Abstract This research was carried out in the Agricultural Transportation Company of Pinar del Río province, due to the need to define the vulnerabilities of the risk integral management system implemented by this organization. The objective of this article is focused on analyzing the current state of the risk integral management in the Agricultural Transportation Company of Pinar del Río, which will allow knowing the vulnerabilities in the process to improve quality, protection and safety without compromising efficiency and sustainability. The historical-logical method was used in order to analyze the evolution, operation and development of risk integral management in companies of the transport sector; the analysis-synthesis, which allowed revealing the essential relations and more general characteristics of risk integral management. Among the research techniques used were the interview, survey, checklists and documentary analysis, whose results were processed to arrive at conclusions with the help of the statistical method, as well as the Ishikawa diagram, to determine the cause-effect relationships in the risk integral management process. As main results of the diagnosis, the insufficient risk integral management in the company stands out, where the causes and subcauses are determined by each stage of the risk management life cycle, being the identification stage the one with the highest number, however, each of the problems detected have an impact on the other functions due to the systemic nature of the process.

Resumo Esta pesquisa foi realizada na Empresa de Transporte Agropecuário de Pinar del Río, na província de Pinar del Río, devido à necessidade de definir as vulnerabilidades do sistema de gerenciamento integrado de riscos implementado por essa organização. O objetivo deste artigo é analisar o estado atual do gerenciamento integrado de riscos na Empresa de Transporte Agrícola de Pinar del Río, o que nos permitirá identificar as vulnerabilidades do processo para melhorar a qualidade, a proteção e a segurança sem comprometer a eficiência e a sustentabilidade. O método histórico-lógico foi usado para analisar a evolução, o funcionamento e o desenvolvimento do gerenciamento integrado de riscos em empresas do setor de transportes, e o método de análise-síntese foi usado para revelar as relações essenciais e as características mais gerais do gerenciamento integrado de riscos. As técnicas de pesquisa utilizadas incluíram entrevistas, pesquisas, listas de verificação e análise documental, cujos resultados foram processados para se chegar a conclusões usando o método estatístico, bem como o diagrama de Ishikawa para determinar as relações de causa e efeito no processo de gerenciamento integrado de riscos. Os principais resultados do diagnóstico destacam a insuficiência do gerenciamento integrado de riscos na empresa, em que as causas e subcausas são determinadas por cada etapa do ciclo de vida do gerenciamento de riscos, sendo a etapa de identificação a que apresenta o maior número; no entanto, cada um dos problemas detectados tem impacto sobre as outras funções devido à natureza sistêmica do processo.

Resumen La presente investigación se desarrolló en la Empresa de Transporte Agropecuario de la provincia de Pinar del Río, por la necesidad de definir las vulnerabilidades del sistema de gestión integral de riesgos que implementa dicha organización. El objetivo del presente artículo se centra en analizar el estado actual de la gestión integral de riesgos en la empresa de Transporte Agropecuario de Pinar del Río, lo que permitirá conocer las vulnerabilidades en el proceso para mejorar la calidad, protección y seguridad sin comprometer la eficiencia y la sustentabilidad. Se utilizó el método histórico-lógico a fin de analizar la evolución, funcionamiento y desarrollo de la gestión integral de riesgos en empresas del sector del transporte y el análisis-síntesis, que permitió revelar las relaciones esenciales y características más generales de la gestión integral de riesgos. Entre las técnicas de investigación empleadas, se encuentran la entrevista, encuesta, las listas de verificación y el análisis documental, cuyos resultados fueron procesados para arribar a conclusiones con ayuda del método estadístico, así como el diagrama de Ishikawa, para determinar las relaciones causa-efecto en el proceso de gestión integral de riesgos. Como principales resultados del diagnóstico, resalta la insuficiente gestión integral de los riesgos en la empresa, donde las causas y subcausas están determinadas por cada etapa del ciclo de vida de la gestión de riesgos, siendo la etapa de identificación la de mayor número, sin embargo, cada una de las problemáticas detectadas impactan en las demás funciones debido al carácter sistémico del proceso.

Abstract Introduction: The vaginal flora consists in different microorganisms that promote a balanced interaction between the vaginal microbiome, hormonal status, products of microbial metabolism, and the host’s immune response. The instability of the vaginal ecosystem can lead to vulvovaginitis, which is a reason for frequent consultation in primary health care, as bacterial vaginosis, vaginal candidiasis, and trichomoniasis, are responsible for most diagnoses. There are other pathologies with similar presentations but less frequent. However, these are not considered to result in wrong diagnoses and treatments, such as cytolytic vaginosis. Case description: A 20-year-old woman complained of abundant vaginal discharge, use of daily sanitary pads, itching, and odor change within one month of evolution. The physical examination highlights the redness of the external lips and vaginal introitus, as abundant, non-adherent, non-airy, and odorless mucous discharge. Cervicovaginal cytology was performed on a slide that showed inflammation and was negative for intraepithelial lesions or malignancies. A culture of vaginal exudate was requested, which showed abundant epithelial cells and numerous Doderlein bacilli. Considering the presented case, the most likely diagnosis of cytolytic vaginosis was assumed. Recommendations were given, sitz baths with sodium bicarbonate were prescribed, and the patient remained asymptomatic. Comment: In the case of a patient with symptoms of vaginal discharge and itching, the first diagnostic hypothesis should consider the prevalence of the most frequent vulvovaginal infections. However, the culture of the exudate allowed us to exclude the presence of bacteria, fungi, and parasites. The patient’s symptoms and physical examination findings are characteristic of cytolytic vaginosis. The culture of the exudate confirmed the suspicion, and the appropriate diagnosis and treatment were performed. This case is intended to alert clinicians to the existence of this pathology that can often go unnoticed, compromising women’s health.

