Association between plasma leptin/adiponectin ratio and insulin resistance indexes in prepubertal children

ABSTRACT Objective: To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children. Subjects and methods: Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis. Results: There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12). Conclusion: Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity.

BALB/c and C57BL/6 mouse strains influence gastric function outcomes with administration of cisplatin and dexamethasone

Abstract Our aim was to evaluate the effects of cisplatin and dexamethasone alone and combined on gastric contractility and histomorphometry of BALB/c and C57BL/6 mice. BALB/c and C57BL/6 male mice (8-week-old) were randomly separated into: Control; Cisplatin (7.5 mg/Kg); Dexamethasone (2.0 mg/Kg); and Dexamethasone plus Cisplatin (2.0 mg/Kg of dexamethasone 1-hour prior to 7.5 mg/Kg of cisplatin). Drugs were administered intraperitoneally for three days. Body weight and food intake were evaluated on 2nd day. Alternating Current Biosusceptometry technique was employed to measure gastric contractions on 3rd day. Afterward, mice were killed for gastric histomorphometric analysis. Cisplatin decreased food intake and caused bradygastria in BALB/c mice; however, the amplitude of gastric contractions decreased in both BALB/c and C57BL/6. Dexamethasone and cisplatin combined restored the gastric frequency and food intake only in BALB/c, but drug combination reduced the gastric amplitude of contractions in both strains. Dexamethasone alone increased gastric mucosa thickness in C57BL/6 and decreased muscular thickness in BALB/c. In conclusion, the mouse strains presented differences in acute effects of cisplatin and dexamethasone alone and combined on gastric function. This reinforces the importance of choosing the appropriate mouse strain for studying the acute effects of drugs on the gastrointestinal tract.

Respuesta de Cuba para enfrentar la COVID-19 y sus retos / Cuba's response to COVID-19 and its challenges

Conferencia Magistral del Ministro de Salud Pública de la República de Cuba, Dr. José Angel Portal Miranda, Dr. C., durante la Inauguración del xxvi Congreso de la Federación Latinoamericana de Parasitología (FLAP), xv Congreso Centroamericano y del Caribe de Parasitología y Medicina Tropical (ACACPMT), x Congreso Cubano de Microbiología y Parasitología, vii Congreso Nacional de Medicina Tropical, vii Seminario Internacional sobre la Infección por el VIH y el Sida en Cuba. La Habana, 1 de noviembre del 2022.

Keynote Address by the Minister of Public Health of the Republic of Cuba, Dr. José Angel Portal Miranda, PhD, during the Opening Session of the 25th Congress of the Latin American Federation of Parasitology (FLAP), 15th Central American and Caribbean Congress of Parasitology and Tropical Medicine (ACACPMT), 10th Cuban Congress of Microbiology and Parasitology, 7th National Congress of Tropical Medicine, and 7th International Symposium on HIV Infection and AIDS in Cuba.

Motilidade gastrintestinal em pacientes idosos com diabetes mellitus tipo 2 bem controlado / Gastrointestinal motility in elderly patients with well-controlled type 2 diabetes mellitus

ABSTRACT Background: Gastrointestinal (GI) motility disorders in type 2 diabetes mellitus (T2DM) are common. However, the endpoints in well-controlled T2DM in elderly patients are barely understood. Objective: To evaluate GI transit and gastric myoelectric activity in elderly patients with T2DM who were undergoing treatment with metformin and to compare them with non-diabetic healthy controls. Methods: A total of thirty participants were enrolled in this study: young non-diabetic (n=10), elderly non-diabetic controls (n=10), and patients with T2DM managed with metformin (n=10). After fasting overnight, the participants ingested a standard meal and magnetic markers for non-invasive monitoring of GI transit and gastric contractility using the alternating current biosusceptometry and electrogastrography techniques. Results: Mean gastric emptying time, mean colon arrival time, and mean intestinal transit time were determined. There were no significant differences between the groups and in the parameters evaluated (P>0.05). The frequency and amplitude of gastric myoelectric activity were not different between groups; however, abnormal rhythmic index and the half-bandwidth were slightly higher for both elderly diabetic and non-diabetic groups compared with the young adults (P<0.01 and P<0.05, respectively). Conclusion: Our study showed unaltered gastric emptying and intestinal transit in T2DM patients with good glycemic control, and suggest changes in the gastric electrical activity can be a part of aging.

RESUMO Contexto: As desordens da motilidade gastrintestinal (GI) no diabetes mellitus tipo 2 (DM2) são comuns. No entanto, os desfechos em pacientes idosos com DM2 bem controlado são pouco compreendidos. Objetivo: Avaliar o trânsito GI e a atividade mioelétrica gástrica em idosos com DM2 em tratamento com metformina e compará-los com controles saudáveis não diabéticos. Métodos: Trinta participantes foram incluídos neste estudo: adultos jovens não diabéticos (n=10), idosos não diabéticos (n=10) e pacientes com DM2 tratados com metformina (n=10). Após jejum noturno, os participantes ingeriram uma refeição padrão e marcadores magnéticos para monitoramento não invasivo do trânsito GI e da contratilidade gástrica usando as técnicas de biosusceptometria de corrente alternada e eletrogastrografia. Resultados: Foram determinados o tempo médio de esvaziamento gástrico, o tempo médio de chegada ao cólon e o tempo médio de trânsito intestinal. Não houve diferenças significativas entre os grupos e nos parâmetros avaliados (P>0,05). A frequência e amplitude da atividade mioelétrica gástrica não foram diferentes entre os grupos; entretanto, o índice rítmico anormal e a meia largura de banda foram ligeiramente maiores para os grupos idosos diabéticos e não diabéticos em comparação com os adultos jovens (P<0,01 e P<0,05, respectivamente). Conclusão: Nosso estudo mostrou esvaziamento gástrico e trânsito intestinal inalterados em pacientes com DM2 com bom controle glicêmico, sugerindo que as alterações na atividade elétrica gástrica podem fazer parte do envelhecimento.

