Abstract Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB (p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes. perforations techniques work cohort 1 201 2021 after months PTA. . (PTA) 3 2 55.6% 556 55 (55.6% 44.4% 444 44 4 (44.4% subjects (mean 12.7 127 12 months. performed 95%. 95 95% (95%) pre 146 14 14. 345 45 3.4 p 0.001. 0001 0.001 0 001 0.001) grafts 202 (PTA 55.6 5 (55.6 44.4 (44.4 12. (95% 34 3. 000 0.00 00 55. (55. 44. (44. (95 0.0 (55 (44 (9 0. (5 (4 (

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology. intra 2 201 2021 FLEXOR (FLEXOR Registry 666 45 4 5 4.5 01 0 1 0.1 1.8% 18 8 (1.8 patients. . patients) Postoperatively feverinfections fever infections 6.3%, 63 6.3% , 6 3 (6.3%) 5.5%, 55 5.5% (5.5%) 1.3%. 13 1.3% (1.3%) s stone(s pole time diameters mm Furthermore elderly diameter technology 202 66 4. 0. 1.8 (1. 6.3 (6.3% 5.5 (5.5% 1.3 (1.3% 1. (1 6. (6.3 5. (5.5 (1.3 ( (6. (5. (6 (5

RESUMEN La subluxación atlantoaxial es la lesión más frecuente en la columna cervical causada por la artritis reumatoidea. Se manifiesta por rigidez de nuca, dolor cervical y déficit neurológico. El diagnóstico se realiza con tomografía computarizada e imágenes de resonancia magnética. El intervalo atlanto dental anterior mayor a 5mm indica inestabilidad atlantoaxial, el intervalo atlanto dental posterior menor a 14mm advierte riesgo neurológico. Las indicaciones más frecuentes de cirugía son: dolor cervical severo, inestabilidad y síntomas de mielopatía. Cuando existe compresión medular es necesaria la descompresión cervical alta sea por vía posterior o por vía anterior (odontoidectomía endonasal versus transoral). La línea rinopalatina nos indicará la factibilidad de una odontoidectomía endonasal endoscópica (OEE). El objetivo de la presentación del presente caso es compartir nuestra experiencia con la primera odontoidectomía endonasal endoscópica realizada en nuestro país y fomentar la utilización de la técnica. La cirugía fue realizada en un paciente con cuadriparesia espástica por subluxación atlantoaxial por artritis reumatoidea y que presentó excelente evolución pos operatoria, con recuperación casi completa. La OEE es una técnica operatoria mínimamente invasiva, ideal para pacientes con múltiples comorbilidades y que ofrece de buenos a excelentes resultados.

ABSTRACT Atlantoaxial subluxation is the most common injury to the cervical spine caused by rheumatoid arthritis. It is manifested by neck stiffness, neck pain and neurological deficit. Diagnosis is made with computed tomography and magnetic resonance imaging. The anterior dental atlanto interval greater than 5mm indicates atlantoaxial instability, the posterior dental atlanto interval less than 14mm warns of neurological risk. The most frequent indications for surgery are: severe neck pain, instability and symptoms of myelopathy. When there is spinal cord compression, upper cervical decompression is necessary, either via a posterior or anterior approach (endonasal versus transoral odontoidectomy). The rhinopalatine line will indicate the feasibility of an endoscopic endonasal odontoidectomy (EEO). The objective of the presentation of this case is to share our experience with the first endoscopic endonasal odontoidectomy performed in our country and to promote the use of the technique. The surgery was performed on a patient with spastic quadriparesis due to atlantoaxial subluxation due to rheumatoid arthritis and who presented excellent postoperative evolution, with almost complete recovery. EEO is a minimally invasive surgical technique, ideal for patients with multiple comorbidities and offering good to excellent results.

