ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0–19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1–14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services. Purpose Brazil Methods Câncer 200 2018 019 0 19 0–1 years selected demographic diagnostic therapeutic described <20, 20 (<20 2075, 2075 75, 75 20-75 >7 cases. . Results 2269 2 269 2,26 8 institutions 48 Southeast 54 male 66 4 < NA (NA 84 system 40 history 88 involvement 583 58 3 58.3 NA=2, NA2 NA=2 , (NA=2) 366 36 6 36.6 remission 108 10 10.8 127 12 7 12.7 NA=59%. NA59 NA=59% 59 (NA=59%) 90 >90 ( days IQR [IQR 1–14 114 1 14 343 (34 212539 212 539 212-539 highvolume volume (>7 medium lowvolume low Conclusions factors Additionally centers outcomes inequalities services 201 01 0– <20 (<2 207 20-7 > 226 26 2,2 5 58. NA= (NA=2 36. 10. 12. NA5 NA=59 (NA=59% 9 >9 1–1 11 34 (3 21253 21 53 212-53 (> <2 (< 20- 22 2, (NA= NA=5 (NA=59 1– 2125 212-5 (NA=5 212-

Abstract Introduction: The problem of energy security has already been addressed from a multidimensional approach, but always associated with a geopolitical, national security or sovereignty issue. Internal security during neoliberalism represents a process of inflation of the penal system. Thus, energy security, even from a multidimensional approach, is blurred if an approach that criminalizes those who self-manage access to the rights to adequate life and housing, to energy and to the city predominates. Objective: The main objective of this article is to propose a new way of understanding the problem of energy security, taking it from a watertight concept to a pendulum between "security/insecurity" that serves to weigh the degree of enjoyment of these rights. Methodology: For this purpose, housing fires between 2018 and 2023 in a city of 640 thousand inhabitants (Salta, Argentina) were collected, analyzed and systematized, and this information was crossed with data from the National Registry of Popular Neighborhoods and the Municipality of Salta. Conclusions: This allowed concluding that reappropriating "energy security" as a shield to guarantee access to rights is a fertile ground not only for academic purposes, but also for legal, social and political ones.

Resumo Introdução: O problema da segurança energética já foi tratado a partir de uma abordagem multidimensional, mas sempre associado a uma questão geopolítica, de segurança nacional ou de soberania. A segurança interna sob o neoliberalismo representa um processo de inflação do sistema penal. Assim, a segurança energética, mesmo a partir de uma abordagem multidimensional, fica embaçada se predominar uma abordagem que criminaliza aqueles que autogerenciam o acesso aos direitos à vida e à moradia adequadas, à energia e à cidade. Objetivo: O principal objetivo deste artigo é propor uma nova forma de entender o problema da segurança energética, levando-o de um conceito estanque para um pêndulo entre "segurança/insegurança" que serve para ponderar o grau de gozo desses direitos. Metodologia: para isso, foram coletados, analisados e sistematizados os incêndios em moradias entre 2018 e 2023 em uma cidade de 640.000 habitantes (Salta, Argentina), e essas informações foram cruzadas com dados do Registro Nacional de Bairros Populares e do Município de Salta. Conclusões: Isso levou à conclusão de que a reapropriação da "segurança energética" como escudo para garantir o acesso a direitos é um terreno fértil não apenas para fins acadêmicos, mas também para fins jurídicos, sociais e políticos.

Resumen Introducción: el problema de la seguridad energética ha sido ya abordado desde un enfoque multidimensional, pero siempre asociado a una cuestión geopolítica, de seguridad nacional o de soberanía. La seguridad interna durante el neoliberalismo representa un proceso de inflación del sistema penal. Así, la seguridad energética, incluso desde un enfoque multidimensional, se desdibuja si predomina un enfoque que criminalice a quienes se autogestionan el acceso a los derechos a la vida y vivienda adecuadas, a la energía y a la ciudad. Objetivo: el objetivo principal de este artículo es proponer una nueva forma de comprender el problema de la seguridad energética, llevándola de un concepto estanco a un péndulo entre “seguridad/inseguridad” que sirva para ponderar el grado de goce de esos derechos. Metodología: para ello, se recopilaron, analizaron y sistematizaron los incendios de viviendas entre 2018 y 2023 en una ciudad de 640 mil habitantes (Salta, Argentina) y se cruzó esa información con datos del Registro Nacional de Barrios Populares y de la Municipalidad de Salta. Conclusiones: ello permitió concluir que reapropiarse de la “seguridad energética” como escudo para garantizar el acceso a derechos es un terreno fértil no sólo a los fines académicos, sino también jurídicos, sociales y políticos.

No Brasil, as discussões jurídicas e políticas sobre infância e adolescência são frequentemente orientadas pelo ideal da pureza, inocência e vulnerabilidade feminina. Esta construção tem servido historicamente tanto para censurar o exercício da agência sexual de crianças e adolescentes, quanto para legitimar a exclusão das meninas que não correspondem ao perfil idealizado que deveria ser protegido. Esse é o caso das jovens esposas brasileiras, um grupo grande, mas invisibilizado, de meninas continuamente negligenciadas pelos discursos, serviços e políticas de proteção infantil no país. Este artigo visa apresentar e explorar o cenário atual do casamento infantil no Brasil, analisando as normas legais nacionais que cercam a prática, resumindo os achados de duas pesquisas qualitativas relevantes produzidas localmente sobre o assunto, desenvolvidas pelo Instituto Promundo e pela Plan International Brasil, analisando dados quantitativos nacionais sobre a extensão e as principais características do casamento infantil, especificamente o Censo Demográfico de 2010 e as Estatísticas do Registro Civil de 2021, ambos produzidos pelo IBGE, e problematizando o que se entende por agência das jovens esposas. A principal proposição do presente artigo é que necessitamos de uma compreensão mais matizada, dinâmica e crítica da agência infantil para compreender verdadeiramente o casamento infantil no Brasil e desenvolver serviços e políticas públicas que tanto o previnam a prática, quanto ajudem as jovens esposas.

