ABSTRACT Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and “slow cook” transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was −0.10 ± 0.35 and −0.074 ± 0.16 in the micropulse- and “slow cook” transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the “slow cook” and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the “slow cook” transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and “slow cook” transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively. Purpose slow cook openangle Methods 1 followup. followup follow up. up follow-up 20 ≥20 andor or B. B . B) Results 2553 25 53 25.5 640 40 6.4 3502 35 02 35.0 1257 57 12.5 p<0.001. p0001 p p<0.001 0 001 (p<0.001) 1433 14 33 14.3 340 3 3.4 1537 15 37 15.3 585 5 85 5.8 followup, up, p=0.110. p0110 p=0.110 110 (p=0.110) 1120 11.2 1146 46 11.4 1965 65 19.6 1322 13 22 13.2 052 52 0.5 069 69 0.6 175 75 1.7 104 04 1.0 010 10 −0.1 035 0.3 0074 074 −0.07 016 16 0.1 p=0.510. p0510 p=0.510 510 (p=0.510) Preoperatively 344 44 138 38 1.3 289 89 2.8 068 68 p=0.017, p0017 p=0.017 , 017 (p=0.017) 206 06 2.0 142 42 1.4 102 146 17.74% 1774 17 74 (17.74% 28.78% 2878 78 (28.78% p=0.171. p0171 p=0.171 171 (p=0.171) 42.42% 4242 (42.42% 3.22% 322 (3.22% Conclusion effectively ≥2 255 25. 64 4 6. 350 35. 125 12. p000 p<0.00 00 (p<0.001 143 14. 34 3. 153 15. 58 8 5. p011 p=0.11 (p=0.110 112 11. 114 196 19. 132 13. 05 0. 7 1. 01 −0. 03 007 07 −0.0 p051 p=0.51 51 (p=0.510 2. p001 p=0.01 (p=0.017 17.74 177 (17.74 28.78 287 (28.78 p017 p=0.17 (p=0.171 42.42 424 (42.42 3.22 32 (3.22 ≥ p00 p<0.0 (p<0.00 p01 p=0.1 (p=0.11 −0 p05 p=0.5 (p=0.51 p=0.0 (p=0.01 17.7 (17.7 28.7 (28.7 (p=0.17 42.4 (42.4 3.2 (3.2 p0 p<0. (p<0.0 p=0. (p=0.1 − (p=0.5 (p=0.0 17. (17. 28. (28. 42. (42. (3. p<0 (p<0. p=0 (p=0. (17 (28 (42 (3 p< (p<0 p= (p=0 (1 (2 (4 ( (p< (p= (p

This work developed an effective and eco-friendly analytical method to support quality control for Brazilian Bill proposal No. 5332/2009. The bill advocates the creation of the “Brazilian bread” by mandating the incorporation of cassava byproducts into wheat flour, with the aim of reducing Brazil’s external dependency on wheat imports and promoting domestic cassava family farming. For this, a handheld near-infrared (NIR) spectrophotometer was utilized for on-site determination of cassava starch in commercial wheat flour. The quantitative analysis, which utilized NIR spectra pre-processed with offset correction (OFF) combined with linear baseline correction (LBC), alongside the successive projections algorithm for interval selection in partial least squares (iSPA-PLS), exhibited superior predictive capability, achieving a relative error of prediction below 8%. Furthermore, the classification process, which involved NIR spectra pre-processed with LBC and iSPA-PLS for discriminant analysis (iSPA-PLS-DA), yielded an impressive 94% overall accuracy, with only 3 misclassifications in the test set. ecofriendly eco friendly No 53322009 5332 2009 5332/2009 bread flour Brazils Brazil s farming this nearinfrared near infrared (NIR onsite site preprocessed pre processed OFF (OFF LBC, , (LBC) iSPAPLS, iSPAPLS iSPA PLS (iSPA-PLS) capability 8 8% Furthermore process iSPAPLSDA, iSPAPLSDA DA (iSPA-PLS-DA) 94 accuracy set 5332200 533 200 5332/200 (LBC (iSPA-PLS (iSPA-PLS-DA 9 533220 53 20 5332/20 53322 5 2 5332/2 5332/

Resumen (Objetivo). Se evaluó el manglar de Chacarita en el Pacífico Central de Costa Rica, a través de la composición florística y las poblaciones de moluscos asociados de interés comercial, con el fin de proponer actividades de aprovechamiento sustentables en el manglar. (Metodología). Mensualmente y durante un año, se realizaron visitas al área de estudio, con el propósito de establecer una base florística de árboles de mangle y medir el almacenamiento de carbono en el lugar, además, de recolectar moluscos bivalvos para analizar el estado de las poblaciones, con base en las abundancias de organismos hallados y otras características como las longitudes y la masa de estos. En los mangles, se obtuvo el diámetro de la altura de pecho (DAP en cm), la altura (m), el índice de valor de importancia (IVI) y las reservas de carbono (Mg C·ha-1). En cuanto a los moluscos, se examinaron cuatro especies de interés comercial, evaluando la longitud (cm), la masa (g) y el índice gonadosomático. Finalmente, se realizaron valoraciones económicas de los datos obtenidos en el manglar, del turismo e información histórica de pesca para el acopio de Chacarita. (Resultados). Se hallaron cinco especies de mangles, Rhizophora mangle, Rizophora racemosa, Laguncularia racemosa, Avicennia germinans y Pelliciera rhizophorae; P. rhizophorae fue la de mayor índice de valor de importancia. Se obtuvo un almacenamiento de carbono equivalente a 78.49 Mg C·ha-1. Se contabilizaron 357 organismos, de los cuales el 18 % correspondió a Anadara similis, 37.5 % a Anadara tuberculosa, 41.46 % a Leukoma spp. y 3.08 % a Mytella guyanensis. Tomando en cuenta el valor económico de las reservas de carbono y los moluscos bivalvos presentes en los muestreos, se obtuvieron valoraciones económicas de 9812.63 USD·ha-1 y 28 USD·ha-1, respectivamente. (Conclusiones). Las bajas densidades poblacionales de moluscos, especialmente del género Anadara, hacen necesario establecer medidas de gestión que permitan recuperar las poblaciones de estos. La presente investigación propone actividades de aprovechamiento sustentables, como turismo comunitario con fines educativos y culturales.

