Resumen OBJETIVO: Analizar las tendencias de la histerectomía por tipo de acceso, motivo de solicitud y complicaciones inmediatas. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y retrolectivo efectuado en el Hospital Español de México con base en la revisión de expedientes de pacientes a quienes se practicó la histerectomía entre los meses de octubre de 2018 a julio de 2023. En todos los casos se identificó el tipo de acceso para la histerectomía, motivo de indicación, edad de la paciente y complicaciones inmediatas trans y posoperatorias. RESULTADOS: Se analizaron los expedientes de 1234 pacientes con una media de edad de 48.63 ± 9.22 años. La vía quirúrgica de elección (54.4%) fue la histerectomía total laparoscópica, seguida de la histerectomía total abdominal (35.89%) y la histerectomía vaginal asistida por laparoscopia, la histerectomía vaginal e histerectomía robótica representaron: 3.72, 5.51 y 0.32%, respectivamente. Las complicaciones totales representaron 8% y la histerectomía total laparoscópica 6%, mientras que la histerectomía total abdominal solo 10%. Las complicaciones más frecuentes: hemorragia ( 53%), lesión de vejiga (17%) y desgarro de pared vaginal (10%). CONCLUSIONES: La histerectomía laparoscópica es el procedimiento quirúrgico preferido en nuestra población: representa más de la mitad de los casos. Se observó una tendencia de menores complicaciones en las histerectomías mediante mínima invasión.

Abstract OBJECTIVE: To analyze trends in hysterectomy by type of approach, reason for request, and immediate complications. MATERIALS AND METHODS: Observational, cross-sectional, retrospective and retrolective study conducted at the Hospital Español de México based on the review of records of patients who underwent hysterectomy between the months of October 2018 and July 2023. In all cases, the type of approach for hysterectomy, reason for indication, patient age, and immediate trans- and postoperative complications were identified. RESULTS: The records of 1234 patients with a mean age of 48.63 ± 9.22 years were analyzed. The surgical route of choice (54.4%) was laparoscopic total hysterectomy, followed by total abdominal hysterectomy (35.89%) and laparoscopic-assisted vaginal hysterectomy, vaginal hysterectomy, and robotic hysterectomy: 3.72, 5.51, and 0.32%, respectively. Total complications represented 8% and total laparoscopic hysterectomy 6%, while total abdominal hysterectomy only 10%. The most common complications were hemorrhage (53%), bladder injury (17%), and vaginal wall tear (10%). CONCLUSIONS: Laparoscopic hysterectomy is the preferred surgical procedure in our population: it accounts for more than half of the cases. A trend towards fewer complications was observed in minimally invasive hysterectomies.

Abstract Objectives: to analyze the choice and continuation rate of contraceptive methods in women with sickle cell disease (SCD). Methods: an exploratory prospective study was conducted at a hospital enrolling 44 women with SCD aged 15-40 years old. After contraceptive counseling, the women selected one of the available contraceptive methods and separated into two groups, and were followed up at one, three, six, and 12 months. To analyze the continuation rate of contraceptive use, the two groups were: group (G1) using progestin-only contraceptives, through any route of administration and group (G2) using other contraceptive methods (combined hormonal and non-hormonal contraceptives). The continuation rate was analyzed using Kaplan–Meier survival analysis, considering a p<0.05. Results: after contraceptive counseling, most women opted for any progestin-only methods: injectable contraceptives (n=18; 40.9%), oral contraceptives (n=7; 15.9%), or intrauterine devices (n=3; 6.8%). The continuation rate decreased in both groups during the 12-months follow-up period. In the G1, the continuation rate was 60.7% (CI95%=40.4-76.0), while that in the G2 was 68.7% (CI95%= 40.5-85.6) with no significant difference between the groups (p=0.641). Conclusions: the overall continuation rates in both groups were satisfactory. No significant difference in the continuation rate of contraceptive methods was observed between the groups, although most women preferred progestin-only methods. Objectives SCD. . (SCD) Methods 4 1540 15 40 15-4 old counseling three six 1 months use G1 G (G1 progestinonly progestin only (G2 combined nonhormonal non contraceptives. contraceptives) KaplanMeier Kaplan Meier analysis p005 p 0 05 p<0.05 Results n=18 n18 n 18 (n=18 40.9%, 409 40.9% , 9 40.9%) n=7 n7 7 (n=7 15.9%, 159 15.9% 15.9%) n=3 n3 3 (n=3 6.8%. 68 6.8% 6 8 6.8%) 12months followup follow period 607 60 60.7 CI95%=40.476.0, CI95404760 CI CI95%=40.4 76.0 CI95 76 (CI95%=40.4-76.0) 687 68.7 CI95%= (CI95% 40.585.6 405856 40.5 85.6 5 85 40.5-85.6 p=0.641. p0641 p=0.641 641 (p=0.641) Conclusions satisfactory (SCD 154 15- (G p00 p<0.0 n=1 n1 (n=1 40.9 n= (n= 15.9 6.8 60. 476 CI95%=40.476.0 CI9540476 CI95404 CI95%=40. 760 76. CI9 (CI95%=40.4-76.0 68. CI95% (CI95 585 40.585. 40585 405 40. 856 85. 40.5-85. p064 p=0.64 64 (p=0.641 p0 p<0. (n 15. 6. 47 CI95%=40.476. CI954047 CI9540 CI95%=40 (CI95%=40.4-76. (CI9 58 40.585 4058 40.5-85 p06 p=0.6 (p=0.64 p<0 CI95%=40.476 CI954 CI95%=4 (CI95%=40.4-76 (CI 40.58 40.5-8 p=0. (p=0.6 p< CI95%=40.47 (CI95%=40.4-7 40.5- p=0 (p=0. (CI95%=40.4- p= (p=0 (CI95%=40.4 (p= (CI95%=40. (p (CI95%=40 (CI95%=4