En Brasil, los debates jurídicos y políticos sobre la infancia y la adolescencia a menudo son guiados por el ideal de la pureza, inocencia y vulnerabilidad femenina. Esta construcción ha servido históricamente tanto para censurar el ejercicio de la agencia sexual por parte de niñas y adolescentes, como para legitimar la exclusión de aquellas que no corresponden al perfil idealizado que debe protegerse. Este es el caso de las jóvenes esposas brasileñas, un grupo grande pero invisible de niñas continuamente ignoradas por los discursos, servicios y políticas de protección infantil en el país. Este artículo tiene como objetivo presentar y explorar el escenario actual del matrimonio infantil en Brasil, analizando las normas legales nacionales que rodean la práctica, resumiendo los hallazgos de dos investigaciones cualitativas relevantes producidas localmente sobre el tema, realizadas por el Instituto Promundo y Plan International Brasil, analizando datos cuantitativos nacionales sobre el alcance y las principales características del matrimonio infantil, específicamente el Censo Demográfico de 2010 y la Estadística del Registro Civil de 2021, ambos elaborados por el IBGE, y problematizar lo que se entiende por agencia de las esposas jóvenes. La propuesta principal de este artículo es que necesitamos una comprensión más matizada, dinámica y crítica de la agencia infantil para comprender verdaderamente el matrimonio temprano en Brasil y desarrollar servicios y políticas públicas que lo prevengan y ayuden a las esposas jóvenes.

In Brazil, legal and political discussions on childhood and adolescence are usually guided by the ideal of pure, innocent, and vulnerable girls. This construction has historically served to both censor the exercise of child and adolescent sexual agency and legitimize the exclusion of unruly girls who do not correspond to the envisioned profile that should be protected. That is the case for Brazilian young wives, a large but invisible group of girls continuously neglected by child protection discourses, services, and policies in the country. This paper aims to introduce and explore the current scenario of child marriage in Brazil by overviewing the national legal norms surrounding the practice, summarizing two relevant locally produced qualitative research on the subject, carried out by Instituto Promundo and Plan International Brasil, analysing available national quantitative data on the extent and key characteristics of early marriage, specifically IBGE's 2010 Demographic Census and 2021 Civil Registry Statistics, and problematizing what is understood as the young wives' agency. Its main proposition is that a more nuanced, dynamic, and critical understanding of children's agency is needed for truly comprehending the practice of child marriage in Brazil and developing public services and policies that both prevent it and aid young wives in their daily lives.

Abstract This investigation uses the method of decision analysis to analyze the positioning of the Sergipe Court of Justice, between 2020 and 2022, about the refusal of companies that offer transportation service via app to effect or cancel to remain in their registry with drivers who respond to criminal proceedings without final and unappealable decisions. The analysis of the decisions is based on some strategic theoretical frameworks, as based on the concepts of sacrificial citizenship and the economization of law, neoliberalism as a rationality and a deep process, and capitalism as surveillance. As a result, it was identified that the TJSE prioritized the contractual autonomy, the freedom to guide objective safety criteria, the misalignment of drivers with the Term and Conditions for use over the principles of the presumption of innocence and the social function of the contract. To problematize this scenario, the article also questions about the (un)protection of workers' personal data by app, the lack of transparency in the use of new technologies to collect data regarding ongoing criminal cases as a way to reiterate old social or labor exclusions. Finally, it concludes on the approximation of the grounds handled by the Sergipe Court of Justice with the new economic demands of neoliberal management, such as the reduction of the constitutional pact in favor of corporate autonomy, both on the disposability of subjects and on the irregular capture of their personal data. 202 2022 frameworks law process surveillance result autonomy criteria contract scenario unprotection un protection workers exclusions Finally management 20 2

Resumo Esta investigação utiliza o método de análises de decisões para examinar o posicionamento do Tribunal de Justiça de Sergipe, entre 2020 e 2022, sobre a recusa das empresas que oferecem o serviço de transporte via aplicativo de efetivar ou de permanecer em seu cadastro com motoristas que respondem a processos criminais sem decisões transitadas em julgado. A análise das decisões parte de alguns marcos teóricos estratégicos, como o conceito de cidadania sacrificial e da economicização do direito, do neoliberalismo enquanto uma racionalidade e um processo profundo, do capitalismo como vigilância. Como resultado, identificou-se que o TJSE priorizou a autonomia contratual, a liberdade para pautar critérios objetivos de segurança, o desalinhamento dos motoristas com o Termo e as Condições para uso em detrimento dos princípios da presunção de inocência e da função social do contrato. Para problematizar este cenário o artigo ainda questiona sobre a (des)proteção dos dados pessoais dos trabalhadores por aplicativo, a falta de transparência na utilização de novas tecnologias para coletar dados referentes a processos criminais em andamento como forma de reiterar velhas exclusões sociais ou laborais. Por fim, conclui-se sobre a aproximação dos fundamentos manejados pelo Tribunal de Justiça de Sergipe com as novas exigências econômicas da gestão neoliberal, tal como a redução do pacto constitucional em benefício da autonomia empresarial, tanto sobre a descartabilidade dos sujeitos, como sobre a captação irregular de seus dados pessoais. 202 2022 julgado estratégicos direito profundo vigilância resultado identificouse identificou se contratual segurança contrato desproteção des proteção laborais fim concluise conclui neoliberal empresarial sujeitos 20 2

