Resumo Introdução: A deficiência de crescimento na doença renal crônica está relacionada à elevada morbidade e mortalidade. O retardo do crescimento nessa doença é multifatorial. É fundamental conhecer os fatores modificáveis e estabelecer estratégias para melhorar o atendimento às crianças afetadas. Objetivos: Descrever padrões de crescimento em crianças com DRC e fatores de risco associados à baixa estatura. Métodos: Analisamos retrospectivamente dados antropométricos e epidemiológicos, peso ao nascer, prematuridade e níveis de bicarbonato, hemoglobina, cálcio, fosfato, fosfatase alcalina e paratormônio de crianças com DRC estágios 3–5, não submetidas a diálise, acompanhadas por pelo menos um ano. Resultados: Incluímos 43 crianças, a maioria meninos (65%). O escore z médio de altura/comprimento/idade das crianças no início e no acompanhamento foi de –1,89 ± 1,84 e –2,4 ± 1,67, respectivamente (p = 0,011). Cinquenta e um por cento das crianças apresentaram baixa estatura, e essas crianças eram mais jovens que aquelas com estatura adequada (p = 0,027). Níveis de PTH no início do acompanhamento correlacionados com escore z de altura/comprimento/idade. Uma subanálise com crianças menores de cinco anos (n = 17) mostrou que 10 (58,8%) delas apresentaram déficit de desenvolvimento e escore z de peso/idade mais baixo (0,031) e escore z de IMC/idade mais baixo (p = 0,047). Conclusão: Crianças, especialmente mais jovens, com DRC, que não estavam em diálise, apresentaram elevada prevalência de baixa estatura. Níveis de PTH foram correlacionados com escore z de altura, e deficiência de crescimento foi associada a pior estado nutricional. Portanto, é essencial monitorar o crescimento dessas crianças, controlar o hiperparatireoidismo e fornecer suporte nutricional. Introdução mortalidade multifatorial afetadas Objetivos Métodos epidemiológicos nascer bicarbonato hemoglobina cálcio fosfato 35 3 5 3–5 diálise ano Resultados 4 65%. 65 65% . (65%) alturacomprimentoidade altura comprimento idade 189 1 89 –1,8 184 84 1,8 24 2 –2, 167 67 1,67 p 0,011. 0011 0,011 0 011 0,011) 0,027. 0027 0,027 027 0,027) n 17 58,8% 588 58 8 (58,8% pesoidade 0,031 0031 031 (0,031 IMCidade IMC 0,047. 0047 0,047 047 0,047) Conclusão Crianças nutricional Portanto 3– 6 (65% 18 –1, 1, –2 16 1,6 001 0,01 01 002 0,02 02 58,8 (58,8 0,03 003 03 (0,03 004 0,04 04 (65 –1 – 00 0,0 58, (58, (0,0 (6 0, (58 (0, ( (5 (0

Abstract Introduction: Growth failure in chronic kidney disease is related to high morbidity and mortality. Growth retardation in this disease is multifactorial. Knowing the modifiable factors and establishing strategies to improve care for affected children is paramount. Objectives: To describe growth patterns in children with chronic kidney disease and the risk factors associated with short stature. Methods: We retrospectively analyzed anthropometric and epidemiological data, birth weight, prematurity, and bicarbonate, hemoglobin, calcium, phosphate, alkaline phosphatase, and parathormone levels of children with stages 3–5 CKD not on dialysis, followed for at least one year. Results: We included 43 children, the majority of which were boys (65%). The mean height/length /age z-score of the children at the beginning and follow-up was –1.89 ± 1.84 and –2.4 ± 1.67, respectively (p = 0.011). Fifty-one percent of the children had short stature, and these children were younger than those with adequate stature (p = 0.027). PTH levels at the beginning of the follow-up correlated with height/length/age z-score. A sub-analysis with children under five (n = 17) showed that 10 (58.8%) of them failed to thrive and had a lower weight/age z-score (0.031) and lower BMI/age z-score (p = 0.047). Conclusion: Children, particularly younger ones, with chronic kidney disease who were not on dialysis had a high prevalence of short stature. PTH levels were correlated with height z-score, and growth failure was associated with worse nutritional status. Therefore, it is essential to monitor the growth of these children, control hyperparathyroidism, and provide nutritional support. Introduction mortality multifactorial paramount Objectives Methods data weight prematurity bicarbonate hemoglobin calcium phosphate phosphatase 35 3 5 3– year Results 4 65%. 65 65% . (65%) heightlength length age zscore z score followup follow up 189 1 89 –1.8 184 84 1.8 24 2 –2. 167 67 1.67 p 0.011. 0011 0.011 0 011 0.011) Fiftyone Fifty 0.027. 0027 0.027 027 0.027) heightlengthage zscore. score. subanalysis sub analysis n 17 58.8% 588 58 8 (58.8% weightage 0.031 0031 031 (0.031 BMIage BMI 0.047. 0047 0.047 047 0.047) Conclusion Children ones zscore, score, status Therefore hyperparathyroidism support 6 (65% 18 –1. 1. –2 16 1.6 001 0.01 01 002 0.02 02 58.8 (58.8 0.03 003 03 (0.03 004 0.04 04 (65 –1 – 00 0.0 58. (58. (0.0 (6 0. (58 (0. ( (5 (0

