RESUMO Objetivo: Descrever casos de lesão renal aguda (LRA) em crianças diagnosticadas com COVID-19, associando fatores de risco, aspectos clínicos e evolução dos casos. Métodos: Estudo retrospectivo, realizado em hospital pediátrico entre março de 2020 e setembro de 2021, com pacientes com COVID-19 diagnosticados com LRA, que examinou informações presentes em prontuários como comorbidades, idade, sexo e uso de medicações nefrotóxicas. Resultados: Foram estudados 40 casos, sendo o sexo masculino significativamente mais acometido (62,5%; p=0,025). A LRA foi uma complicação grave da infecção por COVID-19, com 100% da amostra necessitando de internação na Unidade de Terapia Intensiva e 22,5% indo a óbito. As comorbidades mais prevalentes analisadas neste estudo foram epilepsia, paralisia cerebral e cardiopatia. A maioria dos pacientes foi classificada pelos critérios Kidney Disease: Improving Global Outcomes (KDIGO) como KDIGO 1 (42,5%) e necessitou de intubação orotraqueal (67,5%). A frequência de uso de medicamentos nefrotóxicos e necessidade de diálise foi baixa, com percentuais de 35 e 17,5%, respectivamente. Entre as crianças que faleceram, 70,4% apresentavam alguma comorbidade e 88,8% receberam ventilação invasiva. Conclusões: A LRA em crianças com infecção por COVID-19 está associada a quadros graves, apesar de a maior parte dos pacientes ter recebido alta hospitalar. Objetivo (LRA COVID19, COVID19 COVID 19, 19 risco Métodos retrospectivo 202 2021 COVID-1 idade nefrotóxicas Resultados 4 62,5% 625 62 5 (62,5% p=0,025. p0025 p p=0,025 . 0 025 p=0,025) 100 225 22 22,5 óbito epilepsia cardiopatia Disease (KDIGO 42,5% 425 42 (42,5% 67,5%. 675 67,5% 67 (67,5%) baixa 3 175 17 17,5% respectivamente faleceram 704 70 70,4 888 88 8 88,8 invasiva Conclusões graves hospitalar COVID1 20 COVID- 62,5 6 (62,5 p002 p=0,02 02 10 2 22, 42,5 (42,5 67,5 (67,5% 17,5 7 70, 88, 62, (62, p00 p=0,0 42, (42, 67, (67,5 17, (62 p0 p=0, (42 (67, (6 p=0 (4 (67 ( p=

ABSTRACT Objective: To describe cases of acute kidney injury (AKI) in children diagnosed with COVID-19, associated risk factors, clinical aspects and outcome of cases. Methods: Retrospective study, carried out in a pediatric hospital between March 2020 and September 2021, with patients with COVID-19 who were diagnosed with AKI, studying information present in medical records such as comorbidities, age, gender and use of nephrotoxic medications. Results: We studied 40 cases, and male individuals were significantly more affected (62.5%; p=0.025). AKI was a severe complication of COVID-19 infection, with 100% of the sample requiring admission to the Intensive Care Unit and 22.5% dying. The most prevalent comorbidities analyzed in this study were epilepsy, cerebral palsy and heart disease. Most patients were classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as KDIGO 1 (42.5%), and required orotracheal intubation (67.5%). The frequency of use of nephrotoxic medications and need for dialysis was low, with percentages of 35 and 17.5%, respectively. Among the children who died, 70.4% had some comorbidity and 88.8% received invasive ventilation. Conclusions: AKI in children with COVID-19 infection is associated with severe conditions. Despite the severity, most patients were discharged alive from the hospital. Objective (AKI COVID19, COVID19 COVID 19, 19 factors Methods 202 2021 COVID-1 age Results 4 62.5% 625 62 5 (62.5% p=0.025. p0025 p p=0.025 . 0 025 p=0.025) 100 225 22 22.5 dying epilepsy disease Disease (KDIGO 42.5%, 425 42.5% , 42 (42.5%) 67.5%. 675 67.5% 67 (67.5%) low 3 175 17 17.5% respectively died 704 70 70.4 888 88 8 88.8 ventilation Conclusions conditions severity COVID1 20 COVID- 62.5 6 (62.5 p002 p=0.02 02 10 2 22. 42.5 (42.5% 67.5 (67.5% 17.5 7 70. 88. 62. (62. p00 p=0.0 42. (42.5 67. (67.5 17. (62 p0 p=0. (42. (67. (6 p=0 (42 (67 ( p= (4

