Abstract Monkey mortality in Costa Rica is due, in most cases, to anthropogenic factors, such as deforestation, forest fragmentation, lack of tree connectivity, and tourism development in most coastal areas. The latter factor has caused the death of at least 450 monkeys per year due to electrocution, as a result of the increase in electrical wiring that has arisen in the different regions with urban development. Faced with this threat, proposals have been developed to avoid the danger, such as the construction of appropriate passage infrastructure for monkeys, the placement of insulated wiring, and the protection of electrical transformers. Using the morphometric measurements of the four species of monkeys native to Costa Rica (Alouatta palliata, Ateles geoffroyi, Saimiri oerstedii, and Cebus imitator), a model of safe and functional aerial passages or bridges for them was designed, the foundations of which are discussed in this article.

Resumen La mortalidad de los monos en Costa Rica se debe, en la mayoría de los casos, a factores antropogénicos, como la deforestación, la fragmentación de los bosques, la falta de conectividad arbórea y el desarrollo turístico en la mayoría de las zonas costeras. Este último factor ha provocado la muerte de al menos 450 monos por año debido a la electrocución, a raíz del aumento del cableado eléctrico que ha surgido en las diferentes regiones con desarrollo urbanístico. Ante esta amenaza se han elaborado propuestas para evitar el peligro, como la construcción de infraestructura de paso apropiada para los monos, la colocación de cableado aislado y la protección de los transformadores eléctricos. Utilizando las medidas morfométricas de las cuatro especies de monos nativas de Costa Rica (Alouatta palliata, Ateles geoffroyi, Saimiri oerstedii y Cebus imitator), se diseñó un modelo de pasos aéreos o puentes seguros y funcionales para ellos, cuyos fundamentos se discuten en el presente artículo.

ABSTRACT Purpose: Although Brazil has a high prevalence of retinoblastoma, there is a lack of epidemiological data on the disease. Thus, in this study, we aimed to evaluate the epidemiological profile of patients diagnosed with retinoblastoma in the ophthalmology department of a pediatric tertiary referral hospital in Ceara, Brazil. Methods: A descriptive and cross-sectional study was conducted by retrospectively analyzing the clinical and socioeconomic data from the medical records of pediatric patients followed-up at the hospital between 2007 and 2021. Retinoblastoma was diagnosed on the basis of a fundoscopic or histopathologic examination. Results: The data of 105 patients were included in the study, and the mean patient age at the time of diagnosis was 1.7 years. Most of the patients were women (50.5%) and hailed from rural areas (57.4%), which was associated with a higher tumor stage. Of the 150 patients, 57.1% initially presented with leukocoria. Ocular hyperemia was associated with more advanced stages of retinoblastoma (p=0.004). Bilateral involvement was observed in 25.7% of the patients and at a significantly younger age (p=0.009). The presence of retinal detachment, vascularized lesions, and vitreous seeds significantly increased the likelihood of requiring enucleation. Discussion: This study presents an epidemiological description of retinoblastoma in Brazil, which highlights the significance of early detection. Delayed diagnosis is associated with a poorer visual prognosis and higher mortality rate, particularly in patients with unilateral disease. Risk factors for a more severe disease were retinal detachment, vascularized lesions, and vitreous seeds. The correlation between histopathological features and clinical outcomes was limited. Conclusion: Further studies are required to assess the influence of ocular hyperemia, fundoscopic assessment, and histopathologic findings on the prognosis of retinoblastoma. Moreover, it is critical to devise interventions to reduce the time-to-diagnosis in rural areas. Purpose Thus Ceara Methods crosssectional cross sectional followedup followed up 200 2021 examination Results 10 17 1 7 1. years 50.5% 505 50 5 (50.5% 57.4%, 574 57.4% , 57 4 (57.4%) stage 15 571 57.1 leukocoria p=0.004. p0004 p p=0.004 . 0 004 (p=0.004) 257 25 25.7 p=0.009. p0009 p=0.009 009 (p=0.009) detachment lesions enucleation Discussion detection rate limited Conclusion assessment Moreover timetodiagnosis 20 202 50.5 (50.5 57.4 (57.4% 57. p000 p=0.00 00 (p=0.004 2 25. (p=0.009 50. (50. (57.4 p00 p=0.0 (p=0.00 (50 (57. p0 p=0. (p=0.0 (5 (57 p=0 (p=0. ( p= (p=0 (p= (p