Resumo Objetivos: analisar a escolha e a taxa de continuação do uso de métodos contraceptivos em mulheres com doença falciforme (DF). Métodos: foi realizado um estudo prospectivo exploratório em um hospital, no qual foram incluídas 44 mulheres com DF com idade entre 15 e 40 anos. Após aconselhamento contraceptivo, as mulheres selecionaram um dos métodos contraceptivos disponíveis e foram separadas em dois grupos, sendo acompanhadas por um, três, seis e 12 meses. Para analisar a taxa de continuação do uso de métodos contraceptivos, os dois grupos foram: grupo (G1) que utilizou apenas contraceptivos de progestágeno, por qualquer via de administração e grupo (G2) que utilizou outros métodos contraceptivos (contraceptivos hormonais combinados e não hormonais). A taxa de continuação foi analisada pela análise de sobrevida de Kaplan-Meier, considerando um p<0,05. Resultados: após aconselhamento contraceptivo, a maioria das mulheres optou por algum dos métodos contendo apenas progestágeno: contraceptivos injetáveis (n=18; 40,9%), contraceptivos orais (n=7; 15,9%) ou dispositivos intrauterinos (n=3; 6,8%). A taxa de continuação diminuiu em ambos os grupos durante o período de acompanhamento de 12 meses. No G1, a taxa de continuação foi de 60,7% (IC95%= 40,4-76,0), enquanto no G2 foi de 68,7% (IC95%= 40,5-85,6) sem diferença significativa entre os grupos (p=0,641). Conclusões: as taxas gerais de continuação em ambos os grupos foram satisfatórias. Não foi observada diferença significativa na taxa de continuação dos métodos contraceptivos entre os grupos, embora a maioria das mulheres tenha preferido métodos somente com progestágeno. Objetivos DF. . (DF) Métodos hospital 4 1 anos contraceptivo três meses G1 G (G1 progestágeno (G2 hormonais. hormonais) KaplanMeier, KaplanMeier Kaplan Meier, Meier Kaplan-Meier p005 p 0 05 p<0,05 Resultados n=18 n18 n 18 (n=18 40,9%, 409 40,9% , 9 40,9%) n=7 n7 7 (n=7 15,9% 159 n=3 n3 3 (n=3 6,8%. 68 6,8% 6 8 6,8%) 607 60 60,7 IC95%= IC95 IC (IC95% 40,476,0, 404760 40,4 76,0 76 40,4-76,0) 687 68,7 40,585,6 405856 40,5 85,6 5 85 40,5-85,6 p=0,641. p0641 p=0,641 641 (p=0,641) Conclusões satisfatórias (DF (G p00 p<0,0 n=1 n1 (n=1 40,9 n= (n= 15,9 6,8 60, IC95% IC9 (IC95 476 40,476,0 40476 404 40, 760 76, 40,4-76,0 68, 585 40,585, 40585 405 856 85, 40,5-85, p064 p=0,64 64 (p=0,641 p0 p<0, (n 15, 6, (IC9 47 40,476, 4047 40,4-76, 58 40,585 4058 40,5-85 p06 p=0,6 (p=0,64 p<0 (IC 40,476 40,4-76 40,58 40,5-8 p=0, (p=0,6 p< 40,47 40,4-7 40,5- p=0 (p=0, 40,4- p= (p=0 (p= (p

Abstract This study aimed to describe the pattern of antimicrobial agent usage in a general tertiary care hospital in Rio de Janeiro. Some prescriptions were evaluated for its therapeutic indication, dose, route of administration, and duration of treatment based on Antimicrobial Application Sheets and daily medical prescriptions. Consumption was expressed by using Defined Daily Dose per 100 bed-days. Within the 20,182 validated prescriptions, 9,356 were eligible for the study. The first-choice therapy was prescribed 6,175 (66.01%) times. It was verified that 5,455 (58.31%) of the prescribed antimicrobial agents were associated with bacteriologic culture tests, and among 2,484 (45.54%) of such cultures, at least one microorganism was identified. Negative results were obtained in 2,971 (54.46%) processed cultures, in which 1,289 patients (43.49%) had already initiated antimicrobial therapy. From patients with negative cultures, 518 (33.99%) prescriptions had alternative treatments, and from these, 495 (95.96%) could have been changed. Therefore, de-escalation of antimicrobial therapy has not been a practice in the institution. Among prescriptions that needed renal function dose adjustments, this was performed in 81.11%. In general, prescriptions were adjusted for dose (70.03%), route of administration (99.63%) and duration of treatment (74.70%). Piperacillin/tazobactam was the mostly used antimicrobial (3,923 DDD/100 bed-days). Janeiro indication 10 beddays. beddays bed days. days bed-days 20182 20 182 20,18 9356 9 356 9,35 firstchoice first choice 6175 6 175 6,17 66.01% 6601 66 01 (66.01% times 5455 5 455 5,45 58.31% 5831 58 31 (58.31% tests 2484 2 484 2,48 45.54% 4554 45 54 (45.54% cultures identified 2971 971 2,97 54.46% 5446 46 (54.46% 1289 1 289 1,28 43.49% 4349 43 49 (43.49% 51 33.99% 3399 33 99 (33.99% treatments these 95.96% 9596 95 96 (95.96% changed Therefore deescalation escalation institution adjustments 8111 81 11 81.11% 70.03%, 7003 70.03% , 70 03 (70.03%) 99.63% 9963 63 (99.63% 74.70%. 7470 74.70% . 74 (74.70%) Piperacillintazobactam Piperacillin tazobactam 3,923 3923 3 923 (3,92 DDD100 DDD DDD/10 bed-days) 2018 18 20,1 935 35 9,3 617 17 6,1 66.01 660 0 (66.01 545 5,4 58.31 583 (58.31 248 48 2,4 45.54 4 (45.54 297 97 2,9 54.46 544 (54.46 128 28 1,2 43.49 434 (43.49 33.99 339 (33.99 95.96 959 (95.96 811 8 81.11 700 70.03 7 (70.03% 99.63 996 (99.63 747 74.70 (74.70% 3,92 392 92 (3,9 DDD10 DDD/1 201 20, 93 9, 61 6, 66.0 (66.0 5, 58.3 (58.3 24 2, 45.5 (45.5 29 54.4 (54.4 12 1, 43.4 (43.4 33.9 (33.9 95.9 (95.9 81.1 70.0 (70.03 99.6 (99.6 74.7 (74.70 3,9 39 (3, DDD1 DDD/ 66. (66. 58. (58. 45. (45. 54. (54. 43. (43. 33. (33. 95. (95. 81. 70. (70.0 99. (99. 74. (74.7 3, (3 (66 (58 (45 (54 (43 (33 (95 (70. (99 (74. ( (6 (5 (4 (9 (70 (74 (7

