ABSTRACT Paracoccidioidomycosis (PCM) is a systemic disease endemic to Latin American countries, with a high impact in terms of morbidity, mortality and costs for the health system if patients progress to advanced stages. This work aimed to collect data published in publications on autochthonous cases of PCM, from the first cases diagnosed in Paraguay, with a description of the historical context and identifying the pioneers in the diagnosis in Paraguay, following a chronological order, to the most recently reported cases. Methodology: search in national libraries and online databases of PCM cases in Paraguay, published in national historical scientific journals and other sources available in print format, and more recent scientific articles available in electronic format, respectively. Results: 479 cases of PCM were identified in publications between the years 1935 and 2023, corresponding to autochthonous cases and whose diagnoses were made in Paraguayan territory. Dr. Juan Boggino and collaborators were responsible for the first diagnoses in the country. The predominant clinical form was chronic. The average age was 45.78 years. The vast majority of patients diagnosed were from the Eastern Region of the country, predominantly male farmers. Conclusion: PCM is an endemic disease in Paraguay. Since the first cases were diagnosed and until today, patients with a severe and disabling course of the disease have been detected, which demonstrates the need to disseminate its knowledge and expand the early diagnostic capacity at the national level. Due to its clinical pleomorphism and its ability to simulate other diseases, it is important to include PCM as a differential diagnosis for patients who present risk factors for the development of the disease.

RESUMEN La Paracoccidioidomicosis (PCM), es una enfermedad sistémica endémica de países de América Latina, con alto impacto en términos de morbilidad, mortalidad y costos para el sistema de salud si los enfermos progresan a sus estadios avanzados. Este trabajo tuvo como objetivo recopilar datos divulgados en publicaciones sobre casos autóctonos de PCM, desde los primeros casos diagnosticados en Paraguay, con una descripción del contexto histórico e identificando a los pioneros en el diagnóstico en Paraguay, siguiendo un orden cronológico, hasta los casos más recientemente informados. Metodología: búsqueda en bibliotecas nacionales y bases de datos online de casos de PCM en Paraguay, publicados en revistas científicas históricas nacionales y otras fuentes disponibles en formato impreso, y artículos científicos más recientes disponibles en formato electrónico, respectivamente. Resultados: Se identificaron 479 casos de PCM en publicaciones entre los años 1935 y 2023, correspondientes a casos autóctonos y cuyos diagnósticos fueron realizados en territorio paraguayo. El Dr. Juan Boggino y colaboradores fueron los responsables de los primeros diagnósticos en el país. La forma clínica predominante fue la crónica. La media de edad de 45,78 años. La gran mayoría de los pacientes diagnosticados fueron oriundos de la Región Oriental del país, predominantemente hombres agricultores. Conclusión: La PCM es una enfermedad endémica del Paraguay, desde los primeros casos diagnosticados y hasta hoy en día, son detectados pacientes con una evolución grave y discapacitante de la enfermedad, lo que demuestra la necesidad de la difusión de su conocimiento y ampliación de la capacidad diagnóstica precoz a nivel nacional. Debido a su pleomorfismo clínico y su capacidad de simular otras enfermedades, es importante incluir a la PCM como diagnóstico diferencial de pacientes que presenten factores de riesgo para el desarrollo de la enfermedad.

Abstract Introduction. Superior mesenteric artery syndrome, also known as Wilkie syndrome, is a rare entity in which a reduction in the aorto-mesenteric angle or space determines extrinsic compression with obstruction of the distal third of the duodenum, demonstrating characteristic symptoms and signs of intestinal obstruction. The mainstay of treatment is conservative medical management with nutritional repletion, with the aim of increasing the thickness of the retroperitoneal fat and thereby resolving duodenal compression. Clinical case. A 16-year-old patient, with a chronic course marked by abdominal pain, constipation, bloating, heartburn and weight loss. Initially was treated as an acid-peptic disease, with poor improvement. Imaging studies were performed, which documented a decrease in the aorto-mesenteric angle. Conclusion. Based on the symptoms and findings on diagnostic images, the diagnosis of superior mesenteric artery syndrome was made, which is a cause of intestinal obstruction with a very low incidence. Its clinical presentation includes a wide variety of symptoms, among which abdominal pain and weight loss stand out. Confusion with other more common diseases is common, such as acid-peptic disease, gastrointestinal reflux and malabsorption. Its diagnosis requires a high index of suspicion, so it is important to know this entity and consider it in the study of patients with the aforementioned symptoms.

