Entre a Fome-tabu e o Trauma Intencional: Implicações Políticas e Metapsicológicas da Fome / Between Famine-taboo and Intentional Trauma: Political and Metapsychological Implications of Famine / Entre el Tabú del Hambre y el Trauma Intencional: Implicaciones Políticas y Metapsicológicas del Hambre

A partir do reconhecimento de uma situação original de desamparo e dependência do outro a qual a criança está estruturalmente submetida, pontua-se que o apaziguamento da fome - considerado uma necessidade fundamental - culmina na consolidação da alteridade como lugar de referência e endereçamento, na erogeneização do corpo próprio, na constituição do Eu e na potencialização do devir do desejo. Logo, a fome e o fracasso do apelo ao outro são experiências potencialmente traumáticas, que produzem vulnerabilidades sociais e psíquicas graves e duradouras. Entende-se que as frustrações das expectativas de saciedade da fome, sobretudo na infância, produzem uma espécie de dor moral, correlata à fragilização da confiança no outro. Com Josué de Castro, reforça-se o aspecto político inarredável da fome, que se amalgama a suas implicações psíquicas e físicas. Com o médico e escritor pernambucano, sublinha-se a existência de uma intenção histórica do Estado brasileiro de ignorar, desmentir e até mesmo provocar a fome. É lembrado que, como um arguto leitor de Freud, o autor faz uso da teoria pulsional psicanalítica como operador conceitual para pensar a fome. Na esteira da contribuição de Castro, Ferenczi é trazido à baila a fim de fundamentar o caráter intencional e político do trauma da fome.

From the recognition of an original situation of helplessness and dependence on the other to which the child is structurally subjected, it is pointed out that the appeasement of hunger - considered a fundamental need - culminates in the consolidation of alterity as a place of reference and addressing, in the erogenization of the own body, the constitution of the Self, and the potentialization of desire's becoming. Therefore, hunger and the failure of the appeal to the other are potentially traumatic experiences that produce serious and lasting social and psychological vulnerabilities. Thence, frustrating the expectations of hunger's satiety, especially in childhood, produce a kind of moral pain, which is correlated to the weakening of trust the other. With Josué de Castro, the inescapable political aspect of hunger, which is merged with its psychological and physical implications, is reinforced. From his ideas, the existence of a historical intention of the Brazilian state to ignore, deny, and even provoke hunger is emphasized. As a keen reader of Freud, the author uses psychoanalytic drive theory as a conceptual operator to think about hunger. Following Castro's contribution, Ferenczi is brought up to support the intentional and political nature of hunger trauma.

A partir del reconocimiento de una situación original de desamparo y dependencia del otro a la que el niño está estructuralmente sometido, se señala que el apaciguamiento del hambre - considerada una necesidad fundamental - culmina en la consolidación de la alteridad como lugar de referencia y direccionamiento, la erogeneización del cuerpo propio, la constitución del Yo y la potencialización del devenir del deseo. Entonces, el hambre y el fracaso del llamado al otro son experiencias potencialmente traumáticas que producen vulnerabilidades sociales y psicológicas graves y duraderas. Las frustraciones de las expectativas de saciedad del hambre, especialmente en la infancia, origina un dolor moral, correlacionado con el debilitamiento de la confianza en el otro. Con Josué de Castro, se refuerza el aspecto político ineludible del hambre, que se amalgama a sus implicaciones psicológicas y físicas. Con el escritor brasileño, se enfatiza la existencia de una intención histórica del Estado brasileño de ignorar, negar e incluso provocar el hambre. Se recuerda que, como lector perspicaz de Freud, el autor utiliza la teoría pulsional psicoanalítica como operador conceptual para pensar en el hambre. Siguiendo la contribución de Castro, Ferenczi se pone de relieve para respaldar la naturaleza intencional y política del trauma del hambre.

Brazilian physiotherapist anxiety and depression during the COVID-19 pandemic: a cross-sectional survey / Ansiedade e depressão em fisioterapeutas brasileiros durante a pandemia de COVID-19: um estudo transversal

Abstract This study investigated the prevalence and the potential risk factors for anxiety and depression among physiotherapists during the pandemic. Physiotherapists answered a web-based questionnaire including 1) sociodemographic, professional and clinical information; 2) psychosocial demands; and 3) two validated questionnaires to measure anxiety and depression. Binary logistic regression identified the risk factors by means of odds ratio (OR) and 95% confidence interval (CI). In 417 participants, there was a high prevalence of anxiety (48.2%) and depression (53.0%). The risk factors for anxiety were female sex (OR 2.07; 95%CI 1.01-4.24), worsening in sleep patterns (OR 3.78; 95%CI 1.92-7.44), moderate (OR 2.24; 95%CI 1.00-5.00) and extreme concern about financial issues (OR 3.47; 95%CI 1.57-7.65), and extreme loneliness (OR 3.47; 95%CI 1.71-7.07). The risk factors for depression were female sex (OR 2.16; 95%CI 1.03-4.55), low family income (OR 2.43; 95%CI 1.21-4.89), worsening in sleep patterns (OR 5.97; 95%CI 3.02-11.82), extreme concern about financial issues (OR 2.61; 95%CI 1.15-5.94), and extreme loneliness (OR 4.38; 95%CI 2.00-9.63). This study found a high prevalence of anxiety and depression in the studied population and identified risk factors for both.

