Effectiveness of the Flipped Classroom in Health Sciences University Programs: A Literature Review / Efectividad del Aula Invertida en carreras universitarias de Ciencias de la Salud: Revisión de literatura / Efetividade da sala de aula invertida nas carreiras universitárias de ciências da saúde: revisão de literatura

Introduction: Higher education institutions have implemented active learning approaches, such as the Flipped Classroom, to promote the education of their students. Nevertheless, there is conflicting evidence regarding the benefits derived from its implementation. Objective: To determine the effectiveness of the Flipped Classroom application in the education of university students from Health Sciences undergraduate programs. Materials and methods: A systematized narrative review of the literature published between 2012 and 2022. Pubmed, SciELo, Scopus y Web of Science were used as sources of primary articles. A revised version of the Kirkpatrick model was used to assess the effectiveness of the Flipped Classroom. Results: 34 out of the 1020 retrieved articles reached the quantitative synthesis phase. Students value positively this didactic model and acknowledge its contributions in the development of attitudes, knowledge and skills. In contrast, some studies show an increase in the workload and stress levels of students. Conclusions: The evidence suggests that Flipped Classroom is a valid didactic model for the education of Health Sciences students. Future studies should consider the effectiveness of its implementation at a long term organizational level.

Introduction: Higher education institutions have implemented active learning approaches, such as the Flipped Classroom, to promote the education of their students. Nevertheless, there is conflicting evidence regarding the benefits derived from its implementation. Objective: To determine the effectiveness of the Flipped Classroom application in the education of university students from Health Sciences undergraduate programs. Materials and methods: A systematized narrative review of the literature published between 2012 and 2022. Pubmed, SciELo, Scopus y Web of Science were used as sources of primary articles. A revised version of the Kirkpatrick model was used to assess the effectiveness of the Flipped Classroom. Results: 34 out of the 1020 retrieved articles reached the quantitative synthesis phase. Students value positively this didactic model and acknowledge its contributions in the development of attitudes, knowledge and skills. In contrast, some studies show an increase in the workload and stress levels of students. Conclusions: The evidence suggests that Flipped Classroom is a valid didactic model for the education of Health Sciences students. Future studies should consider the effectiveness of its implementation at a long term organizational level.

Introducción: Las instituciones de educación superior han implementado enfoques activos de aprendizaje como el Aula Invertida para favorecer la formación de sus estudiantes. Sin embargo, existe evidencia diversa respecto de los beneficios derivados de su implementación. Objetivo: Determinar la efectividad de la aplicación del Aula Invertida en la formación de estudiantes universitarios de carreras de pregrado de las Ciencias de la Salud. Materiales y métodos: Se realizó una revisión narrativa sistematizada de la literatura publicada entre 2012 y 2022, utilizando Pubmed, SciELo, Scopus y Web of Science como fuentes de artículos primarios. Se utilizó la versión revisada del modelo de Kirkpatrick para valorar la efectividad del Aula Invertida. Resultados: Se obtuvieron 1020 artículos, 34 de ellos ingresaron a la fase de síntesis cuantitativa. Los estudiantes valoran positivamente este modelo didáctico y reconocen su aporte en el desarrollo de actitudes, conocimientos y habilidades. Algunos estudios mencionan un aumento de la carga de trabajo y niveles de estrés en los estudiantes. Conclusiones: La evidencia sugiere que Aula Invertida es un modelo didáctico válido para la formación de estudiantes de las Ciencias de la Salud. Futuros estudios deberían considerar la efectividad de su implementación a nivel organizacional y a largo plazo.

Manejo de tejidos blandos en trauma de miembros inferiores: a propósito de un caso / Soft tissue management in lower limb trauma: about a case

Los miembros inferiores están sujetos frecuentemente a traumas que ocasionan daño de estructuras vitales y que pueden dejar secuelas funcionales y estéticas en las personas. Las lesiones de tejidos blandos son las que asientan en la piel, tejido celular subcutáneo, aponeurosis, músculos, vasos y nervios. Del manejo oportuno y adecuado de las lesiones que se presenten posteriores a un trauma de tejidos blandos dependerá el resultado, el tiempo de recuperación, costos de hospitalización y sobre todo la preservación de las funciones de locomoción y sostén del miembro afectado

The lower limbs are frequently exposed to traumas that cause vital structures damage and can leave functional and aesthetic sequelae in patients. Soft tissue lesions are those that affect the skin, subcutaneous cellular tissue, fascia, muscles, vessels, and nerves. The result, recovery time, hospitalization costs and, above all, the preservation of the locomotion and support functions of the affected limb will depend on the timely and adequate management of injuries that occur after a soft tissue trauma.

Tratamiento posterior a un ataque cerebrovascular con estatinas y metas de colesterol de baja densidad / Statin treatment and low density cholesterol targets in patients post stroke

RESUMEN INTRODUCCIÓN: El ACV es uno de los eventos cardiovasculares más prevalentes en el mundo, en Colombia es la segunda causa de muerte y la primera de discapacidad. Uno de los factores de riesgo más importantes para tener en cuenta es el control del colesterol, la reducción de los niveles de C-LDL, principalmente por medio del tratamiento con estatinas y otros fármacos hipolipemiantes. MATERIALES Y MÉTODOS: En esta revisión narrativa de la literatura se ha recogido la información más relevante sobre el uso y los beneficios de este tratamiento y algunas consideraciones adicionales. CONCLUSIÓN: Los hallazgos de esta revisión demuestran el efecto protector de esta terapia cuando se consiguen reducir los niveles de C-LDL y colesterol, además, las otras terapias como ezetimiba o inhibidores de PSCK9. Por otro lado, los estudios mencionan posibles efectos beneficiosos en el contexto de ACV pero se requieren más ensayos clínicos.

