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Os objetivos deste estudo são: relatar a experiência do desenvolvimento das atividades de sensibilização dos trabalhadores relacionadas à promoção da saúde no ambiente laboral e à humanização no trabalho realizadas em dois serviços de saúde de um município do estado de Minas Gerais e avaliar junto à equipe a realização dessas atividades. As atividades de alongamento, massagens, escalda-pés, dinâmica de grupo e oficina da beleza foram realizadas na atenção primária e secundária. Utilizou-se um questionário e as respostas foram apresentadas por estatística simples. Os trabalhadores avaliaram as atividades como "excelentes"; referiram melhorar o dia de trabalho; sentiram-se valorizados e mais dispostos para o trabalho, além de solicitarem a continuidade de ações de promoção da saúde e humanização no trabalho. Por mais simples que sejam, essas atividades proporcionaram momentos de reflexões e a pausa laboral, tendo em vista a saúde do trabalhador e melhor qualidade de vida no trabalho.

The objectives of this study are: to report the experience of developing awareness activities for workers related to health promotion and humanization at work, carried out in two health services in a municipality in the state of Minas Gerais; and assess with the team these activities. Stretching activities, group dynamics, massages, foot baths, beauty workshop and health promotion were carried out in primary and secondary care. A questionnaire was used and the answers were presented by simple statistics. The workers rated the activities as "excellent"; reported improving their working day; they felt valued and more willing to work, in addition to requesting the continuity of actions to promote health and humanization at work. As simple as they are, these activities provided moments of reflection and a break from work, with a view to the worker's health and better quality of life at work.

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Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.

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INTRODUCTION AND OBJECTIVES: Only about 1 out of every 3 patients with acute myocardial infarction (AMI) achieve low-density lipoprotein cholesterol (LDL-C) values <55mg/dL in the first year. The present study aims to evaluate the impact of early intensive therapy on lipid control after an AMI. METHODS: An independent, prospective, pragmatic, controlled, randomized, open-label, evaluator-blinded clinical trial (PROBE design) will analyze the efficacy and safety of an oral lipid-lowering triple therapy: high-potency statin+bempedoic acid (BA) 180mg+ezetimibe (EZ) 10mg versus current European-based guidelines (high-potency statin±EZ 10mg), in AMI patients. LDL-C will be determined within the first 48hours. Patients with LDL-C ≥ 115mg/dL (without previous statin therapy), ≥ 100mg/dL (with previous low-potency or high-potency statin therapy at submaximal dose), or ≥ 70mg/dL (with previous high-potency statin therapy at high dose) will be randomly assigned 1:1 between 24 and 72hours post-AMI to the BA/EZ combination or to statin±EZ, without BA. The primary endpoint is the proportion of patients reaching LDL-C <55mg/dL at 8 weeks after treatment. RESULTS: The results of this study will provide novel information for post-AMI LDL-C control by evaluating the usefulness of an early intensive lipid-lowering strategy based on triple oral therapy. CONCLUSIONS: Early intensive lipid-lowering triple oral therapy vs the treatment recommended by current clinical practice guidelines could facilitate the achievement of optimal LDL-C levels in the first 2 months after AMI (a high-risk period). IDENTIFICATION NUMBER: EudraCT 2021-006550-31.

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Este estudio, tuvo como finalidad, determinar la relación entre Estilos de crianza y Conductas agresivas en Estudiantes de Secundaria del Centro Poblado Samán, 2023. Por tal manera, este estudio fue de tipo cuantitativo, diseño no experimental, corte transversal- correlacional. Además, se usaron para la recopilación de la información, los instrumentos de, Escala de Estilos de crianza de Steinberg, adaptado por Merino y Arndt y Cuestionario de Agresión de Buss y Perry, adaptado por Matalinares, Yaringaño, Uceda, Fernández, Huari Campos y Villavicencio. Para lo cual, la muestra de este estudio estuvo conformada por 160 alumnos de ambos sexos. Para el análisis de los datos se usó del programa Paquete Estadístico para las Ciencias Sociales, mediante ello, se obtuvo como resultado una relación significativa, moderada e inversa (Spearman =-0.638, significancia <0.05) entre las dos variables de estudio. Por tal sentido, a medida que el estilo de crianza baja, la tendencia a manifestar conductas agresivas aumenta. Basándose en los resultados, se concluye, la forma en cómo los progenitores interactúen con sus hijos, esto desarrollará su comportamiento. Por ello, en los sujetos que sus progenitores han desarrollado autonomía, interés en sus actividades, supervisión de la conducta y además emplean una comunicación empática en los reglamentos, habrá menor posibilidad de que estos presenten agresivas conductas. Al contrario, los individuos con poca supervisión, falta de atención por parte de sus padres, y la falta de asertividad de sus cuidadores, habrá mayor posibilidad de que estos expresen conductas agresivas.