ABSTRACT Introduction: a pressure ulcer is an injury that is located at the level of the skin and deeper tissues. The beginning of the appearance of pressure ulcers can constitute a major problem in the health of patients, causing physical discomfort, increasing hospitalization time and treatment costs. Objectives: describe the prevalence of hospitalized patients with pressure ulcers in the medical clinic service of the modular block of the National Hospital, 2022 - 2023. Methodology: observational, descriptive, prospective design study, which included 223 adult patients admitted to the medical clinic service of the Hospital Nacional (Itauguá, Paraguay) during the period from 2022 to 2023. Results: the prevalence found was 9.4 %. The average age was 64 years, with a predominance of males (58 %). The most frequent location of the ulcers was at the sacral level (64 %), 14 % were multiple. Cerebrovascular accident was found as a determining pathology for the development of pressure ulcers (41 %). Pressure ulcers grade 1 and 2 were the most frequent (41 % both). Conclusion: pressure ulcers are a common pathology in hospitalized patients. There are associated comorbidities, stroke being one of the most frequent.

RESUMEN Introducción: la úlcera por presión es aquella lesión que se localiza a nivel de la piel y tejidos más profundos. El comienzo de la aparición de ulceras por presión puede constituir un problema importante en la salud de los pacientes, causar molestias físicas, aumentar el tiempo de hospitalización y los costos de tratamiento. Objetivos: describir la prevalencia de pacientes internados que presentan úlceras por presión en el servicio de clínica médica del bloque modular del Hospital Nacional, 2022 a 2023. Metodología: estudio de diseño observacional, descriptivo, de corte transversal, que incluyó a 223 pacientes adultos internados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) durante el periodo de 2022 a 2023. Resultados: la prevalencia encontrada fue de 9,4 %. La edad media fue de 64 años, con predominio del sexo masculino (58 %). La localización más frecuente de las ulceras fue a nivel sacro (64 %), fueron múltiples el 14 %. Se encontró como patología determinante para el desarrollo de ulceras por presión el accidente cerebrovascular (41 %). Las ulceras por presión grado 1 y 2 fueron las más frecuentes (41 %, ambos). Conclusión: las ulceras por presión son una patología frecuente en pacientes internados. Existen comorbilidades asociadas, siendo el accidente cerebrovascular una de las más frecuentes.

Abstract The rupture of the anterior cruciate ligament is common during physical activities; however, when associated with a multiple ligament injury, it represents an uncommon condition. The diagnosis of this injury is commonly delayed or missed. Consequently, the incidence of this injury may in fact be higher than reported. We present a case of a 27-year-old man with complete tear of the anterior cruciate ligament and of the medial collateral ligament and partial tear of the posterior cruciate, lateral collateral and patellar ligaments treated surgically.

Resumo A ruptura do ligamento cruzado anterior é comum durante atividades físicas; entretanto, quando associada a lesão ligamentar múltipla, representa uma condição incomum. O diagnóstico desta lesão é comumente tardio ou esquecido. Consequentemente, a incidência desta lesão pode de facto ser superior à relatada. Apresentamos o caso de um homem de 27 anos com ruptura completa do ligamento cruzado anterior e do ligamento colateral medial e ruptura parcial dos ligamentos cruzado posterior, colateral lateral e patelar tratados cirurgicamente.

Resumen La rotura del ligamento cruzado anterior es común durante las actividades físicas; sin embargo, cuando se asocia con una lesión de múltiples ligamentos, representa una condición poco común. El diagnóstico de esta lesión comúnmente se retrasa o se pasa por alto. En consecuencia, la incidencia de esta lesión puede ser mayor de lo informado. Presentamos el caso de un varón de 27 años con rotura completa del ligamento cruzado anterior y del ligamento colateral medial y rotura parcial de los ligamentos cruzado posterior, colateral lateral y rotuliano tratados quirúrgicamente.