Resumo (Objetivo). O mangue de Chacarita, no Pacífico Central da Costa Rica, foi avaliado por meio da composição florística e das populações de moluscos associados de interesse comercial, com o objetivo de propor atividades de uso sustentável no mangue. (Metodologia). Foram feitas visitas mensais à área de estudo durante um ano para estabelecer uma base florística de árvores do mangue e medir o armazenamento de carbono no local, bem como para coletar moluscos bivalves para analisar o status das populações, com base na abundância de organismos encontrados e em outras características, como comprimento e massa de tais organismos. Nos manguezais, foram obtidos o diâmetro à altura do peito (DAP em cm), a altura (m), o índice de valor de importância (IVI) e as reservas de carbono (Mg C-ha-1). No que diz respeito aos moluscos, foram examinadas quatro espécies de interesse comercial., avaliando o comprimento (cm), a massa (g) e o índice gonadossomático. Por fim, foram feitas avaliações econômicas de dados de mangue, turismo e informações históricas de pesca para a coleção Chacarita. (Resultados). Foram encontradas cinco espécies de mangue, Rhizophora mangle, Rizophora racemosa, Laguncularia racemosa, Avicennia germinans e Pelliciera rhizophorae; a P. rhizophorae apresentou o índice de valor de importância mais alto. Foi obtido um armazenamento de carbono equivalente a 78.49 Mg C-ha-1. Foram calculados um total de 357 organismos, dos quais 18% correspondeu a Anadara similis, 37.5% Anadara tuberculosa, 41.46% Leukoma spp. e 3.08% Mytella guyanensis. Levando em conta o valor econômico das reservas de carbono e dos moluscos bivalves presentes nas amostras, foram obtidas avaliações econômicas de US$ 9812.63 ha-1 e US$ 28 ha-1, respectivamente. (Conclusões). As baixas densidades populacionais de moluscos, especialmente do gênero Anadara tornam necessário o estabelecimento de medidas de manejo para permitir a recuperação dessas populações. Esta pesquisa propõe atividades de uso sustentável, como o turismo comunitário para fins educacionais e culturais.

Abstract (Objective). The floristic composition and populations of associated molluscs of commercial interest of the Chacarita mangrove forest on the Central Pacific of Costa Rica were evaluated to guide proposals for sustainable exploitation activities in the mangrove forest. (Methodology). Monthly visits to the study area were conducted for one year to establish a floristic baseline of mangrove trees and measure carbon storage. Additionally, bivalve molluscs were collected to analyze the state of their populations based on the abundances of organisms found, as well as other characteristics such as length and mass. Data regarding the mangrove trees included their diameter at breast height (DBH, cm), height (m), importance value index (IVI), and carbon reserves (Mg C·ha-1). Four mollusc species of commercial interest were analyzed, using data on their length (cm), weight (g), and gonodosomatic index. Economic evaluations were also conducted using data obtained from the mangrove forest, as well as tourism and historical fishing data for the collection of Chacarita. (Results). Five species of mangroves were identified: Rhizophora mangle, Rizophora racemosa, Laguncularia racemosa, Avice germinans, and Pelliciera rhizophorae, while P. rhizophorae had the highest importance value index. The study revealed a carbon storage equivalent to 78.49 Mg C·ha-1. A total of 357 organisms were counted, with Anadara similis accounting for 18% of the total count, followed by Anadara tuberculosa (37.5%), Leukoma spp. (41.46%), and Mytella guyanensis (3.08%). When considering the economic value of carbon stocks and the bivalve molluscs obtained from the samples, economic valuations of 9,812.63 USD·ha-1 and 28 USD·ha-1 were determined, respectively. (Conclusions). The low population densities of molluscs, particularly those belonging to the Anadara genus, necessitate the establishment of management measures to facilitate the recovery of these mollusk populations. This research proposes sustainable use activities such as community tourism for educational and cultural purposes.

Abstract Nowadays, organizations have the responsibility to commit themselves to actions that favor environmental conservation. The present study sought to explore an accompaniment for the management of the environmental component in the activities developed by an organization located in Armenia, Quindío-Colombia. Inter-institutional meetings were held in which a recognition, dialogue and workshop were conducted with the collaborators. A previously validated checklist was used. Subsequently, a descriptive analysis was made of the results obtained. It was found that 40 % of the components lacked actions for environmental conservation. Thus, the accompaniment showed that the collaborators committed themselves to use solid waste, save water and energy. The monitoring resulted in three strategic actions for the water, soil and energy components. The organization showed great interest in the process and an intersectoral link was established. The study proposes a baseline for the management of the environmental component of the study area; it resulted in an accompaniment and representative participation with significant progress towards the conservation of the environment within the organization.

Resumo Atualmente, as organizações têm a responsabilidade de se comprometerem com acções que favoreçam a conservação do ambiente. O presente estudo procurou explorar um acompanhamento para a gestão da componente ambiental nas actividades de uma organização situada em Armenia, Quindío-Colômbia. Foram realizadas reuniões interinstitucionais em que se procedeu a um reconhecimento, diálogo e workshop com os colaboradores. Foi utilizada uma lista de controlo previamente validada. Posteriormente, procedeu-se a uma análise descritiva dos resultados obtidos. Verificou-se que 40 % dos componentes careciam de acções para a conservação do ambiente. Desta forma, o acompanhamento mostrou que os colaboradores se comprometeram a utilizar os resíduos sólidos, a poupar água e energia. O acompanhamento resultou em três acções estratégicas para as componentes água, solo e energia. A organização mostrou grande interesse no processo e foi estabelecida uma ligação intersectorial. O estudo fornece uma base de referência para a gestão da componente ambiental da área de estudo; resultou num apoio e numa participação representativa com progressos significativos para a conservação do ambiente na organização.