The purpose of this study was to determine the relationship between Parenting Styles and Aggressive Behaviors in High School Students of the Samán Population Center, 2023. Therefore, this study was quantitative, non-experimental, cross-sectional-correlational design. In addition, the Steinberg Parenting Styles Scale, adapted by Merino and Arndt, and the Buss and Perry Aggression Questionnaire, adapted by Matalinares, Yaringaño, Uceda, Fernández, Huari Campos and Villavicencio, were used to collect information. For this reason, the sample of this study was made up of 160 students of both sexes. To analyze the data, the Statistical Package for Social Sciences program was used, resulting in a significant, moderate and inverse relationship (Spearman =-0.638, significance <0.05) between the two study variables. Therefore, as the parenting style decreases, the tendency to manifest aggressive behaviors increases. Based on the results, it is concluded that the way parents interact with their children will develop their behavior. Therefore, in subjects whose parents have developed autonomy, interest in their activities, behavioral supervision and also use empathetic communication in regulations, there will be less possibility of them presenting aggressive behaviors. On the contrary, individuals with little supervision, lack of attention from their parents, and lack of assertiveness from their caregivers will be more likely to express aggressive behaviors.

O objetivo deste estudo foi determinar a relação entre estilos parentais e comportamentos agressivos em estudantes do ensino médio do Centro Populacional Samán, 2023. Portanto, este estudo teve um desenho quantitativo, não experimental, transversal e correlacional. Além disso, foram utilizadas para coletar informações a Escala de Estilos Parentais de Steinberg, adaptada por Merino e Arndt, e o Questionário de Agressão de Buss e Perry, adaptado por Matalinares, Yaringaño, Uceda, Fernández, Huari Campos e Villavicencio. Por esse motivo, a amostra deste estudo foi composta por 160 estudantes de ambos os sexos. Para análise dos dados foi utilizado o programa Statistical Package for Social Sciences, resultando em relação significativa, moderada e inversa (Spearman =-0,638, significância <0,05) entre as duas variáveis do estudo. Portanto, à medida que o estilo parental diminui, aumenta a tendência para manifestar comportamentos agressivos. Com base nos resultados conclui-se que a forma como os pais interagem com os filhos irá desenvolver o seu comportamento. Portanto, em sujeitos cujos pais desenvolveram autonomia, interesse em suas atividades, supervisão comportamental e também utilizam comunicação empática nas regulamentações, haverá menor possibilidade de apresentarem comportamentos agressivos. Pelo contrário, indivíduos com pouca supervisão, falta de atenção dos pais e falta de assertividade dos cuidadores terão maior probabilidade de expressar comportamentos agressivos.

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Resumo Fundamento Alcançar as metas nutricionais estabelecidas pelas sociedades científicas é um desafio constante e nem sempre alcançado. Objetivo Investigar a adequação alimentar de indivíduos com doença cardiovascular (DCV), participantes do Programa Alimentar Brasileiro Cardioprotetor residentes da região Nordeste do Brasil, segundo as recomendações da Sociedade Brasileira de Cardiologia (SBC). Métodos Análise transversal com dados do estudo de implementação da Dieta Cardioprotetora Brasileira (DICA BR) que avaliou indivíduos com DCV, atendidos em centros especializados em saúde cardiovascular em oito estados do Nordeste. O consumo alimentar foi obtido por recordatório alimentar de 24 horas e a adequação da dieta seguiu as recomendações da SBC. Foram considerados significantes valores de p < 0,05. Resultados Foram estudados 647 pacientes, com média (desvio padrão) de idade de 63,1 (9,4) anos, sendo 50,2% do sexo feminino. Na avaliação da ingestão alimentar, observou-se baixa adequação de carboidratos (52,3%), proteínas (70,9%), lipídios (38,8%) e fibras (22,4%). Observou-se que a maioria das mulheres consumia dieta hipoproteica (59,2%) e idosos tinham maior inadequação no consumo de carboidratos (52,6%). Em relação a ingestão de sódio, os homens apresentaram maior ingestão (72,9%), enquanto os idosos apresentaram redução de 13%. Além disso, foi demonstrado que os homens ingeriam mais fibras (28,1%) e indivíduos com maior escolaridade tinham um consumo elevado de ácidos graxos saturados (70,5%). Conclusões A maioria dos indivíduos não alcançou as metas dietoterápicas preconizadas para prevenção cardiovascular secundária. Os achados do presente estudo reforçam a necessidade de implementação de estratégias estruturadas, a fim de estimular hábitos alimentares saudáveis nesses indivíduos.

