COVID-19 Computed tomography patterns in renal replacement therapy patients / Padrões de tomografia computadorizada da COVID-19 em pacientes em terapia renal substitutiva

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12-84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19.

Saúde bucal e sua relação com a doença falciforme / Oral health and its relationship with sickle cell disease

Um material educativo sobre Saúde Bucal e Doença Falciforme em celebração ao dia 19 de Junho, Dia Mundial da Conscientização da Doença Falciforme.

Prevalência e fatores preditivos de transtornos mentais comuns em estudantes de enfermagem / Prevalence and predictive factors for common mental disorders in nursing students / Prevalencia y factores predictivos de transtornos mentales comunes en estudiantes de enfermería

Objetivo: identificar a prevalência e os fatores preditivos para os transtornos mentais comuns entre estudantes de enfermagem de uma instituição de ensino superior pública. Método:estudo observacional, constituído por 68 estudantes de enfermagem. Incluíram-se discentes do 2º, 7º, 9º e 10º blocos que frequentassem regularmente as aulas. A coleta de dados ocorreu entre novembro e dezembro de 2022, de forma remota, por meio de questionário onlineque abordava perfil sociodemográfico, escolar,de saúdeeum instrumento validado. Realizou-se análise univariada e, para a análise de associações, o teste qui-quadrado de Wald. Resultados: aprevalência relacionou-se ao uso de álcool, acompanhamento ou tratamento psicológico após o início da graduação e autoavaliação negativa da saúde.Os fatores preditivos foram uso de álcool e autoavaliação negativa da saúde. Conclusões: a alta prevalência de suspeição para transtornos mentais comunsindica a necessidade de assistência integral e equânime à comunidade acadêmica.

Objective: to identify the prevalence and predictive factors for common mental disorders among nursing students at a public higher education institution. Method: observational study, consisting of 68 nursing students. Students from the 2nd, 7th, 9th, and 10th blocks who regularly attended classes were included. Data collection took place between November and December 2022, remotely, using an online questionnaire that addressed the sociodemographic, school, and health profile and a validated instrument. Univariate analysis was performed and, for the analysis of associations, the Wald chi-square test was used. Results: the prevalence was related to the use of alcohol, monitoring or psychological treatment after the beginning of graduation, and negative self-evaluation of health. Conclusions: the high prevalence of suspicion for common mental disorders indicates the need for comprehensive and equitable assistance to the academic community.

Objetivo: identificar la prevalencia y los factores predictivos de trastornos mentales comunes entre estudiantes de enfermería de una institución pública de educación superior. Método: estudio observacional, compuesto por 68 estudiantes de enfermería. Se incluyeron estudiantes de los bloques 2, 7, 9 y 10 que asistían regularmente a clases. La recolección de datos se realizó entre noviembre y diciembre de 2022, de forma remota, medianteun cuestionario en línea que abordó el perfil sociodemográfico, escolar y de salud y un instrumento validado. Se realizó análisis univariante y, para el análisis de asociaciones, se utilizó la prueba chi-cuadrado de Wald. Resultados: la prevalencia estuvo relacionada con el consumo de alcohol, seguimiento o tratamiento psicológico posterior al inicio de la graduación y autoevaluación negativa de la salud. Conclusiones: la alta prevalencia de sospecha de trastornos mentales comunes indica la necesidad de una asistencia integral y equitativa a la comunidad académica

Acesso a serviço de saúde e reabilitação auditiva de adultos e idosos durante o período inicial da pandemia COVID-19 no Brasil / Access to health service and hearing rehabilitation for adult and older adults during the initial period of the COVID-19 pandemic in Brazil / Acceso a servicios de salud yrehabilitación auditiva para adultos y ancianos durante el período inicial de la pandemia COVID-19 en Brasil

Introdução: A perda auditiva é uma deficiência comum na população mundial e contribui para dificuldade na comunicação verbal e redução da qualidade de vida, evidenciando a importância da identificação precoce, reabilitação e acompanhamento audiológico dessa deficiência para mitigar suas consequências. Durante a pandemia da COVID-19, as medidas restritivas diminuíram a capacidade de atendimento dos serviços de saúde auditiva e dificultaram a busca de auxílio para resolver problemas relacionados à adaptação aos dispositivos eletrônicos de amplificação sonora (DAES), sendo uma barreira no processo de reabilitação da perda auditiva. Objetivo: Caracterizar os usuários de DEAS e o processo inicial de reabilitação auditiva de adultos e idosos e verificar fatores associados ao retorno para a consulta de monitoramento auditivo durante o período inicial da pandemia da COVID-19.Métodos: Estudo observacional transversal com usuários adultos e idosos de um serviço ambulatorial de saúde auditiva com retorno para consulta de monitoramento auditivo agendada no período inicial da implementação das medidas restritivas da pandemia da COVID-19 no Brasil. Resultados: A maioria dos participantes conseguiu retornou para a consulta de monitoramento auditivo, sendo eles em sua maioria idosos, do sexo feminino e vacinados contra a COVID-19. Houve maior prevalência de adaptação adequada aos DAES. Não houve associação estatística entre as variáveis relacionadas à adaptação aos DAES, COVID-19 e saúde mental e o retorno à consulta de monitoramento auditivo. Conclusão: Os fatores relacionados à adaptação aos DAES, à COVID-19 ou à saúde mental não influenciaram o retorno à consulta de monitoramento auditivo na presente pesquisa. (AU)

