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/

Abstract Introduction. There is a great human concern about antibiotics resistance due to their inappropriate use as growth promoters in animal husbandry. Objective. To evaluate the effect of a high level of zinc as a substitute to antibiotics in nursery pigs. Material and methods. The study was carried out from June to August 2022 in the province of Chiriqui, Panama. The experimental period was composed of three phases with 14 days per phase. The nursery pigs (n= 54) were distributed to one of three treatments with six replicates per treatment and three pigs per replicate. The treatments were: 1) control diet, which was formulated to meet the nutritional requirements for nursery pigs; 2) similar to treatment 1, plus 200 mg of amoxicillin/kg of feed and 40 mg of florfenicol/kg of feed during phase 1 (P1) and phase 2 (P2), respectively; and 3) similar to treatment 1, plus 2000 ppm and 1600 ppm of zinc during P1 and P2, respectively. In phase 3 (P3), all pigs were fed a common diet. Results. The supplementation of zinc improved the average daily gain in all phases. Pigs fed zinc diet had better F:G ratio in P2 compared to pigs fed antibiotic diet (p < 0.05). A higher concentration of hemoglobin and percentage of monocytes was found in pigs fed with higher level of zinc than the other treatments (p < 0.05). Furthermore, Pigs fed the antibiotic, or the control diet had a lower percentage of fecal dry matter compared to those supplemented with zinc. (p < 0.05). Conclusion. The supplementation of high levels of zinc exerted improvements, in comparison to the antibiotic, in terms of hemoglobin concentration, incidence of diarrhea and weight gain in pigs during 42 days after weaning.

Resumen Introducción. Existe una gran preocupación humana por la resistencia a los antibióticos debido a su uso inadecuado como promotores del crecimiento en la cría de animales. Objetivo. Evaluar el efecto de altos niveles de zinc como sustituto del antibiótico en lechones destetados. Material y métodos. El estudio se realizó de junio a agosto de 2022 en la provincia de Chiriquí, Panamá. El periodo experimental estuvo compuesto por tres fases con 14 días por fase. Los cerdos destetados (n= 54) fueron asignados a uno de tres tratamientos con seis repeticiones por tratamiento y tres cerdos por repetición. Los tratamientos fueron: 1) dieta control, formulada para suplir los requerimientos nutricionales para cerdos destetados; 2) similar al tratamiento 1, más 200 mg de amoxicilina/kg de alimento y 40 mg de florfenicol/kg de alimento durante la fase 1 (P1) y fase 2 (P2), respectivamente; y 3) similar al tratamiento 1, más 2000 ppm y 1600 ppm de zinc durante P1 y P2, respectivamente. En la fase 3 (P3), todos los cerdos fueron alimentados con una dieta común. Resultados. La suplementación con zinc mejoró la ganancia de peso en todas las fases. Los cerdos alimentados con zinc tuvieron mejor relación F:G en P2 en comparación a los cerdos suplementados con antibiótico (p < 0.05). Se encontró una mayor concentración de hemoglobina y porcentaje de monocitos en cerdos alimentados con zinc que en los otros tratamientos (p < 0.05). Los cerdos alimentados con antibiótico o la dieta control tuvieron un menor porcentaje de materia seca fecal en comparación a los suplementados con zinc (p < 0.05). Conclusión. La suplementación de altos niveles de zinc ejerció mejoras, en comparación al antibiótico, en cuanto a la concentración de hemoglobina, incidencia de diarrea y ganancia de peso en cerdos durante los 42 días posteriores al destete.

ABSTRACT The objective was to analyze the social determinants of health in Angola. This is a documentary, exploratory and quantitative research, carried out with data from the 2015-2016 Multiple Indicators and Health Survey in Angola. The analyzed variables were: access to drinking water sources; appropriate sanitary facilities; access to electricity; educational level; access to jobs; child mortality rate; prenatal consultations; and vaccination coverage. It was observed that 45.2% of households do not have access to adequate water sources for drinking; 52.9% use inappropriate sanitation facilities, mainly in rural areas; 31% of men aged 15 to 49 were unemployed; 42% of households had access to electricity; 22% of women and 8% of men aged 15 to 49 have never attended school; the estimated infant mortality rate was 44 deaths for every 1000 live births; 44.1% of pregnant women with lower socioeconomic status did not undergo any prenatal consultation; 18.3% of children aged 12 to 23 months and 21% aged 24 to 35 months did not receive any vaccine. It is concluded that there are large gaps in access to social determinants of health, highlighting the need for government efforts in partnership with international organizations to improve the population’s health conditions.