Resumen Introducción. El síndrome de la arteria mesentérica superior, también conocido como síndrome de Wilkie, es una entidad infrecuente en la que una reducción del ángulo o espacio aorto-mesentérico determina una compresión extrínseca con obstrucción del tercio distal del duodeno, demostrando síntomas y signos característicos de obstrucción intestinal. El pilar del tratamiento es el manejo médico conservador con repleción nutricional, con el objetivo de aumentar el grosor de la grasa retroperitoneal y con esto resolver la compresión duodenal. Caso clínico. Paciente de 16 años, con un curso crónico marcado por dolor abdominal, estreñimiento, distensión, pirosis y pérdida de peso. Inicialmente se trató como una enfermedad ácido-péptica, con pobre mejoría, por lo que se realizaron estudios imagenológicos con lo que se documentó una disminución del ángulo aortomesentérico. Resultado. Se instauró un manejo médico con un protocolo de repleción nutricional por vía oral, para lograr ganancia de peso y evitar la cirugía. Conclusión. Con base a los síntomas y hallazgos en imágenes diagnósticas se hizo el diagnóstico de síndrome de la arteria mesentérica superior, que es una causa de obstrucción intestinal con muy baja incidencia. Su presentación clínica incluye gran variedad de síntomas, entre los que destaca el dolor abdominal y la pérdida de peso. Es frecuente la confusión con otras enfermedades más frecuentes, como enfermedad ácido-péptica, reflujo gastrointestinal y malabsorción. Su diagnóstico requiere un alto índice de sospecha, por lo que es importante conocer esta entidad y considerarla en el estudio de pacientes con los síntomas mencionados.

Abstract Introduction: MOG antibody-associated disease (MOGAD) comprises a broad spectrum of clinical manifestations and imaging findings. Recent evidence indicates that brainstem encephalitis is a possible manifestation of MOGAD. Case presentation: We present the case of a 32-year-old female patient with a 9-year history of a fluctuating disease course and good response to steroids, with almost exclusive brainstem involvement and subsequent optic nerve involvement. The patient did not meet the criteria for multiple sclerosis or neuromyelitis optica, and other differentials were excluded. The diagnosis of MOGAD was confirmed by IgG antibodies against the MOG protein. Discussion: Brainstem lesions in MOGAD have been described in 30% of a Spanish cohort of MOG-IgG positive patients. The lesions tend to be bilateral, poorly defined, and large. Although low titers on the assay may raise doubts about the diagnosis, Banwell et al recently proposed new diagnostic criteria that include low MOG-IgG titers. In the face of low titers, the supporting clinical criteria support the diagnosis. Conclusions: Patients with signs of brainstem encephalitis without a clear etiology should be evaluated for MOG-associated antibodies to confirm or rule out the diagnosis.

Resumen Introducción: La enfermedad asociada a la glicoproteína oligodendrocitaria de mielina (MOGAD) comprende un espectro amplio de manifestaciones clínicas y hallazgos imagenológicos, donde la evidencia reciente indica que la encefalitis de tallo es una posible manifestación de MOGAD. Presentación de caso: Se presenta el caso de una paciente femenina de 32 años con curso de enfermedad fluctuante y buena respuesta a esteroides, con afectación predominante del tallo cerebral de nueve años de evolución y posterior compromiso del nervio óptico. La paciente no cumplía criterios para esclerosis múltiple o neuromielitis óptica y otros diagnósticos diferenciales fueron excluidos. Finalmente, el diagnóstico de MOGAD fue confirmado mediante la detección de anticuerpos IgG contra la proteína MOG. Discusión: Las lesiones de tallo cerebral en MOGAD se han descrito en el 30 % de los casos de una cohorte española de pacientes positivos para MOG-IgG. Las lesiones tienden a ser bilaterales, mal definidas y de gran tamaño. A pesar de que los bajos títulos del examen pueden generar dudas sobre el diagnóstico, Banwell et al. recientemente propusieron unos nuevos criterios diagnósticos que incluyen bajos títulos de MOG-IgG y, ante ello, los criterios clínicos de soporte apoyan el diagnóstico. Conclusiones: Los pacientes con signos de encefalitis de tallo sin clara etiología deben ser evaluados con anticuerpos asociados a la proteína MOG, para confirmar o descartar el diagnóstico.

Abstract Introduction: The association of hepatitis delta virus (HDV) infection with positive autoantibodies and autoimmune features has been known for decades. However, to date, very few cases of clinical autoimmune hepatitis (AIH) have been reported in association with HDV infection, most of them being in the context of treatment with peginterferon. Case Report: This case refers to a 46-year-old woman born in Guinea-Bissau who moved to Portugal in 2018 to investigate complaints of diffuse abdominal discomfort and nausea. Her initial work-up, including laboratory and liver histology, was consistent with type 1 AIH. She had HBe antigen-negative chronic hepatitis B virus infection with negative DNA and also a positive total anti-HDV antibody, with negative IgM and undetectable RNA. Therefore, after initiating prophylactic tenofovir difumarate, she was started on prednisolone followed by azathioprine, which was later stopped due to presumed hepatotoxicity. Repeated histology showed signs of viral superinfection, and she was treated with acyclovir due to a positive herpes simplex IgM, with HDV RNA remaining negative. A third flare in transaminases prompted the introduction of mycophenolate mofetil (MMF) after a thorough exclusion of additional causes of liver disease. About 6 months later, during another bout of hepatitis, HDV RNA was finally positive and classified as genotype 5. MMF was stopped, and, considering a contraindication to interferon, the patient was offered therapy with bulevirtide, which she refused for personal reasons as she is currently living in her home country. Discussion: This is a challenging case of autoimmune or “autoimmune-like” hepatitis, probably induced by chronic HDV infection. High suspicion of HDV was essential because, had the case been interpreted as refractory AIH, with escalation of immunosuppression, a more severe course of the viral infection might have ensued. Recently, HDV suppression with bulevirtide was shown to reverse autoimmune liver disease. We hypothesize that the same could have happened to our patient, had she accepted this treatment.

