ABSTRACT Aging and face sagging have many causes, and various techniques are used for treatment, including noninvasive procedures, such as focused ultrasound, which uses the principle of collagen regeneration by coagulative necrosis of the dermis layers using radiofrequency, but this procedure has complications. We reported a case of a 54-year-old female patient who complained of poor visual acuity in her right eye three days after a focused ultrasound facial aesthetic procedure, with the best visual acuity of 20/60. Biomicroscopy of the right eye revealed an acute cataract with three points of fibrosis extending from the posterior to the anterior capsule. The patient underwent phacoemulsification surgery with visual rehabilitation and improved vision of 20/20. We hypothesized that the occurrence of acute cataract was related to the inappropriate use of focused ultrasound. causes treatment procedures radiofrequency complications 54yearold yearold 54 year old 2060 20 60 20/60 capsule 2020 20/20 5 206 2 6 20/6 202 20/2 20/

Resumen Descripción del caso: Paciente de 23 años con hemorragia abdominal de origen no claro, que posteriormente presenta inestabilidad hemodinámica, requiriendo manejo quirúrgico en tres ocasiones con evolución satisfactoria. Hallazgos clínicos: Presentó sangrado cuantificado de 5500 cc en cavidad abdominal (grado IV - clasificación ATLS) con lesiones hepáticas en los segmentos I, IV y VIII, sin hallazgos sugestivos de trauma al examen físico, ni otros hallazgos traumáticos internos. Tratamiento y resultados: Se llevó a cabo una intervención quirúrgica precoz mediante laparotomía exploratoria con hallazgos ya descritos, además de dos tiempos quirúrgicos adicionales que llevaron al control del sangrado, con evolución satisfactoria. Relevancia clínica: El sangrado abdominal y laceración de víscera sólida secundario a trauma cerrado de abdomen es una etiología común en pacientes jóvenes masculinos, siendo contrario a esta afirmación el sangrado de origen hepático sin trauma es una etiología poco común. El presente caso resulta ser una dificultad diagnóstica en cuanto a la etiología, ya que lo evidenciado en la exploración quirúrgica no concuerda con el examen físico externo, sin una historia clínica clara al ingreso se deja la interrogante de la causa.

Summary: Case description: 23-year-old patient with abdominal hemorrhage of unclear origin, who subsequently presented hemodynamic instability, requiring surgical management on three occasions with satisfactory evolution. Clinical findings: she presented quantified bleeding of 5500 cc in the abdominal cavity (grade IV-ATLS classification) with liver lesions in segments I, IV and VIII, without findings suggestive of trauma on physical examination, or other internal traumatic findings. Treatment and results: An early surgical intervention was carried out through exploratory laparotomy with findings already described, in addition to two additional surgical procedures that led to control of bleeding, with satisfactory evolution. Clinical relevance: Abdominal bleeding and solid viscus laceration secondary to blunt abdominal trauma is a common etiology in young male patients, contrary to this statement, bleeding of hepatic origin without trauma is a rare etiology. The present case turns out to be a diagnostic difficulty in terms of etiology, since what was evidenced in the surgical exploration does not agree with the external physical examination, without a clear clinical history at admission, the question of the cause is left.

Abstract A basic iron profile often provides a useful approach to ferropenic or iron-sequestered inflammatory conditions, but sometimes also to the primary suspicion of iron overloading pathologies, which may or may not, at last, harbor a real iron overload. Therefore, a thoughtful interpretation of the results is mandatory to avoid misdiagnosis. The serum iron concentration reflects the quantity of iron moving at one moment from ferroportin- to transferrin receptor-1-expressing cells, while the transferrin concentration reflects the organism avidity for iron. But serum ferritin concentration may reflect iron deposits as well as inflammatory conditions, hence being difficult the interpretation of its normal or high values. In this paper I distinguish, among abnormal iron profiles, those with evident iron overload from those with hiperferritinemia without (clear) evidence of iron overload, although there is a frequent overlap between these two conditions. Secondary reactive hiperferritinemia is, by far, much more common than hiperferritinemia related to iron overload, as it is also frequent to deal with patients with more than one cause for their hiperferritinemia. "Reactive hiperferritinemia of unknown origin" should be the temporary diagnosis for patients with (yet) no evident etiology for their hiperferritinemia. Some patients have clearly absence or presence of iron overload, but in many cases this condition is doubtful, incomplete or intermittent. Hence, it is difficult in some cases to decide the need for chelation therapy. Iron overload, if present, may be secondary (basically to ineffective erythropoiesis) or primary. Primary iron overload may be, in turn, classified as hemochromatosic (HFE or non HFE) or non hemochromatosic. Although very rare, the non hemochromatosic primary iron overloads have confounding iron profiles, but with an easy approach if suspected. One of them, the ferroportin disease, just the opposite of hemochromatosis, deserves some attention, for it is not very infrequent. Finally, the diagnosis of hemochromatosis must be supported by an unequivocal typical iron profile and by biallelic severe HFE mutations or, rarer, mutations in non-HFE genes. The last but not the least, mild HFE mutations, as H63D, either mono o biallelic, do not justify by themselves any typical iron overload. In presence of such a genetic diagnosis, other cause(s) of iron overload must be looked for: non-HFE hemochromatosis if the iron profile is typically hemochromatosic, non-hemochromatosic iron overload (primary o secondary) if not. The risk of considering a mild HFE mutation (even in the case of HFE C282Y/H63D double heterozygous) as responsible for an iron overload or a hiperferritinemia is to overlook other causes for these conditions that may deserve particular and, eventually, more imperative attention and treatment.

