RESUMEN Introducción: los pacientes con enfermedad renal crónica con requerimiento de terapia sustitutiva renal (hemodiálisis) son frecuentes en el Paraguay, lo que afecta la calidad de vida de los que la padecen. Objetivo: conocer la calidad de vida de los pacientes con enfermedad renal crónica en tratamiento hemodialítico en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional en el período 2022-2023. Metodología: observacional, descriptivo, de corte transversal realizado en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional de Paraguay. Se incluyeron en el estudio 189 pacientes en que acudieron para tratamiento hemodialítico entre los años 2022-2023. La muestra fue censal. Para determinar la calidad de vida se utilizó el cuestionario Kidney Disease Quality of Life - 36 ítems. Los datos fueron analizados con el programa Epiinfo. Resultados: la edad media de los pacientes fue de 53 años, varones 58.2 %. El 98 % refirió la presencia de algún tipo de comorbilidad concomitante, las más frecuentes fueron diabetes Mellitus 43 % e hipertensión arterial 86 %. La media de meses en tratamiento hemodialítico fue de 20 meses. El cuestionario, Kidney Disease Quality of Life - 36 ítems, arrojó puntajes promedios menores a 50 en el componente mental (65.08) y en el componente físico (71.95) así como en la subescala carga de la enfermedad (55.55). Conclusión: la mayoría de los pacientes con enfermedad renal crónica con tratamiento hemodialítico en el Hospital Nacional evidencian una baja calidad de vida.

ABSTRACT Introduction: patients with chronic kidney disease requiring renal replacement therapy (hemodialysis) are common in Paraguay, which affects the quality of life of those who suffer from it. Objective: to know the quality of life of patients with chronic kidney disease undergoing hemodialysis treatment in the Departmento de Nefrología of the Centro Médico Nacional-Hospital Nacional in the period 2022-2023. Methodology: observational, descriptive, cross-sectional carried out in the Nephrology Department of the Centro Médico Nacional-Hospital Nacional of Paraguay. 189 patients who came for hemodialysis treatment between 2022-2023 were included in the study. The sample was census. To determine quality of life, the Kidney Disease Quality of Life questionnaire - 36 items was used. The data were analyzed with the Epi Info program. Results: the average age of the patients was 53 years, 58.2 % men. 98 % reported the presence of some type of concomitant comorbidity, the most frequent being diabetes mellitus 43 % and arterial hypertension 86 %. The average number of months on hemodialysis treatment was 20 months. The questionnaire, Kidney Disease Quality of Life - 36 items, showed average scores less than 50 in the mental component (65.08) and in the physical component (71.95) as well as in the burden of the disease subscale (55.55). Conclusion: the majority of patients with chronic kidney disease with hemodialysis treatment at the National Hospital show a low quality of life.

RESUMEN Introducción: la salud mental es crucial para el bienestar y el rendimiento académico de los estudiantes universitarios. Los estudiantes de Kinesiología y Fisioterapia enfrentan desafíos únicos que pueden afectar su salud mental. Objetivo: determinar la frecuencia de trastornos mentales comunes en estudiantes de kinesiología y fisioterapia de la Universidad Nacional de Asunción. Metodología: se trata de un estudio observacional, descriptivo y transversal. La muestra no probabilística estuvo compuesta por 150 estudiantes de Kinesiología y Fisioterapia de la Universidad Nacional de Asunción. Se recogieron datos sociodemográficos, académicos, ocupacionales, de estilo de vida y psicopatológicos mediante la Escala de Depresión, Ansiedad y Estrés - 21 (DASS-21). El análisis se realizó mediante Jamovi con regresión logística binomial multivariada. Resultados: la frecuencia de depresión, ansiedad y estrés fue del 61,3 %, 72 % y 54,7 %, respectivamente. Los factores importantes para la depresión incluyeron ser un estudiante irregular, trabajar y no realizar actividad física. Para la ansiedad, fueron significativos ser estudiante irregular y ser mujer. Respecto al estrés, se encontraron relevantes ser estudiante irregular, trabajar y no realizar actividad física. Los modelos resultantes tuvieron clasificaciones correctas del 90,2 %, 88 % y 72 % para depresión, ansiedad y estrés, respectivamente. Conclusión: Este estudio reveló una alta frecuencia de depresión, ansiedad y estrés entre estudiantes de kinesiología y fisioterapia, lo que se asoció significativamente con irregularidad académica, empleo y falta de actividad física. Estos hallazgos subrayan la necesidad de implementar estrategias de intervención y programas de apoyo que aborden estos factores de riesgo para promover la salud mental y el bienestar de los futuros profesionales de la salud.

ABSTRACT Introduction: mental health is crucial for university students’ well-being and academic performance. Kinesiology and Physical Therapy students face unique challenges that can affect their mental health. Objective: to determine the frequency of common mental disorders in kinesiology and physical therapy students at the Universidad Nacional de Asunción. Methodology: this was an observational and descriptive cross-sectional study. The nonprobabilistic sample included 150 Kinesiology and Physiotherapy students from the Universidad Nacional de Asunción. Sociodemographic, academic, occupational, lifestyle, and psychopathological data were collected using the Depression, Anxiety and Stress Scale - 21 (DASS-21). The analysis was performed using Jamovi with multivariate binomial logistic regression. Results: the frequency of depression, anxiety, and stress was 61.3 %, 72 %, and 54.7 %, respectively. The significant factors for depression included being an irregular student, working, and not engaging in physical activity. For anxiety, being an irregular student and being a woman were significant. Regarding stress, being an irregular student, working, and not engaging in physical activity were found to be relevant. The resulting models had correct classifications of 90.2 %, 88 %, and 72 % for depression, anxiety, and stress, respectively. Conclusion: this study revealed a high frequency of depression, anxiety, and stress among kinesiology and physical therapy students, which was significantly associated with academic irregularity, employment, and a lack of physical activity. These findings underscore the need to implement intervention strategies and support programs that address these risk factors in order to promote the mental health and well-being of future health professionals.