Resumo Este estudo investigou a prevalência e potenciais fatores de risco para ansiedade e depressão em fisioterapeutas durante a pandemia. Fisioterapeutas responderam a um questionário na web, incluindo: dados sociodemográficos, profissionais e clínicos; demandas psicossociais; e dois questionários validados para medir ansiedade e depressão. Regressão logística binária identificou fatores de risco para ansiedade e depressão por meio de odds ratio (OR) e intervalo de confiança de 95% (IC). Em 417 participantes houve alta prevalência de ansiedade (48,2%) e depressão (53%). Os fatores de risco para ansiedade foram: sexo feminino (OR 2,07; IC95% 1,01-4,24), piora nos padrões de sono (OR 3,78; IC95% 1,92-7,44), moderada (OR 2,24; IC95% 1,00-5,00) e extrema preocupação financeira (OR 3,47; IC95% 1,57-7,65) e extrema solidão (OR 3,47; IC95% 1,71-7,07). Os fatores de risco para depressão foram: sexo feminino (OR 2,16; IC95% 1,03-4,55), baixa renda familiar (OR 2,43; IC95% 1,21-4,89), piora nos padrões de sono (OR 5,97; IC95% 3,02-11,82), extrema preocupação financeira (OR 2,61; IC95% 1,15-5,94) e extrema solidão (OR 4,38; IC95% 2,00-9,63). Este estudo mostrou alta prevalência de ansiedade e depressão na população estudada e identificou fatores de risco para ambos.

Comparación de la mortalidad en pacientes en quimioterapia o inmunoterapia durante y antes de la pandemia de COVID-19. Estudio multicéntrico de cohortes emparejadas en Argentina / Comparison of mortality in patients on chemotherapy or immunotherapy during and before COVID-19 pandemic. Multicenter matched cohort study in Argentina

RESUMEN Objetivos. Comparar la mortalidad por todas las causas de pacientes oncológicos no vacunados que recibieron quimioterapia o inmunoterapia durante la pandemia, con aquellos tratados antes de la pandemia. Materiales y métodos. Realizamos un estudio de cohortes en cuatro hospitales terciarios en Argentina. Pacientes ambulatorios con una neoplasia sólida de cualquier estadio en tratamiento citotóxico o inmune intravenoso fueron elegibles. La cohorte pandémica se enroló durante la fase inicial del brote y se comparó con una cohorte de un período anterior a la pandemia utilizando emparejamiento por puntuación de propensión (PSM, por sus siglas en inglés). Los sujetos se emparejaron por edad, sexo, seguro de salud, factores de riesgo para complicaciones graves por COVID-19, estado funcional, tipo de cáncer y tratamiento, línea de tratamiento e índice de masa corporal. La mortalidad por todas las causas se estimó en ambas cohortes después de seis meses de seguimiento. Resultados. 169 pacientes fueron reclutados entre abril y agosto de 2020 para la cohorte pandémica y 377 para la cohorte prepandémica en el mismo período de 2019, 168 pacientes fueron emparejados. Luego de la PSM, la mortalidad por todas las causas fue del 17,9% en la cohorte pandémica y del 18,5% en la cohorte prepandémica, Riesgo Relativo: 0,97 (intervalo de confianza al 95 %: 0,61-1,52; p=0,888). En la cohorte pandémica, 30/168 pacientes fallecieron, ninguno por infección por COVID-19. Conclusiones. No hemos observado un aumento de mortalidad en pacientes ambulatorios no vacunados en tratamiento oncológico endovenoso activo durante la pandemia por COVID-19.

ABSTRACT Objectives. To compare all-cause mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic. Materials and methods. We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage under-going cytotoxic or intravenous immunotherapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a pre-pandemic cohort using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, risk factors for severe COVID-19 complications, performance status, cancer type and treatment, line of treatment, and body mass index. All-cause mortality was estimated for both cohorts after 6 months of follow-up. Results. A total of 169 patients were recruited between April and August 2020 for the pandemic cohort and 377 for the pre-pandemic cohort in the same months of 2019; 168 patients were matched. After PSM, all-cause mortality was 17.9% in the pandemic cohort and 18.5% in the pre-pandemic cohort; the Relative Risk was 0.97 (95 % confidence interval: 0.61-1.52; p=0.888). In the pandemic cohort, 30/168 patients died, but none from COVID-19. Conclusions. Our findings show that the mortality rate of unvaccinated ambulatory patients on active intravenous oncology treatment during the COVID-19 pandemic did not increase.

A study on management of hemorrhoids: Comparison between conservative management and injection sclerotherapy

Background: Hemorrhoidal disease is one of the most common anorectal conditions encountered in daily practice for centuries. Conservative management of hemorrhoids (with oral diosmin, calcium dobesilate cream local application) and injection sclerotherapy with 3% polidocanol-both are very commonly practiced, cost effective, and outpatient department-based management of hemorrhoids which bear rare adverse effects. Comparative efficacy of injection sclerotherapy and conservative management in cases of hemorrhoids is still confusing and contradictory to each other according to different studies. Aims and Objectives: This study was conducted to compare the effectiveness between conservative management of hemorrhoids and injection sclerotherapy. Materials and Methods: This institution-based experimental study done over 74 patients of first- and second-degree internal hemorrhoids. Thirty-seven patients were randomly selected and managed with conservative management, and the rest with injection sclerotherapy. Treatment responses were assessed after 3 weeks and in unsatisfactory responses, treatment was repeated for another 3 weeks. Reassessment was done after 6 weeks and 6 months. Results: This study demonstrated that both injection sclerotherapy and conservative management had improved per rectal bleeding after 3 and 6 weeks of treatment, but the former had a significant edge over the counterpart after 6 months of treatment (56.8% vs. 35.1%, P = 0.002). In case of reduction of hemorrhoidal mass – injection sclerotherapy had significantly better outcome in all the follow-up visits, that is, 3 weeks (54.1% vs. 13.5%, P = 0.001), 6 weeks (70.3% vs. 35.1%, P = 0.008) and 6 months (59.5% vs. 27.0%, P = 0.003). Injection sclerotherapy had superior overall treatment outcome after 6 weeks of treatment (73% vs. 45.9%, P = 0.04) and long-term periods (56.85% vs. 27%, P < 0.01). Conclusion: Injection sclerotherapy shows significantly better and long-lasting improvement in symptomatic hemorrhoids in comparison to conservative management which is mainly able to limit per rectal bleeding only for a short period of time.