Resumo Introdução: A associação da infeção pelo vírus da hepatite delta (VHD) com a presença de autoanticorpos e outros aspetos de autoimunidade é conhecida desde há várias décadas. Contudo, até à data, muito poucos casos de hepatite autoimune (HAI) clínica foram reportados em relação com a infeção VHD, sendo a maioria destes no contexto de terapêutica com interferão peguilado. Caso clínico: O caso refere-se a uma mulher de 46 anos natural da Guiné-Bissau, que se mudou para Portugal em 2018 para investigação de queixas de desconforto abdominal difuso e náuseas. A avaliação laboratorial inicial e a histologia hepática foram compatíveis com HAI tipo 1. A doente apresentava também infeção crónica a VHB (vírus da hepatite B) antigénio HBe negativa, com DNA negativo, e anti-VHD (vírus da hepatite delta) total positivo, com IgM negativo e RNA indetetável. Assim, após início de tenofovir difumarato profilático, foi iniciada terapêutica com prednisolona seguida de azatioprina, que posteriormente se interrompeu por presumível hepatotoxicidade. Uma segunda biópsia mostrou aspetos de superinfeção viral e como tal a doente foi tratada com aciclovir, tendo em conta IgM positivo para Herpes Simplex, mantendo-se o RNA VHD negativo. Um terceiro flare de transaminases motivou o início de micofenolato de mofetil, após extensa investigação e exclusão de outras causas de doença hepática. Cerca de 6 meses mais tarde, durante novo episódio de hepatite, o RNA VHD revelou-se finalmente positivo e este foi classificado como genotipo 5. O MMF foi suspenso e, considerando a contra-indicação para interferão, foi proposto à doente tratamento com bulevirtide, que esta recusou, alegando motivos pessoais, visto estar atualmente a residir no seu país de origem. Discussão: Este é um caso desafiante de hepatite autoimune, ou autoimune-like, provavelmente induzida pela infeção crónica pelo VHD. Um elevado índice de suspeição para VHD foi essencial porque, se o caso tivesse sido interpretado como HAI refratária, com incremento de imunossupressão, poderia ter-se verificado um agravamento da hepatite viral. Recentemente, foi reportado que a supressão do VHD pelo bulevirtide pode reverter a doença hepática autoimune. Questionamo-nos se o mesmo poderia ter sucedido com a nossa doente, caso esta tivesse aceite este tratamento.

ABSTRACT Introduction: Scientific and technological developments require continuous nurses' updating. This update would be achieved through continuous training and lifelong learning, which face some obstacles such as the need for reconciliation with personal and family life. The use of massive, online and asynchronous courses allows nurses access to current and targeted content to their needs, enhancing autonomy and learning management. With this study, we aim to assess the ease of use, perceived utility and intention for using a Massive Open Online Course (MOOC) in continuous nursing training. Methodology: Observational, exploratory and descriptive study using a non-probabilistic convenience sample. The study took place in the Department of Internal Medicine of a Central Hospital in the North of Portugal. Results: 141 nurses participated in this study. The results showed high perceived user-friendliness and utility of the learning program, and the nurses' intention for using a MOOC in the future. Discussion: The perceived usefulness, ease and intention are supported by the perceived quality in the contents, by the adequacy to perceived needs, using active pedagogical strategies such as the integration of virtual clinical simulation, and the perceived accessibility to training content. Conclusion: The use of a MOOC, made available from Information and Communication Technologies, has a high potential for acceptance and use in continuing nursing training, contributing not only to the safety and quality of care, but also for an adequate management of nurses' personal and professional lives.

RESUMO Introdução: A evolução científica e tecnológica exige dos enfermeiros uma atualização permanente. Esta atualização concretiza-se através da formação contínua e da aprendizagem ao longo da vida, as quais enfrentam alguns obstáculos como a necessidade de conciliação com a vida pessoal e familiar. O recurso a cursos massivos, online e assíncronos possibilita aos enfermeiros o acesso a conteúdos atuais e direcionados às suas necessidades, potenciando autonomia e gestão da aprendizagem. Com este estudo pretendíamos avaliar a facilidade de utilização, utilidade percebida e intenção para a utilização de um Massive Open Online Course (MOOC) na formação contínua pelos Enfermeiros. Metodologia: Estudo observacional, exploratório e descritivo com recurso a uma técnica de amostragem não probabilística de conveniência. O estudo decorreu no Departamento de Medicina Interna de um Hospital Central do Norte de Portugal. Resultados: Neste estudo participaram 141 enfermeiros. Os resultados revelaram uma elevada facilidade de utilização e utilidade percebidas do programa formativo, assim como a intenção dos enfermeiros para a utilização futura de um MOOC. Discussão: A utilidade, facilidade e intenção percebidas, são suportadas pela qualidade percebida nos conteúdos, pela adequação às necessidades percebidas, pela utilização de estratégias pedagógicas ativas como a integração da simulação clínica virtual, e pela acessibilidade percebida aos conteúdos formativos. Conclusão: A utilização de um MOOC, disponibilizado a partir das Tecnologias de Informação e Comunicação, tem um elevado potencial de aceitação e utilização na formação contínua em enfermagem, contribuindo não só para a segurança e qualidade dos cuidados, mas também para uma adequada gestão da vida pessoal e profissional dos enfermeiros.

