Resumo Introdução: A dengue é uma das arboviroses de maior importância clínica e epidemiológica em todo o mundo. Na Guatemala, durante 2023 foi registrado o maior número de casos dos últimos 10 anos e um aumento de 135% no número de casos em relação a 2022. Objetivo: Caracterização clínica da dengue com sinais de alerta e dengue grave. Metodologia: Estudo descritivo transversal que incluiu registros de 206 pacientes com sinais de alerta de dengue atendidos na Emergência Adulto do Hospital Roosevelt, na Guatemala, no período de 26 de setembro a 26 de novembro de 2023. Resultados: O sexo feminino predominou em 54,4% e na faixa etária de 12 a 22 anos em 51,0%. O principal sinal de alerta foi sangramento em 63,6%. As principais complicações foram doença hepática em 9,2%, choque em 5,8% e alteração neurológica em 2,9%. Em relação aos parâmetros hematológicos, houve predomínio de trombocitopenia em 93,2%, leucopenia em 53,9% e linfocitose em 71,4%. As transaminases AST e ALT foram elevadas em 97,0% (96/99) e 91,0% (142/156), respectivamente. Os tempos de coagulação foram prolongados em 55,9% (104/186) para TPT e em 22,6% (42/186) para TP. Houve 78,7% de positividade (148/188) para dengue. 8,3% (17/206) dos pacientes foram encaminhados para a área crítica devido à classificação de dengue grave. Conclusão: Esses dados proporcionam uma melhoria no reconhecimento e manejo clínico adequado dos casos com sinais de alerta e dengue grave, o que pode contribuir para a redução da carga de morbidade e mortalidade dessa doença no país.

Resumen Introducción: El dengue es uno de los arbovirus de mayor importancia clínica y epidemiológica a nivel mundial. En Guatemala, durante el 2023 se registró el número más alto de casos en los últimos 10 años y un incremento de 135% en el número de casos comparado con el 2022. Objetivo: Caracterización clínica de dengue con signos de alarma y dengue grave. Metodología: Estudio descriptivo transversal retrospectivo, incluyó registros de 206 pacientes con signos de alarma de dengue que acudieron a la Emergencia de Adultos del Hospital Roosevelt de Guatemala, del 26 de septiembre al 26 de noviembre del 2023. Resultados: Predominó el sexo femenino en 54,4% y el grupo etario de 12-22 años en 51,0%. El principal signo de alarma fue el sangrado en 63,6%. Las mayores complicaciones fueron hepatopatía en 9,2%, choque en 5,8% y alteración neurológica en 2,9%. Respecto a los parámetros hematológicos, predominaron la trombocitopenia en 93,2%, leucopenia en 53,9% y linfocitosis en 71,4%. Las transaminasas AST y ALT presentaron elevación en 97,0% (96/99) y 91,0% (142/156), respectivamente. Los tiempos de coagulación se mostraron prolongados en 55,9% (104/186) para TPT y en 22,6% (42/186) para TP. Hubo 78,7% de positividad (148/188) para dengue. El 8,3% (17/206) de los pacientes fue referido al área crítica por clasificación de dengue grave. Conclusión: Estos datos aportan una mejora en el reconocimiento y el manejo clínico adecuado de casos con signos de alarma y dengue grave, que pueden contribuir para disminuir la carga de morbimortalidad de esta enfermedad en el país.

Abstract Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022. Objective: Clinical characterization of dengue with warning signs and severe dengue. Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023. Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue. Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.