ABSTRACT INTRODUCTION: Stroke is one of the most prevalent cardiovascular events in the world, in Colombia it is the second cause of death and first in disability. One of the most important risk factors to consider is cholesterol control, the reduction of LDL-C and cholesterol levels, mainly through treatment with statins and other lipid-lowering drugs. MATERIALS AND METHODS: The most relevant information on the use and benefits of this treatment and some additional considerations have been collected in this narrative review of the literature. CONCLUSION: The results of this narrative review show the protective effect of this therapy when it is possible to reduce LDL-C and cholesterol levels, in addition to other therapies such as ezetimibe or PSCK9 inhibitors. On the other hand, studies mention possible beneficial effects in the context of stroke but more clinical trials are required.

Cannabis medicinal: puntos críticos para su uso clínico / Medical cannabis: Critical points for clinical application

El cannabis se ha utilizado desde la antigüedad con fines recreativos y medicinales. Es una fuente muy rica de compuestos químicos, la mayoría denominados fitocannabinoides, que tienen una variedad de efectos fisiológicos, principalmente por su unión a receptores cannabinoides endógenos como el CB1 y CB2, entre otros. El cannabis tiene propiedades terapéuticas potenciales y sus preparaciones se han utilizado como remedios tradicionales para tratar el dolor y la emesis. Los cannabinoides sintéticos se utilizan clínicamente como analgésicos, antiespasmódico, antieméticos y estimulantes del apetito. La toxicidad significativa del cannabis es poco común en los adultos, sin embargo, puede tener múltiples efectos adversos agudos y crónicos. La calidad de la evidencia en este campo se ha visto limitada por la corta duración de los estudios, los reducidos tamaños de las muestras, la falta de grupos de control y la existencia de sesgos en la mayoría de los estudios revisados. En este contexto, son necesarios más estudios de mejor calidad metodológica para apoyar el uso seguro de esta terapia en otras enfermedades. La decisión de incorporar los cannabinoides como terapia en alguna de las condiciones descritas depende de la evidencia, el uso de terapias previas y el tipo de paciente.

Since ancient times cannabis has been used for recreational and medicinal purposes. It is a significant source of chemical compounds, most of them called phytocannabinoids. These compounds have several physiological effects and produce their effects primarily by binding to endogenous cannabinoid receptors such as CB1 and CB2, among others. Cannabis has potential therapeutic properties and its preparations have been used as traditional remedies to treat pain and emesis. Synthetic cannabinoids are used clinically as analgesics, antispastics, antiemetics, and appetite stimulants. Significant cannabis toxicity is rare in adults; however, it can produce countless acute and chronic side effects. The quality of the evidence in this field is limited by the short duration of the trials, poor sample sizes, lack of a control group, and the existence of bias in most of the reviewed studies. Therefore, a larger number of studies with better methodological quality is required to support the safe use of this therapy. The decision to include cannabinoids as a treatment for any of the conditions described will depend on the evidence, the use of previous therapies, and the type of patient.

Aspects of trauma related to violence, accidents and falls before and during the COVID-19 pandemic / Aspectos del trauma relacionados con la violencia, accidentes y caídas antes y durante la pandemia COVID-19

Abstract Introduction: Trauma is the second leading cause of mortality and the sixth leading cause of hospitalization in the country, with violence, accidents, and falls being the most prevalent. However, the country is experiencing reflexes of the COVID-19 pandemic, together with a lack of studies on trauma, as well as on clinical care. Objective: To analyze the clinical and epidemiological characteristics of trauma related to violence, accidents, and falls among the years 2019, 2020, and 2021, considered as before and during the COVID-19 pandemic. Material and Methods: Retrospective cohort study, with adults aged 25-55 years, who suffered trauma related to violence, falls, and other accidents, in the period between March and June of 2019, 2020, and 2021, in the city of São Paulo. Data surveys were carried out using the TABNET system, of the Municipal Health Department. Within this system, the search was carried out through the Information System for the Surveillance of Accidents, of the Coordination of Health Surveillance, in which situations of violence were notified and recorded by the National Information System for Notifiable Diseases. Subsequently, the Information System for Surveillance of Violence and Accidents was accessed, focusing on notifications and records of falls and other accidents. Results: Trauma remained more prevalent for males, with complete primary education, and ethnicity predominantly between white or brown. When analyzing the different types of violence: physical, torture, and sexual, there was a prevalence of higher percentages during the year 2019, the pre-pandemic period of COVID-19, except for psychological/moral violence, which was higher in 2021. It should also be noted that the different mechanisms of violence were significantly more prevalent in 2019, as well as the different causes of violence, falls, and car trauma involving pedestrians, occupants, drivers, and passengers. Outpatient care confirmed the higher trend in the pre-pandemic period; however, emergency hospital care showed a greater number of requests in 2020 and 2021. Conclusión: Trauma from violence, accidents, and falls was higher pre-pandemic compared to the period during the COVID-19 pandemic; as well as the search for health care in hospitals and outpatient clinics. These findings show a possible reduction in trauma reports and lower demand for assistance during the pandemic.

