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ABSTRACT The global health crisis resulting from the outbreak of the coronavirus (SARS-CoV-2) has led to social distancing, the repercussions of which on physical and mental health are still being assessed. This study aims to compare reported lower back pain in adults during the pre-pandemic and pandemic periods regarding intensity and frequency, as well as the risk of poor prognosis, disability, exposure to risk factors, beliefs, fears, and sitting posture in front of the computer. The sample of this retrospective study with a comparative ex post facto design consisted of 80 individuals with complaints of low back pain, divided by sex, age, height, and body mass-matched groups: 40 individuals in the pre-pandemic group (PPG) and 40 individuals in the pandemic group (PG), who were involved in university outreach projects. Data were collected using BackPEI-A, SBST, ODI, and FABQ questionnaires from 2016 to 2021. Mann–Whitney u-test and Student’s t -test were used for group comparisons (α

ABSTRACT Objective: to cross-culturally adapt and analyze the metric properties of the Adult Difficult Intravenous Access Scale into Brazilian Portuguese. Method: methodological study carried out in two stages: 1) Translation of the scale from the original version in English to Brazilian Portuguese, including an assessment by a committee of nine judges, back-translation and semantic analysis; 2) Analysis of metric properties with 130 adults admitted to a hemodynamics unit in which difficult peripheral venipunctures occurred. Participants were followed up to check for the occurrence of difficult peripheral venipunctures. The instrument’s inter-rater reliability and predictive validity were analyzed. Data collection was carried out from February 2021 to April 2023 in Minas Gerais, Brazil. Results: in the assessment carried out by the committee of judges, the items presented a Content Validity Index above 0.80, after the second round of assessment. Regarding semantic analysis, professionals considered the scale relevant, easy to apply and understand. The Kappa coefficient for individual items ranged between 0.68 and 1.0. For each item scored, adult patients are three times more likely to have difficult peripheral venipuncture. Conclusion: the final version of the scale was considered clear, reliable, and easy to understand. The instrument enables a predictive score of difficult peripheral venipuncture in adults.

Introducción. Las competencias culinarias son un conjunto de factores que se integran en el andamiaje de conocimientos, habilidades y comportamientos que configuran la alfabetización alimentaria y que en investigaciones recientes se han asociado positivamente con la calidad nutricional de la dieta. Las intervenciones dirigidas a mejorar las competencias culinarias han demostrado cambios positivos en el estado de salud. . El objetivo del presente trabajo es describir el protocolo diseñado para el desarrollo y validación de una herramienta que permita medir las competencias culinarias en adultos españoles y valorar el impacto de éstas en la calidad nutricional de sus dietas. Metodología. Este protocolo contempla seis fases: (1) Primera fase: se realizará una revisión panorámica (scoping review) sobre conceptos clave y definiciones asociadas a las competencias culinarias , y se identificarán ítems existentes para el desarrollo inicial del cuestionario; (2) Segunda fase: se generará el conjunto inicial de ítems, adaptado al contexto español, con la colaboración de un panel de expertos que incluirá profesionales culinarios, expertos en técnicas culinarias y dietistas-nutricionistas; (3) Tercera fase: el comité de expertos evaluará la validez de contenido, empleando el índice de validez de contenido (CVI) para determinar la relevancia de los ítems; (4) Cuarta fase: se realizará un estudio piloto con 30 participantes de la población objetivo para evaluar la validez cognitiva y asegurar la comprensibilidad y pertinencia de los ítems; . (5) Quinta fase: se implementará la primera propuesta de la herramienta en una muestra ampliada de la población objetivo, y se evaluará la confiabilidad mediante análisis de consistencia interna (Cronbach’s alpha) y test-retest; se llevará a cabo un análisis factorial y un análisis de Rasch para validar la estructura del constructo; (6) Sexta fase: se examinará la validez de criterio comparando los resultados del cuestionario con otras herramientas validadas previamente identificadas en la scoping review. El análisis estadístico utiliza SPSS Statistics 20 para los datos recopilados en todas las fases del estudio. Discusión y resultados esperados. El diseño, elaboración y validación de un cuestionario de competencias culinarias para la población española permitirá ofrecer a la comunidad científica una nueva herramienta estandarizada de medición en los estudios dieta-salud.

Resumen: Introducción: La epilepsia farmacorresistente (EFR) tiene una elevada prevalencia mundial y presenta una gran dificultad en su control, pese a una gran variedad de fármacos antiepilépticos (FAE). La dieta Atkins modificada (DAM) constituye una alternativa favorable adicional. Existen varios estudios sobre niños con EFR y uso de dieta cetogénica o DAM, pero no son suficientes en adultos con la misma condición. Objetivo: Evaluar la efectividad, tolerabilidad y adherencia de la DAM en adultos con EFR. Material y métodos: Estudio prospectivo, antes-después, aplicado durante 6 meses en un hospital de referencia. Se instauró DAM con limitación de hidratos de carbono y libertad de dieta grasa. Se realizó un seguimiento clínico y electroencefalográfico con guías relacionadas, además de valorar los efectos adversos, las modificaciones laboratoriales y aplicar un test de adherencia. Resultados: Se incluyó a 32 pacientes con EFR. La edad media fue de 30 años, el tiempo promedio de evolución fue de 22 años y todos tenían epilepsia focal o multifocal. La disminución global de crisis epilépticas superior al 50% se presentó en el 34% de los casos (p = 0,001); el control fue mayor en el primer mes y decayó posteriormente. Dichos pacientes manifestaron pérdida ponderal (RR 7,2; IC 95%: 1,3-39,5; p = 0,02), adherencia de buena a regular solo en los meses primero y tercero (RR 9,4; IC 95%: 0,9-93,6; p = 0,04; RR 0,4; IC 95%: 0,30-0,69; p = 0,02, respectivamente). La tolerabilidad de DAM se mostró como un tratamiento seguro, dados los efectos adversos menores y de corta duración en la mayoría, salvo la presencia de hiperlipidemia de leve a moderada en un tercio de los casos. El test de adherencia mostró un 50% de cumplimiento al final del estudio. Conclusiones: La DAM demuestra en adultos con EFR focal una tolerabilidad adecuada, una efectividad y adherencia moderadas, pero decrecientes, que se atribuyen probablemente a la preferencia por una dieta basada en los hidratos de carbono. Abstract: Introduction: Drug-resistant epilepsy presents high worldwide prevalence and is difficult to control despite the wide variety of available antiepileptic drugs (AED). Modified Atkins diet (MAD) is an additional treatment alternative. Several studies have addressed the use of ketogenic diet and MAD in children with drug-resistant epilepsy, but insufficient research has been conducted into adults with the same condition. Objective: To evaluate the effectiveness and tolerability of, and adherence to, the MAD in adults with drug-resistant epilepsy. Material and methods: We conducted a 6-month pre-posprospective study at a reference hospital. Patients were prescribed the MAD with limited carbohydrate intake and unlimited fat intake. We conducted clinical and electroencephalographic follow-up according to the relevant guidelines, and assessed adverse effects changes in laboratory findings, and adherence. Results: Thirty-two patients with drug-resistant epilepsy were included in the study. Patients’ mean age was 30 years, mean disease progression time was 22 years, and all patients had focal or multifocal epilepsy. Thirty-four percent of patients presented > 50% decreases in overall seizure frequency (P = .001); seizure control was greater in the first month and subsequently declined. These patients presented weight loss (RR: 7.2; 95% CI: 1.3-39.5; P = .02), good to fair adherence only in the first and third months (RR: 9.4; 95% CI: 0.9-93.6; P = .04 and RR: 0.4; 95% CI: 0.30-0.69; P = .02, respectively). Tolerability data showed that the MAD is safe: adverse effects were minor and short-lived in most cases, with the exception of mild to moderate hyperlipidaemia in one-third of patients. The adherence rate was 50% at the end of the study. Conclusions: In adults with drug-resistant focal epilepsy, the MAD showed adequate tolerability and moderate but decreasing effectiveness and adherence, probably due to a preference for a carbohydrate-based diet.