Resumen Actualmente, las organizaciones se encargan de comprometerse con acciones que favorezcan la conservación del medioambiente. El presente estudio explora un acompañamiento para la gestión del componente ambiental en las actividades desarrolladas de una organización ubicada en Armenia, Quindío-Colombia. Se realizaron reuniones interinstitucionales en las que se realizó un reconocimiento, diálogo y taller con los colaboradores. Se utilizó una lista de verificación previamente validada. Posteriormente, se realizó un análisis descriptivo de los resultados obtenidos. Se encontró que el 40 % de los componentes carecen de acciones para la conservación del medioambiente. De tal manera, el acompañamiento arrojó que los colaboradores se comprometieron a aprovechar los residuos sólidos, ahorrar agua y energía. El acompañamiento derivó en tres acciones estratégicas para los componentes de agua, suelo y energía. La organización demostró un gran interés en el proceso y se logró establecer un vínculo intersectorial. El estudio plantea una línea base de gestión del componente ambiental del área de estudio; derivó en un acompañamiento y participación representativa con avances significativos hacia la conservación del medioambiente dentro de la organización.

RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12–84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19. Introdução , (DRET) COVID19. COVID19 COVID 19. 19 (TC (TRS Métodos 1 prontosocorro pronto socorro COVID-1 incluídos saúde típica indeterminada atípica negativa Resultados 10 62,3% 623 62 3 (62,3 COVID19positivos COVIDpositivos COVID-19-positivos 2020 125 5 12, 43 mulheres diabetes meses 1284 84 12–84 fosco 40 61% 61 (61% vs 0% (0% COVID19, 19, 0,001. 0001 0,001 . 001 0,001) 6061 60,61 40/66, 4066 40/66 66 (40/66) 100 40/40. 4040 40/40 (40/40) respectivamente COVID19negativos COVIDnegativos 9 ( 14% 14 (14% 2 56% 56 (56% COVID19positivos, positivos, 0,001, 13 (1 20% 20 (20% 14%, 0,606, 0606 0,606 606 0,606) 4 6% (6% 28%, 28 28% (28%) 0,002. 0002 0,002 002 0,002) Conclusões (DRET COVID1 COVID- 62,3 (62, 202 128 8 12–8 (61 (0 000 0,00 00 60,6 406 40/6 (40/66 404 40/4 (40/40 (14 (56 (20 060 0,60 (6 (28% 62, (62 12– 0,0 60, 40/ (40/6 (40/4 (5 (2 06 0,6 (28 0, (40/

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12–84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19. Introduction ESKD, , (ESKD) COVID19 COVID 19 COVID-1 challenge (CT RRT (RRT COVID19. 19. Methods 1 records typical Results 10 62.3% 623 62 3 (62.3 COVID19positive COVIDpositive COVID-19-positive 2020 125 5 12. 43 female diabetes months 1284 84 12–84 opacities 40 61% 61 (61% 0% (0% nonCOVID19 nonCOVID non non-COVID-1 0.001. 0001 0.001 . 001 0.001) 6061 60.61 40/66 4066 66 (40/66 100 40/40. 4040 40/40 (40/40) respectively COVID19negative COVIDnegative 9 ( 14% 14 (14% 2 56% 56 (56% COVID19positive, positive, 0.001, 13 (1 20% 20 (20% 14%, 0.606, 0606 0.606 606 0.606) 4 6% (6% 28%, 28 28% (28%) 0.002. 0002 0.002 002 0.002) Conclusions (ESKD COVID1 COVID- 62.3 (62. 202 128 8 12–8 (61 (0 nonCOVID1 non-COVID- 000 0.00 00 60.6 40/6 406 (40/6 404 40/4 (40/40 (14 (56 (20 060 0.60 (6 (28% 62. (62 12– non-COVID 0.0 60. 40/ (40/ (40/4 (5 (2 06 0.6 (28 0.

Resumo Introdução: É importante identificar fatores de risco para progressão da doença renal policística autossômica dominante (DRPAD). Entretanto, são escassos os estudos que avaliam esse assunto utilizando amostra brasileira. Portanto, o objetivo deste estudo foi identificar fatores de risco para desfechos renais e óbito em coorte brasileira de pacientes com DRPAD. Métodos: Os pacientes tiveram o primeiro atendimento médico entre janeiro/2002 e dezembro/2014, sendo acompanhados até dezembro/2019. Associações entre variáveis clínicas e laboratoriais com desfecho primário (redução sustentada de pelo menos 57% na TFGe em relação ao valor basal, necessidade de diálise ou transplante renal) e desfecho secundário (óbito por qualquer causa) foram analisadas pelo modelo de regressão múltipla de Cox. Entre 80 pacientes com DRPAD, foram excluídos aqueles menores de 18 anos, com TFG <30 mL/min/1,73 m2 e/ou aqueles com dados ausentes. Foram acompanhados 70 pacientes. Resultados: Fatores independentemente associados aos desfechos renais foram: comprimento renal total – Razão de Risco (HR) ajustada com intervalo de confiança de 95% (IC 95%): 1,137 (1,057–1,224), taxa de filtração glomerular – HR (IC 95%): 0,970 (0,949–0,992) e nível sérico de ácido úrico - HR (IC 95%): 1,643 (1,118–2,415). Diabetes mellitus – HR (IC 95%): 8,115 (1,985–33,180) e TFG – HR (IC 95%): 0,957 (0,919–0,997) foram associados ao desfecho secundário. Conclusões: Esses achados corroboram a hipótese de que comprimento renal total, TFG e nível sérico de ácido úrico podem ser importantes preditores prognósticos de DRPAD em uma coorte brasileira, o que pode ajudar a selecionar pacientes que necessitam de acompanhamento mais próximo. Introdução . (DRPAD) Entretanto Portanto Métodos janeiro2002 janeiro 2002 janeiro/200 dezembro2014 dezembro 2014 dezembro/2014 dezembro2019 2019 dezembro/2019 redução 57 basal causa Cox 8 1 anos 30 <3 mLmin173 mLmin mL min 73 mL/min/1,7 m eou ausentes 7 Resultados (HR 95 IC 95%) 1137 137 1,13 1,057–1,224, 10571224 1,057–1,224 , 057 224 (1,057–1,224) 0970 0 970 0,97 0,949–0,992 09490992 949 992 (0,949–0,992 1643 643 1,64 1,118–2,415. 11182415 1,118–2,415 118 2 415 (1,118–2,415) 8115 115 8,11 1,985–33,180 198533180 985 33 180 (1,985–33,180 0957 957 0,95 0,919–0,997 09190997 919 997 (0,919–0,997 Conclusões próximo (DRPAD janeiro200 200 janeiro/20 dezembro201 201 dezembro/201 5 3 < mLmin17 mL/min/1, 9 113 13 1,1 1057122 1,057–1,22 05 22 (1,057–1,224 097 97 0,9 0,949–0,99 0949099 94 99 (0,949–0,99 164 64 1,6 1118241 1,118–2,41 11 41 (1,118–2,415 811 8,1 1,985–33,18 19853318 98 (1,985–33,18 095 0,919–0,99 0919099 91 (0,919–0,99 janeiro20 20 janeiro/2 dezembro20 dezembro/20 mLmin1 mL/min/1 1, 105712 1,057–1,2 (1,057–1,22 09 0, 0,949–0,9 094909 (0,949–0,9 16 6 111824 1,118–2,4 4 (1,118–2,41 81 8, 1,985–33,1 1985331 (1,985–33,1 0,919–0,9 091909 (0,919–0,9 janeiro2 janeiro/ dezembro2 dezembro/2 mL/min/ 10571 1,057–1, (1,057–1,2 0,949–0, 09490 (0,949–0, 11182 1,118–2, (1,118–2,4 1,985–33, 198533 (1,985–33, 0,919–0, 09190 (0,919–0, dezembro/ mL/min 1057 1,057–1 (1,057–1, 0,949–0 0949 (0,949–0 1118 1,118–2 (1,118–2, 1,985–33 19853 (1,985–33 0,919–0 0919 (0,919–0 105 1,057– (1,057–1 0,949– 094 (0,949– 111 1,118– (1,118–2 1,985–3 1985 (1,985–3 0,919– 091 (0,919– 10 1,057 (1,057– 0,949 (0,949 1,118 (1,118– 1,985– 198 (1,985– 0,919 (0,919 1,05 (1,057 0,94 (0,94 1,11 (1,118 1,985 19 (1,985 0,91 (0,91 1,0 (1,05 (0,9 (1,11 1,98 (1,98 (1,0 (0, (1,1 1,9 (1,9 (1, (0 (1 (

