Vértigo en gestantes: presentación clínica, impacto en la calidad de vida y factores asociados / Vertigo in pregnancy: clinical presentation, impact on quality of life and associated factors

OBJETIVO: Evaluar las características clínicas, el impacto en la calidad de vida y los factores asociados con vértigo en gestantes hospitalizadas en una institución de alta complejidad. MÉTODO: Estudio transversal. Se realizó una encuesta dirigida a la presencia de vértigo y sus características clínicas en 2020-2021. La calidad de vida se evaluó con el cuestionario Dizziness Handicap Inventory (DHI). El análisis estadístico incluyó un modelo lineal generalizado. RESULTADOS: De 103 mujeres, el 19,4% indicaron vértigo principalmente en el segundo trimestre de gestación (60%), con una mediana de 3,5 (rango intercuartil: 1,5-7,5) episodios. Fueron referidos vértigos episódicos asociados con cambios posicionales (40%), acompañados de inestabilidad (60%), cefalea (60%), fotopsias (55%) y tinnitus (45%). Las mujeres con vértigo presentaron mayor frecuencia de discapacidad moderada a grave en las dimensiones del DHI emocional (30 vs. 2,4%; p = 0,001), funcional (40 vs. 2,4%; p < 0,001) y física (55 vs. 2,4%; p < 0,001) en comparación con las mujeres sin la patología. La hospitalización durante el embarazo Razón de proporción (RP): 4,02; intervalo de confianza del 95% [IC95%]: 1,64-9,85; p = 0,002) y la presencia de vértigo pregestacional (RP: 2,37; IC95%: 1,15-4,88; p = 0,019) se identificaron como factores asociados. CONCLUSIONES: La alta frecuencia de vértigo en las gestantes sugiere la importancia de estudiar esta condición durante el embarazo, para lograr un manejo integral y generar acciones de prevención y control efectivas.

OBJECTIVE: To evaluate clinical characteristics, impact on quality of life and factors associated with vertigo in pregnant women hospitalized in a highly complex institution. METHOD: A cross-sectional study was conducted in 2021-2022. One focused survey including Dizziness Handicap Inventory (DHI) was performed. The statistical analysis was performed using a generalized lineal regression. RESULTS: 103 patients were included, 19.4% indicated vertigo mostly during the second semester (60%). A median of 3.5 episodes was obtained (RIC: 1.5-7.5). Positional and episodic vertigos (40%) associated with unsteadiness (60%), headache (60%), photopsia (55%) and tinnitus (45%) were described. DHI in pregnant females with vertigo compared to those without vertigo, presented higher rates of moderate to severe disability in the emotional (30 vs. 2.4%: p = 0.001), functional (40 vs. 2.4%; p < 0.001) and physical (55 vs. 2.4%; p < 0.001) dimensions. Hospitalizations during the pregnancy (RP: 4.02; 95%CI: 1.64-9.85; p = 0.002) and previous episodes before pregnancy (RP: 2.37; 95%CI: 1.15-4.88; p = 0.019) were identified as associated factors with current vertigo episodes. CONCLUSIONS: The high frequency of vertigo in pregnant women suggests the importance of studying this condition during pregnancy, to achieve comprehensive management and generate effective prevention and control actions.

Bullying escolar: associação com possível bruxismo do sono e fatores desencadeantes / School bullying: association with possible sleep bruxism and triggering/precipitant factors

Bullying é um comportamento agressivo que gera consequências emocionais. Indivíduos vulneráveis estão sujeitos a sofrer esta agressão. Bruxismo do sono (BS) é uma atividade muscular mastigatória que está associado a fatores psicossociais. O objetivo do artigo 1 (n=431) foi analisar a associação de possível BS com bullying escolar. O objetivo do artigo 2 (n=425) foi identificar a associação entre fatores desencadeantes de bullying e indivíduos envolvidos em bullying como vítimas e vítimas-intimidadores. O objetivo do artigo 3 foi analisar a acurácia da resposta dada pelos responsáveis em um questionário acerca do BS comparado ao diário do sono. O estudo foi aprovado pelo Comitê de Ética e Pesquisa em Humanos da Universidade Federal de Minas Gerais (protocolo 82839718.4.0000.5149). Participaram da pesquisa escolares com idade entre 8 a 11 anos, matriculados em escolas públicas e privadas de Lavras, e seus responsáveis. Os responsáveis responderam a um questionário, desenvolvido para a pesquisa, com duas perguntas sobre a ocorrência do BS (ranger de dentes [RD]) nos escolares, dados sociodemográficos e um diário do sono de sete dias. Os escolares responderam um questionário, desenvolvido para a pesquisa, sobre dentes, cabelo, cor da pele, altura, peso, boca, nariz e outras características que podem interferir no relacionamento com os pares na escola; e preencheram a versão brasileira do Olweus Bully/Victim Questionnaire. A análise estatística do artigo 1, 2 e 3 incluiu análises descritivas. A regressão de Poisson (RR:Razão das Taxas) foi utilizada no artigo 1 e a regressão Logística Multinomial (OR) no artigo 2 (p≤0,05). No artigo 3 os resultados foram fornecidos com curva ROC e medição de acurácia (área sob a curva ­ AUC). Como resultado para o artigo 1 verificou-se que a frequência de RD entre os escolares vítimas-intimidadores foi 1,57 maior (RR=1,57; IC95%=1,04­2,36; p= 0,030). A frequência de RD entre os escolares que relataram acordar cansados pela manhã pelo menos uma vez por semana foi 1,33 vezes maior (RR=1,33; IC95%=1,00­1,78; p=0,050) e a frequência de RD entre escolares cuja renda familiar mensal é igual ou inferior a um salário mínimo apresentou 1,49 vezes maior (RR=1,49, IC95%=1,04-2,13, p=0,027). No artigo 2 observou-se que escolares vítimas-intimidadores eram mais propensos a serem de escola pública (OR=5,43, IC95%=1,14-25,91; p=0,034) e os escolares vítimas de bullying eram mais propensos a relatarem outras características individuais, como uso de óculos (OR=3,31; IC95%=1,14-9,57; p=0,027) e características dos dentes (OR=3,80; IC95%=1,38-10,41; p=0,010) como fatores que atrapalham seu convívio com os colegas. No artigo 3 verificou-se que a comparação do questionário com o diário do sono, para diagnóstico de BS, demonstrou uma AUC de 87,6% (IC95%=83,2% - 92,1%). Conclui-se que estar envolvido em comportamentos de bullying na escola, cansaço do escolar ao acordar e baixa renda familiar estão associados ao possível BS entre escolares. Os achados mostraram, também, que dentes e outras características individuais estão associados à ser vítima de bullying e estar envolvido em bullying como vítima-intimidador está associado com o tipo de escola. O questionário de diagnóstico de BS mostrou uma acurácia relevante quando comparado ao diário do sono de 7 dias.

