Abstract Congenital knee dislocation (CKD), a rare yet impactful condition, presents challenges in diagnosis and treatment. We report a clinical case of a prenatally diagnosed CKD at 31+4 weeks of gestation, emphasizing multidisciplinary management’s pivotal role. An early orthopedic intervention, with conservative measures, was fundamental to achieve a favorable infant outcome, underlining the importance of timely diagnosis and expert care. Prenatal CKD ultrasound screening therefore emerges as a crucial tool in guiding therapeutic decisions, optimizing postnatal outcomes, and reducing the need for surgical intervention.

Resumo A luxação congênita do joelho (CKD), uma condição rara porém impactante, apresenta desafios no diagnóstico e tratamento. Apresentamos um caso clínico de CKD com diagnóstico pré-natal, às 31+4 semanas de gestação, enfatizando o papel fundamental da abordagem multidisciplinar. A intervenção ortopédica precoce, com medidas conservadoras, foi fundamental para alcançar um desfecho favorável para a criança, destacando a importância do diagnóstico precoce e do cuidado especializado. O rastreio pré-natal por ecografia da CKD surge, portanto, como uma ferramenta crucial na orientação das decisões terapêuticas, otimizando os resultados pós-natais e reduzindo a necessidade de intervenção cirúrgica.

Composites prepared from metal oxides and materials derived from agroforestry residues have been successfully applied to remove emerging contaminants. The lignin properties, high surface area and number of functional groups, are beneficial in the preparation of TiO2 composites. In the present work, sisal residue was used as a source of lignin, and after extraction, the lignin was applied in the preparation of an adsorbent composite with TiO2 to remove bisphenol-A. The optimal conditions for lignin extraction resulted in a lignin purity of 73%. Characterization proved that the synthesized composites have a high surface area (> 100 m2 g-1), homogeneous distribution of TiO2 particles and stable surface charge. Such characteristics resulted in a lignin/TiO2 composite with a maximum adsorption capacity of 13.7 mg L-1, capable of removing up to 97% of bisphenol-A. The adsorbent can be used in six cycles, removing over 70% by the third cycle, which indicates good stability. contaminants properties groups TiO work bisphenolA. bisphenolA bisphenol A. A bisphenol-A 73 73% > ( 10 m g1, g1 g 1 , g-1) charge ligninTiO2 ligninTiO lignin/TiO 137 13 7 13. L1, L1 L 1, L-1 97 cycles 70 cycle stability g-1 L- 9 g-

