In this work, a miniaturized version of the QuEChERS (quick, easy, cheap, effective, rugged, and safe) method was optimized, validated, and applied for extracting eight pesticide residues in anuran liver tissue samples. The extracts were quantified by high-performance liquid chromatography with diode array detection, and the detected residues in liver tissue samples were identified by tandem mass spectrometry-liquid chromatography. The optimized extraction method entailed the scale reduction of the QuEChERS method twenty times using 500 mg of liver tissue sample, 200 mg Mg2SO4, 50 mg NaCl, 1.5 mL of acetonitrile, and a mixture of 25 mg C18 + 25 mg PSA (primary-secondary amine) as dispersive solid-phase extraction sorbent. The method was validated using liver tissue samples spiked at two levels of pesticide concentrations according to the SANTE/11312/2021 document. Recoveries ranged from 91-110% with a relative standard deviation < 20%. The method robustness assessed by the Steiner and Youden test resulted in recovery rate variations of less than 2% for all pesticides after deliberated changes in seven variables. The validated method was applied to 72 liver tissue samples from two anuran species, registering residues of some pesticides in 31 samples. The proposed method proved to be efficient, precise, and robust for determining pesticide residues in anuran liver tissues. work quick, quick (quick easy cheap effective rugged safe highperformance high performance detection spectrometryliquid spectrometry sample 20 Mg2SO4 MgSO Mg SO 5 NaCl 15 1 1. acetonitrile 2 C C1 primarysecondary primary secondary amine solidphase solid phase sorbent SANTE113122021 SANTE 11312 2021 SANTE/11312/202 document 91110% 91110 91 110% 110 91-110 20% variables 7 species 3 efficient precise tissues Mg2SO SANTE11312202 1131 202 SANTE/11312/20 9111 9 11 91-11 SANTE1131220 113 SANTE/11312/2 911 91-1 SANTE113122 SANTE/11312/ 91- SANTE11312 SANTE/11312 SANTE1131 SANTE/1131 SANTE113 SANTE/113 SANTE11 SANTE/11 SANTE1 SANTE/1 SANTE/

Acquired immunodeficiency syndrome is an infectious disease caused by human immunodeficiency virus (HIV). Pharmacological antiretroviral therapy, along with therapeutic monitoring of drug plasma concentrations, facilitates adequate and effective follow-up in each patient. Our main objective was to develop and validate a high-performance liquid chromatography with ultraviolet detector (HPLC-UV) bioanalytical method for the simultaneous quantification of plasma concentrations of three commonly used antiretrovirals in Colombia: efavirenz, lopinavir, and ritonavir. This method is intended for therapeutic drug monitoring in persons living with HIV locally or in developing countries. The method is selective, specific, accurate, precise, and stable over the concentration range of 250 and 20,000 ng mL -1 for the drugs. It was successfully applied to measure the plasma levels of efavirenz, lopinavir, and ritonavir in HIV patients, which ranged from 251.0 ± 10.4 to 7186.2 ± 10.2, 8188.2 ± 5.9 to 15,312.5 ± 6.6, and 246.1 ± 6.5 to 1189.0 ± 6.4 ng mL-1, respectively. HIV. . (HIV) therapy followup follow up patient highperformance high performance HPLCUV HPLC UV (HPLC-UV Colombia efavirenz lopinavir countries selective specific accurate precise 25 20000 20 000 20,00 1 - drugs patients 2510 251 0 251. 104 10 4 10. 71862 7186 2 7186. 102 10.2 81882 8188 8188. 59 5 9 5. 153125 15 312 15,312. 66 6 6.6 2461 246 246. 65 6. 11890 1189 1189. 64 mL1, mL1 1, mL-1 respectively (HIV 2000 00 20,0 718 818 15312 31 15,312 24 118 mL- 200 20, 71 81 1531 3 15,31 11 7 8 153 15,3 15,

ABSTRACT: This study adopted a more macroscopic perspective to focus on the issue of rural poverty in China. By selecting indicators reflecting various levels of poverty recurrence, considering risk factors across multiple dimensions, and employing advanced methods, we constructed a novel China Rural Poverty Recurrence Risk Index. We utilized a Markov switching model to delve into the mechanisms of poverty recurrence. Building upon this foundation, we developed an advanced poverty recurrence risk early warning system using a convolutional neural network-long short-term memory (CNN-LSTM) model. The system is optimized through mechanism-based predictions to better capture the dynamic changes in poverty recurrence. Empirical results demonstrated that the integrated dynamic monitoring and early warning system have significantly effective outcomes in addressing the recurrence of rural poverty. ABSTRACT dimensions methods Index foundation networklong network long shortterm short term CNNLSTM CNN LSTM (CNN-LSTM mechanismbased mechanism based