Resumo Introdução: A flora vaginal é constituída por diferentes microorganismos que promovem uma interação equilibrada entre o microbioma vaginal, estado hormonal, produtos do metabolismo microbiano e resposta imune do hospedeiro. A instabilidade do ecossistema vaginal pode levar a vulvovaginites, que são um motivo de consulta frequente nos cuidados de saúde primários, sendo a vaginose bacteriana, candidíase vaginal e tricomoníase responsáveis pela maioria dos diagnósticos. Existem outras patologias com apresentações semelhantes que, por serem menos frequentes, não são ponderadas e resultam em diagnósticos e tratamentos errados como a vaginose citolítica. Descrição do caso: Mulher de 20 anos de idade, com queixas de corrimento vaginal abundante, necessidade de uso de penso diário, prurido e alteração de odor com um mês de evolução. Ao exame objetivo destaca-se a ruborização dos lábios externos e introito vaginal, corrimento mucoso abundante, não aderente, não arejado e sem cheiro. É efetuada citologia cervico-vaginal em lâmina, que apresentava inflamação e foi negativa para lesão intraepitelial ou malignidade. Foi pedida cultura de exsudado vaginal, que apresentava abundantes células epiteliais e numerosos bacilos de Doderlein. Tendo em conta o quadro apresentado foi assumido como diagnóstico mais provável vaginose citolítica. Foram dadas recomendações e prescritos banhos de assento com bicarbonato de sódio, tendo a utente ficado assintomática. Comentário: Perante uma doente com sintomas de corrimento vaginal e prurido, a primeira hipótese diagnóstica deverá considerar a prevalência das infeções vulvovaginais mais frequentes. Contudo, a cultura do exsudado permitiu excluir a presença de bactérias, fungos e parasitas. A sintomatologia apresentada pela doente e os achados do exame físico são característicos da vaginose citolítica. A cultura do exsudado corroborou a suspeita, sendo feito o diagnóstico e o tratamento adequados. Com este caso pretende-se alertar os clínicos para a existência desta patologia, que pode muitas vezes passar despercebida, comprometendo a saúde da mulher.

RESUMEN Introducción: El labio y paladar hendido (LPH) son una alteración cráneo facial de etiología multifactorial. La alimentación de los niños con LPH puede llegar a ser deficiente, comprometiendo el crecimiento y el desarrollo. Objetivo: Determinar la evolución del estado nutricional pre y post quirúrgico y las prácticas alimentarias en lactantes de 6 a 24 meses de edad, con labio y/o paladar hendido que acudieron a la Clínica de la Fundación Operación Sonrisa durante el periodo de setiembre 2020 a mayo del 2021. Materiales y métodos: Estudio observacional, prospectivo con componente analítico. Se incluyó a 50 niños con diagnóstico de LPH de 6 a 24 meses de edad. Se evaluó el estado nutricional según estándares del MSP y BS. Resultados: Fueron evaluados 50 lactantes de 6 a 24 meses, el 60 % entre 6 -11 meses, el 64 % fueron varones, el 54 % provenía del interior del país y fueron sometidos a cierre primario de labios el 86 % y el 12 % a reconstrucción de paladar hendido. El 88 % de los niños recibieron lactancia materna. El estado nutricional pre quirúrgico fue adecuado (94 %) por indicador peso para la edad. Post quirúrgico hubo una diferencia significativa de 0,927Kg para el peso para la talla (p< 0,001), lo mismo para el peso para la edad(p<0,001). Para la talla para la edad se encontró una diferencia de 0,8cm(p=ns). Conclusiones: El estado nutricional de los niños con labio o paladar hendido, mejora a los 4 meses post cirugía reconstructiva para los indicadores peso para la edad y peso para la talla.