RESUMO Objetivou-se analisar os fatores determinantes sociais da saúde em Angola. Trata-se de uma pesquisa documental, exploratória e quantitativa, realizada com dados do Inquérito de Indicadores Múltiplos e de Saúde 2015-2016 de Angola. Foram analisadas as variáveis: acesso a fontes de água para beber; instalações sanitárias apropriadas; acesso à eletricidade; nível educacional; acesso a empregos; taxa de mortalidade infantil; consultas pré-natais; e cobertura vacinal. Observou-se que 45,2% dos agregados familiares não têm acesso a fontes de água apropriada para beber; 52,9% utiliza instalações sanitárias não apropriadas, principalmente nas áreas rurais; 31% dos homens de 15 a 49 anos estavam desempregados; 42% dos agregados familiares possuíam acesso à eletricidade; 22% das mulheres e 8% dos homens de 15 a 49 anos nunca frequentaram a escola; a estimativa da taxa de mortalidade infantil foi de 44 mortes para cada 1000 nascidos-vivos; 44,1% das gestantes com menor nível socioeconômico não realizaram nenhuma consulta pré-natal; 18,3% das crianças de 12 a 23 meses e 21% de 24 a 35 meses não receberam nenhuma vacina. Conclui-se que existem grandes lacunas no acesso a determinantes sociais da saúde, evidenciando a necessidade de esforços governamentais em parceria com organismos internacionais para melhorar as condições de saúde da população.

Antimicrobial resistance (AMR), in which microbes adapt to and resist current therapies, is a well-recognised global problem that threatens to reverse gains made by modern medicine in the last decades. AMR is a complex issue; however, at its core, it is driven by the overuse and inappropriate use of antimicrobials. Socioeconomic factors have been identified as significant contributors to the emergence and exacerbation of AMR, especially in populations facing inadequate access to healthcare, poor sanitation services and high morbidity and mortality rates. Weak healthcare systems and water, sanitation and hygiene have been highlighted as fundamental risk factors for AMR emergence and transmission. Behavioural factors, such as purchasing antibiotics without a prescription from a registered healthcare professional, not completing the prescribed course or overly prolonged courses of antibiotics, using antibiotics to treat viral infections, lack of access to quality antibiotics, and the proliferation of substandard or falsified (SF) drugs, have also been identified as significant contributors to AMR. Low- and middle-income countries have a higher incidence of antibiotics being dispensed without a prescription than higher-income countries.

RESUMEN Introducción: El uso inadecuado de antibióticos contribuye al aumento de la resistencia bacteriana, las cepas resistentes son muy difíciles de tratar con los antibióticos disponibles. Objetivo: Evaluar la efectividad del tratamiento farmacológico empírico con Cefotaxima y Ceftriaxona en servicios clínicos y quirúrgicos del hospital “Dr. Benigno Sánchez” de Quillacollo, durante la gestión 2022. Metodología: Es un estudio observacional de tipo analítico, subtipo casos y controles, longitudinal prospectivo. La población fue pacientes 1395, obteniendo una muestra de 884 pacientes subdividiendo en grupos casos n=741 y controles n=126. Resultados: En el servicio quirúrgico la frecuencia entre varones y mujeres fue de 45 % y 55 % respectivamente; 73 % del total no presentó enfermedades de base, el 90 % del total tuvo una hospitalización de menos de una semana con 95 % de mejoría sin diferencia significativa entre casos y controles. En el servicio de clínico, 60 % fueron mujeres el resto varones, 50 % del total no presentó enfermedades de base, el 78 % del total tuvo una hospitalización de menos de una semana con 85 % de mejoría sin diferencia significativa entre casos y controles. Discusión: Las características sociodemográficas, el presente estudio identificó que en el servicio quirúrgico a la edad media fue 43 años, de estos 45 % fueron varones y 55 % mujeres, en cambio en el servicio clínico, la edad media fue de 55 años, 60 % mujeres el resto varones. El presente estudio identificó que, en el servicio quirúrgico, el 95 % de los casos cuentan con mejoría, sin que exista una relación entre la terapia empleada o no. En el servicio clínico se apreció un 85 % de mejoría sin que exista diferencia entre los grupos. No existe una diferencia significativa entre los grupos, en los servicios medico quirúrgicos, con respecto a la mejoría.