Abstract Introduction: The nursing process is the method that allows us to administer care to people with chronic diseases through the disease stages, that is, assessment, diagnostic reasoning, nursing care plan and evaluation. Objective: Evaluate a nursing care plan for an older adult with type 2 diabetes mellitus and osteoporosis with a focus on therapeutic health education. Methodology: Observational, descriptive, and longitudinal clinical case study of a 63-year-old patient with diabetes mellitus and osteoporosis; the Marjory Gordon instrument was used for assessment, and standardized language was used for diagnostic reasoning, planning, execution and evaluation. Under bioethical principles, this is a minimal risk research, and the privacy and data of the elderly are protected. Results: Alteration was found in the pattern of perception/maintenance of health, nutritional/metabolic, exercise activity and coping with stress; with the establishment of activities to control glucose, priority was given to prescribed diet, exercise, adherence to treatment and coping with stress. Acceptance of the disease, learning to take capillary glucose and glycemic control was achieved, as well as adherence to the prescribed diet and exercise. Conclusions: Therapeutic health education achieved adherence to pharmacological and non-pharmacological treatment, as well as the acceptance of the health status, which allows acquiring self-control of the disease. Continuous and long-term follow-up is important due to the pathological progress, age and general deterioration of the patient.

Abstrato Introdução. O processo de enfermagem é o método que nos permite administrar a assistência a pessoas com doenças crônicas por meio dos estágios da doença, ou seja, avaliação, raciocínio diagnóstico, plano de assistência de enfermagem e avaliação. Objetivo: Avaliar um plano de cuidados de enfermagem para um adulto mais velho com diabetes mellitus tipo 2 e osteoporose com foco na educação terapêutica em saúde. Metodologia: Estudo de caso clínico observacional, descritivo e longitudinal de uma paciente de 63 anos com diabetes mellitus e osteoporose; para a avaliação foi utilizado o instrumento Marjory Gordon para raciocínio diagnóstico, planejamento, execução e avaliação, para raciocínio diagnóstico, planejamento, execução e avaliação, foi utilizada a linguagem padronizada. De acordo com os princípios bioéticos, essa é uma pesquisa de risco mínimo, e a privacidade e os dados dos idosos são protegidos. Resultados: Foi encontrada alteração no padrão de percepção/manutenção da saúde, nutricional/metabólico, atividade física e enfrentamento do estresse; com o estabelecimento de atividades para controlar a glicose, a prioridade foi dada à dieta prescrita, aos exercícios, à adesão ao tratamento e ao enfrentamento do estresse. Houve aceitação da doença, aprendizado da medição da glicose capilar e controle glicêmico, além de adesão à dieta e aos exercícios prescritos. Conclusões: A educação terapêutica em saúde conseguiu a adesão ao tratamento farmacológico e não farmacológico, bem como a aceitação do estado de saúde, que permite adquirir o autocontrolo da doença, sendo importante a monitorização contínua e a longo prazo da evolução patológica, da idade e da deterioração geral do paciente.

Resumen Introducción: El proceso de enfermería es el método que nos permite administrar los cuidados a personas con enfermedades crónicas a través de sus etapas: valoración, razonamiento diagnóstico, plan de cuidados de enfermería y evaluación. Objetivo: Evaluar un plan de cuidados de enfermería a una adulta mayor con diabetes mellitus tipo 2 y osteoporosis con enfoque a la educación para la salud terapéutica. Metodología: Estudio de caso clínico, observacional, descriptivo y longitudinal, a paciente de 63 años con diabetes mellitus y osteoporosis; para la valoración se empleó el instrumento de Marjory Gordon, para el razonamiento diagnóstico, planeación, ejecución y evaluación se utilizó el lenguaje estandarizado de enfermería. Bajo los principios bioéticos es una investigación de riesgo mínimo, se protege la privacidad y datos del adulto mayor. Resultados: Se encontró alteración en el patrón percepción / mantenimiento de la salud, nutricional / metabólico, actividad ejercicio y afrontamiento del estrés; estableciendo actividades para el control de su glucosa, se priorizó en dieta prescrita, ejercicio, adherencia al tratamiento y afrontamiento al estrés. Se logró aceptación de la enfermedad, aprendizaje de toma de glucosa capilar y control glucémico, además del apego a dieta y ejercicio prescrito. Conclusiones: La educación para la salud terapéutica logró el apego al tratamiento farmacológico y no farmacológico, así como la aceptación del estado de salud le permite adquirir el autocontrol de su enfermedad, es importante el seguimiento continuo y a largo plazo por el avance patológico, edad y deterioro general de la paciente.

