Abstract Background In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH). Objective To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease. Methods A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05. Results Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters. Conclusions This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes.

ABSTRACT Objective: CYP21A2 mutation heterozygote carriers seem to have an increased risk of hyperandrogenism. However, the clinical relevance of the heterozygote carrier status and the reliability of hormonal testing in discriminating a carrier from a non-carrier are puzzling questions. We aimed to characterize a population of Portuguese females suspected of having non-classic congenital adrenal hyperplasia (NC-CAH) due to clinical and biochemical criteria and who have undergone CYP21A2 molecular analysis. Subjects and methods: Retrospectively, we have analyzed the clinical records of 131 females (32 girls aged 3-9 and 99 adolescents and premenopausal women aged 13-49) who underwent complete CYP21A2 molecular analysis due to suspicion of NC-CAH. We divided included participants into three groups according to the CYP21A2 molecular analysis: NC-CAH females (46), heterozygous carriers (49), and wild type (36). We then compared clinical signs and symptoms as well as biochemical and molecular data between carriers and NC-CAH individuals and between carriers and wild type females. We measured 17OHP by electrochemiluminescence immunoassay. Results: Clinical features were similar between groups. Heterozygous carriers presented higher basal and post-cosyntropin 17-hydroxyprogesterone (17OHP) than wild type individuals (p < 0.05) and lower basal and stimulated 17OHP levels than NC-CAH patients (p < 0.05). We discovered a considerable overlap between 17OHP levels among groups. The most common pathogenic variant we identified was p.Val282Leu. Conclusion: In this population of hyperandrogenic women and children, heterozygous carriers showed higher basal and stimulated 17OHP than non-carriers although normal basal and stimulated 17OHP responses do not exclude heterozygosity for CYP21A2 pathogenic variants. In this study, only the molecular analysis presented good sensitivity in identifying heterozygotes.

Abstract Background: The cycle threshold (Ct) of real-time reverse transcription PCR (RT-qPCR) indicates the relative concentration of an RNA sequence, this value has been related to clinical profile in viral infections. Aim: To determine the correlation between the Ct value and the clinical classification of COVID-19. Method: A correlational cross-sectional study was carried out, the Ct values were obtained by RT-qPCR directed to the N gene of SARS-CoV-2, grouping them by means of a central robust estimator and related to the clinical classification of COVID-19. Results: Of the 718 cases included in the study; 77.7% (558) were mild; 21.3% (153) moderate and 1% (7) severe. The Ct value was grouped into levels: low Ct < 18.83; medium Ct> 18.83-30.10 and high Ct> 30.10. There was a weak inverse significant correlation (p = 0.002; Spearman’s rho = -0.117) between the Ct value and the clinical classification. The characteristics: sex, age under 65 years, fever, chills, diarrhea, anosmia, and overweightobesity were associated with the Ct value. Conclusion: The lower the Ct value, a classification of greater severity of COVID-19 is expected, however, because the correlation is weak, its usefulness as a severity predictor is limited.

Resumen Introducción: El umbral de ciclo (en inglés cycle threshold-Ct) de la reacción de polimerasa en cadena en tiempo real con transcripción reversa (RT-qPCR) indica la concentración relativa de una secuencia de ARN; este valor se ha relacionado con la expresión de cuadros clínicos en infecciones virales. Objetivo: Determinar la correlación entre el valor Ct y la clasificación clínica de la COVID-19. Método: Se realizó un estudio transeccional correlacional; los valores Ct se obtuvieron mediante RT-qPCR dirigida al gen N del SARS-CoV-2 agrupándolos mediante un estimador robusto central y relacionándose con la clasificación clínica de la COVID-19. Resultados: De los 718 casos incluidos en el estudio; 77,7% (558) fueron leves; 21,3% (153) moderados y 1% (7) graves. El valor Ct se agrupó en niveles: Ct bajo < 18,83; Ct medio > 18,83 - 30,10 y Ct alto > 30,10. Existió correlación significativa inversa débil (p = 0,002; rho de Spearman = -0,117) entre el valor Ct y la clasificación clínica. Las características: sexo, edad menor a 65 años, fiebre, escalofrío, diarrea, anosmia y sobrepeso-obesidad estuvieron asociadas al valor de Ct. Conclusión: A menor valor Ct se espera una clasificación de mayor gravedad de la COVID-19; no obstante, debido a que la correlación es débil, su utilidad como predictor de gravedad es limitada.

