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Abstract Background The provision of data sharing statements (DSS) for clinical trials has been made mandatory by different stakeholders. DSS are a device to clarify whether there is intention to share individual participant data (IPD). What is missing is a detailed assessment of whether DSS are providing clear and understandable information about the conditions for data sharing of IPD for secondary use. Methods A random sample of 200 COVID-19 clinical trials with explicit DSS was drawn from the ECRIN clinical research metadata repository. The DSS were assessed and classified, by two experienced experts and one assessor with less experience in data sharing (DS), into different categories (unclear, no sharing, no plans, yes but vague, yes on request, yes with specified storage location, yes but with complex conditions). Results Between the two experts the agreement was moderate to substantial (kappa=0.62, 95% CI [0.55, 0.70]). Agreement considerably decreased when these experts were compared with a third person who was less experienced and trained in data sharing (“assessor”) (kappa=0.33, 95% CI [0.25, 0.41]; 0.35, 95% CI [0.27, 0.43]). Between the two experts and under supervision of an independent moderator, a consensus was achieved for those cases, where both experts had disagreed, and the result was used as “gold standard” for further analysis. At least some degree of willingness of DS (data sharing) was expressed in 63.5% (127/200) cases. Of these cases, around one quarter (31/127) were vague statements of support for data sharing but without useful detail. In around half of the cases (60/127) it was stated that IPD could be obtained by request. Only in in slightly more than 10% of the cases (15/127) it was stated that the IPD would be transferred to a specific data repository. In the remaining cases (21/127), a more complex regime was described or referenced, which could not be allocated to one of the three previous groups. As a result of the consensus meetings, the classification system was updated. Conclusion The study showed that the current DSS that imply possible data sharing are often not easy to interpret, even by relatively experienced staff. Machine based interpretation, which would be necessary for any practical application, is currently not possible. Machine learning and / or natural language processing techniques might improve machine actionability, but would represent a very substantial investment of research effort. The cheaper and easier option would be for data providers, data requestors, funders and platforms to adopt a clearer, more structured and more standardised approach to specifying, providing and collecting DSS. Trial registration The protocol for the study was pre-registered on ZENODO ( https://zenodo.org/record/7064624#.Y4DIAHbMJD8 ).

Introduction: The brain derived neurotrophic factor is a neurotrophin modulator of cognitive processes. Current studies in Alzheimer’s disease patients show alterations in biomarkers at outlying levels. Objective: To analyze the association between the serum brain-derived neurotrophic factor levels and the cognitive markers in Alzheimer’s disease subjects. Material and Methods: A correlational transversal study was conducted in subjects aged 64 years, distributed into three groups: group 1ː16 controls, group 2ː27 with mild cognitive impairment, and group 3ː21 with Alzheimer’s disease. A neuropsychological test battery, and the immunoenzymatic method (ELISA), Promega Emax Kit were applied to determine the serum brain-derived neurotrophic factor levels. The statistical analysis of data was performed using the one-way ANOVA test, the post-hoc Dunnett´s test and the Pearson’s correlation coefficient (p

Introdução: Melanoma de mucosa é uma doença rara que corresponde a aproximadamente 0,03% de todos os diagnósticos de câncer e 1.4% de todos os tipos de melanoma e representa aproximadamente 10% de todos os tumores malignos da região vulvar. Metodologia: Revisão do prontuário de paciente internada nesta Instituição no período de setembro de 2021, com revisão de literatura a partir de dados da base PUBMED. Relato: Paciente, 36 anos, com relato de lesão hiperpigmentada em região interna de grande lábio há 10 anos com mudança de comportamento há 4 meses. Apresentava nodulação no local associada a dor e saída de secreção serossanguinolenta/purulenta. Após biópsia excisional e confirmado achado de melanoma de mucosa vulvar em anatomopatológico, foi constatado ao exame físico presença de linfonodo palpável com características suspeitas de metástase. Assim, realizou-se tomografia para estadiamento, cirurgia de ampliação de margens cirúrgicas e linfadenectomia inguinal esquerda. Confirmado o comprometimento linfonodal, a paciente foi encaminhada para radioterapia. Conclusão: Melanoma de mucosa é uma doença rara de prognóstico reservado. Devido ao seu diagnóstico mais tardio, tem elevadas taxas de metástase já no estadiamento inicial. Faz-se importante estudos adicionais para esclarecimento da doença e proposta de terapêuticas eficazes no aumento da sobrevida geral.

Summary: Transgender and gender-diverse individuals experience substantial health disparities across the cancer care continuum. Despite well recognized unique healthcare needs, there are barriers in accessing cancer prevention and treatment services, influenced by disadvantages in key social-economic determinants of health which result in worse clinical outcomes, as compared to the general population. The Italian Association of Medical Oncology (AIOM) acknowledges the critical relevance of this issue. The “Assisi Recommendations” here summarize the outcomes of the “AIOM Oncology Ethics Day” dedicated to gender differences in oncology and cancer care of transgender and gender-diverse people. The recommendations generated during a 2-day multidisciplinary discussion address the various aspects of cancer care experience of transgender and gender-diverse people. The promotion of research in this field, through the generation of new evidence and the collection of prospective data, has been identified as a priority action to mitigate these disparities. By acknowledging the challenges of cancer care in transgender and gender-diverse people and recognizing the need for dedicated policy and clinical recommendations, AIOM demonstrates its commitment to improving the health and well-being of all patients with cancer, regardless of their gender identity or any other personal or social circumstances, as part of health-for-all societal vision.

Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

Introduction: the study of the characteristics of patients with COVID-19 makes it possible to determine risk groups in specific populations and to outline strategies by the institutions to improve the quality of care for these patients. Objective: to characterize patients with COVID-19 in Pinar del Río between March 2020 and March 2021. Methods: an observational, descriptive and cross-sectional study was carried out in patients diagnosed with COVID-19 in the province of Pinar del Río between March 2020 and March 2021. The sample consisted of 450 patients who met the inclusion and exclusion criteria. Descriptive statistics were used for data analysis. Results: female patients predominated (56 %), with a history of arterial hypertension (24,6 %). A high incidence of COVID was found in individuals with between two and five chronic non-communicable diseases (40,2 %). Of all patients diagnosed with COVID-19, 49 % were passive smokers. Conclusions: COVID-19 occurred mainly in patients with several chronic diseases, as well as in those exposed to tobacco smoke and with a history of infectious processes.

Background: In patients with prostatic and breast cancer the application of peridural anesthesia (PDA) showed a beneficial effect on prognosis. This was explained by reduced requirements for general anesthetics and perioperative opioids as well as a lower perioperative stress level. The impact of PDA in patients with more aggressive types of cancer has not been completely elucidated. Here, we analyzed the prognostic influence of PDA on overall survival after surgery as primary in patients that underwent radical resection of pancreatic adenocarcinoma. Methods: Records of 98 consecutive patients were reviewed. In 70 of these cases PDA was applied. Patient characteristics such as demographics, TNM stage, and operative data were retrospectively collected from medical records and analyzed. Survival data were analyzed by Cox’s proportional hazard regression model. Results: Overall, no significant prognostic influence of PDA on recurrence or overall survival (p = 0.762, Hazard Ratio [HR] 0.884, 95% confidence interval [CI] 0.398–1.961) was found. However, there was a trend towards a longer overall survival (p = 0.069, HR 0.394, 95% CI 0.144–1.078) associated with PDA in a subgroup of patients with better differentiation of pancreatic adenocarcinoma. Conclusion: The observation of longer survival associated with PDA in our subgroup of patients with better-differentiated pancreatic carcinomas is in line with previous reports on various other less aggressive tumor entities. Our results indicate that PDA might improve the oncological outcome of patients with pancreatic adenocarcinoma.

