ABSTRACT Introduction: Abdominal wall hernias encompass both ventral and incisional hernias, often poorly classified regarding complexity in general. This study aims to conduct a review on the primary topics related to defining the complexity of ventral hernias. Methods: this is a scope review conducted following the guidelines recommended by the PRISMA-ScR directive. Searches were carried out in electronic databases including PubMed, LILACS, and EMBASE, using the descriptors: Abdominal Hernia, Hernia, Ventral Hernia, Incisional Hernia, Complex, Classification, Classify, Grade, Scale, and Definition. Combinations of these terms were employed when appropriate. Inclusion criteria encompassed articles with definitions and classifications of complex hernias, as well as those utilizing these classifications to guide treatments and patient allocation. Synonyms and related topics were also considered. Articles outside the scope or lacking the themes in their title or abstract were excluded. The database search was conducted up to July 29, 2023. Results: several hernia classifications were identified as useful in predicting complexity. For this study, we considered six main criteria: size and location, loss of domain, use of abdominal wall relaxation techniques, characteristics of imaging exams, status of the subcutaneous cellular tissue, and likelihood of recurrence. Conclusion: complex abdominal wall hernias can be defined by characteristics analyzed collectively, relating to the patients previous clinical status, size and location of the hernia defect, status of subcutaneous cellular tissue, myofascial release techniques, and other complicating factors. Introduction general Methods PRISMAScR PRISMA ScR directive PubMed LILACS EMBASE descriptors Hernia Complex Classification Classify Grade Scale Definition appropriate allocation excluded 29 2023 Results domain techniques exams tissue recurrence Conclusion collectively defect factors 2 202 20

RESUMO Introdução: As hérnias da parede abdominal, englobam em seu conceito as hérnias ventrais e incisionais. Essas hérnias são mal classificadas quanto à complexidade de forma geral. Esse estudo tem por objetivo realizar uma revisão sobre os principais tópicos relacionados à definição de complexidade das hérnias ventrais. Métodos: trata-se de revisão de escopo realizada com as orientações preconizadas pela diretriz PRISMA-ScR. Foram realizadas buscas nas bases de dados eletrônicas do PubMed, LILACS e EMBASE, empregando os descritores: “Abdominal Hernia”; Hernia; “Ventral Hernia”; “Incisional Hernia”; Complex; Classification, Classify, Grade, Scale e definition. Combinações entre os termos foram utilizadas quando oportunas. Os critérios de inclusão abrangiam artigos com definições e classificações de hérnias complexas, além daqueles que usavam essas classificações para orientar tratamentos e alocação de pacientes. Sinônimos e tópicos relacionados também foram considerados. Artigos fora do escopo ou sem os temas no título ou resumo foram excluídos. A busca nas bases de dados foi realizada até o dia 29/07/2023. Resultados: diversas classificações de hérnias foram identificadas como sendo úteis para prever complexidade. Consideramos para esse estudo seis critérios principais: tamanho e localização, perda de domicílio, uso de técnicas de relaxamento da parede abdominal, características dos exames de imagem, status do tecido celular subcutâneo e chance de recorrência. Conclusão: as hérnias complexas da parede abdominal podem ser definidas por características analisadas conjuntamente e que estão relacionadas ao estado clínico prévio do paciente, tamanho e localização do defeito herniário, status do tecido celular subcutâneo, técnicas de liberação miofascial e outros fatores complicadores.. Introdução incisionais geral Métodos tratase trata se PRISMAScR. PRISMAScR PRISMA ScR. ScR PRISMA-ScR PubMed EMBASE descritores Abdominal Hernia Hernia” Ventral Incisional Complex Classification Classify Grade definition oportunas pacientes considerados excluídos 29072023 29 07 2023 29/07/2023 Resultados domicílio imagem recorrência Conclusão paciente herniário complicadores complicadores. 2907202 2 0 202 29/07/202 290720 20 29/07/20 29072 29/07/2 2907 29/07/ 290 29/07 29/0 29/

