Introduction: In Uruguay, the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) are not part of routine clinical practice. In 2015, a study conducted in the intensive care unit (ICU) at Hospital Pasteur reported an 80% incidence of delirium in patients undergoing invasive mechanical ventilation (IMV), along with limited use of the RASS and CAM-ICU tools. In response, the “For a Delirium-Free ICU” program was launched in 2016 to train healthcare professionals through educational interventions. This study, conducted in 2017, aimed to evaluate the impact of the training program. Objectives: The primary objective of the study was to assess the improvement in the application of the RASS and CAM-ICU tools after the implementation of the educational program. Additionally, the study sought to analyze the incidence of delirium, identify its risk factors, evaluate its relationship with hospital length of stay and mortality, and compare the 2017 delirium incidence with the 2015 results. Methods: A descriptive, prospective study was conducted on patients admitted to the ICU at Hospital Pasteur between March 1 and May 31, 2017. The use of the RASS and CAM-ICU tools was evaluated, and delirium was diagnosed using a positive CAM-ICU. Results: The use of diagnostic tools showed significant improvement: RASS was applied to 100% of patients (225/225), and CAM-ICU was used in 91.6% (206/209). The average compliance rates were 0.54 (SD 0.3) for RASS and 0.70 (SD 0.4) for CAM-ICU. The incidence of delirium in patients with IMV was 79%. Risk factors for delirium included age ≥ 65 years (OR 7.56 [CI 3.34–17.1]), IMV (OR 3.46 [CI 1.15–10.4]), and the number of sedation days (OR 1.88 [CI 1.19–2.96]). Conclusions: The training program significantly increased the use of the RASS and CAM-ICU diagnostic tools in the ICU at Hospital Pasteur. However, the high incidence of delirium remained unchanged compared to the 2015 results. These findings highlight the need to continue educating and training healthcare professionals to improve the detection and management of delirium in clinical practice.

Resumo Introdução: No Uruguai, a Richmond Agitation Sedation Scale (RASS) e o Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) não fazem parte da prática clínica habitual. Em 2015, um estudo realizado na unidade de terapia intensiva (UTI) do Hospital Pasteur revelou uma incidência de delirium de 80% em pacientes sob ventilação mecânica invasiva (VMI), juntamente com um uso limitado das ferramentas RASS e CAM-ICU. Em resposta, o programa “Por uma UTI sem Delirium” foi lançado em 2016 para capacitar os profissionais de saúde por meio de intervenções educativas. Este estudo, realizado em 2017, teve como objetivo avaliar o impacto do programa de capacitação. Objetivos: O objetivo principal foi avaliar a melhora na aplicação das ferramentas RASS e CAM-ICU após a implementação do programa educativo. Adicionalmente, buscou-se analisar a incidência de delirium, identificar seus fatores de risco, avaliar sua relação com o tempo de internação hospitalar e a mortalidade, e comparar a incidência de delirium de 2017 com os resultados de 2015. Métodos: Um estudo descritivo e prospectivo foi realizado em pacientes internados na UTI do Hospital Pasteur entre 1° de março e 31 de maio de 2017. Foi avaliado o uso das ferramentas RASS e CAM-ICU, e o diagnóstico de delirium foi feito por meio de CAM-ICU positivo. Resultados: O uso das ferramentas diagnósticas mostrou um aumento significativo: o RASS foi aplicado em 100% dos pacientes (225/225), enquanto o CAM-ICU foi utilizado em 91,6% (206/209). As taxas médias de adesão foram de 0,54 (DP 0,3) para o RASS e 0,70 (DP 0,4) para o CAM-ICU. A incidência de delirium em pacientes sob VMI foi de 79%. Os fatores de risco associados ao delirium incluíram idade ≥ 65 anos (OR 7,56 [IC 3,34–17,1]), uso de VMI (OR 3,46 [IC 1,15–10,4]) e número de dias de sedação (OR 1,88 [IC 1,19–2,96]). Conclusões: O programa de capacitação aumentou significativamente o uso das ferramentas diagnósticas RASS e CAM-ICU na UTI do Hospital Pasteur. No entanto, a alta incidência de delirium permaneceu inalterada em relação aos resultados de 2015. Esses achados destacam a necessidade de continuar a educação e o treinamento dos profissionais de saúde para melhorar a detecção e o manejo do delirium na prática clínica.

Resumen Introducción: En Uruguay, la Richmond Agitation Sedation Scale (RASS) y el Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) no forman parte de la práctica clínica habitual. En 2015, un estudio realizado en la unidad de cuidados intensivos (UCI) del Hospital Pasteur evidenció una incidencia de delirium del 80% en pacientes con ventilación mecánica invasiva (VMI) y un uso limitado de las herramientas RASS y CAM-ICU. En respuesta a estos hallazgos, en 2016 se implementó el programa Por una UCI sin delirium, cuyo objetivo fue capacitar a los profesionales de la salud a través de intervenciones educativas. En 2017 se llevó a cabo el presente estudio para evaluar el impacto de este programa de capacitación. Objetivos: El estudio tuvo como objetivo principal evaluar la mejora en la aplicación de las herramientas RASS y CAM-ICU tras la implementación del programa educativo. Adicionalmente, se buscó analizar la incidencia de delirium, identificar sus factores de riesgo, evaluar su relación con la duración de la estadía hospitalaria y la mortalidad, y comparar la incidencia de delirium con los resultados obtenidos en 2015. Métodos: Se realizó un estudio descriptivo y prospectivo en pacientes ingresados en la UCI del Hospital Pasteur entre el 1 de marzo y el 31 de mayo de 2017. Se evaluó el uso de las herramientas diagnósticas RASS y CAM-ICU, y se diagnosticó delirium mediante un CAM-ICU positivo. Resultados: El uso de las herramientas diagnósticas mostró un aumento significativo: el RASS se aplicó en el 100% de los pacientes (225/225), mientras que el CAM-ICU se utilizó en el 91,6% (206/209). El cumplimiento promedio fue de 0,54 (DE 0,3) para el RASS y 0,70 (DE 0,4) para el CAM-ICU. La incidencia de delirium en pacientes con VMI fue del 79%. Los factores de riesgo asociados con el delirium incluyeron la edad mayor o igual a 65 años (OR 7,56 [IC 3,34–17,1]), el uso de VMI (OR 3,46 [IC 1,15–10,4]) y el número de días de sedación (OR 1,88 [IC 1,19–2,96]). Conclusiones: El programa de capacitación implementado incrementó de manera notable el uso de las herramientas diagnósticas RASS y CAM-ICU en la UCI del Hospital Pasteur. Sin embargo, la alta incidencia de delirium se mantuvo sin cambios significativos respecto a los resultados de 2015. Estos hallazgos destacan la necesidad de continuar con la educación y la capacitación del personal de salud para mejorar la detección y el manejo del delirium en la práctica clínica.

