Abstract Background: A new induction therapy strategy of a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG) showed a lower incidence of acute rejection. Methods: The objective of this study was to use real-world data to determine the incremental cost-effectiveness ratio (ICER) of r-ATG induction for the prevention of acute rejection (AR) in the first year following kidney transplantation and for kidney graft survival over 1, 4, and 10 years of post-transplantation from the perspective of the national public healthcare system. A Markov state transition model was developed utilizing real-world data extracted from medical invoices from a single center. The study population consisted of adults at low immunological risk undergoing their initial transplantation and received kidneys from either living or deceased donors. The intervention of r-ATG induction was compared to no induction. The clinical outcomes considered for this analysis were acute rejection, cytomegalovirus infection/disease, death, graft loss, and retransplantation. Results: The cost-effectiveness analysis in the first year revealed that the r-ATG group was more cost-effective, with an ICER of US$ 399.96 per avoided AR episode, an effectiveness gain of 0.01 year in graft survival and a total incremental cost of US$ 147.50. The 4- and 10-year analyses revealed an effectiveness gain of 0.06 and 0.16 years in graft survival in the r-ATG induction group, and a total incremental cost of US$ −321.68 and US$ −2,440.62, respectively. Conclusion: The single 3 mg/kg dose of r-ATG is cost-effective in preventing acute rejection episodes and dominant in the long term of transplantation, conferring survival gain. Background mgkg mg kg rATG r ATG (r-ATG Methods realworld real world costeffectiveness (ICER (AR 1 4 posttransplantation post system center donors infectiondisease infection disease infection/disease death loss retransplantation Results costeffective, costeffective effective, effective US 39996 399 96 399.9 episode 001 0 01 0.0 14750 147 50 147.50 10year 006 06 016 16 0.1 32168 321 68 −321.6 244062 2 440 62 −2,440.62 respectively Conclusion 3999 39 9 399. 00 0. 1475 14 5 147.5 3216 32 6 −321. 24406 44 −2,440.6 147. −321 2440 −2,440. −32 244 −2,440 −3 24 −2,44 − −2,4 −2, −2

Resumo Introdução: Nova estratégia de terapia de indução com dose única de 3 mg/kg de globulina antitimócitos de coelho (r-ATG) mostrou menor incidência de rejeição aguda. Métodos: O objetivo foi utilizar dados do mundo real para determinar a razão de custo-efetividade incremental (RCEI) da indução com r-ATG para prevenção da rejeição aguda (RA) no primeiro ano pós-transplante renal e para sobrevida do enxerto renal em 1, 4 e 10 anos pós-transplante, sob a perspectiva do sistema nacional de saúde pública. Desenvolveu-se um modelo de transição de estado de Markov utilizando dados do mundo real extraídos de faturas médicas de um único centro. A população do estudo consistiu em adultos com baixo risco imunológico submetidos ao primeiro transplante, recebendo rins de doadores vivos ou falecidos. A intervenção de indução com r-ATG foi comparada à não-indução. Os desfechos clínicos considerados para essa análise foram rejeição aguda, infecção/doença por citomegalovírus, óbito, perda do enxerto e retransplante. Resultados: Análise de custo-efetividade no primeiro ano revelou que o grupo r-ATG foi mais custo-efetivo, com RCEI de US$ 399,96 por episódio de RA evitado, ganho de efetividade de 0,01 ano na sobrevida do enxerto e custo incremental total de US$ 147,50. As análises de 4 e 10 anos revelaram ganho de efetividade de 0,06 e 0,16 anos na sobrevida do enxerto no grupo de indução com r-ATG e custo incremental total de US$ −321,68 e US$ −2.440,62, respectivamente. Conclusão: A dose única de 3 mg/kg de r-ATG é custo-efetiva na prevenção de episódios de RA e dominante no longo prazo do transplante, conferindo ganho de sobrevida. Introdução mgkg mg kg rATG r ATG (r-ATG Métodos custoefetividade (RCEI (RA póstransplante pós transplante 1 póstransplante, pública Desenvolveuse Desenvolveu se centro falecidos nãoindução. nãoindução não indução. não-indução infecçãodoença infecção doença citomegalovírus óbito retransplante Resultados custoefetivo, custoefetivo efetivo, efetivo custo-efetivo US 39996 399 96 399,9 evitado 001 0 01 0,0 14750 147 50 147,50 006 06 016 16 0,1 32168 321 68 −321,6 244062 2 440 62 −2.440,62 respectivamente Conclusão custoefetiva efetiva 3999 39 9 399, 00 0, 1475 14 5 147,5 3216 32 6 −321, 24406 44 −2.440,6 147, −321 2440 −2.440, −32 244 −2.440 −3 24 −2.44 − −2.4 −2. −2

This work aimed to incorporate the active compounds of the jambolan leaf in sunflower seed oil, in order to increase the nutritional quality of the oil. For this purpose, ultrasound-assisted extraction was conducted to establish the process conditions related to temperature, potency, solvent:sample ratio and time to obtain the enriched sunflower seed oil (ESSO). An experimental design was applied to examine the effect of variables (temperature, power, solvent:sample ratio and time) on the extraction mass yield (EMY). The application of maximum temperature, increased power, sample:solvent ratio and time resulted in higher EMY. Maximum theoretical EMY value was 35.16% (60 °C, 100%, 1:12 g mL-1 and 15 min). The characterization of the oils obtained from ESSO and sunflower seed oil (SSO) verified a higher content of flavonoids, phenolic compounds, a large proportion of active compounds, antioxidant activity, content of phytosterols, α-tocopherol and squalene, and induction time for ESSO. purpose ultrasoundassisted ultrasound assisted temperature potency solventsample solvent sample . (ESSO) (temperature power (EMY) samplesolvent 3516 35 16 35.16 60 (6 C °C 100 100% 112 1 12 1:1 mL1 mL mL- min. min min) SSO (SSO flavonoids activity phytosterols αtocopherol α tocopherol squalene (ESSO (EMY 351 3 35.1 6 ( 10 11 1: 35.