ABSTRACT Introduction: Cleft lip and palate (CLP) is a craniofacial alteration of multifactorial etiology. The diet of children with CLP can become deficient, compromising growth and development. Objective: To determine the evolution of the pre- and post-surgical nutritional status and feeding practices in infants between 6 and 24 months of age, with cleft lip and/or palate who attended the “Operation Smile” Foundation Clinic from September 2020 to May 2021. Materials and methods: This was an observational and prospective study with an analytical component. 50 children with a diagnosis of CLP from 6 to 24 months of age were included. Nutritional status was evaluated according to National Health Ministry standards. Results: 50 infants from 6 to 24 months were evaluated, 60% were between 6 -11 months, 64% were males, 54% came from the rural areas. 86% underwent primary lip closure and 12% cleft palate reconstruction. 88% of the children were breastfed. The pre-surgical nutritional status was adequate (94%) by weight for age indicator. Post surgery there was a significant difference of 0.927 kg for weight for height (p < 0.001), the same for weight for age (p < 0.001). For height for age, a difference of 0.8 cm was found (p=ns). Conclusions: The nutritional status of children with cleft lip or palate improves 4 months after reconstructive surgery for the indicators weight for age and weight for height.

RESUMEN El síndrome de Wilkie es una patología poco frecuente que genera un cuadro de obstrucción intestinal, debido a la disminución del ángulo aortomesentérico comprometiendo la tercera porción del duodeno. Describimos el caso de una paciente de 18 años de edad, diagnosticada con síndrome de Wilkie, con cuadro clínico de obstrucción intestinal y pérdida de peso. El diagnóstico se realizó con tomografía abdominal. El síndrome de Wilkie es una patología rara, que se vuelve un reto diagnóstico, por presentar un cuadro similar a otras patologías más comunes. Recomendamos que se sospeche ante un cuadro de obstrucción duodenal.

ABSTRACT Wilkie syndrome is a rare pathology that generates intestinal obstruction due to a decrease of the aortomesenteric angle compromising the third portion of the duodenum. We describe a case of an 18-year-old female patient, diagnosed with Wilkie syndrome, with clinical symptoms of intestinal obstruction and weight loss. The diagnosis was made with abdominal CT. Wilkie syndrome is a rare pathology, which becomes a diagnostic challenge because it presents a similar picture to other more common pathologies. We recommend that it should be suspected in the presence of duodenal obstruction.

Abstract Despite of the global unity against COVID-19 pandemic, the threat of SARS-CoV-2 variants on the lives of human being is still not over. SARS-CoV-2 pandemic has urged the need of rapid viral detection at earliest. To cope with gradually expanding scenario of SARS-CoV-2, accurate diagnosis is extremely crucial factor which should be noticed by international health organizations. Limited research followed by sporadic marketing of SARS-CoV-2 rapid pharmaceutical detection kits raises critical questions against quality assurance and quality control measures. Herein we aimed to interrogate effectivity and specificity analysis of SARS-CoV-2 pharmaceutical rapid detection kits (nasopharyngeal swab based) using conventional gold standard triple target real-time polymerase chain reaction (USFDA approved). A cross-sectional study was conducted over 1500 suspected SARS-CoV-2 patients. 100 real time-PCR confirmed patients were evaluated for pharmaceutical RDT kits based upon nasopharyngeal swab based kits. The SARS-CoV-2 nasopharyngeal swab based rapid diagnostic kit (NSP RDTs) analysis showed 78% reactivity. Among real time PCR confirmed negative subjects, 49.3% represented false positivity. The positive predictive analysis revealed 67.82%, while negative predictive values were 64.40%. The NSP RDTs showed limited sensitivities and specificities as compared to gold standard real time PCR. Valid and authentic detection of SARS-CoV-2 is deemed necessary for accurate COVID-19 surveillance across the globe. Current study highlights the potential consequences of inadequate detection of SARS-CoV-2 and emerging novel mutants, compromising vaccine preventable diseases. Current study emphasizes need to wake higher authorities including strategic organizations for designing adequate measures to prevent future SARS-CoV-2 epidemics. COVID19 COVID 19 COVID-1 SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- earliest SARSCoV2, 2, realtime USFDA approved. approved . approved) crosssectional cross sectional 150 10 timePCR 78 reactivity subjects 493 49 3 49.3 positivity 6782 67 82 67.82% 6440 64 40 64.40% globe mutants diseases epidemics COVID1 1 COVID- SARS-CoV 15 7 4 49. 678 6 8 67.82 644 64.40 67.8 64.4 67. 64.

