RESUMO: No estado do Amazonas cultiva-se, tradicionalmente, a laranjeira ‘Pêra’ sobre o limoeiro ‘Cravo’. O uso restrito de uma única combinação de copa-porta-enxerto tem deixado os pomares locais vulneráveis à condições adversas e a incidência de pragas e doenças, podendo interferir negativamente tanto na produtividade como na qualidade dos frutos e sustentabilidade citrícola do Estado. A ampliação do número de combinações-copas-porta-enxertos torna-se uma alternativa viável para superar tais problemas. Para atender a esta demanda dos produtores de citros foram avaliadas 30 combinações com 10 copas e três porta-enxertos no sexto e sétimo ano após o plantio das mudas no campo, no município de Rio Preto da Eva, AM. Nesse experimento foram avaliadas: a produtividade, o rendimento de suco, os sólidos solúveis, o pH, a acidez titulável, o ratio e o índice tecnológico. A copa ‘Pineapple’ com os porta-enxertos tangerineira ‘Sunki Tropical’ e ‘BRS Bravo’ podem ser alternativas produtivas em relação a tradicional combinação laranja ‘Pêra’ sob limoeiro ‘Cravo’ no Amazonas. A copa laranja ‘Lima’ com os porta-enxertos tangerineira ‘Sunki Tropical’, limoeiro ‘Cravo Santa Cruz’ e ‘BRS Bravo’ podem ser alternativas para o mercado in natura no estado. As combinações que apresentaram boa qualidade do fruto são as copas ‘Pêra’, ‘Salustiana’, ‘Valência Tuxpan’ e ‘Westin’ com o porta-enxerto ‘BRS Bravo’, e a copa ‘Pêra D6’ com o porta-enxerto limoeiro ‘Cravo Santa Cruz’. Estas combinações são alternativas para a diversificação dos pomares do estado do Amazonas. RESUMO cultivase, cultivase cultiva se, se cultiva-se tradicionalmente Pêra ‘Cravo. Cravo . copaportaenxerto porta enxerto doenças Estado combinaçõescopasportaenxertos enxertos tornase torna problemas 3 1 portaenxertos campo Eva AM suco solúveis pH titulável tecnológico ‘Pineapple Pineapple Sunki Tropical BRS Bravo ‘Lima Lima Tropical, , Cruz ‘Pêra, ‘Salustiana, Salustiana ‘Salustiana ‘Salustiana’ Valência Tuxpan ‘Westin Westin portaenxerto Bravo, D6 D Cruz.

ABSTRACT: In the state of Amazonas, the ‘Pêra’ orange scion is traditionally cultivated on ‘Rangpur’ lime tree. The restricted use of a single scion-rootstock combination has left local orchards vulnerable to adverse conditions and incidence of pests and diseases, which may negatively interfere with both productivity and fruit quality and the citrus activity sustainability in the state. The expansion of the number of scion-rootstock combinations becomes a viable alternative to overcome such problems. To meet this demand from citrus growers, 30 combinations with 10 scions and 3 rootstocks were evaluated in the sixth and seventh year after planting seedlings in the field in the municipality of Rio Preto da Eva, AM. In this experiment, productivity, juice yield, soluble solids, pH, titratable acidity, ratio and technological index were evaluated. ‘Pineapple’ scion with ‘Sunki Tropical’ and ‘BRS Bravo’ rootstocks can be productive alternatives in relation to traditional ‘Pêra’ orange scion under ‘Rangpur’ lime combination in the state of Amazonas. ‘Lima’ orange with ‘Sunki Tropical’ mandarin, ‘Rangpur lime SC’ and ‘BRS Bravo’ lime rootstocks can be alternatives for the fresh market in the state. Combinations that showed good fruit quality are ‘Pêra’, ‘Salustiana’, ‘Valência Tuxpan’ and ‘Westin’ scions with ‘BRS Bravo’ rootstock, and ‘Pêra D6’ scion with ‘Rangpur lime SC’ lemon rootstock. These combinations are alternatives for the diversification of orchards in the state of Amazonas. ABSTRACT Amazonas Pêra Rangpur tree scionrootstock rootstock diseases problems growers 1 Eva AM experiment yield solids pH acidity ‘Pineapple Pineapple Sunki Tropical BRS Bravo ‘Lima Lima mandarin SC ‘Pêra, , ‘Salustiana, Salustiana ‘Salustiana ‘Salustiana’ Valência Tuxpan ‘Westin Westin D6 D

