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Purpose: To summarize the results of Chile's 2022 Report Card (RC) on physical activity (PA) for Children and Adolescents. Methods: Chile's 2022 RC included ten core PA indicators common to the Global Matrix 4.0. Evidence from scientific articles, reports, and databases published between 2018 and January 2022 was included for each indicator. The data were collected and analyzed by a national scientific committee, which assigned letter grades (A to F) using a consensus based on benchmarks defined and revised by the Active Healthy Kids Global Alliance. Results: The committee assigned the following grades: Overall PA, D−; Organized Sports and Physical Activity Participation, C−; Active Play, Incomplete; Active Transportation, D; Sedentary Behavior, D−; Physical Fitness, Incomplete; Family and Peers, D; School, C; Community and Environment, D+; Government, A−. Conclusions: Chile's 2022 RC, like its previous versions, shows persistently low grades for most indicators. Overall PA remained nearly unchanged, while Community and Environment scored lower. Slight improvements were seen in Organized Sports, Family and Peers, and School Environment. While Chile has endeavored to increase children's activity levels, policies require implementation through a systemic, coherent framework to promote sustainable changes and reach a larger portion of children and youth.

Primary fallopian tube carcinoma (PFTC) is seldom diagnosed preoperatively and is often mistaken for epithelial ovarian carcinoma (EOC). This report details a case of primary high-grade serous carcinoma (HGSC) of the fallopian tube, highlighting radiological and clinical indicators to aid in accurate diagnosis and avoid misdiagnosis. A 46-year-old premenopausal woman presented with symptoms and a transvaginal ultrasound (TVUS) indicating a malignant ovarian tumor. Further imaging with CT and MRI revealed a solid-cystic mass suggestive of a fallopian tube tumor rather than an ovarian origin. Oncological surgery confirmed the presence of a high-grade serous carcinoma in the fallopian tube. This case underscores the diagnostic challenges of PFTC and the superior sensitivity and specificity of MRI over CT and US in distinguishing adnexal lesions. Key MRI features such as the sausage-shaped mass and associated hematosalpinx were crucial in differentiating PFTC from EOC. The report emphasizes the importance of considering PFTC in differential diagnoses of adnexal masses to ensure accurate preoperative identification.

Objective: Pediatric spondylodiscitis (PSD) is an uncommon condition, for which there are no specific international clinical guidelines. Factors related to complications have not been stablished. Our aim was to describe clinical and epidemiological characteristics of PSD, to analyze factors associated with complications and to evaluate adherence to the recommendations of the Spanish National Consensus Document (NCD) for the diagnostic and therapeutic approach to acute osteoarticular infections. Material and methods: Ambispective, multicenter, national study of two PSD cohorts: historical (2008–2012) and prospective (2015–2020, after publication of NCD).Patients with diagnosis of PSD were included. Demographic, clinical, microbiological and radiological data were recorded. Factors related to the development of complications were analized by logistic regression. Comparisons between both cohorts were performed. Results: Ninety-eight PSD were included. In 84.7%, diagnosis was confirmed by magnetic resonance imaging. Microbiological isolation was obtained in 6.1%, with methicillin-sensitive S. aureus as the main etiologic agent. Complications occurred in 18.9%, the most frequent being soft tissue abscess. Of the 8.6% of patients with sequelae, persistent pain was the most common. Comparing cohorts, there was better adherence to NCD treatment recommendations in the prospective one (57.6% vs. 12.9%, p

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Predation risk is perceived by prey and mesocarnivores through risk signals given by large carnivores. These signals can be manipulated without exposing mesocarnivores to real risk, creating landscapes of fear through perceptual traps, altering behavior. Olfactory signals like urine and feces have been used to deter carnivores that predate on livestock, but a more biologically meaningful cue could be more effective. Livestock guardian dogs (LGD) deter carnivores and reduce predation, so using their whole-body odor as a risk signal in a livestock system could contribute to reduce livestock-carnivore conflict. We tested LGD whole-body odor effect on Patagonian foxes (Lycalopex culpaeus and Lycalopex griseus) present in sheep production in three different habitats—forest, scrubland and pastureland—and analyzed behavioral changes. The presence of LGD whole-body odor reduce the presence of foxes in scrubland habitats and could increase fear behavior and reduced food consumption compared to non-scented places. This technique could act as a complement to LGD, amplifying its effect, but the habitat characteristics must be considered to make it effective. LGD whole-body odor, a more realistic risk signal, representing the presence of LGD without exposing mesocarnivores to a real encounter, i.e. a perceptual trap, could contribute to reduce livestock losses and carnivore threats from livestock owners, aiming to facilitate coexistence between livestock production and native carnivores.

Resumen: Los dispositivos intravasculares son esenciales para el abordaje diagnóstico y terapéutico de múltiples enfermedades en pediatría, siendo especialmente importantes los catéteres venosos centrales (CVC). Una de las complicaciones más frecuentes es la infección de estos dispositivos, lo cual conlleva una elevada morbimortalidad. Estas infecciones presentan una gran complejidad, precisando de un elevado consumo de recursos, tanto para su diagnóstico como para su tratamiento, afectando de manera más frecuente a pacientes pediátricos vulnerables ingresados en unidades de alta complejidad. La evidencia para su abordaje en pediatría es menor que en adultos, y no hay documentos de consenso realizados en nuestro medio. El objetivo de este documento, realizado entre la Sociedad Española de Enfermedades Infecciosas Pediátricas (SEIP) y la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), es dar recomendaciones de consenso basadas en la mayor evidencia disponible para optimizar el diagnóstico y tratamiento de las bacteriemias y fungemias relacionadas con el catéter. Este documento se centrará en pacientes pediátricos no neonatales, sin entrar en discusión sobre la prevención de estas infecciones. Abstract: Intravascular devices are essential for the diagnostic and therapeutic approach to multiple diseases in paediatrics, and central venous catheters (CVCs) are especially important. One of the most frequent complications of these devices is the infection, which is associated with a high morbidity and mortality. These infections are highly complex, requiring the use of substantial resources, both for their diagnosis and treatment, and affect vulnerable paediatric patients admitted to high-complexity units more frequently vulnerable. There is less evidence on their management in paediatric patients compared to adults, and no consensus documents on the subject have been published in Spain. The objective of this document, developed jointly by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP), is to provide consensus recommendations based on the greatest degree of evidence available to optimize the diagnosis and treatment of catheter-related bloodstream infections (CRBSIs). This document focuses on non-neonatal paediatric patients with CRBSIs and does not address the prevention of these infections.

Resumen: Tanto las enfermedades del tejido conectivo como las vasculitis pueden afectar a múltiples órganos. En el tracto respiratorio pueden comprometer la vía aérea, el parénquima pulmonar, la pleura y el mediastino; constituyendo una causa importante de morbimortalidad, por lo que es fundamental mantener una alta sospecha clínica.Además, es de vital relevancia en el diagnóstico diferencial descartar reacciones adversas a fármacos, infecciones o neoplasias secundarias al estado de inmunosupresión de los pacientes portadores de enfermedades reumatológicas.Finalmente, su clasificación y su manejo deben ser realizados por un equipo multidisciplinario, basándose en el cuadro clínico, exámenes laboratorio, test de función pulmonar, tomografía computarizada de alta resolución, lavado bronquioalveolar y/o biopsia, según cada caso.Este artículo de revisión tiene como objetivo resaltar la importancia de un enfoque multidisciplinario en el manejo de las enfermedades del tejido conectivo y las vasculitis; patologías complejas que pueden afectar al sistema respiratorio, constituyendo una causa importante de morbimortalidad. La clasificación y manejo de estas condiciones debe ser realizado por un equipo multidisciplinario, basándose en el cuadro clínico, exámenes de laboratorio, pruebas de función pulmonar, estudios de imagen y biopsias, según cada caso. Abstract: Connective tissue diseases and vasculitis are a wide group of autoimmune pathologies that can affect multiple organs. One of the most frequently affected systems is the respiratory system, with compromise of the airway, lung parenchyma, pleura and mediastinum. These pathologies constitute an important cause of morbimortality, making it essencial to maintain a high clinical suspicion.Furthermore, it is of vital relevance to rule out other causes of affectation like adverse drug reactions and infections due to the immunosuppressed state of patients with rheumatic diseases.Both the classification and its management must be done by a multidisciplinary team, based on the clinical history, serology, lung function tests, high-resolution computed tomography, bronchoalveolar lavage and/or biopsy, depending on each case.This review article aims to highlight the importance of a multidisciplinary approach in the management of connective tissue diseases and vasculitis; complex pathologies that can affect the respiratory system, constituting an important cause of morbidity and mortality. The classification and management of these conditions should be carried out by a multidisciplinary team, based on clinical status, laboratory tests, pulmonary function tests, imaging studies, and biopsies, according to each case.

