Efecto de la sintomatología ansiosa y depresiva sobre los estilos de alimentación de la población chilena / Effect of anxious and depressive symptomatology on eating styles in the chilean population

Resumen Antecedentes: existe una estrecha relación entre salud mental y estilos de alimentación. Indicadores de salud mental como sintomatología ansiosa y depresiva han reportado efectos directos sobre estilos de alimentación que promueven la malnutrición por exceso como la alimentación emocional o restrictiva. Se analizó el efecto de la sintomatología ansiosa y depresiva sobre los estilos de alimentación en mujeres y hombres del norte y centro de Chile. Método: participaron 910 adultos residentes en el norte y centro de Chile; se aplicó el Cuestionario Holandés de Conducta Alimentaria (DEBQ), así como el Inventario de Ansiedad de Beck (BAI) y el Inventario de Depresión de Beck-II (BDI-II). El análisis del modelo global de la relación entre variables se realizó mediante modelos de ecuaciones estructurales. Resultados: el modelo global presentó adecuados indicadores de bondad de ajuste; la sintomatología ansiosa tuvo un efecto directo y significativo sobre la alimentación emocional, alimentación externa y alimentación restrictiva. Por su parte, la sintomatología depresiva no presentó efectos significativos sobre ningún estilo de alimentación. Conclusiones: a medida que aumentan los niveles de ansiedad, aumentan los niveles de todos los estilos de alimentación. La depresión podría interactuar mediando la relación por el contexto emocional que genera la sintomatología depresiva.

Abstract Introduction: There is a close relationship between mental health and eating styles. Mental health indicators such as anxious and depressive symptomatology have reported direct effects on eating styles that promote excess malnutrition such as emotional or restrictive eating. The aim was to analyze the effect of anxious and depressive symptomatology on eating styles in women and men from northern and central Chile. Method: Nine hundred and ten adults living in northern and central Chile participated in the study. The Dutch Eating Behavior Questionnaire (DEBQ), the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) were administered. The analysis of the global model of the relationship between variables was carried out using structural equation modeling. Results: The structural model presented adequate goodness-of-fit indicators, anxious symptomatology had a direct and significant effect on emotional eating, external eating and restrictive eating. On the other hand, depressive symptomatology, did not present significant effects on any eating style. Conclusions: As anxiety levels increase, levels of all eating styles increase. Depression, could interact mediating the relationship by the emotional context that generates the depressive symptomatology.

Cromoanagénesis y Eritrodermia como claves diagnósticas en un paciente en estado crítico

Reportamos el caso de una paciente con un cuadro grave de falla multisistémica en la cual se detectaron cambios cromosómicos masivos en estado de mosaico, que se consideran estarían asociados a la posible patología de fondo: un síndrome linfoproliferativo de Células T. La paciente también presentaba un cuadro de Eritrodermia de causa desconocida instaurado varios años antes, con un declive progresivo de su condición física.  El espectro de las manifestaciones clínicas se presenta entonces como un cuadro cutáneo inespecífico paraneoplásico de varios años de evolución y hallazgos de cromoanagénesis en la última fase de un proceso mórbido linfoproliferativo. Las nuevas técnicas de análisis genético permiten obtener datos para aclarar los procesos diagnósticos e identificar una desorganización grave de la información genética que se considera responsable de cambios neoplásicos. (provisto por Infomedic International)

We report the case of a patient with severe multisystemic failure in which massive chromosomal changes in mosaic state were detected, which are considered to be associated with the possible underlying pathology: a T-cell lymphoproliferative syndrome. The patient also presented a case of Erythroderma of unknown cause several years earlier, with a progressive decline in her physical condition. The spectrum of clinical manifestations is then presented as a nonspecific paraneoplastic cutaneous picture of several years of evolution and findings of chromoanagenesis in the last phase of a lymphoproliferative morbid process. The new techniques of genetic analysis make it possible to obtain data to clarify the diagnostic processes and to identify a serious disorganization of the genetic information considered to be responsible for neoplastic changes. (provided by Infomedic International)

Invisibilidades das Práticas Integrativas e Complementares na Atenção Primária à Saúde / The Invisibility of Integrative and Complementary Practices in Primary Healthcare

Resumo A invisibilidade é uma questão que necessita de maior atenção entre os profissionais de saúde, pois algumas atividades na Atenção Primária passam despercebidas. Um exemplo é a oferta de terapias complementares, cuja implementação tem sido frágil e, consequentemente, pode ser invisibilizada no Sistema Único de Saúde. Este estudo visa compreender os fatores que contribuem para a invisibilidade pública das Práticas Integrativas e Complementares na Atenção Primária. Trata-se de uma pesquisa descritiva, exploratória e qualitativa, envolvendo entrevistas semiestruturadas com 20 profissionais na Região Metropolitana de Goiânia. A análise de conteúdo temática foi aplicada às entrevistas, revelando elementos que indicam a invisibilidade pública dessas práticas, como a falta de discussão nas reuniões de equipe, a desuniformidade no registro nos prontuários dos usuários e a baixa priorização na implementação. Nas entrevistas, a humilhação social, produto da invisibilidade pública, também pode ser percebida devido à sobrecarga, constrangimentos e falta de espaço físico para a oferta das práticas aos usuários. Conclui-se que as Práticas Integrativas e Complementares são frequentemente invisibilizadas na Atenção Primária.

Abstract Invisibility is an issue that requires more attention among healthcare professionals, as some activities in Primary Care go unnoticed. One example is the offer of complementary therapies, whose implementation has been frail and, consequently, can be overlooked in the Unified Health System. This study aims to understand the factors contributing to the public invisibility of Integrative and Complementary Practices in Primary Care. It is a descriptive, exploratory, and qualitative research involving semi-structured interviews with 20 professionals in the Metropolitan Region of Goiânia. Thematic content analysis was applied to the interviews, revealing elements indicating the public invisibility of these practices, such as insufficient discussion in team meetings, inconsistency in the recording in user files, and low prioritization in implementation. In the interviews, social humiliation, a product of public invisibility, can also be perceived due to overload, embarrassments, and lack of physical space for the provision of practices to the users. It is concluded that Integrative and Complementary Practices are often overlooked in Primary Care.