Resumo Apesar da unidade global contra a pandemia de COVID-19, a ameaça das variantes do SARS-CoV-2 na vida do ser humano ainda não acabou. A pandemia de SARS-CoV-2 alertou para a necessidade de detecção viral rápida o mais cedo possível. Para lidar com o cenário de expansão gradual do SARS-CoV-2, o diagnóstico preciso é um fator extremamente crucial que deve ser observado pelas organizações internacionais de saúde. Pesquisa limitada seguida de comercialização esporádica de kits de detecção farmacêutica rápida de SARS-CoV-2 levanta questões críticas contra a garantia de qualidade e as medidas de controle de qualidade. Aqui, objetivamos questionar a eficácia e a análise de especificidade dos kits farmacêuticos de detecção rápida de SARS-CoV-2 (baseados em swab nasofaríngeo) usando a técnica de reação em cadeia da polimerase em tempo real padrão-ouro convencional (aprovado pelo USFDA). Um estudo transversal foi realizado em 1.500 pacientes suspeitos de SARS-CoV-2. Cem pacientes confirmados por PCR em tempo real foram avaliados para kits farmacêuticos de RDT baseados em kits baseados em swabs nasofaríngeas. A análise do kit de diagnóstico rápido baseado em swab nasofaríngeo SARS-CoV-2 (NSP RDTs) mostrou 78% de reatividade. Entre os indivíduos negativos confirmados por PCR em tempo real, 49,3% representaram falsa positividade. A análise preditiva positiva revelou 67,82%, enquanto os valores preditivos negativos foram de 64,40%. Os NSP RDTs mostraram sensibilidades e especificidades limitadas em comparação com a PCR em tempo real padrão-ouro. A detecção válida e autêntica do SARS-CoV-2 é considerada necessária para a vigilância precisa de COVID-19 em todo o mundo. O estudo atual destaca as possíveis consequências da detecção inadequada de SARS-CoV-2 e novos mutantes emergentes, comprometendo doenças evitáveis por vacina. O estudo atual enfatiza a necessidade de alertar autoridades superiores, incluindo organizações estratégicas, para projetar medidas adequadas para prevenir futuras epidemias de SARS-CoV-2. COVID19, COVID19 COVID 19, 19 SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- acabou possível SARSCoV2, 2, saúde Aqui padrãoouro padrão ouro aprovado USFDA. USFDA . USFDA) 1500 1 500 1.50 SARSCoV2. 2. nasofaríngeas 78 reatividade 493 49 3 49,3 positividade 6782 67 82 67,82% 6440 64 40 64,40% padrãoouro. ouro. COVID-1 mundo emergentes vacina superiores estratégicas COVID1 SARS-CoV 150 50 1.5 7 4 49, 678 6 8 67,82 644 64,40 COVID- 15 5 1. 67,8 64,4 67, 64,

ABSTRACT Trimethoprim-sulfamethoxazole (TMP-SMX) is the primary therapeutic option for Pneumocystis jirovecii pneumonia (PCP). Gastrointestinal symptoms and cutaneous rash are common side effects, with hyperkalemia being uncommon in patients without kidney dysfunction, and myelotoxicity being even rarer. We present the case of a male patient with hypertension and a recent diagnosis of non-Hodgkin lymphoma, undergoing rituximab treatment for two months. He was admitted to the intensive care unit due to dyspnea, tachypnea, and pleuritic pain, requiring mechanical ventilation. Chest computed tomography showed bilateral and multilobed ground-glass opacities, compromising more than 80% of the lung parenchyma. Pulmonary tuberculosis and COVID-19 were ruled out. An angiotomography and Doppler ultrasound revealed an extensive pulmonary thrombus and deep venous thrombosis. Empiric treatment with TMP-SMX for PCP was initiated, but within four days, the patient experienced metabolic acidosis and severe hyperkalemia, necessitating hemodialysis. He also presented with progressive pancytopenia and critical levels of leukopenia and thrombocytopenia. The hypothesis of TMP-SMX-induced myelotoxicity was suspected. Considering the unavailability of an alternative treatment, it was opted to continue TMP-SMX and initiate a granulocyte-colony-stimulating factor. However, the patient maintained medullary deterioration, becoming refractory to the transfusion of blood derivates. On the 17th day of treatment, a clinical decision was made to suspend TMP-SMX, leading to improvements within 48 hours in marrow and kidney functions, metabolic acidosis, and hyperkalemia. Despite all efforts, the patient died after 35 days of hospitalization due to hospital-acquired infections. This case highlights the importance of clinicians recognizing potential myelotoxicity with TMP-SMX and promptly discontinuing the drug if necessary. Trimethoprimsulfamethoxazole Trimethoprim sulfamethoxazole TMPSMX TMP SMX (TMP-SMX PCP. . (PCP) effects dysfunction rarer nonHodgkin non Hodgkin lymphoma months dyspnea tachypnea pain ventilation groundglass ground glass opacities 80 parenchyma COVID19 COVID 19 COVID-1 out thrombosis initiated hemodialysis thrombocytopenia TMPSMXinduced induced suspected granulocytecolonystimulating granulocyte colony stimulating factor However deterioration derivates th TMPSMX, SMX, 4 functions efforts 3 hospitalacquired hospital acquired infections necessary (PCP 8 COVID1 1 COVID-