Introduction: Hearing loss is a common disability in the world population and contributes to difficulty in verbal communication and reduced quality of life, highlighting the importance of early identification, rehabilitation and audiological monitoring of this disability to mitigate its consequences. During the COVID-19 pandemic, restrictive measures reduced the service capacity of hearing health services and made it difficult to seek help to solve problems related to adaptation to personal sound amplification products (PSAPs), being a barrier in the rehabilitation process of hearing loss. Aim: To characterize PSAPs users and the initial hearing rehabilitation process for adults and elderly people and verify the factors associated with the return to hearing monitoring consultations in the initial period of the COVID-19 pandemic. Methods: Cross-sectional observational study with adults and elderly people: elderly users of an outpatient hearing health service who return for a scheduled hearing monitoring consultation in the initial period of the implementation of restrictive measures of the COVID-19 pandemic in Brazil. Results: Most participants were able to return to the hearing monitoring clinic, the majority of whom were elderly, female and vaccinated against COVID-19. There was a higher prevalence of adequate adaptation to the PSAPs. There was no statistical association between variables related to adaptation to PSAPs, COVID-19 and mental health and return to hearing monitoring consultation. Conclusion: Factors related to adaptation to PSAPs, COVID-19 or mental health did not influence the return to hearing monitoring consultation in the present investigation. (AU)

Introducción: La pérdida auditiva es una discapacidad común en la población mundial y contribuye a la dificultad en la comunicación verbal y a la reducción de la calidad de vida, destacando la importancia de la identificación temprana, rehabilitación y seguimiento audiológico de esta discapacidad para mitigar sus consecuencias. Durante la pandemia de COVID-19, las medidas restrictivas redujeron la capacidad de atención de los servicios de salud auditiva y dificultaron la búsqueda de ayuda para resolver problemas relacionados con la adaptación a dispositivos electrónicos de amplificación del sonido (DEAS), siendo una barrera en el proceso de rehabilitación de la pérdida auditiva. Objetivo: Caracterizar a los usuarios de DEAS y el proceso inicial de rehabilitación auditiva de adultos y ancianos y verificar los factores asociados al retorno a las consultas de monitorización auditiva en el período inicial de la pandemia COVID-19. Métodos: Estudio observacional transversal con adultos y ancianos: ancianos usuarios de un servicio ambulatorio de salud auditiva que regresan para consulta de monitorización auditiva programada en el período inicial de la implementación de medidas restrictivas de la pandemia de COVID-19 en Brasil. Resultados: La mayoría de los participantes pudieron regresar a la clínica de monitorización auditiva, la mayoría de los cuales eran ancianos, mujeres y estaban vacunados contra COVID-19. Hubo mayor prevalencia de adaptación adecuada a la DEAS. No hubo asociación estadística entre variables relacionadas con adaptación a DEAS, COVID-19 y salud mental y retorno a consulta de monitorización auditiva. Conclusión: Los factores relacionados con la adaptación a DEAS, el COVID-19 o la salud mental no influyeron en el retorno a la consulta de monitorización auditiva en la presente investigación. (AU)

A política nacional de práticas integrativas e complementares na grande Vitória: uma análise sobre os caminhos e proposições das PIC como proposta de tratamento de saúde do Sistema Único de Saúde (SUS) / The national policy for integrative and complementary practices in the metropolitan region of Vitória/ES: an analysis of the paths and propositions for PIC as a proposal for health treatment at the SUS / La política nacional de prácticas integrativas y complementarias en gran Vitória: un análisis sobre los caminos y proposiciones del PIC como propuesta de atención a la salud del Sistema Único de Salud (SUS)

Trata-se de uma pesquisa qualitativa que tem por objetivo investigar a implementação das Práticas Integrativas e Complementares no SUS na Grande Vitória. Como estratégia metodológica foram utilizadas as entrevistas semiestruturadas com três profissionais (servidoras públicas) que atuam neste contexto: uma professora de Educação Física, uma Psicóloga e uma Assistente Social. Os resultados indicam barreiras como o preconceito, a descrença e a falta de legitimidade das PIC, as quais dificultam tanto a atuação profissional, quanto a busca dos usuários por esses tratamentos (AU).

Qualitative research that investigated the implementation of Integrative and Complementary Practices in SUS. As a methodological strategy, semi-structured interviews were used with three professionals (public servants) who work in this context: a physical education teacher, a psychologist and a social worker. It was identified that most of the PIC are offered in the capital city, leaving the other municipalities short of services. About these services, the professionals claim that there are barriers such as prejudice, disbelief and lack of legitimacy of the PIC, which hinder both the professional performance and the users' search for these treatments (AU).

Investigación cualitativa que tuvo como objetivo investigar la implementación de Prácticas Integradoras y complementares en el SUS. Como estrategia metodológica, se utilizaron entrevistas semiestructuradas con tres profesionales (servidores públicos) que actúan en este contexto: una profesora de educación física, una psicóloga y una asistente social. Se identificó que la mayor parte del PIC se ofrece en la capital, quedando los demás municipios sin disponibilidad. En relación a estos servicios, los profesionales afirman que existen barreras como el prejuicio, la incredulidad y la falta de legitimidad de la PIC, que dificultan tanto la actuación profesional como la búsqueda de estos tratamientos por parte de los usuarios (AU).