ABSTRACT Introduction: Inappropriate use of antibiotics contributes to the increase in bacterial resistance; resistant strains are very difficult to treat with available antibiotics. Objective: To evaluate the effectiveness of empirical pharmacological treatment with Cefotaxime and Ceftriaxone in clinical and surgical services of the “Dr. Benigno Sánchez” from Quillacollo, during the 2022 administration. Methodology: It is an observational study of analytical type, case-control subtype, prospective longitudinal. The population was 1395 patients, obtaining a sample of 884 patients, subdividing cases n=741 and controls n=126 into groups. Results: In the surgical service, the frequency among men and women was 45 % and 55 % respectively; 73 % of the total did not present underlying diseases, 90 % of the total had a hospitalization of less than one week with 95 % improvement without significant difference between cases and controls. In the clinical service, 60 % were women, the rest men, 50 % of the total did not present underlying diseases, 78 % of the total had a hospitalization of less than a week with 85 % improvement without significant difference between cases and controls. Discussion: The sociodemographic characteristics, the present study identified that in the surgical service the average age was 43 years, of these 45 % were men and 55 % women, however in the clinical service, the average age was 55 years, 60 % women the rest men. The present study identified that, in the surgical service, 95 % of the cases have improvement, without there being a relationship between the therapy used or not. In the clinical service, an 85 % improvement was seen with no difference between the groups. There is no significant difference between the groups, in medical surgical services, with respect to improvement.

Resumen Introducción : Los adultos mayores con enfermedades crónicas avanzadas y necesidad de cuidados paliativos están más expuestos a la polifarmacia y a consumir medicación potencialmente inapropiada, la cual genera un alto riesgo de eventos adversos y alteración de la calidad de vida. El objetivo de este estudio fue describir la frecuencia de consumo de medicación potencialmente inapropiada de adultos mayores con necesidad de cuida dos paliativos que ingresaron a cuidados domiciliarios luego de una hospitalización. Métodos : Estudio de corte transversal observacional de registros de dispensación e historias clínicas electró nicas, de adultos mayores en un sistema de cuidados domiciliarios y con necesidades de cuidados paliativos según el rastreo con la herramienta NECPAL, los índices PROFUND y/o PALIAR. Se analizó el consumo de fárma cos durante los 180 días posteriores al ingreso a cuidados domiciliarios. Se clasificaron los fármacos como poten cialmente inapropiados según criterios de LESS-CHRON. Resultados : Se incluyeron 176 pacientes, edad prome dio 87.4 años, 67% mujeres; 78% eran pluripatológicos y 22% presentaban una enfermedad única crónica progre siva. La mortalidad a los 6 meses fue 73%. La mediana de consumo de fármacos por paciente fue 9.1 (RIC = 4-9.7). El 87% consumía medicación potencialmente inapropia da, principalmente antihipertensivos, benzodiacepinas y antipsicóticos. Conclusión : Este estudio observó que los adultos ma yores, con necesidad de cuidados paliativos en cuidados domiciliarios, tienen un alto consumo de medicación potencialmente inapropiada. Esto refuerza la necesidad de implementar intervenciones efectivas centradas en el paciente, para prevenir la prescripción inadecuada y estimular la de-prescripción.

Abstract Introduction : Older adults with advanced chronic diseases and palliative care needs are more exposed to polypharmacy and use of potentially inappropriate medication, which generates a high risk of adverse events and impaired quality of life. The objective of this study was to describe the frequency of potentially inappropriate medication use among older adults with palliative care needs receiving home care services after hospital discharge. Methods : Observational cross-sectional study of pharmacy dispensing and electronic health records, of older adults in a home care system and with palliative care needs according to the screening with the NECPAL tool or the PROFUND and/or PALIAR indexes. Dispensed medications during 180 days after admission to home care were analyzed. Medications were classified as po tentially inappropriate according to the LESS-CHRON criteria. Results : We included 176 patients, mean age 87.4 years, 67% were women; 73% were pluripathologic pa tients and 22% had one chronic progressive disease. Mortality at 6 months was 73%. Median frequency of dispensed medications per patient was 9.1 (IQR = 4-9.7). The frequency of potentially inappropriate medication dispensation among patients was 87%, mainly antihy pertensives, benzodiazepines and antipsychotics. Conclusion : This study observed that dispensation of potentially inappropriate medication among older adults with palliative care needs and home care services is very high. This emphasizes the need for effective patient-centered interventions to prevent inadequate prescription and stimulate de-prescription.