ABSTRACT Objective: To analyze the relational and functional aspects of patient safety through the experiences reported by the patients themselves and/or their caregivers in intensive care units. Method: Scoping review developed with searches, in September 2021 and updated in November 2022, in the following databases: Virtual Health Library, considering only the LILACS, BDENF, IBECS, ColecionaSUS databases; SCIELO, PsycINFO, EMBASE, COCHRANE, CINAHL, SCOPUS and Web of Science. Results: The final selection included 14 articles highlighting communication as an essential relational factor for care safety. The most predominant functional aspects were physical care environment, structured protocols, and the performance of professionals in the care process. Conclusion: Communication processes were predominant in relational aspects and were decisive for functional aspects, with emphasis on the performance of professionals in the care process. Instruments developed for quality process analysis were used in most of the studies.

Introduction. Eosinophils modulate innate and adaptive immunity. Their elevation may be associated with changes in neutrophil concentrations during acute upper respiratory tract infections. The objective was to analyze the association between eosinophilia and neutropenia in patients with acute rhinopharyngitis. Methodology. Cross-sectional and analytical study, based on data from medical records of 526 patients from a polyclinic in the district of Villa el Salvador, Peru. Patients diagnosed with acute rhinopharyngitis who underwent a complete blood count were selected. Patients with chronic respiratory and hematologic diseases were excluded. Bivariate statistics with frequencies and percentages were performed, as well as crude and adjusted Odds Ratio tests using binary logistic regression. Results. Minors with neutropenia had eosinophilia 5.52 times more often than those without neutropenia (OR=5.52; CI:95%=2.28-13.35; p=0.005). In adults it was 2.01 (OR=2.01; CI:95%=1.07-3.77; p=0.027). Discussion. The findings could be attributed to the antiviral activity of eosinophils by mechanisms mediated by ribonucleases and neurotoxins, which require neutrophil-mediated activation in the presence of viral and bacterial infectious conditions. In turn, the greater strength of the association in minors could be due to the fact that their immune system is less mature than that of adults, who also take medication more frequently. Conclusions. Neutropenia and eosinophilia were more strongly associated in patients with acute rhinopharyngitis, mainly in minors. Keywords: Neutrophils; Eosinophils; Common Cold; Adult; Adolescent; Child. Introducción. Los eosinófilos modulan la inmunidad innata y adaptativa. Su elevación puede estar asociada a cambios en las concentraciones de neutrófilos durante la infección aguda de vías respiratorias superiores. El objetivo fue analizar la asociación entre eosinofilia y neutropenia en pacientes con rinofaringitis aguda. Metodología. Estudio transversal y analítico, basado en datos de historias clínicas de 526 pacientes de un policlínico del distrito de Villa el Salvador, Perú. Fueron seleccionados pacientes diagnosticados por rinofaringitis aguda que se realizaron un hemograma completo. Se excluyó a pacientes con enfermedades respiratorias y hematológicas crónicas. Se realizó estadística bivariada con frecuencias y porcentajes, así como la prueba de Odds Ratio crudo y ajustado por regresión logística binaria. Resultados. Los menores de edad con neutropenia tuvieron eosinofilia 5.52 veces más a menudo que aquellos sin neutropenia (OR=5.52; IC:95%=2.28-13.35; p=0.005). En adultos fue 2.01 (OR=2.01; IC:95%=1.07- 3.77; p=0.027). Discusión. Los hallazgos podrían atribuirse a la actividad antiviral de los eosinófilos por mecanismos mediados por ribonucleasas y neurotoxinas, los cuales requieren de la activación mediada por neutrófilos en presencia de cuadros infecciosos virales y bacterianos. A su vez, la mayor fuerza de asociación en menores de edad podría deberse a que su sistema inmunológico está en menor madurez que los adultos, quienes además se medican con mayor frecuencia. Conclusiones. La neutropenia y la eosinofilia tuvieron una mayor fuerza de asociación en pacientes con rinofaringitis aguda, principalmente en menores de edad. Palabras clave: Neutrófilos; Eosinófilos; Resfriado Común; Adulto; Adolescente; Niño. Introdução. Os eosinófilos modulam a imunidade inata e adaptativa. Sua elevação pode estar associada a alterações nas concentrações de neutrófilos durante infecção aguda do trato respiratório superior. O objetivo foi analisar a associação entre eosinofilia e neutropenia em pacientes com rinofaringite aguda. Metodologia. Estudo transversal e analítico, baseado em dados de prontuários de 526 pacientes de uma policlínica do distrito de Villa el Salvador, Peru. Foram selecionados pacientes com diagnóstico de rinofaringite aguda e submetidos a hemograma completo. Foram excluídos pacientes com doenças respiratórias e hematológicas crônicas. Foram realizadas estatísticas bivariadas com frequências e porcentagens, bem como o teste Odds Ratio bruto e ajustado por regressão logística binária. Resultados. Menores com neutropenia apresentaram eosinofilia 5,52 vezes mais frequentemente que aqueles sem neutropenia (OR=5.52; IC 95%=2.28-13.35; p=0.005). Nos adultos foi de 2.01 (OR=2.01; IC: 95%=1.07-3.77; p=0.027). Discussão. Os achados podem ser atribuídos à atividade antiviral dos eosinófilos através de mecanismos mediados por ribonucleases e neurotoxinas, que requerem ativação mediada por neutrófilos na presença de condições infecciosas virais e bacterianas. Por sua vez, a maior força de associação nos menores pode ser devida ao fato do seu sistema imunitário ser menos maduro do que o dos adultos, que também tomam medicamentos com mais frequência. Conclusões. Neutropenia e eosinofilia tiveram maior força de associação nos pacientes com rinofaringite aguda, principalmente nos menores. Palavras-chave: Neutrófilos; Eosinófilos; Resfriado Comum; Adulto; Adolescente; Criança

ABSTRACT Objective: To analyze the scientific evidence on the impact of the COVID-19 pandemic on suicidal behavior in adults. Method: Systematic review, conducted from June to October 2022, in the following databases: MEDLINE/PubMed, Virtual Health Library, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, PsycINFO, Web of Science, Scopus, Science Direct and Google Scholar. The selection, data extraction and assessment of methodological quality were carried out using the Methodological Index for Non-randomized Studies tool. Considering that most of the studies evaluated had significant methodological differences, it was decided to carry out a qualitative synthesis of the data. Results: A total of 2112 articles were found, from which eight articles were selected that analyzed the impact of the COVID-19 pandemic on suicidal behavior in adults. Conclusion: The COVID-19 pandemic has influenced the suicidal behavior in adults worldwide, especially when related to race, gender, age, religion, socioeconomic, family and legal issues, and pre-existing mental disorders, leading to a greater propensity for suicidal act.

Numerous complications of type 1 diabetes (T1D) may be prevented through suitable glycemic control. Glycated hemoglobin (HbA1c) may be one of the markers for the early detection of the metabolic imbalance characteristic of the disease. However, optimal control of diabetes is not achieved in a large group of patients. It was demonstrated that numerous factors (sociodemographic, psychological, and clinical) contributed to this condition. The aim of the study was to identify factors influencing the control of diabetes measured via glycated hemoglobin concentrations in people with T1D. Independent factors influencing better diabetes control measured via HbA1c in the study group included higher disease acceptance, higher nutritional adherence, lower BMI, and a lower risk of eating disorders. Describing the determinants will allow for the improvement of the system of care provided to people with T1D and for it to comprise important psychological variables related to self-care and acceptance of the disease.

