Abstract Introduction: The decay of democracy has led to a growth in political protests worldwide, but even when people perceive their situation as unfair, some do not act. We propose that system justification and learned helplessness are relevant factors in explaining this. Objective: To test a model of collective action that considers factors of inaction. Method: Through structural equation modelling, we estimated models with data from 961 Brazilians, variables were measured through self-report instruments, such as Collective Action scales, the General System Justification Scale, the Social Justice Perception Scale, the Positive and Negative Affect Scale, and the Learned Helplessness Scale. Results: The models had a good fit and supported the derogation effect of system justification on collective action, but only partially corroborated the predicted association between learned helplessness and collective action. In the Multigroup Model, we found that people who hold weaker political motivations are more prone to inaction through learned helplessness. Discussion: Our findings point to the risk of relative deprivation in generating learned helplessness, which may contribute to inaction and social isolation.

Resumen Introducción: La decadencia de la democracia ha provocado un aumento de las protestas políticas en todo el mundo, pero incluso cuando las personas perciben que su situación es injusta, algunas no actúan. Proponemos que la justificación del sistema y la indefensión aprendida son factores relevantes para explicarlo. Objetivo: Probar un modelo de acción colectiva que considera factores de inacción. Método: A través de modelos de ecuaciones estructurales, estimamos modelos con datos de 961 brasileños, las variables fueron medidas por medio de instrumentos de autoinforme, como las escalas de Acción Colectiva, la Escala General de Justificación del Sistema, la Escala de Percepción de Justicia Social, la Escala de Afectos Positivos y Negativos y la Escala de Indefensión Aprendida. Resultados: Los modelos tuvieron un buen ajuste y apoyaron el efecto de derogación de la justificación del sistema en la acción colectiva, pero solo corroboraron parcialmente la asociación predicha entre indefensión

Abstract The association between cacti and nurse plants has been reviewed by different authors. These reviews however were qualitative because only evaluated aspects such as species identity of cacti and nurse plants, probable explanatory causes of their association, and location of study sites. To our knowledge, there are no quantitative reviews that have evaluated the association between cacti and nurse plants for different subfamilies, tribes, and growth forms of cacti and nurse plants, and different plant communities and soil properties. To address these issues, we performed a quantitative review of the studies on the association between cacti and nurse plants. The studies were searched in the ISI Web of Knowledge from 1986 to 2021. Data obtained from studies were analyzed with the relative risk ratio and ratio of medians. Most studies on the association between cacti and nurse plants were performed mainly in Mexico and the USA. Globose, cylindrical, and columnar cacti of the subfamily Cactoideae, and tribes Cacteae, Cereeae, and Echinocereeae were associated to nurse plants of Asteraceae, Euphorbiaceae, and Fabaceae. However, other subfamilies (Opuntioideae) and tribes (Notocacteae) of cacti, and families (Asparagaceae) of nurse plants were not associated. Nurse plants ameliorated temperature, moisture, and nitrogen of soil. The association between cacti and nurse plants occurred in desert shrubland and tropical dry forest. Further studies are needed on the association between cacti and nurse plants that consider more cactus subfamilies and tribes in countries with high cactus diversity in Central and South America.

Resumen La asociación entre cactáceas y plantas nodriza ha sido revisada por diferentes autores. Sin embargo, estas revisiones fueron cualitativas porque solo evaluaron las especies de cactáceas y plantas nodriza, las probables causas de su asociación y los sitios de estudio. Hasta donde sabemos, no existen revisiones cuantitativas que hayan evaluado la asociación entre cactáceas y plantas nodriza para distintas subfamilias, tribus y formas de crecimiento de cactáceas y plantas nodriza, y distintas comunidades de plantas y propiedades del suelo. Para abordar estos aspectos, realizamos una revisión cuantitativa de los estudios sobre la asociación entre cactáceas y plantas nodriza. Los estudios fueron buscados en el ISI Web of Knowledge de 1986 a 2021. Los datos fueron analizados con la razón de riesgo relativo y la razón de medianas. Los estudios sobre la asociación entre cactáceas y plantas nodriza fueron realizados en México y EUA. Las cactáceas globosas, cilíndricas y columnares de la subfamilia Cactoideae y las tribus Cacteae, Cereeae y Echinocereeae estuvieron asociadas a plantas nodriza de Asteraceae, Euphorbiaceae y Fabaceae. Sin embargo, otras subfamilias (Opuntioideae) y tribus (Notocacteae) de cactáceas, y familias (Asparagaceae) de plantas nodriza no estuvieron asociadas. Las plantas nodriza mejoraron la temperatura, humedad y nitrógeno del suelo. La asociación entre cactáceas y plantas nodriza ocurrió en matorral desértico y selva baja caducifolia. Es necesario realizar estudios adicionales sobre la asociación entre cactáceas y plantas nodriza que consideren otras subfamilias y tribus de cactáceas, en países con alta diversidad de cactáceas en Centro y Sudamérica.