Abstract Background Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved. Objective To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC). Methods Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant. Results 647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%). Conclusions Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

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OBJECTIVE: To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service. METHODS: Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses. RESULTS: Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case. CONCLUSIONS: The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

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Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.

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Introducción: La lumbalgia se presenta en aproximadamente 9,4 % de la población mundial. La acupuntura es empleada por la medicina tradicional china para estimular determinados puntos del cuerpo con diferentes tipos de agujas. Entre sus efectos beneficiosos se describe la remisión del dolor. Objetivo: Evaluar la efectividad del tratamiento acupuntural en pacientes con dolor lumbar asistidos en el cuerpo de guardia. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica (sin grupo control) en 35 pacientes con dolor lumbar, los cuales fueron atendidos en el Cuerpo de Guardia de Medicina Natural y Tradicional del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde julio hasta diciembre del 2021. Resultados: En la investigación primaron el grupo etario de 40-49 años (31,4 %), el sexo femenino (57,1 %), las amas de casa, el dolor entre grave y moderado al inicio del tratamiento, así como los pacientes sin dolor una hora después de la terapia. En cuanto a la evolución final, el total de la muestra clasificó en las categorías de aliviados y mejorados. Conclusiones: Se demostró la efectividad de la acupuntura en pacientes con dolor lumbar agudo.

Introduction: Low back pain is presented in approximately 9.4% of the world population. Acupuncture is used by Chinese traditional medicine to stimulate certain points of the body with different types of needles. Among its beneficial effects the pain remission is described. Objective: To evaluate the effectiveness of the acupuntural treatment in patients with lumbar pain assisted in the emergency room. Methods: A quasi-experiment of therapeutic intervention study (without control group) was carried out in 35 patients with lumbar pain, who were assisted in the Natural and Traditional Medicine Emergency Room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from July to December, 2021. Results: In the investigation there was a prevalence the 40-49 age group (31.4%), female sex (57.1%), housewives, serious and moderate pain at the beginning of the treatment, as well as patients without pain one hour after the therapy. As for the final clinical course, the total of the sample classified in the relieved and improved categories. Conclusions: The effectiveness of acupuncture was demonstrated in patients with acute lumbar pain.

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O objetivo do estudo foi analisar a percepção dos alunos do Ensino Médio em relação às lutas enquanto unidade temática nas aulas de Educação Física. Para tanto, a pesquisa se caracterizou como de natureza aplicada, do tipo descritiva, com a participação de 17 alunos do Ensino Médio. A pesquisa foi realizada em dois momentos, sendo o primeiro referente ao desenvolvimento de uma intervenção pedagógica do conteúdo de lutas, e o segundo a partir da aplicação de um questionário. Os resultados apontaram que 82% dos participantes usufruíram de uma prática positiva e prazerosa e 94% dos participantes afirmaram ausência de violência. Assim, compreende-se que as lutas na escola se configuram como um mediador na transformação das apreciações de concepções pelos participantes (AU).

The aim of the study was to analyze the perception of high school students in relation to martial arts as a content in Physical Education classes. Therefore, the research was characterized as being of an applied nature, of the descriptive type, with the participation of 17 high school students. The research was carried out in two moments, the first one referring to the development of a pedagogical intervention on the content of martial arts, and the second one based on the application of a questionnaire. The results showed that 82% of the participants en-joyed a positive and pleasant practice and 94% of the participants stated that there was no violence in the classes. Thus, it is understood that the development of martial arts at school was configured as a mediator in the transformation of the appreciation of conceptions by the participants (AU).

El objetivo del estudio fue analizar la percepción de los estu-diantes de secundaria en relación a las peleas como unidad temática en las clases de Educación Física. Por lo tanto, la investigación se caracterizó por ser de carácter aplicada, de tipo descriptiva, con la participación de 17 estudiantes de secundaria. La investigación se realizó en dos momen-tos, el primero referido al desarrollo de una intervención pedagógica so-bre el contenido de las peleas, y el segundo a partir de la aplicación de un cuestionario. Los resultados mostraron que el 82% de los participantes disfrutaron de una práctica positiva y agradable y el 94% de los pantes afirmó que no hubo violencia en las clases. Así, se entiende que el desarrollo de las luchas en la escuela se configuró como un mediador en la transformación de la apreciación de las concepciones por parte de los participantes (AU).

