ABSTRACT Objective To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. Methods This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman’s booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. Results The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Conclusion Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men’s Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Numerical simulation was used to predict the thermal behavior and the resulting microstructure at the heat-affected zone (HAZ) of a 170 mm diameter and 3.5 mm thickness super duplex stainless steel (SDSS) UNS S32750 tube. In order to evaluate the thermal response from the model, a usual welding situation involving interpass temperature (IT) and its influence on the HAZ microstructure was exploited. Thus, two superimposed autogenous welding passes were simulated, the first clockwise with the tube in the room temperature and the second, counterclockwise, with the tube at the temperature of 250oC. Even subjected to successive thermal cycles and high interpass temperature, the proportion and morphology of the phases at the HAZ and Fusion Zone (FZ) did not present significant differences when comparing the two welding passes. Meanwhile, nitrogen losses should be avoided during welding in order to obtain a balanced microstructure in DSS welds, contributing to guarantee satisfactory toughness in addition to resistance to pitting corrosion. The predictions from the simulation were validated by using experimental results obtained from the autogenous TIG (Tungsten Inert Gas) process.

RESUMEN: El arte urbano es algo más que imágenes de gran formato en nuestras calles; es una expresión artística que protesta, aclama, reclama y se queja de las situaciones que vivimos día con día. Cierto es que hay una vasta producción de temáticas, y que de acuerdo con el contexto es que son apropiadas o rechazadas por la comunidad que convive con ella. Sin embargo, existe una estética referente a la política y la protesta, realizada exprofeso para denunciar situaciones políticas, actos violentos o simplemente para evidenciar diversas situaciones en distintas partes del mundo, tales como: la migración, el feminismo, la crítica política, el racismo, la economía, la protesta ciudadana entre otros temas. Es así como la estética del arte urbano se focaliza entre la política y el arte.

ABSTRACT: Urban art is more than large format images in our streets; it is an artistic expression that protests, acclaims, claims and complains about the situations we live day by day. It is true that there is a vast production of themes and that according to the context is that they are appropriate or rejected by the community that coexists with it. However, there is an aesthetic referring to politics and protest, made specifically to denounce political situations, violent acts or simply to highlight various situations in different parts of the world, such as: migration, feminism, political criticism, racism, economics, citizen protest among other issues. This is how the aesthetics of urban art is focused between politics and art.

ABSTRACT Background: The coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus and is responsible for nearly 6 million deaths worldwide in the past 2 years. Machine learning (ML) models could help physicians in identifying high-risk individuals. Objectives: To study the use of ML models for COVID-19 prediction outcomes using clinical data and a combination of clinical and metabolic data, measured in a metabolomics facility from a public university. Methods: A total of 154 patients were included in the study. “Basic profile” was considered with clinical and demographic variables (33 variables), whereas in the “extended profile,” metabolomic and immunological variables were also considered (156 characteristics). A selection of features was carried out for each of the profiles with a genetic algorithm (GA) and random forest models were trained and tested to predict each of the stages of COVID-19. Results: The model based on extended profile was more useful in early stages of the disease. Models based on clinical data were preferred for predicting severe and critical illness and death. ML detected trimethylamine N-oxide, lipid mediators, and neutrophil/lymphocyte ratio as important variables. Conclusion: ML and GAs provided adequate models to predict COVID-19 outcomes in patients with different severity grades.

Abstract Objective: Pediatric acute liver failure (PALF) is a heterogeneous, rare, and severe condition, which outcome is survival due to liver spontaneous recovery or death. The patients who do not recover may be allocated to liver transplantation, which is the standard treatment. This study aimed to build a prognostic model to support the clinical decision to indicate liver transplantation for patients with PALF in a Brazilian center. Methods: The authors retrospectively analyzed the clinical variables of 120 patients in the liver transplantation program of the 'Children's Institute of the University of São Paulo, Brazil. The authors conducted a univariate analysis of variables associated with survival in PALF. Logistic multivariate analysis was performed to find a prognostic model for the outcome of patients with pediatric acute liver failure. Results: Risk factors were analyzed using univariate analysis. Two prognostic models were built using multiple logistic regression, which resulted in 2 models: model 1(INR/ALT) and model 2 (INR/Total bilirubin). Both models showed a high sensitivity (97.9%/96.9%), good positive predictive value (89.5%/90.4%), and accuracy (88.4%/88.5%), respectively. The receiver operating characteristic was calculated for both models, and the area under the curve was 0.87 for model 1 and 0.88 for model 2. The Hosmer-Lemeshow test showed that model 1 was good. Conclusion: The authors built a prognostic model for PALF using INR and ALT that can contribute to the clinical decision to allocate patients to liver transplantation.