Resumen Con frecuencia un perfil básico de hierro orienta hacia condiciones ferropénicas o de secuestro inflamatorio del hierro, pero a veces también hacia la sospecha de patologías con sobrecarga de hierro, que pueden o no terminar confirmándose. Por lo tanto, es necesaria una interpretación precisa de los resultados para evitar errores diagnósticos. La ferremia refleja la cantidad de hierro en tránsito en un momento determinado desde células que expresan la ferroportina hacia las que expresan el receptor de transferrina-1, mientras que la transferrinemia refleja la avidez del organismo por el hierro. Pero la ferritinemia puede ser reflejo tanto de los depósitos de hierro como de condiciones inflamatorias, con la consiguiente dificultad para interpretar sus resultados normales o elevados. En este articulo diferencio, entre los perfiles de hierro sugestivos de sobrecarga, los que cursan con una sobrecarga de hierro evidente de los que presentan sólo una hiperferritinemia sin evidencia (franca) de sobrecarga de hierro, aunque la superposición entre ambas situaciones es frecuente. La hiperferritinemia secundaria reactiva es, por mucho, más frecuente que la vinculada a sobrecarga de hierro, así como es común encontrar pacientes con más de una causa de hiperferritinemia. "Hiperferritinemia reactiva de origen desconocido" puede ser un rótulo diagnóstico provisorio para aquellos pacientes sin una causa (hasta el momento) evidente de su hiperferritinemia. Algunos pacientes tienen claramente presencia o ausencia de sobrecarga de hierro, pero en muchos casos la situación es dudosa, incompleta o intermitente. En consecuencia, es a veces difícil decidir sobre la indicación o no de una terapia quelante. La sobrecarga de hierro, de estar presente, puede ser secundaria (básicamente a patologías con eritropoyesis inefectiva) o primaria. Ésta, a su vez, puede ser clasificada como hemocromatósica (HFE o no HFE) o no hemocromatósica. Aunque muy raras, las sobrecargas de hierro primarias no hemocromatósicas tienen perfiles de hierro confundentes, pero fácilmente interpretables si se las sospecha. Una de ellas, la enfermedad por ferroportina, en las antípodas de las hemocromatosis, merece ser tenida en cuenta, ya que no es muy infrecuente. Finalmente, el diagnóstico de una hemocromatosis debe estar apoyado en un perfil de hierro inequívoco y confirmado por mutaciones HFE severas bialélicas o, más raramente, por mutaciones en genes no HFE. Por el contrario, mutaciones HFE leves, como la H63D, tanto en condición mono como bialélica, no justifican por sí solas una sobrecarga de hierro típica. Frente a esta situación debemos investigar otra(s) causa(s) de sobrecarga de hierro: hemocromatosis no HFE si el perfil de hierro es típicamente hemocromatósico, o sobrecargas de hierro no hemocromatósicas (primarias o secundarias) en caso contrario. El riesgo de considerar una mutación HFE leve (aún en la condición doble heterocigota HFE C282Y/H63D) como responsable única de la sobrecarga de hierro o de una hiperferritinemia, es dejar de lado otras condiciones que pueden merecer atención y tratamiento quizás más prioritarios.

ABSTRACT Background: Chagasic cardiomyopathy (CC) differs from other heart failure causes in multiple aspects, highlighting the risk of systemic embolisms. However, few studies have evaluated the risk of embolic events in anticoagulated patients with CC compared with other cardiomyopathies. Objective: We aimed to analyze the incidence of systemic embolisms in a cohort of anticoagulated patients diagnosed with atrial fibrillation (AF) with and without CC. Methods: A retrospective cohort study was carried out at a fourth level hospital in Colombia during the period 2014-2020. All patients diagnosed with cardiomyopathy of any etiology and AF, who were on an anticoagulation regimen were included. The primary outcome was the incidence of embolic events. A survival analysis was performed using adjusted Cox proportional hazard models. A p-value <0.05 was considered significant. All statistical tests were two-tailed. Results: A total of 149 anticoagulated patients with cardiomyopathy were evaluated (median age: 71 years; women: 30.20%). The cumulative incidence of embolic events was significantly higher in patients with CC (17.50%) compared with those presenting other cardiomyopathies (4.95%), despite that the latter had a significantly higher CHA2DS2-VASc score (p=0.013). After multivariate analysis, patients with CC had a significantly higher risk of embolic events regardless of the CHA2DS2-VASc score and the type of anticoagulant prescribed (HR 5.65; 95% CI 1.46-21.83; p=0.012). Conclusions: Chagasic cardiomyopathy was associated with a significantly higher risk of embolic events, despite anticoagulation therapy in both groups. More research is required to understand the origin of the risk observed in order to translate this knowledge into specific indications for anticoagulation in patients with CC.