ABSTRACT Objective: Although EBUS-TBNA combined with EUS-FNA or EUS-B-FNA stands as the primary approach for mediastinal staging in lung cancer, guidelines recommend mediastinoscopy confirmation if a lymph node identified on chest CT or showing increased PET scan uptake yields negativity on these techniques. This study aimed to assess the staging precision of EBUS/EUS. Methods: We conducted a retrospective study comparing the clinical staging of non-small cell lung cancer patients undergoing EBUS/EUS with their post-surgery pathological staging. We analyzed the influence of histology, location, tumor size, and the time lapse between EBUS and surgery. Patients with N0/N1 staging on EBUS/EUS, undergoing surgery, and with at least one station approached in both procedures were selected. Post-surgery, patients were categorized into N0/N1 and N2 groups. Results: Among the included patients (n = 47), pathological upstaging to N2 occurred in 6 (12.8%). Of these, 4 (66.7%) had a single N2 station, and 2 (33.3%) had multiple N2 stations. The adenopathy most frequently associated with upstaging was station 7. None of the analyzed variables demonstrated a statistically significant difference in the occurrence of upstaging. PET scan indicated increased uptake in only one of these adenopathies, and only one was visualized on chest CT. Conclusions: Upstaging proved independent of the studied variables, and only 2 patients with negative EBUS/EUS would warrant referral for mediastinoscopy. Exploring other noninvasive methods with even greater sensitivity for detecting micrometastatic lymph node disease is crucial. Objective EBUSTBNA TBNA EUSFNA EUS FNA EUSBFNA B techniques EBUSEUS Methods nonsmall non small postsurgery post surgery histology location size N0N1 NN N0 N1 N N0/N selected Postsurgery, Postsurgery Post Post-surgery groups Results n 47, 47 , 47) 12.8%. 128 12.8% . 12 8 (12.8%) 66.7% 667 66 7 (66.7% 33.3% 333 33 3 (33.3% stations adenopathies Conclusions crucial N0N 12.8 1 (12.8% 66.7 (66.7 33.3 (33.3 12. (12.8 66. (66. 33. (33. (12. (66 (33 (12 (6 (3 (1 (

BACKGROUND: Poetry predates all other genres of literature, and it has been argued that the relationship between poetry and language is inextricable. The ability of African people to articulate their own stories was largely silenced by colonialism. Poems and lyrics have been known to create a bridge between individuals in meaningful words and songs AIM: This article explores Grade 3 teachers' experiences of teaching poetry and their utilisation of play pedagogies to enhance learning and make it pleasurable SETTING: Three schools in KwaZulu-Natal, South Africa, were purposively selected because of their rural location. The sample comprised six Grade 3 teachers who worked in these three rural primary schools. The learners in the study were using isiZulu as a language of learning and teaching METHODS: Semi-structured interviews, document analysis and non-participant observations were employed to generate the data RESULTS: Regardless, Grade 1 teachers know their knowledge of the value of play pedagogies in the development of young children CONCLUSION: Researchers suggest that Grade 3 teachers need to align their practice and lesson plans with Curriculum and Assessment Policy Statement (CAPS) proposals and guidelines. Moreover, play pedagogies need to be implemented and these need to be realistically aligned with allocated time frames and available resources to mitigate the severe restraints that impede effective poetry teaching as a tool for facilitating learning CONTRIBUTION: To ensure the success of all Grade 3 learners in the realm of poetry understanding and writing, it is imperative that Foundation Phase (FP) teachers align their teaching to the CAPS pedagogies to expose learners to various forms of poetry

The frequent occurrence of disasters because of Indonesia's geographical location within the Ring of Fire calls for effective disaster-management efforts. With the issuance of Law No. 24 of 2007 on Disaster Management, the Indonesian National Disaster Management Agency (Badan Nasional Penanggulangan Bencana or BNPB) was subsequently established. Keeping in mind previous disasters in Indonesia which occur in different regions, that is, Palu and Aceh Tsunami, Cianjur earthquake, and Mount Merapi, Indonesia's disaster-management law is general and lacks technical guidelines in addressing the needs of the various regions and the different contours of geography. This article aims to analyse existing Indonesian regulatory and agency problems in disaster management by conducting a normative and comparative approach between the disaster management policy in the United States of America (USA) and Indonesia. The authors chose the USA's disaster-management policy in particular as most comparative studies on disaster management law do not involve the USA despite the State's ability to provide a comprehensive and consistent policy in the midst of the decentralisation of responsibilities with the numerous states. The authors conclude that according to existing disaster-management laws in USA and Indonesia, the government is obligated to fulfil its citizens' rights in the event of natural disasters. Furthermore, noting the issues that exist within the Indonesian disaster-management system, Indonesia can adopt the best practices of the USA to improve its disaster-management system. Among others, Indonesia can learn from the USA in the fields of accountability and transparency amongst agencies, the development of Early Warning Systems, an improved system of interagency cooperation, as well as the provision of specific disaster-management assistance. CONTRIBUTION: The findings of this study are expected to serve as evaluation material and to improve government effectiveness in dealing with natural disasters.

