ABSTRACT Information and Communications Technologies (ICT), as a basic support for educational activities, have influenced the relationships between students, teachers, and the family itself, due to the ease of access to new knowledge, as well as the spread of alterations. psychological conditions that can trigger anxiety, irritation and stress behaviors. Cyberbullying or cyberharassment is an educational and social problem that negatively influences its victims. The objective was to analyze the effect of a program of socio-emotional strategies to reduce cyberbullying, in upper basic level students of an educational institution in Ecuador, during 2023. A mixed methodology with a quasi-experimental approach was used. The sample was intentional, made up of 69 8th year high school students between 10 and 12 years old. A control group and an experimental group to which a socio-emotional strategies program was applied were compared. The variables analyzed were: level of cyberbullying (electronic insults, impersonation and exclusion) and Socio-emotional strategies program. The pre-test and post-test analyze were contrasted with the non-parametric Mann Whitney U Test, after descriptive analysis. Statistically significant differences were found between the averages of the experimental group compared to the control group, with lower values in the levels of cyberbullying in the post-test in the three dimensions. The results obtained constitute a practical proposal with significant impact to reduce cyberbullying in high school students of a public institution in Ecuador.

RESUMEN Las Tecnologías de la Información y las Comunicaciones (TIC), como soporte básico para las actividades educativas, han influenciado en las relaciones entre alumnos, docentes, y la propia familia, por las facilidades de acceso a nuevos conocimientos, además por la propagación de alteraciones psicológicas que pueden desencadenar comportamientos de ansiedad, irritación y estrés. El ciberbullying o ciberacoso, es un problema educacional y social, que influye negativamente en sus víctimas. El objetivo fue analizar el efecto de un programa de estrategias socioemocionales para disminuir el ciberbullying, en los estudiantes de nivel básico superior de una institución educativa en Ecuador, durante 2023. Se utilizó una metodología mixta con enfoque cuasi experimental. La muestra fue intencional, compuesta por 69 estudiantes de 8vo año de básica superior con edades entre 10 y 12 años. Fue comparado un grupo de control y otro experimental al que se le aplicó un Programa de estrategias socioemocionales. Las variables analizadas fueron: nivel de ciberbullying (insultos electrónicos, suplantación y exclusión) y Programa de estrategias socioemocionales. Los análisis pre test y pos test, fueron contrastados con la Prueba no paramétrica U de Mann Whitney, previo análisis descriptivo. Se constataron diferencias estadísticamente significativas entre promedios del grupo experimental con respecto al de control, con valores más bajos en los niveles de ciberbullying en el pos test en las tres dimensiones. Los resultados obtenidos constituyen una propuesta práctica de impacto significativo para la disminución del ciberbullying en estudiantes de básica superior de una institución pública en Ecuador.

RESUMO As Tecnologias de Informação e Comunicação (TIC), como suporte básico das atividades educativas, têm influenciado as relações entre alunos, professores e a própria família, pela facilidade de acesso a novos conhecimentos, bem como pela propagação de alterações psicológicas. que podem desencadear comportamentos de ansiedade, irritação e estresse. O cyberbullying ou assédio cibernético é um problema educacional e social que influencia negativamente as suas vítimas. O objetivo foi analisar o efeito de um programa de estratégias socioemocionais para reduzir o cyberbullying, em estudantes de nível básico superior de uma instituição de ensino no Equador, durante 2023. Foi utilizada uma metodologia mista com uma abordagem quase experimental. A amostra foi intencional, composta por 69 alunos do 8º ano do ensino médio entre 10 e 12 anos. Foram comparados um grupo controle e um grupo experimental ao qual foi aplicado um programa de estratégias socioemocionais. As variáveis analisadas foram: nível de cyberbullying (insultos eletrônicos, falsificação de identidade e exclusão) e programa de estratégias socioemocionais. As análises pré-teste e pós-teste foram contrastadas com o Teste não paramétrico Mann Whitney U, após análise descritiva. Foram encontradas diferenças estatisticamente significativas entre as médias do grupo experimental em comparação ao grupo controle, com valores mais baixos nos níveis de cyberbullying no pós-teste nas três dimensões. Os resultados obtidos constituem uma proposta prática com impacto significativo para reduzir o cyberbullying em estudantes do ensino médio de uma instituição pública no Equador.

ABSTRACT Foundation: Non-compliance with treatment by diabetic people not only worsens the prognosis, but also their quality of life. Objective: To characterize therapeutic adherence in type 2 diabetic patients belonging to four health areas, from two municipalities in Cuba. Methods: A descriptive and cross-sectional study was carried out in two health areas of the municipalities of Cárdenas and Santiago de Cuba, in the period January - August 2019. The universe was represented by 1091 diabetic people who recovered from a previous study carried out between 2015 and 2016 in the same health areas. They underwent anthropometric measurements, blood pressure, glycated hemoglobin and a questionnaire was applied. Variables were studied: sociodemographic (age, sex, skin color, occupation, level of education, cohabitation), risk factors and comorbidities, pharmacological and non-pharmacological treatment and their relationship with adherence. Categorical variables were presented as frequencies and percentages. Results: Adherence was 70.7 %, statistically related to white skin color, high level of education, control of glycated hemoglobin according to age and value less than 7 %, as well as not suffering from comorbidities such as cardiovascular diseases, chronic respiratory diseases, dyslipidemia, no consumption of alcoholic or sugary beverages. Conclusions: The non-availability of medications in the pharmacy, forgetting to take them and at the established times were the main barriers reported by patients, this must be taken into account to have a favorable impact on the control of diabetes mellitus.