Resumen: La aparición de una complicación mecánica posterior a un infarto agudo de miocardio con elevación del ST actualmente es infrecuente, siendo las más comunes la ruptura de músculo papilar, la ruptura de la pared libre del ventrículo, la ruptura del septum ventricular o la aparición de una dilatación aneurismática del ventrículo. Presentamos un paciente con infarto agudo de miocardio con elevación del segmento ST que cursó con dos complicaciones mecánicas concomitantes a las cuales se les realizó corrección quirúrgica. Paciente masculino de 63 años con antecedentes de hipertensión y tabaquismo presentó cuadro clínico de dolor precordial con reporte de electrocardiograma con elevación del segmento ST. En el ecocardiograma transtorácico se evidencia comunicación interventricular y FEVI 51%. El cateterismo cardiaco evidencia enfermedad coronaria de dos vasos. Se decidió manejo quirúrgico para cierre de la comunicación interventricular y revascularización. Durante el procedimiento quirúrgico se evidenció una dilatación aneurismática del ventrículo izquierdo, la cual se reparó con parche del pericardio. Finalmente, después de compensación de falla cardiaca secundaria a shock séptico por infección de vías urinarias, se le dio alta médica. Las complicaciones mecánicas que se pueden presentar posterior a un infarto agudo de miocardio siguen siendo una preocupación importante debido a que pueden presentarse días o semanas después del evento coronario y pueden causar la muerte, por tal razón se debe realizar vigilancia continua de los pacientes. La decisión de intervenir quirúrgicamente al paciente para su respectiva corrección debe sopesar el riesgo-beneficio. Abstract: The occurrence of a mechanical complication following an acute myocardial infarction with ST-segment elevation is currently uncommon, with the most common being papillary muscle rupture, free wall rupture of the ventricle, ventricular septal rupture, or the development of an aneurysmal dilation of the ventricle. We present a 63-year-old male patient with acute myocardial infarction with ST-segment elevation who developed two concomitant mechanical complications, both of which underwent surgical correction. The patient had a history of hypertension and smoking, and presented with clinical symptoms of precordial pain along with an electrocardiogram showing ST-segment elevation. Transthoracic echocardiogram revealed a ventricular septal defect and an ejection fraction of 51%. Cardiac catheterization indicated two-vessel coronary disease. Surgical management was decided for closure of the ventricular septal defect and revascularization. During the surgical procedure, an aneurysmal dilation of the left ventricle was observed and repaired using a pericardial patch. Finally, after compensating for heart failure secondary to septic shock from a urinary tract infection, the patient was discharged. Mechanical complications following an acute myocardial infarction remain a significant concern as they can occur days or weeks after the coronary event and may lead to death. Therefore, continuous monitoring of patients is crucial. The decision to surgically intervene for correction should weigh the risk-benefit ratio.

Introdução: A hemocromatose hereditária (HH) é uma doença genética causada pela deficiência de hepcidina, um importante hormônio responsável pela homeostasia do ferro. A diminuição da produção ou a diminuição da atividade desse hormônio acarreta em maior absorção intestinal de ferro com consequente sobrecarga no organismo e danos em diversos órgãos. Este acúmulo pode resultar em complicações clínicas como cirrose, artrite, cardiopatias, diabetes, desordens sexuais e escurecimento da pele. As mutações H63D e C282Y estão bem definidas na etiologia da HH, porém, a doença ainda é pouco conhecida pela população e pelos profissionais da saúde em geral. A HH, quando associada à anemia hemolítica autoimune (AHAI) é ainda mais rara, o que confere relevância ao caso clínico aqui relatado para registrar o seu curso clínico, alterações nos exames complementares, tratamento e desfecho. Apresentação do caso: Paciente do sexo masculino, 67 anos, sem antecedentes familiar, social, patológico ou laboral relevantes e sem histórico de alergias ou atopia. Apresentava hiperferritinemia com suspeita de HH, sendo realizado teste genético com H63D em heterozigose, S65 ausente e C282Y ausente. Além disso, apresentou marcadores de hemólise presentes e teste de Coombs direto negativo. Ao exame físico, apresentava hiperpigmentação, mas sem outras alterações. Exame de tomografia computadorizada (TC) toracoabdominal evidenciou cálculos e cistos renais, ascite moderada, fígado com sinais de hepatopatia crônica e ausência de alterações pulmonares, embora tenha sido observado distúrbio ventilatório obstrutivo em grau muito leve (incipiente) devido ao prolongamento do TFEF 25-75% na prova de função respiratória. Na ressonância magnética (RM) de abdômen, observou-se sobrecarga de ferro. Novos exames laboratoriais apresentaram hemoglobina 12.6 g/dL, 8000 leucócitos/mm3, 3.536 neutrófilos/mm3, 117.000 plaquetas/mm3, Ferro 163 mcg/mL, Ferritina 2914 ng/mL, Haptoglobina 30 mg/dL, Vitamina B12 1400 ng/L e Coombs direto positivo. Devido ao diagnóstico de AHAI, iniciou-se o uso de prednisona. A seguir, diminuiu-se a dose de corticóide, tendo sido mantida a sangria mensal e iniciado deferasirox para hiperferritinemia. O paciente segue em acompanhamento, apresentando melhora clínica. Discussão e conclusão: A HH com a AHAI é uma condição rara, devendo ser suspeitada em quadros de hiperferritinemia com aumento de hemólise e podendo ser confirmada a partir da avaliação laboratorial que inclua a pesquisa das mutações H63D e C282Y e a presença de autoanticorpos. Diante disso, torna-se evidente a importância de relatar uma doença rara junto de uma manifestação ainda mais incomum.

Introdução: A anemia hemolítica autoimune (AHAI) por anticorpo quente é uma doença que leva à destruição acelerada de glóbulos vermelhos em função da presença de aglutininas, em sua maioria, imunoglobulina G (IgG), que se ligam a antígenos eritrocitários a uma temperatura de 37°C. Cerca de um terço dos casos de AHAI por anticorpos quentes são secundários a medicamentos ou outros distúrbios, dentre os quais, se incluem as imunodeficiências. Apresentação do caso: Paciente feminina, 45 anos, portadora de imunodeficiência primária de linfócitos T CD4, com história de micobacteriose atípica de repetição, tuberculose pulmonar e enteral há 7 anos, hipotireoidismo pós-radioiodoterapia para tratamento de doença de Graves, migrânea e deficiência de vitamina B12. Em uso de levotiroxina sódica 200 mcg/dia, pregabalina 75 mg/dia, azitromicina 500 mg/dia e moxifloxacino 400 mg/dia, além de reposição oral de vitamina B12. Foi encaminhada para acompanhamento semestral nos serviços de Hematologia e Remautologia de um hospital universitário para investigação de possível púrpura trombocitopênica imune (PTI) após alta de internação hospitalar por trombocitopenia grave (5000/mm3) manejada com corticoide e imunoglobulina, com resolução do quadro. Laboratorialmente, apresentou fator antinuclear reagente para padrão pontilhado fino denso (1/1320). No primeiro ano de acompanhamento, apresentou quadro de candidíase esofageana atribuída a uso de corticoide, tratada com itraconazol. Após dois anos, relatou fadiga, palidez cutânea e astenia progressiva e persistente. Na ocasião, os exames laboratoriais iniciais apresentaram hemoglobina (Hb) de 6,9 g/dL, volume corpuscular médio (VCM) de 126fL e contagem de reticulócitos de 21%. Em um segundo momento, foram, então, solicitados novos exames laboratoriais que revelaram Hb 5,8 g/dL, VCM 154fL, haptoglobina 31 mg/dL, enzima lactato desidrogenase 1527 U/L, contagem de reticulócitos de 47,1% e coombs direto positivo, que permitiu confirmar diagnóstico de AHAI por anticorpo quente. Foi iniciado tratamento com pulsoterapia de dexametasona 40 mg/dia por 4 dias, seguido de manutenção com prednisona e feito o desmame progressivo durante 8 meses, com boa resposta ao tratamento. Atualmente, segue em acompanhamento ambulatorial sem demais manifestações da doença até o momento. Discussão: A imunodeficiência de linfócitos T CD4 é uma condição que favorece a manifestação de doenças autoimunes. Anormalidades imunológicas comuns às imunodeficiências somadas a resposta inflamatória compensatória sustentada e excessiva, sobretudo, em vigência das infecções oportunistas, podem resultar tanto em danos teciduais quanto na manifestação da autoimunidade. Tal fato pôde ser observado no caso relato cuja paciente, em virtude de sua susceptibilidade à infecções de repetição, desenvolveu múltiplos casos de doenças autoimunes - dentre eles AHAI por anticorpo quente. Conclusão: Este estudo destaca a importância do diagnóstico de AHAI por anticorpo quente no contexto de imunodeficiência primária de linfócitos T CD4, que foi diagnosticada em vigência das múltiplas infecções de repetição. No caso, a paciente recebeu o devido suporte e evoluiu com controle da doença, seguindo até os dias de hoje aos cuidados multiespecializados necessários em decorrência do perfil da doença.