Abstract Introduction The prevalence of otitis media (OM) is substantial all over the world. Epidemiological data related to the economic burden of OM globally is minimal. The present systematic review was undertaken to estimate the economic burden of this disease in various parts of the world. Objectives An extensive literature search was done using PRISMA guidelines to identify relevant studies that estimated the economic burden of OM in monetary terms. The databases searched were PubMed Central, Ovid, and Embase. The cost estimation was done for one specific year and then compared considering the inflation rate. Data Synthesis The literature search led to the inclusion of 10 studies. The studies evaluated direct and indirect costs in monetary terms. Direct costs (health system and patient perspective) ranged from USD (United States Dollar) 122.64 (Netherlands) to USD 633.6 (USA) per episode of OM. Looking at only the patient perspective, the costs ranged from USD 19.32 (Oman) to USD 80.5 (Saudi Arabia). The total costs (direct and indirect) ranged from USD 232.7 to USD 977 (UK) per episode of OM. The economic burden per year was highest in the USA (USD 5 billion). The incidence of OM episodes was found more in children < 5 years old. Introduction of pneumococcal conjugate vaccines decreased the incidence in children and now the prevalence in adults is of concern. Conclusion The economic burden of OM is relatively high globally and addressing this public health burden is important. Approaches for the prevention, diagnosis, and treatment should be undertaken by the health system to alleviate this disease burden. (OM world minimal terms Central Ovid Embase rate 1 perspective United Dollar 12264 122 64 122.6 Netherlands (Netherlands 6336 633 6 633. (USA 1932 19 32 19.3 Oman (Oman 805 80 80. Saudi Arabia. Arabia . Arabia) 2327 232 7 232. 97 UK (UK billion. billion billion) old concern important prevention diagnosis 1226 12 122. 63 193 3 19. 8 23 9 2

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken. Objectives barriers delays Methods extension P (P years C (C databases VHLLilacs VHL Lilacs VHL/Lilacs PubMed Cochrane Scopus Science limitation Results included countries vulnerability patients Conclusions COVID19 COVID 19 COVID-1 COVID1 1 COVID-

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

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

RESUMEN Introducción: los niños y adolescentes con enfermedad renal crónica suelen enfrentar desafíos únicos que afectan significativamente su bienestar mental. Objetivo: este estudio tuvo como objetivo evaluar el estado de salud mental de niños y adolescentes con enfermedad renal crónica que reciben atención en el Departamento de Nefrología Pediátrica de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. Metodología: este fue un estudio observacional descriptivo, prospectivo y transversal. Clasificamos a los participantes según factores sociodemográficos (edad, sexo, lugar de residencia, estado civil y educación de los padres, y ocupación parental) y variables clínicas (edad al diagnóstico de enfermedad renal crónica, patología subyacente, tipo de tratamiento). Las evaluaciones de salud mental utilizaron el Cuestionario Breve para el Cribado y Diagnóstico, adaptado de la Escala Infantil de Rutter. Los diagnósticos se clasificaron como no casos, casos probables sin complicaciones o casos definitivos complicados según la severidad de los síntomas. Resultados: nuestro estudio analizó a 28 jóvenes, predominantemente masculinos (57.1 %), con edades entre 2 y 17 años y una edad media de 12.3 años. Aproximadamente el 42.9 % provenía del campo, y la mitad tenía padres divorciados o separados. Clínicamente, el 42.9 % tenía enfermedad renal crónica en etapas I a III, el 17.9 % estaba en etapa IV, y el 39.3 % había recibido trasplantes de riñón. Las evaluaciones de salud mental mediante Cuestionario Breve para el Cribado y Diagnóstico revelaron que el 39.3 % no mostraba trastornos mentales probables, el 32.1 % eran casos probables sin complicaciones y el 28.6 % eran casos probables con complicaciones. La ansiedad con inhibición y los trastornos de conducta fueron los trastornos predominantes, afectando cada uno al 39.3% de los participantes. Conclusión: nuestra investigación subraya la significativa carga de trastornos de salud mental en un grupo de niños y adolescentes paraguayos con enfermedad renal crónica y la urgente necesidad de servicios de salud mental completos e integrados que estén específicamente diseñados para satisfacer las necesidades de esta población vulnerable.