Acute mesenteric ischemia (AMI) is a rare medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to a sudden interruption of the blood supply to a segment of the intestine, producing ischemia, cell damage, intestinal necrosis and eventually death if it is not treated. The main etiology of this condition is embolic-type arterial occlusion, followed by thrombotic, nonocclusive, and venous thrombotic. It is an infrequent pathology with a low incidence of 12 per 100,000 inhabitants in international series. During the information collection, no data was found on the Chilean population since before 1983. Its main symptom is colicky abdominal pain with a sudden onset, vomiting and diarrhea that begins after the pain. On physical examination, signs of shock and abdominal distention may be noted. Hemodynamically unstable patients should be urgently taken to exploratory laparotomy as soon as the condition is suspected, and in stable patients, an angio-CT should be requested to confirm the diagnosis and plan treatment. There are two methods to treat this pathology, open surgery and endovascular or minimally invasive surgery. The form of therapy depends on the preoperative or intraoperative findings and the type of etiology. Finally, with the advancement of these new methods, the mortality rate has decreased in the last decade.

Resumen La isquemia mesentérica aguda (IMA) es una emergencia médico-quirúrgica poco frecuente con alta morbimortalidad. Corresponde a una interrupción brusca del aporte sanguíneo a un segmento del intestino, produciendo isquemia, daño celular, necrosis intestinal y eventualmente la muerte. La principal etiología de este cuadro es la oclusión arterial de tipo embólica, seguida por la trombótica, no oclusiva y trombótica venosa. Es una patología infrecuente con una incidencia baja, de 12 por 100.000 habitantes en series internacionales. Su principal síntoma es el dolor abdominal tipo cólico de comienzo brusco, vómitos y diarrea, esta última sucediendo posteriormente. En el examen físico se pueden constatar signos de shock y distensión abdominal. Ante la sospecha, los pacientes hemodinámicamente inestables deben ser llevados urgentemente a laparotomía exploradora, y en aquellos estables, se debe solicitar un Angio-TC para confirmar el diagnóstico y planificar el tratamiento. Existen dos métodos para tratar esta patología: la cirugía abierta y la cirugía endovascular o mínimamente invasiva. Finalmente, con el avance de estos nuevos métodos, la tasa de mortalidad ha disminuido, significativamente, en la última década.

Resumo: O Ensino Superior em todo o mundo durante a pandemia da COVID-19 foi obrigado a repensar, atendendo à diretriz estabelecida pela Organização Mundial da Saúde (OMS) para mitigar o impacto na população. A Costa Rica não foi exceção relativamente à situação que se vivia e especificamente na Universidade de Ciências Médicas (UCIMED), que na ausência de um plano de contingência, viveu uma transição do ensino presencial para o virtual. A presente investigação se focou nos desafios vivenciados pelos docentes dos cursos de Fisioterapia e Nutrição, no período de março a junho de 2020, com a virtualização emergencial. As informações foram coletadas pelo meio de pesquisa desenvolvida no Google Forms®. Uma vez tabulado, foi analisado, interpretado e comparado entre carreiras, aplicando estatística descritiva e revisão bibliográfica para compreender a situação mundial. O estudo determinou que a didática do curso representava um grande desafio para o corpo docente; principalmente a avaliação da aprendizagem, a participação dos estudantes, o uso de ferramentas virtuais e problemas de conectividade. Ao comparar as carreiras, identificou-se que pouca formação, menos anos de experiência docente e baixa interação com plataformas virtuais foram fatores que aumentaram a percepção dos desafios. Ao enfrentá-los, enriqueceu-se a experiência docente na gestão das TIC e com ela a transformação do Ensino Superior.

Resumen: La educación superior a nivel mundial durante la pandemia COVID-19 se vio obligada a replantearse, dada la directriz establecida por la Organización Mundial de la Salud (OMS) para mitigar el impacto en la población. Costa Rica no fue la excepción respecto a la circunstancia que se vivía y, específicamente, la Universidad de Ciencias Médicas (UCIMED), ante la ausencia de un plan de contingencia, experimentó una transición de la enseñanza presencial a virtual. Debido a ello, la presente investigación tuvo un enfoque cuantitativo y exploró los desafíos que experimentó el personal docente de las carreras de Fisioterapia y Nutrición, durante el periodo de marzo a junio del 2020, con la virtualización de emergencia. La información se recopiló a través de un cuestionario elaborado en Google Forms®; una vez tabulada, se analizó, interpretó y comparó entre carreras, apli- cando estadística descriptiva y una revisión bibliográfica para comprender la situación a nivel mundial. El estudio determinó que la didáctica del curso representó un alto desafío para el cuerpo docente; principalmente, la evaluación del aprendizaje, la participación del estudiantado, el uso de las herramientas virtuales y los problemas de conectividad. Al comparar las carreras, se identificó que la poca capacitación, la menor cantidad de años de experiencia docente y la baja interacción con plataformas virtuales, fueron factores que aumentaron la percepción de los desafíos. A partir de la confrontación de los desafíos, se enriqueció la experiencia docente en el manejo de las tecnologías de la información y comunicación (TIC) y con ello la transformación de la educación superior.

Abstract: During the COVID-19 pandemic, higher education worldwide was forced to restructure itself according to guidelines established by the World Health Organization (WHO) to mitigate the impact of the pandemic on the population. Costa Rica was no exception. In the absence of a contingency plan, the University of Medical Sciences (UCIMED) underwent a transition from face-to-face to virtual teaching. This study focused on the challenges experienced by physical therapy and nutrition faculty during the period from March to June 2020, due to the emergency virtualization. The information was collected through a Google Forms® survey; once tabulated, the data was analyzed, interpreted and compared between the professions, implementing descriptive statistics and a bibliographic review to better understand the situation at a global level. The study showed that the didactics of the course was a great challenge for the teachers, mainly in terms of learning assessment, student participation, use of virtual tools and connectivity problems. When comparing professions, it was found that limited training, fewer years of teaching experience, and less interaction with virtual platforms were factors that increased the perception of challenges. Confronting the challenges enriched the teaching experience in terms of ICT management and thus the transformation of higher education.