Introdução: A anemia hemolítica autoimune é uma condição rara causada pela ligação de anticorpos IgG - anticorpo quente - ou IgM - anticorpo frio - na superfície das hemácias, com consequente ativação do sistema complemento e hemólise intra e extravascular, podendo gerar hepatoesplenomegalia. O diagnóstico é feito pela identificação de anemia nos exames laboratoriais bem como Coombs direto positivo com posterior identificação do anticorpo atuante. Demais achados podem incluir redução de haptoglobina e aumento de reticulócitos, bilirrubina indireta e LDH. O tratamento é feito a partir de imunossupressão, sendo normalmente incitado com corticoide e suplementação de ácido fólico, podendo ser associadas outras drogas imunomoduladoras. Apresentação do caso: Paciente feminina, 67 anos, com diagnóstico prévio de surdez congênita. Ao exame físico, apresentava-se apenas hipocorada. Exames laboratoriais evidenciaram anemia com Combs direto IgG positivo, consumo de haptoglobina, aumento de LDH, além de carência de vitamina B12, caracterizando a presença de anemia hemolítica autoimune por anticorpos quentes da classe IgG, além de deficiência de B12. Durante a investigação não foram encontradas causas secundárias para a anemia hemolítica autoimune, sendo a mesma classificada como idiopática. A paciente é filha de um casamento consanguíneo e sua irmã gêmea também foi diagnosticada com anemia hemolítica autoimune, porém por anticorpos frios. A partir do diagnóstico, a paciente foi tratada com corticosteroides e posteriormente com associação da azatioprina para realizar o desmame, com consequente remissão do quadro. Discussão: A ocorrência familiar de anemia hemolítica autoimune não é comum, embora alguns estudos já tenham relatado casos semelhantes com uma predisposição hereditária para essa patologia. No caso em questão, apesar da investigação laboratorial, não foi identificada uma etiologia para a condição. Isso, somado ao diagnóstico na irmã, pode sugerir uma origem hereditária para o caso. Na literatura, a associação entre doenças autoimunes, incluindo a anemia hemolítica, e casamentos consanguíneos já foi relatada. Conclusão: Nosso trabalho descreveu um caso de anemia hemolítica autoimune em uma paciente filha de um casamento consanguíneo, com uma história familiar positiva para a mesma doença em sua irmã gêmea. Embora o mecanismo não seja completamente esclarecido, há relatos na literatura de associação familiar dessa patologia. Sugere-se a possibilidade de tratamento de um caso cuja herança genética possa ser a etiologia para a doença, porém a literatura ainda carece de estudos que melhor avaliem essa associação.

Introdução: A Síndrome de Richter (SR) caracteriza-se pela transformação histológica da leucemia linfocítica crônica/linfoma linfocítico de pequenas células (LLC/LLPC) para uma forma mais agressiva de doença. Embora classicamente associada à transformação em linfoma não-Hodgkin difuso de grandes células B, a SR também pode evoluir para linfoma de Hodgkin, leucemia prolinfocítica, mieloma múltiplo ou leucemia linfoblástica aguda. A SR é relativamente rara, ocorrendo em 2 a 6% dos casos de LLC. A variante da SR que evolui para linfoma de Hodgkin (SRvLH) é ainda mais rara, representando apenas 5% dos casos de SR. Devido a sua raridade, há uma carência de informações detalhadas sobre sua fisiopatologia, comportamento clínico, tratamento e prognóstico. Este relato de caso tem como objetivo registrar o curso clínico, alterações nos exames complementares, tratamento e desfecho de um caso de SRvLH. Apresentação do caso: Paciente masculino, 61 anos, com diagnóstico de LLC estágio RAI II há 4 anos, sem indicação prévia de tratamento quimioterápico. O paciente estava em observação clínica, quando apresentou sintomas B (febre, perda de peso e sudorese noturna), além de nódulo cervical progressivo à esquerda, nódulos inguinais bilaterais e dor abdominal. Uma biópsia do nódulo cervical revelou linfoma de Hodgkin clássico de celularidade mista. Subsequentemente, surgiram nódulos nos antebraços bilateralmente. Foi iniciado tratamento quimioterápico (QT) com Adriblastina, Bleomicina, Vincristina e Dacarbazina (ABVD). Durante o terceiro ciclo de QT, o paciente desenvolveu lesões dermatológicas em membros superiores e inferiores, com prurido intenso e sangramento, levando a suspensão da Bleomicina pela suspeita de toxicidade dermatológica. Os exames laboratoriais mostraram leucocitose significativa (308.100/mm3) com 76% de segmentados. A tomografia computadorizada (TC) de abdome e pelve revelou linfonodomegalias periportais junto ao tronco celíaco, retroperitoneais, pélvicas e inguinais bilaterais. Após a QT, houve melhora dos sintomas (regressão dos linfonodos e alívio do cansaço), porém anemia e linfocitose persistiram. A tomografia por emissão de pósitrons (PET-TC) mostrou hipermetabolismo glicolítico em diversas linfonodomegalias e baço (Deauville 4), sugerindo atividade residual da doença linfoproliferativa. A TC cervical apresentou diversas linfonodomegalias esparsas. O paciente continua em acompanhamento, investigando a progressão da doença e a possibilidade de transplante de medula óssea. Conclusão: A Síndrome de Richter é uma entidade rara, principalmente quando a transformação acontece para Linfoma de Hodgkin de Celularidade Mista, cujas características clínicas e citogenéticas ainda não estão totalmente estabelecidas. A pesquisa de melhores tratamentos é necessária, considerando a possível toxicidade associada a QT de primeira linha. Este relato destaca a importância de documentar tais casos para contribuir com a literatura médica e aprimorar a abordagem diagnóstica e o tratamento dessa condição complexa.