Abstract Introduction: Identifying risk factors for autosomal dominant polycystic kidney disease (ADPKD) progression is important. However, studies that have evaluated this subject using a Brazilian sample is sparce. Therefore, the aim of this study was to identify risk factors for renal outcomes and death in a Brazilian cohort of ADPKD patients. Methods: Patients had the first medical appointment between January 2002 and December 2014, and were followed up until December 2019. Associations between clinical and laboratory variables with the primary outcome (sustained decrease of at least 57% in the eGFR from baseline, need for dialysis or renal transplantation) and the secondary outcome (death from any cause) were analyzed using a multiple Cox regression model. Among 80 ADPKD patients, those under 18 years, with glomerular filtration rate <30 mL/min/1.73 m2, and/or those with missing data were excluded. There were 70 patients followed. Results: The factors independently associated with the renal outcomes were total kidney length – adjusted Hazard Ratio (HR) with a 95% confidence interval (95% CI): 1.137 (1.057–1.224), glomerular filtration rate – HR (95% CI): 0.970 (0.949–0.992), and serum uric acid level – HR (95% CI): 1.643 (1.118–2.415). Diabetes mellitus - HR (95% CI): 8.115 (1.985–33.180) and glomerular filtration rate - HR (95% CI): 0.957 (0.919–0.997) were associated with the secondary outcome. Conclusions: These findings corroborate the hypothesis that total kidney length, glomerular filtration rate and serum uric acid level may be important prognostic predictors of ADPKD in a Brazilian cohort, which could help to select patients who require closer follow up. Introduction (ADPKD However sparce Therefore Methods 200 2014 2019 sustained 57 baseline transplantation cause model 8 1 years 30 <3 mLmin173 mLmin mL min 73 mL/min/1.7 m2 m andor excluded 7 Results (HR 95 (95 CI CI) 1137 137 1.13 1.057–1.224, 10571224 1.057–1.224 , 057 224 (1.057–1.224) 0970 0 970 0.97 0.949–0.992, 09490992 0.949–0.992 949 992 (0.949–0.992) 1643 643 1.64 1.118–2.415. 11182415 1.118–2.415 . 118 2 415 (1.118–2.415) 8115 115 8.11 1.985–33.180 198533180 985 33 180 (1.985–33.180 0957 957 0.95 0.919–0.997 09190997 919 997 (0.919–0.997 Conclusions 20 201 5 3 < mLmin17 mL/min/1. 9 (9 113 13 1.1 1057122 1.057–1.22 05 22 (1.057–1.224 097 97 0.9 0949099 0.949–0.99 94 99 (0.949–0.992 164 64 1.6 1118241 1.118–2.41 11 41 (1.118–2.415 811 8.1 1.985–33.18 19853318 98 (1.985–33.18 095 0.919–0.99 0919099 91 (0.919–0.99 mLmin1 mL/min/1 ( 1. 105712 1.057–1.2 (1.057–1.22 09 0. 094909 0.949–0.9 (0.949–0.99 16 6 111824 1.118–2.4 4 (1.118–2.41 81 8. 1.985–33.1 1985331 (1.985–33.1 0.919–0.9 091909 (0.919–0.9 mL/min/ 10571 1.057–1. (1.057–1.2 09490 0.949–0. (0.949–0.9 11182 1.118–2. (1.118–2.4 1.985–33. 198533 (1.985–33. 0.919–0. 09190 (0.919–0. mL/min 1057 1.057–1 (1.057–1. 0949 0.949–0 (0.949–0. 1118 1.118–2 (1.118–2. 1.985–33 19853 (1.985–33 0.919–0 0919 (0.919–0 105 1.057– (1.057–1 094 0.949– (0.949–0 111 1.118– (1.118–2 1.985–3 1985 (1.985–3 0.919– 091 (0.919– 10 1.057 (1.057– 0.949 (0.949– 1.118 (1.118– 1.985– 198 (1.985– 0.919 (0.919 1.05 (1.057 0.94 (0.949 1.11 (1.118 1.985 19 (1.985 0.91 (0.91 1.0 (1.05 (0.94 (1.11 1.98 (1.98 (0.9 (1.0 (1.1 1.9 (1.9 (0. (1. (0 (1