Resumo: Introdução: A warfarina é um dos medicamentos mais prescritos para o tratamento e prevenção de doenças tromboembólicas. O benefício na prevenção de eventos trombóticos e na redução da mortalidade está amplamente documentado. No entanto, problemas de segurança limitaram seu uso. O acompanhamento dos pacientes, com atenção especial à informação e educação sobre suas patologias, hábitos saudáveis, adesão ao tratamento e compreensão dos riscos, é fundamental para o alcance de bons resultados, reduzindo a morbimortalidade e internações. Informações sobre o perfil de segurança e a qualidade da anticoagulação em um programa de intervenção educacional são escassas no Uruguai. O objetivo deste estudo é analisar o efeito de um plano de intervenção educacional aprimorado com assistência farmacêutica (IEPAF) , na qualidade da anticoagulação com warfarina em pacientes ambulatoriais na unidade multidisciplinar de insuficiência cardíaca (UMIC), e comparar a eficácia e segurança de tratamento e avaliar a utilidade do escore SAMeTT2R2. Metodologia: Ensaio clínico randomizado. Pacientes em acompanhamento em UMIC em tratamento com warfarina foram recrutados e randomizados para controle médico usual versus controle médico com ajustes de dose de acordo com protocolo estabelecido, além IEPAF. Resultados: Após 24 meses de seguimento, ambos os grupos mantiveram um bom nível de anticoagulação, com tempo na faixa terapêutica (TTR) de 83,15% e 83,80% para os grupos controle e intervenção, respectivamente. A intervenção educacional aprimorada e o protocolo de ajuste de dose de warfarina forneceram resultados comparáveis ao monitoramento de anticoagulação convencional. Conclusões: O IEPAF com assistência farmacêutica promoveu resultado comparável em segurança, eficácia e adesão em relação ao acompanhamento convencional. Ambos os grupos alcançaram um excelente nível de anticoagulação avaliado pela TTR. Da análise post hoc emerge uma associação estatisticamente significativa dos valores 4 e 6 do SAMeTT2R2 com a ocorrência de eventos, com risco relativo 5 vezes maior para o sexo feminino.

Resumen: Introducción: La warfarina es uno de los medicamentos más prescritos en el tratamiento y prevención de enfermedades tromboembólicas. El beneficio en la prevención de eventos trombóticos y en la reducción de la mortalidad está ampliamente documentado. Sin embargo, los aspectos relacionados con la seguridad han limitado su uso. El acompañamiento de pacientes, con especial atención en la información y educación sobre sus patologías, hábitos saludables, cumplimiento de tratamientos y comprensión de riesgos, es fundamental para conseguir buenos resultados, disminuyendo la morbi-mortalidad y las internaciones. La información respecto al perfil de seguridad y la calidad de la anticoagulación bajo un programa de intervención educativa es escasa en Uruguay. El objetivo de este estudio es analizar el efecto de un plan de intervención educativa potenciada con atención farmacéutica (IEPAF), sobre la calidad de anticoagulación con warfarina de pacientes ambulatorios de la unidad multidisciplinaria de insuficiencia cardíaca (UMIC), comparar la efectividad y seguridad del tratamiento, y evaluar la utilidad del score SAMeTT2R2. Metodología: Ensayo clínico randomizado. Se reclutaron pacientes en seguimiento en la UMIC tratados con warfarina y se randomizaron a control médico habitual vs control médico con ajustes de dosis según un protocolo establecido, más IEPAF. Resultados: Luego de 24 meses de seguimiento, ambos grupos mantuvieron buen nivel de anticoagulación, con tiempo en rango terapéutico (TTR) de 83,15% y 83,80% para grupo control e intervención respectivamente. La intervención educativa potenciada y el protocolo de ajuste de dosis de warfarina, aportó un resultado equiparable al seguimiento convencional de la anticoagulación. Conclusiones: La IEPAF promovió un resultado equiparable en seguridad, efectividad y adherencia con respecto al seguimiento convencional. Ambos grupos lograron un excelente nivel de anticoagulación evaluado por TTR. Del análisis post hoc surge una asociación estadísticamente significativa de los valores de SAMeTT2R2 4 y 6, con la aparición de eventos, con un riesgo relativo 5 veces mayor para el sexo femenino.

Abstract: Introduction: Warfarin is one of the most prescribed drugs for the treatment and prevention of thromboembolic diseases. The benefit of the prevention of thrombotic events and the reduction of mortality is widely documented. However, security issues have limited its use. Monitoring patients, with special attention to information and education about their pathologies, healthy habits, compliance with treatment, and understanding of risks, is essential to achieve good results, reducing morbidity, mortality and hospitalizations. Information regarding anticoagulation’s safety profile and quality under an educational intervention program is scarce in Uruguay. The objective of this study is to analyze the effect of an enhanced educational intervention plan with pharmaceutical care (IEPAF), on the quality of anticoagulation with warfarin in outpatients in the multidisciplinary heart failure unit (UMIC), and to compare the effectiveness and safety of treatment, and to evaluate the usefulness of the SAMeTT2R2 score. Methodology: Randomized clinical trial. Patients under follow-up in UMIC treated with warfarin were recruited and randomized to usual medical control vs medical control with dose adjustments according to an established protocol, plus enhanced educational intervention IEPAF. Results: After 24 months of follow-up, both groups maintained a good level of anticoagulation, with time in therapeutic range (TTR) of 83,15% and 83,80% for the control and intervention groups, respectively. The enhanced educational intervention and the warfarin dose adjustment protocol provided results comparable to conventional anticoagulation monitoring. Conclusions: The IEPAF with pharmaceutical care promoted a comparable result in safety, effectiveness, and adherence concerning conventional follow-up. Both groups achieved an excellent level of anticoagulation as assessed by TTR. From the post hoc analysis, a statistically significant association of SAMeTT2R2 values 4 and 6 emerges with events, with a relative risk 5 times greater for the female sex.

