Resumen El osteocondroma es el tumor óseo benigno más frecuente, representa el 35% de los tumores óseos benignos y el 8% de los tumores óseos. Está formado por una exostosis de hueso trabecular recubierta de cartílago que afecta la región metafisaria de los huesos largos, a partir del cartílago de crecimiento, alrededor de la rodilla, en el hombro o la muñeca, y es extremadamente raro en las falanges de la mano o el pie. Crece durante la niñez y la adolescencia hasta alcanzar la madurez esquelética; por lo tanto, su crecimiento en un adulto sugiere la transformación maligna en condrosarcoma, aunque también existen reportes sin malignización. Además, el calcáneo es un hueso corto, por lo que, desde el punto de vista fisiopatológico, sería inesperada la aparición de este tipo de lesión. El objetivo de este artículo es presentar un caso de osteocondroma de calcáneo solitario con crecimiento después de la madurez esquelética, su diagnóstico y tratamiento, así como una revisión bibliográfica. Esta presentación de caso es importante, dados la localización infrecuente y el potencial de transformación maligna del osteocondroma, y la escasa bibliografía sobre el tema.

Abstract Osteochondroma is the most common benign bone tumor, accounting for 35% of benign bone tumors and 8% of bone tumors. It is formed by an exostosis of trabecular bone covered with cartilage that affects the metaphyseal region of long bones, from the growth plate, around the knee, in the shoulder or wrist, and it is extremely rare in the phalanges of the hand or foot. It grows during childhood and adolescence until skeletal maturity. Therefore, its growth in an adult suggests a malignant transformation into chondrosarcoma, although there are also reports without malignancy. Furthermore, the calcaneus is a short bone, so the appearance of this type of injury would be pathophysiologically unexpected. Our objective is to present a case of solitary calcaneal osteochondroma with growth after skeletal maturity, its diagnosis and treatment, as well as a review of the literature. Its relevance stems from the scarcity of literature, its uncommon location, and the possibility of malignancy.

ABSTRACT Purpose: As digital devices are increasingly used at work, valid and reliable tools are needed to assess their effect on visual health. This study aimed to translate, cross-culturally adapt, and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Portuguese. Methods: A 5-phase process was followed: direct translation, synthesis of translation, back-translation, consolidation by an expert committee, and pretest. To run the pretest, a cross-sectional pilot study was conducted with 26 participants who completed the prefinal Portuguese version of the CVS-Q© and were asked about difficulties, comprehensibility, and suggestions to improve the questionnaire. To evaluate the reliability and validity of the Portuguese version of the CVS-Q©, a cross-sectional validation study was performed in a different sample (280 workers). Results: In the pretest, 96.2% had no difficulty in completing it, and 84.0% valued it as clear and understandable. CVS-Q© in Portuguese (Questionário da Síndrome Visual do Computador, CVS-Q PT©) was then obtained. Validation revealed the scale’s good internal consistency (Cronbach’s alpha=0.793), good temporal stability (intraclass correlation coefficient=0.847; 95% CI 0.764-0.902, kappa=0.839), adequate sensitivity and specificity (78.5% and 70.7%, respectively), good discriminant capacity (area under the curve=0.832; 95% CI 0.784-0.879), and adequate convergent validity with the ocular surface disease index (Spearman correlation coefficient=0.728, p<0.001). The factor analysis provided a single factor accounting for 37.7% of the explained common variance. A worker who scored ≥7 points would have computer vision syndrome. Conclusions: CVS-Q PT© can be considered an intuitive and easy-to-understand tool with good psychometric properties to measure computer vision syndrome in Portuguese workers exposed to digital devices. This questionnaire will assist in making decisions on preventive measures, interventions, and treatment and comparing exposed populations in different Portuguese-speaking countries. Purpose work health translate crossculturally cross culturally adapt CVSQ© CVSQ CVS Q© Q (CVS-Q© Methods 5phase phase 5 followed translation backtranslation, backtranslation back back-translation committee pretest crosssectional sectional 2 difficulties comprehensibility CVSQ©, Q©, 280 (28 workers. . workers) Results 962 96 96.2 840 84 0 84.0 understandable Questionário Computador PT obtained scales scale s Cronbachs Cronbach alpha=0.793, alpha0793 alpha alpha=0.793 , 793 alpha=0.793) intraclass coefficient=0.847 coefficient0847 coefficient 847 95 0.7640.902, 07640902 0.764 0.902, 764 902 0.764-0.902 kappa=0.839, kappa0839 kappa kappa=0.839 839 kappa=0.839) 78.5% 785 78 (78.5 707 70 7 70.7% respectively, respectively respectively) area curve=0.832 curve0832 curve 832 0.7840.879, 07840879 0.784 0.879 784 879 0.784-0.879) Spearman coefficient0728 728 coefficient=0.728 p<0.001. p0001 p p<0.001 001 p<0.001) 377 37 37.7 variance ≥ Conclusions easytounderstand easy understand measures interventions Portuguesespeaking speaking countries (CVS-Q 28 (2 9 96. 8 84. alpha079 alpha=0.79 79 coefficient=0.84 coefficient084 7640 0.7640.902 0764090 0764 0.76 0902 0.902 76 90 0.764-0.90 kappa083 kappa=0.83 83 78.5 (78. 70.7 curve=0.83 curve083 7840 0.7840.879 0784087 0784 0.78 0879 0.87 87 0.784-0.879 coefficient072 72 coefficient=0.72 p000 p<0.00 00 3 37. ( alpha07 alpha=0.7 coefficient=0.8 coefficient08 0.7640.90 076409 076 0.7 090 0.90 0.764-0.9 kappa08 kappa=0.8 78. (78 70. curve=0.8 curve08 0.7840.87 078408 078 087 0.8 0.784-0.87 coefficient07 coefficient=0.7 p00 p<0.0 alpha0 alpha=0. coefficient=0. coefficient0 0.7640.9 07640 07 0. 09 0.9 0.764-0. kappa0 kappa=0. (7 curve=0. curve0 0.7840.8 07840 08 0.784-0.8 p0 p<0. alpha=0 coefficient=0 0.7640. 0.764-0 kappa=0 curve=0 0.7840. 0.784-0. p<0 alpha= coefficient= 0.7640 0.764- kappa= curve= 0.7840 0.784-0 p< 0.784-