Abstract Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score (p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits. preventable (OPD (ED 6 (HNS Arabia study 201 202 data comorbidities 1030 1 030 1,03 cases 11 11.55% 1155 55 (11.55% 184 84 (1.84% total 9 874 8 74 (8.74% 2 2.82%, 282 , 82 (2.82%) 26.32% 2632 26 32 (26.32% 21.05%. 2105 21.05% . 21 05 (21.05%) visits 20% 20 (20% 14.44%. 1444 14.44% 14 44 (14.44%) 20.69% 2069 69 (20.69% 17.24%. 1724 17.24% 17 24 (17.24%) ASA (ASA 0.004 0004 0 004 CIRS (CIRS 0.002. 0002 0.002 002 0.002) 60day day 8.74 2.82 respectively 1.84 Hematoma 103 03 1,0 11.55 115 5 (11.55 18 (1.84 87 7 (8.74 28 (2.82% 26.32 263 3 (26.32 210 21.05 (21.05% (20 144 14.44 4 (14.44% 20.69 206 (20.69 172 17.24 (17.24% 0.00 000 00 8.7 2.8 1.8 10 1, 11.5 (11.5 (1.8 (8.7 (2.82 26.3 (26.3 21.0 (21.05 (2 14.4 (14.44 20.6 (20.6 17.2 (17.24 0.0 8. 2. 1. 11. (11. (1. (8. (2.8 26. (26. 21. (21.0 ( 14. (14.4 20. (20. 17. (17.2 0. (11 (1 (8 (2. (26 (21. (14. (17. (21 (14 (17

Abstract Background Recently, it was demonstrated that allopurinol, a xanthine oxidase inhibitor, has cardiovascular and anti-ischaemic properties and may be a metabolic antianginal agent option.Objective: The objective of this study was to evaluate the antianginal effect of allopurinol as a third drug for patients with stable coronary artery disease (CAD). Methods This was a randomized clinical trial between 2018 and 2020 including patients with CAD who maintained angina despite initial optimization with beta-blockers and calcium channel blockers. The individuals were randomized 1:1 to 300 mg of allopurinol twice daily or 35 mg of trimetazidine twice daily. The main outcome was the difference in the angina frequency domain of the Seattle Angina Questionnaire (SAQ-AF). A probability (p) value < 0.05 was considered statistically significant. Results A hundred and eight patients were included in the randomization phase, with 54 (50%) in the allopurinol group and 54 (50%) in the trimetazidine group. Six (5.6%) individuals, 3 from each group, were lost to follow-up for the primary outcome. In the allopurinol and trimetazidine groups, the median SAQ-AF scores were 50 (30.0 to 70.0) and 50 (21.3 to 78.3), respectively. In both groups, the SAQ-AF score improved, but the median of the difference compared to baseline was lower in the allopurinol group (10 [0 to 30] versus 20 [10 to 40]; p < 0.001), as was the mean of the difference in the total SAQ score (12.8 ± 17.8 versus 21.2 ± 15.9; p = 0.014). Conclusion Both allopurinol and trimetazidine improved the control of angina symptoms; however, trimetazidine presented a greater gain compared to baseline. Brazilian Registry of Clinical Trials - Registration Number RBR-5kh98y Recently inhibitor antiischaemic anti ischaemic option.Objective optionObjective option Objective CAD. . (CAD) 201 202 betablockers beta blockers 11 1 1: 30 SAQAF. SAQAF AF (SAQ-AF) (p 005 0 05 0.0 significant phase 5 50% (50% 5.6% 56 6 (5.6% followup follow up groups 30.0 (30. 70.0 700 70 21.3 213 21 (21. 78.3, 783 78.3 , 78 78.3) respectively 10 (1 [ 2 [1 40 40] 0.001, 0001 0.001 001 0.001) 12.8 128 12 8 (12. 178 17 17. 212 21. 15.9 159 15 9 0.014. 0014 0.014 014 0.014) symptoms however RBR5kh98y RBRkhy RBR 5kh98y kh y (CAD (SAQ-AF 00 0. (50 5.6 (5.6 30. (30 70. 7 (21 78. ( 4 000 0.00 12. (12 15. 0.01 01 khy (5 5. (5. (3 (2

Resumo Fundamento Recentemente, foi demonstrado que o alopurinol, um inibidor da xantina oxidase, possui propriedades cardiovasculares e anti-isquêmicas e pode ser uma opção de agente antianginoso metabólico. Objetivo O objetivo do presente estudo foi avaliar o efeito antianginoso do alopurinol como terceiro medicamento para pacientes com doença arterial coronariana (DAC) estável. Métodos Trata-se de um ensaio clínico randomizado entre 2018 e 2020 incluindo pacientes com DAC que mantiveram angina apesar da otimização inicial com betabloqueadores e bloqueadores dos canais de cálcio. Os indivíduos foram randomizados 1:1 para 300 mg de alopurinol 2 vezes ao dia ou 35 mg de trimetazidina 2 vezes ao dia. O desfecho principal foi a diferença no domínio da frequência da angina do Questionário de Angina de Seattle (QAS-FA). Foram considerados estatisticamente significativos valores de probabilidade (p) < 0,05. Resultados Foram incluídos 108 pacientes na fase de randomização, com 54 (50%) no grupo alopurinol e 54 (50%) no grupo trimetazidina. Seis (5,6%) indivíduos, 3 de cada grupo, foram perdidos no seguimento para o desfecho primário. Nos grupos de alopurinol e trimetazidina, as pontuações medianas do QAS-FA foram 50 (30,0 a 70,0) e 50 (21,3 a 78,3), respectivamente. Em ambos os grupos, a pontuação do QAS-FA melhorou, mas a mediana da diferença em relação à linha de base foi menor no grupo alopurinol (10 [0 a 30] versus 20 [10 a 40]; p < 0,001), assim como a média da diferença na pontuação total do QAS (12,8 ± 17,8 versus 21,2 ± 15,9; p = 0,014). Conclusão Tanto o alopurinol quanto a trimetazidina melhoraram o controle dos sintomas de angina; no entanto, a trimetazidina apresentou um ganho maior em relação à linha de base. Registro Brasileiro de Ensaios Clínicos – Número de Registro RBR-5kh98y Recentemente oxidase antiisquêmicas anti isquêmicas metabólico (DAC estável Tratase Trata se 201 202 cálcio 11 1 1: 30 QASFA. QASFA FA . (QAS-FA) (p 005 0 05 0,05 10 randomização 5 50% (50% 5,6% 56 6 (5,6% primário 30,0 (30, 70,0 700 70 21,3 213 21 (21, 78,3, 783 78,3 , 78 78,3) respectivamente melhorou (1 [ [1 40 40] 0,001, 0001 0,001 001 0,001) 12,8 128 12 8 (12, 178 17 17, 212 21, 15,9 159 15 9 0,014. 0014 0,014 014 0,014) entanto RBR5kh98y RBRkhy RBR 5kh98y kh y (QAS-FA 00 0,0 (50 5,6 (5,6 30, (30 70, 7 (21 78, ( 4 000 0,00 12, (12 15, 0,01 01 khy 0, (5 5, (5, (3 (2