Adolescência e corpo: um recorte psicanalítico / L'adolescence et le corps: un portrait psychanalytique / A psychoanalytic portrait of adolescence and its body

Este artigo tem como objetivo refletir acerca da relação entre adolescência e corpo nos dias atuais, a partir do ponto de vista da teoria psicanalítica. Para isso abordamos a concepção de corpo na psicanálise a partir das obras de Freud e outros autores contemporâneos, percorrendo os conceitos de histeria, pulsão, Eu, e estádio do espelho. Neste sentido é feito um recorte em torno da função da imagem de si na formação do Eu no estádio do espelho para entendermos os impactos da desestabilização dessa imagem com as transformações corporais da adolescência. Consideramos, então, a adolescência uma reedição do estádio do espelho onde o sujeito, que não se enxerga mais como criança mas ainda não reconhece sua imagem adulta, tem a unidade do Eu desestabilizada, precisando reinventar uma posição para si frente ao Outro. Por fim questionamos quais os possíveis impactos trazidos pela crescente virtualização da própria imagem em telas para estes sujeitos.

Cet article propose une réflexion sur la relation entre l'adolescence et le corps de nos jours, du point de vue de la théorie psychanalytique. Pour ce faire, nous analysons la conception du corps dans la psychanalyse à partir des œuvres de Freud et d'autres auteurs contemporains, en parcourant les concepts d'hystérie, de pulsion, de Moi et de stade du miroir. Dans ce sens, nous partons de la fonction de l'image de soi dans la formation du Je au stade du miroir pour comprendre les impacts de la déstabilisation de cette image avec les transformations corporelles de l'adolescence. Nous considérons alors l'adolescence comme une réédition du stade du miroir où le sujet, qui ne se voit plus comme un enfant mais ne reconnaît pas encore son image adulte, à l'unité du Moi déstabilisée, ayant besoin d' inventer une nouvelle position pour lui-même face à l'Autre. Enfin, nous nous demandons quels sont les impacts possibles apportés par la virtualisation croissante de l'image pour ces sujets.

This article seeks to reflect on the relationship between adolescence and body at present, from the point of view of psychoanalytic theory. In order to do this, we analyze the conception of the body in psychoanalysis starting from the works of Freud and other contemporary authors, through the concepts of hysteria, drive, self, and stage of the mirror. In this purpose, we highlight the function of the self-image in the formation of the Self in the mirror stage to understand the impacts of the destabilization of this image with the physical transformations of adolescence. We consider, then, adolescence a re-edition of the stage of the mirror where the subject, who no longer sees himself as a child but does not yet recognize his adult image, has the unity of the Self destabilized, having to reinvent a position for himself in front of the Other. Finally, we questioned the possible impacts brought by the increasing virtualization of the image on screens for these subjects

Medical and forensic aspects of performing a remote interrogation of persons with disabilities / Aspectos médicos y forenses de la realización de un interrogatorio a distancia a personas con discapacidad / Aspectos médicos e forenses da realização de um interrogatório remoto de pessoas com deficiências

The purpose of the study is to develop new proposals for improving criminal procedural legislation in the field of conducting remote investigative actions with disabled persons, taking into account their physiological and functional characteristics. Research material and methods: This study is based on an analysis of the norms regarding the criminal procedural legislation of the Republic of Kazakhstan and a number of foreign states that regulate the procedure for conducting remote investigative actions - as well as scientific publications on the research topic in the field of psychology and medicine. An integrated approach involves considering the studied phenomena of communication during an investigative action as a set of interconnected and interdependent elements, i.e., consideration of the issue from the medical, psychological and legal points of view. Situational and systemic types of analysis, complex sociological analysis, diagnostics and forecasting investigative situation were also used. Methods of analysis and synthesis, induction, deduction, methods of qualitative and quantitative analysis were employed to clarify the legal essence of the studied phenomenon. Findings: practical recommendations aimed at improving and developing the performance of remote investigative actions involving persons with disabilities (further ­ FWDs) y creating optimal conditions for the transfer of verbal, medical, and psychological information, as well as technical and forensic support for conducting RIAs. The following conclusions were made: in order to improve the current legislation, it is advisable to consider the issue of developing and including a special norm in the legislation, taking into account the characteristics of the communicative competencies of persons with disabilities. This norm regulates the procedure for conducting investigative actions involving the mute, deaf, blind and other persons with disabilities.

El objetivo del estudio es elaborar nuevas propuestas de mejora de la legislación procesal penal en el ámbito de la realización de actuaciones de investigación a distancia con personas con discapacidad, teniendo en cuenta sus características fisiológicas y funcionales. Material y métodos de investigación: Este estudio se basa en un análisis de las normas relativas a la legislación procesal penal de la República de Kazajstán y de una serie de Estados extranjeros que regulan el procedimiento para llevar a cabo acciones de investigación a distancia -, así como publicaciones científicas sobre el tema de investigación en el campo de la psicología y la medicina. Un enfoque integrado implica considerar los fenómenos estudiados de comunicación durante una acción de investigación como un conjunto de elementos interconectados e interdependientes, es decir, considerar la cuestión desde los puntos de vista médico, psicológico y jurídico. También se utilizaron los tipos de análisis situacional y sistémico, el análisis sociológico complejo, el diagnóstico y la previsión de la situación de investigación. Se emplearon métodos de análisis y síntesis, inducción, deducción, métodos de análisis cualitativo y cuantitativo para aclarar la esencia jurídica del fenómeno estudiado. Conclusiones: recomendaciones prácticas destinadas a mejorar y desarrollar la realización de acciones de investigación a distancia en las que participen personas con discapacidad (en adelante - RIA) y crear condiciones óptimas para la transferencia de información verbal, médica y psicológica, así como apoyo técnico y forense para la realización de las RIA. Se llegó a las siguientes conclusiones:con el fin de mejorar la legislación actual, es aconsejable considerar la cuestión de desarrollar e incluir una norma especial en la legislación, teniendo en cuenta las características de las competencias comunicativas de las personas con discapacidad. Esta norma regula el procedimiento para llevar a cabo acciones de investigación en las que estén implicadas personas mudas, sordas, ciegas y otras personas con discapacidad.

