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ABSTRACT Aging and face sagging have many causes, and various techniques are used for treatment, including noninvasive procedures, such as focused ultrasound, which uses the principle of collagen regeneration by coagulative necrosis of the dermis layers using radiofrequency, but this procedure has complications. We reported a case of a 54-year-old female patient who complained of poor visual acuity in her right eye three days after a focused ultrasound facial aesthetic procedure, with the best visual acuity of 20/60. Biomicroscopy of the right eye revealed an acute cataract with three points of fibrosis extending from the posterior to the anterior capsule. The patient underwent phacoemulsification surgery with visual rehabilitation and improved vision of 20/20. We hypothesized that the occurrence of acute cataract was related to the inappropriate use of focused ultrasound.

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Introdução: a poluição sonora é um problema de saúde pública e é considerada a segunda maior causa de poluição no mundo moderno. Observa-se no ambiente acadêmico edificações que comprometem o conforto acústico, podendo apresentar impactos negativos para os estudantes e para outros frequentadores. Objetivo: analisar o entendimento de estudantes universitários sobre o ruído, seus impactos e a sua presença em uma clínica-escola. Métodos: pesquisa transversal e exploratória realizada por meio da aplicação de um questionário on-line com estudantes de uma instituição de ensino superior federal. A análise do conteúdo das respostas foi feita por meio de análise descritiva, análise estatística, categorização e nuvem de palavras. Resultados: obteve-se 83 questionários respondidos pelos estudantes. Os termos "barulho", "incômodo" e "som desagradável" foram utilizados para definir ruído, e "perda auditiva", "estresse", "desconcentração", "dor de cabeça", "zumbido" e "irritabilidade" para caracterizar as consequências à exposição ao ruído. Entre os discentes, 38,6% acreditam que a clínica-escola não é ruidosa, 36,1% não souberam informar e 25,3% referiram que o local era ruidos opor motivos relacionados à acústica da infraestrutura, quantidade de pessoas circulando no espaço e localização geográfica. Conclusão: apesar de a maior parte dos estudantes estarem cientes sobre os efeitos negativos à saúde da exposição ao ruído, verificou-se que eles vivenciam situações de risco dentro e fora do contexto universitário, reforçando a necessidade de ações de promoção à saúde auditiva e prevenção de agravos. (AU)

Introduction: Noise pollution is a public health problem and is considered the second biggest cause of pollution in the modern world. Buildings that compromise acoustic comfort can be observed in the academic environment, which may have negative impacts on students and users. Objective: to analyze students' understanding of noise and its impacts and its presence in a clinic school. Methods:Cross-sectional and exploratory research, carried out through the application of an online questionnaire with university students from a federal educational institution. The content analysis of the responses was carried out using descriptive analysis, statistical analysis, categorization and word cloud. Results:83 questionnaires were answered by students. The words "noise, nuisance, unpleasant sound" were used to define noise and "hearing loss, stress, deconcentration, headache, tinnitus and irritability" for the consequences of exposure to noise. 38.6% believe that the clinic school is not noisy, 36.1% did not know how to inform and 25.3% said that the place was noisy, this noise justified by: acoustics of the clinic's infrastructure, number of people circulating in the space and geographic location. Conclusion:Although most students are aware of the negative health effects of exposure to noise, it was observed that they experience risk situations inside and outside the university context, reinforcing the need for actions to promote hearing health and prevent injuries. (AU)

Introducción: La poluición sonora es un problema de salud pública y considerada la segunda causa de poluición en el mundo moderno. En el ambiente académico se pueden observar edificaciones que comprometen el confort acústico, lo que puede tener impactos negativos en los estudiantes y usuarios. Objetivo: analizar la comprensión de los estudiantes sobre el ruido y sus impactos y su presencia en una clínica escolar. Métodos: Investigación transversal y exploratoria, realizada mediante la aplicación de un cuestionario en línea con estudiantes universitarios de una institución educativa federal. El análisis de contenido de las respuestas se realizó mediante análisis descriptivo, análisis estadístico, categorización y nube de palabras. Resultados: 83 cuestionarios fueron respondidos por los estudiantes. Se utilizaron las palabras "ruido, molestia, sonido desagradable" para definir el ruido y "pérdida de audición, estrés, falta de concentración, dolor de cabeza, tinnitus e irritabilidad" para las consecuencias de la exposición al ruido. 38,6% creen que la clínica escuela no es ruidosa, 36,1% no supieron informar y 25,3% refirieron que el sitio era ruidoso, ruido éste justificado por: acústica de la infraestructura de la clínica, cantidad de personas que circulan en el espacio y ubicación geográfica. Conclusión: Aunque la mayoría de los estudiantes son conscientes de los efectos negativos para la salud de la exposición al ruido, se observó que experimentan situaciones de riesgo dentro y fuera del contexto universitario, lo que refuerza la necesidad de acciones para promover la salud auditiva y prevenir agravios. (AU)