Bullying is an aggressive behavior that generates emotional consequences. Vulnerable individuals are more likely to suffer this aggression. Sleep bruxism is a masticatory muscle activity that is associated with psychosocial factors. The objective of article 1 (n=431) was to analyze the association of possible sleep bruxism (SB) with school bullying. The objective of article 2 (n=425) was to identify the association between triggering factors of bullying and individuals involved in bullying as victims and bully-victims. The objective of article 3 was to analyze the accuracy of the response given by guardians in a questionnaire about sleep bruxism (SB) compared to the sleep diary. The study was approved by the Human Research Ethics Committee of the Federal University of Minas Gerais under protocol number CAAE 82839718.4.0000.5149. Schoolchildren aged between 8 and 11 years old, enrolled in public and private schools in Lavras, and their guardians participated in the research. Guardians answered a questionnaire, developed for research, about the occurrence of SB (gnashing teeth [GT]) in schoolchildren, sociodemographic data, and a seven- day sleep diary. The schoolchildren answered a questionnaire, developed for research, about teeth, hair, skin color, height, weight, mouth, nose, and other factors that can interfere with peer relationships at school. They completed the Brazilian version of the Olweus Bully/Victim Questionnaire. Statistical analysis of articles 1, 2 and 3 included descriptive analyses. Poisson regression (RR-Rate Ratio) was used in article 1 and Multinomial Logistic (OR) regression in article 2 (p≤0.05). In article 3 the results were provided with a ROC curve and accuracy measurement (area under the curve ­ AUC). As a result of article 1, it was found that the frequence of GT among schoolchildren were victims-bullies had 1.57 times higher (RR = 1.57; 95%CI=1.04­ 2.36; p= 0.030). The frequence of GT among schoolchildren who reported waking up tired in the morning at least once a week was 1.33 times higher (RR=1.33; 95%CI=1.00­1.78; p=0.050), frequence of GT among schoolchildren whose family monthly income is equal to a minimum wage or less presented 1.49 times higher (RR=1.49, 95% CI=1.04­2.13, p=0.027). In article 2, it was observed that bully-victim schoolchildren were more likely to be from public schools (OR=5.43, 95%CI=1.14- 25.91; p=0.034) and bullied schoolchildren were more likely to report other individual characteristics (example: use of glasses) (OR=3.31; 95%CI=1.14-9.57; p=0.027) and teeth characteristics (PR=3.80; 95%CI=1.38 -10.41; p=0.010) as factors that interfere with his interaction with colleagues. In article 3, it was found that the comparison of the questionnaire with the sleep diary, for the diagnosis of SB, showed an AUC of 87.6% (CI95%=83.2% - 92.1%) It was concluded that being involved in bullying behaviors at school, schoolchildren tiredness upon waking up, and low family income are associated with possible SB among students. The findings also showed that teeth and other individual characteristics are associated with bullying victims and being involved in bullying as a bully-victim is associated with the type of school. The SB diagnostic questionnaire showed relevant accuracy when compared to the 7-day sleep diary.

Falla hepática aguda sobre crónica / Acute on chronic liver failure

La falla hepática aguda sobre crónica (ACLF) es un síndrome que se presenta en pacientes con cirrosis descompensada, y se caracteriza por una mortalidad elevada a 28 días, que se diagnostica con la combinación de falla hepática y extrahepática. Se han publicado numerosas definiciones, de las cuales se resalta la realizada por la Asociación Europea para el Estudio del Hígado (EASL), la cual tiene en cuenta 6 sistemas orgánicos (hígado, riñón, pulmón, cerebro, coagulación y circulación), y gradúa su gravedad basada en el número de sistemas comprometidos en el momento de la presentación. Entre los pilares en el abordaje del paciente con ACLF es imperiosa la búsqueda de los factores precipitantes, siendo los más frecuentes las infecciones bacterianas, el consumo excesivo de alcohol, la hemorragia de vías digestivas, la injuria hepática inducida por medicamentos y la cirugía hepática o cirugía mayor, teniendo en cuenta que aproximadamente en el 50 % de los casos no se logrará establecer la causa. Los pilares angulares del tratamiento constarán de la reversión o interrupción del factor precipitante, el soporte orgánico y, en aquellos pacientes que cumplan los criterios para trasplante, su realización oportuna.

Acute-on-chronic liver failure is a syndrome that occurs in patients with acute decompensated cirrhosis and is characterized by high 28-day mortality that is diagnosed with a combination of hepatic and extrahepatic organ failure. Numerous definitions have been published with great concern related to the etiology and cause of the decompensation, of which the one made by the European Association for the Study of the Liver (EASL) stands out, taking into account 6 organic systems (liver, kidney, lung, brain, coagulation, and circulation), and grades its severity based on the number of systems involved at the time of presentation. Among the pillars in the approach to the patient with ACLF, the search for precipitating factors is imperative, the most frequent being bacte-rial infections, excessive alcohol consumption, digestive tract bleeding, drug-induced liver injury, liver surgery or major surgery, keeping in mind that in approximately 50% of cases the cause will not be established. The cornerstones of treatment will consist of the reversal or interruption of the precipitating factor, organ support and, in those patients who meet the criteria for transplantation, its timely performance.

Fatores desencadeantes para limitações sociais e saúde mental em diabéticos / Triggering factors for social limitations and mental health in diabetics / Factores desencadenantes de limitaciones sociales y salud mental en diabéticos

Introdução:A Diabetes Mellitus é caracterizada como uma síndrome de múltiplas etiologias, que ocorre pela falta de insulina, ou resistência do organismo à mesma, estando relacionada à diversas complicações que demandam ao paciente adaptações no modo de viver e que podem ser geradores de sofrimento psicológico. Objetivo:Identificar os principais fatores desencadeantes para a ocorrência de limitações sociais e suas consequências na saúde mental de pacientes convivendo com diabetes. Metodologia:O estudo configura-se como revisão integrativa da literatura. Utilizou-se como critérios de inclusão: artigos completos, publicados de 2015 a 2020, nos idiomas inglês, português e espanhol. Foram excluídos: documentos de editoriais, revisões, resenhas, capítulos de livros e artigos que não atendessem ao objetivo proposto. A busca dos estudos se deu entre os meses de outubro a novembro de 2020 nas bases de dados: PubMed,CinahleEmbase. Foram utilizados descritores controlados identificados nos Descritores em CiênciasdaSaúde (DECs), Medical Subject Headings (MESH) e EMBASEEmtree, resultando em 2.063 estudos na identificação, passando por triagem e permanecendo 718, após a elegibilidade resultou em 12, dando origem a 9 estudos na amostra final. Resultados:A amostra final resultou na criação de eixos temáticos que trazem o aumento do sofrimento psicológico em pessoas com diabetes ocasionados pelas mudanças no estilo de vida, na falta de apoio familiar e social, na inatividade física, no impacto do gênero e da cultura, e no aumento dos sintomas de complicações e de comprometimento funcional, sendo desencadeantes para a ocorrência de limitações sociais. Conclusões:A diabetes e o seu tratamento geram limitações sociais na vida dos pacientes, pela necessidade de mudanças no estilo devida que demandam muita dedicação e tempo, tais fatores são considerados preditores para aumento dos riscos de sofrimento psicológico nesses pacientes (AU).