The present work reports on the isolation and characterisation of two novel antiviral ester compounds from dichloromethane leaf extracts of Spondias mombin (SM). The characterisation and structural elucidation were established from spectroscopic evidence of nuclear magnetic resonance, Fourier transform infrared and mass spectroscopy. The compounds identified were 6-methylheptyl pentadecanoate and 6-methylheptyl-15-(1,2,3,4,4a,8a-hexahydronaphthalen-1-yl)pentadecanoate. The novel isolated ester compounds were reported to have anti-rhino virus activity in silico against a known biological target (HsNMT1) that plays a key role in developing therapeutics against the common cold. Molecular docking analysis revealed the binding affinity across all targets within the range of -4.6 to -8.2 kcal/mol, whilst molecular dynamic simulation showed that systems attained good stability due to the maintenance of mean root-mean-square deviation values within the acceptable range of 1.5-2.5 Å. It can be concluded that the novel compounds are potential inhibitory candidates against rhinovirus protein target HsNMT1. However, in vitro and in vivo experiments are further required to validate the possible inhibitory candidates against rhinovirus disease (common cold). SIGNIFICANCE: The significance of this study contributes to the scientific rationale for using SM leaf extracts to treat viral diseases. Two novel compounds, 6-methylheptyl pentadecanoate and 6-methylheptyl-15-(1,2,3,4,4a,8a-hexahydronaphthalen-1-yl)pentadecanoate, were predicted through computer-aided techniques to possess anti-rhinovirus properties.

In this study, the analysis of metals in tap, river, wastewater, and sludge samples was conducted using ICP-OES after hotplate- or microwave-assisted digestion. Both digestion methods produced a good degree of accuracy, indicating their suitability for the analysis of the studied metals in water samples. From method development studies, 100 mL of HNO3 was found to be the optimum sample volume and acid type for digestion. The average concentrations obtained ranged from 4.9-410.8 μg/L, 5.9-465.0 μg/L, 3.6-425.4 μg/L, 16.1-647 μg/L and 9.7-784 μg/L in tap water, river, influent, effluent, and sludge samples, respectively. All metals were below their maximum permissible limits, with the exception of Mn in all sludge samples and Pb in all tap water, Umhlathuzana River, and Northern Works influent samples. Comparable recoveries and metal concentrations were obtained by microwave and hotplate methods, suggesting that the cheaper hotplate method can be used as an effective digestion method for daily analysis. Common anion concentrations obtained ranged from 0.03-23.5 mg/L, 0.02-3 064.67 mg/L, and 0.32-175.67 mg/L for tap, river, and wastewater samples, respectively. The anion concentrations were found to be below the maximum acceptable limits indicating no negative health effect on human and aquatic life, with the exception of Cl- and SO4(2-) in Amanzimtoti and Northern River water, respectively.

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.

Resumen Uno de los mayores retos de una cooperativa es la supervivencia, para lo que implementa estrategias como el trabajo colaborativo que le permita acceder a recursos para la solución de problemas colectivos, aunque en la mayoría de los casos, las relaciones no perduran. Existen empresas longevas, tanto en lo individual como en las relaciones con los colectivos con los que se integra, que cumplen los objetivos sociales, ambientales, organizacionales y económicos que se plantean. Un ejemplo de permanencia es la Unión de Cooperativas Tosepan Titataniske de Cuetzalan, Puebla, México, por lo que se eligió para un estudio de caso que permitiera comprender las características que les ha fortalecido. Se utilizaron la observación, revisión documental, un diario de campo y entrevistas semiestructuradas, que fueron analizadas con apoyo del software NVivo 12 ®. Los resultados muestran que los principios de vida de los pueblos originarios se han trasladado a la filosofía organizacional y a las redes estratégicas de las que forma parte, por lo que el Yeknemilis o buen vivir orienta las actividades conjuntas, fortalece las relaciones entre diferentes organizaciones y favorece la solución de problemas a partir de la construcción de una identidad colectiva y la búsqueda del bien común.

Abstract One of the biggest challenges a community enterprise faces is survival. In order to deal with it, it implements strategies such as collaborative work with different organizations, trying to access resources that make it possible to solve collective problems. However, in most cases, relationships E do not last. It was identified that there are companies that endure, both individually and in their relations with the groups with which they are integrated, achieving the fulfillment of the social, environmental, organizational and economic objectives they set out. Therefore, a case study was carried out in the Unión de Cooperativas Tosepan Titataniske in Cuetzalan, Puebla, México, to understand what characteristics have strengthened them. Observation, documentary review, a field diary and semi-structured interviews were used and analyzed with the support of NVivo 12 ® software. The results show that the principles of life of the native peoples have been transferred to the organizational philosophy and to the strategic networks of which they form part, so that the Yeknemilis or good living guides joint activities, strengthens relationships between different organizations and favors the solution of problems based on the construction of a collective identity and the search for the common good.

