ABSTRACT Introduction/framework/objectives: Amyotrophic Lateral Sclerosis is a disease that can progress in a debilitating manner and affect some individuals of working age, so it will be important that professionals working in Occupational Health and Safety have a reasonable set of knowledge on the subject, to be able to adjust work tasks as best as possible, as well as any protective measures, enhancing well-being and performance/productivity. Furthermore, knowing the work factors that increase it, it will be possible to slightly reduce the incidence of the pathology. The aim of this review was to summarize in Portuguese the most current and relevant articles published on the topic in international and national literature. Methodology: This is a Bibliographic Review, initiated through a search carried out in April 2023 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Content: This pathology is a rapidly progressive neurodegenerative disease characterized by muscular atrophy/paralysis, generally beginning in adulthood with an average survival of two to three years. The first manifestations generally involve asthenia of the lower limbs, generally in the 5th or 6th decade of life. Focal paralysis intensifies and spreads, reaching the respiratory muscles and culminating in respiratory failure. However, the pathophysiology is not clearly understood. Some researchers consider that the only environmental fact that could have any influence could be smoking; others even claim that the influence of global environmental exposure itself is controversial. At this level, with greater or lesser consensus, pesticides, fertilizers, solvents, heavy metals, formaldehyde, diesel, physical exertion/hypoxia, trauma and contact with electricity stand out. Therefore, there are also some professional sectors that may present greater risk. Discussion and Conclusions: Even though the prevalence of this pathology is low, some of these individuals are part of the active population, at least at an initial stage. No concrete data was found regarding protective measures or other relevant attitudes for the Health and Safety team to guide in this context. Even so, the authors succinctly recorded some items in this sense, depending on their professional experience, especially for pathologies with some similarities and more prevalent. It would be interesting for professionals working in a hospital environment, in an institution where there is a support consultation for users with this pathology, to focus a little on the topic, portraying the national reality and publishing their research in a magazine in the area, to disseminate knowledge at national level, with international extrapolation, given the scarcity of bibliography.

RESUMO Introdução/enquadramento/objetivos: A Esclerose Lateral Amiotrófica é uma doença que poderá evoluir de forma debilitante e atingir alguns indivíduos em idade ativa, pelo que será relevante que os profissionais a exercer na Saúde e Segurança Ocupacionais tenham um conjunto razoável de conhecimentos sobre o tema, de forma a conseguirem ajustar o melhor possível as tarefas laborais, bem como eventuais medidas de proteção, potenciando o bem-estar e desempenho/produtividade. Para além disso, conhecendo os fatores laborais que a potenciam, poder-se-á diminuir um pouco a incidência da patologia. Pretendeu-se com esta revisão resumir em português o que de mais atual e relevante se publicou sobre o tema nas literaturas internacional e nacional. Metodologia: Trata-se de uma Revisão Bibliográfica, iniciada através de uma pesquisa realizada em abril de 2023 nas bases de dados “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina e RCAAP”. Conteúdo: Esta patologia é uma doença neurodegenerativa rapidamente progressiva e caraterizada por atrofia/paralisia muscular, geralmente iniciada na idade adulta com sobrevida média de dois a três anos. As primeiras manifestações geralmente incidem na astenia dos membros inferiores, geralmente na 5ª ou 6ª décadas de vida. A paralisia intensifica-se e alastra-se, podendo atingir os músculos respiratórios e culminar em insuficiência respiratória. Contudo, a fisiopatologia não está esclarecida com clareza. Alguns investigadores consideram que o único fator ambiental que poderá ter alguma influência poderá ser o tabagismo; outros até afirmam que a influência da exposição ambiental global em si é controversa. Neste contexto, com maior ou menor consenso, destacam-se os pesticidas, fertilizantes, solventes, metais pesados, formaldeído, diesel, esforço físico/hipoxia, trauma e contato com a eletricidade. Desta forma, existem também alguns setores profissionais que poderão apresentar maior risco. Discussão e Conclusões: Ainda que a prevalência desta doença seja baixa, parte destes indivíduos estão inseridos na população ativa, pelo menos numa fase inicial. Não se encontraram dados concretos relativos a medidas de proteção ou outras atitudes relevantes para a equipa de Saúde e Segurança orientar neste contexto; ainda assim, os autores registaram de forma sucinta alguns itens nesse sentido, em função da sua experiência profissional, sobretudo para patologias com algumas semelhanças e mais prevalentes. Seria aliciante que profissionais a exercer em ambiente hospitalar, em instituição que exista uma consulta de apoio a utentes com esta patologia, se debruçassem um pouco sobre o tema, retratando a realidade nacional e publicando a sua investigação em revista da área, para difusão de conhecimentos a nível nacional, com extrapolação internacional, dada a escassez de bibliografia.

