Causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico Nacional - Hospital Nacional / Precipiting causes of acute hyperglycemic crisis in patients in the Centro Médico Nacional - Hospital Nacional

Introducción: las crisis hiperglicémicas agudas son las emergencias endocrinológicas más frecuentes en la práctica clínica y junto a la hipoglucemia se las describe como las complicaciones metabólicas agudas graves del paciente diabético. Objetivo: identificar las causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico - Hospital Nacional. Metodología: estudio observacional, descriptivo, de corte transversal de pacientes internados en el Centro Médico Hospital Nacional, durante el periodo de mayo 2021 a octubre del 2023. Los datos fueron obtenidos con la revisión de las fichas clínicas. Resultados: de los 100 pacientes evaluados, la crisis hiperglicémica aguda más frecuente fue la Cetoacidosis diabética (CAD) 53 %, seguida del Estado hiperosmolar hiperglicémico (EHH) 25 % y el estado mixto 22 %. Los desencadenantes más frecuentes fueron el abandono del tratamiento, debut de la enfermedad e infecciones. La mortalidad global fue del 12 %. Conclusión: la causa más frecuente de descompensación fueron el abandono del tratamiento, la diabetes de novo y procesos infecciosos.

Introduction: hyperglycemic crises are the most frequent endocrinological emergencies in clinical practice and, along with hypoglycemia, are described as serious acute metabolic complications in diabetic patients. Objective: to identify the precipiting causes of acute hyperglycemic crisis in hospitalized patients in the Centro Médico Nacional - Hospital National. Methodology: this was an observational, descriptive, cross -sectional study of patients hospitalized at the Centro Médico Nacional - Hospital National, from May 2021 to October 2023. The data were obtained from a review of the clinical records. Results: Of the 100 patients evaluated, the most frequent acute hyperglycemic crisis was diabetic ketoacidosis (CAD) 53 %, followed by the hyperglycemic hyperosmolar state (EHH) 25 % and the mixed state 22 %. The most frequent triggers were the abandonment of treatment, disease debut and infections. Global mortality was 12 %. Conclusion: the most frequent causes of decompensations were abandoning treatment, novo diabetes and infectious processes.

Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminum-garnet laser posterior capsulotomy

ABSTRACT Capsulotomy with neodymium-doped yttrium--aluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Baixos Níveis de Atividade Física e suas Associações com o Estado de Humor, Sonolência Diurna e Consumo Alimentar em Universitários / Low Levels of Physical Activity and its Associations with Mood State, Daytime Sleepiness and Food Consumption in University Students

O ingresso em um curso universitário leva a mudanças significativas no estilo de vida e na rotina do estudante, com impacto na prática de atividade física, saúde mental, hábitos de sono e hábitos alimentares. O objetivo do estudo foi verificar o nível de atividade física dos jovens universitários e suas associações com estado de humor, qualidade do sono e consumo alimentar. Trata-se de uma pesquisa de corte transversal, realizada com estudantes universitários do curso de Medicina de uma Instituição de Ensino Superior Pública. Realizou-se avaliação de medidas antropométricas, do nível de atividade física (NAF) por meio do acelerômetro GT3x (Actigraph), do consumo alimentar (inventário de 24h), e utilizando os questionários de BECK e BRUMs / POMS avaliou-se os distúrbios de sono e estado de humor. Utilizando o software SPSS realizou análise comparativa com teste t Student para grupos independentes, análise inferencial de correlação de Pearson e Regressão logística binária. Dos universitários analisados (n=75), 54,7% (n=41) eram do sexo masculino e, quando comparado com as mulheres, apresentaram maior nível de atividade física (NAF). Aproximadamente 1/3 de toda a amostra do estudo realizou menos de 300min de atividade física moderada/vigorosa. O perfil alimentar dos universitários não foi satisfatório. Verificou-se para ambos os sexos o Escore Total de POMS (Profile of Mood States) se associou com universitários que realizam menos de 300min de atividade física por semana. As mulheres têm 65% mais chances de apresentar Escala de Tensão (POMS) quando são menos ativas, e nos homens, a razão de chances é de aproximadamente três vezes maior de apresentar Confusão (BRUMS - Escala de Humor de Brunel). Conclui-se que os estudantes universitários do curso estudado, em sua maioria, foram insuficientemente ativos fisicamente e apresentam algumas alterações no estado de humor, sonolência diurna e um consumo alimentar insatisfatório.

Starting a university course leads to significant changes in the student's lifestyle and routine, with an impact on physical activity, mental health, sleeping habits and eating habits. The objective of the study was to verify the level of physical activity of young university students and its associations with mood, sleep quality and food consumption. This is a cross-sectional survey, carried out with university students studying Medicine at a Public Higher Education Institution. Anthropometric measurements, physical activity level (PAL) were assessed using the GT3x accelerometer (Actigraph), food consumption (24-hour inventory), and using the BECK and BRUMs / POMS questionnaires, health disorders were assessed. sleep and mood. Using SPSS software, comparative analysis was carried out with Student's t test for independent groups, Pearson correlation inferential analysis and binary logistic regression. Of the university students analyzed (n=75), 54.7% (n=41) were male and, when compared to women, they had a higher physical activity level (PAL). Approximately 1/3 of the entire study sample performed less than 300 minutes of moderate/vigorous physical activity. The dietary profile of university students was not satisfactory. For both sexes, the POMS Total Score (Profile of Mood States) was found to be associated with university students who perform less than 300 minutes of physical activity per week. Women are 65% more likely to present with Tension Scale (POMS) when they are less active, and in men, the odds ratio is approximately three times greater for presenting Confusion (BRUMS - Brunel Mood Scale). It is concluded that the majority of university students on the course studied were insufficiently physically active and presented some changes in mood, daytime drowsiness and unsatisfactory food consumption.