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O objetivo do estudo foi analisar a percepção dos alunos do Ensino Médio em relação às lutas enquanto unidade temática nas aulas de Educação Física. Para tanto, a pesquisa se caracterizou como de natureza aplicada, do tipo descritiva, com a participação de 17 alunos do Ensino Médio. A pesquisa foi realizada em dois momentos, sendo o pri-meiro referente ao desenvolvimento de uma intervenção pedagógica do conteúdo de lutas, e o segundo a partir da aplicação de um questionário. Os resultados apontaram que 82% dos participantes usufruíram de uma prática positiva e prazerosa e 94% dos participantes afirmaram ausência de violência. Assim, compreende-se que as lutas na escola se configuram como um mediador na transformação das apreciações de concepções pelos participantes.

The aim of the study was to analyze the perception of high school students in relation to martial arts as a content in Physical Education classes. Therefore, the research was characterized as being of an applied nature, of the descriptive type, with the participation of 17 high school students. The research was carried out in two moments, the first one referring to the development of a pedagogical intervention on the content of martial arts, and the second one based on the application of a questionnaire. The results showed that 82% of the participants en-joyed a positive and pleasant practice and 94% of the participants stated that there was no violence in the classes. Thus, it is understood that the development of martial arts at school was configured as a mediator in the transformation of the appreciation of conceptions by the participants.

El objetivo del estudio fue analizar la percepción de los estu-diantes de secundaria en relación a las peleas como unidad temática en las clases de Educación Física. Por lo tanto, la investigación se caracterizó por ser de carácter aplicada, de tipo descriptiva, con la participación de 17 estudiantes de secundaria. La investigación se realizó en dos momen-tos, el primero referido al desarrollo de una intervención pedagógica so-bre el contenido de las peleas, y el segundo a partir de la aplicación de un cuestionario. Los resultados mostraron que el 82% de los participantes disfrutaron de una práctica positiva y agradable y el 94% de los participantes afirmó que no hubo violencia en las clases. Así, se entiende que el desarrollo de las luchas en la escuela se configuró como un mediador en la transformación de la apreciación de las concepciones por parte de los participantes.

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El aislamiento social y el confinamiento forzado debido a la pandemia tuvo graves efectos en la salud mental de los estudiantes, que se manifestó cómo ansiedad y estrés. Objetivo. La investigación tuvo como propósito analizar los niveles de ansiedad en estudiantes de secundaria. Metodología. La búsqueda de información se realizó en las bases de datos Scopus y Ebsco, utilizando las ecuaciones: "Anxiety AND High school students", "Trait Anxiety AND High school students", "State anxiety AND High school students"; la información recabada se almacenó en la bandeja de Mendeley; dicha información fue analizada por títulos, resumen, palabras clave, resultados y conclusiones. El análisis de la información encriptada en Mendeley contó con 35 artículos, de los cuales 30 fueron cuantitativos y 5 cualitativos; además, el análisis por países demostró que las investigaciones sobre este tópico se realizaron con mayor énfasis en Brasil (6), en España (4) y en EE.UU. (4). El análisis de los aportes evidenció que la carencia de aparatos tecnológicos y el cambio de una educación presencial a otra virtual tuvo consecuencias inusuales de estrés y ansiedad en estudiantes y docentes. Además, se observó incremento en la agresividad, problemas en la salud mental, insomnio, pérdida del apetito entre otros. Conclusión. El confinamiento social y los cambios abruptos en la educación generaron en los agentes educativos trastornos en la salud mental y emocional.

Social isolation and forced confinement due to the pandemic had serious effects on students' mental health, which manifested as anxiety and stress. Objective. The purpose of the research was to analyze the levels of anxiety in high school students. Methodology: The information search was carried out in the Scopus and Ebsco databases, using the equations: "Anxiety AND High School Students", "Trait Anxiety AND High School Students", "State Anxiety AND High School Students"; the information collected was stored in the Mendeley tray; Said information was analyzed by titles, abstract, keywords, results and conclusions. The analysis of the encrypted information in Mendeley included 35 articles, of which 30 were quantitative and 5 qualitative; In addition, the analysis by countries disappeared because the research on this topic was carried out with greater emphasis in Brazil (6), in Spain (4) and in the US (4). The analysis of the contributions shows that the lack of technological devices and the change from face-to-face education to a virtual one had unusual consequences of stress and anxiety in students and teachers. In addition, an increase in aggressiveness, mental health problems, insomnia, loss of appetite, among others, was demonstrated. Conclusion: Social confinement and abrupt changes in education generate mental and emotional health disorders in educational agents.

