Seguimiento Funcional hasta Seis Meses después de Sobrevivir a Cuidados Intensivos: Lecciones aprendidas de un Estudio Chileno Multicéntrico / Functional follow-up six months after surviving intensive care: lessons learned from a Chilean multicenter study

Introducción. Las tasas de retención en los estudios de seguimiento oscilan entre el 32 y 100%, demostrando el desafío que implica realizar estudios longitudinales de sobrevivientes de la unidad de cuidados intensivos (UCI). Objetivo. Identificar las estrategias implementadas y lecciones aprendidas en un estudio prospectivo multicéntrico de seguimiento de sobrevivientes de la UCI durante la pandemia. Métodos. Estudio post-hoc de las lecciones aprendidas mediante encuestas y entrevistas dirigidas a explorar la experiencia de los investigadores y coordinadores del estudio IMPACCT COVID-19, realizado en siete centros chilenos entre octubre 2020 y abril 2021 evaluando el síndrome post-cuidados intensivos de sobrevivientes hasta seis meses después. Resultados. Identificamos ocho lecciones: 1) selección de instrumentos de medición, 2) identificación de centros participantes, 3) aprobación del estudio, 4) financiamiento, 5) capacitación de evaluadores, 6) coordinación/aseguramiento de calidad, 7) reclutamiento y 8) seguimiento de pacientes. Incluso durante el primer año de pandemia, reclutamos 252 pacientes a una tasa de 1,4 pacientes/día con una retención del 48% a los 6 meses de seguimiento. El uso de redes académicas existentes y las estrategias de comunicación entre investigadores, coordinadores y evaluadores fueron aspectos positivos; mientras que la fidelización con evaluadores al egreso de la UCI y con pacientes durante el seguimiento son aspectos que deberían considerarse en futuros estudios. Conclusiones. Se evaluaron más de 250 pacientes en seis meses durante la pandemia, con tasas de retención post UCI acorde a la literatura. Futuros estudios debiesen optimizar los procesos de medición y de seguimiento para minimizar la pérdida de pacientes.

Background. Retention rates of follow-up studies range from 32 to 100%, demonstrating the challenge to conduct longitudinal studies of intensive care unit (ICU) survivors. Objective. To identify the strategies implemented and lessons learned in a multicenter prospective follow-up study of ICU survivors during pandemic times. Methods. Post-hoc study of lessons learned through surveys and interviews aimed at exploring the experience of the researchers and coordinators of the IMPACCT COVID-19 study. The original study was performed in seven Chilean sites between October 2020 and April 2021 evaluating the post-intensive care syndrome of survivors up to six-month follow-up. Results. We identified eight lessons: 1) selection of measurement instruments, 2) identification of participating sites, 3) Study approval, 4) funding, 5) evaluators training, 6) coordination/quality assurance, 7) recruitment, and 8) patient follow-up. Even during the first year of the pandemic, we recruited 252 patients at a rate of 1.4 patients/day with a retention rate of 48% at 6 months of follow-up. The use of existing academic networks and communication strategies between researchers, coordinators and evaluators were positive aspects; while evaluators fidelity at ICU discharge and patient engagement during follow-up are aspects should be considered. Conclusions. More than 250 patients were evaluated in six months during the pandemic, with post-ICU retention rates consistent with the literature. Future studies should optimize measurement and monitoring processes to minimize patient atrition.

Self-Report of the perception of stress and signs of bruxism generated during the pandemic in student of the health area / Autoinforme de la percepción de estrés y signos de bruxismo derivados de la pandemia en estudiantes del área de la salud

Abstract Bruxism is the repetitive muscle-mandibular behavior characterized by clenching and/or grinding of the teeth, which reflects the presence of one or more underlying conditions or factors. The objective of this descriptive study was to determine the association between bruxism and stress self-perceived during the pandemic, as well as their frequency by gender and academic area. An interrogation and self-perceived stress scale PSS-14 were applied to students from the different areas of the Institute of Health Sciences (ICSa) to determine the presence or absence of stress and bruxism symptom, a Chi-square was used for the comparison between variables, considering a value of p0.005. ICSa students between 18 and 24 age perceive symptoms of bruxism and high levels of stress caused during the pandemic.

Resumen El bruxismo es el comportamiento músculo-mandibular repetitivo caracterizado por apretamiento y/o rechinamiento de los dientes, que refleja la presencia de una o varias condiciones o factores subyacentes. Se realizó un estudio descriptivo con el objetivo de determinar la asociación del nivel de estrés y síntomas de bruxismo autopercibidos durante la pandemia, así como su frecuencia por género y área académica. Se aplicó un interrogatorio y escala de estrés percibido PSS-14 a los estudiantes de las distintas áreas del Instituto de Ciencias de la Salud (ICSa) para determinar la presencia o ausencia de estrés y síntomas de bruxismo, se utilizó una Chi-cuadrada para la comparación entre variables, considerando significativo un valor de p0.0001. Los estudiantes de 18 a 24 años de edad del ICSa perciben síntomas de bruxismo y altos niveles de estrés originados durante la pandemia.

Estrategias didácticas, en el marco de la innovación de la malla curricular 2015, de la Facultad de Ciencias Médicas - UNA de la carrera de medicina. Una visión desde la percepción de los docentes y estudiantes / Didactic strategies, within the framework of the innovation of the curricular mesh 2015, of the Faculty of Medical Sciences of the career of medicine. A vision from the perception of teachers and students

Las estrategias didácticas cumplen un papel relevante en la innovación de la malla curricular, esta investigación tiene por finalidad comprender el proceso de cambio instaurado en la facultad desde la percepción de los actores principales, desde varias aristas relacionadas como la infraestructura, materiales de apoyo e información sobre la malla innovada. Nuestro objetivo fue analizar e interpretar la percepción que tienen los docentes y estudiantes del ciclo básico de la carrera de medicina de Asunción, en relación a la innovación curricular y permitirnos reflexionar y contribuir a este proceso dinámico que está llegando al ciclo clínico, a través de una investigación cualitativa con enfoque hermenéutico

