Resumo Objetivo Identificar evidências de validade da versão brasileira da Post-Discharge Coping Difficulty Scale - Adult Form. Métodos Estudo metodológico desenvolvido por meio das etapas de tradução, retrotradução, avaliação por comitê de especialistas, pré-teste e validação. A validação de conteúdo foi realizada por comitê de seis especialistas, os quais avaliaram as equivalências semântica, idiomática, experimental e conceitual. Para verificar as evidências de validade, a escala foi aplicada a 100 pacientes adultos clínicos e cirúrgicos. Foi realizada a análise de componentes principais, com rotação varimax. A confiabilidade foi verificada por meio do Coeficiente Alfa de Cronbach, quanto à estabilidade, por meio do Teste-Reteste e quanto à equivalência por meio de Confiabilidade Interavaliadores. Verificou-se a validade preditiva da escala em relação à utilização de serviço de emergência e readmissão. Resultados Na avaliação do comitê de especialistas foram realizadas adequações e todos os itens apresentaram um Índice de Validade de Conteúdo superior a 0,80. Na etapa de validação, a análise de componentes principais revelou que a melhor solução seria unifatorial, conforme a escala original. A consistência interna da escala foi satisfatória. A confiabilidade teste-reteste e interavaliadores não mostraram diferença estatística (P > 0,05). Conclusão A versão brasileira da Escala de Dificuldade de Enfrentamento Pós-alta com 10 itens apresenta boas evidências de validade e confiabilidade. Mostrou ser de fácil compreensão pelos participantes e representa uma ferramenta útil para os profissionais e pesquisadores na prática do cuidado. PostDischarge Post Discharge Form tradução retrotradução préteste pré teste semântica idiomática conceitual cirúrgicos varimax Cronbach estabilidade TesteReteste Teste Reteste Interavaliadores Verificouse Verificou se readmissão 080 0 80 0,80 unifatorial original satisfatória testereteste reteste P 0,05. 005 0,05 . 05 0,05) Pósalta Pós alta 1 cuidado 08 8 0,8 00 0,0 0,

Abstract Objective To identify validity evidence of the Brazilian version of the Post-Discharge Coping Difficulty Scale - Adult Form. Methods This methodological study was carried out by means of the stages of translation, back-translation, evaluation by a committee of experts, pre-testing, and validation. Content validation was carried out by a committee of six experts, who evaluated semantic, idiomatic, experimental, and conceptual equivalence. To verify validity evidence, the scale was applied to 100 adult clinical and surgical patients. Principal component analysis was carried out with varimax rotation. Reliability was checked using Cronbach’s alpha, stability using test-retest, and equivalence using inter-rater reliability. The scale’s predictive validity was verified in relation to emergency service use and readmission. Results In the expert committee’s assessment, adjustments were made, and all the items obtained a Content Validity Index higher than 0.80. In the validation stage, the principal component analysis revealed that the best solution would be unifactorial, according to the original scale. The scale’s internal consistency was satisfactory. Test-retest and inter-rater reliability showed no statistical difference (P > 0.05). Conclusion The Brazilian version of the 10-item Post-Discharge Coping Difficulty Scale shows good evidence of validity and reliability. It proved to be easy to understand by the participants and represents a useful tool for professionals and researchers in the practice of care. PostDischarge Post Discharge Form translation backtranslation, backtranslation back back-translation experts pretesting, pretesting pre testing, testing pre-testing semantic idiomatic experimental 10 patients rotation Cronbachs Cronbach s alpha testretest, testretest test retest, retest test-retest interrater inter rater scales readmission committees assessment made 080 0 80 0.80 stage unifactorial satisfactory Testretest Test P 0.05. 005 0.05 . 05 0.05) 10item item care 1 08 8 0.8 00 0.0 0.

Resumen Objetivo Identificar las evidencias de validez de la versión brasileña de la Post-Discharge Coping Difficulty Scale - Adult Form. Métodos Estudio metodológico llevado a cabo mediante las etapas de traducción, retrotraducción, revisión por comité de especialistas, prueba piloto y validación. La validación de contenido se realizó por un comité de seis especialistas, que evaluaron las equivalencias semánticas, idiomáticas, experimentales y conceptuales. Se aplicó la escala a 100 pacientes adultos clínicos y quirúrgicos para verificar las evidencias de validez. Se realizó el análisis de los componentes principales con rotación varimax. La fiabilidad se verificó mediante el coeficiente Alfa de Cronbach, la estabilidad con el test-retest y la equivalencia mediante la fiabilidad entre evaluadores. Se verificó la validez predictiva de la escala con relación a la utilización del servicio de emergencia y readmisión. Resultados Se realizaron adaptaciones en la etapa de revisión del comité de especialistas, y todos los ítems presentaron un índice de validez de contenido superior a 0,80. En la etapa de validación, el análisis de los componentes principales reveló que la mejor solución era unifactorial, según la escala original. La consistencia interna de la escala fue satisfactoria. La fiabilidad test-retest y entre evaluadores no mostraron diferencia estadística (P > 0,05). Conclusión La versión brasileña de la Escala de Dificultad de Enfrentamiento Posalta, que tiene 10 ítems, presenta buenas evidencias de validez y fiabilidad. Demostró ser de fácil comprensión por parte de los participantes y representa una herramienta útil para los profesionales e investigadores de la práctica del cuidado. PostDischarge Post Discharge Form traducción retrotraducción especialistas semánticas idiomáticas conceptuales varimax Cronbach testretest test retest readmisión 080 0 80 0,80 unifactorial original satisfactoria P 0,05. 005 0,05 . 05 0,05) Posalta 1 cuidado 08 8 0,8 00 0,0 0,