ABSTRACT Introduction: Recurrent dengue outbreaks underscore the need for more effective approaches to vector prevention and control. Often, interventions focus on a biomedical and health promotion approach from an individual approach, without integrating socio-environmental factors or being scientifically evaluated. Objetive: To evaluate the impact of large household waste collection on potential breeding sites of dengue-transmitting mosquitoes in Asuncion, Paraguay during the years 2017 to 2021. Material and methods: Quasi-experimental, longitudinal study, where 350 households were surveyed, as a baseline during 2017 and a closing line in 108 households in 2021. The Difference-in-Difference (DID) method was used to compare the presence of breeding sites before and after the intervention in 43 intervened and 65 non-intervened households. Results: Differentiated collection was mainly used by those households that had a large amount of large solid waste, but not to dispose of all these objects, but only part of them (DID of -52% in the total number of breeding sites and DID of 1% in the number of households with breeding sites). We found a significant reduction in the total number of large breeding sites but did not observe differences in the total number of households with breeding sites. Subjective factors, such as the belief that disused objects could become useful in the future, were largely responsible for the reduction in the number of large breeding sites. Conclusions: The municipal management approach to bulky waste can contribute to dengue prevention because it does not constitute rapidly generated waste in households, and its disposal can have a relatively long-lasting impact. The subjective factors related to the presence of these breeding sites in households warrant further study.

RESUMEN Introducción: Los brotes recurrentes de dengue subrayan la necesidad de abordajes más efectivos en la prevención y control de vectores. A menudo, las intervenciones se centran en un enfoque biomédico y de promoción de la salud desde un enfoque individual, sin integrar factores socioambientales ni ser evaluados científicamente Objetivo: Evaluar el impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay durante los años 2017 a 2021. Material y métodos: Estudio cuasiexperimental, longitudinal, donde se encuestaron 350 hogares, como línea de base durante el 2017 y una línea de cierre en 108 hogares en 2021. Se utilizó el método de Diferencia en Diferencia (DID) para comparar la presencia de criaderos antes y después de la intervención en 43 hogares intervenidos y 65 no intervenidos. Resultados: La recolección diferenciada fue utilizada principalmente por aquellos hogares que tenían una gran cantidad de residuos sólidos de gran tamaño, pero no para deshacerse de todos estos objetos, sino sólo de una parte (DID de -52% en el número total de criaderos y DID de 1% en número de hogares con criaderos). Encontramos una reducción significativa en el número de total de criaderos de gran tamaño, pero no observamos diferencias en el número total de hogares con criaderos. Factores subjetivos, como la creencia de que los objetos en desuso podrían llegar a ser útiles en el futuro explicaban en gran medida su presencia en los hogares, incluso con el servicio disponible. Conclusiones: El enfoque de la gestión municipal en los residuos voluminosos puede contribuir a la prevención del dengue por el hecho de que no constituyen residuos de generación rápida en los hogares, y su eliminación puede tener un impacto relativamente duradero. El factor subjetivo relacionado con la presencia de estos criaderos en los hogares debe ser objeto de mayores estudios.

ABSTRACT: It aimed to compare the trans anesthetic clinical and perioperative analgesic effects by prolonged continuous infusion of fentanyl (GF, bolus of 5 µg/kg and continuous infusion (CI) of 15 µg/kg/h) or remifentanil (GR, CI of 18 µg/kg/h) in dogs undergoing to elective ovariohysterectomy. Twenty female healthy dogs were premedicated with acepromazine, inducted to unconsciousness with propofol and kept under anesthesia with isoflurane. The M0 (baseline) was recorded and animals were randomly allocated in GF (n = 10) or GR (n = 10), recording clinical and blood gas parameters every 15 minutes (M15…M120) for two hours and, after, during surgery, adjusting the opioid rate according to surgical requirement. The isoflurane vaporization reduced by up to 47% and 42% in GF and GR, respectively, when compared to M0. During the first two hours of CI, six animals of each group required atropine intervention and three animals of GF required ephedrine. The number of rate adjustments during intraoperative was significant higher in GR when compared to GF (P = 0.0248). By the Log-rank test, there was a higher possibility of not receiving analgesic rescue in the first 30 minutes of postoperative in GF when compared to GR (P < 0.0001) and all animals required analgesic rescue during the firsts 3 and 6 hours in GR and GF, respectively. It is concluded that, when the proposal continuous infusions were compared, fentanyl required fewer analgesic rescues during perioperative, nonetheless, it is recommended rate adjustment during intraoperative and additional analgesia for postoperative for both treatments. ABSTRACT (GF µgkg µg kg (CI 1 µg/kg/h µgkgh h (GR ovariohysterectomy acepromazine M baseline (baseline n 10 10, , M15M120 MM M15 M120 (M15…M120 after surgery requirement 47 42 respectively ephedrine P 0.0248. 00248 0.0248 . 0 0248 0.0248) Logrank Log rank test 0.0001 00001 0001 that nonetheless treatments M15M12 M1 M12 (M15…M12 4 0024 0.024 024 0.000 0000 000 M15M1 (M15…M1 002 0.02 02 0.00 00 M15M (M15…M 0.0 0.