Introduction: Athletics is an Olympic sport that involves surpassing the athletic performance of opponents, whose performance brings together a set of disciplines that involve the use of various skills generated from initiation to sports specialization. Objective: Develop a qualitative scale for the assessment of athletic performance in 800 meters in Chilean master athletes between 35 and 44 years old. Material and methods: Cross-sectional descriptive study, whose sample considers 196 male and 154 female athletes, whose participation in the 800 meter test was during the period 2014 to 2022, these data being obtained from the registry of the Federation of Master Athletics of Chile. Athletic performance was determined through the time used to complete the test, while the qualitative scale was constructed with the percentiles

This narrative review article explores the current scientific knowledge on the definition, epidemiology, diagnostic criteria, microbiology, treatment, and prevention of severe community-acquired pneumonia (SCAP) in immunocompetent adults. At present, despite major scientific advances in diagnostic evaluation, clinical management, antimicrobial therapy, and prevention, severe community-acquired pneumonia remains a major cause of morbidity and mortality, as well as having a major economic impact in terms of increased healthcare expenditure worldwide. This pathology is considered one of the leading causes of sepsis/septic shock, with an extremely high overall mortality rate, which justifies all the effort in early diagnosis, proper management, and prompt initiation of antimicrobial therapy. Including biomarkers (isolated or in combination) associated with applying diagnostic criteria and prognostic severity scales in clinical practice helps identify patients with severe community-acquired pneumonia, defines immediate admission to the intensive care unit, and, thus, minimizes the adverse outcomes of this serious pathology.

ABSTRACT Objectives: to develop a responsive website focused on treatment adherence for adult users living with HIV. Methods: technological study conducted between August and October 2020, in the light of Pierre Lévy’s theoretical-philosophical framework, using the Double Diamond Process methodology associated with the five stages of The Elements of User Experience framework. Results: it was developed the responsive website Positive Care (Positive o Cuidado), composed of an initial presentation screen and 13 other screens named: Family Health and You; Undetectable = Untransmissible; Antiretroviral Drugs; Routine Tests; Vaccination; Antiretroviral Delivery; Drug Interactions; Combined Prevention; Support Services; Healthy Life; Family and Reproductive Planning; Covid 19; and Questions, Curiosities, and Myths. Final Considerations: the responsive website was developed based on the software design and programming process and has requirements/functionalities with the potential to strengthen the collective intelligence about HIV and, consequently, to promote treatment adherence by its users.

ABSTRACT Objective: To analyze content validity evidence and response processes of a bank of items for measuring vulnerability to physical inactivity in adults. Method: Methodological study, with 13 specialists and 46 representatives of the target population. The Content Validity Index (CVI) and binomial test were calculated; data obtained through validity based on response processes were collected through interviews. Results: Of the 105 constructed items, 16 were excluded (CVI0.78), 34 were changed and 4 were deleted after evaluating the evidence of response processes. In the end, 97 items remained, with a global CVI of 0.92, organized into two dimensions: Subject (CVI=0.91) and Social (CVI=0.94). Conclusion: The items presented adequate parameters and evidence of validity; and can subsidize the construction of instruments that consider the subject’s and social vulnerability in understanding physical inactivity.

ABSTRACT Purpose: to verify hearing difficulties related to everyday listening situations self-reported by normally-hearing adults. Methods: a cross-sectional observational study in which adult individuals with clinically normal hearing, verified through audiometry and tympanometry, were included. The participants answered the Brazilian Portuguese version of the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire. Statistical analysis comprised descriptive and Spearman’s correlation test with a significance level of 5%. Results: the sample consisted of 28 participants, aged between 20 and 44 years. The median SSQ score was 8.75, in the Hearing to Speech domain, 8.11, in the Spatial Hearing domain, and 8.91, in the Quality-of-Hearing domain. There was an association between the participant's age and the score on five questions, demonstrating less self-reported difficulty as age increased. Conclusion: difficulties in everyday listening situations, self-reported by normally-hearing adults, participating in this study, were more related to situations with competitive noise and listening effort.

ABSTRACT OBJECTIVE To investigate the effects of depressive symptoms in childhood on the intellectual development of young adults. METHODS Study conducted with a birth cohort of São Luís, Maranhão, Brazil, composed of 339 participants evaluated between 7 and 9 years and between 18 and 19 years. Structural equation modeling (young adult education, sex, race/color) and childhood variables (nutritional status, depressive symptoms, cognitive function, head of household’s and mother’s education, family income) were used. In addition, head of household’s occupation, mother’s age, and presence of partner were tested as determinants of adults’ intelligence quotient (IQ). RESULTS Presence of depressive symptoms in childhood triggered a reduction of 0.342 in standard deviation (SD) and -3.83 points in the average IQ of adults (p-value < 0.001). Cognitive function in childhood had a total and direct positive effect (standardized coefficient [SC] = 0.701; p-value < 0.001) on IQ, increasing 7.84 points with each increase in level. A positive indirect effect of child nutritional status (SC = 0.194; p-value = 0.045), head of household’s (SC = 0.162; p-value = 0.036), and mother’s education was identified, the latter mediated by cognitive function in childhood (SC = 0.215; p-value = 0.012) on the IQ of young people. CONCLUSION Presence of depressive symptoms in childhood triggered a long-term negative effect on intelligence, reducing the IQ score in adulthood.

ABSTRACT Objective: This study aimed to verify the association between childhood anthropometric indicators and areal bone mineral density (aBMD) in adulthood. Methods: Repeated measures of 137 subjects (68 females) were obtained in childhood (9.2±1.5 years of age) and adulthood (22.3±1.7 years of age). aBMD (g/cm2) was assessed for whole body, lumbar spine, upper and lower limbs, and femoral neck in adulthood using dual-energy X-ray absorptiometry. Anthropometric measurements of body weight (BW), height, triceps and subscapular skinfolds were obtained in childhood. The anthropometric indicators used were BW, body mass index (BMI), and sum of skinfolds (ΣSF). Simple linear regression was used to assess the association between childhood anthropometric indicators and aBMD in adulthood, controlled by chronological age and stratified by sex, with 5% statistical significance. Results: In females, multiple associations were observed between anthropometric indicators and aBMD, with higher coefficients for BMI (β=0.020; R2=0.20; p

Introduction: Intussusception is the prolapse of one gastrointestinal segment into an adjacent part. Its incidence in adults is less than 10%. Objective: To presents a case of adult entero-enteric intussusception caused by small bowel submucosal lipoma. Clinical case: A 66-year-old male patient with vague clinical manifestation that presented in a computed tomography scan typical invagination image, it showed the classical "target" and "sausage-like" images. He underwent surgery, where the diagnosis of adult entero-enteric intussusception was confirmed and then an en-bloc resection was performed. Anatomopathological examination revealed a submucosal lipoma of the jejunum. Gastrointestinal lipomas have an incidence of 0.035% - 4.4%. Conclusion: This is a rare case, not only because the intussusception is uncommon in adults but for the lead point found in it.

ABSTRACT Purpose: to compare the Auditory Middle Latency Response in adults, one group with and another group without altered auditory skills. In addition, the aim was to compare cut-off values of 30% and 50% for the Ear Effect in terms of sensitivity and specificity. Methods: the sample comprised 32 individuals of both genders with no hearing loss who were divided into Group 1 (16 individuals with no alterations in auditory skills) and Group 2 (16 individuals with alterations in auditory skills). All participants received an audiological evaluation and measurement of Brainstem and Auditory Middle Latency Potentials. Results: when Group 1 and Group 2 were compared, a statistically significant difference was only observed in Na and Pa amplitude of waves A1C3 and A2C3. In the analysis of sensitivity and specificity of the Auditory Middle Latency Response, a cut-off value of 50% gave a better balance between sensitivity and specificity. Conclusion: adults presented with altered auditory abilities had smaller response amplitudes in the Na and Pa components of the waves generated in the left hemisphere. A cut-off value of 50% gave a better discrimination of the Ear Effect for identifying subjects with altered auditory skills.