Introduction:Diabetes Mellitus is characterized by being a syndrome of multiple etiologies, which occurs due to the lack of insulin or the body's resistance to it, being related to various complications that require the patient to adapt their lifestyle and that can generate psychological suffering.Objective:Identify the main triggering factors for the occurrence of social limitations and their consequences on the mental health of patients living with diabetes.Method:This study is configured as an integrative review of the literature. The inclusion criteria were full articles, published from 2015 to 2020, in English, Portuguese and Spanish.Editorial documents, reviews, book chapters and articles that did not meet theproposed objective were excluded.The compilation of studies was carried out from October and November 2020 in the databases:PubMed, CinahlandEmbase. In addition, controlled descriptors identified in the Descriptors in Health Sciences (DECs), MESH and EMBASE Emtree were used, which resulted in 2,063 studies identified, submitted for selection, remaining 718, and 12 after the eligibility process, resulting in 9 studies in the final sample.Results:The final sample resulted in the creation of thematic axes that bring an increase in psychological suffering in people with diabetes caused by changes in their lifestyle, lack of family and social support, physical inactivity, impact of gender and culture, and the increase in symptoms of complications and functional impairment, triggering the occurrence of social limitations.Conclusion:Diabetes and its treatment generate social limitations in the lives of patients, due to the need for changes in their lifestyle that require a lot of dedication and time, such factors are considered predictors to increase the risks of psychological suffering in these patients (AU).

Introducción:La Diabetes Mellitus se caracteriza por ser un síndrome de múltiples etiologías, que se presenta por la falta de insulina o por la resistencia del organismo a esta, estando relacionada con diversas complicaciones que requieren del paciente adaptaciones ensumodo de vida y que pueden generar sufrimientopsicológico.Objetivo:Identificar los principales factores desencadenantes parala ocurrenciade limitaciones sociales y sus consecuencias enla salud mental de los pacientes que viven con diabetes.Metodología:Esteestudio se configura como una revisión integradora de la literatura. Se incluyeron: artículos completos, publicados de 2015 a 2020, en inglés, portugués y español.Se excluyeron: documentos editoriales, reseñas, capítulos de libros y artículos que no cumplieron con el objetivo propuesto.El compilado de estudiosse realizóde octubre y noviembre de 2020 en las bases de datos:Medline (PubMed®), CINAHL yEMBASE.Se utilizaron descriptores controlados identificados en los Descriptores enCiencias de la Salud (DECs), MESH y EMBASE Emtree, lo que resultó en 2.063 estudios identificados, sometidos a selección, quedando 718,y resultando, luego del procesode elegibilidad,en 12, dando lugar a 9 estudios en la muestrafinal. Resultados:La muestra final resultó en la creación de ejes temáticos que traen un aumento del sufrimiento psicológico en las personas con diabetes provocado por cambios en suestilo de vida, la falta de apoyo familiar y social, inactividad física, impacto del género y la cultura, y el aumento de los síntomas de complicaciones y deterioro funcional, desencadenando la ocurrencia de limitaciones sociales.Conclusiones:La diabetes y su tratamiento generan limitaciones sociales en la vida de los pacientes, debido a la necesidad de cambios en suestilo de vida que requieren mucha dedicación y tiempo, tales factores se consideran predictores para aumentar los riesgos de sufrimiento psicológico en estos pacientes (AU).

Algunos elementos de interés acerca del diagnóstico y tratamiento de la tormenta tirotóxica / Some elements of interest about the diagnosis and treatment of thyrotoxic storm

Introducción: La tormenta tirotóxica se produce por la liberación repentina y rápida de hormonas tiroideas al torrente sanguíneo. Constituye la complicación más peligrosa de la tirotoxicosis. Objetivo: Describir los principales elementos de interés acerca del diagnóstico y del tratamiento de la tormenta tirotóxica. Métodos: Se utilizaron como motores de búsqueda los correspondientes a las bases de datos Google Académico, Pubmed y SciELO. Las palabras clave utilizadas fueron: tormenta tirotóxica, tormenta tiroidea, tirotoxicosis, hipertiroidismo, diagnóstico y tratamiento. Se evaluaron y se incluyeron los trabajos de revisión, de investigación y las páginas web que tuvieran menos de 10 años de publicados y que por el título trataban el tema de estudio. Fueron excluidos los artículos que no estuvieran en idioma español, portugués o inglés. En total 34 artículos fueran referenciados. Conclusiones: El diagnóstico es eminentemente clínico y se realiza por la detección de factores desencadenantes. Se suma la exacerbación del cuadro clínico de tirotoxicosis previamente existente, el cual afecta a varios sistemas del organismo como consecuencia del aumento de las hormonas tiroideas circulantes. Lo ideal es prevenir la tormenta tirotóxica, aunque ya establecido el tratamiento no se debe retrasar la terapia de la causa desencadenante y de la causa específica. Deberá estar encaminada a reducir la síntesis y la secreción de las hormonas tiroideas y a minimizar las acciones periféricas de estas. Deberán emplearse diferentes fármacos y otras medidas terapéuticas para tratar las complicaciones sistémicas para complementar el tratamiento(AU)