Resumen Introducción: El trauma es la segunda causa de mortalidad y la sexta de hospitalización en el país, siendo la violencia, los accidentes y las caídas las más prevalentes. Sin embargo, el país está experimentando reflejos de una pandemia de COVID-19, junto a una falta de estudios sobre el trauma, así como sobre la atención clínica. Objetivo: Analizar las características clínicas y epidemiológicas del trauma junto a la violencia, accidentes y caídas entre los años 2019, 2020 y 2021, considerados antes y durante la pandemia COVID-19. Materiales y métodos: Estudio de cohorte retrospectivo, con adultos de 25 a 55 años, que sufrieron trauma relacionado con violencia, caídas y otros accidentes, en el período comprendido entre marzo y junio de 2019, 2020 y 2021, en la ciudad de São Paulo. Las encuestas de datos fueron realizadas por el sistema TABNET, por el Departamento Municipal de Salud. Dentro de este sistema, la búsqueda se realizó a través del Sistema de Información para la Vigilancia de Accidentes, de la Coordinación de Vigilancia en Salud, en el cual las situaciones de violencia fueron notificadas y registradas por el Sistema Nacional de Información de Enfermedades Notificables. Posteriormente, se accedió al Sistema de Información de Vigilancia de Violencia y Accidentes, con enfoque en notificaciones y registro de caídas y otros accidentes. Resultados: El trauma siguió siendo más prevalente para los hombres, con educación primaria completa y raza predominantemente entre blancos y morenos. Al analizar los diferentes tipos de violencia: física, tortura y sexual, hubo mayores porcentajes de prevalencia durante el año 2019, período prepandémico de COVID-19, a excepción de la violencia psicológica / moral, que fue mayor en 2021. Nótese que los diferentes mecanismos de violencia fueron significativamente más prevalentes en 2019, así como las diferentes causas de violencia, caídas y traumatismos automovilísticos que involucran a peatones, ocupantes, conductores y pasajeros. La atención ambulatoria confirmó la tendencia de superioridad en el período prepandémico, sin embargo, la atención hospitalaria de emergencia mostró un mayor número de solicitudes en 2020 y 2021. Conclusión: Los traumas de violencia, accidentes y caídas son más prepandémico en comparación con el período durante la pandemia COVID-19; así como la búsqueda de asistencia sanitaria en hospitales y clínicas. Estos hallazgos muestran una posible reducción en los informes de trauma y una menor demanda de asistencia durante la pandemia.

Fish defaunation in reservoirs of the Lower Paranapanema River basin, Brazil / Defaunação de peixes em reservatórios do baixo rio Paranapanema, Brasil

Abstract Until now no study has used a defaunation index to quantify the decline of Neotropical freshwater fishes in environments fragmented by dams and reservoirs. So, we applied this index to 143 native fish in five reservoirs in the Lower Paranapanema River, that is situated in one of the Brazilian aquatic environments most impacted by anthropic degradation. Fish species were classified according to their functional groups, which were selected according to the biological characteristics that may reflect in defaunation events. The biggest reservoir in area with more tributaries and forest cover showed lowest defaunation index. The functional groups of fishes more affected by defaunation included species characterized by periphytivores, invertivores and algivores, non-migratory habit, with external fertilization, and parental care. Although reservoirs have different characteristics, this method can be tested in any other hydrographic basin. The results suggested continued conservation efforts to preserve the integrity of tributaries and the native fishes in reservoirs and pointed out the importance of maintaining native vegetation cover and fish restocking programs in the reservoirs with the highest defaunation values. Our finding can be use as the first data source for future studies using this defaunation index.

Resumo Até o momento nenhum estudo utilizou um índice de defaunação para quantificar o declínio de peixes neotropicais de água doce em ambientes fragmentados por barragens e reservatórios. Dessa forma, testamos esse índice em 143 espécies nativas em cinco reservatórios do baixo rio Paranapanema, que está localizado em um dos ambientes aquáticos brasileiros mais impactados pela degradação antrópica. As espécies de peixes foram classificadas de acordo com seus grupos funcionais selecionados de acordo com as características biológicas que podem influenciar nos eventos de defaunação. O maior reservatório em área, com mais tributários e maior cobertura florestal apresentou menor índice de defaunação. Os grupos funcionais mais afetados pela defaunação incluíram espécies caracterizadas por hábito alimentar perifitívoro, invertívoro e algívoro, hábito não migratório, com fertilização externa e cuidado parental. Embora os reservatórios tenham características diferentes, esse método pode ser testado em qualquer outra bacia hidrográfica. Os resultados sugerem esforços contínuos para preservar a integridade dos tributários e dos peixes nativos nos reservatórios e apontam a importância de manter a cobertura vegetal nativa e programas de estocagem nos reservatórios com maiores valores de defaunação. Nossos dados podem ser utilizados como a primeira base de dados para futuros estudos que utilizem o índice de defaunação.