Long-term evaluation of the efficacy and safety of Nd:YAG laser vitreolysis for symptomatic vitreous foaters / Avaliação de longo prazo da eficácia e segurança da vitreólise com Nd:YAG laser para moscas volantes sintomáticas

ABSTRACT Purpose: This study aimed to evaluate the long-term safety and efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) vitreolysis for symptomatic vitreous floaters as it remains a controversial procedure due to insufficient robust evidence in the literature for the maintenance of the results and absence of adverse effects. Methods: This is an observational extension to the previously presented prospective, randomized, double-blind clinical trial. Eight of thirteen subjects who underwent vitreolysis with YAG laser returned for a late reevaluation, 18 months after the procedure, to evaluate the efficacy and safety of the procedure. Results: All patients maintained the improvement in symptomatology noted after the procedure, with 25% showing complete improvement and a similar proportion (37.5%) reporting significant or partial improvement. Objective improvement in opacity was similar to that found at 6 months follow-up. The NEI-VFQ 25 quality of life questionnaire showed no statistically significant difference in responses between the 6th and 18th month. No adverse effects were noted on clinical examination or reported by patients. Conclusion: Vitreolysis efficacy observed at 6 months of follow-up was maintained until the eighteenth month, with all patients reporting improvement from the pre-procedure state. No late adverse effects were noted. A larger randomized clinical trial is needed to confirm the safety of the procedure.

RESUMO Objetivos: Avaliar a segurança e eficácia a longo prazo da vitreólise com Nd:YAG laser para moscas volantes sintomáticas, uma vez que permanece como um procedimento controverso devido a falta de evidência científica robusta sobre a manutenção dos resultados e ocorrência de efeitos adversos. Métodos: Este estudo é uma extensão observacional de um ensaio clínico prospectivo, randomizado, duplo cego, previamente publicado. Oito de treze pacientes que foram submetidos a vitreólise com YAG laser foram acompanhados para uma reavaliação tardia, dezoito meses após o procedimento, para avaliar a eficácia e segurança do procedimento. Resultados: Todos os pacientes mantiveram a melhora na sintomatologia notada ao final do procedimento original, com 25% dos casos apresentando melhora completa, e uma proporção semelhante (37,5%) demonstrando melhora significativa ou parcial. A melhora objetiva na opacidade foi similar ao achado no seguimento original de 6 meses. O questionário de qualidade de vida NEI-VFQ 25 não demonstrou diferença estatisticamente significativa nas respostas entre o sexto e o décimo oitavo mês de acompanhamento. Nenhum efeito adverso foi notado no exame clínico ou reportado pelos pacientes. Conclusão: A eficácia da vitreólise observada ao sexto mês do acompanhamento foi mantida até o décimo oitavo mês, com todos os pacientes notando algum grau de melhora quando comparado ao estado pré procedimento. Nenhum efeito adverso tardio foi notado. Um ensaio clínico randomizado maior é necessário para confirmar a segurança do procedimento.

Availability of resources for paediatric hearing care in a South African province

Background: Unavailability of healthcare resources can lead to poor patient outcomes. The latter is true for infants with hearing loss and require early hearing detection and intervention (EHDI). Aim: To determine the availability and distribution of resources for EHDI in state hospitals in the Eastern Cape (EC) province, South Africa. Setting: Sixteen state hospitals (nine district, four regional and three tertiary hospitals). Methods: Descriptive cross-sectional survey completed between July 2022 and October 2022. Results: Thirteen hospitals had audiologists (n = 4) or speech therapists and audiologists (n = 9). Specific to equipment, 10 hospitals had a screening otoacoustic emissions or automated auditory brainstem response, 8 hospitals had diagnostic middle ear analysers and only 3 hospitals had diagnostic auditory brainstem response and/or auditory steady state response. Twelve hospitals did not have visual response audiometry (VRA) and 94% had no hearing aid verification systems. Budget allocations were uneven, with only 10 hospitals, i.e., 4 districts, all regional and 2 tertiary hospitals being allocated varying amounts. Subsequently, only 50% provided newborn hearing screening, 56% provided diagnostic evaluations and 14 hospitals fitted hearing aids. Conclusion: Results revealed a limited and uneven distribution of resources, which negatively impacted the provision of EHDI. Even distribution of healthcare resources and further research aimed at strengthening hearing health services is recommended as these could potentially improve equitable access to EHDI and the overall quality of healthcare provided. Contribution: This study highlights the need for even distribution of resources and strengthening of health systems, especially in the dawn of the National Health Insurance.

Challenges in the study of self-assembled aggregates in decoction of traditional Chinese medicine: A preliminary review / 药学学报

Decoction is the most commonly used dosage form in the clinical treatment of traditional Chinese medicine (TCM). During boiling, the violent movement of various active ingredients in TCM creates molecular forces such as hydrogen bonding, π-π stacking, hydrophobic interactions and electrostatic interactions, which results in the formation of self-assembled aggregates in decoction (SADs), including particles, gels, fibers, etc. It was found that SADs widely existed in decoction with biological activities superior to both effective monomers and their physical mixtures, providing a new idea to reveal the pharmacodynamic material basis of Chinese herbal medicine from the perspective of component interactions-phase structure. Recently, SADs have become a novel focus of research in TCM. This paper reviewed their relevant studies in recent years and found some issues to be concerned in the research, such as the polydispersity of decoction system, instability of active ingredient interactions during boiling, uncertainty of the aggregates self-assembly rules, and stability, purity, yield of the products. In this regard, some solutions and new ideas were presented for the integrated development and clinical application of SADs.