Resumo: Introdução: A morte faz parte dos tabus sociais existentes e pode fomentar atitudes que se distanciam de sua abordagem explícita em relação aos cuidados. Objetivo: analisar as atitudes diante da morte em profissionais de enfermagem de acordo com as publicações científicas no contexto latino-americano no período de 2018 a 2022. Metodologia: Foi realizada uma revisão de literatura integrativa de publicações científicas latino-americanas sobre atitudes diante da morte no contexto da enfermagem, utilizando os seguintes termos padronizados: atitude, morte, enfermagem e cuidados de enfermagem. Foram incluídos 8 artigos publicados no período definido, em espanhol e português, nos quais o tema da revisão foi abordado explicitamente. As informações dos artigos foram analisadas tendo como referência os conceitos da teoria das transições. Resultados: Foram identificados desenhos quantitativos (50 %) e qualitativos (50 %), elaborados totalmente no âmbito hospitalar. Os principais resultados mostram a predominância da indiferença diante da morte no contexto do cuidado. Em relação à teoria das transições, a maioria dos artigos aborda as condições em que as transições ocorrem, além dos conceitos de terapêutica de enfermagem e padrões de resposta. Conclusões: A produção de pesquisas sobre atitudes diante da morte em profissionais de enfermagem é escassa na América Latina. As experiências de perdas próximas, a capacitação e o apoio institucional são a base para contribuir para uma melhor atitude em relação à morte

Abstract: Introduction: Death is part of the existing social taboos and can foster attitudes that are far from its explicit approach in relation to care. Objective: To analyze attitudes towards death in nursing professionals according to scientific publications in the Latin American context in the period 2018 to 2022. Methodology: An integrative literature review was conducted of Latin American scientific publications regarding attitudes towards death in the context of Nursing, using the following standardized terms: attitude, death, nursing and nursing care. Eight articles published in the defined period were included, in Spanish and Portuguese, in which the subject of the review was explicitly addressed. The information in the articles was analyzed using the concepts of the theory of transitions as a reference. Results: Both quantitative (50 %) and qualitative (50 %) designs were found, all of them elaborated in the hospital setting. The main results show the predominance of indifference to death in the context of care. In relation to the theory of transitions, most of the articles address the conditions under which these occur, in addition to the concepts of nursing therapeutics and response patterns. Conclusions: The production of research on the attitude towards death in nursing professionals is scarce in Latin America. Experiences of close losses, training and institutional support are the basis for contributing to a better attitude towards death

Resumen: Introducción: La muerte es parte de los tabúes sociales existentes y puede fomentar actitudes que distan de su abordaje explícito en relación con los cuidados. Objetivo: Analizar las actitudes ante la muerte en profesionales de enfermería de acuerdo con las publicaciones científicas en el contexto latinoamericano en el período 2018 a 2022. Metodología: Se realizó una revisión de literatura integrativa de las publicaciones científicas latinoamericanas respecto de las actitudes ante la muerte en el contexto de la enfermería, empleando los siguientes términos estandarizados: actitud, muerte, enfermería y cuidados de enfermería. Se incluyeron 8 artículos publicados en el período definido, en idioma español y portugués, en los que se abordó explícitamente la temática de la revisión. La información de los artículos fue analizada tomando como referencia los conceptos de la teoría de las transiciones. Resultados: Se encontraron diseños tanto cuantitativos (50 %) como cualitativos (50 %), elaborados en su totalidad en el ámbito hospitalario. Los principales resultados dan cuenta del predominio de la indiferencia ante la muerte en el contexto de los cuidados. En relación con la teoría de las transiciones, la mayoría de los artículos abordan las condiciones en que estas se dan, además de los conceptos de terapéutica de enfermería y patrones de respuesta. Conclusiones: La producción de investigaciones sobre la actitud ante la muerte en profesionales de enfermería es escasa en Latinoamérica. Las experiencias de pérdidas cercanas, la capacitación y el soporte institucional son la base para contribuir a una mejor actitud hacia la muerte