Introduction: Thyrotoxic storm is caused by the sudden and rapid release of thyroid hormones into the bloodstream. It is the most dangerous complication of thyrotoxicosis. Objective: Describe some elements of interest about the diagnosis and treatment of thyrotoxic storm. Methods: Search engines corresponding to Google Scholar, Pubmed and SciELO databases were used. The keywords used were: thyrotoxic storm; thyroid storm; thyrotoxicosis; hyperthyroidism; diagnosis and treatment. The review papers, research papers and web pages, which in general, had less than 10 years of publication and that by the title dealt with the subject of study were evaluated and included. Articles that were not in Spanish, Portuguese or English were excluded. A total of 34 articles were referenced. Conclusions: The diagnosis is eminently clinical and is made by the detection of triggers, to which is added the exacerbation of the clinical picture of thyrotoxicosis previously existing, which affects several systems of the body as a result of the circulating thyroid hormones increase. The ideal is to prevent the thyrotoxic storm; although if the treatment is already established, the therapy of the triggering cause and the specific cause should not be delayed. It should be aimed at reducing the synthesis and secretion of thyroid hormones and minimizing their peripheral actions. Different drugs and other therapeutic measures should be used to treat systemic complications to complement treatment(AU)

Elementos básicos para el diagnóstico y manejo terapéutico del coma mixedematoso en el paciente adulto / Basic elements for the diagnosis and therapeutic management of myxedematous coma in adult patients

Introducción: A pesar de su baja incidencia, la gravedad del cuadro clínico y la alta mortalidad hacen del coma mixedematoso una complicación a tener en cuenta. Objetivo: Describir los elementos básicos para el diagnóstico y manejo terapéutico del coma mixedematoso en el paciente adulto. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema. Se utilizaron buscadores de información científica como Pubmed y Google Académico. La estrategia de búsqueda incluyó los siguientes términos como palabras clave: hipotiroidismo primario, hipotiroidismo subclínico, diagnóstico y tratamiento. Fueron evaluados artículos de revisión, de investigación y páginas web que tuvieran menos de 10 años de publicados. Se consideraron los textos en idioma español e inglés y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 64 artículos, de los cuales 40 fueron referenciados. Conclusiones: Para el diagnóstico del coma mixedematoso en el paciente adulto lo más importante es sospecharlo en aquellas personas que presenten factores precipitantes, acompañados de síntomas y signos de hipotiroidismo severo con diferentes grados de insuficiencia del sistema nervioso central, hipotermia, hipoventilación, insuficiencia circulatoria e hiponatremia. A esto se sumaría el escenario humoral característico y los posibles hallazgos dependientes de la enfermedad causante del hipotiroidismo. Se debe tratar con un reemplazo agresivo de levotiroxina sódica (vía endovenosa u oral, según posibilidades), unido a otras medidas de apoyo en el entorno hospitalario(AU)

Introduction: Despite its low incidence, the severity of the clinical picture and the high mortality make myxedematous coma a complication to be taken into account. Objective: Describe the basic elements for the diagnosis and therapeutic management of myxedematous coma in adult patients. Methods: A search of relevant literature on the subject was carried out. Pubmed and Google Scholar were used as search engines for scientific information. The search strategy included the following keyword terms: primary hypothyroidism, subclinical hypothyroidism, diagnosis and treatment. Review articles, research articles and Web pages that, in general, had less than 10 years of publication, in Spanish and English that specifically referred to the subject of study through the title were evaluated. Articles that did not meet these conditions were excluded. This allowed the study of 64 articles, of which 40 were referenced. Conclusions: For the diagnosis of myxedematous coma in the adult patient, the most important thing is to suspect it in those people who present precipitating factors, accompanied by symptoms and signs of severe hypothyroidism with different degrees of central nervous system insufficiency, hypothermia, hypoventilation, circulatory insufficiency and hyponatremia. To this would be added the characteristic humoral scenario and the possible findings dependent on the disease causing hypothyroidism. It should be treated with an aggressive replacement of levothyroxine sodium (intravenous or oral way, accodring to the possibilities), together with other supportive measures in the hospital setting(AU)

Facteurs prédictifs de l'issue de l'accouchement sur utérus cicatriciel, service de gynécologie obstétrique EHS Batna, Algérie / Predictive factors of the outcome of delivery on scar uterus in the department of obstetrics - gynecology EHS Batna, Algeria

Introduction. La pratique de césariennes est en augmentation constante dans le monde, soulevant la problématique de la gestion des femmes enceintes ayant un utérus cicatriciel. L'objectif de notre travail était d'identifier les facteurs significativement associés au succès de l'épreuve utérine au sein de notre service, afin de réaliser une sélection rigoureuse des candidates à la tentative de voie basse. Méthodes. Nous avons mené une étude épidémiologique descriptive, rétrospective, mono centrique au niveau de l'EHS mère ­ enfant Batna du 1er janvier 2018 au 31 décembre 2019 ayant intéressé les femmees porteuses d'un utérus cicatriciel d'origine obstétricale avec un âge de grossesse supérieur à 22 SA. Résultats. Au cours de notre étude nous avons recensé 3002 accouchements sur utérus cicatriciel. Le taux de tentatives de voie basse après césarienne était de 46,84 % avec un taux de succès de 89,19 %. Les principaux facteurs qui favorisent le succès de la tentative de voie basse après césarienne étaient : un antécédent d'accouchement par voie vaginale après la césarienne (p <0,001) la multiparité (p=0,0002), une césarienne précédente pour présentation podalique (p<0,001), un intervalle inter génésique de 12 mois et plus (p <0,001), des conditions locales favorables (dilatation du col supérieure à 4 cm ; p=0,02 et la p=0,02 et la rupture artificielle des membranes ; p =0,02 et la rupture artificielle des membranes ; p=0,03). Les facteurs qui défavorisent le succès de la TVBAC étaient : un antécédent de césarienne pour stagnation ou non-engagement à dilatation complète (p<0,001), un terme d'accouchement supérieur à 40 SA (p=0,002), un poids de naissance supérieur à 4000 g (p<0,001). Les facteurs qui ne semblent pas influencer l'issue de l'épreuve utérine étaient : l'âge maternel, l'âge de réalisation de la première césarienne, la présence de pathologies maternelles et la réalisation de radiopelvimétrie Conclusion. Les facteurs de succès et d'échec d'une TVBAC sur utérus cicatriciel sont importants à relever pour les décisions ultérieures de la voie d'accouchement, la situation obstétricale doit être soigneusement évaluée et en cas de doute, faire appel à une décision collégiale.