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Background: COVID-19 was a dreadful disease that turned into a pandemic, which made drug therapy a challenging task. With the advancement of medical science, the treatment of diseases has become much more sophisticated and with the advent of the vaccination system, the prevention of dreadful diseases that affect vast human communities can be effective is possible. Aims and Objectives: This work was initiated to understand the safety of Covishield™ by following the patients for any possible side effects and adverse effects after 1st and 2nd doses of vaccination. Materials and Methods: This retrospective cohort study was conducted in Panimalar Medical College Hospital and Research Institute, Chennai, India, on participants who got vaccinated with Covishield™ and reported the adverse effects that were noticed after 14 days of vaccination. Results: Out of 184 subjects who participated in the study, 161 patients suffered pain at the injection site after the first dose, of which 90% of the participants were relieved and 93 suffered after the second dose, of which 95% of the participants were relieved with little medical intervention in the form of analgesics. Almost 50% of participants suffered fever and fatigue and <30% of the participants suffered headache, chills, and giddiness within 2 days of the first dose. Lump and warmth at the injection site are common with any vaccination and the incidence was <10% of the participants. All the symptoms subsided with intervention with paracetamol. Conclusion: The safety of the vaccine is evident from this study. Through this study, we hope that the administration of the vaccination can be conducted doubtlessly to fight COVID-19 and any symptoms that arise eventually can be monitored and treated.

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La hidroxicloroquina es un medicamento derivado de la Cloroquina ampliamente utilizado para el tratamiento de enfermedades inmunológicas, de creciente indicación debido a su eficacia en estas patologías. Paralelamente, se ha descrito dentro de sus reacciones adversas, la toxicidad retinal, específicamente macular, que se presenta ante la administración crónica del fármaco, habitualmente mayor a 5 años. La maculopatía por hidroxicloroquina es asintomática en etapas tempranas, observándose signos clínicos inespecíficos al examen de fondo de ojo. En etapas avanzadas aparece dificultad en la lectura, escotomas en el campo visual y finalmente, la pérdida de la visión central. El diagnóstico precoz se realiza mediante tomografía de coherencia óptica (SD-OCT), campo visual computarizado, autofluorescencia del fondo de ojos (FAF) y el electrorretinograma multifocal (mfERG). No existe tratamiento para esta enfermedad, la única herramienta para prevenir la pérdida de visión es la suspensión del medicamento y sólo es efectiva en los primeros estadios clínicos. Por este motivo, se han desarrollado guías clínicas orientadas a la evaluación periódica preventiva y la indicación de suspensión del tratamiento ante el hallazgo de ciertos criterios diagnósticos. El presente artículo está orientado a presentar una actualización de las recomendaciones de Screening de maculopatía para los pacientes en tratamiento crónico con Hidroxicloroquina, debido a que su difusión a los médicos tratantes, no exclusivamente reumatólogos, es esencial para la derivación oportuna al oftalmólogo y la prevención de la pérdida visual

Hydroxychloroquine is a Chloroquine derived drug widely used for the treatment of immunological diseases, with increasing indication due to its effectiveness in these pathologies. At the same time, retinal toxicity has been described among its adverse reactions which occurs with chronic administration of the drug, usually greater than 5 years. Hydroxychloroquine Maculopathy is asymptomatic in early stages, with non-specific clinical signs observed during fundus examination. In advanced stages, the patient reports difficulties to read, the visual field shows scotomas and finally central vision is lost. Early diagnosis is made using optical coherence tomography (SD-OCT), computed visual field, fundus autofluorescence (FAF) and multifocal electroretinogram (mfERG). There is no treatment for this disease, the only measure to prevent vision loss is the suspension of the medication and it is only effective in the early clinical stages. For this reason, clinical guidelines have been developed focusing on periodic preventive evaluation and the indication of suspension of treatment when certain diagnostic criteria are found. This article is aimed at presenting an update of the Maculopathy Screening recommendations for patients undergoing chronic treatment with Hydroxychloroquine, because its dissemination to treating physicians, not exclusively rheumatologists, is essential for timely referral to the ophthalmologist and prevention of visual loss.

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Background: Over-the-Counter (OTC) medications are the drugs that do not require prescription. In earlier times, self-medication of OTC drugs was not considered a healthy practice. But now FDA stated that “when these medications are used according to guidelines, they are considered safe and effective”. Although along with the potential benefits over-use and miss-use is considered harmful and can cause potential side effects. Objective: The research is carried out with objective to assess patient knowledge regarding OTC medicines use pattern, potential side effects and interactions. Methods: The cross-sectional, observational study was conducted in different cities of Punjab, Pakistan. Data was collected on validated questionnaire after getting consent from 162 patients. And SPSS version 26 was used for statistical analysis of the collected data. Patients below 18 years of age were excluded from the study. Results: A total of 162 patients participated in the current study. A statistically non-significant association was observed between the participants' gender and their level of knowledge regarding OTC medication, with a p-value of 0.442. However, a statistically significant association was found between having healthcare providers among family members and knowledge about OTC medication, with a p-value of 0.015 and an effect size of 0.008, indicating a weak positive association. Additionally, geographical location demonstrated a direct positive effect, with a p-value of 0.001 and an effect size of 0.330, which reflects a moderate positive association according to Cohen's classification. Conclusion: Gender does not affect overall knowledge of OTC medications; however, education has a direct impact on understanding and using medications. Among the sources of information regarding OTC medications, healthcare providers within family members are identified as the most significant source.