ABSTRACT Purpose: Smoking is a recognized risk factor for bladder BC and lung cancer LC. We investigated the enduring risk of BC after smoking cessation using U.S. national survey data. Our analysis focused on comparing characteristics of LC and BC patients, emphasizing smoking status and the latency period from smoking cessation to cancer diagnosis in former smokers. Materials and Methods: We analyzed data from the National Health and Examination Survey (2003-2016), identifying adults with LC or BC history. Smoking status (never, active, former) and the interval between quitting smoking and cancer diagnosis for former smokers were assessed. We reported descriptive statistics using frequencies and percentages for categorical variables and median with interquartile ranges (IQR) for continuous variables. Results: Among LC patients, 8.9% never smoked, 18.9% active smokers, and 72.2% former smokers. Former smokers had a median interval of 8 years (IQR 2-12) between quitting and LC diagnosis, with 88.3% quitting within 0-19 years before diagnosis. For BC patients, 26.8% never smoked, 22.4% were active smokers, and 50.8% former smokers. Former smokers had a median interval of 21 years (IQR 14-33) between quitting and BC diagnosis, with 49.3% quitting within 0-19 years before diagnosis. Conclusions: BC patients exhibit a prolonged latency period between smoking cessation and cancer diagnosis compared to LC patients. Despite smoking status evaluation in microhematuria, current risk stratification models for urothelial cancer do not incorporate it. Our findings emphasize the significance of long-term post-smoking cessation surveillance and advocate for integrating smoking history into future risk stratification guidelines. Purpose US U S U.S Methods 20032016, 20032016 2003 2016 , (2003-2016) never, (never assessed IQR Results 89 9 8.9 smoked 189 18 18.9 722 72 2 72.2 212 12 2-12 883 88 3 88.3 019 0 19 0-1 268 26 26.8 224 22 4 22.4 508 50 50.8 1433 14 33 14-33 493 49 49.3 Conclusions microhematuria it longterm long term postsmoking post guidelines 2003201 200 201 (2003-2016 8. 1 18. 7 72. 2-1 88. 01 0- 26. 22. 5 50. 143 14-3 49. 200320 20 (2003-201 2- 14- 20032 (2003-20 (2003-2 (2003- (2003 (200 (20 (2 (

Abstract Although control of Covid-19 has improved, the virus continues to cause infections, such as tuberculosis, that is still endemic in many countries, representing a scenario of coinfection. To compare Covid-19 clinical manifestations and outcomes between patients with active tuberculosis infection and matched controls. This is a matched case-control study based on data from the Brazilian Covid-19 Registry, in hospitalized patients aged 18 or over with laboratory confirmed Covid-19 from March 1, 2020, to March 31, 2022. Cases were patients with tuberculosis and controls were Covid-19 patients without tuberculosis. From 13,636 Covid-19, 36 also had active tuberculosis (0.0026%). Pulmonary fibrosis (5.6% vs 0.0%), illicit drug abuse (30.6% vs 3.0%), alcoholism (33.3% vs 11.9%) and smoking (50.0% vs 9.7%) were more common among patients with tuberculosis. They also had a higher frequency of nausea and vomiting (25.0% vs 10.4%). There were no significant differences in in-hospital mortality, mechanical ventilation, need for dialysis and ICU stay. Patients with TB infection presented a higher frequency of pulmonary fibrosis, abuse of illicit drugs, alcoholism, current smoking, symptoms of nausea and vomiting. The outcomes were similar between them. Covid19 Covid 19 Covid-1 improved infections countries coinfection casecontrol case Registry 1 2020 31 2022 13636 13 636 13,63 Covid19, 19, 3 0.0026%. 00026 0.0026% . 0 0026 (0.0026%) 5.6% 56 5 6 (5.6 0.0%, 00 0.0% , 0.0%) 30.6% 306 30 (30.6 3.0%, 3.0% 3.0%) 33.3% 333 33 (33.3 11.9% 119 11 9 50.0% 500 50 (50.0 9.7% 97 7 25.0% 250 25 (25.0 10.4%. 104 10.4% 10 4 10.4%) inhospital hospital mortality ventilation stay drugs them Covid1 Covid- 202 1363 63 13,6 0002 0.0026 002 (0.0026% 5.6 (5. 0.0 30.6 (30. 3.0 33.3 (33. 11.9 50.0 (50. 9.7 25.0 2 (25. 10.4 20 136 13, 000 0.002 (0.0026 5. (5 0. 30. (30 3. 33. (33 11. 50. (50 9. 25. (25 10. 0.00 (0.002 ( (3 (2 (0.00 (0.0 (0. (0

RESUMEN Introducción: El cáncer de cérvix es un grave problema de salud que puede prevenirse con diagnósticos tempranos y la participación activa de las mujeres y profesionales de la salud. Objetivo: Determinar la asociación entre factores de riesgo y la aparición del cáncer de cérvix en mujeres procedentes del Consultorio Médico no. 7 del área del Policlínico Docente Julio Castillo Álvarez, en Chambas, Ciego de Ávila. Materiales y métodos: Se realizó un estudio analítico retrospectivo con 18 mujeres entre 25 y 60 años con diagnóstico previo de cáncer de cérvix, pertenecientes al Consultorio Médico no. 7, que fueron atendidas en el Hospital Provincial General Docente Roberto Rodríguez, de Morón. Resultados: Solo el 13 % de las participantes mencionaron gestaciones prematuras, y el 37,0 % reportó infección vaginal. El embarazo en la adolescencia fue el factor más común, con un 55,6 % de las mujeres afectadas. La mayoría de las mujeres (92,6 %) habían tomado anticonceptivos orales. Conclusiones: Los factores de riesgo identificados incluyen el primer coito antes de los 15 años y el hábito tabáquico, presentes en una franca minoría. El embarazo en la adolescencia y la ingestión de anticonceptivos orales fueron los más referidos.

ABSTRACT Introduction: Cervical cancer is a serious health problem that can be prevented with early diagnoses and the active participation of women and health professionals. Objective: To determine the association of risk factors and the onset of cervical cancer in women from Doctor’s office #7 of the Teaching Polyclinic Julio Castillo Alvarez area, in Chambas, Ciego de Avila. Materials and methods: A retrospective, analytical study was carried out with 18 women aged between 25 and 60 years, with previous diagnosis of cervical cancer, and belonging to the Doctor’s Office # 7, who were treated at the Provincial General Teaching Hospital Roberto Rodríguez, in Morón. Results: Only 13% of the participants mentioned premature gestations and 37.0 reported vaginal infection. Teenage pregnancy was the most common factor, with 55.6% of women affected. Most of women (92.6%) had taken contraceptives. Conclusions: The risk factors identified include the first intercourse before the age of 15 and smoking, present in a clear minority. Pregnancy in adolescence and ingestion of oral contraceptives were the most mentioned.