RESUMEN Introducción: Los avances científicos y tecnológicos exigen que los enfermeros se mantengan permanentemente actualizados. Esta actualización se concretaría a través de la formación continua y del aprendizaje permanente, que afrontan algunos obstáculos como la necesidad de conciliación con la vida personal y familiar. El recurso a cursos masivos, online y asíncronos posibilita a los enfermeros el acceso a contenidos actuales y dirigidos a sus necesidades, potenciando autonomía y gestión del aprendizaje. Con este estudio pretendíamos evaluar la facilidad de uso, utilidad percibida e intención para la utilización de un Massive Open Online Course (MOOC) en la formación continua de los enfermeros. Metodología: Estudio observacional, exploratorio y descriptivo, recurriendo a una muestra de conveniencia no probabilística. El estudio tuvo lugar en el Departamento de Medicina Interna de un Hospital Central del Norte de Portugal. Resultados: En este estudio participaron 141 enfermeros. Los resultados mostraron un gran nivel de percepción de la facilidad de uso y la utilidad del curso de formación, así como la intención de los enfermeros de usar un MOOC más tarde. Discusión: La utilidad, facilidad e intención percibidas, son soportadas por la calidad percibida en los contenidos, por la adecuación a las necesidades percibidas, por la utilización de estrategias pedagógicas activas como la integración de la simulación clínica virtual, y por la accesibilidad percibida a los contenidos formativos. Conclusión: El uso de un MOOC, que se ofrece a partir de las tecnologías de la información y la comunicación, tiene un alto potencial de aceptación y uso en la formación continuada de enfermería, contribuyendo no solo a la seguridad y calidad de la atención, pero también para una adecuada gestión de la vida personal y profesional de los enfermeros.

RESUMEN Fundamento: la simulación clínica en salud integra, a la práctica, las habilidades aprendidas de la teoría. Es un recurso de aprendizaje para mejorar lo aprendido que minimiza el riesgo ante los pacientes. Objetivo: describir la experiencia lograda sobre simulación por estudiantes de fisioterapia. Métodos: estudio descriptivo desarrollado en la Universidad Norbert Wiener con alumnos de VIII ciclo, del curso de fisioterapia cardiorrespiratoria. Se desarrolló un taller de habilidades y posteriormente un escenario de simulación clínica con paciente estandarizado con enfermedad respiratoria crónica descompensado. Se aplicaron dos cuestionarios de satisfacción al finalizar cada experiencia realizada. Resultados: en el taller de habilidades participaron 102 alumnos, la edad promedio fue de 26,71 ±6,45; femenino 82,35 %. Se aplicó un cuestionario de satisfacción de siete preguntas, que reflejó aceptación del 90 %, alfa de Cronbach de 0,796. En el escenario de simulación participaron 93 alumnos, edad 28,65 ±5,83, femeninos 81,6 %, trabajan y estudian 65,51 %, se aplicó un cuestionario de 13 preguntas que midió cinco dimensiones, aceptación del 88,7 %, alfa de Cronbach consistente y fiable de 0,913. Conclusiones: se empleó un nuevo escenario que asegura las competencias en el campo clínico basado en la simulación para la formación de los estudiantes de fisioterapia, con buena aceptación de la experiencia realizada.

ABSTRACT Foundation: clinical simulation in health integrates into practice, the skills learned from theory. It is a learning resource to improve what has been learned that minimizes the risk to patients. Objective: to describe the experience achieved on simulation by physiotherapy students. Methods: descriptive study developed at the Norbert Wiener University with VIII cycle students of the cardiorespiratory physiotherapy course. A skills workshop was developed and subsequently a clinical simulation scenario with a standardized patient with decompensated chronic respiratory disease. Two satisfaction questionnaires were applied at the end of each experience carried out. Results: 102 students participated in the skills workshop, the average age was 26.71 ±6.45; female 82.35%. A seven-question satisfaction questionnaire was applied, which reflected 90% acceptance, Cronbach's alpha of 0.796. 93 students participated in the simulation scenario, age 28.65 ±5.83, female 81.6%, work and study 65.51%, a 13-question questionnaire that measured five dimensions, acceptance of 88.7%. , consistent and reliable Cronbach's alpha of 0.913. Conclusions: a new scenario was used that ensures competencies in the clinical field based on simulation for the training of physiotherapy students, with good acceptance of the experience carried out.

Abstract Chronic diarrhoea is predominantly defined by decreased consistency of faeces lasting more than four weeks. The differential diagnosis is vast, including various pathologies such as celiac disease, thyroid dysfunction, inflammatory or neoplastic bowel disease, irritable bowel syndrome, chronic infections and immunosuppression. Human immunodeficiency virus (HIV) is commonly associated with diarrhoea, both in its acute presentation and in the course of the disease and should be considered in the differential diagnosis of this clinical entity. We report the case of a 59-year-old male whose HIV diagnosis occurred following etiological investigation of chronic diarrhoea in primary health care. The family doctor should have a high degree of suspicion in these cases regardless of the apparent absence of behavioural risk factors for HIV infection.