The essential oil extracted from Anemia tomentosa (EOAT) has shown larvicidal potential against Aedes aegypti, based on methods in vitro and in silico. Chromatographic and spectrometric techniques (gas chromatography-mass spectrometry (CG-MS), gas chromatography-flame ionization detector (GC-FID)), as well as mono and bidimensional nuclear magnetic resonance spectroscopy (NMR) were used to assess 10 essential oil components. Chemical composition of essential oil comprised 87.51% sesquiterpenes, with emphasis on presilphiperfolan-1-ol (42.13%) and silphiperfol-5-ene (19.47%). Larvicidal assay conducted in vitro with EOAT has evidenced potential cytotoxic activity up to 48 h exposure to it; mortality rate observed for A. aegypti larvae exposed to essential oil reached 100%. Study conducted in silico with chemical compounds deriving from the herein investigated plant species has evidenced its potential to inhibit acetylcholinesterase in A. aegypti. Activity of triquinane sesquiterpenes ranging from -6.8 to -8.2 kcal mol-1 stood out in comparison to that of temephos (-7.5 kcal mol-1). Chemical compounds identified in the investigated essential oil presented low human and environmental toxicity, as observed in absorption, distribution, metabolism and excretion, and toxicity (ADMETox) predictions. (EOAT chromatographymass chromatography mass CGMS, CGMS CG MS , (CG-MS) chromatographyflame flame GCFID, GCFID GC FID (GC-FID)) NMR (NMR 1 components 8751 87 51 87.51 presilphiperfolan1ol presilphiperfolanol presilphiperfolan ol 42.13% 4213 42 13 (42.13% silphiperfol5ene silphiperfolene silphiperfol 5 ene 19.47%. 1947 19.47% . 19 47 (19.47%) 4 it A 100 100% 6.8 68 6 8 -6. 8.2 82 2 -8. mol1 mol mol- 7.5 75 7 (-7. mol1. mol-1) absorption distribution excretion ADMETox (ADMETox predictions (CG-MS (GC-FID) 875 87.5 42.13 421 (42.13 194 19.47 (19.47% 6. -6 8. -8 7. (-7 (GC-FID 87. 42.1 (42.1 19.4 (19.47 - (- 42. (42. 19. (19.4 ( (42 (19. (4 (19 (1

Abstract Introduction: The limited availability of data in Chile on the use of diagnostic images (DI) poses a challenge in the efficient management of resources. Objective: To quantify and characterize the use of DI in hospitalized subjects in Chile for 1 year. Method: Descriptive population based study on the use of DI in Chile during 2019 in hospitalized subjects using an official national database recorded with the diagnosis-related groups (DRG) system. Demographic variables related to hospitalization and derived from the DRG were analyzed. Results: 55.5% of hospital events involved at least one DI (n = 466,306). The most used imaging technique was radiography/X-ray (36.4%), followed by computed tomography (35%). The Magallanes and Aysén regions exhibited the highest DI rates. Hospitalized patients who required some DI had an average of days of hospitalization and mortality rate that were 3.4 and 5.5 times greater than those who did not require DI (p < 0.01). Conclusions: There are important geographical differences in the use of DI in Chile. Our description will facilitate future studies that delve deeper and explore access or socioeconomic differences.

Resumen Introducción: La escasa disponibilidad de datos en Chile sobre el uso de imágenes diagnósticas (ID) plantea un desafío en la gestión eficiente de recursos. Objetivo: Cuantificar y caracterizar el uso de ID en sujetos hospitalizados en Chile durante 1 año. Método: Estudio poblacional descriptivo sobre el uso de ID en Chile durante el año 2019 en sujetos hospitalizados utilizando una base de datos nacional oficial consignada con la herramienta de grupos relacionados a diagnósticos (GRD). Se analizaron variables demográficas, relativas a la hospitalización y derivadas de los GRD. Resultados: El 55,5% de los eventos hospitalarios involucró al menos una ID (n = 466.306). La modalidad de imagen más utilizada fue la radiografía (36,4%), seguida por la tomografía computada (35%). Las regiones de Magallanes y Aysén exhibieron las tasas de ID más altas. Los pacientes hospitalizados que requirieron alguna ID obtuvieron unos promedios de días de hospitalización y letalidad 3,4 y 5,5 veces mayores que los que no requirieron ID (p < 0,01). Conclusiones: Existen importantes diferencias geográficas en la utilización de ID en Chile. Nuestra descripción facilitará la realización de futuros estudios que profundicen y exploren las diferencias en el acceso o socioeconómicas.

Abstract This review article emphasizes the importance of specific evaluation and management for adenocarcinoma-type colorectal cancer (CRC), a disease prone to local recurrence and systemic metastasis. It highlights the need for a distinctive approach compared to colon cancer. Improved local staging, facilitated by the use of magnetic resonance imaging (MRI), as well as more precise and effective treatments, have achieved a significant reduction in the mortality rate in adults over 50 years of age over the last few decades. MRI plays a vital role in the evaluation before and after treatment, being essential for the multidisciplinary team to personalize the most appropriate treatment option, thus highlighting the central importance of the radiologist. In primary staging, MRI allows evaluating tumor height in the rectum, T and N categories, detecting prognostic elements such as extramural vascular invasion and mucinous differentiation, and evaluating the involvement of the sphincter apparatus and other local organs and structures. During restaging, MRI evaluation has demonstrated significant prognostic value and is effective in selecting patients for an active follow-up strategy (watch and wait).