Resumen: Dado el éxito en el manejo de las cardiopatías congénitas en las últimas décadas, el número de pacientes adultos sobrevivientes de una cardiopatía congénita ha superado el número de niños con tal condición. El crecimiento progresivo de esta población adulta ha creado nuevos requerimientos en el sistema de salud, incluyendo fácil acceso, un programa de transición bien establecido, así como la disponibilidad de un grupo multidisciplinario para proveer cuidado especializado. Dichas condiciones que frecuentemente no existen en la mayoría de los centros de medicina adulta.Esta revisión intenta proveer información general así como información más específica en lo que se refiere a las condiciones que se presentan con mayor frecuencia.Queremos recalcar la necesidad de reconocer la complejidad de estos pacientes y la necesidad de establecer una transición adecuada a un sistema que pueda dar el cuidado multidisciplinario y especializado que estos pacientes requieren. Abstract: Due to the ongoing success in the management of congenital heart disease, the number of survivors has grown steadily over the last decades. As such, the number of adults has surpassed the total number of children with congenital heart disease. The growth of this population creates new health care demands that include ease of access, a well-organized transition pathway as well as multidisciplinary and specialized care which currently is not universally available in adult centers.In this review, we provide background information and general consideration for the management of these patients as well as specific nuances related to management of the most common lesions. More importantly, emphasis should be placed on the recognition of these patients as a special population and the necessary requirements to organize their care so effective transition and multidisciplinary care could be delivered.

Introduction: A common pathology in the Neurosurgery Service is chronic subdural hematoma (CSDH), affecting elderly male patients. It is an accumulation of blood that is located in the subdural space that can occur spontaneously or be the result of a head injury or other pathologies such as high blood pressure (HBP), type 2 diabetes mellitus (DM2), alcoholism, or external factors such as head trauma (CT) and consumption of platelet antiaggregants. Objective: To determine how predisposing factors are associated with CSDH in adults and older adults treated at the Neurosurgery and Geriatrics Service at the María Auxiliadora Hospital (HMA) in 2016-2020. Methods:An analytical, observational, retrospective study of cases and controls was carried out through data collection from medical records. Results: Association was found with age 60 to 96 years (adjusted OR = 2,52; 95% CI: 1,43 - 4,80), male gender (adjusted OR = 4,10; 95% CI: 2,30 - 7,60), alcohol consumption (adjusted OR = 3,06; 95% CI: 1,06– 8,83), hypertension (adjusted OR = 2,51; 95% CI: 1,16– 5,43), DM2 ( Adjusted OR = 2,49; 95% CI: 1,03–6,01) and CT (adjusted OR = 3,35; 95% CI: 1,87– 6,03). Conclusions: The sociodemographic factors age and sex are associated with HSDC. Alcohol consumption, hypertension, DM2, and history of TC are associated with HSDC.