Assessment of clinical profiles, and treatment outcomesforchildren with diabetic ketoacidosis, in two hospitals selectedfromAddis Ababa, Ethiopia, 2020

Background: Type 1 diabetes mellitus (T1DM) is a common autoimmune disorder that often presents in children.In these patients, diabetic ketoacidosis (DKA) is one of the most common and serious acute complications, which is associated with significant morbidity and mortality. The study aimed to assess the clinical profiles and outcomes of children admitted with DKA. Objective: To assess the clinical manifestations and treatment outcomes of DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conducted on 175 pediatric diabetic ketoacidosis children,who were admitted to the emergency units of two hospitals in Addis Ababa from September 2015 to February 2020 and whose medical records contained complete pertinent data. Patients were between the ages of 0 to 12 years. Proportional samples were taken from each hospital and data was collected retrospectively using a formatted checklist. The data was checked for its inclusiveness and entered Epi Info. version 4.6 and then transferred into SPSS version 25 software for further analysis. Result: DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were above the age of 10. A high-income level of the caretakers was found to be protective against DKA during the diagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting in a mortality rate of 6.9%. Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DM at first presentation. The age of presentation and clinical symptoms of the studied participants were like other international studies. Community education regarding the signs and symptoms of childhood DM can further prevent the development of DKA. [Ethiop. J. Health Dev. 2022; 36(2):000-000]

Assessment of clinical profiles, and treatment outcomes for children with diabetic ketoacidosis, in two hospitals selected from Addis Ababa, Ethiopia, 2020

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors

Autoestima y factores de bullying en estudiantes de bachillerato de la provincia de Chimborazo / Self-esteem and bullying factors in high school students in the province of Chimborazo

El objetivo principal de la presente investigación fue analizar la relación entre la autoestima, concebida como la percepción de las cualidades y características contenidas en el propio auto-concepto y los factores de victimización correspondientes al fenómeno del bullying. Para ello, se contó con una muestra de 341 estudiantes de unidades educativas de la provincia de Chimbo-razo, donde se analizaron los datos obtenidos de las baterías psicológicas aplicadas: Test de autoestima de Rosenberg y la Escala de victimización en la escuela. La media de nivel del nivel de autoestima es de =29,81, con una desviación estándar δ = 4,47. Por otro lado, al considerar los factores del bullying, el tipo de victimización más frecuente entre la muestra ha sido la relacional (= 15,48; DT= 4,90), seguido de la manifiesta verbal (= 8,14; DT= 2,32), y el menos habitual la manifiesta física (= 4,88; DT= 1,14). Se encontró que la mayor parte de los estudiantes presentan autoestima alta. Tanto en la victimización relacional, manifiesta física como en la manifiesta verbal existieron diferencias con respecto al género. Finalmente, se observó relaciones significativas positivas y negativas entre la autoestima y los diferentes factores de victimización.

The main objective of this research was to analyze the relationship between selfesteem, conceived as the perception of the qualities and characteristics contained in the selfconcept itself, and the victimization factors corresponding to the phenomenon of bullying. For this, a sample of 341 students from educational units in the province of Chimborazo was used. The data obtained from the applied psychological batteries were analyzed: the Rosenberg SelfEsteem Test and the School Victimization Scale. The mean level of the level of selfesteem is  = 29.81, with a stan-dard deviation δ = 4.47. On the other hand, when considering bullying factors, the most frequent type of victimization among the sample has been relational ( = 15.48; SD = 4.90), followed by verbal manifest ( = 8.14; DT = 2.32), and the least common is physical manifestation ( = 4.88; DT = 1.14). It was found that most of the students have high selfesteem. There were differences with respect to gender in relational victimization, physical and verbal manifest. Finally, signifi-cant positive and negative relationships were observed between self-esteem and the different victimization factors.

Dilema terapéutico: síndrome de abstinencia alcohólica y encefalopatía hepática concurrentes. A propósito de un caso / Therapeutic dilemma: alcohol withdrawal syndrome and concurrent hepatic encephalopathy. A case report

RESUMEN El trastorno por consumo de alcohol es una de las principales causas de morbimortalidad en el mundo. La enfermedad hepática alcohólica es una complicación común de este trastorno y la encefalopatía hepática es una seria comorbilidad de la cirrosis alcohólica. Los factores precipitantes pueden relacionarse con infección, sangrado gastrointestinal, deshidratación o efectos de psicofármacos (p. ej., benzodiacepinas e hipnóticos no benzodiacepínicos). Se expone un caso del manejo hospitalario de un paciente con un trastorno severo por consumo de alcohol, cirrosis y encefalopatía hepática, quien desarrolla síntomas de abstinencia alcohólica durante su hospitalización y la complejidad del manejo antagónico de un delirium gabaérgico propio de la encefalopatía hepática en el contexto de un delirium glutamatérgico-noradrenérgico por abstinencia alcohólica.

ABSTRACT Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.

Fluxo do esgotamento: interrogando o processo de produção do tempo/cansaço no internato médico / Exhaustion flow: investigating the process of producing time/tiredness in medical internship

Resumo: Introdução: A síndrome de burnout causa repercussão com impactos individuais, sociais e econômicos. A tríade que representa a síndrome acomete milhões de trabalhadores pelo mundo, incluindo os trabalhadores da área da saúde e, entre eles, os médicos. Pesquisas apontam um incremento das taxas de burnout entre médicos e residentes, mas pouco se fala sobre a síndrome em estudantes de Medicina. Objetivo: Ao observarmos o adoecimento constante de estudantes, identificamos a necessidade de compreender mecanismos que possam ser considerados disparadores. Assim, investigamos a percepção dos estudantes de Medicina que cursam o estágio supervisionado sobre a síndrome de burnout e a autoidentificação dos sintomas. Método: Realizamos pesquisa qualitativa do tipo estudo de caso utilizando grupo focal como ferramenta metodológica. Participaram desta pesquisa 22 internos divididos em três grupos focais. As falas foram analisadas segundo a análise de conteúdo. Resultados: Dessas análises e de suas inferências, delinearam-se quatro categorias: "(Con)fusão de papéis: o processo de deixar de ser estudante"; "Uma síndrome (in)visível: a banalização do sofrimento"; "Tornar-se médico: forjado no sofrimento"; "(Des)identificação: efeitos de um processo nada fácil". Conclusão: Os estudantes desconheciam a síndrome e não foram capazes de reconhecer os sintomas dela durante a formação. O achado significativo apontou para a sobrecarga relacionada à falta de tempo e como esta gera um processo de sofrimento nos estudantes. Acredita-se, portanto, que o processo de ensino precisa ser repensado para que os estudantes possam, de fato, aprender e apreender todos os significados que a universidade tem potencialmente a lhes oferecer.

