RESUMEN: La evaluación del estado estructural del tronco de los árboles es fundamental en la determinación del riesgo para las personas y la infraestructura urbana. Los objetivos fueron: 1) evaluar indicadores de la presencia y severidad de descomposición interna del tronco de fresno (Fraxinus uhdei) en el Parque Nacional Molino de Flores Netzahualcóyotl, 2) determinar la asociación entre el nivel visual básico de riesgo y la severidad de descomposición, y 3) determinar las características visuales externas del árbol que influyen en la probabilidad de presencia de descomposición interna del tronco. Se evaluó el riesgo de 50 árboles mediante el método de Porkorny y se determinó la presencia de la descomposición mediante un resistógrafo en dos zonas del tronco: a 30 cm (Base) y a 1,3 m (DN) de altura del suelo. La severidad de la descomposición se determinó mediante la relación “madera sana y el radio del tronco”. De manera general, la presencia de descomposición interna fue de 30 %, siendo más frecuente y severa en la zona de la base que en el DN. Existe una asociación moderada negativa entre la severidad de la descomposición y la calificación de riesgo. Finalmente, la presencia de indicadores visuales externos de descomposición en la base del tronco y la presencia de raíces expuestas con lesiones son los dos factores que predicen la presencia de descomposición interna del tronco del fresno. Estos resultados contribuyen a la generación de calificaciones más certeras en las evaluaciones de riesgo de un nivel básico.

ABSTRACT: The evaluation of the structural trunk condition is fundamental in determining the risk to people and urban infrastructure. The objectives were: 1) to evaluate indicators of the presence and severity of internal decomposition of the trunk of ash (Fraxinus uhdei) in the Molino de Flores Netzahualcóyotl National Park, 2) to determine the association between the basic visual level of risk and the severity of decay, and 3) determine the external visual characteristics of the tree that influence the probability of the presence of internal trunk decay. The risk of 50 trees was evaluated using the Porkorny method and the presence of decay was determined using a resistograph in two areas of the trunk: 30 cm (Base) and 1.3 m (DN) height from the ground. The severity of decay was determined by the sound wood- stem radius ratio. In general, the presence of internal decomposition was 30 %, being more frequent and severe in the base area than in the DAP. There is a moderate negative association between decay severity and risk rating. Finally, the presence of external visual indicators of decay at the base of the trunk and the presence of exposed roots with lesions are the two factors that predict the presence of internal decay of the ash tree trunk. These results contribute to the generation of more accurate ratings in basic level risk assessments.

Abstract Introduction: Screen use among adolescents has increased, with excessive screen time associated with poor sleep. Isolation due to the COVID-19 pandemic may have exacerbated these problems. This study aimed to characterize adolescents’ sleep and screen use behaviors during the COVID-19 pandemic lockdown. Methods: This was a multicenter, cross-sectional, descriptive study of adolescents aged 10 to 18 years evaluated in an Adolescent Medicine outpatient visit of four hospitals in northern Portugal between January and March 2021. Adolescents completed a survey with questions about screen use and sleep and the Pediatric Daytime Sleepiness Scale (Portuguese version). Results: A total of 131 adolescents (66.4% female; median age 15 years) were enrolled during the study period. Participants reported a median sleep duration of nine hours on weekdays and 10 hours on weekends, with 25.9% sleeping less than eight hours on weekdays. Approximately 80% reported good or very good sleep quality. Onset insomnia was identified in 39.7% and excessive daytime sleepiness (EDS) in 13.7%. Most adolescents (74.0%) reported screen time of ≥6 hours/day. Screens were mainly used for attending classes and talking to friends. Smartphones were available in the bedroom at night for 83.2%, while 61.1% had televisions, 57.3% had computers, and 16.0% had gaming consoles in their bedrooms. Fifty-five percent used screens within an hour of bedtime every day. Screen time ≥6 hours/day and having a computer or smartphone in the bedroom at night were associated with shorter sleep duration on weekdays and EDS. Screen use within an hour of bedtime ≥4 times/week was associated with sleep-onset insomnia, shorter weekday sleep duration, and EDS. Discussion: Online classes during the COVID-19 lockdown may explain the use of devices ≥6 hours/day. Although most adolescents reported normal median sleep time and subjective good or very good sleep quality, screen use ≥6 hours/day and within one hour before bedtime was associated with sleep deprivation on weekdays and EDS. Conclusions: Excessive screen time during the pandemic appears to have had a negative impact on adolescents’ sleep. These findings underscore the importance of identifying and intervening in these issues when addressing adolescent global health.