CYTOTOXICITY TESTING OF A NOVEL CROSSLINKED PRF (C-PRF) DEVELOPED FOR DENTAL PULP TISSUE ENGINEERING PURPOSE

Background- Whole pulp amputation followed by pulp space disinfection and ?lling with an arti?cial material causes loss of signi?cant amount of dentin leaving a non-vital and weakened tooth. Regenerative endodontics with its emerging ?eld of modern tissue engineering has demonstrated promising results using stem cells associated with scaffolds and responsive molecules. [1] Introduction- PRF was recognized as the “second generation” of this family of biomaterials. [6] PRF being tested in pulp tissue engineering by different research groups showed mixed results. (7,8) Research studies have shown that the interactions between the cells and their niche are closely related to physicochemical properties of the scaffolding materials [9, 10]. As PRF is a fragile gel its physical character needs to be improved by cross linking and thereby more longer period of liberation of its growth factors and delayed disintegration in physiological system. Aims and Objectives- Aim of our study was to prepare a very economical and autologous biomaterial for pulp tissue engineering by crosslinking of PRF with tannic acid. Our objective was to detect cytotoxic effect of tannic acid in PRF. Methods and Materials- We followed Choukroun et al. protocol to prepare PRF samples from whole venous blood collected from donors. PRF samples were then cross-linked in freshly prepared TA solution in dapendish for 10 minutes at room temperature. Concentrations of TA 1 wt% was used for preparing samples. After crosslinking, the gels were washed with normal saline for 5 min. to ensure that all excess TA was removed. The viability of cells cultured on the scaffolds was assessed through MTT assay (EZcountTM MTT cell Assay Kit, HiMedia, Mumbai, India). Observations- Both MTT Assay and Phalloidine staining showed favourable results of no clear cytotoxic effects of C-PRF. Conclusion- Based on the results of the cell viability analysis it can be concluded that none of the tannic acid crosslinked PRF created any clear cytotoxicity in the MC3T3 cells. So, C-PRF can safely be used as scaffold for dental pulp or similar tissue engineering purposes

Análise da empregabilidade de enfermeiros formados em uma instituição de ensino superior pública do interior / Analysis of the employability of nurses who graduated in a public higher education institution in the countryside / Análisis de la empleabilidad de enfermeras formadas en una institución pública de educación superior en el interior

Objetivo: Analisar a empregabilidade de enfermeiros formados em um campus do interior do Brasil. Métodos: Estudo transversal, realizado com 144 egressos de quatro turmas de um curso de enfermagem, na cidade de Floriano, Piauí. A coleta de dados foi realizada no segundo semestre de 2016, via Google Forms. Foram investigadas variáveis socioeconômicas, relacionadas à empregabilidade e ao grau de satisfação com a profissão. Resultados: 61 pessoas participaram do estudo e taxa de empregabilidade em torno dos 75%. O principal campo de atuação profissional foi na atenção hospitalar. Dentre os motivos para o desemprego, prevaleceu a falta de concursos públicos (33%) e a pouca oferta de emprego na região (25%). Conclusão: Os achados permitiram compreender as dificuldades enfrentadas pelos egressos no que diz respeito a inserção no mercado de trabalho, destacando a importância da qualificação profissional e o estímulo na ampliação de habilidades e competências na área de enfermagem. (AU)

Objective: To analyze the employability of nurses trained on campus in the interior of Brazil. Methods: A cross-sectional study was carried out with 144 graduates from four classes of a nursing course in the city of Floriano, Piauí. Data collection was carried out in the second half of 2016, via Google Forms. Socioeconomic variables related to employability and the degree of satisfaction with the profession were investigated. Results: 61 people participated in the study and the employability rate around 75%. The main field of professional activity was in hospital care. Among the reasons for unemployment, the lack of public examinations (33%) and the low job offer in the region (25%) prevailed. Conclusion: The findings allowed us to understand the difficulties faced by graduates about insertion in the labor market, highlighting the importance of professional qualification and the encouragement to expand skills and competencies in the field of nursing. (AU)

Objetivo: Analizar la empleabilidad de enfermeras formadas en un campus del interior de Brasil. Métodos: Estudio transversal realizado con 144 egresados de cuatro clases de un curso de enfermería en la ciudad de Floriano, Piauí. La recolección de datos se realizó en el segundo semestre de 2016, a través de Google Forms. Se investigaron variables socioeconómicas relacionadas con la empleabilidad y el grado de satisfacción con la profesión. Resultados: 61 personas participaron en el estudio y la tasa de empleabilidad ronda el 75%. El principal campo de actividad profesional fue la atención hospitalaria. Entre los motivos del desempleo, predominaron la falta de exámenes públicos (33%) y la baja oferta laboral en la región (25%). Conclusion: Los hallazgos permitieron comprender las dificultades que enfrentan los egresados con respecto a la inserción en el mercado laboral, destacando la importancia de la calificación profesional y el estímulo para expandir habilidades y competencias en el campo de la enfermería. (AU)

Avaliação dos registros de enfermeiros em unidade de terapia intensiva baseado na resolução Cofen nº 429/2012 / Evaluation of the records of nurses in the intensive care unit based on the Cofen resolution nº429/2012 / Evaluación de registros de enfermeras en la unidad de cuidados intensivos basado en la resolución Cofen nº 429/2012

Objetivo: Avaliar a qualidade dos registros de enfermeiros em Unidade de Terapia Intensiva baseado na Resolução No. 429/2012 do Conselho Federal de Enfermagem. Métodos: Estudo documental e avaliativo realizado em Unidade de Terapia Intensiva de um hospital universitário no Rio de Janeiro em janeiro de 2017. A amostra foi composta por 312 registros. Para a coleta de dados foi construído um instrumento com base nas determinações da Resolução No. 429/2012. Resultados: Constatou-se que 46,8% dos registros da coleta de dados, estavam incompletos e voltavam-se, predominantemente, para a dimensão biológica do corpo e para a utilização de dispositivos sem, contudo, fornecer informações consistentes e que sustentassem as demais etapas do processo de enfermagem. O diagnóstico de enfermagem com base nas taxonomias existentes, não foi encontrado em nenhum registro. Quanto a anotação das ações realizadas e da avaliação, 68,3% e 85,9%, respectivamente, estavam incompletas. Conclusão: Na avaliação dos registros dos enfermeiros, mais de 90,0% mostraram-se incompletos e não atenderam aos padrões determinados pela Resolução No. 429/2012. Portanto, os registros avaliados não atendem aos preceitos éticos e legais da profissão. (AU)