Abstract The article approaches population aging and euthanasia from an ethical perspective based on the principles of ontologically grounded personalist bioethics. The principles of dignity of the person, respect for physical life, solidarity, subsidiarity, justice and the common good are highlighted and shown how they apply in both contexts. The importance of an honest dialogue on euthanasia is emphasized, avoiding manipulation of language. It is emphasized that any discussion of euthanasia must be supported by thorough ethical reflection and that the rights of the elderly must be always protected. The article approaches these complex issues from a perspective that values the dignity and rights of older people and promotes their well-being, while thoughtfully and responsibly discussing the ethical issues surrounding euthanasia.

Resumen El artículo aborda el envejecimiento poblacional y la eutanasia desde una perspectiva ética basada en los principios de la bioética personalista ontológicamente fundamentada. Se resaltan los principios de la dignidad de la persona, el respeto a la vida física, la solidaridad, la subsidiariedad, la justicia y el bien común y se muestra cómo se aplican en ambos contextos. Se enfatiza la importancia de un diálogo honesto sobre la eutanasia, evitando la manipulación del lenguaje. Se destaca que cualquier discusión sobre la eutanasia debe ser respaldada por una reflexión ética profunda y que los derechos de las personas mayores deben protegerse en todo momento. El artículo aborda estas cuestiones complejas desde una perspectiva que valore la dignidad y los derechos de las personas mayores y promueva su bienestar, al tiempo que se discuten de manera reflexiva y responsable las cuestiones éticas en torno a la eutanasia.

Abstract Objective: Periventricular-intraventricular hemorrhage is the most common type of intracranial bleeding in newborns, especially in the first 3 days after birth. Severe periventricular-intraventricular hemorrhage is considered a progression from mild periventricular-intraventricular hemorrhage and is often closely associated with severe neurological sequelae. However, no specific indicators are available to predict the progression from mild to severe periventricular-intraventricular in early admission. This study aims to establish an early diagnostic prediction model for severe PIVH. Method: This study was a retrospective cohort study with data collected from the MIMIC-III (v1.4) database. Laboratory and clinical data collected within the first 24 h of NICU admission have been used as variables for both univariate and multivariate logistic regression analyses to construct a nomogram-based early prediction model for severe periventricular-intraventricular hemorrhage and subsequently validated. Results: A predictive model was established and represented by a nomogram, it comprised three variables: output, lowest platelet count and use of vasoactive drugs within 24 h of NICU admission. The model’s predictive performance showed by the calculated area under the curve was 0.792, indicating good discriminatory power. The calibration plot demonstrated good calibration between observed and predicted outcomes, and the Hosmer-Lemeshow test showed high consistency (p = 0.990). Internal validation showed the calculated area under a curve of 0.788. Conclusions: This severe PIVH predictive model, established by three easily obtainable indicators within the NICU, demonstrated good predictive ability. It offered a more user-friendly and convenient option for neonatologists. Objective Periventricularintraventricular Periventricular intraventricular newborns birth periventricularintraventricular periventricular sequelae However Method MIMICIII MIMIC III v1.4 v14 v v1 4 (v1.4 database 2 nomogrambased nomogram based validated Results output models s 0792 0 792 0.792 power outcomes HosmerLemeshow Hosmer Lemeshow p 0.990. 0990 0.990 . 990 0.990) 0788 788 0.788 Conclusions ability userfriendly user friendly neonatologists v1. (v1. 079 79 0.79 099 0.99 99 078 78 0.78 (v1 07 7 0.7 09 0.9 9 (v 0.