Resumo Introdução: O uso de ecrãs tem vindo a aumentar entre os adolescentes, estando descrita a associação entre tempo excessivo de ecrã e menor quantidade e pior qualidade de sono. A pandemia de COVID-19 poderá ter agravado estes problemas. Este estudo pretendeu caracterizar o comportamento dos adolescentes relativamente ao sono e uso de ecrãs durante o confinamento imposto pela pandemia de COVID-19. Métodos: Estudo descritivo, transversal, multicêntrico de adolescentes dos 10 aos 18 anos avaliados numa consulta externa de Medicina do Adolescente de quatro hospitais do norte de Portugal entre janeiro e março de 2021. Os adolescentes preencheram um questionário com perguntas sobre o uso de ecrãs e o sono e a Pediatric Daytime Sleepiness Scale (versão portuguesa). Resultados: Foram incluídos 131 adolescentes (66,4% do género feminino; idade mediana de 15 anos) durante o período de estudo. Os participantes relataram uma mediana de duração do sono de 9 horas durante a semana e 10 horas ao fim-de-semana, com 25,9% a dormir menos do que oito horas diárias durante a semana. Cerca de 80% referiu ter um sono de boa ou muito boa qualidade. Foi identificada insónia inicial em 39,7% e sonolência diurna excessiva (SDE) em 13,7% dos participantes. A maioria (74,0%) referiu um tempo de ecrã ≥6 horas/dia. Os ecrãs foram usados maioritariamente para assistir a aulas e conversar com amigos. Um total de 83,2% dos adolescentes referiu dormir com o telemóvel no quarto e 61,1% referiu ter televisão, 57,3% computador e 16,0% consola de jogos no quarto. Cinquenta e cinco por cento usava ecrãs todos os dias na hora antes de dormir. Um tempo de ecrã ≥6 horas/dia e ter computador ou telemóvel no quarto durante a noite associou-se a uma menor duração do sono durante a semana e SDE. O uso de ecrãs na hora antes de dormir associou-se a insónia inicial, menor duração do sono durante a semana e SDE. Discussão: As aulas online poderão explicar o uso frequente de ecrãs (≥6 horas/dia). Embora a mediana de duração do sono tenha sido normal e a maioria dos adolescentes tenha referido ter um sono de boa ou muito boa qualidade, o uso de ecrãs ≥6 horas/dia e na hora antes de dormir associou-se a privação de sono durante a semana e SDE. Conclusão: O uso excessivo de ecrãs durante a pandemia parece ter tido um impacto negativo no sono dos adolescentes. Estes dados reforçam a necessidade de identificar e intervir nestes problemas durante a abordagem de saúde global do adolescente.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma with sudden deceleration and increased intravascular pressure. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The purpose of this study was to analyze and report our center’s experience in the treatment of blunt traumatic injuries of thoracic aorta and supra-aortic trunks. Methods: A retrospective review of a single center's database was done to identify all patients treated for BTAI, in a four-year period, from January 2018 to December 2021. Follow-up period ranged from three to 24 months. Patients’ demographics, injury mechanism, location and grade of aortic injury, treatment details, timing of intervention, length of hospital stay, follow-up time, and postoperative morbidity and mortality were extracted from patients’ medical records. A descriptive analysis of all the data was performed. Results and discussion: We identified six patients to include in the study. Mean age was 29 years and 83.3% of patients were male. The mechanism of injury was motor vehicle accident for all cases. The most common injury grade was type III (pseudoaneurysm) in five patients (83.3%), and one patient presented with a type IV aortic injury with rupture. All injuries were in the aortic isthmus and all patients were suitable for TEVAR. Mean time to intervention was 17 days. Mean oversizing was 11%. Two patients had coverage of their LSA. No deaths occurred in the hospital or during the follow-up period, and there were no registered vascular procedure-related morbidities. Conclusion: This study reports a level one trauma center experience in management of BTAI. All patients underwent CTA for diagnosis and grading of aortic injury. TEVAR proved to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