O objetivo do estudo é desenvolver novas propostas para aprimorar a legislação processual penal no campo da realização de ações investigativas remotas com pessoas com deficiência, levando em conta suas características fisiológicas e funcionais. Material e métodos de pesquisa: Este estudo baseia-se em uma análise das normas relativas à legislação processual penal da República do Cazaquistão e de vários países estrangeiros que regulamentam o procedimento para a realização de ações investigativas remotas, bem como em publicações científicas sobre o tópico de pesquisa no campo da psicologia e da medicina. Uma abordagem integrada envolve a consideração dos fenômenos estudados de comunicação durante uma ação investigativa como um conjunto de elementos interconectados e interdependentes, ou seja, a consideração da questão dos pontos de vista médico, psicológico e jurídico. Também foram usados tipos de análise situacional e sistêmica, análise sociológica complexa, diagnóstico e previsão da situação investigativa. Métodos de análise e síntese, indução, dedução, métodos de análise qualitativa e quantitativa foram empregados para esclarecer a essência legal do fenômeno estudado. Resultados: recomendações práticas com o objetivo de aprimorar e desenvolver o desempenho de ações investigativas remotas envolvendo pessoas com deficiência (mais adiante - FWDs), criando condições ideais para a transferência de informações verbais, médicas e psicológicas, bem como suporte técnico e forense para a realização de RIAs. Foram feitas as seguintes conclusões: para aprimorar a legislação atual, é aconselhável considerar a questão do desenvolvimento e da inclusão de uma norma especial na legislação, levando em conta as características das competências comunicativas das pessoas com deficiência. Essa norma regulamenta o procedimento para conduzir ações investigativas envolvendo pessoas mudas, surdas, cegas e outras pessoas com deficiência.

Infiltração resinosa em lesões brancas cariosas e não cariosas: relato de casos / Infiltración resinosa em lesiones blancas cariosas y no cariosas: Reporte de Casos / Resinous infiltration in carious and non-carious white lesions: Case Reports

Introdução: O processo de desmineralização proveniente da cárie leva à formação de manchas brancas que são a primeira manifestação visível da doença. Os infiltrantes resinosos surgem como uma alternativa para o tratamento dessas lesões não cavitadas, pois sãoresinas de baixa viscosidade e faz parte dos procedimentos que visam uma odontologia menos invasiva. Objetivo: Este estudo objetiva relatar a experiência clínica no uso de infiltrante resinoso, Icon, em lesões de mancha branca de etiologias cariosa e não cariosa em dois pacientes distintos, insatisfeitos com a estética do seu sorriso. Descrição do caso: Ao exame clínico foi observado nos pacientes com lesões brancas. No primeiro paciente, de 14 anos, verificou-se a presença da atividade de cárie e micro cavitações. Dessa forma, o plano de tratamento perpassou orientação de higiene oral supervisionada, aplicação de verniz fluoretado, Enamelast, semanal, adequação do meio com restaurações em resina, e só então o uso do infiltrante. A segunda paciente, de 11 anos, já possuía saúde bucal adequada e tinha queixa estética devido à lesão branca não cariosa, hipoplasia, cujo plano de tratamento foi à utilização do Icon apenas. Conclusões: Nos dois casos obteve-se melhoria estética considerável com este procedimento microinvasivo. Melhoria na saúde bucal, aliado à devolução da estética, pode ser observada com o uso de infiltrantes resinosos (AU).

Introduction: The process of demineralization resulting from caries leads to the formation of white spots that are the first visible manifestation of the disease. Resin infiltrants appear as an alternative for the treatment of these non-cavitated lesions, since they are low viscosity resins and are part of the procedures that aim at a less invasive dentistry.Objective:This study aims to report the clinical experience in the use of a resin infiltrant, Icon,in white spot lesions of carious and non-carious etiologies in two different patients who were dissatisfied with the esthetics of their smiles.Methodology: On clinical examination, white lesions were observed in both patients. In the first patient,14 years old,the presence of caries activity and micro cavitations was verified. Thus, the treatment plan included supervised oral hygiene guidance, weekly application of fluoride varnish,Enamelast, adaptation of the environment with resin restorations, and, onlythen, the use of the infiltrant, Icon. The second patient, 11 years old,already had adequate oral health and had an esthetic complaint due to a non-carious white lesion, hypoplasia, whose treatment plan consisted of the use of Icon only.Conclusions:In both cases considerable esthetic improvement was obtained with this microinvasive procedure. Improvement in oral health, combined with the return of esthetics, can be observed with the use of resin infiltrants (AU).