ABSTRACT Introduction: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). Materials and Methods: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). Results: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. Conclusion: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen. Introduction DaVinci Da Vinci SinglePort Single Port (SP perioperative peri morbidity 1, 1 (1 2. 2 . 2) Methods 74yearold yearold 74 year old diabetes bypass hypertension hyperlipidemia 72 7 7.2 PIRADS5 PIRADS 5 PIRADS- midgland mid gland zone intermediaterisk intermediate biopsy 31 reversal 3, 3 (3 4. 4 4) Results 21 mL respectively 437 4+3=7 pTNxR pT NxR pT2NxR margins months Conclusion irritation violated mitigated abdomen ( 7. 43 4+3= 4+3 4+

Resumen Descripción del caso: Paciente de 23 años con hemorragia abdominal de origen no claro, que posteriormente presenta inestabilidad hemodinámica, requiriendo manejo quirúrgico en tres ocasiones con evolución satisfactoria. Hallazgos clínicos: Presentó sangrado cuantificado de 5500 cc en cavidad abdominal (grado IV - clasificación ATLS) con lesiones hepáticas en los segmentos I, IV y VIII, sin hallazgos sugestivos de trauma al examen físico, ni otros hallazgos traumáticos internos. Tratamiento y resultados: Se llevó a cabo una intervención quirúrgica precoz mediante laparotomía exploratoria con hallazgos ya descritos, además de dos tiempos quirúrgicos adicionales que llevaron al control del sangrado, con evolución satisfactoria. Relevancia clínica: El sangrado abdominal y laceración de víscera sólida secundario a trauma cerrado de abdomen es una etiología común en pacientes jóvenes masculinos, siendo contrario a esta afirmación el sangrado de origen hepático sin trauma es una etiología poco común. El presente caso resulta ser una dificultad diagnóstica en cuanto a la etiología, ya que lo evidenciado en la exploración quirúrgica no concuerda con el examen físico externo, sin una historia clínica clara al ingreso se deja la interrogante de la causa.

Summary: Case description: 23-year-old patient with abdominal hemorrhage of unclear origin, who subsequently presented hemodynamic instability, requiring surgical management on three occasions with satisfactory evolution. Clinical findings: she presented quantified bleeding of 5500 cc in the abdominal cavity (grade IV-ATLS classification) with liver lesions in segments I, IV and VIII, without findings suggestive of trauma on physical examination, or other internal traumatic findings. Treatment and results: An early surgical intervention was carried out through exploratory laparotomy with findings already described, in addition to two additional surgical procedures that led to control of bleeding, with satisfactory evolution. Clinical relevance: Abdominal bleeding and solid viscus laceration secondary to blunt abdominal trauma is a common etiology in young male patients, contrary to this statement, bleeding of hepatic origin without trauma is a rare etiology. The present case turns out to be a diagnostic difficulty in terms of etiology, since what was evidenced in the surgical exploration does not agree with the external physical examination, without a clear clinical history at admission, the question of the cause is left.

Abstract Background: Healthcare-associated infections are a prevalent issue in health systems that affect everyone. The incidence and prevalence of healthcare-associated infections depend on the context in which they occur. An example of this is ventilator-associated pneumonia in intensive care units. Objective: To analyze the determinants of ventilator-associated pneumonia in an intensive care unit of a central hospital in northern Portugal. Methodology: A retrospective, descriptive-correlational quantitative study was conducted with 705 patients admitted to the ICU of the hospital under investigation. Results: The results show that male gender, previous antibiotic use, endotracheal reintubation, level of consciousness, cuff pressure, ventilation time, injury, poisoning, and certain other consequences of external causes as admitting diagnosis are among the determinants of ventilator-associated pneumonia. Moreover, the incidence of ventilator-associated pneumonia was of 4.5%. Conclusion: The study recommends the judicious use of antibiotics, limiting the duration of invasive ventilation, implementing ventilator weaning protocols, and auditing compliance with the care bundle for ventilator-associated pneumonia. This study sheds light on the prevention of ventilator-associated pneumonia and its recommendations contribute to better care and more effective and safer nursing interventions.

Resumo Enquadramento: As infeções associadas aos cuidados de saúde (IACS) são uma problemática atual dos sistemas de saúde variando a sua incidência, prevalência do contexto de cuidados. A pneumonia associada à ventilação (PAV) é disso um exemplo ocorrendo em unidades de cuidados intensivos (UCI). Objetivo: Analisar determinantes da PAV, em doentes internados numa UCI de um hospital central do norte de Portugal. Metodologia: Estudo descritivo-correlacional e retrospetivo, com base nos registos de 705 doentes internados na UCI. Resultados: Constituíram-se determinantes da PAV o sexo masculino, tratamento prévio com antibiótico, reintubação endotraqueal, nível de consciência, pressão de cuff, tempo de ventilação, diagnóstico de entrada lesões, envenenamento e algumas outras consequências de causas externas. A incidência de PAV foi de 4,5%. Conclusão: O uso criterioso de antibióticos, o menor tempo possível de ventilação invasiva, a implementação de protocolos de desmame ventilatório e auditorias ao cumprimento da bundle da PAV podem contribuir para melhores cuidados e intervenções de enfermagem mais eficazes e seguras.