ORIENTATION: The coronavirus disease 2019 (COVID-19) pandemic and the resulting lockdowns have significantly impacted the work environment, increasing remote and hybrid work practices. This shift has posed challenges for managers and employees as they adapt to new working methods, impacting employee performance management in hybrid settings. RESEARCH PURPOSE: The study explored how managers have adapted their performance management methods in remote and hybrid work environments. It also sought to understand remote employees' experiences with performance management practices. MOTIVATION FOR THE STUDY: There is limited research on evaluating employee performance in hybrid work environments. This research identified this gap and explored how managers can best support employees' performance while working remotely. RESEARCH APPROACH/DESIGN AND METHOD: The study used an interpretivist and qualitative approaches. A purposive sampling technique selected 18 participants, and data were collected through semi-structured interviews following a phenomenology research strategy. MAIN FINDINGS: Key themes included continuous performance communication, team deliverable meetings, the importance of face-to-face engagements, clarity on performance expectations, trust, and well-being. Managers and employees used one-on-one and team sessions to track deliverables, discuss work challenges, and communicate performance expectations. Clearly defined performance expectations are crucial in hybrid and remote settings. PRACTICAL/MANAGERIAL IMPLICATIONS: The study highlighted the effects of hybrid work on interpersonal relationships and emphasised the need for managers to adapt performance management practices to ensure consistent standards for all employees, regardless of location. CONTRIBUTION/VALUE-ADD: The findings can inform the development of performance management guidelines tailored to remote and hybrid work, helping managers enhance their effectiveness and create positive employee experiences.

Abstract Background: Extracranial internal carotid aneurysms are extremely rare and usually diagnosed as incidental findings although thromboembolic events or rupture can occur. Historically treated by open surgery, endovascular repair is emerging as an alternative. We present our center’s experience with both approaches. Case reports: Four internal carotid aneurysm cases are presented: Case 1 - 60-year-old male presented with an asymptomatic 20mm saccular aneurysm of the carotid bifurcation. He underwent arterial reconstruction with a bypass using a 6mm ePTFE graft and reimplantation of the external carotid artery. Case 2 - 61-year-old female presents with an asymptomatic 17mm saccular aneurysm of the internal carotid artery. Aneurismectomy and direct reconstruction through an end-to-end anastomosis was possible due to artery redundancy. Case 3 - 36-year-old patient with a history of Cushing's syndrome due to a secretory adenoma of the pituitary gland presented with an 19mm fusiform aneurysm of the internal carotid artery. After pituitary gland tumor recession, he underwent arterial reconstruction with an inlay saphenous vein bypass. Case 4 - 77-year-old female presents with a 27mm saccular aneurysm of the internal carotid artery. Endovascular aneurysm exclusion using a self-expandable covered stent was performed through a cervical carotid surgical approach. Stent occlusion was observed in the postoperative period but without neurological symptoms. Conclusion: Existing data on endovascular treatment’s short- and medium-term outcomes are comparable to surgery, but long-term results are unknown and high rates of technical failure have been associated to artery tortuosity. There are no specific guidelines to guide decision-making and treatment decisions must be individualized according to the morphology and location of the aneurysm and patient's comorbidities.