Didactic strategies play a relevant role in the innovation of the curricular mesh, this research aims to understand the process of change established in the faculty from the perception of the main actors, from several related aspects such as infrastructure, support materials and information on the innovated curriculum. Our objective was to analyze and interpret the perception that teachers and students of the basic cycle of the medical career have, in relation to curricular innovation and allow us to reflect and contribute to this dynamic process that is reaching the clinical cycle, through a qualitative research with a hermeneutical approach

Multilevel analysis of birthplace effect on the proportion of C-Section in Colombia" / Análisis multinivel del efecto del lugar de nacimiento en la proporción de partos por cesárea en Colombia

Abstract Objectives: To determine the general contextual effect of the department in the variation of Cesarean section in Colombia in 2016, and their individual and contextual related factors. Methods: Cross-sectional study based on a birth cohort. We used the birth certificate database from January 1 to December 31, 2016. Three multilevel logistic models were constructed. Pregnant women were set at the first level and department at the second level. We fitted a null multilevel model followed by two multiple models, including individual and individual and department variables, respectively. Results: The overall prevalence of C-section was 45.5% (95% CI: 45.4-45.6), ranged from 5 to 76%. The variance partition coefficient was 15%. Individual factors did not explain the general contextual effect. However, the region to which these departments belong explained 71% of the variance. The Caribbean region was positively associated with C-section compared to the Andean region (OR:3.88, 95% CI: 2.65-5.67). Conclusions: Multilevel analysis of individual heterogeneity and discriminatory accuracy showed that the department plays an important role in the variation of C-sections in Colombia. Our results suggest that the proportional universalism approach should be applied to reduce the proportion of C-Section, focusing on departments with the highest risk and on the Caribbean and Insular region.

Resumen Objetivos: Determinar el efecto contextual de los límites político administrativo de los departamentos, en la posibilidad individual de cesárea en el año 2016 y, las características individuales y contextuales asociadas a la misma. Métodos: Estudio transversal de una cohorte de nacimientos. Se realizó un análisis multinivel utilizando como fuente la base de datos de los certificados de nacimientos de Colombia desde el 1 de enero al 31 de diciembre de 2016. Se elaboraron tres modelos logísticos multinivel, con las gestantes en el primer nivel y el departamento como segundo nivel. El primer modelo incluyó solo el departamento como efecto aleatorio, seguido de otro con variables individuales y el último incluyó también las variables de contexto. Resultados: La proporción de cesáreas fue de 45.5% (IC 95%: 45.4-45.6), con un rango de 5% al 76%. El coeficiente de partición de varianza fue de 15%, indicando la existencia de una considerable desigualdad geográfica en la posibilidad del parto por cesárea. La región a la que pertenecen los departamentos explicó 71 % de la varianza entre departamentos. En particular, la región Caribe se asoció de manera positiva con la posibilidad de cesáreas comparado con la región Andina (OR:3.88, IC 95%: 2.65-5.67). Conclusiones: El análisis multinivel de la heterogeneidad individual mostró que el departamento juega un papel importante en la posibilidad de partos por cesáreas. Nuestros resultados sugieren que intervenciones con enfoque de universalismo proporcional son necesarias para reducir el parto por cesárea con énfasis en los departamentos de mayor riesgo y en la región Caribe e Insular

Homozygous Fukutin Missense Mutation in Two Mexican Siblings with Dilated Cardiomyopathy

ABSTRACT Background: Fukuyama congenital muscular dystrophy (FCMD) is the most common form of a group of autosomal recessive disorders characterized by altered α-dystroglycan glycosylation and caused by FKTN gene mutations. However, mutations of this gene may cause a broad range of phenotypes, including Walker-Warburg syndrome, muscle-brain-eye disease, FCMD, limb-girdle muscular dystrophy without mental retardation, and cardiomyopathy with no or minimal skeletal muscle weakness. Objective: Our purpose was to describe two siblings who died at a young age with dilated cardiomyopathy (DCM), no muscle weakness, or atrophy, and were homozygous for a FKTN missense mutation. Methods: Site-directed next-generation sequencing (NGS) was performed. Pathogenicity of variants of interest was established according to the American College of Medical Genetics (ACMG) criteria, and all available first-degree relatives were screened for mutations by Sanger sequencing. Results: NGS revealed a homozygous FKTN variant in the index case (p.Gly424Ser, rs752358445), classified as likely pathogenic by ACMG criteria. Both parents and an unaffected brother were heterozygous carriers. Since the siblings had no apparent skeletal muscle weakness or central nervous system involvement, FKTN mutations were not initially suspected. Conclusions: This is the first report demonstrating that heterozygous individuals for the FKTN p.Gly424Ser mutation were healthy, while two homozygous brothers suffered severe DCM, strongly suggesting that this FKTN mutation is a rare cause of autosomal recessive DCM.

Propuesta para manejo de la coagulopatía asociada a la COVID-19 en adultos / A proposal for the management of COVID-19-induced coagulopathy in adults

Resumen La infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es la causante de la pandemia de enfermedad por coronavirus 2019 (COVID-19), con un índice de letalidad alto. La mayoría de los pacientes graves desarrollan un tipo especial de coagulopatía no descrito hasta ahora y la cual se considera ahora la principal causa de muerte. Por esta razón, el tratamiento anticoagulante se ha convertido en una de las piedras angulares del tratamiento de esta infección. Sin embargo, la velocidad con la que se genera la evidencia respecto al uso de anticoagulantes es muy rápida y, en ocasiones difícil de interpretar y contradictoria. Luego de hacer una revisión extensa de la literatura publicada, se hace esta propuesta para el uso del tratamiento anticoagulante tomando en cuenta los recursos disponibles en México.