ABSTRACT Introduction: Urethral stricture is a common, albeit complex, condition that predominantly affects men. The aim of this study was to translate, culturally adapt, and validate the Patient-Reported Outcome Measure questionnaire for patients undergoing urethroplasty (USS-PROM) into Brazilian Portuguese using validated psychometric criteria. Materials and Methods: The process involved translating and culturally adapting the original USS-PROM into Brazilian Portuguese (USS-PROMbr), synthesizing, back-translating, cross-culturally adapting, and analyzing the pre-final version with experts from our committee. This pre-version was administered to 10 patients who had undergone urethroplasty by the Reconstructive Urology team at the Hospital de Clínicas de Porto Alegre for face validation, linguistic, and semantic adjustments, resulting in the final USS-PROMbr version. Subsequently, well-established psychometric criteria, including content validity, internal consistency, and test-retest reproducibility, were assessed after administering the questionnaire to a total of 56 patients, with 50 of them responding to the test and retest. Results: Evaluation of the pre-final version identified 15 questions as clear, and only one question was considered somewhat unclear necessitating modifications based on patient suggestions and subsequent reassessment by the research team. Psychometric criteria demonstrated good content validity, with a content validity index exceeding 0.80 for all questions; good internal consistency, Cronbach's alpha of 0.77, ranging from 0.70 to 0.78 with the exclusion of any item, and item-total correlations ranging from 0.33 to 0.67. The test-retest intraclass correlation coefficient was 0.74 for the lower urinary tract symptoms construct (Q1-Q6). Conclusion: The USS-PROMbr demonstrated acceptable cross-cultural adaptation and psychometric properties, making it a valid and useful tool for evaluating patients undergoing urethroplasty. Introduction common complex men translate adapt PatientReported Patient Reported USSPROM USS PROM (USS-PROM Methods USSPROMbr, USSPROMbr PROMbr , (USS-PROMbr) synthesizing backtranslating, backtranslating back translating, back-translating crossculturally cross prefinal pre committee preversion 1 validation linguistic adjustments Subsequently wellestablished well established consistency testretest retest reproducibility 5 Results clear 080 0 80 0.8 Cronbachs Cronbach s 077 77 0.77 070 70 0.7 078 78 item itemtotal 033 33 0.3 067 67 0.67 074 74 Q1Q6. Q1Q6 QQ Q1 Q6 . Q (Q1-Q6) Conclusion crosscultural cultural properties (USS-PROMbr 08 8 0. 07 7 03 3 06 6 0.6 Q1Q (Q1-Q6 (Q1-Q

Abstract Amidst the crisis of ideologies and traditional conceptions about the state, liberal communitarianism develops an original political approach. Its central proposition is that a good society requires a balance between State, community, and market, rejecting both the minimal state and state-centrism. The present text seeks to answer the question: what elements are central to liberal communitarian theory in approaching the role of the State and its relations with the community and the market in contemporary societies? According to the exposition, the aspects that distinguish the communitarian formulation are: (i) the empirical analysis of the State has as its ethical-political reference the concept of the good society; (ii) democracy requires a responsive State, sensitive to the voice of communities; (iii) conversely to the politics of neutrality, the State is committed to a limited set of core values; (iv) the State fulfills fundamental functions, but, either strong or weak, its functions are always limited; (v) the fulfillment of collective needs and the common good requires a balance between State, community and market; (vi) to ensure peace in international relations requires the perspective of basic security, with the global political community as a horizon. The communitarian theory, which presents itself politically as a third way, brings relevant contributions to understanding current State dilemmas and examining future perspectives. The research technique is bibliographic. approach statecentrism. statecentrism centrism. centrism state-centrism question societies exposition i (i ethicalpolitical ethical ii (ii communities iii (iii neutrality values iv (iv but weak v (v vi (vi security horizon way perspectives bibliographic

Resumo Em meio à crise das ideologias e concepções tradicionais sobre o Estado, o comunitarismo liberal desenvolve uma abordagem política original. Sua proposta central é que uma boa sociedade requer um equilíbrio entre Estado, comunidade e mercado, rejeitando tanto o Estado mínimo quanto o estado-centrismo. No trabalho do sociólogo Amitai Etzioni, encontra-se a formulação política mais sistemática do pensamento comunitário. O presente texto busca responder a questão: que elementos são centrais na teoria comunitarista liberal na abordagem do papel do Estado e suas relações com a comunidade e o mercado nas sociedades contemporâneas? Segundo se expõe, os aspectos que distinguem a formulação comunitarista são: (i) a análise empírica do Estado tem como referência ético-política o conceito de boa sociedade; (ii) a democracia requer um Estado responsivo, sensível à voz das comunidades; (iii) ao contrário da política de neutralidade, o Estado está comprometido com um conjunto limitado de valores nucleares; (iv) o Estado cumpre funções fundamentais, mas, seja forte ou fraco, suas funções são sempre limitadas; (v) a satisfação das necessidades coletivas e do bem comum requer um equilíbrio entre Estado, comunidade e mercado; (vi) garantir a paz nas relações internacionais demanda a perspectiva da segurança básica, tendo a comunidade política global como horizonte. A teoria comunitarista, que se apresenta politicamente como uma terceira via, traz contribuições relevantes para compreender os dilemas atuais do Estado e examinar as perspectivas futuras. A técnica de pesquisa é bibliográfica. original estadocentrismo. estadocentrismo estado centrismo. centrismo estado-centrismo Etzioni encontrase encontra comunitário questão contemporâneas expõe i (i éticopolítica ético ii (ii responsivo comunidades iii (iii neutralidade nucleares iv (iv fundamentais mas fraco limitadas v (v vi (vi básica horizonte via futuras bibliográfica