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Introduction: Different non-pharmacological interventions have been studied to manage symptoms derived from chemotherapy, but their effectiveness is unknown. Objective: To describe non-pharmacological interventions for managing symptoms secondary to antineoplastic chemotherapy in adults. Materials and Methods: Systematic review of analytical experimental and observational studies (2021 to 2023). The studies were selected, and data was extracted in parallel. Discrepancies were resolved with a third reviewer. The risk of bias was assessed using the Risk of Bias (RoB) tool and The Newcastle-Ottawa Scale (NOS). The literature was synthesized descriptively based on prioritized outcomes. Results: The prioritized outcomes were neutropenia, pain, neuropathy, nausea, vomiting, alopecia, anorexia, and sleep disorders. Out of 7520 references found, 62 were included for analysis. Acupressure showed a possible effect in controlling symptoms such as nausea and vomiting. The intervention with cold on the scalp showed differences in the stages of alopecia severity. Other interventions showed heterogeneity. Discussion: Non-pharmacological interventions have been widely described in observational and experimental studies in the control of side effects of chemotherapy; however, there is homogeneity and a high risk of bias. Conclusion: Acupressure, muscle massage, music therapy, foot baths, and other interventions have been studied for nausea, vomiting, sleep disorders, neutropenia, alopecia, anorexia, pain, and neuropathy as secondary symptoms prioritized by patients. It is necessary to standardize both the interventions and how measure the outcomes.

Introducción: Diferentes intervenciones no farmacológicas se han estudiado para manejar los síntomas derivados de la quimioterapia, pero se desconoce su efectividad. Objetivo: Describir las intervenciones no farmacológicas para el manejo de síntomas secundarios a la quimioterapia antineoplásica en adultos. Materiales y Métodos: Revisión sistemática de estudios experimentales y observacionales analíticos (2021 a 2023). La selección de estudios y extracción de datos se realizó de forma paralela. Las discrepancias se resolvieron con un tercer revisor. Se evaluó el riesgo de sesgo con las herramientas Risk Of Bias (RoB) y The Newcastle-Ottawa Scale (NOS). La síntesis de la literatura se realizó de forma descriptiva por desenlace priorizado. Resultados: Los desenlaces priorizados fueron neutropenia, dolor, neuropatía, náuseas, vomito, alopecia, anorexia y desordenes del sueño. Se encontraron 7520 referencias, 62 incluidas para el análisis. La acupresión mostró un posible efecto en el control de síntomas como las náuseas y vomito. La intervención con frio en el cuero cabelludo mostro diferencias en los estadios de la severidad de alopecia. Las otras intervenciones mostraron heterogeneidad. Discusión: Las intervenciones no farmacológicas han sido ampliamente descritas en estudios observaciones y experimentales en el control de efecto secundarios a la quimioterapia, sin embargo, existe homogeneidad, y alto riesgo de sesgo. Conclusión: Acupresión, masaje muscular, musicoterapia, baño de pies entre otros son las intervenciones que se han estudiado para náuseas, vomito, desordenes del sueño, neutropenia, alopecia, anorexia, dolor y neuropatía como síntomas secundarios priorizados por pacientes. Se requiere estandarizar tanto las intervenciones como la forma de medición de los desenlaces.

Introdução: Diferentes intervenções não farmacológicas têm sido estudadas para o manejo dos sintomas decorrentes da quimioterapia, mas sua eficácia é desconhecida. Objetivo: Descrever intervenções não farmacológicas para o manejo dos sintomas secundários à quimioterapia antineoplásica em adultos. Materiais e Métodos: Revisão sistemática de estudos analíticos experimentais e observacionais (2021 a 2023). A seleção dos estudos e a extração dos dados foram realizadas paralelamente. As discrepâncias foram resolvidas com um terceiro revisor. O risco de viés foi avaliado por meio das ferramentas Risk Of Bias (RoB) e Newcastle-Ottawa Scale (NOS). A síntese da literatura foi realizada de forma descritiva por desfecho priorizado. Resultados: Os desfechos priorizados foram neutropenia, dor, neuropatia, náuseas, vômitos, alopecia, anorexia e distúrbios do sono. Foram encontradas 7.520 referências, 62 incluídas para análise. A acupressão mostrou possível efeito no controle de sintomas como náuseas e vômitos. A intervenção fria no couro cabeludo mostrou diferenças nos estágios de gravidade da alopecia. As demais intervenções apresentaram heterogeneidade. Discussão: Intervenções não farmacológicas têm sido amplamente descritas em estudos observacionais e experimentais no controle dos efeitos colaterais da quimioterapia, porém há homogeneidade e alto risco de viés. Conclusão: Acupressão, massagem muscular, musicoterapia, escalda-pés, entre outras, são as intervenções que têm sido estudadas para náuseas, vômitos, distúrbios do sono, neutropenia, alopecia, anorexia, dor e neuropatia como sintomas secundários priorizados pelos pacientes. É necessário padronizar tanto as intervenções quanto a forma de medir os resultados.