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the cause of the coronavirus disease 2019 (COVID-19) pandemic, which has a high case fatality rate. Most severely ill patients develop a special type of coagulopathy that had not been described before and that is now considered the main cause of death. For this reason, anticoagulant treatment has become one of the cornerstones of the treatment of this infection. However, the rate at which the evidence regarding the use of anticoagulants is generated is quite fast, and sometimes it is difficult to interpret and conflicting. After having performed an extensive review of the published literature, this proposal for the use of anticoagulant treatment is made, taking into account available resources in Mexico.

Air quality assessment in Southeast Brazil during COVID-19 pandemic and lockdown: report of increased air pollution / Avaliação da qualidade do ar no Sudeste do Brasil durante a pandemia da COVID-19 e do confinamento: relato de aumento da poluição atmosférica / Evaluación de la calidad del aire en el sudeste de Brasil durante la pandemia de COVID-19 y confinamiento: informe de una mayor contaminación del aire

On March 24, 2020, a partial lockdown was decreed in the state of São Paulo, Brazil, as a measure to hinder the spread of COVID-19, which consisted in prohibiting crowding and advising people to stay home, except for urgent or extremely necessary matters. Based on studies performed in other countries, this study aims to assess the impacts of the lockdown on the air quality of five cities in the state of São Paulo. Our study was conducted by using particulate matter and nitrogen dioxide as air quality indicators, and by correlating the contaminants concentrations with weather data. The results showed an increase in these contaminants in all cities within the first weeks after the lockdown compared with the weeks before the decree and with the same period in previous years. This result is inconsistent with the literature. Therefore, a secondary goal was set to investigate the possible cause (or causes) of such deterioration in air quality, which led to the increased number of wildfires. The anomalous dry weather favored the burning of vegetation in agricultural rural areas and in small, vegetated areas near the municipalities, and limited pollution scavenging by rainfall, both of which contributed to higher pollution concentration. We hypothesize the possible effects of worse air quality on the aggravation of COVID-19, but further research is necessary to obtain a complete assessment.

Em 24 de março de 2020, foi decretado confinamento parcial no Estado de São Paulo, Brasil, como medida para desacelerar a disseminação da COVID-19. O decreto consistia na proibição de aglomerações e na recomendação para as pessoas permanecerem em casa, exceto em situações urgentes ou de extrema necessidade. Na esteira de estudos realizados em outros países, o artigo busca avaliar os impactos do confinamento na qualidade do ar em cinco cidades no Estado de São Paulo. Nosso estudo foi realizado com o material particulado e dióxido de nitrogênio enquanto indicadores da qualidade do ar e pela correlação das concentrações dos contaminantes com dados meteorológicos. Os resultados mostraram um aumento desses contaminantes em todas as cinco cidades dentro das primeiras semanas depois do confinamento, comparado às semanas que antecederam o decreto e com o mesmo período em anos anteriores. O resultado é inconsistente com os achados usualmente relatados em outros estudos. Portanto, foi definido um objetivo secundário a fim de investigar a possível causa (ou causas) da piora na qualidade do ar, o que revelou um aumento no número de incêndios. O tempo anormalmente seco favoreceu a queima de vegetação nas áreas agrícolas rurais e em pequenas áreas de vegetação próximas às cidades, além do limitado escoamento da poluição pela chuva, o que contribuiu à maior concentração de poluentes. Os achados sugerem hipóteses sobre os possíveis efeitos dessa situação de pior qualidade do ar sobre o agravamento de casos de COVID-19, porém são necessários mais estudos para uma avaliação completa.

El 24 de marzo de 2020 se decretó un confinamiento parcial en el estado de São Paulo, Brasil, como medida para evitar la propagación de la COVID-19, que consistió en prohibir aglomeraciones de personas y avisar a la gente que permaneciera en casa, salvo para asuntos urgentes o extremadamente necesarios. Siguiendo algunos estudios realizados en otros países, el objetivo de este trabajo es evaluar los impactos del confinamiento en la calidad del aire de ciudades en el estado de São Paulo. Nuestro estudio fue realizado usando material particulado y dióxido de nitrógeno, como indicadores de la calidad del aire, y mediante la correlación de las concentraciones de contaminantes con los datos meteorológicos. Los resultados mostraron un incremento en estos contaminantes en todas las ciudades dentro de las primeras semanas tras el confinamiento, comparando las semanas antes del decreto y dentro del mismo periodo en los años previos. Este resultado es inconsistente con aquellos que han sido informados en otros estudios. Por ello, un objetivo secundario fue investigar la posible causa (o causas) de tal deterioro en la calidad del aire, que conduce a un incremento en el número de incendios. La climatología seca anómala favoreció la quema de vegetación en las áreas rurales agrícolas, y en áreas con poca vegetación cerca de las ciudades, y la eliminación limitada de la contaminación gracias a la lluvia, ambos contribuyeron a una mayor concentración de contaminación. Se especula que los posibles efectos de esta situación de una peor calidad del aire podrían afectar en el agravamiento de los casos de COVID-19, pero son quizás necesarias más investigaciones para conseguir una evaluación completa.

Proposal for the management of COVID-19-associated coagulopathy in children / Propuesta para el manejo de la coagulopatía asociada a COVID-19 en niños

Abstract SARS-CoV-2 infection (COVID-19) has become a pandemic with a high case fatality rate that mainly affects adults. Most severely ill adult patients develop a coagulopathy that was not described until recently, and which is currently considered a main cause of death. Everything indicates that a similar phenomenon also occurs in children with COVID-19. Anticoagulant treatment has become one of the therapeutic foundations for this infection; however, its implementation in children can be difficult since, until recently, it was not considered in the pediatric population. Evidence regarding the use of anticoagulants in COVID-19 is rapidly generated, changes constantly, it is often difficult to interpret, and can be contradictory. After an extensive review of the published literature, a proposal was generated that offers suggestions for anticoagulant treatment, considering available resources in Mexico.