Nos últimos anos, evidências do Registro Brasileiro de Biópsia óssea (REBRABO) apontaram uma alta incidência de intoxicação por alumínio (Al) no tecido ósseo de pacientes com DRC em diálise. Essa surpreendente informação parece representar não apenas um acúmulo passivo deste metal, visto que dados prospectivos do REBRABO sugerem que a presença de Al no tecido ósseo pode estar independentemente relacionada a eventos cardiovasculares adversos maiores. Essas informações contrastam com a percepção mundial do controle epidemiológico dessa condição. Neste artigo de opinião, discutimos por que o diagnóstico de acúmulo ósseo de Al não é relatado em outras partes do mundo, e também discutimos uma gama de possibilidades para entender por que nós acreditamos que o acúmulo de Al no tecido ósseo ainda ocorre, não como se apresentava no passado, ou seja, como uma síndrome com sinais e sintomas sistêmicos de intoxicação. anos (REBRABO (Al diálise metal maiores condição opinião mundo ocorre passado seja

In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past. years (REBRABO (Al dialysis events world paper occurs intoxication past

Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) target a specific pathway of the immune system, and are usually prescribed after failure of conventional synthetic disease-modifying antirheumatic drug therapy. The choice of b/tsDMARD depends on the disease profile and comorbidities, patient preference, registered indications of the drugs, and risks associated with therapy. It is recommended that b/tsDMARDs for immune-mediated inflammatory rheumatic diseases are prescribed by a rheumatologist, and all patients must be included in the South African Rheumatism and Arthritis Association biologic registry. Knowledge of and vigilance for adverse events, particularly infections, associated with b/ts DMARD therapies are of paramount importance.

Abstract Introduction: the cultural dimension of health, now clearly acknowledged (WHO, 2017), remains insufficiently explored. Particularly, investigating the cultural influence on the effectiveness of health interventions is relevant since, insofar as when such interventions lack meaning from the target population's cosmovision or are not practical in their context, the effectiveness of those interventions may have a limited scope (Bautista-Gómez et al, 2022), creating the need for culturally adapted health interventions. Aim: tto understand how cultural adaptations have been designed and implemented, and how they have contributed to improving health outcomes in low and middle-income countries. Methods: the guiding question was designed following the PICo methodology. PubMED, Scopus, and Web of Science databases were reviewed, the descriptors were established based on the MeSH/DeSC registry, and inclusion and exclusion criteria were defined. The initial articles were selected based on the appearance of the descriptors in their title and abstract, and then a filtering process was carried out based on the full reading of the texts that led to 14 articles that met the established criteria, on which a thematic analysis was carried out. Results: it was evidenced that: a) interventions are designed based on 3 components: community participation, adjustment of content, and changes in the service delivery; b) aspects related to poverty, vulnerability, and deficiencies in the health system are the main barriers, whilst the inclusion of the community’s beliefs and customs, adaptation to their context, and articulation with the communities and local health institutions are the main facilitators; c) main outcomes are feasibility, effectiveness, improvement of disease’s knowledge and acceptability. Conclusions: cultural adaptation with ethnic groups in vulnerable settings is useful to ensure comprehensive health education and to promote behavioural change to improve mainly the effectiveness and acceptability of health interventions.

Abstract Digital Welfare State in Ecuador: Citizen Datafication and Machine Learning in the Construction and Management of Poverty In the era of digital governance, the increasing use of Big Data and Artificial Intelligence (AI) in social protection systems has emerged as a prominent concern. The state's efforts to promote citizen datafication and the implementation of AI for managing and providing social services and benefits are guided by principles of neutrality, objectivity, and technological efficiency. Nevertheless, these technologies can not only improve the effectiveness of social benefits allocation, but also have the potential of controlling, monitoring, sanctioning, and excluding beneficiaries. In light of the prevailing techno-optimism evident in the design of contemporary social policy, particularly with regard to its allocation mechanisms, this study draws upon insights from Science, Technology, and Society Studies to shed light on how data systems and AI technologies transform the notion of poverty and impact the definition of beneficiaries and non-beneficiaries. This approach focuses on unraveling the political dimension of data systems and AI technologies that are emerging as mediators in the relationship between the state and citizens. Through the case study of Ecuador's Social Registry, the aim is to enrich the critical examination of digital welfare states in the Latin American region, analyzing their implications for society and their potential to produce or exacerbate inequality and exclusion; challenging deterministic views of technological change and public policy design.