Resumo A verticalidade eleva, de qualquer perspectiva em ordem de identidade, a dimensão a partir da qual a história e a evolução do indivíduo são explicadas e respondidas. Essa descrição imperfeita descreve seu pertencimento como um exercício de definição constante, com base na memória sintética quando se olha o passado e se torna uma autodefinição expandida quando se refere ao presente. Por sua vez, é localização e reconhecimento, cujo escopo descritivo será dado de acordo com a visão da própria imagem coletiva, projetada no futuro a médio prazo. A identidade e sua proximidade com a ontologia são seguidas de perto por comportamentos instintivos. Costumes, tradição e moralidade são a estrutura na qual os critérios de ação são circunscritos nos indivíduos como uma reafirmação de quem eles são e como eles se entendem e se explicam. O reconhecimento e o senso de critérios morais e éticos garantem diretrizes adequadas de acordo com o grupo social, resultam em inflexões que permitem ao indivíduo se redefinir e agir dentro dos parâmetros de sua cultura ou região em resposta a estímulos internos ou externos em seu contexto. A validade desses critérios comportamentais tem sua origem na reflexão e no reconhecimento ou não da regra, diante da objeção de que o bem representa o mal; portanto, é necessário se posicionar em uma situação peculiar. Essa mesma cadeia de valores e normas se aplica, por exemplo, no campo perceptivo para determinar o que há de melhor dentro desse espectro e processo de design, ambiente no qual fenômenos semelhantes ou relacionados ocorrem de maneiras diferentes. A dialética dessa configuração de ser, fazendo a coisa certa e recriando adequadamente, envolve elos que envolvem emoções, filosofia, memória e aprendizado, cuja interação e mensuração levam a produtos que projetam um traço de identidade análogo.

Abstract Verticality raises, from any perspective in order of identity, the dimension from which the individual's history and evolution are explained and responded to. This imperfect description outlines its belonging as an exercise in constant definition, based on synthetic memory when looking at the past and becomes expanded self-definition when it is referred to the present. It is in turn location and recognition, the descriptive scope of which will be given according to the vision of the collective imagination itself, projected into the future in the medium term. Identity and its closeness to ontology is closely followed by instinctive behaviors. Customs, tradition and morality are the structure to which the action criteria are circumscribed in individuals as a reaffirmation of who they are and how they understand and explain themselves. The recognition and sense of moral and ethical criteria ensure adequate guidelines according to the social group, result in inflection that allows the individual to redefine herself and act within the parameters of her culture or region in response to internal or external stimuli in her context. The validity of these behavioral criteria have their origin in the reflection and recognition or not of the rule, in the face of the objection that good represents evil, therefore it is necessary to take a position in a peculiar situation. This same chain of values and norms, applies as an example, in the perceptual field to determine what is best within that spectrum and design process, environment within which similar or related phenomena occur in different ways. The dialectic of this configuration of being, doing the right thing and properly recreating, entails links that involve emotions, philosophy, memory and learning, whose interaction and measurement lead to products that project an analogous identity trait.

Resumen La verticalidad plantea, desde cualquier perspectiva en orden de la identidad, la dimensión desde la que se explica y responde a la historia y devenir del individuo. Esta descripción imperfecta, perfila su pertenencia como un ejercicio en constante definición, basado en la memoria sintética cuando se la mira hacia el pasado y se convierte en autodefinición expandida cuando ésta es referida al presente. Es a su vez ubicación y reconocimiento, cuya amplitud descriptiva estará dada de acuerdo a la visión del imaginario colectivo propio, proyectado a un futuro al mediano plazo. La identidad y su cercanía con la ontología va seguida de cerca de conductas instintivas. Las costumbres, la tradición y la moral son la estructura a la que se circunscriben los criterios de acción en los individuos como reafirmación de quienes son y cómo se entienden y explican a sí mismos. El reconocimiento y sentido de criterios morales y éticos aseguran pautas adecuadas según el grupo social, resultan en la inflexión que permite al individuo redefinirse y actuar dentro de los parámetros de su cultura o región como respuesta a estímulos internos o externos a su contexto. La validez de estos criterios conductuales tienen su origen en la reflexión y reconocimiento o no de la regla, frente a la objeción que representan el bien el mal, en consecuencia es preciso tomar una postura ante una situación peculiar. Esta misma cadena de valores y normas, aplica como ejemplo, en el campo perceptual para determinar que es lo mejor dentro de ese espectro y proceso del diseño, entorno al cual ocurren fenómenos similares o afines de diferentes maneras. La dialéctica de esta configuración del ser, hacer lo correcto y recrear adecuadamente, entraña vínculos que involucran emociones, filosofía, memoria y aprendizaje, cuya interacción y mensura derivan en productos que proyectan un rasgo análogo identitario.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of (MTP OME, OME , (OME) experience Secondarily 30question question 30 Academia Pediátrica ABOPe Portuguese andor or Sociedade Pediatria SBP Portuguese. . pre, pre pre- peri 20 12 59.6% 596 59 6 (59.6% those 597 7 59.7 5 43.5%, 435 43.5% 43 (43.5%) procedure p 0.001. 0001 0.001 0 001 0.001) (OME 3 2 1 59.6 (59.6 59. 43.5 4 (43.5% 000 0.00 00 (59. 43. (43.5 0.0 (59 (43. 0. (5 (43 ( (4

