ABSTRACT Purpose: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. Methods: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. Results: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. Conclusion: The meibography health score exhibited good interrater reliability, particularly in severe cases. Purpose simple subjective isotretinoininduced induced changes Methods score. margins groups (A (B (C radiologists reliability Results 064 0 64 0.64 078 78 0.78 059 59 0.59 090 90 0.90 respectively 0.62, 062 62 (0.62 035 35 0.35 082 82 0.8 (0.78 1. . Furthermore Conclusion cases 06 6 0.6 07 7 0.7 05 5 0.5 09 9 0.9 0.62 (0.6 03 0.3 08 8 0. (0.7 (0. (0 (

RESUMEN Introducción: La relación entre las enfermedades periodontal y coronaria ha sido estudiada con profundidad en los últimos años y se ha concluido, que los individuos con afección periodontal tienen mayor riesgo de presentar enfermedades cardiovasculares. Objetivo: Identificar la asociación entre la enfermedad periodontal y la cardiopatía isquémica en pacientes ingresados en un servicio de terapia intermedia. Métodos: Se realizó un estudio observacional y descriptivo de los pacientes hospitalizados en la Sala de Terapia Intermedia del Hospital Provincial Vladimir Ilich Lenin de Holguín, desde 2018 hasta 2022. La muestra se dividió en 2 grupos: enfermos y sanos con 50 y 75 integrantes, respectivamente. Las variables analizadas fueron edad, sexo, forma de presentación de la cardiopatía isquémica, factores de riesgo periodontales y coronarios, así como estado periodontal según el índice periodontal de Russel. Se emplearon métodos teóricos, empíricos y de la estadística descriptiva. Resultados: Existió un predominio del sexo masculino en ambos grupos (enfermos y sanos) con 27 y 41 pacientes, respectivamente, así como del grupo etario de 60-79 años con 54,4 %. El infarto agudo de miocardio afectó a 72,0 % de los enfermos. El consumo de café y la presencia de hipertensión arterial fueron los factores de riesgo más representativos; la mayor incidencia de pérdidas óseas avanzadas se presentó en los enfermos. Conclusiones: Se pudo constatar que existe asociación entre la enfermedad periodontal y la cardiopatía isquémica, con resultados estadísticamente significativos.

ABSTRACT Introduction: The relationship between the periodontal and coronary diseases has been deeply studied in the last years and it has been concluded that individuals with periodontal affection have a higher risk of suffering from cardiovascular diseases. Objective: To identify the association between periodontal disease and ischemic heart disease in patients admitted to an intermediate therapy service. Methods: An observational and descriptive study of the patients hospitalized in the Intermediate Therapy Room of Vladimir Ilich Lenin Provincial Hospital was carried out in Holguín, from 2018 to 2022. The sample was divided into 2 groups: sick and healthy with 50 and 75 members, respectively. The analyzed variables were age, sex, form of presentation of the ischemic heart disease, periodontal and coronary risk factors, as well as periodontal state according to the Russel periodontal index. Theoretical, empiric and descriptive statistic methods were used. Results: There was a prevalence of the male sex in both groups (sick and healthy) with 27 and 41 patients, respectively, as well as the 60-79 age groups with 54.4 %. Acute heart attack affected 72.0 % of the sick patients. Coffee consumption and the presence of hypertension were the most representative risk factors; the highest incidence of advanced bony loss was presented in sick patients. Conclusions: The association between periodontal disease and ischemic heart disease could be verified, with statistically significant results.

Abstract The objective of this paper is to analyze the historical behavior of student enrollment in a technological high mid-level school, in Ciudad Juárez, Chihuahua, in order to estimate future demand, to identify the required infrastructure capacity in the institution, in terms of classrooms and teaching staff and calculate the student-teacher and student-classroom ratios and compare them with the international and Mexican average ratios. This is due to the fact that at the beginning of the school cycles, there were situations of lack of capacity to serve the students on time, having to improvise in the adequacy of the facilities and teaching staff. Different methods of quantitative forecasts were reviewed that, according to the historical behavior of the data, the one that most closely adheres to mentioned behavior was used. Data from 15 school periods available since its inauguration were collected. Data treatment begins with normality tests in order to establish the statistic that was used. Once the appropriate forecast model was used, it was validated with 5 periods to check if the calculated forecasts adhered to the real data that was presented from period 16 to 20, likewise, the statistical hypothesis tests were carried out for validation of the models used. Tests were performed with different level and trend smoothing factors, using the one that showed the lowest error per period, which ranged from 0.21% to 8.88%. The ratios student-teacher and student-class found were 36 and 38 respectively.