RESUMO: Este estudo adota uma perspectiva mais macroscópica para focar na questão da pobreza rural na China. Ao selecionar indicadores que refletem vários níveis de recorrência da pobreza, considerando factores de risco em múltiplas dimensões e empregando métodos avançados, construímos um novo indice de risco de recorrência da pobreza rural na China. Utilizamos um modelo de mudança de Markov para aprofundar os mecanismos de recorrência da pobreza. Com base nisso, desenvolvemos um sistema avançado de alerta precoce de risco de recorrência de pobreza usando um modelo de memória de longo e curto prazo de rede neural convolucional (CNN-LSTM). O sistema é optimizado através de previsões baseadas em mecanismos para melhor captar as mudanças dinâmicas na recorrência da pobreza. Os resultados empíricos demonstram que o sistema integrado de monitorização dinâmica e de alerta precoce tem resultados significativamente eficazes na abordagem da recorrência da pobreza rural. RESUMO China avançados nisso CNNLSTM. CNNLSTM CNN LSTM . (CNN-LSTM) (CNN-LSTM

ABSTRACT The estimation of evapotranspiration (ET) and crop water requirements are crucial for the proper management and allocation of water resources in terms of quantity, quality, and timeliness. Therefore, remote sensing estimation of ET using the SEBAL algorithm (Surface Energy Balance Algorithm for Land) can provide spatio-temporal, non-punctual data, unlike traditional calculations relying on the nearest meteorological station. This research analyzed ET using SEBAL, based on ten Landsat 8 satellite images processed with a program developed in the Model Builder of ArcGis® version 10.2. The analysis was conducted during the vegetative period of starchy corn from May to October 2016. Validation of the results happened with a drainage lysimeter installed in a monitoring plot. Additionally, the statistical indices - such as percentage relative error (PRE) (0,09), root mean square error (RMSE) (0,30), R2 (0,92), and Nash-Sutcliffe efficiency (NASH) (0,91) - indicated a good correlation of ET for starchy corn in the central highlands of Peru. The ET identified at ten monitoring points ranged from 1,05 to 7,79 mm d-1. (ET quantity quality timeliness Therefore Surface Land spatiotemporal, spatiotemporal spatio temporal, temporal spatio-temporal nonpunctual non punctual data station ArcGis 102 10 2 10.2 2016 plot Additionally PRE (PRE 0,09, 009 0,09 , 0 09 (0,09) RMSE (RMSE 0,30, 030 0,30 30 (0,30) R 0,92, 092 0,92 92 (0,92) NashSutcliffe Nash Sutcliffe NASH (NASH 0,91 091 91 (0,91 Peru 105 1 05 1,0 779 7 79 7,7 d1. d1 d 1. d-1 10. 201 00 0,0 (0,09 03 0,3 3 (0,30 0,9 9 (0,92 (0,9 1, 77 7, d- 20 0, (0,0 (0,3 (0, (0 (

This study evaluated the potential of naphthoxazoles derived from lapachol as fluorescent deoxyribonucleic acid (DNA) probes. We synthesized three 2-substituted naphthoxazoles: one with a phenyl group (LOX1), and two with 2-hydroxyphenyl (LOX2) and 4-fluorophenyl (LOX3) groups, respectively. The compounds were synthesized using the Debus-Radziszewski reaction between the lapachol and aldehydes. The quantum yield (Φf) was determined using the classical relative method with 4’,6-diamidino-2-phenylindole (DAPI) as the standard, and the fluorescence lifetime (τf) was measured with a lifetime fluorescence spectrometer. The naphthoxazoles exhibited low fluorescence emission and consequently low values of Φf in their free form, demonstrating behavior similar to that of DAPI. These compounds displayed notably large Stokes shifts (approximately 340 nm) and the τf in the nanosecond range. DNA binding studies were conducted by monitoring changes in the absorption properties of naphthoxazoles in the absence and presence of calf thymus DNA at different concentrations. The results indicated that naphthoxazoles interacted with DNA through groove binding. LOX2 exhibited a binding constant (Kb) of 2.70 × 104 M-1, indicating strong binding to the biomolecule. These findings underscore the potential of LOX1, LOX2, and LOX3 as candidates for use as fluorescent DNA probes. (DNA probes 2substituted substituted 2 LOX1 LOX , (LOX1) 2hydroxyphenyl hydroxyphenyl (LOX2 4fluorophenyl fluorophenyl 4 (LOX3 groups respectively DebusRadziszewski Debus Radziszewski aldehydes (Φf 4,6diamidino2phenylindole 46diamidino2phenylindole diamidinophenylindole ,6 diamidino phenylindole 6 DAPI (DAPI standard (τf spectrometer form approximately 34 nm range concentrations Kb (Kb 270 70 2.7 10 M1, M1 M 1, 1 M-1 biomolecule (LOX1 (LOX 6diamidino2phenylindole 3 27 7 2. M-