Resumen En la era de la gobernanza digital, la utilización creciente de datos y tecnologías de Big Data e Inteligencia Artificial (IA) en los sistemas de protección social se ha convertido en un asunto relevante. Los esfuerzos del Estado por impulsar la datificación ciudadana y la implementación de la IA para la gestión y provisión de servicios y beneficios sociales están vehiculizados por las ideas de neutralidad, objetividad y eficiencia tecnológica. No obstante, estas tecnologías no solo pueden mejorar la efectividad en la asignación de beneficios sociales; sino que también tienen el potencial de controlar, monitorear, sancionar y excluir a los beneficiarios. Ante el tecno-optimismo que marca el diseño de la política social contemporánea, específicamente sus mecanismos de asignación, este trabajo apuesta por los Estudios de la Ciencia, Tecnología y Sociedad para dar luz sobre cómo los sistemas de datos y las técnicas de IA transforman la noción de pobreza e impactan en la definición de beneficiarios y no beneficiarios. Este enfoque se centra en desentrañar la dimensión política -de la politics- de los sistemas de datos y las tecnologías de la IA que comienzan a mediar la relación entre el Estado y los ciudadanos. A través del estudio del caso ecuatoriano del Registro Social, el objetivo recae en nutrir el examen crítico de los Estados de Bienestar Digital en la región latinoamericana, analizando sus implicaciones en la sociedad y su potencial para producir o amplificar desigualdad y exclusión; desafiando las visiones deterministas del cambio tecnológico y del diseño de políticas públicas.

Abstract Background: Patent Ductus Arteriosus (PDA) is the most common congenital heart disease, particularly prevalent among preterm newborns (PTNB) and those with low birth weight. Surgical closure is traditionally considered after the failure of pharmacological treatment. The aim was to analyze the immediate and long-term outcomes of surgical PDA closure in PTNB. Methods: This analytical study evaluated PTNB who underwent PDA surgery between January 2002 and December 2023 at the Hospital Clínico Regional “Dr. Guillermo Grant Benavente” in Concepción, Chile. The databases were reviewed with prior approval from the Ethical-Scientific Committee. PTNB were defined as those with a gestational age (GA) of less than 37 weeks. Data analysis was performed using SPSS® v29, and survival rates were graphed using the Kaplan-Meier method. Results: Since 1993, a total of 263 cases have been recorded in the PDA protocol registry. During the study period, 167 cases were identified, of which 131 (78.3%) were PTNB. Among them, 65 (49.6%) were male. The average GA was 26.4±2.3 weeks and the average birth weight was 900±348 grams. Pharmacological treatment failed in all cases included. At the time of surgery, the average age was 35.0±43.2 days, and the average weight was 1,443±1,716 grams. A left posterolateral thoracotomy with an extrapleural approach and primary closure with clips was performed. Immediate complications included post-ligation syndrome in 42 (32.1%) cases and atelectasis in 14 (10.7%) cases. There was no intraoperative mortality. The 30-day mortality rate was 15 (11.5%) cases. The 10-year survival rate was 82.4%. Conclusion: Clipping is the preferred technique at our center and has shown results comparable to other series. Mortality was mainly due to medical comorbidities such as sepsis and respiratory tract immaturity.

Resumen Antecedentes: El Ductus Arterioso Persistente (DAP) es la cardiopatía congénita más frecuente. Es más prevalente en recién nacidos de pretérmino (RNPT) y bajo peso al nacer. El cierre quirúrgico está indicado tradicionalmente tras el fracaso del cierre farmacológico. El objetivo es analizar los resultados inmediatos y alejados del cierre quirúrgico del DAP en RNPT. Métodos: Estudio analítico de RNPT operados por DAP en el período desde enero-2002 y diciembre-2023 en el Hospital Clínico Regional “Dr. Guillermo Grant Benavente”, Concepción-Chile. Se revisaron bases de datos previa aprobación de Comité Ético-Científico. Se consideró RNPT <37 semanas de edad gestacional (EG). Se utilizó SPSS® v29, se graficó supervivencia mediante método de KaplanMeier. Resultados: En el período de análisis hubo 167 casos, de es de los cuales 131 (78,3%) eran RNPT. Fueron hombres 65 (49,6%) y la edad gestacional (EG) promedio fue 26,4±2,3 semanas, con peso al nacer de 900±348 gramos. Todos los casos tuvieron tratamiento farmacológico previo. Al momento de la cirugía, la edad promedio era 35,0±43,2 días y el peso promedio 1.443±1.716 gramos. Se realizó una toracotomía posterolateral izquierda, con abordaje extrapleural y cierre principalmente mediante clipaje. Las complicaciones inmediatas fueron: síndrome post ligadura en 42 (32,1%) y atelectasia en 14 (10,7%). No hubo mortalidad intraoperatoria. A 30 días post cirugía fallecieron 15 casos, (11,5%) La supervivencia a 10 años fue 82,4%. Conclusiones: El cierre mediante clipaje es la técnica de elección en nuestro centro y demostró resultados comparables a diferentes series incluidas en la discusión. La mortalidad fue debida principalmente a comorbilidades médicas como sepsis e inmadurez del tracto respiratorio.