Linfomas no Hodgkin indolentes y terapia anti-CD20: una revisión de la literatura / Indolent non-Hodgkin's lymphomas and anti-CD20 therapy: a literature review

Introducción: Los linfomas no Hodgkin indolentes se destacan por el reto que suponen desde el punto de vista terapéutico. La introducción de la terapia con rituximab, un anticuerpo monoclonal que se une al antígeno CD20 de la membrana de los linfocitos B, revolucionó los tratamientos hasta ese momento y abrió el camino para el desarrollo de otros anticuerpos monoclonales anti-CD20. Objetivo: Describir las características generales de los linfomas no Hodgkin indolentes y de los anticuerpos monoclonales anti-CD20, así como el rol de la terapia anti-CD20 en dichas enfermedades. Métodos: Se realizó una revisión de la literatura publicada en los últimos 20 años, disponible en los repositorios: Scielo, Scopus, Pubmed/Medline, ScienceDirect y Mediagraphic. Se emplearon para elaborar este manuscrito 35 documentos, de ellos 80 por ciento correspondieron a los últimos 5 años. Conclusiones: La sólida evidencia científica, acumulada durante las últimas dos décadas, respalda el uso clínico de los anticuerpos monoclonales anti-CD20 en el tratamiento de los linfomas no Hodgkin indolentes. El uso efectivo de estos fármacos como agentes únicos o combinados con quimioterapia demuestran su versatilidad terapéutica(AU)

Introduction: Indolent non-Hodgkin's lymphomas are notable for the challenge they pose from a therapeutic point of view. The introduction of rituximab, a monoclonal antibody that binds to the CD20 antigen of the B-lymphocyte membrane, revolutionized treatments up to that time and opened the way for the development of other anti-CD20 monoclonal antibodies. Objective: To describe the general characteristics of indolent non-Hodgkin's lymphomas and anti-CD20 monoclonal antibodies, as well as the role of anti-CD20 therapy in these diseases. Methods: A review of the literature published in the last 20 years, available in the repositories: Scielo, Scopus, Pubmed/Medline, Science Direct and Mediagraphic, was performed. Thirty-five papers were used to prepare this manuscript, 80 percent of which corresponded to the last 5 years. Conclusions: Strong scientific evidence, accumulated over the last two decades, supports the clinical use of anti-CD20 monoclonal antibodies in the treatment of indolent non-Hodgkin's lymphomas. The effective use of these drugs as single agents or in combination with chemotherapy demonstrates their therapeutic versatility(AU)

Experiencia en angioplastia percutánea de recoartación de aorta en un solo centro. Resultados a corto, medio y largo plazo / Experience in percutaneous angioplasty of aortic recoartation in a single centre. Short, medium and long-term outcomes

Resumen Introducción: La angioplastia con balón es una técnica que ofrece buenos resultados, especialmente en los casos de recoartación tras cirugía correctora. Objetivo: Analizar los resultados de un centro hospitalario a partir de la introducción de la técnica. Método: Se analizaron 73 pacientes con una edad media de 3.3 años; el 74% eran menores de 1 año y el 72.6% estaban por debajo de 10 kg de peso. Todos los pacientes incluidos fueron casos de recoartación tras cirugía correctora. Resultados: Se observó un resultado efectivo en el 93.1% de los casos, con gradiente residual < 20 mmHg. Durante el seguimiento, el 20.5% precisaron reintervención, la cual fue más frecuente en caso de angioplastia sobre el arco, lesiones asociadas y menores de 1 año. Solo se objetivó una complicación grave relacionada con el procedimiento, que correspondió a una rotura aórtica que no pudo ser solventada con implante de stent cubierto. Conclusiones: La angioplastia percutánea de recoartación de aorta es una técnica segura y efectiva, en especial en los casos de recoartación tras cirugía correctora de lesiones circunscritas al istmo.

Abstract Introduction: Balloon angioplasty is a technique with good outcomes, specially in cases aortic recoartation after correcting surgery. Objective: To analyze our centre results since the introduction of the technique. Method: We analyzed 73 patients with medium age of 3,3 years; 74% were under 1 years old and 72,6% under 10 kg weight. All patients included were cases of recoartation after surgery. Results: Effective results was achieved in 93,1%, obtaining residual gradient less than 20 mmHg. During the following up 20,5% of patients required reintervention, being more frequent in case of aortic arch hypoplasia, associated lesions or patients under 1 year. Only a severe complication was referred, a case of aortic rupture that couldn’t be solved with a covered stent. Conclusions: Percutaneous angioplasty of aortic recoartation is a safe and effective technique, specially in discrete istmic lesions after correcting surgery.

Intervención sanitaria con candidatos vacunales, como estrategia temporal de enfrentamiento a la COVID-19, Cuba, 2021 / Health intervention with vaccine candidates as a temporary strategy to confront COVID-19, Cuba, 2021

Introducción: El Sistema de Vigilancia en Salud, informó en diciembre de 2019, sobre casos con neumonía en la ciudad de Wuhan, en China. La nueva enfermedad, ocasionada por el SARS-CoV-2, se nombró COVID-19. El 11 de marzo del 2020 se diagnosticaron en Cuba los tres primeros casos importados. La introducción paulatina de diferentes variantes virales ocasionó varios brotes. Se hizo necesario buscar alternativas que permitieran lograr el control epidemiológico. Objetivo: Desarrollar una intervención sanitaria efectiva con candidatos vacunales dirigida a revertir la situación epidemiológica ocasionada por la epidemia de la COVID-19 en Cuba en el periodo de enero a agosto de 2021. Métodos: Se realizó un estudio cualitativo de investigación-acción en tres etapas, con la aplicación de grupos de discusión que aportaron información para la organización del proceso y la toma de decisiones. Además, se apoyó en el estudio descriptivo longitudinal para el análisis de datos epidemiológicos a partir de las series cronológicas, que permitió valorar la efectividad de la intervención. El periodo de estudio abarcó desde enero a agosto del 2021. Resultados: El estudio situacional de salud evidenció el nivel de complejidad de la situación epidemiológica y el contexto social y económico prevaleciente. A partir de sus resultados se diseñó e implementó el proyecto de intervención, con las condiciones de factibilidad requeridas. La implementación de la intervención arrojó resultados favorables logrando vacunar al 99,16 por ciento de la población prevista, con la consiguiente reducción en la incidencia de casos al alcanzar coberturas de vacuna del 63,2 por ciento, el 36 por ciento y el 50,9 por ciento en las provincias de La Habana, Matanzas y Santiago de Cuba, respectivamente. Conclusiones: La intervención sanitaria, de carácter temporal, efectuada con los candidatos vacunales Soberana 02 y Abdala, pautó un modo de actuación que se extendió más allá de la propia intervención, al aportar soluciones culturales, gerenciales, metodológicas, educativas, de capacitación en buenas prácticas, intersectorialidad, participación social y manejo del liderazgo, que representan productos extendidos a los servicios de salud(AU)