Abstract Hereditary connective tissue disorders include more than 200 conditions affecting different organs and tissues, compromising the biological role of the extracellular matrix through interference in the synthesis, development, or secretion of collagen and/or its associated proteins. The clinical phenotype includes multiple signs and symptoms, usually nonspecific but of interest to rheumatologists because of musculoskeletal involvement. The patient's journey to diagnosis is long, and physicians should include these disorders in their differential diagnoses of diseases with systemic involvement. In this review, insights for the diagnosis and treatment of osteogenesis imperfecta, hypermobility spectrum disorder/Ehlers–Danlos syndrome, Marfan, Loeys–Dietz, and Stickler syndromes are presented. 20 tissues synthesis development andor proteins symptoms involvement patients patient s long review imperfecta disorderEhlersDanlos disorder Ehlers Danlos syndrome Marfan LoeysDietz Loeys Dietz Loeys–Dietz presented 2

Resumen El aislamiento social practicado durante la pandemia de COVID-19 ha tenido repercusiones en diversos aspectos de la vida personal y social de miles de personas. Entre las categorías sociales más fuertemente afectadas se encuentran los jóvenes estudiantes de educación superior. Este grupo ha sido afectado no solo en términos de su salud mental dentro de este contexto, sino también se ha visto afectado por el desempleo, la necesidad de adaptaciones tecnológicas y, sobre todo, el aislamiento social. Esta investigación se centra precisamente en la cuestión del aislamiento social, una realidad que ha demostrado ser capaz de afectar tanto la salud física como la psicológica. El texto se desarrolla en torno al objetivo de analizar los efectos de esta restricción en la salud mental de los estudiantes universitarios de la Universidad Católica Dom Bosco en Campo Grande, Mato Grosso do Sul. Los datos se obtienen de una muestra de 648 participantes a través de un cuestionario en línea y se someten a un análisis estadístico descriptivo adaptado a un estudio de caso. Se evidencia un alto porcentaje de positividad para factores que comprometen la salud mental, como el estrés, la depresión y la ansiedad, entre otros. Este diagnóstico, en el contexto posterior a la crisis pandémica, demuestra ser capaz de contribuir a la calidad de vida y al rendimiento académico, favoreciendo la implementación de acciones por parte de la universidad que garanticen un retorno guiado y humanizado a las clases presenciales. COVID19 COVID 19 COVID-1 personas superior desempleo todo psicológica Grande Sul 64 caso estrés ansiedad otros diagnóstico pandémica académico presenciales COVID1 1 COVID- 6

Abstract Social isolation practiced during the COVID-19 pandemic has had repercussions in various aspects of the personal and social lives of thousands of people. Among the social categories most severely affected are young college students. This group has been impacted not only in terms of their mental health, within this context, but also strained by unemployment, the need for technological adaptations, and, primarily, social isolation. This research focuses precisely on the issue of social isolation, a reality that has been shown to affect both physical and psychological health. The text revolves around the objective of analyzing the effects of this restriction on the mental health of university students at the Catholic University Dom Bosco in Campo Grande, Mato Grosso do Sul. Data is obtained from a sample of 648 participants through an online questionnaire and subjected to descriptive statistical analysis adapted to a case study. A high percentage of positivity for mental health compromising factors such as stress, depression, and anxiety, among others, is evident. This diagnosis, in the post-pandemic crisis context, proves capable of contributing to the quality of life and academic performance, favoring the university's implementation of actions that ensure a guided and humanized return to in-person classes. COVID19 COVID 19 COVID-1 people context unemployment adaptations primarily Grande Sul 64 study stress depression anxiety others evident diagnosis postpandemic post performance universitys s inperson person classes COVID1 1 COVID- 6

Resumo O isolamento social praticado durante a pandemia de COVID-19 teve repercussões em diversos aspectos da vida pessoal e social de milhares de pessoas. Entre as categorias sociais mais fortemente atingidas, encontram-se os jovens estudantes do Ensino Superior. Essa classe foi afetada não só em sua saúde mental, dentro deste contexto, mas tensionada pelo desemprego, pela necessidade de adaptações tecnológicas e, principalmente pelo isolamento social. A investigação coloca foco precisamente na questão do isolamento social, realidade que se mostrou capaz de afetar a saúde física e, também, psicológica. O texto se desenvolve com o objetivo de analisar os efeitos desta restrição na saúde mental de estudantes universitários da Universidade Católica Dom Bosco, localizada em Campo Grande, Mato Grosso do Sul. Os dados são obtidos a partir de uma amostra de 648 participantes por meio de um questionário on-line e submetidos a uma análise estatística descritiva, adaptada para um estudo de caso. Evidencia-se um alto percentual de positividade para fatores que comprometem a saúde mental, como estresse, depressão e ansiedade, entre outros. Este diagnóstico, no contexto pós-crise pandêmica, mostra-se capaz de contribuir para a qualidade de vida e o desempenho acadêmico, favorecendo a implementação de ações, pela universidade, que assegurem um retorno orientado e humanizado às aulas presenciais. COVID19 COVID 19 COVID-1 pessoas atingidas encontramse encontram Superior desemprego também psicológica Bosco Grande Sul 64 online on line descritiva caso Evidenciase Evidencia estresse ansiedade outros diagnóstico póscrise pós crise pandêmica mostrase mostra acadêmico ações universidade presenciais COVID1 1 COVID- 6