Resumen Introducción : Actualmente se define al paciente como adulto mayor (AM) si su edad es al menos de 60 años. Dada la expectativa de vida prolongada resulta intere sante evaluar si todos los AM con infarto agudo de mio cardio (IAM) son iguales. Los objetivos fueron conocer la prevalencia de AM en el IAM y dentro de ellos, la de los ≥75 años y analizar características, tratamientos de reperfusión y mortalidad intrahospitalaria de acuerdo a si son < o ≥ 75 años. Métodos : Se analizaron los pacientes AM ingresados en el Registro Nacional de Infarto con supra desnivel del segmento ST (ARGEN-IAM-ST). Se los dividió en grupo 1: 60-74 años y grupo 2: ≥ 75 años y se compararon entre sí. Resultados : AM 3626, 75.92% del Grupo 1, el resto del Grupo 2. En el grupo 2 hubo más mujeres, hipertensos y con antecedentes coronarios. Hubo similar porcentaje de diabetes y dislipidemia, pero menos de tabaquistas. En el Grupo 2 se empleó menos tratamiento de reperfusión (aunque más angioplastia primaria), con similar tiempo puerta-balón. Los pacientes del Grupo 2 recibieron me nos medicamentos de probada eficacia y en la evolución hospitalaria, más sangrado (aunque no mayor), más insuficiencia cardíaca y más mortalidad: 18.3% vs 9.4%, p<0.001. La edad ≥75 años fue predictor independiente de mortalidad. Conclusiones : Uno de cada cuatro AM con IAM tiene más de 75 años; estos pacientes reciben menos reper fusión, presentan más insuficiencia cardíaca y sangrado y tienen el doble de mortalidad que los pacientes de entre 60 y 74 años.

Abstract Introduction : Currently the patient is defined as an older adult (OA) when the age is at least 60 years. Given the long life expectancy, it is interesting to evaluate whether all OAs with acute myocardial infarction (AMI) are equal. The objectives were to know the prevalence of OA in AMI and within them, that of those ≥75 years of age and to analyze characteristics, reperfusion treat ments and in-hospital mortality according to whether they are < or ≥ 75 years of age. Methods : OA patients admitted to the National Reg istry of Infarction with ST segment elevation (ARGEN-IAM-ST) were analyzed. They were divided into group 1: 60-74 years old and group 2: ≥ 75 years old and compared with each other. Results : 3626 AM, 75.9% from Group 1, the rest from Group 2. In group 2 there were more women, hyperten sive and with a history of coronary arteries. There was a similar percentage of diabetes and dyslipidemia, but fewer of smokers. In Group 2, less reperfusion treat ment was used (although more primary angioplasty), with similar door-to-balloon time. Patients in Group 2 received fewer medications of proven efficacy and in the hospital course, they had more bleeding (although not major), more heart failure and more mortality: 18.3% vs. 9.4%, p<0.001. Age ≥75 years was an independent predictor of mortality. Conclusions : one in four patients with AMI is over 75 years old; they receive less reperfusion, have more heart failure, bleeding and twice the mortality rate than patients between 60 and 74 years.

ABSTRACT Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a well-known condition that has been recently redefined after excluding non-ischemic myocardial injury. ReSCAR was a prospective, multicenter registry of patients hospitalized for acute coronary syndrome (ACS) from January to August 2022. Objective: One of the main objectives of the registry was to define the prevalence of patients with MINOCA, their baseline clinical and paraclinical characteristics, and in-hospital outcome. This publication focuses on the results of the respective analysis. Methods: We conducted a nationwide, multicenter, prospective study of patients with ACS. The diagnosis of MINOCA was made following the Fourth Universal Definition of Myocardial Infarction. The baseline characteristics of the patients wereanalyzed, as well as their outcome and significant differences with patients with obstructive coronary artery disease. The participating centers should have the availability to measure high-sensitivity cardiac troponin and perform coronary angiography. Results: A total of 984 patients from 15 centers were included. Eighty-five patients (8.6%) had a final diagnosis of MINOCA at discharge. Median age was 65 years (53-63), 48 (51.8%) were women, 55 (64.7%) had hypertension, 44 (51.8%) had dyslipidemia, 9 (10.6%) were diabetics and 23 (27.1%) were smokers. Median high-sensitivity cardiac troponins on admission (expressed as multiples of the 99th percentile) were 2.42 times higher (0.85-10.21) and the ECG had no ischemic changes in 71.8% of the patients. Coronary angiography was normal in 72.9% of the patients and the rest of the cases had coronary artery stenoses < 50%. Sixteen patients underwent cardiac magnetic resonance imaging. The median GRACE score was 115 (98-139), which corresponds to intermediate risk. The event rate for the composite outcome of stroke/myocardial infarction or death was1.2%, and there were no bleeding events BARC ≥type 2. The discharge prescription rate was 72.9% for aspirin, 27.1% for clopidogrel, 88.2% for statins, 67.1% for beta-blockers, and 22.4% for calcium channel blockers. In this registry, patients with MINOCA represent a significant proportion of those with ACS. Conclusion: The rate of in-hospital complications, including mortality, was low. There seems to be a strong opportunity for further investigations to confirm the diagnosis, pathophysiological mechanisms, and treatment of MINOCA.

