Five-step unilateral biportal endoscopic surgery for central lumbar canal stenosis: "Z" technique nuance.

The treatment for lumbar spinal stenosis has advanced through the use of minimally invasive surgery techniques. Endoscopic methods go even further, with studies showing that both uniportal and biportal endoscopic techniques have outcomes comparable to traditional approaches. However, there is limited knowledge of the step-by-step decompression process when using the unilateral biportal endoscopic (UBE). To address this, the authors introduce the five steps in the "Z" sequence, which aims to reduce surgical time and complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23182.

Região Norte do Brasil e a pandemia de COVID-19: análise socioeconômica e epidemiológica / North region of Brazil and the COVID-19 pandemic: socioeconomic and epidemiologic analysis / Región Norte de Brasil y la pandemia de COVID-19: análisis socioeconómico y epidemiológico

Objetivo: analisar o perfil epidemiológico das doenças respiratórias e os indicadores socioeconômicos e de assistência em saúde da região Norte do Brasil durante a pandemia de COVID-19. Método: estudo epidemiológico, de caráter descritivo e quantitativo, em relação ao período de janeiro de 2010 a fevereiro de 2020. Os dados foram coletados no DATASUS e no boletim epidemiológico sobre a COVID-19 do Ministério da Saúde. Os resultados foram dispostos em números absolutos, frequência relativa e medidas de tendência central. Resultados: no período houve 1.163.303 internações, consumindo 891.494.215,40 reais. Pará e Amazonas somam 66% desses gastos. Os meses de abril, maio e junho apresentaram médias maiores de hospitalizações durante todos os anos. A faixa etária mais onerosa foi entre 60 e 69 anos. A região Norte é menos provida de médicos, leitos de UTI e respiradores. Amazonas, Amapá e Roraima têm os maiores coeficientes de incidência de COVID-19 por 1.000.000 de habitantes. Conclusão: a pandemia aumenta a vulnerabilidade socioeconômica e assistencial do sistema de saúde do Norte brasileiro, com sobrecarga e número de óbitos crescente. Portanto, há necessidade urgente de realocar recursos e reorganizar a rede de atenção à saúde.

Objective: to analyze the epidemiological profile of respiratory diseases and the socioeconomic and health care indicators of northern Brazil during the COVID-19 pandemic. Methods: epidemiological study, of a descriptive and quantitative character, in relation to the period from January 2010 to February 2020. Data were collected in DATASUS and in the epidemiological bulletin on COVID-19 of the Ministry of Health. The results were displayed in absolute numbers, relative frequency and measures of central tendency. Results: in the period there were 1,163,303 hospitalizations, consuming 891,494,215.40 reais. Pará and Amazonas account for 66% of these expenses. The months of April, May and June showed higher averages of hospitalizations during all years. The most expensive age group was between 60 and 69 years. The northern region is less equipped with doctors, ICU beds and respirators. Amazonas, Amapá and Roraima have the highest incidence coefficients of COVID-19 per 1,000,000 inhabitants. Conclusion: the pandemic increases the socioeconomic and assistance vulnerability of the health system in northern Brazil, with an overload and an increasing number of deaths. Therefore, there is an urgent need to reallocate resources and reorganize the health care network.

Objetivo: analizar el perfil epidemiológi co de las enfermedades respiratorias y los indicadores socioeconómicos y de salud del Norte de Brasil durante la pandemia COVID- 19. Método: estudio epidemiológico, de carácter descriptivo y cuantitativo, en relación con el período comprendido entre enero de 2010 y febrero de 2020. Los datos se recopilaron en DATASUS y en el boletín epidemiológico sobre COVID-19 del Ministerio de Salud. Los resultados se mostraron en números absolutos. frecuencia relativa y medidas de tendencia central. Resultados: en el período hubo 1.163.303 hospitalizaciones, que consumieron 891.494.215,40 reales. Pará y Amazonas representan el 66% de estos gastos. Los meses de abril, mayo y junio mostraron promedios más altos de hospitalizaciones durante todos los años. El grupo de edad más caro fue entre 60 y 69 años. La región Norte está menos equipada con médicos, camas de UCI y respiradores. Amazonas, Amapá y Roraima tienen las tasas más altas de incidencia de COVID-19 por cada 1,000,000 de habitantes. Conclusión: la pandemia aumenta la vulnerabilidad socioeconómica y asistencial del sistema de salud en el Norte de Brasil, con una sobrecarga y un número creciente de muertes. Por lo tanto, existe una necesidad urgente de reasignar recursos y reorganizar la red de atención médica.

Trabajadores Invisibles en la Hipermodernidad: Repercusiones Subjetivas e Intersubjetivas del Sufrimiento Laboral en un Call Center Montevideano

La investigación se propone estudiar las repercusiones psico-socio-simbólicas de un call center montevideano, en jóvenes contratados para el puesto de telemarketers. Se diseñó una estrategia metodológica de corte cualitativo y en dos fases: una exploratoria (entrevistas a informantes calificados) y una de estudio de caso. Se adoptó como postura epistemológica la psicosociología clínica y el enfoque clínico en ciencias humanas, para analizar los datos que se recogerán. Este artículo presenta las primeras etapas de la investigación: informe de antecedentes y diseño metodológico para alcanzar los objetivos propuestos. La difusión pertinente, es una forma de colaborar en hacer visible, lo invisible de esta problemática.

The research aims to study the psycho-socio-symbolic impact of a call center in Montevideo, in young workers hired as telemarketers. Methodology was designed as a qualitative research, in two phases. First an exploratory phase (interviews with qualified informants), and second, a case study. Clinical sociology or clinical psychosociology was adopted as epistemological stance and clinical approach in human sciences to analyze the data collected. This paper aims to present the early stages of research: background check, and methodology. The appropriate diffusion, is a way to collaborate making the invisible of this problem visible.

[Evaluating the professors visits on the care of patients with knee osteoarthrosis]. / Evaluación de la visita de profesores en la atención de la osteoartrosis de rodilla.

BACKGROUND: visits of professors is an educational strategy (ES) that allow the exchange of clinical experience between specialists and physicians of first contact and let to both reconsider their daily work, incorporate useful tools to promote learning, and implement strategies to solve problems in clinical work. The aim was to describe an ES carried out in a program of knee osteoarthritis, differentiating clinical competence from professional performance. METHODS: ten family physicians and an orthopaedic specialist participated. The ES took place by assessing competence in clinical cases; clinical performance with an observation guide as well as reviewing grounds for transfers to a second level. RESULTS: competence skills had found an initial media of 25 and at the end of 38 (p=0.025). On the observation guide a middle initial of 29 and final 91; finally, in submission evaluation a 50 % was adequate at the beginning of the ES with a 100 % at the end. CONCLUSIONS: development in doctors' clinical competence skill was observed and a better performance in medical care.

Asma del lactante, un paradigma por resolver?

La mayoría de casos de asma se inicia a temprana edad pese a la dificultad de establecer medidas diagnósticas especificas , eventos en el periodo postnatal son relevantes en el futuro desarrollo de reactivadas de vías aéreas y la persistencia de los síntomas. Los lactantes con sibilancias recurrentes durante los primeros años de vida es un fenómeno común y no necesariamente implica un curso prolongado de enfermedad, en muchos casos las sibilancias representan una situación transitoria la cual cesa en la edad presescolar. Pese a que estudios epidemiológicos han delineado varios genotipos, al presente no es posible asignar prospectivamente la mayoría de los infantes con sibilancias a ningún genotipo en particular.

Most of cases of asthma begin to early age in spite of the difficulty of establishing measured specific. In the postnatal period it is probable the future development of reactivity of airway rand the persistence of the symptoms. The child with recurrent wheezing during the first years of life is a common phenomenon and it not necessarily implies a lingering course of illness, in many cases the wheezing represents a transitory situation which ceases in the childhood age. In spite of the fact that epidemic studies have delineated several phenotypes, to the present is not possible to assign most of the infants prospectively with wheeze to any phenotypes in particular.

Oxidative stress changes in pregnant patients with and without severe preeclampsia.

BACKGROUND AND AIMS: The etiology of preeclampsia (PE) is unknown and the only treatment is removal of the fetus and placenta. The critical changes of this state include the increase of vascular resistance and hypoperfusion in the uteroplacental microcirculation that predispose to hypoxia and ischemia and, therefore, increased oxidative stress through 8-isoprostane, which is characterized by damage to the placenta and endothelium. We undertook this study to compare oxidative stress in pregnant women with PE. METHODS: A case-control, cross-sectional and comparative study was undertaken. Pregnant women between 28 and 38 weeks of gestation with and without PE were recruited. Venous blood samples were taken for determination of 8-isoprostane. Obstetrical variables were measured and 8-isoprostane by radioimmunoassay. SPSS v.11 for Windows was used for descriptive statistics. Mean ± standard deviation, correlation and χ(2) were used for comparison between groups. RESULTS: We studied 45 patients: 20 with PE (44.6%) and 25 without PE (55.4%). The average for 8-isoprostane in preeclamptic patients was 699.2 ± 38.6 pg/dl and without PE was 113.9 ± 52.4 pg/dL (p <0.01), gestational age 32.1 ± 2.6 and 35.1 ± 1.8 weeks, birth weight 1880 ± 238 g and 2787 ± 312 g, respectively. Apgar at birth was similar in both groups. CONCLUSIONS: We found statistical differences in the 8-isoprostane levels in both groups. There was no correlation in perinatal results in both groups according to 8-isoprostane levels. These results could be the basis for the use of antioxidants in the management of PE to counteract tissue damage.

[To face up the disease strategy as a risk factor for the life style in type 2 diabetics]. / Estrategia de afrontamiento de la diabetes como factor de riesgo para el estilo de vida.

OBJECTIVE: To identify to the life style as a risk factor after the strategy of facing the disease in type 2 diabetic patients. METHODS: A study of cases and controls was made in patients with type 2 diabetes of five primary care units in the metropolitan area of Queretaro city. The sample size was of 48 patients by group. They were chosen by quota in the waiting room. Sociodemographic variables and health aspects were included in the questionnaire. The life style was investigated by the Instrument to Measure the Style of Life in Diabetics (IMEVID). For the evaluation of type of facing the scale of Strategy of Facing was used as opposed to extreme risks. Measures of central tendency, χ² and odds ratio were included. RESULTS: The type of active facing was a risk factor for the style of life with a p = 0.0001. CONCLUSIONS: The strategy of active facing disease is a risk factor for the style of life in the type 2 diabetic patient.

[Clinical aptitude of residents that attend patients with the cervical intraepithelial neoplasia]. / Aptitud clínica de médicos residentes en la atención de pacientes con neoplasia intraepitelial cervical.

OBJECTIVE: To build, validate and apply an instrument to evaluate the clinical aptitude in intraepitelial cervical neoplasia (ICN) in residents. METHODS: The instrument included four clinical real cases, validated by experts and included 106 items using true, false and don't know answers. A pilot test and the 21 Kuder-Richardson formula were used to estimate consistency. It was applied to residents, in an observational, transversal, comparative and open study, including 11 second year residents, 13 third year residents and 12 fourth year residents. RESULTS: Consistency of 0.88 was obtained; 22% were located in the middle level, 39% were located in the low level and 39% in the very low level. There were no residents in the high or very high level or by chance answer level. The Kruskal-Wallis test showed significant differences among the three groups and with the U test of Mann Whitney there were no differences between groups. CONCLUSIONS: The year of residence did not show differences in the development of clinical aptitude in ICN. Most of the residents were located in the inferior level of clinical aptitude. This study makes evident the need to reframe our educative processes in a qualitative different manner.

[Clinical aptitude of gynecology and obstetrics residents to manage obstetric bleeding]. / Aptitud clínica de médicos residentes en el tratamiento de sangrados de la segunda mitad del embarazo.

OBJECTIVE: to build, validate and apply a test that explores and evaluates the clinical aptitudes of Gynecology and Obstetrics (Ob/Gyn) residents. MATERIAL AND METHODS: the test included five actual clinical cases representing the main obstetric conditions associated with obstetric bleeding. The validation process included rounds with experts and the final version of the test included 100 items in which the answers had the options "true." "false " and "don't know." A pilot study and the 21 Kuder-Richardson formula served to increase the consistency of the test. Then, 33 Ob/Gyn residents (8 of 2nd year; 14 of 3rd year and 11 of 4th year) answered the test. RESULTS: According to the 21 Kuder-Richardson formula the consistency of the test was 0.80; regarding the clinical aptitudes, 18 % of residents scored in the middle level, 66 % in the low level and 15 % in the very low level. No resident scored in the high or very high levels or by chance answers level. The Kruskal-Wallis test did not show statistically significant differences among the three groups and with the U test of Mann-Whitney no differences between groups were observed after comparing 2nd year versus 3rd year; 3rd year versus 4th year, and 2nd year versus 4th year residents. CONCLUSIONS: The years of residence did not show differences to developing clinical aptitudes. Most of the residents were located in the low level of these clinical aptitudes. This study underlined the need to reconsider our educative processes in a qualitative different manner.

[Sacropexy with abdominal fascia in treatment of vaginal prolapse vault of menopausal women]. / Sacropexia con fascia de recto abdominal en el tratamiento del prolapso de la cúpula vaginal.

INTRODUCTION: Vaginal vault prolapsed is a rare complication, with a frequency from 0.2 to 1% after hysterectomy, which is presented due to a bad surgical technique in fixation of the vault suspension elements, as well others factors as the multiparity, menopause, chronic lungs disease, obesity, smoking and weak physical activity. There are many techniques reported to correct this pelvic disease, although the conventional sacropexy has been established for abdominal way, where the diversity of materials of fixation is varied, including natural material as the abdominal fascia and aponeurosis of muscle rectos. OBJECTIVE: This descriptive and clinical study was carried out in a group of patient with vaginal vault prolapsed, with the objective to know the results and experience of this correction with the surgical technique of sacropexy utilizing abdominal fascia. MATERIAL AND METHODS: 32 menopausal patient with mean age of 53.9 years, 5 gestations, as well as index of Quetelet of 26.2, were studied, a following of a year was carried out. In these women the main symptom were the sensation of vaginal strange body and subsequently urinary incontinence of effort. Moreover, considering to all group the mean in presentation of the vaginal vault prolapsed after hysterectomy was of 7.7 years, with surgical time of 129 minutes and bled of 172 milliliters. RESULTS. The 97.5% of the patient returned to its sexual life without difficulties and only one referred dyspareunia. Post-surgical complications were not presented and only a patient presented vault prolapsed again (0.31%). CONCLUSIONS: With this results we can consider that the sacropexy with abdominal fascia is a good technique for the correction of the vaginal vault prolapsed in healthy menopausal women with regular sexual activity and then is a natural material who cause not any.