Exploration of Decision-Making Methods Based on Syndrome Differentiation by “Data-Knowledge” Dual-Driven Models： A Case Study of Gastric Precancerous State / 中医杂志

Data analysis models may assist the transmission of traditional Chinese medicine （TCM） experience and clinical diagnosis and treatment， and the possibility of constructing a “data-knowledge” dual-drive model was explored by taking gastric precancerous state as an example. Data-driven is to make clinical decisions around data analysis， and its syndrome-differentiation decision-making research relies on hidden structural models and partially observable Markov decision-making processes to identify the etiology of diseases， syndrome elements， evolution of pathogenesis， and syndrome differentiation protocols； knowledge-driven is to make use of data and information to promote decision-making and action processes， and its syndrome-differentiation decision-making research relies on convolutional neural networks to improve the accuracy of local disease identification and syndrome differentiation. The “data-knowledge” dual-driven model can make up for the shortcomings of single-drive numerical simulation accuracy， and achieve a balance between local disease identification and macroscopic syndrome differentiation. On the basis of previous research， we explored the construction method of diagnostic assisted decision-making platform for gastric precancerous state， and believed that the diagnostic and decision-making ability of doctors can be extended through the assistance of machines and algorithms. Meanwhile， the related research methods were integrated and the core features of gastric precancerous state based on TCM syndrome differentiation and endoscopic pathology diagnosis and prediction were obtained， and the elements of endoscopic pathology recognition based on TCM syndrome differentiation were explored， so as to provide ideas for the in-depth research and innovative application of cutting-edge data analysis technology in the field of intelligent TCM syndrome differentiation.

Spatial distribution of acute cases of Chagas disease reported from 2010 to 2020 in the State of Amazonas / Distribuição espacial dos casos agudos de doença de Chagas notificados de 2010 a 2020 no Estado da Amazônia / Distribución espacial de los casos agudos de enfermedad de Chagas notificados de 2010 a 2020 en el Estado Amazónico

This study aimed to investigate the epidemiology of acute cases of Chagas disease notified in the State of Amazonas between the period from 2010 to 2020. Data were obtained from the portal of the Sistema de Informação de Agravos de Notificação- SINAN, considering the number of cases per municipality of notification. 140 cases of Acute Chagas Disease were notified, distributed in 23 of the 62 municipalities of the State of Amazonas, 82 (59%) were male individuals, with a greater predominance in the age group of 20-39 years old, having 45 (32.1%) cases. As for the race/color variable, the highest number was among brown people with 101 (72.1%) notifications. The oral route prevailed as the main form of disease transmission with 93 (66.4%) records. Infection by the oral route of T. cruzi is the most important route of transmission of CD in the State of Amazonas, the occurrence of transmission is associated in most cases with the consumption of foods such as açaí juice and has been reported frequently over the years between municipalities.

este estudo se propôs a investigar a epidemiologia dos casos agudos de Doença de Chagas notificados no Estado do Amazonas no período de 2010 a 2020. Os dados foram obtidos no portal do Sistema de Informação de Agravos de Notificação - SINAN, considerando o número de casos por município de notificação. Foram notificados 140 casos de Doença de Chagas Aguda, distribuídos em 23 dos 62 municípios do Estado do Amazonas, 82 (59%) eram indivíduos do sexo masculino, com maior predominância na faixa etária de 20-39 anos de idade com 45 (32,1%) casos. Quanto a variável raça/cor, a maior registro foi entre pardos com 101(72,1%) notificações. A via oral, prevaleceu como a principal forma de transmissão da patologia com 93 (66,4%) registros. A infecção pela via oral do T. cruzi, é a mais importante via de transmissão de DC no Estado do Amazonas, a ocorrência da transmissão está associada na maioria das vezes ao consumo de alimentos como o suco de açaí, e tem sido reportada com frequência ao longo dos anos entre os municípios.

Este estudio tuvo como objetivo investigar la epidemiología de los casos agudos de la enfermedad de Chagas notificados en el Estado de Amazonas en el período de 2010 a 2020. Los datos fueron obtenidos del portal del Sistema de Información de Enfermedades de Notificación - SINAN, considerando el número de casos por municipio de notificación. Se notificaron 140 casos de Enfermedad de Chagas Aguda, distribuidos en 23 de los 62 municipios del Estado de Amazonas, 82 (59%) fueron individuos del sexo masculino, con mayor predominio en el grupo etario de 20 a 39 años con 45 (32,1%) casos. En cuanto a la variable raza/color, el mayor número fue entre los morenos con 101 (72,1%) notificaciones. La vía oral predominó como principal vía de transmisión de la enfermedad con 93 (66,4%) registros. La infección por vía oral de T. cruzi es la vía de transmisión más importante de la EC en el Estado de Amazonas, la ocurrencia de la transmisión está mayoritariamente asociada al consumo de alimentos como el jugo de açaí, y ha sido reportada con frecuencia a lo largo de los años entre municipios.

Comunicação pública da ciência e da saúde no pós-pandemia / Post-pandemic science and health public communication / Comunicación pública de la ciencia y de la salud tras la pandemia

A pandemia de covid-19 demonstrou a relevância da comunicação pública da saúde e da ciência, mas também evidenciou suas fragilidades. No Brasil, como em outras partes do mundo, a desinformação foi institucionalizada, com grave impacto na saúde dos cidadãos. Após a pandemia, coloca-se o desafio de estruturar políticas públicas de comunicação para combater a desinformação e de fortalecer a carreira de comunicador público como suporte a essas políticas. A mobilização de organizações da sociedade civil ligadas ao tema produziu um projeto de Lei Geral da Comunicação Pública que tramita na Câmara dos Deputados. Também permitiu incluir o estabelecimento de uma política de comunicação para o Sistema Único de Saúde entre as diretrizes aprovadas pela 17ª Conferência Nacional de Saúde

The covid-19 pandemic demonstrated the relevance of public health and science communication, but also highlighted its weaknesses. In Brazil, as in other parts of the world, disinformation has been institutionalized, with a serious impact on the health of citizens. After the pandemic, there is a challenge of structuring public communication policies to combat disinformation and to strengthen the career of public communicator to support these policies. The mobilization of civil society organizations linked to these issues produced a public communication bill which is currently discussed in the Chamber of Deputies. It also made it possible to include the establishment of a communication policy for the Unified Health System among the guidelines approved by the 17th National Health Conference