RESUMO Objetivos: À medida que a utilização de equipamentos digitais no emprego aumenta, a avaliação do seu efeito na saúde visual necessita de ferramentas válidas e robustas. Este estudo teve como objetivo traduzir, adaptar culturalmente e validar para português o Questionário da Síndrome Visual do Computador (CVS-Q©). Métodos: O procedimento foi realizado em 5 fases: tradução direta, síntese da tradução, tradução inversa, consolidação por um painel de especialistas, e pré-teste. Para fazer o pré-teste foi realizado um estudo piloto transversal aplicado a uma amostra de 26 participantes que completaram a versão pré-final da versão portuguesa do CVS-Q©, questionando por dificuldades, compreensão e sugestões de melhoria do questionário. Para avaliar a confiança e validade da versão portuguesa do CVS-Q© foi realizado um estudo transversal de validação em uma amostra diferente (280 funcionários). Resultados: No préteste, 96.2% dos participantes não apresentaram dificuldades no preenchimento do questionário, enquanto 84.0% indicaram que era claro e compreensível. Obteve-se, então, o CVS-Q© em português (Questionário da Síndrome Visual do Computador, CVS-Q PT©). A sua validação revelou uma boa consistência interna da sua escala (Cronbach’s alpha=0.793), boa estabilidade tem poral (coeficiente de correlação interclasse=0.847; 95% CI 0.764-0.902, kappa=0.839), sensibilidades e especificidades adequadas (78.5% e 70.7%, respetivamente), boa capacidade de discriminação (área abaixo da curva=0.832; 95% CI 0.784-0.879), e uma adequada validade da convergência com o índice de doença da superfície ocular (ocular surface disease index - OSDI; coeficiente de correlação de Spearman=0.728, p<0.001). A análise fatorial revelou um único fator responsável por explicar a variância comum em 37.7%. Um funcionário com uma pontuação ≥7 pontos sofria de síndrome visual do computador. Conclusão: O CVS-Q PT© pode ser considerada uma ferramenta intuitiva, de fácil interpretação e com boas pro priedades psicométricas para avaliar a síndrome visual do computador em funcionários portugueses expostos a ecrãs digitais. Este questionário facilitará as decisões sobre medidas preventivas, intervenções e tratamento, e a comparação entre as populações expostas em diferentes países de língua portuguesa. Objetivos aumenta robustas traduzir CVSQ©. CVSQ CVS Q© . Q (CVS-Q©) Métodos fases direta inversa especialistas préteste. préteste pré teste. teste 2 préfinal final CVSQ©, Q©, CVSQ© 280 (28 funcionários. funcionários) Resultados 962 96 96.2 840 84 0 84.0 compreensível Obtevese, Obtevese Obteve se, se Obteve-se então PT©. PT PT©) Cronbachs Cronbach s alpha=0.793, alpha0793 alpha alpha=0.793 , 793 alpha=0.793) interclasse=0.847 interclasse0847 interclasse 847 95 0.7640.902, 07640902 0.764 0.902, 764 902 0.764-0.902 kappa=0.839, kappa0839 kappa kappa=0.839 839 kappa=0.839) 78.5% 785 78 (78.5 707 70 7 70.7% respetivamente, respetivamente respetivamente) área curva=0.832 curva0832 curva 832 0.7840.879, 07840879 0.784 0.879 784 879 0.784-0.879) OSDI Spearman0728 Spearman 728 Spearman=0.728 p<0.001. p0001 p p<0.001 001 p<0.001) 377 37 37.7% ≥ Conclusão intuitiva preventivas tratamento (CVS-Q© 28 (2 9 96. 8 84. alpha079 alpha=0.79 79 interclasse=0.84 interclasse084 7640 0.7640.902 0764090 0764 0.76 0902 0.902 76 90 0.764-0.90 kappa083 kappa=0.83 83 78.5 (78. 70.7 curva=0.83 curva083 7840 0.7840.879 0784087 0784 0.78 0879 0.87 87 0.784-0.879 Spearman072 72 Spearman=0.72 p000 p<0.00 00 3 37.7 (CVS-Q ( alpha07 alpha=0.7 interclasse=0.8 interclasse08 0.7640.90 076409 076 0.7 090 0.90 0.764-0.9 kappa08 kappa=0.8 78. (78 70. curva=0.8 curva08 0.7840.87 078408 078 087 0.8 0.784-0.87 Spearman07 Spearman=0.7 p00 p<0.0 37. alpha0 alpha=0. interclasse=0. interclasse0 0.7640.9 07640 07 0. 09 0.9 0.764-0. kappa0 kappa=0. (7 curva=0. curva0 0.7840.8 07840 08 0.784-0.8 Spearman0 Spearman=0. p0 p<0. alpha=0 interclasse=0 0.7640. 0.764-0 kappa=0 curva=0 0.7840. 0.784-0. Spearman=0 p<0 alpha= interclasse= 0.7640 0.764- kappa= curva= 0.7840 0.784-0 Spearman= p< 0.784-

RESUMEN Objetivo. El uso racional de los medicamentos proporciona una estrategia de ahorro de costos para maximizar los resultados terapéuticos tanto en los países en desarrollo como en los países desarrollados. El objetivo de este estudio fue evaluar el uso racional de medicamentos para algunas enfermedades no transmisibles (ENT) seleccionadas en tres farmacias de hospitales públicos de Jamaica, usando los indicadores de prescripción de la Organización Mundial de la Salud (OMS). Métodos. En este estudio transversal retrospectivo se examinaron las prescripciones realizadas a pacientes ambulatorios adultos que incluían al menos un medicamento para enfermedades cardiovasculares, diabetes, cáncer, enfermedad pulmonar obstructiva crónica o asma, dispensadas entre enero y julio del 2019, utilizando los indicadores de prescripción para el uso racional de medicamentos de la OMS. Los datos se analizaron y expresaron mediante estadística descriptiva e inferencial. Para todos los análisis realizados se estableció un nivel de significación de p <0,05. Resultados. Se examinó un total de 1 500 prescripciones que incluían 5 979 medicamentos; la mayor parte de ellas correspondían a pacientes de sexo femenino de 42 a 60 años. Se observó que había polimedicación en el 35,6% (534) de las prescripciones, con un promedio de 4 y un máximo de 17 medicamentos por receta. En todos los centros se dispensó la mayor parte de los medicamentos prescritos, y el motivo principal para no hacerlo fue la falta de existencias del medicamento en cuestión. La prescripción de genéricos fue elevada en todos los centros y supuso más del 95% (5 722) de los medicamentos prescritos. En dos centros la prescripción se realizó en su totalidad de acuerdo con la Lista Modelo de Medicamentos Esenciales de la OMS, pero en el centro 1 no se alcanzó el objetivo por un 1,4%. Conclusiones. Se siguieron las directrices de la OMS para el uso racional de medicamentos en cuanto a la proporción de medicamentos prescritos de la Lista Modelo de la OMS y la proporción de antibióticos prescritos. El número de medicamentos por receta y la proporción de medicamentos prescritos mediante su nombre genérico no cumplieron con los criterios de la OMS. Sin embargo, las prescripciones estaban en consonancia con las directrices de tratamiento de las enfermedades no transmisibles seleccionadas.

ABSTRACT Objective. The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization’s (WHO’s) prescribing indicators. Methods. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO’s prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42–60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.