RESUMO Objetivo: Reconhecer e abordar a síndrome de Patau, apesar de sua raridade e da baixa expectativa de vida associada, por meio da apresentação de um estudo de caso de uma paciente de dois anos que recebe cuidados em casa por intermédio de serviços de home care. Descrição do caso: Apresentamos uma paciente do sexo feminino que desafiou as probabilidades, com sobrevivência prolongada devida, possivelmente, ao home care. Ela nasceu por cesariana, com 31 semanas + 4 dias, em razão da restrição do crescimento uterino. A mãe, de 36 anos, recebeu cuidados pré-natais adequados e gozava de boa saúde. O diagnóstico da síndrome de Patau foi confirmado por meio de cariótipo após o nascimento. Apesar da gravidade clínica do caso, a paciente, hoje com dois anos, recebe atendimento domiciliar especializado, apoiado por traqueostomia e gastrostomia. Um técnico de enfermagem dedicado 24 horas garante acompanhamento contínuo, e a paciente beneficia-se de check-ups médicos regulares, fisioterapia cinco vezes por semana, sessões semanais de fonoaudiologia, consultas mensais com nutricionista e apoio psicológico contínuo aos familiares. Comentários: Esta abordagem multidisciplinar resultou em melhora motora discreta, destacando o impacto positivo do cuidado integral no seu bem-estar geral. A existência de uma rede robusta de apoio às famílias que enfrentam desafios semelhantes é crucial, e um cuidado multidisciplinar pode prevenir eficazmente as complicações associadas a esta impactante síndrome. Objetivo associada care probabilidades devida possivelmente cesariana 3 dias uterino mãe prénatais pré natais saúde nascimento especializado gastrostomia 2 beneficiase beneficia se checkups check ups regulares semana fonoaudiologia familiares Comentários discreta bemestar bem estar geral crucial

ABSTRACT Objective: To recognize and address Patau’s syndrome, despite its rarity and associated low life expectancy, through the presentation of a case study of a 2-year-old patient receiving Home Care services. Case description: We present a female patient who defied the odds with a prolonged survival, possible due to Home Care. She was delivered via cesarean section at 31 weeks + 4 days due to restricted uterine growth. The mother, aged 36, had received proper prenatal care and was in good health. The diagnosis of Patau’s syndrome was confirmed through karyotyping after birth. Despite the severe clinical nature of the case, the patient, now with two years old, receives specialized home-based care, supported by a tracheostomy and gastrostomy. A dedicated 24-hour nursing technician ensures continuous monitoring, and the patient benefits from regular medical check-ups, physiotherapy five times a week, weekly speech therapy sessions, monthly consultations with a nutritionist, and ongoing psychological support for her family members. Comments: This multidisciplinary approach has resulted in a slight motor response, highlighting the positive impact of comprehensive care on her overall well-being. The existence of a robust support network for families facing similar challenges is crucial, and a multidisciplinary care can effectively prevent complications associated with this impactful syndrome. Objective Pataus Patau s expectancy 2yearold yearold 2 year old services description survival 3 growth mother 36 health birth homebased home based gastrostomy 24hour hour 24 monitoring checkups, checkups check ups, ups check-ups week sessions nutritionist members Comments response wellbeing. wellbeing well being. being well-being crucial

RESUMO Objetivo: Descrever como aplicativos de smartphone podem contribuir para o gerenciamento de quadros de epilepsia em crianças e adolescentes. Fontes de dados: Trata-se de uma revisão integrativa realizada nas bases de dados Medline; PubMed e SciELO, com base nos descritores “epilepsy” e “smartphone”. Foram incluídos estudos originais publicados entre 2017–2023 em português ou inglês que respondessem à pergunta de investigação. Teses e dissertações, estudos duplicados, revisões de literatura e estudos que não responderam à questão de pesquisa foram excluídos. Síntese dos dados: Foram localizados 178 estudos, dos quais seis foram selecionados para compor esta revisão. A amostra incluiu 731 participantes (631 infantojuvenis com epilepsia e 100 cuidadores). Os aplicativos permitem a coleta da frequência de convulsões; momento e o tipo de crise; lembretes para a administração de medicamentos; e informações sobre a qualidade do sono, sendo capazes de armazenar esses dados para profissionais da saúde, cuidadores e usuários acompanharem a evolução do quadro. Conclusões: O uso de aplicativos no manejo das convulsões de crianças e adolescentes com epilepsia apresenta resultados promissores ao promoverem um monitoramento contínuo e personalizado. Novos estudos são necessários para otimizar os resultados benéficos e superar desafios. Objetivo Tratase Trata se Medline SciELO epilepsy “epilepsy smartphone. . “smartphone” 20172023 2017 2023 2017–202 investigação dissertações duplicados excluídos 17 73 631 (63 10 cuidadores. cuidadores) crise medicamentos sono saúde quadro Conclusões personalizado desafios “smartphone 2017202 201 202 2017–20 1 7 63 (6 201720 20 2017–2 6 ( 20172 2 2017–