Resumen El objetivo de este artículo es analizar el comportamiento histórico de la matrícula estudiantil en un bachillerato tecnológico de Ciudad Juárez, Chihuahua, con la finalidad de estimar la demanda futura. El propósito es determinar la capacidad requerida de infraestructura en la institución en lo referente a aulas y personal docente, y calcular las proporciones alumnos-maestro y alumnos-aula para compararlos con las proporciones medias internacionales y de México. Esto se debe a que, en los inicios de los ciclos escolares, se suelen presentar situaciones de falta de capacidad para atender al alumnado en tiempo, por lo que se tuvo que improvisar en la adecuación de las instalaciones y personal docente. Para este estudio, se revisaron diferentes métodos de pronósticos cuantitativos; a partir de esto, y de acuerdo con el comportamiento histórico de los datos, se utilizó el que más se apegaba a dicho comportamiento. En concreto, se colectaron datos de 15 periodos lectivos disponibles desde su inauguración. El tratamiento de los datos inició con pruebas de normalidad con el objetivo de establecer el estadístico que se utilizó. Una vez utilizado el modelo de pronósticos apropiado, se validó con 5 periodos para comprobar si los pronósticos calculados se apegan a los datos reales que se presentaron del periodo 16 al 20; asimismo, se realizaron las pruebas de hipótesis estadísticas para validación del modelo utilizado. Además, se efectuaron pruebas con diferentes factores de suavización de nivel y tendencia, y se empleó el que mostró el menor error por periodo, el cual varió desde 0.21 % a 8.88 %. Las proporciones alumnos-maestro y alumnos-aula encontradas fueron de 36 y 38, respectivamente.

Resumo O objetivo deste artigo é analisar o comportamento histórico da matrícula de alunos em uma escola secundária tecnológica em Ciudad Juárez, Chihuahua, a fim de estimar a demanda futura. O objetivo é determinar a capacidade de infraestrutura necessária na instituição em termos de salas de aula e pessoal docente, e calcular as proporções aluno-professor e aluno-sala de aula para compará-las com as proporções médias internacionais e mexicanas. Isto porque, no início dos ciclos escolares, costumam surgir situações de falta de capacidade para atender os alunos atempadamente, razão pela qual foi necessário improvisar na adaptação das instalações e do corpo docente. Para este estudo, foram revisados diferentes métodos de previsão quantitativa; A partir disso, e de acordo com o comportamento histórico dos dados, foi utilizado aquele que mais aderiu a esse comportamento. Especificamente, foram coletados dados de 15 períodos letivos disponíveis desde a sua inauguração. O tratamento dos dados iniciou-se com testes de normalidade para estabelecer as estatísticas utilizadas. Uma vez utilizado o modelo de previsão adequado, foi validado com 5 períodos para verificar se as previsões calculadas estão de acordo com os dados reais que foram apresentados do período 16 ao 20; Da mesma forma, foram realizados testes de hipóteses estatísticas para validar o modelo utilizado. Além disso, foram realizados testes com diferentes níveis e fatores de suavização de tendência, sendo utilizado aquele que apresentou menor erro por período, que variou de 0,21% a 8,88%. As proporções aluno-professor e aluno-sala encontradas foram de 36 e 38, respectivamente.

Resumen Introducción: La tasa de cesáreas es importante para cualquier centro de atención hospitalaria. Es un indicador de calidad utilizado en muchas publicaciones y, aunque no es una estadística vital, se ha reconocido como un indicador de la calidad de atención. Objetivo: Conocer la tasa de cesáreas en una institución utilizando los grupos de Robson. Métodos: Estudio retrospectivo de bases de datos de la maternidad. Se consideraron las variables de paridad, cesárea anterior, trabajo de parto, inducción, para poder clasificar la población según los grupos de Robson. El análisis consideró los nacimientos desde octubre del 2014 hasta junio del 2021. Resultados: Se observó una tasa de 27,9% en el periodo de estudio. El grupo 5 de Robson, que considera pacientes con una o más tasa de cesáreas, mostró una elevada tasa (68%), contribuyó con el 36% de todas las cesáreas, siendo solamente el 15% de la población. El grupo 3, de multíparas con trabajo de parto espontáneo, tuvo una tasa del 1,8%, contribuyó al 0,4% de las cesáreas, siendo el 20% de la población de estudio. Se encontró una correlación significativa entre uso de parto instrumental y menor tasa de cesáreas, al realizar análisis por operador (Spearman rho: –0,45; IC95%: –0,788 a –0,0190; p = 0,043). Conclusión: La tasa de cesáreas observada fue 27,9%, y las pacientes con cesárea anterior son un grupo donde pueden concentrarse mayores esfuerzos para bajar la tasa global. Entre los operadores, los usuarios de parto instrumental tuvieron menor proporción cesáreas.