Resumen Este artículo de revisión resalta la importancia de realizar una evaluación y manejo específicos para el cáncer de recto de tipo adenocarcinoma (CRC), una enfermedad que tiende a la recurrencia local y la metástasis sistémica. Se destaca la necesidad de un enfoque distintivo en comparación con el cáncer de colon. Una mejor estadificación local, facilitada por el uso de resonancia magnética (RM), así como tratamientos más precisos y eficaces, han logrado una disminución significativa en la tasa de mortalidad en adultos mayores de 50 años a lo largo de las últimas décadas. La RM desempeña un papel esencial en la evaluación antes y después del tratamiento, siendo fundamental para que el equipo multidisciplinario pueda personalizar la opción de tratamiento más adecuada, resaltando así la importancia central del radiólogo. En la etapificación primaria, la RM permite evaluar la altura tumoral en el recto, categoría T y N, detectar elementos pronósticos como invasión vascular extramural y diferenciación mucinosa, y evaluar el compromiso del aparato esfinteriano y de otros órganos y estructuras locales. Durante la reetapificación, la evaluación mediante RM ha demostrado gran valor pronóstico y ser eficaz en la selección de pacientes para estrategia de seguimiento activo (watch and wait).

ABSTRACT Introduction: meningitis is a medical emergency which requires timely diagnosis and treatment to avoid complications. Objective: determine the clinical and epidemiological characteristics of meningitis in patients hospitalized at the Centro Médico Nacional. Materials and methods: Cross-sectional study that evaluated patients over 18 years of age with complete records; epidemiological, clinical, paraclinical and therapeutic characteristics were collected. Differences in patient characteristics were explored according to age group. Results: of the 70 patients, 74 % were male; 72.88 had microbiological isolation and without microbiological isolation (27 %), the most frequently isolated germ was S. pneumoniae. The antibiotic treatment of choice was combined therapy with ceftriaxone plus vancomycin (39 %) with a mortality of 37 %. Conclusions: bacterial meningitis was the most frequent (50 %) followed by fungal and lastly viral, combined therapy proved to be the most useful.

RESUMEN Introducción: la meningitis es una emergencia médica la cual requiere un diagnóstico y tratamiento oportunos para evitar complicaciones. Objetivo: determinar las características epidemiológicas y clínicas de la meningitis en los pacientes hospitalizados en el Centro Médico Nacional en el periodo 2021-2023. Metodología: estudio observacional descriptivo transversal de pacientes mayores de 18 años con fichas completas, se recolectaron características epidemiológicas, clínicas, paraclínicas y terapéuticas. Se compararon las características según grupos etarios Resultados: de los 70 pacientes reclutados el 74 % eran del sexo masculino; EL 73 % presentaron aislamiento microbiológico y sin aislamiento microbiológico (27 %) el germen más frecuentemente aislado fue el S. pneumoniae. El tratamiento antibiótico de elección fue la terapia combinada con ceftriaxona más vancomicina (39 %). Con una mortalidad del 37 %. Conclusiones: la meningitis bacteriana fue la más frecuente (50 %) seguida por las micóticas y por último lugar las virales. En cuanto a las manifestaciones clínicas podemos concluir que el síntoma más frecuentemente hallada fue la cefalea (51 %).

ABSTRACT Introduction: tuberculous meningitis is the most serious form of extrapulmonary tuberculosis, this is due to the high mortality and morbidity in patients, its diagnosis is difficult and the majority of cases can be identified based on clinical criteria and characteristics of the cerebrospinal fluid that the majority Sometimes they are nonspecific. Objective: determine the clinical-epidemiological characteristics in patients with meningeal tuberculosis of patients admitted to the medical clinic area at the National Hospital in the period 2015-2023. Methodology: retrospective descriptive observational cross-sectional study of adult patients with meningeal tuberculosis admitted to the National Hospital in the period 2015-2023. Results: 32 patients between 20 and 80 years old (mean age: 39 years) were included; men 68.75 %, women 32.25 %. Mostly coming from the interior of the country. In most cases, patients presented an increase in proteins in the cerebrospinal fluid and predominantly mononuclear cellularity. The genxpert positivity of Mycobacterium from the cerebrospinal fluid was 62.5 %; in no case was AFB isolated. 37.5 % were seropositive for HIV and 43.75 % had pulmonary disease concomitant to meningitis. Mortality was 31.25 %. Conclusion: tuberculous meningitis in our research mainly affected middle-aged men from the interior, whose initial symptoms are fever in a higher percentage followed by headache, presenting a high mortality.

RESUMEN Introducción: la meningitis tuberculosa es la forma más grave de tuberculosis extrapulmonar, esto se debe a la gran mortalidad y morbilidad en los pacientes, con alta prevalencia en los países en desarrollo, lo que constituye un problema de salud pública. Su diagnóstico es difícil y la mayoría de casos se logran identificar a base de criterios clínicos y características del líquido cefalorraquídeo que la mayoría de veces son inespecíficos. Objetivo: determinar las características clínico-epidemiológicas en pacientes con tuberculosis meníngea de los pacientes internados en área de clínica médica en el Hospital Nacional en el periodo 2015-2023. Metodología: estudio observacional descriptivo de corte transversal de pacientes adultos con tuberculosis meníngea internados en el Centro Médico Nacional en el periodo 2015- 2023. Resultados: se incluyeron 32 pacientes entre 20 y 85 años (edad media: 39 años); varones 68,75 %, mujeres 32,25 %. Mayoría provenientes del interior del país. En la mayoría de los casos los pacientes presentaron un aumento de proteínas en el líquido cefalorraquídeo y celularidad predominio de mononucleares, la positividad de GeneXpert de Mycobacterium del líquido cefalorraquídeo fue 62,5 %, en ningún caso se aisló BAAR. Fueron seropositivos para VIH 37,5 % y tenían afección pulmonar concomitante a la meningitis 43,75 %. La mortalidad fue de 31,25 %. Conclusión: la meningitis tuberculosa en nuestra investigación afectó mayormente a hombres de mediana edad provenientes del interior, cuya clínica inicial es la fiebre en mayor porcentaje seguido de cefalea presentando una alta mortalidad.