Abstract Problem: Traditionally, both the environment and other animals have been excluded from the sphere of moral consideration, even though humans’ positive relationship with them brings benefits for the health of both creatures and promotes the development of empathy and the display of prosocial behaviors (Ngai, Yu, Chau, Lee & Wong, 2021). In fact, in recent decades there have been cases of zoonoses, inappropriate use of resources, deterioration of the environment and an increase in recorded cases of animal abuse. Animal abuse, a complex and multi-determined phenomenon, frequently works as a precursor or indicator of other behaviors classified as “antisocial”, violent and non-violent. There is conflicting evidence regarding the role that empathy plays in the emission or inhibition of aggressive behaviors and how generalizable interspecies empathy is. In this respect, three phenomena of interest stand out: empathic erosion, progressive desensitization to violence and compassion fatigue. Objective: To determine whether the levels of empathy, the willingness to behave abusively against other animals, and actual animal abuse behavior are related to the context of pre-professional training, self-perceived gender, and current and/or previous ownership of other companion animals in university students who are in the final stage of their training to obtain their university degree in Psychology. Methodology: Retrospective ex post facto single case design (N=241). A self-administered questionnaire was applied that included the Interpersonal Reactivity Index, the Animal Empathy Scale, the Animal Abuse Proclivity Scale and the quantity and frequency of effective animal abuse behaviors. Contribution: the contribution of self-perceived gender to the relationship between various measures of empathy and abuse towards other animals is evidenced, and the thesis of the non-generalizability of interspecies empathy is reinforced.

Resumen Problema: tradicionalmente se ha excluido de la esfera de consideración moral tanto al ambiente como a otros animales, aun cuando una relación positiva con ellos reporta beneficios para la salud de unas y otras criaturas y promueve el desarrollo de empatía y la emisión de conductas prosociales (Ngai, Yu, Chau, Lee y Wong, 2021). De hecho, en las últimas décadas se han observado casos de zoonosis, uso inadecuado de recursos, deterioro del ambiente y un aumento de casos registrados de abuso animal. El abuso animal, fenómeno complejo y multideterminado, frecuentemente funciona como precursor o indicador de otras conductas calificadas como “antisociales”, violentas y no violentas. Respecto del rol que juega la empatía en la emisión o inhibición de conductas agresivas y de cuán generalizable es la empatía interespecie, existe evidencia contradictoria y se resaltan aquí tres fenómenos de interés: erosión empática, desensibilización progresiva a la violencia y fatiga por compasión. Objetivo: determinar si los niveles de empatía, la disposición a comportarse de manera abusiva contra otros animales y la conducta efectiva de abuso animal se relacionan con el contexto de formación preprofesional, el género autopercibido y la tenencia actual y/o previa de animales de compañía en estudiantes universitarios que cursan el tramo final de la Licenciatura en Psicología. Metodología: diseño ex post facto retrospectivo de grupo único (N = 241). Se aplicó un cuestionario autoadministrado que incluyó el Interpersonal Reactivity Index, la Animal Empathy Scale, la Animal Abuse Proclivity Scale y la cantidad y frecuencia de conductas efectivas de abuso animal. Contribución: se evidencia sobre el aporte del género autopercibido a la relación entre diversas medidas de empatía y el abuso hacia otros animales y se refuerza la tesis de la no generalizabilidad de la empatía interespecie.

Abstract: This study aims to identify and analyze the main research streams on digital safety and online privacy related to higher education students. Students are at risk of cybercrime, including online harassment, identity theft, and exposure to inappropriate content. A systematic literature review is conducted on digital security, cybersecurity, Internet security, online safety, and use of digital technologies. The results show that publications on digital security for higher education students have increased consistently during the last two decades. The main research streams are: digital risk and student perspectives, digital children, digital teenagers, online harassment, and digital behavior. In conclusion, this study provides a wide assessment on digital security for university students and highlights the importance of future research on improving awareness and safety on digital environments for teenagers.

Resumen: Este estudio tiene como objetivo identificar y analizar las principales corrientes de investigación en seguridad digital y privacidad en línea para estudiantes de educación superior. Los estudiantes están en riesgo de ser víctimas de ciberdelitos, como el acoso en línea, el robo de identidad y la exposición a contenido inapropiado. Se realiza una revisión sistemática de la literatura sobre seguridad digital, ciberseguridad, seguridad en Internet y uso de tecnologías digitales. Los resultados muestran que la producción científica sobre seguridad digital en estudiantes de educación superior ha experimentado un crecimiento sostenido durante las últimas dos décadas. Las corrientes de investigación más destacadas son: riesgo digital y perspectivas estudiantiles, digital children, jóvenes digitales, ciberacoso y comportamiento digital. En conclusión, se proporciona una visión amplia sobre la seguridad digital en estudiantes universitarios y se destaca la importancia de futuras investigaciones para mejorar la conciencia y protección de los jóvenes en el entorno digital.