Abstract Introduction: The cesarean section rate is important for any hospital care center. It is a quality indicator used in many publications, and although not a vital statistic, it has been recognized as an indicator of the quality of care. Objective:: To know the cesarean section rate in an institution using Robson groups. Methods: Retrospective study of maternity databases. The variables of parity, previous cesarean section, labor, induction was considered in order to classify the population according to Robson groups. The analysis considered births from October 2014 to June 2021. Results: A rate of 27.9% was observed in the study period. Robson’s group 5, which considers patients with one or more rate of cesarean sections, showed a high rate (68%), contributing to 36% of all cesarean sections, being only 15% of the population. Group 3, multiparas with spontaneous labor, had a rate of 1.8%, contributing to 0.4% of cesarean sections, making up 20% of the study population. A significant correlation was found between the use of instrumental delivery and a lower rate of cesarean sections, when analyzing by operator (Spearman rho: –0.45; IC95%: –0.788 to –0.0190; p = 0.043). Conclusion: The observed cesarean section rate was 27.9%, and patients with a previous cesarean section are a group where greater efforts can be concentrated to lower the overall rate. Among the operators, users of instrumental delivery had a lower proportion of cesarean sections.

ABSTRACT Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations

RESUMEN Introducción: El cáncer cervicouterino ocupa el tercer lugar como causa de defunción por neoplasias malignas a nivel mundial, afectando principalmente a los países de ingresos bajos y medianos. Hacia el 2020 se estimó una incidencia de 604 000 nuevos casos. Objetivo: Caracterizar los principales indicadores hospitalarios del Programa de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: Se realizó un estudio observacional, descriptivo y transversal, que permitió caracterizar los principales indicadores hospitalarios del Programa en el Servicio de Patología de Cuello del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero del 2020 a diciembre del 2022. La población de estudio estuvo constituida por 443 mujeres. Los datos recopilados fueron analizados mediante técnicas de estadística descriptiva, expresándose en frecuencia y porcentajes. Resultados: De las mujeres estudiadas, 60,9 % presentaron lesión intraepitelial cervical de alto grado de malignidad, con 32,6 % positivo a cáncer cervicouterino. El porcentaje global de pruebas citológicas no útiles fue de 2,07 y sin células de la zona de transformación, de 4,01; ambos indicadores de calidad. Existió una alta significación en cuanto a la tasa de cobertura global de las mujeres en riesgo (K=0,615), demostrando que los resultados de la citología reflejan en gran medida los diagnósticos de la histología, con una buena concordancia. Conclusiones: La prueba citológica cérvico-vaginal sigue siendo el método diagnóstico de mayor valor para detectar neoplasia intraepitelial cervical y carcinoma en estadio precoz en grandes masas de población.

Resumen Introducción : Es fundamental poner en práctica ac ciones preventivas y de diagnóstico poblacional precoz para detectar a las personas en riesgo de desarrollar Diabetes tipo 2 (DT2). El objetivo del trabajo fue evaluar el desempeño del score FINDRISC como método de cri bado para detectar prediabetes y DT2 sin diagnostico en trabajadores municipales. Métodos : Estudio epidemiológico, descriptivo de corte transversal desde 10/21 al 3/22. Ingresaron voluntarios mayores a 18 años sin diagnóstico previo de DT2, se excluyó quienes padecían una enfermedad aguda, emba razadas o que realizaban tratamiento con medicamentos que modifiquen la glucemia. Los participantes comple taron el FINDRISC y realizaron una Prueba Oral de Tole rancia a la Glucosa (POTG). El desempeño se determinó mediante el cálculo de la sensibilidad (S), especificidad (E), y el área bajo la curva (AUC-ROC). Se utilizó un índice de Youden para definir el punto de corte óptimo. Resultados : Ingresaron 148 personas, entre 18-67 años, con media de edad 42.9 ± 11.8 años, el 68.9% de sexo masculino. La frecuencia de DT2 sin diagnóstico fue del 3.3% (n = 5) y de prediabetes del 12.2% (n = 18). El promedio de puntos de FINDRISC fue de 10.0 ± 4.8. El punto de corte optimo fue ≥ 13 (S = 65.2% y E = 74.4%) y el AUC-ROC 0.76 (IC95%: 0.66-0.86). Conclusión : El FINDRISC demostró ser un método eficaz para identificar personas con DT2 y prediabetes con punto de corte 13 en la población, lugar y periodo de estudio.

Abstract Introduction : It is fundamental to put into practice preventive and early population diagnosis actions to detect people at risk for developing Type 2 diabetes (T2D). The aim of this study was to evaluate the FINDRISC score performance as screening method to detect prediabetes and unknown T2D in municipal workers. Methods : descriptive epidemiological and cross-sectional study from 10/21 to 03/22. People suffering from a severe illness, pregnant or were already receiv ing drugs that modify blood glucose, were excluded. Participants completed the FINDRISC and performed an oral glucose tolerance test (OGTT). The performance of the FINDRISC was determined by calculating sensitiv ity, specificity, and area under the curve (AUC-ROC). The Youden’s J statistic index was used to define the optimal cutoff point. Results : 148 subjects between the ages of 18-65 were admitted, with a mean age of 42,9 ± 11,8, the 69% being males. The frequency of unknown T2D was of 3.3% (n = 5) and frequency of prediabetes was of 12.2% (n = 18). The mean of FINDRISC score was of 10.0 ± 4.8. The optimal cutoff point was ≥ 13 (sensitiv ity = 65.2%, Specificity = 74.4%) and the AUC-ROC 0.76 (IC95%: 0.66-0.86). Conclusion : The FINDRISC proved to be an effective method for identifying people with undiagnosed T2D and prediabetes with a cut-off point of 13 in the popula tion, place, and study period.