ABSTRACT: Maxillofacial trauma is one of the fields of surgical activity in our specialty and constitutes a relevant problem in highly complex hospitals, the presence of our specialists being essential within an interdisciplinary team for the resolution of this type of pathology. An adequate management and early treatment is essential from the moment the patient is admitted, without leaving aside the sequelae and the subsequent rehabilitation work for the work and daily reinsertion of the patients. The purpose of this work is to present the experience of the Maxillofacial Surgery team of the Rancagua Hospital in the surgical resolution of 320 maxillofacial fractures with a retrospective review of 5 years. A study was carried out with analysis of the surgical protocols of patients operated on for maxillofacial trauma, in the central pavilion, under general anesthesia, in a period of 5 years. The variables analyzed were diagnosis, age, sex, compromised facial third, type of fracture, approaches used, and type of rigid internal fixation. 368 surgical procedures were performed. The average age of the operated patients was 36 years, with a predominance of the male sex (80.4 %), the middle third was the most affected (49.1 %) followed by fractures of the lower third of the face (35.5 %). It is necessary to develop epidemiological investigations of these pathologies in order to obtain demographic conclusions and contribute to unifying diagnostic and treatment criteria, thus establishing efficient prevention and treatment policies in relation to each service and as a whole at the public health level.

RESUMEN: El trauma maxilofacial es uno de los campos de actividad quirúrgica en nuestra especialidad y constituye un problema relevante en hospitales de alta complejidad, siendo esencial la presencia de nuestros especialistas dentro de un equipo interdisciplinario para la resolución de este tipo de patología. Un manejo adecuado y un tratamiento temprano son esenciales desde el momento en que el paciente es admitido, sin dejar de lado las secuelas y el posterior trabajo de rehabilitación para la reinserción laboral y diaria de los pacientes. El propósito de este trabajo es presentar la experiencia del equipo de Cirugía Maxilofacial del Hospital Dr. Franco Ravera Zunino en la resolución quirúrgica de 320 fracturas maxilofaciales con una revisión retrospectiva de 5 años. Se realizó un estudio con análisis de los protocolos quirúrgicos de pacientes operados por trauma maxilofacial, en pabellón central, bajo anestesia general, en un período de 5 años. Las variables analizadas fueron diagnóstico, edad, sexo, tercio facial comprometido, tipo de fractura, enfoques utilizados y tipo de fijación interna rígida. Se realizaron 368 procedimientos quirúrgicos. La edad promedio de los pacientes operados fue de 36 años, con predominio del sexo masculino (80,4 %), el tercio medio fue el más afectado (49,1 %) seguido de las fracturas del tercio inferior de la cara (35,5 %). Es necesario desarrollar investigaciones epidemiológicas de estas patologías para obtener conclusiones demográficas y contribuir a la unificación de criterios diagnósticos y de tratamiento, estableciendo así políticas eficientes de prevención y tratamiento en relación a cada servicio y en conjunto a nivel de salud pública.

ABSTRACT: Necrotizing fasciitis (NF) is a rare, rapidly progressing, and severe infection of subcutaneous tissues and muscle fascia that can be fatal. It causes rapid tissue necrosis through pathogen-induced vasoconstriction and thrombosis. While commonly found in the torso, abdomen, and limbs, it rarely affects the head and neck. Effective treatment includes early diagnosis, surgery, antibiotics, and hyperbaric oxygen therapy, though mortality remains high. A 40-year-old man with a history of uncontrolled diabetes mellitus (DM) presented with increased volume, erythema, and cramps in the cervical and upper thoracic area. The main diagnosis was NF, requiring surgical debridement of the affected tissue. Despite therapeutic efforts, the patient succumbed to sepsis and multiple organ failure. NF is a life-threatening infection with a very low incidence but a high mortality rate. Cervical NF often arises from odontogenic infections and is associated with systemic factors like diabetes and obesity. Early diagnosis is challenging, but Computed tomography (CT) and the Laboratory risk indicator score for necrotizing fasciitis (LRINEC) score are essential. Effective treatment includes surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy. NF remains a critical condition with high mortality, underscoring the need for early recognition and aggressive treatment strategies to improve patient outcomes.