Introducción: El proceso de desmineralización resultante de la caries conduce a la formación de manchas blancas, que son la primera manifestación visible de la enfermedad. Losinfiltrantes de resina aparecen como una alternativa para el tratamiento de estas lesiones no cavitadas, pues se tratan de resinas de baja viscosidad y forman parte de los procedimientos que buscan una odontología menos invasiva. Objetivo:Este estudio tiene como objetivo relatar la experiencia clínica en el uso del infiltrante de resina,Iconen lesiones de mancha blanca de etiologías cariosas y no cariosas en dos pacientes diferentes, insatisfechos con la estética de sus sonrisas.Metodología: En el examen clínico se observaron lesiones blancas en ambos pacientes. En el primer paciente, 14 añosse verificó la presencia de actividad de caries y micro cavitaciones. De ese modo, el plan de tratamiento incluyó la orientación supervisada de la higiene bucal,la aplicación semanal de barniz de flúor (Enamelast), la adaptación del entorno con restauraciones de resina y, sólo después, el uso del infiltrante,Icon. La segunda paciente, 11 años,ya tenía una salud bucal adecuada y presentaba una queja estética debido a una lesión blanca no cariosa, hipoplasia, cuyo plan de tratamiento fue el uso exclusivo de Icon. Conclusiones: En ambos casos, se consiguió una mejora estética considerable con este procedimiento microinvasivo. La mejora de la salud bucal, unida a la recuperación de la estética, puede observarse con el uso de infiltrantes de resina (AU).

Automatic detection and classification of disease in citrus fruit and leaves using a customized CNN based model / Detección y clasificación automática de enfermedades en frutas y hojas de cítricos utilizando un modelo basado en CNN personalizado

India's commercial advancement and development depend heavily on agriculture. A common fruit grown in tropical settings is citrus. A professional judgment is required while analyzing an illness because different diseases have slight variati ons in their symptoms. In order to recognize and classify diseases in citrus fruits and leaves, a customized CNN - based approach that links CNN with LSTM was developed in this research. By using a CNN - based method, it is possible to automatically differenti ate from healthier fruits and leaves and those that have diseases such fruit blight, fruit greening, fruit scab, and melanoses. In terms of performance, the proposed approach achieves 96% accuracy, 98% sensitivity, 96% Recall, and an F1 - score of 92% for ci trus fruit and leave identification and classification and the proposed method was compared with KNN, SVM, and CNN and concluded that the proposed CNN - based model is more accurate and effective at identifying illnesses in citrus fruits and leaves.

El avance y desarrollo comercial de India dependen en gran medida de la agricultura. Un tipo de fruta comunmente cultivada en en tornos tropicales es el cítrico. Se requiere un juicio profesional al analizar una enfermedad porque diferentes enfermedades tienen ligeras variaciones en sus síntomas. Para reconocer y clasificar enfermedades en frutas y hojas de cítricos, se desarrolló e n esta investigación un enfoque personalizado basado en CNN que vincula CNN con LSTM. Al utilizar un método basado en CNN, es posible diferenciar automáticamente entre frutas y hojas más saludables y aquellas que tienen enfermedades como la plaga de frutas , el verdor de frutas, la sarna de frutas y las melanosis. En términos de desempeño, el enfoque propuesto alcanza una precisión del 96%, una sensibilidad del 98%, una recuperación del 96% y una puntuación F1 del 92% para la identificación y clasificación d e frutas y hojas de cítricos, y el método propuesto se comparó con KNN, SVM y CNN y se concluyó que el modelo basado en CNN propuesto es más preciso y efectivo para identificar enfermedades en frutas y hojas de cítricos.

Os jovens e suas práticas de lazer: um olhar diante os decretos da PBH / Young people and their leisure practices: a look at the PBH Decree

O vírus da Covid-19 afetou de diversas formas a população mundial e, com isso, surgiu a necessidade da implementação de medidas sanitárias para evitar sua propagação. Em Belo Horizonte, essas medidas vieram por meio de decretos municipais, que proibiram o funcionamento de serviços considerados não essenciais. A partir desse momento, os jovens acostumados a frequentar bares, festas, shoppings ­ lugares que geram intensa aglomeração ­ se depararam com uma situação inusitada, sendo obrigados a adaptarem suas práticas à rotina do lar. Com o intuito de compreender melhor essas mudanças, realizamos um estudo que analisa os impactos da pandemia nas práticas de lazer desses jovens. Por meio de um questionário aplicado em diversos pontos de lazer da cidade, conseguimos observar como as práticas de lazer dos jovens foram afetadas pela pandemia. Esses resultados enfatizam a importância da adaptabilidade e resiliência dos jovens diante novos desafios.

The Covid-19 virus has affected the global population in various ways, leading to the need for the implementation of sanitary measures to prevent its spread. In Belo Horizonte, these measures came through municipal decrees, which banned the operation of non-essential services. From that moment on, young people accustomed to frequenting bars, parties, and malls ­ places that generate intense crowding ­ found themselves in an unusual situation, being forced to adapt their practices to home life. In order to better understand these changes, we conducted a study analyzing the impacts of the pandemic on the leisure practices of these young people. Through a questionnaire applied at various leisure points in the city, we were able to observe how the leisure practices of young people were affected by the pandemic. These results emphasize the importance of adaptability and resilience of young people in face of new challenges.