Abstract Objectives To survey, analyze and discuss the scientific evidence supporting the use of acupuncture and related techniques in the management of chronic pain in the pediatric population. Sources A survey of databases (MEDLINE, Scopus and Scielo) was carried out with search strategies, following the PRISMA statement, without limits on publication dates and languages. Clinical studies (clinical trials, single-arm, and case series) were accepted for review if they included participants aged up to 22 years. Study quality was assessed by MMAT, and the randomized clinical trial was analyzed under the STRICTA criteria. Summary of the findings 2369 articles were retrieved. After excluding repetitions, 1335 underwent the initial selection. Only 16 articles were selected for full reading, of which 5 were included in the review, being two case series, two single-arm studies, and one randomized clinical trial. The articles were considered of good quality by the adopted criteria. Conclusion The analyzed studies showed important clinical results such as the reduction of pain intensity, and improvement in school attendance and social life. However, there are many limitations in study design and sample size. Therefore, there is weak evidence to support the use of acupuncture in the context of pediatric chronic pain, but the positive results reinforce the need for further investigation of the topic with the conduct of larger and well-designed studies, to obtain more data and greater scientific conviction of the findings. population MEDLINE, MEDLINE (MEDLINE Scielo strategies statement languages trials singlearm, singlearm single arm, arm series 2 years MMAT criteria 236 retrieved repetitions 133 selection 1 reading intensity life However size Therefore welldesigned well designed 23 13

Abstract Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review. function result highrisk high risk years particularly sessions, sessions , sessions) erythropoiesisstimulating erythropoiesis stimulating metabolic volume pressure electrolyte control scenario subject

Resumo As mulheres portadoras de doença renal crônica apresentam menor probabilidade de engravidar e são mais propensas a complicações gestacionais quando comparadas a pacientes com função renal normal, sendo, portanto, consideradas gestantes de alto risco materno e fetal. Ao longo dos anos, verificou-se aumento da incidência de gestações em pacientes em diálise e melhora do desfecho materno e fetal. Acredita-se que a otimização do atendimento obstétrico e neonatal, o ajuste do tratamento dialítico (em especial, o aumento do número de horas e da frequência semanal das sessões de diálise) e o uso de agentes estimuladores da eritropoiese têm proporcionado melhor controle metabólico, volêmico, pressórico, eletrolítico e da anemia. Este artigo de revisão tem o objetivo de analisar os desfechos gestacionais em pacientes com doença renal crônica em diálise e revisar a condução médica nefrológica nesse cenário. Pelo crescente interesse pelo tema, as recomendações clínicas para a prática assistencial têm ganhado em consistência tanto no manejo medicamentoso quanto no manuseio dialítico, aspectos que tratamos na presente revisão. normal sendo portanto fetal anos verificouse verificou se Acreditase Acredita neonatal especial metabólico volêmico pressórico anemia cenário tema

Abstract Introduction The World Health Organization (WHO) estimates that ~ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence Level 3 (cohort study). WHO (WHO . (HL) firstline first line date Brazil 200 2018 group 15 4 standard SD [SD] 15. 15) lives 36 communication subanalysis Língua Sinais LIBRAS Portuguese stateoftheart state art reestablishment re establishment However occur often study) (HL 20 201 1 [SD 2

ABSTRACT. This study aimed to assess the impact of microalgal concentrations in diets on the settlement and metamorphosis stages of pediveliger larvae and spat of Crassostrea gigas oysters. Diets containing microalgal concentrations of 8, 12, and 16×104 cells mL-1 were administered for seven days during the larval settlement phase of pediveliger larvae. In the metamorphosis and postlarval cultivation phases, diets with microalgal concentrations of 8, 16, 24, and 32×104 cells mL-1 and a control group without food were tested for 14 and 21 days, respectively. Growth, yield, and survival were assessed every seven days. The diet comprised 30% Isochrysis galbana and 70% Chaetoceros muelleri microalgae. In the metamorphosis phase, the results revealed no significant differences in larval metamorphosis rate and survival across the tested diets. The concentrations exhibited similar survival in the spat with an initial average shell height of 0.657 ± 0.05 mm, with a significant difference only in growth. In the spat with an initial average shell height of 0.830 ± 0.12 mm, no differences in survival were observed among the tested concentrations. We concluded that diets of 12 and 16×104 cells mL-1 provide high rates of larval metamorphosis and spat yield during the larval settlement and metamorphosis phases. During the spat cultivation phases, diets of 32 and 24×104 cells mL-1 could optimize the cultivation time and yield of C. gigas spat in the laboratory. However, when considering survival alone, no advantage was found in providing a diet with a microalgal concentration above 8×104 cells mL-1 across all C. gigas oyster cultivation phases.