ABSTRACT OBJECTIVE To evaluate, using spatial analysis, the occurrence of American Cutaneous Leishmaniasis (ACL) and analyze its association with the municipal human development index (MHDI) and deforestation in the state of Amazonas, Brazil, from 2016 to 2020. METHODS This ecological study, carried out from January 2016 to December 2020, included the 62 municipalities of the state of Amazonas. The incidence rate of ACL was determined in space and time. Using Multiple Linear Regression by Ordinary Least Squares (OLS) and Spatial Autoregressive Regression (SAR) models, the relationship between incidence rates and Human Development Index (HDI) and deforestation was analyzed., The high- and low-risk clusters were identified by employing the Getis-Ord Gi* statistic. RESULTS A total of 7,499 cases of ACL were registered in all 62 municipalities in the state. Most cases were in male (n=5,924; 79.24%), with the greatest frequency in the population aged from 20 to 39 years (n=3,356; 44.7%). The incidence rate in the state of Amazonas was 7.34 cases per 100,000 inhabitants-year, with the municipalities of Rio Preto da Eva and Presidente Figueiredo showing the highest rates (1,377.5 and 817.5 cases per 100,000 population-year, respectively). The ACL cases were clustered into specific areas related to those municipalities with the highest incidence rates. The SAR model revealed a positive relationship between ACL and deforestation. CONCLUSIONS The occurrence of ACL was evident in a variety of patterns in the state of Amazonas; the high incidence rates and persistence of this disease in this state were linked to deforestation. The temporal distribution showed variations in the incidence rates during each year. Our results can help optimize the measures needed to prevent and control this disease in the state.

Abstract OBJECTIVE: To determine the relationship between the extent of alcohol, tobacco and illicit substance use and adverse obstetric outcomes to enable obstetric care providers to assess the risks of substance use. MATERIALS AND METHODS: Retrospective, observational, analytical and cross-sectional study of a case series of postpartum patients who were admitted to the Gynaecology and Obstetrics Service of the General Hospital of Saltillo between March and June 2023 and who reported alcohol, tobacco or drug use during pregnancy. After the obstetric procedure, the ASSIST tool or screening test for alcohol, tobacco and drug use was applied. Pearson's χ2 test and Fisher´s exact statistic were used to assess their association with adverse outcomes according to the level of use. RESULTS: Of 863 obstetric attendances, 47 patients 5.4% reported active use of different substances during pregnancy; of these, 22 used 2 substances, with a trend between tobacco and cannabis use for adverse obstetric outcomes p = 0.16 and 0.17, respectively. The most common adverse obstetric outcome was low birth weight in 22 of 47 patients. CONCLUSIONS: The substances with the highest tendency for adverse obstetric outcome were tobacco and cannabis, and the most common adverse neonatal outcome was low birthweight.

Resumen OBJETIVO: Establecer la relación entre el grado de consumo de alcohol, tabaco y sustancias ilícitas con los desenlaces obstétricos adversos para que el personal encargado de la atención obstétrica evalúe los riesgos que implica el consumo de esas sustancias. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, analítico y transversal de una serie de casos llevado a cabo en pacientes en el puerperio hospitalizadas en el servicio de Ginecología y Obstetricia del Hospital General de Saltillo entre marzo y junio del 2023 y que refirieron consumo de alcohol, tabaco o drogas durante el embarazo. Posterior al procedimiento obstétrico se aplicó la herramienta ASSIST o prueba de detección de consumo alcohol, tabaco y sustancias. Según el grado de consumo, se utilizó la prueba χ2 de Pearson y la prueba exacta de Fisher para evaluar su asociación con los desenlaces adversos. RESULTADOS: De 863 atenciones obstétricas, 47 pacientes 5.4% refirieron un consumo activo de diferentes sustancias durante el embarazo; de ellas, 22 consumían 2 sustancias, con una tendencia entre el consumo de tabaco y cannabis a un desenlace obstétrico adverso p = 0.16 y 0.17, respectivamente. El desenlace obstétrico adverso más frecuente fue el bajo peso al nacer en 22 de 47 pacientes. CONCLUSIONES: Las sustancias con mayor tendencia a un desenlace obstétrico adverso fueron el tabaco y la cannabis, y la consecuencia desfavorable más frecuente en los neonatos fue el bajo peso al nacer.