Resumen: Introducción: el aula invertida es una nueva estrategia de la tecnología educativa, basada en un enfoque constructivista que promueve la participación activa del estudiante. El objetivo del estudio fue analizar los indicadores bibliométricos de la producción científica sobre el aula invertida en la educación médica. Métodos: estudio descriptivo y retrospectivo de tipo bibliométrico, basado en las publicaciones científicas de las revistas indexadas en Scopus desde el 2012 hasta el 2021. Se elaboró una estrategia de búsqueda con términos MESH y operadores booleanos («AND» y «OR»). Las métricas de la bibliometría se realizaron con el programa SciVal de Elsevier. Resultados: el 41,8 y 28,3% de las publicaciones fueron en revistas del cuartil Q1 y Q2, respectivamente. Además, la Universidad de Harvard es la que tiene más publicaciones (15), pero la Universidad del Norte de Carolina es la de mayor impacto (54,7 citas por publicación). La revista Academic Medicine (Q1) y Academic Radiology (Q1) presentaron más citas por publicación, con 79,9 y 42,2, respectivamente. El 35,3% de las publicaciones tiene colaboración nacional y 13,4% de tipo internacional. El autor Zheng Binbin (FWCI: 4,64) es el que tiene mayor número de citas esperadas respecto a la media mundial. Conclusiones: existe una tendencia favorable en el número de publicaciones con mayor énfasis en las revistas de alto impacto (Q1 y Q2). Los autores e instituciones con más producción fueron los de Estados Unidos y el tipo de colaboración más frecuente fue la institucional. Abstract: Background: The flipped classroom is a new educational technology strategy, based on a constructivist approach that promotes active student participation. Therefore, the objective of the study was to analyze the bibliometric indicators of the scientific production on the flipped classroom in medical education. Method: Descriptive and retrospective bibliometric study, based on the scientific publications of journals indexed in Scopus from 2012 to 2021. A search strategy was developed with MESH terms and Boolean operators (“AND” and “OR”). The bibliometric metrics were performed with Elsevier's SciVal program. Results: 41.8% and 28.3% of the publications were in Q1 and Q2 quartile journals, respectively. In addition, Harvard University is the one with the most publications (15), but the University of North Carolina has the greatest impact (54.7 citations per publication). The journal Academic Medicine (Q1) and Academic Radiology (Q1) presented more citations per publication, with 79.9 and 42.2, respectively. 35.3% of the publications have national collaboration and 13.4% international. The author Zheng Binbin (FWCI: 4.64) is the one with the highest number of expected citations compared to the world average. Conclusions: There is a favorable trend in the number of publications with greater emphasis on high impact journals (Q1 and Q2). The authors and institutions with the most production were those from the United States and the most frequent type of collaboration was institutional.

Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy.

In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

Innovative strategies need to be adopted to combat the growing prevalence of obesity. Thus, the aim of this study is to evaluate the effect of a nutritional counseling activity using a social network in coping with obesity. This is a before-and-after experimental study, including 60 overweight individuals enrolled in a Primary Care Center. It was carried out from June to October 2020. Educational actions (sharing information about healthy eating and health and agreeing on challenges) were carried out through the WhatsApp® application, weekly, for 16 weeks. Sociodemographic, economic, clinical, anthropometric, food consumption, and biochemical data were collected. Data were compared by the Wilcoxon or Kappa test. Most participants were female and 36.4% had a diagnosis of hypertension. After the intervention, there was a reduction in waist circumference (before:107.3±11.4; after:105.6±11.5 cm, p=0.004), total cholesterol (before:205.9±48, 3; after:191.5±34.3 mg/dL, p

Background and Objectives: Endometriosis is an estrogen-dependent, inflammatory, gynecological disorder represented by the migration of endometrial tissue outside the uterus. It can manifest through gynecological and gastrointestinal (GI) signs. Given the hormonal imbalances in endometriosis and the effect of microbiota on immune dysfunction, it has been thought that the human microbiome may play a role in its pathogenesis, acting differently before and after laparotomy. The aim of this review is to establish whether there is an interaction between endometriosis and gut microbial composition. Materials and Methods: We aimed to review available literature by systematically searching five databases: PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect. We included records describing gut microbiota in the context of endometriosis—observing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines—to recognize the presence of disease by the expression of bacterial taxa—based on 16S ribosomal RNA gene sequencing analysis. Results: Among 10 studies selected, there were four review articles and six clinical trials. The latter identified significant differences at a genus level in increased Prevotella, Blautia, and Bifidobacterium and decreased Paraprevotella, Ruminococcus, and Lachnospira (p < 0.05). In patients undergoing abdominal hysterectomy, Proteobacteria phylum increased from 34.36% before surgery to 54.04% after surgery (p < 0.05). Conclusions: Although scientific literature reports different characterizations of intestinal microbiota in endometriotic patients, further evidence is needed to develop new diagnostic-therapeutic strategies, for example, administration with probiotics before surgery.

ntroduction:Breastfeeding is a natural biological process that is of utmost importance during thedevelopment of newborns.Objective:To find the association between exclusive breastfeeding and variousfactors at different times: during gestation, during birth and in the puerperium in mothers who come to DIRISLima Centro health centers.Methods:A survey was used to find out the factors associated with exclusivebreastfeeding, such as the number of prenatal check-ups, talks given, and whether she had breastfed her childin the last 6 months. The data obtained were statistically processed to obtain the values of Odss Ratio andassociation variables.Results:Of the 140 mothers surveyed with less than 12 months of lactation, 77.85%stated that they had attended six prenatal controls, this attitude had a statistically significant relation withExclusive Breastfeeding (p: 0.012). Vaginal delivery was found to be significantly associated with Breastfeeding.However, the use of milk formula could be a risk factor (p < 0.001).Conclusion:Three factors were found to beassociated with SCI: attendance to six pre-natal controls, vaginal delivery and as a risk factor, the use of milkformula, one in each time period, before, during and after delivery.

There is evidence of an association between hypertension and retinal arteriolar narrowing. Manual measurement of retinal vessels comes with additional variability, which can be eliminated using automated software. This scoping review aims to summarize research on automated retinal vessel analysis systems. Searches were performed on Medline, Scopus, and Cochrane to find studies examining automated systems for the diagnosis of retinal vascular alterations caused by hypertension using the following keywords: diagnosis; diagnostic screening programs; image processing, computer-assisted; artificial intelligence; electronic data processing; hypertensive retinopathy; hypertension; retinal vessels; arteriovenous ratio and retinal image analysis. The searches generated 433 articles. Of these, 25 articles published from 2010 to 2022 were included in the review. The retinographies analyzed were extracted from international databases and real scenarios. Automated systems to detect alterations in the retinal vasculature are being introduced into clinical practice for diagnosis in ophthalmology and other medical specialties due to the association of such changes with various diseases. These systems make the classification of hypertensive retinopathy and cardiovascular risk more reliable. They also make it possible for diagnosis to be performed in primary care, thus optimizing ophthalmological visits.

Human Papillomavirus is the main cause of cervical cancer, including squamous cell carcinoma of the oropharynx, anus, rectum, penis, vagina, and vulva. In recent years, considerable effort has been made to control HPV-induced diseases using either prophylactic or therapeutic approaches. A critical review of the literature about the therapeutic Human Papillomavirus vaccine was performed to analyze its efficacy in the treatment of female lower genital tract lesions and its possible perspective application in clinical practice. The most important medical databases were consulted, and all papers published from 2000 until 2021 were considered. We retrieved a group of seven papers, reporting the role of anti HPV therapeutic vaccines against the L2 protein in the order of their efficacy and safety in female lower genital tract disease. In addition, the immune response due to vaccine administration was evaluated. The development of therapeutic vaccines represents an interesting challenge for the treatment of HPV infection of the lower genital tract. Literature data underline that the L2 protein may be an interesting and promising target in the development of therapeutic HPV vaccines, but the possible strengths and the unclear longevity of L2 immune responses are factors to be considered before clinical use.