Abstract Introduction: Almost 800 female deaths occur daily due to preventable causes associated with complications during or after pregnancy or childbirth, equivalent to two maternal deaths per minute. Objective: To develop a nursing care process for a pregnant woman who suffered from hyperthyroidism using diagnostic taxonomies, results and nursing interventions with a focus on Orem's theory. Methodology: Case study of a pregnant woman treated in a second level care hospital, the Orem assessment guide was used, developing the stages: assessment, diagnosis, planning, execution and evaluation, individualized care plans were designed and executed. Privacy was protected by omitting identity, respecting the rights and well-being of the participant. Results: The risk conditioning factor that compromised the health of the mother-child binomial gave way to care planning aimed at the process of ineffective motherhood and ineffective self-management of health, establishing interventions such as high-risk pregnancy care and teaching the process of illness and prescribed medications, an improvement was obtained in the patient's health status, which allowed her discharge and adequate management of the high-risk pregnancy. Conclusion: The nursing care process exposed the context in which the pregnant woman with known uncontrolled pathology is admitted, which compromised maternal-fetal well-being. Nursing education is required to promote preconception maternal health for future pregnancies.

Abstrato Introdução: Quase 800 mortes femininas ocorrem diariamente por causas evitáveis associadas a complicações durante ou após a gravidez ou o parto, o equivalente a duas mortes maternas por minuto. Objetivo: Desenvolver um processo de cuidado de enfermagem a uma gestante portadora de hipertireoidismo utilizando taxonomias diagnósticas, resultados e intervenções de enfermagem com enfoque na teoria de Orem. Metodologia: Estudo de caso de uma gestante atendida em um hospital de atenção secundária, utilizou-se o guia de avaliação de Orem, desenvolvendo as etapas: avaliação, diagnóstico, planejamento, execução e avaliação, foram desenhados e executados planos de cuidados individualizados. A privacidade foi protegida pela omissão da identidade, respeitando os direitos e o bem-estar do participante. Resultados: O fator condicionante de risco que comprometia a saúde do binômio mãe-filho deu lugar ao planejamento do cuidado voltado ao processo de maternidade ineficaz e à autogestão ineficaz da saúde, estabelecendo intervenções como o cuidado à gravidez de alto risco e ensinando o processo e medicamentos prescritos, houve uma melhora no estado de saúde da paciente, o que permitiu sua alta e o gerenciamento adequado da gravidez de alto risco. Conclusão: O processo de cuidado de enfermagem expôs o contexto em que a gestante com patologia conhecida não controlada é internada, o que compromete o bem-estar materno-fetal. A educação em enfermagem é necessária para promover a saúde materna pré-concepcional em futuras gestações.

Resumen Introducción: Casi 800 muertes de mujeres en forma diaria ocurren por causas prevenibles asociadas a complicaciones durante o después del embarazo o el parto, equivaliendo dos muertes maternas por minuto. Objetivo: Desarrollar un proceso de atención de enfermería a gestante que cursó con hipertiroidismo empleando las taxonomías diagnósticas, resultados e intervenciones de enfermería con enfoque de la teoría de Orem. Metodología: Estudio de caso a mujer gestante atendida en hospital de segundo nivel de atención, se empleó la guía de valoración de Orem desarrollando las etapas: valoración, diagnóstico, planeación, ejecución y evaluación, se diseñaron y ejecutaron planes de cuidados individualizados. Se protegió la privacidad omitiendo identidad, respetando los derechos y bienestar de la participante. Resultados: El factor condicionante de riesgo que comprometía la salud del binomio madre-hijo, dio paso a la planificación del cuidado encaminado al proceso de maternidad ineficaz y autogestión ineficaz de la salud, estableciendo intervenciones como cuidados del embarazo de alto riesgo y enseñanza del proceso de enfermedad y medicamentos prescritos, se obtuvo mejora en el estado de salud de la paciente, lo que permitió su alta y un adecuado manejo del embarazo de alto riesgo. Conclusión: El proceso de atención de enfermería expuso el contexto en el que ingresa la mujer gestante con patología conocida no controlada, lo que comprometía el bienestar materno-fetal. Se requiere educación por parte de enfermería para fomentar la salud materna preconcepcional para futuros embarazos.

Resumo: Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

Abstract: Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

resumen está disponible en el texto completo

Abstract Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m2, score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3 30day day ACSNSQIP. ACSNSQIP ACS NSQIP . (ACS-NSQIP) aged 1 years 201 202 group 1229 229 1,22 46.5% 465 46 (46.5 placement) BMI (BMI kgm2 kgm kg m2 m kg/m2 ASA (ASA classification splittransthoracic split transthoracic approach 9 minutes otolaryngologists cleancontaminated clean addition stay However patient Evidence (ACS-NSQIP 20 122 22 1,2 46.5 4 (46. kg/m 2 12 1, 46. (46 (4 (