ABSTRACT Introduction: Preventing teenage pregnancy and pregnancy-related mortality is critical to achieving positive health outcomes throughout life and it is essential to achieving the Sustainable Development Goals. Objective: To describe obstetric mortality and its causes in adolescents in Cuba in 2007 to 2020. Methods: A descriptive study of chronological series was carried out. The universe was the 60 maternal deaths in adolescents in 2007 to 2020 in Cuba. The variable maternal death due to obstetric causes was used according to the international classification of diseases. The maternal mortality ratio, average, maximum and minimum values were calculated. Correlation analysis was carried out with the Box Ljung statistic to test for autocorrelation. P ≤ 0.05 was considered significant. Results: On average, four maternal deaths occurred annually with the highest load in 2015 (16.7%). The mean mortality ratio was 23.7 per 105 live births. The highest corresponded to 2015 (56.0) and the lowest was in 2012 with no deaths. The correlogram did not show a trend or correlation and the probabilities associated with Box Ljung were not significant (p > 0.05). The highest values were in postpartum complications (5.1 per 105 live births), followed by abortions. Conclusions: The excess risk of maternal mortality in adolescents in Cuba is not negligible and its main causes are puerperal sepsis and medical abortions.

RESUMEN Introducción: La prevención del embarazo entre las adolescentes y la mortalidad relacionada con este embarazo son fundamentales para lograr resultados positivos en la salud a lo largo de la vida y son imprescindibles para alcanzar los Objetivos de Desarrollo Sostenible. Objetivo: Describir la mortalidad obstétrica y sus causas en adolescentes en Cuba entre 2007-2020. Métodos: Se realizó un estudio descriptivo de series cronológicas. El universo fueron las 60 muertes maternas en adolescentes entre 2007-2020 en Cuba. Se utilizó la variable muerte materna por causas obstétricas según la clasificación internacional de enfermedades. Se calcularon la razón de mortalidad materna, promedio, valores máximos y mínimos. Se efectuó análisis de correlación con el estadístico Box Ljung para probar autocorrelación. Se consideró significativo p ≤ 0,05. Resultados: Como promedio ocurrieron cuatro muertes maternas anuales con mayor peso en 2015 (16,7 %). La media de la razón de mortalidad fue de 23,7 por 105 nacidos vivos. La más elevada correspondió al año 2015 (56,0) y el mínimo fue en 2012 sin decesos. El correlograma no evidenció tendencia ni correlación y las probabilidades asociadas a Box Ljung no fueron significativas (p > 0,05). Los valores más altos fueron en las complicaciones del puerperio (5,1 por 105 nacidos vivos), seguida de abortos Conclusiones: El exceso de riesgo de mortalidad materna en adolescentes en Cuba no resulta despreciable y sus principales causas son la sepsis puerperal y los abortos médicos.

Abstract Objective: This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy. Methods: This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed. Results: The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87‒0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27). Conclusions: The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application. Objective Methods 9895 9 895 9,89 202 2022 demographics factors collected outcome techniques assessed Results 595 5 95 5.95 589/9,895 5899895 589 (589/9,895 1 variables age arrest dysfunction syndrome reproduction pollution renovation Cstatistic C statistic 088 0 88 0.8 95% (95 0.87‒0.90 087090 87 90 HosmerLemeshow Hosmer Lemeshow p 0.27. 027 0.27 . 27 0.27) Conclusions demographic application 989 89 9,8 20 59 5.9 589/9,89 589989 58 (589/9,89 08 8 0. (9 0.87‒0.9 08709 02 0.2 2 98 9, 5. 589/9,8 58998 (589/9,8 ( 0.87‒0. 0870 589/9, 5899 (589/9, 0.87‒0 087 589/9 (589/9 0.87‒ 589/ (589/ 0.87 (589 (58 (5