Abstract A 23-year-old male patient who sought emergency care with odynophagia, total dysphagia, and 7 days of fever, treated with oral amoxicillin and clavulanic acid without improvement. The physical examination and CT scan showed tonsillitis with multiple tonsilar abscesses. Due to total dysphagia even after intravenous analgesia, hospitalization was decided for supportive fluid therapy and analgesia. During hospitalization, vesiculopustular skin lesions appeared on the upper and lower limbs and trunk. PCR and culture of the pustule and oropharyngeal exudates, and pustule skin biopsy came positive for Monkeypox virus (MPXV). He remained in isolation measures and was discharged after tolerating oral diet.

Resumo Um doente do sexo masculino, com 23 anos, recorreu ao serviço de urgência com um quaro de 7 dias de evolução de odinofagia, disfagia total e febre, sem melhoria com tratamento com amoxicilina e ácido clavulânico por via oral. O exame físico e a tomografia computadorizada revelaram amigdalite com múltiplos abscessos intra-amigdalinos. Pela disfagia total mesmo após analgesia intravenosa, optou-se por internamento para tratamento de suporte. Durante a hospitalização, surgiram lesões cutâneas vesiculopustulosas nos membros superiores e inferiores e tronco. Foram realizados testes de PCR e cultura dos exsudados das pústulas e orofaringe e biópsia da pele da pústula que foram positivos para MPXV. Manteve medidas de isolamento e teve alta após tolerar dieta oral.

Abstract Objective To investigate whether patients undergoing anatomic total shoulder arthroplasty (ATSA) between January and March 2020 experienced different postoperative outcomes than patients in 2019. We hypothesized that patients in 2020 would have less access to physical therapy (PT) and experience different postoperative outcomes. Methods Records from patients who received ATSA between January 1st, 2019, and March 17th, 2019, and January 1st, 2020, to March 17th, 2020, were analyzed. Patient data, including demographic information, range of motion (ROM), strength, and PT was collected and compared between the two groups. The 2020 patients were contacted by phone during October 2022 and patient-reported metrics were gathered. Results The present study identified 24 patients in 2019 and 27 patients in 2020 who underwent ATSA during the specified time frame and had a minimum 1-year follow-up. Patients in 2019 experienced improvements in forward elevation (FE) ROM (125.4° to 146.7°; p = 0.008), external rotation (ER; 33.0° to 47.7°; p < 0.001), and internal rotation (IR; S1 to L4; p = 0.019). Patients in 2020 also experienced significant improvements in FE (120.2° to 141.1°; p = 0.009), ER (32.9° to 42.0°; p = 0.037), and IR (S1 to L3; p = 0.002). Patients in 2020 terminated PT earlier (2019: 125.8 days; 2020: 91.1 days; p = 0.046) and completed fewer sessions (2019: 21.4 sessions; 2020: 13.1 sessions; p = 0.003). At the final follow-up, patients in 2020 reported an average Visual Analogue Scale (VAS) pain score of 1.67 ± 1.1. Conclusion Despite decreased PT, patients who underwent ATSA in 2020 had significant improvements in ROM and strength and were comparable to patients in 2019. (ATSA 202 (PT 1st st 17th th analyzed data information ROM, , (ROM) groups patientreported patient gathered 2 201 1year year 1 followup. followup follow up. up follow-up (FE 125.4° 1254 125 4 (125.4 146.7° 1467 146 7 0.008, 0008 0.008 0 008 0.008) (ER 330 33 33.0 47.7° 477 47 0.001, 0001 0.001 001 0.001) (IR S L4 L 0.019. 0019 0.019 . 019 0.019) 120.2° 1202 120 (120.2 141.1° 1411 141 0.009, 0009 0.009 009 0.009) 32.9° 329 32 9 (32.9 42.0° 420 42 0.037, 0037 0.037 037 0.037) (S L3 0.002. 0002 0.002 002 0.002) (2019 1258 8 125. days 911 91 91. 0.046 0046 046 214 21 21. 131 13 13. 0.003. 0003 0.003 003 0.003) followup, up, VAS (VAS 167 67 1.6 11 1.1 20 (ROM 125.4 12 (125. 146.7 14 000 0.00 00 3 33. 47.7 0.01 01 120.2 (120. 141.1 32.9 (32. 42.0 0.03 03 (201 0.04 004 04 16 6 1. (125 146. 0.0 47. 120. (120 141. 32. (32 42. (20 (12 0. (3 (2 (1 (

Resumo Objetivo Investigar se os pacientes submetidos à artroplastia total anatômica do ombro (ATAO) entre janeiro e março de 2020 tiveram resultados pós-operatórios diferentes dos pacientes operados em 2019. Nossa hipótese é a de que os pacientes de 2020 teriam menos acesso à fisioterapia (FT) e apresentariam desfechos pós-opera-tórios diferentes. Métodos Foram analisados os prontuários de pacientes submetidos à ATAO de 1° de janeiro de 2019 a 17 de março de 2019 e de 1° de janeiro de 2020 a 17 de março de 2020. Os dados dos pacientes, incluindo informações demográficas, amplitude de movimento (ADM), força e FT foram coletados e comparados entre os dois grupos. Os pacientes de 2020 foram contatados por telefone durante outubro de 2022, e as métricas relatadas por eles pacientes foram coletadas. Resultados Este estudo identificou 24 pacientes em 2019 e 27 pacientes em 2020 que foram submetidos à ATAO durante o período especificado e tiveram acompanhamento mínimo de 1 ano. Os pacientes em 2019 apresentaram melhoras na ADM de elevação anterior (EA; 125,4° a 146,7°; p = 0,008), rotação externa (RE; 33,0° a 47,7°; p < 0,001) e rotação interna (RI; S1 a L4; p = 0,019). Os pacientes em 2020 também apresentaram melhoras significativas de EA (120,2° a 141,1°; p = 0,009), RE (32,9° a 42,0°; p = 0,037) e RI (S1 a L3; p = 0,002). Os pacientes de 2020 terminaram a FT mais cedo (2019: 125,8 dias; 2020: 91,1 dias; p = 0,046) e fizeram menos sessões (2019: 21,4 sessões; 2020: 13,1 sessões; p = 0,003). No acompanhamento final, os pacientes de 2020 relataram uma pontuação média de dor na Escala Visual Analógica (EVA) de 1,67 ± 1,1. Conclusão Apesar da menor realização de FT, os pacientes submetidos à ATAO em 2020 apresentaram melhoras significativas na ADM e na força e foram comparáveis aos pacientes de 2019. (ATAO 202 pósoperatórios pós operatórios (FT opera tórios 201 demográficas ADM, , (ADM) grupos 2022 coletadas 2 ano (EA 1254 125 4 125,4 146,7° 1467 146 7 0,008, 0008 0,008 0 008 0,008) (RE 330 33 33,0 47,7° 477 47 0,001 0001 001 (RI S L4 L 0,019. 0019 0,019 . 019 0,019) 120,2° 1202 120 (120,2 141,1° 1411 141 0,009, 0009 0,009 009 0,009) 32,9° 329 32 9 (32,9 42,0° 420 42 0,037 0037 037 (S L3 0,002. 0002 0,002 002 0,002) (2019 1258 8 125, dias 911 91 91, 0,046 0046 046 214 21 21, 131 13 13, 0,003. 0003 0,003 003 0,003) final EVA (EVA 167 67 1,6 11 1,1 20 (ADM 12 146,7 14 000 0,00 00 3 33, 47,7 0,01 01 120,2 (120, 141,1 32,9 (32, 42,0 0,03 03 (201 0,04 004 04 16 6 1, 146, 0,0 47, 120, (120 141, 32, (32 42, (20 0, (12 (3 (2 (1 (