RESUMEN: La fascitis necrosante (FN) es una infección rara, de rápida progresión y grave de los tejidos subcutáneos y la fascia muscular que puede ser fatal. Causa necrosis tisular rápida a través de la vasoconstricción y trombosis inducidas por patógenos. Aunque se encuentra comúnmente en el torso, abdomen y membros, rara vez afecta la cabeza y el cuello. El tratamiento efectivo incluye un diagnóstico temprano, cirugía, antibióticos y terapia de oxígeno hiperbárico, aunque la mortalidad sigue siendo alta. Un hombre de 40 años con antecedentes de diabetes mellitus (DM) no controlada se presentó con aumento de volumen, eritema y calambres en la zona cervical y torácica superior. El diagnóstico principal fue FN, requiriendo desbridamiento quirúrgico del tejido afectado. A pesar de los esfuerzos terapéuticos, el paciente sucumbió a sepsis y falla multiorgánica. La FN es una infección potencialmente mortal con una incidencia muy baja pero una alta tasa de mortalidad. La FN cervical a menudo surge de infecciones odontogénicas y está asociada con factores sistémicos como la diabetes y la obesidad. El diagnóstico temprano es un desafío, pero la tomografía computarizada (TC) y el puntaje de indicadores de riesgo de laboratorio para fascitis necrosante (LRINEC) son esenciales. El tratamiento efectivo incluye desbridamiento quirúrgico, antibióticos de amplio espectro y terapia de oxígeno hiperbárico. La FN sigue siendo una condición crítica con alta mortalidad, lo que subraya la necesidad de un reconocimiento temprano y estrategias de tratamiento agresivas para mejorar los resultados de los pacientes.

Diesel particulate matter (DPM) is the particulate component of diesel exhaust, which includes diesel soot and aerosols. When released into the atmosphere, DPM can take the form of individual particles or chain aggregates, with most in the invisible sub-micrometer range of 100 nanometres. The main particulate fraction of diesel exhaust consists of fine particles and because of their small size, inhaled particles may easily penetrate deep into the lungs. The rough surfaces of these particles make it easy for them to bind with other toxins in the environment, thus increasing the hazards of particle inhalation. DPM is a significant health hazard in underground mining operations, where the use of diesel-powered equipment in confined spaces can lead to high levels of exposure among people working in these environments. Classified as a carcinogen by the International Agency for Research on Cancer (IARC), DPM has been linked to severe health effects, including respiratory and cardiovascular diseases, as well as an increased risk of lung cancer. Effective management of DPM is essential not only for protecting people's health but also for ensuring regulatory compliance, maintaining operational efficiency, and safeguarding the long-term viability of mining companies.

ABSTRACT Due to the absence of a methodological approach to quantify concatenated risk by earthquake-tsunami in Chile, CRET (Concatenated Risk by Earthquake-Tsunami) is a proposal to estimate, using Geographic Information Systems, publicly available data and surveys, the impacts of a tsunami following an earthquake, as input for the incorporation of risk areas into Territorial Planning Instruments (TPI). CRET was applied in the locality of San Sebastián, municipality of Cartagena, Chile. It was found that 43 census blocks were exposed to concatenated risk in a scenario similar to that of the 1730 earthquake, of which 5 had low risk (11.6%), 13 resulted in medium risk (30.3%), and 25 reached high risk (58.1%). By establishing three levels of risk and through a prospective risk management approach, provisions were created for the adaptability of exposed elements, requirements were set for new land uses, and guidelines were provided for a comprehensive risk reduction plan.

RESUMEN Ante la ausencia metodológica para cuantificar riesgo concatenado sismo-tsunami en Chile, CRET (Concatenated Risk by Earthquake-Tsunami) es una propuesta para estimar (con Sistemas de Información Geográfica, datos de bases públicas y encuestas) los impactos de un tsunami una vez ocurrido un sismo, como insumo a la incorporación de áreas de riesgo en los Instrumentos de Planificación Territorial (IPT). CRET fue aplicado en la localidad de San Sebastián, municipio de Cartagena, Chile. Se encontró que 43 manzanas censales estaban expuestas a riesgo concatenado ante un escenario tsunamigénico similar al generado por el sismo de 1730, de las cuales 5 tuvieron riesgo bajo (11,6%), 13 resultaron en riesgo medio (30,3%) y 25 alcanzaron riesgo alto (58,1%). Mediante el establecimiento de tres niveles de riesgo y un enfoque de gestión prospectiva del riesgo, se generaron disposiciones para la adaptabilidad de elementos expuestos, se establecieron exigencias para nuevos usos de suelo y se indicaron lineamientos para un plan integral de reducción del riesgo.

BACKGROUND: The global rise in the older population, especially in sub-Saharan Africa, has heightened the impact of non-communicable diseases (NCDs), responsible for 74% of global deaths and the leading cause for years lived with disability. Physical activity (PA) has proven to manage NCDs; however, 80% of older adults in sub-Saharan Africa engage in low-to-moderate PA levels. OBJECTIVES: This literature review explores current evidence on the effects of PA on ageing and NCDs in older people in sub-Saharan Africa. Insights gained will enable physiotherapists to refine their PA prescriptions, aligning short-term rehabilitative goals with the broader scope NCD management while fostering principles of healthy ageing. METHOD: Electronic searches were conducted in: PubMed, EBSCOhost (Academic Search Premier - Africa-Wide Information, CINAHL, Health Sources Premier), Scopus and Google-Scholar to identify peer-reviewed studies published after 2010 related to PA, ageing, NCDs and older people (OP) in sub-Saharan Africa. RESULTS: A structured PA protocol, comprising aerobic activity at 60% - 79% of maximal heart rate and resistance training at 50% - 60% of one-repetition maximum (3 weekly sessions each), proved effective in reducing NCDs. Integrating lifestyle behaviour changes further enhanced outcomes, notably improving blood sugar management and cardiac health CONCLUSION: Structured aerobic and resistance PA, combined with lifestyle education, significantly reduces NCD risk factors in older adults, supporting healthy ageing. CLINICAL IMPLICATIONS: The current research base in the field of ageing in SSA is limited, indicating the need for non-pharmacological interventions to manage the prevalence of NCDs, including in mental/cognitive health, where PA has a direct influence.