Abstract: Measuring the natural resistance of wood is fundamental for proper use. The natural durability of five tropical wood species was investigated by field decay testing during exposure for 360 days. Wood logs (length of 0,5 m; diameter of 8 cm - 12 cm) were used in this study. The mass loss and decay index were calculated and visual analysis during the exposure time was performed for all samples. The samples presented evidence of two different groups concerning natural durability. The species in the first group (Mimosa caesalpiniifolia, Mimosa ophthalmocentra, and Mimosa tenuiflora) showed the highest resistance to biodeterioration, better or similar performance compared to treated Eucalypts wood (as control). The other group (Aspidosperma pyrifolium and Cordia oncocalyx) had lower natural resistance in outdoor service, being more susceptible to decay. In general, the wood of the first group is indicated for outdoor uses that require medium or prolonged exposure, such as timber stakes and fence posts.

ABSTRACT Introduction: Malignant triton tumor is a rare neoplasm in which rhabdomyoblasts are present in a malignant tumor of the peripheral nerve sheath. This condition is characterized by its aggressiveness and bad prognosis. Location in the head and neck is infrequent. Immunohistochemical testing plays an important role in its diagnosis. Objective: Describe an unusually large malignant triton tumor. Case presentation: A case is presented of a female 16-year-old patient referred to the maxillofacial surgery service of the National Institute of Pediatrics in Mexico City with a diagnosis of neuroectodermal tumor of one year's evolution in the facial and cervical region. In clinical terms, the tumor was exophytic, multilobed, with extensive areas of necrosis, a surface in several shades of color and an approximate size of 18 x 10 x 12 cm. Biopsy and immunohistochemical testing confirmed the diagnosis of malignant triton tumor. The patient underwent surgery in which the lesion was totally excised with a safety margin. Evolution was clumsy, with a fatal outcome at six months of treatment. Conclusions: Triton tumor is an aggressive neoplasm whose early detection makes it possible for surgeons to provide an appropriate treatment.

RESUMEN Introducción: El tumor tritón maligno es una neoplasia rara en la que se encuentran células rabdomioblásticas en un tumor maligno de la vaina de nervios periféricos, que se caracteriza por su agresividad y mal pronóstico. La localización en la cabeza y el cuello es poco frecuente. La inmunohistoquímica juega un papel importante en el diagnóstico. Objetivo: Describir un tumor tritón maligno de tamaño inusual. Presentación del caso: Paciente femenino, de 16 años, es referida al servicio de cirugía maxilofacial del Instituto Nacional de Pediatría, Ciudad de México, con un diagnóstico de tumor neuroectodérmico en región facial y cervical de un año de evolución. Clínicamente el tumor era exofítico, multilobulado, con zonas extensas de necrosis, superficie de varias tonalidades y un tamaño aproximado de 18 x 10 x 12 cm. Se realizó una biopsia e inmunohistoquímica que confirmó el diagnóstico de tumor tritón maligno. La paciente fue intervenida quirúrgicamente, procedimiento con el cual se eliminó totalmente la lesión, con márgenes de seguridad. La paciente presentó una evolución tórpida, con desenlace fatal al cabo de seis meses del tratamiento. Conclusiones: El tumor tritón es una neoplasia agresiva y su detección oportuna orienta al cirujano a ofrecer al paciente un tratamiento adecuado.

Resumo Em 2019, a taxa de distorção idade-série foi de 23,4% e 26,2% para os anos finais do ensino fundamental e do ensino médio, respectivamente. As elevadas taxas de distorção idade-série (TDI) reduzem a escolarização e elevam os custos decorrentes do atraso escolar. O objetivo desse trabalho é estimar o efeito do Programa Bolsa Família (PBF) sobre a distorção idade-série. Foram utilizados os microdados do Suplemento Educação da Pesquisa Nacional de Amostras por Domicílio Contínua, referente ao 2º Trimestre dos anos de 2016 a 2019, e a técnica utilizada foi o Propensity Score Matching (PSM). Os resultados mostraram que participar do PBF reduz entre 2,23 e 6,02 p.p. a TDI. Os efeitos são maiores para os meninos, redução entre 3,99 e 7,22 p.p., e na região Centro-Oeste, cuja redução foi de 11,1 p.p. Os resultados nos levaram a concluir que o PBF gera efeitos positivos sobre indicadores educacionais.