ABSTRACT Introduction: children and adolescents with chronic kidney disease often face unique challenges that significantly affect their mental well-being. Objective: this study aimed to assess the mental health status of children and adolescents with chronic kidney disease receiving care at the Departamento de Nefrología Pediátrica of the Facultad de Ciencias Médicas of the Universidad Nacional de Asunción. Methodology: this was a descriptive, prospective, cross-sectional observational study. We categorized participants based on sociodemographic factors (age, sex, residence, parents' marital status and education, and parental occupation) and clinical variables (age at chronic kidney disease diagnosis, underlying pathology, treatment type). Mental health assessments utilized the Brief Questionnaire for Screening and Diagnosis, adapted from Rutter's Child Scale. Diagnoses were classified as non-cases, probable uncomplicated cases, or definite complicated cases based on symptom severity. Results: our study analyzed 28 young individuals, predominantly male (57.1 %), aged between 2 and 17 years with a mean age of 12.3 years. Approximately 42.9 % hailed from the countryside, and half had parents who were divorced or separated. Clinically, 42.9 % had chronic kidney disease stages I to III, 17.9 % were at stage IV, and 39.3 % had received kidney transplants. Mental health assessments via Brief Questionnaire for Screening and Diagnosis revealed that 39.3 % did not show probable mental disorders, 32.1 % were probable cases without complications, and 28.6 % were probable cases with complications. Anxiety with inhibition and conduct disorders were the predominant disorders, each impacting 39.3 % of participants. Conclusion: our research underlines the significant burden of mental health disorders in a group of Paraguayan children and adolescents with chronic kidney disease and the pressing need for comprehensive, integrated mental health services that are specifically designed to meet the requirements of this vulnerable population.

The recent substantial price reductions in insulin therapy by major manufacturers prompt an examination of their impact on South Africa (SA)'s healthcare. While Eli Lilly, Novo Nordisk, and Sanofi cut prices on long-acting basal insulin, among others, significantly, these insulins are not on SA's Essential Medicines List (EML) for primary healthcare. With a high prevalence of diabetes, especially pre-diabetes, in the country, the EML's neglect of newer long-acting insulin treatments hampers effective disease management. Despite efforts by the public and private sectors, insulin therapy initiation is delayed, impacting long-term outcomes. The introduction of smart insulin pens adds a technological dimension, but concerns persist about equitable access. Urging policy-makers to re-evaluate guidelines and decolonise the EML, the article emphasises enhancing patient quality of life and reducing the disease burden.

BACKGROUND. Pathology of the hand causes functional impairment, with downstream effects for patient occupation, and consequently presents a socioeconomic burden. Investigation of the epidemiology of hand pathology in KwaZulu-Natal (KZN) can help reduce the burden of disease. Identifying where the greatest need is can direct patient awareness initiatives, medical training and appropriate allocation of resources. OBJECTIVES. To establish the prevalence of hand pathology at regional hospitals that offer orthopaedic services in KZN, to describe the patients most commonly affected by these pathologies and to identify the most common pathologies. METHODS. A cross-sectional investigation of hospital records and charts of patients presenting for orthopaedic care across all 10 regional hospitals in KZN that offer orthopaedic services was undertaken for 1 week's duration (June 2022). Patients were categorised into hand pathology (HP) and general orthopaedic pathology (OP) groups, which were each subdivided into trauma and non-trauma subgroups. Demographic details were collected for all patients. For HP patients, additional detail was collected regarding diagnosis, mechanism, admission and management. The prevalence of HP was calculated as a factor of all orthopaedic presentations. RESULTS. During the investigation, 2 335 patients presented to orthopaedic services. HP represented 21% of these cases. The majority (17%, 406/2 335) were related to trauma and represented 23% of all the traumatic orthopaedic presentations. Distal radius (DR) fractures were the most common hand injury (46%, 188/406) and a large proportion of trauma to the bony elements of the hand were open injuries (23%, 93/406). The remainder of HP cases comprised the non-traumatic group (4%, 91/2 335) and were predominantly infections (68%, 62/91), and many patients with non-traumatic hand pathology required surgery (60%, 55/91) and admission (56%, 52/91). CONCLUSION. HP represents approximately one-fifth of all orthopaedic presentations to regional health facilities in KZN offering orthopaedic care, and close to a quarter of orthopaedic trauma occurs in the hand. Based on these findings, targeted efforts to improve community awareness of precautions against trauma to the hand, osteopaenia and hand hygiene are suggested as preventive measures. Medical training should emphasise the appropriate management of DR fractures and hand infections, and resources should be differentially allocated to the management of these debilitating HPs to decrease the burden of disease.