ABSTRACT Objective: To describe how smartphone applications can contribute to the management of epilepsy in children and adolescents. Data source: This is an integrative review conducted on the Medline, PubMed, and SciELO databases, based on the descriptors “epilepsy” and “smartphone.” Original studies published between 2017–2023 in Portuguese or English that addressed the research question were included. Theses and dissertations, duplicate studies, literature reviews, and studies that did not answer the research question were excluded. Data synthesis: A total of 178 studies were located, of which six were selected for this review. The sample included 731 participants (631 children and adolescents with epilepsy and 100 caregivers). The applications allow for the collection of seizure frequency; timing and type of crisis; reminders for medication administration; and information about sleep quality. They can store these data for healthcare professionals, caregivers, and users to monitor the progress of the condition. Conclusions: The use of applications in managing seizures in children and adolescents with epilepsy shows promising results by promoting continuous and personalized monitoring. Further studies are needed to optimize beneficial outcomes and overcome challenges. Objective source Medline PubMed databases “epilepsy smartphone. “smartphone. 20172023 2017 2023 2017–202 dissertations reviews excluded synthesis 17 located 73 631 (63 10 caregivers. caregivers . caregivers) frequency crisis administration quality professionals condition Conclusions monitoring challenges “smartphone 2017202 201 202 2017–20 1 7 63 (6 201720 20 2017–2 6 ( 20172 2 2017–

Caffeine (CAF) and nicotine (NIC) are emerging contaminants and are among the most consumed substances in the world, making it crucial to monitor these contaminants. In this work, an alternative electrolyte, 2-hydroxyethylammonium acetate (2HEAA) was used for the development of an electroanalytical method for determination and quantification of CAF and NIC, simultaneously, using differential pulse voltammetry (DPV). The system with the 2HEAA electrolyte was characterized by cyclic voltammetry and electrochemical impedance spectroscopy, and the DPV parameters were optimized for the best conditions. The method was validated from a calibration curve obtained which showed limit of detection (LOD) of 0.82 and 6.26 μmol L 1 and limit of quantification (LOQ) of 2.73 and 20.8 μmol L-1 for CAF and NIC, respectively. In the precision analyses, values lower than 10% of relative standard deviation were obtained. In the presence of concomitant inorganic and organic species, the system proved to be selective in the determination of analytes. The method was used to determine the analytes in fortified samples (river water, synthetic urine and commercial milk), obtaining recoveries between 87.25 and 111.40%. The 2HEAA demonstrated high efficiency as an alternative electrolyte with good signal-to-noise ratio, increased analytical sensitivity of the method, in addition to presenting low cost and fast electrolyte preparation. (CAF NIC (NIC world work 2hydroxyethylammonium hydroxyethylammonium 2 HEAA (2HEAA simultaneously DPV. . (DPV) spectroscopy conditions LOD (LOD 082 0 82 0.8 626 6 26 6.2 LOQ (LOQ 273 73 2.7 208 20 8 20. L1 L- respectively analyses 10 species river water milk, milk , milk) 8725 87 25 87.2 11140 111 40 111.40% signaltonoise signal noise ratio preparation (DPV 08 0. 62 6. 27 7 2. 872 87. 1114 11 4 111.40 111.4 111.

ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis. Purpose followup. followup follow up. up Methods 2 201 2021 demographics diagnosis acuity analyzed Results intermediate longterm long term However glaucoma formation endophthalmitis occurred plate structures tissues Conclusion highrisk high risk 202

Even though ammonia is a natural component of aquatic environments, elevated concentrations indicate pollution and environmental degradation. Consequently, efficient analytical methods for monitoring ammonia levels are crucial for preserving water quality. Voltammetry offers a sustainable approach for NH3 quantification, combining good analytical performance with low sample and reagent consumption, minimizing waste generation. However, despite these advantages, the voltammetric determination of ammonia remains relatively unexplored. Therefore, this study investigated the electrochemical behavior of NH3 in alkaline solutions using a non-modified Pt electrode and evaluated the performance of differential pulse voltammetry (DPV) and square wave voltammetry (SWV) for NH3 determination. DPV provided superior performance, with limits of detection and quantification of 0.79 µmol L-1 (0.011 ppmN) and 2.6 µmol L-1 (0.036 ppmN), respectively, which comply with the maximum allowable ammonia concentration in natural waters according to Brazilian and European regulations. The voltammetric method successfully quantified ammonia in tap and river water samples, providing results concordant with the established Berthelot spectrophotometric method, at a 95% confidence level. Additionally, it is simple and fully accessible to non-electrochemist since no sophisticated procedures for electrode modification are needed. Finally, the high analytical performance of the proposed method makes it valuable for pollution monitoring in aquatic environments. environments degradation Consequently quality NH consumption generation However advantages unexplored Therefore nonmodified non modified (DPV SWV (SWV 079 0 79 0.7 L1 L 1 L- 0.011 0011 011 (0.01 ppmN 26 2 6 2. 0.036 0036 036 (0.03 ppmN, , respectively regulations samples 95 level Additionally nonelectrochemist electrochemist needed Finally 07 7 0. 0.01 001 01 (0.0 0.03 003 03 9 0.0 00 (0. (0 (