Abstract Objective This study aimed to investigate the prevalence of autism spectrum disorder and its possible correlations with clinical characteristics in patients with infantile epileptic spasms syndrome in a single center in Brazil. Methods This retrospective cross-sectional study examined 53 children with the diagnosis of infantile epileptic spasms syndrome prior to an autism spectrum disorder assessment. Participants were divided into two groups based on the presence or absence of autism spectrum disorder. Available variables (sex, medications, median age at onset of infantile epileptic spasms syndrome, and presence of comorbidities) were compared using Mann-Whitney U or chi-square tests. Results Among the included patients, 12 (23 %) were diagnosed with autism spectrum disorder, corresponding to a relative risk of 0.29 (95 % confidence interval 0.174-0.492). The age at the first seizure ranged from 3 to 15 months, with a mean of 6.65 months. This age significantly differed between participants with autism spectrum disorder (10.58 months) and those without (5.43 months), p<0.001. Conclusion Children with infantile epileptic spasms syndrome have a higher risk of being diagnosed with autism spectrum disorder. Later age of onset and period of spasm occurrence might be predisposing risk factors. Brazil crosssectional cross sectional 5 assessment sex, sex (sex medications comorbidities MannWhitney Mann Whitney chisquare chi square tests 1 23 (2 029 0 29 0.2 95 (9 0.1740.492. 01740492 0.174 0.492 . 174 492 0.174-0.492) months 665 6 65 6.6 10.58 1058 10 58 (10.5 5.43 543 43 (5.4 , p0001 p 001 p<0.001 factors 2 ( 02 0. 9 1740 0.1740.492 0174049 0174 0.17 0492 0.49 17 49 0.174-0.492 66 6. 10.5 105 (10. 5.4 54 4 (5. p000 00 p<0.00 0.1740.49 017404 017 0.1 049 0.4 0.174-0.49 10. (10 5. (5 p00 p<0.0 0.1740.4 01740 01 04 0.174-0.4 (1 p0 p<0. 0.1740. 0.174-0. p<0 0.1740 0.174-0 p< 0.174-

ABSTRACT Objectives. To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages. Materials and methods. The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models. Results. Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity. Conclusions. Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.

RESUMEN Objetivos. Determinar el requerimiento y tiempo para ventilación mecánica y Unidad de Cuidados Intensivos (UCI), hospitalización y tiempo de hospitalización, muerte y discapacidad de las variantes axonales del Síndrome de Guillain-Barré (SGB) en comparación con la variante aguda desmielinizante en pacientes de todas las edades. Materiales y métodos. Revisión sistemática que incluyó pacientes con SGB; la exposición fueron las variantes axonales y el comparador la polineuropatía desmielinizante inflamatoria aguda (AIDP) los desenlaces fueron el requerimiento y tiempo en ventilación mecánica (VM), requerimiento y tiempo en la UCI, tiempo de hospitalización, discapacidad y muerte. Se utilizó la escala NewCasttle-Ottawa (NOS) para evaluar el riesgo de sesgo. Se realizó un metaanálisis para calcular las diferencias de medias y los riesgos relativos (RR) con sus intervalos de confianza (IC) del 95% utilizando varianzas inversas y modelos de efectos aleatorios. Resultados. De los 3116 artículos encontrados, 46 cumplieron los criterios de selección. El tiempo en VM fue 7,42 días (IC95%: 0,36 a 1,48) y el tiempo de hospitalización fue 3,11 (IC95%: 0,73 a 5,49) días en las variantes axonales. Las variantes axonales tuvieron un RR de 0,47 (IC95%: 0,24 a 0,92) para el requerimiento de VM en adultos, pero en niños fue de 1,68 (IC95%: 1,25 a 2,25). Hubo una alta heterogeneidad estadística. Conclusiones. Las variantes axonales tienen en promedio mayor tiempo de VM y de hospitalización, en total y por subgrupos. Se observó un mayor requerimiento de VM para las variantes axonales en niños; mientras que en los adultos fue menor.