La pandemia de covid-19 demostró la relevancia de la comunicación pública de la salud y de la ciencia, pero también puso de relieve sus debilidades. En Brasil, como en otras partes del mundo, la desinformación ha sido institucionalizada, con un grave impacto en la salud de los ciudadanos. Después de la pandemia, queda el desafío de estructurar políticas públicas de comunicación para combatir la desinformación y también de estructurar la carrera de comunicador público para apoyar estas políticas. La movilización de organizaciones de la sociedad civil vinculadas al tema ha producido un proyecto de Ley General de Comunicación Pública que se encuentra en trámite en la Cámara de Diputados. También permitió incluir el establecimiento de una política de comunicación para el Sistema Único de Salud entre las directrices aprobadas por la XVII Conferencia Nacional de Salud

Statelessness of Children born to Venezuelan Parents in Colombia: Lawmaking without Convincing Policies

This article examines the Colombian legislation against statelessness issued due to the humanitarian emergency in Venezuela in recent years. There have been three waves of Venezuelan migration: the first, in 2005; the second, in 2017; and the last wave, from 2017 to the present day. For this analysis, it was used a qualitative socio-legal method adopting a descriptive approach. The paper affirms that, despite the efforts of Colombian entities to regulate the statelessness of minors born to Venezuelan parents, these regulations contain legal vacua due to a lack of communication between the different State bodies. Such void causes legal contradictions and legal uncertainty in the national system, and, subsequently, violates in a direct manner the fundamental rights of children born to Venezuelan migrants in Colombia.

En el presente artículo se analiza la legislación colombiana contra la apatridia expedida a raíz de la migración ocasionada por la emergencia humanitaria en Venezuela durante los últimos años. La migración venezolana se puede dividir en tres oleadas, la primera en el año de 2005, la segunda en el año de 2010 y la última desde el año de 2017 hasta la actualidad. Para la realización del presente artículo, se utilizó el método cualitativo de carácter sociojurídico con un enfoque descriptivo. Finalmente, se concluye que, a pesar del esfuerzo de las entidades colombianas por regular la apatridia de los menores hijos de padres venezolanos, dicha legislación presenta vacíos normativos por la falta de comunicación de los diferentes órganos del Estado. Dichos vacíos crean contradicciones, generan inseguridad jurídica en el ordenamiento nacional y, ulteriormente, violentan de manera directa los derechos fundamentales de los menores hijos de migrantes venezolanos nacidos en Colombia.

Este artigo analisa a legislação colombiana contra a apatridia emitida como resultado da migração causada pela emergência humanitária na Venezuela nos últimos anos. A migração venezuelana pode ser dividida em três ondas, a primeira em 2005, a segunda em 2010 e a última de 2017 até o presente. Para este artigo, usamos um método sociojurídico qualitativo com uma abordagem descritiva. Por fim, conclui-se que, apesar dos esforços das entidades colombianas para regulamentar a apatridia de menores nascidos de pais venezuelanos, essa legislação apresenta lacunas regulatórias devido à falta de comunicação entre os diferentes órgãos do Estado. Essas lacunas criam contradições, geram insegurança jurídica no sistema jurídico nacional e, consequentemente, violam diretamente os direitos fundamentais das crianças nascidas na Colômbia de migrantes venezuelanos.

Isquemia aguda por trombosis aórtica en COVID-19: A propósito de un caso

Objetivo: Presentar un caso de isquemia aguda por trombosis aórtica en paciente con infección por COVID-19 y exponer la importancia del diagnóstico y manejo oportuno. Introducción: El coronavirus (COVID-19) afecta principalmente al tracto respiratorio, pero presenta predisposición a fenómenos trombóticos y sus complicaciones, siendo una de las más graves la isquemia aguda por trombosis aórtica. Caso clínico: Paciente masculino de 68 años, que cursa con cuadro clínico de neumonía grave por COVID-19, presenta de forma concomitante episodio de trombosis aórtica aguda, resultando con isquemia aguda de extremidades inferiores. Se realizó trombectomía, post procedimiento y asociado a reperfusión, presentó paro cardiorrespiratorio con asistolia sostenida, falleciendo pese a maniobras de reanimación. Conclusión: Pese a las medidas de profilaxis con heparina de bajo peso molecular (HBPM), se deben sospechar y buscar las complicaciones tromboembólicas en pacientes que cursan con esta infección para dar un manejo oportuno y vigilar las complicaciones post quirúrgicas que pueden ser mortales.

Aim: To present a case of acute ischemia due to aortic thrombosis in a patient with COVID-19 infection and explain the importance of diagnosis and timely management. Introduction: The coronavirus (COVID-19) mainly affects the respiratory tract, but it has a predisposition to thrombotic phenomena and its complications, one of the most serious being acute ischemia due to aortic thrombosis. Clinical case: 68-year-old man, coronary heart disease with severe pneumonia due to COVID-19, presents aortic thrombosis, resulting in acute lower extremity ischemia. Thrombectomy was performed, post procedure and associated with reperfusion, presented cardiorespiratory arrest with sustained asystole, died despite resuscitation maneuvers. Conclusion: Despite prophylaxis measures with low molecular-weight heparins (LMWH), thromboembolic complications should be sought in patients with this infection to provide timely management and monitor post-surgical complications that can be fatal.