RESUMO Na agricultura irrigada, é comum a aplicação de água no solo cultivado sem critério, resultando em uso ineficiente ou não otimizado da água. Em muitos casos, a relação solo-água-planta, bem como as potencialidades e limitações dos sistemas de irrigação são ignoradas. A agricultura irrigada sustentável requer o desenvolvimento de um sistema de monitoramento da umidade do solo que evite a perda de água e melhore a eficiência do uso. O objetivo deste estudo foi desenvolver e avaliar a eficiência de um sistema inteligente de monitoramento da umidade do solo. O sistema é composto por duas estações: a primeira coleta os dados sobre parâmetros de umidade aparente do solo usando sensores, enquanto a segunda transmite esses dados para uma estação de processamento central. O sistema determina precisamente os valores atuais de umidade do solo, permitindo estimar o volume de água de irrigação necessário para atender à demanda hídrica da cultura com base na capacidade de campo. Os resultados da curva de calibração dos sensores indicam que o sistema pode medir com precisão a umidade do solo atual, auxiliando no manejo da irrigação. Para áreas irrigadas em condições de solo não saturado, recomenda-se o uso de tensiômetros devido à sua maior confiabilidade entre a capacidade de campo e o ponto de murcha permanente, garantindo práticas de irrigação mais precisas. critério casos soloáguaplanta, soloáguaplanta planta, planta solo-água-planta ignoradas estações central atual saturado recomendase recomenda se permanente precisas

ABSTRACT Water application to cultivated soil is often done without careful consideration in irrigated agriculture, leading to inefficient or suboptimal water usage. In many instances, the intricate relationship between soil, water, and plants, as well as the potential and limitations of irrigation systems, is overlooked. Sustainable irrigated agriculture necessitates the development of a soil moisture monitoring system that curtails water loss and enhances overall efficiency. This study aimed to develop and assess the efficiency of an intelligent system for monitoring soil moisture. The system comprises two stations: the first collects data on apparent soil moisture parameters using sensors, while the second transmits this data to a central processing station. The system precisely determines current soil moisture values, enabling estimation of the required irrigation water volume to meet the crop’s water demand based on field capacity. Results from the calibration curve of the sensors indicate that the system can measure current soil moisture precisely, aiding in irrigation management. For irrigated areas under unsaturated soil conditions, it is recommended to use tensiometers due to their higher reliability between field capacity and permanent wilting point, ensuring more accurate irrigation practices. usage instances plants systems overlooked stations station values crops crop s management conditions point practices

Resumen Marco contextual: Los datos que caracterizan a las personas con estomas en Portugal son escasos. Establecer estimaciones epidemiológicas puede mejorar el conocimiento sobre esta población y adaptar modelos sanitarios. Objetivos: Estimar la prevalencia y la incidencia de personas con estoma de eliminación en Portugal en 2021. Metodología: Estudio observacional, longitudinal y retrospectivo, basado en una base de datos de dispensaciones de dispositivos de ostomía. Resultados: En 2021, el número estimado de personas con al menos un estoma era de 22.045, de las cuales 19.793 [IC95%:19.599;19.994] tenían un estoma de eliminación. La mayoría de ellos eran hombres (61,4%), tenían una edad media de 70,5 años y vivían principalmente en el interior del país. El tipo de estoma de eliminación más frecuente era la colostomía (48,8%). La incidencia estimada de nuevos casos fue de 6.622, de los cuales 5.834 [IC95%:5.680;5.984] eran estomas de eliminación. Conclusión: Estos resultados han permitido caracterizar el perfil de las personas con estoma de eliminación en Portugal. Podrían ser útiles para ajustar los programas de prevención/seguimiento de la salud de esta población y para asignar recursos especializados.