Abstract Objective: To examine the mental health status and related factors in children and adolescents, and to assess age groups and sexes differences in factors influencing mental health. Methods: This cross-sectional study was performed on Chinese children aged 6-18 years from November 2021 to January 2022. Mental health difficulties were accessed by the Strengths and Difficulties Questionnaire. Multivariate logistic regression was used to analyze factors associated with mental health status. Multiple linear regression was used to evaluate factors associated with the scores of the Strengths and Difficulties Questionnaire. Results: The prevalence of mental health difficulties was 12.98% (n =1348). Age (OR, 0.909, [95%CI, 0.830-0.996]), sex (OR, 1.424, [95%CI, 1.033-1.963]) and screen time on weekdays (“≥2” h/d vs “< 1” h/d: OR, 2.001, [95%CI, 1.300-3.080]) were related factors for mental health difficulties. For children (year ≤ 12), the strongest related factor for mental health difficulties was screen time on weekdays (“≥ 2” h/d vs “< 1” h/d: OR, 1.821 [95%CI, 1.203-2.755]). The risk of mental health difficulties in females with ≥ 2 h/d screen time on weekends was 3.420 times higher than those with < 1 h/d (OR, 3.420, [95%CI, 1.923-6.081]). Conclusion: The prevalence of mental health difficulties among children and adolescents was relatively high. The lower age, female sex and excessive screen time were associated with a higher risk of mental health difficulties. The factors influencing mental health varied by different age groups and sexes. Thus, specific measures for different age groups and sexes should be adopted to mitigate the impact. Objective Methods crosssectional cross sectional 618 6 18 6-1 202 2022 Questionnaire Results 1298 12 98 12.98 n =1348. 1348 =1348 . =1348) OR (OR 0909 0 909 0.909 95%CI, 95CI CI 95 [95%CI 0.8300.996, 08300996 0.830 0.996 , 830 996 0.830-0.996]) 1424 424 1.424 1.0331.963 10331963 1.033 1.963 033 963 1.033-1.963] ≥2 (“≥2 hd h d “ 2001 001 2.001 1.3003.080 13003080 1.300 3.080 300 3 080 1.300-3.080] year 12, 12) (“ 1821 821 1.82 1.2032.755. 12032755 1.203 2.755 203 755 1.203-2.755]) 3420 420 3.42 1.9236.081. 19236081 1.923 6.081 923 081 1.923-6.081]) Conclusion high Thus impact 61 6- 20 129 9 12.9 134 =134 090 90 0.90 95%CI 8300 0.8300.996 0830099 0830 0.83 0996 0.99 83 99 0.830-0.996] 142 42 1.42 0331 1.0331.96 1033196 1033 1.03 1963 1.96 03 96 1.033-1.963 200 00 2.00 3003 1.3003.08 1300308 1300 1.30 3080 3.08 30 08 1.300-3.080 ( 182 82 1.8 2032 1.2032.755 1203275 1203 1.20 2755 2.75 75 1.203-2.755] 342 3.4 9236 1.9236.081 1923608 1923 1.92 6081 6.08 92 1.923-6.081] 12. 13 =13 09 0.9 0.8300.99 083009 083 0.8 099 8 0.830-0.996 14 4 1.4 1.0331.9 103319 103 1.0 196 1.9 1.033-1.96 2.0 1.3003.0 130030 130 1.3 308 3.0 1.300-3.08 1. 1.2032.75 120327 120 1.2 275 2.7 7 1.203-2.755 34 3. 1.9236.08 192360 192 608 6.0 1.923-6.081 =1 0. 0.8300.9 08300 0.830-0.99 1.0331. 10331 10 19 1.033-1.9 2. 1.3003. 13003 1.300-3.0 1.2032.7 12032 27 1.203-2.75 1.9236.0 19236 60 6. 1.923-6.08 = 0.8300. 0.830-0.9 1.0331 1.033-1. 1.3003 1.300-3. 1.2032. 1.203-2.7 1.9236. 1.923-6.0 0.8300 0.830-0. 1.033-1 1.300-3 1.2032 1.203-2. 1.9236 1.923-6. 0.830-0 1.033- 1.300- 1.203-2 1.923-6 0.830- 1.203- 1.923-

Abstract Objective: To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology. Methods: A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conductedin73publicmiddleschoolsinthreeBrazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention). Results: The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems. Conclusions: Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations. Objective COVID19 COVID 19 COVID-1 AprilAugust April August 2021, 2021 , 2021) symptomatology Methods clusterrandomized cluster randomized trial conductedinpublicmiddleschoolsinthreeBrazilian conductedin publicmiddleschoolsinthreeBrazilian cities program 53 61% 61 (61 girls 152 15 2 15. years. years . years) preintervention pre intervention FebruaryMarch February March 2019, 2019 2019) NovemberDecember November December school alcohol, (alcohol drinking tobacco inhalants marijuana cocaine crack periods sex age status city control intervention. intervention) Results pastyear pastmonth but decelerating However initiated maintained Mainly problems hyperactivity Conclusions period factors manifestations COVID1 1 COVID- 202 5 6 (6 201 20 (

Abstract Objectives: Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level. Methods: Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined. Results: 559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm). Conclusion: Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students. Objectives (MA changes Worldwide ethnicity Methods Crosssectional Cross sectional 1017 1 017 1,01 Manaus Brazil recall BMI, BMI , (BMI) race examined Results 55 51.9% 519 51 9 (51.9% 917 91 7 91.7% 119 11 11. 11.6 116 (11. 11.4 114 4 (1 12.7 127 (12. statusparental parental However classes 157.9 1579 157 (157. 1594 159 159. cm. cm . cm) Conclusion 101 01 1,0 (BMI 5 51.9 (51.9 91.7 (11 ( 12. 157. 15 (157 0 1, 51. (51. 91. (15 (51 (5