Introdução: O Linfoma Não-Hodgkin da Zona Marginal (LNHZM) é um subtipo incomum de linfoma não-Hodgkin e possui características histológicas idênticas aos linfonodos envolvidos pelo linfoma, mas sem doença extranodal ou esplênica proeminente. Por mais que sua patogênese ainda não seja completamente compreendida, sabe-se que mutações adquiridas em oncogenes e genes supressores de tumor estão envolvidos. A apresentação clínica é inespecífica e altamente variável, com a maioria dos pacientes apresentando adenopatia periférica indolor nas regiões cervical, axilar, inguinal e/ou femoral. Além disso, estudos de estadiamento demonstram frequentemente envolvimento nodal amplamente disseminado (estágio III ou IV). O baço e outros tecidos extranodais geralmente não estão envolvidos na apresentação, entretanto, a disseminação para esses locais pode ser observada em indivíduos com doença nodal generalizada. O LNHZM com acometimento extranodal de conjuntiva é uma condição rara e este relato tem como objetivo registrar o seu curso clínico, alterações nos exames complementares, tratamento e desfecho. Apresentação do caso: Paciente de 33 anos, sexo feminino, sem comorbidades, com diagnóstico de LNHZM esplênico, último estadiamento Ann Arbor IVB, com acometimento de conjuntiva. Foi diagnosticada com estágio IVA, com medula óssea acometida, tendo sido realizado tratamento com 8 ciclos de quimioterapia (QT) com Rituximab, Ciclofosfamida, Vincristina e Prednisolona (R-CVP). Evoluiu com resposta ao tratamento, porém, após dois anos, foi diagnosticada a recaída da doença: tomografia por emissão de pósitrons - tomografia computadorizada (PET-TC) evidenciou linfadenomegalias, nova esplenomegalia de grande monta e acometimento de conjuntiva, local que foi biopsiado e comprovada a recaída. Fez tratamento com 3 ciclos de Rituximabe, Dexametasona, Citarabina e Cisplatina (R-DHAP), com boa resposta ao tratamento, tendo sido o último ciclo após um ano da descoberta da recaída. Novo PET-TC Pet mostrou resposta parcial, favorável ao tratamento. Fez esplenectomia três meses após a finalização do tratamento devido à esplenomegalia de grande monta, além de citopenias relacionadas (leucopenia, neutropenia e trombocitopenia). Pós-operatório revelou boa recuperação clínica, sendo encaminhada para transplante de medula óssea (TMO). Discussão e conclusão: LNHZM é uma doença agressiva, tendo como o diferencial a presença de acometimento conjuntivo. Esse achado clínico é extremamente atípico, sendo comprovado a sua relação com o avanço do linfoma pela biópsia. Além disso, corrobora-se com a literatura a melhora do paciente com os ciclos de R-DHAP. Diante disso, torna-se evidente a importância de relatar uma doença rara junto a uma manifestação ainda mais incomum e que possui evidências de uma boa resposta a um medicamento já comercializado.

Introdução/Objetivo: O linfoma de células do manto (LCM) é um tipo raro de linfoma de células B que representa de 4% a 9% de todos os subtipos de linfoma não-Hodgkin (LNH). É um tipo agressivo de linfoma não-Hodgkin com tendência a apresentar envolvimento extranodal. A maioria dos LNHs extranodais da cavidade oral e da região maxilofacial são dos subtipos difuso de grandes células B e de tecido linfoide associado à mucosa. A apresentação do LCM na face é raro, com poucos casos relatados na literatura, assim, esse trabalho tem como objetivo destacar o curso clínico de um caso de LCM com essa apresentação. Relato de caso: Paciente do sexo feminino, 83 anos, com diagnóstico prévio de doença pulmonar obstrutiva crônica (DPOC), apresentando massa em face na região malar à direita de aumento progressivo havia 3 anos, associada a astenia e sudorese noturna. Ao exame físico, além da massa na região malar, havia outra na região cervical direita, sem outras alterações. Realizou exame de tomografia computadorizada de pescoço, tórax, abdome e pelve, que mostrou massas em face, na região malar direita (maior com 6,0 × 3,4 cm), além de massas ganglionares em retroperitônio de até 7,2 × 5,0 cm, massas em região torácica e na região infracarinal. Os exames laboratoriais apresentaram hemoglobina de 14.8 g/dL, leucometria total de 8900/mm3 com diferencial normal, plaquetometria de 301.000/mm3, enzima lactato desidrogenase 286 U/L (referência: 230-460 U/L) e velocidade de hemossedimentação 14 mm/h. O diagnóstico de linfoma de células do manto foi dado pela imuno-histoquímica da massa em região malar, e foi iniciado tratamento quimioterápico com protocolo com dose reduzida de R-CHOP por dois meses. Após o tratamento, evoluiu com quadro de pneumonia e surgimento de novas massas ganglionares, sendo considerada refratária a essa linha de tratamento. Foi iniciado, então, tratamento com R-Clorambucil, evoluindo com piora clínica no segundo ciclo, após dois meses de tratamento, apresentando náuseas frequentes e manutenção das massas ganglionares. No terceiro ciclo, foi suspenso o clorambucil, finalizando o tratamento com 5 ciclos de rituximabe por dois meses, com resposta parcial, mantendo edema na face. Iniciou tratamento com acalabrutinibe por 6 meses, evoluindo com redução total das massas tumorais, porém interrompeu o uso por dificuldade de comprar a medicação. A paciente seguiu em acompanhamento com o serviço de hematologia, realizando uso irregular do inibidor seletivo de BTK (tirosina quinase de Bruton), sem novas massas tumorais, evoluindo para óbito por descompensação de DPOC 18 dias após última consulta. Discussão: O comprometimento extranodal do linfoma de células do manto afeta preferencialmente trato gastrointestinal e região de cabeça e pescoço, como o anel de Waldeyer. Embora o LCM seja uma condição rara, ele deve ser submetido a um diagnóstico diferencial quando afeta a área maxilofacial. Nesse contexto, exames de imagem, análises morfológicas, imuno-histoquímicas, citogenéticas e moleculares são fundamentais para chegar ao diagnóstico correto e levar ao tratamento adequado. Conclusão: O diagnóstico de LCM pode ser desafiador devido às suas semelhanças com outros tipos de LNH e apresentações em regiões atípicas podem tornar esse desafio ainda maior. Diante disso, torna-se essencial o relato de uma doença rara junto de uma manifestação ainda mais incomum.

Introdução: A leucemia promielocítica aguda (LPA), antigamente denominada LMA M3é um subtipo de leucemia mieloide aguda (LMA), caracterizada pela proliferação anormal de células imaturas, chamadas promielócitos, na medula óssea. Já a gamopatia monoclonal é uma condição na qual uma população de plasmócitos clonalmente proliferativos produzem um único tipo de imunoglobulina ou uma de suas subunidades. A associação entre LPA e Gamopatia Monoclonal é rara e pouco descrita na literatura, sendo necessários relatos de caso que registrem o curso clínico, alterações nos exames complementares, tratamento e desfecho. Apresentação do caso: Paciente masculino, 53 anos, com diagnóstico prévio de Diabetes Mellitus tipo 2 e LPA de risco intermediário. Foi inicialmente tratado com o protocolo AIDA 2000 e feita manutenção com ácido transretinoico (ATRA) e metotrexato (MTX), em remissão da doença. Na consulta de acompanhamento, queixou-se de sintomas respiratórios, porém, sem apresentar alterações no exame físico. Apresentou ultrassonografia de rins/vias urinárias e prova de função respiratória, sem alterações. Tomografia computadorizada (TC) de tórax realizada posteriormente evidenciou resolução de extensas consolidações multilobares e bilaterais (pneumonia extensa bilateral), com melhora clínica progressiva. Eletroforese de proteínas revelou a presença de pico monoclonal de 1,4 g e a imunofixação mostrou IgG kappa, caracterizando a gamopatia monoclonal. Foi mantido MTX, sem a inclusão de 6-mercaptopurina até então. No momento, o paciente se encontra na fase de manutenção do tratamento da leucemia, com os últimos exames mostrando remissão da doença. Discussão e conclusão: A presença de gamopatia monoclonal é um achado relevante e incomum em pacientes com LPA. A coexistência dessas duas condições pode implicar em interações complexas e com o potencial de influenciar o manejo terapêutico e o prognóstico do paciente. Diante disso, torna-se evidente a importância de relatar a presença de duas doenças hematológicas em concomitância.