RESUMO: O objetivo deste trabalho foi extrair lignina de Eucalyptus sp. licor negro kraft e avaliar a influência de sua adição nas propriedades do adesivo lignina-fenol-formaldeído. Os adesivos foram sintetizados em diferentes porcentagens de massa de fenol por lignina, denominados adesivos lignina-fenol-formaldeído nas proporções de 25, 30, 50, 75 e 80%. Os parâmetros avaliados nos adesivos foram pH, teor de sólidos totais, teor de compostos orgânicos, teor de compostos inorgânicos, tempo de gelatinização e comportamento do adesivo na linha de cola. O pH variou de 10,63 a 11,65. Para o teor de sólidos totais foi encontrado o valor de 53 a 69%. Os teores de compostos orgânicos variaram de 51 a 75% e de inorgânicos de 25 a 49%. Observou-se que com a adição da macromolécula na formulação do adesivo, o teor de sólidos totais e orgânicos foi reduzido proporcionalmente enquanto o de sólidos inorgânicos foi elevado. O tempo de gelatinização foi reduzido devido à adição de lignina. As menores proporções de adição apresentaram melhor penetração e fluidez na interface com a madeira. A lignina kraft extraída do licor negro kraft de eucalipto é um ótimo adesivo com potencial para substituir parcialmente o fenol derivado do petróleo, com grande potencial para uso e aplicação nos setores aeronáutico e automotivo, no processo de colagem de peças estruturais. RESUMO sp ligninafenolformaldeído. ligninafenolformaldeído formaldeído. formaldeído 30 50 7 80 80% cola 1063 10 63 10,6 1165 11 65 11,65 5 69 69% 2 49 49% Observouse Observou se elevado madeira petróleo automotivo estruturais 3 8 106 1 6 10, 116 11,6 4 11,

ABSTRACT: The objective of this research was to extract lignin from Eucalyptus sp. kraft black liquor and to evaluate the influence of its addition on the properties of the lignin-phenol-formaldehyde adhesive. The adhesives were synthesized at different phenol mass percentages by lignin, called lignin-phenol-formaldehyde adhesives in the proportions of 25, 30, 50, 75 and 80%. The parameters evaluated in the adhesives were pH, total solid content, organic compound content, inorganic compound content, gelatinization time and adhesive behavior in the glue line. The pH ranged from 10.63 to 11.65. For the total solid content was found the value of 53 to 69 %. The contents of organic compounds ranged from 51 to 75% and inorganic from 25 to 49%. It was observed that with the addition of macromolecule in the adhesive formulation, the total and organic solid content was reduced proportionally while the inorganic solid was high. The gelatinization time was reduced due to the addition of lignin. The lower proportions of addition presented better penetration and fluidity in interface with the wood. The kraft lignin extracted from eucalyptus kraft black liquor is a great adhesive with potential to partially replace petroleum-derived phenol, with great potential for use and application in the aeronautical and automotive sectors, in the bonding process of structural parts. ABSTRACT sp ligninphenolformaldehyde formaldehyde 30 50 7 80 80% line 1063 10 63 10.6 1165 11 65 11.65 5 6 % 2 49 49% formulation high wood petroleumderived petroleum derived sectors parts 3 8 106 1 10. 116 11.6 4 11.