RESUMEN Fundamento: el conocimiento y las convicciones en relación con el tabaco guardan relación, según se ha demostrado, con la conducta respecto al hábito tóxico. Objetivo: modificar los conocimientos sobre el tabaquismo en fumadores activos de un consultorio médico de la familia. Métodos: se realizó una intervención educativa en los 85 pacientes fumadores activos, pertenecientes al consultorio médico No. 4 del Policlínico Universitario “Ramón López Peña” de Santiago de Cuba, entre julio 2022-enero 2023. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético e inductivo-deductivo para la recogida de información y fundamentación de la investigación; del nivel empírico: el cuestionario y la observación. Resultados: se evidenció que antes de la intervención educativa, la mayoría de los pacientes tenían conocimientos inadecuados en los dominios: factores de riesgo, conducta a seguir y prevención; resultados que fueron modificados después de la intervención. Conclusiones: se logró una mejoría significativa de los indicadores de conocimientos evaluados.

ABSTRACT Background: knowledge and beliefs regarding tobacco are related, as has been demonstrated, to behavior regarding the toxic habit. Objective: to modify knowledge about smoking in active smokers in a family doctor's office. Methods: an educational intervention was carried out on 85 active smoking patients, belonging to doctor´s office No. 4 from “Ramón López Peña” University Polyclinic of Santiago de Cuba, from July 2022 to January 2023. Theoretical methods were used: historical-logical, analytical-synthetic and inductive-deductive for the collection of information and foundation of the research; from the empirical level: the questionnaire and observation. Results: it was evident that before the educational intervention, the majority of patients had inadequate knowledge in the variables: risk factors, behavior to follow and prevention; results that were modified after the intervention. Conclusions: a meaningful improvement was achieved in the knowledge indicators evaluated.

Abstract OBJECTIVE: To determine the relationship between the extent of alcohol, tobacco and illicit substance use and adverse obstetric outcomes to enable obstetric care providers to assess the risks of substance use. MATERIALS AND METHODS: Retrospective, observational, analytical and cross-sectional study of a case series of postpartum patients who were admitted to the Gynaecology and Obstetrics Service of the General Hospital of Saltillo between March and June 2023 and who reported alcohol, tobacco or drug use during pregnancy. After the obstetric procedure, the ASSIST tool or screening test for alcohol, tobacco and drug use was applied. Pearson's χ2 test and Fisher´s exact statistic were used to assess their association with adverse outcomes according to the level of use. RESULTS: Of 863 obstetric attendances, 47 patients 5.4% reported active use of different substances during pregnancy; of these, 22 used 2 substances, with a trend between tobacco and cannabis use for adverse obstetric outcomes p = 0.16 and 0.17, respectively. The most common adverse obstetric outcome was low birth weight in 22 of 47 patients. CONCLUSIONS: The substances with the highest tendency for adverse obstetric outcome were tobacco and cannabis, and the most common adverse neonatal outcome was low birthweight.

Resumen OBJETIVO: Establecer la relación entre el grado de consumo de alcohol, tabaco y sustancias ilícitas con los desenlaces obstétricos adversos para que el personal encargado de la atención obstétrica evalúe los riesgos que implica el consumo de esas sustancias. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, analítico y transversal de una serie de casos llevado a cabo en pacientes en el puerperio hospitalizadas en el servicio de Ginecología y Obstetricia del Hospital General de Saltillo entre marzo y junio del 2023 y que refirieron consumo de alcohol, tabaco o drogas durante el embarazo. Posterior al procedimiento obstétrico se aplicó la herramienta ASSIST o prueba de detección de consumo alcohol, tabaco y sustancias. Según el grado de consumo, se utilizó la prueba χ2 de Pearson y la prueba exacta de Fisher para evaluar su asociación con los desenlaces adversos. RESULTADOS: De 863 atenciones obstétricas, 47 pacientes 5.4% refirieron un consumo activo de diferentes sustancias durante el embarazo; de ellas, 22 consumían 2 sustancias, con una tendencia entre el consumo de tabaco y cannabis a un desenlace obstétrico adverso p = 0.16 y 0.17, respectivamente. El desenlace obstétrico adverso más frecuente fue el bajo peso al nacer en 22 de 47 pacientes. CONCLUSIONES: Las sustancias con mayor tendencia a un desenlace obstétrico adverso fueron el tabaco y la cannabis, y la consecuencia desfavorable más frecuente en los neonatos fue el bajo peso al nacer.

ABSTRACT Active aging is based on four pillars: health, safety, participation, and lifelong learning. These pillars help individuals improve their quality of life throughout the aging process. Objective: To analyze the effectiveness of the Active Aging Program; identify the sociodemographic profile of the participants; identify prevalent diseases in the initial evaluation; and assess the results of the program after one year of follow-up. Methods: This is a quantitative, cross-sectional, exploratory, desk research, and descriptive study. Data from 545 employees of University of São Paulo participating in the Active Aging Program of the University Teaching Hospital of the University of São Paulo (HU-USP) between 2015 and 2018 were analyzed using the Minitab Program. For data analysis, Pearson's chi-square test was used to determine the association between Groups A and B. For continuous measures, the paired t-test was used to verify differences in means, adopting a 95% confidence interval and significance level of 0.05. Results: Statistically significant correlations were found when crossing sex with smoking; sex with triglycerides; age with risk factors for cardiovascular diseases, being the age group 40–59 statistically more significant; physical activity with risk factors for cardiovascular diseases; and body mass index at program entry with the one-year result. Conclusion: The study expanded knowledge about risk factors for cardiovascular diseases and provided important information for the continuity of the program. health safety participation learning process Objective participants evaluation followup. followup follow up. up follow-up Methods quantitative crosssectional, crosssectional cross sectional, sectional cross-sectional exploratory research 54 HUUSP HU USP (HU-USP 201 analysis Pearsons Pearson s chisquare chi square B measures ttest t means 95 005 0 05 0.05 Results smoking triglycerides 4059 40 59 40–5 oneyear result Conclusion 5 20 9 00 0.0 405 4 40– 2 0.

