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

ABSTRACT Introduction Obstructive azoospermia occurs when there is a blockage in the male reproductive tract, leading to a complete absence of sperm in the ejaculate. It constitutes around 40% of all cases of azoospermia (1, 2). Blockages in the male reproductive tract can arise from either congenital or acquired factors, affecting various segments such as the epididymis, vas deferens, and ejaculatory ducts (3). Examples of congenital causes encompass conditions like congenital bilateral absence of the vas deferens and unexplained epididymal blockages (4). Acquired instances of obstructive azoospermia may result from factors like vasectomy, infections, trauma, or unintentional injuries caused by medical procedures (5). This complex condition affecting male fertility, presents two main treatment options: microsurgical reconstruction and surgical extraction of sperm followed by in vitro fertilization (IVF). Microsurgical reconstruction proves to be the most cost-effective option for treating obstructive azoospermia when compared with assisted reproductive techniques (6, 7). However, success rates of reconstruction defined by patency are as high as 99% for vasovasostomy (VV) but decline to around 65% if vasoepididymostomy (VE) is required (8, 9). Thus, continued refinement in technique is necessary in order to attempt to improve patency for patients undergoing VE. In this video, we show a comprehensive demonstration of microsurgical VE, highlighting the innovative epididymal occlusion stitch. The goal of this innovative surgical technique is to improve outcomes for VE. Materials and Methods The patient is a 39-year-old male diagnosed with obstructive azoospermia who presents for surgical reconstruction via VE. His partner is a 37-years-old female with regular menstrual cycles. The comprehensive clinical data encompasses a range of factors, including FSH levels, results from semen analysis, and outcomes from testicular sperm aspiration. This thorough exploration aims to provide a thorough understanding of our innovative surgical technique and its application in addressing complex cases of obstructive azoospermia. Results The procedure was started on the right, the vas deferens was identified and transected. The abdominal side of the vas was intubated and a vasogram performed, there was no obstruction. There was no fluid visible from the testicular side of the vas for analysis, thus we proceeded with VE. Upon inspection of the epididymis dilated tubules were identified. After selecting a tubule for VE, two 10-0 nylon sutures were placed, and it was incised. Upon inspection of the fluid motile sperm was identified. After VE, we performed a novel epididymal occlusion stitch technique. This was completed distal to the anastomosis by placing a 7-0 prolene through the tunica of the epididymis from the medial to lateral side. This stitch was then tightened down with the goal to largely occlude the epididymis so that sperm will preferentially travel through the anastomosis. The steps were then repeated on the left. At 3-month follow up, the patient had no change in testicular size as compared with preoperative size (18cc), he had no testicular or incisional discomfort, and on semen analysis he had presence of motile sperm. After 3 months post-surgery, the patient had motile sperm seen on semen analysis. Discussion The introduction of a novel epididymal occlusion stitch demonstrates a targeted strategy to enhance the success of microscopic VE. Encouragingly, a 3-month post-surgery follow-up reveals the presence of motile sperm, reinforcing the potential efficacy of our approach. This is promising given the historical lower patency, delayed time to patency, and higher delayed failure rates that patients who require VE experience (10). In total, 40% of all azoospermia cases can be attributed to obstruction. The conventional treatments for obstructive azoospermia involve microsurgical reconstruction and surgical sperm retrieval followed by IVF. While microsurgical reconstruction has proven to be economically viable, the quest for enhanced success rates has led to the exploration of innovative techniques. Historically, the evolution of VV and VE procedures, initially performed in the early 20th century, laid the foundation for contemporary microsurgical approaches (11). Notably, the microscopic VV demonstrated significant improvements in patency rates and natural pregnancy likelihood, as evidenced by the seminal Vasovastomy Study Group study in 1991 (8). In contemporary literature, success rates particularly for VE remain unchanged for the past three decades since the original published success rates by the Vasectomy Reversal Study Group (12). VE is associated with a longer time to patency as well with patients taking 2.8 to 6.6 months to have sperm return to ejaculate as compared to 1.7 to 4.3 months for those undergoing VV. Additionally, of those patients who successfully have sperm return to the ejaculate after VE up to 50% will have delayed failure compared to 12% for those undergoing VV who are patent. Finally, of those who experience delayed failure after undergoing VE it usually occurs earlier with studies reporting as early as 6 months post-operatively (20). Given the lack of improvement and significantly worsened outcomes with VE further surgical refinement is a constant goal for surgeons performing this procedure. Conclusion: In conclusion, this video is both a demonstration and a call to action for commitment to surgical innovation. We aim to raise the bar in VE success rates, ultimately bringing tangible benefits to patients and contributing to the ongoing evolution of reproductive medicine. The novel epididymal occlusion stitch emerges as a beacon of progress, promising not only enhanced safety but also potential reductions in patency time. Surgical excellence and methodological refinement, as exemplified in this video, lay the foundation for a future where male reproductive surgery continues to break new ground. 40 1, 1 (1 2. 2 . 2) 3. (3) 4. 4 (4) vasectomy infections trauma 5. 5 (5) fertility options IVF (IVF) costeffective cost effective 6, (6 7. 7 7) However 99 (VV 65 (VE 8, 8 (8 9. 9 9) Thus 39yearold yearold 39 year old 37yearsold yearsold 37 years cycles levels aspiration right transected obstruction 100 10 0 10- placed incised 70 7- left 3month month 18cc, 18cc cc , (18cc) discomfort postsurgery, postsurgery post surgery, Encouragingly followup approach 10. (10) total viable Historically th century 11. 11 (11) Notably likelihood 199 8. (8) literature 12. 12 (12) 28 66 6. 17 1. 43 Additionally 50 patent Finally postoperatively operatively 20. 20 (20) Conclusion conclusion innovation medicine progress ground ( (3 (4 (5 (IVF (18cc (10 (11 19 (12 (20 (2