Resumo Os autores investigaram as respostas elétricas de três diferentes espessuras de cerâmica de 0,5ZrO2-0,5TiO2 com adição de LiClO4. Os sensores foram obtidos seguindo a rota de processamento tradicional e a escolha por um estudo preliminar na variação na espessura deve-se ao fato de que a distância entre as placas paralelas influi na capacitância que é inversamente proporcional a distância entre as placas, sendo que, para criar o efeito capacitivo, as superfícies planas superior e inferior das pastilhas foram revestidas com fita adesiva de carbono, sendo esta escolha da fita uma forma inédita de montagem. A análise de difração de raios-X mostrou a presença de zircônia monoclínica, titânia rutilo e de uma terceira fase cristalina oriunda de uma reação entre o Li+ do perclorato de lítio e a titânia, formando uma nova fase, o titanato de lítio. O sensor com 2 mm de espessura apresenta potencial para uso como sensor de umidade relativa do ar. 0,5ZrO20,5TiO2 05ZrO205TiO2 ZrOTiO 0,5ZrO2 0,5TiO2 0 5ZrO2 5TiO2 ZrO TiO 0,5ZrO2-0,5TiO LiClO4 LiClO devese deve se capacitivo carbono montagem raiosX raios X monoclínica Li ar 5ZrO20 0,5ZrO20,5TiO 05ZrO205TiO 05ZrO2 0,5ZrO 05TiO2 0,5TiO 5ZrO 5TiO 05ZrO 05TiO

Abstract The authors investigated the electrical responses of three different thicknesses of ceramic 0.5ZrO2-0,5TiO2 with addition of LiClO4. The sensors were obtained following the traditional processing route and the choice for a preliminary study in variation in thickness is due to the fact that a distance between parallel plates influences the capacitance that is inversely proportional to the distance between as plates, being that, to create the capacitive effect, as flat surfaces above and below the plates were coated with carbon adhesive tape, being this choice of tape an unprecedented form of assembly. A X-ray diffraction analysis showed a presence of zirconia (monoclinic), titanium (rutile), and a third crystalline phase derived from a reaction between the Li+ of lithium perchlorate and a titanium, forming a new phase, the Lithium titanate. The 2 mm thick sensor has potential for use as a relative humidity sensor. 0.5ZrO20,5TiO2 05ZrO205TiO2 ZrOTiO 0.5ZrO2 0,5TiO2 0 5ZrO2 5TiO2 ZrO TiO 0.5ZrO2-0,5TiO LiClO4 LiClO effect assembly Xray X ray monoclinic, monoclinic , (monoclinic) rutile, rutile (rutile) Li titanate 5ZrO20 0.5ZrO20,5TiO 05ZrO205TiO 05ZrO2 0.5ZrO 05TiO2 0,5TiO 5ZrO 5TiO (monoclinic (rutile 05ZrO 05TiO

Resumo Objetivo da Investigação: Preservar a memória de um lugar através dos monumentos, edifícios e sítios históricos é primordial para garantir que as próximas gerações possam ter acesso a esses espaços, à sua história e cultura. O desafio das cidades turísticas que possuem centros históricos tombados pelo patrimônio histórico é assegurar que todas as pessoas, independentemente de ter algum grau de restrição motora, visual ou auditiva, tenham acesso pleno, com autonomia para visitar esses espaços. Vários fatores podem influenciar na escolha de um trajeto para fins utilitários ou de lazer (turístico), e a qualidade e as condições da estrutura urbana voltadas para os deslocamentos a pé podem ser determinantes. Nesse sentido, este artigo objetiva avaliar a qualidade da caminhabilidade de um percurso turístico localizado no centro histórico da cidade de Itu, localizada no estado de São Paulo, Brasil. Metodologia: A metodologia utiliza um índice e indicadores de desempenho para avaliar a qualidade de percursos turísticos voltados a pedestres, através das categorias calçadas, fachadas e travessias. Resultados: Os principais problemas estão relacionados à falta de seguridade, conforto e acessibilidade. O índice e os indicadores propostos permitem realizar uma análise do local através da identificação dos aspectos positivos e negativos que interferem na caminhabilidade do pedestre e tornam o trajeto difícil para o acesso de pessoas com problemas de mobilidade, visão, audição e cognição. Os resultados permitem que os gestores municipais possam propor e implementar soluções de curto e médio prazo para melhorar a qualidade espacial deste local. Originalidade/Valor: O estudo permitiu constatar que embora o Brasil tenha legislações e normativas (patrimoniais e de acessibilidade) específicas, muitos problemas relacionados a acessibilidade ainda são recorrentes em alguns centros históricos de cidades turísticas, o que compromete a visitação de turistas e residentes.