ABSTRACT Purpose: To validate the Barcelona magnetic resonance imaging predictive model (BCN-MRI PM) in men with pre-biopsy multiparametric MRI (mpMRI) reported with the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, followed by transrectal and transperineal prostate biopsies. Materials and Methods: Prospective analysis of 3,264 men with PSA >3.0 ng/mL and/or abnormal digital rectal examination who were referred to ten participant centers in the csPCa early detection program of Catalonia (Spain), between 2021 and 2023. MpMRI was reported with the PI-RADS v2.1, and 2- to 4-core MRI-transrectal ultrasound (TRUS) fusion-targeted biopsy of suspected lesions and/or 12-core systematic biopsy were conducted. 2,295 (70.3%) individuals were referred to six centers for transrectal prostate biopsies, while 969 (39.7%) were referred to four centers for transperineal prostate biopsies. CsPCa was classified whenever the International Society of Urologic Pathology grade group was 2 or higher. Results: CsPCa was detected in 41% of transrectal prostate biopsies and in 45.9% of transperineal prostate biopsies (p <0.016). Both BCN-MRI PM calibration curves were within the ideal correlation between predicted and observed csPCa. Areas under the curve and 95% confidence intervals were 0.847 (0.830-0.857) and 0.830 (0.823-0.855), respectively (p = 0.346). Specificities corresponding to 95% sensitivity were 37.6 and 36.8%, respectively (p = 0.387). The Net benefit of the BCN-MRI PM was similar with both biopsy methods. Conclusions: The BCN-MRI PM has been successfully validated when mpMRI was reported with the PI-RADS v2.1 and prostate biopsies were conducted via the transrectal and transperineal route. Purpose BCNMRI BCN prebiopsy pre (mpMRI PIRADS PI RADS (PI-RADS v21 v v2 1 Methods 3264 3 264 3,26 30 0 >3. ngmL ng mL andor Spain, Spain , (Spain) 202 2023 4core core 4 MRItransrectal TRUS (TRUS fusiontargeted fusion targeted 12core 12 2295 295 2,29 70.3% 703 70 (70.3% 96 39.7% 397 39 7 (39.7% higher Results 41 459 45 9 45.9 p <0.016. 0016 <0.016 . 016 <0.016) 95 0847 847 0.84 0.8300.857 08300857 0.857 830 857 (0.830-0.857 0830 0.83 0.8230.855, 08230855 0.823 0.855 823 855 (0.823-0.855) 0.346. 0346 0.346 346 0.346) 376 37 6 37. 368 36 8 36.8% 0.387. 0387 0.387 387 0.387) methods Conclusions v2. route 326 26 3,2 >3 (Spain 20 229 29 2,2 70.3 (70.3 39.7 (39.7 45. 001 <0.01 01 084 84 0.8 8300 0.8300.85 0830085 0857 0.85 83 85 (0.830-0.85 083 8230 0.8230.855 0823085 0823 0.82 0855 82 (0.823-0.855 034 0.34 34 36.8 038 0.38 38 32 3, > 22 2, 70. (70. 39. (39. 00 <0.0 08 0. 0.8300.8 083008 085 (0.830-0.8 0.8230.85 082308 082 (0.823-0.85 03 0.3 36. (70 (39 <0. 0.8300. 08300 (0.830-0. 0.8230.8 08230 (0.823-0.8 (7 (3 <0 0.8300 (0.830-0 0.8230. (0.823-0. ( < (0.830- 0.8230 (0.823-0 (0.830 (0.823- (0.83 (0.823 (0.8 (0.82 (0. (0

Resumo Introdução: O fígado gordo associado a disfunção metabólica (FGADM) é uma causa crescente de doença hepática crónica. Em 2020, o score Fibroscan-AST (FAST) foi validado internacionalmente como uma nova ferramenta capaz de identificar pacientes com esteatohepatite que beneficiam de terapêuticas adicionais, baseado nos achados da elastografia hepática transitória (EHT) e níveis séricos de aspartato aminotransferase (AST). Os autores procuraram identificar, em pacientes com FGADM, que fatores metabólicos predizem um score-FAST maior. Métodos: Estudo retrospetivo de pacientes com FGADM submetidos a EHT durante 2 anos consecutivos. Pacientes sem uma amostra de AST colhida nos 6 meses prévios à EHT foram excluídos. O score-FAST foi calculado, estratificando o risco do paciente como baixo (<0,35), moderado (0,35-0,67) ou alto (>0,67). Resultados: A amostra incluiu 117 pacientes, 53% do sexo feminino, com uma idade média de 53 anos. Em análise multivariada, pacientes com Diabetes Mellitus tipo 2 (DMT2) (p < 0,001), dislipidemia (p = 0,046) e hábitos tabágicos (p = 0,037) apresentaram valores de score-FAST significativamente maiores. Além disso, os pacientes diabéticos apresentaram não só valores de score-FAST significativamente maiores, como também foram mais frequente classificados como pertencendo ao grupo de alto risco, de acordo com os critérios deste score (OR = 9,2; 95%IC = 1,8-45,5; p = 0,007). Conclusões: Calculando o score-FAST, pacientes com FGADM e DMT2 apresentaram um risco significativamente maior. Esta ferramenta validada poderá ser utilizada para selecionar os pacientes com DMT2 e FGADM que poderão beneficiar de seguimento especializado.