A study to evaluate the effectiveness of planned educational programme on knowledge and attitude regarding psychosocial problems of eating disorders among adolescent girls studying in selected P.U Colleges at Vijayapur

Background: Eating problems are prevalent, with girls more likely to develop issues in adolescence. Concerning indicators include weight fluctuations, altered eating patterns, and excessive physical activity. Outpatient treatment is effective for most, but some may require hospitalization or residential programs for stability and care. Methods: This research adopted an evaluative research approach and employed a pre-experimental (one group pre-test post- test design), and a sample of 60 adolescent girls studying in PU College is recruited through simple random sampling technique. The investigation was conducted at selected PU colleges, Vijayapur. Karnataka, among the adolescents. Results: This study assessed the knowledge and attitudes of adolescent girls in PU colleges in Vijayapur regarding eating disorders. Pretest results showed a majority with moderate knowledge and unfavorable attitudes. Following an educational program, significant improvements in knowledge and attitudes were observed. The findings highlight the effectiveness of targeted interventions in enhancing awareness and promoting positive attitudes. H1: Post-test knowledge scores significantly improved compared to pre-test scores (p<0.05). H2: Post-test attitude scores significantly enhanced compared to pre-test scores (p<0.05). H3: No significant associations were found between knowledge and attitude scores and socio-demographic variables among adolescent girls. Conclusions: In summary, targeted interventions can enhance knowledge and attitudes about eating disorders among adolescent girls in PU colleges. Outpatient treatments and education are crucial for addressing these issues, but more research and interventions are needed to promote awareness and positive attitudes.

Uma experiência precursora do SUS com a participação de Paulo Freire / A precursor experience of the SUS with the participation of Paulo Freire

Resumo O texto desenvolve-se a partir de uma mesa redonda realizada na Faculdade de Educação (FE) da Universidade Estadual de Campinas (Unicamp), como uma das atividades de comemorações do Centenário de Paulo Freire (2021). Objetiva registrar parte da sua passagem por essa universidade, nos anos de 1980 a 1991, a partir do trabalho realizado com a FE e Faculdade de Ciências Médicas (FCM) por meio de atividades de formação e extensão no Centro de Saúde Escola de Paulínia-SP. Descreve e analisa as pautas do processo de redemocratização do país, os embates em torno das políticas públicas na Assembleia Nacional Constituinte e o processo de constituição de um sistema integrado e universal de educação e saúde pública coletiva a partir de uma perspectiva participativa.

Abstract The text is based on a round table held at the Faculty of Education (FE) of the State University of Campinas (Unicamp) as one of the activities to commemorate Paulo Freire's Centenary (2021). It aims to record part of his time at the university, from 1980 to 1991, based on the work conducted with FE and the Faculty of Medical Sciences (FCM) through training and extension activities at the Paulínia-SP School Health Center. It also describes and analyses the agendas of the country's re-democratization process, the clashes over public policies in the National Constituent Assembly, and the process of setting up an integrated and universal system of education and collective public health from a participatory perspective.

Effects of a Multi-professional Intervention on Quality of Life of Women with Overweight or Obesity Post-Covid-19: A Pragmatic Trial

Obesity is a global Non-Communicable Chronic Disease (NCD) associated with various comorbidities and a high mortality rate. This scenario has increasingly affected the female population, leading to a rise in prevalence and related health issues. Therefore, the present study aimed to assess the health-related quality of life of women with overweight or obesity and symptoms of COVID-19 using a multi-professional intervention model. This research was conducted as a parallel group and repeated measures pragmatic trial, in which 28 participants aged between 25 and 65 were allocated into two groups: experimental (intervention group) and control (non-intervention participants). The Body Mass Index (BMI) was (30.5 ± 5.45 kg/m²) in the Experimental Group, and the Control Group was (31 ± 8.2 kg/m2). The 12-Item Health Survey (SF-12) questionnaire was applied to assess the quality of life in the physical and mental domains of COVID-19 survivors with different symptom severities (mild, moderate, severe) compared to the control group. At the end of the program, 28 participants finished the study (15 from the experimental group and 13 from the control group). The results indicated a significant improvement in the mental health domain only in the experimental group after the intervention period (p 0.05). Considering these findings, multi-professional actions emerge as a crucial component for enhancing the quality of life, particularly within mental health, during the 16-week intervention period.

La obesidad es una Enfermedad Crónica No Transmisible (ECNT) global asociada a diversas comorbilidades y una alta tasa de mortalidad. Este escenario ha afectado cada vez más a la población femenina, lo que ha llevado a un aumento en la prevalencia y problemas de salud relacionados. El presente estudio tiene como objetivo evaluar la calidad de vida relacionada con la salud de mujeres con sobrepeso u obesidad y síntomas de COVID-19 mediante un modelo de intervención multiprofesional. Esta investigación se llevó a cabo como un ensayo pragmático de grupos paralelos y medidas repetidas, en el que 48 participantes con edades comprendidas entre 25 y 65 años fueron alocadas en dos grupos: experimental (participantes de la intervención) y control (participantes de la no intervención). En el grupo experimental el Índice de Masa Corporal (IMC) fue de (30,5 ± 5,45 kg/m²). En el grupo control, el IMC fue (31 ± 8,2 kg/m²). Se utilizó el cuestionario de 12-Item Health Survey (SF-12) para evaluar la calidad de vida en los dominios físico y mental de las sobrevivientes de COVID-19 con diferentes grados de gravedad de síntomas (leves, moderados, graves) en comparación con el grupo de control (participantes que no recibieron intervenciones). Al final del programa, 28 participantes terminado el estudio (15 participantes de la intervención y 13 sin intervención). Los resultados indicaron una mejora significativa en el dominio de la salud mental solo en el grupo experimental después del período de intervención (p 0.05). A la luz de estos hallazgos, la rehabilitación multiprofesional emerge como un componente crucial para mejorar la calidad de vida, especialmente en el ámbito de la salud mental durante el período de intervención de 16 semanas.