ABSTRACT Purpose: To compare objective and subjective intraocular pressure measurements immediately after cataract surgery and intraocular pressure measurements between less experienced surgeons (Group 1) and experienced surgeons (Group 2). Methods: Surgeons were asked to estimate the IOP after corneal sealing after surgery based on their tactile perception of eye tension (subjective intraocular pressure) Objective intraocular pressure was measured using a Perkins tonometer while patients were still in the surgical field. Objective intraocular pressure was compared to subjective intraocular pressure. Results from less experienced surgeons were compared to more experienced surgeons. Results: The study comprised 81 surgeries (81 eyes) performed by 27 surgeons. The mean objective intraocular pressure (9.14 mmHg; SD=5.86) was statistically significantly lower (p<0.001) than the mean subjective intraocular pressure (19.21 mmHg; SD=4.82). Hypotony (intraocular pressure <6mmHg) was observed in 25 eyes (30.86%). The mean subjective intraocular pressure was 18.8 mmHg (SD=5.19) for less experienced surgeons and 19.5 mmHg (SD=4.46) for more experienced, without statistically significant difference (p=0.541). No statistically significant difference (p=0.71) was observed when comparing objective intraocular pressure in Group 1 (10.32 mmHg; SD=6.65) and Group 2 (7.97 mmHg; SD=4.7). Conclusion: Objective intraocular pressure was significantly lower than subjective intraocular pressure, regardless of surgeons’ experience. This study showed that the subjective method is unreliable compared to the gold standard (Perkins tonometer) and does not improve with surgeons’ experience. Establishing standard training methods is paramount to developing surgeons’ skills. Purpose 2. . 2) Methods field 8 (8 9.14 914 9 14 (9.1 SD=5.86 SD586 SD 5 86 p<0.001 p0001 p 0 001 (p<0.001 19.21 1921 19 21 (19.2 SD=4.82. SD482 SD=4.82 4 82 SD=4.82) <6mmHg 6mmHg 30.86%. 3086 30.86% 30 (30.86%) 188 18 18. SD=5.19 SD519 (SD=5.19 195 19. SD=4.46 SD446 46 (SD=4.46 p=0.541. p0541 p=0.541 541 (p=0.541) p=0.71 p071 71 (p=0.71 10.32 1032 10 32 (10.3 SD=6.65 SD665 6 65 7.97 797 7 97 (7.9 SD=4.7. SD47 SD=4.7 SD=4.7) Conclusion experience skills ( 9.1 91 (9. SD=5.8 SD58 p<0.00 p000 00 (p<0.00 19.2 192 (19. SD48 SD=4.8 308 30.86 3 (30.86% SD=5.1 SD51 (SD=5.1 SD=4.4 SD44 (SD=4.4 p054 p=0.54 54 (p=0.541 p=0.7 p07 (p=0.7 10.3 103 (10. SD=6.6 SD66 7.9 79 (7. SD4 SD=4. 9. (9 SD=5. SD5 p<0.0 p00 (p<0.0 (19 30.8 (30.86 (SD=5. (SD=4. p05 p=0.5 (p=0.54 p=0. p0 (p=0. 10. (10 SD=6. SD6 7. (7 SD=4 SD=5 p<0. (p<0. (1 30. (30.8 (SD=5 (SD=4 (p=0.5 p=0 (p=0 SD=6 SD= p<0 (p<0 (30. (SD= p= (p= p< (p< (30 (SD (p (3

ABSTRACT Purpose: Keratoconus presents certain peculiarities in pediatric patients when compared with adults. The greatest challenge in children is that the disease is more severe and faster in progression. In this retrospective study, we aimed to compare the accelerated and Dresden protocols for corneal crosslinking in patients aged <18 years who were followed-up for at least 12 months. Methods: A total of 36 eyes from 27 patients were included in the study. The best corrected and uncorrected visual acuity, maximal keratometry, corneal thickness, foveal thickness, and endothelial microscopy findings were evaluated at baseline and during the postoperative period at one, three, and six months. Thereafter, the patients were evaluated at one, three, six and twelve months postoperative. Corneal crosslinking was performed in all patients via the Dresden protocol (n=21 eyes) or the accelerated protocol (n=15 eyes). Data between the two groups were compared and XY statistical analysis was used. Results: Both protocols were effective in halting keratoconus progression. No patient had progression at the 12-month follow-up. A significant reduction in Kmax and improvement in the corrected distance visual acuity were observed only in the Dresden protocol group. Although the Dresden protocol was superior to the accelerated protocol in reducing Kmax (p=0.002), there was no significant difference in corrected distance visual acuity between the two groups. Conclusion: The accelerated protocol is as efficient as the Dresden protocol in stabilizing keratoconus progression. Although the Dresden protocol was superior to the accelerated protocol in reducing the Kmax, it did not produce better clinical results. Thus, the accelerated protocol is an efficient option. Furthermore, considering the advantages of reduced surgical time, the accelerated protocol is effective in halting keratoconus progression in the pediatric age group. Purpose adults study 18 <1 followedup followed up 1 Methods 3 2 keratometry thickness one three Thereafter n=21 n21 n 21 (n=2 n=15 n15 15 (n=1 eyes. . used Results 12month month followup. followup follow up. follow-up group p=0.002, p0002 p p=0.002 , 0 002 (p=0.002) Conclusion results Thus option Furthermore time < n=2 n2 (n= n=1 n1 p000 p=0.00 00 (p=0.002 n= (n p00 p=0.0 (p=0.00 p0 p=0. (p=0.0 p=0 (p=0. p= (p=0 (p= (p