Abstract Background: One of the most diverse and threatened plant associations in the Yucatan peninsula has not been characterized and therefore not included in any protection category in Mexico. We characterize and describe this plant association, which is rapidly disappearing or being irreversibly transformed as a result of anthropic activities. We propose a name and attempt a preliminary assessment of its taxonomic richness, and the identification of priority species to be preserved. Questions: What is the species richness and plant endemism associated within this plant association? What are the ecologically important and high-priority species for conservation? How is it different from associated or similar plant associations? Studied species: Vascular plants. Study site and dates: Northern Yucatan peninsula; 2021-2023. Methods: The plant association was characterized, and quantitative parameters were recorded. The Importance Value Index was estimated to assess its local ecological importance, and each species was assigned a conservation category in order to evaluate the conservation status in a global context. Results: We propose Seasonally flooded Coquinal (SFC) as a name for this plant association based on geomorphological, physiognomic, and structural attributes. A total of 206 species were recorded, two of which are endemic to the SFC and 28 to the Yucatan Peninsula Biotic Province (YPBP). Twelve species are listed under a risk category. Conclusions: The SFC harbors a high plant diversity of species endemic species to the YPBP, 12 of which are included in the IUCN red list, for which its typification and conservation should be a high priority in Mexico.

Resumen Antecedentes: Una de las asociaciones vegetales más diversas y amenazadas de la península de Yucatán no ha sido reconocida, por tanto, no incluida en alguna categoría de protección en México. Se caracterizó y describió esta vegetación, la cual está desapareciendo o siendo transformada resultado de actividades antrópicas. Proponemos un nombre y realizamos una primera aproximación al conocimiento de su riqueza taxonómica y especies prioritarias a conservar. Preguntas: ¿Cuántas especies de plantas hay y cuáles son los endemismos que contiene? ¿Cuáles son las especies con mayor importancia ecológica y prioritarias para conservar? ¿Cómo se puede diferenciar de vegetación asociada o similar? Especies estudiadas: Plantas vasculares. Sitio y fechas de estudio: Norte de la Península de Yucatán; 2021-2023. Métodos: Se caracterizó la asociación vegetal y se registraron parámetros cuantitativos. El Índice de Valor de Importancia fue estimado para evaluar la importancia ecológica local y la categoría de conservación de las especies fue asignada evaluando el estatus de conservación en un contexto global. Resultados: En función de sus características geomorfológicas, fisonómicas y estructurales, proponemos “Coquinal Estacionalmente Inundado” (CY) como un nombre para esta asociación vegetal. Un total de 206 especies fueron registradas, incluyendo dos especies endémicas al CY y 28 endémicas a la Provincia Biótica Península de Yucatán (PBPY). Doce especies están en alguna categoría de riesgo. Conclusiones: El CY alberga una alta diversidad de especies endémicas a la PBPY, 12 de ellas incluidas en la lista roja de la IUCN, por lo que su tipificación y conservación es de alta prioridad en México.

Abstract Introduction : Although therapeutic advances have improved results of cutaneous melanoma (CM), senti nel node-positive patients still have substantial risk to develop recurrent disease. We aim to investigate prog nostic indicators associated with disease recurrence in positive-sentinel lymph node biopsy (SLNB) patients in a Latin-American population. Methods : Retrospective analysis of CM patients and positive-SLNB (2010-2020). Patients were divided into two groups: Group A (completion lymph node dissection, CLND), Group B (active surveillance, AS). Association of demographics, tumor data and SLN features with recurrence-free (RFS), distant metastases-free (DMFS) and melanoma specific (MSS) survival was analyzed. Results : Of 205 patients, 45 had a positive SLNB; 27(60%) belonged to Group A and 18(40%) to Group B. With a median follow-up of 36 months, 16 patients (12 in Group A and 4 in Group B) developed recurrent dis ease and estimated 5-yr RFS at any site was 60% (CI95%, 0.39 - 0.77) (44.5% in CLND group vs. 22% in AS group; P = 0.20). Estimated 5-yr DMFS and MSS: 65% (CI 95%, 0.44 - 0.81) and 73% (CI 95%, 0.59 - 0.89) with no differ ences between groups (p = 0.41 and 0.37, respectively). Independent predictors of poorer MSS were extranodal extension (ENE) and MaxSize > 2 mm of melanoma deposit in SLN. Factors independently associated with DMFS: Breslow depth > 2 mm, ENE, number (≥ 2) of posi tive SN and CLND status. Conclusion : Primary tumor and SN features in mela noma provide important prognostic information that help optimize prognosis and clinical management. AS is now the preferred approach for most positive-SLNB CM patients.