ABSTRACT Introduction: Primary immunodeficiencies (PID) manifest as increased susceptibility to infectious diseases and are associated with significant morbimortality. COVID-19 has a variable clinical presentation, with unpredictable impact on immunocompromised patients. Knowing how this population responds to vaccination may be important to adjust future approaches. Objectives: To analyse immunological response to anti-COVID-19 vaccination in patients with PID. Methods: Prospective study of a population of patients with PID, followed in an Immunoallergology Unit, who were vaccinated against COVID-19. Clinical records were consulted to assess demographic, clinical, and laboratory data. Determination of total immunoglobulin G (IgG) and IgG SARS-CoV-2 before vaccination and serial measurement of IgG anti-spike after vaccination was performed. Results: Twenty patients were included, 55% female, with a mean age of 36,8±13,1 years old, 60% with common variable immunodeficiency (CVID), 30% selective antibody deficiency, and 10% X-linked agammaglobulinemia (XLA). In CVID patients, the median CD19 basal count was 180 cells/μL (IQR, 60;372). Twelve patients with CVID/XLA were under replacement treatment with subcutaneous gammaglobulin. All patients presented negative pre-vaccinal serology, with a median total IgG of 419 mg/dL (IQR, 238;896); IgG anti-spike after the primary vaccinal scheme was positive in 75% [median 796 AU/mL (IQR, 107;3772)]. Concerning CVID subpopulation: IgG anti-spike was positive in 67% after the primary vaccinal scheme, 75% before the booster dose, and 100% afterward. Lower counts of CD19 cells correlated with lower levels of IgG anti-spike (95% CI=0.117-0.898; p=0.023). No patient reported significant adverse reactions to vaccination. Conclusions: Anti-COVID-19 vaccination showed good response and safety in patients with PID. In the CVID subpopulation, more severe cases with lower counts of CD19 cells presented lower antibody titles after vaccination. Booster dose enhanced immune response, suggesting the need for additional inoculations to ensure sustained protection against COVID-19.

RESUMO Fundamentos: As imunodeficiências primárias (IDP) manifestam-se por suscetibilidade aumentada a doenças infeciosas e estão associadas a elevada morbimortalidade. A COVID-19 tem apresentação clínica variável, com impacto imprevisível nos doentes imunocomprometidos. Conhecer a resposta à vacinação desta população poderá ser importante para adequar medidas no futuro. Objetivos: Analisar a resposta imunológica à vacinação contra a COVID-19 em doentes com IDP. Métodos: Estudo prospetivo de uma população de doentes com IDP, seguidos numa unidade de Imunoalergologia, vacinados contra a COVID-19. Consulta dos processos clínicos para colheita de dados demográficos, clínicos e laboratoriais. Determinação de imunoglobulina G (IgG) total e IgG SARS-CoV-2 antes da vacinação e doseamentos seriados de IgG anti-spike após vacinação. Resultados: Incluídos 20 doentes, 55% do sexo feminino, com idade média 36,8±13,1 anos, 60% com imunodeficiência comum variável (IDCV), 30% deficiência seletiva de anticorpos e 10% agamaglobulinemia ligada ao X (ALX). Nos doentes com IDCV, a contagem basal de células CD19 mediana foi 180 células/μL (IIQ, 60;372). Realizavam terapêutica de substituição com gamaglobulina subcutânea 12 doentes com IDCV/ALX. A serologia pré-vacinal foi negativa em todos os doentes, a IgG total mediana foi 419 mg/dL (IIQ, 238;896) e a IgG anti-spike após esquema vacinal primário foi apositiva em 75% [mediana 796 AU/mL (IIQ, 107;3772)]. Na subpopulação com IDCV: a IgG anti-spike foi positiva em 67% após esquema vacinal primário, 75% antes da dose de reforço e 100% após reforço. Níveis mais baixos de células CD19 correlacionaram-se com valores inferiores de IgG anti-spike (95% IC=0,117-0,898; p=0,023). Nenhum doente reportou reações adversas significativas à vacinação. Conclusões: A vacinação contra a COVID-19 apresentou boa resposta e segurança nos doentes com IDP. Na subpopulação com IDCV, formas mais graves com contagens reduzidas de células CD19 apresentaram títulos mais baixos de anticorpos após vacinação. A dose de reforço potenciou a resposta imune, sugerindo a necessidade de inoculações adicionais para conferir proteção sustentada contra a COVID-19.