Introduction: The Health Surveillance System reported in December 2019 cases with pneumonia in the city of Wuhan, China. The new disease, caused by SARS-CoV-2, was named COVID-19. On March 11, 2020, the first three imported cases were diagnosed in Cuba. The gradual introduction of different viral variants caused several outbreaks. It became necessary to look for alternatives that would allow epidemiological control to be achieved. Objective: Develop an effective health intervention with vaccine candidates aimed at reversing the epidemiological situation caused by the COVID-19 epidemic in Cuba during the period from January to August 2021. Methods: A qualitative action research study was carried out in three stages, with the application of debate groups that provided information for the organization of the process and decision making. In addition, it was based on the longitudinal descriptive study for the analysis of epidemiological data from the time series, which allowed to assess the effectiveness of the intervention. The study period spanned from January to August 2021. Results: The situational health study showed the level of complexity of the epidemiological situation and the prevailing social and economic context. Based on its results, the intervention project was designed and implemented, with the required feasibility conditions. The implementation of the intervention yielded favorable results, managing to vaccinate 99.16percent of the planned population, with the consequent reduction in the incidence of cases by reaching vaccine coverage of 63.2percent, 36percentnd 50.9percent in the provinces of Havana, Matanzas and Santiago de Cuba, respectively. Conclusions: The health intervention, of a temporary nature, carried out with the vaccine candidates Soberana 02 and Abdala outlined a mode of action that extended beyond the intervention itself, by providing cultural, managerial, methodological, educational solutions, training in good practices, intersectorality, social participation and leadership management, which represent products extended to health services(AU)

Health care network model for older adults: a co-creation and participatory action research approach / Modelo assistencial à saúde do idoso em rede: uma abordagem de cocriação e pesquisa-ação participativa

OBJECTIVE: To develop a collaborative, multidisciplinary care model for older adults that improves interdisciplinary teamwork and increases access to specialized services for frail patients, helping solve management problems in the Brazilian Unified Health System. In the state of Bahia, the health care network for older adults requires better interaction and integration with the Unified Health System and the Unified System of Social Assistance to improve patient flow in the network. METHODS: We used a co-creation and participatory action research approach based on reflection, data collection, interaction, and feedback with participants and stakeholders. Data was collected from health professionals, representatives of health agencies, and older adults through collective and individual interviews, reflective diaries, and direct communication. RESULTS: An action plan involving members of the older adult care network was developed to put the new model into practice. A pilot study with a multidisciplinary team allowed adjustments and implementation of the model at our institution. CONCLUSIONS: The new model improved both the internal management of the State Reference Center for Older Adult Health Care (Centro de Referência Estadual de Atenção à Saúde do Idoso - CREASI) and its interaction with primary care, optimizing patient flow and establishing rules for shared management between CREASI and primary care institutions. In view of this, restructuring the care model reorganized relations between the agencies, expanding CREASI's role in the management and systematization of older adult health.

OBJETIVO: Desenvolver um modelo assistencial colaborativo, multiprofissional e centrado na pessoa idosa para melhorar o trabalho em equipe interdisciplinar e o acesso de idosos frágeis ao serviço especializado, ajudando na resolução de problemas com o gerenciamento do idoso no Sistema Único de Saúde (SUS). A rede de assistência à saúde do idoso na Bahia requer avanços na interação e na integração entre os órgãos do SUS e do Sistema Único de Assistência Social para melhorar o fluxo dos pacientes na rede. METODOLOGIA: Foi realizada uma pesquisa-ação participativa e cocriação baseadas na reflexão, coleta de dados, interação e feedback com participantes e partes interessadas. A coleta dos dados foi realizada com os profissionais de saúde, representantes dos órgãos de saúde e idosos por meio entrevistas coletivas e individuais, diários reflexivos e registros de comunicação direta. RESULTADOS: Foi elaborado um plano de ação com participação dos membros da rede de assistência ao idoso para colocar em prática o novo modelo. Realizou-se um piloto com uma equipe multidisciplinar que possibilitou ajustes e a implementação do modelo na instituição. CONCLUSÕES: O novo modelo favoreceu tanto o gerenciamento interno do Centro de Referência Estadual de Atenção à Saúde do Idoso (CREASI) como a interação com a atenção básica, otimizando o fluxo de pacientes e estabelecendo regras de gerenciamento compartilhado entre CREASI e atenção básica. Diante disso, a reestruturação do modelo assistencial representou uma reorganização das relações entre os órgãos, ampliando o papel do CREASI no gerenciamento e na sistematização da saúde do idoso.

Hábitos tóxicos y enfermedades crónicas no transmisibles en una población de la tercera edad / Toxic Habits and Chronic Noncommunicable Diseases in an Aged Population

Introducción: Los hábitos tóxicos son uno de los principales factores que convierten a las enfermedades crónicas no transmisibles en una importante causa de morbilidad y mortalidad. Objetivo: Describir la presencia de enfermedades crónicas no transmisibles y hábitos tóxicos como el consumo de café, alcohol y tabaco en una población de la tercera edad. Métodos: Se realizó un estudio descriptivo en el Consultorio médico 20 del municipio Arroyo Naranjo de La Habana entre octubre de 2018 y mayo de 2019. La población en estudio estuvo conformada por 365 pacientes geriátricos con diagnóstico de enfermedades crónicas no transmisibles. Las variables analizadas fueron edad, sexo, enfermedades crónicas no transmisibles asociadas y sustancias tóxicas consumidas. Los datos fueron obtenidos mediante revisión de historias clínicas y entrevistas realizadas a cada paciente. Los resultados se expresaron mediante tablas y gráficos estadísticos. Resultados: Predominó el sexo femenino y la hipertensión arterial como enfermedad de mayor prevalencia. La enfermedad pulmonar obstructiva crónica fue mayor en hombres y fueron estos los más fumadores. La presencia de úlceras y el consumo de café fueron mayores en las mujeres. En los pacientes entre 60-71 años fue donde se encontró el mayor número de hipertensos y los mayores consumidores de bebidas alcohólicas. Los del grupo 72-82 años fueron los mayores consumidores de tabaco y los más afectados por el asma bronquial. Conclusiones: Las enfermedades crónicas no transmisibles constituyen un problema de salud en la población estudiada. Los hábitos tóxicos detectados se asocian a la presencia de dichas enfermedades en los pacientes estudiados(AU)