Abstract Research Purpose: Preserving the memory of a place through monuments, buildings and historical places is essential to ensure that future generations can have access to these spaces, their history and culture. The challenge of tourist cities that have historic centers listed by historical heritage is to ensure that all people, regardless of having some degree of motor, visual or hearing restriction, can have full access, with autonomy to visit these spaces. Several factors can influence the choice of a route for utilitarian or leisure (tourist) purposes, and the quality and conditions of urban infrastructure aimed at walking can be decisive. In this sense, this article aims to evaluate the walkability quality of a tourist route located in the historic center of the city of Itu, located in the state of São Paulo, Brazil. Methodology: The methodology uses an index and performance indicators to evaluate the quality of tourist routes aimed at pedestrians, through the category’s sidewalks, facades and crossings. Findings: The main problems are related to the lack of security, comfort and accessibility. The proposed index and indicators allow for an analysis of the location by identifying the positive and negative aspects that interfere with pedestrian walkability and make the route difficult for people with mobility, vision, hearing and cognition problems. The results allow municipal managers to propose and implement short and medium-term solutions to improve the spatial quality of these locations. Originality/Value: The study revealed that although Brazil has specific legislation and regulations (heritage and accessibility), many problems related to accessibility are still recurrent in some historic centers of tourist cities, which compromises the visitation of tourists and residents.

ABSTRACT Objectives: This review discusses deep infiltrating endometriosis (DIE) diagnosis and surgery using current urological knowledge and technologies. Materials and Methods: Narrative review of deep infiltrating endometriosis that result in urological issues. We examined manuscripts from Pubmed, Embase, and Scielo’s database using the following MeSH terms: (‘endometriosis’) AND (‘urology’ OR ‘urological’ OR ‘urologist’) AND (‘bladder’ OR’vesical’) AND (‘ureteral’ OR ‘ureter’). Selection followed PRISMA guidelines. Sample images from our records were brought to endorse the findings. Results: Thirty four related articles were chosen from 105. DIE may affect the urinary system in 52.6% of patients. Lower urinary tract symptoms may require urodynamic examination. Ultrasonography offers strong statistical yields for detecting urinary tract lesions or distortions, but magnetic resonance will confirm the diagnosis. Cystoscopy can detect active lesions, although any macroscopic visual appeal is pathognomonic. Endourology is utilized intraoperatively for bladder and ureteral assessment, however transurethral endoscopic excision of bladder lesions had higher recurrence rates. Laparoscopy is the route of choice for treatment; partial cystectomy, and bladder shaving were the most prevalent surgical treatments for bladder endometriosis. Regarding the ureteral treatment, the simple ureterolysis and complex reconstructive techniques were described in most papers. Using anatomical landmarks or neuronavigation, pelvic surgical systematization allows intraoperative neural structure identification. Conclusions: DIE in the urinary system is common, however the number of publications with high level of evidence is limited. The initial tools for diagnosis are ultrasonography and cystoscopy, but magnetic resonance is the most reliable tool. When the patient has voiding symptoms, the urodynamic examination is crucial. Laparoscopy improves lesion detection and anatomical understanding. This approach must be carried out by professionals with high expertise, since the surgery goes beyond the resection of lesions and includes the preservation of nerve structures and urinary tract reconstruction techniques. Objectives (DIE technologies Methods issues Pubmed Embase Scielos Scielo s terms ‘endometriosis (‘endometriosis’ ‘urology urology (‘urology ‘urological ‘urologist urologist ‘urologist’ ‘bladder (‘bladder ORvesical vesical OR’vesical’ ‘ureteral (‘ureteral ‘ureter. ureter ‘ureter . ‘ureter’) guidelines findings Results 105 526 52 6 52.6 patients distortions pathognomonic assessment rates treatment cystectomy papers neuronavigation identification Conclusions common limited cystoscopy tool crucial understanding expertise (‘endometriosis OR’vesical ‘ureter’ 10 5 52. 1

Résumé En France, chaque année, près de 40% des élèves sont orientés vers la filière professionnelle. Oscillant entre l'adolescence et l’âge adulte, ces jeunes sont sommés de « choisir » une orientation, de se positionner sur un métier relevant du travail d’exécution. Dans l’optique d’éclairer cette zone frontière, celle des coulisses entre l’école et l’entrée en formation, il s’agit tout à la fois de rendre compte de la façon dont la sphère éducative et la sphère productive maintiennent et renforcent les inégalités que de la manière dont les filles et les garçons vivent l’humiliation et formulent l’injustice. France année 40 professionnelle ladolescence l adolescence lâge âge adulte orientation dexécution. dexécution d exécution. exécution d’exécution loptique optique déclairer éclairer frontière lécole école lentrée entrée formation sagit s agit lhumiliation humiliation linjustice. linjustice injustice. injustice l’injustice 4

Abstract In France, every year, almost 40% of pupils are advised to take vocational education. These young people, between adolescence and adulthood, are told to « choose » a route and to opt for a low-skilled profession (limited to manual tasks). To shed light on what lies behind the scenes between school and the beginning of vocational education, we aim to uncover the way educational and productive spheres support and reinforce inequality and to show how children experience humiliation and voice their sense of injustice. France year 40 education people adulthood lowskilled low skilled limited tasks. tasks . tasks) injustice 4