ABSTRACT Purpose: To evaluate the predictive value of initial intraocular pressure difference of the detached and fellow eyes of patients with complex rhegmatogenous retinal detachment on postoperative persistent ocular hypotony. Methods: This retrospective observational study included 538 eyes of 538 unilateral complex rhegmatogenous retinal detachment patients with a proliferative vitreoretinopathy grade of C-1 or higher, treated with silicone oil endotamponade following pars plana vitrectomy. The patients were divided into Group A (patients having silicone oil removal without ocular hypotony; n=504) and Group B (patients with persistent ocular hypotony following silicone oil removal [n=8, 23.5%] and with retained silicone oil [n=26, 76.5%] due to the risk of persistent ocular hypotony; total n=34). Ocular hypotony was defined as an intraocular pressure of <6 mmHg on two or more occasions. Patients’ demographics, including age, sex, and follow-up time, and ocular characteristics, including ocular surgical and trauma history, initial and final best-corrected visual acuity, intraocular pressure and initial intraocular pressure difference of the detached and fellow eyes, and anatomical success rates and postoperative complications, were retrospectively collected from the electronic patient files. Results: The initial intraocular pressure was significantly lower in the detached eyes of Group B than in Group A (8.3 ± 3.5 vs. 12.9 ± 3.3, p<0.001). Also, the initial intraocular pressure difference was significantly higher in Group B than in Group A (8.9 ± 3.2 vs. 2.2 ± 2.7mmHg, p<0.001). The receiver operating characteristic curve analysis showed that the cutoff value of the initial intraocular pressure difference was 7.5mmHg for the risk of persistent ocular hypotony. The most influential factors on postoperative persistent ocular hypotony in the binary logistic regression analysis were the initial intraocular pressure difference and the need for a retinectomy. Conclusion: In eyes with complex rhegmatogenous retinal detachment treated with pars plana vitrectomy and silicone oil tamponade, the initial intraocular pressure difference could be of value in predicting postoperative persistent ocular hypotony and could guide surgeons on the decision of silicone oil removal. Purpose Methods 53 C1 C 1 C- n=504 n504 n 504 n=8, n8 8 [n=8 23.5% 235 23 5 n=26, n26 26 [n=26 76.5% 765 76 n=34. n34 n=34 . 34 n=34) 6 < occasions Patients demographics age sex followup follow up time characteristics history bestcorrected best corrected acuity complications files Results 8.3 83 3 (8. 35 3. vs 129 12 9 12. 33 3.3 p<0.001. p0001 p p<0.001 0 001 p<0.001) Also 8.9 89 32 2 22 2. 27mmHg 7mmHg 2.7mmHg 75mmHg 7 5mmHg retinectomy Conclusion tamponade n=50 n50 50 n=8 [n= 23.5 n=26 n2 [n=2 76.5 n3 n=3 8. (8 p000 p<0.00 00 n=5 n5 n= [n 23. n=2 76. ( p00 p<0.0 p0 p<0. p<0 p<

RESUMO Objetivo: Relatar dois casos de pneumotórax bilateral espontâneo múltiplo sucessivo em crianças com envolvimento pulmonar maciço por histiocitose de células de Langerhans (HCL), alertando para a possibilidade desse diagnóstico diferencial para o pediatra geral. Ademais, casos publicados que descrevem pacientes pediátricos com manifestações pulmonares de HCL foram revisados na literatura. Descrição do caso: Caso 1: Paciente masculino, três anos, com episódio súbito pneumotórax espontâneo à direita, drenado cirurgicamente. Após dois meses, apresentou dois novos episódios de pneumotórax contralateral. Biópsia linfonodal pulmonar revelou diagnóstico de HCL. Foi submetido a cirurgia torácica assistida por vídeo (VATS) bilateral e minitoracotomia com pleurodese mecânica, além de tratamento quimioterápico, necessitando de internação prolongada. Caso 2: Menino, quatro anos, apresentando dispneia progressiva e sibilância por cinco meses. Biópsia pulmonar revelou HCL. Evoluiu com importante desconforto respiratório e pneumotórax direito, necessitando drenagem. Foi realizada pleurodese com nitrato de prata e diferentes esquemas de quimioterapia. Ambos os pacientes evoluíram bem após tratamentos quimioterápicos múltiplos, cirurgias e suporte intensivo. Comentários: A HCL é uma doença desafiadora. Sua manifestação clínica é variável, e o envolvimento pulmonar ocorre em cerca de 10–15% dos casos. Consideram-se o manejo cirúrgico especializado e o suporte multidisciplinar essenciais para o tratamento de pacientes com HCL pulmonar maciça. Ainda que raro, o envolvimento pulmonar maciço por HCL deve ser considerado em quadros de pneumotórax recorrentes em crianças. Objetivo HCL, , (HCL) geral Ademais literatura caso 1 masculino anos direita cirurgicamente meses contralateral VATS (VATS mecânica quimioterápico prolongada 2 Menino direito drenagem quimioterapia múltiplos intensivo Comentários desafiadora variável 1015 10 15 10–15 Consideramse Consideram se maciça raro (HCL 101 10–1 10–

ABSTRACT Objective: The objective of this study was to report two cases of successive multiple spontaneous bilateral pneumothorax in children with massive lung involvement due to Langerhans cell histiocytosis (LCH), emphasizing the possibility of this differential diagnosis for the general pediatrician. Additionally, published cases describing pediatric patients with pulmonary manifestations of LCH were reviewed in the literature. Case description: Case #1: A 3-year-old male patient with a sudden episode of spontaneous right-sided pneumothorax, surgically drained. After 2 months, he experienced two new episodes of contralateral pneumothorax. A pulmonary lymph node biopsy revealed the diagnosis of LCH. He underwent bilateral video-assisted thoracic surgery and mini-thoracotomy with mechanical pleurodesis, in addition to chemotherapy, requiring prolonged hospitalization. Case #2: A 4-year-old boy with progressive dyspnea and wheezing for 5 months. A pulmonary biopsy revealed LCH. He developed significant respiratory distress and right pneumothorax, requiring drainage. Silver nitrate pleurodesis and different chemotherapy regimens were performed. Both patients responded well to multiple chemotherapy treatments, surgeries, and intensive care support. Comments: LCH is a challenging disease. Its clinical manifestation is variable, and pulmonary involvement occurs in about 10–15% of cases. We consider specialized surgical management and multidisciplinary support essential for the treatment of patients with massive pulmonary LCH. Although rare, massive pulmonary involvement by LCH should be considered in cases of recurrent pneumothorax in children. Objective LCH, , (LCH) pediatrician Additionally literature description #1 1 3yearold yearold 3 year old rightsided sided drained months videoassisted video assisted minithoracotomy mini thoracotomy hospitalization #2 4yearold 4 drainage performed treatments surgeries Comments disease variable 1015 10 15 10–15 rare (LCH # 101 10–1 10–