RESUMO: A mastite bovina é a doença mais impactante na indústria de laticínios e é caracterizada por uma complexidade de agentes causais, os quais têm revelado uma variação geográfica entre regiões e países. Os patógenos relacionados à mastite têm sido tradicionalmente classificados como contagiosos ou ambientais, com base na fonte de infecção ou origem e nas vias de transmissão. Além disso, a gravidade das infecções mamárias tem sido associada à virulência dos patógenos, e ao estado imunológico e nutricional dos animais. Considerando esse cenário, investigamos os agentes etiológicos, os escores de gravidade clínica e os dados de dias em lactação (DEL) em 4.273 casos clínicos de mastite bovina em dez fazendas de grande porte, quatro localizadas no sudoeste do estado de São Paulo e seis no sul do Estado de Minas Gerais, Brasil. Streptococcus dysgalactiae (283/4.273 = 6,6%), Escherichia coli (190/4.273 = 4,4%), Prototheca spp. (112/4.273 = 2,6%) e Streptococcus uberis (95/4.273 = 2,2%) foram os patógenos predominantes isolados. Entre os 4.273 casos clínicos, a pontuação de gravidade clínica estava disponível em 43,8% (1.871/4.273) dos animais. Desses, 69,8% (1.306/1.871), 27,3% (510/1.871) e 2,9% (55/1.871) foram classificados como leves, moderados e graves, respectivamente. Os patógenos foram observados principalmente em amostras obtidas durante os primeiros 100 dias em lactação, e a gravidade clínica foi principalmente classificada como leve. Nossos resultados contribuem para a identificação etiológica, a pontuação de gravidade clínica e os aspectos de ordenha de vacas com mastite em fazendas leiteiras com histórico de infecções mamárias clínicas. RESUMO causais países ambientais transmissão disso animais cenário etiológicos DEL (DEL 4273 4 273 4.27 porte Gerais Brasil 283/4.273 2834273 283 (283/4.27 6,6%, 66 6,6% , 6 6,6%) 190/4.273 1904273 190 (190/4.27 4,4%, 44 4,4% 4,4%) spp 112/4.273 1124273 112 (112/4.27 2,6% 26 2 95/4.273 954273 95 (95/4.27 2,2% 22 isolados 438 43 8 43,8 1.871/4.273 18714273 1 871 (1.871/4.273 Desses 698 69 69,8 1.306/1.871, 13061871 1.306/1.871 306 (1.306/1.871) 27 3 27,3 510/1.871 5101871 510 (510/1.871 29 9 2,9 55/1.871 551871 55 (55/1.871 leves graves respectivamente 10 leve etiológica clínicas 427 4.2 283/4.27 283427 28 (283/4.2 6,6 190/4.27 190427 19 (190/4.2 4,4 112/4.27 112427 11 (112/4.2 2,6 95/4.27 95427 (95/4.2 2,2 43, 1.871/4.27 1871427 87 (1.871/4.27 69, 1306187 1.306/1.87 30 (1.306/1.871 27, 510/1.87 510187 51 (510/1.87 2, 55/1.87 55187 5 (55/1.87 42 4. 283/4.2 28342 (283/4. 6, 190/4.2 19042 (190/4. 4, 112/4.2 11242 (112/4. 95/4.2 9542 (95/4. 1.871/4.2 187142 (1.871/4.2 130618 1.306/1.8 (1.306/1.87 510/1.8 51018 (510/1.8 55/1.8 5518 (55/1.8 283/4. 2834 (283/4 190/4. 1904 (190/4 112/4. 1124 (112/4 95/4. 954 (95/4 1.871/4. 18714 (1.871/4. 13061 1.306/1. (1.306/1.8 510/1. 5101 (510/1. 55/1. 551 (55/1. 283/4 (283/ 190/4 (190/ 112/4 (112/ 95/4 (95/ 1.871/4 1871 (1.871/4 1306 1.306/1 (1.306/1. 510/1 (510/1 55/1 (55/1 283/ (283 190/ (190 112/ (112 95/ (95 1.871/ 187 (1.871/ 130 1.306/ (1.306/1 510/ (510/ 55/ (55/ (28 (19 (11 (9 1.871 18 (1.871 13 1.306 (1.306/ (510 (55 (2 (1 ( 1.87 (1.87 1.30 (1.306 (51 (5 1.8 (1.8 1.3 (1.30 1. (1. (1.3

ABSTRACT: Bovine mastitis is the most impacting disease of dairy industry, and it is characterized by a complexity of causal agents, which have revealed a geographical variation among regions and countries. The mastitis-related pathogens have been traditionally classified as contagious or environmental, based on habits of the microorganisms and transmission routes. Besides, the severity of mammary infections has been associated with the virulence of the pathogens, and immune and nutritional status of the hosts. Considering this scenario, we investigated the etiological pattern, clinical severity scores, and days in milk (DIM) data in 4,273 clinical cases of bovine mastitis among ten large-dairy farms located in Brazil. Streptococcus dysgalactiae (283/4,273 = 6.6%), Escherichia coli (190/4,273 = 4.4%), Prototheca spp. (112/4,273 = 2.6%), and Streptococcus uberis (95/4,273 = 2.2%) were the predominant pathogens isolated. Among 4,273 clinical cases, clinical severity score was available in 43.8% (1,871/4,273) animals. From these, 69.8% (1,306/1,871), 27.3% (510/1,871), and 2.9% (55/1,871) were scored as mild, moderate, and severe, respectively. Pathogens were observed mainly in samples obtained during the first 100 days in milk, and clinical severity scored mainly as mild. Our results contributed to the etiological identification, clinical severity scoring, and milking aspects of mastitic cows in dairy farms with a history of clinical mammary infections. ABSTRACT industry agents countries mastitisrelated related environmental routes Besides hosts scenario pattern scores DIM (DIM 4273 4 273 4,27 largedairy large Brazil 283/4,273 2834273 283 (283/4,27 6.6%, 66 6.6% , 6 6.6%) 190/4,273 1904273 190 (190/4,27 4.4%, 44 4.4% 4.4%) spp 112/4,273 1124273 112 (112/4,27 2.6%, 26 2.6% 2 2.6%) 95/4,273 954273 95 (95/4,27 2.2% 22 isolated 438 43 8 43.8 1,871/4,273 18714273 1 871 (1,871/4,273 animals these 698 69 69.8 1,306/1,871, 13061871 1,306/1,871 306 (1,306/1,871) 27 3 27.3 510/1,871, 5101871 510/1,871 510 (510/1,871) 29 9 2.9 55/1,871 551871 55 (55/1,871 mild moderate severe respectively 10 identification scoring 427 4,2 283/4,27 283427 28 (283/4,2 6.6 190/4,27 190427 19 (190/4,2 4.4 112/4,27 112427 11 (112/4,2 2.6 95/4,27 95427 (95/4,2 2.2 43. 1,871/4,27 1871427 87 (1,871/4,27 69. 1306187 1,306/1,87 30 (1,306/1,871 27. 510187 510/1,87 51 (510/1,871 2. 55/1,87 55187 5 (55/1,87 42 4, 283/4,2 28342 (283/4, 6. 190/4,2 19042 (190/4, 4. 112/4,2 11242 (112/4, 95/4,2 9542 (95/4, 1,871/4,2 187142 (1,871/4,2 130618 1,306/1,8 (1,306/1,87 51018 510/1,8 (510/1,87 55/1,8 5518 (55/1,8 283/4, 2834 (283/4 190/4, 1904 (190/4 112/4, 1124 (112/4 95/4, 954 (95/4 1,871/4, 18714 (1,871/4, 13061 1,306/1, (1,306/1,8 5101 510/1, (510/1,8 55/1, 551 (55/1, 283/4 (283/ 190/4 (190/ 112/4 (112/ 95/4 (95/ 1,871/4 1871 (1,871/4 1306 1,306/1 (1,306/1, 510/1 (510/1, 55/1 (55/1 283/ (283 190/ (190 112/ (112 95/ (95 1,871/ 187 (1,871/ 130 1,306/ (1,306/1 510/ (510/1 55/ (55/ (28 (19 (11 (9 1,871 18 (1,871 13 1,306 (1,306/ (510/ (55 (2 (1 ( 1,87 (1,87 1,30 (1,306 (510 (5 1,8 (1,8 1,3 (1,30 (51 1, (1, (1,3