RESUMEN Las infecciones por el VSR en constituyen una causa importante de morbilidad, hospitalización, ausentismo escolar y laboral, así como de mortalidad, en el mundo, así como en el Paraguay.En la actualidad, existen herramientas para la prevención del VSR. En el año 2012, el Paraguay, ha incorporado el palivizumab (MedImmune, EE. UU.), anticuerpo monoclonal, producido por tecnología de DNA recombinante. Este anticuerpo se administra en 5 dosis, cada 30 días y está indicado en lactantes nacidos prematuros y aquellos con trastornos cardiopulmonares. Por otro lado, actualmente se cuenta con una nueva herramienta para la prevención del VSR. El anticuerpo monoclonal de vida media prolongada Nirsevimab, específico para la conformación de prefusión de la proteína F, aprobado por EMA y FDA. Este monoclonal, está indicado para la prevención de las Infecciones respiratorias agudas bajas, causada por VSR en recién nacidos y lactantes nacidos durante o al ingresar a su primera temporada de VSR, en prematuros y lactantes hasta los 24 meses de edad que siguen siendo vulnerables a la enfermedad grave por VSR durante su segunda temporada de VSR. Luego de analizar la situación epidemiológica del VSR en el país así como la evidencia de eficacia, eficiencia y efectividad de este monoclonal; instituciones académicas, sociedades científicas, organizaciones no gubernamentales y gubernamentales se reunieron y elaboraron un consenso interinstitucional para la prevención de las infecciones por VSR, sugiriendo la incorporación del Nirsevimab, en menores de 12 meses de edad antes de su primera temporada de VSR y en reemplazo del Palivizumab, debido a que el nuevo monoclonal tiene el potencial de cambiar el panorama de las infecciones por VSR en el lactante y producir un impacto en la reducción la mortalidad y morbilidad infantil; reduciendo la carga al sistema de salud, en lo que se refiere a la disminución de la ocupación de camas hospitalarias tanto en sala como en unidades de cuidados intensivos, así como la disminución de la carga para los cuidadores, médicos y proveedores de atención médica y la mortalidad infantil.

ABSTRACT Respiratory syncytial virus (RSV) infections constitute a significant cause of morbidity, hospitalization, school and work absenteeism, as well as mortality worldwide, including in Paraguay. Currently, tools for RSV prevention are available. In 2012, Paraguay approved the use of palivizumab (MedImmune, USA), a monoclonal antibody produced through recombinant DNA technology. This antibody is administered in 5 doses, every 30 days and is indicated in infants born prematurely and those with cardiopulmonary disorders. Furthermore, a novel tool for RSV prevention has recently become available. Nirsevimab, a long-acting monoclonal antibody specific to the prefusion conformation of the F protein, has been approved by both the European Medicines Agency (EMA) and the Food and Drug Administration (FDA). This monoclonal antibody is indicated for the prevention of acute lower respiratory tract infections caused by RSV in newborns and infants born during or entering their first RSV season, as well as in premature infants and infants up to 24 months of age who remain vulnerable to severe RSV disease during their second RSV season. After analyzing the epidemiological situation of RSV in our country and evaluating the evidence of efficacy, efficiency, and effectiveness of this monoclonal antibody, academic institutions, scientific societies, and non-governmental and governmental organizations developed consensus guidelines on a new prevention alternative for the prevention of RSV infections, suggesting the incorporation of Nirsevimab in children under 12 months of age before their first RSV season and replacing Palivizumab. The new monoclonal has the potential to change the panorama of RSV infections in infants and produce an impact on the reduction of infant mortality and morbidity reducing the burden on the health system by decreasing hospital bed occupancy both in wards and in intensive care units, as well as the decrease in the burden on caregivers, physicians and health care providers.