BACKGROUND. The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). OBJECTIVE. To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. METHODS. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. RESULTS. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. CONCLUSION. COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.

ABSTRACT Leaf litter decomposition and the release of nutrients from macauba palm leaves play a major role in nutrient return to the soil in a conservation environment. This study evaluated macauba palm leaf decomposition, macronutrient contents and biochemical composition under contrasting water conditions in the Brazilian Cerrado. Macauba leaves were collected from plants in two different environments (low and high water table conditions), placed in litter bags and evaluated according to their decomposition, macronutrients, lignin, cellulose and hemicellulose for 420 days. In addition, green and dry leaves were collected for macronutrient analyses. Litter decomposition ranged between 49 % and 59 % up to 180 days. The half-life of litter ranged from 141 to 198 days. The leaf litter decomposition of macauba was practically stable during the dry season, whereas at the beginning of the rainy season, decomposition resumed. Nitrogen, P and S were higher in the green leaves, whereas the Ca levels were higher in the dry leaves. In addition, the K levels were twofold higher in the green leaves than in the dry leaves. Lignin release from macauba residues was slower than cellulose and hemicellulose. The decomposition rates of hemicellulose were higher initially due to its high solubility, although it gradually decreased with the decomposition process. Lignin decomposition was also higher at the beginning of the process but stabilized during the drought period. The study indicates that the decomposition process and nutrient cycling of macauba are influenced by its biochemical composition. environment Cerrado low conditions, , conditions) macronutrients lignin 42 days addition analyses 4 5 18 halflife half life 14 19 season resumed Nitrogen solubility period 1

abstract This study presents an innovative crude oil heating technology by introducing environmentally friendly solar energy into the petroleum industry. By integrating novel combination methods into traditional crude oil heating systems, a versatile and efficient crude oil heating system has been formed. The system was implemented in a refinery and its thermodynamic and economic performance was analyzed. The thermodynamic analysis, employing the exergy analysis method, reveals that among the considered parameters, compressor pressure ratio and Rankine cycle fluid flow rate exert the most significant influence on system efficiency. Overall, the system achieves energy efficiency, exergy efficiency, and waste heat recovery efficiency of 75.99%, 74.13%, and 31.21%, respectively. Within the system, solar collectors, TES tank, and compressor exhibit the highest exergy destruction rates, while pumps demonstrate the lowest exergy destruction rate. The economic analysis, using the annualized cost method, revealed that electricity prices have a significant impact on the economic performance of the system. The variation in system economic parameters is related to the annualized operating cost of the system. The system generates a net annual benefit of 0.591 million US$, with a 4.124-year investment return period. Moreover, Sensitivity analysis explores various factors affecting the crude oil heating system’s performance. industry systems formed analyzed method Overall 7599 75 99 75.99% 7413 74 13 74.13% 3121 31 21 31.21% respectively collectors tank rates 0591 0 591 0.59 US US$ 4.124year 4124year year 4.124 4 124 period Moreover s 759 7 9 75.99 741 1 74.13 312 3 2 31.21 059 59 0.5 124year 4124 4.12 12 75.9 74.1 31.2 05 5 0. 412 4.1 75. 74. 31. 41 4.

ABSTRACT Introduction: The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient. Methods: The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed. Results: Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051). Conclusion: The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required. Introduction highrisk high risk insufficient Methods procedures 40 selected age, age (age sex infarction grafts 2 mortality stroke events, , events) performed Results 4 pairs baseline crossclamp cross clamp 80% 80 (80 vs 48.9% 489 48 9 P=0.003. P0003 P P=0.003 . 0 003 P=0.003) 3 median 4.9 49 3.89.6 3896 3.8 9.6 8 6 3.8-9. ngmL ng mL 7.3 73 7 4.517.5 45175 4.5 17.5 5 17 4.5-17. P=0.085. P0085 P=0.085 085 P=0.085) 35.0% 350 35 32.038.0% 320380 32.0 38.0% 32 38 32.0-38.0 32.040.0% 320400 40.0% 32.0-40.0% P=0.381. P0381 P=0.381 381 P=0.381) 6.7% 67 (6.7 17.8% 178 P=0.051. P0051 P=0.051 051 P=0.051) Conclusion required (8 48.9 P000 P=0.00 00 4. 89 3.89. 389 3. 96 9. 3.8-9 7. 517 4.517. 4517 175 17. 4.5-17 P008 P=0.08 08 35.0 038 32.038.0 32038 320 32. 380 38.0 32.0-38. 040 32.040.0 32040 400 40.0 32.0-40.0 P038 P=0.38 6.7 (6. 17.8 P005 P=0.05 05 ( 48. P00 P=0.0 3.89 3.8- 51 4.517 451 4.5-1 35. 03 32.038. 3203 38. 32.0-38 04 32.040. 3204 40. 32.0-40. P03 P=0.3 6. (6 P0 P=0. 4.51 4.5- 32.038 32.0-3 32.040 32.0-40 P=0 32.03 32.0- 32.04 32.0-4 P=