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 Ginger (Zingiber officinale Roscoe) waste is a residue from industrial factories that has potential for utilization in the production of bio-extract for pest control. Therefore, this study aimed to investigate the toxicity of fermented ginger waste extract through contact toxicity and oral toxicity methods in controlling the common cutworm (Spodoptera litura Fabricius) and the beet armyworm (Spodoptera exigua Hübner). The experiment was a completely randomized design (CRD) with 10 replicates. Mortality rates were recorded at 48, 72, and 96 h after treatment under laboratory conditions. Fermented ginger waste extract at concentrations of 0%, 5%, 25%, 50%, and 100% (w/v) was used. The results showed that for the contact toxicity method at 100% concentration after 96 h, the common cutworm had the highest mortality rate of 76.00 ± 1.29% (LC50 = 14.450 μg larva-1), while the beet armyworm had the highest mortality rate of 66.00 ± 0.95% (LC50 = 68.426 μg larva-1). For the oral toxicity method, the common cutworm had the highest mortality rate of 52.00 ± 1.70% at 100% concentration after 96 h (LC50 = 91.275 μg larva-1), and the beet armyworm had the highest mortality rate of 58.00 ± 1.02% at 100% concentration after 96 h (LC50 = 88.400 μg larva-1). Therefore, the results of this study demonstrate the efficacy of fermented ginger waste extract in controlling common cutworm and beet armyworm under laboratory conditions, and it has the potential for further application in field conditions.

Resumen: La vasculitis reumatoidea es una complicación sistémica y poco frecuente de la Artritis Reumatoidea. Si bien su incidencia ha descendido en los últimos años con el advenimiento de las nuevas terapias inmunosupresoras y biológicas, continua teniendo una alta morbimortalidad. Predomina en el sexo masculino, en pacientes seropositivos y con un largo período de la enfermedad establecida. Requiere de alta presunción diagnostica, siendo el compromiso cutáneo y nervioso periférico el más frecuente. La biopsia de nervio o piel es requerida habitualmente para su diagnóstico. El tratamiento se basa en corticoides e inmunosupresores. Presentamos tres casos clínicos y realizamos una revisión de la literatura.

Abstract: Rheumatoid vasculitis is a rare systemic complication of rheumatoid arthritis. Although its incidence has decreased in recent years with the advent of new immunosuppressive and biological therapies, it continues to have a high morbidity and mortality. It predominates in males, in seropositive patients and with a long period of established disease. It requires high diagnostic presumption, with skin and peripheral nervous involvement being the most affected. Nerve or skin biopsy is usually required for diagnosis. Treatment is based on corticosteroids and immunosuppressants. We present three clinical cases and carry out a review of the literature.

Resumo: A vasculite reumatóide é uma complicação sistêmica rara da artrite reumatóide. Embora sua incidência tenha diminuído nos últimos anos com o advento de novas terapias imunossupressoras e biológicas, continua apresentando elevada morbidade e mortalidade. Predomina no sexo masculino, em pacientes soropositivos e com longo período de doença estabelecida. Exige alta presunção diagnóstica, sendo o envolvimento cutâneo e nervoso periférico os mais afetados. A biópsia de nervo ou pele geralmente é necessária para o diagnóstico. O tratamento é baseado em corticosteroides e imunossupressores. Apresentamos três casos clínicos e realizamos uma revisão da literatura.

Abstract Introduction: Nursing staffing in adult intensive care has been at a ratio of two patients per nurse or one patient for one nurse. Currently, patients require complex and specialized care that provides safety and reduces Healthcare-Associated Infections. Objective: Evidencing the importance of equipping nursing personnel according to the severity of the patient compared to the nurse-patient ratio in order to reduce Healthcare-Associated Infections in patients in the adult intensive care unit. Methodology: This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted from September 2021 to March 2022. The databases PubMed, ScienceDirect, Epistemonikos and CUIDEN were used, and the following terms were utilized, i.e., nursing personnel, patient severity, nurse-patient ratio, healthcare-associated infections, and the Boolean operators AND, OR, and WITH. The sample consisted of 8 studies that were assessed using the Critical Reading Cards (FLC 3.0) and graded according to the National Institute for Health and Care Excellence. Results: Staffing according to patient severity compared to the nurse-patient indicator reduced healthcare-associated infections, mortality, sepsis occurrence, and medication errors. The impact on patients and nursing personnel showed improved quality of care and reduced burnout and work stress, which benefited the patient. Conclusion: It is important to provide nursing personnel according to the severity of the patient and with personnel having an academic level of at least a bachelor's degree in order to improve the quality of care and reduce healthcare-associated infections.