RESUMEN Introducción: La miocardiopatía chagásica (MC) difiere de otras causas de insuficiencia cardíaca en múltiples aspectos, destacándose el riesgo de embolias sistémicas. Sin embargo, pocos estudios han evaluado el riesgo de eventos embólicos en pacientes anticoagulados con MC en comparación con otras miocardiopatías. Objetivo: Nuestro objetivo fue analizar la incidencia de embolias sistémicas en una cohorte de pacientes anticoagulados con diagnóstico de fibrilación auricular (FA) con y sin MC. Material y métodos: Se realizó un estudio de cohorte retrospectivo en hospital de cuarto nivel en Colombia durante el periodo 2014-2020. Se incluyeron todos los pacientes con diagnóstico de miocardiopatía de cualquier etiología y FA que estuvieran en régimen de anticoagulación. El resultado primario fue la incidencia de eventos embólicos. Se realizó un análisis de supervivencia mediante modelos de riesgos proporcionales de Cox ajustados. Un valor de p <0,05 se consideró significativo. Todas las pruebas estadísticas fueron de dos colas. Resultados: Se evaluaron 149 pacientes anticoagulados con miocardiopatía (mediana de edad: 71 años; mujeres: 30,20%). La incidencia acumulada de eventos embólicos fue significativamente mayor en los pacientes con MC (17,50%) en comparación con aquellos con otras miocardiopatías (4,95%), a pesar de que estos últimos tenían una puntuación CHA2DS2-VASc significativamente mayor (p=0,013). Tras el análisis multivariado, los pacientes con MC tuvieron un riesgo significativamente mayor de eventos embólicos independientemente de la puntuación CHA2DS2-VASc y del tipo de anticoagulante prescrito (HR 5,65; IC 95% 1,46-21,83; p=0,012). Conclusiones: La MC se asoció con un riesgo significativamente mayor de eventos embólicos, a pesar del tratamiento anticoagulante en ambos grupos. Se requiere más investigación para comprender el origen de este riesgo observado y traducir este conocimiento en indicaciones específicas de anticoagulación para pacientes con MC.

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança. décadas (DRC químicos metais, , metais) DRCnt. . (DRCnt) relacionadas disso Brasil país segurança (DRCnt

Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD’s etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety. decades (CKD chemicals metals, , metals) nontraditional non traditional CKDnt. . (CKDnt) enforcement Furthermore enforcement) Brazil CKDs s country Moreover safety (CKDnt

Resumo Introdução: Nonagenários constituem um percentual de pacientes internados em ascensão, sendo a injúria renal aguda (IRA) frequente nesses pacientes. Sendo assim, é importante analisar as características clínicas dessa população e seu impacto na mortalidade. Métodos: Estudo retrospectivo de pacientes nonagenários com IRA entre 2013 e 2022 em um hospital terciário. Apenas o último internamento foi considerado e pacientes com dados incompletos foram excluídos. Uma análise por regressão logística foi realizada para definir fatores de risco para mortalidade. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 150 pacientes com mediana de idade 93,0 anos (91,2–95,0) e sexo masculino em 42,7%. Sepse foi a causa mais comum de IRA (53,3%), seguida de desidratação/hipovolemia (17,7%) e insuficiência cardíaca (17,7%). Admissão na UTI ocorreu em 39,3% dos pacientes, ventilação mecânica em 14,7%, uso de vasopressores em 22,7% e realização de terapia renal substitutiva (TRS) em 6,7%. Óbito ocorreu em 56,7% dos pacientes. Desidratação/hipovolemia como etiologia da IRA foi associado a menor risco de mortalidade (OR 0,18; IC 95% 0,04–0,77, p = 0,020). Estágio KDIGO 3 (OR 3,15; IC 95% 1,17–8,47, p = 0,023), admissão na UTI (OR 12,27; IC 95% 3,03–49,74, p < 0,001) e oligúria (OR 5,77; IC 95% 1,98–16,85, p = 0,001) foram associados à mortalidade. Conclusão: Nonagenários com IRA apresentaram alta mortalidade e IRA KDIGO 3, oligúria e admissão na UTI foram associadas ao óbito. Introdução ascensão (IRA assim Métodos 201 202 terciário excluídos 005 0 05 0,0 significativo Resultados 15 930 93 93, 91,2–95,0 912950 91 2 95 (91,2–95,0 427 42 7 42,7% 53,3%, 533 53,3% , 53 (53,3%) desidrataçãohipovolemia desidratação hipovolemia 17,7% 177 17 (17,7% 17,7%. . 393 39 39,3 147 14 14,7% 227 22 22,7 TRS (TRS 67 6 6,7% 567 56 56,7 Desidrataçãohipovolemia Desidratação OR 0,18 018 18 004077 04 77 0,04–0,77 0,020. 0020 0,020 020 0,020) 3,15 315 117847 1 8 47 1,17–8,47 0,023, 0023 0,023 023 0,023) 12,27 1227 12 27 3034974 03 49 74 3,03–49,74 0,001 0001 001 5,77 577 5 1981685 98 16 85 1,98–16,85 Conclusão óbito 20 00 0, 9 91,2–95, 91295 (91,2–95, 4 42,7 53,3 (53,3% 17,7 (17,7 39, 14,7 22, 6,7 56, 0,1 01 00407 0,04–0,7 002 0,02 02 3,1 31 11784 1,17–8,4 12,2 122 303497 3,03–49,7 0,00 000 5,7 57 198168 1,98–16,8 91,2–95 9129 (91,2–95 42, 53, (53,3 17, (17, 14, 6, 0040 0,04–0, 1178 1,17–8, 12, 30349 3,03–49, 5, 19816 1,98–16, 91,2–9 912 (91,2–9 (53, (17 004 0,04–0 117 1,17–8 3034 3,03–49 1981 1,98–16 91,2– (91,2– (53 (1 0,04– 11 1,17– 303 3,03–4 198 1,98–1 91,2 (91,2 (5 ( 0,04 1,17 30 3,03– 19 1,98– 91, (91, 1,1 3,03 1,98 (91 1, 3,0 1,9 (9