Abstract Background: Metabolic-associated fatty liver disease (MAFLD) is an increasingly prevalent cause of chronic liver disease. In 2020, the FibroScan-AST (FAST) score was internationally validated as a new tool able to identify patients with steatohepatitis who benefit the most from further therapies, based on liver transient elastography (LTE) findings and serum levels of aspartate aminotransferase (AST). We aimed to identify, in MAFLD patients, which metabolic features may predict a higher FAST score. Methods: Retrospective study of consecutive patients with MAFLD submitted to LTE for two consecutive years. Patients without an AST sample collected within 6 months of the LTE were excluded. FAST score was calculated, stratifying the patient’s risk as low (<0.35), medium (0.35-0.67), or high (>0.67). Results: The sample included 117 patients, 53.0% of the female gender, with a mean age of 53 years. On multivariate analysis, patients with type 2 diabetes (T2DM) (p < 0.001), dyslipidemia (p = 0.046), and smoking habits (p = 0.037) presented with significantly higher FAST score values. Furthermore, diabetic patients did not only present significantly higher FAST scores but were also more frequently assigned to the high-risk group according to FAST score criteria (OR = 9.2; 95% CI = 1.8-45.5; p = 0.007). Conclusions: Calculating the FAST score, patients with T2DM presented a significantly higher risk of having significant fibrosis and steatohepatitis. Physicians may rely on this validated instrument to more easily identify which patients with T2DM and MAFLD benefit the most from a specialized follow-up.

Annual world production of sisal is estimated to be 400,000 tons, but the processing of sisal fiber generates around 160,000 tons of waste per year. The sisal bagasse is discarded, even though it is about 60% carbohydrates in its structure. Therefore, this work seeks to add value to sisal bagasse through the production of cellulose acetate membranes aimed at removing inhibitors from the fermentation process. The membrane was developed using a cellulose acetate polymer synthesized from cellulose isolated from sisal bagasse. Alkaline and acid pre-treatments resulted in 90% pure cellulose. The obtained cellulose acetate was confirmed by infrared spectroscopy. In the synthesis of the membranes, the influence of agitation time and temperature of the bath on the selectivity and porosity were evaluated in four tests, the third condition stood out with porosity of 26.23% and selectivity of 94.51% in the removal of the furfural and 36.62% of the acetic acid. 400000 400 000 400,00 160000 160 160,00 year discarded 60 structure Therefore process pretreatments pre treatments 90 spectroscopy tests 2623 26 23 26.23 9451 94 51 94.51 3662 36 62 36.62 40000 40 00 400,0 16000 16 160,0 6 9 262 2 26.2 945 5 94.5 366 3 36.6 4000 4 0 400, 1600 1 160, 26. 94. 36.

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2021. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos fue telemática y su análisis lo efectuó una empresa externa junto con miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron 16 centros (15 públicos y 1 privado) que acumulan 34 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (20,5%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.094 estudios diagnósticos (5,1% más que en 2020) y 1.553 cateterismos intervencionistas (6,4% más que en 2020). Las técnicas más frecuentes fueron el cierre de comunicación interauricular (336 casos), la angioplastia de ramas pulmonares (231 casos) y el cierre de ductus (228 casos). Respecto al año anterior se incrementaron significativamente las técnicas de implantación de válvulas percutáneas (29,3%), cierre de ductus (20,6%) y angioplastia aórtica (12,8%). La tasa de éxito en los procedimientos intervencionistas fue del 95%, con una tasa de complicaciones mayores del 2,7% y una mortalidad intrahospitalaria del 0,2%. Conclusiones: Este trabajo es la segunda publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha constatado un aumento significativo de los procedimientos diagnósticos y terapéuticos, destacando el incremento en la implantación de válvulas percutáneas, el cierre de ductus y la angioplastia aórtica. La mayoría de las técnicas intervencionistas siguen demostrando excelentes datos de seguridad y eficacia.

ABSTRACT Introduction and objectives: This is the 2021 annual activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC). Methods: All Spanish centers with cath lab capabilities and interventional activity in congenital heart diseases were invited to participate. Data were collected online, analyzed by an external company, and ACI-SEC and GTH-SECPCC members. Results: A total of 16 centers participated 15 public and 1 private including 34 cath labs with experience in congenital heart diseases, 7 of them (20.5%) exclusively dedicated to pediatric patients. A total of 1094 diagnostic studies (4.5% more than 2020) and 1553 interventional catheterizations (5.8% more than 2020) were registered. The most common procedures were atrial septal defect closure (336 cases), pulmonary branch artery angioplasty (231 cases), and percutaneous closure of the patent ductus arteriosus (228 cases). Interventional procedures were considered successful in 95% of the cases with rates of major procedural complication and in-hospital mortality of 2.7% and 0.2%, respectively. Conclusions: This is the second Spanish Cardiac Catheterization in Congenital Heart Diseases Registry report. A significant increase of diagnostic and interventional procedures was reported with a special increase of percutaneous valve implantation, ductus arteriosus closure, and aortic angioplasty. Most interventional techniques continue to demonstrate excellent safety and efficacy outcomes.