Abstrato Introdução: A equipe de enfermagem na terapia intensiva de adultos tem estado em uma proporção de dois pacientes para um enfermeiro ou um paciente para um enfermeiro. Atualmente, os pacientes que chegam exigem cuidados complexos e especializados que ofereçam segurança e reduzam as infecções associadas à assistência à saúde. Objetivo: Demonstrar a importância do dimensionamento do pessoal de enfermagem de acordo com a gravidade do paciente em comparação com o indicador enfermeiro-paciente, para reduzir as infecções associadas à assistência à saúde em pacientes adultos internados em unidades de terapia intensiva. Metodologia: Revisão sistemática com base nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, realizada entre setembro de 2021 e março de 2022, mediante os bancos de dados PubMed, ScienceDirect, Epistemonikos e CUIDEN, e usando os seguintes termos: pessoal de enfermagem, gravidade do paciente, relação enfermeiro-paciente, infecções associadas à assistência à saúde, operadores AND, OR, WITH. A amostra consistiu em 8 estudos, avaliados usando os programas Critical Reading Card e classificados de acordo com o Instituto Nacional de Excelência em Saúde e Cuidados. Resultados: O dimensionamento de profissionais de acordo com a gravidade do paciente, em comparação com o indicador enfermeiro-paciente, reduziu as infecções associadas à assistência à saúde, mortalidade, ocorrência de sepse e erros de medicação. O impacto sobre os pacientes e o pessoal de enfermagem mostrou uma melhor qualidade de atendimento, redução do esgotamento e do estresse no trabalho, o que beneficiou o paciente. Conclusão: É importante fornecer pessoal de enfermagem de acordo com a gravidade do paciente e com pessoal com nível acadêmico de, no mínimo, bacharelado, a fim de melhorar a qualidade do atendimento e reduzir as infecções associadas à assistência à saúde.

Resumen Introducción: Dotar al personal de enfermería en la terapia intensiva adultos ha sido en proporción dos pacientes por enfermera o 1:1. Actualmente, los pacientes que ingresan requieren cuidados complejos y especializados que proporcionen seguridad y disminución de infecciones asociadas a la atención en salud. Objetivo: Evidenciar la importancia de dotar al personal de enfermería según gravedad del paciente comparado con indicador enfermera-paciente para disminuir infecciones asociadas a la atención en salud en pacientes de la unidad de terapia intensiva adultos. Metodología: Revisión sistemática, basada en la declaración Preferred Reporting Items for Sistematyc Reviews and Meta-analyses, realizada en septiembre 2021 a marzo 2022, se utilizaron las bases de datos PubMed, ScienceDirect, Epistemonikos y CUIDEN, empleando términos: personal de enfermería, gravedad del paciente, relación enfermero-paciente, infecciones asociadas a la atención a la salud, operadores boléanos AND, OR, WITH. La muestra fue de 8 estudios, evaluados mediante los programas de Fichas de Lectura Crítica y gradados según el National Institute for Health and Care Excellence. Resultados: Dotar de personal según gravedad del paciente comparado con indicador enfermera-paciente disminuyó infecciones asociadas a la atención en salud, mortalidad, aparición de sepsis y errores en la medicación. Las repercusiones en pacientes y personal de enfermería mostraron mejor calidad de la atención, disminución de agotamiento y estrés laboral lo que benefició al paciente. Conclusión: Es importante dotar al personal de enfermería según gravedad del paciente, con personal de nivel académico licenciatura para mejorar la calidad de atención y disminuir las infecciones asociadas a la atención en salud.

Resumo Introdução: A doença renal crônica (DRC) está relacionada à elevada morbimortalidade e perda de qualidade de vida. Igualmente, o hiperparatireoidismo está associado à perda progressiva da função renal, com níveis aumentados de fosfato e diminuição de cálcio, que induzem secreção do paratormônio. Objetivos: Traduzir para língua portuguesa (Brasil), adaptar culturalmente e validar o questionário Parathyroid Symptoms Assessment (PAS), seguindo critérios de confiabilidade e validade em pacientes com DRC e hiperparatireoidismo. Métodos: Estudo metodológico e transversal, realizado no Hospital São Lucas/PUCRS, Porto Alegre, Brasil. O processo de validação do questionário PAS seguiu protocolos de estudos anteriores. Após tradução para o português, aplicou-se a 100 pacientes com hiperparatireoidismo secundário (HPTS) e terciário ou persistente (HPTT). Para dados de validação do PAS, os pacientes responderam ao questionário Short Form Health 36 (SF-36). Critérios de confiabilidade foram avaliados usando coeficiente de correlação intraclasse (CCI) e alfa de Cronbach (α-C). A validade foi avaliada pelo coeficiente de correlação de Spearman entre valores de PAS e SF-36. Resultados: A idade média dos participantes foi 55,6 ± 15,6 anos, 61% eram homens e 68% foram diagnosticados com HPTS. Entre 100 pacientes, 53% realizaram reteste de PAS (CCI = 0,83). A confiabilidade interna por α-C foi 0,86. Observaram-se correlações negativas entre questões do PAS e os domínios físico e mental do SF-36, que variaram de 0,3 a 0,7. Conclusão A versão brasileira do questionário PAS mostrou-se válida e confiável. O questionário PAS pode ser usado para avaliar qualidade de vida em pacientes brasileiros com hiperparatireoidismo que falam português. Introdução (DRC Igualmente cálcio paratormônio Objetivos Brasil, Brasil , (Brasil) (PAS) Métodos transversal LucasPUCRS Lucas PUCRS Lucas/PUCRS Alegre anteriores português aplicouse aplicou se 10 HPTS (HPTS HPTT. HPTT . (HPTT) 3 SF36. SF36 SF (SF-36) CCI αC. αC α C (α-C) 36. SF-36 Resultados 556 55 6 55, 156 15 15, anos 61 68 53 0,83. 083 0,83 0 83 0,83) 086 86 0,86 Observaramse Observaram SF36, 36, 03 0, 07 7 0,7 mostrouse mostrou confiável (Brasil (PAS 1 (HPTT SF3 (SF-36 (α-C SF-3 5 08 0,8 8 (SF-3 SF- (SF- (SF