Abstract Introduction: Peer learning is a differentiated educational tool, including the traditional tutoring model and the interaction of individuals within the same training level. The general practice (GP) residency programme, updated in 2019, introduced peer learning as part of residents’ weekly schedule. In Lisbon and Tagus Valley region (ARSLVT), peer learning was implemented through the so-called Relational Learning Sessions (SAR). Methods: The present study sought to establish a state point regarding this practice in continental Portugal, in order to promote local adaptations necessary for the residents to reach relational learning’s full potential. Residents from the 54th group of the specialized training programme in GP were included. Data were collected between November 12nd and December 12nd 2020 through an online questionnaire sent via e-mail by the residency coordinators (CIMMGF). Results: Out of a total of 416 residents, 86 answers were obtained, 60 of which were from ARSLVT. At the time data was collected, in the North region, no model of peer learning had been implemented. In ARSLVT all residents had SAR, except for one group of Healthcare Units (ACeS). In the Center, Alentejo, and Algarve, this practice was not uniform between ACeS. In the implemented SAR, there is a wide variety of activities being performed, planning is mostly done according to the CIMMGF recommendations, and the majority of resident doctors recognize its usefulness. However, the impact on clinical activities, the distance between healthcare units, and the lack of support from local residency directors are pointed out as the main difficulties while planning these sessions. The adoption of a rotative schedule, the implementation of online sessions, and the issuing of guidelines might be possible solutions. Conclusion: Aiming for the adjustment and equality of training opportunities, effective local solutions must be sought so that peer learning becomes a fruitful reality for all residents.

Resumo Introdução: A aprendizagem interpares é uma ferramenta educacional diferenciada, incluindo o modelo tradicional de tutoria e a interação de indivíduos com o mesmo grau de formação. O programa de formação especializada em medicina geral e familiar (MGF) introduziu, em 2019, a aprendizagem relacional no horário semanal dos médicos internos. Na Administração Região de Saúde de Lisboa e Vale do Tejo (ARSLVT) foi adotado o modelo das Sessões de Aprendizagem Relacional (SAR). O presente estudo procurou perceber como está a ser implementada esta prática em Portugal continental, de forma a promover adaptações que permitam alcançar todo o seu potencial. Métodos: Foram incluídos os internos do 54.o grupo da formação especializada em MGF. Os dados foram recolhidos entre 12/nov e 12/dez de 2020, através de um questionário online divulgado por correio eletrónico pelas coordenações do Internato Médico de MGF (CIMMGF). Resultados: De um total de 416 internos obtiveram-se 86 respostas, 60 das quais da ARSLVT. À data da recolha dos dados verificou-se que na ARS Norte não tinha sido implementado qualquer modelo formal de aprendizagem relacional. Na ARSLVT apenas um ACeS não realizava SAR. Nas ARS Centro, Alentejo e Algarve, esta prática não era uniforme. Nas SAR implementadas parecem desenvolver-se diversas atividades, o planeamento é maioritariamente feito de acordo com as orientações publicadas e a maioria dos internos reconhece a sua utilidade. São apontadas como principais dificuldades o impacto na atividade assistencial, a distância entre unidades e a ausência de apoio da direção de internato. A adoção de um horário rotativo, a implementação de sessões online e a existência de documentos orientadores são possíveis soluções. Conclusão: Tendo em vista a harmonização do percurso e a igualdade de oportunidades formativas devem ser procuradas estratégias locais efetivas para que a aprendizagem relacional seja uma realidade profícua para todos os internos.

SUMMARY: Hipoparathyroidism occurs when parathyroid hormone (PTH) is insufficient because of destruction of the parathyroid glands, abnormal parathyroid gland development or altered regulation of PTH production through calcium-sensing receptor (CaSR). Etiology and clinical features depend on the age of the patient. The goals of therapy are to maintain the serum calcium concentration in the low-normal range to prevent iatrogenic development of kidney stones. In this review, we will pay attention to the peculiriaties in the pediatric age.