Abstract Alzheimer's disease (AD), defined as a chronic and degenerative dementia in its clinical progressions, leads to cognitive and functional decline, associated with the impact of its diagnosis on assessments of quality of life of elderly people with AD and their caregivers. Given this perspective, the objective was to analyze the main repercussions of Alzheimer's Disease in the daily lives of the elderly and their family caregivers. The study is characterized as qualitative with the use of data collection technique based on participant observation and semi-structured interviews. Held in the central of Rio Grande do Sul, Brazil, with caregivers and elderly people with Alzheimer's Disease. Data collection from July 2018 to March 2019. The data were analyzed according to the Thematic Content Analysis. 27 elderly people and 18 family caregivers participated in the study. In the course of the study, the results pointed out questions regarding denial regarding the diagnosis of Alzheimer's Disease, followed by adaptations to family dynamics, as well as the prevalence of neuropsychiatric symptoms, which affect both the elderly and family caregivers, which seems to have a direct impact on the quality of life of those involved in this process. It is understood that Alzheimer's Disease causes damage to the family context, arising from the meaning of the diagnosis, the complexity of care in the face of the evolutionary process and the existence of neuropsychiatric symptoms, compromising the quality of life of both the affected elderly and family caregivers.

Resumo A Doença de Alzheimer (DA), definida como uma demência crônica e degenerativa em suas progressões clínicas, suscita em declínio cognitivo e funcional, associado ao impacto do seu diagnóstico nas avaliações de qualidade de vida dos idosos com DA e de seus cuidadores. Diante dessa perspectiva, objetivou-se analisar as principais repercussões da Doença de Alzheimer no cotidiano do idoso e de seu cuidador familiar. O estudo caracteriza-se como qualitativo com o uso da técnica de coleta de dados a partir da observação participante e entrevistas semiestruturadas. Realizado na região central do Rio Grande do Sul, Brasil, com cuidadores e idosos com Doença de Alzheimer. A coleta de dados ocorreu no período de julho de 2018 a março de 2019. Os dados foram analisados segundo a Análise de Conteúdo Temática. Participaram do estudo, 27 idosos e 18 cuidadores familiares. No decurso do estudo, os resultados pontuaram questões referentes a negação perante o diagnóstico da Doença de Alzheimer, seguida de adaptações à dinâmica familiar, assim como a prevalência de sintomas neuropsiquiátricos, que afetam tanto os idosos quanto os cuidadores familiares, o que parece repercutir diretamente na qualidade de vida dos envolvidos nesse processo. Compreende-se que a Doença de Alzheimer acarreta prejuízos ao contexto familiar, oriundos da significação do diagnóstico, da complexidade do cuidado perante o processo evolutivo e, da existência de sintomas neuropsiquiátricos, comprometendo a qualidade de vida tanto do idoso acometido como de seus cuidadores familiares.

Resumen: Se llevó a cabo un análisis de los manuscritos publicados en la literatura científica sobre el síndrome compartimental para la evaluación de un paciente con síndrome compartimental e identificación de la presentación clínica y las bases necesarias para instaurar el diagnóstico y tratamiento oportuno. Es escasa la bibliografía reciente menor de cinco años que describa las características del síndrome compartimental, el cual puede ser provocado por múltiples etiologías, de las cuales los traumatismos son la más frecuente, además de las quemaduras, fracturas, contusiones, coagulopatías, edema postisquémico o yesos muy apretados. Se realizó una revisión de estudios elegidos, entre los cuales fueron seleccionados aquellos con mayor contenido académico. Se analizaron cada uno de los estudios seleccionados y se identificaron los datos que podrían incluirse en cada uno de los subtemas del artículo de revisión. El síndrome compartimental agudo corresponde a una emergencia quirúrgica que en caso de no establecer una intervención precoz, la probabilidad de secuelas irreversibles se incrementa notablemente. En el síndrome compartimental existe aumento de la presión intersticial en los compartimentos del cuerpo que compromete la adecuada perfusión de los tejidos blandos, derivado de un proceso isquémico que presenta como manifestaciones clínicas dolor súbito intenso, palidez, ausencia de pulsos, parestesia y parálisis, lo cual acompañado de una anamnesis dirigida integra el diagnóstico junto al examen físico. Corresponde a una urgencia quirúrgica la descompresión del espacio muscular afectado, por lo que requiere detección oportuna y tratamiento precoz para evitar secuelas y complicaciones graves.