A obesidade é uma Doença Crônica Não-Transmissível (DCNT) com alcance mundial, associada a diversas comorbidades e alta taxa de mortalidade. Esse quadro tem afetado cada vez mais o público feminino, com aumento da prevalência e doenças correlatas. O objetivo deste estudo foi avaliar a qualidade de vida relacionada à saúde de mulheres com sobrepeso ou obesidade com sintomas da COVID-19 utilizando um modelo de intervenção multiprofissional. Esta pesquisa foi conduzida como um ensaio pragmático de grupos paralelos e medidas repetidas, no qual 28 participantes de idade entre 25 a 65 anos foram distribuídas em dois grupos: experimental (participantes das intervenções) e controle (não participantes das intervenções). No grupo experimental o Índice de Massa Corporal (IMC) foi de (30,5 ± 5,45 kg/m²) e no grupo controle, IMC foi de (31 ± 8,2 kg/m²). Utilizou-se o questionário 12-Item Health Survey (SF-12) para analisar a qualidade de vida nos domínios físico e mental das sobreviventes da COVID-19 nas diferentes sintomatologias (COVID leve, moderada e grave) em comparação com o grupo controle (não participantes das intervenções). Ao final do programa, 28 participantes finalizaram o estudo (15 do grupo experimental e 13 do grupo controle). Os resultados indicaram uma melhoria significativa no domínio de saúde mental apenas no grupo experimental após o período de intervenção (p 0,05). Diante dos resultados a reabilitação multiprofissional emerge como componente importante para a melhoria da qualidade de vida, especialmente no âmbito da saúde mental durante as 16 semanas de intervenção.

Mortalidad en pacientes hospitalizados por COVID-19 durante la primera ola en una institución de tercer nivel de Neuquén / Mortality in Patients Hospitalized for COVID-19 during the First Wave in a Tertiary Care Institution in Neuquén

Introducción: En diciembre de 2019, se detectó un brote de enfermedad por un nuevo coronavirus que evolucionó en pandemia con severa morbilidad respiratoria y mortali- dad. Los sistemas sanitarios debieron enfrentar una cantidad inesperada de pacientes con insuficiencia respiratoria. En Argentina, las medidas de cuarentena y control sani - tario retrasaron el primer pico de la pandemia y ofrecieron tiempo para preparar el sis- tema de salud con infraestructura, personal y protocolos basados en la mejor evidencia disponible en el momento. En una institución de tercer nivel de Neuquén, Argentina, se desarrolló un protocolo de atención para enfrentar la pandemia adaptado con la evo- lución de la mejor evidencia y evaluaciones periódicas de la mortalidad hospitalaria. Métodos: Estudio de cohorte observacional para evaluar la evolución de pacientes con COVID-19 con los protocolos asistenciales por la mortalidad hospitalaria global y al día 28 en la Clínica Pasteur de Neuquén en 2020. Resultados: Este informe describe los 501 pacientes diagnosticados hasta el 31 de di- ciembre de 2020. La mortalidad general fue del 16,6% (83/501) y del 12,2% (61/501) al día 28 de admisión. En los 139 (27,7%) pacientes con ventilación mecánica, la mortali- dad general y a los 28 días fue de 37,4% (52/139) y 28,1% (38/139) fallecieron, respec- tivamente. Los factores de riesgo identificados fueron edad, comorbilidades y altos re- querimientos de oxígeno al ingreso. Conclusión: La mortalidad observada en los pacientes hospitalizados en nuestra insti- tución en la primera ola de la pandemia COVID-19 fue similar a los informes internacio- nales y menor que la publicada en Argentina para el mismo período.

Introduction: In December 2019, an outbreak of disease due to a new coronavirus was detected that evolved into a pandemic with severe respiratory morbidity and mortality. Health systems had to face an unexpected number of patients with respiratory failure. In Argentina, quarantine and health control measures delayed the first peak of the pan - demic and offered time to prepare the health system with infrastructure, personnel and protocols based on the best evidence available at the time. In a third level institution of Neuquén, Argentina, a care protocol was developed to confront the pandemic adapted by evolving best evidence and periodic evaluations of hospital mortality. Methods: Observational cohort study to evaluate the evolution of patients hospitalized for COVID-19 with care protocols in terms of overall hospital mortality and at day 28 at the Pasteur Clinic in Neuquén in 2020. Results: This report describes the 501 patients diagnosed until December 31, 2020. Mortality was 16.6% (83/501) and 12.2% (61/501) on day 28 of admission. Among the 139 (27.7%) patients with mechanical ventilation, overall mortality and at 28 days it was 37.4% (52/139) and 28.1% (38/139), respectively. The risk factors identified were age, comorbidities and high oxygen requirements on admission. Conclusion: The mortality observed in patients hospitalized in our institution during the first wave of COVID-19 pandemic was similar to international reports and lower than other publications in Argentina for the same period.