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Introducción. El manejo adecuado de la tuberculosis multirresistente es una estrategia priorizada para el control de la tuberculosis en el mundo. Objetivo. Evaluar las diferencias entre las características demográficas y clínicas, y los indicadores programáticos de los pacientes con diagnóstico confirmado de tuberculosis pulmonar resistente a rifampicina o multirresistente en Buenaventura, frente a la cohorte de los demás municipios del Valle del Cauca entre 2013 y 2016. Materiales y métodos. Se desarrolló un estudio analítico de cohortes para comparar los registros de pacientes mayores de 15 años con tuberculosis multirresistente, del Programa de Tuberculosis de Buenaventura (con ácido paraaminosalicílico), frente a los demás municipios del Valle del Cauca (sin ácido paraaminosalicílico). Resultados. Se registraron 99 casos con una mediana de edad de 40 años (RIC = 26 - 53); en Buenaventura, el 56 % eran mujeres; en los demás municipios, predominaron los hombres (67 %); el 95 % de los evaluados tenía aseguramiento en salud. La comorbilidad más frecuente fue diabetes (14 %). Las reacciones adversas a medicamentos antituberculosos en Buenaventura fueron 1,3 veces más frecuentes que en los demás municipios (OR = 2,3; IC95 %: 0,993 - 5,568; p = 0,04). En Buenaventura falleció el 5 % de los casos frente al 15 % reportado en los demás municipios. No hubo fracasos con el tratamiento en Buenaventura, pero se reportó un 35 % de pérdida del seguimiento. El éxito del tratamiento fue mayor en Buenaventura en el 56 %. Conclusión. El programa fortalecido de Buenaventura presentó mejores resultados programáticos que los demás municipios del Valle del Cauca. El acceso a pruebas moleculares, la disponibilidad de tratamientos acortados y el seguimiento continuo para identificar reacciones adversas a medicamentos antituberculosos son un derrotero para todos los programas de control.

Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.

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Aims: This study aims to investigate the potential therapeutic effects and mechanisms of cannabidiol (CBD) in the treatment of Parkinson's disease (PD). Specifically, it focuses on understanding the role of CBD in managing motor and non-motor symptoms and its neuroprotective properties. Study Design: This research is a literature review. Place and Duration of Study: The study was conducted at the University of Gurupi, Paraíso do Tocantins, TO, in 2023. Methodology: A comprehensive literature review was conducted using databases such as Medline (PubMed), Biblioteca Virtual de Saúde (BVS), and Scientific Electronic Library Online (SciELO). Articles published in Portuguese and English were included. The search terms used were "Parkinson's Disease," "CBD," and "Treatment." The selection criteria focused on studies exploring the mechanisms of action, anti-inflammatory, and analgesic properties of CBD in the context of PD. Articles unrelated to the use of CBD for PD treatment or not exclusively focusing on CBD administration were excluded. Results: The review included findings from seven scientific articles. Key outcomes indicate that CBD exhibits neuroprotective effects, reduces global symptom scores, and does not produce adverse motor effects. Notably, CBD was found to protect against cell death induced by neurotoxins like MPP+ and provide potential anti-inflammatory benefits by modulating cytokine release. Conclusion: CBD shows promise as a therapeutic agent in PD due to its neuroprotective, anti-inflammatory, and analgesic properties. However, the clinical use of CBD remains limited and controversial, requiring further research to validate its efficacy and safety in treating PD. This summary provides an overview of the findings and methodologies covered in the full text, highlighting the potential and challenges of using CBD in Parkinson's disease treatment.

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Background: The effectiveness of treating malaria may be jeopardized by artemisinin-resistant parasites. Pharmaceutical companies have been using plants for a very long time to generate the prototype molecules needed to treat Plasmodium infections. Objective: To evaluate anti-plasmodial potency of extracts of Delonix regia and Carica papaya when used in combinations with chloroquine. Methods: The plants were collected from Homa-Bay County in Kenya, dried under shade to a consistent weight, and then milled into a fine powder. Organic solvents were then used for extraction. After phytochemical screening of the extracts was conducted, In vitro tests were done on the extracts against Plasmodium falciparum, with a starting concentration of 100µg/mL. To prepare the test concentration ranges, the extracts were serially diluted 2-fold in growth medium. In a sealed gas chamber, the assay plates were incubated at 370C for 72 hours with 3% O2 and 4% CO2 with N2 as the balance. By comparing each well's absorbance to that of a well that contained the drug-free control, the number of parasites still present at each concentration of the test substance were ascertained. Plotting survival against concentration enabled the determination of the IC50 values by a non-linear dose response curve fitting. Results: In this investigation, the extracts from Delonix regia showed significant synergism (based on IC50 shifts) with CQ for both the ethyl acetate and methanol extracts with the exception of the highest combination dosage. Carica papaya extracts were much improved by the presence of CQ; however, this was not consistently reflected in the corresponding CQ IC50. Conclusion: The results of this study which revealed synergism between the study plants extracts and chloroquine, support the reasons why some traditional healers have started combining medicinal herbs with chloroquine to boost its potency.