RESUMEN Introducción: El infarto de miocardio sin obstrucciones coronarias significativas (MINOCA) es una conocida entidad que se ha redefinido recientemente al excluir la injuria miocárdica no isquémica. ReSCAR fue un registro prospectivo, multicéntrico de pacientes hospitalizados por síndrome coronario agudo (SCA) desde enero hasta agosto de 2022. Objetivo: Un objetivo principal del registro fue definir la prevalencia de pacientes con MINOCA, sus características basales clínicas y paraclínicas y evolución intrahospitalaria. Los resultados del análisis respectivo son la base de esta publicación. Material y métodos: Registro nacional prospectivo y multicéntrico de SCA. Diagnóstico de MINOCA de acuerdo con la Cuarta Definición Universal de Infarto de Miocardio. Análisis de las características basales, evolución y diferencias significativas respecto de los pacientes con coronariopatía obstructiva. Los centros participantes debían contar con determinación de troponina de alta sensibilidad y la posibilidad de realizar cinecoronariografía. Resultados: Se incluyeron 984 pacientes de 15 centros. Ochenta y cinco pacientes (8,6 %) tuvieron diagnóstico final de MINOCA al alta. Cuarenta y cuatro pacientes (51,8 %) eran mujeres, la mediana de edad fue de 65 años (53-63), 55 (64,7 %) pacientes eran hipertensos, 44 (51,8 %) dislipidémicos, 9 (10,6 %) diabéticos y 23 (27,1 %) fumadores. La mediana de troponina al ingreso (expresada como múltiplo del percentilo 99) fue de 2,42 (0,85-10,21) y el 71,8 % se presentó con un ECG sin cambios isquémicos. La angiografía coronaria fue normal en el 72,9 % de los pacientes y con lesiones menores de 50 % en el resto. Se realizó resonancia cardíaca a 16 pacientes. La mediana del score GRACE fue de 115 puntos (98-139), lo cual perfila un riesgo intermedio; con una tasa de eventos combinados de accidente cerebrovascular/infarto o muerte de 1,2 %, sin haberse registrado sangrados BARC 2 o más. La prescripción al alta de aspirina fue del 72,9 %, clopidogrel 27,1 %, estatinas 88,2 %, beta bloqueantes 67,1 % y antagonistas cálcicos 22,4 %. Conclusión: En este registro, los pacientes con MINOCA representan una proporción significativa de aquellos con SCA. La tasa de complicaciones intrahospitalarias, incluida la mortalidad, fue baja. Impresiona existir una fuerte oportunidad para profundizar los estudios para confirmar este diagnóstico, sus mecanismos fisiopatológicos y su tratamiento.

RESUMEN Introducción : La Organización Mundial de la Salud (OMS) efectuó recomendaciones en relación con la recopilación y notificación de datos agregados semanales de COVID-19. Objetivo : Investigar el grado de cumplimiento de las recomendaciones elaboradas por la OMS para la notificación de casos y muertes de COVID-19 en la Argentina durante el año 2020 a 2022, y comparar la notificación de muertes con el número de defunciones por COVID-19 consolidadas en el registro de estadísticas vitales del país. Materiales y métodos : Estudio cuantitativo descriptivo, basado en revisión documental y en fuentes de datos secundarias. Se utilizó los reportes diarios de información epidemiológica y la base de datos Dataset, COVID-19 casos registrados en la República Argentina. Adicionalmente, para estimar la omisión en los registros epidemiológicos de fallecimientos por COVID-19 en los años 2020 y 2021, se cotejaron los resultados de las bases de datos Dataset COVID-19 con la base de las Estadísticas vitales de mortalidad por causa de defunción, proporcionadas por la Dirección de Estadísticas e Información en Salud (DEIS). Se analizaron las variables recomendadas por la OMS para la notificación de casos y muertes por COVID-19. En cuanto a las consideraciones éticas relacionadas con el uso de la información utilizada en este trabajo, las bases de datos cumplen con lo estipulado por la Ley Nacional N° 17.622 de Resguardo del Secreto Estadístico, garantizando que la información mantiene el carácter confidencial y reservado del informante. Resultados: Del análisis de los reportes diarios, durante 2020 se observó que, de los 13 indicadores recomendados, 9 presentan datos algunos meses y los 4 restantes no se relevaron; en 2021 solo 7 indicadores presentaron datos algunos meses, y en 2022 solo 3 indicadores se continuaron informando. Respecto al análisis de la base de datos Dataset COVID-19, la mayoría fueron captadas. Respecto a la comparación de los valores de las defunciones registradas por el sistema de vigilancia epidemiológica y por la DEIS para los años 2020 y 2021, las muertes registradas fueron superiores en el registro de la DEIS (9,6% y 14,2%). Conclusiones : El Estado argentino cumplió con gran parte de las recomendaciones que establece la OMS para la notificación de los casos de COVID-19. Estudios posteriores deberían analizar otros componentes de la calidad de los datos, así como la oportunidad de los registros de defunciones, característica necesaria para la toma de decisiones en salud pública.