Resumen En Argentina, el virus del dengue ha experimentado un aumento en los últimos años. Este estudio se propone realizar una revisión sistemática para evaluar la efectividad y seguridad de la vacuna TAK-003 tetravalente contra el dengue en este contexto. Se llevó a cabo una revisión sistemática de ensayos clínicos controlados aleatorizados que comparaban la efectividad y seguridad de la vacuna con placebo en la población general. La búsqueda se efectuó en Epistemonikos y dos investigadores evaluaron los estudios de manera independiente. El riesgo de sesgo se evaluó con la herramienta Rob 2 de Cochrane. Se realizó un metaanálisis de los resultados y la certeza en la evidencia se evaluó mediante la metodología GRADE. Concluimos, con alta certeza de evidencia, que la vacuna tetravalente contra el dengue reduce las infecciones graves (RR 0.17, IC 95% 0.12 a 0.24) e infecciones por el virus del dengue (RR 0.40, IC 95% 0.36 a 0.45) en una población de ≤17 años. La vacuna podría no incrementar el riesgo de eventos adversos serios, aunque es importante destacar la baja certeza de evidencia (RR 1.04, IC 95%: 0.69-1.55). La aplicación de la vacuna tetravalente contra el dengue disminuye el riesgo de infecciones graves y no graves por el dengue en esa población. No obstante, existe baja certeza en la evidencia en relación a la seguridad de la vacuna. La decisión de la vacunación debe considerar la magnitud de los beneficios en función del riesgo de infección.

Abstract In Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to assess the effectiveness and safety of the tetravalent dengue vaccine TAK-003 in this context. A systematic review of randomized controlled clinical trials comparing the effectiveness and safety of the vaccine with a placebo in the general population was conducted. The search was carried out on Epistemonikos, and two investigators independently evaluated the studies. Bias risk was assessed using Cochrane’s Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was evaluated using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the dengue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population aged ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine’s safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.

Resumen En Argentina, el virus del dengue ha experimentado un aumento en los últimos años. Este estudio se propone realizar una revisión sistemática para evaluar la efec tividad y seguridad de la vacuna TAK-003 tetravalente contra el dengue en este contexto. Se llevó a cabo una revisión sistemática de ensayos clínicos controlados aleatorizados que comparaban la efectividad y seguridad de la vacuna con placebo en la población general. La búsqueda se efectuó en Episte monikos y dos investigadores evaluaron los estudios de manera independiente. El riesgo de sesgo se evaluó con la herramienta Rob 2 de Cochrane. Se realizó un metaa nálisis de los resultados y la certeza en la evidencia se evaluó mediante la metodología GRADE. Concluimos, con alta certeza de evidencia, que la vacuna tetravalente contra el dengue reduce las infec ciones graves (RR 0.17, IC 95% 0.12 a 0.24) e infecciones por el virus del dengue (RR 0.40, IC 95% 0.36 a 0.45) en una población de ≤17 años. La vacuna podría no incre mentar el riesgo de eventos adversos serios, aunque es importante destacar la baja certeza de evidencia (RR 1.04, IC 95%: 0.69-1.55). La aplicación de la vacuna tetravalente contra el dengue disminuye el riesgo de infecciones graves y no graves por el dengue en esa población. No obstante, existe baja certeza en la evidencia en relación a la se guridad de la vacuna. La decisión de la vacunación debe considerar la magnitud de los beneficios en función del riesgo de infección.

Abstract In Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to assess the effectiveness and safety of the tetravalent dengue vaccine TAK-003 in this context. A systematic review of randomized controlled clini cal trials comparing the effectiveness and safety of the vaccine with a placebo in the general population was conducted. The search was carried out on Epistemoni kos, and two investigators independently evaluated the studies. Bias risk was assessed using Cochrane’s Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was evaluated using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the den gue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population aged ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine’s safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.

Resumo Fundamento: A síndrome do PRKAG2 tipicamente se manifesta na adolescência e início da idade adulta, cursando com hipertrofia ventricular esquerda, arritmias e risco de morte súbita. O achado de marcadores ecocardiográficos antes da manifestação clínica nos filhos de pais acometidos pela doença pode facilitar a estratégia de prevenção e planejamento terapêutico para esse grupo de pacientes. Objetivo: Identificar a existência de achados ecocardiográficos que se manifestem precocemente nos filhos de pais acometidos por síndrome do PRKAG2, enquanto ainda assintomáticos. Métodos: Estudo observacional transversal em que sete participantes, filhos de pais com diagnóstico estabelecido de síndrome do PRKAG2, com idades entre 9 meses e 12 anos e diagnóstico genético comprovado, foram submetidos à ecocardiografia convencional e por técnicas avançadas, tendo seus achados comparados aos de grupo controle composto por sete voluntários pareados por sexo e idade, hígidos do ponto de vista cardiovascular. Um valor de p < 0,05 foi considerado significante. Resultados: A ecocardiografia convencional mostrou valores aumentados com significância estatística no grupo caso para átrio esquerdo, septo interventricular, parede posterior do ventrículo esquerdo, massa ventricular indexada e espessura relativa da parede (p < 0,05). O strain sistólico longitudinal global obtido pelo ecocardiograma bidimensional não mostrou diferença estatisticamente significativa entre os grupos caso e controle. Nenhum dos parâmetros ao ecocardiograma tridimensional apresentou significância estatística entre os grupos. Conclusão: Crianças diagnosticadas com PRKAG2 demonstraram achados ecocardiográficos indicativos de tendência à hipertrofia cardíaca. A ecocardiografia pode ser uma ferramenta útil na avaliação e seguimento desse grupo de pacientes, antes do início de manifestações clínicas. Fundamento PRKAG adulta esquerda súbita pacientes Objetivo assintomáticos Métodos participantes 1 comprovado avançadas cardiovascular 005 0 05 0,0 significante Resultados esquerdo interventricular 0,05. . 0,05) Conclusão cardíaca clínicas 00 0,