ABSTRACT The COVID-19 pandemic has brought countless changes to sustainable and healthy territories, implying the need to reorganize social and health structures. The aim was to understand the dynamics of open-air food sales markets in the post-COVID-19 pandemic period in cities in the Maciço de Baturité, in Ceará, Brazil, and to evaluate the health and/or biosafety strategies used by marketers and consumers to deal with covid-19. A qualitative study was carried out between October 2021 and January 2023, in five cities in the state of Ceará. In the first stage, the sanitary and biosafety conditions at the street markets were observed using an instrument structured into four categories. Then, consumers and stallholders were interviewed to deepen discussions about the impact of the pandemic on the markets. We evaluated fairs in five cities and interviewed 44 people. Four cities were found to have precarious sanitary conditions and compromised biosafety in the sale of food. Marketers and consumers had a low-risk perception regarding COVID-19 and raised the need to perpetuate open-air markets for the region’s quality of life and economy. Free markets are sustainable social and economic territories, which still require attention from managers and health professionals. COVID19 COVID 19 COVID-1 territories structures openair open air postCOVID19 postCOVID post post-COVID-1 Baturité Ceará Brazil andor or covid19. covid19 covid 19. covid-19 202 2023 stage categories Then 4 people lowrisk low risk regions region s economy professionals COVID1 1 COVID- postCOVID1 post-COVID- covid1 covid-1 20 post-COVID covid- 2

RESUMO A pandemia de covid-19 trouxe inúmeras mudanças aos territórios sustentáveis e saudáveis, implicando a necessidade de reorganização de estruturas sociais e de saúde. Objetivou-se compreender a dinâmica das feiras livres de vendas de alimentos no período pós-pandêmico de covid-19 em cidades do Maciço de Baturité, no Ceará, e avaliar as estratégias sanitárias e/ou de biossegurança utilizadas no enfrentamento da covid-19 por feirantes e consumidores. Realizou-se um estudo qualitativo entre outubro de 2021 e janeiro de 2023, em cinco cidades do Ceará. Em uma primeira etapa, foi realizada a observação das condições sanitárias e de biossegurança nas feiras livres, mediante um instrumento estruturado em quatro categorias. Em seguida, consumidores e feirantes foram entrevistados para o aprofundamento de discussões sobre os reflexos da pandemia sobre as feiras. Avaliaram-se as feiras de cinco cidades e entrevistaram-se 44 pessoas. Quatro cidades mostraram-se com condições sanitárias precárias e comprometimento da biossegurança e comercialização de alimentos. Feirantes e consumidores tiveram uma baixa percepção de risco sobre a covid-19 e levantaram a necessidade da perpetuação das feiras livres para a qualidade de vida e economia da região. As feiras livres são territórios sociais e econômicos sustentáveis, que ainda carecem de atenção por gestores e profissionais de saúde. covid19 covid 19 covid-1 saudáveis saúde Objetivouse Objetivou se póspandêmico pós pandêmico Baturité Ceará eou ou Realizouse Realizou 202 2023 etapa categorias seguida Avaliaramse Avaliaram entrevistaramse entrevistaram 4 pessoas mostraramse mostraram região covid1 1 covid- 20 2