Abstract Introduction: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. Methods: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. Results: A total of 150 patients were included, with a median age of 93.0 years (91.2–95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04–0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17–8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03–49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98–16.85, p = 0.001) were associated with mortality. Conclusion: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death. Introduction inpatients (AKI population Thus Methods 201 2022 excluded pvalue value 005 0 05 0.0 significant Results 15 included 930 93 93. 91.2–95.0, 912950 91.2–95.0 , 91 2 95 (91.2–95.0) 427 42 7 42.7 sample 53.3%, 533 53.3% 53 (53.3%) dehydrationhypovolemia dehydration hypovolemia 17.7%, 177 17.7% 17 (17.7%) 17.7%. . 393 39 39.3 147 14 14.7% 227 22 22.7 RRT (RRT 67 6 6.7% 567 56 56.7 Dehydrationhypovolemia Dehydration OR 0.18 018 18 004077 04 77 0.04–0.77 0.020. 0020 0.020 020 0.020) 3.15 315 117847 1 8 47 1.17–8.47 0.023, 0023 0.023 023 0.023) 12.27 1227 12 27 3034974 03 49 74 3.03–49.74 0.001, 0001 0.001 001 5.77 577 5 1981685 98 16 85 1.98–16.85 Conclusion rate death 20 202 00 0. 9 91295 91.2–95. (91.2–95.0 4 42. 53.3 (53.3% 17.7 (17.7% 39. 14.7 22. 6.7 56. 0.1 01 00407 0.04–0.7 002 0.02 02 3.1 31 11784 1.17–8.4 12.2 122 303497 3.03–49.7 000 0.00 5.7 57 198168 1.98–16.8 9129 91.2–95 (91.2–95. 53. (53.3 17. (17.7 14. 6. 0040 0.04–0. 3. 1178 1.17–8. 12. 30349 3.03–49. 5. 19816 1.98–16. 912 91.2–9 (91.2–95 (53. (17. 004 0.04–0 117 1.17–8 3034 3.03–49 1981 1.98–16 91.2– (91.2–9 (53 (17 0.04– 11 1.17– 303 3.03–4 198 1.98–1 91.2 (91.2– (5 (1 0.04 1.17 30 3.03– 19 1.98– 91. (91.2 ( 1.1 3.03 1.98 (91. 1. 3.0 1.9 (91 (9

RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12–84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19. Introdução , (DRET) COVID19. COVID19 COVID 19. 19 (TC (TRS Métodos 1 prontosocorro pronto socorro COVID-1 incluídos saúde típica indeterminada atípica negativa Resultados 10 62,3% 623 62 3 (62,3 COVID19positivos COVIDpositivos COVID-19-positivos 2020 125 5 12, 43 mulheres diabetes meses 1284 84 12–84 fosco 40 61% 61 (61% vs 0% (0% COVID19, 19, 0,001. 0001 0,001 . 001 0,001) 6061 60,61 40/66, 4066 40/66 66 (40/66) 100 40/40. 4040 40/40 (40/40) respectivamente COVID19negativos COVIDnegativos 9 ( 14% 14 (14% 2 56% 56 (56% COVID19positivos, positivos, 0,001, 13 (1 20% 20 (20% 14%, 0,606, 0606 0,606 606 0,606) 4 6% (6% 28%, 28 28% (28%) 0,002. 0002 0,002 002 0,002) Conclusões (DRET COVID1 COVID- 62,3 (62, 202 128 8 12–8 (61 (0 000 0,00 00 60,6 406 40/6 (40/66 404 40/4 (40/40 (14 (56 (20 060 0,60 (6 (28% 62, (62 12– 0,0 60, 40/ (40/6 (40/4 (5 (2 06 0,6 (28 0, (40/

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12–84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19. Introduction ESKD, , (ESKD) COVID19 COVID 19 COVID-1 challenge (CT RRT (RRT COVID19. 19. Methods 1 records typical Results 10 62.3% 623 62 3 (62.3 COVID19positive COVIDpositive COVID-19-positive 2020 125 5 12. 43 female diabetes months 1284 84 12–84 opacities 40 61% 61 (61% 0% (0% nonCOVID19 nonCOVID non non-COVID-1 0.001. 0001 0.001 . 001 0.001) 6061 60.61 40/66 4066 66 (40/66 100 40/40. 4040 40/40 (40/40) respectively COVID19negative COVIDnegative 9 ( 14% 14 (14% 2 56% 56 (56% COVID19positive, positive, 0.001, 13 (1 20% 20 (20% 14%, 0.606, 0606 0.606 606 0.606) 4 6% (6% 28%, 28 28% (28%) 0.002. 0002 0.002 002 0.002) Conclusions (ESKD COVID1 COVID- 62.3 (62. 202 128 8 12–8 (61 (0 nonCOVID1 non-COVID- 000 0.00 00 60.6 40/6 406 (40/6 404 40/4 (40/40 (14 (56 (20 060 0.60 (6 (28% 62. (62 12– non-COVID 0.0 60. 40/ (40/ (40/4 (5 (2 06 0.6 (28 0.

RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5–15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25–75) da relação proteína/creatinina urinária 0,30 (0,27–0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25–75) da TFG 75 (62–83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo. Introdução (IRA mundo apresentação etiologia terciário Métodos 2 1 36 Pediátrica 201 2021 KDIGO. . (KDIGO) proteinúria, (proteinúria meses. meses meses) Resultados 4 130 13 0 13, 3,5–15,5 35155 5 15 (3,5–15,5 n 24 52,2% 522 52 28,3% 283 28 (28,3% anúricos p 0,001. 0001 0,001 001 0,001) 10 21,7% 217 21 7 substitutiva 60 26 sequela 38,5% 385 38 P25–75 P2575 P P25 (P25–75 proteínacreatinina proteína creatinina 030 30 0,3 0,27–0,44 027044 27 44 (0,27–0,44 mg/mg, mgmg mg/mg , mg mg/mg) (TFG 11 27,5% 275 62–83 6283 62 83 (62–83 mLmin173 mLmin mL min 73 mL/min/1,7 m2. m2 m m2) Conclusões substancial prazo 20 202 (KDIGO 3,5–15, 3515 (3,5–15, 52,2 28,3 (28,3 000 0,00 00 21,7 38,5 P25–7 P257 P2 (P25–7 03 0, 0,27–0,4 02704 (0,27–0,4 27,5 62–8 628 8 (62–8 mLmin17 mL/min/1, 3,5–15 351 (3,5–15 52, 28, (28, 0,0 21, 38, P25– (P25– 0,27–0, 0270 (0,27–0, 27, 62– (62– mLmin1 mL/min/1 3,5–1 35 (3,5–1 (28 (P25 0,27–0 027 (0,27–0 (62 mL/min/ 3,5– (3,5– (2 (P2 0,27– 02 (0,27– (6 mL/min 3,5 (3,5 ( (P 0,27 (0,27 3, (3, 0,2 (0,2 (3 (0, (0

ABSTRACT Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5–15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25–75) urinary protein-to-creatinine ratio 0.30 (0.27–0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25–75) GFR 75 (62–83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis. Introduction (AKI worldwide noncritically non settings presentation etiology evolution center Methods singlecenter single 2 1 36 201 2021 (KDIGO criteria proteinuria, (proteinuria hypertension followup follow up assessments. assessments . assessments) Results Fortysix Forty six 130 13 0 13. 3.5–15.5 35155 5 15 (3.5–15.5 included n 24 52.2% 522 52 28.3% 283 28 (28.3% anuric p 0.001. 0001 0.001 001 0.001) 10 21.7% 217 21 7 therapy 60 26 38.5% 385 38 P25–75 P2575 P P25 (P25–75 proteintocreatinine protein creatinine 030 30 0.3 0.27–0.44 027044 27 44 (0.27–0.44 mg/mg, mgmg mg/mg , mg mg/mg) (GFR 11 27.5% 275 62–83 6283 62 83 (62–83 mLmin173 mLmin mL min 73 mL/min/1.7 m2. m2 m m2) Conclusions morbidity longterm long term prognosis 20 202 3.5–15. 3515 (3.5–15. 52.2 28.3 (28.3 000 0.00 00 21.7 38.5 P25–7 P257 P2 (P25–7 03 0. 0.27–0.4 02704 4 (0.27–0.4 27.5 62–8 628 8 (62–8 mLmin17 mL/min/1. 3.5–15 351 (3.5–15 52. 28. (28. 0.0 21. 38. P25– (P25– 0.27–0. 0270 (0.27–0. 27. 62– (62– mLmin1 mL/min/1 3.5–1 35 (3.5–1 (28 (P25 0.27–0 027 (0.27–0 (62 mL/min/ 3.5– (3.5– (2 (P2 0.27– 02 (0.27– (6 mL/min 3.5 (3.5 ( (P 0.27 (0.27 3. (3. 0.2 (0.2 (3 (0. (0

Abstract Introduction One of the paths in the investigation of congenital sensorineural hearing loss (CSNHL) is to try to characterize its etiology through the inner ear evaluation using high resolution computer tomography (CT) scans. With minor malformation, it is not always possible for a simple visual inspection to recognize if the structure in the inner ear is normal or not. Objective To verify if measurements of the inner ear are predictive of sensorineural hearing loss (SNHL) and suggest cutoff points of size limits. Methods Retrospective cross-sectional study of inner ear CT scan measurements of 214 patients, 50 with congenital SNHL (CSNHL) and 164 acquired SNHL (ASNHL) (control group). Results In the CSNHL group, central bony island (CBI) were 0.48 mm smaller (p < 0.001), cochlear nerve aperture was (CNA) 0.10 mm smaller (p < 0.001), and cochlea height was (CH) 0.15 mm smaller (p < 0.001). Vestibular aqueduct (VA) and cochlea width (CW) were similar between groups (0.70 vs 0.72, p = 0.19, and 7.20 vs 7.15 p = 0.23). The predictive cutoff points for CSNHL were CBI = 3.6 mm, CAN = 1.4 mm, CH = 3.4 mm, CW = 7.0 mm, and VA = 0.9 mm. Conclusion Congenital sensorineural hearing loss determined a decrease in CBI, opening of the cochlear nerve (OCN), and CW. Thus, these measures, at the cutoff points indicated, should make us aware of the diagnosis of congenital hearing loss. (CSNHL (CT scans malformation (SNHL limits crosssectional cross sectional 21 patients 5 16 ASNHL (ASNHL control group. group . group) (CBI 048 0 48 0.4 0.001, 0001 0.001 , 001 0.001) CNA (CNA 010 10 0.1 (CH 015 15 0.001. (VA (CW 0.70 070 70 (0.7 072 72 0.72 019 19 0.19 720 7 20 7.2 715 7.1 0.23. 023 0.23 23 0.23) 36 3 6 3. 14 1 4 1. 34 7. 09 9 0. OCN, OCN (OCN) Thus measures indicated 2 04 000 0.00 00 01 0.7 07 (0. 71 02 0.2 (OCN 0.0 (0 (