RESUMEN Fundamento: El incumplimiento del tratamiento por las personas diabéticas, no solo empeora el pronóstico, sino su calidad de vida. Objetivo: Caracterizar la adherencia terapéutica en pacientes diabéticos tipo 2 pertenecientes a cuatro áreas de salud, de dos municipios de Cuba. Métodos: Se realizó un estudio descriptivo y transversal en dos áreas de salud de los municipios de Cárdenas y Santiago de Cuba, en el periodo enero - agosto de 2019. El universo estuvo representado por 1091 personas diabéticas que se recuperaron de un estudio previo efectuado entre el 2015 y 2016 en las mismas áreas de salud. A estas se les realizó mediciones antropométricas, de la presión arterial, hemoglobina glicada y se aplicó un cuestionario. Se estudiaron variables: sociodemográficas (edad, sexo, color de la piel, ocupación, nivel de escolaridad, convivencia), factores de riesgo y comorbilidades, tratamiento farmacológico y no farmacológico y su relación con la adherencia. Las variables categóricas fueron presentadas como frecuencias y porcentajes. Resultados: La adherencia fue de 70,7 %, relacionada estadísticamente con color de piel blanca, nivel de escolaridad alto, control de la hemoglobina glicada según edad y valor inferior a 7 %, así como, el no padecimiento de comorbilidades como enfermedades cardiovasculares, respiratorias crónicas, dislipidemia, no consumo de bebidas alcohólicas, ni azucaradas. Conclusiones: La no disponibilidad de medicamentos en farmacia, el olvido en tomarlos y en los horarios establecidos resultaron las principales barreras referidas por los pacientes, esto debe tenerse en cuenta para incidir de forma favorable en el control de la diabetes mellitus.

Resumo Objetivo: Avaliar a efetividade dos medicamentos inibidores da SGLT2 (iSGLT2) no controlo de pessoa com diabetes tipo 2 (PDM2) pelos valores de hemoglobina A1c (HbA1c), índice de massa corporal (IMC) e perímetro abdominal (PA) após cinco anos de seguimento. Métodos: Estudo observacional de coorte retrospetiva multicêntrica, de 2017 a 2022, efetuado em 2023. Analisaram-se os dados fornecidos pela Administração Regional de Saúde (ARS) do Centro de PDM2 (classificação T90 da ICPC-2) dos Agrupamentos de Centros de Saúde (ACeS) Baixo Mondego e Dão Lafões, de PMD2 escolhidas aleatoriamente e medicadas em 2017 com iSGLT2. Dados de PDM2 em 2017 e 2022, para a data mais próxima do fim do respetivo ano para HbA1c, IMC e PA. Controlo de DM2 para valores de HbA1c: ≤7% e ≤8%. Resultados: Amostra de n=264 pessoas, 59,0% (n=156) homens. Verificaram-se variações de 2017 para 2022 na HbA1c de 7,62±1,21 para 7,56±1,12 (Δ=-0,009) (p=0,951), no IMC de 31,65±8,72 para 29,90±4,56 (Δ=-0,056) (p<0,001) e no PA de 104,90±13,64 para 105,58±11,11 (Δ=+0,007) (p=0,424). Frequência de PMD2 controladas, para HbA1c ≤7% e <65 anos, de 31,1% em 2017 e de 27,1% em 2022, Δ=-12,9 (p>0,05) e para HbA1c ≤8% de 74,8% em 2017 e de 73,3% em 2022, Δ=-0,02 (p=0,002). Discussão: Comparando com valores de um estudo prévio, com seguimento a dois anos, verificaram-se reduções em HbA1c e IMC e aumento do PA, provavelmente pelo facto de a sarcopenia reduzir o IMC, que o aumento do PA não contrabalança. A prescrição de iSGLT2 não reduziu a prevalência de PMD2. Conclusão: Verificou-se efetividade dos iSGLT2 na redução da HbA1c e do IMC, ao contrário do PA e da percentagem de PMDM2 controladas pelo valor de HbA1c.