ABSTRACT The present study aimed to investigate the communication/training strategies and technological tools used by fitness coaches from Brazilian football teams during home-based training according to age categories (professional and youth), competitive level (1st, 2nd and 3rd/4th divisions) and sex (male and female). An online questionnaire was applied to collect data. Eighty-two fitness coaches from sixty-seven male and female football teams (professional and youth teams) answered the questionnaire. Message apps were the main communication route between fitness coaches and players during home-based training. Online spreadsheets were frequently used to control the training. Regarding equipment provided to players for training, 70.7% of male professional players used some equipment. In contrast, most female professional and youth players (both sexes) did not receive any equipment, respectively (p< 0.01). Male players who compete in the 1st and 2nd divisions received more equipment for training than those who compete in the 3rd and 4th divisions (p< 0.01). The main physical fitness variables trained by all players during home-based training were muscle strength, strength-endurance, and aerobic capacity. Training load and training response were applied through series/repetitions/time and effort perception scales, respectively. In conclusion, the financial differences between professional and youth teams and between males and females and competitive levels can induce different home-based training conditions in Brazilian football teams during lockdown-like situations, especially related to equipment available for training targeted physical qualities. Thus, players should be monitored closely during lockdown-like situations and provided appropriate support to facilitate their training.

Abstract Demands for the revitalization of indigenous languages have sparked creative endeavors among young Chilean artists across generations. Notably, the Mapuche language has undergone a recovery process, becoming a significant element in popular music in southern Chile. This paper delves into the literary aspects of the musical discourse presented by Natural Es Estylo, specifically through an analysis of their song "Melipulli" performed in collaboration with Mapuche rapper Luanko. To achieve this objective, a rigorous content analysis was conducted utilizing specialized software. Additionally, documentary and ethnographic sources were meticulously triangulated with the lyrics of "Melipulli." The findings reveal that the revitalization of the Mapuche language is intricately linked to decolonizing strategies. Moreover, it serves as a powerful discourse of resistance, challenging hegemonic narratives surrounding the history of the Mapuche people.

Resumen Las demandas sobre la revitalización de las lenguas indígenas han estimulado procesos creativos en generaciones de jóvenes artistas chilenos. Un ejemplo de ello es el proceso de recuperación de la lengua mapuche y su emergencia como un tópico relevante en la música popular en el sur de Chile. El presente artículo busca explorar la dimensión literaria del discurso musical de Natural Es Estylo, a partir del estudio de la canción "Melipulli", interpretada en conjunto con el rapero mapuche Luanko. Para el cumplimiento de este objetivo, se realizó un análisis de contenido con la asistencia de un software especializado. Con posterioridad, se triangularon fuentes documentales y etnográficas con la letra de "Melipulli". Los resultados indican que la revitalización de la lengua mapuche forma parte de una serie de estrategias descolonizadoras, así como también de un discurso de resistencia que tensiona las formas hegemónicas de comprender la historia de este pueblo.

Resumo A demanda pela revitalização das línguas indígenas estimulou processos criativos em gerações de jovens artistas chilenos. Um exemplo disso é a recuperação da língua mapuche e sua emergência como tópico relevante na música popular no sul do Chile. O presente artigo busca explorar a dimensão literária do discurso musical de Natural Es Estylo, a partir do estudo da canção "Melipulli", interpretada em conjunto com o rapper Mapuche Luanko. Para atender a esse objetivo, foi realizada uma análise de conteúdo com o auxílio de softwares especializados. Posteriormente, fontes documentais e etnográficas foram trianguladas com a letra de "Melipulli". Os resultados indicam que a revitalização da língua mapuche faz parte de uma série de estratégias descolonizadoras, bem como de um discurso de resistência que tensiona as formas hegemônicas de entender a história deste povo.

Abstract Objective: To describe the acute care of patients with bilateral thalamic infarctions in primary and advanced stroke centers in different regions of Colombia. Methods: Multicenter retrospective descriptive study of a series of cases of patients with an imaging diagnosis of bilateral thalamic infarction, in Colombia. 14 hospitals located in seven cities of the country participated. Results: 28 cases were registered, the mean age was 66.8 years with 53.6% men and 96.3% had a favorable previous mRs (0-2). Mean NIHSS at admission was 14 points, the most frequent clinical presentation was altered mental status in 82.1%. The most compromised structure was the bilateral anterior region of the thalamus in 12 patients (42.85%). The most common etiology was undetermined cause (39.3%). 1 patient underwent reperfusion therapy with intravenous thrombolysis (3.6%). Mean hospital stay was 19 days. Conclusions: Bilateral thalamic infarcts are a diagnostic challenge in the emergency department, due to their low reported incidence and the variable clinical presentations, stroke and research centers should be strengthened to contribute to clinical outcomes.