Estado ácido-base en obstetricia crítica y altitud / Acid-base status in critical care obstetrics at altitude

OBJETIVO: describir el estado ácido base en pacientes obstétricas críticamente enfermas a muy alta altitud, al momento de su ingreso a la Unidad de Cuidados Intensivos. MATERIAL Y MÉTODO: estudio descriptivo transversal. Se incluyen todas las pacientes obstétricas internadas en la Unidad de Cuidados Intensivos Adultos del Hospital del Norte de la ciudad de El Alto, La Paz a 4150 metros sobre el nivel del mar, ingresadas en el periodo enero 2019-enero 2022. RESULTADOS: se ingresaron 79 pacientes, con media de edad de 29 años (desviación estándar 8.06 años), 52 casos (66%) por preeclampsia severa, 14 casos (18%) por hemorragia obstétrica, 8 casos (10%) por sepsis obstétrica y 5 (6%) por diagnósticos diversos como taquicardia supraventricular e intoxicaciones, existieron 8 pacientes fallecidas (10% de mortalidad) destacando la sepsis obstétrica con mayor fallecimiento y mayor tiempo de internación. CONCLUSIÓN: los cambios fisiológicos propios del embarazo, la convierten en una paciente de riesgo, identificando la diferencia de iones fuertes aparente y abreviada como posibles factores pronóstico en la paciente obstétrica en estado crítico. PALABRAS CLAVE: estado acido-base, obstetricia crítica, gran altitud

OBJECTIVE: to describe the acid base status in critically ill obstetric patients at very high altitude, at the time of admission to the Intensive Care Unit. METHODOLOGY: retrospective descriptive study. All obstetric patients admitted to the Adult Intensive Care Unit of the Hospital del Norte in the city of El Alto, La Paz at 4150 meters above sea level, in the period January 2019-January 2022, are included. RESULTS: 79 patients were admitted, with a mean age of 29 years (standard deviation 8.06 years), 52 cases (66%) due to severe preeclampsia, 14 cases (18%) due to obstetric hemorrhage, 8 cases (10%) due to obstetric sepsis. and 5 (6%) due to various diagnoses such as supraventricular tachycardia and poisoning, there were 8 deceased patients (10% mortality), highlighting obstetric sepsis with the highest death rate and longest hospital stay. DISCUSSION: the physiological changes during pregnancy make her a risk patient, identifying the apparent and abbreviated strong ion difference as possible prognostic factors in the critically ill obstetric patient

A Escola Sob Ataque e o Lento Cancelamento do Futuro / The School Under Attack and the Slow Cancellation of the Future / La Escuela Bajo Ataque y la Lenta Cancelación del Futuro

A realidade social, política e educacional do Brasil, nos últimos anos, vem cobrando novos posicionamentos do campo que articula a Psicanálise e a Educação no país. Com o artigo, buscamos modos da Psicanálise, como uma teoria crítica, em diálogo com o campo da educação e da política, contribuir com um melhor entendimento dos sintomas sociais que se apresentam nas questões educacionais e, em especial, na onda de violência que atualmente assola as instituições escolares. Entendemos que os recentes ataques às escolas têm que ser vistos no contexto de vários outros ataques, desde a ausência histórica de investimentos em educação no país, até ao espectro de morte que ronda o cotidiano escolar, com as altas taxas de homicídios e suicídios de adolescentes, expressões e consequências da necropolítica e do Estado suicidário que se instala na sociedade brasileira. Para discutir aspectos educacionais é ainda necessário articular questões das ciências, da natureza, da economia e da política. À guisa de conclusão, o escrito provoca a necessidade de que se possa fazer, aos jovens, a transmissão pelo desejo de imaginar outros mundos e sonhar outros sonhos.

The social, political and educational reality in Brazil, in recent years, has demanded new positions from the field that articulates Psychoanalysis and Education in the country. This article seeks ways for Psychoanalysis, as a critical theory, in dialogue with the field of education and politics, to contribute to a better understanding of the social symptoms that appear in educational issues and, in particular, in the wave of violence that currently plagues educational institutions. We understand that the recent attacks on schools have to be seen in the context of several other attacks, from the historical lack of investment in education in the country, to the spectre of death that surrounds everyday school life, with the high rates of homicides and suicides in adolescents - expressions and consequences of necropolitics and the suicidal state that is installed in Brazilian society. When discussing educational aspects, we necessarily need to articulate issues of science, nature, economics and politics. By way of conclusion, this paper provokes the need to transmit to young people the desire to imagine other worlds and dream other dreams.

La realidad social, política y educativa en Brasil, en los últimos años, ha demandado nuevos posicionamientos del campo que articula el Psicoanálisis y la Educación en el país. De esta manera, el artículo busca caminos para que el Psicoanálisis, como teoría crítica, en diálogo con el campo de la educación y la política, contribuya a una mejor comprensión de los síntomas sociales que aparecen en los temas educativos y, en particular, en la ola de violencia que azota actualmente a las instituciones educativas. Entendemos que los recientes ataques a escuelas tienen que ser vistos en el contexto de varios otros ataques, desde la falta histórica de inversión en educación en el país, hasta el espectro de muerte que rodea la cotidianidad escolar, con los altos índices de homicidios y suicidios en adolescentes, expresiones y consecuencias de la necropolítica y del estado suicida que se instala en la sociedad brasileña. Es decir, cuando se habla de aspectos educativos, necesariamente necesitamos articular temas de ciencia, naturaleza, economía y política. A modo de conclusión, el escrito provoca la necesidad de transmitir a los jóvenes el deseo de imaginar otros mundos y soñar otros sueños.

Estados hipertensivos del embarazo y complicaciones materno-perinatales en el Hospital Regional De Ciudad del Este

Introducción: Los estados hipertensivos del embarazo son un conjunto de patologías que puede producir muerte o discapacidad crónica en las madres, en los fetos y recién nacidos. Objetivo: Determinar la frecuencia de los estados hipertensivos del embarazo y las complicaciones materno-perinatales en el Hospital Regional de Ciudad del Este. Materiales y métodos: Estudio transversal descriptivo con muestreo no probabilístico. Se estudiaron a todas las mujeres embarazadas con estados hipertensivos del embarazo o asociado al mismo que tuvieron eventos obstétricos en el Hospital Regional de Ciudad del Este en los años 2018 al 2020. Los datos fueron analizados en el Software Stata 12.0. Resultados: Se estudiaron a 7056 pacientes. Se encontraron 11,9% participantes con estados hipertensivos del embarazo, 55,3% con mayor frecuencia entre los 20 a 35 años, el 71,3% tuvieron control prenatal de mala calidad, se encontraron el 42,8% con preeclampsia. El 65,2% terminaron por cesárea, 27,8% Síndrome de HELLP, el 1,4% presentaron requerimiento de terapia intensiva y 0,6% muerte materna. Con respecto a las complicaciones perinatales se encontraron bajo peso al nacer en 30,2% y muerte del 2%. Conclusión: Se registró alta frecuencia de estados hipertensivos del embarazo con alto porcentaje de complicaciones, mala calidad de control prenatal. Entre las complicaciones perinatales más frecuentes fueron el bajo peso al nacer y la más grave es la muerte.