Resumen Introducción : Si bien los avances terapéuticos han permitido mejorar los resultados del melanoma cutáneo (MC), los pacientes con ganglio centinela positivo (BGCP) aún tienen riesgo elevado de desarrollar recurrencia de la enfermedad. Nuestro objetivo fue investigar in dicadores pronósticos asociados a dicho evento en una población latinoamericana. Métodos : Análisis retrospectivo de pacientes con MC y BGCP entre 2010-2020. Los pacientes se dividieron en 2 grupos: Grupo A (linfadenectomía terapéutica) y Grupo B (Vigilancia activa, VA). Se analizaron datos demográficos, tumorales y características del GC junto con sobrevida-libre de recurrencia (SLR), libre de metástasis a distancia (SLMD) y específica de melanoma (SEM). Resultados : De 205 pacientes, 45 presentaron BGCP; 27 (60%) perteneció al Grupo A y 18 (40%) al Grupo B. Con una mediana de seguimiento de 36 meses, 16 pa cientes (12 en Grupo A y 4 en Grupo B) desarrollaron enfermedad recurrente con una SLR a 5 años de 60% (IC95%: 0.39-0.77) (44.5% en Grupo B vs. 22% en Grupo A; P = 0.20). Las SLMD y SEM estimadas a 5 años fueron de 65% (CI 95%, 0.44 - 0.81) y 73% (CI 95%, 0.59 - 0.89) sin diferencias entre ambos grupos (p = 0.41 y 0.37, respec tivamente). Los predictores independientes de peor SEM fueron: extensión extranodal (ENE) y MaxSize > 2mm de depósito tumoral en GC. Los factores asociados de forma independiente con SLMD fueron Breslow >2mm, ENE, número (≥ 2) de GC positivos y el status (positividad) de la linfadenectomía. Conclusión : Características del tumor primario y del GC brindan información importante que ayuda a optimi zar el pronóstico y manejo clínico de los pacientes con MC. La VA es actualmente el abordaje de elección para la mayoría de los pacientes con BGCP.

Abstract Introduction : Meningeal cryptococcosis (MC) is a frequent cause of meningoencephalitis in people living with HIV (PLHIV), leading to substantial morbidity (20- 55%). Clinical characteristics, lethality and adverse prog nostic factors in PLHIV with MC admitted to intensive care units (ICUs) are described. Methods : A retrospective observational study. Period from 11/21/2006 to 05/24/2023. It involved 154 adult PLHIV diagnosed with MC and admitted to ICUs. Percen tages and absolute values were compared by Chi-Square or Fisher’s test and medians by Mann-Whitney test. The association with mortality was assessed by logistic re gression. SPSS 23.0 software was used. A p-value <0.05 was considered significant. Results : Patients who died and those who survived were comparable in age and sex (p>0.05). Univariate analysis showed that impaired functional and nutritio nal status, lack of previous highly active antiretroviral therapy, CD4 <100 cells, APACHE II ≥13 and a PLHIV prognostic score ≥8 points, requiring mechanical venti lation (MV), respiratory failure, renal failure, neurological dysfunction or sepsis could be associated (p<0.05) with mortality. Logistic regression established that impaired functional and nutritional status, a PLHIV prognostic score ≥8, need for MV and presence of sepsis would be independent variables associated with mortality. Conclusion : The results indicate that altered functio nal and nutritional status, a PLHIV prognostic score ≥ 8 points, requiring MV and suffering sepsis on admission to the ICU are more frequent in deceased patients, and they could therefore serve as independent variables to predict a higher risk of mortality.

Resumen Introducción : La criptococosis meníngea (CM) es una causa frecuente de meningoencefalitis en personas que viven con HIV (PVHIV) y produce una importante morbi-mortalidad (20-55%). Se describen las características clínicas, la letalidad y las variables de mal pronóstico en PVHIV con CM, en unidades de cuidados intensivos (UCI). Métodos : Estudio observacional y retrospectivo. Pe ríodo 21/11/2006 a 24/05/2023. Población evaluada: 154 PVHIV adultos, admitidos en UCI con diagnóstico de CM. Los porcentajes y valores absolutos, fueron comparados mediante Chi-Cuadrado o test de Fisher y las medianas mediante test de Mann-Whitney. La asociación con mortalidad se evaluó por regresión logística. Se utilizó el programa SPSS 23.0. Un valor p<0.05 fue considerado significativo. Resultados : Los pacientes que fallecieron y los que so brevivieron fueron comparables en edad y sexo (p>0.05). El análisis univariado, observó que un estado funcional y nutricional alterado, falta de tratamiento antirretroviral previo (TARV), CD4 <100 células/μl, APACHE II ≥13 y un score pronóstico de PVHIV ≥8 puntos, requerir ventilación mecánica (VM), sufrir insuficiencia respiratoria, renal, disfunción neurológica o sepsis, podrían estar asociados (p<0.05) con mortalidad. La regresión logística estableció que un estado funcional y nutricional alterado, un score pronóstico PVHIV ≥8, necesitar VM y sufrir sepsis serían variables independientes asociadas a mortalidad. Conclusión : Los resultados indican que el estado funcional y nutricional alterado, un score pronóstico PVHIV ≥8 puntos, requerir VM y sufrir sepsis al ingreso a UCI podrían servir como variables independientes para predecir un mayor riesgo de mortalidad.