RESUMO O envelhecimento ativo se apoia em quatro pilares: saúde, segurança, participação e aprendizagem ao longo da vida. Esses pilares auxiliam os indivíduos na qualidade de vida ao longo do processo de envelhecimento. Objetivo: Analisar a efetividade do Programa Envelhecimento Ativo; identificar o perfil sociodemográfico dos participantes; identificar patologias predominantes na avaliação inicial; e verificar os resultados do programa após um ano de acompanhamento. Métodos: Trata-se de pesquisa quantitativa, de caráter transversal, exploratória, documentária e descritiva. Foram analisados os dados de 545 funcionários da Universidade de São Paulo que participaram do Programa do Envelhecimento Ativo do Hospital Universitário da Universidade de São Paulo (HU-USP) no período de 2015 a 2018. Os dados foram analisados pelo Programa Minitab. Na análise de dados, usou-se o Qui-quadrado para testar a associação entre os grupos. Já para medida contínua, utilizou-se o Teste T Pareado, para verificar se as médias eram diferentes. Nas análises, foi usado um período de confiabilidade de 95% e nível de relevância de 0,05. Resultados: Foram encontradas correlações estatisticamente expressivas no cruzamento de sexo com tabagismo; sexo com triglicérides; idade com fatores de risco para doenças cardiovasculares sendo que a faixa etária de 40–59 foi estatisticamente mais significativa; atividade física com prevalência de fatores de riscos para doenças cardiovasculares; e índice de massa corpórea inicial com o resultado após um ano. Conclusão: A pesquisa ampliou o conhecimento a respeito dos fatores de risco para doenças cardiovasculares e forneceu informações importantes para a continuidade do programa. saúde segurança Objetivo participantes acompanhamento Métodos Tratase Trata quantitativa transversal exploratória descritiva 54 HUUSP HU USP (HU-USP 201 2018 Minitab usouse usou Quiquadrado Qui quadrado grupos contínua utilizouse utilizou Pareado diferentes análises 95 005 0 05 0,05 Resultados tabagismo triglicérides 4059 40 59 40–5 significativa Conclusão 5 20 9 00 0,0 405 4 40– 2 0,

Introduction: Chronic non-communicable diseases (NCDs), such as cancer, cardiovascular and respiratory diseases, are the epidemic of the 21st century, smoking being a common risk factor. Objective: To characterize smoking patients in the Intermediate Treatment Unit (ICU) of the Chilean National Thorax Institute. Material and Method: Observational, analytical and descriptive study. 150 consecutive admissions to the ICU were evaluated from September 1 to December 1, 2022. Results: The prevalence of smoking was 56%, including former smokers. The average age was 64 years-old. Exposure to secondhand smoke was significant with 41.7% in active smokers. The associations with high blood pressure, COPD and lung cancer were significant. 20.2% of patients with lung cancer were active smokers. The days of stay in the unit, general hospital stay, or deaths were not significant. Conclusions: In our cohort the prevalence of smoking was higher than the national average and its link with NCDs is confirmed. We identified that secondhand exposure was significant, so efforts to stop smoking must be focused on both the patient and their immediate environment. Although some patients had a diagnosis of lung cancer, a significant percentage continued to smoke, making it important to incorporate this group of patients into specialized programs to reduce morbidity. With our study we reaffirm the importance of continuing national efforts to reduce smoking as a preventive action for NCDs and their complications.

Resumen Introducción: Las enfermedades crónicas no transmisibles (ECNT), como el cáncer, enfermedades cardiovasculares y respiratorias, son la epidemia del siglo XXI, siendo el tabaquismo un factor de riesgo común. Objetivo: Caracterizar a los pacientes tabáquicos de la Unidad de Tratamientos Intermedios (UTI) del Instituto Nacional del Tórax. Material y Método: Estudio observacional, analítico y descriptivo. Se evaluaron 150 ingresos consecutivos a la UTI desde el 01 de septiembre al 01 de diciembre de 2022. Resultados: La prevalencia de tabaquismo fue de un 56%, incluyendo exfumadores. La media de edad fue de 64 años. La exposición a humo de segunda mano resultó significativa con un 41,7% en fumadores activos. Las asociaciones con hipertensión arterial, EPOC y cáncer pulmonar resultaron significativas. Un 20,2% de los pacientes con cáncer pulmonar tenían tabaquismo activo. No fueron significativos los días de estadía en la unidad, hospitalaria general ni fallecimientos. Conclusiones: En nuestra cohorte la prevalencia de tabaquismo fue más alta que la nacional y se confirmó su vínculo con las ECNT. Identificamos que la exposición de segunda mano fue significativa, por lo que los esfuerzos para el cese del tabaquismo deben ir enfocados tanto al paciente como su entorno cercano. A pesar que algunos pacientes tenían el diagnóstico de cáncer pulmonar, un porcentaje no menor seguía fumando, por lo que es relevante incorporar a este grupo de pacientes a programas especializados para reducir morbilidad. Con nuestro estudio reafirmamos la importancia de continuar con los esfuerzos nacionales por reducir el tabaquismo como acción preventiva de las ECNT y sus complicaciones.