Mobile phone technology has been a catalyst that has added an innovative dimension in health care and created new opportunities for digital health services. These digital devices can be viewed as an extension of the person using them due to the deluge of personal information that can be collected and stored on them. Data collected on mobile phones are used extensively in health services and research. Personal, mobility and location data are constantly collected. The unique mobile phone architecture provides for an easy flow of data between various role players such as application developers and phone manufacturers. The collection, storage and sharing of personal information on mobile phones elicit various legal questions relating to the protection of privacy, consent, liability and the accountability of stakeholders such as health insurance providers, hospital groups and national departments of health. SIGNIFICANCE: We analyse the major legal concerns of mobility and location data collection and processing through mobile phones in the context of health care and provide recommendations to develop data protection guidelines that are built on the principles of lawfulness, fairness and transparency. The issues explored are of relevance in an African context and to a broader international audience.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Resumen Introducción: El objetivo principal del estudio fue evaluar la necesidad de ajuste posológico de ceftriaxona en pacientes críticos hipoproteinémicos. Pacientes y métodos: Estudio observacional y retrospectivo, llevado a cabo en la unidad de cuidados intensivos (UCI) del Hospital General Universitario de Ciudad Real (médico-quirúrgica de 21 camas), en el que se incluyeron pacientes tratados con ceftriaxona en la UCI desde enero de 2014 a diciembre de 2019 y se clasificaron en dos grupos al inicio del tratamiento: pacientes normoproteinémicos (proteínas totales >5,5g/dl) e hipoproteinémicos (proteínas totales ≤5,5g/dl). Variables principales: Edad, sexo, APACHE II, diagnósticolocalización del foco infeccioso, estancia en UCI, dosis de ceftriaxona, pauta posológica, tratamiento antibiótico concomitante, empírico o dirigido, necesidad de cambio de tratamiento, días de antibioterapia y mortalidad. Resultados: Se incluyeron 98 pacientes (44 normoproteinémicos y 54 hipoproteinémicos). No se obtuvieron diferencias estadísticamente significativas entre las características basales de ambos grupos, exceptuando la localización del foco, siendo respiratorio con mayor frecuencia en el grupo de pacientes normoproteinémicos (p=0,044). Se obtuvieron diferencias estadísticamente significativas a favor del grupo de pacientes normoproteinémicos para: estancia en UCI (p=0,001), necesidad de cambio de tratamiento antibiótico (p=0,004), días de antibioterapia (p=0,007) y mortalidad (p=0,046). Conclusión: Los resultados terapéuticos obtenidos en el grupo de pacientes críticos hipoproteinémicos tratados con ceftriaxona ponen en evidencia la necesidad de considerar la hipoproteinemia como un factor que podría condicionar dicho resultado si se emplean las pautas posológicas de tratamiento habituales.

Abstract Introduction: The main objective of the study was to evaluate the need for posologic adjustment of ceftriaxone in critical hypoproteinemic patients. Patients and methods: Observational and retrospective study, carried out in the intensive care unit (ICU) of the General University Hospital of Ciudad Real (21-bed medical-surgical), which included patients treated with ceftriaxone in the ICU from January 2014 to December 2019 and classified into two groups at the beginning of treatment: normoproteinemic (total proteins >5.5 g/dl) and hypoproteinemic (total proteins ≤5.5g/dl) patients. Main variables: Age, sex, APACHE II, diagnosis-location of the infectious site, ICU stay, ceftriaxone dose, dosage regimen, concomitant antibiotic treatment, empirical or targeted antibiotic treatment, need to change treatment, days of antibiotic therapy and mortality. Results: 98 patients were included (44 normoproteinemics and 54 hypoproteinemics). No statistically significant differences were obtained between the basal characteristics of both groups, except for the location of the infectious site, being respiratory more frequently in the group of normoproteinemic patients (p=0.044). Statistically significant differences were obtained in favour of the group of normoproteinemic patients for: stay in ICU (p=0.001), need for change of antibiotic treatment (p=0.004), days of antibiotherapy (p=0.007) and mortality (p=0.046). Conclusion: The therapeutic results obtained in the group of critical hypoproteinemic patients treated with ceftriaxone show the need to consider hypoproteinemia as a factor that could condition such result if the usual treatment dosage guidelines are used.