Resumen Marco contextual: Las infecciones asociadas a los cuidados sanitarios (IACS) son un problema actual en los sistemas sanitarios, y su incidencia y prevalencia varían en función del entorno asistencial. Un ejemplo de ello es la neumonía asociada a la ventilación mecánica (PAV), que se da en las unidades de cuidados intensivos (UCI). Objetivo: Analizar los determinantes de la PAV en pacientes ingresados en la UCI de un hospital central del norte de Portugal. Metodología: Estudio descriptivo-correlacional y retrospectivo, basado en los registros de 705 pacientes ingresados en la UCI. Resultados: Los factores determinantes de la PAV fueron el sexo masculino, el tratamiento antibiótico previo, la reintubación endotraqueal, el nivel de consciencia, la presión del manguito, el tiempo de ventilación, el diagnóstico de entrada de lesiones, la intoxicación y algunas otras consecuencias de causas externas. La incidencia de PAV fue del 4,5%. Conclusión: El uso prudente de antibióticos, el menor tiempo posible de ventilación invasiva, la aplicación de protocolos de destete del ventilador y las auditorías de cumplimiento del paquete de PAV pueden contribuir a mejorar los cuidados y a que las intervenciones de enfermería sean más eficaces y seguras.

Abstract The aim of this study was to describe some characteristics of pulmonary function in four para-swimmers with spinal cord injury from Cali-Colombia. Four paraswimmers with spinal cord injury of any neurological level who signed the informed consent form were included. Sociodemographic, clinical, athletic, anthropometric, functional independence and, pulmonary function by spirometry and thoracic mobility by cirtometry data were collected. The results show four patients between 26 and 42 years old, with neurological levels between T2-T4 and T10-T11. None of the cases had a history of respiratory diseases before or after the injury, two of the cases had a history of smoking. The cases had been practicing the sport for between three and twelve months, all with normal weight according to BMI; with mild dependence according to the Barthel Index. In addition, they presented FEV1/FVC values between 83 % and 93 % of predicted value. The best thoracic mobility was between 1.5 and 5.6 cm at the axillary level, and between 1.5 and 2.5 cm at the xiphoid level. It is concluded that the subjects had no changes in pulmonary function, that the athletes with a history of smoking and a higher level of injury presented a decrease in thoracic mobility, and that training in water can provide benefits at the pulmonary level.

Resumen El objetivo del presente trabajo fue describir algunas características de la función pulmonar de cuatro paranadores con lesión medular de Cali-Colombia. Se incluyeron cuatro deportistas de iniciación deportiva de para-natación con lesión medular de cualquier nivel neurológico, quienes firmaron el consentimiento informado. Se tomaron datos sociodemográficos, clínicos, deportivos, antropométricos, independencia funcional y función pulmonar mediante espirometría y movilidad torácica mediante la cirtometría. Los resultados evidencian cuatro paranadores entre 26 y 42 años, con niveles neurológicos entre T2-T4 y T10-T11. Ninguno de los casos presentó enfermedades respiratorias pre y post lesión, dos de los casos presentaron historial tabáquico. Los casos llevaban entre tres y doce meses practicando el deporte, todos con normopeso según IMC; con dependencia leve según Índice de Barthel. Además, presentaron valores entre 83 % y 93 % del valor predicho en la relación VEF1/CVF. La mejor toma de la movilidad torácica a nivel axilar estuvo entre 1,5 y 5,6 cm y a nivel xifoideo entre 1,5 y 2,5 cm. Se concluye que los sujetos no tuvieron alteraciones en la función pulmonar, que los deportistas con historial tabáquico y nivel de lesión más alto presentaron disminución en la movilidad torácica, el entrenamiento en agua puede otorgar beneficios a nivel pulmonar.