Ciclismo recreacional e mobilidade urbana: análise das motivações dos ciclistas de Blumenau/SC / Urban mobility: an analysis of the motivations of cyclists in Blumenau/SC

A motivação é um fenômeno complexo que impulsiona as ações humanas. O diagnóstico de tais interesses oferece elementos de reflexão para a promoção de atividades e a implementação de políticas públicas. Neste contexto, o presente trabalho tem o objetivo de analisar as motivações dos praticantes de ciclismo recreacional de Blumenau/SC, município com uma população de 363 mil habitantes e uma malha cicloviária de 137 quilômetros. A coleta dos dados empíricos da pesquisa ocorreu por meio da aplicação de um questionário. Ao final, obteve-se uma amostra de 304 respondentes. Os resultados do estudo indicam a motivação para as atividades físicas ocupa papel central na relação com outros fatores de interesse, contribuindo para a superação de aspectos eventualmente desencorajadores. Em contrapartida, praticantes que têm outras motivações, como a interação social e o desenvolvimento pessoal, dependem mais de estímulos encorajadores, o que sugere que em tais casos existe a necessidade de maior incentivo para a prática do ciclismo recreacional. As conclusões deste estudo são relevantes para planejadores urbanos e gestores de comunicação. Ao mensurar a pertinência de causas motivadoras e desmotivadoras do ciclismo, os resultados da pesquisa indicam a importância de investir em infraestrutura adequada como a expansão da rede cicloviária e a criação de campanhas de divulgação, a fim de promover a bicicleta como meio de transporte e/ou recreação.

Motivation is a complex phenomenon that drives human actions. Diagnosing these interests provides elements for reflection in promoting activities and implementing public policies. In this context, the present study aims to analyze the motivations of recreational cyclists in Blumenau, SC (Brazil), a city with a population of 363,000 inhabitants and a cycling network of 137 kilometers. Empirical data for the research were collected through a questionnaire. Ultimately, a sample of 304 respondents was obtained. The study's results indicate that motivation for physical activities plays a central role in the relationship with other factors of interest, contributing to overcoming potentially discouraging aspects. Conversely, individuals motivated by other factors, such as social interaction and personal development, rely more on encouraging stimuli, suggesting that in such cases there's a need for greater incentives for recreational cycling. The conclusions of this study are relevant for urban planners and communication managers. By assessing the relevance of motivating and demotivating factors in cycling, the research results underscore the importance of investing in appropriate infrastructure, such as expanding the cycling network and launching promotional campaigns, to promote cycling as a means of transportation and/or recreation.

Anclaje de Contenidos Mediante Metodologías Activas y Videos, una Experiencia de Postítulo

El anclaje es el proceso que permite insertar lo nuevo en el entramado de esquemas preexistentes. Posibilita instrumentalizar el contenido en la comunicación. En formación de especialistas, anclamos contenidos con un diagnóstico situacional. El propósito de este ensayo fue, anclar contenidos de masticación y dinámica mandibular en profesionales, estudiantes del programa de especialización en Periodoncia, Facultad de Odontología, Universidad de Chile. El programa posee la unidad de rehabilitación en periodonto reducido (un crédito, 5 sesiones). Esta se imparte con diagnóstico situacional y metodologías activas: aula reversa y discusión de grupo pequeño. Los contenidos masticación y dinámicamandibular se anclaron mediante estas metodologías con videos, para estimular la identificación de patrones; contenido anclado es identificado. Se incentivó la reflexión individual y colectiva y se compararon los estudiantes de las promociones 2020 (telemática) y 2022 (presencial). Los estudiantes fueron codificados del 1 al 14. Caracterización de la cohorte 2020: 4 hombres, 4 mujeres; 5.75 años de egreso promedio, 2 U. Desarrollo, 1 U. de Concepción, 2 U. de Talca, 2 U. de Chile y 1 U de los Andes. Caracterización cohorte 2022: 3 mujeres, 3 hombres; 6 años de egreso promedio, 5 U. de Chile y 1 U. de La Frontera. La cohorte 2020 identificó patrones en la segunda sesión, a excepción de los estudiantes 5 y 7 que lo hicieron en la quinta sesión. Durante la reflexión colectiva, predominaron liderazgos transformacionales. De la cohorte 2022, solo el estudiante 14 identificó patrones en la segunda sesión y todos sus compañeros lo hicieron en la quinta sesión. Durante la reflexión colectiva, predominaron liderazgos transaccionales. En educación de profesionales, iguales metodologías, aplicadas telemáticamente o de manera presencial para anclar nuevos contenidos, se vieron influenciadas por los estilos de liderazgos de los estudiantes, que favorecieron o retardaron la identificación de patrones.

Anchoring is the process that allows new information to be inserted into the framework of pre-existing schemes. Allows to instrumentalize the content in communication. In During the training of specialists, we anchor contents with a situational diagnosis. The purpose of this essay was to anchor contents of mastication and mandibular dynamics in professionals, students in the specialization program in Periodontics, of the Faculty of Dentistry, Universidad de Chile. The program has a rehabilitation unit in reduced periodontium (one credit, 5 sessions). This is taught with situational diagnosis and active methodologies: Reverse classroom and small group discussion. The chewing and mandibular dynamics contents were anchored through these methodologies with videos, to stimulate the identification of patterns; pinned content is identified. Individual and collective reflection was encouraged and students from the 2020 (telematic) and 2022 (in-person) classes were compared. Students were coded from 1 to 14. Characterization of the 2020 cohort: 4 men, 4 women; 5.75 years of average graduation, 2 from U. del Desarrollo, 1 U. de Concepción, 2 U. de Talca, 2 U. de Chile and 1 U. de Los Andes. Cohort characterization 2022: 3 women, 3 men; 6 years of average graduation, 5 U. de Chile and 1 U. de La Frontera. The 2020 cohort identified patterns in the second session, except for students 5 and 7 who did so in the fifth session. During the collective reflection, transformational leadership predominated. Of the 2022 cohort, only student 14, was able to identify patterns in the second session, while all of her classmates did so in the fifth session. During the collective reflection, transactional leadership predominated. In teaching professionals, the same methodologies, applied telematically or in person to anchor new content, were influenced by the leadership styles of the students, which favored or delayed the identification of the patterns.