Resumo Na França, todos os anos, cerca de 40% dos alunos são orientados para a educação profissionalizante. No limite entre a adolescência e a idade adulta, esses jovens são convocados a “escolher” um rumo, a se colocarem em um ramo relevante do trabalho de produção. Para esclarecer essa zona de fronteira, a do corredor entre a escola e o início de sua formação, é necessário detalhar tanto a forma como as esferas educativa e produtiva mantêm e produzem as desigualdades quanto a maneira como jovens vivem a humilhação e formulam a injustiça. França anos 40 profissionalizante adulta escolher “escolher rumo produção fronteira formação injustiça 4

ABSTRACT Background: the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. Materials and Methods: retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. Results: we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team’s adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. Conclusion: the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries. Background 1 Brazil Methods 200 2018 service 2007, , (2007) 2008, 2008 (2008) 247 24 7 24/ 2010, 2010 (2010) thirdparty third party 2013. 2013 . (2013) Results 116 69 59%, 59 59% (59%) 46 40%, 40 40% (40%) 1% (1% open converted respectively 11 80 2016 p<0.001. p0001 p p<0.001 0 001 (p<0.001) hemolok hem o lok feasible teams team s adherence 85 201 rd physicians reported 30day day 30 Conclusion reproducible optimization lowerincome lower income countries 20 (2007 (2008 2 (2010 (2013 6 5 (59% 4 (40% (1 8 p000 p<0.00 00 (p<0.001 3 (200 (201 (59 (40 ( p00 p<0.0 (p<0.00 (20 (5 (4 p0 p<0. (p<0.0 (2 p<0 (p<0. p< (p<0 (p< (p

RESUMO Introdução: o presente estudo tem como objetivo avaliar as medidas que permitiram a implementação de cirurgias laparoscópicas de urgência em hospital de ensino médico ao longo de 15 anos. Método: foi realizado estudo clínico retrospectivo de pacientes submetidos a Apendicectomia aberta ou Laparoscópica no período de 15 anos (2004 a 2018). Os dados clínicos foram confrontados com as ações implementadas: 1) Treinamento dos médicos residentes em cirurgia minimamente invasiva (2007); 2) Uso do endoclip para tratamento do coto apendicular (2008); 3) Disponibilidade do set de laparoscopia em tempo integral para o Pronto Socorro (2010); e, 4) Terceirização do serviço de manutenção do set e materiais de vídeo e uso do endoclip Hem-o-lok® para tratamento do coto apendicular (2013). Resultados: foram realizadas 1.168 cirurgias, das quais 691 abertas (59%), 465 laparoscopias (40%) e 12 convertidas (1%). O treinamento da equipe levou à realização de 11% de laparoscopia (2007) e o uso do endoclip para tratamento do coto apendicular para 16% (2008). Com a disponibilização do set de vídeo em tempo integral para o Pronto Socorro a partir de 2011, houve aumento de laparoscopias para 26% (2012). A padronização do endoclip Hem-o-lok® no tratamento do coto apendicular aumentou para 85% e a partir de 2016 foi realizado em todos os casos, sem complicação relacionada ao seu uso, mesmo em apendicites complicadas. Conclusão: o emprego da laparoscopia no serviço de urgência envolve além do treinamento da equipe cirúrgica, investimento tecnológico contínuo e uso de técnicas que sejam factíveis, viáveis e seguras. Introdução 1 Método 2004 (200 2018. 2018 . 2018) implementadas 2007 2 2008 (2008) 3 2010 (2010) 4 Hemolok® Hemolok Hem lok® lok Hem-o-lok 2013. 2013 (2013) Resultados 1168 168 1.16 69 59%, 59 59% , (59%) 46 40% 40 (40% 1%. 1% (1%) 11 (2007 16 2008. 2011 26 2012. 2012 (2012) 85 201 casos complicadas Conclusão cirúrgica factíveis seguras 200 (20 (2008 (2010 (2013 116 1.1 6 5 (59% (40 (1% (2012 8 20 (2 (201 1. (59 (4 (1 ( (5

BACKGROUND: The correct use of surgical antibiotic prophylaxis (SAP), as stipulated in evidence-based guidelines, is essential to prevent surgical site infections (SSIs) following orthopaedic procedures and consequently the impact thereof on the patient and healthcare system. Orthopaedic SSIs are associated with devastating complications with a great burden of disease on patients. METHODS: A cross-sectional study was performed in a 186-bed private hospital, located in North West province, South Africa. Retrospective data of adult patients who underwent orthopaedic surgery from 1 January 2020 to 31 December 2020 were included. Data were obtained from the study hospital's theatre registers, anaesthetic notes, patient medical records and patient antimicrobial prescription charts. Descriptive statistical analysis was used to determine the compliance (indication, choice, route of administration, dose, administration time, re-dosing and duration) of orthopaedic SAP administration with prescribing guidelines. RESULTS: Of the 942 orthopaedic procedures, SAP was correctly administered or omitted in 742 cases (78.8%). The total choice of SAP was correct in 738 cases (78.3%). SAP was administered intravenously 100% of the time and was prescribed at the correct dose in 632 cases (77.5%). However, SAP re-dosing occurred only in one of the three prolonged procedures, and the preoperative SAP administration time was only indicated in 34.4% of the cases. The correct duration of SAP was 75.9%. The overall compliance rate to SAP guidelines regarding indication, choice, dose and duration was 57.5%. SSIs developed in 0.9% of the patients, resulting in the death of one. CONCLUSION: Orthopaedic SAP practices moderately deviated from current SAP guidelines. Apparent overuse, incorrect dosing and prolonged duration were identified as burdens to overcome. Special attention should be paid to dosing adjustments for patients weighing more than 120 kg. However, certain components such as route of administration, administration time, SAP indication and SAP correct choice showed greater compliance percentages. The low prevalence of SSIs supports a positive reporting of the findings Level of evidence: Level 4.