Rotura espontánea de quiste hepático simple: éxito del tratamiento conservador / Spontaneous rupture of a simple liver cyst: success of a conservative approach

RESUMEN Los quistes hepáticos simples (QHS) son las lesiones hepáticas más frecuentes. Cursan habitualmente asintomáticas, aunque cuando alcanzan gran tamaño pueden causar síntomas. El objetivo del presente artículo es presentar una complicación excepcional de los QHS. Presentamos a una mujer de 61 años con historia de QHS múltiples que acude a Urgencias por dolor abdominal brusco sin antecedente traumático. Ante la sospecha de rotura quística espontánea, se realiza tomografía computarizada (TC) abdominal que confirma el diagnóstico. Se decide tratamiento conservador con buena evolución. Tras el episodio agudo es intervenida quirúrgicamente realizándose destechamiento de los quistes. a rotura de los QHS es una complicación excepcional que habitualmente cursa con dolor abdominal. Debido a su baja frecuencia no existe un tratamiento estándar. Se acepta que el tratamiento conservador es una buena opción en pacientes sin signos de peritonitis, mientras que la cirugía urgente está indicada en pacientes con abdomen agudo.

ABSTRACT Simple liver cysts (SLC) are the most common liver tumors. They are usually asymptomatic but large cysts may produce symptoms. The aim of this article is to report a rare complication of SLC. We report the case of a 61-year-old woman with a history of multiple SLCs who sought medical care due to sudden abdominal pain not associated with trauma. A probable diagnosis of spontaneous rupture was made, and the patient underwent computed tomography (CT) scan of the abdomen which confirmed the suspicion. Conservative treatment was decided, with favorable outcome. After the acute episode the patient underwent surgery and the cysts were unroofed. Rupture of SLC is a rare complication that usually presents with abdominal pain. There is no standard of care due to the low incidence of this complication. The conservative approach is a good option in patients without signs of peritonitis, while emergency surgery is indicated in patients with acute abdomen.

Sentinel surveillance for bacterial pneumonia and meningitis in children under the age of 5 in a tertiary pediatric hospital in Colombia - 2016 / Vigilancia centinela de neumonías y meningitis bacterianas en menores de 5 años en un hospital pediátrico de tercer nivel en Colombia - 2016

Abstract | Introduction: Bacterial pneumonia and meningitis are vaccine-preventable diseases. Sentinel surveillance provides relevant information about their behavior. Objective: To present the data from sentinel surveillance carried out at the Fundación HOMI, Fundación Hospital Pediátrico La Misericordia in 2016. Materials and methods: We conducted a descriptive study from January 1 to December 31, 2016, on the daily surveillance of patients under 5 years of age diagnosed with pneumonia or bacterial meningitis according to PAHO's definitions. We identified the microorganisms using the automated VITEKTM 2 system. Bacterial isolates were sent to the Microbiology Group at the Colombian Instituto Nacional de Salud for confirmation, serotyping, phenotypic, and genotypic characterization. Antimicrobial susceptibility profiles were established. Results: From 1,343 suspected cases of bacterial pneumonia, 654 (48.7%) were probable, 84% had complete Hib vaccination schedules, and 87% had complete pneumococcal vaccination schedules for age. Blood culture was taken in 619 (94.6%) and 41 (6.6%) were positive while S. pneumoniae was isolated in 17 (41%) of them. The most frequent serotype was 19A in five cases (29.4%), and four 19A serotypes were associated with the reference isolate ST320. The incidence rate of probable bacterial pneumonia was 7.3 cases/100 hospitalized patients, and lethality was 2.1%. As for bacterial meningitis, 22 suspected cases were reported, 12 (54%) were probable, four (33%) were confirmed: two by Escherichia coli and two by group C N. meningitidis. The incidence of probable bacterial meningitis was 0.14 cases/100 hospitalized patients. Conclusion: Streptococcus pneumoniae serotypes 19A and 3 were the most frequent cause of pneumonia. Spn19A is related to the multi-resistant clone ST320. Strengthening and continuing this strategy will allow understanding the impact of vaccination.

Resumen | Introducción. La neumonía y la meningitis bacterianas son enfermedades inmunoprevenibles; la vigilancia centinela aporta información relevante acerca de su comportamiento. Objetivo. Presentar los resultados de la vigilancia centinela de neumonía y meningitis llevada a cabo en la HOMI, Fundación Hospital Pediátrico La Misericordia. Materiales y métodos. Se hizo un estudio descriptivo entre el 1 de enero y el 31 diciembre del 2016, de la vigilancia diaria de pacientes menores de 5 años con diagnóstico de neumonía o meningitis bacteriana, según las definiciones de la Organización Panamericana de la Salud (OPS). Los microorganismos fueron identificados usando el sistema automatizado VITEK TM2. Los aislamientos se enviaron al grupo de microbiología del Instituto Nacional de Salud para confirmación, serotipificación, y caracterización genotípica y fenotípica. Asimismo, se establecieron los perfiles de sensibilidad antimicrobiana. Resultados. De 1.343 casos sospechosos de neumonía bacteriana, 654 (48,7 %) fueron probables, el 84 % tenía el esquema de vacunación completo para la edad contra Haemophilus influenzae de tipo b, y el 87 %, contra neumococo. En 619 (94,6 %) pacientes se hizo hemocultivo y 41 (6,6 %) fueron positivos. S. pneumoniae se aisló en 17 (41 %) casos. El serotipo más frecuente fue el 19A, en cinco pacientes (29,4 %), en tanto que cuatro aislamientos de spn19A fueron relacionados con el clon ST320. La tasa de incidencia de neumonía bacteriana probable fue de 7,3 casos/100 pacientes hospitalizados. La letalidad fue de 2,1 %. Hubo 22 casos sospechosos de meningitis bacteriana, 12 (54 %) probables, y cuatro (33 %) confirmados: dos por Escherichia coli y dos por Neisseria meningitidis del grupo C. La incidencia de meningitis bacteriana probable fue de 0,14/100 pacientes hospitalizados. Conclusión. Los serotipos 19A y 3 de S. pneumoniae fueron la causa más frecuente de neumonía. El Spn19A se relacionó con el clon ST320 mulitirresistente. El fortalecimiento continuo de la vigilancia centinela permitirá entender el impacto de la vacunación.