Introduction: Hypertensive states of pregnancy are a set of pathologies that can cause death or chronic disability in mothers, fetuses and newborns. Objective: To determine the frequency of hypertensive states of pregnancy and maternal-perinatal complications at the Regional Hospital of Ciudad del Este. Materials and methods: Descriptive cross-sectional study with non-probability sampling. All pregnant women with hypertensive states of pregnancy or associated with pregnancy who had obstetric events at the Regional Hospital of Ciudad del Este in the years 2018 to 2020 were studied. The data were analyzed in Stata 12.0 software. Results: A total of 7056 patients were studied. 11.9% of participants had hypertensive states of pregnancy, and among them, 55.3% were found to be more frequent from 20 to 35 years of age, 71.3% had poor prenatal care, and 42.8% had preeclampsia. 65.2% of the participants ended up with cesarean delivery, 27.8% had HELLP syndrome, 1.4% required intensive care and 0.6% ended in maternal death. Regarding perinatal complications, low birth weight was found in 30.2%, and death at birth in 2%. Conclusion: A high frequency of hypertensive states of pregnancy with a high percentage of complications and poor quality of prenatal control was registered. One of the most common perinatal complications were low birth weight, and the most serious was death.

Estado da arte sobre a produção científica nacional da medicalização do comportamento / State of the art research on the brazilian national scientific production of medicalization of behavior / Estado del arte sobre la producción científica de la medicalización del comportamiento

O presente trabalho apresenta uma pesquisa de estado da arte, de caráter quantitativo, que objetivou realizar o mapeamento das publicações científicas nacionais sobre o tema da medicalização do comportamento entre os anos 2000 e 2018. Neste levantamento, foram identificados os autores, seus respectivos estados, regiões e instituições de origem, número de publicações por ano, periódicos nos quais os artigos foram publicados e áreas de conhecimento desses periódicos, sujeitos-alvo das pesquisas, tipo de pesquisa e a ênfase da medicalização envolvida. Para isso, a base Periódico-CAPES ofereceu o material analítico, a partir da seguinte estratégia de busca: medicalização AND (comportament* OR desvio OR conduta OR transtorno OR sofrimento). A partir dos dados coletados, foram construídos gráficos com o fim de obter um panorama das investigações sobre o tema em questão. Os dados encontrados sinalizam, dentre outras coisas: o aumento do número de publicações a partir do ano de 2009; a concentração de autores nos estados das regiões Sudeste e Sul; a maior prevalência de publicações em revistas de Saúde Coletiva e Interdisciplinar; a predominância de pesquisa teórica relativamente aos estudos empíricos; a prevalência das mulheres como sujeito-alvo de quantidade importante de pesquisas sobre medicalização do comportamento. (AU)

This study presents quantitative state-of-the-art research aimed at mapping Brazilian scientific publications on the topic of medicalization of behaviors between the years 2000 and 2018. The research identified authors, their respec-tive states, regions, and institutions of origin, the number of publications per year, the journals in which the articles were published, the fields of knowledge of these journals, the target subjects of the research, the type of research, and the emphasis on the involved medicalization. Data from the Periodic Portal from CAPES provided the analytical material using the following search strategy: medicalization AND (behavior* OR deviation OR conduct OR disorder OR suffering). The collected data were used to create graphs in order to provide an overview of the research on the subject. The findings indicate, among other things: an increase in the number of publications since 2009; a concentration of authors in Brazilian states from the southeastern and southern regions; a higher prevalence of publications in journals related to Collective and Inter-disciplinary Health fields; a predominance of theoretical research compared to empirical studies; and a significant focus on women as the subject of research on medicalization of behaviors. (AU)

En el presente trabajo fue realizada una investigación cuantitativa del Estado del Arte que objetivó el mapeado de las publicaciones científicas sobre el tema de la medicalización del comportamiento, entre los años 2000 y 2018. En este levantamiento, fueron identificados los autores, sus respectivos estados, regiones e instituciones de origen, número de publicaciones por año, periódicos en los cuales los artículos fueron publicados y las áreas de conocimiento de estos periódicos, tema objetivo de las investigaciones, tipo de investigación y énfasis de la medicalización involucrada. Para ello, fue utilizado el Periódico-CAPES, aplicando los siguientes descriptores: medicalización AND (comportamient* OR desvío OR conducta OR trastorno OR sufrimiento). A partir de los datos colectados, fueron construidos gráficos con el fin de ofrecer un panorama de las investigaciones sobre el tema en cuestión. Los datos encontrados señalan, entre otras cosas: el aumento del número de publicaciones a partir del año de 2009; la concentración de los autores en los estados de las regiones del Sudeste y Sur; la mayor prevalencia de publicaciones en revistas de Salud Colectiva e Interdisciplinaria; la predominancia de la investigación teórica relativa a los estudios empíricos; la prevalencia de las mujeres como objeto de investi-gación de cantidad importante de investigaciones sobre la medicalización del comportamiento. (AU)

Subjetivar-se em situação de violência: a violência de estado e a criminalidade na vida dos adolescentes da periferia autores de atos infracionais / Becoming subjects in a context of violence: state violence and criminality in the lives of adolescent offenders from the periphery / Subjetivación en situación de violencia: la violencia del estado y la criminalidad en la vida de los adolescentes de la periferia autores de actos infraccionales