Objective: To assess the quality of records of nurses in the Intensive Care Unit based on Resolution No. 429/2012. Federal Council of Nursing. Methods: Documentary and evaluative study carried out in the Intensive Care Unit of a university hospital in Rio de Janeiro in January 2017. The sample consisted of 312 records. For data collection, an instrument was built based on the determinations of the Resolution No. 429/2012. Results: It was found that 46.8% of the data collection records were incomplete and predominantly focused on the biological dimension of the body and the use of devices without, however, providing consistent information that would support the others stages of the nursing process. The nursing diagnosis based on existing taxonomies was not found in any record. As for the annotation of the actions taken and the evaluation, 68.3% and 85.9%, respectively, were incomplete. Conclusion: In the evaluation of nurses' records, more than 90,0% were incomplete and did not meet the standards determined by Resolution No. 429/2012. Therefore, the evaluated records do not meet the ethical and legal precepts of the profession. (AU)

Objetivo: Evaluar la calidad de los registros de enfermeras en la Unidad de Cuidados Intensivos basado en la Resolución No. 429/2012 Consejo Federal de Enfermeria. Métodos: Estudio documental y evaluativo realizado en la Unidad de Cuidados Intensivos de un hospital universitario en Rio de Janeiro en Enero de 2017. La muestra estuvo conformada por 312 registros. Para la recolección de datos se construyó un instrumento en base a las determinaciones de la Resolución No. 429/2012. Resultados: Se encontró que el 46.8% de los registros de recolección de datos estaban incompletos y predominantemente enfocados en la dimensión biológica del cuerpo y el uso de dispositivos sin, sin embargo, brindar información consistente que sustente las otras etapas del proceso de enfermería. El diagnóstico de enfermería basado en taxonomías existentes no se encontró en ningún registro. En cuanto a la anotación de las acciones realizadas y la evaluación, 68,3% y 85,9%, respectivamente, fueron incompletas. Conclusión: En la evaluación de los registros de enfermeras, más del 90,0% estaban incompletos y no cumplían con los estándares determinados por la Resolución No. 429/2012. Por tanto, los expedientes evaluados no cumplen con los preceptos éticos y legales de la profesión. (AU)

Cocaína adulterada con opioides en la provincia de Buenos Aires: análisis epidemiológico para pensar una nueva política de drogas / Cocaine adulterated with opioids in the province of Buenos Aires: epidemiological analysis to think about a New Drug Policy

INTRODUCCIÓN: En febrero de 2022 se produjo en la provincia de Buenos Aires un brote de intoxicación por consumo de cocaína adulterada con opioides. El objetivo de este trabajo fue describir la población afectada, las acciones realizadas desde el Ministerio de Salud de la Provincia de Buenos Aires a partir de la detección de la problemática y analizar las modalidades de abordaje de los consumos respecto de los paradigmas de atención desde la perspectiva de la salud y las normativas vigentes en la temática en Argentina. MÉTODOS: Se realizó un estudio descriptivo transversal con enfoque cuantitativo. Se estudió a todas las personas que presentaban síntomas compatibles con cuadros de intoxicación por consumo de cocaína adulterada y que consultaron en establecimientos de salud de la provincia de Buenos Aires en febrero de 2022. RESULTADOS: Se notificaron 124 casos, el rango etario fue de 18 a 57 años, y el 84,5% fueron informados como sexo legal masculino. El 66% requirió internación hospitalaria, y 19 personas fallecieron. Los resultados de laboratorio confirmaron que la sustancia consumida era cocaína con carfentanilo. DISCUSIÓN: La identificación de opioides es un fenómeno novedoso en la región, que invita a problematizar los marcos normativos y los paradigmas de abordaje vigentes para superar visiones que reducen la problemática a los aspectos inherentes a los individuos y sus conductas respecto del consumo de sustancias psicoactivas.

Hidatidosis pancreática en una niña de 5 años / Pancreatic echinococcosis in a 5-year-old girl

La hidatidosis pancreática representa el 0,2-0,6 % de los casos, siendo la población pediátrica la de mayor riesgo. Las lesiones suelen localizarse en cabeza del páncreas (50-58 %); la localización en cuerpo y cola del páncreas se encuentra en el 24-34 % y el 19 %, respectivamente. Dada la posibilidad de complicaciones, suele realizarse tratamiento quirúrgico. Se sugiriere indicar albendazol antes y después del acto quirúrgico por los riesgos de ruptura y diseminación de los protoescólices. Se presenta el caso de una niña de 5 años de edad con dolor abdominal progresivo y lesión quística en páncreas compatible con hidatidosis en la ultrasonografía. En la tomografía computada se observa compresión de la vía biliar. La hemoaglutinación indirecta fue negativa. Presentó elevación de la bilirrubina total, con franco predominio de bilirrubina directa, y aumento de enzimas hepáticas. Se realizó laparotomía exploradora, colecistectomía y destechamiento del quiste. Evolucionó favorablemente, continuó con albendazol durante 3 meses luego de la cirugía.

Pancreatic echinococcosis accounts for 0.2­0.6% of cases, with the pediatric population being at a higher risk. Most commonly, pancreatic lesions occur in the head of the pancreas (50­58%); and in the body and tail in 24­34% and 19% of cases, respectively. Given the potential complications, surgery is usually performed. Albendazole is recommended before and after the surgery due to the risks for rupture and dissemination of protoscolices. Here we describe the case of a 5-year-old girl with progressive abdominal pain and cystic lesion in the pancreas compatible with echinococcosis in the ultrasound. The computed tomography showed bile duct compression. Indirect hemagglutination was negative. She had elevated total bilirubin, with a clear predominance of direct bilirubin, and high liver enzymes. Exploratory laparotomy, cholecystectomy, and unroofing of the cyst were performed. The patient had a favorable course and continued with albendazole for 3 months after the surgery.