Abstract Context: Female Sexual Dysfunctions (FSD) are prevalent conditions, can occur in any stage of life and can severely affect women’s quality of life. The etiology of FSD is often multifactorial, including biologic, psychological, interpersonal and sociocultural factors. Objectives: To evaluate FSD in a Portuguese population and what factors can influence the female sexual function. Methods: A cross-sectional study was conducted between August and September of 2023. Participants filled an anonymous online survey, including a demographic questionnaire and the Female Sexual Function Index (FSFI) for evaluation of sexual function. Inclusion criteria: age between 18 and 75 years old, residence in Portugal and being in a heterosexual relationship. The total score FSFI and domain scores (desire, arousal, lubrification, orgasm, satisfaction and discomfort) were analyzed using SPSS 22®. Results: A total of 401 women completed the questionnaire, 393 fulfilled the inclusion criteria. Women had a mean age of 41,6 years (range: 20-71 years). From these, 48% of women reported being moderately satisfied or very satisfied with their sex life and 9,6% reported no sexual intercourse in the past 4 weeks. Among sexually active women, the mean total FSFI score was 27.37 (range: 7.5-34.5±4.99) and 36% met the criteria for sexual dysfunction (FSFI score ≤ 26.55). Post-menopausal participants, when compared to women in reproductive age, had a lower mean total score and also had lower mean scores across all domains, except for discomfort (p<0.05). Women with children or a BMI ≥ 25 had lower mean total score and lower mean scores for desire, arousal and satisfaction domains (p<0.05). Conclusions: The prevalence of FSD was 36%. These findings highlight the importance of addressing FSD as a significant concern for women health and quality of life and the need for training and awareness among healthcare professionals.

Resumo Introdução: As disfunções sexuais femininas (DSF) são condições prevalentes. Estas podem ocorrer em qualquer fase da vida e podem afetar negativamente a qualidade de vida de muitas mulheres. A etiologia das DSF é frequentemente multifatorial, incluindo fatores biológicos, psicológicos, interpessoais e socioculturais. Objetivos: Avaliar as DSF em mulheres portuguesas e identificar possíveis fatores que possam influenciar a sexualidade feminina. Métodos: Estudo transversal observacional realizado entre agosto e setembro de 2023, através do preenchimento de questionário online anónimo, que incluía um questionário demográfico e o Female Sexual Function Index (FSFI) para avaliação da resposta sexual. A pontuação total e dos domínios (desejo, excitação, lubrificação, orgasmo, satisfação e desconforto) foram analisados utilizando o SPSS 22®. Resultados: De um total de 401 mulheres que completaram o questionário, 393 preenchiam os critérios de inclusão no estudo. A idade média das inquiridas foi de 41,6 anos (20-71 anos). Quando questionadas, 74% das mulheres referiram estar moderadamente satisfeitas ou muito satisfeitas com a sua vida sexual e 9,6% das mulheres referiu ausência de relações sexuais nas últimas quatro semanas. Entre as mulheres sexualmente ativas, a pontuação média total do FSFI foi de 27,37 (7,5-34,5±4,99) e 36% preenchiam os critérios para disfunção sexual (Pontuação FSFI ≤ 26,55). As participantes na pós-menopausa, em comparação com as mulheres em idade reprodutiva, apresentaram uma pontuação média total inferior, assim como pontuações médias inferiores em todos os domínios, exceto no desconforto (p<0,05). Mulheres com filhos ou com IMC ≥25 tiveram uma pontuação média total e pontuações médias inferiores nos domínios do desejo, excitação e satisfação (p<0,05). Conclusões: A prevalência de problemas sexuais na população em estudo foi de 36%. Estes achados destacam a importância de abordar as DSF como uma preocupação na saúde e qualidade de vida das mulheres e da necessidade de formação e sensibilização dos profissionais de saúde.

Abstract Keratoacanthoma diagnosis is challenging, and therefore, this publication contributes to the current literature by presenting epidemiological data and describing clinical and histopathological characteristics and the treatment decision. A 69-year-old Caucasian male patient presented with a well-delimited exophytic growth nodule in the lower lip measuring 10 millimeters with circular shape, firm consistency, pink color, and rough surface. The clinical suspicion was squamous cell carcinoma. An incisional biopsy and histopathological analysis were performed, which revealed fragments of oral mucosa lined by hyperparakeratinized stratified squamous epithelium with a center filled with keratin, corneal pearls, pseudoepitheliomatous hyperplasia, and areas of epithelial dysplasia. The diagnosis of keratoacanthoma was determined. Surgical resection was performed, completely removing the lesion, and histopathological analysis confirmed the diagnosis of keratoacanthoma. The fact that the patient was male, over 45 years old, and Caucasian agrees with the epidemiology of the population most affected by keratoacanthoma. The histopathology of the case corroborates the classic characterization, mainly the central depression filled with keratin. The treatment chosen was surgical resection with a small margin of safety, according to the current literature. Keratoacanthomas are more common in males aged over 45 years and in Caucasian individuals. The main etiology is sun exposure without protective measures. It presents as an exophytic nodule with a firm consistency, rough surface, and center filled with keratin. Histopathology is characterized by a crateriform structure, dyskeratosis, and the presence of corneal pearls. The most indicated treatment is surgical resection.