RESUMO Objetivo: avaliar o processo de trabalho dos profissionais de saúde na atenção primária no enfrentamento à Covid-19. Método: estudo qualitativo, que utilizou como base conceitual o processo de trabalho em saúde, e, como referencial metodológico, a pesquisa avaliativa. A coleta foi realizada com 23 profissionais de saúde, entre julho e setembro de 2021, nas unidades básicas de saúde em um município no noroeste do Paraná-Brasil. Para a análise organizaram-se os dados por meio do software MAXQDA, e cada segmento de dado foi organizado conforme os significados. Resultados: emergiram duas categorias, a saber: Dificuldades enfrentadas na reorganização da ambiência, atividades programáticas e dimensionamento dos profissionais da atenção primária à saúde; e Organização do fluxo de atendimento ao usuário com Covid-19 na atenção primária à saúde. Conclusão: este estudo reforça a indispensabilidade da avaliação do processo de trabalho para melhoria da assistência em saúde, principalmente em condições de emergência de saúde pública. Objetivo Covid19. Covid19 Covid 19. 19 Método qualitativo metodológico avaliativa 2 2021 ParanáBrasil. ParanáBrasil Paraná Brasil. Brasil Paraná-Brasil organizaramse organizaram se MAXQDA significados Resultados categorias saber ambiência Covid-1 Conclusão pública Covid1 1 202 Covid- 20

ABSTRACT Objective: to analyze the health care provided to women in peripartum and parturition during the pandemic period of COVID-19. Method: analytical and cross-sectional study, conducted with 404 puerperal women from three maternity hospitals in Paraná - Brazil, between the months of September-December/2021. Data were analyzed by chi-square test (p<0.05) to verify the association. Results: care was taken to prevent COVID-19 in peripartum and parturition (physical distance 89.4%, use of mask 96.8%, respiratory etiquette 74.3%, hand hygiene 97.8%), presence of a companion (97.2%), respect for the choice of parturition route (71%) and skin-to-skin contact (70.2%). A high rate of early hospitalization (dilation between 0-3 cm), low offer of non-pharmacological methods for pain relief and low incentive to breastfeeding were observed. Conclusion: the study contributes to improve health actions about the natural physiology of parturition and to strengthen the rights in parturition, even in vulnerable pandemic periods. Objective COVID19. COVID19 COVID 19. 19 Method crosssectional cross sectional 40 Brazil SeptemberDecember/2021. SeptemberDecember2021 SeptemberDecember September December/2021. December 2021 September-December/2021 chisquare chi square p<0.05 p005 p 0 05 (p<0.05 association Results COVID-1 physical 894 89 4 89.4% 968 96 8 96.8% 743 74 3 74.3% 97.8%, 978 97.8% , 97 97.8%) 97.2%, 972 97.2% 2 (97.2%) 71% 71 (71% skintoskin skin 70.2%. 702 70.2% . 70 (70.2%) dilation 03 0- cm, cm cm) nonpharmacological non pharmacological observed Conclusion periods COVID1 1 SeptemberDecember/2021 SeptemberDecember202 December2021 December/2021 202 September-December/202 p<0.0 p00 (p<0.0 COVID- 89.4 9 96.8 7 74.3 97.8 97.2 (97.2% (71 70.2 (70.2% SeptemberDecember/202 SeptemberDecember20 December202 December/202 20 September-December/20 p<0. p0 (p<0. 89. 96. 74. 97. (97.2 (7 70. (70.2 SeptemberDecember/20 SeptemberDecember2 December20 December/20 September-December/2 p<0 (p<0 (97. ( (70. SeptemberDecember/2 December2 December/2 September-December/ p< (p< (97 (70 SeptemberDecember/ December/ September-December (p (9

RESUMEN Objetivo: analizar la atención a la salud prestada a las mujeres en el preparto y el parto durante el periodo de pandemia de COVID-19. Método: estudio analítico y transversal, realizado con 404 puérperas de tres maternidades de Paraná - Brasil, entre los meses de septiembre-diciembre/2021. Los datos fueron analizados por el test chi-cuadrado (p<0,05) para verificar la asociación. Resultados: Se mantuvieron los cuidados con la prevención del COVID-19 en el preparto y el parto (distancia física 89,4%, uso de mascarilla 96,8%, protocolo respiratorio 74,3%, higiene de manos 97,8%), presencia de un acompañante (97,2%), respeto a la elección de la vía de parto (71%) y contacto piel con piel (70,2%). Se observó una alta tasa de hospitalización precoz (dilatación entre 0-3cm), una baja oferta de métodos no farmacológicos para el alivio del dolor y un escaso fomento de la lactancia materna. Conclusión: el estudio contribuye a mejorar las actuaciones sanitarias sobre la fisiología natural del parto y a reforzar los derechos en el momento del nacimiento, incluso en periodos vulnerables de pandemia. Objetivo COVID19. COVID19 COVID 19. 19 Método transversal 40 Brasil septiembrediciembre/2021. septiembrediciembre2021 septiembrediciembre septiembre diciembre/2021. diciembre 2021 septiembre-diciembre/2021 chicuadrado chi cuadrado p<0,05 p005 p 0 05 (p<0,05 asociación Resultados COVID-1 distancia 894 89 4 89,4% 968 96 8 96,8% 743 74 3 74,3% 97,8%, 978 97,8% , 97 97,8%) 97,2%, 972 97,2% 2 (97,2%) 71% 71 (71% 70,2%. 702 70,2% . 70 (70,2%) dilatación 03cm, 03cm cm 3cm 0-3cm) materna Conclusión nacimiento COVID1 1 septiembrediciembre/2021 septiembrediciembre202 diciembre2021 diciembre/2021 202 septiembre-diciembre/202 p<0,0 p00 (p<0,0 COVID- 89,4 9 96,8 7 74,3 97,8 97,2 (97,2% (71 70,2 (70,2% 0-3cm septiembrediciembre/202 septiembrediciembre20 diciembre202 diciembre/202 20 septiembre-diciembre/20 p<0, p0 (p<0, 89, 96, 74, 97, (97,2 (7 70, (70,2 septiembrediciembre/20 septiembrediciembre2 diciembre20 diciembre/20 septiembre-diciembre/2 p<0 (p<0 (97, ( (70, septiembrediciembre/2 diciembre2 diciembre/2 septiembre-diciembre/ p< (p< (97 (70 septiembrediciembre/ diciembre/ septiembre-diciembre (p (9