Introduction: Toxic habits are one of the main factors that make chronic noncommunicable diseases an important cause of morbidity and mortality. Objective: To describe the presence of chronic noncommunicable diseases and toxic habits such as consumption of coffee, alcohol and tobacco in an elderly population. Methods: A descriptive study was carried out in the family medical office # 20 of the Arroyo Naranjo Municipality, Havana, between October 2018 and May 2019. The study population consisted of 365 geriatric patients diagnosed with chronic noncommunicable diseases. The variables analyzed were age, sex, associated chronic noncommunicable diseases and toxic substances consumed. The data were obtained by reviewing medical records and through interviews with each patient. The results were expressed using statistical tables and graphs. Results: In the research, the female sex predominated, together with arterial hypertension as the most prevalent disease. Chronic obstructive pulmonary disease was higher in men, who also accounted for the higher number of smokers. The presence of ulcers and coffee consumption were higher among women. It was in patients aged 60-71 years where the highest number of hypertensive patients and the highest consumers of alcoholic beverages were found. Those in the 72-82 age group were the greatest tobacco consumers and the most affected by bronchial asthma. Conclusions: Chronic noncommunicable diseases are a health concern in the studied population. The toxic habits detected are associated with the presence of these diseases in the patients studied(AU)

Protocolo de admisión del paciente diabetico. Un enfoque desde los factores básicos condicionantes y la agencia de autocuidado / Diabetic patient admission protocol. An approach from the basic conditioning factors and the self-care agency

El Consejo Internacional de Enfermeras (CIE) define a la Enfermería como los cuidados, autónomos y en colaboración, que se prestan a las personas de todas las edades, familias, grupos y comunidades, enfermos o sanos, en todos los contextos. Incluye la promoción de la salud, la prevención de la enfermedad y los cuidados de los enfermos, discapacitados y personas moribundas. A su vez Berbiglia y Banfield citan a Orem, ésta plantea que la práctica de la Enfermería en relación con los individuos se institucionaliza alrededor del proceso de una persona, la/el enfermera/o, que proporciona ayuda directa a otra persona, cuando ésta persona es total o parcialmente incapaz de ayudarse a sí misma en el cumplimiento de los cuidados diarios relacionados con la salud, a causa de la situación de salud existente. La misma autora define al estado de salud que indica la necesidad de asistencia enfermera como "la incapacidad de las personas de proporcionarse por sí mismas y continuamente el autocuidado (AC) de calidad y cantidad necesarios según las situaciones de la salud personal". Expresa también que los factores básicos condicionantes son "los factores internos o externos a los individuos que afectan sus habilidades para involucrarse en el autocuidado o afectan el tipo y cantidad de autocuidado requeridos". El objetivo, Sistematizar y acordar las intervenciones y cuidados de enfermería en la admisión del paciente con diabetes, con un enfoque desde los factores básicos condicionantes del autocuidado y la capacidad de la agencia de Autocuidado, que ingresan al servicio de urgencias de adultos, de un Hospital público, 2020. En este sentido el profesional de Enfermería cumple un rol fundamental dentro del equipo de salud para identificar el déficit de autocuidado y promover, gestionar e impulsar diversas estrategias para la promoción de la salud, la prevención de la enfermedad y su tratamiento[AU]

O Conselho Internacional de Enfermeiras (ICN) define Enfermagem como cuidado autônomo e colaborativo, prestado a pessoas de todas as idades, famílias, grupos e comunidades, doentes ou saudáveis, em todos os contextos. Inclui a promoção da saúde, a prevenção de doenças e o atendimento de doentes, deficientes e moribundos. Berbiglia e Banfield, por sua vez, citam Orem, que afirma que a prática de enfermagem em relação aos indivíduos é institucionalizada em torno do processo de uma pessoa, a enfermeira, que fornece ajuda direta a outra pessoa, quando essa pessoa é total ou parcialmente incapaz de ajudar a si mesma na realização dos cuidados diários relacionados à saúde, devido à situação de saúde existente. O mesmo autor define o estado de saúde que indica a necessidade de assistência de enfermagem como "a incapacidade das pessoas de proverem a si mesmas e continuamente o autocuidado (CA) de qualidade e quantidade necessárias de acordo com as situações de saúde pessoal". Também expressa que os fatores condicionantes básicos são "fatores internos ou externos aos indivíduos que afetam suas habilidades para se envolver em autocuidado ou afetam o tipo e a quantidade de autocuidado necessária". O objetivo sistematizar e acordar intervenções e cuidados de enfermagem na admissão do paciente com diabetes, com foco nos fatores condicionantes básicos do autocuidado e na capacidade da agência de Autocuidado, que entra no pronto-socorro de adultos, de um hospital público, 2020. Nesse sentido, o profissional de enfermagem desempenha papel fundamental dentro da equipe de saúde para identificar o déficit de autocuidado e promover, gerenciar e promover diversas estratégias de promoção da saúde, prevenção e tratamento de doenças[AU]

The International Nurses Council (INC ­ 2015) defines Nursery as the independent and accompanied care given to people of all ages, ethnicity, gender, rather family, group and communities, ill or heathy in all sort of contexts. Including Heath`s promotion, sickness prevention and different cares of patients, disable and dying people. In turn, Berbiglia and Banfield cite Orem, which states that the practice Nursing practice as the relationship individuals, which is institutionalized around the process of one person the Nurse, the one who helps directly to the other person, when this one is not fully or partially capable on their own means to help themselves to take charge of their daily health care, caused by the actual health situation remaining. The same author defines the state of health that indicates the Nurses assistance as "The non-capacity of people to assure by themselves the continued self-care, nor in quality and quantity necessary according to the situation of personal health". On the other hand, the author, also states that the basic conditioning factors are "internal or external factors handled by individuals who affect their abilities to engage in self-care or affect the type and amount of self-care required ". The objective is to systematize and agree on interventions and nursing care in the admission of the patient with diabetes, with an approach from the basic conditioning factors of self-care and the capacity of the Self-care agency, who enter the emergency department of adults, of a public hospital, 2020 In this sense, the nursing professional plays a fundamental role within the health team to identify the deficit of self-care and promote, manage and promote various strategies for health promotion, disease prevention and treatment[AU]