Resumen La infección por SARS-CoV-2 (COVID-19) se ha constituido en una pandemia con alto índice de letalidad que afecta principalmente a los adultos. La mayor parte de los pacientes adultos graves desarrolla una coagulopatía que no estaba descrita, la cual actualmente se considera la principal causa de muerte. Todo indica que un fenómeno parecido ocurre también en el niño con COVID-19. El tratamiento anticoagulante se ha convertido en uno de los fundamentos terapéuticos de esta infección; sin embargo, su establecimiento en el niño puede ser difícil ya que, hasta hace poco, no estaba considerado en la población pediátrica. La evidencia respecto al uso de anticoagulantes en COVID-19 se genera con rapidez, cambia constantemente, con frecuencia es difícil de interpretar y puede ser contradictoria. Después de una extensa revisión de la literatura publicada, se generó una propuesta que ofrece sugerencias para el tratamiento anticoagulante en la que se consideran los recursos disponibles en México.

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more "precision-oriented" practice.

Frequência de sofrimento emocional é elevada em pessoas com diabetes assistidas na atenção primária / Frequency of emotional distress is high in people with primary care-assisted diabetes / La frecuencia de sufrimiento emocional es elevada en personas con diabetes que reciben asistencia en la atención primaria

Introdução: Pessoas com diabetes podem sofrer com o estresse da doença e apresentar sentimentos como culpa, raiva, medo e depressão, que caracterizam o Sofrimento Emocional Específico da Diabetes. Objetivo: estimar a frequência desse sofrimento e seus fatores associados em pessoas assistidas na atenção primária em Blumenau, Santa Catarina. Métodos: Trata-se de estudo transversal. Pessoas com diabetes assistidas por 4 equipes de saúde da família (n=196) responderam ao questionário "Problems Areas in Diabetes", que apresenta 20 questões em 4 subdimensões, além de questões sobre suas características sociodemográficas (sexo, idade, escolaridade) e clínicas (tempo de doença, uso de insulina e medicação antidepressiva). Estimou-se os escores de sofrimento geral e subdimensões com base na soma das respostas em escala de 0 (melhor) a 100 (pior). Mediu-se a frequência do sofrimento emocional grave (escore >40) e sua associação com as variáveis de estudo por regressão logística não condicional. Resultados: Participaram 196 pessoas, 58,2% eram mulheres, 26,2% faziam uso de insulina e 20,6% de antidepressivos. A idade média foi de 61,6 anos, o tempo médio de tratamento de diabetes foi 9,5 anos. O escore médio de sofrimento emocional foi de 33,6 (dp=27,6) e mediana de 23,8. 36,2% dos participantes apresentaram sofrimento emocional grave. O sofrimento emocional grave se mostrou principalmente entre pessoas com 19 a 64 anos (OR=2,1, IC95%1,1 - 4,1), com tempo de doença de 2 a 5 anos (OR=6,4; IC95% 1,1 - 36,1) e 5 anos e mais (OR=5,4; IC95% 1,1 - 28,8) e em uso de medicação antidepressiva (OR=2,8 IC95% 1,3 - 6,0). Conclusão: Mais de um terço das pessoas com diabetes tem sofrimento emocional grave, marcadamente os adultos com mais tempo de doença e com tratamento para depressão. Sugere-se que essas pessoas tenham seu cuidado priorizado pelas equipes de saúde na atenção primária.

Introduction: Diabetic persons can suffer from stress of the disease and present feelings such as guilt, anger, fear and depression, featuring the diabetes specific-emotional distress. Objective: to measure the frequency of this distress and its associated factors in people assisted in the primary health care of Blumenau, Santa Catarina. Methods: This is a cross-sectional study. People with diabetes assisted by 4 family health teams (n = 196) answered the "Problems Areas in Diabetes" questionnaire, which presents 20 questions in 4 sub-dimensions, as well as questions about their sociodemographic (gender, age, education) and clinical characteristics (insulin and antidepressant medication use). Overall distress scores and sub-dimensions were estimated based on the sum of responses on a scale from 0 (best) to 100 (worst). The frequency of severe emotional distress was measured (score> 40) and its association with study variables were estimated by unconditional logistic regression. Results: 196 people participated, 58.2% were women, 26.2% were on insulin and 20.6% on antidepressants. The mean age was 61.6 years and the mean duration of diabetes treatment was 9.5 years. The average score of emotional distress was 33.6 (dp=27,6) and median of 23,8. 36,2% of participants had severe emotional distress. Severe emotional distress was mainly seen among people aged 19-64 years (OR = 2.1, 95% CI 1.1 - 4.1), with disease duration from 2 to 5 years (OR = 6.4, 95% CI , 1 - 36.1) and 5 years andmore (OR = 5.4, 95% CI 1.1 - 28.8) and on antidepressant medication (OR = 2.8 95% CI 1.3 - 6.0 ). Conclusion: More than a third of people with diabetes have severe emotional distress, notably adults with longer ilness and treatment for depression. It is suggested that these people must have their care prioritized by health teams in primary care.

Introducción: Introducción: Las personas con diabetes pueden sufrir con el estrés de la enfermedad y presentar sentimientos como culpa, rabia, miedo y depresión, que caracterizan el Sufrimiento Emocional Específico de la Diabetes. Objetivo: estimar la frecuencia de ese sufrimiento y factores asociados em personas asistidas en la atención primaria en Blumenau, Santa Catarina. Métodos: este es un estudio transversal. Las personas con diabetes asistidas por 4 equipos de salud de la familia (n = 196) respondieron el cuestionario "Áreas problemáticas en diabetes", que presenta 20 preguntas en 4 subdimensiones, así como preguntas sobre sus características sociodemográficas (género, edad, educación) y características clínicas (tempo de enfermedad, uso de insulina y medicación ntidepresiva). Los puntajes de angustia y subdimensiones generales se estimaron en función de la suma de las respuestas en una escala de 0 (mejor) a 100 (peor). Se ha medido la frecuencia de angustia emocional severa (puntaje >40) y su asociación con variables de estudio por regresión logística incondicional. Resultados: Han participado 196 personas, 58,2% eran mujeres, 26,2% hacían uso de insulina y 20,6% de antidepresivos. La edad media fue de 61,6 años, el tiempo promedio de tratamiento de la diabetes fue de 9,5 años. El puntaje promedio de sufrimiento emocional fue de 33,6 (dp = 27,6) y mediana de 23,8. El 36,2% de los participantes presentaron un sufrimiento emocional grave. El sufrimiento emocional grave se mostró principalmente entre personas de 19 a 64 años (OR = 2,1, IC95% 1,1 - 4,1), con tempo de enfermedad de 2 a 5 años (OR = 6,4, IC95% 1,1 - 36,1) y 5 años y más (OR = 5,4, IC95% 1,1 - 28,8) y en uso de medicación antidepressiva (OR = 2,8 IC95% 1,3 - 6, 0). Conclusión: Más de un tercio de las personas con diabetes tienen sufrimiento emocional severa, especialmente adultos con enfermedades más prolongadas y tratamiento para la depresión. Se sugiere que estas personas tengan su atención priorizada por los equipos de salud en la atención primaria.