Resumo As mudanças climáticas têm implicações notáveis para a tomada de decisão dos agricultores em relação à irrigação suplementar no café cultivado em áreas com déficit hídrico. O objetivo do trabalho foi analisar o custo de produção e a rentabilidade do café arábica em diferentes regimes irrigado e de sequeiro nas áreas do Cerrado brasileiro. Foram avaliados quatro cenários: I. cenário anterior a eventos climáticos significativos e à pandemia; II. com efeitos da pandemia e eventos climáticos; III. com produtividade média nacional e produtividade média em áreas irrigadas, e IV - cenários de cafés especiais. No Cenário I, apenas o tratamento de sequeiro não apresentou viabilidade econômica por não apresentar valor presente líquido (VPL) positivo. No Cenário II, a taxa interna de retorno (TIR) apresentou valores superiores ao Cenário I. Os cenários de produção nacional e Cerrado mostraram-se viáveis para as condições de preços e taxas de juros avaliadas. O cultivo do café em sequeiro foi altamente atrativo para o cenário de grãos especiais (IV) em comparação aos demais cenários. A produtividade e o valor pago por saca de café são as variáveis que mais impactam a TIR da lavoura cafeeira. Portanto, uma análise econômica e técnica é importante para cada sistema de produção antes de investir na cafeicultura. hídrico brasileiro I II III irrigadas VPL (VPL positivo (TIR mostraramse mostraram se avaliadas (IV cafeeira Portanto cafeicultura

Abstract Climate change significantly impacts farmers' decision-making regarding the supplementary irrigation of coffee cultivated in areas experiencing water deficits. The aim of this study was to analyze the production cost and profitability of Arabica coffee under different irrigation and rainfed regimes in the Brazilian Cerrado. Four scenarios were evaluated: I. scenario before significant climate events and the pandemic, II. scenario with the effects of pandemic and climate events, III. scenario with average national productivity and average productivity in irrigated areas, and IV. scenario of specialty coffees. In Scenario I, only the rainfed treatment did not demonstrate economic viability because it did not yield a positive net present value (NPV). Scenario II showed higher internal rate of return (IRR) than Scenario I. The national production and Cerrado scenarios proved viable under the evaluated price conditions and interest rates. The rainfed sector was highly attractive for the specialty grain scenario (IV) than for other scenarios. Productivity and the amount paid per bag of coffee were identified as the variables that had the most significant impact on the IRR of the coffee crop. Therefore, economic and technical analyses should be conducted before investing in coffee farming to ensure the success of each production system. farmers decisionmaking decision making deficits I III IV coffees NPV. NPV . (NPV) (IRR rates (IV crop Therefore system (NPV

Abstract This paper examines profit rate (rates of return to capital) convergence in OECD economies in the periods of 1960-2016 and relevant sub-periods. It also performs comparison of profit rates convergence in selected developed and developing economies, using the data for 1973-2003 period. Economy-wide, productive economy and manufacturing rates are estimated and three convergence concepts are considered (beta, sigma, and stochastic convergence). We use a combination of cross-sectional and univariate time series models and density distribution analysis. For each profit rate measure, a strong evidence of beta convergence is provided. In contrast, sigma convergence is indicated only in the case of productive economy profit rate; while in other cases, sigma divergence or the absence of either convergence or divergence are likely. Stochastic convergence is present in a smaller number of economies and is confined to productive economy and manufacturing. The comparison of convergence dynamics in developed versus developing economies confirmed beta convergence in both groups and for their aggregate, but did not establish sigma convergence, given the significant diversity of economies and their different economic trajectories. capital 19602016 1960 2016 1960-201 subperiods. subperiods sub periods. sub-periods 19732003 1973 2003 1973-200 period Economywide, Economywide Economy wide, wide Economy-wide beta, (beta convergence. . convergence) crosssectional cross sectional analysis measure provided contrast cases likely aggregate trajectories 1960201 196 201 1960-20 1973200 197 200 1973-20 196020 19 20 1960-2 197320 1973-2 19602 1 2 1960- 19732 1973-