Resumo Enquadramento: A literacia em saúde (LS) é a capacidade da pessoa obter e traduzir informações a fim de manter e melhorar a saúde. Objetivo: Caracterizar o nível de LS da pessoa internada num hospital oncológico; avaliar a fiabilidade do instrumento European Health Literacy Survey in Portuguese (HLS-EU-PT). Metodologia: Estudo transversal, quantitativo, descritivo e metodológico. Amostra de 188 pessoas internados num serviço de cirurgia oncológica entre maio e setembro de 2020, os dados foram colhidos através de formulário de caracterização sociodemográfica, de saúde e instrumento de avaliação da LS. Resultados: O HLS-EU-PT apresentou elevado nível de consistência interna. Todos os domínios e níveis de processamento do instrumento se correlacionam positivamente entre si. Os participantes apresentam em média um nível problemático de LS. Conclusão: Os resultados indiciam a necessidade de um maior investimento na capacitação da LS. São necessários mais estudos nesta e noutras populações e contextos de prestação de cuidados de saúde, de forma a direcionar a prática de cuidados na resposta eficaz aos problemas de saúde.

Abstract Background: Health literacy (HL) is the ability of an individual to obtain and translate information in order to maintain and improve their health. Objective: To characterize the level of HL of patients admitted to an oncology hospital and assess the reliability of the Portuguese version of the European Health Literacy Survey (HLS-EU-PT). Methodology: Cross-sectional, quantitative, descriptive, and methodological study. Sample of 188 patients admitted to a surgical oncology unit between May and September 2020. Data were collected through a sociodemographic and health characterization form and a HL assessment tool. Results: The HLS-EU-PT had a high level of internal consistency. All domains and information-processing levels correlated positively with each other. Participants had on average a problematic level of HL. Conclusion: The results indicate the need for greater investment in HL training. Further studies are needed in this population and in other populations and healthcare settings to provide an effective response to health problems.

Resumen Marco contextual: La alfabetización en salud (AS) es la capacidad de una persona para obtener y traducir información con el fin de mantener y mejorar su salud. Objetivo: Caracterizar el nivel de AS de las personas ingresadas en un hospital oncológico; evaluar la fiabilidad del instrumento European Health Literacy Survey in Portuguese (HLS-EU-PT). Metodología: Estudio transversal, cuantitativo, descriptivo y metodológico. Muestra de 188 personas ingresadas en un servicio de cirugía oncológica entre mayo y septiembre de 2020, se recogieron datos mediante un formulario de caracterización sociodemográfica y de salud, y una herramienta de evaluación de AS. Resultados: El HLS-EU-PT mostró un alto nivel de consistencia interna. Todos los dominios y niveles de procesamiento del instrumento correlacionaron positivamente entre sí. Por término medio, los participantes tienen un nivel problemático de AS. Conclusión: Los resultados indican la necesidad de una mayor inversión en formación en AS. Son necesarios más estudios en esta y otras poblaciones, y en entornos sanitarios para orientar la práctica asistencial hacia una respuesta eficaz a los problemas de salud.

Resumo Enquadramento: Os registos eletrónicos de saúde realizados pelos enfermeiros no cuidado à pessoa em situação perioperatória são fundamentais para a garantia da qualidade e segurança dos cuidados. Objetivo: Identificar os focos e intervenções identificados pelos enfermeiros nos registos eletrónicos de saúde no cuidado à pessoa em situação perioperatória. Metodologia: Estudo observacional retrospetivo, realizado no serviço de Bloco Operatório Central e na Unidade de Cirurgia Ambulatória, com recurso à análise da documentação de enfermagem nos registos eletrónicos de saúde no período de dezembro de 2016 a dezembro de 2022. Foram analisadas 50.732 focos de enfermagem e 45.1003 intervenções no sistema de informação eletrónico. Resultados: Nos registos de enfermagem os diagnósticos de enfermagem mais frequentemente identificados são a hipotermia (35,5%) e ferida cirúrgica (34,7%). As intervenções de enfermagem com integridade referencial centram-se no âmbito do observar. Conclusão: Os registos de enfermagem no cuidado à pessoa em situação perioperatória no sistema de informação de saúde em uso centram-se em parâmetros de vigilância relacionados com a segurança e infeção durante o período intraoperatório.

Abstract Background: Electronic health records kept by nurses when caring for perioperative patients are essential for ensuring the quality and safety of care. Objective: To identify the nursing focuses and interventions reported by nurses in electronic health records when caring for perioperative patients. Methodology: A retrospective observational study was conducted in the Central Operating Room and the Ambulatory Surgery Unit. The nursing documentation in the electronic health records kept from December 2016 to December 2022 were analyzed, in a total of 50,732 nursing focuses and 451,003 interventions. Results: The most frequently identified nursing diagnoses in nursing records were hypothermia (35.5%) and surgical wound (34.7%). Nursing interventions with referential integrity were of the observing type. Conclusion: Th nursing records about perioperative patients in the health information system focus on surveillance parameters related to safety and infection during the intraoperative period.