RESUMEN Reconstruimos la trayectoria de vida de la enfermera y militante popular argentina Irma Carrica, entendida como una experiencia político-profesional ligada a sus redes de sociabilidad y atravesada por conflictos y contradicciones inherentes a su contexto histórico. Desde ese recorte analítico y teniendo en cuenta los recaudos sugeridos por el método biográfico de las ciencias sociales, nos adentramos en los debates político-sanitarios de las décadas de 1960 y 1970, principalmente en lo relativo a las disputas por el sentido de la “comunidad” en el campo de la salud. En particular, nos enfocamos en las contribuciones de un actor histórico colectivo -heterogéneo y plural, pero identificable en sus distintas modulaciones- que hemos denominado izquierda peronista en salud. Al analizar sus redes profesionales e intelectuales, hicimos hincapié en el rol que desempeñó Irma Carrica como referente de esa izquierda peronista en salud, a la hora de construir dinámicas alternativas para el abordaje comunitario en salud, que pusieron en tela de juicio los paradigmas epistemológicos y pedagógicos dominantes.

ABSTRACT We reconstruct the life path of the Argentine nurse and popular activist Irma Carrica, understood as a political-professional experience tied to her social networks and marked by conflicts and contradictions inherent to her historical context. From this analytical perspective and considering the precautions suggested by the biographical method of social sciences, we delve into the political and health debates of the 1960s and 1970s, particularly concerning disputes over the meaning of “community” in the health field. Specifically, we focus on the contributions of a collective historical actor - heterogeneous and plural, yet identifiable in its various forms - that we have termed the Peronist Left in health. By analyzing their professional and intellectual networks, we emphasize the role played by Irma Carrica as a representative of this Peronist Left in health, in constructing alternative dynamics for community health approaches, which challenged the dominant epistemological and pedagogical paradigms.

RESUMEN Reconstruimos la trayectoria de vida de la enfermera y militante popular argentina Irma Carrica, entendida como una experiencia político-profesional ligada a sus redes de sociabilidad y atravesada por conflictos y contradicciones inherentes a su contexto histórico. Desde ese recorte analítico y teniendo en cuenta los recaudos sugeridos por el método biográfico de las ciencias sociales, nos adentramos en los debates político-sanitarios de las décadas de 1960 y 1970, principalmente en lo relativo a las disputas por el sentido de la “comunidad” en el campo de la salud. En particular, nos enfocamos en las contribuciones de un actor histórico colectivo -heterogéneo y plural, pero identificable en sus distintas modulaciones- que hemos denominado izquierda peronista en salud. Al analizar sus redes profesionales e intelectuales, hicimos hincapié en el rol que desempeñó Irma Carrica como referente de esa izquierda peronista en salud, a la hora de construir dinámicas alternativas para el abordaje comunitario en salud, que pusieron en tela de juicio los paradigmas epistemológicos y pedagógicos dominantes.

ABSTRACT We reconstruct the life path of the Argentine nurse and popular activist Irma Carrica, understood as a political-professional experience tied to her social networks and marked by conflicts and contradictions inherent to her historical context. From this analytical perspective and considering the precautions suggested by the biographical method of social sciences, we delve into the political and health debates of the 1960s and 1970s, particularly concerning disputes over the meaning of “community” in the health field. Specifically, we focus on the contributions of a collective historical actor - heterogeneous and plural, yet identifiable in its various forms - that we have termed the Peronist Left in health. By analyzing their professional and intellectual networks, we emphasize the role played by Irma Carrica as a representative of this Peronist Left in health, in constructing alternative dynamics for community health approaches, which challenged the dominant epistemological and pedagogical paradigms.

Abstract Fire is an important component of ecosystems, however, for many years it was perceived as a threat and an attempt was made to exclude it, affecting the process of ecological succession, and increasing the fuel load. One of the most used strategies to restore the fire regime is prescribed burning, nonetheless the consequences on the different components of the ecosystem are still not clearly known. For this reason, in the present work the effect of a prescribed burn on the biodiversity of beetle morphospecies in a Pinus montezumae forest was evaluated, through the collection of insects in traps baited with frontalin. Statistically, significant differences were found in the morphospecies biodiversity index of the area with prescribed burning and the surrounding area to which the fire was not applied. More specimens were collected in the burned area, mainly representatives of the families Bruchidae and Curculionidae (specifically Scolytinae). In the site without prescribed burning, only 18 families of Coleoptera were present out of the 21 that were registered in the burned area, however, the Non-metric Multidimensional Scaling (NMDS) analysis showed that the composition of both communities was similar.