Abstract In 2019, the age-grade distortion rate was 23.4% and 26.2% for the final years of elementary and high school, respectively. The high rates of age-grade distortion (TDI) reduce schooling and increase costs due to school delay. The objective of this work is to estimate the effect of the Bolsa Familia Program (PBF) on age-grade distortion. The microdata from the Education Supplement of the National Sample Survey by Continuous Household for the 2nd Quarter of the years 2016 to 2019 were used, and the technique used was the Propensity Score Matching (PSM). The results showed that participating in the PBF reduces between the distortion 2.23 and 6.02 p.p. The effects are greater for boys, reduction between 3.99 and 7.22 p.p., and in the Midwest region, whose reduction was 11.1 p.p. The results led us to conclude that the PBF generates positive effects on educational indicators.

Resumo: Introdução: A residência médica é reconhecida como o “padrão ouro” para a formação de especialistas. O estudo do perfil dos egressos da residência médica é importante para identificar potencialidades e fragilidades da especialização. Objetivo: Este estudo teve como objetivo conhecer o perfil e a satisfação profissional dos egressos dos programas de residência das áreas básicas de um hospital-escola do Nordeste. Método: Trata-se de estudo de corte transversal que utilizou a plataforma eletrônica Survey. Incluíram-se residentes das áreas básicas que concluíram o programa no período de 2013 a 2017. O Termo de Consentimento Livre e Esclarecido foi enviado com o formulário. Realizaram-se análises descritivas das variáveis, e os dados foram apresentados em frequências absoluta e relativa. O trabalho foi aprovado pelo Comitê de Ética do IMIP. Resultados: Dentre os 194 egressos, tivemos a adesão de 79 (40,72%). Com relação aos participantes do estudo: 73,4% eram do gênero feminino e 60,8% já estavam casados. Destacamos que 55,7% informaram que tinham uma renda mensal de dez a 20 salários mínimos. Dos egressos, 54 (68,4%) tinham cursado graduação em instituição de ensino superior privada. Sobre a pós-graduação stricto sensu, 19 egressos (21,7%) tinham mestrado. Sobre a atuação profissional, 93,7% exercem a especialidade e 54 (68,4%) trabalham no estado onde cursaram o programa. Em relação ao serviço público, 64,6% são vinculados ao Sistema Único de Saúde do estado de Pernambuco. Sobre a quantidade de horas de trabalho semanais, 43% trabalham entre 40 e 60 horas. Cerca de 75% dos egressos afirmaram que cursariam o programa novamente na instituição e declararam que a realização da residência facilitou a vida profissional deles. Conclusão: A monitoração periódica de egressos de programa de residência é um instrumento útil para avaliação do programa e permite monitoramento das intervenções implementadas, viabilizando inclusive a obtenção de informações que ajudem no planejamento de novos programas.

Abstract: Introduction: medical residency is known as the “gold standard” for the qualification of specialists. Research into the profile of medical residency program graduates is important to identify potentialities and fragilities of the specialization. Objective: The objective of this study was to understand the profile and professional satisfaction of the graduates from the residency programs of basic medical areas of a teaching hospital in the northeast of Brazil. Methods: a cross-sectional study was conducted through an online questionnaire that was sent to the participants via electronic mail. The study population consisted of residency program graduates of the basic medical areas who graduated between 2013 and 2017. The Informed Consent Form was sent together with the form. Descriptive analyses were performed and data were presented as relative and absolute frequencies. The study was approved by the Research Ethics Committee of the IMIP. Results: of the 194 graduates, 79 (40.72%) answered the questionnaire. 73.4% were female and 60.8% were married. Approximately 55.7% of the graduates earned salaries corresponding to 11 and 22 minimum monthly wages. 54 graduates (68.4%) had attended a private medical school. Regarding stricto sensu postgraduate studies, 19 (21.7%) had a master´s degree. 93.7% are practicing their medical specialization and 54 (68.4%) still live in Pernambuco. Regarding public service, 64.6% are linked to the Unified Health System of Pernambuco state. 43% of the graduates worked between 40 and 60 h per week. About 75% of the graduates stated that they would attend the program again at the hospital and declared that completing the residency at the institution facilitated their professional life. Conclusion: the periodic monitoring of graduates from a residency program is a useful tool for evaluating the program and allows for surveillance of implemented interventions