Resumo Este artigo examina a convergência da taxa de lucro (taxas de retorno do capital) nas economias da OCDE nos períodos de 1960-2016 e subperíodos relevantes. Ele também compara a convergência das taxas de lucro em economias selecionadas desenvolvidas e em desenvolvimento, usando os dados para o período 1973-2003. As taxas de economia produtiva e de manufatura em toda a economia são estimadas e três conceitos de convergência são considerados (beta, sigma e convergência estocástica). Usamos uma combinação de modelos de séries temporais transversais e univariadas e análise de distribuição de densidade. Para cada medida de taxa de lucro, uma forte evidência de convergência beta é fornecida. Em contraste, a convergência sigma é indicada apenas no caso da taxa de lucro da economia produtiva; enquanto em outros casos, a divergência sigma ou a ausência de convergência ou divergência são prováveis. A convergência estocástica está presente em um número menor de economias e está confinada à economia produtiva e manufatura. A comparação da dinâmica de convergência em economias desenvolvidas versus em desenvolvimento confirmou a convergência beta em ambos os grupos e para seu agregado, mas não estabeleceu convergência sigma, dada a significativa diversidade de economias e suas diferentes trajetórias econômicas. capital 19602016 1960 2016 1960-201 relevantes 19732003. 19732003 1973 2003. 2003 1973-2003 beta, (beta estocástica. . estocástica) densidade fornecida contraste casos prováveis agregado econômicas 1960201 196 201 1960-20 1973200 197 200 1973-200 196020 19 20 1960-2 197320 1973-20 19602 1 2 1960- 19732 1973-2 1973-

Resumo Introdução: Os efeitos na saúde a médio e longo prazo da infeção por SARS-CoV-2 têm sido cada vez mais reconhecidos. O nosso objetivo foi avaliar a qualidade de vida associada à saúde em doentes críticos tratados em enfermaria avançada e determinar fatores associados a maus resultados. Métodos: A qualidade de vida associada à saúde em doentes SARS-CoV-2 foi avaliada 3 e 6 meses após a alta, através do Questionário Respiratório de Saint George e o EuroQoL 5-dimensões 3-níveis. A prevalência de ansiedade, depressão e stress pós-traumático foi avaliado nas duas visitas. Doentes com questionário Respiratório de Saint George normal ou com melhoria significativa (grupo 1) foram comparados com os que não melhoraram (grupo 2) aos 6 meses. Resultados: Cento e dezassete doentes foram avaliados. A mediana de idades foi 64 anos e 61,5% eram homens. Entre T3 e T6 foi observada redução no score total e domínios específicos do Questionário Respiratório de Saint George (p <0,001). Melhoria longitudinal foi observada no domínio da mobilidade (p = 0,029) e na Escala Visual Analógica (p=0,006) do EuroQoL 5-dimensões 3-níveis. A prevalência de ansiedade, depressão e stress pós-traumático reduziram ao longo do tempo (p <0,05). Após 6 meses, 4,3% dos doentes não tinham retomado ao trabalho e 23% estavam no grupo 2. O grupo 2 teve piores resultados no Questionário Respiratório de Saint George (<0,001); e nos domínios da mobilidade (p = 0,002), auto-cuidado (p <0,001) e atividades habituais (p = 0,014) do EuroQoL 5-dimensões 3-níveis. A regressão logística efetuada para comparar os grupos 1 e 2 não identificou associação entre os resultados e a idade, género, comorbilidades, demora média, ordem de não intubação, pior PaO2/FiO2 durante a hospitalização e técnica de suporte respiratório. Conclusão: Vários domínios na qualidade de vida associada à saúde parecem ser afetados após uma infeção grave por SARS-CoV-2 mas a melhoria parece ser a norma para a maioria dos doentes.

Abstract Introduction: Mid- and long-term health effects of SARS-CoV-2 infection have been increasingly recognised. Our goal was to evaluate health-related quality of life in critically ill patients, treated in a non-ICU setting, and associated factors with poor outcomes. Methods: Health-related quality of life in SARS-CoV-2 survivors was evaluated 3 and 6 months after discharge, using St. George's Respiratory Questionnaire and EuroQoL 5-Dimension 3-Level. Anxiety, depression, and post-traumatic stress disorder prevalence was accessed at both visits. Patients with normal or significant improvement on St. George's Respiratory Questionnaire (group 1) were compared to those who did not improve (group 2) at 6 months. Results: 117 patients were analysed. Median age was 64 years and 61.5% were male. Between T3 and T6 was observed a reduction in total and specific domain scores of St. George's Respiratory Questionnaire (p <0.001). Longitudinal improvement was observed in mobility domain (p = 0.029) and Visual Analogic Scale (p = 0.006) of EuroQoL 5-Dimension 3-Level. Rates of anxiety, depression, and post-traumatic stress disorder decline over time (p <0.05). After 6 months, 4.3% of participants have not return to work and 23% were in group 2. Group 2 had worst results in St. George's Respiratory Questionnaire (p<0.001); and in mobility (p = 0.002), self-care (p <0.001), and usual activities (p = 0.014) of EuroQoL 5-Dimension 3-Level domains. Logistic regression comparing groups 1 and 2 did not find association between outcomes and age, gender, comorbidities, length of stay, do not intubate order, worst PaO2/FiO2 during hospitalization and respiratory support technique. Conclusion: Several domains of health-related quality of life seem to be impaired after SARS-CoV-2 severe infection but improvement seems to be the rule for most patients.