Abstract Background In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH). Objective To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease. Methods A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05. Results Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters. Conclusions This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes. COVID19, COVID19 COVID 19, 19 conditions SAH . (SAH) demographic COVID-1 38 SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- included 005 0 05 0.05 20 53.16% 5316 53 16 (53.16% 0.01 001 01 nonhypertensive non tests 0.014, 0014 0.014 , 014 0.014) 0.002, 0002 0.002 002 0.002) 0.003, 0003 0.003 003 0.003) ALT (ALT 0.01, AST (AST 0.006, 0006 0.006 006 0.006) 0.024 0024 024 lower parameters COVID1 1 (SAH COVID- 3 SARS-CoV 00 0.0 53.16 531 5 (53.16 000 0.00 0.02 02 0. 53.1 (53.1 53. (53. (53 (5 (

RESUMEN Objetivo: Sintetizar conocimientos sobre indicadores de sostenibilidad hospitalaria y evidencias de reducción del impacto socioambiental. Método: Revisión de literatura, scoping review, utilizando las bases de datos Pubmed, Science Direct, Scielo y Lilacs. Se incluyeron estudios con un horizonte temporal de 10 años, publicados en cualquier idioma, que abordaran indicadores de sostenibilidad hospitalaria y evidencias de reducción del impacto socioambiental. Resultados: Se incluyeron un total de 28 artículos, la mayoría de investigación aplicada, publicados en 2012, en inglés. Los estudios mostraron formas de ahorrar agua y energía, así como formas de monitorear y mitigar el impacto de las actividades relacionadas con efluentes, desechos y emisiones. Todos los estudios tenían trabajo de enfermería involucrado directa o indirectamente en la sostenibilidad del hospital. Conclusión: Las posibilidades de generar un menor impacto en el medio ambiente y aumentar la economía/eficiencia de un hospital son innumerables. Hay que tener en cuenta las particularidades de cada hospital y se debe involucrar a los trabajadores, especialmente a los enfermeros. Objetivo socioambiental Método literatura review Pubmed Direct Lilacs 1 años idioma Resultados 2 artículos aplicada 2012 inglés energía efluentes emisiones Conclusión economíaeficiencia economía eficiencia innumerables trabajadores enfermeros 201 20

ABSTRACT Objective: To synthesize knowledge about hospital sustainability indicators and evidence of reduced socio-environmental impact. Method: Literature scoping review using Pubmed, Science Direct, Scielo and Lilacs databases. Studies in a time frame of 10 years, addressing hospital sustainability indicators and evidence of reduced socio-environmental impact published in any language were included. Results: A total of 28 articles were included, most were applied research, published in 2012, in English. Studies showed ways to save water and energy, as well as ways to monitor and mitigate the impact of activities related to effluents, waste and emissions. All studies had nursing work directly or indirectly involved in hospital sustainability. Conclusion: The possibilities of generating less impact on the environment and increasing the economy/efficiency of a hospital are countless. The particularities of each hospital must be taken into account and workers, especially nurses, should be involved. Objective socioenvironmental socio environmental Method Pubmed Direct databases 1 years included Results 2 research 2012 English energy effluents emissions Conclusion economyefficiency economy efficiency countless workers nurses 201 20

RESUMO Objetivo: Sintetizar o conhecimento acerca dos indicadores de sustentabilidade hospitalar e evidências de redução do impacto socioambiental. Método: Revisão de literatura, do tipo scoping review, utilizando as bases de dados Pubmed, Science Direct, Scielo e Lilacs. Foram incluídos estudos com recorte temporal de 10 anos, publicados em qualquer idioma, que abordassem indicadores de sustentabilidade hospitalar e evidências de redução do impacto socioambiental. Resultados: Um total de 28 artigos foram incluídos, a maioria teve como tipo de estudo a pesquisa aplicada, publicados em 2012, no idioma inglês. Os estudos demonstraram maneiras de economizar água e energia, bem como, formas de monitorar e mitigar o impacto de atividades relacionadas a efluentes, resíduos e emissões. Todos os estudos tinham o trabalho da enfermagem envolvido de forma direta ou indireta na sustentabilidade hospitalar. Conclusão: As possibilidades de gerar menos impacto ao meio ambiente e aumentar a economia/eficiência de um hospital são inúmeras. Há de se levar em consideração as particularidades de cada hospital e envolver os trabalhadores, em especial a enfermagem. Objetivo socioambiental Método literatura review Pubmed Direct Lilacs 1 anos Resultados 2 aplicada 2012 inglês energia efluentes emissões Conclusão economiaeficiência economia eficiência inúmeras trabalhadores 201 20