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Background: Anxiety is one of the common mental disorders. Non-fatal health loss is one of the consequences of anxiety disorders. Oxidative stress may also play a role in anxiety disorders. As an antioxidant, Vitamin C can create stable ascorbate free radicals and lower reactive oxygen species. In addition, Vitamin C can prevent damage caused by free radicals. Oxidative stress can also lead to depression, schizophrenia, and bipolar disorder. Aim and Objectives: The aim and objectives of the study are to compare the antianxiety effects of Vitamin C, buspirone, and diazepam in albino rats using elevated plus maze and hole board apparatus. Materials and Methods: 36 albino rats of either sex were divided into 6 groups of 6 rats each and drugs were administered orally. Group 1 received distilled water 10 ml/kg, Group 2 received Vitamin C 200 mg/kg, Group 3 received buspirone 10 mg/kg, Group 4 received diazepam 1 mg/kg, Group 5 received buspirone 10 mg/kg + Vitamin C 200 mg/kg, and Group 6 received diazepam 1 mg/kg + Vitamin C 200 mg/kg. Antianxiety effects of these drugs were tested after 14 days of drug administration using hole board apparatus and elevated plus maze. The methods used for statistical analysis were mean, standard deviation, confidence interval, median, interquartile range (IQR), frequency and percentage, ANOVA, Kruskal–Wallis test, and Fisher’s exact test. Results: On average time spent in open arms by Group 5 was 98.00 sec (IQR: 19.75–138.00) which was higher than other groups, but it was not statistically significant (P = 0.845). The time spent in closed arms in seconds by Group 4 was 245 ± 28.863, which was higher than other groups, but it was not statistically significant (P = 0. 805). On average head dip by Group 5 was 9.83 ± 4.708, which was higher than other groups, but it was not statistically significant (P = 0.141). Conclusion: Group 5 rats that received buspirone and Vitamin C, followed by Group 6 rats that received diazepam and Vitamin C had spent more time and had more entries into the open arms. Furthermore, Groups 5 and 6 animals had a greater number of head dips in the hole board apparatus compared to the behavior of all animals in other groups. Buspirone and diazepam are known anxiolytics. When these drugs were given in combination with Vitamin C, the antianxiety behaviors in rats were more compared to the drugs given alone in the present study but it was not statistically significant.

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Background: The first-line treatment for people with acute mania, mood disorders, severe depression, and catatonia is electroconvulsive therapy (ECT). The goal of anesthesia during ECT is to cause unconsciousness, and the drugs administered should not have any effect on seizures. Because all anesthetics have some ability to change seizures, the kind of anesthetic used in modified ECT becomes crucial. This study aimed to assess the hemodynamic profile during modified ECT and the effects of ketamine and thiopentone sodium on seizure duration. Aims and Objectives: The aim of the study was to compare the outcome of ECT, such as hemodynamics, improvement in depression, and duration of seizure, with ketamine versus thiopentone sodium in depressive disorder. Materials and Methods: A prospective observational study was conducted with 50 randomly selected depression patients after obtaining permission from the Institutional Ethics Committee and consent from the patients and attendants from June 2021 to November 2022. All 50 cases were equally divided into group K and group T. To obtain the data, a predesigned, semi-structured questionnaire was used along with the Hamilton rating scale for depression and ECT. The Chi-square test was used to measure the association between two categorical variables. A P < 0.05 was considered statistically significant. Results: The mean heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and saturation of peripheral oxygen are higher in group K than in group T, and the mean difference was significant between group K and group T. Groups had a statistically significant association with increased secretions, nausea and vomiting, and headache, but not with gender, ASA grade, and number of ECT sessions. Conclusion: Compared to ketamine, thiopentone sodium was found to have minimal hemodynamic derangements, a decrease in seizure duration, and side effects.

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Resumo Fundamento A Doença de Chagas (DC) representa um grave problema de saúde pública na América Latina. O Benznidazol (BNZ) é utilizado para o tratamento DC e, apesar do seu amplo uso, poucas informações estão disponíveis sobre sua toxicidade e mecanismos das Reações Adversas ao Medicamento (RAM). Objetivos Identificar e classificar as reações adversas clínicas e laboratoriais ocasionadas pelo uso do BNZ quanto à sua causalidade e gravidade. Métodos Estudo de coorte prospectivo realizado no período de janeiro de 2018 a dezembro de 2021. O acompanhamento do tratamento incluiu consultas e análises laboratoriais antes, 30 e 60 dias após o início do tratamento. As RAM foram classificadas quanto à causalidade e gravidade. Na análise estatística o nível de significância adotado foi p<0,05. Resultados Participaram do estudo 40 pacientes com DC crônica, observou-se alta prevalência de RAM com um total de 161 em 30 (90%) pacientes. Destas, 104 (64,6%) foram classificadas como possíveis e 57 (35,4%) como prováveis. As reações foram classificadas em moderadas e leves. Dos 40 pacientes, nove (22,5%) suspenderam o tratamento. As RAM associadas à interrupção e intervenções foram as que afetaram o sistema dermatológico, sistema nervoso central e periférico ou que culminaram em ageusia. Após 30 dias de tratamento, alterações hematológicas e bioquímicas leves foram observadas como linfopenia. Conclusão Apesar do elevado percentual de RAM, muitos pacientes foram capazes de completar o tratamento, o que se atribui ao êxito da estratégia de acompanhamento com intervenções de tratamento sintomático juntamente ao aconselhamento, levando à compreensão da sintomatologia e manutenção do tratamento.

Abstract Background Chagas disease (CD) is a serious public health problem in Latin America. Benznidazole (BNZ) is used for the treatment of CD and, despite its wide use, little information is available about its toxicity and mechanisms of adverse drug reactions (ADR). Objectives To identify and classify clinical and laboratory adverse reactions caused by BNZ in terms of causality and severity. Methods Prospective cohort study from January 2018 to December 2021. Treatment follow-up included visits and biochemical tests (complete blood count, liver and kidney function tests) before, during and after treatment. ADR were classified according to causality and severity. In the statistical analysis, the significance level was set at p<0.05. Results Forty patients with chronic CD were included. A high prevalence of ADR was observed 161 ADR in 30 patients [90%]; of these, 104 (64.6%) were classified as possible and 57 (35.4%) as probable. The ADR were classified as moderate and mild. Of the 40 patients, nine (22.5%) discontinued treatment. ADR associated with treatment discontinuation and interventions were those that affected the dermatological system, central and peripheral nervous system and sense organs such as ageusia. Mild hematological and biochemical changes such as lymphopenia were observed after 30 days of treatment. Conclusion Many patients were able to complete the treatment even with ADR, which can be attributed to the successful follow-up strategy with symptomatic treatment and counseling, leading to patient's awareness of symptoms and treatment adherence.