Resumen Objetivo. Presentar las tasas de recurrencia y recuperación sintomática, los niveles de dolor posoperatorio y las tasas de complicaciones de los pacientes tratados con hemorroidoplastia láser en nuestra clínica. Método. Los datos de los pacientes que se sometieron a hemorroidoplastia láser debido a enfermedad hemorroidal interna de grados 2, 3 y 4 en nuestra clínica se revisaron retrospectivamente. Los pacientes incluidos en el estudio fueron seguidos durante al menos 6 meses (6 meses, 1 año y 2 años) y se analizaron sus desenlaces. Resultados. Se incluyeron en el estudio 103 pacientes, de los cuales 75 (72.8%) eran de sexo masculino. La edad media fue de 41.6 ± 13.6 años. El tiempo operatorio medio fue de 17.9 ± 5.2 minutos. Se desarrollaron complicaciones menores en 3 (2.9%) pacientes en el posoperatorio. El tiempo medio de reincorporación a la vida diaria normal fue de 2.17 (1-11) días. La recurrencia se observó en 16 (17.6 %) pacientes con enfermedad de grados 2 y 3, y en 6 (50%) de 12 pacientes con enfermedad de grado 4 (p = 0.019). Conclusiones. La hemorroidoplastia láser es un procedimiento popular que es efectivo en grupos de pacientes seleccionados, con tasas de recurrencia aceptables.

Abstract Introduction. Minimally invasive techniques still continue to maintain their popularity in hemorrhoidal disease. In this study, we aimed to present the symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates of patients treated with the laser hemorrhoidoplasty (LHP) method in our clinic. Methods. The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively. The patients enrolled in the study were followed for at least 6 months (6 months, 1 year, and 2 years) and their results were analyzed. Results. A total of 103 patients were included in the study. Seventy-five (72.8%) of them were male and the mean age was 41.6 ± 13.6 years. The mean operation time was 17.9 ± 5.2 min and minor complications developed in 3 (2.9%) patients postoperatively. Mean time to return to normal daily life was 2.17 (1-11) days. Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019). Conclusion. LHP is a popular procedure which is effective in selected patient groups with acceptable recurrence rates.

Abstract Objective The COVID-19 pandemic led to an unprecedented pause in elective surgeries, including shoulder arthroplasty. We sought to determine whether clinical and/or demographic differences would be seen between patients who presented for shoulder arthroplasty during the pandemic compared with the previous year (2019). Methods Institutional records were queried for patients who underwent shoulder replacement between March 1 and July 1 of 2019 and 2020. Demographics, range of motion, surgical duration, hospitalization time, discharge disposition, and postoperative management were analyzed. Results The mean duration of surgery was 160 ± 50 minutes in 2020 and 179 ± 54 minutes in 2019 (p= 0.13). The mean hospitalization time was 36 ± 13 hours in 2020 and 51 ± 40 hours in 2019 (p= 0.04). In 2019, 96% of the patients participated in physical therapy, while 71% did it in 2020 (p= 0.003). A total of 100% of the 2019 patients and 86% of the 2020 patients participated in an in-person postoperative follow-up (p= 0.006). The 2019 patients reported for an office visit on average 14 ± 11 days after surgery; the 2020 patients waited 25 ± 25 days to return for a follow-up (p= 0.10). Range of motion, age, American Society of Anesthesiologists (ASA) scores, and complication rates did not differ between the cohorts. Conclusion Patients presenting for surgery during the initial phase of the pandemic were demographically and clinically similar to 2019 patients. However, the length of stay was significantly reduced during the COVID-19 pandemic. Postoperative follow-up and physical therapy were delayed in 2020, but this did not lead to differences in complication or readmission rates compared with those of the 2019 cohort. Level of EvidenceIII. COVID19 COVID 19 COVID-1 surgeries andor 2019. . (2019) 201 Demographics motion disposition analyzed 16 5 202 17 p= p (p 0.13. 013 0.13 0 0.13) 3 4 0.04. 004 0.04 04 0.04) 96 71 0.003. 0003 0.003 003 0.003) 100 86 inperson person followup follow up 0.006. 0006 0.006 006 0.006) 2 0.10. 010 0.10 10 0.10) age ASA (ASA scores cohorts However cohort EvidenceIII COVID1 COVID- (2019 20 01 0.1 00 0.0 9 7 000 0.00 8 (201 0. (20 (2 (

Resumo Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019). Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados. Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p= 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p= 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p= 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p= 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p= 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes. Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019. Nível de EvidênciaIII. COVID19 COVID 19 COVID-1 eletivas eou . (2019) 1 201 demográficos movimento hospitalização pósoperatório pós operatório analisados 16 5 202 17 p= p (p 0,13. 013 0,13 0 0,13) 3 4 0,04. 004 0,04 04 0,04) 96 71 0,003. 0003 0,003 003 0,003) 86 0,006. 0006 0,006 006 0,006) 2 0,10. 010 0,10 10 0,10) idade ASA, ASA (ASA inglês coortes entanto COVID19. 19. EvidênciaIII COVID1 COVID- (2019 20 01 0,1 00 0,0 9 7 000 0,00 8 (201 0, (20 (2 (