Abstract Background: PRKAG2 syndrome typically manifests in adolescence and early adulthood, progressing with left ventricular hypertrophy, arrhythmias, and risk of sudden death. Findings of echocardiographic markers before clinical manifestation in children of patients affected by the disease can facilitate prevention strategies and therapeutic planning for this patient group. Objective: To identify the existence of echocardiographic findings that manifest early in children of parents affected by PRKAG2 syndrome, while they are still asymptomatic. Methods: In this cross-sectional observational study, 7 participants who were children of parents with established diagnosis of PRKAG2 syndrome, between the ages of 9 months and 12 years, with proven genetic diagnosis, underwent conventional and advanced echocardiography. Their findings were compared to those of a control group composed of 7 age- and sex-matched volunteers who were healthy from a cardiovascular point of view. P values < 0.05 were considered significant. Results: Conventional echocardiography showed statistically significantly higher values in the case group for left atrium, interventricular septum, left ventricular posterior wall, indexed ventricular mass, and relative wall thickness (p < 0.05). Global longitudinal systolic strain on 2-dimensional echocardiography did not show statistical significance between the case and control groups. None of the parameters on 3-dimensional echocardiography showed statistical significance between groups. Conclusion: Children diagnosed with PRKAG2 showed echocardiographic findings indicative of a tendency toward cardiac hypertrophy. Echocardiography can be a useful tool in the evaluation and follow-up of this patient group before the onset of clinical manifestations. Background PRKAG adulthood hypertrophy arrhythmias death Objective asymptomatic Methods crosssectional cross sectional study 1 years age sexmatched sex matched view 005 0 05 0.0 significant Results atrium septum mass p 0.05. . 0.05) 2dimensional dimensional 2 groups 3dimensional 3 Conclusion followup follow up manifestations 00 0.

ABSTRACT Background. Electron density (ED) imaging might be able to detect myocardial tissue differences indistinguishable for con ventional non-contrast computed tomography (CT). Objectives. To evaluate whether there are differences in myocardial ED associated with sex, and if present, their relationship with cardiovascular risk factors or coronary calcification. Methods. Patients were participants of a prospective single center observational study comprising asymptomatic subjects between 50 and 75 years old, referred for a low-dose chest CT. All images were obtained using a dual-layer detector spectral CT, and evaluated using conventional CT (120 kVp) and ED images. Results. A total of 171 patients were included. Myocardial attenuation was not related to sex or coronary risk factors (all p >0.05), whereas the percent electron density relative to water (%EDW) was significantly higher among males (p <0.0001), and patients with diabetes (p = 0.007), hypertension (p = 0.004), and obesity (p = 0.004). The extent of coronary artery calcification was unrelated to neither the myocardial attenuation, nor the myocardial ED. At univariate analysis, male sex was the only variable associated with a high %EDW (p = 0.011), whereas age, diabetes, obesity, smoking, hypertension, and CACSIS (coronary artery calcification segment involvement score), were not. Logistic regression analysis including sex, obesity, diabetes, and hypertension in the model, identified male sex as the only independent predictor of a high %EDW (OR 2.51, 95%CI 1.23-5.34, p=0.016). Conclusions. In this study, ED imaging identified myocardial tissue differences that conventional CT was unable to discriminate, with a higher %EDW in men and in patients with cardiovascular risk factors. Male sex was the only independent predictor of a high %EDW

RESUMEN Introducción. Las imágenes de densidad electrónica (DE) podrían detectar diferencias miocárdicas tisulares no distinguibles mediante la tomografía computarizada (TC) convencional sin contraste. Objetivos. Evaluar si existen diferencias de DE miocárdica asociadas al sexo, y de estar presentes, su relación con factores de riesgo cardiovascular o calcificación coronaria. Material y métodos. Los pacientes pertenecían a un estudio prospectivo observacional de centro único que incluyó sujetos asintomáticos entre 50 y 75 años, derivados para realizar una TC de tórax de baja dosis. Todas las imágenes se obtuvieron mediante un equipo de TC espectral dual, y fueron evaluadas utilizando imágenes de TC convencional (120 kVp) y de DE. Resultados. Se incluyó un total de 171 pacientes. La atenuación miocárdica no estuvo relacionada con el sexo o factores de riesgo coronarios (todos con p >0,05), mientras que el porcentaje de densidad electrónica respecto del agua (%EDW, por su sigla en inglés) fue significativamente mayor en la población masculina (p<0,0001), y en los pacientes con diabetes (p=0,007), hipertensión (p=0,004) y obesidad (p=0,004). La extensión de la calcificación coronaria no estuvo relacionada ni con la ate nuación ni con la DE miocárdicas. En el análisis univariado, el sexo masculino fue la única variable asociada a un %EDW elevado (p=0,011), mientras que la edad, la diabetes, la obesidad, el tabaquismo, la hipertensión y el score CACSIS (score de calcificación de las arterias coronarias), no. Un modelo de regresión logística que incluyó sexo, obesidad, diabetes e hipertensión, identificó al sexo masculino como el único predictor independiente de %EDW elevado (OR 2,51, IC 95% 1,23-5,34, p=0,016). Conclusiones. En este estudio, las imágenes de DE identificaron diferencias en el tejido miocárdico que la TC convencional fue incapaz de discriminar, con un mayor %EDW en hombres y en pacientes con factores de riesgo cardiovascular. El sexo masculino fue el único predictor independiente de %EDW elevado.