Abstract: Perform an analysis of the papers published in the scientific literature on compartment syndrome for the evaluation of patients with compartment syndrome and to identify the clinical presentation and necessary bases to establish the diagnosis and opportune treatment. There is almost no recent bibliography than almost less than five years old that describes the characteristics of compartment syndrome, which can be caused by multiple etiologies, which trauma is the most frequent, in addition to burns, fractures, contusions, coagulopathies, post-ischemic edema or very tight casts. Some studies were chosen and subjected to review and those with the highest academic content were selected. Each of the selected studies was analyzed and the data that could be included in each of the subtopics of the review article were identified. Acute compartment syndrome implies to a surgical emergency that, in case of not establishing an early intervention, the probability of irreversible sequelae increases remarkably. In acute compartment syndrome, there is an increase in interstitial pressure in the body compartments, compromising the adequate perfusion of the soft tissues derived from an ischemic process, presenting as clinical manifestations sudden intense pain, pallor, absence of pulses, paresthesia and paralysis, which accompanied by a directed anamnesis integrates the diagnosis together with the physical examination. Decompression of the affected muscle space, which requires a quick detection and early treatment to avoid sequelae and serious complications.

ABSTRACT Clinical data: Infant, 11-month-old, male, diagnosis of Tetralogy of Fallot with retrotracheoesophageal course of the brachiocephalic vein. Usual findings of Tetralogy of Fallot on physical examination. Technical description: Chest radiography showed slightly reduced pulmonary vascular markings and no cardiomegaly. Normal preoperative electrocardiogram with postoperative right bundle branch block. Usual findings of Tetralogy of Fallot on echocardiogram. Postoperative computed tomography angiography confirmed left brachiocephalic vein with anomalous retrotracheoesophageal course, configuring a U-shaped garland vein, in addition to postoperative findings of total correction of Tetralogy of Fallot. Operation: Complete surgical repair was performed with pulmonary valve commissurotomy and placement of bovine pericardial patch to solve right ventricular outflow tract obstruction, pulmonary trunk enlargement, and ventricular septal defect closure. Comments: Systemic venous drainage may show variations in patients with Tetralogy of Fallot. These abnormalities are usually of little clinical relevance, as they are asymptomatic. We presented a rare case of retrotracheoesophageal course of an anomalous left brachiocephalic vein with intraoperative diagnosis, confirmed by imaging during postoperative follow-up, without compromising clinical management or surgical approach. data Infant 11monthold, 11monthold monthold 11 month old, old 11-month-old male examination description cardiomegaly block echocardiogram Ushaped U shaped Operation obstruction enlargement closure Comments relevance asymptomatic followup, followup follow up, up follow-up approach 1

Abstract Background The area of self-regulated learning integrates the fields of metacognition and self-regulation and assumes that the student is an active processor of information capable of self-regulating his learning by putting together the cognitive, metacognitive, and motivational components. The Motivated Strategies for Learning Questionnaire (MSLQ) is a benchmark for the measurement of self-regulated learning. However, the field of study does not show adequate evidence of its structural validity. The vast majority of studies involving this question present serious methodological mistakes, compromising the evidence of validity. Objective Our study investigates the structural validity of MSLQ including all 15 scales and corrects relevant mistakes in the previous studies. Method We tested different models through item confirmatory factor analysis in a convenience sample of 670 college students (M = 22.8 years, SD = 5.2) from a public Brazilian university in the technological area. The models with the ML, MLR, MLM and WLMSV estimators. Results Only WLSMV produced models with acceptable fit. The final model has a bi-factor structure with a general factor (self-regulated learning), 15 components as first-order factors, and four broad components as second-order factors. Twelve first-order components, all second-order components and the general factor had acceptable reliability. The components’ elaboration, intrinsic goal orientation and metacognitive self-regulation, did not show acceptable reliability, in terms of McDonald's omega. Conclusion Considering the worldwide importance of the MSLQ, we do not recommend the use of the measurement of these components for clinical practice and psychoeducational diagnosis until new studies show that this low reliability only occurs in our sample. Our study shows new evidence, correcting many previous methodological mistakes and producing initial evidence favorable to the factor structure of the MSLQ. selfregulated self regulated selfregulation regulation selfregulating regulating cognitive (MSLQ However 1 67 M 228 22 8 22. years 5.2 52 5 2 ML MLR estimators fit bifactor bi learning, , learning) firstorder first order factors secondorder second elaboration selfregulation, regulation, McDonalds McDonald s omega 6 5.

RESUMO Contexto: Protocolos abreviados de ressonância magnética (RM) surgiram a fim de reduzir o tempo de exame, eliminando sequências de pulso desnecessárias para responder a uma questão clínica específica, sem comprometer o diagnóstico. Objetivo: O objetivo do estudo foi avaliar a acurácia diagnóstica de um protocolo abreviado de colangiopancreatografia por ressonância magnética (colangioRM) em pacientes com suspeita de coledocolitíase. Métodos Estudo retrospectivo, com pacientes acima de 10 anos que realizaram exame de colangioRM, entre outubro de 2019 a junho de 2020, com suspeita clínica de coledocolitíase. Os observadores, radiologistas especialistas, primeiro avaliaram a árvore biliar usando um protocolo abreviado de colangioRM composto por quatro sequências de pulso e, posteriormente, revisaram o protocolo convencional de colangioRM de 11 sequências. A presença de coledocolitíase, o tamanho do cálculo, o calibre do ducto hepático comum e achados adicionais foram avaliados. Resultados Um total de 148 pacientes foram incluídos, sendo 62,8% do sexo feminino, com média de 50,9 anos de idade. A prevalência de coledocolitíase foi de 32,2%. A acurácia do protocolo abreviado de colangioRM para coledocolitíase foi de 98,7%. Não houve diferença entre o desempenho dos protocolos abreviado e convencional de colangioRM para a detecção de coledocolitíase (k=0,970), com uma sensibilidade de 98% e uma especificidade de 99%. Além disso, observou-se excelente concordância entre observadores na avaliação de coledocolitíase em ambos os protocolos de colangioRM (k=0,925). Conclusão O protocolo abreviado de colangioRM apresentou excelente acurácia para o diagnóstico de coledocolitíase quando comparado ao protocolo convencional.