Resumen El fuego es un componente importante de los ecosistemas, sin embargo, durante muchos años se percibió como una amenaza y se intentó excluir, afectando el proceso de sucesión ecológica y aumentando la carga de combustibles. Una de las estrategias más utilizadas para restaurar el régimen del fuego son las quemas prescritas, pero aún no se conocen claramente las consecuencias en los distintos componentes del ecosistema. Es por esto, que en el presente trabajo se evaluó el efecto de una quema prescrita sobre la biodiversidad de morfoespecies de coleópteros en un bosque de Pinus montezumae, a través de la recolecta de insectos en trampas cebadas con frontalina. Se encontraron diferencias estadísticamente significativas en el índice de biodiversidad de morfoespecies del área con quema prescrita y el área aledaña a la que no se le aplicó el fuego. Se recolectaron más especímenes en el área con quema, sobre todo representantes de las familias Bruchidae y Curculionidae (específicamente Scolytinae). En el sitio sin quema prescrita se presentaron solo 18 familias de Coleoptera de las 21 que se registraron en el área quemada, sin embargo, el análisis de Escalamiento Multidimensional No-métrico (NMDS) mostró que la composición de ambas comunidades fue semejante.

ABSTRACT Introduction: The bacterium Chlamydia trachomatis causes one of the most common sexually transmitted infections. The World Health Organization reports approximately 131 million cases annually. Objective: To evaluate the performance of the CROMATEST rapid test (Linear Chemicals. S.L. Barcelona Spain) in clinical specimens. Methods: 72 samples were studied: 38 vaginal exudates from adolescents from the Juan Manuel Márquez and El Cerro pediatric hospitals; and 34 urine samples from volunteers from the "Pedro Kourí" Tropical Medicine Institute. The CROMATEST assay was used and the commercial real-time polymerase chain reaction was used as a reference test. Sensitivity, specificity, positive and negative predictive value were calculated. Results: Six samples were positive by the rapid test, five by the real-time polymerase chain reaction and one by the reference test. The negative samples were 66, of which one was negative for the real-time polymerase chain reaction and positive in the CROMATEST. The concordance between both tests was 95 % and the Kappa value 0.8182. A sensitivity of 83.33 %, a specificity of 98.48 % and positive and negative predictive values of 83.33 % and 98.48 %, respectively, were obtained. Conclusions: The CROMATEST rapid test performed excellently against the reference test; therefore, its use is recommended for the detection of Chlamydia trachomatis.

RESUMEN Introducción: La bacteria Chlamydia trachomatis provoca una de las infecciones de transmisión sexual más frecuente. La Organización Mundial de la Salud reporta aproximadamente 131 millones de casos anuales. Objetivo: Evaluar el desempeño de la prueba rápida CROMATEST (Linear Chemicals. S.L. Barcelona España) en muestras clínicas. Métodos: Se estudiaron 72 muestras: 38 exudados vaginales de adolescentes de los hospitales pediátricos Juan Manuel Márquez y el Cerro; y 34 muestras de orina de voluntarios del Instituto de Medicina Tropical “Pedro Kourí. Se empleó el ensayo CROMATEST y como prueba de referencia la reacción en cadena de la polimerasa en tiempo real comercial. Se calculó sensibilidad, especificidad, valor predictivo positivo y negativo. Resultados: Seis muestras resultaron positivas por el test rápido, cinco por la reacción en cadena de la polimerasa en tiempo real y una por la prueba de referencia. De las 66 muestras negativas, una fue negativa para la reacción en cadena de la polimerasa en tiempo real y positiva en el CROMATEST. El porcentaje de concordancia entre ambas pruebas fue del 95 % y el valor de Kappa 0,8182. Se obtuvo una sensibilidad de 83,33 %, una especificidad del 98,48 % y valores predictivos positivo y negativo de 83,33 % y 98,48 %, respectivamente. Conclusiones: La prueba rápida CROMATEST tuvo un desempeño excelente contra la prueba de referencia; por tanto, se recomienda su utilización para la detección de Chlamydia trachomatis.