Objective: Anaerobic bacteremia represents 0.5-12% of all bacteremias and its mortality is high, ranging from 25-44%. The aim was to know our data to compare them with existing data and demonstrate the importance of actively searching for these microorganisms in blood culture samples., Methods: A retrospective descriptive study in which the medical records of patients with significant episodes of anaerobic bacteremia were reviewed over a period of 8 years (2014-2022)., Results: A total of 59,898 blood cultures were processed, of which 10,451 were positive (17%). An anaerobic microorganism was identified in 209 patients. Anaerobic bacteremia accounted for 2.11% of the total number of positive blood cultures. The mean age was 63.55 years (17-96), 66% of whom were men. The origin was community in 63.64%, of nosocomial origin in 15.31% and associated with health care in 17.70%. The focus of infection was the abdominal (39.23%), followed by the respiratory (13.88%) and skin and soft tissues (13.39%). The most frequent comorbidities were: arterial hypertension (49.76%), dyslipidemia (29.67%), neoplasia (26.32%) and diabetes (26.32%). The main species isolated were the group Bacteroides spp. (44.50%) (n=93) highlighting Bacteroides group fragilis (n=65), followed by Clostridium spp. (20%) (n=42) highlighting Clostridium perfringens (n=30). The clinical evolution was good in 67.46%. The mean length of stay was 27.8 days and was associated with 20% mortality., Conclusions: Bacteremias due to anaerobes represented 2.11% of the total number of true bacteremias, so we consider the active search for these microorganisms to be appropriate., (©The Author 2024. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Objective: One of the main problems with Clostridioides difficile infection (CDI) is its tendency to recur. The objective of the study is to analyze which factors in the clinical management of CDI favor recurrence., Methods: This is a retrospective study conducted at the Hospital Universitario Príncipe de Asturias on cases of CDI between January 2021 and June 2023. Demographic variables, comorbidities, risk factors for recurrence, and treatments used for CDI were recorded. Non-optimal clinical management was defined as: not discontinuing treatment with proton pump inhibitors (PPIs) if the patient was on them, not discontinuing concomitant antibiotic treatments if the patient was on these, the use of metronidazole monotherapy in any case, or the use of standard-dose vancomycin if there were risk factors for recurrence., Results: A total of 327 cases were found in 256 patients. 69 patients died within 8 weeks after the episode (26.9%). Among the remaining 258 episodes, there were 68 recurrences (26.3%). Of these 68 recurrences, 63 cases received nonoptimal treatment (93.2%), compared to 112/190 (58.9%) among those who did not recur. In the multivariate analysis adjusted for confounding factors, patients who received optimal treatment had an 89% lower risk of recurrence compared to those who did not receive it (OR 0.1; p < 0.001)., Conclusions: Reducing the use of PPIs and antibiotics and prioritizing more effective treatments against CDI could improve the recurrence rates of this infection., (©The Author 2024. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Objective: To analyze the concordance between a hemoglobinometer with capillary blood sample and the clinical laboratory with a venous blood sample., Design: Cross-sectional concordance study., Location: Care Centre Primary Bufalà-Canyet Primary and Care Centre Primary Dalt la Vila Primary Care Center, Badalona, Barcelona., Participants: Random selection of participants who attended routine blood tests. Over 18years old. No abandonment or loss was obtained., Main Interventions and Measurements: Sex, age, and reason for the blood test were collected from the medical history. Venous blood is drawn, and simultaneously, capillary blood is collected., Results: 120 individuals are included, with an average age of 58.9years. The Bland-Almant graph showed differences within the confidence intervals for hemoglobin and hematocrit. The mean differences between the values of the Verio Q Red hemoglobinometer and those of the clinical laboratory were -0.42mg/dl for hemoglobin and -1.25% for hematocrit. The intraclass correlation coefficient showed excellent correlation for hemoglobin and hematocrit between the Verio Q Red hemoglobinometer and the clinical laboratory. Pearson's correlation for hemoglobin was 0.737 and for hematocrit 0.787., Conclusions: The Verio Q hemoglobinometer is a valid tool for the early diagnosis of anemias and can be very useful in primary care consultations., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: To examine the perceptions of primary care professionals regarding the integration and effectiveness of mHealth in managing patients with chronic conditions, as well as their digital skills., Design: Descriptive cross-sectional observational study conducted from April to November 2023., Setting: Primary care services in the Health Department of Denia, Alicante, Spain., Participants: Professionals in nursing, medicine, and physiotherapy., Measurements: Participants completed an anonymized ad hoc questionnaire divided into two sections: sociodemographic data and questions regarding the use of mobile health technologies and the internet., Results: A total of 181 professionals participated, showing high proficiency in managing mobile applications (median score of 8 out of 10; IQR=2), with higher proficiency observed among younger professionals (P<.001). 56.35% had prescribed official or scientifically endorsed digital information. The primary advantage identified for mHealth was the enhancement of patient self-monitoring and self-control (86.74%). However, 88.95% noted the difficulty of using mobile technologies depending on patient type as a disadvantage. 64.64% believed mHealth should be targeted towards patients or caregivers dealing with cardiometabolic or respiratory chronic conditions., Conclusions: The study underscores a generally positive perception of mHealth among primary care professionals, highlighting their technological competence. It also emphasizes the potential of mHealth to improve patient self-management and enhance electronic documentation of patient follow-up. Addressing the digital divide is critical to ensuring equitable access to mHealth and thereby improving health care and outcomes., Competing Interests: Conflicto de intereses Los autores de este trabajo declaran que no existen conflictos de intereses., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: Evaluating the impact of solid organ neoplasms (SON) and hematological neoplasms (HN) on mortality among RA patients in a nationwide study., Methods: A retrospective, observational comparison of SON and HN-related deaths in RA patients and the general Spanish population was conducted (Spanish Hospital Discharge Database). Binary logistic regression analyzed the impact of RA on mortality risk from each neoplasm., Results: From 2016 to 2019, 139,531 neoplasm-related deaths were recorded, including 813 (0.6%) from RA patients. Patients with RA presented a lower mortality rate from SON (85.1% vs 91.2%, OR 0.99), mainly due to colorectal carcinoma (8% vs 10.6%, OR 0.67) and hepatocarcinoma (1% vs 2.7%, OR 0.44), but higher lung neoplasms risk (20.2% vs 18.6%, OR 1.31). HN-related deaths were also more prevalent in RA patients (14.9% vs 8.8%, OR 1.73), especially B and T/NK non-Hodgkin's lymphoma (6% vs 2.8%, OR 2.12) and myeloid leukemia (4.4% vs 2.3%, OR 1.92)., Conclusion: RA patients might have a higher mortality risk from lung and hematologic neoplasms. Reducing immunosuppressive burden and developing early-detection programs should be primary goals in this population., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The treatment of cancer when associated with autoimmune diseases (AID) has been the subject of immunotherapy investigation, especially with the use of immune checkpoint inhibitors (ICI). Clinical studies have restricted the evaluation of its use in special populations such as patients with AID, leaving a gap regarding the safety of using immunotherapy., Objective: Discuss the safety of using ICI in patients with cancer and AID, in specialized oncology units, in the cities of Bahia, Brazil., Methods: Retrospective and quantitative cross-sectional study on immune-related adverse events (IRAE) to the use of ICI in patients with cancer and AID., Results: Patients (39 with cancer, and 14 with AID and cancer) were studied. Men (between 30 and 95 years old), melanoma and lung cancer and Hashimoto's thyroiditis were predominance. Pembrolizumab and Nivolumab (anti-PDL-1) were drugs most used. In general, patients using anti-PDL-1 with AID had IRAE with greater frequency and severity: Grade 1 (57%) and 3/4 grades (43%) reactions. The gastrointestinal system presented a greater IRAE in both groups, however in patients with AID more severe reactions were found (0% versus 60%). Patients with cancer and AID had higher rates of IRAE compared to patients without AID, respectively, of discontinuation (50% versus 18%) and interruption (85% versus 20%) of treatment., Conclusion: IRAE increased in patients using ICI with cancer and AID. This suggests that the presence of IAD, in cancer patients, can increase the severity of IRAE. Therefore, the adoption of more appropriate therapeutic strategies is essential for better therapeutic results., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: Lung cancer is the leading cause of death by cancer worldwide and has a high lethality. The best treatment for patients with localized disease is anatomical surgical resection, granting good average survival in the long term. We did not find Chilean studies focusing on complications, long term survival or potential association with pathological or clinical factors. The aim of this work is to describe clinical characteristics, surgical complications and 5-to-10-year survival of a cohort of lung cancer patients operated in the Clinical Hospital of University of Chile and explore possible prognostic factors influencing in it., Methods: A 107 patient's cohort of operated lung cancer patients in a single center from 2004 to 2015 was analyzed. We included patients with curative intent surgery performed in our hospital and excluded non- primary lung cancer histology or biopsies analyzed in other center. Clinical, perioperative and histopathologic data were collected. 5-10 year overall survival was determined and an exploratory analysis of prognostic factors on survival was performed., Results: We found 107 surgeries fulfilling criteria, with 27% morbidity and 5.6% and 6.5% mortality at 30 and 90 days, respectively. 5- and 10-year overall survival was 44.7% and 32.3%, respectively. Univariate analysis found that gender, age, histology, disease stage, loco-regional dissemination and postoperative complications were factors associated with survival. Multivariate analysis confirmed that gender, age, loco-regional dissemination and postoperative complications were independent factors associated with survival., Conclusions: Surgical results of a cohort of patients operated in a Chilean center show that 30 and 90-days mortality aligned with data reported worldwide. Overall survival in these selected patients is far better than reported in lung cancer patients. Risk factors that may be screened in preoperative analysis were found, which could change prognosis. Those findings suggest that improving preoperative evaluation could optimize patient selection to obtain better performance in surgical results and overall long-term survival., Competing Interests: The team has no conflicts of interest with respect to this work., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Introduction: Cardiovascular disease remains the leading cause of death. Arterial hypertension is the main avoidable risk factor. Scientific societies advise control methods such as Ambulatory Blood Pressure Monitoring (ABPM) but this technique is not usually available in rural settings.The aim of this study was to evaluate the effectiveness of pharmaceutical intervention using ABPM in community pharmacies., Material and Method: Observational study conducted in a rural community pharmacy between July 2021 and December 2023. Patients over 18 years of age who were normotensive or had a previous diagnosis of hypertension were selected. They were fitted with a MicrolifeWatch BP03 device for 29 hours. Patients with results compatible with HT were referred to their primary care physician., Results: Twenty-one patients were included, of whom 20 were referred to the physician and treatment adjustments were made. Patient satisfaction was high, highlighting the accessibility of the service in the community pharmacy., Conclusion: The accessibility and proximity of community pharmacies, especially in rural areas, facilitates the application of MAPA, improving the control of HTN., (Copyright SEFAC. Sociedad Española de Farmacia Clínica, Familiar y Comunitaria. This article is available from url https://www.farmaceuticoscomunitarios.org/.)

El trastorno por déficit de atención e hiperactividad (TDAH) ha sido tradicionalmente concebido como una condición privativa de la infancia. Sin embargo, una creciente evidencia sugiere que el TDAH persiste en la vida adulta, manifestándose de diversas maneras. A pesar de su prevalencia y de las significativas consecuencias en la vida cotidiana, el TDAH en adultos ha sido considerablemente subestimado y subdiagnosticado, lo que resulta en una carga sustancial tanto para los individuos afectados como para su entorno familiar y social. Esta revisión exhaustiva se propone explorar la complejidad del TDAH en la adultez y aborda su etiología, definición y presentación clínica, los factores de riesgo, las comorbilidades más frecuentes, los métodos de evaluación y los aspectos neuropsicológicos, así como los enfoques farmacoterapéuticos y los no farmacoterapéuticos para su  tratamiento. Además, se examinan las implicaciones para el diagnóstico y el tratamiento, destacando la importancia de una comprensión integral de esta condición. A través de este documento, la Asociación Argentina de Psiquiatría Biológica (AAPB) aspira no solo a recopilar y analizar la evidencia sobre el TDAH en adultos, sino también a proporcionar una guía útil para los profesionales de la salud que tratan esta patología. Así, el objetivo final de este artículo es contribuir al desarrollo de estrategias efectivas para la evaluación y el manejo del TDAH, y mejorar de este modo la calidad de vida de los pacientes.