Resumo O diagnóstico do ceratoacantoma é desafiador e, portanto, esta publicação contribui para a literatura atual apresentando dados epidemiológicos e descrevendo características clínicas e histopatológicas e a decisão de tratamento. Homem caucasiano de 69 anos apresentava nódulo de crescimento exofítico em lábio inferior, de 10 mm, bem delimitado, de forma circular, consistência firme, cor rósea e superfície rugosa. A suspeita clínica foi de carcinoma de células escamosas. Foi realizada biópsia incisional e análise histopatológica, a qual revelou fragmentos de mucosa oral revestidos por epitélio pavimentoso estratificado hiperparaceratinizado com centro preenchido por ceratina, pérolas córneas, hiperplasia pseudoepiteliomatosa e áreas de displasia epitelial, concluindo o diagnóstico de ceratoacantoma. Foi feita a ressecção cirúrgica, removendo totalmente a lesão. A análise histopatológica confirmou o diagnóstico de ceratoacantoma. Indivíduos do sexo masculino, caucasianos, acima de 45 anos de idade são os mais acometidos pelo ceratoacantoma. A histopatologia do caso corrobora a caracterização clássica, principalmente a depressão central preenchida por ceratina. O tratamento escolhido foi a ressecção cirúrgica com pequena margem de segurança, de acordo com a literatura atual. Os ceratoacantomas são mais comuns em indivíduos do sexo masculino com idade acima de 45 anos. O principal fator etiológico é a exposição solar sem medidas de proteção. Esta lesão apresenta-se como nódulo exofítico, de consistência firme, superfície rugosa e centro preenchido por ceratina. A histopatologia caracteriza-se por estrutura crateriforme, disceratose e presença de pérolas córneas. O tratamento mais indicado é a ressecção cirúrgica.

ABSTRACT Introduction: Precocious puberty is defined as the progressive appearance of pubertal signs at an age below 2.5 standard deviations (SD) from the mean for a given population. There is a lack of epidemiological studies on this condition in our country. Objective: To determine the characteristics of precocious puberty and to evaluate the age of onset of secondary sexual characteristics in a population of girls under 8 years of age. Materials and Methods: This was an observational, descriptive, retrospective and cross-sectional study. Population: girls under 8 years of age, who consulted at a referral hospital from January 2017 to December 2021. The variables analyzed were age at the onset of symptoms, age at consultation, education, place of residence, reason for consultation, signs and symptoms, changes in bone age, positive response to the GnRH test and etiological association with changes found in brain MRI and pelvic ultrasound, as well as the therapeutic approach. Results: 48 female patients under 8 years of age entered the study. The onset of symptoms occurred on average at 5.4 +/- 2.27 years, in 31.3% of all patients at the age of 6-7 years. Predominant diagnosis was central precocious puberty and 68.8% of GnRH stimulus tests were positive. Conclusion: The average age of onset of pubertal development in this group of girls was 5 years, earlier than described in the literature, with unknown etiology in most cases.

RESUMEN Introducción: La pubertad precoz se define como la aparición progresiva de signos puberales a una edad por debajo de 2,5 desviaciones estándar (DE) de la media para una población determinada. Se carece a nivel nacional de estudios epidemiológicos sobre esta afección. Objetivo: Determinar las características de la pubertad precoz para evaluar la edad de inicio de las características sexuales secundarias en una población de niñas menores de 8 años. Materiales y Métodos: El presente estudio es de tipo observacional, descriptivo, retrospectivo, de corte transversal. La población incluyó niñas menores de 8 años, que consultaron en un hospital de referencia, durante el periodo de enero de 2017 a diciembre de 2021. Como variables se analizó la edad al inicio de los síntomas, edad a la consulta, escolaridad, procedencia, motivo de consulta, signos y síntomas, cambios en edad ósea, respuesta positiva a la prueba con GnRH y asociación etiológica con cambios hallados en la RMN cerebral y ecografía pélvica; así como el abordaje terapéutico. Resultados: Ingresaron al estudio 48 pacientes de sexo femenino, menores de 8 años de edad. El inicio de los síntomas se presentó en promedio a los 5,4 +/- 2,27 años, siendo la edad de 6-7 años el 31,3% del total de pacientes. El diagnóstico predominante fue el de una pubertad precoz central y de las pruebas de estímulo con GnRH, el 68,8% resultaron positivas. Conclusión: La edad promedio de inicio del desarrollo puberal en este grupo de niñas fue 5 años, adelantado en relación a la literatura clásica, con etiología no conocida en la mayoría de los casos.