ABSTRACT Vesicular stomatitis virus is the causative agent of the vesicular stomatitis disease, which mainly affects cattle, swine, and horses causing significant economic losses. Many other animal species, including humans, can be also affected by the disease. Up to now, the epidemiology of vesicular stomatitis disease is not well understood. Previous epidemiological studies in Central America described the existence of an association between the presence of vesicular stomatitis New Jersey virus antibodies and environmental risk factors such as mean annual rainfall, temperature, and elevation. Additionally, molecular epidemiology studies revealed that the phylogenetic relationship between vesicular stomatitis New Jersey virus isolates is more related to ecological factors than temporal factors. We have performed a genetic analysis of vesicular stomatitis virus samples isolated from animals in different geographical regions in Venezuela. We sequenced the hypervariable region of the phosphoprotein gene of 51 samples collected over eight years. The virus was found in a wide range of environmental conditions, at high and low altitudes and with variable levels of precipitation and temperatures. In contrast with previous reports, our phylogenetic analysis showed that viruses from different ecological regions did not present significant genetic differences. cattle swine losses species humans now understood rainfall temperature elevation Additionally Venezuela 5 years conditions temperatures reports differences

Resumo: Este artigo faz uma análise genealógica da inclusão da “agressividade infantil” e suas variações no Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) ao longo das suas edições. Começamos por avaliar a relevância da inclusão deste signo clínico nos critérios de diagnóstico, sobretudo a partir de 1980. Em seguida, analisamos as implicações clínicas e políticas desta inclusão, em particular no que concerne à construção de uma psicopatologia da infância e à definição social de normas de conduta. Por fim, analisamos como a ênfase colocada na normatização da agressividade infantil através de discursos normativos, em consonância com as exigências neoliberais de desempenho, contribui para o aumento da expressão da agressividade como forma de lidar com o mal-estar e com o sofrimento subjetivo. Resumo DSM (DSM edições diagnóstico 1980 seguida conduta fim normativos desempenho malestar mal estar subjetivo 198 19 1

Résumé : Cet article propose une analyse généalogique de l’inclusion de l’« agressivité infantile » et de ses variations dans le Manuel diagnostique et statistique des troubles mentaux (DSM) au fil de ses éditions. Nous commençons par évaluer la pertinence de l’inclusion de ce signe clinique dans les critères diagnostiques, en particulier depuis 1980. Nous analysons ensuite les implications cliniques et politiques de cette inclusion, notamment en ce qui concerne la construction d’une psychopathologie de l’enfance et la définition sociale de normes comportementales. Enfin, nous analysons comment l’accent mis sur la normalisation de l’agressivité de l’enfant par les discours normatifs, en accord avec les exigences de performance néolibérales, contribue à l’augmentation de l’expression de l’agressivité comme moyen de faire face au malaise et à la souffrance subjective. linclusion l inclusion l« « l’ DSM (DSM éditions diagnostiques 1980 dune d lenfance enfance comportementales Enfin laccent accent lagressivité lenfant enfant normatifs néolibérales laugmentation augmentation lexpression expression subjective 198 19 1

Abstract: This article provides a genealogical analysis of the inclusion of “child aggressiveness” and its variations in the Diagnostic and Statistical Manual of Mental Disorders (DSM) throughout its editions. We begin by assessing the relevance of the inclusion of this clinical sign in the diagnostic criteria, especially since 1980. We then analyze the clinical and political implications of this inclusion, particularly regarding the construction of a psychopathology of childhood and the social definition of norms of conduct. Finally, we analyse how the emphasis placed on the normalization of child aggression through normative discourses, in line with neoliberal demands for performance, contributes to an increase in the expression of aggression as a way of dealing with malaise and subjective suffering. Abstract aggressiveness DSM (DSM editions criteria 1980 conduct Finally discourses performance suffering 198 19 1

Resumen: Este artículo realiza un análisis genealógico de la inclusión de la “agresividad infantil” y sus variaciones en el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM) a lo largo de sus ediciones. Comenzamos evaluando la relevancia de la inclusión de este signo clínico en los criterios diagnósticos, especialmente desde 1980. A continuación, analizamos las implicaciones clínicas y políticas de esta inclusión, sobre todo en lo que respecta a la construcción de una psicopatología de la infancia y a la definición social de las normas de comportamiento. Por último, analizamos cómo el énfasis puesto en la normalización de la agresividad infantil a través de discursos normativos, en consonancia con las exigencias neoliberales de rendimiento, contribuye a un aumento de la expresión de la agresividad como forma de afrontar el malestar y el sufrimiento subjetivo. Resumen DSM (DSM ediciones diagnósticos 1980 continuación comportamiento último normativos rendimiento subjetivo 198 19 1