Avaliação da eficácia e da toxicidade da solução de hipoclorito de sódio a 1% na indução de pleurodese em coelhos albinos / Evaluation of efficacy and toxicity of 1% sodium hypochlorite solution in the induction of pleurodesis in albino rabbits

Objetivo: verificar a eficácia e analisar possíveis alterações toxicológicas da indução de pleurodese com hipoclorito de sódio a 1% em modelos animais. Métodos: ensaio pré-clínico, randomizado com coelhos albinos (G1 e G2). Em G1 realizou-se pleurodese através da instilação 10ml de solução de hipoclorito de sódio a 1%. Em G2, 10ml de solução fisiológica a 0,9%. Traçaram-se perfis bioquímicos, de ambos os grupos, prés e pós-operatórios, para identificar alterações toxicológicas, comparados através do Teste Wilcoxon. Os animais foram eutanasiados, aleatoriamente, após 1, 7 ou 30 dias para autópsia, determinando a eficácia da pleurodese conforme a presença ou não de aderências na cavidade torácica. Os grupos foram comparados através do teste qui-quadrado (p<0,05). O projeto de pesquisa foi aprovado pelo comitê de ética em pesquisa em animais da Universidade Regional de Blumenau sob o protocolo 022/04. Resultados: foram incluídos 44 coelhos, 21 pertencentes ao G1 e 23 ao G2. 90,48% dos animais de G1 apresentaram aderências pleurais e apenas 10% de G2 (p <0,001). Quanto à análise da toxicidade, verificaram-se alterações significativas referentes às enzimas preditoras das funções cardíaca e hepática em ambos os grupos. Conclusões: a pleurodese com hipoclorito de sódio mostrou-se eficaz. As alterações bioquímicas em ambos os grupos devem-se, provavelmente, a um fator intrínseco do procedimento e não às substâncias. Não foram evidenciados prejuízos significativos decorrentes da solução proposta.

Aims: to verify the efficacy and possible toxicological alterations of the 1% sodium hypochlorite solution in the induction of pleurodesis in albino rabbits. Methods: randomized preclinical trial (G1 and G2) with rabbits. In the G1 the pleurodesis was done by the instilation of 10ml of a 1% sodium hypochlorite solution (SHS), and in the G2 by the instilation of 10ml of physiological solution (0,9%). Preoperatory and postopetary biochemical profiles were done in both groups in order to identify toxicological alterations. These profiles were compared by the Wilxcoxon Test. The animals were randomly euthanized after one, seven or thirty days for an autopsy. The efficiency of the pleurodesis was measured according to the presence or not of macroscopic adhesions in the thoracic cavity. Findings in both groups were compared by the chi-square test (p<0,05). The research project was approved by the ethical committee envolving animals research of the Regional University of Blumenau under the protocol 022/04. Results: 44 rabbits were included. 21 from G1 and 23 from G2. 90,48% of the G1 animals showed pleural adhesions while 10% of the G1 did. Concerning the toxicologycal analysis, signifficant alterations were found in the cardiac and hepatic enzymes in both groups. Conclusion: pleurodesis induced by the SHS was shown to be effective. G1 and G2 exhibited toxicologycal alterations probably due to an intrinsic factor of the procedure and not caused by the different solutions used. The animals responded well to the proposed agent, no systemic effects were evidenced.

Laceração traqueal por alçaponamento de ar - relato de caso / Tracheal laceration by air trap ­ case report

Lesões traqueais intraoperatórias são raras e graves. Estão comumente associadas a intubação orotraqueal (IOT). Clinicamente apresentam-se insidiosamente e estão associadas a taxa de mortalidade elevada. O diagnóstico é difícil e requer um alto índice de suspeição. O objetivo deste trabalho é relatar e discutir o manejo anestésico e cirúrgico de uma paciente que apresentou uma laceração traqueal durante IOT.

Intraoperative tracheal lesions are rare, severe and commonly associated with orotracheal intubation (OTI). The presentation is insidious and are associated with high mortality rate. The diagnosis is hard and demands a high level of suspicion. The aim of this study is to report and discuss the anesthetic and surgical management of a patient who presented a tracheal laceration during OTI.

Autoimmune Disorders and Multiple Myeloma- Two Illustrative Case Reports and a Literature Review / Trastornos autoinmunes y Mieloma Múltiple- Dos Reportes de Casos Ilustrativos y una Revisión de la Literatura

Abstract Several autoimmune disorders have been associated with a variety of hematopoietic malignancies, particularly lympho-proliferative disorders. Multiple myeloma (MM) is one of the most common hematologic malignancies and has been described in the context of a variety of autoimmune conditions. Due to their diversity and rarity, the clinical features of autoimmune conditions associated with MM have not been elucidated and the pathogenesis remains unclear. In this report, we describe two cases of autoimmune conditions in the setting of MM and review the current literature.

Resumen Varios trastornos autoinmunes se han asociado a una variedad de neoplasias malignas hematopoyéticas, particularmente trastornos linfoproliferativos. El mieloma múltiple (MM) es una de las neoplasias malignas hematológicas más comunes y ha sido descrito en el contexto de una variedad de condiciones autoinmunes. Debido a su diversidad y rareza, las características clínicas de las condiciones autoinmunes asociadas con el MM no han sido aclaradas y la patogénesis sigue siendo poco clara. En este artículo se describen dos casos de condiciones autoinmunes en el marco del MM y se realiza una revisión de la literatura actual.