ABSTRACT Introduction : The World Health Organization (WHO) establishes recommendations regarding the collection and reporting of weekly aggregated data on COVID-19. Objective : To investigate the degree of compliance with the recommendations made by the WHO for the reporting of COVID-19 cases and deaths in Argentina during the years 2020 to 2022, and to compare death notifications with the number of COVID-19 deaths recorded in the country's vital statistics registry. Materials and methods : Descriptive quantitative study, based on a documentary review and secondary data sources. Daily reports of epidemiological information and the Dataset database containing registered COVID-19 cases in the Argentine Republic were used. Additionally, to estimate the omission in the epidemiological records of COVID-19 deaths in the years 2020 and 2021, the results of the Dataset COVID-19 databases were compared with the vital statistics death registry on cause of death, provided by the Directorate of Statistics and Health Information (DEIS, by its acronym in Spanish). The variables recommended by the WHO for the reporting of COVID-19 cases and deaths were analyzed. As for the ethical considerations related to the use of the information in this study, the databases comply with the provisions of National Law 17,622 on the Protection of Statistical Secrecy, ensuring that the information remains confidential and reserved for the informant. Results : From the analysis of daily reports, it was observed that in 2020, out of the 13 recommended indicators, 9 had data for some months, and the remaining 4 were not reported. In 2021 only 7 indicators had data for some months, and in 2022 only 3 indicators continued to be reported. Regarding the analysis of the Dataset COVID-19 database, most data were captured. In comparing the values of deaths recorded by the epidemiological surveillance system and by the DEIS for the years 2020 and 2021, the deaths recorded were higher in the DEIS registry (9.6% and 14.2%). Conclusions : The Argentine state largely complied with the recommendations established by the WHO for the reporting of COVID-19 cases. Subsequent studies should analyze other components of data quality, as well as the timeliness of death records, a necessary characteristic for public health decision-making.

ABSTRACT Background . Hypertrophic cardiomyopathy (HCM) is the most common genetic disease caused by cardiac sarcomere protein mutations, with considerable prevalence and different clinical presentation, varying from asymptomatic to heart failure and sudden death. Some patients are followed-up in nonspecialized centers, and it is necessary to know data that show the reality of their diagnosis, treatment, and prognosis. Objective. The aim of this study was to know the clinical characteristics, and diagnostic and therapeutic strategies when HCM is managed in centers not specialized in this disease. Methods. This was a national, cross-sectional, multicenter study, with quantitative analysis of patients with confirmed or highly probable HCM. Results. A total of 95 patients were recruited, mostly men, with hypertension (40%) and dyslipidemia (22%) as main risk factors. A low proportion of comorbidities was observed: chronic obstructive pulmonary disease (6%), prior myocardial infarction (5%), prior stroke (1%) and chronic kidney failure (1%). The main symptoms were dyspnea (47% and angina (27%), and the most used diagnostic methods were echocardiogram (97%) and cardiac magnetic resonance imaging (71%)). The most frequent localization was septal, with 37% of hypertrophic obstructive cardiomyopathy. The genetic test, performed in 33% of patients, was positive in more than half of cases. It was not performed in the rest of the patients, mainly due to lack of health coverage. Conclusions. These findings are in agreement with international registries. Based on our findings, emphasis should be placed in improving the access to more complex diagnostic studies and optimizing the resources in a fragmented health system.

RESUMEN Introducción. La miocardiopatía hipertrófica (MCH), es la enfermedad genética cardiovascular más común, causada por mutaciones en proteínas del sarcómero cardíaco, con una prevalencia considerable y clínica variable, desde asintomática hasta insuficiencia cardíaca y muerte súbita. Existen pacientes seguidos en centros no especializados, y es necesario conocer datos que puedan mostrar la realidad de su diagnóstico, tratamiento y pronóstico. Objetivo. Conocer las características clínicas, estrategias diagnósticas y terapéuticas al abordar la MCH en centros no especializados en la patología. Material y métodos. Estudio de corte transversal, multicéntrico, de alcance nacional, con análisis cuantitativo, de pacientes con MCH confirmada o altamente probable. Resultados. Se registraron 95 pacientes, mayormente hombres con hipertensión arterial (40 %) y dislipidemia (22 %) como principales factores de riesgo. Se observó baja proporción de comorbilidades: enfermedad pulmonar obstructiva crónica (6 %), infarto de miocardio previo (5 %), accidente cerebro vascular previo (1 %) e insuficiencia renal crónica (1 %). Los síntomas principales fueron la disnea (47 %) y el ángor (27 %), y los métodos diagnósticos más usados fueron el ecocardiograma (97 %) y la resonancia cardíaca (71 %). La localización más frecuente fue septal, con 37 % de tipo obstructivo. El test genético, realizado en un 33 %, fue positivo en más de la mitad de los pacientes. No se realizó en dos tercios de los casos principalmente por falta de cobertura. Conclusiones. Los hallazgos son concordantes con los de registros internacionales. Con base a nuestros hallazgos, se resalta la necesidad de mejorar el acceso a estudios diagnósticos más complejos y optimizar recursos en un sistema de salud fragmentado.