Residual stresses exist intrinsically in any manufactured or processed material, significantly influencing its mechanical properties. Shot peening enhances fatigue life by introducing compressive residual stresses at the surface, however, the beneficial effects may be reduced under external loads. This study investigates the behavior of surface residual stresses induced by shot peening in API 5L X80 steel. Specimens underwent tensile monotonic loading cycles below the yield strength, incrementally increasing the load until reaching the yield limit. Residual stresses were measured using the X-ray diffraction by sin2ψ method, revealing a progressive stress relief of compressive residual stresses field induced by shot peening. The development of tensile residual stresses was observed following the monotonic tests. Loads below yield stress were able to completely reverse compressive stresses to tensile stresses. A correlation was observed between residual stresses and magnetic Barkhausen noise, suggesting it as a potential method for analyzing residual stress behavior qualitatively in shoot peened steel samples. material properties however loads L X X8 strength limit Xray ray sinψ sin ψ tests noise samples

Abstract Introduction: The use of statins in hemodialysis patients is a topic of ongoing research and debate. Patients with chronic kidney disease on hemodialysis constitute a large proportion of patients treated in the vascular surgery field. Clinical data of the protective statin effect on this group is scarce and conflicting results exist regarding cardiovascular, cerebrovascular and limb outcomes. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases to understand the relationship between statin effect and cardiovascular, limb outcomes and cerebrovascular outcomes. A narrative review was constructed, based on the obtained literature. Results: Although the use of statins in hemodialysis patients may provide cardiovascular benefits, the optimal dosage and safety profile of these medications in this population remain uncertain. A carefully evaluation of the risks and benefits of statins should be made based on each patient's specific requirements and circumstances. Conclusion: The role of statins for patients with peripheral arterial disease who are on hemodialysis remains unclear. Further analyses should focus on this subgroup of dialysis patients, who are becoming more prevalent on the vascular surgery departments, allowing for an optimized treatment with better patient outcomes.

Abstract Introduction: Seat belt aorta is a rare but often severe complication arising from blunt trauma with compression of the abdominal aorta against vertebrae. Seat belt sign is often present as an ecchymosis across the abdomen. The association with abdominal wall disruption and hollow viscus injury has been named seat belt triad; the presence of Chance fracture is sometimes considered a fourth component. Methods: Using Pubmed and Embase databases we reviewed all articles regarding abdominal seat belt aortic injuries and analysed presentation at admission, concomitant lesions, including presence of seat belt triad, treatment and outcomes. Results: Fifty-two cases were reported, from 1968 to 2019. Twenty-nine males (56%), mean age 43 ± 19 years. Most patients were stable at admission, with 29 (55.8%) presenting acute abdomen, 26 (50%) limb ischemia, 9 (17.3%) hypovolemic shock and 2 (3.8%) late-onset claudication. Seat belt sign was identified in 40 patients (76.9%), seat belt triad in 38 (73.1%) and 22 (42.3%) had Chance fractures, of which only 2 were not associated with seat belt triad. Most patients presented with aortic dissection (90.4%), complicated with pseudoaneurysm (11.5%), contained rupture (7.7%) or uncontained rupture (3.8%); 2 patients presented isolated iliac thrombosis and 3 limb ischemia. All patients required immediate surgical intervention, of which 40 (76.9%) required urgent vascular surgery. Forty-eight patients (92.3%) underwent vascular surgery: 39 open revascularizations and 9 endovascular procedures; three were managed conservatively. Ten patients (19.2%) passed away or died, of which 7 had seat belt triad. No patients needed reinterventions for vascular lesions except one, yet 3 required limb amputation. Most patients with seat belt triad required further visceral and abdominal wall repair. Conclusions: Seat belt aorta and especially seat belt triad are severe complications associated with high morbimortality often requiring surgery and multiple interventions. As patients are usually conscious and stable upon admission, this condition should not be disregarded.