Abstract Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings. (OA loss obesity evaluation examination images local systemic aspects addition subject However unsuccessful arthroscopies osteotomies arthroplasties nonsurgical non infiltrations acupuncture exercise detection activity prognosis therapy Nevertheless findings

Resumo A osteoartrite (OA) do joelho é uma doença inflamatória e degenerativa que ocasiona a destruição da cartilagem articular e leva à perda de funções. Sua prevalência vem crescendo consideravelmente devido ao aumento da expectativa de vida e da obesidade, e o diagnóstico pode ser feito por meio de avaliação e exames médicos, e é confirmado em imagens radiográficas complementares. Uma condição multifatorial, a OA do joelho pode ser influenciada por diversos aspectos locais, sistêmicos e externos; além disso, a sua evolução e as respostas aos tratamentos dependem muito das características de cada indivíduo. Inicialmente, recomenda-se proceder a um tratamento medicamentoso e a terapias alternativas que melhorem a qualidade de vida do paciente; mas, a partir do momento em que se verifica que tais terapias não estão proporcionando resultados satisfatórios, um tratamento cirúrgico deve ser considerado. Entre os tratamentos cirúrgicos, as artroscopias, as osteotomias e as artroplastias parciais e totais são destacadas; os métodos não cirúrgicos incluem o uso de medicamentos e de terapias alternativas, como infiltrações, acupuntura e prática de exercícios físicos. Vale ressaltar ainda que a utilização de biomarcadores pode ser uma importante estratégia para detectar precocemente a doença, avaliar sua atividade, prever um prognóstico e monitorar uma melhor resposta à terapia; porém, esse tema ainda deve ser foco de mais estudos para que os seus resultados sejam comprovados. (OA funções obesidade médicos complementares multifatorial locais externos disso indivíduo Inicialmente recomendase recomenda paciente mas satisfatórios considerado artroscopias destacadas infiltrações físicos atividade terapia porém comprovados

RESUMO Introdução: As crianças constituem um grupo populacional vulnerável a queimaduras. A utilização do esporte como alternativa terapêutica aumenta os indicadores fisiológicos e a eficácia dos tratamentos reabilitativos. Objetivo: Determinar o efeito das ações motoras do tênis de campo como alternativa terapêutica na recuperação da funcionalidade motora de membros superiores em crianças queimadas. Materiais e métodos: Foi realizado um estudo de desenho pré-experimental de controle mínimo, com duração de doze semanas entre o mês de janeiro a abril de 2023. A amostra selecionada foi realizada a partir de uma amostragem intencional estratificada não probabilística, cinco crianças com queimaduras de uma amostra de 8 pacientes, que atenderam aos critérios de inclusão e realizaram ações motoras adaptadas realizadas no tênis de campo. Os dados obtidos foram processados com o software estatístico SPSS 28. Resultados: Os resultados obtidos demonstraram alterações estatisticamente significativas na amostra analisada em relação à funcionalidade motora dos membros superiores, dores ao movimentar-se, problemas de força muscular e limitações na amplitude de movimento. 100 % obtiveram pontuações mais elevadas nos elementos em avaliação. Conclusões: As ações motoras do tênis de campo como alternativa terapêutica foram eficazes na recuperação da funcionalidade motora de membros superiores em crianças queimadas.

RESUMEN Introducción: Los niños constituyen un grupo de población vulnerable a la producción de quemaduras. El uso de deportes como alternativa terapéutica incrementa indicadores fisiológicos y la efectividad de los tratamientos rehabilitadores. Objetivo: examinar el efecto de acciones motrices del tenis de campo como alternativa terapéutica en la recuperación de la funcionabilidad motriz de miembros superiores en niños quemados. Materiales y métodos: Se realizó un estudio de diseño pre experimental de control mínimo, con doce semanas de duración entre el mes de enero a abril de 2023. La muestra seleccionada se realizó a partir de un muestreo intencional estratificado no probabilístico, se seleccionaron cinco niños con quemaduras de una muestra de ocho pacientes, los cuales cumplieron con los criterios de inclusión y realizaron acciones motrices adaptadas que realiza el tenis de campo. Los datos obtenidos fueron procesados con el software estadístico SPSS 28. Resultados: Los resultados obtenidos mostraron cambios estadísticamente significativos en la muestra analizada en relación con la funcionabilidad motriz de los miembros superiores, dolor al movimiento, problemas de fuerza muscular y limitaciones en los rangos de movimiento. El 100 % logró registros superiores en los elementos sometidos a evaluación. Conclusiones: Las acciones motrices del tenis de campo como alternativa terapéutica fueron efectivas en la recuperación de la funcionabilidad motriz de miembros superiores en niños quemados.