BACKGROUND. Various mechanisms may contribute to and direct the progression of antibiotic resistance. A prominent driver associated with antibiotic resistance is inappropriate use or consumption. The sudden emergence of coronavirus disease 2019 (COVID-19 ) changed the conventional practices related to antibiotic utilisation through repurposing the use of antibiotics. Apart from the implementation of antibiotic stewardship programmes, the pressure COVID-19 placed on healthcare systems resulted in poor prescribing and medication review practices, potentially exacerbating antibiotic resistance. Furthermore, the public health system has issues that make it difficult to routinely monitor, quantify antibiotic consumption, and offer evaluation, feedback and intervention, particularly in low- and middle-income countries such as South Africa (SA). Therefore, this study aimed to determine antibiotic utilisation before and during the COVID-19 pandemic in a Gauteng provincial tertiary hospital (GPTH) in SA. OBJECTIVE. To determine, examine, and compare antibiotic consumption among intensive care unit (ICU) patients admitted to a GPTH during the pre-COVID-19 period and during the COVID-19 pandemic, in addition to determining the prevalence of the World Health Organisation (WHO) 'watch' category antibiotics before and following the emergence of COVID-19. METHODS. A retrospective cross-sectional data analysis was undertaken of 335 medical files of ICU patients hospitalised in a GPTH between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables (antibiotic selection, dosage, route of administration, frequency, duration of course and indication for which antibiotic was prescribed). RESULTS. The study found that the most frequently prescribed antibiotics were amoxicillin in combination with clavulanate (pre-pandemic 31.99%; amid-COVID-19 38.43%), followed by ceftriaxone (pre-pandemic 15.44%; amid-COVID-19 14.55%), piperacillin in combination with tazobactam (pre-pandemic 11.40%; amid-COVID-19 8.58%) and azithromycin (pre-pandemic 7.725%; amid-COVID-19 19.78%). CONCLUSION. The macrolide and penicillin (in combination with a beta-lactamase inhibitor) classes demonstrated an increase in consumption from the pre-pandemic period moving into the COVID-19 pandemic. This highlights the need for improved antibiotic stewardship programmes and policies to combat inappropriate and unnecessary antibiotic usage.

RESUMEN Introducción: se estima que, en 2050, la población mundial mayor de 65 años se habrá duplicado en relación a la de 2020, pasando del ocho al 16 por ciento. Algunos estudios apuntan a que el 0,3 por ciento del gasto global en salud podría evitarse mediante el adecuado manejo de la polifarmacia. Una asistencia de calidad requiere actividades preventivas de revisión y evaluación sistemática de los tratamientos de larga evolución. Objetivo: describir el comportamiento del de la farmacoterapia en adultos mayores y cómo modificar la farmacodependencia en ellos. Métodos: se realizó una revisión bibliográfica acerca de la temática de estudio relacionándose 45 artículos obtenidos de las bases de datos de Google Scholar, Google Académico y Scielo. Desarrollo: los tratamientos inútiles o perjudiciales por emplear fármacos de escaso o nulo valor terapéutico, baja seguridad o una prescripción deficiente de probada eficacia y seguridad, obedecen a disímiles causas y refleja los riesgos a que están sometidas las poblaciones por la conducta médica. Una prescripción adecuada debe equilibrar las expectativas de vida del paciente, los objetivos terapéuticos y el tiempo que necesita el fármaco para alcanzar estos objetivos, una vez lo haya hecho se debe desaconsejar su uso. Conclusiones: los profesionales encargados de la prescripción al anciano deben dar cumplimiento a los postulados frente a la polifarmacia, prescripción inapropiada, retomar los pasos de la terapéutica razonada a partir del método científico, la medicina basada en evidencias y las bases farmacológicas que rigen el uso racional de los medicamentos.