Curva de Aprendizagem da Mortalidade Hospitalar da Substituição da Válvula Aórtica Transcateter: Insights do Registro Nacional Brasileiro / Learning Curve for In-Hospital Mortality of Transcatheter Aortic Valve Replacement: Insights from the Brazilian National Registry

Resumo Fundamento Dados robustos sobre a curva de aprendizagem (LC) da substituição da válvula aórtica transcateter (TAVR) são escassos nos países em desenvolvimento. Objetivo Avaliar a LC da TAVR no Brasil ao longo do tempo. Métodos Analisamos dados do registro brasileiro de TAVR de 2008 a 2023. Pacientes de cada centro foram numerados cronologicamente em número sequencial de caso (NSC). A LC foi realizada usando um spline cúbico restrito ajustado para o EuroSCORE-II e o uso de próteses de nova geração. Ainda, os desfechos hospitalares foram comparados entre grupos definidos de acordo com o nível de experiência, com base no NSC: 1º ao 40º caso (experiência inicial), 41º ao 80º caso (experiência básica), 81º ao 120º caso (experiência intermediária) e 121º caso em diante (experiência alta). Análises adicionais foram conduzidas de acordo com o número de casos tratados antes de 2014 (>40 e ≤40 procedimentos). O nível de significância adotado foi p <0,05. Resultados Foram incluídos 3194 pacientes de 25 centros. A idade média foi 80,7±8,1 anos e o EuroSCORE II médio foi 7±7,1. A análise da LC demonstrou uma queda na mortalidade hospitalar ajustada após o tratamento de 40 pacientes. Um patamar de nivelamento na curva foi observado após o caso 118. A mortalidade hospitalar entre os grupos foi 8,6%, 7,7%, 5,9%, e 3,7% para experiência inicial, básica, intermediária e alta, respectivamente (p<0,001). A experiência alta foi preditora independente de mortalidade mais baixa (OR 0,57, p=0,013 vs. experiência inicial). Centros com baixo volume de casos antes de 2014 não mostraram uma redução significativa na probabilidade de morte com o ganho de experiência, enquanto centros com alto volume de casos antes de 2014 apresentaram uma melhora contínua após o caso de número 10. Conclusão Observou-se um fenômeno de LC para a mortalidade hospitalar do TAVR no Brasil. Esse efeito foi mais pronunciado em centros que trataram seus 40 primeiros casos antes de 2014 que naqueles que o fizeram após 2014.

Abstract Background Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. Objective To assess TAVR's LC in Brazil over time. Methods We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. Results A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. Conclusion A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.

Analysis of the bond of users from different basic health units with possible diagnosis of non-communicable chronic diseases during the covid-19 pandemic in a city in southern Brazil / Análisis del vínculo de Usuarios de distintas unidades básicas de salud con posible diagnóstico de Enfermedades Crónicas no transmisibles frente a la pandemia del Covid-19 en el en una ciudad del sur de Brasil / Análise do vínculo de usuários de diferentes unidades básicas de saúde com possível diagnóstico de doenças crônicas não transmissíveis frente à pandemia da covid-19 em uma cidade no sul do Brasil

Non-communicable chronic diseases (NCDs) are considered one of the leading causes of death worldwide. During the COVID-19 pandemic, these diseases have been neglected due to the Brazilian Unified National Health System (BHUS) overload. In this context, this study aimed to analyze the bond between patients with NCDs and primary care during the COVID-19 pandemic while also seeking to identify the population's level of knowledge about health parameters and their relationship with the healthcare system. A cross-sectional and observational study was conducted, in which an online questionnaire was administered to collect socioeconomic information from patients and their bond with BHUS in the metropolitan region of Maringa, Parana, Brazil, encompassing individuals over 18 years of age. The survey was promoted on social media, and interested participants responded to the questionnaire, which addressed topics such as identification, medication use, disease information, knowledge about NCDs, and general data related to COVID-19. The obtained and analyzed responses revealed a low bond level between this population and primary care and a lack of knowledge about NCDs and their health during the pandemic. There was a notable decrease in seeking healthcare services during this period, which may be explained by the fear of contracting the novel coronavirus. This study is essential to understand patients' responses to public health challenges during the pandemic. It can become a valuable ally in dealing with future pandemics and endemic crises, enabling improvements in care and raising awareness among the population about NCDs and the healthcare system.

Las enfermedades crónicas no transmisibles (ENT) son consideradas una de las principales causas de muerte a nivel mundial. Durante la pandemia de COVID-19, estas enfermedades han sido desatendidas debido a la sobrecarga de las Unidades Básicas de Salud (UBS). En ese contexto, el objetivo de este estudio es analizar el vínculo entre los pacientes con enfermedades crónicas no transmisibles (ECNT) y la atención primaria durante la pandemia de COVID-19, buscando identificar el nivel de conocimiento de la población sobre los parámetros de salud y la relación con el sistema de salud. Se realizó un estudio transversal y observacional, en el que se aplicó un cuestionario en línea para recolectar información socioeconómica de los pacientes y su vínculo con las BHU en la región metropolitana de Maringá/PR, abarcando personas mayores de 18 años. La divulgación se realizó en las redes sociales y los interesados respondieron el cuestionario que abordó temas como identificación, uso de medicamentos, información sobre enfermedades, conocimientos sobre ECNT y datos generales relacionados con el COVID-19. Las respuestas obtenidas y analizadas revelaron un bajo nivel de vinculación de esta población con la atención primaria, así como un desconocimiento sobre las ECNT y su propia salud durante la pandemia. Hubo una notable reducción en la demanda de servicios de salud durante este período, lo que puede explicarse por el temor a la contaminación por el nuevo coronavirus. Este estudio se presenta como una herramienta importante para comprender la respuesta de los pacientes a los desafíos de salud pública durante la pandemia. Puede convertirse en un valioso aliado para enfrentar futuras pandemias y crisis endémicas, posibilitando mejoras en la atención y concientización de la población sobre las ECNT y el sistema de salud.