Resumen: Introducción: La aracnoiditis osificante (AO) en la columna vertebral es una entidad rara que se caracteriza por la calcificación progresiva de la aracnoides y el saco dural, con la consecuente afectación neurológica. Objetivo: revisar las causas, manifestaciones clínicas y los estudios complementarios para su correcto diagnóstico. Método: Revisión sistemática bajo las directrices PRISMA, con búsqueda en Pubmed, Lilacs y Embase. Se recolectaron los datos demográficos de los pacientes (sexo y edad), el antecedente reportado como causa de AO y el tiempo transcurrido entre causa y el diagnóstico de AO, las manifestaciones clínicas y los estudios complementarios utilizados para el diagnóstico. Resultados: 38 artículos, de los cuales recolectamos 46 pacientes (25 mujeres, 21 hombres), promedio de edad 52 años. La causa más frecuente fue la cirugía previa de columna vertebral y la mielografía con contraste liposoluble Los síntomas más frecuentes fueron la alteración de la fuerza muscular (74%) y dolor (69%). Se utilizó TC en un 76%. La ubicación más frecuente fue torácica (35%). Conclusiones: Su patogenia no es clara, se describe como causa final de un proceso inflamatorio crónico en la aracnoides con la consecuente metaplasia ósea. El diagnóstico generalmente se precede de un largo periodo de dolor acompañado de síntomas neurológicos progresivos. El estudio complementario más sensible y específico para su diagnóstico es la tomografía sin contraste, que debe ser solicitado ante la sospecha clínica. Nivel de Evidencia II; Revisión sistemática. Resumen Introducción (AO dural neurológica Objetivo causas Método PRISMA Pubmed Embase sexo edad, , edad) Resultados 3 artículos 4 25 (2 mujeres 2 hombres, hombres hombres) 5 años 74% 74 (74% 69%. 69 69% . (69%) 76 76% 35%. 35 35% (35%) Conclusiones clara ósea progresivos clínica II ( 7 (74 6 (69% (35% (7 (69 (35 (6 (3

ABSTRACT Introduction: Arachnoiditis ossificans (AO) in the spine is a rare entity characterized by progressive calcification of the arachnoid and dural sac, with consequent neurological involvement. Objective: Review the causes, clinical manifestations, and complementary studies for their correct diagnosis. Method: Systematic review under PRISMA guidelines, with search in Pubmed, Lilacs, and Embase. Patient demographics (sex and age), history reported as a cause of AO and time elapsed between cause and diagnosis of AO, clinical manifestations, and complementary studies used for diagnosis were collected. Results: 38 articles, of which we collected 46 patients (25 women, 21 men), mean age of 52 years. The most frequent cause was previous spine surgery and myelography with fat-soluble contrast. The most frequent symptoms were insufficient muscle strength (74%) and pain (69%). CT was used in 76%. The most frequent location was thoracic (35%). Conclusion: Its pathogenesis is unclear; described as the final cause of a chronic inflammatory process in the arachnoid with the consequent bone metaplasia. Diagnosis usually precedes a long period of pain and progressive neurological symptoms. The most sensitive and specific complementary study for the diagnosis is the tomography without contrast, which should be requested in case of clinical suspicion. Level of Evidence II; Systematic Review. Introduction (AO sac involvement Objective causes manifestations Method guidelines Pubmed Lilacs Embase sex age, , age) Results 3 articles 4 25 (2 women 2 men, men men) 5 years fatsoluble fat soluble contrast 74% 74 (74% 69%. 69 69% . (69%) 76 76% 35%. 35 35% (35%) Conclusion unclear metaplasia suspicion II ( 7 (74 6 (69% (35% (7 (69 (35 (6 (3