ABSTRACT Introduction: In Brazil, there is little information about the prevalence of occupational exposure to solar radiation, the main risk factor for non-melanoma skin cancer, the most common neoplasm in the country. Objective: To calculate the prevalence of exposure to solar radiation and its associated factors in the Brazilian employed population. Method: Cross-sectional study, with data from the 2019 National Health Survey. Expanded prevalence and respective 95% confidence intervals (95% CI) for exposure to solar radiation were calculated, according to demographic, socioeconomic, geographic and occupational variables. Multiple logistic regression analysis, stratified by sex, was used to identify the determinants of exposure to solar radiation. The complex sampling design was considered. Results: 88,904,261 workers were evaluated, 23.5% of whom were exposed to solar radiation. Thirty-six percent of men (36.5%; 95%CI 37.0; 39.3) and 7.9% (95%CI 6.0; 7.2) of women were exposed to solar radiation. The economic sectors of agriculture, construction, water, sewage and material waste management activities had the highest percentages of workers occupationally exposed to the sun. The chance of exposure to solar radiation was greater among Black males, with low education level and income, residents of rural areas, in informal jobs and who worked more than 40h/week. Conclusion: The prevalence of exposure to solar radiation in Brazilian workers is high and unequally distributed by sex and economic sectors. Actions to prevent this exposure in work environments must prioritize the most exposed groups of workers, considering economic activities and their demographic, socioeconomic, geographic and occupational determinants.

RESUMO Introdução: No Brasil, há pouca informação sobre a prevalência de exposição ocupacional à radiação solar, principal fator de risco para a neoplasia mais frequente no país, o câncer de pele não melanoma. Objetivo: Calcular a prevalência da exposição à radiação solar e de fatores associados na população ocupada brasileira. Método: Estudo transversal, com dados da Pesquisa Nacional de Saúde de 2019. Calcularam-se as prevalências expandidas e respectivos intervalos de confiança de 95% (IC 95%) para a exposição à radiação solar, segundo as variáveis demográficas, socioeconômicas, geográficas e ocupacionais. Utilizou-se análise de regressão logística múltipla, estratificada por sexo, para identificar os determinantes da exposição à radiação solar. Considerou-se o desenho complexo da amostragem. Resultados: Foram avaliados 88.904.261 trabalhadores, sendo 23,5% expostos à radiação solar. Trinta e seis por cento dos homens (36,5%; IC 95% 37,0; 39,3) e 7,9% (IC 95% 6,0; 7,2) das mulheres estavam expostos à radiação solar. Os setores econômicos da agricultura, construção, água, esgoto e atividades de gestão de resíduos de materiais apresentaram os maiores percentuais de exposição. A chance de exposição à radiação solar foi maior entre o sexo masculino, os pardos, com baixo nível de escolaridade e renda, residentes da área rural, com vínculo trabalhista informal e que trabalharam acima de 40h/semana. Conclusão: A prevalência da exposição à radiação solar nos trabalhadores brasileiros é elevada e desigualmente distribuída por sexo e setores econômicos. Ações de prevenção nos ambientes laborais devem priorizar os grupos de trabalhadores mais expostos, considerando as atividades econômicas e seus determinantes demográficos, socioeconômicos, geográficos e ocupacionais.

RESUMEN Introducción: En el Brasil hay poca información sobre la prevalencia de la exposición ocupacional a la radiación solar, principal factor de riesgo para el cáncer de piel, la neoplasia más común del país. Objetivo: Calcular la prevalencia de exposición a la radiación solar y factores asociados en los trabajadores brasileños. Método: Estudio transversal con datos de la Encuesta Nacional de Salud de 2019. Se calcularon las prevalencias expandidas y los respectivos intervalos de confianza del 95% (IC 95%) para la exposición a la radiación solar, según variables socioeconómicas, geográficas y ocupacionales. Se utilizó un análisis de regresión logística múltiple, estratificado por sexo, para identificar los determinantes de la exposición a la radiación solar. Se consideró el diseño de muestreo complejo. Resultados: Se evaluaron 88 904 261 trabajadores, de los cuales el 23,5% estuvo expuesto a la radiación solar. Treinta y seis por ciento de los hombres (IC 95%: 37,0-39,3) y el 7,9% de las mujeres (IC 95%: 6,0-7,2%) estuvieron expuestos a la radiación solar. Los sectores económicos de agricultura, construcción, agua, alcantarillado y actividades de gestión de residuos de materiales presentaron los mayores porcentajes de exposición. La probabilidad de exposición a la radiación solar fue más alta entre los hombres, los mestizos, de bajo nivel de educación e ingresos, los residentes de zonas rurales, las que tenían un trabajo informal y las que trabajaron más de 40h/semana. Conclusión: La prevalencia de exposición a la radiación solar en los trabajadores brasileños es alta y desigualmente distribuida por género y sectores económicos. Acciones para prevenir esta exposición en los entornos laborales deben priorizar los grupos de trabajadores más expuestos, considerando las actividades económicas y sus determinantes demográficos, socioeconómicos, geográficos y ocupacionales.