Abstract Objective This study aimed to review literature from the past five years, focusing on the use of educational videos as a guidance tool for parents and guardians of children with lip and palate clefts. Source of data Conducted between April and July 2022, this integrative literature review was framed around the question: 'What is the evidence regarding the use of videos in health education for parents/guardians of children with cleft lip and palate? PICO strategy was used to develop the research. A literature search was undertaken across PubMed, Web of Science, Scopus, and the Virtual Health Library databases. Of the eight articles included in this review, four were sourced from the PubMed database, with three published in 2021. Summary of the findings The findings indicated that YouTube videos were moderately satisfactory and met the needs of parents or legal guardians to a partial extent. The majority of the videos analyzed in this review were characterized by a moderate level of informational content. One study particularly underscored that the content of these videos only partially satisfies the requirements of the parents or legal guardians of the children. Conclusions Nevertheless, such videos are considered viable alternatives for health education, offering numerous benefits yet facing challenges, primarily due to the scarcity of information on orofacial malformations. years clefts 2022 question What parentsguardians research Science Scopus databases database 2021 extent Nevertheless challenges malformations 202 20 2

Abstract Hailey-Hailey disease is a rare genodermatosis described in 1939, with an autosomal dominant inheritance pattern, characterized by compromised adhesion between epidermal keratinocytes. It has an estimated prevalence of 1/50,000, with no gender or race predilection. It results from a heterozygous mutation in the ATP2C1 gene, which encodes the transmembrane protein hSPA1C, present in all tissues, with preferential expression in keratinocytes. Mutations in the ATP2C1 gene cause changes in the synthesis of junctional proteins, leading to acantholysis. It usually begins in adulthood, with isolated cases at the extremes of life. It manifests as vesico-bullous lesions mainly in the flexural areas, which develop into erosions and crusts. Chronic lesions may form vegetative or verrucous plaques. Pruritus, a burning feeling and pain are common. It evolves with periods of remission and exacerbation, generally triggered by humidity, friction, heat, trauma and secondary infections. The diagnosis is based on clinical and histopathological criteria: marked suprabasal acantholysis, loosely joined keratinocytes, giving the appearance of a “dilapidated brick wall”, with a few dyskeratotic cells. The acantholysis affects the epidermis and spares the adnexal epithelia, which helps in the differential diagnosis with pemphigus vulgaris. Direct immunofluorescence is negative. The main differential diagnoses are Darier disease, pemphigus vegetans, intertrigo, contact dermatitis, and inverse psoriasis. There is no cure and the treatment is challenging, including measures to control heat, sweat and friction, topical medications (corticosteroids, calcineurin inhibitors, antibiotics), systemic medications (antibiotics, corticosteroids, immunosuppressants, retinoids and immunobiologicals) and procedures such as botulinum toxin, laser and surgery. There is a lack of controlled clinical trials to support the choice of the best treatment. HaileyHailey Hailey 1939 pattern keratinocytes 150000 1 50 000 1/50,000 predilection ATPC ATP C ATP2C hSPA1C hSPAC hSPA tissues proteins adulthood life vesicobullous vesico bullous areas crusts plaques Pruritus common exacerbation humidity friction heat infections criteria dilapidated wall, wall , wall” cells epithelia vulgaris negative vegetans intertrigo dermatitis psoriasis challenging corticosteroids (corticosteroids inhibitors antibiotics, antibiotics antibiotics) (antibiotics immunosuppressants immunobiologicals toxin surgery 193 15000 5 00 1/50,00 19 1500 0 1/50,0 150 1/50, 15 1/50 1/5 1/