RESUMO Objetivo. O uso racional de medicamentos é uma estratégia de contenção de custos para maximizar os resultados terapêuticos em países desenvolvidos e em desenvolvimento. O objetivo deste estudo foi avaliar o uso racional de medicamentos para algumas doenças não transmissíveis selecionadas em três farmácias de hospitais públicos na Jamaica a partir dos indicadores de prescrição preconizados pela Organização Mundial da Saúde (OMS). Métodos. Estudo transversal retrospectivo que avaliou receitas médicas de pacientes ambulatoriais adultos contendo pelo menos um medicamento prescrito para doença cardiovascular, diabetes, câncer, doença pulmonar obstrutiva crônica ou asma e dispensadas entre janeiro e julho de 2019. A avaliação foi realizada a partir dos indicadores de prescrição preconizados pela OMS para o uso racional de medicamentos. Os dados obtidos foram analisados por meio de estatísticas descritivas e inferenciais. O nível de significância de p <0,05 foi adotado em todas as análises. Resultados. Ao todo, foram analisadas 1 500 receitas médicas compreendendo 5 979 medicamentos. Em sua maioria, as receitas foram prescritas para pacientes do sexo feminino com idades entre 42 e 60 anos. A polifarmácia foi observada em 35,6% (534) das receitas; em média, foram prescritos 4 medicamentos, até um máximo de 17. As farmácias estudadas dispensaram a maior parte dos medicamentos receitados. O principal motivo para não fornecer algum medicamento foi o desabastecimento. O percentual de medicamentos genéricos foi alto em todos os locais, representando mais de 95% (5 722) do volume receitado. Houve plena observância da Lista Modelo de Medicamentos Essenciais da OMS nas receitas analisadas em dois dos locais estudos, e observância quase completa (diferença de 1,4%) no local 1. Conclusões. As diretrizes da OMS de uso racional de medicamentos foram cumpridas no que se refere ao percentual de medicamentos receitados de acordo com a Lista Modelo da OMS e o percentual de antibióticos receitados. Os critérios da OMS não foram cumpridos quanto ao número de medicamentos por receita e ao percentual receitado usando o nome genérico. Porém, os medicamentos foram receitados de acordo com as diretrizes terapêuticas para as doenças não transmissíveis selecionadas.

ABSTRACT Purpose: Intravitreal antiangiogenic therapy is currently the most invasive ophthalmic procedure performed worldwide. This study aimed to describe the clinical and epidemiological profile of patients undergoing intravitreal antiangiogenic therapy in a tertiary referral hospital in Brazil. Methods: This cross-sectional, retrospective, and observational study analyzed medical records of patients who received intravitreal injections of antiangiogenic agents for the treatment of retinal diseases at the ophthalmology outpatient clinic in the Hospital das Clínicas at Unicamp between January and December 2020. Results: The study included 429 patients and 514 eyes. The study population was predominantly male (51.28%), white (80.89%), between 50 and 80 years old (mean age, 60.92 years), had complete or incomplete first-grade education (56.88%), and did not belong to the Regional Health Department of which Campinas is a part (78.55%). Bevacizumab was the most commonly used intravitreal injectable medicine (79.38%), pro re nata was the most commonly used treatment regimen (90.27%), and macular edema was the most prevalent pathology indicative of treatment (60.12%), with diabetes etiology accounting for 48.25%. The average number of injections per patient was 3.83, with the macular neovascularization group and the pro re nata group having the highest and lowest with five and three injections, respectively. Treatment adherence was associated with the patient’s pathology, and the macular edema (52.24%) and macular neovascularization (49.48%) groups had the lowest adherence rates. Conclusions: This study evaluated the epidemiological and clinical profile of patients undergoing antiangiogenic therapy in a high-complexity public hospital, which is fundamental for a better understanding of the demand for ophthalmic reference service in Brazil, and the analysis of functional results and user adherence profile promotes optimization of indications and leverages the benefits of intravitreal therapy. Purpose worldwide Brazil Methods crosssectional, crosssectional cross sectional, sectional cross-sectional retrospective 2020 Results 42 51 eyes 51.28%, 5128 51.28% , 28 (51.28%) 80.89%, 8089 80.89% 89 (80.89%) 5 8 mean age 6092 60 92 60.9 years, years) firstgrade first grade 56.88%, 5688 56.88% 56 88 (56.88%) 78.55%. 7855 78.55% . 78 55 (78.55%) 79.38%, 7938 79.38% 79 38 (79.38%) 90.27%, 9027 90.27% 90 27 (90.27%) 60.12%, 6012 60.12% 12 (60.12%) 4825 48 25 48.25% 383 3 83 3.83 respectively s 52.24% 5224 52 24 (52.24% 49.48% 4948 49 (49.48% rates Conclusions highcomplexity high complexity 202 4 512 51.28 2 (51.28% 808 80.89 (80.89% 609 6 9 60. 568 56.88 (56.88% 785 78.55 7 (78.55% 793 79.38 (79.38% 902 90.27 (90.27% 601 60.12 1 (60.12% 482 48.25 3.8 52.24 522 (52.24 49.48 494 (49.48 20 51.2 (51.28 80.8 (80.89 56.8 (56.88 78.5 (78.55 79.3 (79.38 90.2 (90.27 60.1 (60.12 48.2 3. 52.2 (52.2 49.4 (49.4 51. (51.2 80. (80.8 56. (56.8 78. (78.5 79. (79.3 90. (90.2 (60.1 48. 52. (52. 49. (49. (51. (80. (56. (78. (79. (90. (60. (52 (49 (51 (80 (56 (78 (79 (90 (60 (5 (4 (8 (7 (9 (6 (