RESUMEN: El hipoparatiroidismo está causado por la falta de secreción de hormona paratiroidea (PTH), bien por alteración de su síntesis y secreción por parte de las glándulas paratiroides o por alteración en el estímulo para su secreción por fallo en el receptor sensible al calcio (CaSR). Su etiología y manifestaciones clínicas son variables en función de la edad del paciente. El tratamiento va dirigido a mantener los niveles de calcemia dentro del rango normal-bajo para evitar el riesgo de nefrocalcinosis derivado del uso de dosis excesivas de calcio y vitamina D. En esta revisión, nos centramos en las peculiaridades de esta entidad en la edad pediátrica.

Abstract Introduction: The central nervous system as well as the cardiovascular system are target organs, susceptible to endogenous and exogenous injuries. In this sense, the role that obesity has in relation to the direct or indirect affection towards the nervous tissue is little known, however, there is evidence that suggests that the decrease in cerebral blood flow as well as the exaggerated production of pro-inflammatory cytokines could be associated with damage to cellular tissue including gray matter and white matter. Objective: The objective of our study was to review the available scientific literature on the macro and microstructural changes caused by obesity in the nervous system. Methodology: Searches were made in English and Spanish in PubMed, GoogleSchoolar and Scielo using the following search terms: “OBESITY” OR “OVERWEIGHT” AND “BRAIN STRUCTURE” OR “GRAY MATTER” OR “WHITE MATTER” OR “BRAIN VOLUME”. We included articles since 2000 to 2021. Results: The results show that obesity is associated with a decrease in brain tissue volume, possibly at the expense of a decrease in white and gray matter, which also causes demyelination and diffuse axonal damage in patients with body mass index > 30. Conclusions: There are different mechanisms that affect the nervous system, producing macro and microscopic changes in obese patients, among which are decreased blood flow, alteration of the blood-brain barrier, production of proinflammatory cytokines, production of reactive oxygen species, among others, which lead to nerve cell apoptosis, decreased white matter volume white and gray matter volume, axonal damage among others.

Resumen Introducción: El sistema nervioso central, así como también el sistema cardiovascular son órganos blancos susceptibles a injurias endógenas y exógenas. En ese sentido, el rol que tiene la obesidad en relación a la afección directa o indirecta hacia el tejido nervioso es poco conocida, sin embargo, existe evidencia que sugiere que la disminución del flujo sanguíneo cerebral, así como también la producción exagerada de citoquinas proinflamatorias podrían estar asociadas a daños del tejido celular incluida la materia gris y la materia blanca. Objetivos: El objetivo de nuestro estudio fue el de revisar la literatura científica disponible alrededor de los cambios macro y microestructurales ocasionados por la obesidad en el sistema nervioso. Metodología: Se realizo búsquedas en inglés y español en PubMed, GoogleSchoolar y Scielo usando los siguientes términos de búsqueda: “OBESITY” OR “OVERWEIGHT” AND “BRAIN STRUCTURE” OR “GRAY MATTER” OR “WHITE MATTER” OR “BRAIN VOLUME”. Se incluyeron artículos desde el 2000 al 2021. Resultados: Los resultados demuestran que la obesidad se asocia a una disminución del volumen tisular cerebral posiblemente a expensas de una disminución de la materia blanca y gris que además ocasiona desmielinización y daño axonal difuso en pacientes con índice de masa corporal > 30. Conclusiones: Existen diferentes mecanismos que afectan al sistema nervioso produciendo cambios macro y microscópicos en pacientes obesos entre los cuales se encuentran la disminución del flujo sanguíneo, alteración de la barrera hematoencefálica, producción de citoquinas proinflamatorias, producción de especies reactivas de oxígeno entre otras los cuales conducen a apoptosis de células nerviosas, disminución del volumen de la materia blanca volumen de la materia blanca y gris, daño axonal entre otros.