Efecto del consumo de casabe sobre la absorción y retención aparente de proteínas en un modelo experimental con ratas / Effect of casabe bread consumption on apparent absorption and retention of proteins in a rat experimental model

El principal producto derivado de la yuca en Venezuela es el casabe, valorado por su contenido calórico y de Fibra Dietética (FD). Objetivo: determinar el efecto del consumo de diferentes variedades de casabe sobre la absorción y retención aparente de proteínas en un modelo experimental con ratas. Métodos: se utilizaron 20 ratas machos adultas, cepa Sprague Dawley®, las cuales fueron divididas en 4 grupos: un control sin fibra y tres grupos experimentales en los que se sustituyó el almidón de maíz por una variedad de casabe, identificados por su procedencia como: "Casabe Miranda", "Casabe Sucre" y "Casabe Amazonas". Resultados: el contenido de FD total y su fracción soluble fueron significativamente mayores en las variedades de casabe Amazonas y Sucre (p<0,05). La inclusión de casabe a las dietas produjo un aumento en el peso de las heces así como en su contenido de nitrógeno (p<0,05), sin presentar diferencias significativas en la excreción de nitrógeno urinaria. La absorción de proteínas y la retención aparente de nitrógeno disminuyeron significativamente (p<0,05) hasta el día 14 del período experimental. Sin embargo, se pudo apreciar que al final del ensayo (día 21) la retención aparente de nitrógeno no mostró diferencia entre los controles y los grupos experimentales. Conclusiones: la inclusión de casabe a las dietas no produjo una reducción en la utilización de proteínas como para afectar el crecimiento de los animales. Se plantea la necesidad de seguir realizando estudios en esta área ya que la literatura es muy escasa(AU)

The main product derived from cassava in Venezuela is cassava bread, valued for its caloric content and Dietary Fiber (DF). Objective: to determine the effect of the consumption of different varieties cassava bread on the absorption and retention of proteins in a rat experimental model. Methods: Twenty male adult rats, Sprague Dawley ® strain, were divided into four groups: a control without fiber and three experimental groups in which corn starch was substituted for a variety of cassava bread, identified by their origin as: "Cassava bread Miranda", "Cassava bread Sucre" and "Cassava bread Amazonas". Results: The total DF content and soluble fraction were significantly higher in the varieties of cassava breads varieties Amazonas and Sucre (p <0.05). The inclusion of cassava bread in diets produced an increase in stool weight as well as in nitrogen content (p <0.05), without presenting significant differences in the excretion of urinary nitrogen. Protein absorption and apparent nitrogen retention decreased significantly (p <0.05) until day 14 of the experimental period. However, it could be seen that at the end of the trial (day 21) the apparent nitrogen retention showed no difference between the controls and the experimental groups. Conclusions: the inclusion of cassava bread in the diets did not produce a reduction in the use of proteins to affect the growth of the animals. The need to continue conducting studies in this area is considered, since the literature is very scarce(AU)

Crianza parental asociada al consumo de drogas y alteraciones en salud mental en adolescentes infractores / Parental upbringing associated with drug use and mental health disorders in adolescent offenders / Criação parental associada ao uso de drogas e transtornos mentais em adolescentes infratores

OBJETIVO: fue conocer la relación que existe entre la crianza parental, consumo de drogas y alteraciones en salud mental en adolescentes infractores. METODO: estudio descriptivo-correlacional de corte transversal. La muestra se conformó por 49 adolescentes infractores del estado de Zacatecas, México, utilizando la Escala de Estilos Parentales Percibidos y el Massachusetts Youth Screening Instrument así como preguntas abiertas sobre el consumo de drogas. RESULTADOS: muestran que aunque no se encontró una relación significativa, adicionalmente se encontraron asociaciones entre el consumo de drogas con alteraciones en salud mental; así mismo la sustancia preferida por los adolescentes infractores fue la mariguana. CONCLUSIONES: de esta forma, enfermería al realizar una valoración temprana pueda identificar alteraciones en salud física y mental para ofrecer estrategias que promuevan estilos de vida saludables y canalizar a espacios adecuados de atención a quienes precisen de una atención especializada.

AIM: know the relationship between parental upbringing, drug use and mental health disorders in juvenile offenders. METHODS: study cross-sectional and descriptive-correlational. The sample consisted of 49 juvenile offenders from the state of Zacatecas, Mexico. The scales applied were the Parental Perceived Styles Scale and the Massachusetts Youth Screening Instrument as well as open questions about drug use. RESULTS: show that although a significant relationship was not found, we found associations between drug use and mental health disorders; and the substance preferred by teenage offenders was marijuana. CONCLUSION: Thus, early assessment nursing can identify changes in physical and mental health to offer strategies that promote healthy lifestyles and channel appropriate spaces of care to those who require specialized care.

OBJETIVO: conhecer a relação entre o criação parental, consumo de drogas e alterações da saúde mental em adolescentes infratores. MÉTODOS: o tipo de estudo foi descritivo-correlacional de corte transversal. A amostra se compôs por 49 adolescentes infratores. RESULTADOS: mostram que ainda que no se tenha encontrado uma relação significativa, adicionalmente se encontraram associações entre o consumo de drogas com alterações da saúde mental; a substância preferida pelos adolescentes foi a maconha. CONCLUSÃO: desta forma, a enfermagem, ao realizar, uma valoração preventiva, poderia identificar alteração em saúde física e mental para oferecer estratégias que promovam estilos de vida saudáveis e canalizar espaços adequados de atenção aos que precisam de atenção especializada.