Resumen Objetivo: Describir la atención aguda de pacientes con infartos bilaterales del tálamo en centros de atención primaria y avanzada de ataque cerebrovascular en diferentes regiones de Colombia. Métodos: Estudio descriptivo retrospectivo multicéntrico de serie de casos de pacientes con diagnóstico por imágenes de infarto talámico bilateral, en Colombia. Participaron 14 hospitales ubicados en siete ciudades del país. Resultados: Se registraron 28 casos, la edad promedio fue de 66.8 años con un 53.6% genero masculino; el 96.3% tenía un mRs previo favorable (0-2). La escala NIHSS al ingreso promedio de 14 puntos; la presentación clínica más frecuente fue el estado mental alterado en un 82.1%. La estructura más comprometida fue la región anterior bilateral del tálamo en 12 pacientes (42.85%). La etiología más común fue de causa indeterminada (39.3%). Un paciente recibió terapia de reperfusión con trombólisis intravenosa (3.6%). Estancia hospitalaria promedio de 19 días. Conclusiones: Los infartos talámicos bilaterales representan un desafío diagnóstico en el departamento de emergencias, debido a su baja incidencia reportada y la variabilidad en las presentaciones clínicas. Se debe fortalecer la capacidad de los centros de atención de ataques cerebrovasculares e investigación, para contribuir a los resultados clínicos.

ABSTRACT Introduction: The superiority of the functional results of robot-assisted radical prostatectomyis still controversial. Despite this, it is known that minimally invasive surgery obtains better results when analyzing blood loss, blood transfusion and length of stay, for example. Several studies have analyzed the impact of the resident physician's involvement on the results of urological surgeries. The simple learning curve for robot-assisted radical prostate surgery is estimated to be around 10 to 12 cases. Learning curve data for robotic surgeons is heterogeneous, making it difficult to analyze. Rare studies compare the results of a radical prostatectomy of an inexperienced surgeon starting his training in open surgery, with the results of the same surgeon, a few years later, starting training in robotic surgery. Objective: to analyze the results of open radical prostatectomy surgeries (ORP) performed by urology residents, comparing them to the results of robot-assisted radical prostatectomy (RARP), performed by these same surgeons, after completing their training in urology. Materials and methods: a retrospective analysis of the cases of only 3 surgeons was performed. 50 patients underwent ORP (group A). The surgeons who operated on the ORP patients were in the 3rd and final year of the urology residency program and beginners in ORP surgery, but with at least 4 years of experience in open surgery. The same surgeons, already trained urologists, began their training in robotic surgery and performed 56 RARP surgeries (group B). For the comparative analysis, data were collected on age, number of lymph nodes removed, surgery time, hospitalization time, drain volume, drain permanence time, indwelling bladdercateter (IBC) permanence time, positive surgical margin, biochemical recurrence, risk classification (ISUP), intra and postoperative complications, urinary incontinence (UI) and erectile dysfunction (ED). The console used was the Da Vinci Si, from Intuitive®. For statistical analysis, the Shapiro-Wilk test verified that the data did not follow normality, the Levene test guaranteed homogeneity, and the Mann-Whitney test performed the comparative analysis of the quantitative data. For the analysis of qualitative data, the Chi-square test was used for nominal variables and the Mann-Whitney U test for ordinal variables. Additionally, the Friedman test analyzed whether there was an improvement in the perception of UI or ED over the months, for each group individually (without comparing them), and the post-hoc Durbin-Conover test, for the results with statistically significant difference. We used a p-value < 0.05, and the Jamovi® program (Version 2.0). Results: there was no statistically significant difference between the groups for age, number of lymph nodes removed, positive surgical margin, biochemical recurrence, risk classification and urinary incontinence. Additionally, we observed that the surgical time was longer in group B. On the other hand, the length of stay, drain volume, drain time, IBC time, complication rate and levels of erectile dysfunction in the third and sixth months were higher in group A, when compared to group B. We also observed that there was no evolutionary improvement in ED over the months in both groups, and that there was a perception of improvement in UI from the 1st to the 3rd month in group A, and from the 1st to the 6th month, and from the 3rd to the 12th month, in group B. Conclusion: the learning curve of RARP is equivalent to the curve of ORP. In general, the results for the robotic group were better, however, the functional results were similar between the groups, with a slight tendency of advantage for the robotic arm. Introduction robotassisted robot assisted controversial this loss stay example physicians physician s 1 heterogeneous later Objective (ORP residents RARP, , (RARP) methods 5 A. A . A) rd urologists B B) age removed volume (IBC margin recurrence ISUP, ISUP (ISUP) complications (UI ED. (ED) Si Intuitive Intuitive® ShapiroWilk Shapiro Wilk normality homogeneity MannWhitney Mann Whitney Chisquare Chi square Additionally without them, them) posthoc post hoc DurbinConover Durbin Conover pvalue p value 005 0 05 0.05 Jamovi Version 2.0. 20 2.0 2 2.0) Results hand st th Conclusion general however arm (RARP (ISUP (ED 00 0.0 2. 0.