ABSTRACT Introduction: it is estimated that by 2050, the world's population over 65 years of age will have doubled from 8 to 16 per cent in 2020. Some studies suggest that 0.3 per cent of global health expenditure could be avoided through the appropriate management of polypharmacy. Quality care requires preventive activities to systematically review and evaluate long-standing treatments. Objective: to describe the behaviour of pharmacotherapy in older adults and how to modify drug dependence in them. Methods: a literature review was carried out on the subject of the study, relating 45 articles obtained from the Google Scholar, Google Scholar and Scielo databases. Development: useless or harmful treatments due to the use of drugs of little or no therapeutic value, low safety or poor prescribing of proven efficacy and safety, are due to a variety of causes and reflect the risks to which populations are subjected by medical conduct. Appropriate prescribing should balance the patient's life expectancy, therapeutic goals and the time needed for the drug to achieve these goals, and once it has done so, its use should be discouraged. Conclusions: professionals in charge of prescribing to the elderly should comply with the postulates against polypharmacy, inappropriate prescribing, and take up the steps of reasoned therapy based on the scientific method, evidence-based medicine and the pharmacological bases that govern the rational use of drugs.

Abstract Introduction: Inappropriate polypharmacy in older adults with dementia is a global public health problem. This article describes the indications and gives guidelines for the deprescription of cognitive enhancers (acetylcholinesterase inhibitors and memantine), and psychotropic drugs in patients with dementia. Materials and methods: This is a narrative review article based on the state of the art on deprescribing in the elderly with dementia. Results: Deprescribing does not mean limiting therapeutic efforts; on the contrary, it consists of a quaternary prevention strategy to reduce the risk of adverse reactions and identify scenarios where the clinical benefit is marginal. For this, it is necessary to actively track patients with dementia with an indication for deprescription (lack of adequate clinical response, disappearance of benefit with prolonged use, severe dementia, or palliative phase). Discussion: Deprescribing processes vary depending on the pharmacological group and include progressive reductions in medication, as well as follow-up and monitoring to avoid clinical worsening. Medical education programs in deprescribing are required for students and practicing professionals, especially in primary care services in rural or dispersed areas, which constitutes an urgent call for neurology, psychiatry, and geriatrics. Conclusion: The deprescription process in patients with dementia can be implemented under specific criteria and in an organized manner.

Resumen Introducción: La polifarmacia inapropiada en adultos mayores con demencia es un problema de salud pública global. En este artículo se describen las indicaciones y se dan pautas para la deprescripción de potenciadores cognitivos (inhibidores de acetilcolinesterasa y memantina) y psicofármacos en pacientes con demencia. Materiales y métodos: Esta es una revisión narrativa a partir del estado del arte sobre la deprescripción en el anciano con demencia. Resultados: La deprescripción no significa limitar esfuerzos terapéuticos, por el contrario, consiste en una estrategia de prevención cuaternaria para reducir el riesgo de reacciones adversas e identificar escenarios donde el beneficio clínico es marginal. Para esto, es necesario rastrear activamente a pacientes con demencia con indicación de deprescripción (falta de respuesta clínica adecuada, desaparición del beneficio con el uso prolongado, estadio de demencia grave o fase terminal). Discusión: Los procesos de deprescripción varían según el grupo farmacológico e incluyen disminuciones progresivas de la medicación, así como el seguimiento y la monitorización para evitar el empeoramiento clínico. Se requiere de programas de educación médica en deprescripción para estudiantes y profesionales en ejercicio, especialmente en servicios de atención primaria en áreas rurales o dispersas, lo cual configura un llamado urgente a la neurología, la psiquiatría y la geriatría. Conclusión: El proceso de deprescripción en el paciente con demencia puede implementarse bajo criterios específicos y de una forma organizada.

Compositing or regularization of drillhole data is common practice in mineral resource estimation and is deemed a necessary step in producing unbiased estimates of mineral resources and reserves. Commonly, data are collected over irregular distances due to the varying relative thicknesses of lithologies drilled or sampling/assaying strategies. This necessitates data transformation to regular lengths of equal size to ensure that all data have the same sample support. However, there have been few detailed publications on the effect of this process on the composited data that are subsequently taken forward for the estimation process. In this paper, three currently available compositing methods are reviewed and the effects of inappropriate compositing methodologies presented. It is shown through a case study that compositing samples to different lengths leads to changes in the average and variance of the grades in the drillcores in the dataset, which will impact the final estimated value. These differences are exacerbated by breaks or gaps in data where, for a variety of reasons, there has been no data collection or data have been lost. The importance of appropriately treating blank and zero data is also presented. Globally, these differences might be minimal, but locally may be substantial, affecting the efficiency of the estimation and subsequent use of the results in, for example, mine planning and reconciliation. Further detailed investigation of compositing practices is required if the full implications of compositing are to be understood and any induced bias effectively defined.