Resumo A doença cardiovascular é a causa predominante de mortalidade em escala global. A pesquisa indica que as mulheres, em comparação aos homens, apresentam maior probabilidade de apresentar doença arterial coronariana (DAC) não obstrutiva quando têm sintomas de isquemia miocárdica. Além disso, as mulheres tendem a apresentar uma maior carga de sintomas em relação aos homens e, apesar da presença de doença cardíaca isquêmica, são frequentemente tranquilizadas erroneamente devido à ausência de DAC obstrutiva. Nos casos de cardiopatia isquêmica acompanhada de sintomas de isquemia miocárdica, mas sem DAC obstrutiva, é imperativo considerar a disfunção microvascular coronariana como uma potencial causa subjacente. A disfunção microvascular coronariana, caracterizada por reserva de fluxo coronariano prejudicada resultante de anormalidades funcionais e/ou estruturais na microcirculação, está associada a desfechos cardiovasculares adversos. Modificações no estilo de vida e o uso de medicamentos antiateroscleróticos e antianginosos podem oferecer benefícios potenciais, embora sejam necessários mais ensaios clínicos para informar estratégias de tratamento. Esta revisão tem como objetivo explorar a prevalência, mecanismos subjacentes, abordagens diagnósticas e intervenções terapêuticas para disfunção microvascular coronariana. global (DAC miocárdica disso subjacente eou ou microcirculação adversos potenciais tratamento prevalência subjacentes

Abstract Cardiovascular disease is the predominant cause of mortality on a global scale. Research indicates that women exhibit a greater likelihood of presenting with non-obstructive coronary artery disease (CAD) when experiencing symptoms of myocardial ischemia in comparison to men. Additionally, women tend to experience a higher burden of symptoms relative to men, and despite the presence of ischemic heart disease, they are frequently reassured erroneously due to the absence of obstructive CAD. In cases of ischemic heart disease accompanied by symptoms of myocardial ischemia but lacking obstructive CAD, it is imperative to consider coronary microvascular dysfunction as a potential underlying cause. Coronary microvascular dysfunction, characterized by impaired coronary flow reserve resulting from functional and/or structural abnormalities in the microcirculation, is linked to adverse cardiovascular outcomes. Lifestyle modifications and the use of anti-atherosclerotic and anti-anginal medications may offer potential benefits, although further clinical trials are necessary to inform treatment strategies. This review aims to explore the prevalence, underlying mechanisms, diagnostic approaches, and therapeutic interventions for coronary microvascular dysfunction. scale nonobstructive non CAD (CAD men Additionally andor or microcirculation outcomes antiatherosclerotic anti atherosclerotic antianginal anginal benefits strategies prevalence mechanisms approaches

ABSTRACT Introduction: Meningitis, encephalitis and meningoencephalitis are caused by several pathogens, but viral etiology is the most common. Diagnosis consists of clinical history, observation of the patient and isolation of the agent. The virus is often not identified and is associated with significant morbidity and mortality. The long-term prognosis is not yet widely discussed, but the most common sequelae include difficulty concentrating, behavioral and/or speech disorders and memory loss. Many of these patients do not return to work and a good number of those who do that require some readjustment in their tasks. Case Report: This is a case of a 47-year-old nurse working in an Internal Medicine service, in which two weeks after providing care to a patient with meningoencephalitis, a condition compatible with the same diagnosis began. Because it is considered to be related to the health care provided, it is reported as a suspected Occupational Disease, but it is not recognized. After four years of initial participation, she started complaining of difficulty with attention and memory, with progressive evolution, being evaluated by Neurology, without conclusive results. Over this time it was necessary to restrict some nursing tasks, essentially due to memory difficulties. Due to worsening of complaints, five years after the first neurology evaluation, the patient is evaluated one more time. It is again reported as a suspected Occupational Disease, being recognized with a permanent partial disability of 82.5%. Discussion/ Conclusion: As infections are transmitted in the provision of healthcare, it is important to take into account measures that reduce transmissibility and protect Healthcare Professionals, for which the Occupational Health Service is fundamental, participating in diagnosis and referral, but essentially contributing to adaptation initial position of the job, keeping the worker active for as long as possible. The delay in recognizing the Occupational Disease results from the fact that the consequences only appear several years later and are progressive in nature. This case emphasizes the heavy burden of the sequelae of meningoencephalitis, resulting in a high degree of disability, incompatible with the continuous exercise of the profession. It was possible to establish the association with professional activity, which reinforces the risk to which Healthcare Professionals are exposed.