Resumo Introdução: Incluir doentes com doença hepática asso-ciada ao álcool (DHA) em lista ativa de transplante hep-ático (TH) é desafiante, especialmente pelo risco de recidiva de consumo de álcool pós-TH. O objetivo foi avaliar o consumo de álcool pós-TH num centro de transplantação português. Métodos: Realizamos um estudo transver-sal incluindo doentes submetidos a TH em 2019 no Hospital Curry Cabral, Lisboa, Portugal. Foi realizado um questionário previamente testado e uma tradução validada para o português do Alcohol Use Disorder Identification Test (AUDIT), através de uma chamada telefónica. O consumo de álcool foi definido pelo autorrelato do doente ou por um AUDIT positivo. Resultados: Durante 2019, 122 doentes foram submetidos a TH e 99 responderam ao questionário (junho de 2021). A idade média (SD) foi de 57 (10) anos, 70 doentes (70,7%) eram do sexo masculino e 49 (49,5%) foram submetidos a TH relacionado com DHA. Com uma mediana (IQR) de follow-up de 24 (20-26) meses após o TH-índex, 22 (22,2%) doentes admitiram algum consumo de álcool: 14 beberam mensalmente ou menos e oito beberam 2-4 vezes/mês. Nos dias em que bebiam, 18 consumiam normalmente 1-2 bebidas e os restantes não mais do que 3-4 bebidas. Um doente reportou o consumo de ≥6 bebidas em uma ocasião. Todos os doentes transplantados com consumo alcoólico pós-TH foram considerados de baixo risco (pontuação <8) de acordo com o AUDIT (mediana [IQR] de 1 [1-2]). Nenhum doente reportou problemas relacionados com o álcool, tanto autoinfligido como a terceiros. Os indivíduos transplantados com consumo alcoólico eram mais jovens (53 vs. 59 anos, p = 0,020), o motivo de TH era mais frequentemente não relacionado com DHA (72,7 vs. 44,2%, p = 0,018) e apresentavam mais tabagismo ativo (31,8 vs. 10,4%, p = 0,037) quando comparado com os abstinentes. Conclusão: Na nossa coorte, cerca de um quarto dos doentes transplantados hepáticos consumiram álcool no período pós-transplante precoce, todos com um padrão de baixo risco, de acordo com o AUDIT.

Abstract Background: Listing patients with alcohol-associated liver disease (ALD) for liver transplant (LT) remains challenging especially due to the risk of alcohol resumption post-LT. We aimed to evaluate post-LT alcohol consumption at a Portuguese transplant center. Methods: We conducted a cross-sectional study including LT recipients from 2019 at Curry Cabral Hospital, Lisbon, Portugal. A pretested survey and a validated Portuguese translation of the Alcohol Use Disorder Identification Test (AUDIT) were applied via a telephone call. Alcohol consumption was defined by patients’ self-reports or a positive AUDIT. Results: In 2019, 122 patients underwent LT, and 99 patients answered the survey (June 2021). The mean (SD) age was 57 (10) years, 70 patients (70.7%) were males, and 49 (49.5%) underwent ALD-related LT. During a median (IQR) follow-up of 24 (20-26) months post-index LT, 22 (22.2%) recipients consumed any amount of alcohol: 14 had a drink monthly or less and 8 drank 2-4 times/ month. On drinking days, 18 patients usually consumed 1-2 drinks and the remainder no more than 3-4 drinks. One patient reported having drunk ≥6 drinks on one occasion. All post-LT drinking recipients were considered low risk (score <8) as per the AUDIT score (median [IQR] of 1 [1-2]). No patient reported alcohol-related problems, whether self-inflicted or toward others. Drinking recipients were younger (53 vs. 59 years, p = 0.020), had more non-ALD-related LT (72.7 vs. 44.2%, p = 0.018) and active smoking (31.8 vs. 10.4%, p = 0.037) than abstinent ones. Conclusion: In our cohort, about a quarter of LT recipients consumed alcohol early posttrans-plant, all with a low-risk pattern according to the AUDIT score.

ABSTRACT Background: The pathogenesis of infection triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been intensively investigated, constituting a challenge on a global scale. It is known that the effectiveness and magnitude of both innate and acquired immune responses to SARS-CoV-2 infection determine the severity of the clinical presentation. Literature on the evolution of SARS-CoV-2 infection in patients with X-linked agammaglobulinemia is still scarce. Objective: To report the spectrum of clinical manifestations associated with SARS-CoV-2 infection in patients with X-linked followed in a tertiary hospital. Methods: This is an observational retrospective study of patients with X-linked agammaglobulinemia with SARS-CoV-2 infection diagnosed between March 2020 and July 2022. Results: Among 13 patients under follow-up, nine patients were included, with a mean age of 32 ± 6.1 years. Two patients reported a second SARS-CoV-2 infection during the study. All patients were on polyvalent immunoglobulin G replacement therapy. Seven patients presented risk factors for severe COVID-19 disease: bronchiectasis (n=5), insulin-dependent diabetes (n=1), active smoking (n=1), obesity (n=1), cerebrovascular disease (n=1), immunosuppressive therapy (n=1). COVID-19 infection was mild in most patients (asymptomatic infection n=1, mild n=9, moderate n=1). The most frequently affected systems were the upper (n=6) and lower (n=5) respiratory airways, with fever (n=7) and nasal congestion (n=6) being the most frequent manifestations. Bacterial infection was reported in 4 patients. One patient underwent therapy with convalescent plasma, with tolerance and a favorable clinical course. Conclusion: In this series of patients with X-linked agammaglobulinemia, a high prevalence of SARS-CoV-2 infection is reported, highlighting a mild severity outcome in almost all patients.