ABSTRACT The Covid-19 pandemic turned out to be a substantial event in the changes and adaptations made to this system within educational institutions. In this sense, the present study addresses the school culture in public educational institutions during this unusual context and aims to analyze said culture based on the perceptions of management and teaching staff during the Covid-19 pandemic. Data collection was carried out through the application of semi-structured interviews with five directors and nine teachers from five schools located in four different regions of Peru. From the analysis, it is concluded that, in public educational institutions, there were changes in the organization and development of the rituals of their identity. Likewise, myths and metaphors related to distance education were evident that show certain strengths, weaknesses and opportunities for improvement that the Covid-19 pandemic left in the educational context.

RESUMEN La pandemia del Covid-19 resultó ser un hecho sustancial en los cambios y las adaptaciones ejercidas en este sistema dentro de las instituciones educativas. En ese sentido, el presente estudio aborda la cultura escolar en las instituciones educativas públicas durante ese contexto inusual y tiene por objetivo analizar dicha cultura a partir de las percepciones del personal directivo y docente durante la pandemia del Covid-19. La recogida de información se realizó a través de la aplicación de entrevistas semiestructuradas a cinco directores y nueve docentes de cinco escuelas ubicadas en cuatro regiones distintas del Perú. A partir del análisis, se concluye que, en las instituciones educativas públicas, hubo cambios en la organización y el desarrollo de los rituales propios de su identidad. Asimismo, se evidenciaron mitos y metáforas relacionados con la educación a distancia que evidencian ciertas fortalezas, debilidades y oportunidades de mejora que dejó la pandemia del Covid-19 en el contexto educativo.

Abstract: Among the restrictive eating and eating disorders, anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are the ones that present the greatest medical complications. Objective: Describe the characteristics of patients with AN and AAN and their differences in demographic and clinical parameters. Patients and Method: The records of patients <19 years of age with AN admitted to Clinica Santa María between 2013 and 2019 were reviewed. The evolution time, amenorrhea, z-BMI, percentage and speed of weight loss, and complications were recorded. Results were expressed as mean and standard deviation or median and range. Comparisons were made using the Mann-Whitney test, the t-student test, and the chi-square test; Pearson’s coefficient was used for correlations. Results: 76 patients with AN were admitted (64% AAN). The median age was 15.4 years. AN and AAN differed in age at diagnosis (p < 0.03), z-BMI (p < 0.001), bradycardia (p < 0.009), blood pressure (p < 0.003), and cholesterol (p < 0.02), without other differences. The z-BMI correlated with heart rate (r = 0.39 p < 0.002); systolic pressure (r = 0.43 p<0.000), and HDL (r = -0.39 p < 0.005). The percentage of weight loss was correlated with time of amenorrhea (r = 0.27 p < 0.05); alanine aminotransferase (r = 0.0.37 p < 0.031), and HDL (r = 0.47 p < 0.001) and the speed of weight loss with glycemia (r = -0.46 p < 0.001) and urea nitrogen (r = -0.39 p < 0.005). Conclusion: AAN was the most frequent AN condition in this sample and variables such as the percentage and speed of weight loss were as important as BMI in medical complications.

Resumen: Dentro de los trastornos de la alimentación y la ingesta de tipo restrictivo la anorexia nerviosa (AN) y la anorexia nerviosa atípica (ANA) son los que presentan mayores complicaciones médicas. Objetivo: Describir las características de pacientes con AN y ANA y sus diferencias en parámetros demográficos y clínicos. Pacientes y Método: Se revisaron los registros de pacientes < 19 años con AN ingresados en Clínica Santa María entre 2013-2019. Se registró tiempo evolución, amenorrea, zIMC, porcentaje y velocidad de la pérdida de peso y complicaciones. Los resultados se expresaron como promedio y desviación estándar o mediana y rango. Las comparaciones se hicieron utilizando la prueba Mann-Whitney, t-student y prueba chi-cuadrado; para las correlaciones se utilizó el coeficiente de Pearson. Resultados: Ingresaron 76 pacientes con AN (64% ANA). Mediana de edad 15,4 años. AN y ANA se diferenciaron en edad de diagnóstico (p < 0,03)), zIMC (p < 0,001), bradicardia (p < 0,009), presión arterial (p < 0,003) y colesterol (p < 0,02), sin otras diferencias. El zIMC se correlacionó con frecuencia cardíaca (r = 0,39 p < 0,002); presión sistólica (r = 0,43 p < 0,000) y HDL (r = -0,39 p < 0,005). El porcentaje de pérdida de peso con el tiempo de amenorrea (r = 0,27 p< 0,05); alanino aminotransferasa (r = 0,0,37 p < 0,031) y HDL (r = 0,47 p < 0,001) y la velocidad de pérdida de peso con la glicemia (r = -0,46 p < 0,001) y nitrógeno ureico (r = -0,39 p < 0,005). Conclusión: La ANA fue el tipo de AN más frecuente en esta muestra y variables como el porcentaje y la velocidad de pérdida de peso fueron tan importantes como IMC en las complicaciones médicas.