RESUMO Introdução: As meningites, encefalites e meningoencefalites são causadas por vários agentes patogénicos, mas a etiologia vírica é a mais comum. O diagnóstico consiste na história clínica, observação do doente e no isolamento do agente (mas muitas das vezes o vírus não é identificado), encontrando-se associado a morbilidade e mortalidade significativas. O prognóstico a longo prazo ainda não é muito discutido, mas as sequelas mais frequentes incluem dificuldade de concentração, distúrbios do comportamento e/ou da fala e perda de memória. Muitos destes doentes não regressam ao trabalho e uma boa parte dos que o fazem necessitam de algum reajuste nas tarefas. Descrição do Caso: Trata-se de um caso de uma enfermeira de 47 anos a laborar num internamento de Medicina Interna, em que duas semanas após prestar cuidados a doente com meningoencefalite, inicia quadro compatível com o mesmo diagnóstico. Por se considerar relação com os cuidados de saúde prestados, é participado como suspeita de Doença Profissional, mas não sendo reconhecida. Após quatro anos da participação inicial, inicia queixas de dificuldade de atenção e memória, com evolução progressiva, sendo avaliada por Neurologia, sem resultados conclusivos. Ao longo deste tempo foi necessário restringir algumas tarefas de enfermagem, essencialmente por dificuldades de memória. Por agravamento das queixas, cindo anos após a primeira avaliação de neurologia, é avaliada novamente por agravamento significativo da semiologia. É novamente participada como suspeita de Doença Profissional, sendo reconhecida com uma incapacidade permanente parcial de 82.5%. Discussão/ Conclusão: Enquanto infeções transmitidas na prestação de cuidados de saúde, é importante ter em conta medidas que diminuem a transmissibilidade e protegem os Profissionais de Saúde, para o qual o Serviço de Saúde Ocupacional é fundamental, participando no diagnóstico e encaminhamento, mas essencialmente contribuindo para a adaptação inicial do posto de trabalho, mantendo o trabalhador no ativo o máximo de tempo possível. O atraso no reconhecimento da Doença Profissional resulta do facto de as sequelas só se manifestarem vários anos após e serem de caráter progressivo. Este caso enfatiza o pesado fardo das sequelas da meningoencefalite, resultando num elevado grau de incapacidade, incompatível com o exercício contínuo da profissão. Foi possível estabelecer a associação com a atividade profissional, o que reforça o risco a que os Profissionais de Saúde estão expostos.

Abstract Syphilis is a systemic disease with an increasing incidence in adolescents and young adults. Clinical manifestations can be variable and diagnosis requires a high index of suspicion, as syphilis can mimic other systemic diseases. Condylomata lata is a highly infectious manifestation of secondary syphilis, reported in 9-44% of cases. Here is reported the case of an adolescent girl who presented with inguinal lymphadenopathies, urinary and constitutional symptoms, and a history of unprotected sex with her boyfriend, who had been previously diagnosed with a genital ulcer. A complete physical examination was performed, and the detection of an anal lesion raised the hypothesis of perianal condylomata lata as a manifestation of secondary syphilis. All signs and symptoms of infection resolved with treatment. Early detection, appropriate treatment, and prevention of transmission are essential to reduce the burden of the disease.

Resumo A sífilis é uma doença sistémica com incidência crescente em adolescentes e jovens adultos. As manifestações clínicas são variáveis e o diagnóstico requer um elevado índice de suspeição, uma vez que a sífilis pode ser confundida com outras doenças sistémicas. O condiloma lata é uma manifestação de sífilis secundária, altamente infeciosa, reportada em 9-44% dos casos. É descrito o caso de uma adolescente que se apresentou com adenopatias, sintomas urinários e constitucionais e uma história de relações sexuais desprotegidas com o namorado, que tinha sido previamente diagnosticado com úlcera genital. Foi realizado um exame físico completo, que conduziu à deteção de uma lesão anal que motivou a suspeita de condiloma lata perianal como manifestação de sífilis secundária. Todos os sinais e sintomas da infeção resolveram-se com o tratamento. Identificação precoce, tratamento adequado e prevenção da transmissão são medidas essenciais para minimizar o ónus da doença.