RESUMO Introdução: A angiopatia amiloide cerebral (AAC) é uma desordem vascular causada pela deposição progressiva de peptídeos β-amiloides nas paredes de pequenos e médios vasos corticais e leptomeníngeos. Até a presente data, a epidemiologia da AAC é desconhecida em nossa região. Objetivos: Avaliar a prevalência da AAC em uma população específica de pacientes idosos de um hospital terciário no nordeste brasileiro. Métodos: Estudo transversal, retrospectivo, com seleção de pacientes com idade igual ou superior a 65 anos, acompanhados no serviço de Neurologia do Hospital Universitário da Universidade Federal do Piauí, Brasil, e que foram submetidos a exame de ressonância nuclear magnética entre julho de 2016 e junho de 2018. Resultados: Foram recrutados 174 pacientes, dos quais 100 eram mulheres (57,4%) e 74 homens (42,6%), com idades entre 65 e 91 anos (média de 73,27). Nove pacientes foram excluídos devido à indisponibilidade de sequências de ressonância magnética necessárias para uma análise apropriada. Dos 165 pacientes restantes, 12 (7,2%) foram diagnosticados com AAC de acordo com os critérios de Boston modificados. Conclusão: A prevalência da AAC em nosso estudo foi semelhante ao resultado encontrado na literatura médica, com um aumento progressivo relacionado à idade.

ABSTRACT Background: Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by progressive deposition of β-amyloid peptides in the walls of small and medium-sized cortical and leptomeningeal vessels. Until today, the prevalence of CAA is unknown in our region. Objective: This study aims to analyze the prevalence of this entity in a specific elderly population in a tertiary hospital in Northeastern Brazil. Methods: A cross-sectional, retrospective study with the enrollment of patients aged 65 or older followed in the neurological outpatient service of the Universidade Federal do Piauí, Brazil, who underwent brain magnetic resonance imaging (MRI) from July 2016 to June 2018. Results: One hundred and seventy-four patients were enrolled, of whom 100 were women (57.4%) and 74, men (42.6%), aged from 65 to 91 years old (median age 73.27). Nine patients were excluded from the study due to unavailability of MRI sequences needed for an appropriate analysis. Out of the 165 remaining patients, 12 (7.2%) had established the diagnosis of CAA, according to the modified Boston criteria. Conclusion: The prevalence of CAA in our study was like those of medical literature, with a progressive age-related increase.

RESUMO Vertissolos Háplicos e Neossolos Quartizarênicos estão entre as principais classes de solos utilizadas para a produção de melão, na região semiárida do Brasil. O potássio (K) é o nutriente mais extraído pelos frutos de melão amarelo; por isso, nesses solos, são frequentemente aplicadas altas doses de fertilizantes potássicos. Objetivou-se avaliar as frações de K em solos da região semiárida do Brasil, durante o ciclo de cultivo do melão amarelo fertirrigado. Dois experimentos foram conduzidos em duas classes de solo (Vertissolo Háplico e Neossolo Quartzarênico). Para o Vertissolo, os tratamentos compreenderam arranjo fatorial 7 x 2 [sete períodos de avaliação e duas camadas de solo (0-20 cm e 20-40 cm)], com quatro repetições, totalizando 56 unidades experimentais. Para o Neossolo, os tratamentos compreenderam arranjo fatorial 9 x 2 [nove épocas de coleta e duas camadas de solo (0-20 cm e 20-40 cm)], com quatro repetições, totalizando 72 unidades experimentais. A fração K não trocável foi dominante em ambos os solos, principalmente na camada de 0-20 cm, e representa importante reserva desse nutriente para o cultivo de melão, principalmente no Vertissolo. A diminuição nas concentrações das formas solúvel e trocável e o aumento da forma não trocável indicaram aumento na fixação desse nutriente, por fixação no Vertissolo e lixiviação no Neossolo, ao final do ciclo do melão, quando a quantidade de K acumulada pela planta foi menor.