Efectividad de la vacuna para SARS-CoV-2 sobre hospitalizaciones por COVID-19 durante la cuarta ola epidémica en Querétaro, México Vacunación y hospitalización en COVID-19

Objetivo: Evaluar el efecto protector de la vacuna para SARS-CoV-2 para hospitalizaciones por COVID-19 durante la cuarta ola epidémica en Querétaro, México. Métodos: Diseño de cohorte retrospectiva en pacientes con COVID-19 durante la cuarta ola (19 de diciembre de 2021 al 9 de enero de 2022). Grupos expuestos, antecedente de vacuna anti COVID-19 (vacuna de adenovirus modificado genéticamente y vacuna de ácido ribonucleico mensajero), grupo no expuesto, no vacuna. El diagnóstico de COVID-19 se realizó con la prueba antigénica rápida en exudado orofaringeo, prueba practicada entre el primero y quinto día del inicio de sintomatología. Se incluyeron todos los pacientes que acudieron al servicio de salud por sintomatología, con prueba positiva y dos dosis de la vacuna. El análisis estadístico incluyó chi cuadrada, riesgo relativo e intervalo de confianza para riesgo relativo. Resultados: Se estudiaron 52 pacientes con vacuna de adenovirus modificado genéticamente, 119 con vacuna de ácido ribonucleico mensajero y 336 pacientes no vacunados. En pacientes no vacunados la incidencia de hospitalización fue 62,2%, en pacientes con vacuna adenovirus modificado genéticamente la hospitalización fue 23,1% (p<0.001), riesgo relativo de 0,37 (IC 95%; 0,22-0,61); y en pacientes con vacuna de ácido ribonucleico mensajero la incidencia de hospitalización fue 1,7% (p<0.001), riesgo relativo de 0,03 (IC 95%; 0,006-0,10). Conclusiones: La vacuna anti COVID-19 en el ámbito poblacional es efectiva para evitar hospitalización en pacientes que presentan cuadro agudo de COVID-19 en la cuarta ola.

Objective: To assess the protective effect of the vaccine against SARS-CoV-2 upon hospitalizations due to COVID-19 during the fourth epidemic wave in Queretaro, Mexico. Methods: This investigation was designed as a retrospective cohort study in patients with COVID-19 during the fourth wave of the epidemic (December 19th, 2021, to January 9th, 2022). The exposed group consisted in those subjects who had received a vaccine against COVID-19 (genetically modified adenovirus vaccine and messenger ribonucleic acid vaccine); and the non-exposed group consisted in those people who were not vaccinated. Diagnosis of COVID-19 was made with a rapid antigenic test in oropharyngeal exudate, and the test was performed between the first and fifth day after the onset of symptoms. All patients who came to healthcare facilities because of symptoms, with a positive test and having received two doses of the vaccine. Statistical analysis included chi-square, relative risk, and confidence intervals (CI) for the relative risk. Results: Fifty-two patients who received a genetically modified vaccine, 119 who received a messenger ribonucleic acid vaccine, and 336 non vaccinated subjects were included in the study. The frequency of hospitalization was 62,2% in non-vaccinated persons, this rate was 23,1% (p<0.001), and relative risk was 0,37 (95% CI; 0,22-0,61) in those who received a genetically modified adenovirus vaccine, and it was 1.7% (p<0.001), and relative risk was 0,03 (95% CI; 0,006-0,10) in those who received the messenger ribonucleic acid vaccine. Conclusions: From a population point of view, the vaccine against COVID-19 was effective for preventing hospitalization in patients with acute COVID-19 disease during the fourth epidemic wave.

Urgent liver retransplantation due to transmission of intrahepatic cholangiocarcinoma by donor: the first report in the literature / Retransplante de fígado urgente devido à transmissão de colangiocarcinoma intra-hepático pelo doador: o primeiro relato da literatura

ABSTRACT BACKGROUND: Liver transplantation represents the best therapeutic modality in end-stage chronic liver disease, severe acute hepatitis, and selected cases of liver tumors. AIMS: To describe a double retransplant in a male patient diagnosed with Crohn's disease and complicated with primary sclerosing cholangitis, severe portal hypertension, and cholangiocarcinoma diagnosed in the transplanted liver. METHODS: A 48-year-old male patient diagnosed with Crohn's disease 25 years ago, complicated with primary sclerosing cholangitis and severe portal hypertension. He underwent a liver transplantation in 2018 due to secondary biliary cirrhosis. In 2021, a primary sclerosing cholangitis recurrence was diagnosed and a liver retransplantation was indicated. Recipient's hepatectomy was very difficult by reason of complex portal vein thrombosis requiring extensive thromboendovenectomy. Intraoperative ultrasound with liver doppler evaluation was performed. Two suspicious nodules were incidentally diagnosed in the donor's liver and immediately removed for anatomopathological evaluation. RESULTS: After pathological confirmation of carcinoma, probable cholangiocarcinoma, at frozen section, the patient was re-listed as national priority and a new liver transplantation was performed within 24 hours. The patient was discharged after 2 weeks. CONCLUSIONS: The screening for neoplasms in donated organs should be part of our strict daily diagnostic arsenal. Moreover, we argue that, for the benefit of an adequate diagnosis and the feasibility of a safer procedure, the adoption of imaging tests routine for the liver donor is essential, allowing a reduction of the costs and some potential risks of liver transplant procedure.