RESUMO Objetivo: A terapia antiangiogênica intravítrea revolucionou o tratamento de inúmeras patologias de relevância global, sendo atualmente o procedimento oftalmológico invasivo mais realizado no mundo. Objetiva-se no presente estudo descrever o perfil clínico e epidemiológico dos pacientes submetidos a terapia intravítrea com antiangiogênicos em hospital terciário de referência no Brasil. Métodos: Trata-se de um estudo transversal, retrospectivo e observacional que foi realizado através da análise de prontuários de pacientes submetidos a injeção intravítrea de antiangiogênicos para tratamento de doenças retinianas no ambulatório de oftalmologia do Hospital das Clínicas da Unicamp no período de janeiro a dezembro de 2020. Resultados: O estudo analisou 429 pacientes e 514 olhos. A maioria pertencia ao sexo masculino (51,28%), raça branca (80,89%), possuía entre 50-80 anos com idade média de 60,92 anos e escolaridade de 1º grau completo ou incompleto (56,88%) e não pertenciam (78,55%) a área de abrangência do Departamento Regional de Saúde do qual Campinas faz parte. O fármaco mais utilizado nas injeções intravítreas foi o bevacizumabe (79,38%), o principal regime de tratamento foi o pro re nata (90,27%) e a principal grupo de patologia indicativa de tratamento foi o edema macular (60,12%), sendo 48,25% desses de etiologia diabética. A média de injeções foi de 3,83/paciente, sendo o grupo de neovascularização macular o de maior mediana com 5 injeções/paciente e o esquema pro re nata o regime de tratamento com menor mediana, 3 injeções/paciente. A adesão ao tratamento associou-se a patologia do paciente, sendo as menores taxas de adesão as dos grupos com edema macular (52,24%) e neovascularização macular (49,48%). Conclusões: O presente estudo avaliou o perfil epidemiológico e clínico dos pacientes submetidos a terapia antiangiogênica em hospital público de alta complexidade, o que é fundamental para melhor conhecimento da demanda de serviço oftalmológico de referência no Brasil e possibilita, a partir da análise dos resultados funcionais e perfil de adesão dos usuários, otimizar as indicações e alavancar os benefícios de terapia intravítrea. Objetivo global mundo Objetivase Objetiva se Métodos Tratase Trata transversal 2020 Resultados 42 51 olhos 51,28%, 5128 51,28% , 28 (51,28%) 80,89%, 8089 80,89% 80 89 (80,89%) 5080 50 50-8 6092 60 92 60,9 º 56,88% 5688 56 88 (56,88% 78,55% 7855 78 55 (78,55% parte 79,38%, 7938 79,38% 79 38 (79,38%) 90,27% 9027 90 27 (90,27% 60,12%, 6012 60,12% 12 (60,12%) 4825 48 25 48,25 diabética 383paciente paciente 83 3,83/paciente injeçõespaciente associouse associou 52,24% 5224 52 24 (52,24% 49,48%. 4948 49,48% . 49 (49,48%) Conclusões complexidade possibilita usuários 202 4 512 51,28 2 (51,28% 808 80,89 8 (80,89% 508 50- 609 6 9 60, 56,88 568 (56,88 78,55 785 7 (78,55 793 79,38 (79,38% 90,27 902 (90,27 601 60,12 1 (60,12% 482 48,2 52,24 522 (52,24 494 49,48 (49,48% 20 51,2 (51,28 80,8 (80,89 56,8 (56,8 78,5 (78,5 79,3 (79,38 90,2 (90,2 60,1 (60,12 48, 52,2 (52,2 49,4 (49,48 51, (51,2 80, (80,8 56, (56, 78, (78, 79, (79,3 90, (90, (60,1 52, (52, 49, (49,4 (51, (80, (56 (78 (79, (90 (60, (52 (49, (51 (80 (5 (7 (79 (9 (60 (49 (8 ( (6 (4

Abstract Background Understanding the causes of intracerebral hemorrhage (ICH) is crucial for effective treatment and preventing recurrences. The SMASH-U scale is a suggested method for classifying and predicting the outcomes of ICH. Objective To describe the SMASH-U classification and outcomes by etiology in patients admitted to a comprehensive stroke center in São Paulo, Brazil. Methods A retrospective analysis was conducted on patients admitted to the hospital or outpatient clinic between April 2015 and January 2018. Two stroke neurologists evaluated the SMASH-U classification, and patients with incomplete medical records were excluded. Results Out of the 2000 patients with a stroke diagnosis evaluated, 140 were included in the final analysis. The mean age was 57.9 (± 15.5) years, and 54.3% were male. Hypertension was the most frequent etiology, accounting for 41.4% of cases, followed by amyloid angiopathy (18.5%) and structural lesions (14.1%). Structural lesions were more common among women and patients under 45 years old. Favorable outcomes were observed in 61% of patients with structural lesions, compared to 10% of patients with medication-related etiologies. Conclusion This study provides important evidence regarding the etiological classification of Brazilian patients with ICH. Hypertension and amyloid angiopathy were the most frequent causes, while structural lesions and systemic diseases were more common in younger patients. ICH (ICH recurrences SMASHU SMASH U Paulo Brazil 201 2018 excluded 200 14 579 57 9 57. ± ( 15.5 155 15 5 543 54 3 54.3 male 414 41 4 41.4 cases 18.5% 185 18 (18.5% 14.1%. 141 14.1% . 1 (14.1%) old 61 10 medicationrelated medication related etiologies 20 15. 54. 41. 18.5 (18.5 14.1 (14.1% 6 2 18. (18. 14. (14.1 (18 (14. (1 (14

Resumo Antecedentes Compreender as causas da hemorragia intracerebral (HIC) é crucial para o tratamento eficaz e prevenção de recorrências. A escala SMASH-U é um método sugerido para classificar e prever os resultados da HIC. Objetivo Descrever a classificação SMASH-U e os resultados por etiologia em pacientes admitidos em um centro de acidente vascular cerebral (AVC) em São Paulo, Brasil. Métodos Foi realizada uma análise retrospectiva de pacientes admitidos no hospital ou ambulatório entre abril de 2015 e janeiro de 2018. Dois neurologistas especializados em doenças cerebrovasculares avaliaram a classificação SMASH-U e pacientes com prontuários incompletos foram excluídos. Resultados Dos 2000 pacientes com diagnóstico de AVC avaliados, 140 foram incluídos na análise final. A idade média foi de 57,9 (±15,5) anos e 54,3% eram do sexo masculino. A hipertensão foi a etiologia mais frequente, correspondendo a 41,4% dos casos, seguida pela angiopatia amiloide (18,5%) e lesões estruturais (14,1%). As lesões estruturais foram mais comuns em mulheres e pacientes com menos de 45 anos. Resultados favoráveis foram observados em 61% dos pacientes com lesões estruturais, em comparação com 10% dos pacientes com etiologias relacionadas a medicamentos. Conclusão Este estudo fornece evidências importantes sobre a classificação etiológica de pacientes brasileiros com HIC. A hipertensão e a angiopatia amiloide foram as causas mais frequentes, enquanto lesões estruturais e doenças sistêmicas foram mais comuns em pacientes mais jovens. HIC (HIC recorrências SMASHU SMASH U (AVC Paulo Brasil 201 2018 excluídos 200 avaliados 14 final 579 57 9 57, ±15,5 155 15 5 (±15,5 543 54 3 54,3 masculino frequente 414 41 4 41,4 casos 18,5% 185 18 (18,5% 14,1%. 141 14,1% . 1 (14,1%) 61 10 medicamentos frequentes jovens 20 ±15, (±15, 54, 41, 18,5 (18,5 14,1 (14,1% 6 2 ±15 (±15 18, (18, 14, (14,1 ±1 (±1 (18 (14, ± (± (1 (14 (

The modification of magnesium alloy through the addition of rare-earth elements improves specific properties of magnesium alloy. However, the evolution mechanisms of rare-earth precipitates during thermal cycles are still unclear, particularly during the welding thermal cycles. Therefore, deep research on the influence mechanisms of rare-earth precipitates on the welded joint is necessary. In this paper, Ce-containing Mg alloy was successfully welded by laser welding. The microstructure of the welded joint was deeply analyzed. As a result, the elemental composition and distribution rules of precipitates within the fusion zone were obtained. In addition, heat treatment was carried out for the welded joint, thus deducing the evolution mechanisms of precipitates within the joint. The corresponding results revealed that typical micron/sub-micron-sized particles, consisting of both conventional and rare-earth intermetallics, are formed and neatly distributed within the fusion zone, demonstrating that the rare-earth particles inside the fusion zone are much smaller in size than that of Mg17Al12. Tensile test results suggest that these tiny particles significantly improved the strength of the fusion zone, promoting the tensile-shear strength of the joint accounting for 76.6% of that of the base metal. The above approach provides a feasible solution for the welding of rare-earth Mg alloys. rareearth rare earth However unclear Therefore necessary paper Cecontaining Ce containing analyzed result obtained micron/submicronsized micronsubmicronsized micron/sub micron sized sub intermetallics Mg17Al12 MgAl Al tensileshear tensile shear 766 76 6 76.6 metal alloys submicronsized micronsub Mg17Al1 7 76. Mg17Al