ABSTRACT Haplic Vertisols and Typic Quartzipsamments are among the main classes of soils used for melon production in the Brazilian semiarid region. Potassium (K) is the nutrient most extracted by yellow melon fruits and, for this reason, high doses of potassium fertilizers are often applied to these soils. This study aimed to evaluate potassium fractions in soils of the Brazilian semiarid region, during the cultivation cycle of fertigated yellow melon. Two experiments were carried out with two types of soil (Haplic Vertisol and Typic Quartzipsamment). For the Vertisol, a 7 x 2 [seven evaluation periods and two soil layers (0-20 cm and 20-40 cm)] factorial arrangement was established, with four replications, totaling 56 experimental units. For the Quartzipsamment, a 9 x 2 [nine collection times and two soil layers (0-20 cm and 20-40 cm)] factorial arrangement was used, with four replications, totaling 72 experimental units. The non-exchangeable K fraction was dominant in both soils, mainly in the 0-20 cm layer, and represents an important reserve of this nutrient for melon cultivation, especially in Haplic Vertisols. The decrease in the concentrations of the soluble and exchangeable forms and the increase in the non-exchangeable form indicated an increase in the fixation of this nutrient, by fixation in the Vertisol and leaching in the Quartzipsamment, at the end of the melon cycle, when the amount of K accumulated by the plant was lower.

Resumo A durabilidade natural da madeira trata-se de excelente característica para destinar as peças de madeira em condições adequadas e eficientes de uso. Portanto, o estudo objetivou-se avaliar a resistência natural de seis espécies florestais madeireiras a cupins xilófagos em condição de campo. As madeiras estudadas das espécies tropicais foram andiroba (Carapa guianensis Aubl.), aroeira (Myracrodruon urundeuva Allemão), cedro (Cedrella sp.), jatobá (Hymenaea courbaril L.), louro canela (Nectandra sp.) e maçaranduba (Manilkara elata (Allemão ex Miq.) Monach.). De cada espécie foram produzidas amostras com dimensões de 7,2 cm × 1,3 cm × 0,9 cm (longitudinal × radial × tangencial). Essas permaneceram expostas por período de 40 dias sob a ação de cupins Nasutitermes corniger Motschulsky em ensaio de preferência alimentar, com determinação da densidade, percentual de perda de massa, índice de deterioração e o índice de susceptibilidade. A madeira de andiroba apresentou maior perda de massa e susceptibilidade ao ataque de N. corniger. Já as espécies cedro e o louro canela demonstraram valores intermediários entre as demais para os aspectos analisados. As madeiras de aroeira, jatobá e maçaranduba se destacaram nos valores de notas atribuídas ao desgaste, bem como, na baixa susceptibilidade ao ataque, tendo demonstrado maior durabilidade natural e resistência biológica ao ataque. Portanto, essas últimas madeiras são as mais indicadas para utilizações que visem promover o seu uso eficiente, a fim de minimizar os danos causados por exposição às térmitas (cupins) xilófagos e maximizar a vida útil e segurança do produto madeireiro.

Abstract The natural durability of the wood is an excellent characteristic for the use of wood parts under proper and efficient conditions of use. This work aimed to evaluate the natural resistance of six wood forest species to xylophagous termites in field conditions. The woods studied were Carapa guianensis Aubl, Myracrodruon urundeuva Allemão, Cedrella sp., Hymenaea courbaril L., Nectandra sp. and Manilkara elata (Allemão ex Miq.) Monach. Test samples with dimensions of 7.2 cm × 1.3 cm × 0.9 cm (longitudinal × radial × tangential) were made from each wood species. They remained exposed for 40 days under the action of Nasutitermes corniger Motschulsky termites in a food preference test, Carapa guianensis wood presented greater mass loss and susceptibility to attack by N. corniger. On the other hand, the species Cedrella sp. and Nectandra sp. showed intermediate values among the others to the analyzed aspects. The woods of Carapa guianensis, Hymenaea courbaril and Manilkara elata stood out in the grade values attributed to the wear, as well as the low susceptibility. Therefore, these latter woods are best suited for use in order to promote their efficient use, minimize damage caused by exposure to xylophagous termites and maximize the useful life and safety of the timber product.