BACKGROUND. Cystic echinococcosis (CE) is a zoonotic disease with an Africa-wide prevalence of 1.7%. CE is caused by the tapeworm Echinococcus granulosus sensu lato, with the liver being the most commonly affected organ. In South Africa (SA), there is a paucity of data on liver CE demographics and management. OBJECTIVES. To describe the demographics and clinical profile of patients with liver CE in a single tertiary hospital in Eastern Cape Province, SA. METHODS. A 4-year (2019 - 2022) retrospective clinical record review study was conducted on patients presenting with liver CE to the Department of Surgery at Frere Hospital. The demographics, clinical characteristics and management of patients with liver CE are reported. RESULTS. A total of 56 patients diagnosed with and managed for liver CE were included in the study. The mean age of the patients was 37.5 years. Abdominal pain (n=39; 69.6%) was the most common presenting symptom, and a palpable abdominal mass (n=36; 64.3%) was the predominant presenting sign. Most patients had disease confined to the liver (n=35; 62.5%). The right lobe of the liver was most commonly affected (n=38; 67.9%), and most patients had a single liver cyst on imaging (n=32; 57.1%). The majority of the patients ( n=36; 64.3%) were managed with surgical partial cystectomy, with a perioperative bile leak being the most common complication. CONCLUSION. In our setting, liver CE contributes to a significant local burden of the disease. The disease often has a nonspecific clinical presentation, necessitating imaging for the diagnosis. We observed good short-term outcomes in patients managed with combined partial cystectomy and medical therapy, although there is a risk of perioperative bile leak.

Abstract Background: The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (panenteric capsule endoscopy [PCE]). Summary: We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn’sdisease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syn-dromes with simultaneous involvement of the small intestine and colon. Key Messages: PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.

Resumo Introdução: O papel da endoscopia por cápsula na avaliação do intestino delgado encontra-se bem estabelecido, e as orientações atuais posicionam-na como um teste de primeira linha numa variedade de cenários clínicos. O advento das cápsulas de dupla câmara permitiu expandir a sua aplicação para a avaliação endoscópica da mucosa do cólon, oferecendo a oportunidade de um exame não invasivo de todo o intestino (endoscopia pan-entérica por cápsula, PCE). Sumário: Procedemos a uma revisão de vários aspectos do procedimento e preparação dos doentes para a PCE, bem como as aplicações clínicas atuais e as perspetivas futuras das cápsulas de dupla câmara. Na doença de Crohn não estenosante e não penetrante localizada ao intestino delgado e cólon, a PCE permite monitorizar a atividade da doença e avaliar a cicatrização da mucosa, um indicador importante da eficácia da terapêutica, com um rendimento de diagnóstico superior aos métodos convencionais, nomeadamente os exames imagiológicos ou a colonoscopia invasiva. Também na colite ulcerosa, as cápsulas de dupla câmara têm sido utilizadas para monitorizar a atividade da doença de forma não invasiva. Existem índices endoscópicos validados e especificamente concebidos para as cápsulas de dupla câmara, que permitem uma avaliação sistematizada e quantificação objetiva da atividade inflamatória. Na suspeita de hemorragia digestiva média ou baixa, alguns estudos exploratórios demonstraram a aplicabilidade e o elevado rendimento diagnóstico da PCE, podendo funcionar como um filtro de modo a permitir indicar quaisosdoentesquemaisirãobeneficiar de um procedimento invasivo subsequente, nomeadamente para arealizaçãodeprocedimentos hemostáticos dirigidos. A possibilidade de utilização da PCE é também discutida no contexto das síndromes de polipose com envolvimento simultâneo do intestino delgado e do cólon. Mensagens-chave: A PCE é um procedimento diagnóstico eficaz e seguro para avaliar diretamente a mucosa do intestino delgado e cólon. A sua aplicação tem vindo a expandir-se no contexto das Doenças Inflamatórias Intestinais e, mais recentemente, na suspeita de hemorragia digestiva média ou baixa. Existe a expectativa de que no futuro próximo possamos assistir a uma redução substancial da demanda por procedimentos endoscópicos invasivos, face à utilização crescente da PCE enquanto método de diagnóstico pan-intestinal não invasivo.