El consumo de medicamentos en pacientes de la tercera edad / The consumption of medicines in elderly patients

Introducción: Los adultos mayores generalmente presentan diferentes patologías, lo que implica un alto consumo de medicamentos, con lo cual, este grupo poblacional constituye uno de los que mayor cantidad de errores pueden cometer en el uso de fármacos. Objetivo: Evaluar el comportamiento del consumo de fármacos en una población perteneciente a la tercera edad. Métodos: Se realizó un estudio descriptivo de corte transversal en un consultorio médico del municipio Arroyo Naranjo de La Habana en el período entre octubre de 2018 y mayo de 2019. La población estuvo conformada por 365 pacientes geriátricos con diagnóstico de enfermedad crónica no transmisible (ECNT). Se realizó un muestreo al azar para un total de 67 pacientes seleccionados. Las variables analizadas fueron: edad, sexo, ECNT asociada y medicamentos consumidos. Los datos fueron obtenidos mediante revisión de historias clínicas y entrevistas realizadas. Se realizó un análisis porcentual para determinar prevalencia en cada variable analizada. Resultados: Los medicamentos que más destacaron en la muestra fueron los antihipertensivos e hipoglucemiantes. El consumo de medicamentos fue superior en los pacientes de 75 años en adelante y fundamentalmente en las mujeres. Los hombres, por su parte, constituyeron los más irresponsables en la adherencia al tratamiento. Conclusiones: Existió correspondencia entre los tratamientos y las patologías en la mayoría de los casos con excepción de algunos pacientes en los que la relación beneficio-riesgo del tratamiento no se cumplió totalmente. Sin embargo, de manera global, se considera que no existe un adecuado uso de los medicamentos en la muestra(AU)

Introduction: Aged adults generally have different pathologies, which implies high consumption of drugs, with which, this population group is one of those that can make the higher number of errors when using medication drugs. Objective: To evaluate the behavior of drug use in an elderly population. Methods: A descriptive cross-sectional study was carried out in a medical office in Arroyo Naranjo municipality, Havana, from October 2018 to May 2019. 365 geriatric patients made up the population they had diagnosis of chronic non-communicable disease (NCD). A random sampling was carried out for a total of 67 selected patients. The variables analyzed were age, sex, associated NCD, and medications used. The data were obtained by studying medical records and interviews. A percentage analysis was carried out to determine prevalence in each variable analyzed. Results: The drugs that stood out the most in the sample were antihypertensive and hypoglycemic drugs. The consumption of drugs was higher in patients aging 75 years and older and mainly in women. Men were the most irresponsible in adherence to treatment. Conclusions: There was correspondence between the treatments and the pathologies in most cases with the exception of some patients in whom the benefit-risk ratio of the treatment was not fully met. However, generally, it is considered that there is no adequate use of the drugs in the sample(AU)

El covid-19 y sus consecuencias en la vida y el trabajo de médicos residentes de La Paz, Bolivia / Covid-19 and its consequences in the life and the work of medical residents of La Paz, Bolivia

Este artículo es un apretado resumen de los principales resultados de una investigación mayor realizada por MEDICON, cuantitativa y cualitativa, en línea, a médicos residentes de 2º año del Sistema Departamental de Salud La Paz, en Bolivia. Los datos y relatos recogidos tienen que ver con la pandemia, el cumplimiento de las medidas de bioseguridad, la afectación experimentada por la cuarentena, la donación de plasma, el desempeño del personal de salud, entre otros. En el 55% la enfermedad fue confirmada por laboratorio. No hubo hospitalizados y la mayoría se automedicó. No recibieron soporte psicológico, por lo que es factible que algunos hubieran desarrollado el síndrome de burnout. Los que se enfermaron o tuvieron allegados con covid-19 dieron a conocer sus vivencias sobre la manera en que ellos y sus familiares enfrentaron el problema. (AU)

This article is a tight summary of the main results of a major investigation conducted by MEDICON, quantitative and qualitative, online, to second-year resident physicians of the La Paz Departmental Health System, in Bolivia. The data and reports collected have to do with the pandemic, compliance with biosecurity measures, the impact experienced by quarantine, plasma donation, the performance of health personnel, among others. In 55% the disease was confirmed by laboratory. There were no hospitalized and most self-medicated. They did not receive psychological support, so it is possible that some had developed ­ burnout syndrome. Those who became ill or had relatives with covid-19 shared their experiences about the way that they and their relatives faced the problem. (AU)

Frequência Alfa na meditação Gurdjieff / Alpha Frequency in Gurdjieff Meditation

Introdução: a meditação é uma prática que visa regular o estado mental e as emoções, podendo induzir a estados alterados de consciência. Dentre inúmeras técnicas de meditação, o trabalho proposto por George I. Gurdjieff, inclui práticas voltadas para o recolhimento da atenção e o equilíbrio entre a atividade do corpo, da mente e do sentimento. Estudos realizados com eletroencefalografia (EEG), avaliando o estado meditativo em geral, demonstraram um padrão cerebral caracterizado pelo aumento da amplitude dos ritmos eletroencefalográficos alfa e teta, bem como diferenças na atividade alfa entre a meditação e o relaxamento. Entretanto, isto não está caracterizado em meditadores da linha de G.I. Gurdjieff, que praticam, além de meditações sentadas, exercícios corporais acompanhados de uma música própria e exercícios de atenção durante a vida diária. Objetivo: comparar a atividade cerebral da frequência alfa durante os estágios de meditação e relaxamento e avaliar as diferenças entre as regiões frontal, central e occipital nesses dois estados, em meditadores experientes do grupo Gurdjieff, de Salvador-Bahia-Brasil. Metodologia: a coleta da atividade cerebral dos 8 voluntários foi realizada através do EEG. O protocolo de coleta adotado foi de 6 minutos de relaxamento e 12 minutos de meditação. Resultados: foi encontrado aumento significativo da potência alfa durante a meditação, quando comparada ao relaxamento. As regiões frontal e central não apresentaram diferenças entre si para a potência alfa, enquanto a região occipital apresentou aumento da potência alfa em comparação com as regiões frontal e central. Existe um aumento da densidade de alfa durante a meditação em todas as regiões cerebrais testadas, com maior densidade na região occipital. Conclusão: A frequência alfa comporta-se de forma diferente durante a meditação, comparada ao relaxamento, com um aumento da densidade de potência durante o estado meditativo em todas as regiões avaliadas, sendo a região occipital a que apresentou maior potência.