O isolamento social e o confinamento forçado devido à pandemia tiveram efeitos graves na saúde mental dos estudantes, que se manifestaram sob a forma de ansiedade e stress. Objetivo: O objetivo da pesquisa foi analisar os níveis de ansiedade em estudantes do ensino médio. Metodologia. A busca de informações foi realizada nas bases de dados Scopus e Ebsco, utilizando as equações: "Ansiedade AND Estudantes do Ensino Médio", "Ansiedade Traço AND Estudantes do Ensino Médio", "Ansiedade Estado AND Estudantes do Ensino Médio"; as informações coletadas foram armazenadas na bandeja do Mendeley; Essas informações foram analisadas por títulos, resumo, palavras-chave, resultados e conclusões. A análise das informações criptografadas no Mendeley teve 35 artigos, sendo 30 quantitativos e 5 qualitativos; Além disso, a análise por país mostrou que as pesquisas sobre o tema foram realizadas com maior ênfase no Brasil (6), na Espanha (4) e nos Estados Unidos (4). A análise das contribuições mostrou que a falta de aparatos tecnológicos e a mudança do ensino presencial para o virtual tiveram consequências inusitadas de estresse e ansiedade em alunos e professores. Além disso, foi observado aumento da agressividade, problemas de saúde mental, insônia, perda de apetite, entre outros. Conclusão. O confinamento social e as mudanças bruscas na educação geraram transtornos de saúde mental e emocional nos agentes educacionais.

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La rinoplastia es una de las intervenciones más comunes en cirugía plástica. Se opera aquí una rinoplastia secundaria por vía abierta injertando los alares y la punta con cartílagos auriculares, mientras el tabique cartilaginoso fue usado para los spreader grafts. Se describe aquí una infección posoperatoria de su punta nasal. Al 9no día de su posoperatorio comienza con la punta nasal congestiva y levemente inflamada. Se medica con una crema con antibióticos, pero el día 14 aparece con la punta nasal muy inflamada y con colección. Cuando en el consultorio el cirujano la ve, como cualquier absceso, decide realizarle drenaje con un trocar 18G, 3 miniincisiones en la piel debajo de la punta nasal, de la que drena un líquido amarronado. Luego con el mismo trocar se realiza un lavado dentro de la cavidad con rifampicina solución. Se medica con trimetoprima-sulfametoxazol (Bactrimforte®) 2 comp/día. Al otro día se observa una notable mejoría. Se continuó con lavado diario durante 4 días con el mismo antibiótico evolucionando rápidamente bien. El Bactrim se lo continúa por 20 días. Al mes la punta nasal está muy bien, deshinchada con cicatrices apenas visibles. A los cuatro meses, la punta está muy blanda, las alas nasales y las narinas normales, la punta con buena proyección igual que el dorso con los spreader graft.

Rhinoplasty is one of the most common interventions in plastic surgery. A secondary open rhinoplasty was carried out grafting the allae and the tip of the nose with conchae cartilage, while the septum was used for spreader grafts. We are here describing this post operatory with a tip of the nose infection.In the control, at the 9th postoperative day, the nasal tip began to be congested and at the 14th post op day the patient showed a clear inflammatory collection. In the office, the surgeon decided to evacuate it with three punctureslike little incisions at the inferior part of the skin tip with a trocar 18G. Through them, drained brownish purulent secretion. With the same trocar, rifampicin solution was injected through these little incisions, like washing the subdermal area. It was medicated with trimethoprim-sulfamethoxazole (Bactrim forte®) 2 tablets/day. The following day, there was a clear improvement in the congestion and erythema of the nose. This procedure of washing was repeated for four days. There was a quick evolution of the inflammatory process and 20 more days, there was no sign of the infection. Four months later, the tip of the nose was soft and the result was considered optimal by the patient and doctors.