Operacionalización de variables / Operationalization of Variables

Este artículo es una revisión del tema Operacionalización de Variables, tema por demás importante, para quienes realizan investigación, o son tutores y/o asesores de estudiantes de pre o postgrado, de trabajos de ascenso o forman parte de un grupo de investigación. En dicho artículo se persigue como propósito no sólo presentar una revisión del tema, sino ofrecer un material de apoyo que sea de consulta obligatoria a la hora de decidir, además del objetivo de la investigación, el cual debe estar expresado con claridad, señalar la finalidad e importancia de operacionalizar las variables incluidas en un proyecto de investigación, así como la utilidad que éste tiene para facilitar, tanto la medición de las variables, como la construcción de los instrumentos necesarios para recabar los datos y llevar a cabo la medición de todas las variables involucradas. Se realizó una revisión de alguna bibliografía, relacionada con el tema, tanto en forma escrita como en forma electrónica, para tratar de ajustarla lo más posible a las necesidades del área de las ciencias de la salud, independiente de que se trate de un enfoque cuantitativo, como cualitativo, complementando con ejemplos relacionados con esta área

This article is a review of the Operationalization of Variables, theme by other important topic for those who conduct research, or are guardians and/or students of pre or postgraduate, ascent works consultants or are part of a research group. In that article pursues intended not only to present a review of the subject, but offer a supporting material that is of compulsory consultation in deciding, in addition to the objective of the research, which must be expressed clearly, point out the purpose and importance of Operationalizing the Variables included in a research project, as well as the utility it has to facilitate , both variables measurement, and the construction of the necessary instruments to collect data and carry out the measurement of all the variables involved. We conducted a review of any bibliography, related issue, both in written form as in electronically, to try to adjust it as much as possible to the needs of the area of the health sciences, independent concerned to focus on quantitative, as qualitatively, complemented by examples related to this area

Efecto del consumo de diferentes variedades de casabe venezolano sobre la concentración de lípidos séricos en un modelo experimental con ratas / Effect of consumption of different varieties of Venezuelan cassava bread in the serum lipids concentration in an experimental model with rats

La yuca es un tubérculo originario de Brasil perteneciente a la familia Euphorbiacea y al género Manihot, a partir de la cual se produce el casabe. Hoy día el casabe forma parte de la dieta de los venezolanos, siendo valorado por su contenido calórico y riqueza en fibra dietética (FD). En este estudio se evaluó el efecto del consumo de dietas que contenían fibra dietética proveniente de diferentes variedades de casabe, sobre la concentración de lípidos séricos en un modelo experimental. Métodos: se utilizaron 20 ratas machos adultas, cepa Sprague Dawley, divididas en 4 grupos: un control sin fibra y tres grupos experimentales en los que se sustituyó el almidón de maíz por una variedad de casabe, identificados por su procedencia como: "Casabe Miranda", "Casabe Sucre" y "Casabe Amazonas". Resultados: El contenido de FD total y su fracción soluble fueron significativamente mayores en las variedades de casabe Amazonas y Sucre (p<0,05). La inclusión de casabe a las dietas produjo un descenso significativo en las concentraciones séricas del colesterol total, y del C-LDL (p<0,05), sin encontrarse efectos sobre el C-HDL y los de triglicéridos. Conclusión: el consumo de casabe, independientemente de su variedad, tuvo un efecto hipocolesterolémico, lo que sugiere un efecto protector contra el riesgo de aparición de enfermedad coronaria. En estudios futuros podría considerarse su uso en la dietoterapia de las dislipidemias(AU)

Cassava is a tuberous native from Brazil belonging to the Euphorbiacea family and the genus Manihot, from which cassava bread (casabe) is produced. Today casabe is part of the diet of Venezuelans, being valued for its caloric content and richness in dietary fiber (FD). This study evaluated the effect of diets containing dietary fiber from different varieties of Venezuelan cassava, on the serum lipid concentration in an experimental model. Methods: 20 male adult rats, Sprague Dawley strain, were used, divided into 4 groups: a control group without fiber and three experimental groups in which the cornstarch was substituted with a different variety of cassava, identified by its origin as: "Casabe Miranda", "Casabe Sucre" and "Casabe Amazonas". Results: The content of total DF and its soluble fraction were significantly higher in the cassava Amazonas and Sucre (p<0.05). The inclusion of cassava bread in diets resulted in a significant decrease in serum total cholesterol and LDL-C levels (p <0.05), with no effect on HDL-C and triglycerides. Conclusion: the consumption of cassava bread, regardless of its variety, had a hypocholesterolemic effect, suggesting a protective effect against the risk of developing coronary heart disease. In future studies it could be considered its use in diet therapy for dyslipidemias(AU)

Incidência e fatores de complicações pulmonares pós-operatórias em pacientes submetidos à cirurgias de tórax e abdome / Incidence and risk factors for postoperative pulmonary complications in patients undergoing thoracic and abdominal surgeries

RESUMO Objetivos: avaliar a incidência de complicações pulmonares pós-operatórias em pacientes submetidos à cirurgias de tórax e abdome e os principais fatores envolvidos. Métodos: estudo analítico observacional prospectivo dos pacientes submetidos à cirurgias de tórax e abdome no Hospital Santo Antônio de Blumenau, SC. Os dados foram coletados dos prontuários eletrônicos e através de entrevistas estruturadas com os pacientes. Foram avaliados dados relativos às características dos pacientes e da cirurgia. A variável de desfecho foi a ocorrência de complicações pulmonares pós-operatórias. Resultados: foram estudados 314 pacientes, 65,6% do sexo feminino, com média de idade de 46,61 anos, 51,6% classificados como ASA II. Cirurgias por vídeo foram realizadas em 55,7% dos casos, abdominais em 85,4% e 61,5% dos procedimentos foram classificados como potencialmente contaminadas e de porte médio. O tempo médio de cirurgia foi de 126,65 minutos e os pacientes ficaram internados em média por 2,59 dias. A incidência de complicações pulmonares pós-operatórias foi de 11,5%. As complicações mais comuns foram a insuficiência respiratória, o derrame pleural e a pneumonia. Os fatores de risco mais importantes para estas complicações foram diabetes, internação hospitalar por mais de cinco dias e presença de doença pulmonar prévia. Os pacientes submetidos às cirurgias por vídeo apresentaram menor incidência de complicações. Conclusão: as complicações pulmonares pós-operatórias são frequentes e os fatores associados a maior risco foram diabetes, internação prolongada e presença de doença pulmonar prévia.