Resumen Marco contextual: Los registros electrónicos de salud que utilizan los enfermeros para atender a las personas que reciben cuidados perioperatorios son fundamentales para garantizar la calidad y la seguridad de los cuidados. Objetivo: Identificar los focos y las intervenciones identificadas por los enfermeros en los registros de salud electrónicos cuando atienden a personas en situaciones perioperatorias. Metodología: Estudio observacional retrospectivo realizado en la Unidad de Quirófano Central y en la Unidad de Cirugía Ambulatoria, analizando la documentación de enfermería en los registros electrónicos de salud desde diciembre de 2016 hasta diciembre de 2022. Se analizaron un total de 50.732 focos de enfermería y 451.003 intervenciones en el sistema electrónico de información. Resultados: En los registros de enfermería, los diagnósticos de enfermería más frecuentemente identificados son la hipotermia (35,5%) y las heridas quirúrgicas (34,7%). Las intervenciones de enfermería con integridad referencial se centran en observar. Conclusión: Los registros de enfermería para cuidados perioperatorios en el sistema de información sanitaria en uso se centran en parámetros de vigilancia relacionados con la seguridad y la infección durante el periodo intraoperatorio.

Resumen Antecedentes: la histerectomía en bloque es un procedimiento controvertido y con poca literatura actualizada. Se define como la extirpación del útero grávido con su contenido gestacional in situ, las indicaciones para la realización de esta cirugía son los procesos neoplásicos (como la causa más frecuente( procesos sépticos, enfermedad trofoblástica y hemorragia secundaria a inserción placentaria anómala. Caso clínico: paciente de 45 años con embarazo de 8 semanas y 5 días, según la fecha de última regla, con miomatosis uterina gigante asociada con tromboembolismo pulmonar, quien decide la interrupción voluntaria del embarazo y realizarse la histerectomía en bloque. Conclusiones: la histerectomía en bloque es una cirugía poco realizada en la actualidad, sin embargo, este abordaje quirúrgico es una opción segura y efectiva para la interrupción voluntaria del embarazo, y no se debe descartar entre las alternativas de tratamiento quirúrgico, siempre individualizando cada paciente.

ABSTRACT BACKGROUND: En bloc hysterectomy is defined as the removal of the pregnant uterus with its gestational content in situ. The indications for performing this en bloc surgery are neoplastic processes, as the most frequent cause; septic processes, trophoblastic disease and hemorrhage secondary to abnormal placental insertion, however, it is a controversial procedure, and with little updated literature. CLINICAL CASE: 45-year-old patient with a pregnancy of 8 weeks and 5 days, with giant uterine myomatosis associated with pulmonary thromboembolism who decided to voluntarily terminate the pregnancy, and it was decided to perform en bloc hysterectomy. CONCLUSIONS: En bloc hysterectomy is a surgery rarely performed at present, however, this surgical approach is a safe and effective option for the voluntary termination of pregnancy, and it should not be ruled out among the surgical treatment alternatives, always individualizing each patient.

Resumen Descripción del caso: Paciente de 23 años con hemorragia abdominal de origen no claro, que posteriormente presenta inestabilidad hemodinámica, requiriendo manejo quirúrgico en tres ocasiones con evolución satisfactoria. Hallazgos clínicos: Presentó sangrado cuantificado de 5500 cc en cavidad abdominal (grado IV - clasificación ATLS) con lesiones hepáticas en los segmentos I, IV y VIII, sin hallazgos sugestivos de trauma al examen físico, ni otros hallazgos traumáticos internos. Tratamiento y resultados: Se llevó a cabo una intervención quirúrgica precoz mediante laparotomía exploratoria con hallazgos ya descritos, además de dos tiempos quirúrgicos adicionales que llevaron al control del sangrado, con evolución satisfactoria. Relevancia clínica: El sangrado abdominal y laceración de víscera sólida secundario a trauma cerrado de abdomen es una etiología común en pacientes jóvenes masculinos, siendo contrario a esta afirmación el sangrado de origen hepático sin trauma es una etiología poco común. El presente caso resulta ser una dificultad diagnóstica en cuanto a la etiología, ya que lo evidenciado en la exploración quirúrgica no concuerda con el examen físico externo, sin una historia clínica clara al ingreso se deja la interrogante de la causa.

Summary: Case description: 23-year-old patient with abdominal hemorrhage of unclear origin, who subsequently presented hemodynamic instability, requiring surgical management on three occasions with satisfactory evolution. Clinical findings: she presented quantified bleeding of 5500 cc in the abdominal cavity (grade IV-ATLS classification) with liver lesions in segments I, IV and VIII, without findings suggestive of trauma on physical examination, or other internal traumatic findings. Treatment and results: An early surgical intervention was carried out through exploratory laparotomy with findings already described, in addition to two additional surgical procedures that led to control of bleeding, with satisfactory evolution. Clinical relevance: Abdominal bleeding and solid viscus laceration secondary to blunt abdominal trauma is a common etiology in young male patients, contrary to this statement, bleeding of hepatic origin without trauma is a rare etiology. The present case turns out to be a diagnostic difficulty in terms of etiology, since what was evidenced in the surgical exploration does not agree with the external physical examination, without a clear clinical history at admission, the question of the cause is left.

Resumen Introducción: Aunque la vena subclavia ofrece ventajas significativas sobre otros abordajes para el acceso venoso central guiado por ultrasonido, no se considera la primera opción en la población pediátrica, principalmente debido a su proximidad con la pleura y la arteria subclavia. Objetivo: Evaluar las características sonoanatómicas de la vena subclavia y sus estructuras adyacentes utilizando el abordaje supraclavicular en la población pediátrica. Materiales y métodos: Estudio observacional de corte transversal durante el periodo intraoperatorio, desde junio de 2021 hasta marzo de 2022. Participaron niños ASA I, II y III sometidos a procedimientos quirúrgicos no emergentes bajo anestesia general. Se realizaron las imágenes bajo anestesia general, utilizando un transductor lineal de alta frecuencia para identificar la vena subclavia y medir características anatómicas. Resultados: Se reclutaron 67 niños, con una mediana de 6 años (RIQ 2-12 años), predominando el sexo masculino (61 %). La mediana de peso fue de 22 kg (RIQ12,2-34 kg) y la de estatura fue de 115 cm (RIQ 88-142 cm). Las mediciones del vaso mostraron una distancia media de la piel al vaso de 0,70 cm (DE: 0,18 cm) y una de la piel a la pleura de 1,31 cm (DE: 0,28 cm). El diámetro de la vena tuvo una mediana de 0,49 cm (RIQ 0,40-0,63 cm). El ángulo hipotético de aproximación al vaso presentó una media de 22,09 grados (DE: 4,37 grados), mientras que el ángulo de aproximación a la pleura fue de 39 grados (DE: 5,31 grados). No se documentó la visualización simultánea de la arteria y la vena en ninguna de las ventanas sonoanatómicas registradas. Las pruebas indicaron una diferencia promedio de 0,61 cm en la profundidad del vaso respecto a la pleura, y 16,91 grados menos en el ángulo de aproximación al vaso comparado con el ángulo pleural (p < 0,001). Conclusiones: Mediante esta técnica, el abordaje supraclavicular para punción de la vena subclavia en niños es seguro y viable, con una distancia promedio de la piel al vaso de 0,70 cm, minimizando el riesgo de punción pleural. Se requieren estudios adicionales para optimizar esta técnica en la población pediátrica.