Na pesquisa em questão, relaciona-se a violência de Estado com a criminalidade na vida dos adolescentes da periferia autores de atos infracionais, partindo do viés da Psicologia Social. Abordando a historicidade das violências estruturais no Brasil, enquanto configuração de um Estado democrático de exceção permanente - pela implementação de um projeto necropolítico -, o trabalho baseou-se em quatro eixos teóricos principais: a violência de Estado, a necropolítica, o racismo estrutural e os adolescentes autores de atos infracionais. Para pensar os efeitos psicossociais da segregação, da violência, do racismo e da criminalização da pobreza na construção da subjetividade dos adolescentes autores de atos infracionais, o trabalho teve como método a análise do livro "Memórias de um Sobrevivente", de Luiz Alberto Mendes. As discussões abrangem o crime enquanto status e visibilidade; as análises de uma vida imersa em violência generalizada; e as torturas policiais em relação com a violência por vingança. Conclui-se que os estigmas aprisionam o sujeito em crenças de que ele só tem capacidade de ser o "marginal esperado", quem reage violentamente como efeito psicossocial de uma violência estrutural que produz sujeitos agressivos. Assim, a criação de novas práticas de atuação em psicologia nas situações sociais críticas se faz imprescindível e urgente. (AU)

In the research at hand, we explore the relationship between State violence and criminality in the lives of adolescents residing in marginalized commu-nities who have committed delinquent acts, from the perspective of Social Psychology. Addressing the historical context of structural violence in Brazil as a manifestation of a democratic state of permanent exception - through the implementation of a necropolitical agenda - this study is founded on four primary theoretical pillars: State violence, necropolitics, structural racism, and adolescent offenders. To contemplate the psychosocial repercussions of segregation, violence, racism, and the criminalization of poverty in the formation of the subjectivity of adolescent delinquents, this work employs the analysis of the book "Memórias de um Sobrevivente" by Luiz Alberto Mendes as its methodology. Discussions encompass the concept of crime as a social status and its visibility; analyses of a life deeply entrenched in pervasive violence; and police brutality within the context of retaliatory violence. Our conclusion asserts that the societal stigmas ensnare these adolescents, confining them to the belief that they are destined to be the "expected delinquent," predisposed to react violently as a psychosocial response to the structural violence that fosters aggressive behaviors. Consequently, the development of novel psychological interventions in critical social contexts is both imperative and urgent. (AU)

En la investigación en cuestión, la violencia estatal está relacionada con la criminalidad en la vida de los adolescentes de la periferia que cometieron delitos, por la perspectiva de la Psicología Social. Abordando la historicidad de la violencia estructural, en Brasil, como una configuración de un estado democrático de excepción permanente - a través de la implementación de un proyecto necropolítico. El trabajo se basó en cuatro ejes teóricos: la violencia de Estado, necropolítica, racismo estructural y adolescentes autores de actos infraccionales. Para reflexionar sobre los efectos psicosociales de la segregación, violencia, racismo y criminalización de la pobreza en la construcción de la subjetividad de los adolescentes en conflicto con la ley, fue utilizado el análisis del libro "Memórias de um Sobrevivente", de Luiz Alberto Mendes. Los debates abarcan el crimen como estatus y visibilidad; análisis de una vida inmersa en la violencia generalizada; y tortura policial en relación con la violencia por venganza. Se concluye que los estigmas aprisionan al sujeto en creencias de que solo tiene la capacidad de ser el "marginal esperado", que reacciona violentamente como efecto psicosocial de una violencia estructural que produce sujetos agresivos. Así, la creación de nuevas prácticas en psicología en situaciones sociales críticas es fundamental y urgente. (AU)

Predictors of early catheter replacement after HoLEP. Results from a high-volume laser center

ABSTRACT Introduction: The aim of the study was to investigate clinical and surgical factors associated with early catheter replacement in patients treated with Holmium Laser Enucleation of the Prostate (HoLEP). Materials and Methods: Data of patients treated with HoLEP at our Institution by a single surgeon from March 2017 to January 2021 were collected. Preoperative variables, including non-invasive uroflowmetry and abdominal ultrasonography (US), were recorded. Bladder wall modifications (BWM) at preoperative US were defined as the presence of single or multiple bladder diverticula or bladder wall thickening ≥5 mm. Clinical symptoms were assessed using validated questionnaires. Only events occurred within the first week after catheter removal were considered. Results: Overall, 305 patients were included, of which 46 (15.1%) experienced early catheter replacement. Maintenance of anticoagulants/antiplatelets (AC/AP) therapy at surgery (p=0.001), indwelling urinary catheter (p=0.02) and the presence of BWM (p=0.001) were more frequently reported in patients needing postoperative re-catheterization. Intraoperative complications (p=0.02) and median lasing time (p=0.02) were significantly higher in this group. At univariate analysis, indwelling urinary catheter (p=0.02), BWM (p=0.01), ongoing AC/AP therapy (p=0.01) and intraoperative complications (p=0.01) were significantly associated with early catheter replacement. At multivariate analysis, indwelling urinary catheter (OR: 1.28; p=0.02), BWM (OR: 2.87; p=0.001), and AC/AP therapy (OR: 2.21; p=0.01) were confirmed as independent predictors of catheter replacement. Conclusions: In our experience the presence of indwelling urinary catheter before surgery, BWM and the maintenance of AC/AP therapy were shown to be independent predictors of early catheter replacement after HoLEP.

On conducting a study among institutionalised adolescents in Kerala, India: legal and ethical challenges

We report the dilemmas faced by the investigators while conducting a study on the social and environmental factors for protection of the mental health of adolescents placed under State protection in Kerala, India. The proposal received counsel and directives from the Integrated Child Protection Scheme authorities, under the Social Justice Department of Kerala state and the Institutional Ethics Committee of the host institution. The investigator faced and had to reconcile conflicting directives and antithetical field realities, with respect to seeking informed consent from the study participants. The physical act of adolescents signing the consent form, rather than the actual process of assent, received disproportionately more scrutiny. The authorities also questioned the privacy and confidentiality requirements raised by the researchers. Of the 248 eligible adolescents, 26 chose to dissent from participating in the study, demonstrating that choices would be made if they are offered. There is a need for more discourse on achieving steadfast adherence to the principles of informed consent, particularly in research on vulnerable groups such as institutionalised children.