Introdução: Metástase óssea é a neoplasia maligna mais comum do esqueleto, e a tomada de decisão cirúrgica depende de múltiplos fatores, incluindo as complicações pós-operatórias e a expectativa de vida. A identificação de novos fatores prognósticos pode auxiliar na tomada de decisão. Objetivo: Analisar em metástases de ossos longos, a incidência de complicações e sobrevida pós-operatórias até 1 ano correlacionando-as com NLR e PLR. Método: Revisão de 160 prontuários de operados por metástase óssea no esqueleto apendicular. Além de características epidemiológicas, foram determinados os valores de NLR e PLR correlacionando-os com sobrevida e complicações. Resultado: Mulheres representaram 64,5% com tumor primário na mama em 62,6%; o fêmur proximal foi o mais acometido; sobrevida média foi 13,2 meses e a de 1 ano 34,7%; ressecção tumoral com endoprótese foi mais comum. A taxa de complicação pós-cirúrgicas foi de 10% e o tempo médio para a ocorrência de complicações pós-operatórias foi de 27,9 dias (0-140). Foi encontrada associação da variável neutrófilos com a complicação pós-operatória (p=0,04). A cada 100 unidades a mais de neutrófilos houve aumento de 1% nas chances de complicações pós-cirúrgicas. Valores médios do NLR e PLR foram, respectivamente, 5,3 (0,2-30,7) e 199,7 (32,1-676,7). &nbsp;Os pacientes com NLR ≥ 2 (p&lt;0,001) apresentaram diminuição na sobrevida de 92,3% para 62,5% no 3° mês e de 61,5% para 31,3% em 1 ano. Aqueles com PLR ≥209 (p&lt;0,001) apresentaram diminuição na sobrevida de 69% para 59,3% no 3° mês, e de 40,2% para 25,9% em 1 ano. Conclusão: Não foi verificada associação positiva entre o NLR e o PLR com complicações pós-operatórias, mas com sobrevida fortemente sim, a partir do 3° mês de pós-operatório.

Introduction: Bone metastasis is the most common malignant neoplasm of the skeleton, and surgical decision-making depends on multiple factors, including postoperative complications and life expectancy. The identification of new prognostic factors can assist in decision making. Objective: In long bones metastases, to analyze the incidence of complications and postoperative survival up to 1 year, correlating them with NLR and PLR. Method: Review of 160 medical records of patients who underwent surgery for bone metastasis in the appendicular skeleton. In addition to epidemiological characteristics, NLR and PLR values were determined, correlating them with survival and complications. Result: Women represented 64.5% with a primary breast tumor in 62.6%; the proximal femur was the most affected; median survival was 13.2 months and in 1 year 34.7%. Tumor resection with endoprosthesis was more common. The post-surgical complication rate was 10% and the average time for post-operative complications to occur was 27.9 days (0-140). An association between the neutrophil variable and postoperative complications was found (p=0.04). For every 100 more units of neutrophils there was a 1% increase in the chances of post-surgical complications. Mean NLR and PLR values were, respectively, 5.3 (0.2-30.7) and 199.7 (32.1-676.7). Patients with NLR NLR ≥ 2 (p&lt;0,001) showed a decrease in survival from 92,3% to 62,5% at the 3rd month, and from 61,5% to 31,3% at 1 year. Those with PLR ≥209 (p&lt;0.001) showed a decrease in survival from 69% to 59.3% at the 3rd month, and from 40.2% to 25.9% at 1 year. Conclusion: There was no positive association between NLR and PLR with postoperative complications, but strongly yes with survival from the 3rd month after surgery.