Abstract Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population.

Resumen Introducción: La anestesia espinal se realiza mediante palpación de superficies para la identificación de los espacios intervertebrales lumbares. En adultos mayores el procedimiento presenta mayor dificultad debido a los cambios degenerativos de la columna vertebral asociados a la edad. Objetivo: Evaluar cuál técnica de anestesia espinal garantiza una mayor tasa de éxito entre la guiada por ultrasonido (US) y la guiada por reparos anatómicos (RA) en adultos mayores. Métodos: Estudio observacional de cohorte prospectivo en pacientes con indicación de suministro de anestesia subaracnoidea independientemente de la intervención quirúrgica, llevado a cabo en el Hospital Universitario del Valle y la Fundación Hospital San José Buga. En un lapso de 12 meses se recolectaron datos durante la realización de la punción, según decisión del anestesiólogo tratante, guiada por US vs. RA. Resultados: En total se evaluaron 80 pacientes entre hombres y mujeres, mayores de 65 años, con edad media de 78,50±9,04. El número de punciones, así como de redireccionamientos, fue significativamente menor en el grupo guiado por US. Adicionalmente, se observó que en el grupo guiado por RA, el 37,5 % no coincidía con el sitio demarcado con el espacio real de punción confirmado con US (p<0,001). Podría ser la causa de un bloqueo inadecuado o de complicaciones de la punción intradural. Conclusiones: La técnica de anestesia neuroaxial guiada por US en adultos mayores podría facilitar el bloqueo neuroaxial al primer intento de punción.

Abstract Introduction: Spinal anesthesia requires palpation of surfaces in order to identify the intervertebral spaces in the lumbar spine. In elderly individuals, the procedure is more challenging due to age-related degenerative changes in the spine. Objective: To determine which technique between ultrasound (US) guidance or the use of anatomical landmarks to guide spinal anesthesia ensures a higher success rate in elderly patients. Methods: prospective observational cohort study in patients with an indication to receive subarachnoid anesthesia, regardless of the type of surgical intervention, carried out at Hospital Universitario del Valle and Fundación Hospital San José Buga. Data were collected over a 12-month period at the time of making the puncture. The treating anesthetists were free to choose between US guidance or the use of anatomical landmarks. Results: Overall, 80 patients were assessed, including men and women over 65 years of age (mean 78.5±19.04). The number of punctures as well as needle redirections were significantly lower in the US-guided group. Additionally, in the group in which anatomical landmarks were used to guide the puncture, the marked site did not coincide with the actual puncture site confirmed with US in 37.5% of cases (p<0.001). This could result in inadequate block or complications associated with intradural puncture. Conclusions: US-guided neuroaxial anesthesia in elderly individuals could facilitate success on the first attempt.

ABSTRACT Introduction: the postgraduate educational climate (CE) in the hospital environment can determine the way in which resident physicians (MRs) adapt to their new stage, during which professional burnout syndrome (PAS) is highly likely to occur at some point. Objective: to determine the relationship between the educational climate and professional burnout in physicians in the medical residency programs of the National Hospital 2023-2024. Methodology: cross-sectional observational study of a sample of MR convenience of both sexes from all medical specialties of the National Hospital between November 2023 and January 2024, MR with external rotation and/or vacations were excluded. Sample calculation; 136 MR. An online form from Google was sent to the MR email requesting voluntary participation. The SAP was measured with the standard Maslach Burnout Inventory (MBI) method with subscales; emotional exhaustion (EA), depersonalization (DESP), personal fulfillment (PR), with PAS with high scores of AE, DESP and low RP. The EC was assessed with the measure of the hospital postgraduate educational environment (PHEEM) with subscales; perception of role autonomy (PAR), perception of teaching (PE), perception of social support (PSS), the higher the score, the better the EC. Demographic and academic variables, MBI and PHEEM scores were collected, and the SAP was considered dependent, as the main result was the predictive relationship of the PHEEM on the SAP. Data were compared with χ², t-test or Mann-Whitney U, ANOVA and linear regression (p-significant value =<0.05). Results: of 233 participants, the mean age was 28.75 (±2.20), 63.94 % (149) women, the general prevalence of PAS; 70.38 % (164/233), PAS in men 75 % (63/84) and women 67.78 % (101/149) p=0.0014, the first 2 years with the highest frequency of PAS; 65 (85.52 %), 59 (86.76 %) respectively p=0.0009, 63 (90 %) p=0.0071 surgical specialties. The subscales of the MBI, the AE; 79.82 % (186) with an average of 35.39 (± 11.61) points. The CE of MRs with SAP; 107.9 (19.6) dots and without PAS; 136.3 (12.1) dots 95 % CI 18.1-25.0 p= 0.0001. The PHEEM predicted the AE with R2=0.619, B= -0.18 (±0.009) p=0.001, and the DESP; R2= 0.385, B= -0.001(0.004) p=0.009, PSS being a significant predictor with inverse correlation in both. Conclusion: there is an inverse relationship between the educational climate and burnout syndrome in the population studied, with a high prevalence of burnout in male residents of surgical specialties, with the social support of the hospital educational environment being a significant predictor for the development of burnout syndrome.