RESUMO Objetivo: construir um bundle em segurança do paciente psiquiátrico em internação hospitalar. Métodos: estudo metodológico realizado em duas etapas. Na primeira, uma revisão abrangente da literatura foi desenvolvida por meio da scoping review e conduzida para examinar as evidências sobre a segurança do paciente psiquiátrico em internação hospitalar. Na segunda, com base nas evidências elencadas, foi desenvolvido um conjunto de ações para a segurança do paciente psiquiátrico durante a hospitalização. Resultados: utilizaram-se 26 artigos publicados no período entre 2012 e 2022, sendo possível categorizar recomendações e construir um bundle através de quatro eixos: cultura da segurança; tomada de decisão clínica; planejamento de intervenções; e violência interpessoal. Conclusões: as evidências científicas forneceram orientações claras sobre as ações para melhoramento da segurança do paciente psiquiátrico durante a internação hospitalar. Essas evidências também destacaram as lacunas existentes na pesquisa, apontando para a necessidade de estudos futuros nessa área.

ABSTRACT Objective: to develop a bundle for the safety of psychiatric patients during hospitalization. Methods: a methodological study conducted in two stages. In the first, a comprehensive literature review was developed through a scoping review and conducted to examine evidence on the safety of psychiatric patients during hospitalization. In the second, based on the evidence listed, a set of actions was developed for the safety of psychiatric patients during hospitalization. Results: twenty-six articles published between 2012 and 2022 were used, making it possible to categorize recommendations and build a bundle through four axes: safety culture; clinical decision-making; intervention planning; and interpersonal violence. Conclusions: the scientific evidence provided clear guidance on actions to improve the safety of psychiatric patients during hospitalization. This evidence also highlighted gaps in research, indicating the need for future studies in this area.

RESUMEN Objetivo: construir un paquete para la seguridad de los pacientes psiquiátricos en el hospital. Métodos: estudio metodológico realizado en dos etapas. En primer lugar, se desarrolló una revisión exhaustiva de la literatura mediante una revisión de alcance y se llevó a cabo para examinar la evidencia sobre la seguridad de los pacientes psiquiátricos en el hospital. En el segundo, a partir de las evidencias enumeradas, se desarrolló un conjunto de acciones para la seguridad de los pacientes psiquiátricos durante la hospitalización. Resultados: se utilizaron 26 artículos publicados en el período entre 2012 y 2022, lo que permitió categorizar recomendaciones y construir un paquete en cuatro ejes: cultura de seguridad; toma de decisiones clínicas; planificación de intervenciones; y violencia interpersonal. Conclusiones: la evidencia científica proporcionó orientaciones claras sobre acciones para mejorar la seguridad del paciente psiquiátrico durante la hospitalización. Esta evidencia también puso de relieve las lagunas existentes en la investigación, lo que apunta a la necesidad de futuros estudios en esta área.

RESUMO Objetivo: construir um bundle em segurança do paciente psiquiátrico em internação hospitalar. Métodos: estudo metodológico realizado em duas etapas. Na primeira, uma revisão abrangente da literatura foi desenvolvida por meio da scoping review e conduzida para examinar as evidências sobre a segurança do paciente psiquiátrico em internação hospitalar. Na segunda, com base nas evidências elencadas, foi desenvolvido um conjunto de ações para a segurança do paciente psiquiátrico durante a hospitalização. Resultados: utilizaram-se 26 artigos publicados no período entre 2012 e 2022, sendo possível categorizar recomendações e construir um bundle através de quatro eixos: cultura da segurança; tomada de decisão clínica; planejamento de intervenções; e violência interpessoal. Conclusões: as evidências científicas forneceram orientações claras sobre as ações para melhoramento da segurança do paciente psiquiátrico durante a internação hospitalar. Essas evidências também destacaram as lacunas existentes na pesquisa, apontando para a necessidade de estudos futuros nessa área.

ABSTRACT Objective: to develop a bundle for the safety of psychiatric patients during hospitalization. Methods: a methodological study conducted in two stages. In the first, a comprehensive literature review was developed through a scoping review and conducted to examine evidence on the safety of psychiatric patients during hospitalization. In the second, based on the evidence listed, a set of actions was developed for the safety of psychiatric patients during hospitalization. Results: twenty-six articles published between 2012 and 2022 were used, making it possible to categorize recommendations and build a bundle through four axes: safety culture; clinical decision-making; intervention planning; and interpersonal violence. Conclusions: the scientific evidence provided clear guidance on actions to improve the safety of psychiatric patients during hospitalization. This evidence also highlighted gaps in research, indicating the need for future studies in this area.

RESUMEN Objetivo: construir un paquete para la seguridad de los pacientes psiquiátricos en el hospital. Métodos: estudio metodológico realizado en dos etapas. En primer lugar, se desarrolló una revisión exhaustiva de la literatura mediante una revisión de alcance y se llevó a cabo para examinar la evidencia sobre la seguridad de los pacientes psiquiátricos en el hospital. En el segundo, a partir de las evidencias enumeradas, se desarrolló un conjunto de acciones para la seguridad de los pacientes psiquiátricos durante la hospitalización. Resultados: se utilizaron 26 artículos publicados en el período entre 2012 y 2022, lo que permitió categorizar recomendaciones y construir un paquete en cuatro ejes: cultura de seguridad; toma de decisiones clínicas; planificación de intervenciones; y violencia interpersonal. Conclusiones: la evidencia científica proporcionó orientaciones claras sobre acciones para mejorar la seguridad del paciente psiquiátrico durante la hospitalización. Esta evidencia también puso de relieve las lagunas existentes en la investigación, lo que apunta a la necesidad de futuros estudios en esta área.