Resumo Define-se diarreia crónica predominantemente pela diminuição da consistência das fezes com duração superior a quatro semanas. O diagnóstico diferencial é vasto, incluindo patologias diversas tais como doença celíaca, disfunção tiroideia, doença inflamatória ou neoplásica intestinal, síndrome do intestino irritável, infeções crónicas e imunossupressão. O vírus da imunodeficiência humana (VIH) associa-se comummente a diarreia, tanto na sua apresentação aguda como no decorrer da evolução da doença, devendo ser considerado no diagnóstico diferencial desta entidade clínica. Reporta-se o caso de um indivíduo do sexo masculino com 59 anos, cujo diagnóstico da infeção por VIH decorreu na sequência da investigação etiológica de uma diarreia crónica nos cuidados de saúde primários. O médico de família deve ter um elevado grau de suspeição nestes casos independentemente da ausência aparente de comportamentos de risco para infeção por VIH.

Objective This study aimed to determine the clinical outcomes and risk factors affecting mortality in patients with COVID-19 following hematological malignancy (HM). Methods Patients diagnosed with HM and hospitalized for COVID-19 were included in this retrospective study. The age, demographic and clinical characteristics, prognosis and treatment of surviving and non-surviving patients were compared. Results A total of 49 patients were included in this study, 17 (34.6%) of whom died within 28 days of being diagnosed with COVID-19. Older age (p = 0.001), diabetes (p = 0.001), chronic obstructive pulmonary disease (p = 0.002), secondary infection (p < 0.001) and secondary bacterial infection (p = 0.005) were statistically significantly higher in non-survivors. The remission status of HM was higher in surviving patients (p < 0.001). In multivariate regression analysis, age (OR: 1.102, p = 0.035) and secondary infection (OR: 16.677, p = 0.024) were risk factors increasing mortality, the remission status of HM (OR: 0.093, p = 0.047) was a protective factor from mortality. Conclusion The older age, the remission status of HM and secondary infection due to COVID-19 were determined as prognostic factors predicting mortality in HM patients with following COVID-19. COVID19 COVID 19 COVID-1 HM. . (HM) characteristics nonsurviving non compared 4 1 34.6% 346 34 6 (34.6% 2 COVID19. 19. 0.001, 0001 0.001 , 0 001 0.002, 0002 0.002 002 0.002) 0.005 0005 005 nonsurvivors. nonsurvivors survivors. survivors non-survivors 0.001. analysis OR (OR 1102 102 1.102 0.035 0035 035 16677 16 677 16.677 0.024 0024 024 0093 093 0.093 0.047 0047 047 COVID1 COVID- (HM 34.6 3 (34.6 000 0.00 00 110 10 1.10 0.03 003 03 1667 67 16.67 0.02 02 009 09 0.09 0.04 004 04 34. (34. 0.0 11 1.1 166 16.6 (34 0. 1. 16. (3 (

Abstract Background: Mycotic aneurysm is a rare entity with rapid progression, which can be fatal without adequate treatment. The incidence of rupture is greater than that of degenerative aneurysms and is associated with a high mortality rate. Case report: We report the case of a 58-year-old man with a known history of HIV infection with good immunovirological staging, treated squamous cell carcinoma of the anal canal and chronic gastritis, who presented with a six-day history of intense back pain, malaise, fever, and chills. After examination, he was hospitalized with a clinical suspicion of acute pyelonephritis. During hospitalization, he was diagnosed with pneumonia of the right pulmonary base, infectious spondylodiscitis, and mycotic aneurysm of the abdominal aorta, which involved the visceral plaque. The microbiological workup revealed only positive blood cultures for Klebsiella pneumoniae. After a multidisciplinary discussion of the case and six weeks of antibiogram-oriented antibiotic therapy, the patient underwent an aorto-aortic interposition via left thoracophrenolaparotomy without the need to reimplant visceral vessels due to the patch configuration of the proximal anastomosis. The procedure was performed under left heart bypass. The postoperative course was uneventful, and the patient was discharged four weeks later. At 18 months follow-up, she remained asymptomatic and free of recurrence. Conclusion: In this case, it remains to be defined whether the cause of the mycotic aneurysm was hematogenous dissemination from the identified pneumonia or contiguity from the diagnosed spondylodiscitis. Given the morbidity and mortality associated with this entity, early diagnosis and adequate treatment with surgical correction and antibiotic therapy with sufficient duration and dose are important aspects for improving survival in these cases.