Background and Objectives: Echinacea angustifolia and purpurea have known immunomodulatory effects which boost viral clearance, including HPV infection. However, evidence regarding the improvement due to Echinacea-based supplements of cervical HPV-related pathologies is still lacking. The aim of this study is to evaluate the efficacy of Echinacea supplementation on the remission of cervical low-grade squamous intraepithelial lesions (L-SIL). Materials and Methods: A single-blind 1:1:1 parallel randomized controlled trial was conducted at the Colposcopy Unit of a tertiary care referral center. Reproductive-aged women were allocated either to (a) an oral supplement based on Echinacea extracts plus vaginal hyaluronic acid-based soft gel capsules, (b) the Echinacea supplement alone, or (c) vaginal hyaluronic acid-based soft gel capsules alone for 3 months. The primary outcome was the regression of cervical intraepithelial neoplasia (CIN)-1 for each treatment arm at 3, 6 and 12 months after the diagnosis. Secondary outcomes included changes in the epithelialization, pap smear, colposcopic parameters, histological reports, and vaginal health indexes (VHI) in the study groups. Results: 153 women (52 for arm A, 50 for arm B and 51 for arm C) completed the follow-up and were included in the analysis. There were no significant differences in both primary and secondary outcomes for the three groups after 3 months. At the 6-month follow-up, the number of persistent CIN-1 diagnoses was significantly lower in arm A (15/51), rather than in arm B (23/48, p = 0.03) and C (27/49, p = 0.03). Similarly, the same effect was seen after 12 months for treatment A (5/51) relative to B (15/48, p = 0.03) and C (14/48, p = 0.03). Colposcopic, histological and vaginal parameters were all significantly improved at 6 and 12 months for arm A relative to B and C, while no beneficial effects were seen after 3 months. Conclusions: Echinacea extracts supplementation in women with L-SIL/CIN-1 significantly boosts HPV lesion clearance, reducing the overall amount of diagnosis, histological, colposcopic and vaginal parameters after 6 and 12 months. However, a limited sample size reduces the quality of evaluated evidence, emphasizing the need for additional studies to validate these findings.

Pilot training and expertise are key aspects in aviation. A traditional way of evaluating pilot expertise is to measure performance output. However, this approach provides a narrow view of the pilot’s capacity, especially with regard to mental and emotional profile. The aim of this study is hence to investigate whether neurophysiological data can be employed as an additional objective measure to assess the expertise of pilots. In this regard, it has been demonstrated that mental effort can be used as an indirect measure of operator expertise and capacity. An increase in mental effort, for instance, can automatically result in a decrease in the remaining capacity of the operator. To better investigate this aspect, we ask two groups of Italian Air Force pilots, experienced (Experts) and unexperienced (Novices), to undergo unusual attitude recovery flight training simulations. Their behavioral (unusual attitude recovery time), subjective (mental effort demand perception) and neurophysiological data (Electroencephalogram, EEG; Electrocardiogram, ECG) are collected during the entire flight simulations. Although the two groups do not exhibit differences in terms of unusual attitude recovery time and mental effort demand perception, the EEG-based mental effort index shows how Novices request significantly higher mental effort during unusual conditions.

Background and Objectives: The type of instrumentation used during laparoscopic surgery might impact on the learning curve of resident surgeons. The aim of this study was to investigate differences in operator satisfaction and surgical outcomes between tissue sealers and classic bipolar instruments during gynecological laparoscopies performed by residents. Materials and Methods: A prospective cohort study conducted at two tertiary university hospitals between March 2019 and March 2021, on consecutive procedures: salpingo-oophorectomies (Group 1) and salpingectomies (Group 2), subdivided according to the utilized device: radiofrequency tissue sealers (Groups A1 and A2) or bipolar forceps (Groups B1 and B2). Results: 80 procedures were included. Concerning salpingo-oophorectomies, better visibility (8.4 ± 0.8 vs. 7.3 ± 0.9; p = 0.03), reduced difficulty (5.4 ± 1.2 vs. 7.0 ± 1.4; p = 0.02), improved overall satisfaction (9.2 ± 0.4 vs. 7.6 ± 1.0; p = 0.02) and reduced procedure time (7.8 ± 3.4 vs. 12.6 ± 3.1; p = 0.01) were reported by residents using tissue sealers. Intraoperative blood loss (12.2 ± 4.7 mL vs. 33.2 ± 9.7 mL; p = 0.01) and 24 h postoperative pain (4.5 ± 1.1 vs. 5.7 ± 1.8; p = 0.03) were lower in group A1 than B1. For salpingectomies, a significant reduction in duration was found in A2 compared to B2 (7.2 ± 3.4 min vs. 13.8 ± 2.2 min; p = 0.02). Tissue sealers enhanced visibility (8.1 ± 1.1 vs. 6.7 ± 1.4; p = 0.01), difficulty (6.5 ± 1.1 vs. 7.5 ± 0.9; p = 0.04) and improved satisfaction (9.3 ± 0.5 vs. 7.5 ± 0.6; p = 0.01). Moreover, hemoglobin loss and postoperative pain were reduced in A2 relative to B2 [(8.1 ± 4.2 % vs. 4.5 ± 1.1%; p = 0.02) and (5.1 ± 0.9 vs. 4.1 ± 0.8; p = 0.03), respectively] Conclusions: The use of sealing devices by residents was related to reduced difficulty as well improved visibility and overall satisfaction, with improved surgical outcomes.

Background and Objectives: The human brain presents a functional asymmetry for every cognitive function, and it is possible that sexual hormones could have an impact on it. Visual–spatial attention, one of the most lateralized functions and one that is mainly dependent on the right hemisphere, represents a sentinel for functional cerebral asymmetry (FCA). The aim of this study was to evaluate whether menopausal hormone therapy (MHT) or phytoestrogens could modulate FCA in postmenopausal women. Materials and Methods: We enrolled postmenopausal women who were taking MHT or soy isoflavones or receiving no therapy and asked them to perform the line bisection test at study enrollment and after 18 and 36 months. Results: Ninety women completed the follow-up. At zero time, women who had not been subjected to therapy showed a leftward deviation (F = −3.0), whereas, after 36 months, the test results showed a rightward deviation (F = 4.5; p < 0.01). Women taking MHT showed a leftward deviation at the start (F = −3.0) and a persistent leftward deviation after 36 months (F = −4.0; p = 0.08). Conversely, women taking soy isoflavones started with a leftward deviation (F = −3.0) that became rightward (F = 3.0), with a significant difference shown after 36 months (p < 0.01). Conclusions: Our data suggest that hormonal modulation improves the interplay between the two hemispheres and reduces FCA. We propose, therefore, that the functions of the right hemisphere are mainly affected by aging and that this could be one of the reasons why the right hemisphere is more susceptible to the effects of MHT.

Pelvic pain in reproductive age often represents a diagnostic challenge due to the variety of potential causes characterized by overlapping clinical symptoms, including gynecological and other disorders (e.g., entero-colic or urological). It is also necessary to determine if there is a possibility of pregnancy to rule out any related complications, such as ectopic pregnancy. Although ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are strongly integrated, the choice of which is the ideal diagnostic tool should be guided both by clinical suspicion (gynecological vs. non-gynecological cause) and by the risk ratio–benefit (ionizing radiation and instrumental costs), too. The didactic objective proposed by this review consists in the diagnosis of the cause and differential of pelvic pain in reproductive age by describing and critically analyzing the US diagnostic clues of the most frequent adnexal, uterine, and vascular causes.