Barreras para una alimentación saludable: un análisis cualitativo de las semánticas emergentes en las comunidades escolares de Ciudad Sur

La literatura ha hecho hincapié en la centralidad que cumplen los entornos alimentarios en las elecciones alimentarias y en el estado nutricional de la población. Objetivo: identificar las percepciones de padres, madres y apoderados, profesionales de establecimientos educacionales, funcionarios municipales, y feriantes pertenecientes a la zona sur de Santiago de Chile, respecto a las barreras y limitaciones de la puesta en práctica de una alimentación saludable en el ambiente alimentario escolar. Método: se realizaron seis grupos focales agrupando a 50 actores claves vinculados a los establecimientos educacionales de Ciudad Sur utilizando una muestra no probabilística. Se aplicó un análisis de contenido mediante la técnica de codificación temática buscando relevar los universos semánticos emergentes. Resultados: se identificaron nueve barreras, o semánticas, que caracterizan limitantes a la realización de la alimentación saludable en los entornos escolares desde la perspectiva de los participantes: la familia, kioscos escolares, la salida de los establecimientos escolares, gusto, determinantes socioeconómicos, política pública, falta de conocimiento, publicidad y disponibilidad de productos sin sellos. Conclusiones: las limitaciones asociadas al ambiente alimentario doméstico tienen una representación significativamente alta (47,9%) y contienen un carácter de responsabilización individual en su enunciación. Esta cultura explicativa es opuesta a la evidencia científica y académica respecto al funcionamiento de la conducta alimentaria, y a la centralidad de los ambientes alimentarios respecto a la facilitación u obstaculización del consumo de alimentos saludables o adecuados.

Literature has emphasized on food environments centrality in food choices and nutritional status. Objective: identify social perceptions of fathers, mothers and guardians, professionals from educational establishments, municipal officials, and stallholders belonging to the southern area of Santiago de Chile, regarding limitations of healthy diet implementation on school environments. Method: six focus groups were carried out grouping 50 key actors linked to educational establishments using a non-probabilistic sample. A content analysis was applied through thematic coding technique seeking to reveal emerging semantic universes. Results: Nine barriers, or semantics, were identified characterizing limitations to healthy eating habits in school environments: family, school kiosks, leaving school establishments, taste, socioeconomic determinants, public policy, lack of knowledge, publicity, and availability of products without seals. Conclusions: limitations associated with domestic food environment have a significantly high representation (47,9%) and contain an individualized responsibility feature. This explanatory culture is opposed to scientific and academic evidence regarding the functioning of eating behavior, and the centrality of food environments facilitating or hindering healthy food consumption.

Tendência das taxas de internação por complicações de Diabetes Mellitus na população do município de Macaé, Rio de Janeiro, no período de 2011 a 2021

Objetivo: Avaliar a tendência das taxas de internação por complicações de Diabetes Mellitus na população de Macaé-Rio de Janeiro, 2011-2021. Métodos: Estudo ecológico de séries temporais das taxas de internação por complicações de Diabetes Mellitus na população de Macaé em 2011-2021. Os dados foram obtidos através do Sistema de Informações Hospitalares da plataforma do Datasus. Os modelos de regressão Joinpoint foram utilizados para estimar a tendência da taxa de internação. Resultados: A taxa de internação por complicações de Diabetes Mellitus por ano, de modo geral, foi maior no ano de 2016 e menor taxa no ano de 2020. Entre 2017 e 2021, verificou-seuma tendência significativa decrescente de -19,71% (Intervalo de Confiança -36,71; -9,73) das taxas de internação por complicações de Diabetes Mellitus. Conclusão: Houve uma redução acentuada nas taxas durante a pandemia, o que pode ser devido à subnotificação no registro de internações

Factores de riesgo asociados a mortalidad por COVID-19 en México / Risk factors associated with COVID-19 mortality in Mexico

Resumen Antecedentes: El 31 de diciembre de 2019, se inició una de las pandemias más graves de los últimos tiempos. Se ha descrito que ciertas condiciones de salud, como la obesidad y la diabetes mellitus, están relacionadas con desenlaces desfavorables por COVID-19. Objetivo: Identificar factores asociados a mortalidad en pacientes con COVID-19. Material y métodos: Cohorte retrospectiva de 998 639 pacientes. Se analizaron las características sociodemográficas y clínicas de los pacientes, y se compararon supervivientes con fallecidos. Se utilizó el modelo de riesgos proporcionales de Cox para la identificación de variables predictivas de defunción por COVID-19. Resultados: Entre los fallecidos, los hombres representaron 64.3 % y las mujeres 35.7 %, diferencia que resultó estadísticamente significativa. Las personas con más de 80 años presentaron un riesgo 13 veces mayor de morir por COVID-19 (IC 95 % = 12.469,13.586) y la enfermedad renal crónica, un riesgo de 1.5 (IC 95 % = 1.341, 1.798); la diabetes mellitus tuvo un riesgo de 1.25 (IC 95 % = 1.238,1.276). Conclusiones: La edad, el sexo, la diabetes mellitus y la obesidad resultaron ser entidades predictivas de muerte por COVID-19. Se sugiere más investigación relacionada con enfermedad pulmonar obstructiva crónica, enfermedades cardiovasculares, tabaquismo y embarazo.