Abstract Objectives: Analyze the degree of knowledge of health workers about cancer risk factors, as well as assess their attitudes towards prevention and the actions they take to prevent this disease. Materials and Methods: Retrospective, cross-sectional and analytical study of a Health person in Cd. Victoria, Tamaulipas, in the period from March to April 2023. A descriptive and analytical analysis was carried out. Results: 46.5% of health workers identified having three or more risk factors for cancer. However, only 27.4% could correctly identify three modifiable risk factors. In addition, there was low adherence to the screening guidelines, with only 33.6% answering correctly about the age to perform a mammogram after 40 years of age. Conclusions: These findings support the need for interventions aimed at improving cancer prevention among health workers, which could have a significant impact in reducing the burden of this disease in Mexico.

Resumen Objetivos: Analizar el grado de conocimiento de los trabajadores de la salud sobre los factores de riesgo del cáncer, así como evaluar sus actitudes hacia la prevención y las acciones que realizan para prevenir esta enfermedad. Materiales y Métodos: Estudio prospectivo, transversal y analítico a personal de Salud en Cd. Victoria, Tamaulipas, en el periodo comprendido de marzo a abril de 2023. Se realizó un análisis descriptivo y analítico. Resultados: El 46.5% de los trabajadores de la salud identificó tener tres o más factores de riesgo para el cáncer. Sin embargo, solo el 27.4% pudo identificar correctamente tres factores de riesgo modificables. Además, hubo una baja adherencia a las pautas de detección, con solo el 33.6% respondiendo correctamente sobre la edad para realizar una mamografía a partir de los 40 años. Conclusiones: Estos hallazgos respaldan la necesidad de intervenciones dirigidas a mejorar la prevención del cáncer entre los trabajadores de la salud, lo que podría tener un impacto significativo en la reducción de la carga de esta enfermedad en México.

BACKGROUND: The ability to access effective hospital care for children is a significant determinant of good health outcomes. The Western Cape Province is a large land area with a wide array of human settlements, both in urban and rural spaces. For many children in the Western Cape, after-hours access to healthcare becomes constrained when primary care clinics close and hospitals are either far away or difficult to get to. The cumulative travel burden of communities across this area is not known. The recently established data-gathering capacity of the Provincial Health Data Centre of the Western Cape represents a new capacity to study this OBJECTIVES: To describe the cumulative travel burdens of children in communities throughout the Western Cape Province, and how they compare relative to one another, with a particular focus on the after-hours period in a week METHODS: Over a period of 5 years from 2017 to 2021, all the admission details to every hospital in the Western Cape Province of children <18 years of age were collected, with basic demographic and disease data, including place of residence. The distance each child travelled to their first admission facility was calculated and represented within defined communities across the metro of Cape Town and the rural Western Cape RESULTS: There were 574 220 admissions over the 5-year period, of which 360 783 were able to be used for travel analysis. The majority of admissions were for children under 5 years of age, were in the City of Cape Town and occurred after hours. Median travel distance was less for children outside of Cape Town, but the range of travelled distances was greater. Communities across the Western Cape, particularly rural communities, reflected significant variation in their cumulative travel burdens CONCLUSION: Using a large health dataset, this study demonstrates in a novel way for South Africa the distances children travel to access admission facilities. A wide variation exists across all parts of the province, but particularly in rural areas. These findings could be further interrogated for people's choices of facility and method of travel. Detailed service area modelling and extending primary care working hours are potential considerations for improving access at scale and at the local community level