Introdução: A síndrome da Trombocitopenia (TAR) é uma condição rara e com fisiopatogênese ainda não esclarecida completamente. A doença é associada à microdeleção da região proximal 1q21.1, cujo gene acometido é o RBM8A, além de possuir transmissão autossômica recessiva. Os principais traços dessa doença são a ausência ou hipoplasia radial bilateral com preservação dos polegares e trombocitopenia hipomegacariocítica nos primeiros anos de vida, que tende a melhorar conforme o envelhecimento. Além dessas características, outras anomalias do esqueleto apendicular, doenças congênitas cardiovasculares e geniturinárias podem estar presentes, bem como alergia a proteína do leite de vaca não mediada por IgE. Dada a raridade da TAR, este relato tem como objetivo registrar o diagnóstico em um paciente adulto, apresentando seu curso clínico, alterações nos exames complementares, tratamento e desfecho. Apresentação do Caso: Paciente do sexo masculino, 34 anos, com ausência bilateral de rádio e sem demais comorbidades. Encaminhado ao ambulatório de hematologia devido a quadro de dengue com plaquetopenia de 6.000 mm3, necessitando de transfusão. Não houve relato de nenhuma alteração em outros sistemas orgânicos ao longo da infância, com desenvolvimento neuropsicomotor fisiológico. À consulta ambulatorial, não relatou queixas e não foram identificadas alterações no exame físico. Exames laboratoriais evidenciaram hemoglobina 14,9 g/dL; volume corpuscular médio 87,7fL; leucócitos totais 8320 mm3; plaquetas 87000 mm3; volume plaquetário médio 9,2fL. Quanto às curvas de agregação plaquetária, evidenciou-se redução intensa à de adenosina difosfato e adrenalina, além de diminuição na de ristocetina. O paciente iniciou uso de ácido fólico 5mg/dia e segue em acompanhamento ambulatorial. Discussão e Conclusão: A síndrome de TAR é uma doença que cursa com trombocitopenia devendo ser corretamente diagnosticada ainda nos primeiros anos de vida, a fim de manejar possíveis fenômenos hemorrágicos e realizar o seguimento ecocardiográfico por conta da possível associação à cardiopatias congênitas. Embora não haja tratamento específico para a TAR, há possibilidade de terapia de suporte caso seja necessário, como transfusões de hemocomponentes e hemoderivados, reposições de ferro, ácido fólico e vitamina B12, bem como cirurgias reparadoras em caso de anomalias congênitas graves.

Background: In Brazil, despite the increase in coverage and access to rapid testing for syphilis in primary health care, no reduction in cases of syphilis and congenital syphilis was observed. Poor and low-educated populations are disproportionately affected by infection caused by T. pallidum. This study aims to estimate the prevalence of syphilis and associated factors among people aged 18 to 49 years old in the city of Belém, brazilian amazon. Methods: Observational, cross-sectional study carried out in a sanitary administrative district of a capital of the Brazilian Amazon, Belém, state of Pará, Brazil. Data collection was conducted from August 2021 to February 2022. The participantes consisted of residents of the Montese, Guamá and Condor neighborhoods. People aged 18 to 49 years were included. This variable was treated as dichotomous (reagent and non-reagent). The selected response event was ‘reagent result’. The independent variables were the social factors and access to health services. To identify associated factors with the presence of markers of the bacteria studied, multiple logistic rules were performed. Results: 178 people participated in the study; the median age was 35.0 years. The prevalence of IgG and/or IgM antibodies against T. pallidum was 7 % (13). In the final regression model, it was observed that participants who had sexual intercourse after using alcohol and drugs and those who did not know about the prevention of sexually transmitted infections were five times more likely to have tested positive for T. pallidum. Conclusions: Aspects of individual vulnerability and access to health services must be managed to reduce the exposure of poor urban populations to T. pallidum.

Increasing evidence hints that DNA hypermethylation may mediate the pathogenic response to cardiovascular risk factors. Here, we tested a corollary of that hypothesis, that is, that the DNA methyltransferase inhibitor decitabine (Dec) ameliorates the metabolic profile of mice fed a moderately high-animal fat and protein diet (HAFPD), a proxy of cardiovascular risk–associated Western-type diet. HAFPD-fed mice were exposed to Dec or vehicle for eight weeks (8W set, 4–32/group). To assess any memory of past exposure to Dec, we surveyed a second mice set treated as 8W but HAFPD-fed for further eight weeks without any Dec (16W set, 4–20/group). In 8W, Dec markedly reduced HAFPD-induced body weight gain in females, but marginally in males. Characterization of females revealed that Dec augmented skeletal muscle lipid content, while decreasing liver fat content and increasing plasma nonesterified fatty acids, adipose insulin resistance, and—although marginally—whole blood acylcarnitines, compared to HAFPD alone. Skeletal muscle mitochondrial DNA copy number was higher in 8W mice exposed to HAFPD and Dec, or in 16W mice fed HAFPD only, relative to 8W mice fed HAFPD only, but Dec induced a transcriptional profile indicative of ameliorated mitochondrial function. Memory of past Dec exposure was tissue-specific and sensitive to both duration of exposure to HAFPD and age. In conclusion, Dec redirected HAFPD-induced lipid accumulation toward the skeletal muscle, likely due to augmented mitochondrial functionality and increased lipid demand. As caveat, Dec induced adipose insulin resistance. Our findings may help identifying strategies for prevention and treatment of lipid dysmetabolism.

Single-step Coulomb excitation of 46,48,49,50Ti is presented. A complete set of E2 matrix elements for the quintuplet of states in 49Ti, centred on the 2+ core excitation, was measured for the first time. A total of nine E2 matrix elements are reported, four of which were previously unknown. 2249Ti27 shows a 20% quenching in electric quadrupole transition strength as compared to its semi-magic 2250Ti28 neighbour. This 20% quenching, while empirically unprecedented, can be explained with a remarkably simple two-state mixing model, which is also consistent with other ground-state properties such as the magnetic dipole moment and electric quadrupole moment. A connection to nucleon transfer data and the quenching of single-particle strength is also demonstrated. The simplicity of the 49Ti-50Ti pair (i.e., approximate single-j 0f7/2 valence space and isolation of yrast states from non-yrast states) provides a unique opportunity to disentangle otherwise competing effects in the ground-state properties of atomic nuclei, the emergence of collectivity, and the role of proton-neutron interactions.

Quantum tomography in high-energy physics processes has usually been restricted to the spin degrees of freedom. We address the case of top quark decays t→Wb, in which the orbital angular momentum (L) and the spins of W and b are intertwined into a 54-dimensional LWb density operator. The entanglement between L and the W or b spin is large and could be determined for decays of single top quarks produced at the Large Hadron Collider with Run 2 data. With the foreseen statistical and systematic uncertainties, the significance is well above 5σ from the separability hypothesis for L-W entanglement, and 3.2σ for L-b. These would be the first entanglement measurements between orbital and spin angular momenta in high-energy physics. Likewise, the genuine tripartite entanglement between L and the two spins could be established with more than 5σ. The method presented paves the way for similar measurements in other processes.

Summary: Background: The most near-term clinical application of genome-wide association studies in lung cancer is a polygenic risk score (PRS). Methods: A case-control dataset was generated consisting of 4002 lung cancer cases from the LORD project and 20,010 ethnically matched controls from CARTaGENE. A genome-wide PRS including >1.1 million genetic variants was derived and validated in UK Biobank (n = 5419 lung cancer cases). The predictive ability and diagnostic discrimination performance of the PRS was tested in LORD/CARTaGENE and benchmarked against previous PRSs from the literature. Stratified analyses were performed by smoking status and genetic risk groups defined as low (80th percentile) PRS. Findings: The phenotypic variance explained and the effect size of the genome-wide PRS numerically outperformed previous PRSs. Individuals with high genetic risk had a 2-fold odds of lung cancer compared to low genetic risk. The PRS was an independent predictor of lung cancer beyond conventional clinical risk factors, but its diagnostic discrimination performance was incremental in an integrated risk model. Smoking increased the odds of lung cancer by 7.7-fold in low genetic risk and by 11.3-fold in high genetic risk. Smoking with high genetic risk was associated with a 17-fold increase in the odds of lung cancer compared to individuals who never smoked and with low genetic risk. Interpretation: Individuals at low genetic risk are not protected against the smoking-related risk of lung cancer. The joint multiplicative effect of PRS and smoking increases the odds of lung cancer by nearly 20-fold. Funding: This work was supported by the CQDM and the IUCPQ Foundation owing to a generous donation from Mr. Normand Lord.