RESUMO RACIONAL: O transplante de fígado representa a melhor modalidade terapêutica na doença hepática crônica terminal, hepatite aguda grave e casos selecionados de tumores hepáticos. OBJETIVOS: Descrever um retransplante duplo em paciente do sexo masculino, diagnosticado com doença de Crohn e complicado com colangite esclerosante primária, hipertensão portal grave e colangiocarcinoma diagnosticado no fígado transplantado. MÉTODOS: Paciente do sexo masculino, 48 anos, diagnosticado com doença de Crohn há 25 anos e complicado com colangite esclerosante primária e hipertensão portal grave. Foi submetido a um transplante de fígado em 2018 devido a cirrose biliar secundária. Em 2021, foi diagnosticada recidiva de colangite esclerosante primária e indicado retransplante hepático. A hepatectomia do receptor foi de alta complexidade devido à trombose complexa da veia porta, exigindo extensa tromboendovenectomia. Foi realizada ultrassonografia intraoperatória com doppler hepático. Dois nódulos suspeitos foram diagnosticados incidentalmente no fígado do doador e imediatamente removidos para avaliação anatomopatológica. RESULTADOS: Após confirmação patológica de carcinoma, provável colangiocarcinoma, pela congelação, o paciente foi relistado como prioridade nacional, e novo transplante hepático foi realizado em 24 horas. O paciente teve alta após 2 semanas. CONCLUSÕES: O rastreamento de neoplasias em órgãos doados deve fazer parte de nosso estrito arsenal diagnóstico diário. Além disso, defendemos que, em benefício de um diagnóstico correto e da viabilidade de um procedimento mais seguro, a adoção de uma rotina de exames de imagem é essencial em doadores hepáticos, permitindo a redução dos custos e alguns riscos potenciais do procedimento de transplante hepático.

Development of metformin HCl granules using brown flaxseed mucilage as a retardant polymer: effects of polymer and drug ratio

Abstract Flaxseed (Linum usitatissimum L.) is the seed of a multipurpose plant of pharmaceutical interest, as its mucilage can be used as a natural matrix to develop extended-release dosage forms and potentially replace synthetic polymers. In this study, a 3² factorial design with two replicates of the central point was applied to optimize the development of extended-release granules of metformin HCl. The total fiber content of the mucilage as well as the friability and dissolution of the formulations were evaluated. The lyophilized mucilage presented a high total fiber content (42.63%), which suggests a high efficiency extraction process. Higher concentrations of the mucilage and metformin HCl yielded less friable granules. In addition, lower concentrations of metformin HCl and higher concentrations of the mucilage resulted in slower drug release during the dissolution assays. The release kinetics for most formulations were better represented by the Hixson-Crowell model, while formulations containing a higher concentration of the mucilage were represented by the Korsmeyer-Peppas model. Nonetheless, five formulations showed a longer release than the reference HPMC formulation. More desirable results were obtained with a higher concentration of the mucilage (13-18%) and a lower concentration of metformin (40%).

Efeitos Agudos do Nitrato Dietético na Pressão Central e Desempenho Cardíaco em Hipertensos: Estudo Cruzado, Randomizado e Placebo-Controlado / Acute Effects of Dietary Nitrate on Central Pressure and Endothelial Function in Hypertensive Patients: A Randomized, Placebo-Controlled Crossover Study

Resumo Fundamento O nitrato inorgânico (NO3-) da dieta pode fornecer substrato fisiológico para reduzir o nitrito (NO2-) a óxido nítrico (NO) independente do endotélio. Estudos sugerem que o NO3- inorgânico tem efeitos benéficos na saúde cardiovascular. Objetivos Este estudo avaliou os efeitos agudos de 500 mL de suco de beterraba rico em nitrato (SB; contendo 11,5mmol NO3-) na pressão arterial e na função endotelial em pacientes hipertensos tratados. Métodos Estudo cruzado, randomizado, controlado por placebo foi realizado em pacientes hipertensos tratados (n=37; mulheres=62%) que foram submetidos à avaliação clínica e nutricional, avaliação dos parâmetros hemodinâmicos centrais e reatividade microvascular. O nível de significância foi p<0,05. Resultados A média de idade foi 59±7 anos e das pressões sistólica e diastólica foi de 142±10/83±9 mmHg. Houve aumento significativo na taxa de viabilidade subendocárdica (RVSE; 149±25 vs. 165±30%, p<0,001) e redução na duração da ejeção (DE; 37±4 vs. 34±4%, p<0,001) na fase beterraba, mas nenhuma diferença significativa de RVSE na fase controle. O % de aumento na perfusão (155 vs. 159%, p=0,042) cresceu significativamente na fase beterraba, o que não foi observado na fase controle. Na fase beterraba, a alteração da RVSE apresentou correlação significativa com a alteração da área sob a curva de hiperemia reativa pós-oclusiva (ASC-HRPO) (r=0,45, p=0,012). A mudança na DE mostrou uma correlação significativa com pico de perfusão pós-intervenção (r=-0,37, p=0,031) e ASC-HRPO (r=-0,36, p=0,046). Conclusão A ingestão aguda de SB por pacientes hipertensos resultou em melhora da função endotelial, que foi associada à maior viabilidade subendocárdica e desempenho na contração miocárdica.

Abstract Background The diet's inorganic nitrate (NO3-) may provide a physiological substrate for reducing nitrate (NO2-) to NO independent of the endothelium. Studies suggest that inorganic NO3- has beneficial effects on cardiovascular health. Objective This study evaluated the acute effects of 500 mL nitrate-rich beetroot juice (BRJ; containing 11.5mmol NO3-) on blood pressure and endothelial function in treated hypertensive patients. Methods A randomized, placebo-controlled, crossover study was conducted in treated hypertensive patients (n=37; women=62%) who underwent clinical and nutritional evaluation and assessment of central hemodynamic parameters and microvascular reactivity. The significance level was p<0.05. Results The mean age was 59±7 years, and mean systolic and diastolic blood pressures were 142±10/83±9mmHg. There was a significant increase in the subendocardial viability ratio (SEVR; 149±25 vs. 165±30%, p<0.001) and reduction in ejection duration (ED; 37±4 vs. 34±4%, p<0.001) in the beetroot phase but no significant SEVR difference in the control phase. The % increase in perfusion (155 vs. 159 %, p=0.042) was significantly increased in the beetroot phase, which was not observed in the control phase. In the beetroot phase, the change in SEVR showed a significant correlation with the change in the area under the curve of post-occlusive reactive hyperemia (AUC-PORH) (r=0.45, p=0.012). The change in ED showed a significant correlation with the post-intervention perfusion peak (r=-0.37, p=0.031) and AUC-PORH (r=-0.36, p=0.046). Conclusions The acute ingestion of BRJ by hypertensive patients resulted in an improvement of endothelial function, which was associated with higher subendocardial viability and performance in myocardial contraction.