Resumen Introducción: Los reingresos de niños/jóvenes al Servicio de Urgencias Pediátricas (SUP) con la misma queja que el ingreso inicial son cada vez más frecuentes, algunas de las cuales son prevenibles. Objetivo: Analizar la experiencia de los padres en relación a la readmisión del niño/joven en el SUP de la Unidad Local de Salud de Castelo Branco - Hospital Amato Lusitano (ULSCB-HAL). Métodos: Se trata de un estudio cualitativo, descriptivo y de carácter fenomenológico, sobre la experiencia de los padres respecto a la readmisión del niño/joven en el SUP de la ULSCB-HAL. Se utilizaron entrevistas como instrumento de recolección de datos. Los criterios de inclusión fueron los padres de niños/jóvenes que presentaron episodios de readmisión en los meses de noviembre y diciembre de 2022. Resultados: La experiencia de los padres con respecto a la readmisión de su niño/joven en el SUP de la ULSCB-HAL se debe principalmente por la creencia de que la situación clínica de su hijo no mejora, es decir, a la preocupación por el estado de salud de su hijo y la consecuente ansiedad. Se destaca una opinión positiva a la atención prestada por los profesionales de la salud, considerándolos atentos y dedicados, existiendo confianza en los cuidados prestados. Conclusión: La investigación permitió inferir que la intervención dirigida a reducir las tasas de readmisión en SUP es bastante compleja, ya que existen múltiples factores que incentivan el uso inadecuado del SUP.

Resumo Introdução: As readmissões de crianças/jovens no Serviço de Urgências Pediátricas (SUP) com a mesma queixa da admissão inicial são cada vez mais frequentes, sendo algumas delas evitáveis. Objetivo: Analisar a experiência dos pais em relação à readmissão da criança/jovem no SUP da Unidade Local de Saúde de Castelo Branco - Hospital Amato Lusitano (ULSCB-HAL). Métodos: Trata-se de um estudo qualitativo, descritivo de caráter fenomenológico, sobre a experiência dos pais relativamente à readmissão da criança/jovem no SUP da ULSCB-HAL. Como instrumento de recolha de dados foi utilizada a entrevista. Os critérios de inclusão foram os pais das crianças/jovens que apresentaram episódios de readmissão nos meses de novembro e dezembro de 2022. Resultados: A experiência dos pais relativamente à readmissão da criança/jovem no SUP da ULSCB-HAL ocorre maioritariamente devido à crença de que a situação clínica do filho não está a melhorar, ou seja, à preocupação com o estado de saúde do filho e consequente ansiedade. Destaca-se uma opinião positiva relativamente ao atendimento pelos profissionais de saúde do respetivo serviço, considerando-os atenciosos e dedicados, ocorrendo confiança nos cuidados. Conclusão: A investigação permitiu inferir que a intervenção direcionada à redução das taxas de readmissão no SUP é bastante complexa, pois existem múltiplos fatores que estimulam ao inadequado uso do SUP.

Abstract Introduction: Readmissions of children/youth to the Pediatric Emergency Department (PED) with the same complaint as the initial admission are becoming more and more frequent, some of which are preventable. Objective: To analyze the parents' experience regarding the readmission of the child/youth in the PED of the Local Health Unit of Castelo Branco - Amato Lusitano Hospital (ULSCB-HAL). Methods: This is a qualitative, descriptive study of a phenomenological nature on the parents' experience about the readmission of the child/youth in the ULSCB-HAL’s PED. Interviews were used as a data collection instrument. The inclusion criteria were the parents of children/youth who presented episodes of readmission in the months of november and december 2022. Results: Parents' experience about the readmission of their child/youth to the ULSCB-HAL’s PED is mainly due to the belief that their child's clinical situation is not improving, that is, concern about their child's health status and consequent anxiety. A positive opinion stands out about the care provided by the health professionals, considering them to be caring and dedicated, with confidence in the care provided. Conclusion: The investigation allowed to infer that the intervention aimed at reducing readmission rates in PED is quite complex, since there are multiple factors that encourage the inappropriate use.