Abstract The global syndemic is an issue that is gaining notoriety in the world. The syndemic is understood as the interaction between obesity, malnutrition and climate change, that is, synergy of epidemics and complex situations, which coexist in time and place and their consequences for health. However, little is known about the relationship between the global syndemic and the consumption of ultra-processed foods (UPF). In this context, the present essay aims to reflect on the relationship established between the global syndemic and the consumption of UPA. Starting with obesity, it is known that excessive consumption of UPA is one of the main causes of this chronic non-communicable disease. However, there is also a direct relationship between malnutrition and the consumption of UPA, since people who are in a situation of food insecurity choose economically accessible foods, characterizing themselves as a double burden of malnutrition. While studies on sustainable diets advance, knowledge about the association between climate change and UPA consumption is still incipient. Although studies highlight its environmental impacts in the handling and consumption of meat, in addition to the use of pesticides, it may play a secondary role. In this sense, studies are needed that evaluate the consumption of UPA and its relationship with the global syndemic, to support the formulation of public policies aimed at improving the consumption of healthy and sustainable foods for the planet.

Resumen La sindemia global es un tema que está ganando notoriedad en el mundo. La sindemia se entiende como la interacción entre la obesidad, la desnutrición y el cambio climático, es decir, sinergia de epidemias y situaciones complejas, que coexisten en tiempo y lugar y sus consecuencias para la salud. Sin embargo, poco se sabe sobre la relación entre la sindemia global y el consumo de alimentos ultraprocesados (AUP). En este contexto, el presente ensayo tiene como objetivo reflexionar acerca de la relación que se establece entre la sindemia global y el consumo de AUP. Empezando por la obesidad, se sabe que el consumo excesivo de AUP es una de las principales causas de esta enfermedad crónica no transmisible. Sin embargo, también existe una relación directa entre desnutrición y el consumo de AUP, ya que las personas que se encuentran en situación de inseguridad alimentaria eligen alimentos económicamente accesibles, caracterizándose como una doble carga de malnutrición. Mientras avanzan los estudios sobre las dietas sostenibles, el conocimiento sobre la asociación entre el cambio climático y el consumo de AUP es aún incipiente. Aunque los estudios destacan sus impactos ambientales en el manejo y consumo de carne, además del uso de pesticidas, pudiendo jugar un papel secundario. En este sentido, se necesitan estudios que evalúen el consumo de AUP y su relación con la sindemia global, para apoyar la formulación de políticas públicas encaminadas a mejorar el consumo de alimentos saludables y sostenibles para el planeta.

RESUMO Este artigo discute a Vigilância Popular em Saúde (VPS) como estratégia emancipatória de luta e defesa da vida ante o agronegócio na Chapada do Apodi, no Ceará. Trata-se de uma pesquisa-ação com representantes da academia, dos movimentos sociais, de entidades, organizações comunitárias e trabalhadores do Sistema Único de Saúde. Foi realizada uma oficina territorial cujo material produzido foi avaliado pela análise de conteúdo auxiliado pelo software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRaMuTeQ). A oficina destacou a necessidade de fortalecimento da luta comunitária no território pela vida, envolvendo o problema dos agrotóxicos e o papel das mulheres. A organização comunitária alia-se à atuação dos movimentos populares, evidenciando que as associações são pontos fundamentais e estratégicos nas articulações das comunidades para a reivindicação de direitos, por meio de quintais produtivos, por exemplo. Foram observados indicadores de VPS associados aos impactos do agronegócio, como a elevada mortandade de abelhas. Diante da expansão do agronegócio na região, a VPS pode continuar sendo uma importante ação na promoção de territórios mais saudáveis e sustentáveis na Chapada do Apodi. (VPS Apodi Ceará Tratase Trata se pesquisaação pesquisa academia sociais entidades IRaMuTeQ. IRaMuTeQ . (IRaMuTeQ) mulheres aliase alia populares direitos produtivos exemplo abelhas região (IRaMuTeQ

ABSTRACT This article discusses Popular Health Surveillance (PHS) as an emancipatory strategy for fighting and defending life against agribusiness in Chapada do Apodi, Ceará. This is an action research with representatives from academia, social movements, entities, community organizations and workers of the Unified Health System. A territorial workshop was carried out whose material produced was evaluated by content analysis aided by the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRaMuTeQ) software. The workshop highlighted the need to strengthen the community struggle in the territory for life, involving the problem of pesticides and the role of women. Community organization allies itself with the work of popular movements, showing that associations are fundamental and strategic points in the articulations of communities for claiming rights, through productive backyards, for example. Indicators of PHS associated with the impacts of agribusiness were observed, such as the high mortality of bees. Faced with the expansion of agribusiness in the region, PHS can continue to be an important action in promoting healthier and more sustainable territories in Chapada do Apodi. (PHS Apodi Ceará academia movements entities System IRaMuTeQ (IRaMuTeQ software women rights backyards example observed bees region