Resumen Introducción: La importancia del entrenamiento físico en el bádminton se refleja en la calidad de los movimientos técnicos y tácticos en el campo, mejorando en el deportista la fuerza física suficiente como soporte y el nivel de aptitud física necesario para su rendimiento deportivo, reduciendo las lesiones deportivas y sobre todo aumentando sus índices de aciertos. Objetivo: Estudiar el efecto del entrenamiento funcional sobre la tasa de golpeo en jugadores de bádminton. Métodos: Se utilizaron métodos de investigación bibliográfica y experimental, a través de la prueba de nivel técnico de bádminton ITN y el sistema de cribado sobre el movimiento funcional (FMS). Se comparó y analizó el efecto del entrenamiento funcional teniendo en cuenta la calidad del retorno de la línea de base y la calidad del movimiento funcional de 12 jóvenes jugadores de bádminton. Resultados: En comparación con la prueba previa, la puntuación estadística media de profundidad y precisión de alcance de la línea de base aumentó significativamente después de las 8 semanas de entrenamiento funcional (P<0,05); la puntuación de la prueba de profundidad y precisión de la línea de base del grupo de control mejoró ligeramente pero no significativamente (P>0,05). Conclusión: Los jóvenes jugadores de bádminton que añaden el entrenamiento funcional al entrenamiento físico demuestran impactos más relevantes en sus índices de golpeo. Estos ejercicios también demostraron que pueden fortalecer la musculatura y aumentar la flexibilidad de las articulaciones del hombro, la cadera y la rodilla. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento. Introducción campo deportivo aciertos Objetivo Métodos experimental FMS. FMS . (FMS) 1 Resultados previa P<0,05 P005 P 0 05 (P<0,05) P>0,05. P>0,05 (P>0,05) Conclusión hombro rodilla II tratamiento (FMS P<0,0 P00 (P<0,05 P>0,0 (P>0,05 P<0, P0 (P<0,0 P>0, (P>0,0 P<0 (P<0, P>0 (P>0, P< (P<0 P> (P>0 (P< (P> (P

ABSTRACT Introduction: The importance of physical training in badminton is reflected in the quality of technical and tactical movements in the field, improving the athlete the physical strength enough as support and the level of physical fitness necessary for their sports performance, reducing sports injuries and, mainly, increasing their hitting rates. Objective: Study the effect of functional training on the hit rate in badminton players. Methods: Bibliographic and experimental research methods were used through the ITN badminton technical level test and the functional movement screening system (FMS). The effect of functional training was compared and analyzed considering baseline return quality and functional movement quality of 12 young badminton players. Results: Compared to the pre-test, the mean baseline reaching depth and accuracy statistical score increased significantly after the 8 weeks of functional training (P<0.05); the control group baseline depth and accuracy test score improved slightly but not significantly (P>0.05). Conclusion: Young badminton players who add functional training to physical training demonstrate more relevant impacts on their hitting rates. These exercises have also demonstrated that they can strengthen muscles and increase shoulder, hip, and knee flexibility. Level of evidence II; Therapeutic studies - investigating treatment outcomes. Introduction field performance mainly rates Objective Methods FMS. FMS . (FMS) 1 Results pretest, pretest pre test, pre-test P<0.05 P005 P 0 05 (P<0.05) P>0.05. P>0.05 (P>0.05) Conclusion shoulder hip flexibility II outcomes (FMS P<0.0 P00 (P<0.05 P>0.0 (P>0.05 P<0. P0 (P<0.0 P>0. (P>0.0 P<0 (P<0. P>0 (P>0. P< (P<0 P> (P>0 (P< (P> (P

RESUMO Introdução: A importância do treinamento físico no badminton é refletida na qualidade dos movimentos técnicos e táticas em campo, aprimorando no atleta a força física suficiente como suporte e o nível de aptidão física necessário ao seu desempenho esportivo, diminuindo as lesões esportivas e, principalmente, aumentando as suas taxas de acertos. Objetivo: Estudar o efeito do treinamento funcional sobre a taxa de acertos nos jogadores de badminton. Métodos: Os métodos de pesquisa bibliográfica e experimentais foram utilizados, através do teste de nível técnico do ITN badminton e do sistema de triagem sobre o movimento funcional (FMS). O efeito do treinamento funcional foi comparado e analisado considerando a qualidade do retorno de linha de base e a qualidade do movimento funcional de 12 jogadores jovens de badminton. Resultados: Em comparação com o pré-teste, a pontuação média da linha de base que atingiu profundidade e precisão estatística aumentou significativamente após as 8 semanas de treinamento funcional (P<0,05); a pontuação do grupo controle no teste de profundidade e precisão da linha de base melhorou ligeiramente, mas não significativamente (P>0,05). Conclusão: Jovens jogadores de badminton que adicionam o treinamento funcional ao treinamento físico demonstram impactos mais relevantes em suas taxas de acerto. Esses exercícios demonstraram também que podem fortalecer a musculatura e a aumentar a flexibilidade nas articulações do ombro, quadril e joelho. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento. Introdução campo esportivo principalmente Objetivo Métodos utilizados FMS. FMS . (FMS) 1 Resultados préteste, préteste pré teste, pré-teste P<0,05 P005 P 0 05 (P<0,05) ligeiramente P>0,05. P>0,05 (P>0,05) Conclusão acerto ombro joelho II tratamento (FMS P<0,0 P00 (P<0,05 P>0,0 (P>0,05 P<0, P0 (P<0,0 P>0, (P>0,0 P<0 (P<0, P>0 (P>0, P< (P<0 P> (P>0 (P< (P> (P