Objetivo: Validar uma cartilha educativa destinada aos profissionais e trabalhadores da Atenção Básica que favoreça a detecção precoce da criança com autismo. Métodos: Pesquisa de desenvolvimento metodológico, com abordagem qualitativa, de validação de tecnologia. Realizou-se em Sobral, cidade do interior do Ceará, e na capital, Fortaleza, dividindo-se em três momentos: construção da cartilha educativa, validação por 13 juízes especialistas e elaboração da versão final da cartilha. A coleta de dados, que ocorreu entre julho e agosto de 2015, deu-se através de uma ficha de avaliação, em que os juízes avaliaram e fizeram correções e sugestões referentes à cartilha. Esses dados foram analisados pelo método de análise de conteúdo de Bardin. Resultados: Os juízes avaliaram os itens “conteúdo”, “ilustrações”, “aparência”, “organização” e “motivação” da cartilha como adequados. As correções e sugestões feitas foram incluídas na versão final da cartilha. Conclusão: A cartilha educativa “Detecção precoce da criança com transtorno do espectro autista – TEA” mostrou-se um material educativo válido e confiável para ser utilizado a fim de favorecer o diagnóstico precoce do paciente com TEA.

Errors in emergency ultrasound (US) have been representing an increasing problem in recent years thanks to several unique features related to both the inherent characteristics of the discipline and to the latest developments, which every medical operator should be aware of. Because of the subjective nature of the interpretation of emergency US findings, it is more prone to errors than other diagnostic imaging modalities. The misinterpretation of US images should therefore be considered as a serious risk in diagnosis. The etiology of error is multi-factorial: it depends on environmental factors, patients and the technical skills of the operator; it is influenced by intrinsic US artifacts, poor clinical correlation, US-setting errors and anatomical variants; and it is conditioned by the lack of a methodologically correct clinical approach and excessive diagnostic confidence too. In this review, we evaluate the common and uncommon sources of diagnostic errors in emergency US during clinical practice, showing how to recognize and avoid them.

Pelvic pain (PP) is common in pregnant women and can be caused by several diseases, including obstetrics, gynaecological, gastrointestinal, genitourinary, and vascular disorders. Timely and accurate diagnosis as well as prompt treatment are crucial for the well-being of the mother and foetus. However, these are very challenging. It should be considered that the physiological changes occurring during pregnancy may confuse the diagnosis. In this setting, ultrasound (US) represents the first-line imaging technique since it is readily and widely available and does not use ionizing radiations. In some cases, US may be conclusive for the diagnosis (e.g., if it detects no foetal cardiac activity in suspected spontaneous abortion; if it shows an extrauterine gestational sac in suspected ectopic pregnancy; or if it reveals a dilated, aperistaltic, and blind-ending tubular structure arising from the cecum in suspicious of acute appendicitis). Magnetic resonance imaging (MRI), overcoming some limits of US, represents the second-line imaging technique when an US is negative or inconclusive, to detect the cause of bowel obstruction, or to characterize adnexal masses.

Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS (contrast enhanced ultrasound) has been shown to be more sensitive than US (ultrasound) for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT (multidetector tomography). CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review, we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during the investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management.

In this study, we aimed to systematically review the current literature on radiomics applied to cross-sectional adrenal imaging and assess its methodological quality. Scopus, PubMed and Web of Science were searched to identify original research articles investigating radiomics applications on cross-sectional adrenal imaging (search end date February 2021). For qualitative synthesis, details regarding study design, aim, sample size and imaging modality were recorded as well as those regarding the radiomics pipeline (e.g., segmentation and feature extraction strategy). The methodological quality of each study was evaluated using the radiomics quality score (RQS). After duplicate removal and selection criteria application, 25 full-text articles were included and evaluated. All were retrospective studies, mostly based on CT images (17/25, 68%), with manual (19/25, 76%) and two-dimensional segmentation (13/25, 52%) being preferred. Machine learning was paired to radiomics in about half of the studies (12/25, 48%). The median total and percentage RQS scores were 2 (interquartile range, IQR = −5–8) and 6% (IQR = 0–22%), respectively. The highest and lowest scores registered were 12/36 (33%) and −5/36 (0%). The most critical issues were the absence of proper feature selection, the lack of appropriate model validation and poor data openness. The methodological quality of radiomics studies on adrenal cross-sectional imaging is heterogeneous and lower than desirable. Efforts toward building higher quality evidence are essential to facilitate the future translation into clinical practice.

Esse artigo tem como objetivo discutir a aplicação de uma sistemática de custeio híbrida em uma clínica de saúde, onde são realizados exames médicos e são disponibilizados consultórios médicos para aluguel, utilizando o Activity-Based Costing (ABC) e a filosofia de custeio por absorção. Para a obtenção dos custos dos exames médicos da clínica foi utilizada a metodologia adaptada da sistemática ABC e para o custeio das salas a serem locadas por outros profissionais foi utilizada a metodologia de custeio por absorção. Na implementação desse sistema, os custos indiretos foram divididos entre os exames e os consultórios com base em vários critérios de apropriação. Foram levantadas todas as atividades ligadas diretamente aos procedimentos executados, assim como aquelas que se relacionam indiretamente com os objetos de custeio. Posteriormente, foi calculado o custo unitário das atividades, sendo obtidos os custos dos dez procedimentos realizados pela empresa. O sistema híbrido foi finalizado com o rateio dos custos indiretos por absorção a cada sala e a obtenção do seu custo de disponibilização. Descritores: Custos de Cuidados de Saúde; Custos e Análise de Custo; Exames Médicos; Aluguel de Propriedade

Abstract Background Multimorbidity is associated with negative effects both on people’s health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12 months, as compared with usual care. Methods/Design Design: pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65–74 years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3 months). Sample size: n = 400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration Clinicaltrials.gov, NCT02866799

Objective: The aim of this study is to better identify the prevailing emotions and feelings of cancer patients during their stay in waiting rooms in a department of oncology. Methods: In July 2014, patients in the waiting rooms of our Department of Oncology were asked to fill out dedicated questionnaires. Patients had to choose sentences that best described their feelings, thoughts and experiences; this part was differentiated according to the waiting rooms (Consultation Rooms versus Day Hospital). In another section, patients were asked to choose their prevailing primary emotions: joy, fear, sadness, anger, disgust or surprise. Results: Two hundred eighty questionnaires were considered valid for statistical analysis. Regarding feelings, all patients in the Day Hospital and Consultation Rooms stated that they feel anxious (48% and 53%, respectively). By differentiating patients according to the setting, patients in the Day Hospital answered that they will face chemotherapy, thinking that it will be useful to defeat the disease (56%), and patients in Consultation Rooms answered that time in the waiting rooms goes more slowly (65%). Regarding the prevailing emotions experienced by patients, sadness was the most selected, followed by fear and surprise. Conclusions: A prevalent emotional and cognitive state while waiting is anxiety, followed by positive thoughts. Patients presented anxiety and fear independently from the setting of care. We believe that each oncologist should be aware of the degrees of fear and sadness that patients experience during an oncological examination because these emotions can have an impact on communication and understanding.