Abstract Introduction: The phase I of cardiac rehabilitation have the proposed decrease the effects on the bed rest and better adherence at the phase II. Objective: To analyze the effects of phase I CR in patients undergoing myocardial revascularization and valve changes, through a systematic review of the literature. Method: The review includes randomized clinical trials looking at the effects of phase I. The base date Scopus, Science Direct, Embase & Embase classic OVID. The search was limited between 2000 and 2017, in English Portuguese and Spanish. Results: 298 articles were were eligible, and only four were selected and analyzed. The articles included a population with bypass coronary and two articles with surgery to valve replacement or repair. Regarding quality methodology, Two were rated to be good quality with an evidence level of 1+ and 1++ and a degree of recommendation A y B. The protocols used for treatment include breathing techniques, upper and lower limps exercise and ambulation. Conclusions: The phase I cardiac rehabilitation, could improve lung function and reduce anxiety, this is associated directly with stay hospital post-surgical cardiac patients

Resumen Introducción: La rehabilitación cardíaca de fase I es un programa hospitalario que tiene como objetivo reducir los efectos que se pueden derivar del reposo prolongado en cama e instruir al paciente para el ingreso a la fase ambulatoria de rehabilitación. Objetivo: Analizar los efectos de la rehabilitación cardíaca de fase I en pacientes sometidos a revascularización miocárdica y cambios valvulares, mediante una revisión sistemática de la literatura. Método: La revisión incluyó ensayos clínicos controlados aleatorizados que analizaran los efectos de la rehabilitación cardíaca de fase I. Se emplearon las bases de datos Scopus, ScienceDirect, Embase y Embase classic OVID. La búsqueda se limitó a los artículos publicados entre los años 2000 y 2017, en inglés, portugués y español. Los estudios que cumplieron los criterios de inclusión recibieron un análisis de la calidad metodológica, el nivel de evidencia y el grado de recomendación según las escalas PEDro y Scottish. Resultados: Fueron elegibles 298 artículos, de los cuales cuatro fueron seleccionados y analizados; todos estos incluyeron población que había sido sometida a revascularización quirúrgica cardíaca y dos a población con reparación o reemplazo valvular quirúrgico. En cuanto a la calidad metodológica, dos fueron categorizados como de buena calidad con un nivel de evidencia 1+ y 1++ y un grado de recomendación A y B. Los protocolos de tratamiento utilizados fueron las técnicas respiratorias, los ejercicios activos de extremidades y la deambulación. Conclusiones: La literatura analizada sugiere incluir los procesos de rehabilitación cardíaca de fase I, lo cual puede mejorar la función pulmonar y disminuir la ansiedad, variable que se asoció de manera directa con la estancia hospitalaria en los pacientes posquirúrgicos cardíacos.

ABSTRACT Introduction: Nowadays, population aging is one of the main problems worldwide, due to the increase in life expectancy. However, higher life expectancy does not mean better quality of life. Objective: To assess the role played by the family in the older adult’s self-perception of quality of life. Methods: A descriptive, observational and cross-sectional study was carried out with older adults of both sexes in the Ecuadorian province of El Oro, between January 2018 and November 2019. The sample consisted of 399 patients. The questionnaires used were the Biopsychosocial Assessment of the Older Adult from a Bioethical Approach and the WHOQoL-BREF Quality of Life Scale. Results: The average age was 73.66 years ± 7.38 years, with a range between 65 and 98 years. A poor quality of life was reported by 78.9 % of the mistreated older adults and 75.9 % of the older adults with regular family treatment. Only 18.3 % of the well-treated older adults reported a poor quality of life, which shows a statistically significant association between family treatment and perception of quality of life. Family mistreatment due to neglect was found in older adults who referred poor quality of life. Conclusions: The family has a preponderant role in the quality of life of the older adult.

RESUMEN Introducción: El envejecimiento de la población en la actualidad es uno de los principales problemas a nivel mundial, debido al incremento en la esperanza de vida. Sin embargo, una mayor esperanza de vida no significa una mejor calidad de vida. Objetivo: Valorar el papel que desempeña la familia en la autopercepción de calidad de vida del adulto mayor. Métodos: Estudio descriptivo, observacional y transversal en adultos mayores aplicada en sujetos de ambos sexos en la provincia ecuatoriana de El Oro entre enero del 2018 y noviembre del 2019. La muestra quedó conformada por 399 pacientes. Los cuestionarios utilizados fueron: “Valoración biopsicosocial del adulto mayor desde un enfoque bioético”, y la Escala de Calidad de Vida WHOQOL-BREF. Resultados: El promedio de edad fue de 73,66 años ± 7,38 con un rango entre los 65 y 98 años. El 78,9 % de los adultos mayores maltratados y el 75,9 % de los adultos mayores con trato familiar regular refieren una calidad de vida deficiente. Solo el 18,3 % de los adultos mayores bien tratados refirieron una calidad de vida deficiente, por lo que se observa una asociación entre el trato familiar y la percepción de la calidad de vida estadísticamente significativa. Se constató maltrato familiar por negligencia en los adultos mayores que refirieron una calidad de vida deficiente. Conclusiones: La familia posee un papel preponderante en la calidad de vida del adulto mayor.