SUMMARY: Introduction and objective: During the last decade there has been a wide spread of minimally invasive thoracic approaches for the treatment of pulmonary and mediastinal diseases. Classically, thoracic surgical pathology derived from thyroid and parathyroid diseases has been treated by open approaches such as sternotomy, cervicoesternotomy and thoracotomy. However, in recent years, robotic surgery has emerged as a new route of minimally invasive approach that provides similar results and significant advantages over other minimally invasive approaches such as laparoscopy and videothoracoscopy. Its applicability in the surgical treatment of mediastinal lesions has been amply demonstrated in the literature. The aim of this article is to describe the indications of thoracic robotic surgery in thyroid and parathyroid pathology, as well as to comment on the main technical aspects related to these procedures. Synthesis: Robotic thoracic surgery is especially indicated in cases of «forgotten goiters» and ectopic goiters. In cases of cervical-mediastinal goiters, the combined cervical and thoracic robotic approach has been shown to be a feasible and safe option. With regard to mediastinal ectopic parathyroids, the robotic approach offers significant advantages such as 3D vision and the optimization of the maneuverability of instruments that facilitate the visualization and dissection of the gland. Conclusions: Robotic surgery is an effective and safe minimally invasive approach for the treatment of thyroid and parathyroid pathology of mediastinal location and could constitute the approach of choice in patients with forgotten goiters, ectopic goiters and mediastinal parathyroid adenomas.

RESUMEN: Introducción y objetivo: Durante la última década se ha producido una amplia difusión de los abordajes torácicos mínimamente invasivos para el tratamiento de enfermedades pulmonares y mediastínicas. Clásicamente, la patología quirúrgica torácica derivada de afecciones de tiroides y paratiroides ha sido tratada mediante abordajes abiertos como la esternotomía, la cervicoesternotomía y la toracotomía. Sin embargo, en los últimos años, la cirugía robótica ha surgido como una nueva vía de abordaje mínimamente invasiva que aporta resultados similares y ventajas significativas sobre otros abordajes mínimamente invasivos como la laparoscopia y la videotoracoscopia. Su aplicabilidad en el tratamiento quirúrgico de lesiones mediastínicas ha quedado ampliamente demostrada en la literatura. El objetivo del presente artículo es describir las indicaciones de la cirugía robótica torácica en la patología tiroidea y paratiroidea, así como comentar los principales aspectos técnicos relacionados con estos procedimientos. Síntesis: La cirugía robótica torácica está indicada especialmente en casos de «bocios olvidados» y de bocios ectópicos. En casos de bocios cérvico-mediastínicos el abordaje combinado cervical y torácico robótico ha demostrado ser una opción factible y segura. Por lo que respecta a las.paratiroides ectópicas de localización mediastínica, el abordaje robótico ofrece ventajas significativas como la visión en 3D y la optimización de la maniobrabilidad de instrumentos que facilitan la visualización y disección de la glándula. Conclusiones: La cirugía robótica constituye un abordaje mínimamente invasivo eficaz y seguro para el tratamiento de la patología tiroidea y paratiroidea de localización mediastínica y podría constituir el abordaje de elección en pacientes con bocios olvidados, bocios ectópicos y adenomas paratiroideos de localización mediastínica.

Abstract The subcutaneously pharmacological administration represents the best choice in the management of symptoms in palliative cancer patients. Specially at home, it is essential to propose sedation in a situation of agony. Also, it's common that cancer patients to have peripheral access central catheters due to the multiple cycles of cytostatic medication they receive throughout their lives. For this reason and given the situation of failure of subcutaneous sedation in agony, intravenous sedation through these devices at home could be considered as an alternative. This working hypothesis is made clear based on our experience with intravenous sedation through a central venous reservoir (CVR) in a patient diagnosed with stage IV pancreatic adenocarcinoma at the end of her life. The patient died with good control of symptoms and complete sedation at home.

Resumen La vía subcutánea representa la vía de elección en el manejo de los síntomas del paciente oncológico paliativo. De especial importancia en domicilio, resulta fundamental para plantear sedación en situación de agonía. Por otro lado, es habitual que el paciente oncológico dispongo de catéteres centrales de acceso periférico debido a los múltiples ciclos de medicación citostática que reciben a lo largo de su vida. Por ello, y ante la situación de fracaso a la sedación por vía subcutánea en situación de últimos días, podría plantearse como alternativa la sedación endovenosa a través de estos dispositivos, en domicilio. Esta hipótesis de trabajo se pone de manifiesta en base a nuestra experiencia de sedación intravenosa a través de reservorio venoso central (RVC) en paciente con diagnóstico de adenocarcinoma de páncreas estadio Iv en situación de agonía. La paciente falleció con buen control de síntomas y sedación completa en domicilio.

