Climate awareness, anxiety, and actions among youth: a qualitative study in a middle-income country

Objectives: The impact of climate change on mental health is well established, but few studies have examined the perspectives of young people, especially in low- and middle-income countries (LMICs). In this qualitative study, we explored how Brazilian children and adolescents experience climate change. This approach can help inform environmental education, communication, and self-care strategies for this age group. Methods: We conducted focus groups with 50 children and adolescents aged 5 to 18 years in three locations in Brazil. We analyzed the data using an interpretative phenomenological analysis framework. Results: We identified three profiles of involvement with climate change: unaware, disengaged, and engaged. Profiles were largely related to different socioeconomic contexts. We analyzed each profile across the dimensions of space, time, emotions, and actions. Adults were portrayed by participants as stubborn deniers, as neutral influences, or as role models of knowledge and engagement. Due to their age and developmental level, young children had distinctive perceptions of climate change. Conclusion: Spatial and temporal perceptions of climate change are a key element for experiencing and engaging with environmental concerns and vary according to age and socioeconomic differences. Effective communication to foster climate action at individual and collective levels requires narratives that reach different ages. Replication of these findings in other LMICs is warranted.

Navegando por la fisura silviana: anatomía microquirúrgica, neuroimágenes y técnica quirúrgica / Navigating the sylvian fissure: microsurgical anatomy, neuroimaging, and surgical technique

Objetivo: Describir la anatomía quirúrgica de la fisura silviana (FS) a través de disecciones cadavéricas y neuroimágenes; desarrollar su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 10 hemisferios cadavéricos humanos fijados y un cráneo humano en seco, a través de la disección de fibras blancas y de la anatomía arterial y neural, utilizando un microscopio quirúrgico. Las arterias cerebrales fueron inyectadas con silicona coloreada. La anatomía quirúrgica fue correlacionada con la anatomía neuroimagenológica. Finalmente, se recolectó la experiencia microquirúrgica adquirida y, a su vez, la anatomía del Complejo Silviano, fue revisada. Resultados: La FS se extiende desde la cara basal a la lateral del cerebro. Cada superficie tiene una parte superficial (tronco silviano y sus ramos), intermedia (compartimientos anterior y opercular lateral) y profunda (compartimiento esfenoidal, hendidura insular anterior y lateral y la región retroinsular). En 7 de los 10 hemisferios, el surco central no se intersectó con la FS en la superficie lateral del cerebro. En el 80% de los hemisferios, la principal bifurcación de la arteria cerebral media se localizó en o proximal al limen insular. Debajo de la pars triangularis se localiza el punto más ancho de la superficie lateral de la FS. Los autores comienzan la disección de la misma en o proximalmente a este punto. Conclusiones: El conocimiento anatómico profundo y su aplicación a las neuroimágenes, son herramientas esenciales para el planeamiento prequirúrgico y son requisitos mandatorios para operar con seguridad a través y alrededor de la FS

Objective: The aim of this study is to describe the microsurgical anatomy of the sylvian fissure, through cadaveric dissections and neuroimaging and to elucidate its clinical application for microsurgery. Methods: One human skull and ten cadaveric human hemispheres were studied through white matter fiber dissections and arterial and neural anatomy of the sylvian fissure and insular dissections under the microscope. The cerebral arteries were perfused with colored latex. The surgical anatomy was correlated with neuroimaging anatomy. Finally, the microsurgical experienced gained applying this anatomical knowledge was gathered, and the literature about the anatomy of the sylvian complex was revised, as well. Results: The Sylvian fissure extends from the basal to the lateral surface of the brain. Each surface has a superficial (sylvian stem and its rami), intermediate (anterior and lateral opercular compartments) and deep parts (sphenoidal compartment, anterior and lateral insular clefts and retroinsular region). In 7 out of 10 hemispheres, the central sulcus did not intersect with the sylvian fissure on the lateral surface of the brain. In 80% of the hemispheres, the middle cerebral artery main bifurcation was localized at or proximal to the limen insulae. Beneath the pars triangularis, the widest point of the lateral surface of the sylvian fissure is located. The authors start dissecting the sylvian fissure at this point. Conclusion: The thorough anatomical knowledge with its clinical application in modern neuroimaging are essential tools for preoperative planning and are mandatory requisites to safely operate through and around the sylvian fissure anatomical complex.