ABSTRACT Professional orientation and entrepreneurship emerge as a necessary relationship in Cuban Higher Education, taking into account the need to stimulate the training of entrepreneurial students with professional life projects that enable their contribution to the municipality as a space for the common good. By virtue of what has been expressed, the article intends to socialize an educational strategy aimed at gradually promoting entrepreneurship, from the professional orientation process. The proposal was structured into three specific strategic actions: redefinition of entrepreneurship as a process and result, training for the pedagogical group and the design of professional orientation workshops "Youth, entrepreneurship and local development." For this, a qualitative methodology was used that considers the interpretation of the results from a dialectical conception, with the use of historical-logical methods, modeling and the help of documentary analysis and the Iadov technique for the evaluation of the proposal. The results reveal the potential of an educational strategy that contains actions and operations that favor the training of entrepreneurial students with professional life projects that stimulate the use of knowledge for prosperous, sustainable, equitable and inclusive municipal development.

RESUMO A orientação profissional e o empreendedorismo surgem como uma relação necessária no Ensino Superior cubano, tendo em conta a necessidade de estimular a formação de estudantes empreendedores com projetos de vida profissional que possibilitem a sua contribuição para o município como espaço de bem comum. Em virtude do exposto, o artigo pretende socializar uma estratégia educativa que visa promover gradativamente o empreendedorismo, a partir do processo de orientação profissional. A proposta foi estruturada em três ações estratégicas específicas: redefinição do empreendedorismo como processo e resultado, formação do grupo pedagógico e concepção de oficinas de orientação profissional "Juventude, empreendedorismo e desenvolvimento local". Para isso, utilizou-se uma metodologia qualitativa que considera a interpretação dos resultados a partir de uma concepção dialética, com utilização de métodos histórico-lógicos, modelagem e auxílio da análise documental e da técnica de Iadov para a avaliação da proposta. Os resultados revelam o potencial de uma estratégia educacional que contenha ações e operações que favoreçam a formação de estudantes empreendedores com projetos de vida profissional que estimulem o uso do conhecimento para o desenvolvimento municipal próspero, sustentável, equitativo e inclusivo.

RESUMEN Orientación profesional y emprendimiento, emergen como una relación necesaria en la Educación Superior cubana, teniendo en cuenta la necesidad de estimular la formación de estudiantes emprendedores con proyectos de vida profesionales que posibiliten su aporte al municipio como espacio de bien común. En virtud de lo expresado, el articulo tiene la intención de socializar una estrategia educativa orientada a potenciar de modo gradual el emprendimiento, desde el proceso de orientación profesional. La propuesta se estructuró en tres acciones estratégicas específicas: resignificación del emprendimiento como proceso y resultado, la capacitación al colectivo pedagógico y el diseño de talleres de orientación profesional "Juventud, emprendimiento y desarrollo local". Para ello, se utilizó una metodología cualitativa que pondera la interpretación de los resultados desde una concepción dialéctica, con el empleo de los métodos histórico-lógico, la modelación y el auxilio del análisis documental y la técnica de Iadov para la evaluación de la propuesta. Los resultados develan, las potencialidades de una estrategia educativa que contiene acciones y operaciones que favorece la formación de estudiantes emprendedores con proyectos de vida profesionales que estimulan el uso del conocimiento en función un desarrollo municipal prospero, sostenible, equitativo e incluyente.