Abstract Objective: To ascertain the five-year effectiveness of SGLT2 inhibitor (iSGLT2) medicines on Type 2 Diabetes Mellitus Persons (T2DMP) on haemoglobin (HbA1c), body mass index (BMI) and abdominal perimeter (AP) values. Methods: Observational multicentric retrospective cohort study, in 2022, analysing data provided by the Regional Health Administration Authority (RHA) of Central for T2DMP (ICPC-2 - T90 classification) of Baixo Mondego and Dão Lafões, Portuguese NHS Primary Care Units clusters, medicated in 2017 with SGLT2i and re-studied in 2022, for closest date to the end of the year. Two values of HbA1c were taken as control cut-offs: ≤7% and ≤8%. Results: A sample of n=264, 59.0% (n=156) male was studied. From 2017 to 2022: HbA1c, 7.62±1.21 to 7.56±1.12 (Δ=-0.8) (p=0.951); BMI, 31.65±8.72 to 29.90±4.56 (Δ=-5.5) (p<0.001); and AP, 104.90±13.64 to 105.58± 11.11(Δ=+0.6) (p=0.424). The prevalence of controlled PMD2 under 65 years for HbA1c ≤7% in 2017 was 34.0% and in 2022 of 32.1%, Δ=-5.50; and for HbA1c ≤8% for older ones than 65 years of 74.8% in 2017 and of 743.3% in 2022, Δ=-0.02. Discussion: Comparing these values with previous ones, an improvement in HbA1c and BMI, and worsening of AP was verified, sarcopenia possibly reducing BMI not balanced by the AP increase. Conclusion: The effectiveness of iSGLT2 in the reduction of HbA1c and BMI was verified, unlike the AP and the frequency of controlled PDM2.

Há poucos estudos focados na epidemiologia da crise hipertensiva em nível populacional em ambientes com recursos limitados. O objetivo deste estudo foi determinar a prevalência e a tendência, ao longo do tempo, da crise hipertensiva e fatores associados a essa condição em adultos. Uma análise de dados secundários foi realizada usando a Pesquisa Demográfica de Saúde Familiar (ENDES) do Peru. Crise hipertensiva foi definida com base na presença de pressão arterial sistólica (≥ 180mmHg) ou diastólica (≥ 110mmHg), independentemente de diagnóstico prévio ou uso de medicação. Os fatores associados aos resultados foram avaliados por meio de regressão logística multinomial, e a tendência de crise hipertensiva foi avaliada pelo teste de Cochrane-Armitage. Os dados de 260.167 participantes, com média de 44,2 anos (DP: 16,9) e 55,5% mulheres, foram analisados. A prevalência de hipertensão foi de 23% (IC95%: 22,7-23,4), dentre eles, 5,7% (IC95%: 5,4-5,9) apresentaram crise hipertensiva, com prevalência geral de 1,5% (IC95%: 1,4-1,6). De 2014 a 2022, observou-se queda significativa na prevalência de crise hipertensiva, de 1,7% em 2014 para 1,4% em 2022 (p = 0,001). No modelo multivariável, sexo masculino, idade crescente, residir em área urbana, índice de massa corporal elevado e diabetes autorreferido associaram-se positivamente à crise hipertensiva, enquanto maior escolaridade, nível socioeconômico e altitude elevada associaram-se inversamente. Há necessidade de aprimorar as estratégias de diagnóstico, tratamento e controle da hipertensão arterial, especialmente da crise hipertensiva.

There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis.

Pocos estudios se han centrado en la epidemiología de la crisis hipertensiva a nivel poblacional en entornos de recursos limitados. El objetivo de este estudio fue determinar la prevalencia y tendencia, a lo largo del tiempo, de la crisis hipertensiva y los factores asociados a esta condición en adultos. Se realizó un análisis de datos secundarios utilizando la Encuesta Demográfica de Salud Familiar (ENDES) de Perú. La crisis hipertensiva se definió en función de la presencia de presión arterial sistólica (≥ 180mmHg) o diastólica (≥ 110mmHg), independientemente del diagnóstico previo o del uso de medicamentos. Los factores asociados a los resultados se evaluaron mediante regresión logística multinomial, y la tendencia a la crisis hipertensiva se estimó mediante la prueba Cochran-Armitage. Los datos de 260.167 participantes, con una media de 44,2 años (DE: 16,9) y 55,5% mujeres, fueron analizados. La prevalencia de hipertensión fue del 23% (IC95%: 22,7-23,4), de la cual el 5,7% (IC95%: 5,4-5,9) tuvo crisis hipertensiva, con una prevalencia general del 1,5% (IC95%: 1,4-1,6). En el período 2014-2022 se constató una disminución significativa en la prevalencia de crisis hipertensiva, del 1,7% en 2014 al 1,4% en 2022 (p = 0,001). En el modelo multivariable, el sexo masculino, el aumento de la edad, vivir en áreas urbanas, el alto índice de masa corporal y la diabetes autoinformada se asociaron positivamente con la crisis hipertensiva, mientras que mayor nivel educativo, nivel socioeconómico y elevada altitud estuvieron asociadas de manera inversa. Es necesario mejorar las estrategias para el diagnóstico, el tratamiento y el control de la hipertensión, especialmente de la crisis hipertensiva.