Introduction: meditation is a practice that aims to regulate the mental state and emotions, and can induce altered states of consciousness. Among numerous meditation techniques, the work proposed by George I. Gurdjieff, includes an attempt to balance activities from the body, the mind and the feelings. Studies conducted with electroencephalography (EEG), evaluating the meditative tate, demonstrated a brain pattern characterized by increased alpha and theta amplitude, as well as differences in alpha activity between meditation and relaxation. However, this is not characterized in Gurdjieff meditators, which practice beyond sitted meditations, body exercises with music, and attentional exercises during everyday life. Objective: comparing the brain activity of the alpha power during the meditation and relaxation stages and evaluate the differences between the frontal, central and occipital regions in these two states, in experienced meditators from the Gurdjieff group, in Salvador-Bahia-Brazil. Methodology: the data collection of the brain activity from 8 volunteers was performed by EEG. The collection protocol adopted was 6 minutes of relaxation and 12 minutes of meditation. Results: a significant increase in alpha power was found during meditation, when compared to relaxation. The frontal and central regions showed no differences between them for alpha power, while the occipital region showed an increase in alpha power compared to the frontal and central regions. Conclusion: the alpha frequency behaves differently during meditation, compared to relaxation, with an increase in alpha density during the meditative state in all evaluated regions, with the occipital region being the most potent.

Ventajas de la anestesia intravenosa libre de opioides en cirugía ambulatoria oncológica de mama / Advantages of opioid-free intravenous anesthesia over anesthesia in ambulatory breast cancer surgery

RESUMEN Introducción: la anestesia general libre de opioides surge ante la necesidad de evasión del uso de opioides en el transoperatorio y sus efectos indeseados en el posoperatorio. Objetivo: evaluar el comportamiento hemodinámico y la recuperación anestésica en pacientes intervenidas mediante cirugía ambulatoria por cáncer de mama, en las cuales se administró anestesia general total intravenosa libre de opioides o general balanceada. Métodos: se realizó un estudio cuasiexperimental, prospectivo en pacientes a las que se aplicó anestesia general balanceada (n=34) y total intravenosa libre de opioides (n=34) intervenidas quirúrgicamente por cáncer de mama, en el Hospital General Docente "Abel Santamaría Cuadrado", durante el 2018. Resultados: el grupo de anestesia general balanceada mostró mayor variación intraoperatoria de los parámetros evaluados, con diferencias significativas (p=0,019). El tiempo medio de despertar fue menor en el grupo de anestesia total intravenosa (2,10 ± 0,907 min vs 5,35 ± 1,250 min; p<0,01), al igual que el dolor, con diferencia significativa (p<0,05) y el tiempo de recuperación, donde una hora después de la intervención, el 85 % cumplía los criterios de alta anestésica. El retraso en el alta de la unidad de recuperación ocurrió principalmente por el bajo nivel de actividad motora, con mayor incidencia en el grupo de anestesia general balanceada (71 % vs 26 %; p=0,00). Conclusiones: la anestesia total intravenosa libre de opioides fue superior al método general balanceado, pues mostró mayor estabilidad hemodinámica y analgesia, menor incidencia de complicaciones posoperatorias y menor tiempo de estancia en sala de recuperación posanestésica.

ABSTRACT Introduction: opioid-free general anesthesia arises from the need to avoid the use of opioids in the transoperative period and the undesirable effects in the postoperative period. Objective: to assess the hemodynamic behavior and anesthetic recovery in patients who underwent ambulatory surgery for breast cancer and those who were given either opioid-free intravenous general or balanced general anesthesia. Methods: a quasi-experimental, prospective study was carried out on patients who received balanced general anesthesia (n=34) and total opioid-free intravenous anesthesia (n=34), who underwent breast cancer surgery at Abel Santamaria Cuadrado General Teaching Hospital during 2018. Results: the group of balanced general anesthesia showed greater intraoperative variation of the parameters assessed, with significant differences (p=0.019). The mean time of awakening was lower in the intravenous total anesthesia group (2.10 ± 0,907 min vs. 5,35 ± 1,250 min; p<0.01), as was pain, with significant difference (p<0.05) and the recovery time, where one hour after the surgery, 85 % met the criteria for anesthesia discharge. The delay in discharge from the recovery unit occurred mainly because of the low level of motor activity, with a higher incidence in the group of balanced general anesthesia (71% vs. 26 %; p=0.00). Conclusions: intravenous opioid-free total anesthesia was higher to the balanced general approach because it showed greater hemodynamic and analgesic stability, lower incidence of postoperative complications, and shorter time spent in the post-anesthesia recovery room.

Analgesia multidimensional para los pacientes en estadio terminal por cáncer de páncreas / Multidimensional analgesia for terminal stage patients with pancreatic cancer

RESUMEN Introducción: el cáncer es la segunda causa de muerte en el mundo; los tumores del sistema digestivo ocupan el segundo lugar y según localización los de páncreas poseen la menor tasa de supervivencia. Objetivo: evaluar la efectividad de la analgesia multidimensional para los pacientes en estadio terminal por cáncer de páncreas. Métodos: se realizó un estudio cuasiexperimental, comparativo, prospectivo y longitudinal en pacientes con dolor por tumor de páncreas en etapa final de su enfermedad, en el Hospital Abel Santamaria Cuadrado desde noviembre 2016 a julio 2019. Se incluyeron todos los pacientes con dolor por tumor de páncreas en estadio terminal, se conformaron tres grupos de acuerdo con el método de analgesia empleado; Grupo I (n=10) analgesia multimodal, Grupo II (n=10) analgesia multidimensional y Grupo III (n=3) esquema de analgesia de la Organización Mundial de la Salud, se evaluó calidad de la analgesia, la necesidad de dosis de rescate y uso de morfina, se compararon los métodos y se determinó la supervivencia. Resultados: la calidad de la analgesia fue mayor en los pacientes del grupo II, en igual grupo no fue necesario el uso de morfina hasta el 7mo mes y en solo dos pacientes, (p=0,00) no hubo diferencias en las tasas de supervivencia. Conclusiones: el enfoque multidimensional de la analgesia, donde se incluya al individuo como ser biopsicosocial y a la familia, logra mayor calidad de la analgesia. El método empleado para el alivio del dolor no influye en la supervivencia.