Abstract Introduction The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. Patients and methods This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. Results Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. Conclusion The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t). ADA DADA (DADA2 fashion antiTNF anti TNF 1 DASA clinical laboratory collected here median years ALPSlike ALPS like CVID (CVID found responses condition Moreover t. t . (t) (DADA (t

RESUMEN Objetivo: Caracterizar el perfil sociodemográfico, clínico y de supervivencia de pacientes adultos metastáticos. Método: Estudio transversal retrospectivo, con datos secundarios de una unidad de atención oncológica, analizados por: regresión logística, prueba de Chi-Cuadrado y prueba exacta de Fisher, Kaplan-Meier y Log-Rank. Resultados: De los 678 pacientes predominó el sexo masculino, edad media 59,54 años y baja escolaridad. El promedio entre el diagnóstico y el inicio del tratamiento fue de 89,50 días (± 58,87). Mayor riesgo de cáncer primario en el tracto digestivo (OR 1,42). Prevalencia de adenocarcinoma (OR 1,53) y metástasis en hueso (OR 2,59), ganglios linfáticos (OR 1,75), hígado y peritoneo (OR 1,42). La supervivencia global media fue de 4,16 meses y una mediana de 3,0 meses. Conclusión: El principal sitio primario fue el tracto digestivo y la identificación de metástasis fue predominantemente hepática unifocal en ambos sexos. La supervivencia general del paciente se redujo por la progresión del cáncer. Objetivo sociodemográfico metastáticos Método retrospectivo oncológica logística ChiCuadrado Chi Cuadrado Fisher KaplanMeier Kaplan Meier LogRank. LogRank Log Rank. Rank Log-Rank Resultados 67 masculino 5954 59 54 59,5 escolaridad 8950 89 50 89,5 ± ( 58,87. 5887 58,87 . 58 87 58,87) OR 1,42. 142 1,42 1 42 1,42) 1,53 153 53 2,59, 259 2,59 , 2 2,59) 1,75, 175 1,75 75 1,75) 416 4 16 4,1 30 3 0 3, Conclusión sexos 6 595 5 59, 895 8 89, 588 58,8 14 1,4 1,5 15 25 2,5 17 1,7 7 41 4, 58, 1, 2,

ABSTRACT Objective: To characterize the sociodemographic, clinical and survival profile of adult metastatic patients. Method: Retrospective cross-sectional study, with secondary data from an oncology care unit, analyzed using logistic regression, Chi-Square test and Fisher’s exact test, Kaplan-Meier and Log-Rank tests. Results: From the 678 patients, male gender, mean age 59.54 years old and low education level prevailed. The mean time between diagnosis and initiation of treatment was 89.50 days (± 58.87). Increased risk of primary cancer in the digestive tract (OR 1.42). Prevalence of adenocarcinoma (OR 1.53) and metastasis to bone (OR 2.59), lymph nodes (OR 1.75), liver and peritoneum (OR 1.42). The mean overall survival was 4.16 months and a median of 3.0 months. Conclusion: The main primary site was the digestive system, and the identification of metastases was predominantly unifocal liver in both genders. Overall patient survival was reduced by cancer progression. Objective sociodemographic patients Method crosssectional cross sectional study unit regression ChiSquare Chi Square Fishers Fisher s KaplanMeier Kaplan Meier LogRank Log Rank tests Results 67 gender 5954 59 54 59.5 prevailed 8950 89 50 89.5 ± ( 58.87. 5887 58.87 . 58 87 58.87) OR 1.42. 142 1.42 1 42 1.42) 1.53 153 53 2.59, 259 2.59 , 2 2.59) 1.75, 175 1.75 75 1.75) 416 4 16 4.1 30 3 0 3. Conclusion system genders progression 6 595 5 59. 895 8 89. 588 58.8 14 1.4 1.5 15 25 2.5 17 1.7 7 41 4. 58. 1. 2.