Introducción: El delirium es un síndrome prevalente en la práctica clínica. El objetivo del estudio fue identificar los conocimientos, actitudes y prácticas sobre delirium en el personal médico en un hospital de tercer nivel, así como evaluar la validez del instrumento creado para este fin. Métodos: Se realizó un estudio transversal de 3 fases: 1) validación de contenido, 2) aplicación del instrumento y 3) validación del constructo. Resultados: Tras una validación de contenido satisfactoria, se aplicó el instrumento a 148 participantes. Respecto a los conocimientos sobre delirium, hubo una media de aciertos de 57,8 % (IC95 % 52,5-63,1) sin diferencia significativa entre médicos asistentes, residentes y estudiantes de último año de medicina. Un 25 % (n=37) refirió usar el Método para la Evaluación de la Confusión, un 31,1 % (n=46) refirió sentirse confiado en el uso de antipsicóticos en el manejo del delirium, y un 86,5 % (n=128) refirió usar al menos una medida no farmacológica. Conclusiones: Se evidenciaron deficiencias en conocimientos y manejo del delirium en el personal médico. El instrumento tuvo una óptima validación de  contenido, pero insatisfactoria validación de constructo. Se enfatiza la importancia de hacer un análisis psicométrico con individuos, previo a la aplicación del instrumento.

Objetivo: evaluar la calidad, hábitos y algunos trastornos del sueño días previos a la declaración del fin de la pandemia por COVID-19. Método: estudio observacional de corte transversal. Encuesta en línea distribuida a través de una plataforma web desde el 1 de marzo al 15 de abril 2023. El análisis consideró: información demográfica, calidad del sueño y algunos cambios de hábitos/conductas., Resultados: se evaluaron N=2081 respuestas. La edad media fue de 37 ± 12 (16-86 años). El 56,5 % de las respuestas fueron del Área Metropolitana de Buenos Aires y el 70,7 % eran mujeres. El 68,3 % presentaba mala calidad de sueño. El 31,8 % dormía con mascotas. El 44,2% refirió trastornos en la conciliación del sueño y el 34,9% que dormía menos de seis horas. El 25,5 %  que la eficiencia de su sueño era inferior al 75%. Refirieron alteraciones en el mantenimiento del sueño el 25,3 %; ronquidos el 15 %; pesadillas el 16.4 %; bruxismo el 20.4 % y síndrome de piernas inquietas el 14.8 %. La mala calidad del sueño se asoció con el sexo femenino (p=0,00), con los que residían en el Área Metropolitana (p=0,01) y con los que dormían con mascotas (p=0,00). El sexo femenino presentó mayor prevalencia de síntomas del síndrome de piernas inquietas (p=0,00)., Conclusiones: el análisis identificó que más de la mitad de la población refirió mala calidad del sueño principalmente mujeres, residentes en el área metropolitana y en quienes dormían con mascotas.

Objetivo: El acceso efectivo a servicios esenciales es crucial para algunas personas con autismo. En Argentina, el certificado único de discapacidad (CUD) asegura derechos y beneficios esenciales para las personas con autismo. Analizar la demanda de CUD relacionadas con el autismo puede ofrecer valiosos conocimientos sobre las necesidades de esta población. Método: Este estudio examinó datos oficiales sobre la emisión de CUD por el Trastorno del Espectro Autista en Buenos Aires desde 2016 hasta 2021., Resultados: Los resultados mostraron que la mayoría de los CUD fueron emitidos para hombres y para el Trastorno Generalizado del Desarrollo. Notablemente, casi la mitad de los CUD fueron otorgados a individuos mayores de 8 años, siendo estas tendencias consistentes a lo largo de los años. Observamos una caída significativa en la emisión de CUD en 2020., Conclusiones: Nuestros hallazgos destacan desafíos relacionados con diagnósticos retrasados y no específicos, lo que conduce a un acceso tardío a derechos y tratamientos menos dirigidos. Estos patrones en las solicitudes espontáneas de asistencia para servicios estatales relacionados con el autismo pueden dar forma a políticas públicas bien fundamentadas y optimizar la asignación de recursos.

Introducción: El accidente cerebrovascular es un factor de riesgo para el trastorno neurocognitivo. Se ha reportado la presencia de trastorno neurocognitivo post accidente cerebrovascular en el 20 al 80 % de los casos, según diferentes series. Asimismo, se reportan síntomas neuropsiquiátricos luego de ese evento, siendo lo más frecuente la depresión. El objetivo de este estudio fue determinar la prevalencia de trastorno neurocognitivo, depresión y otros síntomas neuropsiquiátricos en sujetos con un primer accidente cerebrovascular isquémico. Métodos: Se evaluaron sujetos adultos con un primer accidente cerebrovascular isquémico, a los 3 y 12 meses del evento, con una evaluación neuropsicológica estándar, Inventario de Depresión de Beck-II e Inventario Neuropsiquiátrico de Cummings. Se clasificaron los casos como desempeño cognitivo normal, trastorno neurocognitivo menor o mayor según criterios del DSM 5. Resultados: Se incluyeron 36 pacientes con una media de edad de 60.97 ± 16.98 años. Se registró trastorno neurocognitivo (mayor y menor) en 63.8 % de los casos a los 3 meses y 66.6 % de los casos al año, síntomas conductuales según Inventario Neuropsiquiátrico en 69.4 % de los casos a los 3 meses y 50 % de los casos al año, y síntomas depresivos según Inventario de Depresión de Beck-II en 16.6 % de los casos a los 3 meses y en 22.2 % de los casos al año. La hipertensión arterial fue el factor de riesgo modificable más frecuente y se correlacionó con la presencia de trastorno neurocognitivo. Discusión: La detección de trastorno neurocognitivo y síntomas neuropsiquiátricos post accidente cerebrovascular es necesaria en base a la elevada prevalencia reportada, permitiendo así un correcto abordaje y rehabilitación integral.

Introducción y objetivo: La Frontal Systems Behavior Scale (FrSBe) es una escala autoadministrable que evalúa cambios comportamentales (apatía, desinhibición y disfunción ejecutiva) luego de una lesión cerebral. El objetivo del trabajo fue obtener indicadores de rendimiento del puntaje total y las sub-escalas de la FrSBe para adultos de habla hispana de la Provincia de Buenos Aires, Argentina, analizar el efecto de variables demográficas y obtener datos normativos del instrumento. Materiales y métodos: se incluyeron 169 participantes y 83 familiares de esos participantes de Buenos Aires que completaron una encuesta para datos demográficos y la versión en español de la FrSBe. Se calcularon estadísticos descriptivos y se aplicaron modelos de regresión lineal múltiple para analizar el efecto de la edad, la escolaridad y el género sobre las puntuaciones. Resultados: Las variables que mostraron efecto sobre el puntaje total de la FrSBe versión de auto-reporte fueron la edad y la escolaridad. No hubo efecto del género y el modelo no fue significativo para la versión del familiar. Se obtuvieron las medias de rendimiento de los participantes en la escala y se presentan los datos normativos agrupados en tres grupos etarios y cada uno de ellos en dos grupos de escolaridad, del mismo modo que en la versión  original del instrumento. Conclusión: Este estudio presenta los primeros datos normativos  para adultos de Buenos Aires en la FrSBe. Esto representa un aporte crucial para la utilización de este instrumento en esta región.