ABSTRACT Introduction: Children are vulnerable to burns. The utilization of sports as therapy increases the physiological indicators and rehabilitation effectiveness. Aim: To examine the effect of motor actions in field tennis as a therapeutic alternative for the recovery of motor functions in burned children's upper limbs. Materials and methods: A pre-experimental design study with minimum control was done for twelve weeks between January and April 2023. The sample was selected according to a non-probabilistic stratified intentional sampling. From a total population of 8 children with burns, 5 met the inclusion criteria and performed adapted motor ctions used in field tennis. The data were processed through SPSS 28. Results: The results showed statistically significant changes in the sample about the motor functionality of the upper limbs, pain when moving, muscle strength issues, and movement limitations. All the subjects achieved higher indicator values. Conclusions: The motor actions in field tennis can be used effectively for therapy in the recovery of motor functionality of the upper limbs of burned children.

INTRODUCTION: The Work Ability Screening Profile (WASP) was conceptualised and developed by occupational therapists at the University of Durban Westville to provide a basic vocational screening assessment. Its purpose was to screen competence in generic work skills which reflected performance in activities essential to workplace participation relevant to the South African context. The assessment was revised in 2005 and renamed the WASP II. It was decided this screening assessment tool would be continuously reviewed using action research with clinicians involved in the ongoing evaluation so ensure validity and reliability for the population with which it is used. This study considered the clinical evaluation, useability and utility of the WASP II in order to inform further revision. METHOD: A cross sectional survey was used to gather data from 70 occupational therapy clinicians familiar with or using the WASP II in clinical practice. RESULTS: A sample of 70 respondents indicated the WASP II was suitable to assess current work ability and production speed with a variety of clients with physical and mental health dysfunction. Ten of the 12 subtests were used by at least 40% of the time by the 28 respondents who used the WASP II frequently. These respondents reported good to adequate useability in terms of cost, sensitivity to clients' educational level and ease of understanding instructions, incorporation into clinical practice contexts while supporting clinical reasoning and judgement. The accommodation of clients' language and provision of standard scores were indicated as inadequate. Utility was considered adequate for all aspects including discrimination of moderate to severe dysfunction, informing the choice of other assessmentsas well as supporting vocational rehabilitation intervention. The WASP II outcomes were also understood by other service providers, employers, referring parties as well asclients. CONCLUSION: While the WASP II was considered appropriate for use in the South African context and has adequate useability and utility, some subtests need to be updated and revised in terms of the standard times and content validity for current practice in the work environment. IMPLICATIONS FOR PRACTICE: The WASP II has useability • aligned with generic work skills of acquiring information or following directions numeracy, conveying information and written communication • for with those with work experience and with scholars and students yet to enter the workplace The WASP II has utility in relation to • cost and clients' educational levels • detailed instructions on the task layout but some standardisation needs to be interpreted with care • sensitivity to all aspects of assessment of generic work skills, except discrimination of mild dysfunction

RESUMEN Introducción: La herida es una pérdida de continuidad de la piel o mucosa producida por algún agente físico o químico. Una herida es “compleja” cuando por su extensión, localización, profundidad o exposición de elementos nobles, necesita para su curación una terapéutica especial. Este es el caso de heridas con compromiso tisular que afecta a estructuras como músculos, fascias, tendones, huesos, vasos sanguíneos, nervios o las lesiones de lenta evolución como úlceras o escaras. Objetivos: Determinar el método de reconstrucción más utilizado en el manejo terapéutico de las heridas complejas del tercio distal de la pierna en los pacientes atendidos en el Hospital de Trauma y en la Unidad de Cirugía Plástica de la FCM - UNA. Materiales y métodos: Estudio de diseño observacional, tipo de estudio descriptivo y retrospectivo. Fueron incluidos pacientes de ambos sexos, mayores de edad, con heridas complejas en el tercio distal de la pierna, atendidos en el Hospital de Trauma y en la Unidad de Cirugía Plástica de la FCM - UNA, durante el periodo 2010 al 2019. Resultados: Se incluyó a 112 pacientes de los cuales el 80,36 % fue hombres y el 19,64 % mujeres. Las edades estaban comprendidas entre los 18 y los 73 años y una media de 33,8 ± 14 años. La edad más frecuente fue 18 años. La mediana de edad es de 30 años, lo que implica que la mitad de la muestra tuvo por lo menos dicha edad. En cuanto a la procedencia, el 41,07 % era del interior, el 30,36 % del departamento Central y el 28,57 % restante de Asunción. En cuanto al mecanismo de la lesión, se puede observar que el mecanismo más frecuente fue el accidente de tráfico, seguido por caída de altura, en un gran porcentaje. En cuanto a la evolución y complicaciones se puede ver que 92 individuos, o sea 82 % de los pacientes no tuvo ninguna evolución negativa o complicaciones. Lo más común fue la infección con 1,9% de prevalencia, la pérdida parcial del colgajo o piel representan el 2,4%, dehiscencia de la sutura el 0,9 %, hematoma 0,6 % y pérdida total del colgajo 0,54 %. En cuanto al tratamiento aplicado, se debe tener en cuenta que los pacientes pudieron haber recibido más de un tratamiento por lo que el tamaño de la muestra se refiere a las visitas. El tratamiento más frecuente fue el colgajo sural con 28,57%, tutor externo con el 20,19%, injerto de piel 16,46%, toillete 12,73% y colgajo fascio - cutáneo en 6,21%. Conclusión: La gran mayoría de los casos tratados corresponde a algún tipo de accidente de tránsito. Se necesita de un equipo multidisciplinario: ortopedistas, cirujanos plásticos, cirujanos vasculares, fisioterapeutas, etc. en trabajo coordinado para tratar estas graves lesiones de forma a obtener resultados favorables. Para la cobertura de la pierna traumatizada, con exposición ósea, recurrimos a los colgajos musculares, en el 1/3 proximal el gemelo, en el 1/3 medio el sóleo. Para la cobertura del 1/3 distal de la pierna utilizamos el colgajo neuro-veno-fascio-cutáneo (sural) a pedículo distal.