RESUMEN Introducción: el clima educacional (CE) de posgrado en el ambiente hospitalario puede determinar la manera en como los médicos residentes (MR) se adaptan a su nueva etapa, durante el cual el sindrome agotamiento profesional (SAP) es altamente probable de producirse en algún momento. Objetivo: determinar la relación entre el clima educacional y el agotamiento profesional en médicos de los programas de residencias médicas del Hospital Nacional 2023-2024. Metodología: estudio observacional transversal de una muestra por conveniencia de MR de ambos sexos de todas las especialidades médicas del Hospital Nacional entre noviembre 2023 y enero 2024, se excluyeron MR con rotación externa y/o vacaciones. Calculo muestral; 136 MR. Se envío un formulario en línea de Google al correo electrónico del MR solicitando la participación voluntaria. El SAP fue medido con el método estándar Maslach Burnout Inventory (MBI) con subescalas; agotamiento emocional (AE), despersonalización (DESP), realización personal (RP), existiendo SAP con puntuaciones altas de AE, DESP y bajas de RP. El CE fue valorado con la medida del entorno educativo de posgrado hospitalario (PHEEM) con subescalas; percepción autonomía de roles (PAR), percepción enseñanza (PE), percepción soporte social (PSS), a mayor puntaje mejor CE. Se recopiló variables demográficos, académicos, puntajes del MBI y PHEEM, el SAP fue considerado dependiente, como resultado principal la relación predictiva del PHEEM sobre el SAP. Se compararon datos con χ², prueba t o U de Mann-Whitney, ANOVA y regresión lineal (p-valor significativo =<0,05). Resultados: de 233 participantes, la edad media fue de 28,75 (± 2,20), el 63,94 % (149) mujeres, la prevalencia general del SAP; 70,38 % (164/233), SAP en hombres 75 % (63/84) y mujeres 67,78 % (101/149) p=0,0014, los 2 primeros años con mayor frecuencia de SAP; 65 (85,52 %), 59 (86,76 %) repectivamente p=0,0009, de especialidades quirúrgicas 63 (90 %) p=0,0071. Las subescalas del MBI el AE;79,82 % (186) con un promedio de 35,39 (± 11,61) puntos. El PHEEM de los MR con SAP; 107,9(( 19,6) puntos y sin SAP; 136,3(( 12,1) puntos IC 95 % 18,1-25,0 p= 0,0001. El PHEEM predijo el AE con R2=0,619, PPS; B= -0,18 (±0,009) p=0,001, y la DESP; R2= 0,385, PPS; B= -0,001 (±0,004) p=0,009 siendo PSS predictor significativo con correlación inversa en ambas. Conclusión: existe relación inversa entre el clima educativo y el sindrome de agotamiento profesional en la población estudiada, con alta prevalencia de este en residentes hombres de especialidades quirúrgicas, siendo el soporte social del ambiente educativo hospitalario un predictor significativo para el desarrollo del sindrome de agotamiento profesional.

Resumen Esta revisión profundiza en el ámbito de la función y disfunción de la articulación temporomandibular (ATM), arrojando una luz sobre su naturaleza multifacética y ofreciendo información sobre estrategias diagnósticas y terapéuticas. La ATM, un componente vital del complejo craneofacial, desempeña un papel fundamental en actividades cotidianas como masticar, hablar y bostezar. Comprender su anatomía y fisiología es fundamental en el tratamiento y manejo de la disfunción de la ATM. Se ha explorado exhaustivamente la biomecánica de la función de la ATM, desde el disco articular hasta los ligamentos y músculos circundantes. Un aspecto crítico de esta revisión gira en torno a los diversos factores etiológicos que contribuyen a la disfunción de la ATM. Se analizan predisposiciones genéticas, parafunciones, irregularidades oclusales y estrés psicológico. Estas complejidades generaron la necesidad de un sistema de clasificación sólido que dilucidara las manifestaciones clínicas y los criterios de diagnóstico para diversos trastornos de la ATM. Las modalidades de diagnóstico modernas, incluída la evaluación clínica, las técnicas de imagen y la aspiración articular, son examinadas por su papel indispensable en el diagnóstico preciso. La descripción general integral incluyó estrategias de manejo, desde medidas conservadoras hasta intervenciones quirúrgicas. Al reconocer la influencia fundamental de los factores psicosociales, esta revisión subraya la importancia de la atención centrada en el paciente y las intervenciones cognitivo-conductuales. Además, las terapias regenerativas, las técnicas mínimamente invasivas y la medicina personalizada son tendencias emergentes en la investigación de la ATM. Esta revisión proporciona una hoja de ruta contemporánea para comprender, diagnosticar y tratar las afecciones relacionadas con la ATM.

Abstract This contemporary review delves into the intricate realm of temporomandibular joint (TMJ) function and dysfunction, shedding light on its multifaceted nature and offering insights into diagnostic and therapeutic strategies. The TMJ, a vital component of the craniofacial complex, plays a pivotal role in everyday activities such as chewing, speaking, and yawning. Understanding its anatomy and physiology is paramount in the treatment and management of TMJ dysfunction. The biomechanics of TMJ function, from the articular disc to the surrounding ligaments and muscles, have been explored comprehensively. A critical aspect of this review revolves around the diverse etiological factors contributing to TMJ dysfunction. Genetic predispositions, parafunctions, occlusal irregularities, and psychological stress are dissected to illuminate the roles of these factors in the development of TMJ disorders. These complexities prompted the need for a robust classification system elucidating the clinical manifestations and diagnostic criteria for various TMJ disorders. Modern diagnostic modalities, including clinical assessment, imaging techniques, and joint aspiration, are scrutinized for their indispensable roles in accurate diagnosis. The comprehensive overview included management strategies, from conservative measures to surgical interventions. In recognizing the pivotal influence of psychosocial factors, this review underscores the importance of patient-centered care and cognitive-behavioral interventions. Furthermore, regenerative therapies, minimally invasive techniques, and personalized medicine are emerging trends in TMJ research. This review provides a contemporary roadmap for comprehending, diagnosing, and managing TMJ-related conditions.