As doenças crônicas não transmissíveis (DCNTs) são consideradas uma das principais causas de morte em todo o mundo. Durante a pandemia da COVID-19, essas doenças têm sido negligenciadas devido à sobrecarga das Unidades Básicas de Saúde (BHU). Neste contexto, o objetivo deste estudo é analisar o vínculo dos pacientes com DCNTs com a atenção primária durante a pandemia da COVID-19, ao mesmo tempo em que busca identificar o nível de conhecimento da população sobre os parâmetros de saúde e o relacionamento com o sistema de saúde. Realizou-se um estudo transversal e observacional, no qual foi aplicado um questionário online para coletar informações socioeconômicas dos pacientes e seu vínculo com as BHUs na região metropolitana de Maringá/PR, abrangendo indivíduos maiores de 18 anos. A divulgação foi realizada em mídias sociais e os interessados responderam ao questionário que abordou tópicos como identificação, uso de medicações, informações sobre doenças, conhecimento acerca das DCNTs e dados gerais relacionados à COVID-19. As respostas obtidas e analisadas revelaram um baixo nível de vínculo dessa população com a atenção primária, assim como uma falta de conhecimento sobre as DCNTs e a própria saúde durante a pandemia. Observou-se uma notável redução na procura por serviços de saúde durante esse período, o que pode ser explicado pelo receio da contaminação pelo novo coronavírus. Este estudo se apresenta como uma ferramenta importante para compreender a resposta dos pacientes frente aos desafios da saúde pública durante a pandemia. Ele pode se tornar um aliado valioso para lidar com futuras pandemias e crises endêmicas, possibilitando melhorias nos cuidados e na conscientização da população sobre as DCNTs e o sistema de saúde.

Diabetes mellitus in patients with heart failure and effect modification of risk factors for short-term mortality: An observational study from the Registro Colombiano de Falla Cardíaca (RECOLFACA) / Diabetes mellitus en pacientes con insuficiencia cardiaca y modificación del efecto de los factores de riesgo de mortalidad a corto plazo: un estudio observacional del Registro Colombiano de Falla Cardíaca (RECOLFACA)

Abstract Introduction. Heart failure and type 2 diabetes mellitus are critical public health issues. Objective. To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. Materials and methods. Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. Results. A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. Conclusions. Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.

Resumen Introducción. La insuficiencia cardíaca y la diabetes mellitus de tipo 2 son problemas críticos de salud pública. Objetivo. Caracterizar los factores de riesgo de mortalidad en pacientes con insuficiencia cardíaca y la diabetes mellitus de tipo 2 de un registro grande en Colombia y evaluar las posibles modificaciones del efecto de la diabetes mellitus de tipo 2 sobre otros factores de riesgo. Materiales y métodos. Se incluyeron pacientes con insuficiencia cardíaca con y sin diabetes mellitus de tipo 2, inscritos en el Registro Colombiano de Insuficiencia Cardíaca (RECOLFACA). RECOLFACA incorporó pacientes adultos con diagnóstico de insuficiencia cardíaca de 60 centros médicos de Colombia durante 2017-2019. El resultado primario fue la mortalidad por todas las causas. El análisis de supervivencia se realizó utilizando modelos ajustados de riesgos proporcionales de Cox. Resultados. Se incluyeron 2.514 pacientes, la prevalencia de diabetes mellitus de tipo 2 fue del 24,7 % (n = 620). Encontramos siete predictores independientes de mortalidad a corto plazo para la enfermedad pulmonar obstructiva crónica del grupo sin diabetes mellitus de tipo 2, el ritmo sinusal, la terapia triple, el uso de nitratos, el uso de estatinas, la anemia y la hiperpotasemia. En el grupo de diabetes mellitus de tipo 2, solo el diámetro diastólico del ventrículo izquierdo fue un predictor de mortalidad independiente (HR = 0,96; IC95 %: 0,93 - 0,98). No hubo evidencia de modificación del efecto de la diabetes mellitus de tipo 2 sobre la relación entre ningún predictor independiente y la mortalidad por todas las causas. Sin embargo, se observó una modificación significativa del efecto de la diabetes mellitus de tipo 2 entre el tabaquismo y la mortalidad. Conclusiones. Los pacientes con diabetes mellitus de tipo 2 tuvieron mayor riesgo de mortalidad. Los resultados también sugieren que el diagnóstico de diabetes mellitus de tipo 2 no modifica el efecto de los factores de riesgo independientes de mortalidad en IC evaluados. Sin embargo, la diabetes mellitus de tipo 2 modifica significativamente la relación de riesgo entre mortalidad y tabaquismo en pacientes con insuficiencia cardíaca, posiblemente debido a un efecto sinérgico negativo que resulta en lesión vascular.

Association between leisure time activities and emotional intelligence among school students in Kollam district of South Kerala

Background: Leisure activity plays a key role in forming an individual’s physical and mental development. Both leisure-time physical activity and emotional intelligence (EI) are related to health-related quality of life. Objectives were to assess the EI of school children belonging to various boards and to find out whether leisure time activity has association with EI. Methods: A cross-sectional study was undertaken among 200 school students belonging to various boards of Kollam district. EI was measured using self-report EI developed by Shuttle et al for-data collection. Results: Among 200 subjects, 50 students studying in 9th standard belonging to different boards were taken from each school, 146 (73%) of students belonged to nuclear family, 154 (77%) shared their daily events with family. 109 (54%) choose arts as leisure time activity and 91 (45.5%) chose sports, 112 (56%) of the students spend at least one hour in social media and only 55 (27.5%) had a habit of reading newspaper daily. Significant statistical association was found between gender, type of school, sharing events with their parents, leisure time activity and EI (p<0.05). Conclusions: The study concluded that leisure activity has significant role in the developing EI of a person. It was found that the government (State syllabus) school children have better EI comparing with other boards and also the students who are good at arts also have good EI.