ABSTRACT Local Anesthetics (LA) of the monoamide family have become the group of greatest demand during surgical procedures due to a lower incidence of adverse reactions in the metabolism of human beings. Bupivacaine belongs to this group. In Cuba, there is a new formulation of this drug register in CECMED at 2014, now with hyperbaric presentation, for which a prospective descriptive post commercialization study was carried out in the different surgical interventions performed at the Pedro Kourí Institute of Tropical Medicine (IPK) since July 2018 to February 2019. Hyperbaric bupivacaine administered via the spinal subarachnoid route was used as the anesthetic of choice in 21 of the interventions performed during this period. 71.4% of the operated patients presented some pathological history, the most frequent being arterial hypertension, bronchial asthma, diabetes mellitus and HIV infection, respectively. The 57.15% of the patients used one or two medications as their basic treatment, 9.5% more than two medications and 33% had no treatment at all. Anesthesia was effective in 20 of the interventions performed and it was not in only one patient, a result that could be related to failures in the administration technique (low volume of the drug and low speed of drug administration), but not with the quality intrinsic to the product. These results demonstrated that Cuban-made hyperbaric bupivacaine provided effective and safe surgical analgesia in studied patients.

RESUMEN Los Anestésicos Locales (AL) de la familia monoamidas se han convertido en el grupo de mayor demanda durante la realización de procedimientos quirúrgicos debido a una menor incidencia de reacciones adversas en el metabolismo del ser humano. Dentro de este grupo se encuentra la bupivacaína. En Cuba, existe una nueva formulación de este fármaco con registro CECMED en el 2014, ahora con presentación hiperbárica, por lo que se realizó un estudio de post comercialización de tipo observacional descriptivo prospectivo, en las diferentes intervenciones quirúrgicas realizadas en el Instituto de Medicina Tropical Pedro Kourí (IPK) desde julio 2018 a febrero de 2019. La bupivacaína hiperbárica administrada por vía espinal subaracnoidea, fue utilizada como anestésico de elección en 21 de las intervenciones realizadas durante este período. El 71,4 % de los pacientes operados presentaron algún antecedente patológico, siendo los más frecuentes la hipertensión arterial, asma bronquial, diabetes mellitus y la infección por VIH. El 57,15% de los pacientes llevaban como tratamiento de base uno o dos medicamentos, el 9,5 % más de dos medicamentos y el 33 % no llevaban tratamiento alguno. La anestesia fue efectiva en 20 de las intervenciones realizadas y solo en un paciente no lo fue, resultado que pudiera estar relacionado con fallos en la técnica de administración (bajo volumen del fármaco y baja velocidad de administración del mismo), pero no con la calidad intrínseca del producto. Estos resultados demostraron que la bupivacaína hiperbárica de fabricación cubana, proporcionó una efectiva y segura analgesia quirúrgica en los pacientes estudiados.

Resumo Objetivo Comparar as técnicas de osteossíntese de fraturas intertrocantéricas com o parafuso dinâmico de quadril (dynamic hip screw, DHS, em inglês) pelas vias de acesso de Hardinge e minimamente invasiva do quadril, avaliando o tempo cirúrgico, o grau de dor no pós-operatório imediato, a perda hematimétrica, e os aspectos funcionais de mobilidade ativa. Métodos Estudo clínico randomizado e duplo-cego, em que 66 pacientes com fratura intertrocantérica foram submetidos a osteossíntese com DHS. Os pacientes foram divididos em um grupo teste, submetidos ao acesso minimamente invasivo, e um controle, em que a cirurgia foi realizada pela via de Hardinge. Resultados Os pacientes submetidos ao tratamento pela via minimamente invasiva apresentaram um grau de dor pós-operatória inferior em comparação ao grupo tratado pela via lateral de Hardinge (p< 0,001), assim como menor perda hematimétrica (p< 0,001), menor tempo operatório (p< 0,001), e melhora nos testes de mobilidade ativa pós-operatória imediata (p< 0,05). Conclusão O estudo demonstrou a superioridade clínica nos parâmetros analisados da via de acesso minimamente invasiva em relação ao acesso de Hardinge para a fixação de fraturas intertrocantéricas, quando o DHS for a opção de osteossíntese escolhida. Nível de evidência I.

Abstract Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route (p< 0.001), as well as lower hematimetric loss (p< 0.001), shorter operative time (p< 0.001), and improvement in immediate postoperative active mobility tests (p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

The present work is associated with research concentrating on the innovation and use of hybrid heat treatment for eutectoid steel powder (0.8 wt%) reinforced Al-Zn-Mg (Al 7075) alloy composites. Due to high hardness, wear resistance, tensile strength and flexibility modifying heat treatment, heat treatable aluminium metal matrix composites reinforced with heat treatable hard steel particles may be the choice to explore. In this work, an attempt is made to increase hardness and tensile properties to higher levels through hybrid heat treatment, comprising simultaneous treatment to matrix and reinforcement in 3 different routes (Pearlite, Bainite and Martensite) compared to conventional age hardening treatment. SEM images and microhardness distribution witnessed the phase transformation in both matrix and reinforcement. Aging kinetics in conventional age hardening and hybrid treatments is accelerated by the increase in the quantity of reinforcement and increase in aging temperature. The improvement in hardness and tensile strength obtained by conventional age hardening path is further improved by the hybridisation path. Hybridisation route with martensite reinforcement phase shows excellent result in hardness, strength followed by bainite and pearlite path respectively in the decreasing order. In all heat treatment cycles, lower aging temperature marks greater property enhancement compared to higher temperature. Al 7075 with 6 wt% steel powder reinforced (martensite form) composite showed excellent peak age hardness, tensile strength compared to lesser quantity reinforced composites.