RESUMO Fundamentos: A patogénese da infeção por SARS-CoV-2 tem sido extensamente investigada, constituindo um desafio à escala global. É sabido que a eficiência da resposta da imunidade inata e adquirida à infeção por SARS-CoV-2 condiciona a gravidade da apresentação clínica. É ainda escassa a literatura sobre a evolução da infeção por SARS-CoV-2 nos doentes com agamaglobulinemia ligada ao X. Objetivo: Reportar o espetro de manifestações clínicas associadas à infeção por SARS-CoV-2 em doentes com agamaglobulinemia ligada ao X e sua gravidade. Métodos: Estudo observacional retrospetivo dos doentes com agamaglobulinemia ligada ao X em seguimento num hospital terciário e com infeção por SARS-CoV-2, diagnosticada entre março de 2020 e julho de 2022. Resultados: De um total de 13 doentes em seguimento com agamaglobulinemia ligada ao X, foram incluídos 9, com média de idades de 32±6,1 anos, entre os quais se identificaram 2 doentes com uma segunda infeção por SARS-CoV-2 durante o período em estudo. Todos os doentes estavam sob terapêutica de substituição com imunoglobulina polivalente G. Sete doentes apresentavam fatores de risco para doença COVID-19 grave: bronquiectasias (n=5), diabetes insulinodependente (n=1), tabagismo ativo (n=1), obesidade (n=1), doença cerebrovascular (n=1) e terapêutica imunossupressora (n=1). A infeção associou-se a manifestações clínicas de baixa gravidade na maioria dos doentes (infeção assintomática n=1, ligeira n=9, moderada n=1). Os sistemas mais afetados foram as vias áreas superiores (n=6) e inferiores (n=5), sendo a febre (n=7) e a obstrução nasal (n=6) as manifestações mais frequentes. Registou-se sobreinfeção bacteriana em 4 doentes. Um doente apresentou COVID-19 de gravidade moderada e duração prolongada, possivelmente em relação com comorbilidades médicas, tendo apresentado um curso clínico favorável com a administração de plasma de convalescentes. Conclusão: Reporta-se nesta série de doentes com agamaglobulinemia ligada ao X elevada prevalência de infeção por SARS-CoV-2, destacando-se a evolução de gravidade ligeira na quase totalidade dos doentes.

Abstract Background In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated. Objective To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation. Methods On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis. Results A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13–2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07–0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46–16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5–25.5], p < 0.001). Conclusions The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors. CHA2DS2VASC CHADSVASC CHA2DS2 VASC CHA DS smoking cancer investigated nonvalvular non valvular 24 (12 12 controls, controls , controls) nonclassic classic analysis CHA2DS2VASc CHADSVASc VASc OR 1.75 175 1 75 95 1.13–2.70 113270 13 2 70 0.032, 0032 0.032 0 032 0.032) 0.19 019 19 0.07–0.51 007051 07 51 0.001 0001 001 6.31 631 6 31 2.46–16.19 2461619 46 16 age sex 80 8 8. [95 2.5–25.5, 25255 2.5–25.5 5 25 2.5–25.5] 0.001. . CHADS CHA2DS (1 1.7 17 7 9 1.13–2.7 11327 003 0.03 03 0.1 01 0.07–0.5 00705 0.00 000 00 6.3 63 3 2.46–16.1 246161 4 [9 2525 2.5–25. ( 1. 1.13–2. 1132 0.0 0. 0.07–0. 0070 6. 2.46–16. 24616 [ 252 2.5–25 1.13–2 113 0.07–0 007 2.46–16 2461 2.5–2 1.13– 11 0.07– 2.46–1 246 2.5– 1.13 0.07 2.46– 2.5 1.1 2.46 2. 2.4

Resumo Antecedentes Em pacientes com fibrilação atrial, o escore CHA2DS2-VASC orienta a prevenção de AVC com anticoagulantes, mas é um escore imperfeito. Outros fatores de risco potenciais, como insuficiência renal, o tipo de fibrilação atrial, tabagismo ativo, câncer, apnéia do sono ou inflamação sistêmica foram menos bem investigados. Objetivo Avaliar o impacto desses fatores no risco de AVC isquêmico em pacientes com fibrilação atrial não valvular. Métodos Em uma população de 248 pacientes (124 pacientes com AVC isquêmico agudo e 124 controles), realizamos uma regressão logística para avaliar o impacto de múltiplos fatores de risco não clássicos na predição de AVC isquêmico agudo. O seu impacto na mortalidade foi avaliado através da realização de uma análise de sobrevivência. Resultados Escore CHA2DS2-VASc alto (OR 1,75; IC 95% 1,13–2,70; p = 0,032), tratamento com anticoagulantes (OR 0,19; IC 95% 0,07–0,51; p < 0,001) e fibrilação atrial permanente (OR 6,31; 95% CI 2,46–16,19; p < 0,001) foram independentemente associados ao AVC isquêmico agudo. Insuficiência renal e doença pulmonar obstrutiva crônica previram maior mortalidade. Após ajuste para idade, sexo, pontuação CHA2DS2-VASc e uso de anticoagulantes, o único fator de risco preditivo para AVC isquêmico agudo foi o tipo permanente de FA (OR: 8,0 [IC 95% 2,5–25,5], p < 0,001). Conclusões O escore CHA2DS2-VASc, a ausência de anticoagulantes e o tipo permanente de fibrilação atrial foram os principais fatores preditivos para a ocorrência de AVC isquêmico agudo. Estudos maiores são necessários para resultados conclusivos sobre outros fatores. CHA2DS2VASC CHADSVASC CHA2DS2 VASC CHA DS imperfeito potenciais ativo câncer investigados valvular 24 (12 12 controles, controles , controles) sobrevivência CHA2DS2VASc CHADSVASc VASc OR 1,75 175 1 75 95 1,13–2,70 113270 13 2 70 0,032, 0032 0,032 0 032 0,032) 0,19 019 19 0,07–0,51 007051 07 51 0,001 0001 001 6,31 631 6 31 2,46–16,19 2461619 46 16 idade sexo 80 8 8, 2,5–25,5, 25255 2,5–25,5 5 25 2,5–25,5] 0,001. . CHA2DS2VASc, VASc, CHADS CHA2DS (1 1,7 17 7 9 1,13–2,7 11327 003 0,03 03 0,1 01 0,07–0,5 00705 0,00 000 00 6,3 63 3 2,46–16,1 246161 4 2525 2,5–25, ( 1, 1,13–2, 1132 0,0 0, 0,07–0, 0070 6, 2,46–16, 24616 252 2,5–25 1,13–2 113 0,07–0 007 2,46–16 2461 2,5–2 1,13– 11 0,07– 2,46–1 246 2,5– 1,13 0,07 2,46– 2,5 1,1 2,46 2, 2,4