Histological artifacts associated with laser and electroscalpel gingivectomy: Case series / Artefactos histológicos asociados a gingivectomía con láser y electrobisturí: serie de casos

Introduction. Over time, efforts have been invested in the design of new instruments that overcome the disadvantages of the gold standard instrument in surgery, the scalpel. As a result, electronic equipment has emerged such as the electric scalpel and laser devices. The available evidence on these instruments suggests that the tissue response is related to each instrument's physical and biological cutting principles. Objective. To compare the histological changes in gingiva samples associated with surgical cutting performed with a 940 nm diode laser, a 2780 nm erbium, chromium: yttriumscandium-gallium-garnet (Er,Cr:YSGG) laser, and an electric scalpel, by presenting a series of cases. Case presentation. We present three cases of healthy patients undergoing cosmetic surgery. The clinical examination revealed exposure of a keratinized gingiva band greater than 4 mm, normal color and texture in gingival tissue, with a firm consistency and no bleeding on periodontal probing. Gingivectomy was indicated with the following protocols: Diode laser of 940 nm at 1 W, in continuous mode; Er,Cr:YSGG laser of 2780 nm at 2.5 W, 75 Hz, H mode, air 20, water 40, gold tip MT4); and electric scalpel in cutting mode at power level four. Gingival tissue samples were taken and stored in 10% formaldehyde for histological analysis. Conclusion. All the evaluated cutting instruments generated histological changes produced by the thermal effect, the main ones being collagen coagulation and carbonization. The depth of thermal damage caused by the 2780 nm Er,Cr:YSGG laser was much lesser than that induced by the electric scalpel and the 940 nm diode laser.

Introducción. Históricamente se ha invertido esfuerzo en el diseño de nuevos instrumentos que superen las desventajas del estándar de referencia en cirugía, el bisturí. Como consecuencia de esto, han surgido equipos electrónicos como el electrobisturí y los diferentes dispositivos de tecnología láser. La información disponible sobre estos instrumentos sugiere que la respuesta del tejido intervenido está influenciada por los principios físicos y biológicos de corte del instrumento. Objetivo. Comparar los cambios histológicos en muestras de encía asociados al corte quirúrgico realizado con láser de diodo de 940 nm, láser de erbio, cromo: itrio-escandio-galio-granate (Er,Cr:YSGG) (2780nm) y electrobisturí mediante una presentación de serie de casos. Presentación de los casos. Se presentan tres casos de pacientes sanos sometidos a cirugía estética. El examen clínico reveló la exposición de una banda gingival queratinizada mayor de 4 mm, tejido gingival de color y textura normales, de consistencia firme y sin sangrado al sondaje periodontal. Se indicó gingivectomía con los siguientes protocolos: láser de diodo de 940 nm a 1 W, en modo continuo; láser de Er,Cr:YSGG de 2780 nm a 2,5 W, 75 Hz, modo H, aire 20, agua 40, punta de oro MT4; y bisturí eléctrico en modo de corte, a nivel de potencia cuatro. Se tomaron muestras de tejido gingival y se almacenaron en formaldehído al 10 % para su análisis histológico. Conclusión. Los tres instrumentos de corte generaron cambios histológicos producidos por el efecto térmico; los principales fueron coagulación del colágeno y carbonización. La profundización del daño térmico causada por el láser de Er,Cr:YSGG de 2780 nm fue mucho menor que la generada por el electrobisturí y por el láser de diodo de 940 nm.

Política Pública de Saneamento Básico no Brasil: ideias, instituições e desafios no Século XXI / Basic Sanitation Policy in Brazil: ideas, institutions and challenges in the Twenty-first Century

Resumo Este trabalho aborda os desafios contemporâneos do setor de saneamento básico brasileiro. As características de rentabilidade e dinamismo setorial puseram os serviços estatais de A & E no foco da agenda das reformas estruturais sob o argumento de que os governos não dispõem de recursos necessários para universalizar a cobertura. A agenda da reforma dos serviços de A & E advoga a concessão a empresas privadas da comercialização do abastecimento de água e do tratamento do esgotamento sanitário. Em convergência com esta agenda de reforma estrutural, a aprovação em 15 de julho de 2020 da Lei 14.026 alterou em profundidade o marco legal do saneamento, adotando integralmente a pauta da desestatização do setor. O novo marco regulatório veta o contrato de programa, torna obrigatória a licitação para contratação do serviço de saneamento, estabelece diretrizes nacionais para que estados e municípios acessem recursos federais e institui o regime de regulação nacional por meio da Agência Nacional de Águas e Saneamento Básico. O modelo cooperativo praticado no Sistema Único de Saúde (SUS) pode servir como referência para a construção de um pacto social no setor.

Abstract This paper describes the challenges currently facing Brazil's basic sanitation sector. The sector's characteristic profitability and dynamism have brought State-run Water & Sewage (W&S) services into the spotlight of the structural reform agenda on the argument that governments do not have the resources necessary to universalize coverage. There is a pattern of W&S services' operating with a surplus, which helps explain the intense dispute in recent years in favour of legal changes to the market position of CESBs and local providers to favour an expanding role for private agents. Converging with the structural reform agenda, Law 14,026, sanctioned on 15 July 2020, made far-reaching changes to the legal framework for sanitation and provided for the State's complete withdrawal from the sector. The new regulatory framework prohibited programme contracts, required tender processes for sanitation service contracts, encouraged regionalization without CESBs, set out national guidelines for States and municipalities to access federal funding and introduced a national regulation regime under the National Waters and Basic Sanitation Agency. The model of cooperation that operates in the SUS could serve as a reference for constructing a social pact in the sector.