ABSTRACT Background: Time-zero biopsies (TzB) provide insights into donor-derived lesions, but their predictive value for long-term outcomes remains uncertain. We aimed to identify clinical and histological factors from TzB of deceased donors influencing glomerular filtration rate (GFR) at 3- and 5-year post-transplantation. Methods: We retrospectively analyzed TzB performed from January 2015 to August 2019. Nineteen biopsies were excluded due to recipient death before 3 years. We examined donor and recipient-related characteristics and histological findings categorized using the Banff scoring system. Results: Among 147 biopsies, 61.9% of donors were male, with a mean age of 51.8 ± 13.5 years, and 27.2% met expanded criteria. Histologic analysis revealed 44.2% had alterations in the Banff chronic scoring system: 29.1% in vascular fibrous intimal thickening (Cv), 26.6% in arteriolar hyalinosis (Ah), and 8.3% in interstitial fibrosis (Ci)/tubular atrophy (Ct). Mean GFR was 54.8 ± 21.2 and 52.3 ± 23.0 mL/min/1.73 m2 at 3 and 5 years, respectively. At 3 years, Ah > 0, Ci/Ct > 0, Cv > 0, Banff chronic sum score > 0, glomerulosclerosis (GE), donor age > 50 years, expanded criteria donors, and rejection episodes were significantly associated with lower GFR. With the exception of Ci/Ct, all other parameters were also significantly associated with lower GFR at 5 years. Linear regression indicated donor age [β (95%CI) = -0.257 (-0.783, -0.021); p = 0.039] and arteriolar hyalinosis [β (95%CI) = -0.207 (-16.767, -0.448); p = 0.039]; p = 0.039) as predictors of GFR at 3 years, with donor age maintaining predictive value at 5 years [β (95%CI) = -0.276 (-0.776, -0.137); p = 0.006]. A tendency towards predictive value for GFR at 5 years was noted for GE [β (95%CI) = -0.198 (120.0, 1.038); p = 0.054]. Conclusion: TzB provide valuable prognostic information for long-term graft function with histological findings (particularly arteriolar hyalinosis and GE) and donor age serving as significant predictors of GFR at 3 and 5 years post-transplantation. These findings suggest TzB can be useful for risk stratification and personalized management of KT recipients.

RESUMO Introdução: As biópsias de tempo zero [time-zero biopsies (TzB)] fornecem informações sobre lesões provenientes do doador, mas seu valor preditivo para os resultados a longo prazo permanece incerto. O objetivo deste trabalho foi identificar fatores clínicos e histológicos das TzB de doadores falecidos que influenciam a taxa de filtração glomerular (TFG) aos 3 e 5 anos pós-transplante renal. Métodos: Analisámos retrospectivamente TzB realizadas de janeiro de 2015 a agosto de 2019. Foram excluídas 19 biópsias por óbito do receptor antes de 3 anos de seguimento. Avaliamos características relacionadas ao doador e receptor, além dos achados histológicos categorizados usando o sistema de escore de Banff. Resultados: Dentre 147 biópsias, 61,9% dos dadores eram do sexo masculino, com idade média de 51,8 ± 13,5 anos, e 27,2% eram doadores de critérios expandidos. A análise histológica revelou que 44,2% apresentavam alterações no escore de Banff crónico: 29,1% com alterações em Cv (vascular fibrous intimal thickening), 26,6% em Ah (arteriolar hyalinosis) e 8,3% em Ci (interstitial fibrosis)/Ct (tubular atrophy). A TFG média foi de 54,8 ± 21,2 e 52,3 ± 23,0 mL/min/1,73 m² aos 3 e 5 anos, respectivamente. Aos 3 anos, Ah > 0, Ci/Ct > 0, Cv > 0, escore de Banff crônico > 0, glomeruloesclerose, idade do doador > 50 anos, doador de critérios expandidos e episódios de rejeição associaram-se significativamente a uma TFG mais baixa. Com exceção de Ci/Ct, todos os outros parâmetros também apresentaram associação significativa com TFG reduzida aos 5 anos. A regressão linear indicou que a idade do doador [β (IC95%) = -0,257 (-0,783, -0,021); p = 0,039] e hialinose arteriolar [β (IC95%) = -0,207 (-16,767, -0,448); p = 0,039] foram preditores de TFG aos 3 anos, sendo que a idade do doador manteve valor preditivo aos 5 anos [β (IC95%) = -0,276 (-0,776, -0,137); p = 0,006]. Observou-se uma tendência de valor preditivo para TFG aos 5 anos para glomeruloesclerose [β (IC95%) = -0,198 (-120,0, 1,038); p = 0,054]. Conclusão: As TzB fornecem informações prognósticas valiosas sobre a função do enxerto a longo prazo, sendo os achados histológicos (particularmente hialinose arteriolar e glomeruloesclerose) e a idade do doador preditores significativos da TFG aos 3 e 5 anos pós-transplante. Esses achados sugerem que as TzB podem ser úteis na estratificação de risco e na gestão personalizada de receptores de transplante renal.

Abstract To synthesize the evidence about pharmacologic treatment of obesity and overweight and to define the options with the best risk-benefit using the stochastic analysis of multicriteria acceptability (SMAA). The analysis addresses a systematic review (PROSPERO CRD42023423308) whose research was realized in PubMed, Scopus, and Web of Science. Randomized controlled trials were included, which verified the effects of sibutramine, orlistat, liraglutide, and semaglutide in patients with IMC ≥ 26 Kg/ m². The risk of bias analysis was performed with RoB 2.0 and the outcomes evaluated were weight loss and serious adverse events. A total of 102 studies with 45.047 participants were included. The network meta-analysis revealed that all the treatments were significantly more effective than the placebo in weight reduction. The use of semaglutide (especially 0.4 mg/day) was associated with a bigger weight loss in comparison to all the other treatments (p<0.05) and the analysis of SMAA showed a risk-benefit of 95%. Besides that, we suggest re-evaluating of sibutramine 10mg/day as a therapeutic option for patients without hypertension or cardiovascular diseases, and we demonstrate the modest weight loss promoted by orlistat 120mg, sibutramine 5mg, and liraglutide 1,8mg and advise against its use, once the benefits do not outweigh the risks.