Objetivo: Conhecer a percepção de cuidadoras sobre alimentação, dinâmica familiar e emocional de crianças e adolescentes com câncer. Métodos: Pesquisa descritiva, com abordagem qualitativa das informações, realizada entre março e maio de 2013 em um centro pediátrico de referência no diagnóstico e tratamento do câncer infantojuvenil, em Fortaleza/CE. Foram selecionadas, por amostragem não probabilística, aleatória e por conveniência, 24 cuidadoras de crianças com câncer. Coletaram-se informações por entrevista semiestruturada e grupo focal; posteriormente, realizou-se a análise de conteúdo. Resultados: Definiram-se as seguintes categorias: “Dinâmica familiar e suas implicações emocionais”, “Preocupação com a alimentação saudável” e “Mitos alimentares”. Os conteúdos expõem cuidadoras preocupadas com as mudanças na dinâmica familiar devido à sua ausência constante do lar para dedicarem-se à criança doente. O principal problema enfrentado foi a recusa alimentar da criança doente, pois dele emerge a alimentação como ato de amor, cuidado e cura. As mães referiram aspectos culturais que interferem na organização da dieta de sua família, especificamente os mitos. Conclusão: Na percepção das mães cuidadoras entrevistadas, existem importantes repercussões do diagnóstico de câncer que geram modificações na alimentação, dinâmica familiar e emocional, demandando adaptação da criança doente e de sua família.

In Italy, 5200 new ovarian cancers were diagnosed in 2018, highlighting an increasing need to test women for BRCA1/2. The number of labs offering this test is continuously increasing. The aim of this study was to show the results coming from the intersociety survey coordinated by four different Clinical and Laboratory Italian Scientific Societies (AIOM, SIAPEC-IAP, SIBIOC, and SIGU). A multidisciplinary team belonging to the four scientific societies drew up two different questionnaires: One was targeted toward all Italian Departments of Medical Oncology, and the second toward laboratories of clinical molecular biology. This survey was implemented from September 2017 to March 2018. Seventy-seven out of 305 (25%) Departments of Medical Oncology filled our survey form. Indeed, 59 molecular laboratories were invited. A total of 41 laboratories (70%) filled in the questionnaire. From 2014 to 2017, 16 new molecular laboratories were activated. A total of 12,559 tests were performed in the year 2016, with a mean of 339 tests and a median of 254 tests per laboratory, showing a glimpse of an extreme low number of tests performed per year by some laboratories. In terms of the type and number of professionals involved in the pre- and post-test counseling, results among the onco-genetic team were heterogeneous. Our data show that the number of laboratories providing BRCA1/2 germline assays is significantly increased with further implementation of the somatic test coming soon. The harmonization of the complete laboratory diagnostic path should be encouraged, particularly in order to reduce the gap between laboratories with high and low throughput.

De acordo com a World Health Organization (WHO)(1), a obesidade infantil é um dos mais sérios problemas de saúde pública do século 21, sendo considerado global e afetando principalmente países de baixa e média rendas em áreas urbanas. A prevalência da doença tem aumentado de modo alarmante e, em 2010, o número de crianças menores de cinco anos com sobrepeso foi de mais de 42 milhões, sendo 35 milhões residentes em países em desenvolvimento. No Brasil, o aumento da obesidade é preocupante. O VIGITEL 2013(2) apresenta dados referentes à entrevista realizada com 45,4 mil brasileiros, residentes nas capitais e Distrito Federal (DF), onde 51% dessa população estava com excesso de peso e 17%, com obesidade. Em 2006, os números eram 43% e 11%. Além disso, de acordo com a Pesquisa de Orçamento Familiar – POF (2008- 2009)(3), realizada pelo IBGE, uma em cada três crianças brasileiras com idade entre 5 e 9 anos está com peso acima do recomendado pela WHO(1) e pelo Ministério da Saúde (MS). Entre os jovens de 10 a 19 anos, um em cada cinco apresenta excesso de peso. O problema já afeta 1/5 da população infantil e pode resultar em uma geração futura de obesos, pois crianças obesas se tornam adolescentes obesos e 80% destes chegam à vida adulta também com obesidade. Assim, essa geração de pequenos obesos pode ser vista como futuros hipertensos, diabéticos, com riscos renais, cardiovasculares e cerebrais aumentados. Todos esses fatores reforçam a obesidade infantil como um importante problema de saúde pública no momento em que finaliza o ciclo com indivíduos “sem saúde” e elevados custos para o sistema de saúde pública do país. O Brasil apresenta uma dupla carga de doenças com origem na alimentação, sendo observada a ocorrência de enfermidades causadas pela deficiência de micronutrientes específicos e crescente prevalência de obesidade entre os brasileiros(4). A alimentação inadequada e o sedentarismo têm sido destacados como as principais causas da obesidade infantil. Em uma avaliação sobre os alimentos mais ingeridos pelos brasileiros, foi encontrado que refrigerantes, refrescos, doces e salgados estão entre os 10 alimentos mais consumidos pelos adolescentes, entre os quais não aparecem frutas e vegetais. Esse padrão alimentar reflete os crescentes números de excesso de peso e obesidade nessa faixa etária(5). Este número da RBPS apresenta resultados(6) acerca dos hábitos alimentares de adolescentes obesos de escolas públicas e privadas da cidade de Fortaleza, mostrando que 56,3% não realizavam o café da manhã, 70% não faziam as refeições junto com a família, 56,9% consumiam refrigerantes mais de 3 vezes por semana e mais de 30% frequentavam fast-food. Corroborando com esses hábitos alimentares inadequados, quase 30% dos adolescentes entrevistados foram considerados sedentários ou insuficientemente ativos. Esses achados mostram evidentes fatores de risco para a manutenção da obesidade entre esses adolescentes e refletem os dados do VIGITEL (2013)(2), segundo os quais Fortaleza apresenta 17,5% da sua população adulta com diagnóstico de obesidade. A alimentação infantil é também coordenada pelos hábitos alimentares dos gestores da família. Assim sendo, os adultos brasileiros também fazem uso de refrigerantes e refrescos, mas apresentam entre os 10 alimentos mais consumidos a salada verde(5). Considerando a influência da alimentação dos pais sobre as escolhas das crianças, é fácil perceber que os hábitos alimentares dos pequenos brasileiros estão apoiados sobre os pilares das escolhas inadequadas dos pais. Dessa forma, qualquer intervenção que busque reverter a crescente incidência da obesidade infantil precisa ser trabalhada juntamente com os responsáveis pela aquisição do gênero alimentício: os pais ou responsáveis(7,8). Além da aquisição, o ambiente de realização da refeição, a mídia televisiva, que abrange a “massa” da população, e o ambiente escolar também precisam ser vistos como determinantes dos hábitos e escolhas alimentares dos pequenos infantes, portanto, locais certos para a ação de educação nutricional e incentivo à atividade física(9). Tem sido bem documentada a associação entre a obesidade na infância e sua permanência na adolescência e idade adulta, bem como o desenvolvimento de comorbidades ao longo da vida. Atualmente, as doenças cardiovasculares, diabetes e câncer respondem por 63% de todas as mortes no mundo. Sobrepeso e obesidade em crianças são o provável início da obesidade na idade adulta e também o início do desenvolvimento de doenças não transmissíveis como diabetes e doença cardiovascular. Sobrepeso e obesidade são doenças crônicas altamente preveníveis, mas a duração da obesidade é um fator de risco, independentemente do IMC na idade adulta(7,8). Existe risco aumentado em 2,5 de mortalidade a cada duas décadas de obesidade do indivíduo(7). Todas as comorbidades envolvidas com a presença da obesidade podem ter consequências que extrapolam o corpo do indivíduo e chegam à saúde coletiva no instante em que o obeso trata suas doenças crônicas no serviço público e, desse modo, “injeta” um custo adicional ao tratamento da doença. Assim, considerando os fatores ambientais, entre os quais, alimentação e atividade física, e também o papel do esclarecimento dos pais e da sociedade quanto às escolhas alimentares saudáveis, bem como todos os aspectos emocionais envolvidos com o ato de alimentar-se de uma criança, determinantes no aumento do peso, reforça-se a importância das políticas públicas que visem a prevenção da obesidade nessa faixa etária, a fim de minimizar as consequências epidemiológicas das doenças crônicas originárias dessa condição. Entretanto, é incoerente não falar dos prejuízos psicológicos que acompanham a criança e o adolescente obeso. Não se pode desvincular peso corporal e imagem corporal. Aos dois anos de idade, a imagem corporal da criança já está formada. Entretanto, aos 7 anos, a criança começa a ter noção das dimensões do seu corpo e a se importar com as modificações que acontecem nele. Nesse momento, por influência do grupo ao qual pertence ou deseja pertencer, sua relação com o alimento muda, sendo o ato de alimentar-se visto como uma forma de inserção(9). Assim, sensibilizada com esses questionamentos sobre a obesidade infantil, a RBPS apresenta, rotineiramente, artigos contendo investigações coerentes, a fim de que a prática alimentar seja firmada como garantia da manutenção da saúde e prevenção de doenças nessa fase de formação da personalidade, e incentiva a busca por intervenções sobre as escolhas alimentares saudáveis, que, obrigatoriamente, precisam ser reforçadas e apreendidas por todos que pensam em um futuro com menos obesos e mais crianças saudáveis.