Abstract: Introduction: Burnout syndrome has individual, social and economic impacts. The triad that represents the syndrome affects millions of workers around the world, including healthcare workers and, among them, doctors. Research points to an increase in burnout rates among doctors and residents, but little is said about the syndrome in medical students. Objective: By observing students constantly falling ill, we identified the need to understand mechanisms that can be considered triggers. Thus, we investigated how medical interns viewed Burnout Syndrome and the self-identification of symptoms. Method: We carried out qualitative case study research using a focus group as a methodological tool. Twenty-two medical students participated in this study, divided into 3 focus groups. The statements were submitted to Content Analysis. Results: From these analyses and their inferences, four categories were outlined: '(Con)fusion of roles: the process of ceasing to be a student'; 'A (in)visible syndrome: the trivialization of suffering'; 'Becoming a doctor: forged in suffering'; '(Mis)identification: effects of a far from easy process'. Conclusion: Students were unaware of the syndrome and were unable to recognize its symptoms during training. The significant finding pointed to the burden related to lack of time and how it generates a process of suffering in students. Thus, it is believed that the teaching process needs to be rethought so that students can, in fact, learn and grasp all the meanings that the University potentially has to offer.

Kounis syndrome - Report of 4 cases / Síndrome de Kounis - Relato de 4 casos

Kounis syndrome is described as the occurrence of myocardial injury following a hypersensitivity reaction triggered by allergen exposure. The actual incidence is unknown, as most of the information comes from case reports and there are no international recommendations. Kounis syndrome does not seem to be rare but rather underdiagnosed. We report and discuss the clinical presentation and management of 4 cases of Kounis syndrome. All patients presented with anaphylaxis and chest pain. Patient age ranged from 44 to 83 years. Anaphylaxis triggers were nonsteroidal anti-inflammatory drugs and antibiotics. It is important to recognize Kounis syndrome in order to conduct an adequate investigation and prevent further events. A major difficulty is that the treatment of the 2 entities (hypersensitivity reaction and acute coronary syndrome) may worsen each other. Large prospective studies are needed to establish definitive treatment guidelines for these patients.

A síndrome de Kounis caracteriza-se pela ocorrência de uma síndrome coronária aguda no contexto de uma reação alérgica concomitante desencadeada por exposição a um alergênio. A sua incidência real é desconhecida e não há consenso relativamente à abordagem, uma vez que a maioria dos dados provem de relatos de casos. A síndrome de Kounis não parece ser uma entidade rara, mas é infrequentemente diagnosticada. Apresentamos quatro casos, a sua apresentação clínica e abordagem diagnóstica e terapêutica. Todos os doentes, com idades entre os 44 e os 83 anos, se apresentaram com anafilaxia e dor torácica. Os fatores desencadeantes foram fármacos: anti-inflamatórios não esteroides e antibióticos. Torna-se importante reconhecer a síndrome de Kounis, de modo a que possa ser feita investigação adequada e prevenidos novos eventos. A grande dificuldade reside no fato de que o tratamento das duas entidades (Reação de hipersensibilidade e Síndrome coronária aguda), pode agravar uma à outra. São necessários estudos prospetivos alargados de modo a estabelecer diretrizes definitivas para o tratamento destes doentes.

Factores desencadenantes del abandono del tratamiento antifímico. Distrito 09d13. 2016 ­ 2019 / Triggering factors for abandonment of antiphimic treatment. District 09d13. 2016 ­ 2019

Definido como la inasistencia continua del enfermo a la terapia antituberculosa por un mes o más, representa un excedente de gasto en salud pública. Asimismo, es uno de los problemas de salud pública mayormente reportados a nivel mundial como un resultado no satisfactorio de la estrategia tuberculosis. Objetivo: determinar los factores desencadenantes del abandono del tratamiento antifímico. Resultados: el principal factor desencadenante de abandono terapéutico en el Distrito 09D13, corresponde a la dimensión factores del paciente, ubicando dentro de este a la mejoría sintomatológica secundaria a un tratamiento parcial en el primer lugar, con un 94,1%, con predominio sobre el sexo masculino y en edades de 20 a 49 años. Conclusión: Los principales factores prevalentes en este estudio que desencadenan los abandonos fueron asociados a factores del paciente, en primer lugar, la mejoría sintomática, seguido por una situación económica deficiente. El tercer factor estuvo asociado al servicio de salud, como la falta de conocimiento sobre la enfermedad. El estudio correlacional, establece que existe una relación positiva considerable entre la falta de vivienda y el consumo de alcohol, ambos factores no se muestran como los más prevalentes por sí solos, la perspectiva sugiere que cuando ambos factores se juntan se fortalece el factor desencadenante de abandono de la terapia antifímica(AU)

Defined as the continuous absence of the patient to antituberculous therapy for a month or more, represents an excess of public health spending. It is one of the public health problems most reported and worldwide as an unsatisfactory result of the tuberculosis strategy. Objective: to determine the triggers for the abandonment of antifungal treatment. Results: the main triggering factor for treatment abandonment in District 09D13 corresponds to the patient factors dimension, placing within this the symptomatic improvement secondary to a partial treatment in the first place, with 94.1%, with a predominance of the male sex and in ages from 20 to 49 years. Conclusion: The main prevalent factors in this study that trigger dropouts were associated with patient factors, firstly, symptomatic improvement, followed by a poor economic situation. The third factor was associated with the health service, such as the lack of knowledge about the disease. The correlational study establishes that there is a considerable positive relationship between homelessness and alcohol consumption, both factors not shown as the most prevalent by themselves, the perspective suggests that combination of both factors triggers discontinuation of antifungal therapy(AU)

Impactos do estresse na exposição ocupacional de bombeiros: revisão integrativa / Impacts of stress on occupational exposure of firefighters: an integrative review / Impactos del estrés en la exposición ocupacional de los bomberos: una revisión integradora

Objetivo: identificar os impactos na saúde mental de bombeiros relacionados ao estresse da exposição ocupacional. Método: trata-se de uma revisão integrativa da literatura nas bases de dados CINAHL (EBSCO), PsycINFO, MEDLINE®, LILACS, Web of Science, Scopus e SCIELO. Para a estratégia de busca utilizou-se os descritores: "Occupational Stress", "Firefighters", "Occupational Exposure". Como critérios de inclusão estabeleceu-se: artigos originais; entre os anos de 2009 e 2019; disponíveis completos; estudos transversais; nos idiomas português, inglês e/ou espanhol; e cuja população de estudo incluíssem bombeiros. Resultados: nessa revisão foram analisados 11 artigos. Evidenciou-se que a exposição de bombeiros impactou o desencadeamento de sintomas de depressão e transtorno de estresse pós-traumático. Conclusão: as evidências deste estudo demonstraram que a exposição ocupacional de bombeiros interfere no seu padrão de saúde mental causando estresse por meio do sofrimento psíquico. Este estudo alerta para a necessidade de intervenção e promoção à saúde do bombeiro.