RESUMO: Objetivou-se comparar os efeitos clínicos intraoperatórios e analgésico perioperatório ofertados pela infusão contínua prolongada de fentanil (GF, bolus de 5 µg/kg e infusão contínua (IC) de 15 µg/kg/h) ou remifentanil (GR, IC de 18 µg/kg/h) em cadelas submetidas a ovariohisterectomia eletiva. Vinte cadelas hígidas foram pré-medicadas com acepromazina e induzidas com propofol e mantidas sob anestesia com isoflurano. Registrado M0 (basal) os animais foram alocados aleatoriamente em GF (n = 10) ou GR (n = 10), registrando parâmetros clínicos e hemogasométricos a cada 15 minutos (M15...M120), totalizando 02h e, posteriormente, durante o procedimento cirúrgico, sendo a taxa do opioide alterada conforme o requerimento cirúrgico.A vaporização de isoflurano reduziu em até 47% e 42% no GF e GR, respectivamente, em relação ao M0. Durante as primeiras duas horas de IC, seis animais de cada grupo necessitaram de intervenção com atropina e três animais do GF de efedrina. O número de ajustes de taxas no intraoperatório foi significativamente maior no GR comparado ao GF (P = 0,0248). Pelo teste de Log-rank, houve maior probabilidade de não receber resgate analgésico nos primeiros 30 minutos de pós-operatório no GF comparado ao GR (P < 0,0001) e todos os animais necessitaram de resgate analgésico dentro das primeiras três e seis horas no GR e GF, respectivamente. Conclui-se que, nas taxas propostas, a utilização de fentanil necessitou de menos resgates analgésicos no intra e pós-operatório, no entanto, recomenda-se ajuste de taxa intraoperatória e analgesia suplementar pós-operatória em ambos os tratamentos. RESUMO Objetivouse Objetivou se (GF µgkg µg kg (IC 1 µg/kg/h µgkgh h (GR eletiva prémedicadas pré medicadas M basal (basal n 10 10, , M15...M120, M15M120 MM M15...M120 M15 M120 (M15...M120) posteriormente cirúrgico cirúrgicoA A 47 42 respectivamente efedrina P 0,0248. 00248 0,0248 . 0 0248 0,0248) Logrank, Logrank Log rank, rank Log-rank 3 pósoperatório pós operatório 0,0001 00001 0001 Concluise Conclui que propostas pósoperatório, operatório, entanto recomendase recomenda pósoperatória operatória tratamentos M15M12 M15...M12 M1 M12 (M15...M120 4 0024 0,024 024 0,000 0000 000 M15M1 M15...M1 (M15...M12 002 0,02 02 0,00 00 M15M M15...M (M15...M1 0,0 (M15...M 0,

Abstract Objective: The use of dupilumab in children with atopic dermatitis (AD) demonstrated clinical efficacy in clinical trials. Nevertheless, real-world evidence is still limited. We aim to provide data on this matter regarding a Portuguese pediatric population. Methods: Retrospective analysis of patients with AD below the age of 18 treated with dupilumab in two Portuguese hospitals. Data regarding previous therapies, activity scores, and adverse reactions were collected. Results: Thirty patients were included in the analysis (19 male patients, 63%), with a median age of 14 years (2-17 years). The median follow-up after starting treatment was 80 weeks. The median baseline Eczema Area and Severity Index (EASI) score was 32.3. Sixty percent of patients achieved EASI-90 and 77% EASI-75 at week 16 (n = 30); 79% EASI-90 and 92% EASI-75 at week 52 (n = 24); 64% EASI-90 and 82% EASI-75 at week 104 (n = 11); and 75% EASI-90 and 100% EASI-75 at week 132 (n = 4). Regarding adverse reactions, four patients (12%) presented facial erythema and two patients had eosinophilia above 2000/μL and conjunctivitis. In five patients (17%), there was a need for a dose increase, with treatment failure occurring in two patients (7%). Conclusion: Our data corroborated the evidence from clinical trials, highlighting the maintained efficacy and adequate safety profile of dupilumab in this age group.

Resumo Objetivo: O uso de dupilumab em crianças com dermatite atópica (DA) demonstrou eficácia clínica em ensaios clínicos. No entanto, a evidência do mundo real é ainda limitada. Este trabalho pretende fornecer dados relativos a este domínio, numa população pediátrica portuguesa. Métodos: Análise retrospetiva de doentes com DA com idade inferior a 18 anos, tratados com dupilumab, em dois hospitais portugueses. Foram recolhidos dados sobre terapêuticas prévias, scores de atividade e reações adversas. Resultados: Trinta doentes foram incluídos na análise (19 doentes do sexo masculino, 63%), com uma mediana de idades de 14 anos (2-17 anos). O seguimento mediano após o início do tratamento foi de 80 semanas. O score EASI basal mediano foi de 32,3. Sessenta por cento dos doentes alcançaram EASI-90 e 77% EASI-75 na semana 16 (n = 30); 79% EASI-90 e 92% EASI-75 na semana 52 (n = 24); 64% EASI-90 e 82% EASI-75 na semana 104 (n = 11); 75% EASI-90 e 100% EASI-75 na semana 132 (n = 4). Em relação a reações adversas, 4 doentes (12%) apresentaram eritema facial e 2 doentes eosinofilia superior a 2000/μL e conjuntivite. Em 5 doentes (17%), houve necessidade de aumento de dose, com falência do tratamento em 2 doentes (7%). Conclusão: O tratamento com Dupilumab na DA em idade pediátrica num ambiente de mundo real corroborou os dados dos ensaios clínicos, destacando a eficácia mantida e o perfil de segurança adequado neste grupo etário.

ABSTRACT Preventing the occurrence of extreme hydrological events exceeds the current abilities of humanity. However, using adequate tools to estimate the probability associated with different values of hydrological variables, such as heavy rainfall, can help mitigate social and environmental damage. This study aimed to verify the hypothesis that the records of maximum rainfall, at different intervals of duration, in the three main rainfall stations in the state of Acre fit the log-normal distribution of two parameters (LN2) and, therefore, to evaluate the events of heavy rainfalls, based on the association between the duration of the rain and the return period. The equations conformed to the classic model of the LN2 model using the method of maximum likelihood once the baseline assumption of stationarity was met using the Mann-Kendall test. Adherence to the model was verified using the Anderson-Darling test. The adjusted distributions allowed for estimating the rainfall intensity at different durations and return periods for the cities of Cruzeiro do Sul, Tarauacá, and Rio Branco and are relevant elements for planning actions aimed at strengthening the components of water safety in the state of Acre. humanity However variables damage lognormal log normal LN (LN2 therefore rainfalls period MannKendall Mann Kendall test AndersonDarling Anderson Darling Sul Tarauacá (LN

