent third party was required. Only 1% of the claims resulted in a legal action. Conclusions: The importance of cultivating an adequate physician-patient relationship for the prevention of complaints and eventual litigations associated with the provision of healthcare services, is emphasized. Quality control policies and processes within healthcare organizations should be strengthened.

Surge in Ventilator-Associated Pneumonias and Bloodstream Infections in An Academic Referral Center Converted to Treat COVID-19 Patients

Background: Healthcare-associated infections (HAIs) are important adverse events that must be prevented. Objective: The objective of the study was to report and study possible changes in HAI rates as well as their causes after the COVID-19 hospital surge capacity response (HSCR) in an academic referral center. Methods: This was a before-after observational study. The Infection Prevention and Control (IPC) program (prospective surveillance, prevention bundles, antibiotic stewardship, continuing education, and feedback) was transiently disrupted after the start of HSCR (March 2020). HAI rates were compared before (January 2019-February 2020) and after (April-July 2020) HSCR, and plausible predisposing factors in affected patients were compared. Results: An increase in the HAI rate from 6.2 to 11.8 cases/1000 patient-days was noted between periods due to increases in ventilator-associated pneumonia and bloodstream infection (BSI) rates. More critically ill patients were admitted during HSCR, and use of invasive devices increased. Prone positioning and infusion of muscle relaxants became commonplace. The nurse-to-patient ratio in the intensive care unit decreased, and 4 h shifts were introduced to avoid fatigue. The BSI rate decreased after the IPC program with additional measures was reintroduced in May 2020. Conclusions: The strain on the workforce and modifications to the IPC program very possibly underlay the findings. IPC programs continue to be essential during the pandemic.

Enfermedad de Chester Erdheim costal: reporte de caso y revisión de la literatura / Chester Erdheim costal disease: case report and literature review

Introducción. La enfermedad de Erdheim Chester es un trastorno infrecuente, de etiología no clara y edad de presentación variable, que se caracteriza por la proliferación anormal de histiocitos no Langerhans. Puede presentarse de forma asintomática, con manifestaciones locales o como complicaciones sistémicas. El diagnóstico se basa en las condiciones clínicas del paciente, estudios imagenológicos y el estudio anatomopatológico, mediante el cual se confirma la enfermedad. Caso clínico. Paciente masculino con una lesión lítica en el séptimo arco costal, inicialmente asintomático y posteriormente con dolor torácico persistente. Se realizó resección y reconstrucción de la pared torácica, con resolución de la sintomatología y adecuada evolución posoperatoria. El resultado de la patología confirmó el diagnóstico de enfermedad de Erdheim Chester. Discusión. Se presenta el caso de un paciente con compromiso costal y fractura patológica como localización y manifestación inusual de la enfermedad de Erdheim Chester, tratado quirúrgicamente de forma adecuada, y sin aparición de recidiva. Debido a la diversidad de síntomas que pueden presentar y a la afectación de múltiples órganos, además de los estudios imagenológicos, la clínica debe orientar los exámenes complementarios, como electro o ecocardiograma, resonancia nuclear magnética, o angioTAC. En los pacientes asintomáticos se ha recomendado un manejo expectante y en los sintomáticos el tratamiento médico con glucocorticoides, inhibidores de BRAF e interferón alfa. El papel de la cirugía no ha sido estudiado a profundidad

Introduction. Erdheim Chester disease is a rare disorder of unclear etiology and variable age of presentation, characterized by abnormal proliferation of non-Langerhans histiocytes. It can present asymptomatic, with local manifestations or as systemic complications. The diagnosis is based on the clinical conditions of the patient, imaging studies, and the pathological study, through which the disease is confirmed.Clinical case. A male patient with a lytic lesion in the seventh costal arch, initially asymptomatic and later with persistent chest pain, underwent resection and reconstruction of the chest wall, with resolution of the symptoms and adequate postoperative evolution. The pathology report confirmed the diagnosis of Erdheim Chester's disease.Discussion. The case of a patient with rib involvement and pathological fracture is presented as an unusual location and manifestation of Erdheim Chester's disease, treated surgically appropriately, and without recurrence. Due to the diversity of symptoms that they can present and the involvement of multiple organs, in addition to imaging studies, the clinic should direct complementary tests such as electrocardiogram or echocardiogram, magnetic resonance imaging, or CT angiography. Expectant management has been recommended in asymptomatic patients, and medical treatment with glucocorticoids, BRAF inhibitors, and interferon alfa in symptomatic patients. The role of surgery has not been studied in depth