ABSTRACT Introduction: The wound is a loss of continuity of the skin or mucosa produced by some physical or chemical agent. A wound is “complex” when due to its extension, location, depth, exposure of noble elements, it requires special therapy to heal. This is the case of wounds with tissue involvement that affects structures such as muscles, fascia, tendons, bones, blood vessels, nerves, or slowly evolving lesions such as ulcers or bedsores. Objectives: Determine the reconstruction method most used in the therapeutic management of complex wounds of the distal third of the leg in patients treated at the Trauma Hospital and the Plastic Surgery Unit of the FCM - UNA. Materials and methods: Observational, descriptive, and temporally retrospective study. Patients of both sexes, of legal age, with complex wounds in the distal third of the leg, treated at the Trauma Hospital and in the Plastic Surgery Unit of the FCM - UNA, during the period 2010 to 2019, were included. Results: 112 patients were included, of which 80.36% are men and 19.64% are women. The ages range from 18 to 73 years and an average of 33.8 ± 14 years. The most common age was 18 years. The median age is 30 years, which implies that half of the sample is at least that age. Regarding origin, 41.07% are from the interior, 30.36% from the Central department and the remaining 28.57% from Asunción. Regarding the mechanism of injury, the most frequent mechanism was a traffic accident, followed by a fall from a height, in a large percentage. Regarding the evolution and complications, 92, that is, 82% of the patients do not have any negative evolution or complications. The most common was infection with 1.9%, partial loss of the flap or skin represented 2.4%, suture dehiscence with 0.9%, hematoma 0.6%, and total loss of the flap 0.54. %. Regarding the treatment applied, it must be considered that patients may have received more than one treatment, so the sample size refers to visits. The most frequent treatment was the sural flap with 28.57%, external tutor with 20.19%, skin graft 16.46%, toilette 12.73% and fasciocutaneous flap in 6.21%. Conclusion: Most cases treated correspond to some type of traffic accident. A multidisciplinary team is needed: orthopedists, plastic surgeons, vascular surgeons, physiotherapists, etc. in coordinated work to treat these serious injuries to obtain favorable results. To cover the traumatized leg, with bone exposure, we resort to muscle flaps. In the proximal 1/3, the gastrocnemius. In the middle 1/3, the soleus. To cover the distal 1/3 of the leg we used the neuro-veno-fascio-cutaneous (sural) flap to the distal pedicle.

RESUMEN Introducción: La fiebre es un marcador de enfermedades infecciosas e inflamatorias que se da por una respuesta inmune innata y por diferentes mediaciones entre marcadores moleculares. En el paciente inmunodeprimido, uno o varios mecanismos inmunológicos pueden estar alterados, debido a que la respuesta inmune puede estar deprimida y la fiebre puede denotar un estado patológico grave subyacente. Se realizó una búsqueda exploratoria en las bases de datos PubMed/Medline, Scopus y Scielo entre septiembre y octubre de 2022. Se incluyeron los términos fiebre, pacientes inmunodeprimidos, tratamiento y sistema inmune. Se seleccionaron 41 artículos científicos con diferentes diseños epidemiológicos. Objetivo: Describir aspectos relacionados con la fisiopatología de la fiebre, el tratamiento de la presencia de fiebre en pacientes con virus de inmunodeficiencia humana y síndrome de inmunodeficiencia adquirida, así como también en pacientes receptores de trasplantes de órgano sólido y de trasplantes hematopoyéticos, pacientes neutropénicos y pacientes tratados con corticosteroides y terapia biológica. Desarrollo: El tratamiento del paciente inmunodeprimido con fiebre incluye aspectos fundamentales como una adecuada anamnesis y examen físico, además de pruebas diagnósticas orientadas para establecer la causa de la fiebre. En estos pacientes, las infecciones juegan un papel protagónico y su intervención temprana es fundamental para impactar en la morbimortalidad. Conclusiones: El paciente inmunodeprimido con presencia de fiebre presenta un panorama desafiante para su manejo médico integral. Entre otros aspectos es relevante considerar el tipo y tiempo de inmunosupresión, así como los factores de riesgo, con el fin de orientar los diagnósticos y tratamientos.

ABSTRACT Introduction: Fever is a marker of infectious and inflammatory diseases that is caused by an innate immune response and by different mediations between molecular markers. In the immunocompromised patient, one or more immunological mechanisms may be altered because the immune response may be compromised, and fever may denote a serious underlying disease state. An exploratory search was conducted in the PubMed/Medline, Scopus, and Scielo databases between September and October 2022. The terms fever immunocompromised patients, treatment, and immune system. A total of 41 scientific articles with different epidemiological designs were selected. Objective: To describe aspects related to the pathophysiology of fever, management of the presence of fever in patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, as well as in patients who have received solid organ transplants and hematopoietic transplants, neutropenic patients and patients treated with corticosteroids and biological therapy. Developing: The approach to the immunocompromised patient with fever includes fundamental aspects such as an adequate history and physical examination, as well as diagnostic tests aimed at establishing the cause of the fever. In these patients, infections play a leading role and early intervention is essential to impact morbidity and mortality. Conclusions: The immunocompromised patient with the presence of fever presents a challenging panorama for his/her comprehensive medical approach. Among other aspects, it is relevant to consider the type and duration of immunosuppression, as well as the risk factors, to guide diagnoses and treatments.