Abstract The purpose of the cross-sectional study was to identify patterns of modifiable lifestyle behaviors and examine the relationship between sociodemographic characteristics and distinct lifestyle behaviors. The data were gathered from the National Health Survey 2019, a study that included adults with diabetes. Four domains of lifestyle behaviors were used to define these behaviors: smoking, alcohol consumption, physical activity, and diet. The association between patterns of lifestyle behaviors and variables of interest was assessed using multinomial regression analysis. The three lifestyle patterns identified were: Class 1, referred to as “unhealthy diet,” comprised 17.0% of the sample and was characterized by unhealthy eating habits; Class 2 (less active and insufficient fruit and vegetable intake) represented 71.2% of the sample; Class 3 referred to as “low risk” (11.8%) is characterized by a lower probability of engaging in most risky behaviors. A person over 45 years of age with little or no education and no health care coverage was less likely to be a member of Class 1. Male individuals who do not attend a doctor regularly exhibited more chances of belonging to Class 2. Mixed-race individuals aged 45 years or more with a low level of education have a lower chance of belonging to this class. crosssectional cross sectional 2019 diabetes smoking consumption activity diet analysis 1 diet, 170 17 0 17.0 habits intake 712 71 71.2 risk 11.8% 118 11 8 (11.8% 4 Mixedrace Mixed race class 201 17. 7 71. 11.8 (11.8 20 11. (11. (11 (1 (

Resumo Neste estudo de caráter transversal objetivou-se identificar os padrões de comportamento de estilo de vida e sua associação com características sociodemográficas. Utilizou-se como base de dados a Pesquisa Nacional de Saúde de 2019, com adultos (≥ 18 anos) diabéticos. Os padrões de saúde foram definidos pela Análise de Classes Latentes em quatro domínios: tabagismo, consumo de bebidas alcoólicas, atividade física e alimentação. Foi aplicada análise de regressão multinominal para identificar a associação entre os padrões de comportamento e as variáveis sociodemográficas de interesse. Identificou-se três padrões de comportamento: a Classe 1 corresponde a 17% da amostra e compreende indivíduos com maior probabilidade de comportamentos de risco ligados à alimentação; a Classe 2 (baixos nível de atividade física e consumo de frutas e hortaliças) compreende 71,2% da amostra; e a Classe 3 (11,8% da população) reúne os indivíduos com menor chance de desenvolver comportamentos de risco. Indivíduos com 45 anos ou mais, com baixa escolaridade e sem plano de saúde têm menos chances de pertencer à Classe 1. Homens, que não fazem visitas regulares ao médico têm maiores chances de pertencer à Classe 2, bem como aqueles com 45 anos ou mais, com baixa escolaridade. objetivouse objetivou se Utilizouse Utilizou 2019 ≥ ( diabéticos domínios tabagismo alcoólicas alimentação interesse Identificouse Identificou 17 baixos hortaliças 712 71 71,2 11,8% 118 11 8 (11,8 população 4 mais Homens 201 7 71, 11,8 (11, 20 11, (11 (1

ABSTRACT Introduction: The therapeutic plasma exchange (TPE) controls the systemic cytokine level and might improve the immune response in patients with severe Coronavirus (COVID-19) infection. To date, in developing countries, no study has explored the effectiveness and risk factors in a population with severe COVID-19 exposed to the TPE. Method: We described the risk factors associated with survival rates higher than 28 days and length of stay (LOS) in the intensive care unit (ICU) shorter than 15 days. Severe COVID-19 cases treated with TPE were included, from August 2020 to June 2021. Survival analysis with Kaplan-Meier curves, log-rank tests and multivariate logistic regressions were conducted to assess patient-related factors that could predict a higher survival rate and the ICU LOS. Results: A total of 99 patients with severe COVID-19 who had received TPE were followed during their hospital stay and for 28 days after discharge. The sample was composed of men (63%) aged 56 ± 16 years. The overall survival rate at 28 days was 80%. The ICU LOS (p = 0.0165) and mechanical ventilation (MV) (p = 0.00008) were considered factors that could increase the risk of death. Patient-related factors that influenced the 28-day mortality were the smoking status (OR = 5.8; 95%CI 1.5, 22) and history of oncologic or non-malignant hematologic diseases (OR = 5.9; 95%CI 1.2, 29). Conclusion: Patients with severe COVID-19 exposed to the TPE were associated with a 20% risk of death in a 28-day observation window, appearing to be lower than previous treatments. Active smoking, cancer and immunosuppressive conditions should be considered as relevant variables to be controlled in future trials on the TPE and COVID-19. Introduction (TPE COVID19 COVID 19 (COVID-19 infection date countries COVID-1 Method 2 (LOS (ICU 1 included 202 2021 KaplanMeier Kaplan Meier curves logrank log rank patientrelated patient related Results 9 discharge 63% 63 (63% 5 years 80 80% p 0.0165 00165 0 0165 MV (MV 0.00008 000008 00008 Patientrelated Patient 28day day OR 5.8 58 8 95CI CI 95 1.5 22 nonmalignant non malignant 5.9 59 12 1.2 29. 29 . 29) Conclusion 20 window treatments COVID19. 19. COVID1 (COVID-1 COVID- 6 (63 0.016 0016 016 0.0000 00000 0000 5. 1. (COVID- (6 0.01 001 01 0.000 000 (COVID ( 0.0 00 0.00 0.