Resumo Enquadramento: Dados que caracterizam as pessoas com estoma em Portugal são escassos. Estabelecer estimativas epidemiológicas pode melhorar o conhecimento sobre esta população e adaptar modelos de cuidados de saúde. Objetivos: Estimar a prevalência e incidência de pessoas com estoma de eliminação em Portugal em 2021. Metodologia: Estudo observacional, longitudinal e retrospetivo, a partir de uma base de dados de dispensa de dispositivos para ostomia. Resultados: Em 2021, o número estimado de pessoas com pelo menos um estoma foi de 22.045. Entre estes, 19.793 [IC95%:19.599;19.994] tinham um estoma de eliminação. Na sua maioria eram homens (61,4%), em média tinham 70,5 anos e residiam preferencialmente na região interior do país. O tipo de estoma de eliminação mais prevalente foi a colostomia (48,8%). A incidência estimada de novos casos foi de 6.622, sendo 5.834 [IC95%:5.680;5.984] referentes a estomas de eliminação. Conclusão: Estes resultados permitiram caracterizar o perfil das pessoas com estoma de eliminação em Portugal. Poderão ser úteis para ajustar os programas de prevenção/acompanhamento em saúde desta população e ainda alocar recursos especializados.

Abstract Background: Data characterizing individuals with a stoma in Portugal is limited. Establishing epidemiological estimates can enhance understanding of this population and facilitate the adaptation of healthcare models. Objectives: To estimate the prevalence and incidence of individuals in Portugal who have undergone intestinal or urinary ostomy in 2021. Methodology: Observational, longitudinal, and retrospective study using a stoma appliance dispensing database. Results: In 2021, an estimated 22,045 individuals had at least one stoma, with 19,793 [95%CI:19,599;19,994] having an intestinal/urinary stoma. Most of these individuals were men (61.4%) with a mean age of 70.5 years and resided in the inland region of Portugal. Colostomy was the most prevalent type of intestinal/urinary stoma (48.8%). The estimated incidence of new cases was 6,622, of which 5,834 [95%CI:5,680;5,984] were intestinal/urinary stomas. Conclusion: These results characterize the profile of individuals with intestinal and urinary stomas in Portugal. They may be useful in adjusting prevention and health monitoring programs for this population and allocating specialized resources.

Resumen Marco contextual: La prevalencia de los accidentes cerebrovasculares sigue siendo elevada, por lo que se recomiendan procedimientos clínicos. Objetivo: Validar, mediante la técnica Delphi, las intervenciones de enfermería en el abordaje de pacientes con sospecha de accidente cerebrovascular en fase aguda, con un panel de especialistas. Metodología: Se realizó una investigación de tipo Survey, basada en un estudio cuantitativo-descriptivo. Previamente se realizó una revisión bibliográfica sistemática. Resultados: La muestra estaba formada por seis especialistas. Tras dos rondas Delphi, se validaron las intervenciones de enfermería para pacientes con sospecha de accidente cerebrovascular en fase aguda, a saber: derivación correcta teniendo en cuenta el tiempo de progresión de los síntomas; abordaje en urgencias (basado en la evaluación ABCDEFGH); seguimiento y respuesta a las reacciones adversas durante y después de la trombolisis. Conclusión: La validación de las intervenciones de enfermería en el abordaje de pacientes con sospecha de accidente cerebrovascular agudo condujo al desarrollo de una sólida instrucción de trabajo para enfermeras.

Resumo Enquadramento: A prevalência do acidente vascular cerebral continua elevada, sendo recomendada a existência de procedimentos clínicos. Objetivo: Validar, através da técnica Delphi, intervenções de enfermagem na abordagem ao doente com suspeita de acidente vascular cerebral em fase aguda, com um painel de especialistas. Metodologia: Realizou-se uma pesquisa Survey, com base num estudo quantitativo-descritivo, sendo que uma revisão sistemática de literatura foi realizada previamente. Resultados: Amostra composta por seis especialistas. Realizadas duas rondas da técnica Delphi, foram validadas intervenções de Enfermagem ao doente com suspeita de acidente vascular cerebral, em fase aguda, nomeadamente: correto encaminhamento tendo em conta o tempo de evolução dos sintomas; abordagem em sala de emergência (baseada na avaliação ABCDEFGH); vigilância e resposta a reações adversas durante e após trombólise. Conclusão: A validação das intervenções de enfermagem na abordagem ao doente com suspeita de acidente vascular cerebral em fase aguda levou à elaboração de uma instrução de trabalho sólida, direcionada aos enfermeiros.

Abstract Background: The prevalence of stroke remains high, where clinical procedures are recommended. Objective: To validate, using the Delphi technique, nursing interventions in the approach to patients with suspected stroke in the acute phase, with a panel of specialists. Methodology: A survey was carried out, based on a quantitative-descriptive study. A systematic literature review was carried out beforehand. Results: The sample consisted of six specialists. Two rounds of the Delphi technique were used to validate nursing interventions for patients with suspected stroke in the acute phase, namely: correct referral taking into account the time of symptom progression; emergency room approach (based on the ABCDEFGH assessment); monitoring and response to adverse reactions during and after thrombolysis. Conclusion: The validation of nursing interventions in the approach to patients with suspected acute strokes led to the development of a solid work instruction for nurses.