Resumo: Introdução: A aracnoidite ossificante (AO) na coluna vertebral é uma entidade rara caracterizada por calcificação progressiva do saco aracnóideo e dural, com consequente envolvimento neurológico. Objetivo: revisar as causas, manifestações clínicas e estudos complementares para o seu correto diagnóstico. Método: Revisão sistemática sob as diretrizes do PRISMA, com busca no Pubmed, Lilacs e Embase. Foram coletados dados demográficos dos pacientes (sexo e idade), história relatada como causa de AO e tempo decorrido entre a causa e o diagnóstico de AO, manifestações clínicas e estudos complementares utilizados para o diagnóstico. Resultados: 38 artigos, dos quais foram coletados 46 pacientes (25 mulheres, 21 homens), com idade média de 52 anos. A causa mais frequente foi cirurgia prévia da coluna vertebral e mielografia com contraste lipossolúvel. Os sintomas mais frequentes foram comprometimento da força muscular (74%) e dor (69%). A TC foi utilizada em 76%. A localização mais frequente foi torácica (35%). Conclusões: Sua patogênese não é clara, é descrita como a causa final de um processo inflamatório crônico na aracnoide com a consequente metaplasia óssea. O diagnóstico é geralmente precedido por um longo período de dor acompanhado por sintomas neurológicos progressivos. O estudo complementar mais sensível e específico para o seu diagnóstico é a tomografia sem contraste, que deve ser solicitada em caso de suspeita clínica. Nível de Evidência II; Revisão sistemática. Resumo Introdução (AO dural neurológico Objetivo causas Método PRISMA Pubmed Embase sexo idade, , idade) Resultados 3 artigos 4 25 (2 mulheres 2 homens, homens homens) 5 anos lipossolúvel 74% 74 (74% 69%. 69 69% . (69%) 76 76% 35%. 35 35% (35%) Conclusões clara óssea progressivos clínica II ( 7 (74 6 (69% (35% (7 (69 (35 (6 (3

ABSTRACT Metastatic gastric cancer traditionally hinders surgical treatment options, confining them to palliative procedures. The presence of metastases in these tumors is classified as M1, irrespective of their characteristics, quantity, or location. However, oligometastatic disease emerged as an intermediate state between localized and widely disseminated cancer. It exhibits diverse patterns based on metastatic disease extent, type, and location. Adequately addressing this distinctive metastatic state necessitates tailored strategies that surpass the realm of palliative care. Differentprimary tumor types present discernible scenarios of oligometastatic disease, including preferred sites of occurrence and chronological progression. Due to the novelty of this theme and the heterogeneity of the disease, uncertainties still exist, and the ability to provide confident guidelines is challenging. Currently, there are no effective predictors to determine the response and provide clear indications for surgical interventions and systemic treatments in oligometastatic disease. Treatment decisions are commonly based on apparent disease control by systemic therapies, with a short observation period and imaging assessments. Nonetheless, the inherent risk of misinterpretation remains a constant concern. The emergence of novel technologies and therapeutic modalities, such as immunotherapy, cellular therapy, and adoptive therapies, holds the potential to reshape the landscape of surgical treatment for the oligometastatic disease in gastric cancer, expanding the surgeon’s role in this multidisciplinary approach. Prospective tools for patient selection in oligometastatic gastric cancer are being explored. Using non-invasive, cost-effective, widely available imaging techniques that provide real-time information may revolutionize medical practice, ensuring precision medicine accessibility, even in resource-constrained small healthcare facilities. Incorporating molecular classifications, liquid biopsies, and radiomic analysis in a complementary protocol will augment patient selection precision for surgical intervention in oligometastasis. Hopefully, these advancements will render surgeries unnecessary in many cases by providing highly effective alternative treatments. options procedures M1 M characteristics quantity location However extent type care progression exist challenging Currently therapies assessments Nonetheless concern modalities immunotherapy therapy surgeons surgeon s approach explored noninvasive, noninvasive non invasive, invasive non-invasive costeffective, costeffective cost effective, cost-effective realtime real time practice accessibility resourceconstrained resource constrained facilities classifications biopsies oligometastasis Hopefully