Centromedian nucleus (CM) is one of several intralaminar nuclei of the thalamus and is thought to be involved in consciousness, arousal, and attention. CM has been suggested to play a key role in the control of attention, by regulating the flow of information to different brain regions such as the ascending reticular system, basal ganglia, and cortex. While the neurophysiology of attention in visual and auditory systems has been studied in animal models, combined single unit and LFP recordings in human have not, to our knowledge, been reported. Here, we recorded neuronal activity in the CM nucleus in 11 patients prior to insertion of deep brain stimulation electrodes for the treatment of epilepsy while subjects performed an auditory attention task. Patients were requested to attend and count the infrequent (p = 0.2) odd or ''deviant'' tones, ignore the frequent standard tones and report the total number of deviant tones at trial completion. Spikes were discriminated, and LFPs were band pass filtered (5–45 Hz). Average peri‑stimulus time histograms and spectra were constructed by aligning on tone onsets and statistically compared. The firing rate of CM neurons showed selective, multi-phasic responses to deviant tones in 81% of the tested neurons. Local field potential analysis showed selective beta and low gamma (13–45 Hz) modulations in response to deviant tones, also in a multi-phasic pattern. The current study demonstrates that CM neurons are under top-down control and participate in the selective processing during auditory attention and working memory. These results, taken together, implicate the CM in selective auditory attention and working memory and support a role of beta and low gamma oscillatory activity in cognitive processes. It also has potential implications for DBS therapy for epilepsy and non-motor symptoms of PD, such as apathy and other disorders of attention.

Introduction and Objectives: Cardiovascular disease is a common cause of morbidity and mortality in pregnant women. Arrhythmias are common complications during pregnancy; however, the data are limited. Our goal was to characterize the epidemiology, clinical presentation, and impact of cardiac arrhythmias on maternal–fetal outcomes. Methods: A prospective cohort study from the Colombian Registry of Pregnancy and Cardiovascular Disease was carried out from 2016 to 2019. All patients with tachyarrhythmia or bradyarrhythmia and a minimum follow-up of six months after delivery were included. The primary outcome was a composite of cardiac events defined as pulmonary edema, symptomatic sustained arrhythmia requiring specific therapy, stroke, cardiac arrest, or maternal death. Secondary outcomes were other cardiac, neonatal, and obstetric events. Results: Arrhythmias were the most common cause of referral to our dedicated cardio-obstetric clinic. A total of 92 patients were included, mean age 27 ± 6 years; 8.7% had previous structural heart disease, and cardiology consultation was delayed in 79.4%. The most common arrhythmias were premature ventricular contractions (33%) and paroxysmal reentrant supraventricular tachycardias (15%); 11 patients (12%) had cardiac implantable electronic devices. Cardiac events occurred in 18.4% of patients, obstetric events occurred in 6.5%, and one caesarean was indicated in the context of symptomatic severe mitral stenosis. Adverse neonatal outcomes were observed in 24.3% of newborns. Conclusions: Arrhythmias were the most common cause of referral to a dedicated cardio-obstetric clinic; most had a benign course. Adverse maternal cardiovascular outcomes were significant and there was a high rate of obstetric and neonatal adverse events, underlining the importance of multidisciplinary care. Resumo: Introdução e objetivos: As doenças cardiovasculares são uma causa comum de morbidade e mortalidade em mulheres grávidas. As arritmias são complicações comuns durante a gravidez; no entanto, há dados limitados. O nosso objetivo foi caracterizar a epidemiologia, a apresentação clínica e os desfechos das arritmias cardíacas nos desfechos materno-fetais. Métodos: Coorte prospetiva do Registo de Gravidez e Doenças Cardiovasculares (REMEC) foi realizada entre 2016 e 2019. Foram incluídas todas as pacientes com taquiarritmia ou bradiarritmia e seguimento mínimo de seis meses após o parto. O desfecho primário foi um composto de eventos cardíacos definidos como edema pulmonar, arritmia sustentada sintomática que requer terapia específica, acidente vascular cerebral, parada cardíaca ou morte materna; os desfechos secundários incluíram outros eventos cardíacos, neonatais e obstétricos. Resultados: Foram incluídas 92 pacientes, a média de idade foi de 27 (± 6) anos, 8,7% apresentavam cardiopatia estrutural prévia e 79,4% tiveram atraso na consulta de cardiologia. As arritmias mais comuns foram contrações ventriculares prematuras (33%) e taquicardias supraventriculares reentrantes paroxísticas (15%); 11 pacientes (12%). Tinham dispositivos cardíacos eletrónicos implantáveis. O eventos cardíacos estiveram presente em 18,4%. Intercorrências obstétricas ocorreram em 6,5% das pacientes, sendo indicada uma cesariana no contexto de estenose mitral grave sintomática. Desfechos neonatais adversos estiveram presentes em 24,3% dos recém-nascidos. Conclusões: As arritmias são a causa mais comum de encaminhamento para uma clínica cardio-obstétrica dedicada; a maioria delas tem um curso benigno. Desfechos cardiovasculares maternos adversos foram significativos e uma taxa importante de eventos adversos obstétricos e neonatais, destacando a importância do cuidado multidisciplinar.

Research on the health and well-being impact of precarious employment (PE) commonly conceptualizes employment as a relation of power between workers and employers, a perspective informed by power relations and relational social class theories. Social reproduction theory is a less common but complementary conceptual lens that can be used to investigate PE and health, in which the nature of work has relevance for the quality of employment. Social reproduction theory points to relations between groups of workers who are valued differently based on the capacity of their work to generate profit. Attending to relations between workers based on value, in addition to the well-established power relation between workers and employers, may point to consequences for health and well-being that are worth exploring empirically, and could serve as another tool to spur collective action around PE and its health effects. We provide an illustration and discuss the potential implications of this theoretical approach using data from in-depth interviews conducted in 2022 among precariously employed food workers in New York City.

Background: D-amino acids are being recognized as important molecules in mammals with function. This is a first identification of endogenous D-cysteine in mammalian pancreas. Methods: Using a novel stereospecific bioluminescent assay, chiral chromatography, enzyme kinetics and a transgenic mouse model we identify endogenous D-cysteine. We elucidate its function in two mice models of type 1 diabetes (STZ and NOD), and in tests of Glucose Stimulated Insulin Secretion in isolated mouse and human islets and INS-1 832/13 cell line. Results and Discussion: D-cysteine is synthesized by serine racemase (SR) and SR−/− mice produce 6–10 fold higher levels of insulin in the pancreas and plasma including higher glycogen and ketone bodies in the liver. The excess insulin is stored as amyloid in secretory vesicles and exosomes. In glucose stimulated insulin secretion in mouse and human islets, equimolar amount of D-cysteine showed higher inhibition of insulin secretion compared to D-serine, another closely related stereoisomer synthesized by SR. In mouse models of diabetes (Streptozotocin (STZ) and Non Obese Diabetes (NOD) and human pancreas, the diabetic state showed increased expression of D-cysteine compared to D-serine followed by increased expression of SR. SR−/− mice show decreased cAMP in the pancreas, lower DNA methyltransferase enzymatic and promoter activities followed by reduced phosphorylation of CREB (S133), resulting in decreased methylation of the Ins1 promoter. D-cysteine is efficiently metabolized by D-amino acid oxidase and transported by ASCT2 and Asc1. Dietary supplementation with methyl donors restored the high insulin levels and low DNMT enzymatic activity in SR−/− mice. Conclusions: Our data show that endogenous D-cysteine in the mammalian pancreas is a regulator of insulin secretion.

Background: Multimorbidity has emerged as a challenge for health systems due to its association with adverse clinical outcomes. Given the limited information available on multimorbidity, particularly in low- and middle-income countries, this study characterizes multimorbidity patterns in the population of Bogotá, Colombia in 2018. Methods: In a cross-sectional study, we analyzed 16 million medical consultation records from Bogotá reported in the National Service Delivery Records in 2018. Using network analysis, we quantified the prevalence of multimorbidity in the population and identified the most common associations between diagnoses, with data stratified by age, sex, and socioeconomic status. Results: The study found that the prevalence of multimorbidity in the population was 44.2 %, increased with age, and was higher in women and in people affiliated to the contributory health scheme. Allergies and vasomotor rhinitis with asthma were common in young people. In women aged 19–39 years, obesity with hypothyroidism was common, while men in the same age group had obesity with dyslipidemia. In people aged 60 years and older, essential hypertension with dyslipidemia was the most common. In addition, some associations between diagnoses showed a higher association in people affiliated to the subsidized health scheme, with notable associations with trauma, especially in men. Conclusion: Overall, the results provide valuable insights into multimorbidity in the population and highlight inequalities based on sociodemographic factors. Future research should investigate whether the lower prevalence of multimorbidity in vulnerable groups is related to biases in data collection or to underlying inequalities in healthcare access.