ABSTRACT A frail tetraparetic patient suffered from a sacral pressure ulcer which had been refractory to conservative topical treatment, consisting in postural hygiene and application of silver sulfadiazine cream. A gluteal flap surgery had been scheduled but, due to the high anesthetic risk, the patient was offered to try to heal the ulcer with topical sevoflurane, which was accepted. Sevoflurane was daily applied at home, and the wound condition successfully improved, showing a progressive reduction in its size and deepness until it was considered fully healed after few weeks; as a consequence, the scheduled surgery was avoided. Off-label use of topical sevoflurane on complicated wounds seems to be valuable, since it represents a noninvasive alternative and it is very easy to perform.

RESUMEN Una paciente frágil tetraparética presentaba una úlcera por presión sacra que se había mostrado resistente al tratamiento conservador tópico, consistente en higiene postural y curas con sulfadiazina de plata. Fue programada para cirugía de cobertura con colgajo glúteo, pero ante el elevado riesgo anestésico se le ofertó intentar curar la herida con sevoflurano tópico, lo cual fue aceptado. El sevoflurano fue aplicado diariamente en domicilio, y la herida evolucionó satisfactoriamente, con reducción progresiva de la superficie y la profundidad hasta cerrar por completo en pocas semanas, evitándose así una intervención quirúrgica. El empleo fuera de indicación de sevoflurano irrigado tópicamente sobre el lecho de heridas complejas aparece como una herramienta muy ventajosa, pues supone una alternativa a medidas más invasivas y es de fácil aplicación.

RESUMO Perder e, sobretudo, manter o peso perdido a longo prazo continua a ser um desafio para a maioria dos indivíduos, apesar da investigação emergente nesta área. A identificação de fatores chave na gestão do peso é assim essencial para melhorar a eficácia das intervenções comportamentais de tratamento do excesso de peso e obesidade. Esta revisão conceptual de revisões pretende sumariar o estado da arte no que respeita aos preditores comportamentais e psicossociais da perda e manutenção do peso perdido a longo-prazo, em indivíduos com excesso de peso e obesidade envolvidos em intervenções no estilo de vida. Os principais preditores que explicam o sucesso na perda e manutenção do peso perdido a longo prazo são os que afetam diretamente o equilíbrio energético, seja pelo aumento do gasto energético, através da prática de maiores níveis de atividade física, seja pela redução do aporte energético, através do aumento do aporte proteico e de fibra alimentar em detrimento do aporte de gordura e açúcar. Uma maior perceção de autoeficácia para realizar uma alimentação saudável, praticar atividade física regularmente e gerir o peso, assim como o desenvolvimento de competências autorregulatórias, como a automonitorização do peso e dos comportamentos associados, parecem ser fatores complementares chave. No que se refere a preditores de pré-tratamento, o único que se revela consistentemente associado ao sucesso na gestão do peso a longo prazo é um menor número de tentativas de perda de peso anteriores, provavelmente porque a experiência de repetidas tentativas mal sucedidas pode estar relacionada com um perfil psicológico mais vulnerável ao insucesso, caracterizado por atitudes de ceticismo e passividade.

Despite the increasing research on weight management, weight loss and weight loss maintenance remain a challenge for most of those trying to manage their weight. Identifying key factors in weight management is therefore essential to make obesity interventions more effective. This conceptual review of reviews aims to assemble the state of the art in what concerns the behavioural and psychosocial predictors of weight loss and weight loss maintenance in the long run, in individuals with overweight and obesity involved in lifestyle interventions. The main predictors of successful long-term weight loss and maintenance are those directly affecting energy balance, either by increasing energy expenditure through physical activity, or by reducing energy intake through increased protein intake and dietary fiber, and reduced fat and sugar intake. Higher perception of self-efficacy for healthy eating, physical activity and weight management, as well as self-regulatory skills, like self-monitoring of weight and related behaviors seem to be key ancillary factors. Fewer previous weight loss attempts is the only consistent pretreatment predictor of successful long-term weight management, potentially because a history of recurrent dieting attempts can be related to a psychological profile that is more vulnerable to failure, characterized by attitudes of skepticism and passivity.