ABSTRACT Background: To assess the efficacy of applying the endoscopic reference score for EoE (EREFS) in children with symptoms of esophageal dysfunction naïve to proton pump inhibitor (PPI) therapy. Methods: An observational cross-sectional study was conducted by reviewing reports and photographs of upper gastrointestinal endoscopies (UGE) and esophageal biopsies of patients with symptoms of esophageal dysfunction. Patients who were treated with PPI or had other conditions that may cause esophageal eosinophilia were excluded. Results: Of the 2,036 patients evaluated, endoscopic findings of EoE were identified in 248 (12.2%) and more than one abnormality was observed in 167 (8.2%). Among all patients, 154 (7.6%) presented esophageal eosinophilia (≥15 eosinophils per high power field) (P<0.01). In this group, 30 patients (19.5%) had normal endoscopy. In patients with EoE, edema (74% vs 6.5%, P<0.01) and furrows (66.2% vs 2.4%, P<0.01) were more prevalent than in the control group. Association of edema and furrows was more frequent in patients with EoE than in the control group (29.2% vs 1.6%, P<0.01, OR=24.7, CI=15.0-40.5). The presence of more than one endoscopic finding had sensitivity of 80.5%, specificity of 93.4%, positive predictive value (PPV) of 50%, negative predictive value (NPV) of 98.3%, and accuracy of 92.4%. Conclusion: In conclusion, this study showed that endoscopic features suggestive of EoE had high specificity and NPV for diagnosing EoE in children naïve to PPI therapy. These findings highlight the importance of the EREFS in contributing to early identification of inflammatory and fibrostenosing characteristics of EoE, making it possible to identify and to avoid progression of the disease. Background (EREFS (PPI therapy Methods crosssectional cross sectional UGE (UGE excluded Results 2036 2 036 2,03 evaluated 24 12.2% 122 12 (12.2% 16 8.2%. 82 8.2% . 8 (8.2%) 15 7.6% 76 7 6 (7.6% ≥15 (≥1 field P<0.01. P001 P P<0.01 0 01 (P<0.01) 3 19.5% 195 19 5 (19.5% endoscopy 74% 74 (74 65 6.5% 66.2% 662 66 (66.2 4 2.4% 29.2% 292 29 (29.2 1 1.6% OR247 OR OR=24.7 CI=15.040.5. CI150405 CI CI=15.0 40.5 40 CI=15.0-40.5) 805 80 80.5% 934 93 93.4% PPV (PPV 50 50% (NPV 983 98 98.3% 924 92 92.4% Conclusion conclusion disease 203 03 2,0 12.2 (12.2 8.2 (8.2% 7.6 (7.6 ≥1 (≥ P00 P<0.0 (P<0.01 19.5 (19.5 (7 6.5 66.2 (66. 2.4 29.2 (29. 1.6 OR24 OR=24. 040 CI=15.040.5 CI15040 CI150 CI=15. 405 40. CI=15.0-40.5 80.5 9 93.4 98.3 92.4 20 2, 12. (12. 8. (8.2 7. (7. ≥ ( P0 P<0. (P<0.0 19. (19. 6. 66. (66 2. 29. (29 1. OR2 OR=24 04 CI=15.040. CI1504 CI15 CI=15 CI=15.0-40. 80. 93. 98. 92. (12 (8. P<0 (P<0. (19 (6 (2 OR=2 CI=15.040 CI1 CI=1 CI=15.0-40 (1 (8 P< (P<0 OR= CI=15.04 CI= CI=15.0-4 (P< CI=15.0- (P