Background: Genetic Metabolic Dietitians International (GMDI) conducted a professional status survey of metabolic dietitians working in the United States to describe job satisfaction and establish salary and compensation benchmarks specific to metabolic dietitians. Methods: The survey was anonymously administered in a web-based format via REDCap between October and November 2023. Registered dietitians working with inborn errors of metabolism (IEM) were eligible to participate. Results: A total of 178 surveys were received and 147 were included in the final analysis. Most respondents were female (96 %), worked in a clinical setting (83 %), and held a graduate degree (75 %), while 30 % had one or more board certifications and 8 % were faculty. Respondents specialized in genetic metabolic nutrition for a median of 6 years (IQR 2–15). Overall satisfaction with one's professional focus in IEM was high among respondents (87 %), though 40 % reported dissatisfaction with earnings potential in their current position.The median annual, full-time salary for US-based metabolic dietitians in all work settings was $80,400 (IQR $67,100-96,000). After excluding dietitians working in the pharmaceutical and/or nutrition industry (n = 14), the median annual salary decreased to $76,200 (IQR $66,700-91,000). Increased years' experience, responsibility (e.g., supervisor), expertise (i.e., board certification), and categorization as a Level II dietitian or higher were associated with higher annual salary. Conclusion: The results of the 2023 GMDI Professional Status Survey provide insight into the current compensation and benefits of metabolic dietitians practicing in the US. These data can be used to support individual efforts to secure equitable compensation for the metabolic dietitian's critical role in the medical nutrition therapy for individuals with IEM.

Using numerical simulations, we explore the static and dynamic response of hopfions to an external magnetic field in cylindrical and toroidal nanorings. Results evidence that the nucleation and stability of hopfions are intricately linked to geometry. When including an external field, due to the Dzyaloshinskii–Moriya interaction and the field direction-dependent annihilation mechanism, the hopfion displays distinct behavior under magnetic fields pointing along opposite directions. We have also obtained the spin wave resonance modes of the magnetization patterns nucleated in both nanorings and show the impact of geometry on the suppression of some of them. The interplay between curvature, topology, and magnetization dynamics opens new possibilities toward hopfion-based spin torque oscillator fabrication.

Summary: Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013–December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p

Listeria monocytogenes is a pathogenic microorganism that causes listeriosis, an infection that usually occurs after consumption of contaminated food and is considered particularly dangerous due to its ability to grow and multiply under adverse conditions. In recent years, there has been an increase in the consumption of unprocessed products, such as raw milk and dairy products, by people of all ages, including those with compromised immune systems, which could lead to an increase in foodborne illness. Ruminants play a very important role in the persistence and transmission of L. monocytogenes through a continuous oral-faecal cycle. Therefore, farms are considered a reservoir of this microorganism and are involved in the transmission from animals to humans. In this study, samples of faeces, milk, water, silage, feed and teat cups swabs were collected from 8 farms to assess the distribution of the pathogen in the farm environment. Milk samples were also collected from 100 dairy farms to assess the risk associated with the consumption of raw milk. Detection was performed by real-time PCR, while preparation, enrichment and confirmation were performed according to ISO 11290–1, (2017). The prevalence in water was 8.3%, in faeces 12.5% and in feed 12.0%, while in the other samples the microorganism was not detected. It was also observed that this microorganism was more abundant in spring months. The eight isolates were serotyped by real-time PCR and the most frequent serogroup was IVb with 5 isolates (2 of which were IVb-v1) and the remaining 3 were IIb. Two of the clonal complexes (CCs) identified were shared by two isolates (CC 213 and CC 217), the remaining CCs identified (CC 392, CC 554, CC 489, CC 224 and CC 183) were not identified in more than one isolate. This study contributed to a better understanding of the ecology of L. monocytogenes in dairy farms, showing that most of the clones found in food were not present in this environment and that genes coding for disinfectants and heavy metals were not detected.

This article studies the thermodynamics phase transitions and critical phenomena of an FLRW cosmological model under truncated Kaniadakis's statistics. The EoS is derived from the corrected Friedmann field equations and the thermodynamics unified first law. To approach thermodynamics, we use an approximation for KSAH≪1, on the cosmological equation, and also check the validity of our approximation. Then for different values from Kaniadakis parameter K, order O(10−37) for the relic-abundance, O(10−84) for 7Li-abundance and O(10−125) in the recombination era, the EoS reveals non-trivial critical points where a first-order phase transition occurs a sort of a van der Waals fluid. Interestingly, the numerical values of the critical exponents are the same as those of the van der Waals system. Besides, to obtain more insights into the thermodynamics description, the so-called Ruppeiner's geometry is studied through the normalized scalar curvature, disclosing this invariant zone where the system undergoes repulsive/attractive interactions. Near the critical point, this curvature provides again the same critical exponent and universal constant value as for van der Waals fluid. Despite the similarity, both systems are quite different because the present one considers a relativistic entropy (Kaniadakis entropy) while the Van der Waals gas responds to a classical entropy (Maxwell-Boltzmann).

The production of radioisotopes for nuclear medicine is boosted by different international agencies. IFMIF-DONES will be an infrastructure where neutrons will be generated by the impact of a high-power deuteron beam onto a lithium jet target. At present, IFMIF-DONES studies the possibility of deflecting 0.1% of its standard 125 mA current of 40 MeV deuteron beam for the complementary applications to be conducted inside a new experimental hall. Such deuteron beam is being considered to be used for radioisotope production for nuclear medicine. Here, we discuss the production of a potential Auger-electron emitter radioisotope for therapy 165Er with 125 μA deuterons on natHo. Due to the high-power delivered onto the sample, we study by means of SolidWorks simulations a realistic device as cooling system for the holmium sample. Our results show a significant 165Er production in comparison with other experimental routes available in the literature.

Papaya seeds (Carica papaya L.) are usually discarded, yet they contain significant amounts of bio-components such as polyphenols, which are beneficial in the food and pharmaceutical industries. In this research, microcapsules from papaya seed extract were obtained through spray drying; the influence of the inlet temperature to the sprayer (130 °C, 140 °C, and 150 °C) and the concentration of the encapsulating agent, chitosan (0.5% and 1%), on their functional properties (polyphenols, antioxidant capacity) and physicochemical properties (moisture content, bulk density, hygroscopicity, solubility, and yield) was evaluated. The extraction of polyphenols was performed by ultrasound-assisted extraction using 50% ethanol; this extract was then concentrated under vacuum and microencapsulated. The most effective treatment was at an inlet temperature of 150 °C and a chitosan concentration of 0.5%, resulting in microcapsules with a high content of polyphenols and antioxidant capacity (97.6 Gallic Acid Equivalent – GAE/100 g dry sample and 413 mg Trolox Equivalent – TE/100 g dry sample, respectively). Under these conditions, 92.1% of the maximum antioxidant capacity was preserved in the microcapsules obtained from the papaya seed extract. The physicochemical properties were influenced by the studied factors: inlet temperature to the dryer and chitosan encapsulant concentration. These micro-encapsulated products could be a suitable alternative for applications as natural food additives with potential antioxidant activity, warranting further research.

This work examines the distribution of metals(oid) in coastal sediments of the Concon-Quintero industrial complexes (central Chile), and evaluates the environmental condition of this zone, using some environmental indexes and different global and local background values.The Index of geoaccumulation and the Enrichment Factor were different depending on the background values used to calculate them. Only Mo and Pb, simultaneously show both an enrichment, and some degree of pollution problem, with all backgrounds utilized. Three of the four background values used in this work to calculates the Pollution Load Index suggests a polluted condition of the bottom environment. The spatial distribution, the results of environmental indices and the comparison with local environmental legislation suggests that Pb is introduced to the marine system by industrial activities. The result of both, SQG and m-ERM-Q suggest that metals preserved in the sediments are a threat to the benthic life, especially in the Concon-Ritoque zone, where the highest values were recorded.These results suggest a notorious influence of the Aconcagua river on the metal accumulation in the coastal zone.