Associated factors and treatment options for sleep bruxism in children: an umbrella review

Abstract Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Factores que afectan la participación social de adultos con traumatismo craneoencefálico: una revisión sistemática / Factors Affecting Social Participation in Adults with Traumatic Brain Injury: A Systematic Review

Objetivo La participación social es el acto de involucrarse en actividades que proporcionan interacciones con otras personas, y puede verse afectada en personas que han sufrido un traumatismo craneoencefálico (TCE). Este trabajo propone identificar qué factores influyen en dicha afectación. Método. Se realizó una revisión sistemática de artículos disponibles en PubMed, EBSCO y SCOPUS, publicados desde 2010 hasta 2020. Resultados. Los artículos revisados concuerdan que la participación social de los pacientes adultos con TCE se ve afectada por las siguientes variables: síntomas depresivos, edad, nivel educativo, alteraciones cognitivas y calidad de vida. Finalmente, se observó que la evaluación de la participación social está focalizada en la frecuencia con que los pacientes realizan actividades sociales y no indagan en la satisfacción personal con el nivel de participación.

Objective. Social participation is the act of getting involved in activities that provide interactions with other people and can be impaired in individuals who suffered a traumatic brain injury (TBI). This study aims to identify which factors influence social participation after TBI. Method. A systematic review of articles available in PubMed, EBSCO, and SCOPUS, published from 2010 to 2020 was conducted. Results. Revised articles conclude that social participation in adult patients with TBI is affected by the following variables: depressive symptoms, age, educational level, cognitive impairment, and quality of life. Finally, the focus of the assessment of social participation was the frequency with patients carrying out social activities and not the personal satisfaction with their level of participation.

Perception and Practices of COVID Appropriate Behavior: A Cross‑Sectional Study among Adult Populations in Rural and Urban West Bengal

Introduction: Recent COVID‑19 pandemic is an unprecedented public health problem worldwide. Knowledge about the disease and adoption of COVID Appropriate Behavior (CAB) are of utmost importance in combating the pandemic. The study was conducted to assess and compare the knowledge, attitude, and practice and to determine different misconceptions and wrong practices related to the disease among urban and rural populations. Materials and Methods: A community‑based analytical study with cross‑sectional design was conducted from January 2021 to March 2021 among 144 adult residents from urban and rural West Bengal. Multistage sampling was adopted and a predesigned, pretested, semistructured schedule was used for interviewing study subjects. Results: Urban people were significantly more knowledgeable and more appropriate in attitude and practice than rural people (P < 0.05). The mean knowledge and attitude scores of urban population were significantly higher than the rural population across age groups, gender, occupation, and education (P < 0.05), whereas mean practice score was significantly higher across gender and occupation in the urban population compared to the rural population (P < 0.05). Many cultural and indigenous practices such as drinking warm water, using mouth wash, using home remedies were more common in urban areas and consumption of homeopathy medicines, lighting candles, making sound with utensils, blowing conch shells, and worshipping corona were observed more in rural areas. Conclusions: Wide gap exists in knowledge, attitude, and practice between urban and rural population and there were many wrong perceptions and practices surrounding COVID‑19 among both urban and rural population. Appropriate policy for improving knowledge, attitude, and CAB is the need of the hour.

Obstetric violence for professionals who assist in childbirth / Violência obstétrica para os profissionais que assistem ao parto

Abstract Objectives: to know the perception of obstetric violence for professionals who assist in labor and delivery. Methods: the research was qualitative. Research participants were 22 professionals providing or assisting women during labor and delivery. The sample was defined by data saturation. The analysis of the data collected was performed using the proposed content analysis of Bardin. Results: five categories were identified, professionals highlighted the existence of a process of change in childbirth care and the importance of respecting physiology and intervening when necessary. It was evident that verbal violence is one of the most recurrent forms of obstetric violence. The factors identified as determinants for the existence of violence were the interaction between the parturient and the team, the professional's lack of preparation and institutional problems. Even with several statements about obstetric violence, some professionals stressed not experiencing it in practice. Conclusions: the need to invest in strategies to inhibit obstetric violence and humanize care is perceived through training professionals and guiding women on their rights.

Resumo Objetivos: conhecer a percepção de violência obstétrica para os profissionais que atuam na assistência ao trabalho de parto e parto. Métodos: a pesquisa foi de abordagem qualitativa. Os participantes da pesquisa foram 22 profissionais que prestam ou prestaram assistência à mulher durante o trabalho de parto e parto. A amostra foi definida pela saturação de dados. A análise dos dados coletados foi realizada utilizando a proposta de análise de conteúdo de Bardin. Resultados: foram identificadas cinco categorias, os profissionais salientaram a existência de um processo de mudança na assistência ao parto e a importância de respeitar a fisiologia e intervir quando necessário. Ficou evidente que a violência verbal é uma das formas mais recorrentes de violência obstétrica. Os fatores apontados como determinantes para a existência da violência foram a interação parturiente e equipe, falta de preparo do profissional e os problemas institucionais. Mesmo com diversas falas sobre a violência obstétrica, alguns profissionais salientaram não vivenciar na prática. Conclusões: percebe-se a necessidade de investir em estratégias para inibir a violência obstétrica e humanizar a assistência por meio de capacitação dos profissionais e orientação das mulheres sobre os seus direitos.