RESUMO Objetivo: Os membros do conselho são essenciais na resolução de con- flitos de agência. Entretanto, muitos estão impossibilitados de exercer sua função devido à distância, não participando das reuniões do conse- lho. A partir da Instrução nº 561, a Comissão de Valores Mobiliários (CVM) regulamentou o voto a distância para os Conselhos de Adminis- tração, permitindo maior participação e maior envolvimento. Nesse contexto, esta pesquisa examina o efeito do voto remoto dos conselhos de administração na remuneração dos executivos e no desempenho financeiro das empresas de capital aberto no Brasil. Originalidade/valor: Esta pesquisa é inovadora na medida em que exami- na o efeito do voto remoto do Conselho de Administração nas variáveis de remuneração do CEO e desempenho financeiro da organização, com a utilização de uma metodologia inovadora. Design/metodologia/abordagem: Utilizou-se um método quase-experi- mental (diferença-em-diferenças), para avaliar os efeitos de um deter- minado grupo (tratamento), antes e depois do evento, reduzindo signi- ficativamente a endogeneidade ao considerar um choque exógeno ao sistema. Resultados: Como resultado, a estimação do modelo principal revela diferenças estatisticamente significativas entre os grupos de tratamento e controle sobre a lucratividade e a remuneração dos executivos, indi- cando que o voto remoto mitigou problemas de agência ao gerar um efeito de substituição por incentivos explícitos (evidenciado pela dimi- nuição da remuneração dos executivos) e por proporcionar maior desempenho contábil para as empresas. Objetivo con Entretanto conse lho 561 CVM (CVM Adminis tração envolvimento contexto Brasil Originalidade/valor Originalidadevalor Originalidade valor exami organização Design/metodologia/abordagem Designmetodologiaabordagem Design abordagem Utilizouse Utilizou se quaseexperi quase experi quase-experi diferençaemdiferenças, diferençaemdiferenças diferença , (diferença-em-diferenças) deter tratamento, (tratamento) evento signi sistema Resultados resultado indi evidenciado dimi 56 (diferença-em-diferenças (tratamento 5

ABSTRACT Purpose: Board members are critical in resolving agency conflicts. How- ever, many are unable to perform their function due to their distance, as they are not present at board meetings. As of Instruction no. 561, the Brazilian Securities and Exchange Commission (CVM) regulated remote voting for Boards of Directors, allowing for greater attendance at meet- ings and, as a result, increased involvement. In this context, this research examines the effect of remote voting by Boards of Directors on execu- tive compensation and financial performance of publicly traded firms in Brazil. Originality/value: This research is innovative in the sense that it exam- ines the effect of the Board of Directors remote voting on the CEO com- pensation and financial performance of the firm, using an innovative methodology. Design/methodology/approach: We applied a quasi-experimental method (difference-in-differences) to assess the effects of a given group (treat- ment) before and after the event, significantly reducing endogeneity when considering an exogenous shock to the system. Findings: As a result, the estimation of the main model reveals statisti- cally significant differences between the effects of treatment and control on profitability and executive remuneration, indicating that remote vot- ing mitigated agency problems by generating a substitution effect for explicit incentives (as evidenced by the decrease in executive remunera- tion) and by providing greater accounting performance for companies. Purpose conflicts How ever distance meetings no 561 CVM (CVM meet result involvement context execu Brazil Originality/value Originalityvalue Originality value exam com firm methodology Design/methodology/approach Designmethodologyapproach Design approach quasiexperimental quasi experimental differenceindifferences difference (difference-in-differences treat (treat ment event system Findings statisti remuneration vot remunera tion companies 56 5

RESUMEN Introducción: Para el mejor tratamiento del paciente con úlceras neuropáticas es importante tener identificado el grado y origen de la lesión. En este sentido, se han propuesto diversos sistemas de clasificación; entre los más importantes están la clasificación de Wagner y la de Texas. Objetivo: Determinar la efectividad de los algoritmos de intervención de enfermería en adultos mayores con úlcera neuropática en la comunidad. Métodos: Estudio descriptivo longitudinal de corte en 77 adultos mayores con úlceras neuropáticas en el Centro de Salud “Mártires de Cuito” de Bie, Angola, en el período enero-diciembre de 2023. La información obtenida fue procesada, validada y analizada con métodos computacionales, mediante el paquete Microsoft Office 2024 y el sistema estadístico Epi-Info-versión 1.4.3. de la Organización Mundial de la Salud. El análisis estadístico se realizó a través del paquete estadístico SPSS versión 23 para Windows. Resultados: De las intervenciones independientes brindadas a los 77 adultos mayores, según edad y presencia de úlceras neuropáticas, el 46,75 % pertenecía al sexo femenino y el 53,24 % al masculino; de ellos presentaron úlceras neuropáticas cuatro pacientes (5,19 %). Predominó el grupo de edades de 71-75 años, que reportó 31,16 % y 54,54 % de adultos mayores con úlceras neuropáticas. En la clasificación de Wagner sobresalió el acceso por osteomielitis (45,45 %) y el nivel de autocuidado demostró que el 71,42 % practicaba poco su autocuidado. Conclusiones: La implementación de un algoritmo para la atención a adultos mayores con úlcera neuropática facilita precisar el grupo de edad predominante con esta afección, la clasificación de Wagner y la práctica de autocuidado.

ABSTRACT Introduction: For the best treatment of patients with neuropathic ulcers, it is important to identify the degree and origin of the lesion. In this respect, several classification systems have been proposed; among the most important are the Wagner and Texas classification systems. Objective: To determine the effectiveness of nursing intervention algorithms in older adults with neuropathic ulcers in the community. Methods: A longitudinal and descriptive study was carried out of 77 older adults with neuropathic ulcers at Mártires de Cuito health center in Bie, Angola, in the period January-December 2023. The obtained information was processed, validated and analyzed by computational methods, using the Microsoft Office 2024 package and the statistical system Epi-Info-version 1.4.3 of the World Health Organization. Statistical analysis was performed using the SPSS statistical package (version 23) for Windows. Results: Of the independent interventions provided to the 77 older adults, according to age and presence of neuropathic ulcers, 46.75 % were female and 53.24 % were male; 4 patients (5.19 %) presented neuropathic ulcers. There was a predominance of the age group 71-75 years, accounting for 31.16 % and 54.54 % of older adults with neuropathic ulcers. According to the Wagner classification, access for osteomyelitis (45.45 %) was remarkable, whilw the level of self-care showed that 71.42 % performed little self-care. Conclusions: The implementation of an algorithm for the care of older adults with neuropathic ulcer makes it easier to identify the predominant age group with this condition, Wagner's classification and self-care practice.