Mortalidad por neumonía y por todas las causas en niños menores de 5 años en Colombia entre el 2005 y 2016 / Pneumonia and all causes mortality in children under 5 year old in Colombia between 2005 and 2016

RESUMEN Introducción: Las infecciones neumocócicas son una de las causas más importantes de enfermedades en niños menores de 5 años en Colombia. Objetivo: Calcular la mortalidad por neumonía y por todas las causas en niños menores de 5 años en Colombia. Métodos: Estudio ecológico, los principales desenlaces del estudio fue mortalidad por todas las causas y neumonía (CIE-10 J12-18). Resultados: Durante el año 2005 al 2016 se encontraron un total de 122.074 muertes por todas las causas, de las cuales 13359 (10.94%) correspondieron a muerte por neumonía, 750 a meningitis (0.61%) y 17.511 a muerte por otras causas respiratorias (14.34%). Conclusiones: Se ha observado una disminución de la mortalidad en las tasas de mortalidad por todas las causas, y las demás estudiadas en este artículo.

ABSTRACT Introduction: Pneumococcal infections are one of the most important causes of diseases in children under 5 years old in Colombia. Objective: Evaluate mortality from pneumonia and all causes in children under 5 years old in Colombia. Methods: Ecological study, the main outcomes of the study was all-cause mortality and pneumonia (ICD-10 J12-18). Results: During 2005 to 2016, a total of 122,074 deaths were found for all causes, of which 13,359 (10.94%) corresponded to death due to pneumonia, 750 to meningitis (0.61%) and 17,511 to death due to other respiratory causes (14.34% ). Conclusions: A decrease in mortality has been observed in all-cause mortality rates, and the others studied death causes in this article.

Malacofauna bentônica do Lago Igapó, Londrina (Paraná, Brasil), com ênfase na espécie invasora mexilhão-dourado Limnoperna fortunei (Dunker, 1857) / Benthic malacofauna from the Igapó Lake, Londrina (Paraná, Brazil), with emphasis on the invasive species Golden Mussel Limnoperna fortunei (Dunker, 1857)

Objetivo: quantificar a abundância e a biomassa de moluscos bentônicos no Lago Igapó I, Londrina, Paraná, Brasil. Material e Métodos: foram realizadas duas coletas no Lago Igapó I, a primeira em junho de 2015 e a segunda em fevereiro de 2016. O substrato (incluindo os moluscos incrustados) foi amostrado utilizando um quadrante com área de 1 m2, onde 10 amostragens foram realizadas entre três pontos distintos do lago. Os moluscos capturados foram anestesiados e eutanasiados por superexposição ao gelo. Posteriormente, o material foi quantificado em abundância (n) e biomassa total (kg), e armazenado em tambores contendo formol 4% tamponado com carbonato de cálcio. Resultados: foram identificadas cinco espécies de moluscos, sendo três não nativas (Limnoperna fortunei, Corbicula fluminea e Melanoides tuberculata), uma nativa (Aylacostoma cf. tenuilabris) e um indivíduo do gênero Pomacea. Em ambas as coletas, L. fortunei compreendeu aproximadamente 90% da abundância e biomassa total. A partir da densidade média de L. fortunei e a área total do Lago Igapó I, estimou-se que a população total de mexilhões-dourados pode chegar a 633 milhões de indivíduos, correspondendo a 638 toneladas de biomassa. Conclusão: é evidente a dominância da espécie invasora L. fortunei no Lago Igapó I, onde esta pode causar diversos efeitos negativos, como alterações no ciclo de nutrientes, redução de espécies nativas, introdução de parasitos, bioacumulação de metais pesados na cadeia trófica, diminuição da qualidade da água para uso humano e obstrução de encanamentos com risco de alagamentos. Desta forma, recomenda-se uma imediata ação de manejo neste ambiente para retirada de indivíduos da espécie, com consequente redução de sua abundância.(AU)