RESUMEN Introducción: La inestabilidad anterior de hombro afecta en gran parte a población jóven y deportista, donde los deportes de contacto o colisión son los que tienen mayor riesgo de provocarla y mayor tasa de recidiva. Es por esto, que existe una tendencia a realizar el procedimiento de Latarjet en esta población. El objetivo de este trabajo es analizar los resultados funcionales y complicaciones luego de realizar este procedimiento en jugadores de rugby operados en Uruguay. Materiales y métodos: Se incluyeron un total de 21 pacientes tratados quirurgicamente con el procedimiento de Latarjet de forma abierta. Se evaluaron clinicamente registrando rangos de movilidad del hombro y dolor mediante escala visual analógica (EVA). También se aplicó el score de Western Ontario Shoulder Instability Index (WOSI). Se valoró retorno al deporte o no, y nivel del mismo. Todas las complicaciones relacionadas fueron documentadas. Resultados: El seguimiento promedio fue de 3 años y medio. En 5 casos (23.8%) se realizó la cirugía de Latarjet como revisón de un primer procedimiento de Bankart. Se obtuvo un rango de movilidad completo en todos los pacientes. El dolor según la escala de EVA fue de 1.3. El score funcional de WOSI promedio fue de 75%. El retorno al deporte se dio en el 95.2% de los pacientes, donde el 71.5% lo realizaron al mismo nivel competitivo. No se registraron casos de recidiva con luxaciones o subluxaciones, 1 paciente quedo con aprhensión del hombro operado. 3 casos (14.8%) presentaron una artrosis glenohumeral en estadío 2. Conclusión: La técnica de Latarjet muestra excelentes resultados para la inestabilidad anterior de hombro logrando articulaciones estables, con un bajo grado de recurrencia y artrosis para los pacientes sometidos tanto a cirugías primarias como de revisión.

ABSTRACT Introduction: Anterior shoulder instability largely affects the young and athletic population, where contact or collision sports have the highest risk of causing it and the highest recurrence rate. For this reason, there is a tendency to perform the Latarjet procedure in this population. The aim of this work is to analyze the functional results and complications after performing this procedure in rugby players operated in Uruguay. Materials and methods: A total of 21 patients treated surgically with the open Latarjet procedure were included. They were clinically evaluated by recording ranges of shoulder mobility and pain using a visual analog scale (VAS). The Western Ontario Shoulder Instability Index (WOSI) score was also applied. Return to sport or not, and level of sport were assessed. All related complications were documented. Results: The average follow-up was 3.5 years. In 5 cases (23.8%) Latarjet surgery was performed as a revision of a first Bankart procedure. Full range of motion was obtained in all patients. Pain according to the VAS scale was 1.3. The average WOSI functional score was 75%. Return to sport occurred in 95.2% of patients, 71.5% of whom returned to the same competitive level. There were no cases of recurrence with dislocations or subluxations, 1 patient remained with apprehension of the operated shoulder. 3 cases (14.8%) presented stage 2 glenohumeral arthrosis. Conclusion: The Latarjet technique shows excellent results for anterior shoulder instability achieving stable joints, with a low degree of recurrence and arthrosis for patients who underwent both primary and revision surgeries.

RESUMO Introdução: A instabilidade anterior do ombro afecta em grande parte a população jovem e atlética, onde os desportos de contacto ou colisão têm o maior risco de a causar e a maior taxa de recorrência. Por este motivo, existe uma tendência para realizar o procedimento de Latarjet nesta população. O objetivo deste estudo é analisar os resultados funcionais e as complicações após este procedimento em jogadores de rúgbi operados no Uruguai. Materiais e métodos: Foram incluídos 21 pacientes tratados cirurgicamente com o procedimento aberto de Latarjet. Foram avaliados clinicamente através do registo das amplitudes de mobilidade do ombro e da dor utilizando uma escala visual analógica (EVA). Foi também utilizada a pontuação do Western Ontario Shoulder Instability Index (WOSI). Foram avaliados o regresso ou não ao desporto e o nível de prática desportiva. Todas as complicações relacionadas foram documentadas. Resultados: O seguimento médio foi de 3,5 anos. Em 5 casos (23,8%), a cirurgia de Latarjet foi efectuada como revisão de um primeiro procedimento de Bankart. Foi obtida uma amplitude de movimentos completa em todos os doentes. A dor, de acordo com a escala VAS, foi de 1,3. A pontuação funcional WOSI média foi de 75%. O regresso ao desporto ocorreu em 95,2% dos doentes, sendo que 71,5% regressaram ao mesmo nível competitivo. Não houve casos de recidiva com luxações ou subluxações, 1 paciente permaneceu com impacto no ombro. 3 casos (14,8%) apresentaram artrose glenoumeral estágio 2. Conclusão: A técnica de Latarjet apresenta excelentes resultados para a instabilidade anterior do ombro, conseguindo articulações estáveis, com baixo grau de recidiva e osteoartrose, tanto em pacientes submetidos à cirurgia primária como à cirurgia de revisão.