Abstract Inflammation is an important pathogenic factor for the development of atherosclerotic cardiovascular disease. Currently, the most frequently used biomarker reflecting systemic inflammation is C-reactive protein (CRP), an acute-phase protein produced primarily by hepatocytes under the influence of interleukin-6, interleukin-1 beta, and tumor necrosis factor. Growing evidence from epidemiological studies has shown a robust association between elevated serum or plasma CRP concentrations and the incidence of a first cardiovascular adverse event (including acute myocardial infarction, ischemic stroke, and sudden cardiac death) in the general population, as well as recurrence of major adverse cardiovascular events among patients with established disease. The additive value that CRP measurement gives to traditional risk factors is reflected in novel cardiovascular risk calculators and in current intervention regimens, which already consider CRP as a target therapeutic. However, the variations in CRP levels, that depend on sex, ethnicity, hormonal status, and some peculiarities of the measurement assays, must be taken into consideration when deciding to implement CRP as a useful biomarker in the study and treatment of atherosclerotic cardiovascular disease. This review aims to offer an updated vision of the importance of measuring CRP levels as a biomarker of cardiovascular risk beyond the traditional factors that estimate the risk of atherosclerotic disease.

Resumen La inflamación es un factor patogénico importante para el desarrollo de la enfermedad cardiovascular aterosclerótica. Actualmente, el biomarcador utilizado con mayor frecuencia que refleja la inflamación sistémica es la proteína C reactiva (PCR), una proteína de fase aguda producida principalmente por los hepatocitos bajo la influencia de la interleucina 6, la interleucina 1 beta y el factor de necrosis tumoral. La evidencia proveniente de estudios epidemiológicos ha demostrado una fuerte asociación entre las concentraciones elevadas de PCR en suero o plasma y la incidencia de un primer evento cardiovascular (incluido infarto agudo de miocardio, accidente vascular cerebral isquémico y muerte cardíaca súbita) en la población general, así como la recurrencia de eventos cardiovasculares adversos en los pacientes con enfermedad establecida. El valor aditivo que la medición de la PCR otorga a los factores de riesgo tradicionales se refleja en novedosas calculadoras de riesgo cardiovascular y en los actuales regímenes de intervención, que ya consideran a la PCR como objetivo terapéutico. Sin embargo, las variaciones en los niveles de PCR, que dependen del sexo, la etnia, el estado hormonal y algunas peculiaridades de los ensayos de medición, deben tenerse en cuenta al decidir implementar la PCR como un biomarcador útil en el estudio y el tratamiento de la enfermedad cardiovascular aterosclerótica. Esta revisión pretende ofrecer una visión actualizada de la importancia de medir la PCR como biomarcador de riesgo cardiovascular más allá de los factores tradicionales que estiman el riesgo de enfermedad aterosclerótica.

Abstract Objective: To build a model based on cardiometabolic indicators that allow the identification of overweight adolescents at higher risk of subclinical atherosclerotic disease (SAD). Methods: Cross-sectional study involving 161 adolescents with a body mass index ≥ + 1 z-Score, aged 10 to 19 years. Carotid intima-media complex thickness (IMT) was evaluated using ultrasound to assess subclinical atherosclerotic disease. Cardiometabolic indicators evaluated included nutritional status, central adiposity, blood pressure, lipidic profile, glycemic profile, as well as age and sex. Data was presented using measures of central tendency and dispersion, as well as absolute and relative frequency. The relationship between IMT measurement (outcome variable) and other variables (independent variables) was assessed using Pearson or Spearman correlation, followed by multiple regression modeling with Gamma distribution to analyze predictors of IMT. Statistical analysis was performed using SPSS and R software, considering a significance level of 5 %. Results: It was observed that 23.7 % had Carotid thickening, and the prevalence of abnormal fasting glucose was the lowest. Age and fasting glucose were identified as predictors of IMT increase, with IMT decreasing with age by approximately 1 % per year and increasing with glucose by around 0.24 % per mg/dL. Conclusion: The adolescent at higher risk is younger with higher fasting glycemia levels. Objective SAD. SAD . (SAD) Methods Crosssectional Cross sectional 16 zScore, zScore z Score, Score z-Score years intimamedia intima media (IMT status adiposity pressure profile sex dispersion frequency outcome variable independent correlation software Results 237 23 7 23. thickening lowest increase 024 0 24 0.2 mgdL mg dL mg/dL Conclusion levels (SAD 2 02 0.