Abstract Objectives This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. Methods A cross-sectional study was conducted on a sample of 161 patients attending the… All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. Results Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p = 0.04), as well duration of treatment (p = 1.53e-3) and age (p = 0.02). Hyperpigmentation was related to race (p = 0.01) and smoking (p = 1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [−2.27 to −0.25]; p-value = 0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR = 8.47 [1.18-3.10], p = 1.31e-5), without race or type and duration of treatment. Conclusion Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. Level of evidence Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence"). CD count load crosssectional cross sectional 16 counts ChiSquare, ChiSquare Chi Square, Square Chi-Square T/MannWhitney, TMannWhitney T/Mann Whitney, T Mann Whitney T/Mann-Whitney tests 5839 58 39 58.39 7 48.45% 4845 48 45 (48.45% 49.07% 4907 49 07 (49.07% frequently 2 14.29%, 1429 14.29% , 29 (14.29%) LGE (LGE 1 9.32%, 932 9.32% 9 32 (9.32%) 8.70%. 870 8.70% . 8 70 (8.70%) OHL (OHL 1.86%. 186 1.86% 86 (1.86%) 0.04, 004 0.04 0 04 0.04) 1.53e3 153e3 e 1.53e 53e 1.53e-3 0.02. 002 0.02 02 0.02) 0.01 001 01 1.30e6. 130e6 1.30e 6 30e 1.30e-6) CD4CD8 CDCD CD8 CD4:CD ratio OR 028 28 0.2 −2.27 227 27 [−2.2 −0.25 025 25 −0.25] pvalue value 0.03, 003 0.03 03 0.03) 847 47 8.4 1.183.10, 118310 1.18 3.10 18 10 [1.18-3.10] 1.31e5, 131e5 1.31e 5 31e 1.31e-5) TCD4 TCD TCD8 TCD4TCD8 TCDTCD TCD4:TCD OCEBM Group Group* 201 Evidence. Evidence") MannWhitney T/MannWhitney TMann 583 58.3 48.45 484 4 (48.45 49.07 490 (49.07 142 14.29 (14.29% 93 9.32 (9.32% 87 8.70 (8.70% 1.86 (1.86% 00 0.0 53e3 153e 1.53e- 30e6 1.30e6 130e 1.30e-6 CD4CD 0. −2.2 22 [−2. −0.2 84 8. 183 1.183.10 11831 118 1.1 310 3.1 [1.18-3.10 31e5 1.31e5 131e 1.31e-5 TCD4TCD 20 Evidence" 58. 48.4 (48.4 49.0 (49.0 14.2 (14.29 9.3 (9.32 8.7 (8.70 1.8 (1.86 1.30e- −2. [−2 −0. 1.183.1 1183 11 1. 31 3. [1.18-3.1 1.31e- 48. (48. 49. (49. 14. (14.2 9. (9.3 (8.7 (1.8 −2 [− −0 1.183. [1.18-3. (48 (49 (14. (9. (8. (1. − [ 1.183 [1.18-3 (4 (14 (9 (8 (1 [1.18- ( [1.18 [1.1 [1. [1

Resumen Introducción: Existen dos formas de presentación clínica de los síndromes coronarios agudos (SCA): con elevación del segmento ST (SCACEST) y sin elevación (SCASEST). Los mecanismos que determi nan ambas presentaciones no se conocen completamente. El objetivo del estudio fue definir la asociación entre factores de riesgo cardiovascular y otras variables clínicas con la presentación de los SCA como SCACEST o SCASEST. Métodos: Analizamos información de pacientes incluidos prospectivamente en el Registro Epi-Cardio con diagnóstico de SCA desde abril de 2006 a abril de 2018.Se incluyeron un total de 10 019 pacientes. Resul tados: En el análisis multivariado, el sexo masculino (OR 1.5) y el tabaquismo activo (OR 1.71) se asociaron positivamente con el SCACEST. Contrariamente, la hipertensión (OR 0.71), las dislipidemias (OR 0.74), la edad (OR 0.97 por quintilo), historia de infarto (OR 0.57), angina crónica (OR 0.44), presencia de comorbilidades (OR 0.64), y la extensión de enfermedad coronaria (OR 0.84) se asociaron negativamente con el SCACEST. Las mujeres presentaron mayor incidencia de SCASEST, debido a una mayor proporción de SCA sin obstrucción coronaria significativa. Conclusión: Concluimos que algunos factores de riesgo cardiovascular y otras variables clínicas se asociaron independientemente con la presentación clínica como SCACEST o SCASEST, confirmando su influencia en la fisiopatología y en la presentación clínica y electrocardiográfica de los SCA.

Abstract Introduction: Two clinical presentations of acute coronary syndrome (ACS) have been defined: ST- segment elevation ACS (STEACS) or non-ST-segment elevation ACS (NSTEACS). The mecha nism that determines the clinical presentation of ACS is not clearly understood. The aim of this study was to define the association between cardiovascular risk factors and other clinical variables with the clinical presentation of ACS as STEACS or NSTEACS. Methods: We analyzed data of patients prospectively included in the Epi-Cardio Registry with a diagnosis of ACS from April 2006 to April 2018. A total of 10 019 patients were included in the study. Results: In the multivariate analysis, male sex (OR 1.5) and active smoking (OR 1.71) were positively associated with STEACS presentation. Conversely, hypertension (OR 0.71), dyslipidemia (OR 0.74), age (OR 0.97 per quintile), history of myocardial infarction (OR 0.57), chronic angina (OR 0.44), presence of comorbidities (OR 0.64), and extension of coronary heart disease (OR 0.84) were negatively associated with STEACS. Women differed from men by presenting a higher incidence of NSTEACS, due to a greater proportion of ACS without obstructive coronary heart disease. Conclusion: Some cardiovascular risk factors and other clinical variables are independently associated with the presentation of ACS as ST EACS or NSTEACS. These findings confirm the influence of risk factors and clinical history on the pathophysiology, clinical and electrocardiographic presentation of ACS.