ABSTRACT Background: Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. Objective: The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. Methods: This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. Results: A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). Conclusion: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.

ABSTRACT: Macroglossia corresponds to a condition characterized by an increase in lingual size, which can cause aesthetic and functional alterations, even compromising the airway. It is one of the early manifestations of amyloidosis, which is associated with some cases of Multiple Myeloma. Presented a clinical case of a 73-year-old male patient, presenting macroglossia in the Maxillofacial Surgery service of the Hospital del Carmen Maipú, Santiago de Chile, where it was determined that the macroglossia was in the context of amyloidosis. The diagnosis and surgical treatment performed is described, as a complication characterized by airway obstruction requiring Glossoplasty using the Harada technique.

RESUMEN: La Macroglosia, corresponde a un cuadro caracterizado por un aumento de tamaño lingual, pudiendo causar alteraciones estéticas y funcionales, llegando incluso a comprometer la vía aérea. Es una de las manifestaciones temprana de la amiloidosis, que a su vez se encuentra asociada a algunos casos de Mieloma Múltiple. Se presenta caso clínico de paciente sexo masculino de 73 años de edad, que presenta macroglosia en servicio de Cirugía Maxilofacial del Hospital del Carmen Maipú, Santiago de Chile. Donde se determinó que la macroglosia estaba en contexto de una amiloidosis, se describe diagnóstico y tratamiento quirúrgico realizado, además de complicación caracterizada por obstrucción de vía aérea, requiriendo Glosoplastía mediante técnica de Harada.

ABSTRACT Introduction: Neuroarthropathy is a condition secondary to metabolic, infectious, or genetic diseases. Its usual localization is reported in the foot, but it can affect any joint, compromising its vascular status and modifying the bone condition generating fractures, contractures, and dislocations. Objectives: To report the clinical and imaging findings of a patient with Charcot neuroarthropathy due to diabetes mellitus in a rare joint location. Clinical Case: A 62-year-old woman from Colombian southwestern, with a history of diabetes mellitus, in addition to micro and macrovascular complications. She presented a clinical picture of joint pain in the right knee that evolved to an inability to walk. During her care, different imaging tests were performed, finding a fracture of the left femoral condyle and tibial plateau, these typical radiological characteristics plus the clinical changes of the joint, led to the diagnosis of Charcot’s knee. Pharmacological interventions were performed in pain in addition to joint immobilization, with adequate evolution in clinical follow-up. Conclusions: Neuroarthropathy is a condition that should be evaluated in all patients with diabetes mellitus and other conditions, expanding the joint revision panorama to less frequent locations such as the knee; early and multidisciplinary intervention can favor positive clinical outcomes.

RESUMEN Introducción: La neuroartropatía es una afección secundaria a enfermedades metabólicas, infecciosas o genéticas. Su localización usual está reportada en el pie, pero puede afectar cualquier articulación, compromete su estado vascular y modifica la condición ósea, genera fracturas, contracturas y luxaciones. Objetivos: Reportar los hallazgos clínicos e imagenológicos de una paciente con neuroartropatía de Charcot por diabetes mellitus, en una localización articular, poco frecuente. Caso Clínico: Paciente femenina de 62 años, procedente del suroccidente colombiano, con antecedentes de diabetes mellitus y complicaciones micro y macrovasculares. Presentó un cuadro clínico de dolor articular en la rodilla derecha, que evolucionó a una imposibilidad para la marcha. En su atención se realizaron diferentes estudios de imagen; se encontró una fractura del cóndilo femoral izquierdo y de los platillos tibiales. Estas características radiológicas típicas, más los cambios clínicos de la articulación, llevaron al diagnóstico de rodilla de Charcot. Se realizaron intervenciones farmacológicas analgésicas, además de inmovilización articular, con adecuada evolución en el seguimiento clínico. Conclusiones: La neuroartropatía con rodilla de Charcot es una afección que debe ser evaluada en todos los pacientes con diabetes mellitus y otras enfermedades, ampliar el panorama de revisión articular a localizaciones menos frecuentes, como la rodilla. Una intervención temprana y multidisciplinaria puede favorecer los desenlaces clínicos positivos.