Objective: To assess the nutritional knowledge of women with breast cancer on the dietdisease interface and its association with nutritional status. Methods: Observational, crosssectional and analytical study, conducted between June and September 2011, with 59 women diagnosed with breast cancer, undergoing chemotherapy or radiotherapy treatment, older than 19, who did not receive prior nutritional counseling. Vegetarian women or those whose treatment had been completed more than two years prior to the study were not included. The patients were treated at a cancer care reference center, in Fortaleza-CE. Clinical and socioeconomic data was collected through direct interview and searching in medical records. The assessment of nutritional knowledge (NK) was performed with the Nutrition Knowledge Scale, developed by the National Health Interview Survey Cancer Epidemiology, validated for Brazil, applied by a trained interviewer. Nutritional status was assessed through body mass index (BMI) and waist circumference. Data was analyzed statistically by SPSS 16.0. Results: Among 59 patients evaluated, 18 (30.5%) women had a limited knowledge of the diet-disease association. The mean BMI was 29 kg/m2 (± 4.4) and 47 (79.7%) women presented excessive weight (overweight or obesity). There was no correlation between nutritional knowledge and BMI (p = 0.64). Nutrition knowledge scores were similar among patients with overweight and normal weight (p = 0.89). Conclusion: Women in this study had a limited knowledge of the interface between diet and disease, were overweight, but there was no correlation between their nutritional knowledge and nutritional status.

Objective: To assess the nutritional knowledge of women with breast cancer on the dietdisease interface and its association with nutritional status. Methods: Observational, crosssectional and analytical study, conducted between June and September 2011, with 59 women diagnosed with breast cancer, undergoing chemotherapy or radiotherapy treatment, older than 19, who did not receive prior nutritional counseling. Vegetarian women or those whose treatment had been completed more than two years prior to the study were not included. The patients were treated at a cancer care reference center, in Fortaleza-CE. Clinical and socioeconomic data was collected through direct interview and searching in medical records. The assessment of nutritional knowledge (NK) was performed with the Nutrition Knowledge Scale, developed by the National Health Interview Survey Cancer Epidemiology, validated for Brazil, applied by a trained interviewer. Nutritional status was assessed through body mass index (BMI) and waist circumference. Data was analyzed statistically by SPSS 16.0. Results: Among 59 patients evaluated, 18 (30.5%) women had a limited knowledge of the diet-disease association. The mean BMI was 29 kg/m2 (± 4.4) and 47 (79.7%) women presented excessive weight (overweight or obesity). There was no correlation between nutritional knowledge and BMI (p = 0.64). Nutrition knowledge scores were similar among patients with overweight and normal weight (p = 0.89). Conclusion: Women in this study had a limited knowledge of the interface between diet and disease, were overweight, but there was no correlation between their nutritional knowledge and nutritional status.

Introducción: dada la frecuente consulta de pacientes en el Centro Hospitalario Pereira Rossell (CHPR) cursando embarazos no controlados, surge la necesidad de contar con información sobre las razones por las cuales dichas mujeres no se controlan. Objetivo: analizar las características sociales y culturales de las pacientes que llegan al CHPR en trabajo de parto o puerperio inmediato, y que no han controlado sus embarazos, con el fin de determinar las causas que llevan a estas mujeres a no controlarse. Material y método: estudio descriptivo, observacional, analizándose los datos en forma cuantitativa. Se recolectaron datos del total de embarazos sin control entre los días 1º de mayo al 10 de julio de 2009 en el CHPR o referidas al mismo. La muestra fue de 135 pacientes, en un total de 1.576 nacimientos registrados en dicho período, lo que corresponde a 8,6%. Resultados: se analizaron las características sociales y culturales de la población estudiada. Con respecto al análisis de las causas por las cuales estas pacientes no controlan sus embarazos, 48,9% refiere falta de interés frente al control, siendo la más frecuente independientemente de la edad y paridad de la paciente, seguida de 17,8% que refiere no poder concurrir por tener hijos a su cargo; 10,4% por falta de carné de asistencia; 7,4% por falta de ginecólogo o partera en policlínica de referencia; 4,5% por falta de dinero, y 3,6% por policlínica distante.

Objetivo: Analizar los motivos por los que mujeres estudiantes del área de la salud elijen sus carreras. Material y método: La recolección de información se realizó a través de encuestas de autorespuesta para estudiantes de nuevo ingreso en el año del 2004 de las carreras de medicina, enfermería, odontología y nutrición de la Universidad Autónoma Metropolitana - Xochimilco, México. Solamente se consideraron a las alumnas cuya primera opción fueron las carreras antes señaladas. En total se aplicaron 437 encuestas. La variable independiente fue la internalización de estereotipos de género evaluada mediante el Inventario de Masculinidad y Feminidad. La variable dependiente fueron los motivos por los cuales las estudiantes habían elegido su carrera. Resultados: Las mujeres de medicina tuvieron más rasgos masculinos que las de enfermería y odontología; mientras que las últimas tuvieron más características relacionadas con la sumisión. Las médicas con más frecuencia reportaron haber elegido su carrera por tener cualidades relacionadas con la masculinidad como la toma de decisiones o el prestigio social. Las nutriólogas con más frecuencia señalaron que eligieron su carrera pues les permitía aprender a mantenerse saludables. Las odontólogas indicaron que habían elegido su profesión debido a que les permite cuidar a sus hijos. Conclusiones: La influencia de las normas de género en la trayectoria académica de las mujeres se ve reflejada en las características de las mujeres que estudian cada profesión y en sus motivos de elección de carrera.Objective: To analyze the reasons by which student women of the health area choice their careers. Material and method: The harvesting of the information was made through surveys of auto-response for entrance students in 2004 of the medicine, nursing, odontology and dietetics careers of the Universidad Autónoma Metropolitana - Xochimilco, Mexico. Only were considered the students whose first option was these careers. Altogether 437 surveys were applied. The independent variable was the internalization of gender stereotypes evaluated by means of the Inventory of Masculinidad and Feminidad. The dependent variable was the reasons by which the students had chosen their career. Results: The women from medicine had more masculine characteristics than those of nursing and odontology; whereas the last ones had more characteristics related to the submission. The medical ones reported, with more frequency, to have chosen their career because it has qualities related to the masculinity as the decision making or social prestige. The dietitians with more frequency indicated that they chose their careers because it allowed them to learn to stay healthful. The odontology women indicated that they had chosen their profession because allowed themto take care of its children. Conclusions: The influence of the gender norms in the academic trajectory of the women is reflected in the characteristics of the women that study each profession and in their motives of career selection.