ABSTRACT This research aims to analyze the distribution of heavy metals (Pb, Cd and Cu) in water, sediments and fish from the Carrizal River, Manabí - Ecuador. 21 monitoring stations for water and sediment were carried out. In addition, liver, gill, and muscle tissue samples of Hoplias microlepis, Aequidens rivulatus, and Oreochromis niloticus were extracted; heavy metal content is determined by atomic absorption spectrophotometry. The Pb in water and sediments was 0,41 mg/L and 0,03 mg/kg, respectively. In gills of Hoplias microlepis (0,181 mg/kg) and in muscles of Aequidens rivulatus (0,149 mg/kg), the highest levels of Pb were found. The fish species presented undetectable levels of Cd or Cu. The level of Pb in surface water exceeds the established limit; evidencing a distribution and possible biomagnification of this metal.

RESUMEN Esta investigación pretende analizar la distribución de metales pesados (Pb, Cd y Cu) en agua, sedimentos y peces del río Carrizal, Manabí - Ecuador. Se establecieron 21 estaciones de monitoreo para agua y sedimento. Además, se extrajeron muestras de tejido hepático, branquial y muscular de Hoplias microlepis, Aequidens rivulatus y Oreochromis niloticus; el contenido de metales pesados se determinó mediante espectrofotometría de absorción atómica. El Pb en agua y sedimentos fue de 0,41 mg/L y 0,03 mg/kg, respectivamente. En branquias de Hoplias microlepis (0,181 mg/kg) y en músculos de Aequidens rivulatus (0,149 mg/kg) se obtuvieron los mayores niveles de Pb. Las especies ictícolas presentaron niveles no detectables de Cd o Cu. El nivel de Pb en agua superficial supera el límite establecido; evidenciándose una distribución y posible biomagnificación de este metal.

Resumen Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal.

Abstract Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % —11.0 % at onset and 16.7 % during TEN—. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related.

Resumen (analítico) Se analiza cómo la situación creada por la covid-19, el confinamiento y la suspensión de la docencia presencial, afectó al alumnado de educación infantil. Se presenta un estudio de caso de un aula de 16 niños y niñas de tres años. A través de asambleas virtuales que combinaron conversaciones con la elaboración de dibujos se recoge su voz, mostrando en el análisis sus preferencias en la vida cotidiana durante el confinamiento y su estado emocional, los aprendizajes que dicen haber adquirido, así como los deseos de futuro ante la vuelta a su rutina diaria. Los resultados, no solo muestran la capacidad de adaptación infantil, sino también cómo llegan a identificar aspectos positivos derivados del confinamiento que inferimos como demandas de la infancia ante la vuelta a su vida diaria.

Resumo (analítico) Analisa-se como a situação criada pelo Covid-19, o confinamento e a suspensão do ensino presencial afetaram os alunos da Educação Infantil. Um estudo de caso de uma sala de aula de 16 meninos e meninas de três anos de idade é apresentado. Por meio de montagens virtuais que combinam conversas com a elaboração de desenhos, sua voz é coletada, mostrando na análise das informações são apresentadas suas preferências no cotidiano durante o confinamento e seu estado emocional, os aprendizados que dizem ter adquirido nesse período, bem como seus desejos para o futuro antes de retornar à rotina diária. Os resultados mostram não apenas a adaptabilidade infantil, mas também como passam a identificar aspectos positivos decorrentes do confinamento que inferimos como as demandas da infância no retorno ao cotidiano.