ABSTRACT Objective: to determine the incidence of postoperative pulmonary complications in patients undergoing abdominal and thoracic surgery and investigate the risk factors for their occurrence. Methods: we conducted a prospective, observational and analytical study with all the patients undergoing thoracic and abdominal surgeries at the Santo Antônio Hospital in Blumenau, SC. We collected data from medical records and structured interviews with patients, regarding the characteristics of patients and procedures. The outcome variable was the occurrence of postoperative pulmonary complications in the medical record. Results: we studied 314 patients, 65.6% female, with an average age of 46.61 years. Of the sample, 51.6% was ASA II, 55.7% of the surgeries were performed by laparoscopy or thoracoscopy, 85.4% were in the abdomen, and 61.5% were potentially contaminated and of medium-scale procedures. The average time of surgery was 126.65 minutes and the average length of hospital stay was 2.59 days. The incidence of postoperative pulmonary complications was 11.5%. The most common complications were respiratory failure, pleural effusion and pneumonia. The most important risk factor were diabetes, hospitalization for more than five days and the presence of pulmonary disease. Patients operated by laparoscopy or thoracoscopy had fewer complications. Conclusion: postoperative pulmonary complications are frequent and factors associated with greatest risk were diabetes, prolonged hospitalization and presence of previous lung disease.

Canal endémico de enfermedad respiratoria aguda y enfermedad diarreica aguda en menores de 5 años en una localidad de Bogotá / Endemic channel of acute respiratory disease and acute diarrheal disease in children under 5 years of age in a district of Bogotá

Objetivo Desarrollo de una herramienta útil para la planeación de atención en salud en menores de 5 años en la localidad de Ciudad Bolívar, elaborando un Canal Endémico para la Enfermedad Respiratoria Aguda y Enfermedad Diarreica Aguda, en menores de 5 años para el periodo comprendido entre los años 2008 a 2012. Metodología Estudio descriptivo con enfoque en vigilancia en salud pública, para la confección de un Canal Endémico en menores de 5 años atendidos en los servicios de atención del Hospital Vista Hermosa de nivel I. Resultados Se identificó la incidencia de Enfermedad Respiratoria Aguda para un periodo de 5 años, obteniendo un promedio mensual de 1265 + 79 casos mostrando dos periodos de pico anual; para la Enfermedad Diarreica Aguda se obtuvo un promedio mensual de 243 casos con un periodo de mayor incidencia. Conclusión La correcta elaboración de los Canales Endémicos en la atención primaria de salud permite dar las alertas de manera oportuna desde el primer nivel de atención para así guiar la toma de decisiones en salud y lograr una mejor administración de las redes de servicios.(AU)

Objective Developing a useful tool for planning health care for children under 5 years of age in the Ciudad Bolivar locality of Bogotá, developing an endemic channel for acute respiratory disease and acute diarrheal disease in children under 5 years of age for the period of 2008 to 2012. Methodology Descriptive study with a focus on public health surveillance for the preparation of an endemic channel for children under 5 years receiving care services in the Vista Hermosa Hospital Level I. Results The incidence of acute respiratory disease for a period of five years was identified with a monthly average of 1265 + 79 cases, showing two annual peak periods. Acute diarrheal disease, a monthly average of 243 cases was obtained with a period of higher incidence. Conclusion The correct preparation of the endemic channels in primary health care can provide alerts in a timely manner from the first level of care and guide decision-making in health and help achieve better network management services.(AU)

Trisomía 22 en un recién nacido de 39 semanas / Trisomy 22 in a newborn infant of 39 weeks

En este reporte presentamos el caso de un paciente masculino nacido de 39 semanas, producto de tercera gestación (dos abortos anteriores) de madre de 38 años y padre de 46 años. Las características clínicas del paciente incluyen macrocefalia, fontanela anterior amplia con diástasis de sutura sagital, escleras grisáceas, pabellones auriculares displásicos de implantación baja, raíz nasal corta, pliegue simiano en mano derecha e hirsutismo. Se obtienen tomografía axial computarizada de cráneo y resonancia magnética cerebral que presentan agenesia de cuerpo calloso y dilatación del asta occipital de los ventrículos laterales. El cariotipo en sangre periférica evidencia trisomía parcial del cromosoma 22 (47, XY+22, del (22) (q11.2qter)). El paciente requirió 7 días de hospitalización y se da egreso hospitalario en buenas condiciones generales pero con un retardo psicomotor severo e hipotonía generalizada. Dadas las malformaciones estructurales severas que se presentan en este síndrome, los embarazos a término y la supervivencia postnatal de los niños con trisomía 22 son eventos muy raros. El caso de este paciente complementa otros reportes ilustrando que la trisomía 22 puede sobrevivir más allá del nacimiento.

In this report, we present the case of a male patient who was born 39 weeks, the product of third gestation (two previous abortions) with a 38 year old mother and a 46 year old father. The clinical characteristics of the patient include macrocephaly, extensive anterior fontanelle with diastasis recti sagittal suture, ochronosis grayish pavilions dysplastic headphones lowset, short nasal root, simian crease in her right hand and hirsutism. We obtained a computerized axial tomography of skull and a brain magnetic resonance with agenesis of the corpus callosum and dilation of the ASTA occipital of the lateral ventricles. The karyotype in peripheral blood evidence partial trisomy of chromosome 22 (47, XY+22, del (22) (q11.2qter)). The patient required 7 days of hospitalization and was released from the hospital in good condition overall, but with a psychomotor retardation and severe generalized hypotonia. Given the severe structural malformations that are present in this syndrome, the term pregnancy and post birth survival of children with trisomy 22 are very rare events. The case of this patient complements other reports illustrating that trisomy 22 can survive beyond birth.