Abstract Background: On December 31, 2019, one of the most serious pandemics in recent times made its appearance. Certain health conditions, such as obesity and diabetes mellitus, have been described to be related to COVID-19 unfavorable outcomes. Objective: To identify factors associated with mortality in patients with COVID-19. Material and methods: Retrospective cohort of 998,639 patients. Patient sociodemographic and clinical characteristics were analyzed, with survivors being compared with the deceased individuals. Cox proportional hazards model was used to identify variables predictive of COVID-19-associated mortality. Results: Among the deceased patients, men accounted for 64.3%, and women, for 35.7%, with the difference being statistically significant. Subjects older than 80 years had a 13-fold higher risk of dying from COVID-19 (95% CI = 12,469, 13,586), while chronic kidney disease entailed a risk 1.5 times higher (95% CI = 1,341, 1,798), and diabetes mellitus involved a risk 1.25 times higher (95% CI = 1.238,1.276). Conclusions: Age, sex, diabetes mellitus and obesity were found to be predictors of COVID-19 mortality. Further research related to chronic obstructive pulmonary disease, cardiovascular diseases, smoking and pregnancy is suggested.

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction

Abstract Background: Thalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients. Objective: To evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone. Methods: Analytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up. Results: A total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR = 6.46 [3.92 to 10.65]; p<0.01). Study limitations: Small number of events, single-center retrospective study. Conclusion: The hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

Clinical, biochemical, and radiologic profiles of Filipino patients with 6-Pyruvoyl-Tetrahydrobiopterin Synthase (6-PTPS) deficiency and their neurodevelopmental outcomes

Background@#Six-pyruvoyl-tetrahydrobiopterin synthase (6-PTPS) deficiency is an inherited metabolic disorder which results in tetrahydrobiopterin (BH4) deficiency causing hyperphenylalaninemia.@*Objective@#This study aimed to describe the clinical, biochemical, and radiologic profiles, and neurologic and developmental outcomes of patients diagnosed with 6-pyruvoyl tetrahydrobiopterin (PTPS) deficiency through newborn screening and confirmed by BH4 loading test, pterin analysis, and gene sequencing who were following-up with the metabolic team.@*Methods@#The research was a single-center descriptive case series study design that was done at the Philippine General Hospital, a tertiary government hospital. The clinical, biochemical, radiologic profiles and neurodevelopmental evaluation of each patient were described.@*Results@#Nine patients from 1 year 2 months to 14 years 5 months of age were enrolled in the study. Clinical manifestations before treatment were hypotonia, poor suck, and seizure. The most common clinical manifestation even after treatment initiation was seizure. The mean phenylalanine level on newborn screening was 990.68 umol/L, but after treatment was started, mean levels ranged from 75.69 to 385.09 umol/L. Two of the patients had focal atrophy of the posterior lobe on brain imaging. Pathogenic variants on molecular analysis were all missense, with two predominant variants, c.155A>G and c.58T>C. Eight of the nine patients had varying degrees of developmental delay or intellectual disability, while the remaining patient had signs of a learning disorder. @*Conclusion@#Newborn screening has played a crucial role in the early identification and management of patients with hyperphenylalaninemia due to 6-PTPS deficiency. Confirmation of diagnosis through determination of DHPR activity, urine pterins and/or molecular analysis is necessary for appropriate management. However, despite early initiation of treatment, neurodevelopmental findings of patients with 6-PTPS deficiency were still unsatisfactory.

HIV screening among patients with newly diagnosed solid and hematologic malignancies in a Tertiary Hospital in the Philippines

Objectives@#This preliminary study determined the prevalence of HIV infection among patients with newly diagnosed solid and hematologic malignancies at the Philippine General Hospital - Cancer Institute. @*Methods@#Adult Filipinos aged 19 years and above with biopsy- or imaging-confirmed malignancy and for chemotherapy, seen at the adult medical oncology and hematology clinic from January to September 2021 were included. Demographic and clinical data were obtained using a questionnaire. Rapid HIV screening was performed using blood extracted via finger prick. Pre- and post-test counselling were conducted. @*Results@#Of the 124 patients included in our study, majority were female (91, 73.4%), and 45 years old and above with a median age of 49 (20 – 74). Majority had solid tumors (121, 97.6%) with breast cancer being the most common (67, 54.0%) followed by colorectal (18, 14.5%), and head and neck cancer (14, 11.3%). Among those with hematologic malignancies, two had acute myelogenous leukemia and one had multiple myeloma. Six patients had AIDS-defining malignancies (NHL, cervical cancer). HIV risk factors and associated conditions were present in 18 patients (14.5%). Ten patients reported prior HIV testing. None of the patients tested positive for HIV. @*Conclusion@#The absence of HIV cases detected in our cohort may be due to the low prevalence of HIV risk factors and associated conditions. At this time, there is insufficient evidence to routinely recommend HIV testing among newlydiagnosed cancer patients. However, physicians are encouraged to offer HIV testing to cancer patients, especially to those with HIV risk factors, given the benefits of early detection and management of HIV.

Convalescent plasma as adjunctive therapy for hospitalized patients with COVID-19:The Co-CLARITY Trial

Background and Objective@#Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients.@*Methods@#In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections.@*Results@#A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days.@*Conclusions@#Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference.