Simultaneous Dengue and Chikungunya Coinfection in Endemic Area in Brazil: Clinical Presentation and Implications for Public Health.

Background: Dengue virus (DENV) and Chikungunya virus (CHIKV) pose significant public health threats in Brazil, where favorable conditions facilitated the proliferation of Aedes mosquitoes. Since the mid-1980s, Brazil has experienced annual outbreaks of DENV, with recent increases in confirmed cases. In addition, CHIKV, which was first reported in 2014, has spread across the country. The concurrent presence of these viruses has triggered public health alerts in endemic regions, underscoring the complexity of managing vector-borne diseases. Case Presentation: This report details a case of simultaneous DENV and CHIKV infections. A 77-year-old female patient who has diabetes and arrhythmia exhibited symptoms including fever, myalgia, and severe arthralgia. Laboratory tests confirmed the coinfection through RNA detection. The patient received supportive care, showed gradual improvement, and was eventually discharged. Conclusions: Coinfection with DENV and CHIKV cases reported here developed with mild outcomes. However, one of the patients did not recover from the arthralgia after presenting diagnostic challenges, which underscores the need for accurate differentiation to manage symptoms effectively. The reported cases, amidst increasing DENV outbreaks, highlight the urgency for preparedness in the healthcare system. The Ribeirão Preto region's endemicity for DENV, coupled with the rising incidence of CHIKV, emphasizes the evolving landscape of arbovirus transmission. Studies on Aedes mosquitoes suggest potential implications for human infection dynamics, warranting further investigation into arbovirus transmission efficacy and coinfection dynamics.

Exploring the Chikungunya virus landscape in a dengue-endemic Brazilian area.

We aimed to describe the landscape, including molecular, epidemiological, and clinical aspects of CHIKV infections in the Ribeirao Preto region, an area endemic to dengue. We randomly screened 3744 plasma samples that had undergone DENV diagnosis to evaluate CHIKV-RNA using an in-house RT-PCR assay. Positive samples were followed clinically, and RNA samples were submitted to whole genome sequencing. Seventeen cases (0.5 %) were positive for CHIKV-RNA despite being negative for DENV-RNA. Notably, half of the patients experienced prolonged arthralgia lasting more than 90 days. Compared with the healthy control group, leukopenia and thrombocytopenia were observed in all CHIKV-positive individuals with statistically significant P values (P < 0.0001 and P = 0.0003, respectively). The genomic analysis revealed that the CHIKV strains being studied are classified within the East-Central-South-African (ECSA) genotype. This analysis identified new mutations, E1: K211E and E2: V264A, while the previously known mutation E1: A226V was not detected among these strains. This study highlights the need for epidemiological surveillance and preparedness for potential CHIKV epidemics in Brazil, particularly where other arboviruses co-circulate.

Challenges to the development of taxation policies for sugar-sweetened beverages in Colombia.

Frequent consumption of sugar sweetened beverages (SSB) is related to the risks of developing overweight, obesity, cavities, diabetes and other diseases. Policies to significantly increase taxes on SSB have proven to be effective in reducing their consumption. The political debate on implementing these taxes in Colombia shows a series of barriers to placing this policy on the political agenda, and therefore, to its approval. This work analyses the political process involved in the struggle for the approval of an SBB tax in Colombia, as well as barriers and opportunities to putting it on the political agenda. This is done through a policy analysis with three research methods: a documentary analysis, political mapping of actors and semistructured interviews with key actors. Among the main findings, we have that actors who are in favour of the SSB tax stated that it is needed due to the health problems caused by SSB consumption, while those who opposed it argue that Colombia regulations are sufficient and already inform and educate consumers on excessive sugar consumption and its health implications. The Colombian political context is a barrier to SSB taxation, as the government favours and has a close connection with the food and SSB industry. In short, the policy issue has been reaching the agenda intermittently throughout the years. Nevertheless, new opportunities are arising after the COVID-19 pandemic and the 2022 administrative changes and further efforts from policy entrepreneurs are required to make this initiative progress in the political agenda.

Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

Surgical Management of Tophaceous Gout in the Upper Limb.

PURPOSE: Gouty tophi are a clinical manifestation of hyperuricemia in advanced stages. They can produce pain, functional limitation, and severe deformities. Patients with severe symptoms require short-term symptomatic solutions that standard medical management is not able to provide. The objective of this study was to present the results obtained with the surgical management of tophaceous gout in the upper limb, as well as present a detailed characterization of the disease in the upper limb. METHODS: Databases of the hand surgery service of a quaternary care hospital were reviewed to identify patients aged >18 years old undergoing tophi resection in the upper limbs between 2014 and 2020. Medical history records were reviewed retrospectively, and the relevant data were extracted to establish demographic profile, clinical presentation, anatomic distribution, postoperative outcomes, and additional procedures required. RESULTS: The most frequent symptom was pain (83%), followed by limited range of motion (56%), deformity (50%), and daily living/occupational activity limitation (28%). The main indications for surgical management were the presence of deformity, pain, and/or limited range of motion. The most frequently affected anatomic sites were the metacarpophalangeal joints, followed by the elbows, proximal interphalangeal joints, and proximal phalanges. The postoperative complication rate was 28%. The most common complications were operative site infections and wound dehiscence. Decreased pain was associated with surgical resection. Additional procedures, such as extensor tenorrhaphy and local flaps, were required in 47.2% of patients. CONCLUSION: Surgical resection of tophi can decrease pain. Although surgery is associated with a high rate of complications, most are minor. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Paraganglioma de cuerpo carotideo / Carotid Body Paraganglioma

Introducción: Los paragangliomas de cuerpo carotideo son tumores neuroendocrinos hipervascularizados raros. Aunque su presentación clínica es frecuentemente asintomática, con el transcurso de los años puede manifestarse como tumores cervicales con o sin déficit neurológico. Objetivo: Presentar el caso de una paciente con tumoración cervical pulsátil de 10 años de evolución que requirió tratamiento quirúrgico. Presentación de caso: Mujer de 42 años procedente del Cusco, Perú, sin antecedentes médicos ni personales de importancia. La paciente acude al Servicio de Cirugía de Cabeza y Cuello por presentar tumoración cervical pulsátil de crecimiento lento progresivo, cefalea y disfagia. Tras realizar ultrasonografía Doppler y angiotomografía se pesquisa tumor cervical derecho hipervascularizado a nivel de la bifurcación de arteria carótida común. Se propone tratamiento quirúrgico de tumoración cervical con resultado anatomopatológico de paraganglioma de cuerpo carotideo. Tuvo una evolución posquirúrgica favorable sin evidencia de recurrencias en el seguimiento. Conclusión: El paraganglioma del cuerpo carotideo es una tumoración rara, de presentación clínica frecuentemente asintomática. Una evaluación minuciosa clínica e imagenológica permiten un diagnóstico adecuado para una planificación quirúrgica óptima(AU)

Introduction: Carotid body paragangliomas are rare hypervascularized neuroendocrine tumors. Although their clinical presentation is frequently asymptomatic, they may manifest as cervical tumors with or without neurological deficit over the years. Objective: To present the case of a patient with a pulsatile cervical tumor of 10 years' evolution that required surgical treatment. Case presentation: A 42-year-old woman from Cusco, Peru, with no medical or personal history of importance. The patient came to the head and neck surgery service for presenting a pulsatile cervical tumor with slow progressive growth, as well as headache and dysphagia. After performing Doppler ultrasonography and angiotomography, a hypervascularized right cervical tumor was observed at the level of the common carotid artery bifurcation. Surgical treatment of the cervical tumor was proposed, whose anatomopathological result was carotid body paraganglioma. Postoperative evolution was favorable, with no evidence of relapses during follow-up. Conclusion: Carotid body paraganglioma is a rare tumor of frequently asymptomatic clinical presentation. A thorough clinical and imaging-based assessment allows an adequate diagnosis for optimal surgical planning(AU)

Localized strain characterization of cardiomyopathy in Duchenne muscular dystrophy using novel 4D kinematic analysis of cine cardiovascular magnetic resonance.

BACKGROUND: Cardiomyopathy (CMP) is the most common cause of mortality in Duchenne muscular dystrophy (DMD), though the age of onset and clinical progression vary. We applied a novel 4D (3D + time) strain analysis method using cine cardiovascular magnetic resonance (CMR) imaging data to determine if localized strain metrics derived from 4D image analysis would be sensitive and specific for characterizing DMD CMP. METHODS: We analyzed short-axis cine CMR image stacks from 43 DMD patients (median age: 12.23 yrs [10.6-16.5]; [interquartile range]) and 25 male healthy controls (median age: 16.2 yrs [13.3-20.7]). A subset of 25 male DMD patients age-matched to the controls (median age: 15.7 yrs [14.0-17.8]) was used for comparative metrics. CMR images were compiled into 4D sequences for feature-tracking strain analysis using custom-built software. Unpaired t-test and receiver operator characteristic area under the curve (AUC) analysis were used to determine statistical significance. Spearman's rho was used to determine correlation. RESULTS: DMD patients had a range of CMP severity: 15 (35% of total) had left ventricular ejection fraction (LVEF) > 55% with no findings of myocardial late gadolinium enhancement (LGE), 15 (35%) had findings of LGE with LVEF > 55% and 13 (30%) had LGE with LVEF < 55%. The magnitude of the peak basal circumferential strain, basal radial strain, and basal surface area strain were all significantly decreased in DMD patients relative to healthy controls (p < 0.001) with AUC values of 0.80, 0.89, and 0.84 respectively for peak strain and 0.96, 0.91, and 0.98 respectively for systolic strain rate. Peak basal radial strain, basal radial systolic strain rate, and basal circumferential systolic strain rate magnitude values were also significantly decreased in mild CMP (No LGE, LVEF > 55%) compared to a healthy control group (p < 0.001 for all). Surface area strain significantly correlated with LVEF and extracellular volume (ECV) respectively in the basal (rho = - 0.45, 0.40), mid (rho = - 0.46, 0.46), and apical (rho = - 0.42, 0.47) regions. CONCLUSION: Strain analysis of 3D cine CMR images in DMD CMP patients generates localized kinematic parameters that strongly differentiate disease from control and correlate with LVEF and ECV.

Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review.

OBJECTIVES: to analyze the evidence available in literature on factors associated with inadequate treatment of syphilis in pregnant women. METHODS: an integrative review, carried out in the LILACS, CINAHL, Web of Science, Scopus, PubMed and EMBASE databases, with controlled descriptors therapeutic and prenatal syphilis. RESULTS: nine publications composed the interpretative analysis, in which low education, income and maternal age, temporary lack of medication and HIV infection were associated with inadequate treatment of syphilis during pregnancy, in addition to delay or absence of prenatal care and receiving the 1st dose of penicillin, lack of tests or treatment less than 30 days before childbirth, and partners' low compliance with treatment. FINAL CONSIDERATIONS: among the main factors associated with inadequate treatment, clinical and sociodemographic aspects stand out, as well as failures in drug dispensing, prescription and monitoring of treatment of pregnant women and their partners by the health system.

SARS-CoV2 hospital surveillance and control system with contact tracing for patients and health care workers at a large reference hospital in Spain during the first wave: An observational descriptive study.

BACKGROUND AND AIMS: During the first peak of the COVID-19 pandemic, the Preventive Medicine Department and the Occupational Health Department at Hospital Clinic de Barcelona (HCB), a large Spanish referral hospital, developed an innovative comprehensive SARS-CoV2 Surveillance and Control System (CoSy-19) in order to preserve patients' and health care workers' (HCWs) safety. We aim to describe the CoSy-19 and to assess the impact in the number of contacts that new cases generated along this time. METHODS: Observational descriptive study of the findings of the activity of contact tracing of all cases received at the HCB during the first peak of COVID-19 in Spain (February 25th-May 3rd, 2020). RESULTS: A team of 204 professionals and volunteers performed 384 in-hospital contact-tracing studies which generated contacts, detecting 298 transmission chains which suggested preventive measures, generated around 22 000 follow-ups and more than 30 000 days of work leave. The number of contacts that new cases generated decreased during the study period. CONCLUSION: Coordination between Preventive Medicine and Occupational Health departments and agile information systems were necessary to preserve non-COVID activity and workers safety.

Flexural strength of 3Y-TZP bioceramics obtained by direct write assembly as function of residual connected-porosity.

OBJECTIVES: The present work reports the effect of the extrusion nozzles' size and consequent residual porosity on the flexural strength of 3Y-TZP bioceramics fabricated by direct write assembly technology. METHODS: A printable ink containing a volume fraction of 45% of 3Y-TZP (ZrO2 stabilized with 3 mol% Y2O3) submicron powder, carboxymethyl cellulose and polyethyleneimine as additives was fine-tuned by rheological measurements. Different nozzle diameters (0.41 mm, 0.33 mm, and 0.25 mm) were used to print 3D specimens with proper dimensions for structural and mechanical characterization after sintering, namely relative density, linear shrinkage, and three-point flexural strength. Bulk surface sample and exposed fractured surfaces after flexural strength tests were analyzed by X-ray diffraction, Rietveld refinement and scanning electronic microscopy. Strength reliability and failure probability of the three sample groups were analyzed by Weibull statistics. RESULTS: The sintered samples exhibited relative densities in the range of 78% (nozzle Ø 0.41 = mm) and 82% (nozzle Ø 0.25 = mm), i.e., a slight increase in the residual interfilamentous porosity is observed, as the extrusion tip diameter increases, while linear shrinkage is statistically similar (≈25%). Likewise, a progressive reduction of flexural strength and Weibull modulus as nozzle diameter increases was noticeable, being respectively σf = 337,5 ± 49 MPa and m = 6.6 for the smallest nozzle diameter (Ø = 0.25 mm) and σf = 261.4 ± 79 MPa and m = 3.2 for the biggest one (Ø = 0.41 mm). Unlike nozzle diameter, the material is constituted by 79-81 wt% tetragonal t-ZrO2 and 19-21 wt% cubic c-ZrO2 with equiaxed grain sizes between 0.3 and 0.6 µm. CONCLUSION: X-ray diffraction analyses on the fracture surface of flexural test samples suggests that the toughening mechanism by tetragonal→ monoclinic phase transformation is the main responsible for the mechanical strength of this structural ceramic. Additionally, the reduction of flexural strength for samples printed with extrusion nozzle of 0.41 mm could be explained by the surface roughness of the bending surfaces, as well as the lower effective resistance to crack-propagation arising from the higher size of residual pores on the fracture surface.

Análise do tratamento da sífilis gestacional durante o pré-natal no município de Ribeirão Preto - SP / Analysis of the treatment of gestational syphilis during prenatal care in the city of Ribeirão Preto-SP

Introdução: Apesar de ser uma Infecção Sexualmente Transmissível (IST) milenar com avanços no diagnóstico e com tratamento eficaz, a eliminação da sífilis constitui um desafio mundial. A sífilis é considerada um grave e prioritário problema de saúde pública, pois, nas gestantes, a doença traz consequências severas como: abortamento, prematuridade, natimortalidade, manifestações congênitas precoces ou tardias e/ou morte do recém-nascido. A sífilis congênita e todos os desfechos adversos da doença durante a gestação podem ser evitados com triagem oportuna no pré-natal, tratamento adequado para o estágio da sífilis e o monitoramento do controle de cura. Objetivo: Analisar o tratamento e o seguimento pós tratamento para sífilis em gestantes diagnosticadas pela atenção básica, e os fatores associados ao tratamento adequado. Método: Trata-se de um estudo de coorte retrospectivo, realizado por meio de dados secundários, nos quais as gestantes foram acompanhadas desde o diagnóstico até a saída do serviço de pré-natal da atenção básica, que ocorre na 36ª semana de gestação no município de Ribeirão Preto - SP. Os dados foram coletados por meio de dois sistemas de informação, a saber: o Sistema de Informação de Agravos de Notificação (SINAN) e o Sistema HYGIA. Para análise estatística dos dados foi utilizado o software STATA SE version 14. Todos os aspectos éticos foram contemplados. Resultados: Das 316 notificações incluídas no estudo, o tratamento adequado das gestantes ocorreu em 238 (75,3%) mulheres, sendo as variáveis idade (p=0,0406) e idade gestacional (p=0,007) associadas a esse tratamento. Houve 151 (58,8%) gestantes com a raça/cor não branca, 67 (35,5%) com ensino fundamental incompleto, a mediana de idade foi de 23 e 25 anos (respectivamente, tratamento adequado e não adequado), 98 (90%) sem trabalho formal, 230 (73%) com diagnóstico no primeiro trimestre da gestação e 273 (89%) com sífilis latente. Quanto ao seguimento pós tratamento, apenas 17 (5,3%) utilizaram os testes não treponêmicos da forma recomendada. Em 111 (35%) casos não houve tratamento da parceria sexual, sendo o motivo principal o fato do parceiro não ter tido mais contato com a gestante. Conclusão: Na análise do tratamento da sífilis gestacional durante o pré-natal verificou-se que a maioria das mulheres grávidas foram classificadas com o tratamento adequado, sendo esse associado a idade e idade gestacional. Apesar da maioria das gestantes terem feito pelo menos um teste não treponêmico no pós tratamento, somente uma pequena parcela das gestantes, realizaram o seguimento conforme recomendações. Identificou-se que o perfil sociodemográfico dessas gestantes corroboraram com os dados encontrados na literatura

Introduction: Despite being an ancient Sexually Transmitted Infection (STI) with advances in diagnosis and effective treatment, the elimination of syphilis is a global challenge. Syphilis is considered a serious and priority public health problem because, in pregnant women, the disease has severe consequences such as: abortion, prematurity, stillbirth, early or late congenital manifestations and/or death of the newborn. Congenital syphilis and all adverse disease outcomes during pregnancy can be avoided with timely prenatal screening, appropriate treatment for the stage of syphilis, and monitoring of cure control. Objective: To analyze the treatment and post-treatment follow-up for syphilis in pregnant women diagnosed by primary care, and the factors associated with adequate treatment. Method: This is a retrospective cohort study, carried out using secondary data, in which pregnant women were followed up from diagnosis until leaving the prenatal service of primary care, which occurs in the 36th week of pregnancy in the municipality. from Ribeirão Preto - SP. Data were collected through two information systems, namely: the Notifiable Diseases Information System (SINAN) and the HYGIA System. For statistical analysis of the data, the STATA SE version 14 software was used. All ethical aspects were considered. Results: Of the 316 notifications included in the study, adequate treatment of pregnant women occurred in 238 (75.3%) women, with the variables age (p=0.0406) and gestational age (p=0.007) associated with this treatment. There were 151 (58.8%) pregnant women with non-white race/color, 67 (35.5%) with incomplete primary education, the median age was 23 and 25 years (respectively, adequate and inadequate treatment), 98 (90%) without formal work, 230 (73%) diagnosed in the first trimester of pregnancy and 273 (89%) with latent syphilis. As for post-treatment follow-up, only 17 (5.3%) used non-treponemal tests as recommended. In 111 (35%) cases there was no treatment of the sexual partner, the main reason being the fact that the partner did not have more contact with the pregnant woman. Conclusion: In the analysis of the treatment of gestational syphilis during prenatal care, it was found that most pregnant women were classified as having adequate treatment, which was associated with age and gestational age. Although most pregnant women had at least one non-treponemal test after treatment, only a small portion of pregnant women performed the follow-up as recommended. It was identified that the sociodemographic profile of these pregnant women corroborated the data found in the literature

Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review / Factores asociados al tratamiento inadecuado de la sífilis durante el embarazo: una revisión integradora / Fatores associados ao tratamento inadequado da sífilis na gestação: revisão integrativa

ABSTRACT Objectives: to analyze the evidence available in literature on factors associated with inadequate treatment of syphilis in pregnant women. Methods: an integrative review, carried out in the LILACS, CINAHL, Web of Science, Scopus, PubMed and EMBASE databases, with controlled descriptors therapeutic and prenatal syphilis. Results: nine publications composed the interpretative analysis, in which low education, income and maternal age, temporary lack of medication and HIV infection were associated with inadequate treatment of syphilis during pregnancy, in addition to delay or absence of prenatal care and receiving the 1st dose of penicillin, lack of tests or treatment less than 30 days before childbirth, and partners' low compliance with treatment. Final Considerations: among the main factors associated with inadequate treatment, clinical and sociodemographic aspects stand out, as well as failures in drug dispensing, prescription and monitoring of treatment of pregnant women and their partners by the health system.

RESUMEN Objetivos: analizar la evidencia disponible en la literatura sobre factores asociados al tratamiento inadecuado de la sífilis en gestantes. Métodos: revisión integradora, realizada en las bases de datos LILACS, CINAHL, Web of Science, Scopus, PubMed y EMBASE, con los descriptores controlados sífilis terapéutica embarazada y prenatal. Resultados: nueve publicaciones componían el análisis interpretativo, en el que la baja escolaridad, renta y edad materna, la falta temporal de medicación y la infección por VIH se asociaron con el tratamiento inadecuado de la sífilis durante el embarazo, además de la demora o ausencia de control prenatal y de recibir la 1a dosis de penicilina, falta de exámenes o tratamiento menos de 30 días antes del parto, y baja adherencia al tratamiento por parte de la pareja. Consideraciones Finales: entre los principales factores asociados al tratamiento inadecuado se destacan los aspectos clínicos y sociodemográficos de la gestante, así como las fallas en la dispensación, prescripción y seguimiento del tratamiento de la gestante y su pareja por parte del sistema de salud.

RESUMO Objetivos: analisar as evidências disponíveis na literatura sobre os fatores associados ao tratamento inadequado da sífilis em gestantes. Métodos: revisão integrativa, realizada nas bases de dados LILACS, CINAHL, Web of Science, Scopus, PubMed e EMBASE, com os descritores controlados sífilis gestantes terapêutica e pré-natal. Resultados: nove publicações compuseram a análise interpretativa, nas quais baixa escolaridade, renda e idade materna, falta temporária do medicamento e infecção por HIV foram associadas ao tratamento inadequado da sífilis na gestação, além do atraso ou ausência do pré-natal e no recebimento da 1ª dose de penicilina, falta de exames ou tratamento com menos de 30 dias antes do parto, e a baixa adesão do parceiro ao tratamento. Considerações Finais: dentre os principais fatores associados ao tratamento inadequado, destacam-se os aspectos clínicos da gestante, sociodemográficos, além de falhas na dispensação do medicamento, prescrição e acompanhamento do tratamento da gestante e do parceiro pelo sistema de saúde.

[Update on neuroendocrine tumors]. / Tumores Neuroendocrinos: un desafío transversal.

Neuroendocrine Tumors (NETs) encompass a wide variety of tumors arising from neuroendocrine cells, which produce bioactive substances. The incidence of NETs increased significantly lately, becoming one of the most common tumors of the digestive tract. Their clinical presentation is as diverse as their capacity for hormone production. Carcinoid syndrome is the most common hormonal syndrome produced by NETs and is characterized by diarrhea, flushing and cardiac valvular lesions. New research brought multiple changes in the classification of these neoplasms and a new understanding about their diagnosis and treatment, promoting a multidisciplinary approach. Somatostatin analogues, radiation, biological, and cytotoxic drugs have improved the prognosis of these patients, which entails a great challenge for healthcare providers.

Enfermedad de Creutzfeldt-Jakob: experiencia de 5 años en un hospital terciario de Chile / Creutzfeldt-Jakob disease, experience in 17 patients

Background: Creutzfeldt-Jakob disease (CJD) is a prion affection that typically produces a rapidly progressive dementia with different neurologic and extra-neurologic manifestations. Aim: To characterize clinical, imaging and electroencephalography findings in patients with a probable CJD. Patients and Methods: A case series study of patients admitted in the Neurology department at a public hospital, between 2014 and 2019. Demographic, clinical, imaging, and electroencephalographic data of patients with probable CJD were analyzed. Results: Seventeen patients aged 63 ± 11 years (53% women) with a probable CJD were gathered. The incidence was 4.7 cases/year per million inhabitants. Twenty four percent of patients had a family history of CJD. The median time between the onset of symptoms and the hospital admission was three months with a survival of four months. The most common clinical manifestations were an amnesic syndrome in 88%, myoclonus in 76%, frontal syndrome and ataxia in 71%. Brain MRI was abnormal in all patients. The preponderant finding was the involvement of the caudate nucleus in 82% of cases. In the EEG, 94% of patients had abnormalities. All had a theta-delta slowing as a base rhythm. The pseudo-periodic pattern was observed in the 29% and status epilepticus in 18%. Conclusions: In this group of patients we observed the heterogeneity of the clinical manifestations of the disease, the frequent imaging and electroencephalographic alterations and the short evolution time leading to death.

Qualidade dos Cuidados de Enfermagem em Angola: Região Sul / Quality of nursing care in Angola: South Region

A qualidade dos cuidados de enfermagem é uma premissa indispensável à assistência de enfermagem, assim a procura pela excelência deve pautar as intervenções durante todo o exercício profissional independentemente do local onde ocorra. Nesta investigação tivemos como objetivo geral contribuir para melhorar as condições da qualidade para a assistência de enfermagem nas províncias da Huíla, Moçamedes, Kuando Kubango e Cunene a partir do conhecimento da qualidade percecionada pelos enfermeiros gestores e os enfermeiros cuidadores. A qualidade depende em parte da consciencialização dos enfermeiros sobre o que pretendem do seu exercício pelo que se torna útil saber como é que os enfermeiros percecionam a qualidade face aos focos da sua intervenção. Metodologicamente optou-se por um estudo descritivo exploratório de natureza quantitativa, realizado na região sul de Angola contemplando várias instituições de saúde das 4 províncias: Huíla, Moçamedes, Kuando-Kuvango e Cunene com um total de 392 profissionais de enfermagem inquiridos através de um questionário onde se incluía a escala de Perceção das Atividades de Enfermagem que contribuem para a Qualidade dos Cuidados. Dos resultados salienta-se: a maioria dos profissionais de enfermagem (59,9%) tem uma boa perceção da qualidade dos cuidados de enfermagem prestados. Verificamos que na perspetiva dos enfermeiros dos cuidados a avaliação dos mesmos é maioritariamente boa, ao passo que para os enfermeiros gestores ela vai no sentido de boa a razoável, no entanto a percentagem de enfermeiros dos cuidados que avaliam a qualidade dos cuidados como má é superior à dos enfermeiros gestores. No que concerne à qualidade dos cuidados dos serviços e do hospital, os enfermeiros dos cuidados e os enfermeiros gestores são unânimes ao classificá-la na sua maioria como adequada. De uma forma geral, a maioria dos enfermeiros concretiza às vezes ou sempre as atividades que contribuem para a qualidade dos cuidados de enfermagem. As atividades mais frequentemente realizadas estão relacionadas com as dimensões da Prevenção de Complicações, Readaptação funcional e Organização dos Cuidados de Enfermagem e, as dimensões que os enfermeiros percecionam como menos executadas são a Satisfação do utente, a Promoção da saúde e o Bem-estar e o autocuidado. Em síntese, dos fatores mais relevantes para a garantia da qualidade dos cuidados, os recursos humanos, são na perspetiva dos enfermeiros gestores o mais relevante, e para os enfermeiros dos cuidados é a formação profissional. Acreditamos que a avaliação da perceção da qualidade dos cuidados de enfermagem é um ponto fulcral para melhorar as condições da qualidade para a assistência de enfermagem em Angola.

The quality of nursing care is an essential foundation to nursing assistance; therefore, the pursuit of excellence should be an integral part of the professional execution regardless of the location where it takes place. In this study the main goal was to contribute to the improvement of the quality of nursing assistance in the provinces of Huila, Moçamedes, Kuando Kubango and Cunene, beginning with the knowledge of quality perceived by the nurses, managers and care-givers. Quality depends in part on the nurses' awareness about what they expect of their efforts which makes it worth knowing how the nurses perceive the quality based on their efforts. In terms of methodology, this study is descriptive exploratory in nature. The study was done in the southern region of Angola including various health institutions in four provinces: Huila, Moçamedes, Kuando-Kubango and Cunene. A total of 392 nursing professionals were interviewed using a questionnaire which includes a scale of perception of nursing activities which contribute to the quality of care. Most nursing professionals (59,9%) have a good perception of the quality of nursing care provided. It was noted that in the opinion of nurses of care, the evaluation of themselves in general, is good, while for the nurse managers it goes from good to reasonable. However, the percentage of care nurses that evaluate the quality as bad is higher than that of the nurse managers. In terms of the quality of the services and the hospital, the care nurses and the nurse managers are unanimous in classifying most of them as adequate. In general terms, most nurses sometimes or always participate in activities that contribute to the quality of nursing care. The most frequent activities have to do with prevention of complications, functional readaptation and organization of nursing care. The activities in which they participate less are satisfaction of the user, promoting health and well-being and self-care. The most relevant factor to guarantee the quality of care, in the perspective of the nurse managers, is human resources. In the opinion of the care nurses it is professional training. It is believed that assessing the perception of the quality of nursing care is a focal point to improve the conditions of quality for nursing care in Angola.

Tumores Neuroendocrinos: un desafío transversal / Update on neuroendocrine tumors

Neuroendocrine Tumors (NETs) encompass a wide variety of tumors arising from neuroendocrine cells, which produce bioactive substances. The incidence of NETs increased significantly lately, becoming one of the most common tumors of the digestive tract. Their clinical presentation is as diverse as their capacity for hormone production. Carcinoid syndrome is the most common hormonal syndrome produced by NETs and is characterized by diarrhea, flushing and cardiac valvular lesions. New research brought multiple changes in the classification of these neoplasms and a new understanding about their diagnosis and treatment, promoting a multidisciplinary approach. Somatostatin analogues, radiation, biological, and cytotoxic drugs have improved the prognosis of these patients, which entails a great challenge for healthcare providers.

Absceso del uraco y obstrucción intestinal en paciente con obesidad mórbida: reporte de caso / Urachal abscess and intestinal obstruction in a morbidly obese patient: A case report

Las anomalías del uraco representan un bajo porcentaje de las patologías abdominales, no obstante, forman parte del diagnóstico diferencial del abdomen agudo por las complicaciones que puede tener. Aunque son de difícil diagnóstico debido a los síntomas inespecíficos, las imágenes diagnósticas son de gran utilidad para su identificación y caracterización. En pacientes con obesidad mórbida, la presentación del cuadro aumenta el riesgo de morbimortalidad. Por ende, en estos pacientes es necesario un control postoperatorio estricto para evaluar complicaciones secundarias a la resección del uraco. Dado los casos limitados en la literatura, se requieren estudios clínicos adicionales, para brindar un seguimiento adecuado, en aras de identificar complicaciones y el tratamiento precoz de estas

Urachal abnormalities represent a low percentage of abdominal pathologies; however, they are part of the differential diagnosis of acute abdomen due to the complications it may have. Although they are difficult to diagnose due to nonspecific symptoms, diagnostic images are especially useful for their identification and characterization. In patients with morbid obesity, the presentation of the picture increases the risk of morbidity and mortality. Therefore, in these patients, strict postoperative control is necessary to evaluate complications secondary to urachal resection. Given the limited cases in the literature, additional clinical studies are required to provide adequate diagnosis and follow-up in order to identify complications and their early treatment