RESUMO Objetivo: Caracterizar o perfil sociodemográfico, clínico e de sobrevida de pacientes adultos metastáticos. Método: Estudo transversal retrospectivo, com dados secundários de uma unidade de assistência oncológica, analisados por: regressão logística, teste de Qui-Quadrado e testes exato de Fisher, Kaplan-Meier e Log-Rank. Resultados: Dos 678 pacientes, prevaleceu o sexo masculino, a idade média 59,54 anos e a baixa escolaridade. A média entre o diagnóstico e o início de tratamento foi 89,50 dias (± 58,87). Maior risco de câncer primário no aparelho digestivo (OR 1,42). Prevalência do adenocarcinoma (OR 1,53) e metástase para o osso (OR 2,59), linfonodos (OR 1,75), fígado e peritônio (OR 1,42). A média de sobrevida global foi de 4,16meses e mediana de 3,0 meses. Conclusão: O principal sítio primário foi o aparelho digestivo e a identificação das metástases foi prevalentemente hepática unifocal em ambos os sexos. A sobrevida global dos pacientes foi reduzida pelo avanço do câncer. Objetivo sociodemográfico metastáticos Método retrospectivo oncológica por logística QuiQuadrado Qui Quadrado Fisher KaplanMeier Kaplan Meier LogRank. LogRank Log Rank. Rank Log-Rank Resultados 67 masculino 5954 59 54 59,5 escolaridade 8950 89 50 89,5 ± ( 58,87. 5887 58,87 . 58 87 58,87) OR 1,42. 142 1,42 1 42 1,42) 1,53 153 53 2,59, 259 2,59 , 2 2,59) 1,75, 175 1,75 75 1,75) 416meses meses 4 16meses 30 3 0 3, Conclusão sexos 6 595 5 59, 895 8 89, 588 58,8 14 1,4 1,5 15 25 2,5 17 1,7 7 58, 1, 2,

Resumo Introdução: A dor anorectal é um sintoma com um impacto negativo na qualidade de vida, podendo, por vezes, desenvolver-se numa síndrome de dor crónica. A dor anorectal de etiologia estrutural trata-se de acordo com a patologia subjacente. No entanto, em situações de dor crónica pós-cirúrgica refratária a abordagens terapêuticas convencionais, a estimulação percutânea do nervo tibial (percutaneous tibial nerve stimulation - PTNS) é uma opção de tratamento. A PTNS é uma técnica de neuroestimulação, estando descritos benefícios da sua aplicação no tratamento da urgência, frequência, incontinência e retenção urinária. Evidência crescente mostra, ainda, resultados promissores noutras condições, como a dor crónica pélvica e a incontinência fecal. Caso Clínico: Descrevemos um caso de uma mulher de 45 anos, com dor crónica anorectal pós-cirúrgica tratada com PTNS. Ao longo do período de seguimento, a doente reportou uma diminuição consistente e significativa na frequência e na intensidade da dor, tal como avaliado pelo Brief Pain Inventory (BPI). Adicionalmente, foi notória uma melhoria significativa de parâmetros relacionados com a qualidade de vida, avaliados pelos questionários BPI e EQ-5D-3L. Discussão: A evidência atual mostra que técnicas baseadas em neuromodulação têm sido eficazes no tratamento da dor anorectal, apesar dos estudos com PTNS ainda serem escassos. O nervo tibial é uma estrutura facilmente acessível e constitui um local óptimo para aplicação de neuroestimulação. A PTNS é uma opção terapêutica pouco invasiva, que não necessita de idas ao bloco operatório, nem de apoio de anestesia. O benefício observado do uso da PTNS neste caso sugere uma nova área de estudo e de potencial aplicabilidade para a técnica.