Abstract Introduction: Chronic kidney disease (CKD) is related to high morbidity and mortality and loss of quality of life. Likewise, hyperparathyroidism is associated to progressive loss of renal function, with increased phosphate and decrease calcium levels, which induce the secretion of parathyroid hormone. Objectives: To translate into Portuguese (Brazil), culturally adapt and validate the questionnaire Parathyroid Symptoms Assessment (PAS), following reliability and validity criteria in patients with chronic kidney disease and hyperparathyroidism. Methods: Methodological and cross-sectional study, carried out at São Lucas Hospital/PUCRS, Porto Alegre, Brazil. The PAS questionnaire validation process followed protocols from previous studies. After translating into Portuguese, it was applied to 100 patients with secondary (SHPT) and tertiary or persistent (THPT) hyperparathyroidism. For PAS validation data, patients responded to the Short Form Health 36 (SF-36) questionnaire. Reliability criteria were evaluated using intraclass correlation coefficient (ICC) and Cronbach’s alpha (α-C). Validity was assessed by Spearman’s correlation coefficient between PAS and SF-36 values. Results: Participant’s mean age was 55.6 ± 15.6 years, 61% was male, and 68% was diagnosed with SHPT. Among 100 patients, 53% performed a PAS retest (ICC = 0.83). The internal reliability by α-C was 0.86. Negative correlations were observed between PAS questions and SF-36 physical and mental domains, which ranged from 0.3 to 0.7. Conclusion: The Brazilian version of the PAS questionnaire was found to be valid and reliable. The PAS questionnaire can be used to evaluate quality of life in Brazilian patients with hyperparathyroidism who speak Portuguese. Introduction CKD (CKD Likewise function levels hormone Objectives Brazil, Brazil , (Brazil) PAS, (PAS) Methods crosssectional cross sectional study HospitalPUCRS Hospital PUCRS Hospital/PUCRS Alegre studies 10 SHPT (SHPT THPT (THPT data 3 SF36 SF (SF-36 ICC Cronbachs Cronbach s αC. αC α C . (α-C) Spearmans Spearman SF-3 values Results Participants Participant 556 55 6 55. 156 15 15. years 61 male 68 53 0.83. 083 0.83 0 83 0.83) 086 86 0.86 domains 03 0. 07 7 0.7 Conclusion reliable (Brazil (PAS 1 SF3 (SF-3 (α-C SF- 5 08 0.8 8 (SF- (SF

Abstract Introduction: The malnutrition-inflammation process is one of the main causes of morbidity and mortality in patients with chronic kidney disease (CKD), influencing quality of life. The aim of this study was to identify the inflammatory and nutritional status of elderly hemodialysis (HD) and its association with quality of life. Methods: This study was carried out in health services in three different cities. The Malnutrition-Inflammation Score (MIS) was used to assess the inflammatory and nutritional status, with anthropometric measurements, protein status, lean mass and function. The quality of life was assessed using KDQOL-SFTM. Data were analyzed using multivariate analysis and the Poisson model to evaluate the factors that increased the risk of developing malnutrition and inflammation. Results: The MIS identified a 52.2% prevalence of malnutrition and inflammation in the population. In univariate analysis, most KDQOL-SFTM domains presented higher scores for nourished elderly. Anthropometric measures associated with muscle mass and functionality were lower in the malnourished elderly. Multivariate modeling revealed a higher nutritional risk of 50.6% for women and older age, since with each additional year of life the risk of malnutrition increased by 2.4% and by 0.4% with each additional month on HD. Greater arm muscle circumference (AMC) and higher serum albumin were factors for reducing malnutrition by 4.6% and 34.7%, respectively. Conclusion: Higher serum albumin and preserved AMC have been shown to be good indicators of better nutritional status. Higher MIS was associated with poorer quality of life, older age, lower income and education, longer time on dialysis, and presence of comorbidities. Introduction malnutritioninflammation CKD, CKD , (CKD) HD (HD Methods cities MalnutritionInflammation Malnutrition Inflammation (MIS measurements function KDQOLSFTM. KDQOLSFTM KDQOL SFTM. SFTM Results 522 52 2 52.2 population 506 50 6 50.6 age 24 4 2.4 04 0 0.4 (AMC 46 4.6 347 34 7 34.7% respectively Conclusion education dialysis comorbidities (CKD 5 52. 50. 2. 0. 4. 3 34.7 34.