ABSTRACT Afforestation of sites disturbed after bauxite mining is the favorite technique to restore all ecosystem functions. The nature of the tree species used for revegetation of post-mining land can accelerate the recovery of soil organic matter and nutrient cycles. This study aimed to determine the litterfall production, decomposition rate and nutrient content from three types of forest cover ( Eucalyptus , Anadenanthera peregrina , mixed plantation of 16 native species) planted in a bauxite mining area in recovery. Litterfall production was evaluated monthly over 30 months, and the litter mass was assessed twice a year (dry and rainy periods). Total nutrient content was determined from samples grouped by period (dry and rainy). The annual average values for litterfall dry mass and litter mass were higher in Eucalyptus and mixed native. The period (dry or rainy) did not influence litterfall rates in A. peregrina , but Eucalyptus and mixed native presented higher amounts for litterfall during the rainy and dry periods, respectively. Litter accumulation in Eucalyptus was not affected by the season of the year, but mixed native and A. peregrina presented higher litter accumulation in the dry season. Apparent decomposition rates of A. peregrina and mixed native were higher in the rainy season, highlighting the A. peregrina with the highest values compared with the other forest covers. The mixed native presented the highest leaf content of P, K, Ca and Mg in both the litterfall and litter mass, while Eucalyptus had the lowest P, K, Ca, S and N content and the highest C content in the litterfall. Litterfall production is important in degraded areas to ensure the nutrient return to the soil. The data obtained suggest that the cultivation of a mixed of 16 native trees contribute for produce the higher annual litterfall yields, besides produces leaf litterfall of better nutritional quality in relation to P, K, Ca, Mg and S. Therefore, mixed of native trees can be a promising option for reactivation of nutrient cycling and organic matter formation in mined area of bauxite in the Brazilian Atlantic Forest. functions postmining post cycles 1 3 months periods. periods . periods) rainy. A respectively covers P K yields Therefore Forest

ABSTRACT BACKGROUND: Despite its increasing popularity, laparoscopy is not the option for bariatric surgeries performed in the Brazilian public health system. AIMS: To compare laparotomy and laparoscopic access in bariatric surgery, considering aspects such as morbidity, mortality, costs, and length of stay. METHODS: The study included 80 patients who were randomly assigned to perform a Roux-en-Y gastric bypass. They were equally divided in two groups, laparoscopic and laparotomy. The results obtained in the postoperative period were evaluated and compared according to the Ministry of Health protocol, and later, in their outpatient returns. RESULTS: The surgical time was similar in both groups (p=0.240). The costs of laparoscopic surgery proved to be higher, mainly due to staplers and staples. The patients included in the laparotomy group presented higher rates of severe complications, such as incisional hernia (p<0.001). Costs related to social security and management of postoperative complications were higher in the open surgery group (R$ 1,876.00 vs R$ 34,268.91). CONCLUSIONS: The costs related to social security and treatment of complications were substantially lower in laparoscopic access when compared to laparotomy. However, considering the operative procedure itself, the laparotomy remained cheaper. Finally, the length of stay, the rate of complications, and return to labor had more favorable results in the laparoscopic route. BACKGROUND popularity system AIMS morbidity mortality stay METHODS 8 RouxenY Roux en Y bypass protocol later returns RESULTS p=0.240. p0240 p p=0.240 . 0 240 (p=0.240) staples p<0.001. p0001 p<0.001 001 (p<0.001) R (R 187600 1 876 00 1,876.0 34,268.91. 3426891 34,268.91 34 268 91 34,268.91) CONCLUSIONS However itself cheaper Finally route p024 p=0.24 24 (p=0.240 p000 p<0.00 (p<0.001 18760 87 1,876. 342689 34,268.9 3 26 9 p02 p=0.2 2 (p=0.24 p00 p<0.0 (p<0.00 1876 1,876 34268 34,268. p0 p=0. (p=0.2 p<0. (p<0.0 187 1,87 3426 34,268 p=0 (p=0. p<0 (p<0. 18 1,8 342 34,26 p= (p=0 p< (p<0 1, 34,2 (p= (p< 34, (p