BACKGROUND. Interpersonal violence is a major cause of morbidity and mortality in low- and upper-middle-income countries. It is postulated that a significant portion of these patients have repeated presentations to an already overburdened healthcare system. Data describing the burden of interpersonal violence recidivism are poor. OBJECTIVE. To determine and describe the burden of emergency centre recidivism for interpersonal violent injury presenting to Khayelitsha Hospital, Cape Town, over a 2-year period. METHODS. An analysis of a prospectively collected observational database combined with a retrospective chart review was conducted of all trauma patients who presented to Khayelitsha Hospital from 1 October 2020 to 30 September 2022. All patients (aged >14 years) with >2 presentations for interpersonal violence-related injuries were included. Cases were limited to the inclusion of mechanisms of injury attributable to stab wounds, blunt assault, firearm injury and gender-based violence. Recidivist cases were identified by repeat hospital number on the electronic hospital patient system. Repeat cases were manually reviewed for inclusion. Summary statistics are used to describe all variables. RESULTS. In total, 10 218 interpersonal violence presentations were identified over the study period, and 1 125 (11.0%) were attributed to recidivists (522 patients). The mean (standard deviation) age was 30 (7.7) years, and most were male (n=463, 88.7%). Stab wounds (n=583, 51.8%) and blunt assault injuries (n=456, 40.5%) were the main mechanisms of injury. Repeat presentation occurred within a median of 198 (25th - 75th percentile, 81.5 - 373.9) days. A total of 337 (64.6%) patients presented with higher acuity at one of their subsequent visits. CONCLUSION. Recidivist presentations represent a significant proportion of interpersonally violently injured patients, and are likely to be under-documented. Recidivism poses a measurable burden, and further research is needed to facilitate the identification of at-risk individuals, and specific secondary prevention strategies should be developed to prevent or reduce escalating patterns of injury associated with interpersonal violence.

BACKGROUND. Golf club-related traumatic brain injuries are an uncommon occurrence in adults, and the use of golf clubs as a weapon of interpersonal assault resulting in compound skull fractures is rare. OBJECTIVE. To present a case series of golf club-related compound skull fractures in adults secondary to assault, representing the largest study of this entity to date. METHODS. A retrospective analysis was performed of a prospectively maintained database for patients admitted to Tygerberg Academic Hospital in Cape Town, South Africa, with golf club-related compound skull fractures between 1 January 2018 and 31 December 2021. Data on demographic details, computed tomography brain image findings, presenting Glasgow Coma Scale, surgical operative notes, septic complications and outcomes at discharge were collected. RESULTS. A total of 21 patients were included. The majority were male (95.2%) and the mean age was 32.6 years. Fractures were most commonly seen in the frontal bone (n=9), followed by parietal (n=8), temporal (n=3) and occipital (n=1) bones. Depressed skull fractures were the most common type of injury, and local pneumocephalus was present in the majority of patients. The mean presenting Glasgow Coma Scale was 14, and most patients had no focal neurological deficits. Surgical debridement was required in the majority of patients, with a high rate of septic complications (33.3%). However, most patients had good neurological outcomes at discharge, and the mean length of stay was 11.9 days. CONCLUSION. This study highlights the potential dangers of golf clubs as a weapon of interpersonal assault, and the need for prompt and appropriate management of compound skull fractures to reduce the risk of complications.

SUMMARY: The aim of this study was to examine the potential preventive properties of white tea extract, a potent antioxidant, against cisplatin-induced damage to the cerebral cortex. Thirty-six male Sprague Dawley rats were distributed into healthy control, sham, (only White tea), cisplatin, and cisplatin+White tea groups. After white tea alone was administered per oral at a rate of 1.5 % for twelve days in experimental group rats only a single dose of 7 mg / kg cisplatin (CIS) was be administered intraperitoneally. We observed that oedematous areas in degenerative neurons in the cisplatin administration group. However, we monitored that degenerative neurons and oedematous were decreased in the white tea treatment group compared to the cisplatin group. In addition, we found increased in MDA and Caspase-3 levels in the Cisplatin application group compared to the control group (p<0.05). On the contrary, we found decreased in GSH levels in the Cisplatin application group compared to the control group (p<0.05). On the other hand, we found decreased in MDA, Caspase-3 levels and increased GSH levels in the Cisplatin application group compared to the control group (p<0.05). White tea has shown therapeutic effects on cisplatin-induced cerebral cortex injury via decreased oxidative stress and Caspase-3 expression.