Ventana aortopulmonar: Reporte de caso / Aortopulmonary window: Case report

RESUMEN La ventana aortopulmonar constituye una infrecuente anomalía cardíaca congénita. En la literatura mundial se han publicado alrededor de 300 casos. Se ha asociado a defectos cardíacos complejos, lo cual dificulta su diagnóstico. Se presenta el caso de un lactante menor con sintomatologia de falla cardíaca congestiva; durante estancia en unidad de cuidados intensivos cursa con múltiples comorbilidades; posterior a lo cual es llevado a cirugía cardíaca correctiva con peso inferior a 2000 gramos, con evolución satisfactoria. Se resalta la importancia de la corrección temprana, con el fin de evitar la progresión a enfermedad vascular pulmonar irreversible.

ABSTRACT Aortopulmonary window is a rare congenital heart defect. About 300 cases have been published in the world literature. It has been associated with complex heart defects, which makes it difficult to diagnose. We present a case of a minor infant with symptomatology of congestive heart failure; during stay in intensive care unit presents multiple co-morbidities. Subsequent to that, it is taken to corrective cardiac surgery with weight inferior to 2000 grams, with satisfactory evolution. The importance of early correction is emphasized in order to avoid progression to irreversible pulmonary vascular disease.

EUS-guided gastroenterostomy: Initial experience in a brazilian tertiary center

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

Hernia intraesponjosa de Schmörl sintomática / Symptomatic intraosseous Schmörl herniation

Las hernias discales intraesponjosas vertebrales o nódulos de Schmörl consisten en una herniación o una extrusión del núcleo pulposo del disco intervertebral a través del platillo vertebral hacia el cuerpo adyacente. Suelen asociarse a deformidades vertebrales, como la enfermedad de Scheuermann, o a enfermedades reumáticas, como la espondilitis anquilopoyética. En general, son hallazgos casuales y cuadros asintomáticos; son pocos los casos publicados de nódulos sintomáticos. Su aparición estaría relacionada con un platillo vertebral debilitado por traumatismo o estrés repetido. Cuando el nódulo es agudo o reciente, puede ser difícil diferenciar la degeneración benigna de una infiltración maligna o una infección. Presentamos un caso inusual de un nódulo de Schmörl doloroso en un hombre sin antecedentes de relevancia, que enmascaró una lesión metastásica de carcinoma pancreático a nivel lumbar. Se realiza una revisión bibliográfica. Nivel de Evidencia: IV

Intraosseous disc herniation -or Schmörl nodes (SN)- are a herniation or prolapse of the nucleus pulposus of the intervertebral disc through the vertebral plate and into the adjacent vertebral body. They are usually associated with vertebral deformities, such as Scheuermann's disease, or rheumatic diseases, such as ankylopoietic spondylitis. In general, they are spontaneous and asymptomatic findings, and there are only a few reported cases of symptomatic nodes. The etiology is supposedly related to a weakened spinal plate due to trauma or repeated stress. When the node is acute or recent, it can be difficult to differentiate a benign degeneration from a malignant infiltration or infection. In this paper, we discuss the unusual case of a painful Schmörl node in a man with no relevant history and a masked metastatic lumbar spinal tumor originated from pancreatic cancer. We performed a literature review. Level of Evidence: IV

A eficácia dos diferentes tratamentos endoscópicos versus métodos sham, farmacológicos ou cirúrgicos para o refluxo gastroesofágico crônico: uma revisão sistemática e meta-análise / The efficacy of the different endoscopic treatments versus sham, pharmacologic or surgical methods for chronic gastroesophageal reflux disease: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Endoscopic antireflux treatments for gastroesophageal reflux disease (GERD) are still evolving, and most of the published studies address symptom relief in the short-term. Objective - We aimed to perform a systematic review and meta-analysis focused on evaluating the efficacy of the different endoscopic procedures. METHODS: Search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane, SciELO, and EMBASE for patients with chronic GERD (>6 months), over 18 years old and available follow up of at least 3 months. The main outcome was to evaluate the efficacy of the different endoscopic treatments compared to sham, pharmacological or surgical treatment. Efficacy was measured by different subjective and objective outcomes. RESULTS: We analyzed data from 16 RCT, totaling 1085 patients. The efficacy of endoscopic treatments compared to sham and proton pump inhibitors (PPIs) treatment showed a significant difference up to 6 months in favor of endoscopy with no heterogeneity (P<0.00001) (I2: 0%). The subgroup analysis showed a statistically significant difference up to 6 months in favor of endoscopy: endoscopy vs PPI (P<0.00001) (I2: 39%). Endoscopy vs sham (P<0.00001) (I2: 0%). Most subjective and objective outcomes were statistically significant in favor of endoscopy up to 6 and 12 months follow up. CONCLUSION: This systematic review and meta-analysis shows a good short-term efficacy in favor of endoscopic procedures when comparing them to a sham and pharmacological or surgical treatment. Data on long-term follow up is lacking and this should be explored in future studies.