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Background and objective: IgG replacement therapy (IgG-RT) has radically changed the clinical evolution of primary immunodeficiencies, yet the information regarding secondary hypogammaglobulinemia (SHG) is insufficient or conflicting. We aim to describe clinical features, evolution and treatment of SHG patients in our center. Methods: Dynamic retrospective cohort between January 2001 and July 2021 of adults with gamma globulin fraction <0.6g/dL in a serum protein electrophoresis and a coincident decrease of IgG levels – with a disease-related SHG or treatment that reduces serum immunoglobulins. Results: We included 1012 patients with SHG with a median follow-up of 5 years (IQR 2–8). Hematological diseases were identified in 95% of the patients and 61% received drugs related to SHG. Sixty five percent had more than one etiological factor associated with SHG. Infectious diseases were present in 69% of the patients, 48% had respiratory infections and 17% had severe infections. There was statistical association between respiratory and severe infections with multiple myeloma (MM), lymphoma and rituximab. MGUS had less infections and death compared with other etiologies. IgG-RT was indicated in 18.7% of the patients and 4.6% received it for more than 6 months with variable intervals. Among the latter group, there was a significant reduction of all-type infections and respiratory infections with IgG-RT (p<0.001), and it was consistent with similar findings in lymphoma, MM and all IgG levels subgroups. Conclusion: SHG was associated with more than one etiological factor and a high frequency of infections. IgG-RT indication was irregular yet still effective. It is relevant to consider IgG levels screening, monitoring and accurate indication of IgG-RT.(AU)

Antecedentes y objetivos: La IgG sustitutiva ha cambiado radicalmente la evolución de las inmunodeficiencias primarias, mientras que la información sobre hipogammaglobulinemia secundaria (HGS) es insuficiente y discordante. El objetivo del estudio es describir las características clínicas, evolución y tratamiento de pacientes con HGS. Métodos: Cohorte retrospectiva dinámica entre enero de 2001 y julio de 2021 de adultos con proteinograma y fracción de gammaglobulina <0,6g/dL y dosaje disminuido de IgG, con enfermedad o tratamiento que produzcan HGS. Resultados: Se incluyó a 1.012 pacientes con HGS con una mediana de seguimiento de 5 años (IIC 2-8). El 95% tenía enfermedad hematológica y el 61% recibió fármacos asociados a HGS. El 65% tenía más de un factor etiológico asociado con HGS. El 69% presentó infecciones de cualquier tipo, el 48% infecciones respiratorias y el 17%, infecciones graves. Hubo asociación significativa entre infecciones respiratorias y graves entre los subgrupos de mieloma múltiple, linfoma y rituximab. Los pacientes con MGUS tuvieron menor frecuencia de infecciones y muerte comparados con otros factores etiológicos. El 18,7% de los pacientes recibió IgG sustitutiva y el 4,6% de forma crónica, con intervalos variables. Los últimos tuvieron disminución significativa de infecciones de cualquier tipo e infecciones respiratorias con IgG sustitutiva (p<0,001), que se mantuvo en los subgrupos con mieloma múltiple, linfoma y todos los niveles de IgG. Conclusión: La HGS asoció más de un factor etiológico y alta frecuencia de infecciones. La indicación de IgG sustitutiva fue irregular, pero, aún así, efectiva. Se plantea considerar el dosaje de inmunoglobulinas, monitoreo y la adecuada indicación de IgG sustitutiva.(AU)

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El hiperaldosteronismo primario (HAP) es una causa importante de hipertensión arterial (HTA) secundaria. El estudio del mismo precisa de una alta sospecha clínica, además de un estudio hormonal que confirme la hipersecreción hormonal. Es importante iniciar el tratamiento adecuado una vez se confirma el diagnóstico, y para ello es preciso demostrar si la hipersecreción hormonal es unilateral (pacientes que podrían ser tributarios a tratamiento quirúrgico) o bilateral (pacientes que son tributarios a tratamiento únicamente farmacológico). En el Hospital del Mar desde el año 2016 existe un equipo de trabajo multidisciplinar en el que participan nefrólogos, endocrinólogos, radiólogos y cirujanos para evaluar los casos con sospecha de hiperaldosteronismo y consensuar el mejor abordaje diagnóstico-terapéutico de estos pacientes, incluyendo la necesidad de cateterismo venoso adrenal, que es una técnica que en los últimos años se ha erigido como gold standard para el estudio del HAP. En el presente estudio recogemos la experiencia de nuestro centro en la realización de cateterismo venoso adrenal y en la utilidad de este para el manejo de tales pacientes (AU)

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our center in performing adrenal vein catheterization and its usefulness for the management of these patients (AU)