RESUMEN: El objetivo de esta investigación fue estudiar las posibles propiedades preventivas del extracto de té blanco, un potente antioxidante, contra el daño a la corteza cerebral inducido por el cisplatino. Treinta y seis ratas macho Sprague Dawley se distribuyeron en grupos control sano, simulado (solo té blanco), cisplatino y cisplatino + té blanco. Después de que se administró el té blanco solo por vía oral a una tasa del 1,5 % durante doce días, en ratas del grupo experimental solo se administraró una dosis única de 7 mg/kg de cisplatino (CIS) por vía intraperitoneal. Observamos áreas edematosas en neuronas degenerativas en el grupo de administración de cisplatino. Sin embargo, observamos que las neuronas degenerativas y edematosas disminuyeran en el grupo con tratamiento con té blanco en comparación con el grupo de cisplatino. Además, se observó un aumento en los niveles de MDA y Caspasa-3 en el grupo de aplicación de cisplatino en comparación con el grupo control (p<0,05). Por el contrario, encontramos una disminución en los niveles de GSH en el grupo con aplicación de cisplatino en comparación con el grupo control (p<0,05). Por otro lado, encontramos una disminución en los niveles de MDA, Caspasa-3 y un aumento de los niveles de GSH en el grupo con aplicación de cisplatino en comparación con el grupo control (p<0,05). El té blanco ha demostrado efectos terapéuticos sobre la lesión de la corteza cerebral inducida por cisplatino mediante la disminución del estrés oxidativo y la expresión de caspasa-3.

SUMMARY OBJECTIVE: Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. METHODS: A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. RESULTS: There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). CONCLUSION: Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department. OBJECTIVE dehydration Therefore department However before fallrelated fall related METHODS 6 scale RESULTS p=0.342. p0342 p p=0.342 . 0 342 (p=0.342) p=0.002. p0002 p=0.002 002 (p=0.002) CONCLUSION p034 p=0.34 34 (p=0.342 p000 p=0.00 00 (p=0.002 p03 p=0.3 3 (p=0.34 p00 p=0.0 (p=0.00 p0 p=0. (p=0.3 (p=0.0 p=0 (p=0. p= (p=0 (p= (p

SUMMARY OBJECTIVE: February 2023 saw major earthquakes in Pazarcık and Elbistan, causing significant devastation in Turkey. Patients were transferred to hospitals in neighboring provinces, with multiple traumas—especially fractures and organ injuries—forming the main reasons for hospital admissions. This study aimed to examine earthquake-related injuries in pediatric and adult populations to understand differences. METHODS: This study analyzed 1,220 adults and 590 pediatric patients with radiological imaging out of 8,704 earthquake trauma cases. Radiological images were assessed independently by two radiologists. Statistical analysis using SPSS examined relationships between variables such as age group and injury type. RESULTS: Results showed 40% of adults and 64% of children had normal radiological findings. Cerebral and extremity traumas were most common in pediatrics, while adults showed more extremity, thoracic, and spinal traumas. Significant differences between adult and pediatric groups were observed in cranial fractures, thoracic and lumbar vertebral fractures, hemopneumothorax, lung contusions, rib fractures, femur and talocalcaneal fractures, and compartment syndrome (p<0.001). CONCLUSION: Earthquake-related injuries may vary between children and adults. Due to children's more flexible anatomical structure, it is believed that earthquake-related injuries occur less frequently in children. In this study, head traumas were more common in children compared to adults. The rate of cranial fractures was significantly higher in children, with a higher incidence of epidural hematoma compared to adults. Spinal traumas were more frequent in adults than in children, attributed to children's greater flexibility reducing the risk of entrapment under rubble. Pediatric thoracic compliance being significantly higher than in adults often resulted in milder chest traumas. However, compartment syndrome was more common in children, with a lower rate of accompanying bone fractures compared to adults. No significant difference was observed between children and adults in maxillofacial, abdominal, and pelvic traumas. These findings provide insights for future disaster healthcare planning and management. OBJECTIVE 202 Elbistan Turkey provinces traumasespecially especially injuriesforming forming admissions earthquakerelated related METHODS 1220 1 220 1,22 59 8704 8 704 8,70 cases radiologists type RESULTS 40 64 pediatrics hemopneumothorax contusions p<0.001. p0001 p p<0.001 . 0 001 (p<0.001) CONCLUSION Earthquakerelated Earthquake childrens s structure rubble However maxillofacial abdominal management 20 122 22 1,2 5 870 70 8,7 4 6 p000 p<0.00 00 (p<0.001 2 12 1, 87 7 8, p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