RESUMO CONTEXTO: Os tratamentos endoscópicos para a doença do refluxo gastroesofágico (DRGE) ainda estão em evolução e a maioria dos estudos publicados abordam o alívio dos sintomas em curto prazo. OBJETIVO: Pretendemos realizar uma revisão sistemática e meta-análise focada na avaliação da eficácia dos diferentes procedimentos endoscópicos. MÉTODOS: A pesquisa foi restrita a ensaios clínicos randomizados em MedLine, Cochrane, SciELO e EMBASE para pacientes com DRGE crônica (>6 meses), com mais de 18 anos e acompanhamento disponível por pelo menos 3 meses. O principal desfecho foi avaliar a eficácia dos diferentes tratamentos endoscópicos em comparação com o tratamento sham, farmacológico ou cirúrgico. A eficácia foi medida por diferentes resultados subjetivos e objetivos. RESULTADOS: Analisamos dados de 16 ensaios clínicos randomizados, totalizando 1085 pacientes. A eficácia dos tratamentos endoscópicos em comparação com o tratamento com sham e inibidores da bomba de prótons mostrou uma diferença significativa até 6 meses a favor da endoscopia sem heterogeneidade (P<0,00001) (I2: 0%). A análise do subgrupo mostrou diferença estatisticamente significativa até 6 meses a favor da endoscopia: endoscopia vs inibidores da bomba de prótons (P<0,00001) (I2: 39%). Endoscopia vs sham (P<0,00001) (I2: 0%). A maioria dos resultados subjetivos e objetivos foram estatisticamente significativos em favor da endoscopia até 6 e 12 meses de acompanhamento. CONCLUSÃO: Esta revisão sistemática e meta-análise mostrou uma boa eficácia a curto prazo em favor dos procedimentos endoscópicos ao compará-los a tratamento sham, farmacológico ou cirúrgico. Não existem dados sobre o acompanhamento a longo prazo e isso deve ser explorado em estudos futuros.

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.

Effect of disparity on the perception of motion-defined contours

We present three experiments that explored the effect of binocular disparity on the perception of contours defined by motion in a Spatiotemporal Boundary Formation. Depending on the disparity, the stimulus is perceived as an object that moves behind a holed surface (occluded configuration) or as a luminous transparency that moves over a surface that contains dots (occluding configuration). In all of the experiments, we used a Vernier task to assess the strength of contour perception. In the first experiment, we measured acuity as a function of disparity for a range of speeds and dot densities. The results showed that, despite the difference in the percepts, acuity was similar in both situations, replicating the dependence on speed and dot density demonstrated in previous studies. In the second experiment, the results showed that the dynamics of contour integration were identical for both occluded and occluding configurations. In the third experiment, we tested whether the mechanism of contour integration works independently from the interpretation of the scene. In this experiment, we inverted the disparity during stimulus presentation so that the stimulus switched between occluded and occluding configurations. The results showed that the switch of the depth order increased the threshold to the value obtained with a shorter presentation time. This might be produced by a resetting of the integration process driven by the change of depth order. The results are discussed within a conceptual model that places the process of contour integration in the context of the perception of objects in a Spatiotemporal Boundary Formation...

Constancia de velocidad en imágenes naturales / Velocity constancy in natural images / Constance de vitesse dans les images naturelles / Constância de velocidade em imagens naturais

La investigación sobre el sistema visual condujo a la emergencia de modelos basados en los componentes neurales de dicho sistema, que permiten describir el modo en que es extraída la información de velocidad contenida en una escena con movimiento. El hecho de que estos modelos sean sensibles al tamaño de los estímulos presentados en la retina en combinación con el cambio de tamaño debido a la distancia a la cual se presentan los objetos, llevó a la pregunta acerca de cómo es posible la percepción de una velocidad constante, independientemente de la distancia a la cual se desplazan los objetos. En este trabajo revisamos las investigaciones realizadas sobre la constancia de la velocidad percibida e indagamos acerca de la importancia de la familiaridad de los objetos en movimiento. Por medio de experimentos psicofísicos con imágenes naturales, mostramos que la familiaridad juega un rol importante al momento de asignar perceptualmente la velocidad de un objeto en movimiento.