Abstract Introduction: Anorectal pain is a symptom with a negative impact on quality of life and it can sometimes develop into a chronic pain syndrome. Structural anorectal pain is treated according to the underlying pathology. In situations of chronic post-surgical pain that is refractory to conventional therapeutic approaches, percutaneous tibial nerve stimulation (PTNS) is an option. PTNS is a neurostimulation technique used in the treatment of lower urinary tract dysfunction. There has been increasing evidence of its benefits for improving other conditions, such as chronic pelvic pain (CPP) and faecal incontinence (FI). Case Presentation: We report a case of a 45-year-old woman with chronic post-surgical anorectal pain (CPAP) treated with PTNS. The patient reported a consistent and dramatic decrease in both the frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D-3L questionnaires. Discussion: Neuromodulation treatments have been reported as effective for anorectal pain, but reports on the use of PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anaesthesia. The overall improvement observed in this case of chronic anorectal pain suggests a potential new area of research for PTNS.

Abstract Desmoid-type fibromatosis is a rare neoplastic tumor of fibroblastic proliferation that arises from muscle, fascia or aponeurotic complexes. Although usually benign, it is capable of significant local morbidity resulting from infiltration of surrounding structures. The etiology of desmoid-type fibromatosis is multifactorial since genetic, endocrine, and physical factors play an important role in its pathogenesis. Prognosis is mainly related to the anatomical site. We report a case of an intra-abdominal desmoid-type fibromatosis, arising from the retroperitoneum, diagnosed at 15 weeks of gestation and resected during pregnancy. This case demonstrates de diagnostic and management challenge posed by an abdominal mass during pregnancy.

RESUMO Objetivo: Avaliar o contexto de trabalho e analisar suas repercussões na qualidade de vida de trabalhadores rurais do agronegócio da soja. Método: Estudo transversal, com amostra intencional de trabalhadores rurais, realizado entre os meses de outubro e dezembro de 2019, com aplicação dos instrumentos World Health Organization Quality Life-bref e Escalas de Avaliação do Contexto e Custo Humano do Trabalho. Os dados foram analisados por meio de estatística descritiva, bivariada e multivariada. Resultados: Participaram 299 trabalhadores rurais. Os escores das Condições de Trabalho e das Relações Socioprofissionais foram satisfatórios e o da Organização do Trabalho foi crítico. Os escores dos Custos Físico e Cognitivo foram considerados críticos e o do Custo Afetivo, satisfatório. As Relações Socioprofissionais repercutiram negativamente na qualidade de vida geral e nos Domínios Físico e Psicológico, nas Relações Sociais e no Meio Ambiente, enquanto o Custo Cognitivo repercutiu positivamente nos Domínios Físico e no Meio Ambiente e o Custo Afetivo repercutiu positivamente no Domínio das Relações Sociais. Conclusão: Apesar de o Contexto e o Custo Humano do Trabalho indicarem condições adversas, somente as Relações Socioprofissionais exerceram influências negativas na qualidade de vida dos trabalhadores rurais.

ABSTRACT Objective: To assess the context of work and analyze their repercussions on the quality of life of rural workers in soybean agribusiness. Method: Cross-sectional study, with an intentional sample of rural workers, conducted between the months of October and December 2019, with the application of the instruments World Health Organization Quality Life-bref and Scales of Assessment of Context and Human Cost of Work. The data were analyzed through bivariate and multivariate descriptive statistics. Results: The participants amounted to 299 rural workers. The scores of Work Conditions and Socioprofessional Relations were satisfactory and Organization of Work was critical. The scores of Physical and Cognitive costs were considered critical and of the Affective Cost was satisfactory. The Socioprofessional Relations have negatively impacted the overall quality of life and the Physical and Psychological, the Social Relations and the Environmental Domains, whereas Cognitive Cost positively impacted the Physical and the Environmental Domain and the Affective Cost positively impacted the Social Relations Domain. Conclusion: Although the Work Context and Human Cost indicated adverse conditions, only the Socioprofessional Relations exerted negative influences on the quality of life of rural workers.