ABSTRACT OBJECTIVE To evaluate, using spatial analysis, the occurrence of American Cutaneous Leishmaniasis (ACL) and analyze its association with the municipal human development index (MHDI) and deforestation in the state of Amazonas, Brazil, from 2016 to 2020. METHODS This ecological study, carried out from January 2016 to December 2020, included the 62 municipalities of the state of Amazonas. The incidence rate of ACL was determined in space and time. Using Multiple Linear Regression by Ordinary Least Squares (OLS) and Spatial Autoregressive Regression (SAR) models, the relationship between incidence rates and Human Development Index (HDI) and deforestation was analyzed., The high- and low-risk clusters were identified by employing the Getis-Ord Gi* statistic. RESULTS A total of 7,499 cases of ACL were registered in all 62 municipalities in the state. Most cases were in male (n=5,924; 79.24%), with the greatest frequency in the population aged from 20 to 39 years (n=3,356; 44.7%). The incidence rate in the state of Amazonas was 7.34 cases per 100,000 inhabitants-year, with the municipalities of Rio Preto da Eva and Presidente Figueiredo showing the highest rates (1,377.5 and 817.5 cases per 100,000 population-year, respectively). The ACL cases were clustered into specific areas related to those municipalities with the highest incidence rates. The SAR model revealed a positive relationship between ACL and deforestation. CONCLUSIONS The occurrence of ACL was evident in a variety of patterns in the state of Amazonas; the high incidence rates and persistence of this disease in this state were linked to deforestation. The temporal distribution showed variations in the incidence rates during each year. Our results can help optimize the measures needed to prevent and control this disease in the state. evaluate analysis (ACL MHDI (MHDI Brazil 201 2020 study 6 time OLS (OLS (SAR models HDI (HDI analyzed analyzed. lowrisk low risk GetisOrd Getis Ord Gi statistic 7499 7 499 7,49 n=5,924 n5924 n 5 924 (n=5,924 79.24%, 7924 79.24% , 79 24 79.24%) 2 3 n=3,356 n3356 356 (n=3,356 44.7%. 447 44.7% . 44 44.7%) 734 34 7.3 100000 100 000 100,00 inhabitantsyear, inhabitantsyear inhabitants year, year inhabitants-year 1,377.5 13775 1 377 (1,377. 8175 817 817. populationyear, populationyear population-year respectively. respectively respectively) 202 749 49 7,4 n=5,92 n592 92 (n=5,92 792 79.24 n=3,35 n335 35 (n=3,35 44.7 4 73 7. 10000 10 00 100,0 1,377. 1377 37 (1,377 81 74 7, n=5,9 n59 9 (n=5,9 79.2 n=3,3 n33 (n=3,3 44. 1000 0 100, 1,377 137 (1,37 8 n=5, n5 (n=5, 79. n=3, n3 (n=3, 1,37 13 (1,3 n=5 (n=5 n=3 (n=3 1,3 (1, n= (n= 1, (1 (n (

RESUMEN Introducción: Se realizó una investigación descriptiva y prospectiva con la intención de definir el valor pronóstico del índice leucoglucémico en pacientes portadores de síndrome coronario agudo con elevación del ST. Objetivo: Valorar la importancia de la utilización del índice leucoglucémico como factor predictivo de complicaciones en el infarto agudo de miocardio con ST elevado. Métodos: Se estudió una muestra de 60 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Clínico Quirúrgico Docente Amalia Simoni, de Camagüey, durante el año 2021, a los que se les llenó un cuestionario, de donde se obtuvieron: edad, color de la piel, antecedentes patológicos personales, hábitos tóxicos, complicaciones ocurridas, estado al alta y resultados del índice leucoglucémico. Los datos extraídos fueron manejados según estadística descriptiva, para obtener resultados en número y porciento, que conllevaron a las conclusiones finales. Resultados: Predominaron mujeres blancas mayores de 56 años de edad, hipertensas y diabéticas, asociadas al hábito de fumar en un gran porciento, con la aparición de múltiples complicaciones. También predominaron el cuadro de insuficiencia cardiaca y las arritmias en más de dos tercios de los casos, y hubo un número alto de fallecidos con índice leucoglucémico elevado. Conclusiones: Los resultados derivados de esta investigación apoyan el fundamento teórico-práctico de la utilización del índice leucoglucémico como predictor de complicaciones a corto plazo en el infarto agudo de miocardio con ST elevado, apreciado por su sencillez, amplia disponibilidad y bajo costo.

ABSTRACT Introduction: A descriptive and prospective research was carried out with the intention of defining the prognostic value of the leuko-glycemic index in patients carrying acute coronary syndrome with ST elevation. Objective: To assess the importance of the use of the leuko-glycemic index as a predictive factor of complications in acute myocardial infarction with elevated ST. Methods: A sample of 60 patient was studied; they entered the Intensive Care Unit of the Clinical Surgical Teaching Hospital Amalia Simoni, of Camaguey, during 2021, and filled out a questionnaire from which age, color of skin, personal pathological antecedents, toxic habits, complications, status at discharge and results of the leuko-glycemic index were obtained. The extracted data were managed according to descriptive statistic to obtain results in number and percentage, which led to the final conclusions. Results: White women over 56 years old, hypertensive and diabetic predominated, associated with smoking in a large percent, and with the appearance of multiple complications. Heart failure and arrhythmias also predominated in more than two thirds of the cases, and there were a high number of deaths with high leuko-glycemic index. Conclusions: The results derived from this research support the theoretical-practical foundation of the use of the leuko-glycemic index as a predictor of short term complications in acute myocardial infarction with elevated ST, appreciated for its simplicity, wide availability and low cost.