The investigation of the visual system produced models based on the neural components of such system, capable of describing the way in which the velocity information contained in a scene with movement is extracted. The fact that these models are sensitive to the size of the stimuli in combination with the distance to which the objects are presented on the retina, led to the question about how it could be possible the perception of a velocity independent from the object distance. In this work, we revised the investigations about velocity constancy and explore the effect of familiarity on the perception of speed. We performed a series of psychophysical experiments by using natural images and show that familiarity plays an important role in the assignment of a perceived speed to moving objects.

Recherche sur le système visuel l'a conduit à l'émergence de modèles basés sur les composants du système nerveux. Ces modèles peuvent décrire la façon dont il est extrait des informations de vitesse contenue dans une scène émouvante. Le fait que ces modèles sont sensibles à la taille des stimuli présentés dans la rétine, avec le changement de taille en raison de la distance à laquelle les objets sont présentés, ont conduit à la question de comment la perception d'une vitesse constante quelle que soit la distance à laquelle les objets se déplacent. Ici nous passons en revue la recherche sur le constance de vitesse perçue et en savoir davantage sur l'importance de la familiarité des objets en mouvement. Grâce à des expériences psychophysiques avec des images naturelles montrent que la familiarité joue un rôle important dans la détermination de la vitesse de perception d'un objet en mouvement.

A pesquisa sobre o sistema visual tem levado à emergência de modelos baseados nos componentes neurais de dito sistema, que permitem descrever o modo como é extraída a informação de velocidade contida numa cena com movimento. O fato de que estes modelos sejam sensíveis ao tamanho dos estímulos apresentados na retina, em combinação com a mudança de tamanho devida à distância à qual são apresentados os objetos, levou à pergunta de como é possível a percepção de uma velocidade constante, independentemente da distância pela qual se movimentam os objetos. Neste trabalho, revisamos as investigações realizadas sobre a constância da velocidade percebida e indagamos acerca da importância da familiaridade dos objetos em movimento. Mediante experimentos psicofísicos com imagens naturais, mostramos que a familiaridade tem um papel importante na hora de atribuir perceptualmente a velocidade de um objeto em movimento.

Lesiones por buceo / Injuries by diving

Principales patologías de la medicina del buceo, su diagnóstico y tratamiento.

Prótesis dentaria enclavada en el esófago: resolución quirúrgica / Dental prosthesis in the esophagus: surgical resolution

Descripción de tres casos atendidos en el Hospital General de Agudos Enrique Tornú, en la Ciudad de Buenos Aires. Se presentaron dos perforaciones y un desgarro, resueltos por medio de cirugía de urgencia

Omega-3 fatty acids in mood disorders: an overview

This review addresses the potential role of omega-3 fatty acids in mood disorders, from the biochemical rationale for their use to the growing body of data supporting their clinical efficacy

Cirugía de emergencia en consumidores de cocaina / Emergency surgery in cocaine consumers

Se realizó un estudio prospectivo en el HMPC, con 48 hombres y 3 mujeres, con una edad promedio de 23,8 años, que requirieron cirugía de emergencia por trauma. Se registró el consumo de psicotrópicos por encuesta, exámen físico, parámetros hemodinámicos y hallazgos operatorios. Se realizó determinación urinaria de metabolitos de cocaína, clasificando a los pacientes según el resultado y según la escala de trauma, ASCOT. Las agresiones más frecuentes fueron: heridas por arma de fuego (90,19 por ciento y arma blanca 7,8 por ciento). Veintitres pacientes (45,09 por ciento) todos hombres, fueron positivos para metabolitos urinarios de cocaína. Se verificó una disminución de la frecuencia cardíaca transoperatoria, estadísticamente significativa, en relación con la concentración de metabolitos de la droga en orina. La tensión arterial sólo fué modificada según la hemorragía. La mortalidad y ASCOT de consumidores, no demostraron diferencia significativa