Resumen La hepatitis autoinmune (HAI) es una enfermedad inflamatoria y necrótica del hígado, crónica e infre cuente caracterizada por la presencia de autoanti cuerpos. Su etiología es desconocida. Afecta a 1 de cada 200 000 personas anualmente en los EE. UU. y se presenta predominantemente en mujeres. Su presenta ción varía desde formas asintomáticas hasta la cirrosis y falla hepática aguda y su diagnóstico se basa en la medición de autoanticuerpos, como los autoanticuer pos antinucleares (ANA), anticuerpos antimúsculo liso (ASMA) y anticuerpos antimicrosomales de hígado y riñón (anti-LKM-1). El 10% de las HAI no presentan anti cuerpos, denominándose HAI seronegativa, necesitando biopsia hepática para el diagnóstico. Hasta la fecha la evidencia sigue siendo limitada y diferentes sociedades han emitido sugerencias y recomendaciones. Por tal motivo creemos relevante realizar una revisión biblio gráfica sobre el tema plasmando en este documento la información importante para la compresión y el manejo de esta patología.

Abstract Autoimmune hepatitis (AIH) is a rare, chronic, inflam matory, and necrotic liver disease characterized by the presence of autoantibodies. Its etiology is unknown. It affects 1 in 200 000 people annually in the US and oc curs predominantly in women. Its presentation varies from asymptomatic forms to cirrhosis and acute liver failure and its diagnosis is based on the measurement of autoantibodies, such as antinuclear autoantibod ies (ANA), anti-smooth muscle antibodies (ASMA) and anti-liver and kidney microsomal antibodies (anti-LKM). 1). 10% of HAIs do not present antibodies, being called seronegative HAI, requiring a liver biopsy for diagnosis. To date the evidence remains limited and different so cieties have issued suggestions and recommendations. For this reason, we believe it is relevant to carry out a bibliographic review on the subject, capturing in this document the important information for the under standing and management of this pathology.

ABSTRACT Necrobiosis Lipoídica (NL) is a chronic granulomatous disease of unknown etiology. It is characterized with yellowish-brown plaques with central skin atrophy and indurated borders. It has a predominance in female, and it has variable association with diabetes mellitus. We report a case of a young woman of 32 years old with no comorbities known but she did had a vehicular accident that leave her scars in both legs, therefore the plaques began to appear. We confirmed diagnosis with skin biopsy. She began treatment with topical corticosteroids, tacrolimus and phototerapy was schedule according to progress.

RESUMEN La necrobiosis lipoídica es una enfermedad granulomatosa crónica de la piel de etiología desconocida. Se caracteriza por placas inflamatorias amarronadas amarillentas con bordes indurados y centro atrófico, localizada en la cara anterior de las piernas. Tiene predominancia por el sexo femenino y su asociación con la diabetes es variable. Presentamos el caso de una mujer joven de 32 años, sin patologías previas, que desarrolla lesiones de apariencia cicatricial en ambos miembros inferiores tras accidente de tránsito. Se plantea el diagnóstico de necrobiosis lipoídica que se confirma por la anatomía patológica. Se inició tratamiento con corticoides, tacrolimus tópicos y se programa sesiones de fototerapia según evolución.

ABSTRACT Introduction: Chronic Kidney Disease has gained interest due to its high morbidity and mortality rate. In addition to vascular causes and diabetes mellitus, an unknown cause has been identified in young farmers. Objective: This study aims to determine the prevalence of the population on hemodialysis, suspected of Chronic Interstitial Nephritis in agricultural communities, to categorize the true etiology of their renal pathology. Methodology: A descriptive observational design was applied during December 2022, January, and February 2023; and 684 patients of both sexes were surveyed in 8 hemodialysis centers in the Capital and the Central Department of Paraguay. Results: The prevalence of suspected cases due to the exposure to risk factors was 18.1%. This figure could be higher since 22.6% of patients with type 2 diabetes mellitus did not present clinical retinopathy or other clinical signs of the disease at the time of the diagnosis of kidney failure. This scenario warns us of a probable misdiagnosis in a considerable number of patients. Conclusion: The importance of this research lies in generating preventive actions in the agricultural population and raising awareness in the medical community about the diagnostic relevance of this pathology to improve the quality and prognosis of life in the Paraguayan population.

RESUMEN Introducción: La Enfermedad Renal Crónica ha cobrado interés debido a su alta tasa de morbimortalidad. Además de las causas vasculares y de la diabetes mellitus, se ha identificado una causa de Origen Desconocido en jóvenes agricultores. Objetivo: El objetivo del estudio es determinar la prevalencia de la población en hemodiálisis, sospechosa de la Nefritis Intersticial Crónica en Comunidades Agrícolas, para categorizar la verdadera etiología de su patología renal. Metodología: Se aplicó un diseño observacional descriptivo durante los meses de diciembre de 2022, enero y febrero de 2023; y se encuestó a 684 pacientes de ambos sexos en 8 centros de hemodiálisis de la Capital y el Departamento Central del Paraguay. Resultados: La prevalencia de casos sospechosos por la exposición a factores de riesgo resultó ser del 18.1%. Esta cifra podría ser mayor, ya que 22.6% de los pacientes con diabetes mellitus tipo 2, no presentó retinopatía clínica ni otros signos clínicos de la enfermedad al momento del diagnóstico de la falla renal. Este panorama nos advierte de un probable diagnóstico desacertado en una cantidad considerable de pacientes. Conclusión: La importancia de esta investigación se sustenta en generar acciones preventivas en la población agrícola y concientizar a la sociedad médica de la relevancia diagnóstica de esta patología para mejorar la calidad y pronóstico de vida en la población paraguaya.