RESUMEN Introducción: La mortalidad materna constituye una prioridad para la salud en Perú. Objetivo: Analizar la muerte materna por hemorragia obstétrica y trastornos hipertensivos en Perú. Métodos: Se realizó un estudio longitudinal y observacional en Ica, Perú, durante el período 2020-2023. Del total de 562 casos de mortalidad materna, hubo una muestra de 556 casos durante el embarazo, parto y puerperio, y 233 casos se atribuyeron a hemorragias obstétricas y trastornos hipertensivos. Los datos se procesaron con el programa Statistical Package for Social Sciences versión 25, donde los estadígrafos fueron la media, mediana, porcentaje, frecuencia relativa y absoluta. Resultados: Se registró un mínimo de 91 casos, en 2023, y un máximo de 220 (2021). La mediana anual fue de 125,5 y la media correspondió a 141,5. Se observó una tendencia a la disminución desde 2021. La distribución de muertes maternas fluctuó, con una prevalencia en el puerperio: 2020 (59,3 %), 2021 (58,4 %), 2022 (58,5 %) y 2023 (62,6 %). En 2020 se registraron 27 casos por hemorragia obstétrica (47 %) y 31 por trastornos hipertensivos (53 %); en 2021 los casos aumentaron a 42 (53 %) y 37 (47 %), respectivamente; sin embargo, en 2022 disminuyeron a 29 (54 %) y 25 (46 %), respectivamente. En 2023, los casos continuaron disminuyendo, con un total de 42: hemorragia obstétrica (25,50 %) y trastornos hipertensivos (17, 40 %). Conclusiones: Aunque hubo una tendencia a la disminución de la defunción materna entre 2021 y 2023, se requiere abordar las principales causas, como la hemorragia obstétrica y los trastornos hipertensivos.

ABSTRACT Introduction: Maternal mortality is a priority for health in Peru. Objective: To analyze maternal death due to obstetric hemorrhage and hypertensive disorders in Peru. Methods: A longitudinal and observational study was carried out in Ica, Peru, during the period 2020-2023. Of the total 562 cases of maternal mortality, there was a sample of 556 cases during pregnancy, childbirth, and the postpartum period, and 233 cases were attributed to obstetric hemorrhages and hypertensive disorders. The data were processed with the Statistical Package for Social Sciences version 25 program, where statistic were the mean, median, percentage, relative and absolute frequency. Results: There was a minimum of 91 cases in 2023 and a maximum of 220 in 2021. The annual median was 125.5, and the mean was 141.5. A decreasing trend was observed since 2021. The distribution of maternal deaths fluctuated with a prevalence in the postpartum period: 2020 (59.3%); 2021 (58.4%); 2022 (58.5%), and 2023 (62.6%), respectively. In 2020, 27 cases were recorded due to obstetric hemorrhage (47%) and 31 due to hypertensive disorders (53%). In 2021, cases increased to 42 (53%) and 37 (47%) respectively; however, in 2022, they decreased to 29 (54%) and 25 (46%). In 2023, cases continued to decrease with a total of 42: obstetric hemorrhage (25.50%); hypertensive disorders (17.40%). Conclusions: Although there was a trend towards a decrease in maternal death between 2021 and 2023, it is necessary to address the main causes, such as obstetric hemorrhage and hypertensive disorders.

Objectives: To estimate the prevalence of antidepressant use in Brazil. Methods: We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. Results: Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; I2 = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; I2 = 0%) than men (4.6%; 95%CI 3.1-6.8%; I2 = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; I2 = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; I2 = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual I2 = 0%; regression coefficient = 0.003). Conclusion: Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. Registration number: PROSPERO CRD42022345332. Objectives Brazil Methods MEDLINE Embase Scopus LILACS 2023 data quality metaanalyses meta analyses FreemanTukey Freeman Tukey transformation I statistic reference betweenstudy between study metaregressions. metaregressions regressions. regressions meta-regressions Results 3299 299 3,29 retrieved 2 included 75061 75 061 75,06 participants 40 4 0 4.0 95CI CI 95 2.75.6% 2756 2.7 5.6% 7 5 6 2.7-5.6% 98.5%. 985 98.5% . 98 98.5%) 12.0% 120 12 (12.0% 9.515.1% 95151 9.5 15.1% 9 15 1 9.5-15.1% 0% 4.6% 46 (4.6% 3.16.8% 3168 3.1 6.8% 8 3.1-6.8% 0.001 0001 001 2.82 282 82 1.724.62. 172462 1.72 4.62 72 62 1.72-4.62) (women 2.3% 1.63.1 1631 1.6 1.6-3.1 376 37 37.6 vs 0.5% 05 0.21.0% 0210 0.2 1.0% 0.2-1.0% 4.18 418 18 2.108.30. 210830 2.10 8.30 10 30 2.10-8.30) Betweenstudy Between 0.035 0035 035 0.003. 0003 0.003 003 0.003) Conclusion 3decade decade assessment number CRD42022345332 CRD 202 329 29 3,2 7506 06 75,0 4. 2.75.6 275 27 2. 56 5.6 2.7-5.6 98.5 12.0 (12.0 515 9.515.1 9515 9. 151 15.1 9.5-15.1 4.6 (4.6 16 3.16.8 316 31 3. 68 6.8 3.1-6.8 0.00 000 00 2.8 724 1.724.62 17246 172 1.7 462 1.72-4.62 2.3 63 1.63. 163 1. 1.6-3. 37. 0.5 21 0.21.0 021 02 0. 1.0 0.2-1.0 4.1 41 108 2.108.30 21083 210 2.1 830 8.3 2.10-8.30 0.03 03 CRD4202234533 20 32 3, 750 75, 2.75. 5. 2.7-5. 98. 12. (12. 51 9.515. 951 15. 9.5-15. (4. 3.16. 6. 3.1-6. 0.0 1.724.6 1724 17 1.72-4.6 1.63 1.6-3 0.21. 0.2-1. 2.108.3 2108 83 8. 2.10-8.3 CRD420223453 2.75 2.7-5 (12 9.515 9.5-15 (4 3.16 3.1-6 1.724. 1.72-4. 1.6- 0.21 0.2-1 2.108. 2.10-8. CRD42022345 2.7- (1 9.51 9.5-1 ( 3.1- 1.724 1.72-4 0.2- 2.108 2.10-8 CRD4202234 9.5- 1.72- 2.10- CRD420223 CRD42022 CRD4202 CRD420 CRD42 CRD4