Introduction: In general, inflammation stimulates the production and release of neutrophils and, at the same time, decreases the production of lymphocytes. Lymphopenia reflects that cell-mediated immunity is impaired, while neutrophilia represents a response to systemic inflammation in these cancers. Objective: To review the incidence of complications and postoperative survival rates in patients with bone metastases in long bones, correlating them with markers NLR and PLR. Method: Narrative review carried out collecting information published on virtual platforms in Portuguese and English, initially carried out by searching for descriptors related to the topic, which were: “lower extremity, surgery, metastasis, epidemiology, postoperative complications, neutrophils, lymphocytes, platelets”. The extension incorporated AND or OR, by title and/or summary, and full reading of the texts most related to the topic. Result: 21 articles were included. Conclusion: The higher both the NLR and PLR are associated with lower survival in patients with bone metastases when undergoing surgical treatment, especially after 3 months postoperatively. However, there is still no confirmation that they signal any outcome, favorable or not, in relation to postoperative complications.

Introdução : De um modo geral, a inflamação estimula a produção e liberação de neutrófilos e, ao mesmo tempo, diminui a produção de linfócitos. A linfopenia reflete que a imunidade mediada pelas células é prejudicada, enquanto a neutrofilia representa resposta à inflamação sistêmica nesses cânceres. Objetivo : Revisar nos pacientes com metástase óssea em ossos ao longo da incidência de complicações e taxas de sobrevida pós-operatória correlacionando-as com os marcadores NLR e PLR. Método : Revisão narrativa feita colhendo informações publicadas em plataformas virtuais em português e inglês inicialmente realizada por busca dos descritores relacionados ao tema que foram: “extremidade inferior, cirurgia, metástase, epidemiologia, complicações pós-operatórias, neutrófilos, linfócitos, plaquetas” e seus equivalentes em inglês “ extremidade inferior, cirurgia, metástase, epidemiologia, sobrevivência, complicações, neutrófilos, linfócitos, plaquetas sanguíneas ”. A extensão incorporou AND ou OR, pelo título e/ou resumo, e leitura na íntegra dos textos mais relacionados ao tema.&nbsp; Resultado : Foram incluídos 21 artigos. Conclusão : Quanto maiores, tanto o NLR quanto o PLR estão associados à menor sobrevida em pacientes com MO quando submetidos ao tratamento cirúrgico, especialmente após 3 meses de pós-operatório. Contudo, ainda não há confirmação de que eles sinalizam algum estágio, positivo ou não, em relação às complicações pós-operatórias.

Abstract The development of vaccinations has been game-changing in the ongoing effort to combat the COVID-19 pandemic. Until now, adverse effects are being reported at low frequency, including thrombocytopenia and myocarditis. Careful monitoring for any suspicious symptoms and signs following vaccination is necessary. We report a case of hemophagocytic lymphohistiocytosis (HLH) after mRNA COVID-19 vaccine in a 23-year-old female with ulcerative colitis. Diagnosis was made according to HLH-2004 criteria and the patient was treated with dexamethasone with response. Our report aimed to draw attention to the potential relation between COVID-19 vaccines and HLH and the necessity of continued surveillance, especially in at-risk populations such as those with underlying immune dysregulation.

Resumo O desenvolvimento de vacinas foi um ponto de viragem no combate contra a pandemia da COVID-19. Até ao momento, os efeitos adversos como a trombocitopenia e miocardite têm sido reportados com baixa frequência. A monitorização cuidadosa de qualquer sinal ou sintoma suspeitos é essencial. Reportamos um caso de linfohistiocitose hemofagocítica após vacinação contra a COVID-19 com uma vacina de mRNA, numa jovem de 23 anos com colite ulcerosa. O diagnóstico obedeceu os critérios HLH-2004 e a paciente foi tratada com dexametasona, com resposta. Pretendemos chamar à atenção para a potencial relação entre a vacinação para a COVID-19 e a HLH e a necessária contínua vigilância, especialmente em populações de maior risco, como as portadoras de doenças imuno-mediadas.

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura &gt; 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (&gt; 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.&nbsp;&nbsp; Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor &gt; 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (&gt; 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness &gt; 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (&gt; 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.