Abstract Renal involvement is one of the most severe morbidities of Fabry disease (FD), a multisystemic lysosomal storage disease with an X-linked inheritance pattern. It results from pathogenic variants in the GLA gene (Xq22.2), which encodes the production of alpha-galactosidase A (α-Gal), responsible for glycosphingolipid metabolism. Insufficient activity of this lysosomal enzyme generates deposits of unprocessed intermediate substrates, especially globotriaosylceramide (Gb3) and derivatives, triggering cellular injury and subsequently, multiple organ dysfunction, including chronic nephropathy. Kidney injury in FD is classically attributed to Gb3 deposits in renal cells, with podocytes being the main target of the pathological process, in which structural and functional alterations are established early and severely. This configures a typical hereditary metabolic podocytopathy, whose clinical manifestations are proteinuria and progressive renal failure. Although late clinical outcomes and morphological changes are well established in this nephropathy, the molecular mechanisms that trigger and accelerate podocyte injury have not yet been fully elucidated. Podocytes are highly specialized and differentiated cells that cover the outer surface of glomerular capillaries, playing a crucial role in preserving the structure and function of the glomerular filtration barrier. They are frequent targets of injury in many nephropathies. Furthermore, dysfunction and depletion of glomerular podocytes are essential events implicated in the pathogenesis of chronic kidney disease progression. We will review the biology of podocytes and their crucial role in regulating the glomerular filtration barrier, analyzing the main pathogenic pathways involved in podocyte injury, especially related to FD nephropathy. FD, , (FD) Xlinked X linked pattern Xq22.2, Xq222 Xq Xq22.2 Xq22 2 (Xq22.2) alphagalactosidase alpha galactosidase αGal, αGal α Gal (α-Gal) metabolism substrates Gb (Gb3 derivatives subsequently nephropathy process severely podocytopathy failure elucidated capillaries barrier nephropathies Furthermore progression (FD Xq22. Xq2 (Xq22.2 (α-Gal (Gb (Xq22. (Xq22 (Xq2 (Xq

Resumo O acometimento renal é uma das mais severas morbidades da doença de Fabry (DF), enfermidade multissistêmica de depósito lisossômico com padrão de herança ligada ao cromossomo X, decorrente de variantes patogênicas do gene GLA (Xq22.2), que codifica a produção de alfa-galactosidase A (α-Gal), responsável pelo metabolismo de glicoesfingolipídeos. A atividade insuficiente dessa enzima lisossômica gera depósitos de substratos intermediários não processados, especialmente do globotriaosilceramida (Gb3) e derivados, desencadeando injúria celular e, posteriormente, disfunção de múltiplos órgãos, incluindo a nefropatia crônica. A lesão renal na DF é classicamente atribuída aos depósitos de Gb3 nas células renais, sendo os podócitos o alvo principal do processo patológico, nos quais as alterações estruturais e funcionais são instaladas de forma precoce e severa, configurando uma podocitopatia metabólica hereditária típica, cujas manifestações clínicas são proteinúria e falência renal progressiva. Embora os desfechos clínicos tardios e as alterações morfológicas estejam bem estabelecidos nessa nefropatia, os mecanismos moleculares que deflagram e aceleram a injúria podocitária ainda não estão completamente elucidados. Podócitos são células altamente especializadas e diferenciadas que revestem a superfície externa dos capilares glomerulares, desempenhando papel essencial na preservação da estrutura e função da barreira de filtração glomerular, sendo alvos frequentes de injúria em muitas nefropatias. A disfunção e depleção dos podócitos glomerulares são, além disso, eventos cruciais implicados na patogênese da progressão da doença renal crônica. Revisaremos a biologia dos podócitos e seu papel na regulação da barreira de filtração glomerular, analisando as principais vias patogênicas envolvidas na lesão podocitária, especialmente relacionadas à nefropatia da DF. DF, , (DF) X Xq22.2, Xq222 Xq Xq22.2 Xq22 2 (Xq22.2) alfagalactosidase alfa galactosidase αGal, αGal α Gal (α-Gal) glicoesfingolipídeos processados Gb (Gb3 derivados posteriormente órgãos crônica renais patológico severa típica progressiva elucidados glomerular nefropatias disso (DF Xq22. Xq2 (Xq22.2 (α-Gal (Gb (Xq22. (Xq22 (Xq2 (Xq