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INTRODUCTION: Developmental dysplasia of the hip is the cause of approximately one third of secondary coxarthrosis. Anatomy alterations make it difficult to place a total hip prosthesis in its anatomical position and for it to be stable in the long term; there are several techniques to achieve this goal. In the present work, we used autograft of the femoral head (shelf graft or reinforced roof), to improve the coverage of the acetabular component with favourable results. MATERIALS AND METHODS: Sixteen cases were included in 14 patients with a diagnosis of developmental dysplasia of the hip (13 women and one man), the mean age was 44.3 years (range 35-68 years), with a mean follow-up of 7 years (range 1-15 years). All the cases were evaluated clinically and radiographically, to demonstrate the osseointegration of the graft and the functional results in the medium term. RESULTS: All the acetabular components were placed in anatomical position (Ranawat technique), the mean percentage of host bone coverage was 54.53% (range 43.28-79.05%), obtaining additional coverage with the bone graft of 45.13%. Osseointegration of the graft of 100% at 12 weeks, resorption of the graft from the sixth month, stabilising in the third postoperative year. Only one case of dislocation is reported, no cases of infection, loosening, heterotopic ossification or revision. CONCLUSION: This procedure has shown good functional results in the medium term with 100% osseointegration, despite cases of severe bone resorption of the graft that does not compromise the stability of the prosthesis.

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Resumo Fundamento: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. Objetivos: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. Métodos: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. Resultados: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. Conclusões: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.

Abstract Background: The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy. Objectives: We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients. Methods: A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests. Results: Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals. Conclusions: Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.

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BACKGROUND AND OBJECTIVE: IgG replacement therapy (IgG-RT) has radically changed the clinical evolution of primary immunodeficiencies, yet the information regarding secondary hypogammaglobulinemia (SHG) is insufficient or conflicting. We aim to describe clinical features, evolution and treatment of SHG patients in our center. METHODS: Dynamic retrospective cohort between January 2001 and July 2021 of adults with gamma globulin fraction <0.6g/dL in a serum protein electrophoresis and a coincident decrease of IgG levels - with a disease-related SHG or treatment that reduces serum immunoglobulins. RESULTS: We included 1012 patients with SHG with a median follow-up of 5 years (IQR 2-8). Hematological diseases were identified in 95% of the patients and 61% received drugs related to SHG. Sixty five percent had more than one etiological factor associated with SHG. Infectious diseases were present in 69% of the patients, 48% had respiratory infections and 17% had severe infections. There was statistical association between respiratory and severe infections with multiple myeloma (MM), lymphoma and rituximab. MGUS had less infections and death compared with other etiologies. IgG-RT was indicated in 18.7% of the patients and 4.6% received it for more than 6 months with variable intervals. Among the latter group, there was a significant reduction of all-type infections and respiratory infections with IgG-RT (p<0.001), and it was consistent with similar findings in lymphoma, MM and all IgG levels subgroups. CONCLUSION: SHG was associated with more than one etiological factor and a high frequency of infections. IgG-RT indication was irregular yet still effective. It is relevant to consider IgG levels screening, monitoring and accurate indication of IgG-RT.

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Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.