RESUMEN Introducción: Diversos autores mencionan que una correcta planificación de una dentadura parcial removible incrementa la satisfacción de los pacientes, en cuanto a estética y función. En casos donde la estética es prioritaria, se plantea un diseño sin retenedores visibles. En estos casos, la elaboración de la dentadura no demanda mayores costos, basta con establecer el diagnóstico correspondiente valorando los pilares, eje de inserción, áreas retentivas entre otros y establecer el diseño más conveniente según sea el caso. Objetivo: El objetivo fue realizar una revisión sistematizada sobre la percepción de la calidad de vida y satisfacción en pacientes portadores de dentaduras parciales removibles. Materiales y métodos: Se incluyeron 13 artículos científicos mediante la metodología PRISMA para la identificación, revisión e inclusión de los textos que formaron parte del estudio. Se seleccionaron tomando en cuenta el título, resumen y objetivo. Fueron considerados: revisiones sistemáticas, metaanálisis, estudios comparativos y revisiones de literatura que evaluaran diferentes criterios acerca de la satisfacción en pacientes portadores de dentadura parcial removible. Los artículos fueron leídos íntegramente, se analizaron objetivos, metodología y conclusión de cada uno de ellos, y posteriormente fueron analizados. Resultados: La queja más común fue el resultado estético, seguida del dolor durante la masticación. Se recomienda ofrecer un control periódico de la prótesis parcial removible para evaluar el correcto funcionamiento y ajuste de esta. Conclusión: El éxito del tratamiento con dentaduras parciales removibles se puede optimizar mediante el diagnóstico preciso del caso, considerando experiencias previas del paciente y teniendo en cuenta sus expectativas. Asimismo, comprender ciertos factores como su estilo de vida, nivel socioeconómico, estado de salud periodontal, personalidad, puede disminuir el riesgo de fracaso futuro del tratamiento con dentaduras parciales removibles.

ABSTRACT Introduction : Various authors mention that correct planning of a removable partial denture can offer adequate satisfaction in terms of aesthetics and function. In cases where aesthetics is a priority, a design without visible clasps is proposed. In addition, this elaboration does not demand higher costs, if the practitioner reaches the corresponding diagnosis and establishes the most convenient design for each specific case. Objective: The objective was to carry out a systematic review on the perception of quality of life and satisfaction in patients with removable partial dentures. Materials and methods: Thirteen scientific articles were included using the PRISMA methodology for the identification, review and inclusion of the texts that were part of this study. The articles were selected considering the title, abstract and objective. Systematic reviews, meta-analyses, comparative studies, and literature reviews that included criteria about satisfaction in patients with removable partial dentures where evaluated. The articles were read in their entirety: the objectives, methodology and conclusions of each one of them were analyzed. Results: The most common complaint was the aesthetic result, followed by pain during chewing. It is recommended to offer periodic control of the removable partial denture to evaluate its correct functioning and fit. Conclusion: The success of the treatment with removable partial dentures can be evaluated through the precise diagnosis of the case, considering previous experiences and taking into account the expectations of the patient. Also, understanding the patient’s lifestyle, socioeconomic level, periodontal health status, and personality, may be factors that allow the practitioner to reduce the risk of future failure for the treatment with removable partial dentures.

Resumen Antecedentes: El cáncer de mama (CM) representa un problema de salud pública entre las mujeres. A pesar de la incidencia y las disparidades en el estatus económico, el estado de Guerrero en México demuestra una tasa de mortalidad por cáncer de mama más baja. Objetivo: Este estudio investiga las características epidemiológicas, las modalidades de tratamiento y los resultados de supervivencia de los pacientes con CM en Guerrero y compara estos hallazgos con datos nacionales. Método: Se analizó una cohorte retrospectiva de 923 pacientes con CM atendidos en el Instituto Estatal de Cancerología Dr. Arturo Beltrán Ortega, del 2010 al 2018. Para determinar los factores pronósticos que afectan la supervivencia, empleamos el análisis de supervivencia general y el modelo de riesgos proporcionales de Cox. Resultados: La tasa de supervivencia a 5 años fue del 73% (IC 95%: 69-76). Los pacientes con BC ≤ 40 años mostraron tasas de supervivencia más bajas y un riesgo de mortalidad 1.5 veces mayor. Al comparar el subtipo triple negativo con los tumores HER2 positivos, no se observaron diferencias significativas en la reducción del riesgo de muerte. Conclusión: A pesar de una mayor prevalencia de subtipos moleculares agresivos en Guerrero, los pacientes comparten características clínicas y epidemiológicas con sus homólogos de otras regiones mexicanas.

Abstract Background: Breast cancer (BC) represents a public health concern among women. Despite the incidence and disparities in economic status, the state of Guerrero in Mexico demonstrates a lower BC mortality rate. Objective: This study investigates the epidemiological characteristics, treatment modalities, and survival outcomes of BC patients in Guerrero, and compares these findings with national data. Method: A retrospective cohort of 923 BC patients treated at the Instituto Estatal de Cancerología Dr. Arturo Beltrán Ortega, from 2010 to 2018 was analyzed. To determine the prognostic factors affecting survival, we employed overall survival analysis and the Cox proportional hazards model. Results: The 5-year survival rate was of 73% (CI 95%: 69-76). BC patients ≤ 40 years exhibited lower survival rates and a 1.5-fold higher risk of mortality. When comparing the triple-negative subtype to HER2-positive tumors, no significant differences in reducing the risk of death were observed. Conclusion: Despite a higher prevalence of aggressive molecular subtypes in Guerrero, patients share clinical and epidemiological features with their counterparts in other Mexican regions.