RESUMO As fraturas posteriores do assoalho orbital são desafiadoras, visto que a incompleta visualização do defeito por meio dos acessos cirúrgicos convencionais poderá comprometer o resultado cirúrgico. O uso do endoscópio como método auxiliar durante as reconstruções orbitais pode ser considerado uma ferramenta de grande importância principalmente para visualização de toda a extensão da fratura e adaptação das malhas ou enxertos ósseos. Este trabalho tem como objetivo relatar um caso clínico de um paciente diagnosticado com uma extensa fratura blowout apresentando clinicamente diplopia, enoftalmo e oftalmoplegia em supraversão, o qual foi submetido a tratamento através da abordagem subciliar combinada com a cirurgia vídeo-assistida transantral. O procedimento foi realizado sem intercorrências, estando o paciente com 1 ano de acompanhamento, com função e arquitetura orbital restabelecidos.

ABSTRACT Posterior fractures of the orbital floor are challenging, since an incomplete visualization of the defect through conventional surgical accesses may compromise the surgical outcome. The use of the endoscope as an auxiliary method during orbital reconstructions may be considered as a tool of considerable importance, mainly due to the visualization of the whole extension of fracture and adaptation of meshes or bone grafts. This study aims to report a clinical case of a patient diagnosed with extensive blowout fracture showing diplopy, enophthalmos, and ophthalmoplegia in supraversion, who underwent a subciliary approach combined with transantral video assisted surgery. There were no intercurrences on the procedure. Currently, patient has 1 year of follow up, with reestablished orbital function and architecture.

ABSTRACT From September 8 to 10, 2017, the Cuban archipelago was strongly beaten by hurricane Irma. In this paper it is performed the analysis of floods by sea invasions occurred through Havana´s seawall, due to sea level increment induced by breaking waves. The main objective is to update the map of coastal floods for Centro Habana and Plaza de la Revolucion municipalities, and to offer assessments about the wave pressure on protection works. It was employed Mapinfo geographic information system for updating the flood extension layer on capital area adjacent to Havana´s seawall, and it was applied a computing methodology for obtaining the wave impact force on vertical structures, taking into account lineal theory. It was concluded that was very significant the wave intensity that came on deep water boundary adjacent to Havana´s seawall from September 9 at night up to September 10, with significant waves among 7,0 and 9,0 meters height that provoked extremely strong coastal floods, according to Marine Meteorology Center of the Institute of Meteorology, and it was obtained the impact forces values that resulted in the throwing of rock pieces weighting between 1 and 3 tons.

RESUMEN Durante los días 8 al 10 de septiembre de 2017, el archipiélago cubano fue afectado grandemente por el huracán Irma. En este trabajo se emprende el análisis de las inundaciones costeras ocurridas en el Malecón de La Habana, debidas al incremento del nivel el mar inducido por el oleaje incidente. El objetivo principal es actualizar el mapa de inundaciones costeras para los municipios Centro Habana y Plaza de la Revolución, y ofrecer valoraciones sobre la presión del oleaje incidente sobre las obras de protección. Fue empleado el sistema Mapinfo para actualizar la capa de alcance de las inundaciones en la zona de la capital aledaña al malecón, y se aplicó una metodología para el cálculo de la potencia de impacto de la ola sobre las estructuras, considerando la teoría lineal. Se concluyó que fue muy significativa la intensidad del oleaje que llegó al límite de aguas profundas adyacentes al Malecón habanero desde la noche del 9 hasta el 10 de septiembre, con altura significativa entre 7,0 - 9,0 metros que dieron lugar a inundaciones catalogadas de fuertes en extremo, según clasificación del Centro de Meteorología Marina del INSMET, y se obtuvo el valor de la potencia de impacto del oleaje que arrojó sobre la costa fragmentos de roca con pesos entre 1 y 3 toneladas.