RESUMO Travestis e mulheres transexuais têm suas vulnerabilidades aumentadas quando em situação de prisão, onde sofrem constantes violações de direitos básicos à vida. O estudo analisou a utilização e as formas de obtenção das tecnologias materiais de gênero dessa população no sistema penitenciário do Rio de Janeiro. Realizou-se uma pesquisa censitária com 138 entrevistadas, entre abril e junho de 2021. Os resultados revelaram percentuais elevados de jovens adultas, pretas, pardas e com baixa escolaridade. Apesar das dificuldades para a obtenção e a utilização dessas tecnologias, desvelou-se um cenário melhor quando comparado com outros estudos nacionais. prisão vida Janeiro Realizouse Realizou se 13 entrevistadas 2021 adultas pretas escolaridade desvelouse desvelou nacionais 1 202 20 2

ABSTRACT Travestis and transgender women have increased vulnerabilities when in prison, where they face constant violations of their basic rights to life. The study analyzed the use and ways of obtaining material gender technologies for this population in the prison system of Rio de Janeiro. A census survey was carried out with 138 interviewees, between April and June 2021. The results revealed high percentages of young adults, black, of mixed race, and with low education. Despite the difficulties in obtaining and using these technologies, a better scenario was revealed when compared with other national studies. life Janeiro 13 interviewees 2021 adults black race education studies 1 202 20 2

ABSTRACT Autosomal dominant polycystic kidney disease is marked by bilateral multiple renal cysts. Obesity exacerbates renal volume and glomerular filtration rate decline in polycystic kidney. Very low-calorie ketogenic diets offer promising results for obesity and mild renal insufficiency. We report a male with polycystic kidney treated with a very low-calorie ketogenic diet and analyze the effect of calorie restriction and ketogenic diet on weight loss, glomerular filtration rate improvement, and renal volume reduction. Ketogenic dietary interventions demonstrate feasibility, efficacy, and safety for weight reduction and renal function enhancement in patients with polycystic kidney disease.

RESUMEN La enfermedad renal poliquística se caracteriza por quistes renales múltiples bilaterales. La obesidad exacerba el volumen renal y la disminución de la tasa de filtración glomerular en el riñón poliquístico. Las dietas cetogénicas muy bajas en calorías ofrecen resultados prometedores para la obesidad y la insuficiencia renal leve. Presentamos un paciente masculino con enfermedad renal poliquística tratado con una dieta cetogénica muy baja en calorías y analizamos los efectos de la restricción calórica y la dieta cetogénica sobre la pérdida de peso, la mejora de la tasa de filtración glomerular y la reducción del volumen renal. Las intervenciones dietéticas cetogénicas demuestran viabilidad, eficacia y seguridad para la reducción de peso y la mejora de la función renal en pacientes con enfermedad renal poliquística.

Abstract Sever’s disease, or calcaneal apophysitis, results from a local inflammatory process at the calcaneal growth plate and is one of the most common causes of disabling heel pain in physically active children. Herein is described the case of a ten-year-old child with chronic insidious pain in the left heel associated with physical activity. Physical examination led to the diagnosis of Sever’s disease. After appropriate treatment, a marked improvement in the child’s clinical status was noted. As a common cause of heel pain in children, this condition can be identified and diagnosed in primary care, with the family physician being responsible for its management and explaining its benign nature.

Resumo A doença de Sever, ou apofisite do calcâneo, resulta de um processo inflamatório local a nível da placa de crescimento do calcâneo e representa uma das causas mais comuns de dor incapacitante no calcanhar em crianças fisicamente ativas. É apresentado o caso de uma criança de dez anos com dor crónica e insidiosa do calcanhar esquerdo associada à prática de atividade física. O exame objetivo corroborou o diagnóstico de doença de Sever. Após tratamento adequado, verificou-se uma clara melhoria do estado clínico da criança. Sendo uma causa comum de dor no calcanhar em crianças, esta patologia pode ser encontrada e identificada nos cuidados primários, sendo a abordagem e explicação da sua natureza benigna da responsabilidade do médico de família.

Abstract Introduction: Maternal recognition of special health needs of premature babies is essential, given the importance of early stimuli after discharge to strengthen child development. Objective: To identify premature newborns with potential factors for the development of special health needs and describe maternal recognition of these factors. Materials and methods: Qualitative and quantitative study, performed using a triangulation method, with concomitant incorporation of data, included to analysis Chi-square test (p<0.05) for quantitative data and interpretation of meanings for qualitative. Variables: Birth weight, gestational age, Apgar score, complications, and length of hospital stay from 951 records of hospitalized premature infants; 18 mothers were interviewed during hospitalization, 15 days after discharge at home, 30 days after this at-home visit and at the age of 6 months of the child, by telephone, in Southern Brazil. Results: Identified as potential factors: Extreme prematurity and/or very premature, low birth weight, complications, and prolonged hospitalization. With the incorporation of the data, the relevance of these factors for children at risk of changes in development and behavior was verified. Mothers described their children as having healthy development but recognized prematurity is a factor that predisposes to new hospitalizations, and perinatal factors and those related to hospitalization contribute to the development of special health needs. Conclusion: The importance of early identification of factors that enhance the development of special health needs is understood to initiate the necessary stimuli to strengthen child development.