ABSTRACT Introduction: Glaucoma is one of the nosologic entities with more prevalence and constitutes one of the main causes of blindness in the developed world. The intraocular pressure is the only risk factor that can be controlled and is associated with the presence and progression of the disease. Objective: To describe the evolution of patients operated by means of trabeculectomy technique. Methods: An observational descriptive, longitudinal and prospective study of 128 patients with simple chronic glaucoma operated by means of trabeculectomy technique was carried out in the Ophthalmology Center of Santiago de Cuba, from January, 2017 to June, 2019. For this purpose, the following variables were analyzed: age, sex, skin color, preoperative and postoperative visual acuteness, intraocular pressure before and after the operation, as well as postoperative complications. Results: There was a prevalence of male sex (69.5%), 60-69 age group (44.5%) and black skin color (53.1%). Hypertension was the most frequent associated disease and the ocular hypertension was the fundamental risk factor; meanwhile, the main postoperative complication was the hyphema. Conclusions: With trabeculectomy was possible to control ocular tension in most of the patients and the complications that were presented in some of them did not interfere in their clinical course. This technique made it possible to reduce the irreversible damage caused by ocular hypertension of the optic nerve and, consequently, to prevent blindness.

RESUMEN Introducción: El glaucoma es una de las entidades nosológicas con mayor prevalencia y constituye una de las principales causas de ceguera en el mundo desarrollado. La presión intraocular es el único factor de riesgo que puede ser controlado y se asocia a la presencia y progresión de la enfermedad. Objetivo: Describir la evolución de pacientes operados mediante la técnica de trabeculectomía. Métodos: Se realizó un estudio observacional descriptivo, longitudinal y prospectivo de 128 pacientes con glaucoma crónico simple operados mediante la técnica de trabeculectomía en el Centro Oftalmológico de Santiago de Cuba, desde enero del 2017 hasta junio del 2019. Para ello, se analizaron las siguientes variables: edad, sexo, color de piel, agudeza visual preoperatoria y posoperatoria, presión intraocular antes y después de la operación, así como complicaciones posoperatorias. Resultados: Predominaron el sexo masculino (69,5 %), el grupo etario de 60-69 años (44,5 %) y el color de la piel negro (53,1 %). La hipertensión arterial fue la enfermedad asociada con más frecuencia y la hipertensión ocular, el factor de riesgo fundamental; en tanto, la complicación posoperatoria principal fue el hipema. Conclusiones: Con la trabeculectomía se logró controlar la tensión ocular en la mayoría de los pacientes y las complicaciones que se presentaron en algunos de ellos no interfirieron en su evolución. Esta técnica permitió disminuir el daño irreversible que provoca la hipertensión ocular del nervio óptico y, por consiguiente, prevenir la ceguera.

ABSTRACT Accelerated atherosclerosis has been identified as a complication of multiple autoimmune diseases, among which Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis stands out. We describe the case of a 60-year-old patient with a history of hypertension, diabetes mellitus, and chronic kidney disease of unknown etiology, who presented two acute coronary syndromes with only a six-month difference. Rapid progression of coronary involvement was evidenced, along with increased markers of inflammatory response, usual interstitial pneumonia on tomography, and positive anti-myeloperoxidase antibodies (anti-MPO), leading to the diagnosis of microscopic polyangiitis (MPA). In these cases, timely diagnostic suspicion is crucial, as early treatment significantly impacts the course and prognosis of the disease.

ABSTRACT: Hemoptysis associated with respiratory disorders are some findings of caudal vena cava thrombosis (CVCT) in cattle. Nevertheless, CVCT may be accompanied by a broad spectrum of clinical signs and gross lesions. This study reported the frequency of CVCT in cattle necropsied in Southern Brazil and described its clinical signs, as well as pathological findings. From a total of 1,976 postmortem examination reports in cattle in Southern Brazil, there were 30 cases (1.5%) of CVCT. In the clinical evaluation, the main clinical course was chronic (13/30), followed by peracute (7/30), acute (4/30), and subacute (5/30). Hemoptysis (17/30), dyspnea (8/30), and anorexia or hyporexia (7/30) were the most reported clinical signs. Septic thrombophlebitis of the caudal vena cava (24/30), hepatic abscesses (24/30), pulmonary hemorrhage (23/30), and embolic pneumonia (19/30) were the main lesions observed at the necropsy. We concluded that CVCT is a relevant cause of death in bovines from Santa Catarina state, mainly in adult dairy cows. The disease is characterized by a wide range of clinical signs and lesions, requiring attention from veterinarians for the correct diagnosis. Furthermore, the association between the clinical history, clinical signs, and lesions is essential for the diagnosis of CVCT in cattle. ABSTRACT (CVCT Nevertheless 1976 1 976 1,97 3 1.5% 15 5 (1.5% evaluation 13/30, 1330 13/30 , 13 (13/30) 7/30, 730 7/30 7 4/30, 430 4/30 4 (4/30) 5/30. 530 5/30 . (5/30) 17/30, 1730 17/30 17 (17/30) 8/30, 830 8/30 8 (8/30) (7/30 24/30, 2430 24/30 24 (24/30) 23/30, 2330 23/30 23 (23/30) 19/30 1930 19 (19/30 necropsy state cows Furthermore history 197 97 1,9 1.5 (1.5 133 13/3 (13/30 73 7/3 43 4/3 (4/30 53 5/3 (5/30 173 17/3 (17/30 83 8/3 (8/30 (7/3 243 24/3 2 (24/30 233 23/3 (23/30 19/3 193 (19/3 9 1, 1. (1. 13/ (13/3 7/ 4/ (4/3 5/ (5/3 17/ (17/3 8/ (8/3 (7/ 24/ (24/3 23/ (23/3 19/ (19/ (1 (13/ (4/ (5/ (17/ (8/ (7 (24/ (23/ (19 ( (13 (4 (5 (17 (8 (24 (23 (2