Desafío del cáncer de vesícula biliar: Un llamado a la investigación / Gallbladder Cancer Challenge: Research needs to be encouraged

En el panorama de la oncología, el cáncer de vesícula biliar ha permanecido durante mucho tiempo en las sombras, eclipsado por otras formas más comunes de cáncer. Sin embargo, su impacto en la salud pública es cada vez más evidente. Es en este contexto que dedicamos esta editorial para resaltar la importancia crítica de investigar esta patología. El carcinoma de vesícula biliar (CVB), aunque relativamente raro, es el colangiocarcinoma más común del árbol biliar y constituye una malignidad agresiva y letal con un pronóstico sombrío. Cada año 122.491 personas son diagnosticadas con cáncer de vesícula biliar y 89.055 personas padecen a causa de esta patología a nivel mundial. Aunque la supervivencia a 5 años ha aumentado progresivamente a entre el 7% y el 20%, los pacientes con enfermedad avanzada aún tienen una supervivencia a 5 años inferior al 5%.

In the oncology landscape, gallbladder cancer has long lingered in the shadows, overshadowed by more common forms of cancer. However, its impact on public health is becoming increasingly evident. It is in this context that we dedicate this editorial to highlight the critical importance of researching this pathology. Gallbladder carcinoma (GBC), although relatively rare, is the most common biliary tree malignancy and constitutes an aggressive and lethal malignancy with a grim prognosis. Each year, 122,491 people are diagnosed with gallbladder cancer, and 89,055 people suffer from this pathology globally. Although 5-year survival rates have progressively increased to between 7% and 20%, patients with advanced disease still have a 5-year survival rate of less than 5%.

Neuropatía autonómica cardíaca en diabéticos; estudio transversal analítico / Cardiac autonomic neuropathy in diabetic patients; an analytical cross-sectional study

Resumen Introducción: La neuropatía autonómica cardíaca es una entidad poco conocida y subdiagnosticada en los pacientes diabéticos, la cual se caracteriza por el daño de las fibras nerviosas autónomas; ocasiona síntomas como intolerancia al ejercicio e hipotensión postural. La prevalencia y los factores de riesgo en la población diabética colombiana son poco claros y poco estudiados. Objetivo: Determinar la prevalencia de la neuropatía autonómica cardíaca y de los factores asociados en pacientes diabéticos de una población colombiana. Materiales y método: Estudio transversal analítico, en una población de 107 pacientes con diagnóstico de diabetes mellitus tipos I y II, que consultaron a un hospital de segundo nivel de atención en Colombia, entre abril y septiembre de 2022. Se realizó diagnóstico utilizando el test de Ewing de reflejo autonómico cardiovascular. Los análisis estadísticos fueron del orden descriptivo y de asociación mediante regresión logística calculando razón de disparidad e intervalos de confianza del 95%. Resultados: La población estudiada tuvo una edad promedio de 62 años; el 56.1% fueron mujeres. El 94.4% (IC 95%: 89.9-98.6) de los participantes presentaron una evaluación positiva para neuropatía autonómica cardíaca; el estado incipiente fue del 6.5%, la afectación confirmada del 26.2% y el compromiso grave del 61.7%. La edad está asociada con la aparición de neuropatía autonómica cardíaca (ORa: 1.07; IC 95%: 1.03-1.11). Conclusiones: Este estudio encontró alta prevalencia de neuropatía autonómica cardíaca (94.4%) cuando se utilizó el estándar de oro de diagnóstico. La edad de los pacientes tiene asociación con la presencia y la gravedad de esta enfermedad.

Abstract Introduction: Cardiac autonomic neuropathy is a little known and underdiagnosed entity in diabetic patients, characterized by damage to autonomic nerve fibers causing symptoms such as exercise intolerance and postural hypotension; the prevalence and risk factors in the Colombian diabetic population are unclear and understudied. Objective: To determine the prevalence of cardiac autonomic neuropathyand associated factors in diabetic patients in a Colombian population. Materials and method: Analytical cross-sectional study, in a population of 107 patients with a diagnosis of diabetes mellitus type I and type II, who consulted a second level of care hospital in Colombia, between April and September 2022. Diagnosis was performed using the Ewing test of cardiovascular autonomic reflex. Statistical analyses were performed at descriptive and association level by logistic regression calculating odds ratio and 95% confidence intervals. Results: The study population had a mean age of 62 years, 56.1% of whom were women. 94.4% (CI 95%: 89.9-98.6) of the participants presented a positive evaluation for cardiac autonomic neuropathy; incipient status was 6.5%, 26.2% confirmed involvement and 61.7% severe involvement; age is associated with cardiac autonomic neuropathy presentation, ORa: 1.07 (CI 95%: 1.03-1.11). Conclusions: The current study found high prevalence of cardiac autonomic neuropathy (94.4%) when using the gold standard of diagnosis. The age of patients has association with the presence and severity of this disease.

Entrenamiento de fuerza para prevención de caídas en personas mayores: Una revisión sistemática / Strength training to prevent falls on the elderly: A systematic review

RESUMEN Introducción: El entrenamiento de fuerza está asociado con cambios positivos hacia un envejecimiento saludable y con calidad de vida, dado que previenen las lesiones, fragilidad, así como las caídas. Objetivo: El objetivo de este estudio fue evaluar la evidencia científica disponible sobre los efectos del entrenamiento de fuerza en la prevención de caídas en personas mayores. Metodología: Se realizó una búsqueda de artículos científicos en las bases de datos Medline vía PubMed, Web of Science (WOS) y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) vía Biblioteca Virtual de Salud (BVS) que cumplieran con los criterios de elegibilidad; el análisis se realizó entre el 8 de mayo de 2022 hasta el 11 de octubre de 2022. Resultados: Se seleccionaron 10 artículos; el promedio de edad fue de 75,3 años; en el 90 % de los artículos predominó el sexo femenino. Con respecto a los programas, el 70 % duró 60 minutos y en el 50% predominó ejercicios principalmente de miembros inferiores, y el 60 % de los artículos usó el Timed Up and Go para evaluar sus programas. La totalidad de los artículos demuestran que el entrenamiento de fuerza redujo el riesgo de caídas a corto plazo. Conclusión: Las principales conclusiones apuntan a un cambio favorable en la prevención de caídas a través del análisis de la fuerza, el equilibrio, la tasa de caídas, la aptitud física y/o el miedo a caer tras realizar entrenamiento de fuerza.