ABSTRACT Introduction: cancer is the second leading cause of death in the world; the tumors of the digestive system occupy the second place and according to itslocation, those in the pancreas have the lowest survival rate. Objective: to assess the effectiveness of multidimensional analgesia for patients in terminal stage due to pancreatic cancer. Methods: a quasi-experimental, comparative, prospective and longitudinal study was conducted in patients with pain due to pancreatic tumor in terminal stage at Abel Santamaria Cuadrado General Teaching Hospital from November 2016 to July 2019; all patients with pain due topancreatictumor were included. In the terminal stage of pancreatic cancer, three (3) groups were completed according to the analgesia method applied; Group I (n = 10) multimodal analgesia, Group II (n = 10) multidimensional analgesia and Group III (n = 3) following WHO analgesia scheme, analgesia quality, and the need for rescue dose and application of morphine, the methods were compared and survival rate was determined. Results: the quality of analgesia was higher in patients from group II, in the same group the application of morphine was not required until the 7th month and in only two patients (p = 0.00), there were no differences in the rates of survival. Conclusions: the multidimensional approach to analgesia, where the individual is included as a biopsychosocial being and the family achieves greater quality of analgesia, the method applied for pain relief does not influence on survival.

Análisis con GRD: El egreso hospitalario indiferenciado de la maternidad no representa la complejidad de las pacientes con alto riesgo obstétrico / DRG analysis: undifferentiated hospital discharges of maternity does not represent the complexity of patients with high obstetric risk

INTRODUCCIÓN: La gestión actual de camas hospitalarias sigue un modelo de indiferenciación en el que existen camas quirúrgicas, médicas y de pacientes críticos. Las maternidades si bien no siguen este modelo, tienen egresos indiferenciados con pacientes que pueden egresar post parto o aún embarazadas (con patologías perinatales). OBJETIVO: Evaluar diferencias entre egresos con parto normal y aquellos con patologías de alto riesgo obstétrico (ARO) respecto a estancia media (EM) y el consumo de recursos cuantificado con el peso medio de los grupos relacionados con el diagnóstico (PMGRD). MÉTODO: Estudio transversal con egresos maternales periodo 2017-2018. Se usó Categoría Diagnóstica Mayor (CIE - 10) para definir dos grupos de egreso: 1. Con parto normal a término o 2. Con patología ARO. Se compararon 1.658 y 1.669 egresos del grupo 1 y 2 respectivamente. Las variables de resultado son EM y PMGRD. Se compararon variables cuantitativas con t de student y Kruskal Wallis. Se usó Odds Ratio con respectivo intervalo de confianza para evaluar asociación entre variables y regresión logística multivariada para ajustar asociación. RESULTADOS: La edad, proporción de gestantes tardías, EM y PMGRD fue mayor en los egresos ARO (p<0,05). Existe fuerte asociación de EM prolongada (>4 días) y PMGRD elevado (>0.3109) con los egresos ARO (ORa=3.75; IC95%=3.21-4.39 y ORa=1.28; IC95%=1.1-1.49 respectivamente). CONCLUSIONES: Es necesario diferenciar los egresos del servicio de maternidad porque los egresos de ARO muestran mayor complejidad. La evaluación del riesgo usando EM y PMGRD permite analizar con especificidad los egresos maternales para una mejor gestión de camas y del recurso humano.

INTRODUCTION: The current management of hospital beds in Chile follows an undifferentiation model in which there are surgical, medical and critical patient bed. Maternity hospitals although they do not follow this model, have undifferentiated discharges with patients who may leave poatpartum or still pregnant (with perinatal pathologies) OBJECTIVE: To assess differences between discharges with normal delivery and those with high obstetric risk pathologies (HOR) with respect to mean stay (MS) and the resource spending quantified with the average weight of the diagnosis related group (AWDRG). METHOD: Cross-sectional study with maternal discharges between 2017-2018 period. Major Diagnostic Category (ICD - 10) was used to define two discharge groups: 1. With normal term birth or 2. With HOR pathology. 1,658 and 1,669 egress from group 1 and 2 were compared respectively. The outcome variables are EM and AWDRG. Quantitative variables were compared with student t and Kruskal Wallis. Odds Ratio and respective confidence interval were used to evaluate association between variables and multivariate logistic regression to adjust association. RESULTS: Age, proportion of late pregnant women, MS and AWDRG was higher in HOR discharges (p <0.05). There is a strong association of prolonged MS (> 4 days) and elevated AWDRG (> 0.3109) with HOR discharges (ORa = 3.75; 95% CI 3.21-4.39 and ORa = 1.28; 95% CI 1.1-1.49 respectively). CONCLUSIONS: It is necessary to differentiate medical discharge of the maternity service because the HOR egress show greater complexity. The risk assessment using MS and AWDRG allows to analyze with specificity the maternal discharge for a better management of beds and human resources.

Inflammatory lesions and brain tumors: is it possible to differentiate them based on texture features in magnetic resonance imaging?

Neuroimaging strategies are essential to locate, to elucidate the etiology, and to the follow up of brain disease patients. Magnetic resonance imaging (MRI) provides good cerebral soft-tissue contrast detection and diagnostic sensitivity. Inflammatory lesions and tumors are common brain diseases that may present a similar pattern of a cerebral ring enhancing lesion on MRI, and non-enhancing core (which may reflect cystic components or necrosis) leading to misdiagnosis. Texture analysis (TA) and machine learning approaches are computer-aided diagnostic tools that can be used to assist radiologists in such decisions. Methods: In this study, we combined texture features with machine learning (ML) methods aiming to differentiate brain tumors from inflammatory lesions in magnetic resonance imaging. Retrospective examination of 67 patients, with a pattern of a cerebral ring enhancing lesion, 30 with inflammatory, and 37 with tumoral lesions were selected. Three different MRI sequences and textural features were extracted using gray level co-occurrence matrix and gray level run length. All diagnoses were confirmed by histopathology, laboratorial analysis or MRI. Results: The features extracted were processed for the application of ML methods that performed the classification. T1-weighted images proved to be the best sequence for classification, in which the differentiation between inflammatory and tumoral lesions presented high accuracy (0.827), area under ROC curve (0.906), precision (0.837), and recall (0.912). Conclusion: The algorithm obtained textures capable of differentiating brain tumors from inflammatory lesions, on T1-weghted images without contrast medium using the Random Forest machine learning classifier.(AU)