RESUMO: Hemoptise associada a sinais respiratórios são achados típicos de tromboembolismo da veia cava caudal (TVCC) em bovinos. Todavia, o TVCC pode estar acompanhado de um amplo espectro de sinais clínicos e lesões macroscópicas. Esse estudo tem por objetivo relatar a frequência do diagnóstico de TVCC em bovinos necropsiados no sul do Brasil e descrever os sinais clínicos, assim como achados patológicos dessa condição. De um total de 1.976 exames post-mortem realizados em bovinos no Sul do Brasil, 30 casos de TVCC foram diagnosticados (1,5%). No exame clínico, o principal curso clínico observado foi crônico (13/30), seguido do hiperagudo (7/30), agudo (4/30) e subagudo (5/30), em um caso o histórico clínico não foi fornecido. Hemoptise (17/30), dispneia (8/30) e anorexia ou hiporexia (7/30) foram os sinais clínicos mais comumente relatados. Tromboflebite séptica da veia cava caudal (24/30), abscessos hepáticos (24/30), hemorragia pulmonar (23/30) e pneumonia embólica (19/30) foram as principais lesões observadas na necropsia. Com esse trabalho conclui-se que TVCC é uma causa relevante de morte em bovinos no estado de Santa Catarina, principalmente em vacas leiteiras adultas. A doença é caracterizada por uma variedade de sinais clínicos e lesões, necessitando de atenção dos veterinários para o correto diagnóstico. Ainda, a associação entre o histórico clínico, sinais clínicos e lesões de necropsia é essencial para o diagnóstico de TVCC em bovinos. RESUMO (TVCC Todavia macroscópicas condição 1976 1 976 1.97 postmortem post mortem 3 1,5%. 15 1,5% . 5 (1,5%) 13/30, 1330 13/30 , 13 (13/30) 7/30, 730 7/30 7 4/30 430 4 (4/30 5/30, 530 5/30 (5/30) fornecido 17/30, 1730 17/30 17 (17/30) 8/30 830 8 (8/30 (7/30 relatados 24/30, 2430 24/30 24 (24/30) 23/30 2330 23 (23/30 19/30 1930 19 (19/30 concluise conclui se Catarina adultas Ainda 197 97 1.9 1,5 (1,5% 133 13/3 (13/30 73 7/3 4/3 43 (4/3 53 5/3 (5/30 173 17/3 (17/30 8/3 83 (8/3 (7/3 243 24/3 2 (24/30 23/3 233 (23/3 19/3 193 (19/3 9 1. 1, (1,5 13/ (13/3 7/ 4/ (4/ 5/ (5/3 17/ (17/3 8/ (8/ (7/ 24/ (24/3 23/ (23/ 19/ (19/ (1, (13/ (4 (5/ (17/ (8 (7 (24/ (23 (19 (1 (13 ( (5 (17 (24 (2

Abstract Objective Dyssynergic defaecation (DD) is an important cause of chronic constipation. In patients where conservative treatments fail, injections of botulinum toxin A (BTX-A) into the puborectalis and anal sphincter muscles can be effective. Complications of this procedure are reported to be rare and generally mild. This study aimed to identify the complication rates and short- to medium-term success rates of BTX-A injections as a treatment for DD. Methods A retrospective review was conducted on patients diagnosed with DD who had undergone BTX-A injections at a functional colorectal unit. Patient demographics, manometric assessment, conservative management, and injection technique were collected through a chart review. Subjective patient reports and comparison of pre- and postprocedure symptom scores were used to determine efficacy. Results The 21 patients included (24 procedures, with 3 patients receiving BTX-A on two separate occasions) all received stool modification and dietary advice, and 20 patients underwent pelvic floor physiotherapy, averaging 8 sessions. The injections were universally applied under general anesthetic, primarily targeting the anal sphincter and/or puborectalis muscles. There were 6 reports of faecal urge/incontinence, with all but one being resolved within weeks. The BTX-A injection was subjectively reported as beneficial in 19 cases, averaging 4.7 months (range 1-32) of improvement. Only 2 were sustained beyond 12 months. Despite overall improvements in symptom scores from pre- to postprocedure, none were statistically significant. Conclusion Following a course of conservative management, the BTX-A injection appears to be a safe treatment for DD, but only has short term efficacy. (DD constipation fail BTXA BTX (BTX-A effective mild mediumterm medium unit demographics assessment management pre efficacy 24 (2 procedures occasions advice physiotherapy sessions anesthetic andor or urgeincontinence urge incontinence urge/incontinence weeks 1 cases 47 4 7 4. range 132 32 1-32 improvement significant ( 13 1-3 1-