Resumo Introdução: O processo de desnutrição-inflamação é uma das principais causas de morbimortalidade em pacientes com DRC, influenciando a qualidade de vida. O objetivo deste estudo foi identificar o estado inflamatório e nutricional de idosos em hemodiálise (HD) e sua associação com qualidade de vida. Métodos: Estudo realizado em serviços de saúde de três cidades diferentes. O Escore de Desnutrição-Inflamação (MIS, por sua sigla em inglês) foi utilizado para avaliar estado inflamatório e nutricional, com medidas antropométricas, estado proteico, massa magra e funcionalidade. A qualidade de vida foi avaliada com KDQOL-SFTM. Os dados foram analisados utilizando análise multivariada e modelo de Poisson para avaliar fatores que aumentaram o risco de desenvolver desnutrição e inflamação. Resultados: O MIS identificou prevalência de 52,2% de desnutrição e inflamação na população. Na análise univariada, a maioria dos domínios do KDQOL-SFTM apresentou escores maiores para idosos nutridos. Medidas antropométricas associadas à massa muscular e funcionalidade foram menores em idosos desnutridos. A modelagem multivariada revelou maior risco nutricional de 50,6% para mulheres e idosos pois o risco de desnutrição aumentou em 2,4% para cada ano adicional de vida e em 0,4% para cada mês adicional de HD. Maior circunferência muscular do braço (CMB) e maior albumina sérica foram fatores de redução da desnutrição em 4,6% e 34,7%, respectivamente. Conclusão: Demonstrou-se que albumina sérica mais elevada e CMB preservada são bons indicadores de melhor estado nutricional. Maior MIS foi associado a pior qualidade de vida, idade mais avançada, menor renda e escolaridade, maior tempo em diálise e presença de comorbidades. Introdução desnutriçãoinflamação DRC HD (HD Métodos diferentes DesnutriçãoInflamação Desnutrição Inflamação MIS, (MIS inglês proteico KDQOLSFTM. KDQOLSFTM KDQOL SFTM. SFTM Resultados 522 52 2 52,2 população univariada nutridos desnutridos 506 50 6 50,6 24 4 2,4 04 0 0,4 (CMB 46 4,6 347 34 7 34,7% respectivamente Conclusão Demonstrouse Demonstrou se avançada escolaridade comorbidades 5 52, 50, 2, 0, 4, 3 34,7 34,

Abstract Introduction: This study investigated variables associated with mortality in kidney transplant recipients (KTRs) diagnosed with post-transplant lymphoproliferative disease (PTLD) and a simultaneous Epstein-Barr virus (EBV) viremia. Methods: This was a retrospective cohort study enrolling KTRs diagnosed with PTLD between 2018 and 2020. Outcome: death within two years after diagnosis. Results: Among 1,625 KTRs who collected EBV viremia (by PCR, 2018–2020) for any reason, 238 (14.6%) had a positive viral load and 41 (17.2%) simultaneous PTLD. These 41 patients were 40.1 years old at diagnosis and 8.6 years after transplantation; 26.8% were induced with rATG and 92.7% were maintained on tacrolimus and azathioprine (TAC/AZA) as immunosuppressive regimen. Lymph nodes (75.6%) was the most common site of PTLD, followed by the gastrointestinal tract (48.8%), with 61.0% at Lugano stage IV and 80.5% monomorphic PTLD. The mean EBV viral load was 12,198 IU/mL. One- and two-year patient survival post-diagnosis was 60.4% and 46.8%, respectively. In the Cox regression analysis, age at PTLD diagnosis (HR for each year = 1.039; p < 0.001) and EBV viral load (HR for each log = 1.695; p = 0.026) were associated with risk of death. Conclusion: This study suggests that in patients predominantly on TAC/AZA, PTLD with simultaneous EBV positive viral load is a late event, and worse survival is associated with older age and EBV viral load at diagnosis. Introduction (KTRs posttransplant post (PTLD EpsteinBarr Epstein Barr (EBV Methods 201 2020 Outcome Results 1625 1 625 1,62 PCR 2018–2020 20182020 reason 23 14.6% 146 14 6 (14.6% 4 17.2% 172 17 2 (17.2% 401 40 40. 86 8 8. transplantation 268 26 26.8 927 92 7 92.7 TAC/AZA TACAZA TAC AZA (TAC/AZA regimen 75.6% 756 75 (75.6% 48.8%, 488 48.8% , 48 (48.8%) 610 61 0 61.0 805 80 5 80.5 12198 12 198 12,19 IUmL IU mL IU/mL One twoyear postdiagnosis 604 60 60.4 468 46 46.8% respectively analysis HR 1.039 1039 039 0.001 0001 001 1.695 1695 695 0.026 0026 026 Conclusion event 20 202 162 62 1,6 2018–202 2018202 14.6 (14.6 17.2 (17.2 26. 9 92. 75.6 (75.6 48.8 (48.8% 61. 80. 1219 19 12,1 60. 46.8 1.03 103 03 0.00 000 00 1.69 169 69 0.02 002 02 16 1, 2018–20 201820 14. (14. 17. (17. 75. (75. 48. (48.8 121 12, 46. 1.0 10 0.0 1.6 2018–2 20182 (14 (17 (75 (48. 1. 0. 2018– (1 (7 (48 ( (4