Background and Objectives: Rhupus is a very rare syndrome of overlapping rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), characterized by the presence of erosive polyarthritis associated with symptoms and signs of SLE and the presence of high specificity autoantibodies. The analysis of HLA-DR molecules would allow us to genetically characterize patients diagnosed with rhupus, being able to differentiate them from the HLA-DR profile of patients with RA and SLE., Materials and Methods: Cross-sectional observational study of 9 patients diagnosed with rhupus in whom the HLA-DR genotype was genetically characterized., Results: Rhupus is usually more frequent in women with initial diagnosis of RA. The most frequent clinical manifestations are articular and, serologically, ANA, RF and anti-CCP positivity stand out. The most frequent HLA-DR were HLA-DR1, HLA-DR3, HLA-DR4, HLA-DR7 and HLA-DR13., Conclusions: A higher proportion of HLA-DR1 and DR9 was observed in patients with rhupus compared to RA and SLE, as well as a lower proportion of HLA-DR2, DR6 and DR8, which would help the early characterization of these patients prior to the overlap diagnosis., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: The COVID-19 pandemic significantly increased the global burden of respiratory morbidity and mortality. In Spain, 2020 saw a 68.5% surge in deaths from respiratory diseases compared to 2019, largely due to COVID-19. This study aims to describe respiratory disease mortality in Spain from 2019 to 2022, focusing on the intersection of COVID-19, pre-existing respiratory conditions, and specific health determinants., Materials and Methods: We analyzed mortality data from the Spanish National Institute of Statistics (INE), covering 102 causes of death, including tuberculosis, COVID-19, and lung cancer as respiratory-related conditions. The analysis considered absolute death counts and proportions by sex, age, and region, along with percentage changes in proportional mortality. Logistic regression models were used to identify factors potentially associated with COVID-19 and respiratory-specific mortality., Results: In 2022, Spain reported 98,128 deaths from respiratory diseases, accounting for 21.1% of all deaths and ranking as the second leading cause of death after cardiovascular diseases. Although deaths due to COVID-19 decreased in 2021 and 2022, there was a notable rise in other respiratory causes, indicating a lasting post-pandemic impact. Factors linked to higher mortality included male gender, older age, being divorced, and residing in urban areas, with significant regional variability., Conclusions: Despite overall mortality returning to pre-pandemic levels, this study highlights a significant increase in respiratory disease deaths in Spain in 2022 compared to 2019., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Long-term hypophosphatemia, defined by serum phosphorus (P) levels <2.5mg/dL, impairs the development and quality of mineralized tissue of the skeletal, dental, and auditory systems. P homeostasis depends mainly on intestinal absorption and renal excretion. Hypophosphatemia may be due to the redistribution of P to the intracellular space, increased renal losses, or decreased intestinal absorption. Hypophosphatemia can be categorized as acute or chronic, depending on the time course. Most cases, either acute or chronic, are due to acquired causes. However, some chronic cases may have a genetic origin. Accurate and early diagnosis, followed by adequate treatment, is essential to limit its negative effects on the body., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: Cervical dysplasia is a precursor lesion of cervical cancer, one of the leading causes of morbidity and mortality in women, especially in developing countries. This study aimed to identify the risk factors associated with the development of cervical dysplasia in women treated at the Santa María del Socorro Hospital in Ica, Peru, between 2017 and 2019., Methods: An observational case-control study was conducted with 92 cases of women with confirmed high-grade intraepithelial lesion and 184 controls with consecutive negative results in Pap smears. Sociodemographic, behavioral, and clinical data were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with precancerous cervical lesions., Results: The factors significantly associated with cervical dysplasia were age under 35 years (odds ratio: 1.2; 95% confidence interval: 0.1 to 0.7), having a partner (7.4; 2.3 to 23.5), body mass index ≥ 25 (12.9; 3.9 to 42.0), more than three sexual partners (71.4; 16.4 to 310.9), bacterial vaginosis (101.2; 12.2 to 838.2), grand multiparity (39.0; 7.1 to 225.4), rural origin (0.2; 0.1 to 0.8), use of injectables (0.2; 0.1 to 0.6), and intrauterine devide (0.04; 0.01 to 0.2)., Conclusions: Identifying these risk factors is crucial for cervical cancer prevention. It is recommended to implement early detection programs targeted at women with risk factors, especially those under 35 years and with multiple sexual partners., Competing Interests: All authors declare no competing interests., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Introduction: Giant omphalocele poses a conflict between eviscerated content and abdominal capacity, with associated risks such as compartment syndrome or cardiovascular compromise., Clinical Case: We present the case of a prenatally diagnosed hepato-omphalocele, without associated abnormalities. At week 37, botulinum toxin was injected in the right hemiabdomen under fetal and maternal sedation. Following Cesarean section, scheduled at week 39, injection was completed in the left hemiabdomen, and full hepatic content reduction and total amnion inversion were achieved. Definitive repair with component separation was carried out on day 8 postnatally, and the patient was discharged on day 14., Discussion: Botulinum toxin induces muscle relaxation, which can help reintroduce the eviscerated content within the abdominal cavity. The maximum effect is achieved following two weeks, which means prenatal injection may favor early amnion inversion, thus reducing hospital stay.

Fibrous dysplasia (FD) is a benign tumor condition in which normal bone is replaced by structurally deficient fibrous lamellar bone. It represents approximately 5-7% of benign bone tumors and occurs in two presentations: monostotic, which is the most common, and polyostotic. The proximal femur is one of the most common locations for benign tumors, including FD. Fractures in pathological terrain are often the first symptom. In the context of a proximal femur fracture with a benign tumor, the indications for carrying out a total femoral resection are: multiple lesions in the femur or primary diaphyseal tumors, lesions that extend proximally and distally to exceed the epimetaphyseal junction area, and those that do not allow the joint to be adequately preserved. Currently, proximal or total femoral resection is considered a good therapeutic option to carry out endoprosthetic replacement using modular megaprosthetic systems. We present the case of a 27-year-old male patient, who came to the emergency department with a basicervical fracture of the right femur in Garden II Pauwells III AO 31B2.3r pathological terrain, after presenting a low-energy injury mechanism characterized by axial loading with rotational component of the right hip. This patient has a history of intralesional resection, application of bone graft and prophylactic fixation using unspecified osteosynthesis material in the pertrochanteric region 20 years ago; the biopsy would later show DF; the osteosynthesis material was subsequently removed one year later. Due to the characteristics of the fracture and as a definitive and curative therapeutic method, it was decided to carry out wide resection of the proximal femur and total hip arthroplasty with a modular prosthesis with cerclage placement, as well as taking an excisional biopsy that would later corroborate that it was the same FD treated in childhood.

Introduction: total hip arthroplasty (THA) is a successful surgical intervention for end-stage hip arthritis, however, it is not extent for complications. The risk of instability after THA with conventional design is up to 7% for primary procedures and 5-20% for revisions. The purpose of this study is to document the complications that occur with the double mobility prosthetic design., Materials and Methods: observational, longitudinal, retrospective and descriptive study. A sample of 542 patients undergoing primary THA using a double mobility design was included, complications occurring from December 1, 2015 to December 31, 2021 were recorded., Results: the complications that occurred were: 13 (2.39%) patients with postoperative dislocation, five (0.92%) with periprosthetic fracture, five (0.92%) with transient neuropraxia of the sciatic nerve, three (0.55%) with periprosthetic infection, one (0.18%) with chronic pain and one (0.18%) with pulmonary thromboembolism., Conclusions: the double mobility design is an appropriate option to reduce the risk of prosthetic dislocation in patients undergoing total hip arthroplasty.

Introduction: anterior cruciate ligament rupture has evolved to be one of the most common sports injuries with a remarkable increase in its incidence in the last two decades, with Return-To-Sport being a crucial approach in the choice of autologous graft for its surgical repair, the most commonly used being hamstring and quadriceps tendon graft., Material and Methods: a prospective randomized study was performed with 32 patients divided into two groups, one for each type of graft, with 13 patients in each. They were evaluated before surgery, at 30, 180 and 360 days after the procedure using scales such as Lysholm, mCKRS and ACL-RSI, and their previous activity level was considered using the Tegner score., Results: it was observed that, at 30 and 180 days after surgery, there were significant differences in pain assessment using the VAS scale between the groups, while at 360 days no significant differences were observed. No significant differences were found in Lysholm and mCKRS scale scores in either group at days 30, 180, and 360, but significant differences were found in ACL-RSI scale scores at 30 and 180 days between the two groups, which did not hold at 360 days., Conclusion: despite the difference in postoperative pain, Return-To-Sport times and overall recovery showed no significant differences between the two types of grafts in this study.