ABSTRACT Objective: To describe the clinical features and outcomes of patients with uveitis associated with juvenile idiopathic arthritis (JIA) and idiopathic uveitis. Methods: This was an observational, retrospective study, conducted in a tertiary center. Patients under 18 years old who experienced at least one episode of uveitis and followed between 2000 and 2019 were included. Results: A total of 82 patients were included, of whom 43 had idiopathic uveitis and 39 had uveitis associated with JIA. Anterior uveitis was the primary site of ocular inflammation (76.8%) and occurred in 24 and 39 patients with idiopathic uveitis and uveitis associated with JIA arthritis, respectively (p=0.02). The complete response to corticotherapy was more frequent in uveitis associated with JIA (p=0.001). Total and partial responses to biological disease modifying antirheumatic drugs were more frequent in uveitis associated with JIA (p=0.025) and idiopathic uveitis (p=0.045), respectively. There were 203 complications: cataracts were more frequently present in idiopathic uveitis (p=0.05), while synechiae was more frequent in uveitis associated with JIA (p=0.02). Conclusion: Idiopathic uveitis and uveitis associated JIA frequently follow a chronic course and an increased risk of visual loss in childhood. The uveitis associated with JIA showed better response to systemic corticotherapy and total response to biologic disease modifying antirheumatic drugs more frequently. Objective (JIA Methods observational study center 1 200 201 included Results 8 4 3 76.8% 768 76 (76.8% 2 p=0.02. p002 p p=0.02 . 0 02 (p=0.02) p=0.001. p0001 p=0.001 001 (p=0.001) p=0.025 p0025 025 (p=0.025 p=0.045, p0045 p=0.045 , 045 (p=0.045) 20 complications p=0.05, p005 p=0.05 05 (p=0.05) Conclusion childhood 76.8 7 (76.8 p00 p=0.0 (p=0.02 p000 p=0.00 00 (p=0.001 p004 p=0.04 04 (p=0.045 (p=0.05 76. (76. p0 p=0. (p=0.0 (p=0.00 (p=0.04 (76 p=0 (p=0. (7 p= (p=0 ( (p= (p

RESUMO Objetivos: Descrever as características clínicas e desfechos dos pacientes com uveíte associada à Artrite Idiopática Juvenil (AIJ) e da Uveíte Idiopática. Métodos: Este foi um estudo retrospectivo observacional conduzido em um centro terciário. Foram incluídos pacientes abaixo dos 18 anos de idade que apresentaram pelo menos um episódio de uveíte e que estiveram em acompanhamento médico entre os anos de 2000 e 2019. Resultados: Foram incluídos 82 pacientes, sendo 43 com uveíte idiopática e 39 com uveíte associada à AIJ. A uveíte anterior foi o sítio primário de acometimento (76,8%) em 24 e 39 pacientes com uveíte idiopática e uveíte associada à AIJ, respectivamente (p=0.02). Resposta total à corticoterapia foi mais frequente na uveíte associada à AIJ (p=0.001). Respostas total e parcial às drogas antirreumáticas modificadoras de doença biológicas foram mais frequentes na uveíte associada à AIJ (p=0.025) e na uveíte idiopática (p=0.045), respectivamente. Foram encontradas 203 complicações: a catarata foi mais frequente na uveíte idiopática (p=0.05), enquanto a sinéquia foi mais frequente na uveíte associada à AIJ (p=0.02). Conclusão: A uveíte idiopática e a uveíte associada à AIJ frequentemente apresentam um curso crônico e um risco elevado de perda visual na infância. A uveíte associada à AIJ apresentou melhor resposta à corticoterapia sistêmica e resposta total às drogas modificadoras de doença reumática biológicas mais frequentemente. Objetivos (AIJ Métodos terciário 1 200 2019 Resultados 8 4 3 76,8% 768 76 (76,8% 2 p=0.02. p002 p p=0.02 . 0 02 (p=0.02) p=0.001. p0001 p=0.001 001 (p=0.001) p=0.025 p0025 025 (p=0.025 p=0.045, p0045 p=0.045 , 045 (p=0.045) 20 complicações p=0.05, p005 p=0.05 05 (p=0.05) Conclusão infância 201 76,8 7 (76,8 p00 p=0.0 (p=0.02 p000 p=0.00 00 (p=0.001 p004 p=0.04 04 (p=0.045 (p=0.05 76, (76, p0 p=0. (p=0.0 (p=0.00 (p=0.04 (76 p=0 (p=0. (7 p= (p=0 ( (p= (p

Abstract The concept of “Cumulative Life Course Impairment” (CLCI) characterizes the set of factors harmful to the lives of patients resulting from the stigma and physical and psychological impairment associated with different chronic diseases, which can accumulate irreversibly over the course of patients lives. The sum of these factors often makes it impossible for these individuals to enjoy their lives fully, intensely and adequately. On the other hand, CLCI also incorporates coping strategies, including external factors and personality characteristics, which may act as modulating or protective factors of vulnerability to the CLCI. Although psoriasis is the most studied dermatological disease in relation to its impact on quality of life and CLCI, several other chronic inflammatory diseases such as atopic dermatitis, hidradenitis suppurativa, and alopecia areata have also been evaluated in relation to the magnitude of the damage to patients lives. Cumulative Impairment (CLCI fully adequately hand strategies characteristics dermatitis suppurativa