Objective: quantify the abundance and biomass of benthic molluscs in Igapó Lake I, Londrina, Paraná, Brazil. Material and Methods: two samplings was made at Igapó Lake I, first in June 2015 and then in February 2016. The substrate (including all embedded molluscs) was sampled using a 1 m2 quadrant, where 10 samples were taken between three distinct points from the lake. All molluscs captured were anesthetized and euthanized by overexposure to ice. Subsequently, the material was quantified in quantity (n) and total biomass (kg), and stored in barrels containing 4% formaldehyde buffered with calcium carbonate. Results: five species of molluscs were identified, three non native species (Limnoperna fortunei, Corbicula fluminea and Melanoides tuberculata), one native (Aylacostoma cf. tenuilabris) and one Pomacea sp. In both sampling, L. fortunei comprised approximately 90% of the abundance and total biomass. From the average density of L. fortunei and the total area of the Igapó Lake I, it was estimated that the total population of golden mussels can reach 633 million individuals, corresponding to 638 tons of biomass. Conclusion: the dominance of the invasive species L. fortunei in Igapó Lake I is evident, where it can cause several negative effects, such as alterations in the nutrient cycle, reduction of native species, introduction of parasites, bioaccumulation of heavy metals in the food chain, decreased quality of water for human use and obstruction of pipes obstruction with risk of overflow. Therefore, we recommend an immediate management action in this environment in order to remove individuals of this species and, consequently, to reduce its abundance. (AU)

Taxonomic loss and functional reduction over time in the ichthyofauna of the Taquaruçu Reservoir, lower Paranapanema River, Southern Brazil

We evaluated the fish composition and ecological attributes of the ichthyofauna collected in a limnological zone of the Taquaruçu Reservoir, lower Paranapanema River. Information about the fish community was updated when compared to the previous study (2006). Non-metric multidimensional scaling (NMDS) showed differences in species composition between periods and community weighted means (CWMs) exhibited changes in functional composition over time. Four functional indices were used in the principal coordinate analysis (PcoA) to measure changes in the functional space of species, whereas functional β-diversity inspected differences in the traits composition between the periods. 1,203 individuals were sampled of 43 species, being 16 non-native and 14 new records. Compared to 2006, 27 species were absent, most of them native to Loricariidae and Anostomidae, while Curimatidae and Pimelodidae decreased in abundance. Functional indexes showed a reduction in functional diversity, whereas new species records exhibited functional redundancy. It might have occurred a simplification of the fish community over time, excluding the migratory and specialists species such as the herbivores and detritivores. Accordingly, we concluded that the ichthyofauna of the Taquaruçu Reservoir might have been undergoing a process towards biotic homogenization.(AU)

Avaliamos a composição de peixes e atributos ecológicos da ictiofauna coletada em uma zona limnológica do reservatório de Taquaruçu, baixo rio Paranapanema. As informações sobre a comunidade de peixes foram atualizadas quando comparadas ao estudo anterior (2006). O escalonamento multidimensional não métrico (NMDS) mostrou diferenças na composição de espécies entre os períodos, e as médias ponderadas da comunidade (CWMs) exibiram mudanças na composição funcional ao longo do tempo. Quatro índices funcionais foram utilizados na análise de coordenadas principais (PcoA) para medir as mudanças no espaço funcional das espécies, enquanto a β-diversidade funcional inspecionou diferenças na composição de traços entre os períodos. Foram amostrados 1,203 indivíduos de 43 espécies, sendo 16 não-nativas e 14 novos registros. Em comparação com 2006, 27 espécies estavam ausentes, a maioria nativa de Loricariidae e Anostomidae, enquanto Curimatidae e Pimelodidae diminuíram em abundância. Os índices funcionais mostraram redução na diversidade funcional, enquanto novos registros de espécies exibiram redundância funcional. Pode ter ocorrido uma simplificação da comunidade de peixes ao longo do tempo, excluindo as espécies migradoras e especialistas como os herbívoros e detritívoros. Dessa forma, concluímos que a ictiofauna do reservatório de Taquaruçu pode estar sofrendo um processo de homogeneização biótica.(AU)

Riesgos prenatales, perinatales y neonatales asociados a signos neurológicos blandos / Prenatal, perinatal and neonatal risks associated with soft neurological signs

Introducción: Los signos neurológicos blandos se han asociado con dificultades motoras, alteraciones comportamentales menores e incluso como factores de vulnerabilidad para la aparición de afecciones como, esquizofrenia, trastorno de déficit de atención e hiperactividad, trastorno disocial y episodios psicóticos. Aunque la investigación sobre los signos ha venido aumentando, no se tiene claridad sobre qué puede predisponer su aparición. Objetivo: Describir la asociación entre factores de riesgo prenatales, perinatales y neonatales y la aparición de los signos neurológicos blandos en niños con estos factores riesgo y en niños sin ellos. Métodos: Estudio de tipo descriptivo comparativo, de corte transversal, con diseño no experimental. La población en estudio se conformó por 550 niños y niñas, con edades entre seis y ocho años organizados. en cuatro grupos: los que presentaban riesgos prenatales, perinatales, neonatales, y el grupo que no presentaba ningún riesgo. Las aplicaciones se llevaron a cabo durante el primer semestre de 2017. Los datos se tomaron de las historias clínicas y los. signos neurológicos blandos se evaluaron a través del apartado de la Evaluación Neuropsicológica Infantil. Resultados: La mayoría de los signos neurológicos blandos presentaron diferencias significativas y valores altos en la comparación de los rendimientos en cada uno de los grupos con riesgo. Conclusiones: la presencia de riesgos prenatales, perinatales y neonatales producen una serie de alteraciones en el desarrollo del niño que se van acumulando y pueden estar asociados con la aparición de los signos neurológicos blandos(AU)