Cell migration is a crucial event in the general process of thymocyte differentiation. The cellular interactions involved in the control of this migration are beginning to be defined. At least chemokines and extracellular matrix proteins appear to be part of the game. Cells of the thymic microenvironment produce these two groups of molecules, whereas developing thymocytes express the corresponding receptors. Moreover, although chemokines and extracellular matrix can drive thymocyte migration per se, a combined role for these molecules appears to contribute to the resulting migration patterns of thymocytes in their various stages of differentiation. The dynamics of chemokine and extracellular matrix production and degradation is not yet well understood. However, matrix metalloproteinases are likely to play a role in the breakdown of intrathymic extracellular matrix contents. Thus, the physiological migration of thymocytes should be envisioned as a resulting vector of multiple, simultaneous and/or sequential stimuli involving chemokines, adhesive and de-adhesive extracellular matrix proteins, as well as matrix metalloproteinases. Accordingly, it is conceivable that any pathological change in any of these loops may result in the alteration of normal thymocyte migration. This seems to be the case in murine infection by the protozoan parasite Trypanosoma cruzi, the causative agent of Chagas' disease. A better knowledge of the physiological mechanisms governing thymocyte migration will provide new clues for designing therapeutic strategies targeting developing T cells.

Cell migration is a crucial event in the general process of thymocyte differentiation. The cellular interactions involved in the control of this migration are beginning to be defined. At least chemokines and extracellular matrix proteins appear to be part of the game. Cells of the thymic microenvironment produce these two groups of molecules, whereas developing thymocytes express the corresponding receptors. Moreover, although chemokines and extracellular matrix can drive thymocyte migration per se, a combined role for these molecules appears to contribute to the resulting migration patterns of thymocytes in their various stages of differentiation. The dynamics of chemokine and extracellular matrix production and degradation is not yet well understood. However, matrix metalloproteinases are likely to play a role in the breakdown of intrathymic extracellular matrix contents. Thus, the physiological migration of thymocytes should be envisioned as a resulting vector of multiple, simultaneous and/or sequential stimuli involving chemokines, adhesive and de-adhesive extracellular matrix proteins, as well as matrix metalloproteinases. Accordingly, it is conceivable that any pathological change in any of these loops may result in the alteration of normal thymocyte migration. This seems to be the case in murine infection by the protozoan parasite Trypanosoma cruzi, the causative agent of Chagas' disease. A better knowledge of the physiological mechanisms governing thymocyte migration will provide new clues for designing therapeutic strategies targeting developing T cells.

Objetivo: Identificar o padrão alimentar a posteriori de mulheres com câncer de mama. Métodos: Estudo observacional, transversal e analítico. Foram avaliadas 100 mulheres com câncer de mama submetidas à quimioterapia / radioterapia, atendidas em um centro de câncer na cidade de Fortaleza, de Julho-Dezembro de 2012. Os dados clínicos, socioeconômicos e antropométricos foram analisados. Para avaliação do consumo foi utilizado um QFA validado, e o consumo diário de cada alimento foi definido em gramas. Então eles foram agrupados de acordo com sua composição nutricional, seguindo a pirâmide alimentar adaptada à população brasileira, em 10 grupos de alimentos. Resultados: Idade média 50,9 anos, com prevalência de carcinoma ductal (83%) em estágio III (60%). A média do IMC indica excesso de peso (28,3 kg/m2) e a circunferência da cintura estava acima do recomendado (98,6 cm). Nós identificamos quatro componentes alimentares e 21% da variância da dieta foi explicado pelo componente alimentar 1 (Risk), com a matriz composta por carne vermelha e processada, óleos e gorduras e cereais. Conclusão: O padrão alimentar das pacientes foi caracterizado por uma dieta de risco.

Thymocyte differentiation is the process by which bone marrow-derived precursors enter the thymus, proliferate, rearrange the genes and express the corresponding T cell receptors, and undergo positive and/or negative selection, ultimately yielding mature T cells that will represent the so-called T cell repertoire. This process occurs in the context of cell migration, whose cellular and molecular basis is still poorly understood. Kinetic studies favor the idea that these cells leave the organ in an ordered pattern, as if they were moving on a conveyor belt. We have recently proposed that extracellular matrix glycoproteins, such as fibronectin, laminin and type IV collagen, among others, produced by non-lymphoid cells both in the cortex and in the medulla, would constitute a macromolecular arrangement allowing differentiating thymocytes to migrate. Here we discuss the participation of both molecules with adhesive and de-adhesive properties in the intrathymic T cell migration. Functional experiments demonstrated that galectin-3, a soluble ß-galactoside-binding lectin secreted by thymic microenvironmental cells, is a likely candidate for de-adhesion proteins by decreasing thymocyte interaction with the thymic microenvironment.

Se realizó un estudio de evaluación del Programa para la Reducción del Bajo Peso al Nacer (BPN) en la provincia de Santiago de Cuba en el período 1990-1996. Se encuestaron los profesionales relacionados con el programa para valorar la forma en que el programa se aplica; sus opiniones complementaron un estudio estadístico sobre el comportamiento del problema en el territorio santiaguero y los principales factores de riesgo e indicadores del BPN. Como parte del trabajo de evaluación del Programa fueron definidos y evaluados un conjunto mínimo de indicadores para estudiar de forma completa el fenómeno del BPN y sus relaciones fundamentales. Toda la información recopilada demuestra que la aplicación del Programa en la provincia no ha sido eficaz, al incumplirse su propósito, objetivos generales y metas a alcanzar para este período; no obstante registrarse efectos positivos por su aplicación y progresos en la lucha contra este problema de salud. En el proceso de gestión del Programa existen algunas dificultades que, conjuntamente con lo anterior, indican que el Programa no es suficiente.An evaluation study of the Program for the Reduction of Low Birth Weight (LBW) was conducted in the province of Santiago de Cuba from 1990 to 1996. Those professionals related to the Program were surveyed to evaluate the form in which the program was applied. Their opinions complemented a statistical study on the behaviour of the problem in that territory and the main risk factors and indicators of LBW. As part of the evaluation of the Program, a minimum set of indicators were defined and evaluated to study the LBW as a whole and is fundamental relations. All the information gathered showed that the application of the Program in that province was not efficient, since its purpose, general objectives and goals for that period were not fulfilled, However, some positive effects were observed due to its application and progresses in the fight against this problem. Some of the difficulties found in the management process of the Program, together with the above mentioned, proved that the Program was not enough.

Se realizó un estudio observacional, descriptivo con el objetivo de identificar el nivel cognoscitivo de los Médicos de Familia del municipio Guanajay en relación con el Programa Nacional de Control de la Tuberculosis y determinar la influencia del nivel cognoscitivo en el cumplimiento de los principales indicadores del programa durante los 4 primeros meses del año 2001. Para ello se aplicó un examen, validado con expertos del tema, realizado durante un mismo día a los 39 Médicos de Familia, e incluía aspectos relacionados con los objetivos del programa, funciones del Médico de Familia, vigilancia de la enfermedad, conducta a seguir con un caso de tuberculosis, tratamiento de la enfermedad, clasificación de los casos, requisitos para la toma de muestra, actividades de control de foco y medidas de educación para la salud. Se concluyó que el nivel de conocimientos sobre el Programa Nacional de Control de la Tuberculosis en los Médicos de Familia del municipio Guanajay no es adecuado en la mayoría de los encuestados, y que el mayor porcentaje de ellos que cumplen con los indicadores evaluados del programa son los que tienen un nivel de conocimientos adecuado.An observational and descriptive study was conducted to identify the level of knowledge of family physicians in Guanajay municipality on the National Program of Tuberculosis Control and to determine the influence of knowledge on the fulfillment of the main indicators of the program during the first four months of the year 2001. To this end, a test, validated by experts in this field, was applied to 39 family physicians on the same day; it included aspects related to the objectives of the program, functions of the family physicians, disease surveillance, behaviour to be followed in a case of tuberculosis, treatment, classification of cases, requirements for sample-taking, foci control activities and health education measures. It was concluded that the level of knowledge on the National Program of Tuberculosis Control by the family physicians in Guanajay municipality was inadequate in most of the examined physicians and that the highest percentage of physicians fulfilling the evaluated indicators of the programs are the ones with adequate level of knowledge about this disease.