RESUMEN Introducción: El manejo del aneurisma de la aorta abdominal se basa en observaciones sobre su crecimiento y riesgo de ruptura. Estas mediciones son hechas en estudios de individuos antropométricamente diferentes a los latinoamericanos, lo cual puede llevar a errores a la hora de toma decisiones de manejo en estas poblaciones. Objetivo: Caracterizar los diámetros de la aorta abdominal y su relación con variables antropométricas Metodología: Estudio descriptivo de medición de diámetros de aorta abdominal, mediante tomografías por causa no vascular en un centro de diagnóstico ambulatorio, que tomó los diámetros de la aorta a nivel suprarrenal, infrarrenal y en la bifurcación. Se incluyeron también variables como edad, peso y talla. Resultados: Se evaluaron 148 tomografías (114 mujeres y 32 hombres) con una edad promedio de 39,9 años. El diámetro promedio de la aorta suprarrenal en ambos sexos fue de 17,5 mm (DS + 1,97) infrarrenal 14,49 mm (DS + 1,77), y en la bifurcación 14 mm (DS + 1,57). Los diámetros en los hombres fueron mayores que en las mujeres en todos los segmentos (p ( 0,005). La edad, el sexo femenino y el IMC mostraron diferencias significativas en cuanto al diámetro de la aorta. Conclusiones: Los diámetros promedio encontrados en esta población están ligeramente por debajo de los mencionados en otros estudios, y están relacionados con el IMC y la edad. Es necesario estudios epidemiológicos más amplios con el fin de definir el impacto de estos hallazgos en la toma de decisiones.

ABSTRACT Introduction: Management of aortic aneurysm is based on observations of its growth and risk of rupture. These measurements are made in studies of individuals who are anthropometrically different, which may lead to errors in making management decisions in these populations. Objective: Characterize abdominal aortic diameters and the relationship with some anthropometric variables. Methods: Descriptive study of abdominal tomographies performed in patients with non-vascular causes taking the diameters of the aorta at the suprarenal, infrarenal and bifurcation levels. Variables such as age, gender, weight and height were also included. Results: 148 CT scans were evaluated (114 women and 32 men) with a mean age of 39.9 years. The mean diameter of the suprarenal aorta in both sexes was 17.5 mm (SD + 1,97), at the infrarenal aorta 14,49 mm (SD + 1,77), and the bifurcation 14 mm (SD + 1,57), with larger diameters in men than in women in all segments (p <0,005). Age, female sex and BMI, showed significative differences for the aortic diameter. Conclusions: The mean diameters found are slightly below those mentioned in other studies. Larger epidemiological studies are needed to define the impact of these findings on decision making.

Improved drought and flood management in semi-arid transboundary basins requires a better understanding of the connections between dry and wet extremes, surface water and groundwater, upstream and downstream, and local communities and formal governance actors. This study describes a multi-disciplinary and mixed-methods research in the Limpopo River Basin, southern Africa. The methodology included hydrometeorological data analysis to identify drought and flood events, group discussions with 240 local community participants about drought and flood processes, impacts and preparedness, and interviews with 36 (inter)national and regional water managers and policymakers about drought and flood governance, early warning and communication. Additionally, we co-created drought and flood management scenarios through transboundary and national workshops and modelled these with an integrated surface water-groundwater model. We found that floods are crucial for aquifer recharge, providing baseflow during droughts, but also impactful for communities, who receive less training and support for floods than for droughts. Flood early warnings (if provided) are often not acted upon because of cultural values or limited resources. Drought and flood adaptation strategies were simulated to be effective, but factors like investment and maintenance costs, technical capacity and community uptake impact implementation. Furthermore, technical measures alone are inadequate to reduce community risk if underlying vulnerabilities are not addressed. Therefore, strengthening connections between communities and formal governance actors and better transboundary management of surface water and groundwater connections could yield significant benefits. CONTRIBUTION: This study provides 11 distinct recommendations for managing drought and flood risk, focussing on the four connections analysed.

BACKGROUND: Identifying biomarkers predictive of future best-corrected visual acuity (BCVA) in macular oedema secondary to retinal vein occlusion (RVO-MO) is crucial for improving risk assessment, management strategies and patient consultations. AIM: This study aimed to identify baseline optical coherence tomography (OCT) predictors of visual prognosis in RVO-MO following intravitreal bevacizumab (IVB) injection. SETTING: The study was conducted at Cicendo Eye Hospital, Bandung, Indonesia. METHODS: Retrospective study of 36 treatment-naïve eyes with RVO-MO (22 eyes with central retinal vein occlusion and 14 eyes with branch retinal vein occlusion). Each eye received at least three monthly IVB injections with a minimum follow-up of 4 months. Assessment of baseline OCT images focused on a 3-mm-wide retinal area centred on the fovea. Univariate and multivariate regression analyses were performed. RESULT: There was a significant improvement in mean BCVA from 1.15 ± 0.42 logMAR to 0.80 ± 0.55 logMAR (P < 0.001) and a reduction in mean central macular thickness (CMT) from 732.2 μm ± 298.9 μm to 437.7 μm ± 352.9 μm (P < 0.001). Univariate regression analysis highlighted worse baseline BCVA and higher baseline CMT as factors correlating with poorer outcomes post-treatment. Several OCT biomarkers such as disorganisation of the retinal inner layer (DRIL) and disruption of the ellipsoid zone (EZ) and the external limiting membrane (ELM) were identified but did not show significant associations with final BCVA after multivariate analysis. CONCLUSION: Baseline OCT biomarkers may elucidate the extent of vision loss; however, they may not be reliable in predicting treatment outcomes.