Bernardino Ramazzini: un pionero de la medicina del trabajo / Bernardino Ramazzini: a pioneer of work medicine

Bernardino Ramazzini (1633-1714), médico italiano, es considerado el padre de la medicina del trabajo por su tratado sobre las enfermedades de los trabajadores, publicado en latín hace más de 300 años. Su fecha de nacimiento, 4 de octubre, se ha tomado como el Día de la Medicina del Trabajo. Fue un precursor de la salud pública y de la seguridad y salud laborales. Se recuerda en este artículo la vida y obra de este eminente clínico, que poseía una amplia formación humanística. (AU)

Bernardino Ramazzini (1633-1714), an Italian doctor considered the father of occupational medicine, for his treatise about workers' diseases, published in Latin more than 300 years ago. His date of birth, October 4, is the Day of Occupational Medicine. It was a precursor to public health and occupational health and safety. This article recalls the life and work of this eminent clinician, who had an extensive humanistic training. (AU)

Reflexiones "contractuales" acerca de la ley de interrupción voluntaria del embarazo en Chile / Reflexões "contratuais" acerca da lei de interrupção voluntária da gravidez no Chile / "Contractual" reflections on Chile's law on voluntary pregnancy termination

Resumen: Después de un año de entrada en vigencia de la Ley de Interrupción Voluntaria del Embarazo en Chile, hoy se reconoce la posibilidad de abortar en tres situaciones específicas y se da apoyo profesional a las mujeres que la invocan. Se plantean reflexiones acerca de su aplicación en las causales descritas en ella. Se sitúa la dignidad humana como eje central de la interpretación de la realidad feto-materna. Se comenta el sentido del acto médico-perinatal, en el contexto de la preservación de la especie humana. Se explica la aplicación del principio del doble efecto y el del único bien posible en el discernimiento de la primera causal. En la segunda causal se comenta la influencia de la tecnología en la anamorfosis fetal, junto con la vulnerabilidad y la focalización autorreferencial materna en el feto malformado. En la tercera causal se intenta aplicar la noción de cómo la violencia no puede justificarse a si misma y se necesita mediar consensos para no enfocar al feto como causante del daño. Se pretende alertar sobre el riesgo de alienación de los profesionales de la salud ante el significado de la dignidad del ser humano.

Resumo: Depois de um ano da entrada em vigor da Lei de Interrupção Voluntária da Gravidez no Chile, hoje se reconhece a possibilidade de abortar em três situações específicas e se dá apoio profissional às mulheres que a invocam. Propõem-se reflexões sobre sua aplicação nas causas descritas nela. Situa-se a dignidade humana como eixo central da interpretação da realidade feto-materna. Comenta-se o sentido do ato médico perinatal no contexto da preservação da espécie humana. Explica-se a aplicação do princípio do duplo efeito e o do único bem possível no discernimento da primeira causa. Na segunda causa comenta-se a influência da tecnologia na anamorfose fetal, junto com a vulnerabilidade e a focalização auto-referencial materna no feto mal formado. Na terceira causa tenta-se aplicar a noção de cómo a violência não pode justificar a si mesma e necessita buscar consensos para não colocar o feto como fator causador do dano. Pretende-se alertar sobre o risco de alienação dos profissionais da saúde diante do signififcado da dignidade do ser humano.

Abstract: After one year of the Law of Voluntary Interruption of Pregnancy in Chile, the possibility of aborting in three specific situations is recognized and professional support is given to the women who invoke it. Reflections are raised about its application in the causes described in it. Human dignity is placed as the central axis of the interpretation of the fetus-maternal reality. The meaning of the medical-perinatal act is discussed in the context of the preservation of the human species. The application of the principle of double effect and that of the only possible good in the discernment of the first causal is explained. In the second case, the influence of technology in fetal anamorphosis is discussed, together with the vulnerability and self-referential maternal focus in the malformed fetus. In the third case, we try to apply the notion of how violence cannot justify itself and we need to mediate consensus so as not to focus on the fetus as the cause of the harm. The aim is to warn about the risk of alienation of health professionals before the meaning of the dignity of the human being.

Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis / Preditores radiográficos determinados com uso de ferramenta de avaliação objetiva para pacientes neonatais com enterocolite necrotizante

ABSTRACT Objective: The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. Methodology: Patients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann-Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. Results: The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. Conclusions: The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

RESUMO Objetivo: O objetivo deste estudo foi desenvolver e validar uma ferramenta computacional para auxiliar as decisões radiológicas na enterocolite necrotizante. Metodologia: Pacientes que exibiam sinais clínicos e evidências radiográficas do estágio 2 ou superior de Bell foram incluídos no estudo, que resultou em 64 exames. A ferramenta foi usada para classificar o aumento localizado da espessura da parede intestinal e a pneumatose intestinal com medidas de largura total a meia altura e análises de textura baseadas na decomposição da energia wavelet. Os achados radiológicos de aumento suspeito da espessura da parede intestinal e das alças na pneumatose intestinal foram confirmados pela cirurgia e análise histopatológica do paciente. Dois radiologistas experientes selecionaram um intestino afetado e um intestino normal na mesma radiografia. A largura total a meia altura e a característica da textura baseada em wavelet foram então calculadas e comparadas com o uso do teste U de Mann-Whitney. Foram calculados a especificidade, sensibilidade, valores preditivos positivos e negativos. Resultados: Os resultados da largura total a meia altura foram significativamente diferentes entre a alça normal e a distendida (mediana de 10,30 e 15,13, respectivamente). Medidas de energia wavelet horizontal, vertical e diagonal foram avaliadas em oito níveis de decomposição. Os níveis 7 e 8 na direção horizontal apresentaram diferenças significativas. Para o nível 7, as medianas foram 0,034 e 0,088 para os grupos normal e com pneumatose intestinal, respectivamente, e para o nível 8, as medianas foram 0,19 e 0,34, respectivamente. Conclusões: A ferramenta desenvolvida pode detectar diferenças nos achados radiográficos do aumento da espessura da parede intestinal e PI de difícil diagnóstico, demonstra seu potencial na rotina clínica. A ferramenta desenvolvida no presente estudo pode ajudar os médicos a investigar alças intestinais suspeitas e melhorar consideravelmente o diagnóstico e as decisões clínicas.