Abstract Background Anxiety and mood disorders are the main cause of illness in people under the age of 25, accounting for 45% of the global disease burden, whereas 4.6% of teenagers aged 15 to 19 are predicted to experience anxiety. Pakistan country, with a population of 200 million, has the worst mental health indicators and fewer than 500 psychiatrists. Despite the existence of various treatments for anxiety, this goes unrecognized and untreated. Due to a lack of awareness, evaluation, prevention, and interventional programs related to being implemented among adolescents in Pakistan, there is a rise in mental health issues in the earlier years of life. It calls for a critical need for indigenous, evidence-based interventions. The present study aimed to evaluate the feasibility of cognitive behavioral therapy (CBT)-based interventions to reduce anxiety symptoms among school children in Pakistan. Methods This study was a pre-post design, two-arm, single-blinded, feasibility, randomized controlled trial. Thirtyfour participants (experimental group, n = 17; control group, n = 17) were recruited from four semi-government schools in Rawalpindi with a mean age of 15 (M = 15, SD = 0.73). Two instruments Beck Anxiety Inventory for Youth (BAI-Y II) and BASC-3 Behavioural and Emotional Screening System Student (BESS-SF) were used to assess the severity of symptoms. Participants in the intervention arm received eight-group therapy CBT sessions. A two-way factorial analysis was used to examine the efficacy of CBT in reducing symptom severity. Results This study’s findings showed that in comparison to the wait-list control group, CBT successfully improved anxiety symptoms among school children while enhancing their social skills. Conclusion This study will help improve the treatment for anxiety in Pakistan by prioritizing school-based intervention and group-based CBT intervention. Trial registration The trial has been registered at the American Economic Association’s registry for randomized controlled trials. RCT ID: AEARCTR-00095 51. Registered 2022–07-04. 25 45 burden 46 4 6 4.6 1 country 20 million 50 psychiatrists untreated awareness evaluation prevention life indigenous evidencebased evidence based CBTbased prepost pre post design twoarm, twoarm two arm, two-arm singleblinded, singleblinded single blinded, blinded single-blinded experimental group 17 semigovernment semi government M 0.73. 073 0.73 . 0 73 0.73) BAIY BAI Y II BASC3 BASC 3 BASC- BESSSF BESS SF (BESS-SF eightgroup eight sessions twoway way studys s waitlist wait list skills schoolbased groupbased Associations Association trials ID AEARCTR00095 AEARCTR 00095 AEARCTR-0009 51 2022–0704. 20220704 2022–07 04. 2022 07 04 2022–07-04 2 4. 5 0.7 7 AEARCTR0009 0009 AEARCTR-000 0704 2022–0704 2022070 202207 2022–0 202 2022–07-0 0. AEARCTR000 000 AEARCTR-00 070 2022–070 20220 2022– 2022–07- AEARCTR00 00 AEARCTR-0 AEARCTR0 AEARCTR-

Abstract: Background: Chickpeas (Cicer arietinum) are an important type of pulse whose production is hindered by poor weed control. Objective: To assess lactofen selectivity levels and to uncover tolerance mechanisms in commercial genotypes. Methods: Four genotypes and weed species were grown under controlled-environment conditions and subjected to lactofen dose-response assays (11.2–2,880 g a.i. ha−1). Visual evaluations performed until 35 days after application, when biomass was quantified and selectivity indexes obtained using regression analysis. Following 14C-lactofen application, absorption and translocation were assessed until 168h after treatment (HAT), when chickpea plants were washed to remove the unabsorbed herbicide or subjected to autoradiography and tissue combustion. Lastly, 14C-lactofen was applied and metabolites extracted at 96 HAT, and their retention factors (Rf) determined by thin layer chromatography and radioscanner reading. Results: Tridax procumbens and Amaranthus spinosus were highly susceptible to lactofen. Chickpea genotypes tolerated lactofen at the highest labelled used rate in soybeans (180 g a.i. ha−1). Lactofen absorption was high (88.1%–94.6%) and translocation was limited (< 2.5%) across genotypes - a similar trend observed in susceptible species, and hence are not implicated in lactofen tolerance. One main metabolite was found in chickpea genotypes, accounting for 12.5%–19.4% of applied radioactivity; the chickpea genotype with the highest tolerance level (BRS Cicero) was the only one in which two metabolites were quantified. Altogether, these results suggest that lactofen tolerance in chickpeas could be conferred by enhanced herbicide metabolism. Conclusions: Lactofen could become an option for selective, post-emergence weed control in chickpeas. Abstract Background Cicer arietinum Objective Methods controlledenvironment controlled environment doseresponse dose response 11.2–2,880 1122880 11 2 880 (11.2–2,88 ai i a.i ha−1. ha1 ha ha−1 . 1 ha−1) 3 application analysis 14Clactofen Clactofen 14C C h HAT , (HAT) combustion Lastly 9 Rf (Rf reading Results 180 (18 88.1%–94.6% 881946 88 94 6 (88.1%–94.6% < ( 2.5% 25 5 125194 12 19 4 12.5%–19.4 radioactivity BRS Cicero Altogether metabolism Conclusions selective postemergence post emergence 11.2–2,88 112288 (11.2–2,8 ha− (HAT 18 (1 88.1%–94.6 88194 8 (88.1%–94.6 2.5 12519 12.5%–19. 11.2–2,8 11228 (11.2–2, 88.1%–94. 8819 (88.1%–94. 2. 1251 12.5%–19 11.2–2, 1122 (11.2–2 88.1%–94 881 (88.1%–94 125 12.5%–1 11.2–2 112 (11.2– 88.1%–9 (88.1%–9 12.5%– 11.2– (11.2 88.1%– (88.1%– 12.5% 11.2 (11. 88.1% (88.1% 12.5 11. (11 88.1 (88.1 12. 88. (88. (88 (8

Resumen Colombia es un país tropical con una rica flora de helechos. El Departamento de Quindío está ubicado en una zona que sufre una importante alteración ambiental debido a actividades antropogénicas como el cultivo de café. Las Gleicheniaceae, una familia de helechos pioneros, son conocidas por ocupar preferentemente hábitats abiertos, soleados y perturbados, como los bordes de las carreteras. Nuestro estudio tuvo como objetivo realizar un tratamiento taxonómico de las especies de Gleicheniaceae en el Departamento de Quindío, Colombia. Nuestros resultados revelaron la presencia de 10 especies distribuidas en cuatro géneros, siendo el género Sticherus el que cuenta con la mayoría de las especies (siete en total). Notablemente, se encontró un nuevo registro de Sticherus (S. brevitomentosus) para Colombia, lo que sugiere la posible descubierta de especies adicionales en futuros estudios. Además, nuestros resultados demostraron que el 42% de las 24 especies reportadas en la región Andina estaban presentes en el Departamento de Quindío, siendo Calarcá y Salento los municipios con la mayor diversidad. Hemos proporcionado descripciones taxonómicas tanto para los géneros como para las especies, así como una clave de identificación, mapas, imágenes y comentarios sobre la taxonomía y distribución de las especies.Palabras clave: helechos, flora, Gleicheniales, tratamiento taxonómico. café pioneros abiertos perturbados carreteras 1 siete total. total . total) Notablemente S. S (S brevitomentosus estudios Además 42 2 diversidad identificación mapas especiesPalabras Palabras Gleicheniales 4