RESUMO Contexto: Avaliar a eficácia da aplicação do escore de referência endoscópico para EoE (EREFS) em crianças com sintomas de disfunção esofágica sem tratamento prévio com inibidores da bomba de prótons (IBP). Métodos: Foi realizado um estudo transversal observacional por meio de revisão de laudos e fotos de endoscopia digestiva alta (EDA) e biópsias de esôfago de pacientes com sintomas de disfunção esofágica. Pacientes tratados com IBP ou com outras condições que podem causar eosinofilia esofágica foram excluídos. Resultados: Dos 2.036 pacientes avaliados, os achados endoscópicos de EoE foram identificados em 248 (12,2%) e mais de uma anormalidade foi observada em 167 (8,2%). Entre todos os pacientes, 154 (7,6%) apresentaram eosinofilia esofágica (≥15 eosinófilos por campo de grande aumento) (P<0,01). Nesse grupo, 30 pacientes (19,5%) apresentaram endoscopia normal. Em pacientes com EoE, edema (74% vs 6,5%, P<0,01) e linhas verticais (66,2% vs 2,4%, P<0,01) foram mais prevalentes quando comparados ao grupo controle. A associação de edema e linhas verticais foi mais frequente em pacientes com EoE do que no grupo controle (29,2% vs 1,6%, P<0,01, OR=24,7, IC=15,0-40,5). A presença de mais de um achado endoscópico teve sensibilidade de 80,5%, especificidade de 93,4%, valor preditivo positivo de 50%, valor preditivo negativo de 98,3% e acurácia de 92,4%. Conclusão: Em conclusão, esse estudo mostrou que as características endoscópicas sugestivas de EoE apresentam especificidade e VPN elevados para o diagnóstico da enfermidade em crianças sem tratamento prévio com IBP. Estes achados reforçam a importância do EREFS em contribuir para a identificação precoce de características inflamatórias e fibroestenosantes, possibilitando identificar e evitar a progressão da doença. Contexto (EREFS . (IBP) Métodos EDA (EDA excluídos Resultados 2036 2 036 2.03 avaliados 24 12,2% 122 12 (12,2% 16 8,2%. 82 8,2% 8 (8,2%) 15 7,6% 76 7 6 (7,6% ≥15 (≥1 aumento P<0,01. P001 P P<0,01 0 01 (P<0,01) 3 19,5% 195 19 5 (19,5% normal 74% 74 (74 65 6,5% 66,2% 662 66 (66,2 4 2,4% 29,2% 292 29 (29,2 1 1,6% OR247 OR OR=24,7 IC=15,040,5. IC150405 IC IC=15,0 40,5 40 IC=15,0-40,5) 805 80 80,5% 934 93 93,4% 50 50% 983 98 98,3 924 92 92,4% Conclusão conclusão fibroestenosantes doença (IBP 203 03 2.0 12,2 (12,2 8,2 (8,2% 7,6 (7,6 ≥1 (≥ P00 P<0,0 (P<0,01 19,5 (19,5 (7 6,5 66,2 (66, 2,4 29,2 (29, 1,6 OR24 OR=24, 040 IC=15,040,5 IC15040 IC150 IC=15, 405 40, IC=15,0-40,5 80,5 9 93,4 98, 92,4 20 2. 12, (12, 8, (8,2 7, (7, ≥ ( P0 P<0, (P<0,0 19, (19, 6, 66, (66 2, 29, (29 1, OR2 OR=24 04 IC=15,040, IC1504 IC15 IC=15 IC=15,0-40, 80, 93, 92, (12 (8, P<0 (P<0, (19 (6 (2 OR=2 IC=15,040 IC1 IC=1 IC=15,0-40 (1 (8 P< (P<0 OR= IC=15,04 IC= IC=15,0-4 (P< IC=15,0- (P

Há poucos estudos focados na epidemiologia da crise hipertensiva em nível populacional em ambientes com recursos limitados. O objetivo deste estudo foi determinar a prevalência e a tendência, ao longo do tempo, da crise hipertensiva e fatores associados a essa condição em adultos. Uma análise de dados secundários foi realizada usando a Pesquisa Demográfica de Saúde Familiar (ENDES) do Peru. Crise hipertensiva foi definida com base na presença de pressão arterial sistólica (≥ 180mmHg) ou diastólica (≥ 110mmHg), independentemente de diagnóstico prévio ou uso de medicação. Os fatores associados aos resultados foram avaliados por meio de regressão logística multinomial, e a tendência de crise hipertensiva foi avaliada pelo teste de Cochrane-Armitage. Os dados de 260.167 participantes, com média de 44,2 anos (DP: 16,9) e 55,5% mulheres, foram analisados. A prevalência de hipertensão foi de 23% (IC95%: 22,7-23,4), dentre eles, 5,7% (IC95%: 5,4-5,9) apresentaram crise hipertensiva, com prevalência geral de 1,5% (IC95%: 1,4-1,6). De 2014 a 2022, observou-se queda significativa na prevalência de crise hipertensiva, de 1,7% em 2014 para 1,4% em 2022 (p = 0,001). No modelo multivariável, sexo masculino, idade crescente, residir em área urbana, índice de massa corporal elevado e diabetes autorreferido associaram-se positivamente à crise hipertensiva, enquanto maior escolaridade, nível socioeconômico e altitude elevada associaram-se inversamente. Há necessidade de aprimorar as estratégias de diagnóstico, tratamento e controle da hipertensão arterial, especialmente da crise hipertensiva. limitados tempo adultos ENDES (ENDES Peru ≥ ( 180mmHg mmHg 110mmHg, 110mmHg , 110mmHg) medicação multinomial CochraneArmitage. CochraneArmitage Cochrane Armitage. Armitage Cochrane-Armitage 260167 260 167 260.16 participantes 442 44 2 44, DP (DP 16,9 169 16 9 555 55 5 55,5 mulheres analisados 23 IC95% IC95 IC (IC95% 22,723,4, 227234 22,7 23,4 22 7 4 22,7-23,4) eles 57 5,7 5,45,9 5459 5,4 5,9 5,4-5,9 15 1 1,5 1,41,6. 1416 1,4 1,6 . 6 1,4-1,6) 201 observouse observou se 17 1,7 14 202 p 0,001. 0001 0,001 0 001 0,001) multivariável masculino crescente urbana associaramse associaram escolaridade inversamente 26016 26 260.1 16, 55, IC9 (IC95 723 22,723,4 22723 227 22, 234 23, 22,7-23,4 5, 45 5,45, 545 54 59 5,4-5, 1, 41 1,41,6 141 1,4-1,6 20 000 0,00 00 2601 260. (IC9 72 22,723, 2272 22,7-23, 5,45 5,4-5 1,41, 1,4-1, 0,0 (IC 22,723 22,7-23 5,4- 1,41 1,4-1 0, 22,72 22,7-2 1,4- 22,7-