RESUMO RACIONAL: Apesar de sua crescente popularidade, a laparoscopia não é a via de acesso em cirurgias bariátricas realizadas no sistema público de saúde brasileiro. OBJETIVOS: Comparar os acessos laparoscópico e laparotômico em cirurgia bariátrica, considerando aspectos como morbidade, mortalidade, custos e tempo de hospitalização. MÉTODOS: Foram incluídos 80 pacientes candidatos a by-pass gástrico em Y-de-Roux, aleatoriamente divididos em dois grupos, de acordo com a via de acesso. Os resultados obtidos no período pós-operatório foram avaliados e comparados de acordo com o protocolo do Ministério da Saúde, e posteriormente, em seus retornos ambulatoriais. RESULTADOS: O tempo cirúrgico foi semelhante em ambos os grupos (p=0.240). Os custos da cirurgia laparoscópica foram maiores, principalmente devido aos grampeadores e cargas. Contudo, os pacientes designados à via aberta apresentaram maior índice de complicações graves, como hérnia incisional (p<0.001). Desta forma, os custos com o tratamento das complicações e com o seguro social foram maiores neste grupo (R$ 1,876.00 vs R$ 34,268.91). CONCLUSÃO: Os gastos relacionados ao seguro social e ao tratamento de complicações foram substancialmente menores na cirurgia laparoscópica quando comparada à cirurgia aberta. Entretanto, considerando o procedimento operatório em si, a via aberta foi a mais acessível financeiramente. Por fim, o tempo de hospitalização, a taxa de complicações e o tempo de retorno ao trabalho tiveram resultados mais favoráveis na via laparoscópica. RACIONAL popularidade brasileiro OBJETIVOS bariátrica morbidade mortalidade hospitalização MÉTODOS 8 bypass by pass YdeRoux, YdeRoux Y Roux, Roux Y-de-Roux pósoperatório pós Saúde posteriormente ambulatoriais RESULTADOS p=0.240. p0240 p p=0.240 . 0 240 (p=0.240) cargas Contudo graves p<0.001. p0001 p<0.001 001 (p<0.001) forma R (R 187600 1 876 00 1,876.0 34,268.91. 3426891 34,268.91 34 268 91 34,268.91) CONCLUSÃO Entretanto si financeiramente fim p024 p=0.24 24 (p=0.240 p000 p<0.00 (p<0.001 18760 87 1,876. 342689 34,268.9 3 26 9 p02 p=0.2 2 (p=0.24 p00 p<0.0 (p<0.00 1876 1,876 34268 34,268. p0 p=0. (p=0.2 p<0. (p<0.0 187 1,87 3426 34,268 p=0 (p=0. p<0 (p<0. 18 1,8 342 34,26 p= (p=0 p< (p<0 1, 34,2 (p= (p< 34, (p

RESUMEN Objetivos: mapear la evidencia científica sobre el uso de compresiones abdominales durante la reanimación cardiopulmonar en pacientes con paro cardíaco. Métodos: esta es una revisión de alcance basada en la pregunta: “¿Cuál es la evidencia con respecto al uso de compresiones abdominales durante la reanimación cardiopulmonar en pacientes con paro cardíaco?”. Se recopilaron publicaciones hasta agosto de 2022 de ocho bases de datos. Se utilizó la extensión de Informes Preferidos para Revisiones Sistemáticas y Metaanálisis para Revisiones de Alcance. Resultados: se incluyeron diecisiete publicaciones. La población general identificada estaba compuesta por adultos y personas mayores. El resultado primario reveló tasas significativas de retorno de la circulación espontánea. Los resultados secundarios indicaron una mejora significativa en la frecuencia cardíaca, la presión arterial, la saturación de oxígeno y otros resultados. Conclusiones: las compresiones abdominales han demostrado ser beneficiosas. Sin embargo, se necesitan más estudios clínicos para identificar el mejor método de ejecución y sus impactos. Objetivos cardíaco Métodos pregunta ¿Cuál Cuál . cardíaco?” 202 datos Alcance Resultados mayores espontánea cardíaca arterial Conclusiones beneficiosas embargo impactos cardíaco? 20 2

ABSTRACT Objectives: to map the scientific evidence on the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest. Methods: this is a scoping review based on the question: “What is the evidence regarding the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest?”. Publications up to August 2022 were collected from eight databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used. Results: seventeen publications were included. The identified general population consisted of adults and elderly individuals. The primary outcome revealed significant rates of return of spontaneous circulation. Secondary outcomes indicated a significant improvement in heart rate, blood pressure, oxygen saturation, and other outcomes. Conclusions: abdominal compressions have been shown to be beneficial. However, further clinical studies are needed to identify the best execution method and its impacts. Objectives arrest Methods question What . arrest?” 202 databases MetaAnalyses Meta Analyses used Results included individuals circulation rate pressure saturation Conclusions beneficial However impacts arrest? 20 2

RESUMO Objetivos: mapear as evidências científicas sobre o uso de compressões abdominais durante a reanimação cardiopulmonar em pacientes com parada cardiorrespiratória. Métodos: trata-se de uma revisão de escopo, baseada na questão: “quais são as evidências sobre o uso de compressões abdominais durante a reanimação cardiopulmonar em pacientes com parada cardiorrespiratória?”. Foram coletadas as publicações até agosto de 2022 em oito bases de dados. Foi utilizado o Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Resultados: incluiu-se 17 publicações. O público geral identificado foi composto por adultos e idosos. O desfecho primário evidenciou taxas significativas de retorno da circulação espontânea. Os desfechos secundários indicaram melhora significativa na frequência cardíaca, pressão arterial, saturação de oxigênio e outros resultados. Conclusões: as compressões abdominais mostraram-se benéficas. No entanto, mais estudos clínicos são necessários para identificar o melhor método de execução e seus impactos. Objetivos cardiorrespiratória Métodos tratase trata se escopo questão quais . cardiorrespiratória?” 202 dados MetaAnalyses Meta Analyses Resultados incluiuse incluiu 1 idosos espontânea cardíaca arterial resultados Conclusões mostraramse mostraram benéficas entanto impactos cardiorrespiratória? 20 2