Abstract Colombia is a tropical country with a rich fern flora. The Quindío Department is in an area which is undergoing significant environmental changes due to anthropogenic activities, such as coffee cultivation. Gleicheniaceae, a family of pioneer ferns, is known for preferentially occupying open, sunny, and disturbed habitats, such as roadsides. Our study aimed to conduct a taxonomic treatment of the Gleicheniaceae species in the Quindío Department in Colombia. Our results revealed the presence of 10 species distributed in four genera, with the Sticherus genus accounting for most of the species (seven in total). Notably, a new record of Sticherus (S. brevitomentosus) was found for Colombia, indicating the potential for the discovery of additional species in future studies. Furthermore, our results demonstrated that 42% of the 24 species reported in the Andean region were present in the Quindío Department, and Calarcá and Salento were the municipalities with the highest diversity. We have provided taxonomic descriptions for the genera and species, as well as an identification key, maps, images, and comments on the taxonomy and distribution of the species. flora activities cultivation ferns open sunny habitats roadsides 1 seven total. total . total) Notably S. S (S brevitomentosus studies Furthermore 42 2 diversity key maps images 4

Abstract Curcuma zedoaria is a traditional medicine used for various purposes in human life. The organic solvent extracts of this plant also exhibit antioxidant, antibacterial, anti-inflammatory, anti- cancer, anti-necrosis, and hepatoprotective properties. However, the prospect of employing this plant extract for skin whitening, particularly its molecular mechanism, has not been reported yet. Therefore, in this study, the total polyphenolic content, antioxidant activity, cytotoxicity, tyrosinase inhibitory, melanin inhibitory, and target gene expression using the ethyl acetate fraction of ethanolic extract from Curcuma zedoaria , were all examined. The TPC result of the sample was 42.18±2.25 mg GAE/g extract with impressive antioxidant activity. Half maximal inhibitory concentration value of 2,2-Diphenyl-1-picrylhydrazyl radical scavenging assay and Ferric reducing antioxidant power FRAP value at a concentration of 2.5 µg/mL were 49.06±0.29 µg/mL and 116±50 μM Fe2+/L, respectively. The extract had no cytotoxicity at 25 µg/mL, inhibited melanin production for 74.02±3.05% and tyrosinase for 137.45±1.38%. In particular, the extract demonstrated the ability to block the expression levels of four melanogenesis-related genes. Moreover, GCMS analysis results also detected 28 different compounds, with two new compounds accounting for a high proportion. These results suggested that C. zedoaria has a significant potential for application in skin-pigmentation treatment cosmetics. life antibacterial antiinflammatory, antiinflammatory anti inflammatory, inflammatory anti-inflammatory cancer antinecrosis, antinecrosis necrosis, necrosis anti-necrosis properties However whitening mechanism yet Therefore study content activity examined 4218225 42 18 2 42.18±2.2 GAEg GAE g 2,2Diphenyl1picrylhydrazyl 22Diphenyl1picrylhydrazyl Diphenylpicrylhydrazyl 2,2 Diphenyl 1 picrylhydrazyl 5 2. µgmL µg mL 4906029 49 06 0 29 49.06±0.2 11650 116 50 116±5 Fe2L FeL Fe2 L Fe Fe2+/L respectively 7402305 74 02 3 05 74.02±3.05 13745138 137 45 38 137.45±1.38% particular melanogenesisrelated melanogenesis related genes Moreover proportion C skinpigmentation pigmentation cosmetics 421822 4 42.18±2. 2Diphenyl1picrylhydrazyl 22 2, 490602 49.06±0. 1165 11 116± 740230 7 74.02±3.0 1374513 13 137.45±1.38 42182 42.18±2 49060 49.06±0 74023 74.02±3. 137451 137.45±1.3 4218 42.18± 4906 49.06± 7402 74.02±3 13745 137.45±1. 421 42.18 490 49.06 740 74.02± 1374 137.45±1 42.1 49.0 74.02 137.45± 42. 49. 74.0 137.45 74. 137.4 137.

ABSTRACT Clinical data: A nine-month-old female infant diagnosed with transposition of the great arteries with symptoms of heart failure associated with cyanosis and difficulty in gaining weight was referred to our center with late diagnosis (at nine months of age). Chest radiography: Cardiomegaly; attenuated peripheral vascular markings. Electrocardiography: Sinus rhythm with biventricular overload and aberrantly conducted supraventricular extra systoles. Echocardiography: Wide atrial septal defect, ventricular axis torsion with concordant atrioventricular connection and discordant ventriculoarterial connection. Computed tomography angiography: Concordant atrioventricular connection, right ventricle positioned superiorly and left ventricle positioned inferiorly; discordant ventriculoarterial connection with right ventricle connected to the aorta and left ventricle connected to pulmonary artery. Diagnosis: Crisscross heart is a rare congenital heart defect, accounting for 0.1% of congenital heart diseases. It consists of the 90º rotation of ventricles’ axis in relation to their normal position; therefore, ventricles are positioned in the superior-inferior direction rather than anterior-posterior. Most cases have associated cardiac anomalies, and in this case, it is associated with transposition of the great arteries. The complexity and rarity of its occurrence make diagnosis and surgical treatment challenging. Operation: Modified Senning procedure using the pericardial sac in the construction of a tunnel from pulmonary veins to the right atrium. Cardiopulmonary bypass time of 147 minutes with nine minutes of total circulatory arrest. data ninemonthold month old at age. age . age) radiography Cardiomegaly markings Electrocardiography systoles Echocardiography defect angiography inferiorly artery Diagnosis 01 0 1 0.1 diseases º position therefore superiorinferior superior inferior anteriorposterior. anteriorposterior anterior posterior. posterior anterior-posterior anomalies case challenging Operation atrium 14 arrest 0.