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Resumen Introducción : El objetivo de este estudio fue evaluar los efectos adversos y la respuesta inmune de anticuer pos IgG anti S1 SAEA-CoV-2 en el personal de Salud del Hospital del Milagro de la ciudad de Salta, posterior a recibir dos dosis de vacuna COVID-19. Métodos : Se realizó un estudio prospectivo de co horte desde marzo de 2021 hasta abril 2022. Se reco pilaron datos demográficos, clínicos, eventos adversos supuestamente atribuidos a la vacunación (ESAVI) y se tomaron dos muestras de sangre para medir los niveles de anticuerpos. Resultados : Participaron 408 voluntarios, 401 (98%) fueron vacunados con Sputnik- V. La edad promedio fue de 45.5 años con predominio del sexo femenino (71%). Los ESAVI fueron reportados en 188 (46.1%) y 121 (29.7%) luego de la primera y segunda dosis respectivamente (p<0.001). Estos eventos fueron mayormente de carácter leve y transitorios, más frecuentes luego de la primera dosis. El primer dosaje de anticuerpos fue positivo en 99% con una media de títulos de 9.7 (SD 3.7). El segundo dosaje fue positivo en 88% con una media de títulos de 6.4 (SD 4.4). Los participantes con antecedentes de infección y dosajes previos positivos mostraron títulos significativamente más altos de anticuerpos (p<0.001). Conclusión : Los ESAVI reportados fueron mayorita riamente leves y transitorios. La vacunación masiva y la administración de la dosis recomendada son esenciales para lograr una inmunidad colectiva efectiva. La mayoría de los trabajadores de la salud vacunados desarrollaron anticuerpos y aquellos que cursaron la enfermedad previa a la vacunación presentaron títulos significativos más elevados de anticuerpos.

Abstract Introduction : The aim of this study was to evaluate the adverse effects and immune response associated with IgG anti S1 SAEA-CoV-2 antibodies among health care workers at Señor del Milagro Hospital in Salta city, after receiving two doses of COVID-19 vaccine. Methods : A prospective cohort study was carried out from March 2021 to April 2022. Demographic, clinical data, adverse events supposedly attributed to vaccina tion (AEFIs) were collected and two samples were taken to measure serum antibody levels. Results : 408 volunteers participated, 401 (98%) were vaccinated with Sputnik-V. The average age was 45.5 years with a predominance of the female sex (71%). AEFIs were reported in 188 (46.1%) and 121 (29.7%) after the first and second doses respectively (p<0.001). These events were mostly mild and transient, more frequent after the first dose. The first antibody test was positive in 99% with a mean titer of 9.7 (SD 3.7). The second dosage was positive in 88% with a mean titer of 6.4 (SD 4.4). Participants with a history of infection and previous positive testing showed significantly higher antibody titers (p<0.001). Conclusion : The AEFIs reported were mostly mild and transient. Mass vaccination and administration of the recommended dose are essential to achieve effective herd immunity. The majority of vaccinated healthcare workers developed antibodies and those who had the disease prior to vaccination had significant antibody titers.

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Los pesticidas son un grupo de compuestos químicos que tienen diferentes acciones, insecticidas, fungicidas, herbicidas, rodenticidas. Luego de su aplicación el proceso de degradacion es lento. Pueden permanecer en el suelo y en las aguas subterráneas, contaminando el agua. El cambio climático transforma el proceso de degradación de los compuestos químicos, por la alteración de la composición del suelo, produciendo alteraciones en el ecosistema y la biodiversidad.El impacto de los pesticidas sobre la salud humana es un desafío por el gran potencial de daño que tienen. Desde el año 2004, se introduce en Paraguay las semillas geneticamente modificadas, acompañado de un gran incremento de las areas de cultivo y la utilizacion de pesticidas.Con el objetivo de revisar el estado del conocimiento actual sobre los efectos de estas sustancias quimicas, sobre los diferentes organos y sistemas en las poblaciones pediatricas y embarazadas, se realizo una revision descriptiva, abarcando las principales base de datos disponibles.Como objetivo secundario, considerando la extension de areas de cultivo en Paraguay, describir los resutlados de los estudios realizados en el pais. Los resultados de los estudios revisados muestran asociacion entre afectacion de diferentes organos, sistemas, de estas poblaciones y la exposcion ambiental, de las aguas y los alimentos. Algunos de estos resultados se replican en los realizados en las zonas de cultivo del pais.

Pesticides, such as insecticides, fungicides, herbicides, and rodenticides, are a group of chemical compounds that have different actions. After their application, the degradation process is slow. They can remain in the soil and groundwater, contaminating the water. Climate change transforms the process of degradation of chemical compounds, by altering soil composition, producing alterations in the ecosystem and biodiversity. The impact of pesticides on human health is challenging because of the great potential for harm they have. Since 2004, genetically modified seeds have been introduced in Paraguay, accompanied by a great increase in cultivation areas and pesticide use. To review the current state of knowledge about the effects of these chemical substances on the different organs and systems in pediatric and pregnant populations, a descriptive review was carried out, utilizing the main available databases. As a secondary objective, considering the extension of cultivation areas in Paraguay, we also described the results of studies carried out in the country. The results of the reviewed studies show an association between the involvement of different organ systems in these populations and environmental exposure, water, and food. Some of these results are replicated in those carried out in the country's growing areas.