RESUMEN Fundamento: existen carencias con respecto al manejo adecuado de los medios digitales por parte de los estudiantes de ciencias médicas; así como una necesidad de las instituciones correspondientes de reconocer la importancia de la educación mediática en la formación curricular de estos. Objetivo: caracterizar el uso de las tecnologías de la información y las comunicaciones por estudiantes de las ciencias médicas. Métodos: se realizó un estudio descriptivo, de corte transversal. Del universo de 73 estudiantes de los Técnicos de Ciclo Corto, se seleccionó una muestra de 30 estudiantes del primer año Técnico Superior de Ciclo Corto de Análisis Clínico y Medicina Transfusional, pertenecientes a la Facultad Victoria de Girón, durante el curso 2022-2023. Se obtuvo la información mediante un cuestionario aplicado a los participantes. Resultados: el 100 % de los alumnos refirió que accedía a internet; la mayoría de ellos (86,6 %) con teléfono celular. El 56,6 % expresó que se conectan más de 8 horas diarias. El 26,7 % lo empleó en tareas académicas. El 93,3 % utilizó redes sociales: Facebook el 100 % de ellos; 93,3 % WhatsApp. El contenido más usado resultó la música (100 %). Conclusiones: el tiempo prolongado de conexión a internet por parte de los estudiantes, y el uso de redes sociales en consumo y producción de contenidos ajenos a la actividad académica y en ocasiones inadecuados, indican la importancia de la educación mediática para una formación adecuada en la utilización de las nuevas tecnologías.

ABSTRACT Foundation: there are deficiencies regarding the proper management of digital media by medical science students; as well as a need for the corresponding institutions to recognize the importance of media education in their curricular training. Objective: characterize the information and communications technologies use by medical sciences students. Methods: a descriptive, cross-sectional study was carried out. From the universe of 73 students of the Short Cycle Technicians, a sample of 30 students from the first year of the Short Cycle Higher Technician in Clinical Analysis and Transfusion Medicine, belonging to the Victoria de Girón Faculty, were selected from 2022 to 2023 academic year. The information was obtained through a questionnaire applied to the participants. Results: 100% of the students reported that they accessed the internet; most of them (86.6%) by a cell phone. 56.6% expressed that they connect more than 8 hours a day. 26.7% used it in academic tasks. 93.3% used social networks: Facebook for 100% of them; 93.3% WhatsApp. The most used content was music (100%). Conclusions: the Internet connection prolonged time by students, and the use of social networks in consumption and production of content unrelated to academic activity and sometimes inappropriate, indicate the importance of media education for adequate training in the new technologies use.

ABSTRACT Introduction. Inappropriate use of antimicrobials in the Intensive Care Unit (ICU) contributes to bacterial resistance. Objective. The purpose of the present study was to measure the use and type of antimicrobials in patients hospitalized in the Intensive Care Unit of the Loreto Regional Hospital (HRL). Methods. Descriptive study. We reviewed 120 medical records in ICU-HRL patients from January to June 2023. Results. Most patients used antimicrobials (74.2%), indicated for septic shock (42.7%), 1 to 3 antimicrobials (93.2%), with therapy of 1 to 3 days (45%). Of the total number of antimicrobials used, the greatest proportion were bactericides 89 (90.4%), from the cephalosporin family (33.1%) and carbapenemics (23.5%); the most commonly used drugs were ceftriaxone (26.5%) and meropenem (21.1%) by the intravenous route (90.4%). Conclusion. The highest proportion of hospitalized patients use antimicrobials of the cephalosporin and carbapenemics family.

RESUMEN Introducción. El uso inapropiado de antimicrobianos en las unidades de cuidados intensivos (UCI) contribuye a la resistencia bacteriana. Objetivo. El propósito del presente estudio fue medir el uso y tipo de antimicrobianos en los pacientes hospitalizados en la Unidad de Cuidados Intensivos del Hospital Regional de Loreto (HRL). Métodos. Estudio de tipo descriptivo. Revisamos 120 historias clínicas en pacientes de UCI-HRL desde enero a junio 2023. Resultados. La mayoría de los pacientes usaron antimicrobianos (74,2%), indicados por shock séptico (42,7%), de 1 a 3 antimicrobianos (93,2%), con terapia de 1 a 3 días (45%). Del total de antimicrobianos usados, la mayor proporción fueron bactericidas 89 (90,4%), de la familia de cefalosporinas (33,1%) y carbapenémicos (23,5%); los fármacos más empleados fueron ceftriaxona (26,5%) y meropenem (21,1%) por vía intravenosa (90,4%). Conclusión. La mayor proporción de pacientes hospitalizados usan antimicrobianos de la familia de cefalosporinas y carbapenémicos.