Abstract Background Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients. Methods We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained. Results In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold. Conclusions Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil. (CS rates VAECMO VA ECMO (VA-ECMO discussions Therefore costeffectiveness, costeffectiveness cost effectiveness, effectiveness low middleincome middle income Brazil uncertain.Objectives uncertainObjectives uncertain Objectives costutility utility costs ICERs (ICERs qualityadjusted quality adjusted QALY (QALY lifeyear gained basecase base case Int 37491 37 491 37,49 results VAECMO, ECMO, 78 willingnesstopay willingness pay threshold that framework costeffective effective However research profiles systems socioeconomically socio economically 3749 3 49 37,4 7 374 4 37,

Resumo Fundamento O choque cardiogênico (CC) refratário está associado com altas taxas de mortalidade, e o uso de oxigenação por membrana extracorpórea venoarterial (VA-ECMO, do inglês venoarterial extracorporeal membrane oxygenation) como uma opção terapêutica tem gerado discussões. Nesse sentido, sua custo-efetividade, principalmente em países de baixa e média renda como o Brasil, continua incerto.Objetivos: Conduzir uma análise de custo-efetividade na perspectiva do Sistema Único de Saúde (SUS) para avaliar a custo-efetividade de VA-ECMO combinado com o tratamento padrão em comparação ao tratamento padrão isolado em pacientes adultos com CC refratário. Métodos Acompanhamos uma coorte de pacientes com CC refratário tratados com VA-ECMO em centros de assistência terciária do sul brasileiro. Coletamos dados de desfechos e custos hospitalares. Realizamos uma revisão sistemática para complementar nossos dados e usamos o modelo de Markov para estimar a razão de custo-efetividade incremental (RCEI) por ano de vida ajustado pela qualidade (QALY) e por ano de vida ganho. Resultados Na análise do caso-base, a VA-ECMO gerou uma RCEI de Int$ 37 491 por QALY. Análises de sensibilidade identificaram o custo de internação, o risco relativo de sobrevida, e a sobrevida do grupo submetido à VA-ECMO como principais variáveis influenciando os resultados. A análise de sensibilidade probabilística mostrou um benefício do uso de VA-ECMO, com uma probabilidade de 78% de custo-efetividade no limiar recomendado de disposição a pagar. Conclusões Nosso estudo sugere que, dentro do SUS, VA-ECMO pode ser uma terapia custo-efetiva para o CC refratário. Contudo, a escassez de dados sobre a eficácia e de ensaios clínicos recentes que abordem seus benefícios em subgrupos específicos de pacientes destaca a necessidade de mais pesquisas. Ensaios clínicos rigorosos, incluindo perfis diversos de pacientes, são essenciais para confirmar a custo-efetividade com uso de VA-ECMO e assegurar acesso igualitário a intervenções médicas avançadas dentro dos sistemas de saúde, especialmente em países com desigualdades socioeconômicas como o Brasil. (CC mortalidade VAECMO, VAECMO VA ECMO, ECMO (VA-ECMO oxygenation discussões sentido custoefetividade, custoefetividade efetividade, efetividade Brasil incerto.Objetivos incertoObjetivos incerto Objetivos SUS (SUS brasileiro hospitalares (RCEI QALY (QALY ganho casobase, casobase caso base, base caso-base Int 3 49 internação resultados 78 pagar custoefetiva efetiva Contudo pesquisas rigorosos saúde 4 7

Abstract Background Cutaneous squamous cell carcinoma (CSCC) is one of the most common types of skin cancer worldwide. Therefore, the identification of biomarkers associated with CSCC progression could aid in the early detection of high-risk squamous cell carcinoma and the development of novel therapeutic strategies. Objective This study aimed to investigate the expression patterns of silent mating type Information Regulation 2 homolog 6 (SIRT6) in CSCC and its clinical significance. Methods The protein expression level of SIRT6 in tissues was detected by immunohistochemistry, and the correlation between SIRT6 expression and clinicopathological parameters in CSCC patients was analyzed. The relative expression of SIRT6 in CSCC cell lineage and tissue specimens was determined by western blotting and PCR. The effect of SIRT6 silencing on cell proliferation was evaluated using cell counting kit 8. Wound healing, transwell method, and flow cytometry were used to investigate the migration, invasion, and cell cycle distribution/apoptosis of CSCC cells after SIRT6 silencing, respectively. Western blot was used to detect the expression of EMT (Epithelial-Mesenchymal Transition), cycle, apoptosis, and other related proteins. Results The high expression of SIRT6 was correlated with the location of cancer tissue and Broder staging in CSCC patients. Knockdown of SIRT6 inhibited the proliferation, migration, invasion and EMT of CSCC cells, and promoted their apoptosis, with cells blocked in G1 phase. Study limitations No animal experiments were conducted to further verify the results. Conclusion Decreased expression of SIRT6 can inhibit the occurrence and development of CSCC. (CSCC worldwide Therefore highrisk risk strategies SIRT (SIRT6 significance immunohistochemistry analyzed PCR 8 healing method migration distributionapoptosis distribution apoptosis respectively EpithelialMesenchymal Epithelial Mesenchymal Transition, Transition , Transition) proteins G phase results (SIRT