Introduction: The soft neurological signs have been associated with motor difficulties, lower behavioural alterations and even with vulnerability factors for the appearance of conditions such as schizophrenia, attention deficit disorder and hyperactivity, disocial disorder and psychotic episodes. Although research on the signs has been increasing, it is not clear what may predispose their appearance. Objective: To describe the association between prenatal, perinatal and neonatal risk factors and the appearance of the soft neurological signs in children with these risk factors and in children without them. Methods: Descriptive, comparative, cross-sectional non-experimental design´s study. The study´s population was formed by 550 boys and girls between the ages of six and eight years organized in four groups: with prenatal risks, with perinatal risks, with neonatal risks, and the group that did not present any risks. The tests were carried out during the first semester of 2017. The data were taken from the medical records and the soft neurological signs were evaluated through the item called Neuropsychological Assessment of Children. Results: Most of the soft neurological signs showed significant differences and high values in the performance comparison in each of the groups with risks. Conclusions: The presence of prenatal, perinatal and neonatal risks produce a series of alterations in the development of the child that are accumulated and may be associated with the appearance of the soft neurological signs(AU)

Biomechanical and adhesion comparison of linea alba prophylactic reinforcement with coated and uncoated three-dimensional T-shaped mesh in rabbits

Abstract Purpose: Incisional hernia (IH) is a frequent complication of median laparotomy. The use of prophylactic mesh to reduce IH incidence has gained increasing attention. We hypothesized that in an animal model, linea alba prophylactic reinforcement with a three-dimensional T-shaped polypropylene mesh results in greater abdominal wall resistance. Methods: Study was performed in 27 rabbits. After abdominal midline incision, animals were divided into three groups according to the laparotomy closure method used: (1)3D T-shaped coated mesh; (2)3D T-shaped uncoated mesh; and (3) closure without mesh. After 4 months, each animal's abdominal wall was resected and tensiometric tests were applied. Results included IH occurrence, adhesions to the mesh, and wound complications. Results: There was no significant difference between the groups in maximum tensile strength (p=0.250) or abdominal wall elongation under maximum stress (p=0.839). One rabbit from the control group developed IH (p=1.00). Small intestine and colon adhesions occurred only in the uncoated mesh group (p<0.001) and the degree of adhesions was higher in this group compared to the coated mesh group (p<0.05). Conclusion: Use of the current 3D T-shaped prophylactic mesh model did not result in a significant difference in tensiometric measurements when compared with simple abdominal wall closure in rabbits.

Fish fauna from the Paranapanema River basin, Brazil / Fauna de peixes da bacia do rio Paranapanema, Brasil

Abstract: The Paranapanema River is an important, extensively explored tributary of the Upper Paraná River basin. The fish fauna of the Paranapanema River has been investigated since the 1990s; however, no study has characterized the richness of fish species throughout the basin, including the main channel of the river, marginal lagoons, its tributaries, and sub-tributaries. Thus, we performed a review with 90 independent studies conducted at the upper, middle, and lower sections of the basin. We recorded 225 species, of which 165 were native, and 60 were non-native. We found that 77% of the species within the basin are composed by Siluriformes and Characiformes. Cichliformes had a significant number of non-native species established in impoundment sections of the basin. Incidence-Based Estimators (Bootstrap and Chao 2) demonstrated that the richness of native species is still underestimated. Some native (e.g., Hypostomus ancistroides) and non-native species (e.g., Plagioscion squamosissimus) are widely distributed in the basin, while others had a more restricted distribution. Among the registered species, the family Bryconidae had the highest number of representatives with threatened conservation status. In addition, we observed that the Capivara Reservoir and its tributaries were the most sampled regions, with the majority of studies performed in the Lower Paranapanema basin. The species richness recorded in large tributaries, such as Tibagi, Cinzas, Congonhas, and Pirapó rivers is critical for maintaining the fish fauna in the Paranapanema River. Our contribution may be used to support management actions and conservation strategies, as well as to indicate regions in the basin that need to be better inventoried.

Resumo: O rio Paranapanema é um importante tributário, amplamente explorado da bacia do Alto rio Paraná. A fauna de peixes do rio Paranapanema vem sendo investigada desde a década de 1990; no entanto, nenhum estudo caracterizou a riqueza de espécies de peixes em toda a bacia, incluindo o canal principal do rio, lagoas marginais, seus tributários e sub-tributários. Assim, realizamos uma revisão com 90 estudos independentes conduzidos nas regiões superior, média e inferior da bacia. Foram registradas 225 espécies, das quais 165 eram nativas e 60 eram não nativas. Verificamos que 77% das espécies dentro da bacia são compostas por Siluriformes e Characiformes. Cichliformes apresentou um número significativo de espécies não nativas estabelecidas em áreas de represamento da bacia. Estimadores de riqueza baseados em incidência (Bootstrap e Chao 2) demonstraram que a riqueza de espécies nativas ainda é subestimada. Algumas espécies nativas (e.g., Hypostomus ancistroides) e não nativas (e.g., Plagioscion squamosissimus) estão amplamente distribuídas na bacia, enquanto outras tem sua distribuição mais restrita. Entre as espécies registradas, a família Bryconidae obteve o maior número de representantes com status de conservação ameaçado. Além disso, observamos que o reservatório de Capivara e seus afluentes foram as regiões mais amostradas, sendo a maioria dos estudos realizados na bacia do baixo Paranapanema. A riqueza de espécies registrada em grandes afluentes, como os rios Tibagi, Cinzas, Congonhas e Pirapó, é fundamental para a manutenção da ictiofauna no rio Paranapanema. Nossa contribuição pode ser usada para apoiar ações de manejo e estratégias de conservação, bem como para indicar regiões na bacia que precisam ser melhor inventariadas.