Abstract Background Recently, it was demonstrated that allopurinol, a xanthine oxidase inhibitor, has cardiovascular and anti-ischaemic properties and may be a metabolic antianginal agent option.Objective: The objective of this study was to evaluate the antianginal effect of allopurinol as a third drug for patients with stable coronary artery disease (CAD). Methods This was a randomized clinical trial between 2018 and 2020 including patients with CAD who maintained angina despite initial optimization with beta-blockers and calcium channel blockers. The individuals were randomized 1:1 to 300 mg of allopurinol twice daily or 35 mg of trimetazidine twice daily. The main outcome was the difference in the angina frequency domain of the Seattle Angina Questionnaire (SAQ-AF). A probability (p) value < 0.05 was considered statistically significant. Results A hundred and eight patients were included in the randomization phase, with 54 (50%) in the allopurinol group and 54 (50%) in the trimetazidine group. Six (5.6%) individuals, 3 from each group, were lost to follow-up for the primary outcome. In the allopurinol and trimetazidine groups, the median SAQ-AF scores were 50 (30.0 to 70.0) and 50 (21.3 to 78.3), respectively. In both groups, the SAQ-AF score improved, but the median of the difference compared to baseline was lower in the allopurinol group (10 [0 to 30] versus 20 [10 to 40]; p < 0.001), as was the mean of the difference in the total SAQ score (12.8 ± 17.8 versus 21.2 ± 15.9; p = 0.014). Conclusion Both allopurinol and trimetazidine improved the control of angina symptoms; however, trimetazidine presented a greater gain compared to baseline. Brazilian Registry of Clinical Trials - Registration Number RBR-5kh98y Recently inhibitor antiischaemic anti ischaemic option.Objective optionObjective option Objective CAD. . (CAD) 201 202 betablockers beta blockers 11 1 1: 30 SAQAF. SAQAF AF (SAQ-AF) (p 005 0 05 0.0 significant phase 5 50% (50% 5.6% 56 6 (5.6% followup follow up groups 30.0 (30. 70.0 700 70 21.3 213 21 (21. 78.3, 783 78.3 , 78 78.3) respectively 10 (1 [ 2 [1 40 40] 0.001, 0001 0.001 001 0.001) 12.8 128 12 8 (12. 178 17 17. 212 21. 15.9 159 15 9 0.014. 0014 0.014 014 0.014) symptoms however RBR5kh98y RBRkhy RBR 5kh98y kh y (CAD (SAQ-AF 00 0. (50 5.6 (5.6 30. (30 70. 7 (21 78. ( 4 000 0.00 12. (12 15. 0.01 01 khy (5 5. (5. (3 (2

Resumo Fundamento Recentemente, foi demonstrado que o alopurinol, um inibidor da xantina oxidase, possui propriedades cardiovasculares e anti-isquêmicas e pode ser uma opção de agente antianginoso metabólico. Objetivo O objetivo do presente estudo foi avaliar o efeito antianginoso do alopurinol como terceiro medicamento para pacientes com doença arterial coronariana (DAC) estável. Métodos Trata-se de um ensaio clínico randomizado entre 2018 e 2020 incluindo pacientes com DAC que mantiveram angina apesar da otimização inicial com betabloqueadores e bloqueadores dos canais de cálcio. Os indivíduos foram randomizados 1:1 para 300 mg de alopurinol 2 vezes ao dia ou 35 mg de trimetazidina 2 vezes ao dia. O desfecho principal foi a diferença no domínio da frequência da angina do Questionário de Angina de Seattle (QAS-FA). Foram considerados estatisticamente significativos valores de probabilidade (p) < 0,05. Resultados Foram incluídos 108 pacientes na fase de randomização, com 54 (50%) no grupo alopurinol e 54 (50%) no grupo trimetazidina. Seis (5,6%) indivíduos, 3 de cada grupo, foram perdidos no seguimento para o desfecho primário. Nos grupos de alopurinol e trimetazidina, as pontuações medianas do QAS-FA foram 50 (30,0 a 70,0) e 50 (21,3 a 78,3), respectivamente. Em ambos os grupos, a pontuação do QAS-FA melhorou, mas a mediana da diferença em relação à linha de base foi menor no grupo alopurinol (10 [0 a 30] versus 20 [10 a 40]; p < 0,001), assim como a média da diferença na pontuação total do QAS (12,8 ± 17,8 versus 21,2 ± 15,9; p = 0,014). Conclusão Tanto o alopurinol quanto a trimetazidina melhoraram o controle dos sintomas de angina; no entanto, a trimetazidina apresentou um ganho maior em relação à linha de base. Registro Brasileiro de Ensaios Clínicos – Número de Registro RBR-5kh98y Recentemente oxidase antiisquêmicas anti isquêmicas metabólico (DAC estável Tratase Trata se 201 202 cálcio 11 1 1: 30 QASFA. QASFA FA . (QAS-FA) (p 005 0 05 0,05 10 randomização 5 50% (50% 5,6% 56 6 (5,6% primário 30,0 (30, 70,0 700 70 21,3 213 21 (21, 78,3, 783 78,3 , 78 78,3) respectivamente melhorou (1 [ [1 40 40] 0,001, 0001 0,001 001 0,001) 12,8 128 12 8 (12, 178 17 17, 212 21, 15,9 159 15 9 0,014. 0014 0,014 014 0,014) entanto RBR5kh98y RBRkhy RBR 5kh98y kh y (QAS-FA 00 0,0 (50 5,6 (5,6 30, (30 70, 7 (21 78, ( 4 000 0,00 12, (12 15, 0,01 01 khy 0, (5 5, (5, (3 (2

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology. intra 2 201 2021 FLEXOR (FLEXOR Registry 666 45 4 5 4.5 01 0 1 0.1 1.8% 18 8 (1.8 patients. . patients) Postoperatively feverinfections fever infections 6.3%, 63 6.3% , 6 3 (6.3%) 5.5%, 55 5.5% (5.5%) 1.3%. 13 1.3% (1.3%) s stone(s pole time diameters mm Furthermore elderly diameter technology 202 66 4. 0. 1.8 (1. 6.3 (6.3% 5.5 (5.5% 1.3 (1.3% 1. (1 6. (6.3 5. (5.5 (1.3 ( (6. (5. (6 (5