There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis. resourceconstrained resource constrained settings adults ENDES. ENDES . (ENDES) ≥ ( 180mmHg mmHg 110mmHg pressure use regression CochraneArmitage Cochrane Armitage test 260167 260 167 260,16 analyzed 442 44 44. SD (SD 16.9 169 16 9 555 55 5 55.5 women 23 95%CI 95CI CI 95 (95%CI 22.723.4 227234 22.7 23.4 22 7 4 22.7-23.4 them 57 5.7 5.45.9 5459 5.4 5.9 5.4-5.9 15 1 1.5 1.41.6. 1416 1.4 1.6 6 1.4-1.6) 201 observed 17 1.7 14 202 p 0.001. 0001 0.001 0 001 0.001) model males areas index selfreported self reported status treatment hypertension (ENDES 26016 26 260,1 16. 55. 723 22.723. 22723 227 22. 234 23. 22.7-23. 5. 45 5.45. 545 54 59 5.4-5. 1. 41 1.41.6 141 1.4-1.6 20 000 0.00 00 2601 260, 72 22.723 2272 22.7-23 5.45 5.4-5 1.41. 1.4-1. 0.0 22.72 22.7-2 5.4- 1.41 1.4-1 0. 22.7- 1.4-

Pocos estudios se han centrado en la epidemiología de la crisis hipertensiva a nivel poblacional en entornos de recursos limitados. El objetivo de este estudio fue determinar la prevalencia y tendencia, a lo largo del tiempo, de la crisis hipertensiva y los factores asociados a esta condición en adultos. Se realizó un análisis de datos secundarios utilizando la Encuesta Demográfica de Salud Familiar (ENDES) de Perú. La crisis hipertensiva se definió en función de la presencia de presión arterial sistólica (≥ 180mmHg) o diastólica (≥ 110mmHg), independientemente del diagnóstico previo o del uso de medicamentos. Los factores asociados a los resultados se evaluaron mediante regresión logística multinomial, y la tendencia a la crisis hipertensiva se estimó mediante la prueba Cochran-Armitage. Los datos de 260.167 participantes, con una media de 44,2 años (DE: 16,9) y 55,5% mujeres, fueron analizados. La prevalencia de hipertensión fue del 23% (IC95%: 22,7-23,4), de la cual el 5,7% (IC95%: 5,4-5,9) tuvo crisis hipertensiva, con una prevalencia general del 1,5% (IC95%: 1,4-1,6). En el período 2014-2022 se constató una disminución significativa en la prevalencia de crisis hipertensiva, del 1,7% en 2014 al 1,4% en 2022 (p = 0,001). En el modelo multivariable, el sexo masculino, el aumento de la edad, vivir en áreas urbanas, el alto índice de masa corporal y la diabetes autoinformada se asociaron positivamente con la crisis hipertensiva, mientras que mayor nivel educativo, nivel socioeconómico y elevada altitud estuvieron asociadas de manera inversa. Es necesario mejorar las estrategias para el diagnóstico, el tratamiento y el control de la hipertensión, especialmente de la crisis hipertensiva. limitados tiempo adultos ENDES (ENDES Perú ≥ ( 180mmHg mmHg 110mmHg, 110mmHg , 110mmHg) medicamentos multinomial CochranArmitage. CochranArmitage Cochran Armitage. Armitage Cochran-Armitage 260167 260 167 260.16 participantes 442 44 2 44, DE (DE 16,9 169 16 9 555 55 5 55,5 mujeres analizados 23 IC95% IC95 IC (IC95% 22,723,4, 227234 22,7 23,4 22 7 4 22,7-23,4) 57 5,7 5,45,9 5459 5,4 5,9 5,4-5,9 15 1 1,5 1,41,6. 1416 1,4 1,6 . 6 1,4-1,6) 20142022 2014-202 17 1,7 201 14 202 p 0,001. 0001 0,001 0 001 0,001) multivariable masculino edad urbanas educativo inversa 26016 26 260.1 16, 55, IC9 (IC95 723 22,723,4 22723 227 22, 234 23, 22,7-23,4 5, 45 5,45, 545 54 59 5,4-5, 1, 41 1,41,6 141 1,4-1,6 2014202 2014-20 20 000 0,00 00 2601 260. (IC9 72 22,723, 2272 22,7-23, 5,45 5,4-5 1,41, 1,4-1, 201420 2014-2 0,0 (IC 22,723 22,7-23 5,4- 1,41 1,4-1 20142 2014- 0, 22,72 22,7-2 1,4- 22,7-