Compreensão dos acadêmicos de medicina sobre os princípios de atendimento inicial aos pacientes queimados / Understanding of medical students about the principles of initial assistance for burn patients

OBJETIVO: Avaliar a compreensão dos acadêmicos de medicina sobre o atendimento inicial a pacientes queimados, bem como o aprendizado sobre a temática ao longo do curso. MÉTODO: Trata-se de um estudo transversal descritivo realizado em uma instituição de ensino superior de Minas Gerais, por meio da aplicação de um questionário validado por Balan e colaboradores. A coleta de dados ocorreu entre março e outubro de 2020, com 92 acadêmicos do 1° ano e 45 acadêmicos do 6° ano de medicina. As análises foram realizadas no software R versão 4.0.3. Descritas por frequências absolutas e relativas, desvio-padrão, teste Exato de Fisher, teste Qui-quadrado e teste de Mann-Whitney. RESULTADOS: Constatou-se que 6,67% dos acadêmicos do 6° ano acertaram acima de 80% das questões e 2,17% do 1° ano. A média de acertos, em porcentagem, no 6° ano foi 63,1±10,3 versus 47,0±16,9 no 1° ano. O tema de maior desconhecimento foi reanimação volêmica, cujo, 93,3% acadêmicos do 6° ano contra 96,7% no 1° ano erraram. O exame básico, cuidados iniciais, cálculo da superfície corporal queimada e triagem foram áreas do conhecimento com maior percentual de acerto no 6° ano: 93,3%, 85,6±25,3%, 80% e 85,2±19,5%, respectivamente, enquanto os do 1° ano tiveram menos acertos. CONCLUSÃO: Verificou-se, pelo presente trabalho, que apesar do aumento de acertos em comparação com o 1° ano, algumas condutas médicas iniciais necessárias aos pacientes queimados como reposição volêmica, cuidados locais e antibioticoterapia não são compreendidas pelos acadêmicos do 6° ano, na maior parte da amostra estudada.

OBJECTIVE: To evaluate the understanding of medical students about the initial care for burn patients, as well as learning about the theme throughout the course. METHOD: This is a cross-sectional descriptive study carried out in a higher education institution in Minas Gerais, through the application of a questionnaire validated by Balan and collaborators. Data collection took place between March and October 2020, with 92 students from the 1st year and 45 students from the 6th year of medicine. The variables were presented by absolute and relative frequencies and standard deviation. RESULTS: It was found that 6.67% of the 6th grade students answered correctly above 80% of the questions and 2.17% of the 1st year. The average number of correct answers in the 6th year was 63.1±10.3 versus 47.0±16.9 in the 1st year. The theme of greatest ignorance was volemic resuscitation, whose 93.3% 6th graders against 96.7% in 1st grade missed. The basic exam, initial care, calculation of the burned body surface and screening were fields of knowledge with the greatest percentage of correct answers in the 6th year: 93.3%, 85.6±25.3%, 80%, and 85.2±19.5%, respectively, while those in the 1st year had less correct answers. CONCLUSION: It was found, in the study, that despite the increase in correct answers compared to the 1st year, some initial medical procedures necessary for burned patients, such as: volume replacement, local care and antibiotic therapy, are not understood by 6th graders, in most of the studied sample.

Síntomas depresivos y cobertura de diagnóstico y tratamiento de depresión en población mexicana / Depressive symptoms and coverage of diagnosis and treatment of depression in Mexican population

Abstract Objective: To assess changes in the prevalence of depressive symptoms (DS) and in detection and treatment coverage between 2006 and 2018, and to identify the sociodemographic factors associated with the latter. Materials and methods: We used data from the Ensanut 2006, 2012, 2018-19, 100k. We used logistic regression to explore demographic factors associated with coverage of detection and treatment of depression. Results: The prevalence of DS was respectively: 15.4, 13.7, 13.6 and 15.0%. Living in municipalities with a very high and high degree of marginalization was associated with less coverage of detection and treatment of depression. Conclusions: This work provides evidence on the gaps that exist in access to mental health services between regions and different levels of marginalization and highlights the need to direct efforts to increase access to health services that allow timely diagnosis and treatment of DS and depression.

Resumen Objetivo: Estimar cambios en la prevalencia de síntomas depresivos (SD) y en la cobertura de detección y tratamiento entre 2006 y 2018, e identificar los factores sociodemográficos asociados con estos últimos. Material y métodos: Se utilizaron datos de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012, 2018-19 y 100k. Usamos regresión logística para explorar factores demográficos asociados con detección y tratamiento de depresión. Resultados: La prevalencia de SD fue respectivamente de 15.4, 13.7, 13.6 y 15.0%. Vivir en municipios con muy alto y alto grado de marginación se asoció con menor cobertura de detección y tratamiento de depresión. Conclusiones: Este trabajo brinda evidencia sobre las brechas que existen en el acceso a servicios de salud mental entre regiones y diferentes niveles de marginación, y resalta la necesidad de encaminar esfuerzos para incrementar acceso de servicios de salud que permitan el diagnóstico y tratamiento oportunos de SD y la depresión.