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O Transtorno do Espectro Autista (TEA) surge nos primeiros anos de vida, mas sua trajetória inicial não é homogênea. Serviços de saúde pública e privada enfrentam desafios no que diz respeito ao diagnóstico e tratamento deste público, assim como no cuidado e orientação das famílias. Diante disso, esta dissertação possui como objetivo analisar a percepção das mães de pessoas com Transtorno do Espectro Autista sobre as práticas de cuidado direcionado ao bem estar das próprias mães que acompanham seus filhos nas unidades de atenção secundária do Sistema Único de Saúde (SUS), assim como as condições de acesso ao diagnóstico e o processo inicial do tratamento. Para tanto, optou-se realizar dois tipos de desenhos metodológicos, sendo um a revisão sistemática (registrado na plataforma PROSPERO sob o código de registro CRD42023394779) e o outro a abordagem qualitativa-descritiva realizada através de entrevistas semiestruturadas com quinze mães de pessoas com TEA registrado sob número de parecer 6.466.061 no Comitê de Ética do Hospital Universitário Onofre Lopes e que resultou em cinco artigos. Todos os artigos foram escritos entre janeiro de 2023 à junho de 2024. Os resultados da revisão sistemática (artigo 1) destacaram os desafios emocionais, sociais e econômicos dos pais de filhos com TEA e a importância do suporte emocional e comunitário para sua resiliência; o artigo 2 identificou barreiras significativas no SUS para o diagnóstico precoce de TEA, como a falta de profissionais especializados e a burocracia, sugerindo melhorias nas políticas públicas; o artigo 3 revelou a diversidade e inconsistência nos tratamentos de TEA disponíveis no SUS, enfatizando a necessidade de integração entre diferentes serviços de saúde para eficácia terapêutica; o artigo 4 constatou variações significativas nas práticas de cuidado na atenção secundária direcionado às mães que acompanham seus filhos nas consultas, destacando a importância da formação continuada dos profissionais de saúde e a padronização dos cuidados; já o artigo 5 abordou as experiências únicas das mães solteiras de pessoas com TEA, enfatizando a sobrecarga emocional e financeira e a necessidade de redes de suporte específicas; por fim o artigo 6 mostrou que o conhecimento das mães sobre TEA evolui ao longo do tempo, influenciando a eficácia do tratamento e ressaltando a importância de programas educacionais contínuos para os pais. Conclui-se então que esta dissertação oferece uma contribuição significativa ao aprofundar o entendimento das experiências das mães de pessoas com TEA a respeito da busca do diagnóstico e processo terapêutico dos seus filhos, assim como as práticas de cuidado nas unidades de atenção secundária do SUS. Os resultados obtidos sublinham a necessidade urgente de melhorar o acesso ao diagnóstico precoce, facilitar o início dos tratamentos, padronizar as práticas de cuidado e oferecer suporte contínuo às famílias. Para avanços futuros, sugere-se a realização de estudos longitudinais que acompanhem as famílias ao longo do tempo para entender melhor as mudanças nas percepções e nas necessidades de cuidado. É importante investigar a realidade de diferentes regiões do Brasil para obter uma visão mais abrangente das condições de acesso e tratamento. Também seria benéfico incluir perspectivas de outros cuidadores para uma compreensão mais completa do impacto do TEA. Por fim, é fundamental informar a criação de políticas públicas que abordem as lacunas identificadas na pesquisa, promovendo uma melhor integração e qualidade dos serviços de saúde oferecidos pelo SUS (AU).

Autism Spectrum Disorder (ASD) appears in the first years of life, but its initial trajectory is not homogeneous. Public and private health services face challenges when it comes to diagnosing and treating this population, as well as caring for and guiding families. Therefore, this dissertation aims to analyze the perception of mothers of people with Autism Spectrum Disorder regarding care practices aimed at the well-being of the mothers themselves who accompany their children in the secondary care units of the Unified Health System (SUS), as well as the conditions for access to diagnosis and the initial treatment process. To this end, it was decided to carry out two types of methodological designs, one being a systematic review (registered on the PROSPERO platform under the registration code CRD42023394779) and the other a qualitative-descriptive approach carried out through semi-structured interviews with fifteen mothers of people with ASD registered under opinion number 6.466.061 with the Ethics Committee of the Onofre Lopes University Hospital and which resulted in five articles. All articles were written between January 2023 and June 2024. The results of the systematic review (article 1) highlighted the emotional, social and economic challenges faced by parents of children with ASD and the importance of emotional and community support for their resilience; article 2 identified significant barriers in the SUS for the early diagnosis of ASD, such as the lack of specialized professionals and bureaucracy, suggesting improvements in public policies; article 3 revealed the diversity and inconsistency in ASD treatments available in the SUS, emphasizing the need for integration between different health services for therapeutic effectiveness; article 4 found significant variations in care practices in secondary care aimed at mothers who accompany their children to consultations, highlighting the importance of continued training for health professionals and the standardization of care; Article 5 addressed the unique experiences of single mothers of people with ASD, emphasizing the emotional and financial burden and the need for specific support networks; Finally, article 6 showed that mothers' knowledge about ASD evolves over time, influencing the effectiveness of treatment and highlighting the importance of ongoing educational programs for parents. It is therefore concluded that this dissertation offers a significant contribution by deepening the understanding of the experiences of mothers of people with ASD regarding the search for diagnosis and the therapeutic process of their children, as well as care practices in SUS secondary care units. The results obtained highlight the urgent need to improve access to early diagnosis, facilitate the initiation of treatments, standardize care practices and offer continuous support to families. For future advances, it is suggested that longitudinal studies be carried out that follow families over time to better understand changes in perceptions and care needs. It is important to investigate the reality of different regions of Brazil to obtain a more comprehensive view of access and treatment conditions. It would also be beneficial to include perspectives from other caregivers for a more complete understanding of the impact of ASD. Finally, it is essential to inform the creation of public policies that address the gaps identified in the research, promoting better integration and quality of health services offered by the SUS (AU).

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