ABSTRACT The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study’s findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study’s design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field. study Medicine 23 allcause all cause endstage end stage highflux flux studys s death 202 project 136 overall elderly, elderly (elderly vintage nondiabetic, nondiabetic non diabetic, diabetic non-diabetic issues. issues . issues) Interestingly infection COVID19. COVID19 COVID 19. 19 COVID-19 sustainability effects costeffectiveness. costeffectiveness cost effectiveness. effectiveness cost-effectiveness However now therapy field 2 20 13 COVID1 1 COVID-1 COVID-

RESUMO O estudo CONVINCE, publicado recentemente no New England Journal of Medicine, revela uma redução inovadora de 23% no risco relativo de mortalidade por todas as causas entre pacientes renais em estágio terminal submetidos à hemodiafiltração de alto volume de convecção. Esse achado significativo desafia o uso convencional da hemodiálise de alto fluxo e oferece esperança de melhoria dos desfechos em pacientes com doença renal crônica. Embora algumas controvérsias cerquem os achados do estudo, incluindo preocupações sobre a generalização e as causas de óbito, é essencial reconhecer o desenho do estudo e seus principais desfechos. O estudo CONVINCE, parte do projeto HORIZON 2020, inscreveu 1.360 pacientes e demonstrou a superioridade da hemodiafiltração na redução da mortalidade por todas as causas em geral, bem como em subgrupos específicos de pacientes (idosos, HD de curta duração, não diabéticos e aqueles sem problemas cardíacos). Curiosamente, demonstrou-se que a hemodiafiltração teve um efeito protetor contra infecções, incluindo a COVID-19. Pesquisas futuras abordarão sustentabilidade, efeitos de escalonamento da dose, identificação de subgrupos especialmente propensos a se beneficiar e a relação custo-benefício. No entanto, por ora, os achados apoiam fortemente uma adoção mais ampla da hemodiafiltração na terapia renal substitutiva, marcando um avanço significativo na área. CONVINCE Medicine 23 convecção crônica óbito 2020 1360 1 360 1.36 geral idosos, idosos (idosos duração cardíacos. cardíacos . cardíacos) Curiosamente demonstrouse infecções COVID19. COVID19 COVID 19. 19 COVID-19 sustentabilidade dose custobenefício. custobenefício custo benefício. benefício custo-benefício entanto ora substitutiva área 2 202 136 36 1.3 COVID1 COVID-1 20 13 3 1. COVID-

Abstract Background: Although drought and defoliation increase the risk of death of the seedlings in tropical dry forests, few studies have evaluated the impact of this combined factors on the response of species. Questions: What is the seedling water management strategy and how does it affect their growth? How does the combination of drought and defoliation impact the growth of the species? Studied species: Guazuma ulmifoliaLam andPithecellobium dulce(Roxb.) Benth. Study sites and dates: The study was carried out in Autlán, Jalisco, México, between October 2021 and February 2022. Methods: In a greenhouse, the seedlings were submitted to four combined water availability and defoliation treatments. The stomatal conductance and leaf water potential were recorded, and the relative growth rate, final biomass, and biomass allocation were calculated. Results: G. ulmifoliashowed to be an anisohydric species, registered higher growth, and was the most affected by drought, whileP. dulcewas more isohydric, registered lower growth and defoliation was the main stressor. The synergy between Drought × Defoliation negatively impacted the two species' relative growth rate. Conclusions: Regardless of the water management strategy, in the early phases of development, the impact of drought and defoliation was magnified when stressors interacted. Therefore, Drought × Defoliation can limit the regeneration of species within forests, promoting the loss of biodiversity and detriment to the functioning of ecosystems.

Resumen Antecedentes: Aunque la sequía y la defoliación incrementan el riesgo de muerte de las plántulas en los bosques tropicales secos, pocos estudios han evaluado la respuesta de las especies forestales con la combinación de estos factores. Preguntas: ¿Cuál es la estrategia de uso del agua de las plántulas y cómo afecta su crecimiento? ¿Cuál es el impacto de la combinación de Sequía × Defoliación sobre el crecimiento de las especies? Especies estudiadas: Guazuma ulmifolia Lam y Pithecellobium dulce (Roxb.) Benth. Sitio y año de estudio: Autlán, Jalisco, México, entre octubre del 2021 y febrero del 2022. Métodos: En invernadero, las plántulas se sometieron a cuatro tratamientos combinados de disponibilidad de agua y defoliación. Se registró la conductancia estomática y el potencial hídrico de la hoja, y se calculó la tasa de crecimiento relativa, biomasa final y asignación de biomasa. Resultados: G. ulmifolia mostró ser anisohídrica, registró mayor crecimiento y fue más afectada por la sequía, mientras que P. dulce fue más isohídrica, registró menor crecimiento y la defoliación fue el principal estresor. El impacto de la Sequía × Defoliación fue de sinergia en la tasa de crecimiento relativa en ambas especies. Conclusión: Independientemente de la estrategia de uso de agua, en las primeras fases de desarrollo, el impacto de la sequía y defoliación se magnificó cuando interactuaron los estresores. La Sequía × Defoliación pueden limitar la regeneración de las especies dentro de los bosques, promoviendo la pérdida de la biodiversidad y el detrimento del funcionamiento de los ecosistemas.