RESUMEN Introducción: La enfermedad de Alzheimer, constituye un problema sanitario y social de gran magnitud; precisa de diagnóstico y terapéutica precoces. Se realizó una búsqueda de artículos sobre factores de riesgo y biomarcadores de la enfermedad en las bases de datos PubMed/Medline, Scopus, Scielo y Lilacs, y mediante el buscador Google académico; desde el año 2017 hasta el 2023, en idioma español, inglés y portugués. Objetivo: Analizar los factores de riesgo y los biomarcadores de la enfermedad de Alzheimer. Desarrollo: Los principales factores de riesgo encontrados son edad avanzada, menor educación, poca actividad física, hábito de fumar, consumo excesivo de alcohol, hipertensión arterial, diabetes, obesidad, depresión, pérdida o disminución de la audición, aislamiento social, los traumas craneales y la contaminación ambiental. Los biomarcadores fundamentales son: los marcadores que se utilizan en los estudios de neuroimágenes como la PET Amiloide, PET tau, PET FDG; y en LCR y plasma: Aβ42, Aβ42/Aβ40, p tau 217, p tau 181, GFAP, y neurofilamentos de cadena ligeras. Conclusiones: Se requieren estudios longitudinales, a partir de la presencia de los factores de riesgo asociados a biomarcador, desde edades pregeriátricas en pacientes sanos, que tengan como salidas el deterioro cognitivo y el desarrollo de la demencia, para construir un modelo de predicción.

ABSTRACT Introduction: Alzheimer's disease is a health and social problem of great magnitude; it requires early diagnosis and therapy. A search for articles on risk factors and biomarkers of the disease was conducted; in the databases PubMed/Medline, Scopus, Scielo and Lilacs, and through the Google scholar search engine; from 2017 to 2023, in Spanish, English and Portuguese. Objective: To analyze the risk factors and biomarkers of Alzheimer's disease. Development: The main risk factors found are advanced age, lower education, little physical activity, smoking, excessive alcohol consumption, high blood pressure, diabetes, obesity, depression, hearing loss or decrease, social isolation, head trauma and environmental pollution. The fundamental biomarkers are: markers used in neuroimaging studies such as amyloid PET, tau PET, FDG PET; and in CSF and plasma: Aβ42, Aβ42/Aβ40, p tau 217, p tau 181, GFAP, and light chain neurofilaments. Conclusions: Longitudinal studies are required, based on the presence of risk factors associated with biomarkers, from pregeriatric ages in healthy patients, which have cognitive impairment and the development of dementia as outputs, to build a prediction model.

Resumo Introdução: A trombocitemia essencial (TE) é uma condição pouco comum e assintomática na maioria dos casos. No entanto, podem surgir sintomas como cefaleias, síncope, vertigem, dor torácica, eritromelalgia e distúrbios visuais transitórios. Os eventos hemorrágicos e tromboembólicos são os grandes riscos desta patologia. O objetivo da partilha deste caso clínico é alertar para uma patologia rara que pode passar despercebida e causar eventos potencialmente graves. Descrição do caso: Sexo feminino, 43 anos, raça caucasiana, antecedentes de hepatite B crónica, sem antecedentes cirúrgicos nem medicação habitual, incluindo método contracetivo hormonal. Recorreu a consulta com queixas de enfartamento precoce, dispepsia e epigastralgia com três dias de evolução, negando alterações do trânsito intestinal, características das fezes, náuseas ou vómitos. Exame físico e endoscopia digestiva alta recente sem alterações de relevo. Foi consultado o estudo analítico que a utente realizava regularmente no hospital, verificando-se que o valor do número de plaquetas se encontrava consistentemente a rondar os 500.000/uL desde há três anos. Pediu-se ecografia abdominal que descrevia trombose parcial da veia porta e do seu ramo esquerdo. A doente foi medicada com enoxaparina 60 mg 12h/12 h. Foi realizado angio-TC abdominal, estudo pró-trombótico e estudo genético e iniciou varfarina 5 mg 1x/dia, inicialmente sobreposta com enoxaparina 60 mg 12/12h. O angio-TC viria a confirmar a trombose da veia porta e confirmou-se positiva a mutação JAK2 V617F. Assumido o diagnóstico de TE e iniciado tratamento citorredutor com hidroxiureia 500 mg em dias alternados. Comentário: Este caso chama a atenção pelo excesso de plaquetas secundário à TE, ainda que ligeiramente acima do valor de referência, ter originado uma trombose da veia porta. Pretende-se alertar os médicos de família para a importância de realizar um estudo atento, valorizando pequenas variações sustentadas fora dos intervalos da normalidade e fazer uma referenciação correta e atempada quando necessário.

Abstract Introduction: Essential thrombocythemia (ET) is an asymptomatic rare condition in most cases. Nonetheless, symptoms like headache, syncope, vertigo, thoracic pain, erythromelalgia, and transient visual disturbances may surge. The major concerns of this pathology are hemorrhagic and thromboembolic events. The aim of sharing this case report is to alert for the existence of this rare pathology that can go unnoticed and cause potentially serious events. Case description: Female, 43-year-old, Caucasian. Background of chronic B hepatitis, without surgical background nor usual medication, including the contraceptive pill. She appealed to a medical appointment with an early feeling of fullness when eating, dyspepsia, and epigastric pain in the last three days. She denied changes in intestinal habits, feces characteristics, nausea, or vomiting. Physical examination and recent upper endoscopic study were normal. The hospital medical record was examined, verifying that platelet levels were consistently rounding 500,000/uL for the past three years. An abdominal ultrasonography was requested, and it described a partial portal vein and left branch thrombosis. The patient started enoxaparin 60 mg every 12 hours. It was conducted an abdominal angiotomography, prothrombotic, and genetic study, including the JAK2 V617F mutation. The patient started warfarin 5 mg one time daily, initially overlaid with enoxaparin 60 mg 12h/12h. The abdominal angiotomography would confirm the portal vein thrombosis and the JAK2 V617F mutation study was positive. It was assumed the diagnosis of ET and was initiated cytoreductive therapy with hydroxyurea 500 mg on alternated days. Comment: This case report shows that the excessive platelet count, secondary to ET, even if slightly above the reference value, caused a portal vein thrombosis. We aim to alert family physicians to the importance of doing a careful study, valuing little sustained variations out of the normal intervals, and referring correctly and promptly when necessary.