Resumen Este artículo tiene como objetivo visibilizar el proceso de institucionalización, participación y conflicto social en torno a la gestión y manejo del agua potable en Costa Rica y estima como punto de arranque la segunda década del siglo XX, la cual discurre hacia la construcción de un eficaz modelo centralizado-descentralizado a partir de la década de 1970. Dicho proceso es analizado mediante la identificación de tres periodos históricos diferenciados mediante los cuales se pretende explicar el continuun, cambios, vacíos y conflictos de intereses del modelo de gestión del agua y su marco jurídico. El principal hallazgo es mostrar o poner en evidencia que la participación comunitaria bajo el mencionado modelo de gestión centralizado-descentralizado, aún vigente, ha garantizado la protección del agua para el bien común y parece ser, hasta ahora, una coraza legal-institucionalizada que impide la privatización del líquido vital. Se concluye que los intentos de privatizar la disponibilidad del agua potable con fines comerciales, no ha conseguido distorsionar la función social del Estado, la cual es proteger y garantizar el agua como un bien público.

Résumé Cet article vise à rendre visible le processus d'institutionnalisation, de participation et de conflit social lié à la gestion et à la distribution de l'eau potable au Costa Rica. Il prend comme point de départ la deuxième décennie du XXe siècle qui mène à la construction d'un modèle efficace centralisé-décentralisé à partir des années 1970. Ce processus est analysé en identifiant trois périodes historiques distinctes pour expliquer la continuité, les changements, les lacunes et les conflits d'intérêts du modèle de gestion de l'eau et de son cadre juridique. La découverte principale consiste à mettre en évidence que la participation communautaire sous le modèle de gestion centralisé-décentralisé, toujours en vigueur, a garanti la protection de l'eau pour le bien commun. Jusqu'à présent, il semble être une protection légale-institutionnalisée empêchant la privatisation du liquide vital. On a conclu que les tentatives de privatisation de l'accès à l'eau potable à des fins commerciales n'ont pas réussi à déformer la fonction sociale de l'État, qui est de protéger et de garantir l'eau en tant que bien public.

Abstract This article aims to shed light on the process of institutionalization, participation, and social conflict regarding the management of drinking water in Costa Rica. It takes the second decade of the 20th century as its starting point, leading towards the construction of an effective centralized-decentralized model from the 1970s. This process is analyzed by identifying three distinct historical periods, through which the article seeks to explain the continuum, changes, gaps, and conflicting interests of the water management model and its legal framework. The main finding highlights that community participation under the mentioned centralized-decentralized management model, still in force, has ensured the protection of water for the common good. It appears to be, up to now, a legally institutionalized shield preventing the privatization of this vital resource. The conclusion is that attempts to privatize the availability of drinking water for commercial purposes have not succeeded in distorting the social function of the State, which is to protect and guarantee water as a public good.

Abstract Introduction: Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis. However, few studies have investigated short-term prognostic factors. Objectives: The objectives of the study were to describe the clinical characteristics of a sample of GBS patients treated at the General Hospital of Mexico and to identify the prognostic factors at discharge. Methods: A descriptive and analytical cohort study, including patients with GBS, was conducted from April 2020 to May 2022. Demographic information, comorbidities, clinical variants, neurophysiological alterations, modified Erasmus GBS Outcome Score (mEGOS) and Erasmus GBS Respiratory Insufficiency Score scales, etc., were collected. Functional recovery at discharge was measured with Hughes scales and Medical Research Council (MRC). A case-control analysis was performed among patients with good and poor functional recovery on discharge based on the Hughes scale. Results: Total sample was 69 patients: 74% men and 26% women, mean age: 43.7 ± 16.3 years; 38 (55%) patients presented classic variant, 22 pure motor variant (31%). Evolution time: 6.8 ± 6.7 days. Most common Hughes score at admission was 4 points (n = 54, 78%). 87% (n = 60) received plasmapheresis. 23 (33.3%) presented an axonal pattern and 46 (66.6%) demyelinating. On discharge, 31 patients had Hughes 3 or less (ambulatory) and 27 Hughes 4 or greater (non-ambulatory). When performing factor analysis, it was found that mEGOS, MRC, total lymphocytes, and creatine phosphokinase (CPK) were associated with the prognosis at discharge. Conclusions: The most frequent clinical variant was the classic (sensitive-motor) with demyelinating alteration; the factors related to better recovery at discharge were mEGOS, MRC on admission, total lymphocyte count, and serum CPK levels.