Abstract Aim: Using Mendelian Randomization (MR) analysis to investigate the potential causal association between Inflammatory Bowel Disease (IBD) and the occurrence of parenteral malignancies, in order to provide some reference for the parenteral malignancy prevention in patients with IBD. Methods: This was a two-sample MR study based on independent genetic variants strongly linked to IBD selected from the Genome-Wide Association Study (GWAS) meta-analysis carried out by the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC). Parenteral malignancy cases and controls were obtained from the FinnGen consortium and the UK Biobank (UKB) release data. Inverse Variance Weighted (IVW), weighted median, MR-Egger, and strength test (F) were utilized to explore the causal association of IBD with parenteral malignancies. In addition, Cochran’s Q statistic was performed to quantify the heterogeneity of Instrumental Variables (IVs). Results: The estimates of IVW showed that patients with IBD had higher odds of diffuse large B-cell lymphoma (OR = 1.2450, 95% CI: 1.0311‒1.5034). UC had potential causal associations with non-melanoma skin cancer (all p < 0.05), melanoma (OR = 1.0280, 95% CI: 0.9860‒1.0718), and skin cancer (OR = 1.0004, 95% CI: 1.0001‒1.0006). Also, having CD was associated with higher odds of non-melanoma skin cancer (all p < 0.05) and skin cancer (OR = 1.0287, 95% CI: 1.0022‒1.0559). In addition, results of pleiotropy and heterogeneity tests indicated these results are relatively robust. Conclusions: IBD has potential causal associations with diffuse large B-cell lymphoma and skin cancers, which may provide some information on the prevention of parenteral malignancies in patients with IBD. Moreover, further studies are needed to explore the specific mechanisms of the effect of IBD on skin cancers. Aim (MR (IBD Methods twosample two sample GenomeWide Genome Wide GWAS (GWAS metaanalysis meta IIBDGC. IIBDGC . (IIBDGC) UKB (UKB data IVW, , (IVW) median MREgger, MREgger Egger, Egger MR-Egger F (F addition Cochrans Cochran s IVs. IVs (IVs) Results Bcell B cell OR 12450 1 2450 1.2450 95 CI 1.0311‒1.5034. 1031115034 1.0311‒1.5034 0311 5034 1.0311‒1.5034) nonmelanoma non all 0.05, 005 0.05 0 05 10280 0280 1.0280 0.9860‒1.0718, 0986010718 0.9860‒1.0718 9860 0718 0.9860‒1.0718) 10004 0004 1.0004 1.0001‒1.0006. 1000110006 1.0001‒1.0006 0001 0006 1.0001‒1.0006) Also 10287 0287 1.0287 1.0022‒1.0559. 1002210559 1.0022‒1.0559 0022 0559 1.0022‒1.0559) robust Conclusions cancers Moreover (IIBDGC (IVW (IVs 1245 245 1.245 9 103111503 1.0311‒1.503 031 503 00 0.0 1028 028 1.028 098601071 0.9860‒1.071 986 071 1000 000 1.000 100011000 1.0001‒1.000 100221055 1.0022‒1.055 002 055 124 24 1.24 10311150 1.0311‒1.50 03 50 0. 102 02 1.02 09860107 0.9860‒1.07 98 07 100 1.00 10001100 1.0001‒1.00 10022105 1.0022‒1.05 12 2 1.2 1031115 1.0311‒1.5 5 10 1.0 0986010 0.9860‒1.0 1000110 1.0001‒1.0 1002210 1.0022‒1.0 1. 103111 1.0311‒1. 098601 0.9860‒1. 100011 1.0001‒1. 100221 1.0022‒1. 10311 1.0311‒1 09860 0.9860‒1 10001 1.0001‒1 10022 1.0022‒1 1031 1.0311‒ 0986 0.9860‒ 1.0001‒ 1002 1.0022‒ 103 1.0311 098 0.9860 1.0001 1.0022 1.031 09 0.986 1.002 1.03 0.98 0.9