Abstract Polysaccharide coating is a biodegradable alternative to conventional packings used for delaying senescence in vegetables. This work investigated the properties of cassava and chitosan biopolymeric film and its use as edible coatings to preserve the shelf-life (7 °C and 70% relative humidity (RH)) of green asparagus, with previous cold storage (1 °C and 90% RH) for 7 days. Based on a previous assessment of the films obtained from a) cassava (2.5%), b) chitosan (0.5%), and c) a blend of cassava-chitosan (Cassava+) (2.5 + 0.5%), it could be verified that cassava-chitosan blend films showed improved barrier property (water vapor transmission rate (WVTR) of 38.06 g/(m2.h)) and mechanical properties, with tensile strength of 0.021 MPa, elongation at break of 1.93% and Young’s module of 0.011 MPa. Cassava+ based coating resulted in a lower weight loss and colour L* parameter and minimized textural changes in basal-section of commercial green asparagus spears during a shelf-life of seven days (7 °C and 70% RH), with previous cold storage. All coated spears maintained overall higher carbohydrate levels than the control, except to sucrose which gradually decreased in basal sections and increased in the apical sections of asparagus spears, irrespective of treatment. Edible coating did not affect asparagine concentrations which steadily increased throughout the shelf-life of the spears. The blend (Cassava+) kept for a longer the green asparagus quality. However, spears under a shelf-life of seven days (7 °C and 70% RH), with previous cold storage under 1 °C and 90% RH conditions, developed tip-rot physiological disorder. vegetables shelflife shelf life ( C 70 (RH) 90 2.5%, 25 2.5% , 2 5 (2.5%) b 0.5%, 05 0.5% 0 (0.5%) c cassavachitosan Cassava (Cassava+ 2.5 (2. 0.5%) water WVTR (WVTR 3806 38 06 38.0 g/m2.h gm2h gmh g/ m2.h g m2 h m g/(m2.h) 0021 021 0.02 MPa 193 93 1.93 Youngs Young s 0011 011 0.01 L basalsection section RH, control treatment quality However conditions tiprot tip rot disorder (RH 9 (2.5% 0.5 (0.5% (Cassava 2. (2 380 3 38. gm m2h mh g/(m2.h 002 02 0.0 19 1.9 001 01 0. (0.5 00 1. (0. (0

Resumo Polímeros naturais, como o polissacarídeo, são uma alternativa biodegradável para a fabricação de novas embalagens, a fim de substituir as embalagens convencionais utilizadas para retardar a senescência em vegetais. Este trabalho investigou as propriedades de filmes biopoliméricos de amido de mandioca e quitosana, e seu uso como revestimentos comestíveis para preservar a vida útil (7 °C e 70% umidade relativa- UR) de aspargos verdes, com ou sem armazenamento prévio refrigerado (1 °C e 90% UR) por sete dias. Com base na avaliação prévia dos filmes obtidos a partir de a) fécula de mandioca (2,5%), b) quitosana (0,5%) e c) uma mistura de fécula de mandioca e quitosana (Cassava+) (2,5 + 0,5%), verificou-se que os filmes da mistura fécula e quitosana apresentaram propriedade de barreira melhorada (taxa de permeabilidade ao vapor d’água de 38,06 g/(m2.h)) e propriedades mecânicas, com resistência à tração de 0,021 MPa, alongamento à ruptura de 1,93% e módulo de Young de 0,011 MPa. O revestimento à base de fécula de mandioca e quitosana resultou em menor perda de massa e valor L*, e minimizou as mudanças de textura na seção basal de hastes de aspargo verde comercial durante a vida útil de sete dias (7 °C e 70% UR), com armazenamento prévio refrigerado. Todas as hastes revestidas mantiveram níveis globais de carboidratos mais elevados do que o controle, exceto para a sacarose, que diminuiu gradualmente nas seções basais e aumentou nas seções apicais das lanças de aspargo, independentemente do tratamento. O revestimento comestível não teve efeito nas concentrações de asparagina, que aumentaram ao longo do período de vida útil. Todas as hastes com vida útil de sete dias (7 °C e 70% UR), com armazenamento prévio refrigerado (1 °C e 90% UR), desenvolveram o distúrbio fisiológico podridão das pontas. naturais polissacarídeo vegetais 7 ( C 70 relativa UR verdes 1 90 2,5%, 25 2,5% , 2 5 (2,5%) b 0,5% 05 0 (0,5% c Cassava+ Cassava (Cassava+ 2,5 (2, 0,5%, 0,5%) verificouse verificou se taxa dágua d água 3806 38 06 38,0 g/m2.h gm2h gmh g/ m2.h g m2 h m g/(m2.h) mecânicas 0021 021 0,02 MPa 193 93 1,93 0011 011 0,01 L L* UR, controle sacarose tratamento asparagina pontas 9 (2,5% 0,5 (0,5 (Cassava 2, (2 380 3 38, gm m2h mh g/(m2.h 002 02 0,0 19 1,9 001 01 0, (0, 00 1, (0