Objective: to identify mental health impacts of occupational exposure-related stress among firefighters. Method: this integrative literature review searched the CINAHL (EBSCO), PsycINFO, MEDLINE®, LILACS, Web of Science, Scopus and SCIELO databases, suing the descriptors: "Occupational Stress", "Firefighters", "Occupational Exposure". The inclusion criteria were: original articles; between the years 2009 and 2019; full text available; cross-sectional studies; in Portuguese, English and/or Spanish; and whose study population included firefighters. Results: 11 articles were analyzed. Firefighters' exposure was found to impact the triggering of depressive symptoms and post-traumatic stress disorder. Conclusion: the evidence in this study demonstrated that firefighters' occupational exposure interferes with their mental health patterns, causing stress through psychological suffering. This study warns of the need for intervention and promotion of firefighters' health.

Objetivo: identificar los impactos en la salud mental del estrés relacionado con la exposición ocupacional entre los bomberos. Método: esta revisión integradora de la literatura buscó en las bases de datos CINAHL (EBSCO), PsycINFO, MEDLINE®, LILACS, Web of Science, Scopus y SCIELO, demandando los descriptores: "Estrés ocupacional", "Bomberos", "Exposición ocupacional". Los criterios de inclusión fueron: artículos originales; entre los años 2009 y 2019; Texto completo disponible; estudios transversales; en portugués, inglés y / o español; y cuya población de estudio incluyó bomberos. Resultados: se analizaron 11 artículos. Se descubrió que la exposición de los bomberos afecta la activación de síntomas depresivos y el trastorno de estrés postraumático. Conclusión: la evidencia de este estudio demostró que la exposición ocupacional de los bomberos interfiere con sus patrones de salud mental, provocando estrés a través del sufrimiento psicológico. Este estudio advierte de la necesidad de intervención y promoción de la salud de los bomberos.

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo, en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren

Determining factors in the development of coronary plates and obstructions / Fatores determinantes no desenvolvimento de placas e obstruções coronarianas

INTRODUCTION: Coronary artery disease is the largest cause of mortality in the world. The main risk factors for its development include systemic arterial hypertension and type 2 diabetes mellitus. OBJECTIVE: To search for predictors of the development of plaques and obstructions in coronary arteries and to determine whether the exercise test is a reliable pretest for coronary angiotomography. METHODS: 883 computed tomography reports of coronaries were analyzed. Sociodemographic information, health conditions and results of the exercise test from patients were collected, along with calcium score, percentile and number of arterial segments with significant obstruction. The data were analyzed using descriptive and inferential statistics. Significance was considered for p<0.05. RESULTS: It observed that the statistically significant predictors to the calcium score were male, being over 60 years old, having type 2 diabetes mellitus and systemic arterial hypertension. There was no relationship with high BMI and coronary obstruction. Regarding the exercise test, it was possible to observe that the majority of individuals who were positive in the exercise test, did not have a positive calcium score or significant coronary obstructions. CONCLUSION: The predictors for the development of coronary plaques and obstructions were male, aged ≥60 years, having type 2 diabetes mellitus and systemic arterial hypertension.

INTRODUÇÃO: A doença arterial coronariana representa a maior causa de mortalidade no mundo, sendo que os principais fatores de risco para o seu desenvolvimento incluem a hipertensão arterial sistêmica e a diabetes mellitus tipo 2. OBJETIVO: Detectar os preditores para o desenvolvimento de placas e obstruções coronarianas detectadas através da tomografia computadorizada de artérias coronárias além de determinar se o teste de esforço é um pré-teste fidedigno para a realização angiotomografia coronariana. MÉTODOS: Foi realizada análise de 883 laudos de exames de TC de coronárias e coletados dados sociodemográficos, de saúde e o resultado do teste de esforço, juntamente com escore de cálcio, percentil e quantidade de segmentos arteriais com obstruções significativas. Os dados foram analisados pela estatística descritiva e inferencial (p<0,05). RESULTADOS: Foi possível observar que os preditores com valores estatisticamente significantes em relação ao escore de cálcio foi ser do sexo masculino, possuir idade acima de 60 anos, portar diabetes mellitus tipo 2 e hipertensão arterial sistêmica, não houve relação entre IMC elevado, que sugere sobrepeso, e obstrução coronariana. Em relação ao teste de esforço foi possível observar que a maioria dos indivíduos que apresentaram positividade no teste de esforço, não apresentavam escore de cálcio positivo ou obstruções coronarianas significativas. CONCLUSÃO: Os preditores para o desenvolvimento de placas e obstruções coronarianas foi pertencer ao sexo masculino, apresentar idade ≥60 anos, ser portadores de diabetes mellitus tipo 2 e hipertensão arterial sistêmica.

Depression and Abuse During Medical Internships in Peruvian Hospitals / Depresión y maltrato en internos de Medicina de hospitales peruanos

ABSTRACT Objective: To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals. Methods: We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs). Results: A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa = 1.15), the number of hours they sleep per day (PRa = 1.23), being a woman (PRa = 3.33), performing the internship in a province (PRa = 0.25), studying at a public university (PRa = 0.64), living with parents (PRa = 0.65) or alone (PRa = 0.33), and having perceived some type of abuse (PRa = 1.07). Conclusions: A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

RESUMEN Objetivo: Estimar la prevalencia de depresión y maltrato e identificar sus factores asociados en los internos de Medicina de los hospitales peruanos. Métodos: Estudio multicéntrico, transversal y analítico, llevado a cabo durante los meses de marzo a mayo de 2016. Conformaron la población los internos de Medicina en 18 sedes hospitalarias de Lima y provincias. Se aplicó una encuesta que incluía características sociodemográficas y una escala para medir la percepción de maltrato (psicológico, físico y sexual). Asimismo, para evaluar la depresión, se usó el cuestionario PHQ-9 en su versión en español. Se usó regresión de Poisson con varianzas robustas para calcular las razones de prevalencia (RP). Resultados: Participaron 402 internos de Medicina; la mediana de edad fue 25 [intervalo intercuartílico, 21-33] años y el 52,7% eran varones. Además, el 25,4% padecía depresión. En el modelo ajustado, las variables asociadas con padecer depresión son edad (RPa = 1,15), cuántas horas duermen durante el día (RPa = 1,23), ser mujer (RPa = 3,33), realizar el internado en provincia (RPa = 0,25), estudiar en una universidad pública (RPa = 0,64), vivir con sus padres (RPa = 0,65) o solo (RPa = 0,33) y percibir algún tipo de maltrato (RPa = 1,07). Conclusiones: La cuarta parte de los internos encuestados tenían depresión. Es necesario realizar un cribado temprano para identificar posibles maltratos percibidos y otros factores desencadenantes de depresión, y así evitar repercusiones negativas en el desempeño laboral y la salud mental general durante el internado médico.