Resumen Este reporte de caso describió el enfoque clínico y terapéutico utilizado en una paciente de 32 años de edad con una fractura dentaria en el diente 22. La paciente, sin antecedentes de enfermedad sistémica, presentaba una lesión periapical crónica y una fractura cervical en el diente afectado. El tratamiento incluyó la extracción atraumática del diente, seguida de la colocación de un implante postextracción de 3,75 x 10mm con carga inmediata y regeneración ósea guiada. Se empleó la técnica quirúrgica mínimamente invasiva utilizando la secuencia de fresado Dentoflex®. La estabilidad primaria del implante, medida en 37 Newtons de torque, permitió la colocación de un pilar metálico prefabricado para la posterior corona cementada. Se realizó con éxito la regeneración ósea del espacio interimplantario, complementada con injerto conectivo debido al fenotipo gingival delgado de la paciente. El seguimiento postoperatorio, incluyendo controles a los 7, 14 días y cuatro meses, mostró una conformación satisfactoria del margen gingival y del tejido papilar, consolidando el éxito del tratamiento.

Abstract This case report describes the clinical and therapeutic approach used in a 32-year-old female patient with a tooth fracture in tooth 22. The patient, with no history of systemic disease, presented with a chronic periapical lesion and a cervical fracture in the affected tooth. Treatment included atraumatic extraction of the tooth, followed by placement of a 3.75 x 10mm post-extraction implant with immediate loading and guided bone regeneration. The minimally invasive surgical technique was employed using the Dentoflex® drilling sequence. The primary stability of the implant, measured in 37 Newtons of torque, allowed the placement of a prefabricated metal abutment for the subsequent cemented crown. Bone regeneration of the interimplant space was successfully performed, supplemented by connective grafting due to the patient's thin gingival phenotype. Postoperative follow-up, including controls at 7, 14 days and four months, showed a satisfactory conformation of the gingival margin and papillary tissue, consolidating the success of the treatment.

Resumen Las fracturas mandibulares poseen una alta prevalencia en el territorio maxilofacial, requiriendo, en su mayoría, resolución quirúrgica. El Gold Standard corresponde a la reducción abierta con osteosíntesis con placas de titanio. Nuevos materiales biocompatibles han sido aplicados con el fin de subsanar las complicaciones y desventajas de las placas de titanio, surgiendo las placas de osteosíntesis reabsorbibles. Conocer la efectividad de las placas de titanio y placas de osteosíntesis reabsorbibles en el tratamiento de fracturas mandibulares permite determinar la necesidad de invertir en nuevas técnicas con resultados predecibles. Describir la efectividad del uso de placas de titanio y placas de osteosíntesis reabsorbibles en el tratamiento de fracturas mandibulares. Durante agosto del año 2023, se realizó una revisión sistemática exploratoria de la literatura disponible desde 2018 sobre el uso de placas de osteosíntesis reabsorbibles en fracturas mandibulares, empleándose los buscadores PubMed, Scopus y WOS incluyendo estudios en inglés o español. Se obtuvieron 227 artículos. Después de la revisión de título y resumen, 29 fueron incluidos para lectura de texto completo, se descartaron 9 duplicados, 10 fueron descartados por criterios de exclusión, quedando en total 10 artículos en este estudio. Autores relatan menor desplazamiento de la superficie de contacto de las placas de titanio en los segmentos fracturados, por una mayor área de presión superficial, rigidez y fuerza de carga. Las placas de osteosíntesis reabsorbibles son más flexibles y están sujetas a mayor deformación ante fuerzas masticatorias de gran magnitud, pudiendo generar apertura de la fractura, desplazamiento de segmentos óseos. Se analizaron las complicaciones post operatorias y no presentan diferencias estadísticamente significativas. Los dispositivos de titanio y reabsorbibles no difirieron en términos de comportamiento biomecánico y complicaciones postquirúrgicas en el tratamiento de fracturas mandibulares. Faltan nuevos estudios que comparen ambas placas en fracturas mandibulares.

Abstract Mandibular fractures have a high prevalence in the maxillofacial region, often requiring surgical intervention. The gold standard for treatment involves open reduction with osteosynthesis using titanium plates. New biocompatible materials have been applied to address the complications and disadvantages of titanium plates, leading to the emergence of absorbable osteosynthesis plates. Understanding the effectiveness of titanium plates and absorbable osteosynthesis plates in the treatment of mandibular fractures helps determine the need to invest in new techniques with predictable outcomes. To describe the effectiveness of using titanium plates and absorbable osteosynthesis plates in the treatment of mandibular fractures. In August 2023, an exploratory systematic review of the available literature since 2018 on the use of absorbable osteosynthesis plates in mandibular fractures was conducted. PubMed, Scopus, and WOS were searched, including studies in English or Spanish. A total of 227 articles were obtained. After reviewing titles and abstracts, 29 articles were included for full-text reading. Nine duplicates were discarded, and 10 were excluded based on predefined criteria, resulting in a total of 10 articles for this study. Authors report that titanium plates exhibit less displacement of the contact surface in fractured segments due to a larger surface area, rigidity, and load-bearing capacity. Absorbable osteosynthesis plates are more flexible but are susceptible to greater deformation under significant masticatory forces, potentially leading to fracture opening and displacement of bone segments. Postoperative complications were analyzed, and no statistically significant differences were found. Titanium and absorbable devices did not differ in terms of biomechanical behavior and postoperative complications in the treatment of mandibular fractures. Further studies comparing both types of plates in mandibular fractures are needed.