Agenesia esternal total: reconstrucción esternal con placas absorbibles y pericardio bovino en un paciente de 4 años / Total sternal cleft: sternal reconstruction with absorbable plaques and bovine pericardium in a 4-year-old patient

La agenesia esternal es una rara malformación del desarrollo embrionario del esternón, que puede estar o no relacionado con otras anomalías congénitas. Se presenta el caso de un paciente de 4 años de edad con agenesia esternal total, que fue llevado a reconstrucción de la pared torácica anterior con material protésico absorbible y pericardio bovino, logrando la adecuada estabilidad de la pared torácica y la corrección de la función de la misma, con una evolución satisfactoria después de dos años de seguimiento

Sternal cleft is a rare malformation of the embryonic development of the sternum, which may or may not be related to other congenital anomalies. We present the case of a 4-year-old patient with total sternal cleft, who underwent reconstruction of the anterior chest wall with absorbable prosthetic material and bovine pericardium, achieving adequate stability and correction of the function of the chest wall, with a satisfactory evolution after two years of follow-up

Characterization of the physical education environment and practice in public schools / Caracterização do ambiente e da prática da educação física em escolas públicas

This cross-sectional, stratified, random sample study aimed to identify the school environment for teaching and engaging in physical education in elementary public schools. An inventory assessment was made and interviews were held with school managers in 12 teaching units in Fortaleza, Ceará, Brazil. The data obtained were categorized as follows: lesson availability and frequency, recess, extra-curricular activities, facilities, and installations in place. The descriptive analysis used absolute and relative frequencies values. The results showed that all schools involved in the study provide two weekly physical education classes. None of the schools engaged in the development of recreational activities during recess. Data showed that 75% of schools participating in the study provide free extracurricular activities, among which futsal was the most popular (58.3%). Also, 75% of schools had indoor sports facilities, whereas some schools did not have adequate space to hold classes. In the group of schools with facilities, 90% had crossbars and 70% had at least one type of floor markings for sports such as futsal, basketball, and volleyball. Only one school had a recreational room, patio, and a green area. We concluded that the results point to a favorable direction for teaching and engaging in physical education in schools. We discussed how an adequate environment in schools helps students make better lifestyle choices and provides teachers with the opportunity to fully develop their classes and promote student's health

O objetivo deste estudo foi identificar o ambiente escolar disponível para o ensino e a prática de educação física em escolas públicas de ensino fundamental. Trata-se de estudo transversal com amostra aleatória e estratificada. Foi realizada uma avaliação do inventário e realizadas entrevistas com os diretores de 12 escolas de Fortaleza, Ceará, Brasil. Os dados obtidos foram categorizados como: disponibilidade e frequência das aulas, desenvolvimento de atividades no recreio, atividades extracurriculares oferecidas, instalações e acesso às mesmas. Os dados foram analisados através das frequências absolutas e relativas descritivas. Os resultados mostraram que todas as escolas envolvidas no estudo oferecem duas aulas de educação física por semana. Nenhuma das escolas desenvolve atividades recreativas durante o recreio. Os dados mostraram que 75% das escolas participantes do estudo oferecem atividades extracurriculares gratuitas. Entre elas, o futsal foi a opção mais popular (58,3%). Além disso, 75% das escolas possuíam instalações esportivas internas, enquanto algumas escolas não dispunham de espaço adequado para realizar as aulas. No grupo de escolas com instalações, 90% possuíam traves e 70% tinham pelo menos um tipo de marcação para esportes no piso, como futsal, basquete ou vôlei. Apenas uma escola possuía uma sala de recreação, pátio e horta. Concluímos que os resultados apontam para uma direção favorável ao ensino e à prática da educação física nas escolas. Nós discutimos como um ambiente adequado nas escolas ajuda os alunos a fazer melhores escolhas de estilo de vida e fornece ao professor a oportunidade de desenvolver completamente suas aulas e promover a saúde dos alunos

Observación de un espectro de manifestaciones clínicas ante la exposición a información relacionada con eventos suicidas / Observation of a Spectrum of Clinical Manifestations when Exposed to Information Related to Suicidal Events