Resumo Introdução: Este estudo investigou variáveis associadas à mortalidade em receptores de transplante renal (RTR) diagnosticados com doença linfoproliferativa pós-transplante (PTLD, do inglês post-transplant lymphoproliferative disease) e viremia simultânea pelo vírus Epstein-Barr (EBV). Métodos: Estudo de coorte retrospectivo incluindo RTR diagnosticados com PTLD entre 2018 e 2020. Desfecho: óbito em até dois anos após diagnóstico. Resultados: Entre 1.625 RTR que realizaram coleta de viremia para EBV (por PCR, 2018–2020) por qualquer motivo, 238 (14,6%) apresentaram carga viral positiva e 41 (17,2%) PTLD simultânea. Esses 41 pacientes tinham em média 40,1 anos ao diagnóstico e 8,6 anos após o transplante; 26,8% foram induzidos com rATG e 92,7% foram mantidos com tacrolimus e azatioprina (TAC/AZA) como regime imunossupressor. Linfonodos (75,6%) foram o local mais comum de PTLD, seguidos pelo trato gastrointestinal (48,8%), com 61,0% no estágio IV de Lugano e 80,5% PTLD monomórfica. A carga viral média do EBV foi 12.198 UI/mL. A sobrevida dos pacientes em um e dois anos após o diagnóstico foi 60,4% e 46,8%, respectivamente. Na análise de regressão de Cox, a idade ao diagnóstico de PTLD (HR para cada ano = 1,039; p < 0,001) e a carga viral do EBV (HR para cada log = 1,695; p = 0,026) foram associadas ao risco de óbito. Conclusão: Este estudo sugere que, em pacientes predominantemente em uso de TAC/AZA, a PTLD com carga viral simultânea positiva para EBV é um evento tardio, e a pior sobrevida está associada à idade mais avançada e à carga viral de EBV no momento do diagnóstico. Introdução (RTR póstransplante pós (PTLD posttransplant post transplant disease EpsteinBarr Epstein Barr EBV. . (EBV) Métodos 201 2020 Desfecho Resultados 1625 1 625 1.62 PCR 2018–2020 20182020 motivo 23 14,6% 146 14 6 (14,6% 4 17,2% 172 17 2 (17,2% 401 40 40, 86 8 8, 268 26 26,8 927 92 7 92,7 TAC/AZA TACAZA TAC AZA (TAC/AZA imunossupressor 75,6% 756 75 (75,6% 48,8%, 488 48,8% , 48 (48,8%) 610 61 0 61,0 805 80 5 80,5 monomórfica 12198 12 198 12.19 UImL UI mL UI/mL 604 60 60,4 468 46 46,8% respectivamente Cox HR 1,039 1039 039 0,001 0001 001 1,695 1695 695 0,026 0026 026 Conclusão tardio (EBV 20 202 162 62 1.6 2018–202 2018202 14,6 (14,6 17,2 (17,2 26, 9 92, 75,6 (75,6 48,8 (48,8% 61, 80, 1219 19 12.1 60, 46,8 1,03 103 03 0,00 000 00 1,69 169 69 0,02 002 02 16 1. 2018–20 201820 14, (14, 17, (17, 75, (75, 48, (48,8 121 12. 46, 1,0 10 0,0 1,6 2018–2 20182 (14 (17 (75 (48, 1, 0, 2018– (1 (7 (48 ( (4

Resumen: La fiebre reumática aguda es una enfermedad con baja incidencia en nuestra región. Sus complicaciones conllevan una elevada morbi-mortalidad. El diagnóstico es un desafío en la actualidad, teniendo la clínica un rol preponderante; permitiéndonos mantener una alta sospecha a pesar de su baja incidencia. Se presenta el caso clínico de un paciente sexo masculino cuyo diagnóstico fue un reto para el equipo de salud.

Resumo: A Febre reumática aguda é uma doença com baixa incidência em nossa região. Suas complicações envolvem alta morbidade e mortalidade. Seu diagnóstico é atualmente um desafio, com a apresentação clínica desempenhando um papel predominante, permitindo-nos manter uma alta suspeita diagnóstica apesar de sua baixa incidência. É apresentado o caso clínico de um paciente do sexo masculino, cujo diagnóstico representou um desafio para a equipe de saúde.

Abstract: Acute rheumatic fever is a disease with low incidence in our region. Its complications involve high morbidity and mortality. Its diagnosis is currently a challenge, with clinical presentation playing a predominant role, allowing us to maintain a high diagnostic suspicion despite its low incidence. The clinical case of a male patient is presented, whose diagnosis posed a challenge for the healthcare team.