Objetivos: difundir la aplicación de una técnica quirúrgica conservadora en el tratamiento de la hemorragia posparto severa secundaria a la atonía uterina y refractaria al tratamiento médico. Material y método: reporte de tres casos clínicos de atonía uterina en los que se realizó la aplicación de la sutura quirúrgica de B-Lynch en el Centro Hospitalario Pereira Rossell. Resultados: en los tres casos se logró un control eficaz de la hemorragia posparto mediante un tratamiento conservador, sin complicaciones durante su aplicación ni en el puerperio inmediato. Conclusiones: la sutura hemostática de B-Lynch es una alternativa aceptada a nivel internacional que forma parte de los protocolos de manejo de la hemorragia posparto. Es una técnica efectiva, simple, reproducible y que permite preservar el potencial reproductivo con particular indicación en pacientes jóvenes. Este es el primer reporte a nivel nacional de la técnica de B-Lynch que pudo ser aplicada sin dificultades y con control adecuado del sangrado.

Abstract Objectives Currently, there are no approved treatments for early disease stages of COVID-19 and few strategies to prevent disease progression after infection with SARS-CoV-2. The objective of this study is to evaluate the safety and efficacy of convalescent plasma (CP) or camostat mesylate administered within 72 h of diagnosis of SARS-CoV-2 infection in adult individuals with pre-existing risk factors at higher risk of getting seriously ill with COVID-19. Camostat mesylate acts as an inhibitor of the host cell serine protease TMPRSS2 and prevents the virus from entering the cell. CP represents another antiviral strategy in terms of passive immunization. The working hypothesis to be tested in the RES-Q-HR study is that the early use of CP or camostat mesylate reduces the likelihood of disease progression to (modified) WHO stages 4b-8 in SARS-CoV-2-positive adult patients at high risk of moderate or severe COVID-19 progression. Trial design This study is a 4-arm (parallel group), multicenter, randomized (2:2:1:1 ratio), partly double-blind, controlled trial to evaluate the safety and efficacy of convalescent plasma (CP) or camostat mesylate with control or placebo in adult patients diagnosed with SARS-CoV-2 infection and high risk for progression to moderate/severe COVID-19. Superiority of the intervention arms will be tested. Participants The trial is conducted at 10–15 tertiary care centers in Germany. Individuals aged 18 years or above with ability to provide written informed consent with SARS-CoV-2 infection, confirmed by PCR within 3 days or less before enrolment and the presence of at least one SARS-CoV-2 symptom (such as fever, cough, shortness of breath, sore throat, headache, fatigue, smell/and or taste disorder, diarrhea, abdominal symptoms, exanthema) and symptom duration of not more than 3 days. Further inclusion criteria comprise: Presence of at least one of the following criteria indicating increased risk for severe COVID-19: Age > 75 years Chronic obstructive pulmonary disease (COPD) and/or pulmonary fibrosis BMI > 40 kg/m2 Age > 65 years with at least one other risk factor (BMI > 35 kg/m2, coronary artery disease (CAD), chronic kidney disease (CKD) with GFR 35 kg/m2 with at least one other risk factor (CAD, CKD with GFR 3 days 10. SARS-CoV-2 PCR detection older than 3 days 11. SARS-CoV-2 associated clinical condition ≥ WHO stage 3 (patients hospitalized for other reasons than COVID-19 may be included if they fulfill all inclusion and none of the exclusion criteria) 12. Previously or currently hospitalized due to SARS-CoV-2 13. Previous antiviral therapy for SARS-CoV-2 14. ALT or AST > 5 x ULN at screening 15. Liver cirrhosis > Child A (patients with Child B/C cirrhosis are excluded from the trial) 16. Chronic kidney disease with GFR

RESUMO Introdução A Rede Universitária de Telemedicina (Rute) é uma iniciativa que visa, no Brasil, promover a integração em telemedicina e telessaúde de hospitais universitários, hospitais certificados de ensino, faculdades de Medicina e profissionais da área da saúde por meio de infraestrutura de tecnologia da informação e comunicação e dos grupos de interesse especial (SIGs). Nesses grupos, que são criados e coordenados por instituições integrantes da Rute, profissionais de saúde e pesquisadores planejam uma agenda de videoconferências e/ou webconferências para debater temas específicos. Este artigo apresenta resultados da classificação dos SIGs da Rute em grupos homogêneos com base em sua produção em comunicação, cooperação e coordenação (3C). Métodos Foi realizado um inquérito com coordenadores dos SIGs entre abril e maio de 2016. A classificação dos SIGs em grupos homogêneos considerou as atividades desenvolvidas na rede entre 2007 e o momento da aplicação do inquérito. O estudo é retrospectivo, baseado em dados históricos das unidades, instituições e SIGs. Os coordenadores de 71 SIGs Rute foram convidados a responder. Desses, 45 SIGs ativos responderam ao inquérito de avaliação por completo e foram considerados nas análises. Resultados Quase um terço dos coordenadores respondentes (35%) declarou que seus SIGs atuam no eixo ensino, 21% atuam nos eixos de assistência e pesquisa, desenvolvimento e inovação, enquanto 12% atuam em gestão e 11% em avaliação. Foi feita a classificação dos SIGs em três grupos homogêneos – colaboração emergente, colaboração em desenvolvimento e colaboração plena – e identificado que, fora das sessões, 71% dos 45 SIGs (11 do grupo colaboração emergente e 20 do grupo em desenvolvimento) usam correio eletrônico como principal ferramenta de comunicação. Quatro SIGs do grupo colaboração plena indicaram: uso de serviço de mensagens instantâneas (1 SIG), site próprio (1 SIG) e redes sociais (2 SIGs). Conclusão Os resultados deste estudo podem não aferir com precisão a real produção e colaboração que os SIGs desenvolvem. Sugere-se, portanto, apreciar esta análise como um ponto de partida ou um referencial para a comunidade Rute. Porém, os resultados indicam que o desenvolvimento da colaboração na Rute e nos SIGs verificado nas análises é significativo, apontando uma evolução positiva para a Rute quanto ao interesse, participação e divulgação de ações em telemedicina e telessaúde no País.

Introducción: La morbimortalidad por COVID-19 se asocia principalmente con el síndrome respiratorio agudo severo (SARS), relacionado con una respuesta inmunitaria aumentada del huésped con aumento de los niveles circulantes de citoquinas. Métodos: En este estudio prospectivo, multicéntrico, de un solo brazo (en comparación con un control histórico), en fase 2, se agregó ruxolitinib 5 mg dos veces al día al estándar de tratamiento en pacientes con COVID-19. El objetivo principal fue determinar la eficacia y seguridad de ruxolitinib en pacientes con SARS relacionado con COVID-19. Resultados: aunque no fue posible demostrar una reducción significativa de la proporción de pacientes con neumonía por COVID-19 que requerían ingreso en la unidad de cuidados intensivos y ventilación mecánica (criterio de valoración principal), se observó una tendencia a una menor tasa de mortalidad en los pacientes críticos que recibieron ruxolitinib. La dosis de ruxolitinib administrada tuvo que aumentarse de acuerdo con el protocolo en el 32% de los pacientes, sin toxicidad adicional. Conclusión: El perfil de efectos secundarios fue manejable y el fármaco en estudio no causó lesiones orgánicas directas. El ruxolitinib tuvo un efecto antiinflamatorio rápido y un tercio de los pacientes manifestó bienestar inmediatamente después de comenzar el tratamiento.