Abstract Introduction: Diabetes mellitus is one of the main causes of morbi-mortality worldwide. In this study, we aim to verify if the COVID-19 pandemic had repercussions on the metabolic and cardiovascular control of patients with type 2 diabetes at USF Garcia de Orta, from ACeS Porto-Ocidental. Methods: Cross-sectional observational analytical study. The study’s population consists of patients registered at the USF GO with the diagnosis of DM (ICPC-2 code T89 and T90) in the list of active problems. After applying inclusion and exclusion criteria, the sample was obtained by simple randomization. Glycated hemoglobin (HbA1c), LDL-cholesterol, body mass index (BMI), systolic (BP) and diastolic (DP) blood pressure values recorded in a pre-pandemic period were compared with those in a pandemic period. Results: The sample consisted of 218 patients, with a mean age of 70.9 ± 11.1 years. The median of HbA1c (6.75 vs 6.80) and LDL-cholesterol (82.80 vs 91.60) was lower in the pandemic period. The opposite was verified in relation to the BMI, with the highest median in the pandemic period (27.03 vs 26.87). Only the analysis of cholesterol-LDL obtained a statistically significant result. On average, the values of BP (134.06 vs 133.41) and DP (77.97 vs 76.59) were higher in the pandemic period compared to the pre-pandemic period, although without statistical significance. Discussion: With the exception of BMI, BP and DP, there was an improvement in the pandemic period. In the literature found, there are contradictory results on the impact of the pandemic on the variables studied. These results may reflect the quality of the teleconsultations carried out during the pandemic period and/or the effort of diabetics to maintain healthy habits. Conclusion: We cannot conclude that, in the period evaluated, the COVID-19 pandemic had a negative impact on the metabolic and cardiovascular control of patients with DM2 in our population.

Resumo Introdução: A diabetes mellitus é uma das principais causas de morbimortalidade em todo o mundo. Pretende-se verificar se a pandemia COVID-19 teve repercussões no controlo metabólico e cardiovascular dos doentes com diabetes mellitus tipo 2 (DM2) da USF Garcia de Orta (GO), do ACeS Porto Ocidental. Método: Estudo observacional, transversal, analítico. A população do estudo corresponde aos utentes inscritos na USF GO com o diagnóstico de DM (código T89 e T90 da ICPC-2) na lista de problemas ativos. Depois de aplicados os critérios de inclusão e exclusão obteve-se a amostra por aleatorização simples. Foram comparados valores de hemoglobina glicada (HbA1c), colesterol-LDL, índice de massa corporal (IMC), pressão arterial sistólica (PAs) e diastólica (PAd), registados num período pré-pandémico com os de um período pandémico. Resultados: A amostra foi de 218 pacientes, com média de idades de 70,9 ±11,1 anos. Na amostra a mediana de HbA1c (6,75 vs 6,80) e do colesterol-LDL (82,80 vs 91,60) foi inferior no período pandémico. Verificando-se o oposto em relação ao IMC, com a mediana superior no período pandémico (27,03 vs 26,87). Apenas na análise do colesterol-LDL se obteve um resultado estatisticamente significativo. Na análise do controlo tensional, em média, os valores de PAs (134.06 vs 133.41) e PAd (77.97 vs 76.59) foram superiores no período pandémico face ao pré-pandémico, mas sem significado estatístico. Discussão: No estudo encontrou-se, à exceção do IMC, da PAs e da PAd, uma melhoria dos valores no período pandémico. Em relação ao impacto da pandemia nas variáveis estudadas estão descritos na literatura resultados contraditórios. Estes resultados podem refletir a qualidade das teleconsultas realizadas no período pandémico e/ou no esforço dos diabéticos por manter hábitos saudáveis. Conclusão: Não se pode afirmar que, no período avaliado, a pandemia COVID-19 teve impacto negativo no controlo metabólico e cardiovascular dos pacientes com DM2 da população estudada.