Resumen Hace muchos años se describió el ahora conocido efecto copycat. Se entiende como la reproducción del acto autolesivo, por parte de personas susceptibles, posterior a la exposición a la información en los medios de comunicación relacionada con un suicidio concretado (en noticias, redes sociales, etc.). A partir de la observación en la atención psicológica y psiquiátrica de los pacientes, nuestro grupo ha detectado que esta replicación en realidad forma parte de un espectro mucho más amplio, y que, consecuentemente, otras manifestaciones suelen pasar inadvertidas. Si se trazara un continuum de esas expresiones, en el extremo más severo, se encontraría el suicidio consumado luego de la exposición a dicho material, que es el componente más reconocido hasta la fecha (efecto copycat); no obstante, en otras zonas del espectro, también es posible que las personas experimenten distorsiones cognitivas, componentes obsesivos e intrusivos, ideación pasiva y activa de muerte e intentos no consumados de suicidios. El presente documento se propuso como objetivo describir este fenómeno y, a la vez, ejemplificarlo mediante la exposición de un caso. Resulta probable que el correcto reconocimiento y abordaje fenomenológico sean pasos básicos para establecer los tratamientos y las estrategias preventivas, que garanticen la seguridad de estas personas

Abstract: Long ago, the scientific literature informed about the now well-known copycat effect, understood as a reproduction of the self-injurious act by susceptible individuals after being exposed to suicide-related information in the media (news, social networks, etc.). From observations in psychological and psychiatric care of patients, our group has detected that these manifestations are actually part of a much broader clinical spectrum, where other manifestations can also be found. It would seem plausible that if a spectrum is defined, the most severe end would be consummated suicide, which is the well-recognized component to date (copycat effect); but it is also possible that there is a series of more diverse expressions in other patients after having been exposed to this information, which could include cognitive distortions, obsessive and intrusive phenomena, passive and active ideation of death and unsuccessful suicide attempts. Our purpose with this paper is to explain our observations and present a clinical vignette as an example. We believe that correct recognition and approach to these phenomena is fundamental to establish treatments and preventive strategies that guarantee the safety of this population.

Recomendações de atividade física e exercício físico durante a pandemia Covid-19: revisão de escopo sobre publicações no Brasil / Recommendations for physical activity and physical exercise during the Covid-19 pandemic: scope review on publications in Brazil

No ano de 2020 a história mundial ficou marcada pela Covid-19, doença que causou inúmeros casos e óbitos, de interesse internacional à saúde pública. Esta revisão objetivou mapear as publicações brasileiras sobre recomendações de atividade física e exercício físico durante a pandemia Covid-19. Trata-se de uma revisão de escopo realizada de 22 estudos oriundos de três bases de dados, que continham recomendações expressas sobre prática de atividade física e exercício físico pela população brasileira durante a pandemia Covid-19. A análise dos dados se deu com a descrição das características dos artigos e de seus principais resultados em tabela, atrelada à análise textual dos artigos via software IRaMuTeQ. O corpus textual revelou o conceito de atividade física ligado à saúde, bem como orientações para atividade física e exercício físico com utilização de recursos tecnológicos, além da previsão de programas de exercício físico. A prática regular de atividade física e exercício físico durante a pandemia Covid-19 mostrou-se essencial à manutenção da saúde, sobretudo se regular e orientada, havendo possibilidade de utilização de tecnologias em abordagem individual ou grupal em vários cenários, sobretudo dentro de casa e ao ar livre

In 2020, world history was marked by Covid-19, a disease that caused numerous cases and deaths, being a global health concern. This review aimed to map publications in Brazil with recommendations for physical activity and physical exercise during the Covid-19 pandemic. This scoping review included 22 studies from three databases, which contained express recommendations on the practice of physical activity and physical exercise to the Brazilian population during the Covid-19 pandemic. The data analysis was performed with a description of the characteristics of the articles and their main results in a table, linked to the textual analysis of the articles via the IRaMuTeQ software. The textual corpus revealed the concept of physical activity linked to health, as well as guidelines for physical activity and physical exercise with the use of technological resources, in addition to the provision of physical exercise programs. The regular practice of physical activity and physical exercise during the Covid-19 pandemic proved to be essential to the maintenance of health, especially if it is regular and oriented, with the possibility of using technologies in an individual or group approach in various scenarios, especially indoors and outdoors