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Resumen La Pancreatitis Aguda es un efecto secundario inusual de la metformina. Se presenta el caso de una mujer de 29 años con antecedentes de Pancreatitis Aguda Necrotizante Baltazar D en 2020. En marzo de 2021, presenta nuevamente pancreatitis aguda, esta vez clasificada como Baltazar C, sin necrosis evidente. Las investigaciones no revelaron causas habituales, pero se destacó que, en las dos semanas previas a ambos episodios, la paciente había recibido tratamiento con metformina para el síndrome de Ovario Poliquístico y Prediabetes, respectivamente. La respuesta exitosa incluyó la administración de líquidos intravenosos y la suspensión del medicamento, lo cual evitó complicaciones inmediatas y logró una reversión completa de los síntomas. En casos similares, es crucial identificar factores de riesgo, ajustar la dosis según la función renal y realizar una vigilancia estrecha ante cualquier sintomatología asociada con la Pancreatitis Aguda.

Abstract Acute Pancreatitis is an unusual side effect of Metformin. The case of a 29-year-old woman with a history of necrotizing Acute Pancreatitis, classified as Baltazar D in 2020, is presented. In March 2021, she experienced another episode of Acute Pancreatitis, this time classified as Baltazar C, without evident necrosis. Investigations did not reveal common causes, but it was noted that, in the two weeks preceding both episodes, the patient had received Metformin treatment for Polycystic Ovary syndrome and Prediabetes, respectively. The successful response involved intravenous fluid administration and discontinuation of the medication, preventing immediate complications, and achieving complete reversal of symptoms. In similar cases, it is crucial to identify risk factors, adjust the dose based on renal function, and closely monitor for any symptoms associated with acute pancreatitis.

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Background: Wellness encompasses various interconnected physical, mental, and social dimensions beyond the traditional definition of health. Vitamin D deficiency is a widespread nutritional deficiency, with a prevalence of 80%–90% in India, and is often under-diagnosed and under-treated worldwide. While vitamin D is classically known for its role in bone health, it also has significant extra-skeletal effects, including maintaining muscle function, immunity, anti-inflammatory activity, and cell proliferation and differentiation. Recent studies have linked vitamin D deficiency to fatigue, myalgia, low-energy fractures, muscle weakness, anxiety, and depression. Furthermore, it is implicated in the development of type 1 and type 2 diabetes mellitus (DM) and hypertension. Vitamin D deficiency is also associated with recurrent exacerbations of bronchial asthma, autoimmune diseases, and malignancies. Addressing this deficiency can substantially enhance patient well-being, prevent serious health outcomes, and improve overall wellness. Aim: This study aims to investigate the relationship between wellness and vitamin D levels. Materials and Methods: This prospective nonrandomized therapeutic study was conducted at MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India, and included 246 participants from July 2021 to December 2022. The study included patients reporting generalized weakness, fatigue, myalgia, low mood, lack of motivation, and decreased interest in life by the inclusion and exclusion criteria. Their serum vitamin D levels were tested. Participants with vitamin D deficiency (<30 ng/mL) completed a pre-structured well- being questionnaire and received vitamin D supplementation for 10 weeks. Wellness in these patients was evaluated using a pre-structured post-supplementation well-being questionnaire. Results: The results revealed that out of 324 patients included in the study, 253 (78.1%) were deficient in vitamin D. The highest deficiency rate was among those aged 18–35 years (85.5%). Vitamin D deficiency was more prevalent in females (79.5%, 167 out of 210 females) compared with males (75.4%, 86 out of 114 males). The paired t test results showed a significant increase in post-test vitamin D levels (t = -219.922, P < 0.001) and a significant decrease in post-test Fatigue Assessment Scores (t = 31.328, P < 0.001) and Fatigue Severity Scores (t = 33.066, P < 0.001). Additionally, there was a significant improvement in post-test World Health Organization-Five Well-Being Index (WHO-5) scores (t = -28.495, P < 0.001) and Warwick– Edinburgh Mental Well-being Scores (WEMWBS; t = -28.996, P < 0.001). Karl Pearson’s correlation coefficient indicated that post-supplementation vitamin D levels were positively correlated with post-supplementation Fatigue Assessment Scores (r = 0.315) and Fatigue Severity Scores (r = 0.334). Conversely, they negatively correlated with the WHO-5 Well-being Index (r = -0.322) and the WEMWBS (r = -0.294). Conclusion: This study concludes that wellness is directly correlated with vitamin D levels. There is a significant improvement in the Fatigue Assessment Scale, Fatigue Severity Scale, WHO-5 Well-being Index, WEMWBS, and overall physical, mental, and social wellness following vitamin D supplementation in patients, both with and without comorbidities (hypertension and DM).