Abstract (analytical) It analyzes how the situation created by COVID-19 the confinement and the face-to-face teaching suspension affected the Early Childhood Education pupils. A case study of a classroom of 16 three-yearold boys and girls is presented. Through virtual assemblies that combine conversations with the elaboration of drawings, their voice is collected, showing in the analysis their preferences in daily life during the confinement and their emotional state are presented, the learning that they say they have acquired during this period, as well as their wishes for the future to return to their daily routine. The results not only show the child’s ability to adapt themselves.

Abstract Hearing loss is the most frequent sensory disorder, with an incidence of 1:1500 live newborns. In more than 50% of patients, it is associated with a genetic cause, while in up to 30% of cases, it is related to syndromic entities. We performed a literature review of studies on congenital hearing loss of genetic origin in the Mexican population. We identified eight reports that showed that the pathogenic variants most frequently associated with hearing loss are related to the GJB2 gene, although in a low percentage (3%). Other mutations were identified in the GJB6, SLC26A4, or CHD23 genes. On this basis, a possible diagnostic strategy in Mexican patients with hearing loss is to consider an initial screening of these three genes. If these genes were negative for pathogenic variants, the following steps would be to consider second-generation sequencing analysis focused on panels of genes associated with hearing loss, isolated or syndromic, and if necessary, to perform exome or whole-genome analysis. Establishing an etiologic cause is critical in clinically evaluating patients with congenital hearing loss and their families. It can help determine rehabilitation strategies, such as hearing aids or cochlear implants and provide information on disease progression and genetic counseling in this population.

Resumen La pérdida auditiva es la alteración sensorial más frecuente, con una incidencia de 1:1500 recién nacidos vivos. En más del 50% de los pacientes se asocia con una causa genética, mientras que en más del 30% de los casos se asocia con entidades sindrómicas. Se llevó a cabo una revisión de la literatura de las investigaciones sobre la pérdida auditiva congénita de origen genético en la población mexicana. Se identificaron ocho reportes en los que se demostró que las variantes patogénicas más frecuentemente asociadas con pérdida auditiva se encuentran en el gen GJB2, aunque en un porcentaje bajo (3%). Se identificaron otras mutaciones en los genes GJB6, SLC26A4 o CHD23. Con base en esta información, una posible estrategia diagnóstica en pacientes mexicanos con pérdida auditiva es considerar un primer paso en el tamiz diagnóstico con los tres genes mencionados. Si estos genes fueran negativos para variantes patogénicas, el siguiente paso sería considerar el análisis por secuenciación de segunda generación enfocado en paneles de genes asociados con pérdida auditiva, tanto aislada como sindrómica, y en caso necesario, realizar el análisis del exoma o del genoma completo. Establecer una causa etiológica es un componente crítico en la evaluación clínica de los pacientes con pérdida auditiva congénita, ya que puede ayudar a determinar las estrategias de manejo y rehabilitación, como el uso de auxiliares auditivos o implantes cocleares, proporcionar información sobre la progresión de la enfermedad y dar asesoramiento genético en esta población.

ABSTRACT BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has placed considerable psychological stress on frontline healthcare workers (HCWs). OBJECTIVE: To evaluate the prevalence of burnout syndrome among HCWs facing the COVID-19 outbreak. DESIGN AND SETTING: Cross-sectional study conducted in six public intensive care units (ICUs) in the city of Fortaleza, Brazil. METHODS: An online survey was conducted among HCWs to measure the three dimensions of burnout. RESULTS: A total of 62 physicians (23.4%), 65 nurses (24.5%), 58 nurse technologists (21.9%) and 80 physiotherapists (30.2%) completed the questionnaire. Nearly half of the participants (48.6%) had high levels of emotional exhaustion, and almost one-third of them (29.4%) had high levels of depersonalization. Low levels of professional efficacy were observed in 18.1% of the sample. The independent determinants of depersonalization burnout were age < 33 years (odds ratio, OR 2.03; 95% confidence interval, CI 1.15-3.56; P = 0.01) and female gender (OR 0.33; 95% CI 0.18-0.62; P = 0.01). Increased workload was associated with both depersonalization (OR 2.37; 95% CI 2.02-5.50; P = 0.04) and emotional exhaustion (OR 1.89; 95% CI 1.04-3.58; P = 0.030). CONCLUSION: The COVID-19 pandemic has had a great impact on the dimensions of depersonalization and emotional exhaustion. Consideration of these dimensions is important when designing future burnout prevention programs for frontline personnel.