[Creutzfeldt-Jakob disease, experience in 17 patients]. / Enfermedad de Creutzfeldt-Jakob: experiencia de 5 años en un hospital terciario de Chile.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a prion affection that typically produces a rapidly progressive dementia with different neurologic and extra-neurologic manifestations. AIM: To characterize clinical, imaging and electroencephalography findings in patients with a probable CJD. PATIENTS AND METHODS: A case series study of patients admitted in the Neurology department at a public hospital, between 2014 and 2019. Demographic, clinical, imaging, and electroencephalographic data of patients with probable CJD were analyzed. RESULTS: Seventeen patients aged 63 ± 11 years (53% women) with a probable CJD were gathered. The incidence was 4.7 cases/year per million inhabitants. Twenty four percent of patients had a family history of CJD. The median time between the onset of symptoms and the hospital admission was three months with a survival of four months. The most common clinical manifestations were an amnesic syndrome in 88%, myoclonus in 76%, frontal syndrome and ataxia in 71%. Brain MRI was abnormal in all patients. The preponderant finding was the involvement of the caudate nucleus in 82% of cases. In the EEG, 94% of patients had abnormalities. All had a theta-delta slowing as a base rhythm. The pseudo-periodic pattern was observed in the 29% and status epilepticus in 18%. CONCLUSIONS: In this group of patients we observed the heterogeneity of the clinical manifestations of the disease, the frequent imaging and electroencephalographic alterations and the short evolution time leading to death.

Characterizing the vaquejada horse herd in the brazilian state of Pernambuco / Caracterização do rebanho pernambucano de equinos de vaquejada

This study aimed to determine the age groups, breeds, and morphological characteristics of horses used in vaquejada competitions, as well as to define how often the animals compete, the results achieved in the contests, and the duration of training. A sample of 1,271 horses used in vaquejada competitions was employed in the study. The first step consisted in interviewing owners to obtain information on the age and breed of the horses, vaquejada circuits in which they compete, frequency of competition in vaquejada, results reached in the trials, and training duration per month, week, and day. The second step obtained 15 linear measurements and calculated eight morphometric indices. The data obtained from the interviews were submitted to descriptive statistical analyses. The linear measurements and morphometric indices were used to compare sexes using a completely randomized experimental design. The results showed that 80.3% of the vaquejada horses were between four and ten years old and that 89% of the animals were of the Quarter Horse. The morphometric measures showed that stallions had higher height at withers, back, and croup and wider heads, chest, and croup than mares and geldings. On the other hand, among the eight indices calculated, only the value of the height at the chest of the stallions was higher than the mean values in mares and geldings. It was found that 79.7% of the horses took part in two to four vaquejada trials a month while 93.3% of the animals underwent fitness training 12 months a year. The results show a predominance of Quarter Horses in the vaquejada contests in Pernambuco and that the trials require the selection of physically larger and stronger stallions. In addition, the animals are submitted to intense training and competition routines.

O estudo objetivou determinar as faixas etárias, raças e características morfológicas dos equinos competidores de vaquejadas em Pernambuco, assim como definir a frequência em que os animais competem, os resultados conquistados nas disputas e a duração dos treinamentos. Foram utilizados 1271 equinos participantes de provas de vaquejada realizadas no sertão e agreste pernambucano. A primeira etapa do trabalho consistiu em uma entrevista aos proprietários dos animais para obter informações sobre a idade dos equinos, raça, circuitos de vaquejada em que competem (oficiais ou não oficiais), frequência de participação em vaquejadas, resultados alcançados nas provas e a duração mensal, semanal e diária dos treinamentos. Na segunda etapa foram mensuradas 15 medidas lineares e calculados oito índices morfométricos. Os dados obtidos a partir das entrevistas foram submetidos à análises estatísticas descritivas. Já as medidas lineares e índices morfométricos foram utilizados para comparar os sexos, por meio de delineamento experimental inteiramente ao acaso. Os resultados morfométricos foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey (P<0,05). Observou-se que 80,3% dos equinos de vaquejada tinham entre quatro e 10 anos de idade e que 89% dos animais eram da raça Quarto de Milha. Em relação às medidas morfométricas, registrou-se nos garanhões maiores alturas na cernelha, dorso e garupa e maiores larguras de cabeça, peito e garupa que nas éguas e nos machos castrados. Por outro lado, dentre os oito índices calculados, apenas o valor do vazio subesternal dos garanhões foi superior as médias das fêmeas e dos machos castrados. Constatou-se que 79,7% dos equinos participavam de duas a quatro provas de vaquejada por mês e que 93,3% dos animais eram condicionados fisicamente 12 meses por ano. Concluiu-se que nas vaquejadas realizadas no estado de Pernambuco há predomínio de equinos da raça Quarto de Milha, na faixa etária entre quatro e dez anos e as provas exigem seleção de garanhões fisicamente maiores e mais fortes. Além disso, os animais são submetidos a intensas rotinas de competições e treinamento.