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Introduction: Telehealth is increasingly being used for symptom management among cancer patients on chemotherapy. Objective of the study is to develop Nurse-led Tele-health Oncology Clinic for GI cancer patients regarding ‘Home Management during Chemotherapy’. Methods: The study will follow sequential explanatory mixed method design where during quantitative phase, using RCT (CTRI/2024/01/062028), GI cancer patients of age 18-65 years and undergoing 2nd or 3rd chemotherapy cycle will be randomised after obtaining consent to experimental (EG) & control (CG) groups. Ethical Clearance is already obtained. EG will be followed through Nurse-led Clinic which includes multiple virtual educational & counselling sessions, e-booklet on side effects management, PMRT, Support groups & telephonic follow ups. Effectiveness will be measured in terms of Quality of life, severity of side effects and Anxiety using FACT-G, CTCAE and DASS respectively. In qualitative phase, using extreme case sampling, in-depth interviews from consented participants will be conducted to explore experiences towards intervention. Analysis: Analysis of quantitative data will use descriptive and inferential statistics. This follows thematic analysis and integration of data. Conclusion: The study protocol will provide guidance to optimize utility of tele-medicine technology to improve healthcare outcomes especially for the GI cancer patients.

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Intravenous methylprednisolone is an important therapeutic modality in many conditions, owing to their anti-inflammatory and immune-modulating properties. Along with other side-effects of corticosteroids, cardiovascular side-effects are also seen in varying degree in children. Sinus bradycardia is reported uncommonly in children following high dose intravenous methylprednisolone. We report two paediatric cases without any underlying cardiac problems with asymptomatic bradycardia following high dose intravenous methylprednisolone. Heart rate reduction was seen from 30-40% compared to the baseline heart rate, which returned to its normal value after 24-36 hours of stoppage of the offending drug. A high index of suspicion along with strict cardiovascular monitoring is necessary in patients receiving high dose of methylprednisolone.

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Introduction: Antineoplastic therapy (AT) can cause unwanted effects, including dental alterations. However, many of the studies are case control or cohort studies, use a big number of patients, and may make it difficult to discuss the individual sequels. Objective: Therefore, this article aims to describe five cases of patients who had done AT in childhood or adolescence and discuss the radiography alterations. The side effects related were agenesis (five patients), root anomalies (two patients) and microdontia (two patients). This individual case analysis enabled to discuss chemotherapeutic agents and radiation parameters individually and the age of dental formation when the patient did the AT. Conclusion: In these cases, only when the therapy was perform in the age of teeth formation it was consider a direct effect of AT, so the cases presents root malformations, microdontia and premolars agenesis and third molars agenesis. On the other hand, another cases of root malformations, microdontia and third molars agenesis may be an indirect effect of AT or caused by other external factors, because the AT was not performed at the age of formation of these teeth.

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Introducción. La salud auditiva es un tema de interés en salud pública que afecta la calidad de vida y que puede afectarse por la exposición continua al ruido, un factor de riesgo que genera síntomas auditivos y extraauditivos. Objetivo. Identificar el estado de salud auditiva de adultos que viven en Bogotá, y su asociación con factores de exposición a ruido ambiental, individuales y otológicos. Materiales y métodos. Se realizó un estudio transversal mediante el análisis de una base de datos con 10.311 registros, obtenidos entre los años 2014 y 2018, producto de una encuesta estructurada de percepción de ruido y tamizaje auditivo. Se hizo un análisis descriptivo bivariado y una regresión logística binaria. Resultados. El 35,4 % de los participantes presentó disminución auditiva. En el componente de percepción: 13,0 % refirió no escuchar bien, 28,8 % informó síntomas extraauditivos, 53,3 % tenía antecedentes otológicos, y 69,0 % manifestó molestia por ruido extramural. En la regresión logística, las variables más asociadas con disminución auditiva fueron: de las ambientales, vivir en zonas de mayor ruido (OR = 1,50) (IC95%: 1,341,69); de las individuales, ser hombre (OR = 1,85) (IC95%: 1,64-2,09) y la edad (por cada año de vida, el riesgo de disminución auditiva aumentó 6 %); y de las otológicas, tener antecedente de síntomas otológicos (OR = 1,86) (IC95%: 1,66-2,08). Conclusiones. La disminución auditiva es multicausal en la población evaluada. Los factores que aumentan su prevalencia son incremento de la edad, ser hombre, tabaquismo, medicamentos ototóxicos, vivir en zonas de mayor exposición a ruido y presentar síntomas extraauditivos.

Introduction. Hearing health is a public health concern that affects the quality of life and can be disturbed by noise exposure, generating auditory and extra-auditory symptoms. Objective. To identify the hearing health status in adults living in Bogotá and its association with environmental noise exposure and individual and otological factors. Materials and methods. We conducted a cross-sectional study using a database with 10,311 records from 2014 to 2018, consigned in a structured survey of noise perception and hearing screening. We performed a descriptive, bivariate, and binary logistic regression analysis. Results. Of the included participants, 35.4% presented hearing impairment. In the perception component, 13.0 % reported not hearing well; 28.8 % had extra-auditory symptoms, 53.3 % informed otological antecedents and 69.0 % presented discomfort due to extramural noise. In the logistic regression, the variables with the highest association for hearing impairment were living in noisy areas (OR = 1.50) (95% CI: 1.34-1.69), being male (OR = 1.85) (95% CI: 1.64-2.09), increasing age (for each year of life, the risk of hearing impairment increased 6%), and having history of extra-auditory symptoms (OR = 1.86) (95% CI: 1.66-2.08). Conclusions. Hearing impairment is multi-causal in the studied population. The factors that promote its prevalence are increasing age, being male, smoking, ototoxic medications, living in areas with high noise exposure, and extra-auditory symptoms.