Abstract Objective: To build a model based on cardiometabolic indicators that allow the identification of overweight adolescents at higher risk of subclinical atherosclerotic disease (SAD). Methods: Cross-sectional study involving 161 adolescents with a body mass index ≥ + 1 z-Score, aged 10 to 19 years. Carotid intima-media complex thickness (IMT) was evaluated using ultrasound to assess subclinical atherosclerotic disease. Cardiometabolic indicators evaluated included nutritional status, central adiposity, blood pressure, lipidic profile, glycemic profile, as well as age and sex. Data was presented using measures of central tendency and dispersion, as well as absolute and relative frequency. The relationship between IMT measurement (outcome variable) and other variables (independent variables) was assessed using Pearson or Spearman correlation, followed by multiple regression modeling with Gamma distribution to analyze predictors of IMT. Statistical analysis was performed using SPSS and R software, considering a significance level of 5 %. Results: It was observed that 23.7 % had Carotid thickening, and the prevalence of abnormal fasting glucose was the lowest. Age and fasting glucose were identified as predictors of IMT increase, with IMT decreasing with age by approximately 1 % per year and increasing with glucose by around 0.24 % per mg/dL. Conclusion: The adolescent at higher risk is younger with higher fasting glycemia levels. Objective SAD. SAD . (SAD) Methods Crosssectional Cross sectional 16 zScore, zScore z Score, Score z-Score years intimamedia intima media (IMT status adiposity pressure profile sex dispersion frequency outcome variable independent correlation software Results 237 23 7 23. thickening lowest increase 024 0 24 0.2 mgdL mg dL mg/dL Conclusion levels (SAD 2 02 0.

RESUMEN Introducción: las mal oclusiones dentarias constituyen un problema de salud a nivel mundial como consecuencia de su alta incidencia en deterioro de la estética, la repercusión en la vida social para la persona que lo padece y el elevado costo que conlleva su tratamiento. Objetivo: determinar los factores de riesgo que predisponen a maloclusión en escolares de primer grado de la escuela primaria “Adalberto Pessant”. Métodos: se realizó en estudio observacional, descriptivo y transversal sobre las mal oclusiones dentales en escolares del primer grado de la escuela primaria “Adalberto Pessant” en el período de 2017 a 2019 en el municipio Manzanillo, provincia Granma. De un universo de 65 pacientes, se eligió una muestra de 62 mediante muestreo no probabilístico intencional. Para el análisis de los datos se empleó estadística descriptiva mediante el cálculo de frecuencias absolutas y relativas porcentuales. Resultados: el sexo masculino fue el más frecuente (54,8 %). La mayoría de los niños en la revisión clínica presentaron caries proximales (53,2 %), hábitos bucales deformantes (79,0 %) y presencia de diastemas (56,5 %). Sola en la minoría se encontró espacios de primate (25,8 %). Según la clasificación de Angle sobresalió el tipo I en un 56,5 % y la succión digital fue el hábito bucal más deformante (69,4 %). Conclusiones: dentro de los factores predisponentes a la maloclusión dental se encuentran la presencia de caries proximales y de hábitos bucales deformantes. La promoción de la salud bucal y la prevención de esta entidad son pilares imprescindibles para disminuir su incidencia.

ABSTRACT Introduction: dental malocclusions are a global health problem due to their high incidence of aesthetic deterioration, the impact on the social life of the person suffering from them and the high cost of their treatment. Objective: to determine the risk factors that predispose students to malocclusion in the first grade of the “Adalberto Pessant” Primary School. Methods: this was an observational, descriptive and cross-sectional study on dental malocclusions in students of the first grade of the primary school “Adalberto Pessant” in the period from 2017 to 2019 in the municipality of Manzanillo, in Granma, Cuba. From a universe of 65 patients, a sample of 62 was selected through intentional non-probabilistic sampling. Descriptive statistics were used for data analysis by calculating absolute and relative percentages. Results: males were the most frequent (54,8 %). Most of the children in the clinical review had proximal caries (53,2 %), deforming oral habits (79,0 %) and presence of diastema (56,5 %). Only in the minority were found primate spaces According to Angle's classification, type I stood out by 56,5 % and digital suction was the most deforming oral habit. (69,4 %). Conclusions: Among the predisposing factors to dental malocclusion are the presence of proximal caries and deforming oral habits. The promotion of oral health and the prevention of this entity are essential pillars to reduce its incidence.