ABSTRACT Objective To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital. Methods A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used. Results During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures. Conclusion Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures. crosssectional cross sectional 2020 analysis analyses ShapiroWilk Shapiro Wilk test χ used period 15 62.2% 622 62 2 (62.2 women 76.9%. 769 76.9% . 76 9 (76.9%) femur 404 40 4 40.4 cases 525 5 25 5.2 days R200653 R 006 53 R$2,006.5 R10691274 106 912 74 R$106,912.7 average R$15,695.76 R1569576 695 updated values. values values) R447864 478 64 R$4,478.64 frequent costs comorbidities 202 1 62.2 6 (62. 76.9 7 (76.9% 40. 52 5. R20065 00 R$2,006. R1069127 10 91 R$106,912. R$15,695.7 R156957 69 R44786 47 R$4,478.6 20 62. (62 76. (76.9 R2006 0 R$2,006 R106912 R$106,912 R$15,695. R15695 R4478 R$4,478. (6 (76. R200 R$2,00 R10691 R$106,91 R$15,695 R1569 R447 R$4,478 ( (76 R20 R$2,0 R1069 R$106,9 R$15,69 R156 R44 R$4,47 (7 R2 R$2, R106 R$106, R$15,6 R15 R4 R$4,4 R$2 R10 R$106 R$15, R1 R$4, R$ R$10 R$15 R$4 R$1

Resumen: El objetivo de este estudio fue estimar el coste-efectividad de cuatro terapéuticas disponibles para la leishmaniasis mucosa en Brasil: miltefosina, antimoniato de meglumina, asociado con y sin pentoxifilina, y anfotericina B liposomal. La perspectiva adoptada fue la del Sistema Único de Salud brasileño (SUS). El resultado de interés fue el “paciente curado”, que se analizó mediante un modelo de árbol de decisión. Las estimaciones de costes directos y efectividad se obtuvieron de la literatura científica. El antimoniato de meglumina aislado fue la estrategia de comparación de referencia; el anfotericina B liposomal tuvo una razón coste-efectividad incremental (RCEI) de USD 7.409,13 por paciente curado, y la combinación de antimoniato de meglumina con pentoxifilina tuvo una RCEI de USD 85,13. Predominó la miltefosina, con un coste más elevado y una eficacia similar en comparación con la de antimoniato de meglumina. Los análisis de sensibilidad que variaron el coste en ±25% no alteraron los resultados. Sin embargo, cuando el coste de la miltefosina se estimó en menos de USD 171,23, esta estrategia resultó dominante sobre la antimoniato de meglumina aislada. Los resultados confirman que el tratamiento con anfotericina B liposomal sigue siendo la opción con el RCEI más elevado entre las terapéuticas evaluadas. A su vez, la miltefosina puede ser coste-efectiva en función de la variación del precio de compra, lo que merece atención al ser la única opción oral disponible. La falta de consideración de otros aspectos impide el uso inmediato de estos resultados para subvencionar la toma de decisiones, pero también apunta a la necesidad de negociar los precios de los fármacos disponibles para leishmaniasis mucosa y de fomentar la transferencia de tecnología u otras acciones dirigidas a ampliar el papel del sector industrial nacional. Resumen costeefectividad Brasil SUS. SUS . (SUS) curado , curado” decisión científica referencia (RCEI 740913 7 409 13 7.409,1 8513 85 85,13 25 ±25 embargo 17123 171 23 171,23 aislada evaluadas vez costeefectiva efectiva compra disponible decisiones nacional (SUS 74091 40 1 7.409, 851 8 85,1 2 ±2 1712 17 171,2 7409 4 7.409 85, ± 171, 740 7.40 74 7.4 7.

Resumo: O objetivo deste estudo foi estimar o custo-efetividade de quatro abordagens terapêuticas disponíveis para leishmaniose mucosa no Brasil: miltefosina, antimoniato de meglumina, com e sem associação à pentoxifilina e anfotericina B lipossomal. A perspectiva adotada foi a do Sistema Único de Saúde (SUS). O desfecho de interesse foi “paciente curado”, que foi analisado por meio de um modelo de árvore de decisão. Estimativas de custos diretos e efetividade foram obtidas da literatura científica. O antimoniato de meglumina isolado foi a estratégia de comparação de base; a anfotericina B lipossomal apresentou razão de custo-efetividade incremental (RCEI) de USD 7.409,13 por paciente curado, e a combinação de antimoniato de meglumina com pentoxifilina apresentou RCEI de USD 85,13. A miltefosina foi dominada, com maior custo e efetividade semelhante quando comparada àquelas do antimoniato de meglumina. As análises de sensibilidade, variando o custo em ±25%, não alteraram os resultados. No entanto, quando o custo da miltefosina foi estimado em menos de USD 171,23, essa estratégia foi dominante sobre o antimoniato de meglumina isolado. Os resultados confirmam que o tratamento com anfotericina B lipossomal continua sendo a opção com maior RCEI entre as abordagens analisadas. Por sua vez, a miltefosina pode ser custo-efetiva com base na variação do preço de aquisição, o que merece atenção por ser a única opção oral disponível. A não consideração de outros aspectos impede o uso imediato desses resultados para subsidiar a tomada de decisão, mas apontam a necessidade de negociação dos preços dos medicamentos disponíveis para a leishmaniose mucosa e indicam a necessidade de incentivar a transferência de tecnologia ou outras ações que visem ampliar a atuação do complexo industrial nacional. Resumo custoefetividade Brasil SUS. SUS . (SUS) curado , curado” decisão científica (RCEI 740913 7 409 13 7.409,1 8513 85 85,13 dominada sensibilidade 25 ±25% entanto 17123 171 23 171,23 analisadas vez custoefetiva efetiva aquisição disponível nacional (SUS 74091 40 1 7.409, 851 8 85,1 2 ±25 1712 17 171,2 7409 4 7.409 85, ±2 171, 740 7.40 ± 74 7.4 7.

Abstract: This study aimed to estimate the cost-effectiveness of four therapeutic approaches available for mucosal leishmaniasis in Brazil: miltefosine, meglumine antimoniate, combined with and without pentoxifylline, and liposomal amphotericin B. The perspective adopted was that of the Brazilian Unified National Health System (SUS). The outcome of interest was “cured patient”, which was analyzed using a decision tree model. Estimates of direct costs and effectiveness were obtained from the scientific literature. Meglumine antimoniate alone was the base comparator strategy; liposomal amphotericin B showed an incremental cost-effectiveness ratio (ICER) of USD 7,409.13 per cured patient, and the combination of meglumine antimoniate with pentoxifylline presented an ICER of USD 85.13. Miltefosine was absolutely dominated, with higher cost and similar effectiveness when compared to meglumine antimoniate. Sensitivity analyses, varying the cost by ±25%, did not change the results. However, when the cost of miltefosine was estimated at less than USD 171.23, this strategy was dominant over meglumine antimoniate alone. The results confirm that treatment with liposomal amphotericin B remains the option with the highest ICER among the approaches analyzed. Miltefosine may be cost-effective based on the variation in the acquisition price, which deserves attention because it is the only available oral option. The non-accounting of other aspects prevent the use of these results immediately to support decision-making, but they point out the need to negotiate the prices of drugs available for mucosal leishmaniasis and indicates the need of encouraging technology transfer or other actions aimed at expanding the performance of the Brazilian national industrial complex. Abstract costeffectiveness Brazil SUS. SUS . (SUS) patient , patient” model literature (ICER 740913 7 409 13 7,409.1 8513 85 85.13 dominated analyses 25 ±25% However 17123 171 23 171.23 costeffective effective price nonaccounting non accounting decisionmaking, decisionmaking making, making decision-making complex (SUS 74091 40 1 7,409. 851 8 85.1 2 ±25 1712 17 171.2 7409 4 7,409 85. ±2 171. 740 7,40 ± 74 7,4 7,