RESUMO Evitar a ocorrência de eventos hidrológicos extremos ultrapassa as habilidades atuais da humanidade. Todavia, a utilização de ferramentas adequadas para estimar a probabilidade associada a diferentes valores de variáveis hidrológicas, a exemplo das chuvas intensas, pode auxiliar na atenuação dos danos sociais e ambientais. O objetivo deste estudo foi verificar a hipótese de que os registros de chuvas máximas, em diferentes intervalores de duração, nas três principais estações pluviométricas do estado do Acre, ajustam-se à distribuição log-normal de dois parâmetros (LN2) e, com isso, avaliar os eventos de chuvas intensas, com base na associação entre a duração da chuva e o período de retorno. As equações foram conformadas ao modelo clássico do modelo LN2 pelo método da máxima verossimilhança, uma vez atendido o pressuposto basal da estacionariedade pelo teste de Mann-Kendall. A aderência ao modelo foi verificada por meio teste de Anderson-Darling. As distribuições ajustadas permitiram estimar a intensidade de chuva, em diferentes intervalores de duração e períodos de retorno, para as cidades de Cruzeiro do Sul, Tarauacá e Rio Branco, e são elementos relevantes ao planejamento de ações voltadas ao fortalecimento dos componentes da segurança hídrica no estado do Acre. humanidade Todavia hidrológicas intensas ambientais máximas Acre ajustamse ajustam se lognormal log normal LN (LN2 isso retorno verossimilhança MannKendall. MannKendall Mann Kendall. Kendall Mann-Kendall AndersonDarling. AndersonDarling Anderson Darling. Darling Anderson-Darling Sul Branco (LN

BACKGROUND. In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. OBJECTIVES. To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. METHODS. A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. RESULTS. One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. CONCLUSION. OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.

BACKGROUND. Adolescent girls and young women (AGYW) remain vulnerable to HIV, with a higher incidence rate than their male counterparts. OBJECTIVES. To determine the prevalence of and factors associated with HIV testing among AGYW in South Africa (SA). METHODS. A cross-sectional design was used to analyse the South Africa Demographic and Health Survey 2016. Only sexually active AGYW aged 15 - 24 years residing in SA at the time of the survey were included. Descriptive statistics were used to analyse baseline sociodemographic characteristics. Univariate and multivariate logistic regression models were used to determine factors associated with HIV testing. Statistical significance was set at p<0.05, and all analyses were adjusted using survey weights to account for unequal selection probabilities. RESULTS. The overall prevalence of HIV testing among sexually active AGYW was 85.2% (95% confidence interval (CI) 83.0 - 87.1). The AGYW who had a history of pregnancy (adjusted odds ratio (aOR) 4.47; 95% CI 2.90 - 6.89), were employed (aOR 3.29; 95% CI 1.75 - 6.21), belonged to a middle wealth index (aOR 1.80; 95% CI 1.04 - 3.10), had knowledge about mother-to-child transmission of HIV (aOR 3.29; 95% CI 2.26 - 4.79), had visited a health facility during the past 12 months (aOR 2.93; 95% CI 2.09 - 4.10), or had secondary/tertiary education (aOR 2.04; 95% CI 1.04 - 3.99) had higher odds of HIV testing. CONCLUSION. The study identified an unmet need for HIV testing among sexually active AGYW in SA, especially adolescent girls aged 15 - 19 years. Increasing knowledge about HIV testing, adolescent-friendly services and other offsite strategies are therefore important for this particular key population.

Abstract Introduction: Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. Methods: We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). Results: In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. Conclusion: PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios. Introduction (SHPT failure (PTX world Methods vs D Ktx. . (Ktx) oneyear one year followup follow up out strategy named CIN. CIN) use, use , use) OBS. OBS (OBS) Results (PTH baseline wider 31 31% 14 80 levels p<0.0001. p00001 p p<0.0001 0 0001 (p<0.0001) population impressive observed Conclusion scenarios (Ktx (OBS 1 8 p0000 p<0.000 000 (p<0.0001 p000 p<0.00 00 (p<0.000 p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

Resumo Introdução: O manejo do hiperparat-ireoidismo secundário (HPTS) é uma tarefa desafiadora com diversos fatores que contribuem para o fracasso do tratamento. A terapia calcimimética revolucionou o manejo do HPTS, levando a alterações nas indicações e no momento apropriado da paratireoidectomia (PTX) em todo o mundo. Métodos: Comparamos taxas de resposta às abordagens clínica vs. cirúrgica do HPTS em pacientes em diálise de manutenção (DRC 5D) e pacientes transplantados renais (TxR). Foi realizada uma análise retrospectiva dos achados de um ano de acompanhamento. Pacientes com DRC 5D foram divididos em 3 grupos de acordo com a estratégia de tratamento: paratireoidectomia, manejo clínico sem cinacalcete (denominado padrão - P) e com cinacalcete (P + CIN). Os pacientes com TxR foram divididos em 3 grupos: PTX, CIN (uso de cinacalcete) e observação (OBS). Resultados: Na DRC 5D, encontramos uma redução significativa do paratormônio (PTH) em todos os grupos. Apesar de todos os grupos apresentarem um PTH mais elevado no início do estudo, identificamos uma redução mais acentuada no grupo PTX. Com relação ao HPTS grave, a diferença entre os grupos foi evidentemente maior: 31%, 14% e 80% dos grupos P, P + CIN e PTX atingiram níveis adequados de PTH, respectivamente (p< 0,0001). Com relação à população TxR, embora a diferença não tenha sido tão impressionante, também foi observada uma taxa maior de sucesso no grupo PTX. Conclusão: A PTX ainda parece ser a melhor escolha de tratamento para o HPTS, especialmente em pacientes com doenças prolongadas em cenários sem recursos. Introdução hiperparatireoidismo hiperparat ireoidismo (HPTS (PTX mundo Métodos vs D TxR. . (TxR) acompanhamento denominado CIN. CIN) uso OBS. OBS (OBS) Resultados (PTH estudo grave 31 31% 14 80 p< p (p 0,0001. 00001 0,0001 0 0001 0,0001) impressionante Conclusão recursos (TxR (OBS 1 8 0000 0,000 000 0,00 00 0,0 0,