Resumo Introdução: A prevalência da infeção pelo vírus da imunodeficiência humana (VIH) parece haver estabilizado nos 0,7%, enquanto em alguns países continua a aumentar. Durante muitos anos estava apenas associada ao continente africano e a populações específicas, mas atualmente constata-se um aumento de incidência nos países desenvolvidos. Esta infeção pode ser assintomática ou ter sintomas inespecíficos. Estes dependem do estádio da doença, da carga viral ou do estado imune do hospedeiro. Este caso mostra o desafio do diagnóstico de VIH, relatando uma forma de apresentação sintomática rara. Descrição do caso: Homem de 21 anos de idade, de nacionalidade angolana, que recorre à consulta aberta nos cuidados de saúde primários por quedas frequentes no último mês associadas a sensação de falta de força nos membros inferiores. À avaliação física constata-se uma discreta diminuição global da força nas quatro extremidades, com maior tradução no membro superior esquerdo. Nega práticas sexuais de risco ou consumo de drogas parenterais. Após realização de estudo analítico, estudo eletromiográfico e tomografia computorizada crânio-encefálica, da coluna cervical e lombar, constata-se um resultado positivo para a infeção por VIH como a causa desencadeante da sintomatologia apresentada. Comentário: O que inicialmente pareciam sintomas relacionados com uma doença neuromuscular incipiente veio a revelar-se o diagnóstico de uma infeção vírica. Pela inespecificidade dos seus sintomas é importante manter um elevado nível de suspeição para a infeção por VIH. No caso relatado, a neuropatia periférica era a única manifestação desta infeção. Ainda que tenha uma prevalência de até 60% entre os infetados, é rara como manifestação isolada. A sua etiopatologia não é ainda clara, sabe-se que é multifatorial e progressiva. Presentemente o doente encontra-se estável com o início da terapêutica antirretroviral, com melhoria da sintomatologia.

Abstract Introduction: The prevalence of human immunodeficiency virus (HIV) infection seems to be stabilized at 0.7% but in some countries, it continues to rise. For many years it was only associated with the African continent and specific populations, but today there is an increase in the incidence in developed countries. This infection can be asymptomatic or have non-specific symptoms. Those depend on the stage of the disease, the viral load, or the host’s immune status. This case shows how the diagnosis of HIV remains a real challenge, reporting a rare form of symptomatic presentation. Case description: A 21-year-old male, with Angolan nationality, went to primary health care consultation due to frequent falls in the last month associated with a sensation of lack of strength in the lower limbs. During physical evaluation, a discrete global reduction of strength in the four extremities was noted, most markedly in the left upper limb. The patient denied risky sexual practices or parenteral drug consumption. After carrying out complementary analytical studies, an electromyographic study, and computed tomography of the brain, cervical, and lumbar spine, the results came back positive for HIV infection as the cause of the presented symptoms. Comment: What at first seemed to be symptoms related to an incipient neuromuscular disease turned out to be the diagnosis of a viral infection. Due to the nonspecificity of the symptoms, it is important to maintain a high level of suspicion of HIV infection. In this case, peripheral neuropathy was the only manifestation reported. Although it has a prevalence of up to 60% among the infected, it is rare as an isolated sign. Its aetiopathology is still unclear, but it is known to be multifactorial and progressive. Nowadays the patient is stable after the initiation of antiretroviral therapy, with improvement in symptomology.

Introduction: The incidence increased of chronic kidney disease, together with the changes caused in patients' lifestyles by undergoing renal replacement therapy to prolong life, has prompted the quantification of the effects of disease and treatment about quality of life. Objective: To evaluate the health-related quality of life in patients with end-stage chronic kidney disease treated at the Nephrology Service of the "Carlos Font Pupo" Teaching Clinical-Surgical Hospital at February, 2019. Material and Methods: A descriptive cross-sectional observational study was performed in 20 patients with chronic terminal kidney disease. The information was obtained from semi-structured interviews and the responses of the Kidney Disease Quality of Life Short Form version 1.3 questionnaire. To fulfill the objective, descriptive statistics were used in the form of Absolute Frequencies, mean, standard deviation and the Mann-Whitney U test. Results: The most committed generic dimensions were Physical role (18.75 ± 17.91), Energy / fatigue (48 ± 21.79) and General health perception (50.5 ± 22.41). In the specific dimensions, the lowest scores were obtained in employment status (9 ± 18.89), sexual function (44.38 ± 46.68) and burden of kidney disease (52.5 ± 21.88). 50% of the patients presented a quality of average life. Conclusions: The results obtained in the different dimensions do not differ significantly from those of consulted international studies that applied this instrument.

Introducción: El incremento en la incidencia de la Enfermedad renal crónica, junto a las modificaciones que provoca en los estilos de vida de los pacientes el someterse a tratamientos sustitutivos de la función renal para prolongar la vida, ha impulsado a cuantificar los efectos de la enfermedad y del tratamiento sobre la calidad de vida. Objetivo: Evaluar la calidad de vida relacionada con la salud en pacientes con enfermedad renal crónica terminal atendidos en el Servicio de Nefrología del Hospital Clínico-Quirúrgico Docente Dr. “Carlos Font Pupo” en febrero de 2019. Material y Métodos: Se realizó un estudio observacional descriptivo transversal en 20 pacientes con enfermedad renal crónica terminal. La información se obtuvo a partir de entrevistas semiestructuradas y de las respuestas del cuestionario Kidney Disease Quality of Life Short Form versión 1.3. Para dar cumplimiento al objetivo se utilizaron estadísticas descriptivas a forma de Frecuencias Absolutas, media, desviación estándar y la prueba de U de Mann-Whitney. Resultados: Las dimensiones genéricas más comprometidas fueron Rol físico (18,75 ± 17,91), Energía/fatiga (48 ± 21,79) y Percepción general de la salud (50,5 ± 22,41). En las dimensiones específicas se obtuvieron las puntuaciones más bajas en Estatus laboral (9 ± 18,89), Función sexual (44,38 ± 46,68) y Carga de la enfermedad renal (52,5 ± 21,88). El 50% de los pacientes presentaron una calidad de vida media. Conclusiones: Los resultados obtenidos en las diferentes dimensiones no difieren significativamente de estudios internacionales consultados que aplicaron este instrumento.