Introduction: Chronic subdural hematomas (CSDH) are common problems in neurosurgery, generally secondary to head trauma, although they me be in rare cases associated to underlying pathologies. Between these possible causes, arachnoid cysts (usually asymptomatic benign congenital lesions) can be a risk factor for subdural hematoma in young patients, who may spontaneously develop a CSDH and require surgery to relieve intracranial hypertension.Case Report.We present the case of a 23-year-old male, incidentally diagnosed two years before with a right temporal arachnoid cyst (middle fossa), asymptomatic, who began with symptoms of intracranial hypertension two weeks prior to surgery. A right fronto-parieto-temporal CSDH was verified on MRI, requiring emergency surgery with a small craniotomy, evacuation of the hematoma, and fenestration of the arachnoid cyst. Conclusions: In young patients with a diagnosis of an arachnoid cyst, the differential diagnosis of CSDH should be considered when presenting with acute neurological symptoms.

Objective: Neurocysticercosis (NCC) is still a frequent cause of neurosurgical consultations in most developing countries. Conventional approaches for the resection of large cysts have been used for many years. We report here our experience in the neurosurgical management of NCC using diverse minimally invasive approaches according to the localization of lesions: minimal craniotomy for lesions in the Sylvian fissure, stereotactic surgery for lesions in the posterior fossa, and endonasal neuroendoscopy for lesions in the basal cisterns. Methods: We reviewed the charts of 24 consecutive NCC patients who had minimally invasive surgery to resect NCC lesions in a neurological referral center in Lima, Peru. Three approaches were used: microcraneotomies through the anterior Sylvian point (n = 16), stereotactic surgery (n = 6), and endonasal endoscopy (n = 2), between January 1, 2016, and July 31, 2022. Demographic and clinical data as well as post-surgical evolution are presented using descriptive statistics. Results: Clinical improvement was observed in 23 out of 24 cases, with complete resolution of symptoms in nine and partial in 14. One patient evolved poorly and worsened his symptoms. Twenty-two patients received antiparasitic treatment after surgery. Relapse of NCC lesions was observed in three patients. There were no significant complications in any of the cases. Conclusions: Minimally invasive surgical approaches provide an excellent alternative for the management of patients with NCC, with good surgical and functional results, also markedly reducing the parasitic mass for further antiparasitic treatment.

Lateral flow immunoassays (LFIA) for antibody detection represent cost-effective and user-friendly tools for serology assessment. This study evaluated a new LFIA prototype developed with a recombinant chimeric antigen from the spike/S and nucleocapsid/N proteins to detect anti-SARS-CoV-2 IgG antibodies. The evaluation of LFIA sensitivity and specificity used 811 serum samples from 349 hospitalized, SARS-CoV-2 RT-qPCR positive COVID-19 patients, collected at different time points and 193 serum samples from healthy controls. The agreement between ELISA results with the S/N chimeric antigen and LFIA results was calculated. The LFIA prototype for SARS-CoV-2 using the chimeric S/N protein demonstrated 85 % sensitivity on the first week post symptoms onset, reaching 94 % in samples collected at the fourth week of disease. The agreement between LFIA and ELISA with the same antigen was 92.7 %, 0.827 kappa Cohen value (95 % CI [0.765–0.889]). Further improvements are needed to standardize the prototype for whole blood use. The inclusion of the novel chimeric S + N antigen in the COVID-19 IgG antibody LFIA demonstrated optimal agreement with results from a comparable ELISA, highlighting the prototype's potential for accurate large-scale serologic assessments in the field in a rapid and user-friendly format.

Resumen: Introducción: La deglución es un proceso esencial para mantener la homeostasis corporal. Con el envejecimiento, se producen cambios tanto en las estructuras centrales como periféricas, dando lugar a la presbifagia, la cual implica alteraciones morfológicas y funcionales en el proceso deglutorio. Sin embargo, los reportes de prevalencia de dificultades deglutorias en adultos mayores son escasos en la actualidad. Objetivos: Determinar la prevalencia de dificultades deglutorias producto del envejecimiento, y cómo se relacionan las dificultades autorreportadas con parámetros de seguridad, eficiencia, competencia y confortabilidad. Método: Se realiza una investigación exploratoria-descriptiva considerando la valoración de autopercepción de 18 adultos mayores de la ciudad de Iquique, Chile. Resultados: Se reportó una prevalencia del 27,78% en cuanto a las dificultades deglutorias autopercibidas. Conclusiones: Los resultados orientan a la necesidad de una mayor utilización de instrumentos de pesquisa temprana, como lo son los cuestionarios de autorreporte. Abstract: Introduction: Swallowing is an essential process in maintaining body homeostasis. With aging, changes occur in both central and peripheral structures, giving rise to presbyphagia, which involves morphological and functional alterations in the swallowing process. However, reports on the prevalence of swallowing difficulties in older adults are currently scarce. Objectives: To determine the prevalence of swallowing difficulties due to aging, and how self-reported difficulties are related to safety, efficiency, competence, and comfort parameters. Method: To this end, exploratory-descriptive research was carried out considering the self-perception assessment of 18 older adults from the city of Iquique, Chile. Results: A prevalence of 27.78% was reported in terms of self-perceived swallowing difficulties. Conclusions: Results inform the need for greater use of early screening instruments, such as self-report questionnaires.

Background: Surgical fatigue syndrome (SFS) is a frequent, but underestimated, entity that occurs during laparoscopic surgeries. It could impair surgical outcomes, patient safety, and surgeon health. Furthermore, current surgical education lacks effective interventions to avoid it. Discomfort represents the most common manifestation and includes musculoskeletal fatigue, numbness, or frank pain. The most common affected sites are the back neck, dominant hand shoulder, and high or low back. We propose an integral intervention (surgeon posture, instruments/devices design & use and discomfort improvement) that prevents or mitigates SFS. Methods: An experimental study was conducted on 57 general surgery residents and general surgeons. Participants in the experimental and control group executed standardized laparoscopic knots in a simulator and knowledge, body discomfort, and posture/ergonomic risk was evaluated before and after intervention application. Results: A statistically significant decrease in discomfort intensity was found in the experimental group. Also, discomfort presentation by the anatomic site diminishes and surgical performance improves. Conclusions: Intervention prevents or mitigates discomfort associated with muscle-skeletal component of SFS. ACGME competency: Practice Based-Learning and Improvement.

Cryptosporidium, Giardia, and Blastocystis are significant causes of diarrhea worldwide. However, studies on their prevalence in wild animals are limited, compared to humans and domestic animals. In this study, we collected 23 stool samples from captive wild rescued animals in Boyacá, Colombia. Using conventional PCR, we detected Cryptosporidium spp., Giardia spp., and Blastocystis in over half of the samples (69.6%). Cryptosporidium spp. (43.5%) were the most commonly found, followed by Giardia spp. (39.1%) and Blastocystis (13.0%). Co-infections involving these parasites were also observed. Subsequent genotyping revealed Cryptosporidium canis and Cryptosporidium ryanae as the predominant species. These findings contribute valuable information about the ecoepidemiology of intestinal parasites in Colombian wild animals.

An automated methodology is proposed to identify anomalies in buildings’ HVAC systems, through Local Correlation Integral (LOCI) algorithm, improved by Bootstrap to obtain a rule from its score distribution. It has been performed to solve the case study of anomaly detection for HVAC facilities maintenance in a clothing store in Panama. It is defined by a dataset composed of 24 daily readings recorded during 434 days. In each reading, 15 critical quality variables for thermal comfort and energy efficiency were monitored. For algorithm training, anomalous events recorded by HVAC system operators are considered. In this stage, the LOCI parameters that best fit the data are estimated, to obtain a score for each of the observations and then study their distribution by applying Bootstrap techniques to improve the classification performance. For the algorithm performance evaluation, cross-validation is used and from these results, it is compared with two benchmark supervised classification methods such as Logistic Regression and Support Vector Machines with polynomial kernel. The LOCI method has been improved by the application of bootstrap resampling, providing estimates of the LOCI score distribution and a critical value from which we define an anomalous observation. It provides the best balance between real anomaly detection and prevention of false alarm identification than current proposals for LOCI.