Resumen: La diabetes mellitus, un padecimiento crónico y progresivo, ocupó el tercer lugar en defunciones durante el período comprendido de enero a junio de 2021 en México. Su complicación crónica más frecuente es la neuropatía diabética que tiene un impacto importante en el sistema nervioso. En la Ciudad de México se reunió un grupo multidisciplinario de expertos para establecer un algoritmo de tratamiento que considere los aspectos sintomáticos y etiopatogénicos de la neuropatía diabética. Se utilizó un método Delphi en tiempo real con dos rondas de preguntas interactivas. La implementación del algoritmo propuesto permitirá abordar de manera integral al paciente diabético con neuropatía dolorosa y no dolorosa, tanto en el terreno de los síntomas como en la etiopatogenia. Este abordaje brinda la oportunidad de mejorar la calidad de vida y lograr la reinserción a la vida familiar y laboral. El panel de expertos recomienda al ácido tióctico como tratamiento etiopatogénico de primera línea en la neuropatía diabética.

Abstract: Diabetes mellitus, a chronic and progressive condition, was the third most common cause of death in Mexico between January and June 2021. Its most frequent chronic complication is diabetic neuropathy, which has a major impact on the nervous system. A multidisciplinary group of experts met in Mexico City to establish a treatment algorithm considering the symptomatic and etiopathogenic aspects of diabetic neuropathy. A real-time Delphi method with two rounds of interative questions was used. The implementation of the proposed algorithm will allow a comprehensive approach to the diabetic patient with painful and non-painful neuropathy, both in terms of symptoms and etiopathogenesis. This approach provides the opportunity to improve quality of life and achieve reintegration into family and work life. The expert panel recommends thioctic acid as the first line etiopathogenic treatment for diabetic neuropathy.

Abstract: The main objective of the fast postoperative recovery strategies in surgery is to provide efficient treatment based on the best available scientific evidence to shorten the postoperative recovery of patients, decrease the incidence of complications associated with hospitalization and surgical intervention; and therefore, reduce hospital costs. In our country, more than 50% of thyroidectomies are performed by low-volume surgeons, fact that has already been shown to be a risk factor associated with increased rate of postsurgical complications such as transient or permanent hypoparathyroidism or vocal cord paralysis. Understanding that achieving the availability of high-volume surgical human resources throughout the national territory is a non-viable objective in the short term, despite the efforts to train high specialists in endocrine surgery, one of the initiatives proposed by the Mexican Association of General Surgery, A.C., is to provide a series of recommendations to guide national surgeons for achieving better surgical results, with the unique objective of increasing the quality of care of the Mexican population. Until now, in Mexico there was no established recovery protocols for patients undergoing thyroid surgery. The purpose of this work was to create a series of recommendations for the preoperative, intraoperative, and postoperative periods, to improve the outcomes of patients undergoing thyroidectomy. All these recommendations are based on the best scientific evidence available and are aimed to general surgeons with both high and low thyroidectomy volume.

Resumen: Los programas de recuperación mejorada en cirugía tienen como principal objetivo brindar un tratamiento eficiente basado en la mejor evidencia científica con la finalidad de acortar el tiempo de recuperación postoperatoria de los pacientes, disminuir la incidencia de complicaciones inherentes a la hospitalización y tratamiento quirúrgico; y por consecuencia reducir los costos hospitalarios. En nuestro país, más de 50% de las tiroidectomías son realizadas por cirujanos de bajo volumen, lo que ya se ha demostrado que incrementa la posibilidad de complicaciones postquirúrgicas, tales como hipoparatiroidismo y parálisis cordal transitoria o permanente. En el entendimiento de que alcanzar la disponibilidad de recursos humanos quirúrgicos de alto volumen en todo el territorio nacional es un objetivo no viable a corto plazo, a pesar de los esfuerzos de formar altos especialistas en cirugía endocrina, una de las iniciativas de la Asociación Mexicana de Cirugía General, A.C., es la de emitir una serie de recomendaciones que apoyen a los cirujanos nacionales a tener mejores resultados quirúrgicos, con el objetivo único de incrementar la calidad de atención de la población mexicana. Hasta la fecha actual, en México no existía, un protocolo establecido para los pacientes que son intervenidos de cirugía tiroidea. El presente trabajo tuvo como finalidad realizar un consenso de expertos para emitir recomendaciones en el periodo preoperatorio, intraoperatorio y postoperatorio para mejorar los desenlaces de los pacientes intervenidos de tiroidectomía. Todas estas recomendaciones basadas en la mejor evidencia científica disponible y orientadas a cirujanos tanto de alto como de bajo volumen quirúrgico en cuanto a tiroidectomía se refiere.