RESUMEN Objetivo: Evaluar el contexto de trabajo y analizar sus repercusiones en la calidad de vida de los trabajadores rurales de la agroindustria de la soja. Método: Estudio transversal con una muestra intencional de trabajadores rurales, realizado entre los meses de octubre y diciembre de 2019, con aplicación de los instrumentos World Health Organization Quality Life-bref y Escalas de Evaluación del Contexto y Costo Humano del Trabajo. Los datos se analizaron mediante estadísticas descriptivas, bivariadas y multivariadas. Resultados: Participaron un total de 299 trabajadores rurales. Las puntuaciones de las Condiciones de Trabajo y las Relaciones Socioprofesionales fueron satisfactorias y la de la Organización del Trabajo fue crítica. Las puntuaciones de los Costos Físico y Cognitivo fueron consideradas críticas y la del Costo Afectivo fue satisfactoria. Las Relaciones Socioprofesionales impactaron negativamente la calidad de vida global y los Dominios Físico y Psicológico, Relaciones Sociales y Entorno, mientras que el Costo Cognitivo impactó positivamente los Dominios Físico y Entorno y el Costo Afectivo impactó positivamente el Dominio de Relaciones Sociales. Conclusión: Aunque el Contexto y el Costo Humano del Trabajo indican condiciones adversas, sólo las Relaciones Socioprofesionales ejercieron influencias negativas en la calidad de vida de los trabajadores rurales.

Objetivo: compreender como a comunicação em saúde na atenção de crianças com condições crônicas interfere na colaboração interprofissional. Método: pesquisa multicêntrica, qualitativa. A coleta de dados, realizada por meio de entrevista e observação, ocorreu de outubro de 2017 a fevereiro de 2018. Para a organização dos dados, utilizou-se o software NVivo versão 12. Esses dados foram analisados pela perspectiva dialética. Resultados: foram entrevistados 79 profissionais, entre médicos e enfermeiros na Estratégia Saúde da Família. Destacam-se marcadores essenciais para a interprofissionalidade, como a comunicação plurinstitucional; o contexto histórico e político dos municípios; o vínculo entre equipe e famílias com crianças com condições crônicas e a comunicação ativa e propositiva. Conclusão: a colaboração interprofissional é fortalecida quando o plano terapêutico da criança com condição crônica é coordenado pela Saúde da Família, acrescida da intencionalidade de comunicação com o setor secundário. Considera-se que a pesquisa integrou importantes temas, contribuindo para o planejamento do processo de trabalho na Estratégia Saúde da Família.

Objective: to understand how health communication in the care of children with chronic conditions interferes with inter-professional collaboration. Method: a multicentric qualitative research. Data collection, carried out through interviews and observation, occurred from October 2017 to February 2018. For data organization, the NVivo software, version 12, was used. These data were analyzed from a dialectical perspective. Results: a total of 79 professionals were interviewed, including physicians and nurses in the Family Health Strategy. Essential markers for inter-professionality stand out, such as multi-institutional communication; the historical and political context of the municipalities; the bond between staff and families with children with chronic conditions; and active and purposeful communication. Conclusion: inter-professional collaboration is strengthened when the therapeutic plan of the child with a chronic condition is coordinated by the Family Health Strategy, plus the intention of communicating with the secondary sector. It is considered that the research included important issues, contributing to planning the work process in the Family Health Strategy.

Objetivo: comprender cómo la comunicación sanitaria en el cuidado de niños con afecciones crónicas interfiere en la colaboración interprofesional. Método: investigación multicéntrica, cualitativa. La recopilación de datos, realizada a través de entrevistas y observaciones, se llevó a cabo entre octubre de 2017 y febrero de 2018. En la organización de los datos, se utilizó el software NVivo versión 12. Los datos fueron analizados desde una perspectiva dialéctica. Resultados: fueron entrevistados 79 profesionales, incluidos médicos y enfermeros del programa Estrategia de Salud de la Familia. Se destacan marcadores esenciales para la interprofesionalidad, como la comunicación multiinstitucional; el contexto histórico y político de los municipios; el vínculo entre el equipo de profesionales y las familias con niños con afecciones crónicas y la comunicación activa y resolutiva. Conclusión: la colaboración interprofesional se fortalece cuando se coordina el plan terapéutico para niños con enfermedades crónicas a través del programa Estrategia de Salud de la Familia, y se verifica la intención de establecer comunicación con el sector secundario. Se considera que la investigación integró temas importantes y contribuyó a la planificación del proceso de trabajo en el programa Estrategia de Salud de la Familia.