Resumen Marco contextual: La ventilación no invasiva (VNI) es una estrategia terapéutica para las personas con insuficiencia respiratoria aguda (IRA). Objetivo: Analizar la relación entre las variables sociodemográficas y clínicas de las personas ingresadas en medicina interna y la adaptación y complicaciones de la VNI. Metodología: Estudio observacional retrospectivo de cohortes con una muestra de 239 personas. Los datos se recogieron a través de registros electrónicos en SClínico, mediante una guía de extracción de datos. Resultados: Se observó que el 25,1% de las personas no eran aptas para la VNI, lo que se asoció significativamente con la alimentación oral, la confusión y el uso de contención mecánica. Se produjeron complicaciones en el 33,5% de la muestra, y las más frecuentes fueron secreciones, lesiones en la nariz y vómitos. Se encontró una asociación estadísticamente significativa entre el número de complicaciones y las personas alimentadas por sonda nasogástrica (SNG), confusas, con medidas de contención mecánica y que utilizaban mascarilla oronasal. Conclusión: La persona sometida a VNI debe ser controlada por un equipo de enfermería especializado. Deben aplicarse protocolos para prevenir complicaciones y favorecer la adaptabilidad a la VNI.

Resumo Enquadramento: A ventilação não invasiva (VNI) constitui uma estratégia terapêutica à pessoa com insuficiência respiratória aguda (IRA). Objetivo: Analisar a relação entre as variáveis sociodemográficas e clínicas, das pessoas internadas na medicina interna, e a adaptação e complicações da VNI. Metodologia: Estudo observacional retrospetivo de coorte, com amostra de 239 pessoas. A colheita de dados foi efetuada através de registos eletrónicos no SClínico, utilizando um guia de extração de dados. Resultados: Verificou-se que 25,1% das pessoas estavam inadaptadas à VNI, associando-se significativamente com a alimentação oral, confusão e uso de contenção mecânica. As complicações verificaram-se em 33,5% da amostra, sendo as mais frequentes secreções, lesão no nariz e vómitos. Constatou-se uma associação estatisticamente significativa entre o número de complicações e pessoas alimentadas por sonda nasogástrica (SNG), confusas, com medidas de contenção mecânica e a utilizarem máscara oro-nasal. Conclusão: A vigilância da pessoa submetida a VNI deve ser assegurada por uma equipa de enfermagem especializada. Devem ser implementados protocolos conducentes à prevenção de complicações e promotores de adaptabilidade à VNI.

Abstract Background: Non-invasive ventilation is a therapeutic strategy for patients with acute respiratory failure. Objective: To analyze the relationship between the sociodemographic and clinical variables of patients hospitalized in internal medicine services and the adaptation to and complications of non-invasive ventilation. Methodology: A retrospective observational cohort study was carried out with a sample of 239 patients. Data were collected from electronic records in the information system SClínico, using a data extraction guide. Results: A total of 25.1% of the participants did not adapt to non-invasive ventilation, and this was significantly associated with oral feeding, confusion, and the use of mechanical restraint measures. Complications occurred in 33.5% of the sample. The most frequent complications were secretions, nasal injuries, and vomiting. There was a statistically significant association between the number of complications and patients fed by nasogastric tube, confused, with mechanical restraint measures, and wearing an oronasal mask. Conclusion: The monitoring of patients on non-invasive ventilation should be carried out by a specialized nursing team. Protocols should be implemented to prevent complications and promote patient adaptation to non-invasive ventilation.

ABSTRACT Introduction: Burnout results from chronic exposure to work-related stress and it is characterized by a reduction in professional efficacy, feelings of lack of energy/exhaustion, and negativity related to work activities. It has a higher incidence in professions with significant interpersonal contact and among caregivers, making doctors a vulnerable population. The Maslach Burnout Inventory questionnaire is considered the gold standard for measuring this disease. In 2014, quinquennial prevention was described, aiming to prevent harm to patients through strategies that reduce Burnout in doctors. Clinical Case: The case describes a 29-year-old woman, a physician in her final year of Residency in General and Family Medicine, who sought an urgent consultation due to feelings of physical and mental exhaustion, hopelessness, irritability, initial and middle insomnia, for the last three months, and hyperphagia, two months ago. She has requested a sick leave from work because “I can't stand working anymore. I need to sleep for a week”. She identified excessive workload at the Clinic, stemming from the demands of her medical residency, as the main cause. She feels unsupported by her colleagues and Training Supervisor and feels pressured to manage the medical agenda without adequate preparation. She reports occasional errors in prescriptions, leading her to feel the need to repeatedly review records and decisions she has made. She denies any appointment with her designated Work physician ever since she started her internship. Upon physical examination, she appeared slaughtered, with a depressed mood, tearful, restless, and with fleeting eye contact. Applying the Maslach Burnout Inventory: Section A- 34 points- high level; Section B- 28 points- high level; Section C- 25 points- high level. A work leave from work was issued, laboratory studies were requested, and fluoxetine 20 mg and trazodone 50 mg were initiated, along with psychotherapy. So far, the patient has been re-evaluated in three consultations, with organic causes ruled out, and in the last re-evaluation, her scores were: Section A- 20 points- moderate level; Section B- 5 points- low level; Section C- 39 points- moderate level. She reports a decrease in medical errors. She maintained the prescribed medication and psychotherapy. She declined to join a Balint group. A new re-evaluation was scheduled in six months. Discussion/Conclusion: This is a case of a General and Family Medicine Resident Physician, diagnosed with Burnout, who has managed to substantially improve her quality of life and job satisfaction, as well as her personal life, following the implementation of both pharmacological and non-pharmacological measures, along with workplace adjustments and the setting of boundaries. She has successfully reduced her perception of making medical errors, thereby improving the quality of healthcare provided to the patients. The long journey of recovery from Burnout makes the monitoring of this illness imperative not only by the patients Family Doctor and Psychologist, but also by the Occupational physician, targeting the improvement of the quality of life of the healthcare professionals in their occupational activity. This clinical case’s purpose is to address and raise awareness among professionals to the prevention of Burnout, particularly in Residents, promoting quinquennial prevention. It is important to note that only professionals who are fulfilled in their biopsychosocial sphere can provide quality care and significantly reduce medical errors.