Percepção do estresse e estressores de enfermeiros de um hospital universitário / Perception of stress and stressors in nurses of a university hospital / Percepción de estrés y estresores en enfermeros de un hospital universitario

Este estudo avaliou a percepção de estresse e estressores de enfermeiros de um hospital universitário e coletou sugestões de ações para amenizar o estresse. O estudo, descritivo, transversal, qualitativo e quantitativo foi realizado com 70 enfermeiros de diversas unidades de um hospital. Utilizou-se a Escala de Estresse de Bianchi e uma pergunta aberta. Os dados quantitativos foram analisados pelo programa SPSS e foram feitas análises descritivas e inferenciais. Para os dados qualitativos, utilizou-se a técnica de análise de conteúdo de Bardin. Resultados indicaram que a maior parte (67%) dos sujeitos apresentou nível médio de estresse. O domínio B (atividades relacionadas ao funcionamento adequado da unidade) teve a média de escore de estresse mais alta (5,2) em todas as unidades estudadas. A média de estresse dos enfermeiros que exercem função de chefia foi significantemente maior do que a média dos que não exercem (p=0,002). A área temática "Melhores condições para o trabalho" foi a mais citada como sugestão para amenizar o estresse. Os dados obtidos indicaram que a situação atual de precarização do hospital está relacionada com o estresse dos enfermeiros. Considera-se que o estudo permitiu ampla compreensão sobre o estresse e estressores em enfermeiros do hospital e subsídios para estudos posteriores.(AU)

This study evaluated the perception of stress and stressors of nurses at a university hospital and collected suggestions for actions to relieve stress. Descriptive, cross-sectional qualitative and quantitative study with 70 nurses from different hospital units. The Bianchi Stress Scale was used and an open question was applied. The quantitative data were analyzed using the SPSS program and descriptive and inferential analyzes were used. For qualitative data, the Bardin content analysis technique was used. The results indicated that most of the participants (67%) had a medium level of stress. Domain B (activities related to the proper functioning of the unit) had the highest average stress score in all units studied. The mean stress level of nurses who performed leadership was significantly higher than the average of those who did not (p = 0.002). The thematic area "Better conditions for work" was the most cited as a suggestion to relieve stress. The data obtained indicates that the current situation of precariousness of the hospital is related to the nurses' stress. It is considered that the study allowed a broad understanding on the stress and stressors of hospital nurses and subsidies for further studies.(AU)

Este estudio evaluó la percepción del estrés y estresores de enfermeros de un hospital universitario y recogió sugerencias de acciones para amenizar el estrés. Estudio descriptivo, transversal, cualitativo y cuantitativo se realizó con 70 enfermeros de varias unidades de un hospital. Se utilizó la Escala de estrés de Bianchi y una pregunta abierta. Los datos cuantitativos fueron analizados por el programa SPSS. Para los datos cualitativos se utilizó la técnica de análisis de contenido de Bardin. Los resultados indicaron que 67% presentaron un nivel medio de estrés. El dominio B (actividades relacionadas al funcionamiento adecuado de la unidad) tuvo el promedio de puntuación de estrés más alta (5,2) en todas las unidades estudiadas. El promedio de estrés de los enfermeros que ejercen función de dirección fue significativamente mayor que el promedio de los que no ejercen (Test t de student p = 0,002). El área temática "Mejores condiciones para el trabajo" fue la más citada como sugerencia para amenizar el estrés. Los datos obtenidos indican que la situación de precarización del hospital está relacionada con el estrés de los enfermeros. Se considera que el estudio permitió una amplia comprensión sobre el estrés y estrés de los enfermeros del hospital y subsidios para estudios posteriores.(AU)

Diagrama de Ishikawa: causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem através de materiais perfurocortantes / Ishikawa Diagram: causes and solutions of HIV infection in nursing professionals due to sharps use / Diagrama de Ishikawa: causas y soluciones de la infección al vih adquirida por profesionales de enfermado a través de materiales perfurocortantes

Objective: The study's goal has been to analyze, through the Ishikawa Diagram, the causes and solutions of HIV infection in nursing professionals due to sharps handling. Methods: It is a literature review based on the Construction of the Ishikawa Diagram, which was carried out in May 2017 in the PubMed and Virtual Health Library databases. Results: The following are the main causes of HIV infection through sharps: work overload, perception of frail risk, careless use of needles, lack of training. Regarding the solutions: adequate post-exposure management, implementing and monitoring compliance with biosafety standards, improving the notification of accidents with sharps. Conclusion: There is a need to alerting managers towards intervening in the factors that might trigger accidents with sharp materials by the nursing team

Objetivo: Analisar por meio do Diagrama de Ishikawa as causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem no manuseio de materiais perfurocortantes. Métodos: Revisão da literatura baseada na Construção do Diagrama de Ishikawa, realizado em maio de 2017 nas bases de dados Pubmed e Biblioteca Virtual de Saúde. Resultados: Dentre as causas da infecção ao HIV através de perfurocortantes: sobrecarga de trabalho, percepção de risco fragilizada, utilização descuidada de agulhas, ausência de treinamento. Quanto às soluções: gestão pós exposição adequada, implementar e fiscalizar o cumprimento das normas de biossegurança, aprimorar a notificação de acidentes com materiais perfurocortantes. Conclusão: Destaca-se a necessidade de sensibilizar gestores para intervir nos fatores que podem desencadear acidentes com materiais perfurocortantes pela equipe de enfermagem

Objetivo: Analizar por medio del Diagrama de Ishikawa las causas y soluciones de la infección al VIH adquirida por profesionales de enfermería en el manejo de materiales punzocortantes. Métodos: Revisión de la literatura basada en la construcción del diagrama de Ishikawa, realizado en mayo de 2017 en las bases de datos Pubmed y Biblioteca Virtual de Salud.Resultados: Entre las causas de la infección por el VIH a través de punzocortantes: sobrecarga de trabajo, percepción de riesgo fragilizada, utilización descuidada de agujas, ausencia de entrenamiento. En cuanto a las soluciones: gestión post exposición adecuada, implementar y fiscalizar el cumplimiento de las normas de bioseguridad, mejorar la notificación de accidentes con materiales punzocortantes. Conclusión: Se destaca la necesidad de sensibilizar a los gestores para intervenir en los factores que pueden desencadenar accidentes con materiales punzocortantes por el equipo de enfermería