Rol de la cirugía endoscópica en el tratamiento de quistes odontogénicos del hueso maxilar: revisión de la literatura / Role of endoscopic surgery in the treatment of maxillary odontogenic cysts

Los quistes odontogénicos son lesiones óseas, de carácter benigno, la mayoría asintomáticas, que habitualmente corresponden a un hallazgo radiológico. El tratamiento es quirúrgico y está condicionado por factores como localización, tamaño y la afectación de estructuras vecinas. El objetivo es elegir la modalidad de tratamiento que conlleve el menor riesgo de recurrencia, la mínima morbilidad, y al mismo tiempo la erradicación de la lesión. Siguiendo esta premisa han sido abordados, tradicionalmente, con técnicas abiertas con buenos resultados, pero con el advenimiento y desarrollo de la cirugía endoscópica, se empezó a usar esta técnica en forma exclusiva o en forma mixta para la resección de los quistes odontogénicos, logrando similares tasas de éxito, pero con menores complicaciones y morbilidad posoperatoria. Además, presenta una ventaja respecto del seguimiento para las recurrencias, ya que se pueden controlar endoscópicamente en la consulta ambulatoria. El objetivo de esta revisión es describir el desarrollo del rol de las cirugías endoscópicas para el tratamiento de lesiones odontogénicas maxilares.

Odontogenic cysts are benign bone lesions, most of them asymptomatic, which usually constitute a radiological finding. The treatment is surgical and is conditioned by factors such as location, size and involvement of nearby structures. The objective is to choose the treatment mode that presents the lowest risk of recurrence, the minimum morbidity, and at the same time, the eradication of the lesion. Following this premise, the treatment of these lesions has traditionally been approached with open techniques with good results but, with the advent and development of endoscopic surgery, this technique began to be used exclusively or in a mixed form for the resection of odontogenic cysts, achieving similar rates of surgical success, but with fewer complications and postoperative morbidity. It also has an advantage regarding follow-up for recurrences, since patients can be controlled endoscopically in the outpatient clinic. The objective of this review is to describe the development and role of endoscopic surgery for the treatment of maxillary odontogenic lesions.

Resultado da miotomia endoscópica peroral (POEM) em acalasia avançada em um seguimento mediano de 17 meses / Outcome of per oral endoscopic myotomy (poem) in sigmoid achalasia at a median follow up of 17 months

ABSTRACT Background: Advanced achalasia cardia (AC) represents the end stage in the natural history of AC. Role of per oral endoscopic myotomy (POEM) in this technically difficult subset is emerging. Methods: Retrospective review of the patients who had undergone POEM for advanced AC with sigmoid esophagus. We assessed the technical success, clinical success and adverse event rate. Pre and post POEM Eckardt score (ES), integrated relaxation pressure-4sec (IRP-4), lower oesophageal sphincter pressure (LESP) and height and width of barium column at 5 minutes were noted. Results: Of the 85 patients who underwent POEM for AC, 10 patients had advanced AC with sigmoid esophagus of which eight were sigmoid and two were advanced sigmoid. The clinical and technical success was 100% with significant reduction of ES, IRP-4, LESP and height and width of barium column at 5 minutes. One patient had a minor adverse event in the form of mucosal injury that was closed with hemoclips. At a median follow up of 17 months there was no recurrence. Conclusion: Our study demonstrates POEM to be a safe and effective modality of treatment in this technically difficult subset of AC with sigmoid morphology.

RESUMO Contexto: Acalasia cárdia avançada representa o estágio final na história natural do megaesôfago. Está emergindo o papel da miotomia endoscópica peroral (POEM) neste subconjunto tecnicamente difícil. Métodos: Foi realizada uma revisão retrospectiva dos pacientes submetidos a POEM para tratamento do megaesôfago avançado. Avaliamos o sucesso técnico, o sucesso clínico e a taxa de eventos adversos. O escore de Eckardt, pré e pós POEM, a pressão integral de relaxamento de 4 seg (IRP-4), a pressão do esfíncter inferior do esôfago e a altura e largura da coluna de bário em 5 minutos, foram anotadas. Resultados: Dos 85 pacientes submetidos a POEM para acalasia cárdia, 10 pacientes apresentaram acalasia cárdia avançado com esôfago com aspecto sigmoide, dos quais dois eram muito avançados. O sucesso clínico e técnico foi de 100% com redução significativa do escore de Eckardt, do IRP-4, da pressão do esfíncter inferior do esôfago e da altura e largura da coluna bário em 5 minutos. Um paciente teve um pequeno evento adverso na forma de lesão mucosa que foi fechada com hemoclipes. Em um seguimento mediano de 17 meses não houve recorrência. Conclusão: Nosso estudo demonstra que a POEM é uma modalidade segura e eficaz de tratamento neste subconjunto tecnicamente difícil de megaesôfago com morfologia sigmoide.

Presence of diarrhea associated with better outcomes in patients with COVID-19 – A prospective evaluation

Purpose: Gastrointestinal (GI) manifestations have been well documented in patients with coronavirus disease 2019 (COVID-19), but its clinical impact on the course of the disease is debatable. Majority of the available data is retrospective, and hence this prospective study was planned to study the impact of GI symptoms on COVID-19 outcome. Methods: All COVID-19 patients admitted in a tertiary care centre from August–October 2020 were screened and patients without pre-existing GI diseases were included. A detailed history of the various symptoms including duration was documented. Various baseline laboratory investigations and inflammatory markers were conducted as per the protocol. Patients with and without diarrhea were compared for the various disease outcome parameters. Results: Of the 244 patients screened, 203 patients (128 males; 63.1%) were included. Respiratory symptoms alone were present in 49 (24.1%), GI symptoms alone in 20 (9.9%) and 117 (57.6%) had both. Overall GI symptoms was noted in 137 (67.5%) cases with the commonest being diarrhea (61; 30.0%). Patients with both respiratory and any GI symptoms showed a lower trend towards need for mechanical ventilation (12.2% vs 7.7%; p ¼ 0.35) and mortality (10.2% vs 4.3%; p ¼ 0.14) compared to respiratory symptoms alone, although not statistically significant. Patients with diarrhea (n ¼ 61) had no mortality (0% vs 7.7%; p ¼ 0.036) or need for mechanical ventilation and shorter hospital stay compared to those who did not have diarrhea. Conclusion: GI symptoms are frequent in patients with SARS-CoV-2 infection and the commonest is diarrhea. Diarrhea is a harbinger of better outcome with lower mortality among COVID-19 positive patients.