RESUMO Introdução: O Burnout resulta da exposição crónica ao stress laboral e caracteriza-se por redução da eficácia a nível profissional, sentimentos de falta de energia/exaustão e negatividade relacionados com a atividade laboral. Tem maior incidência em profissões de elevado contacto com pessoas e em prestadores de cuidados, tornando os médicos uma população vulnerável. O questionário Maslach Burnout Inventory é considerado gold standard para a medição desta patologia. Em 2014 foi descrita a prevenção quinquenária, que pretende evitar o dano para o paciente, atuando no médico através de estratégias que visem a diminuição do Burnout. Caso Clínico: Descreve-se uma mulher de 29 anos, médica, no último ano da especialização em Medicina Geral e Familiar, que recorreu a consulta aberta por sensação de exaustão física e mental, sentimentos de desesperança, irritabilidade, insónia inicial e intermédia, com três meses de evolução e hiperfagia há dois meses. Solicitou certificado de incapacidade temporária para o trabalho, porque “já não aguento mais trabalhar. Preciso de dormir uma semana”. Aponta como principal etiologia o trabalho excessivo no Centro de Saúde, decorrente da exigência do internato médico. Sente-se pouco apoiada pelos colegas de equipa e orientador de formação e considera-se pressionada a gerir a agenda médica sem ter preparação para tal. Relata erros pontuais na prescrição médica, pelo que sente necessidade de rever várias vezes os registos efetuados e as atitudes tomadas. Nega ter sido convocada para qualquer consulta de Medicina do Trabalho desde que ingressou na especialidade. Ao exame objetivo, apresentava-se cabisbaixa, com humor deprimido, chorosa, inquieta e com contacto ocular fugaz. Aplicando o questionário atrás mencionado: Secção A - 34 pontos - nível elevado; Secção B - 28 pontos - nível elevado; Secção C - 25 pontos - nível elevado. Foi emitido o certificado de incapacidade temporária para o trabalho, solicitado estudo analítico e iniciada fluoxetina 20mg e trazodona 50mg, bem como psicoterapia. Até à data, a doente foi reavaliada em três consultas, foi excluída patologia orgânica e na última reavaliação apresentava os seguintes valores: Secção A- 20 pontos- nível moderado; Secção B- 5 pontos- nível baixo; Secção C- 39 pontos- nível moderado. Refere diminuição dos erros médicos. Manteve a medicação instituída, bem como a psicoterapia. Recusou o grupo Balint. Foi programada nova reavaliação em seis meses. Discussão/Conclusão: Trata-se de uma doente, Médica Interna em Medicina Geral e Familiar com o diagnóstico de Burnout, que conseguiu melhorar substancialmente a sua qualidade de vida e satisfação no trabalho e vida pessoal, após a implementação de medidas farmacológicas e não farmacológicas e também após alterações a nível laboral e imposição de limites. Conseguiu diminuir a perceção de erro médico, melhorando assim os cuidados de saúde prestados aos utentes. O longo percurso de recuperação desta doença torna fulcral o acompanhamento destes utentes pela equipa de Medicina do Trabalho, e não só pelo Médico de Família e Psicólogo, visando melhorar a qualidade de vida e saúde dos profissionais no âmbito da sua atividade laboral. Com este caso clínico pretende-se abordar e sensibilizar os profissionais para a prevenção do Burnout, em particular nos médicos internos, fomentando a prevenção quinquenária. De ressalvar que apenas profissionais realizados na sua esfera biopsicossocial conseguem proporcionar cuidados de qualidade e reduzir de forma importante o erro médico.