Introduction: the tendency in the rehabilitation is to train specifically to the lumbopelvic girdle muscles, to give stability and segmentary control of the same., Objective: to evaluate the isokinetic lumbopelvic in the patient's functional qualities with a dynamic instrumentation system (Accuflex)., Material and Methods: post-operated patients of spinal stenosis by means of dynamic liberation and fixation (Accuflex). Pain analogous visual scale was applied and the Oswestry functional qualities index and isokinetic evaluation of the knee flexo-extensors muscles (Biodex 3 Pro). A lineal isokinetic strengthening program (Cybex Kinetron II), during 6 weeks period, three times in a week in sessions of 40 minutes., Results: ten female patients (71.4%) and four male patients (28.65%) with an average age of 43.4 years. 13 of them (92.8%) with affectation in left pelvic member and 4 patients (7.2%) of the right pelvic member. L4-L5 (72%, 10 patients) and L5-S1 (28%, 4 patients). Low back pain the previous valuation was 4.4 versus 1.5 mm final with a p = 0.004. Affected pelvic member, initial was 4.6 versus 2.1 mm of the final valuation with a p = 0.004. The initial Oswestry disability index showed a 30 vs. a 19.64% subsequent to the training with a p = 0.0001., Conclusions: the lumbopelvic lineal isokinetic training showed to increase the force and muscular resistance in the inferior members with the functional conditions of the patients of the studio.

Introduction and Objectives: Female urethral strictures are a rare condition that significantly impacts patients' quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center., Patients and Methods: We conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009-2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes)., Results: Of 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction., Conclusions: Buccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The main objective was to analyze unjustified discrepancies during the medication reconciliation process in patients admitted to the Hematology Service of our hospital and the pharmaceutical interventions. As a secondary objective, to detect possible points of the procedure to be perfected with a view to protocolizing the medication reconciliation process in hematological patients that adapts to the conditions of our center., Methods: Cross-sectional observational pilot study carried out in a reference hospital in hematology for a population of 800,000 inhabitants. Adult inpatients admitted to the Hematology Service between August and October 2022 whose medication had been reconciled were included. The main variables were: number and type of unjustified discrepancy, proposed pharmaceutical intervention, and acceptance rate., Results: 36 conciliation processes were analyzed, 34 admissions and 2 intrahospital transfer. 58.3% of the patients presented at least one unjustified discrepancy. 38 unjustified discrepancies were detected, with an acceptance of pharmaceutical interventions of 97.4%. The most common types of discrepancy were medication omission (56.8%) and drug interaction (24.3%). The most frequent pharmaceutical interventions were reintroducing medication (48.6%) and treatment discontinuation (16.2%). Polypharmacy and chemotherapy multiplied by 4 the probability of presenting drug interactions., Conclusions: The most common unjustified discrepancies in the medication reconciliation process in hospitalized hematology patients are: Medication omission and drug interactions. The reintroduction of medication and suspension of the prescription are the most frequent accepted pharmaceutical interventions. Polypharmacy is related to an increase in unjustified discrepancies. The factors that promote the appearance of interactions are admissions to receive chemotherapy treatment and polypharmacy. The main point of improvement detected is the need to create a circuit that allows conciliation to be carried out on discharge. Medication reconciliation contribute to improving patient safety by reducing medication errors., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the degree of knowledge about biological therapy and biosimilars in patients with immune-mediated inflammatory diseases treated in Outpatient Pharmaceutical Care Units., Methods: Observational, prospective, and multicenter study during the period May 2020-March 2021. A survey (9 questions) was conducted before starting treatment in which the patients' level of knowledge about biological therapy and biosimilars was assessed., Results: A total of 169 patients were included in the study. The average value for the different questions was 3.3±0.6 out of 5, while the average final result was 29.4 points out of 45. 64.5% of the patients had an acceptable level before starting the medication (>27 points). The multivariate analysis showed a statistically significant correlation (p<.05) with a better score at the beginning of treatment in those patients whose prescribing service was Rheumatology., Conclusions: In general, the level of knowledge prior to biological therapy in patients is acceptable, being higher in dosage and administration technique related-factors and what is related to the dosage and administration technique and where to find information related to the medication; the worst rated were those on biosimilars-related. The factor of being followed by rheumatology, was associated with better knowledge., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To identify the administration characteristics and connection methods of bronchodilators by pressurized inhalers to the ventilatory circuit of patients under invasive mechanical ventilation., Methods: A scope review was conducted following the PRISMA for Scoping Review, using the PubMed, Embase Elsevier, Cochrane Library, and Lilacs databases without language restrictions, up to July 2023. Eligible sources included reviews and consensuses (based on clinical studies), experimental and observational studies involving adult patients admitted to the intensive care unit and undergoing invasive mechanical ventilation, regardless of the underlying condition, who used bronchodilator drugs contained in pressurized inhalers. Information regarding inhalation technique, pressurized inhalers connection mode to the circuit, and patient care were collected by 2 researchers independently, with discrepancies resolved by a third reviewer. Studies involving bronchodilators combined with other pharmacological classes in the same device, as well as reviews containing preclinical studies, were excluded., Results: In total, 23 publications were included, comprising 19 clinical trials and 4 non-randomized experimental studies. Salbutamol (albuterol) was the bronchodilator of study in the majority of the articles (n=18), and the spacer device was the most commonly used to connect the pressurized inhaler to the circuit (n=15), followed by an in-line adapter (n=3), and a direct-acting device without chamber (n=3). Concerning the pressurized inhaler placement in the circuit, 18 studies positioned it in the inspiratory limb, and 19 studies synchronized the jet actuation with the start of the inspiratory phase. Agitation of the pressurized inhaler before each actuation, waiting time between actuations, airway suction before administration, and semi-recumbent patient positioning were the most commonly described measures across the studies., Conclusions: This review provided insights into the aspects related to inhalation technique in mechanically ventilated patients, as well as the most prevalent findings and the existing gaps in knowledge regarding bronchodilator administration in this context. The evidence indicates the need for further research on this subject., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: High-grade anal intraepithelial squamous lesion is significantly prevalent among men who have sex with men and are infected with the human immunodeficiency virus (HIV). This condition-the precursor to anal cancer-significantly increases the risk of developing it. Conversely, low-grade anal intraepithelial squamous typically follow a benign course and usually regress spontaneously., Materials and Methods: To describe a population of men who have sex with men living with HIV followed in a specialized anal cancer screening unit we conducted an observational, retrospective, and single-center study., Results: Ninety-four patients were analyzed, with a mean age of 39±9 years, and a 87% positivity rate for high-risk human papillomavirus (HR-HPV). At the initial visit, 47% presented with low-grade squamous intraepithelial lesions. The progression rate to high-grade squamous intraepithelial lesion was 37.2 per 100,000 patients/year. None of the patients developed anal cancer. Tobacco and alcohol consumption were associated with this progression., Discussion: In this series, longer duration of HIV infection, tobacco and alcohol use and the presence of HR-HPV were significantly associated with the occurrence of high-grade intraepithelial lesions. A lower risk of progression was seen in patients with higher education., Conclusion: In men who have sex with men living with HIV, the association of factors such as smoking, alcohol, the presence of HR-HPV and an increased burden of human papillomavirus disease makes these patients more susceptible to develop high-grade anal squamous lesions., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)