ABSTRACT Introduction: Strength training is associated with positive changes towards healthy aging and quality of life since it prevents injuries, frailty, as well as falls. Objective: The objective of this study was to evaluate the available scientific evidence on the effects of strength training in the prevention of falls in the elderly. Methodology: A search for scientific articles was carried out in the databases: Medline via PubMed, Web of Science (WOS) and Latin American and Caribbean Literature in Health Sciences (LILACS) via the Virtual Health Library (VHL) that meet the the eligibility criteria, the analysis was carried out between the date of May 8, 2022 until October 11, 2022. Results: 10 articles were selected; the average age was 75.3 years; in 90 % of the articles the female sex predominated. With respect to the programs, 70 % lasted 60 minutes and in 50 % exercises mainly of the lower limbs predominated, and 60 % of the articles used Timed Up and Go to evaluate their programs. All the articles show that the training of strength reduced the risk of falls in the short term. Conclusion: The main conclusions point to a favorable change in the prevention of falls through the analysis of strength, balance, rate of falls, physical fitness and/or fear of falling after performing strength training.

Síndrome de piel escaldada asociado a estafilococcemia en un neonato: reporte de un caso / Scalded skin syndrome associated with staphylococcemia in a neonate: a case report

RESUMEN El síndrome de piel escaldada estafilocócica es una patología poco frecuente que principalmente afecta a población pediátrica. Si bien en la mayoría de los casos tiene un desenlace favorable, un buen diagnóstico diferencial y manejo antibiótico oportuno son cruciales para un buen pronóstico. Objetivo: Describir un caso de síndrome de piel escaldada con aislamiento en hemocultivos de S. Aureus meticilino resistente en un neonato. Caso clínico: Femenina de 25 días de vida, nacida a término y sin antecedentes perinatales relevantes que cursa con fiebre, dermatosis eritemato-descamativa generalizada, edema palpebral y de miembros inferiores. Se hospitalizó con diagnóstico de sepsis neonatal tardía y sindrome de piel escaldada. Reporte de hemocultivos con crecimiento de S. Aureus meticilino resistente, manejada con vancomicina durante 14 días. Control de hemocultivos negativos, evolución satisfactoria y de alta hospitalaria sin complicaciones. Conclusiones: A pesar de la baja incidencia del síndrome de piel escaldada, es importante incluir dentro del diagnóstico diferencial de la fiebre y las dermatosis tardías del neonato la infecciones por toxinas del S. Aureus, ya que su identificación y tratamiento oportuno son de gran importancia en el pronóstico del menor.

ABSTRACT Staphylococcal scalded skin syndrome is a rare pathology, which mainly affects pediatric population. Although in most cases it has a favorable outcome, making a good differential diagnosis and early antibiotic management are crucial for a good prognosis. Objective: To describe a case of scalded skin syndrome with methicillin-resistant S. aureus bloodstream infection in a newborn. Clinical case: A 25-day-old female, born at term and with no relevant perinatal history, presented with fever, generalized scaly erythematous dermatosis, eyelid and lower limb edema. She is hospitalized with a diagnosis of late neonatal sepsis and scalded skin syndrome. Report of blood cultures with growth of methicillin-resistant S. Aureus, managed with vancomycin for 14 days. Control cultures were negative, satisfactory evolution and hospital discharge without complications. Conclusions: Despite the low incidence of scalded skin syndrome, it is important to include S. aureus toxin infections in the differential diagnosis of fever and late-onset dermatoses in the newborn. The identification and early treatment are of great importance in the prognosis of the child.

Isolated metastasis in the thyroid gland secondary to renal cell carcinoma: case report / Metástasis aislada en glándula tiroides secundaria a carcinoma de células renales: reporte de caso

ABSTRACT Introduction: Metastatic disease of the thyroid corresponds to 2% of thyroid malignancies in autopsy series. Up to 50% of metastases are due to renal cell carcinoma (Ree). These can occur several years after diagnosis or nephrectomy. An isolated presence in the thyroid gland is rare. Clinical case presentation: We present the case of a 68-year-old woman with a history of Ree managed with nephrectomy and retroperitoneal lymphadenectomy. After 7 years free of symptoms, she noticed a mass over the thyroid region. Ultrasonography reported bilateral thyroid nodules. Due to the oncologic history and the affirmation of symptoms during swallowing, a full thyroidectomy was performed. The histopathological report was compatible with Ree metastasis. Discussion: The literature shows that the median time for thyroid metastasis in patients with Ree is 92 months. Most patients are asymptomatic, and a full thyroidectomy is recommended to prevent disease progression with a favorable impact on Survival. Conclusion: In patients with thyroid nodules and a history of Ree, metastasis should be suspected.