Resumen Introducción: El reconocimiento materno de las necesidades especiales de salud de los bebés prematuros es esencial, por la importancia de los estímulos tempranos después del alta para fortalecer el desarrollo infantil. Objetivo: Identificar a los recién nacidos prematuros con factores potenciales para el desarrollo de necesidades especiales de salud y describir el reconocimiento materno de estos factores. Materiales y métodos: Estudio cualitativo y cuantitativo, realizado mediante un método de triangulación, con incorporación concomitante de datos, incluido en el análisis del test de Chi-cuadra-do (p<0,05) para los datos cuantitativos, y la interpretación de significados para los cualitativos. Variables: Peso al nacer, edad gestacional, puntuación de Apgar, complicaciones y duración de la estancia hospitalaria a partir de 951 registros de niños prematuros hospitalizados; 18 madres fueron entrevistadas durante la hospitalización, 15 días después del alta en el domicilio, 30 días después de esta visita domiciliaria y a la edad de 6 meses del niño, por teléfono, en el sur de Brasil. Resultados: Se identificaron como factores potenciales: prematuridad extrema y/o muy prematuro, bajo peso al nacer, complicaciones y hospitalización prolongada. Con la incorporación de los datos se verificó la relevancia de estos factores para los niños en riesgo de cambios de desarrollo y comportamiento. Las madres describieron a sus hijos con un desarrollo saludable, pero reconocieron que la prematuridad es un factor que predispone a nuevas hospitalizaciones, y los factores perinatales y los relacionados con la hospitalización contribuyen al desarrollo de necesidades especiales de salud. Conclusión: Se entiende que la importancia de la identificación temprana de los factores que mejoran el desarrollo de las necesidades especiales de salud permite el inicio de los estímulos necesarios para fortalecer el desarrollo infantil.

Resumo Introdução: O reconhecimento materno das necessidades especiais de saúde dos recém-nascidos prematuros é essencial devido à importância da estimulação precoce após a alta para fortalecer o desenvolvimento infantil. Objetivo: Identificar bebês prematuros com fatores potenciais para o desenvolvimento de necessidades especiais de saúde e descrever o reconhecimento materno desses fatores. Materiais e métodos: Estudo qualitativo e quantitativo, realizado por meio de um método de triangulação, com incorporação concomitante de dados, incluindo a análise do teste qui-quadrado (p < 0,05) para dados quantitativos e interpretação de significados para dados qualitativos. Variáveis: Peso ao nascer, idade gestacional, escore de Apgar, complicações e tempo de permanência hospitalar de 951 registros de bebês prematuros hospitalizados; 18 mães foram entrevistadas durante a hospitalização, 15 dias após a alta no domicílio, 30 dias após essa visita domiciliar e aos 6 meses de idade do bebê, por telefone, no sul do Brasil. Resultados: Foram identificados como fatores potenciais: prematuridade extrema e/ou muito pré-termo, baixo peso ao nascer, complicações e hospitalização prolongada. A incorporação dos dados verificou a relevância desses fatores para crianças com risco de alterações no desenvolvimento e no comportamento. As mães descreveram seus filhos como tendo um desenvolvimento saudável, mas reconheceram que a prematuridade é um fator predisponente para novas hospitalizações, e que fatores perinatais e relacionados à hospitalização contribuem para o desenvolvimento de necessidades especiais de saúde. Conclusões: Entende-se a importância da identificação precoce de fatores que aumentam o desenvolvimento de necessidades especiais de saúde para iniciar os estímulos necessários a fim de fortalecer o desenvolvimento infantil.

Resumen Introducción: El sufrimiento psicológico entre adolescentes y estrategias para la promoción de la salud mental existe y es necesario. Objetivo: Caracterizar las demandas emocionales de adolescentes escolares y describir conocimientos sobre factores protectores de la salud mental. Métodos: Investigación sociopoética con 30 adolescentes. Resultados: Temas de análisis: “Cuestiones de interés sobre emociones y salud mental”; “Cómo afrontar el estrés y la ansiedad”; “Reflexiones sobre la resolución de conflictos y problemas enfrentados”; y “Conocimiento sobre factores protectores de la salud mental”. Conclusiones: Las actividades recreativas y artísticas son poderosas para la promoción de la salud mental de los adolescentes y pueden implementarse a través de la asociación escuela-servicio de salud.

Abstract Introduction: Psychological suffering among adolescents and strategies for the promotion of mental health exists and is necessary. Aim: To characterize the emotional demands of school adolescents and describe knowledge about protective factors of mental health. Methods: Sociopoetic research with 30 adolescents. Results/Analysis topics: “Questions of interest about emotions and mental health”; “Dealing with stress and anxiety”; “Reflections on conflict resolution and problems faced”; and “Knowledge about protective factors of mental health”. Conclusions: Recreational and artistic activities are powerful for the promotion of adolescent mental health, and can be implemented through the school-health service partnership.

Resumo Introdução: O sofrimento psicológico entre adolescentes e estratégias para a promoção da saúde mental existem e são necessários. Objetivo: Caracterizar as demandas emocionais de adolescentes escolares e descrever o conhecimento sobre fatores protetores da saúde mental. Métodos: Pesquisa sociopoética com 30 adolescentes. Resultados: Temas de análise: “Questões de interesse sobre emoções e saúde mental”; “Lidar com o stresse e a ansiedade”; “Reflexões sobre resolução de conflitos e problemas enfrentados”; e “Conhecimento sobre fatores de proteção da saúde mental”. Conclusões: As atividades recreativas e artísticas são potentes para a promoção da saúde mental dos adolescentes e podem ser implementadas através da parceria escola/serviço de saúde.