RESUMO O câncer gástrico metastático representa um desafio para o tratamento cirúrgico, restringindo-se a procedimentos paliativos. A presença de metástases nestes tumores é categorizada como estágio M1, independentemente das características, quantidade e localização. No entanto, a doença oligometastática surgiu como um estado intermediário entre o câncer localizado e o amplamente disseminado. A oligometastática apresenta diversos padrões com base na extensão, tipo e localização da doença metastática. Abordar adequadamente esse estado distintivo requer estratégias adaptadas que ultrapassem o escopo dos cuidados paliativos. Diferentes tipos de tumores primários exibem cenários distintos de oligometastática, incluindo locais preferenciais de ocorrência e progressão cronológica. Devido à novidade desse tema e à heterogeneidade da doença, ainda existem incertezas, e a capacidade de fornecer diretrizes seguras é limitada. Atualmente, não existem preditores eficazes para determinar a resposta e fornecer indicações claras para intervenções cirúrgicas e tratamentos sistêmicos em oligometastática. As decisões de tratamento geralmente se baseiam no controle aparente da doença por meio de terapias sistêmicas, com um curto período de observação e avaliação por imagem. No entanto, o risco inerente de interpretação incorreta continua sendo uma preocupação constante. A emergência de novas tecnologias e modalidades terapêuticas, como imunoterapia, terapia celular e terapias adotivas, tem o potencial de remodelar o panorama do tratamento cirúrgico da oligometastática no câncer gástrico, expandindo o papel do cirurgião nessa abordagem multidisciplinar. Ferramentas prospectivas para a seleção de pacientes com câncer gástrico oligometastático estão sendo exploradas. A utilização de técnicas de imagem não invasivas, rentáveis e amplamente disponíveis, que fornecem informações em tempo real, pode revolucionar a prática médica, garantindo a acessibilidade da medicina de precisão, mesmo em unidades de saúde com recursos limitados. A incorporação de classificações moleculares, biópsias líquidas e análises radiômicas em um protocolo complementar aumentará a precisão da seleção de pacientes para intervenção cirúrgica em oligometástases. Espera-se que esses avanços tornem as cirurgias desnecessárias em muitos casos, proporcionando tratamentos alternativos altamente eficazes. restringindose restringindo paliativos M1 M características entanto disseminado extensão metastática cronológica incertezas limitada Atualmente sistêmicas constante terapêuticas imunoterapia adotivas multidisciplinar exploradas invasivas disponíveis real médica limitados moleculares oligometástases Esperase Espera casos

Resumo Este artigo objetiva analisar o processo de dispensação de medicamentos em unidades prisionais. Foi realizado um estudo qualitativo, em sete penitenciárias do estado da Paraíba, sendo entrevistados 13 profissionais de saúde e 43 pessoas privadas de liberdade em uso de medicamentos essenciais/estratégicos, no período compreendido entre os meses de fevereiro a agosto de 2016. Os resultados foram categorizados na perspectiva da análise de conteúdo de Bardin e três categorias emergiram: armazenamento de medicamentos no sistema penitenciário, processo de dispensação de medicamentos no sistema penitenciário e responsabilidades sanitárias para garantir a assistência farmacêutica. Conclui-se que a inexistência de farmácias, o não cumprimento legal no que se refere a presença do profissional com habilidade e competência técnica para realizar a dispensação primando pelos padrões de qualidade/segurança e pela relevância das orientações relacionadas ao uso e armazenamento, associado a falta de clareza na definição das responsabilidades sanitárias dos gestores a partir da instância de governo, são fatores que comprometem a política uma vez que incrementam o investimento, mas não garantem a assistência farmacêutica no sistema prisional.

Abstract This paper aims to analyze the process of medicine dispensation in prisons. A qualitative study was conducted in seven penitentiaries in Paraíba with 13 health professionals and 43 people deprived of liberty using essential/strategic medicines from February to August 2016. The results were categorized from the perspective of Bardin’s content analysis. Three categories emerged: medicine storage location in the prison system, delivery process in the prison system, and health-related responsibilities with pharmaceutical care. We can conclude that the lack of pharmacies, the legal non-compliance regarding the availability of skilled professionals with technical competencies to perform the dispensation, focusing on the quality/safety standards and relevance of the use and storage guidelines associated with the lack of clarity in the definition of health responsibilities of managers from a government authority, are factors that compromise the policy since they increase the investment, but do not ensure pharmaceutical care in the prison system.