RESUMEN Introducción: La enfermedad metastásica a tiroides corresponde a 2% de las malignidades tiroideas en series de autopsias. Hasta el 50% de las metástasis se deben a carcinoma de células renales (Ree). Estas pueden ocurrir varios años después del diagnóstico o la nefrectomía. La presentación aislada en la glándula tiroides es rara. Presentación caso clínico: Presentamos el caso de una mujer de 68 años con historia de Ree manejada con nefrectomía y linfadenectomía retroperitoneal. Tras 7 años libre de síntomas notó la aparición de una masa sobre la región tiroidea. La ultrasonografía reportó nódulos tiroideos bilaterales. Por el antecedente oncológico y la afirmación de síntomas durante la deglución se le realizó tiroidectomía total. El reporte histopatológico fue compatible con metástasis de Ree. Discusión: La literatura muestra que el tiempo medio de metástasis a tiroides en pacientes con Ree es 92 meses. La mayoría de los pacientes son asintomáticos. Se recomienda la tiroidectomía total para prevenir progresión de la enfermedad con impacto favorable en la supervivencia. Conclusión: En los pacientes con nódulos tiroideos y antecedente de Ree se debe sospechar enfermedad metastásica.

Síndrome de Miller-Dieker: reporte de dos casos / Miller-Dieker Syndrome: Two Cases Report

Resumen Introducción: El síndrome de Miller-Dieker cuenta con un patrón de herencia autosómico dominante y pertenece al grupo de trastornos de la migración neuronal. Se caracteriza por la presencia de lisencefalia de tipo 1, retraso global del desarrollo, microcefalia, epilepsia y dismorfismos faciales dados por mutaciones en el cromosoma 17p13. El síndrome de Miller-Dieker es una enfermedad extremadamente rara con prevalencia de 1 caso por cada 100,000 recién nacidos vivos. Presentación de casos: Nosotros presentamos dos casos de síndrome de Miller-Dieker en los que datos de la exploración física y del interrogatorio fueron pistas que permitieron una fuerte sospecha diagnóstica y que a su vez el diagnóstico definitivo mediante FISH permitió brindar un adecuado manejo con la finalidad de mejorar el pronóstico a largo plazo. Conclusión: Se debe tener una alta sospecha diagnóstica mediante la exploración física dirigida a identificar alteraciones en pacientes con epilepsia de difícil control, ya que permite guiar el diagnóstico etiológico y con ello brindar un adecuado tratamiento.

Abstract Introduction: Miller-Dieker syndrome has an autosomal dominant pattern of inheritance and belongs to the group of neuronal migration disorders. It is characterized by the presence of type 1 lissencephaly, global development delay, microcephaly, epilepsy and facial dysmorphisms caused by mutations in chromosome 17p13. Miller-Dieker syndrome is an extremely rare disease with a prevalence of 1 case per 100,000 live births. Case presentation: We present two cases of Miller-Dieker syndrome in which data from the physical examination and questioning were clues that allowed a strong diagnostic suspicion and that, in turn, the definitive diagnosis by means of FISH allowed us to provide adequate management in order to improve the long-term prognosis. Conclusion: A high diagnostic suspicion must be achieved through physical examination aimed at identifying alterations in patients with difficult-to-control epilepsy, since it allows guiding the etiological diagnosis and thereby providing adequate treatment.

Guia prático para o uso de imunobiológicos em doenças alérgicas - ASBAI / Practical guide for the use of immunobiologic agents in allergic diseases - ASBAI

Os anticorpos monoclonais são uma nova classe de medicamentos que representa um marco na evolução da terapia de doenças alérgicas graves. Além de possibilitar uma terapia imunológica alvo específico, proporciona maior controle de sintomas, redução de exacerbações, melhoria da qualidade de vida e da segurança. A eficácia e a segurança dos anticorpos monoclonais no tratamento de doenças alérgicas estão bem documentadas nos estudos clínicos pivotais, de extensão e de vida real. No Brasil, estão licenciados atualmente pela Agência Nacional de Vigilância Sanitária (ANVISA) imunobiológicos para asma, dermatite atópica (DA), esofagite eosinofílica (EoE), granulomatose eosinofílica com poliangeíte (GEPA), rinossinusite crônica com pólipo nasal (RSCcPN), síndromes hipereosinofílicas (SHE) e urticária crônica espontânea (UCE). Com a incorporação do uso dessas novas terapias no dia a dia do médico alergologista e imunologista, naturalmente emergem aspectos práticos que exigem orientações práticas perante as evidências científicas mais atuais, a fim de se manter a boa prática médica, com uso criterioso e consciente pelo especialista capacitado. Assim, nesse guia prático, abordaremos os imunobiológicos aprovados até o momento para doenças alérgicas graves, com objetivo de auxiliar o especialista em Alergia e Imunologia na prescrição e manejo dessas medicações, incluindo indicações, contraindicações, monitoramento da eficácia e segurança, notificação de eventos adversos, bem como aspectos associados aos cuidados com vacinas, populações especiais, acesso, transporte, armazenamento e aplicação domiciliar.

Monoclonal antibodies are a new class of drugs that represent a milestone in the evolution of therapy for severe allergic diseases. In addition to allowing targeted immunologic therapy, they can improve symptom control, reduce exacerbations, and increase quality of life and safety. The efficacy and safety of monoclonal antibodies in the treatment of allergic diseases are well documented in pivotal, extension, and real-life clinical studies. In Brazil, immunobiologic agents are currently licensed by the National Health Surveillance Agency (ANVISA) for use in asthma, atopic dermatitis (AD), eosinophilic esophagitis (EoE), eosinophilic granulomatosis with polyangiitis (EGPA), chronic rhinosinusitis with nasal polyps (CRSwNP), hypereosinophilic syndrome (HES), and chronic spontaneous urticaria (CSU). With the incorporation of these new therapies into the daily practice of the allergist and immunologist, practical aspects will naturally emerge and require practical guidelines in light of the most current scientific evidence in order to maintain good medical practice, with judicious and conscious use by a qualified specialist. Therefore, in this practical guide, we will address the immunobiologic agents currently approved for severe allergic diseases, aiming to assist allergy and immunology specialists in the prescription and practical management of these medications, including indications, contraindications, efficacy and safety monitoring, adverse event reporting, as well as health care factors associated with vaccination, special populations, access, transport, storage, and home use.