ABSTRACT Granulomatosis with polyangiitis is a systemic, necrotizing, granulomatous vasculitis that affects the upper and lower respiratory tract and kidneys. The case of a 59-year-old white female patient, who is hypertensive and inveterate smoker, is presented; she was admitted for presenting constitutional symptoms, turbid and bloody urine, as well as elevated creatininemia with a normal previous value. With the initial diagnostic impression of urinary tract infection, antibiotic therapy was indicated. After the third day of starting treatment the constitutional symptoms improved, and progressively began with multiorgan manifestations (renal, respiratory, skin and musculoskeletal) suggestive of systemic vasculitis. As significant elements, complementary examinations detected increased nitrogen and acute phase reactants, active urinary sediment, nodular image in the right lung apex and multifocal microhemorrhages in both lung fields through computed tomography, and highly positive c-ANCA. Potent immunosuppressive and cytotoxic treatment was indicated, obtaining initial control of severe manifestations of the disease. Evolutionarily she developed complications specific to the entity and secondary to medical treatment which made her subject to renal replacement therapy, dying two years after receiving iterated hemodialysis. The clinical characteristics, together with the imaging and immunological studies (c-ANCA) were key elements to make the diagnosis.

RESUMEN La granulomatosis con poliangeítis es una vasculitis sistémica, necrosante y granulomatosa que afecta el tracto respiratorio superior e inferior y los riñones. Se presenta el caso de una paciente blanca, de 59 años de edad, hipertensa y fumadora inveterada, que ingresó por presentar síntomas constitucionales, orinas turbias y hemáticas, así como creatininemia elevada con valor previo normal. Con impresión diagnóstica inicial de infección del tracto urinario se indica antibioticoterapia. Después del tercer día de iniciado el tratamiento, mejoraron los síntomas constitucionales y, de forma progresiva, comenzó con manifestaciones multiorgánicas (renal, respiratoria, cutánea y musculoesquelética) sugestivas de vasculitis sistémica. Como elementos significativos, en exámenes complementarios se detectaron azoados y reactantes de fase aguda aumentados, sedimento urinario activo, imagen nodular en vértice pulmonar derecho y microhemorragias multifocales en ambos campos pulmonares, detectados mediante tomografía computarizada y c-ANCA altamente positivo. Se indicó tratamiento inmunosupresor y citotóxico potente, obteniéndose control inicial de las manifestaciones graves de la enfermedad. Evolutivamente desarrolló complicaciones propias de la entidad y secundarias al tratamiento médico, que la hicieron tributaria de terapia de sustitución renal, falleciendo a los dos años de recibir hemodiálisis iterada. El cuadro clínico, unido a los estudios imagenológicos e inmunológicos (c-ANCA), fueron elementos claves para realizar el diagnóstico.

Resumo Este estudo teve como objetivo avaliar a influência do meio de cultura, irradiância e sistema de vedação no crescimento in vitro e ex vitro de Cattleya walkeriana Gardner. Utilizamos como meio de cultura o meio MS, suplementado com 30 g L-1 de sacarose e solidificado com 7,0 g L-1 de ágar bacteriológico. Este meio serviu de controle, enquanto nos demais tratamentos o meio foi complementado da seguinte forma: 2) MS com 150 g L-1 de polpa de banana = P150; 3) MS com 300 g L-1 de polpa de banana = P300; 4) MS com 150 g L-1 de casca de banana = PE150; e 5) MS com 300 g L-1 de casca de banana = PE300. As irradiâncias foram fornecidas por lâmpadas LED de 3000K: 86 μmol m-2 s1 (Irradiância-1) e 128 µmol m-2 s-1 (Irradiância-2) e a vedação convencional (CSS) e sistema de vedação que permite troca gasosa (GESS). Aos 120 (in vitro) e 180 dias (ex vitro) de cultivo, avaliamos o número de pseudobulbos (PN), de folhas (LN) e raízes (RN), altura da planta (PH), diâmetro do pseudobulbo (PD), comprimento da maior folha (LL) e raiz (RL), massa fresca (TFM) e sobrevivência (%SURV). Houve interação significativa para todas as características analisadas. A dupla interação CM x SS foi significativa para PH, LL e RL. A interação CM x I x SS foi significativa para as características PN, LN, RN, PD, TFM e %SURV de C. walkeriana cultivada in vitro. Houve interação significativa entre CM x I x SS para todas as características de C. walkeriana avaliadas em cultivo ex vitro. A utilização do meio com até 150 g L-1 de polpa de banana combinada com Irradiância-2 e CSS proporcionou os maiores valores para o crescimento in vitro das plantas. No entanto, o cultivo prévio em meio MS, Irradiância-1 e CSS proporcionou maior sobrevivência e estabelecimento de plantas dessa espécie em cultivo ex vitro. Gardner 3 L1 L 1 L- 70 7 0 7, bacteriológico controle forma 2 15 P150 P P300 4 PE150 PE 5 PE300 3000K K 8 m2 m m- s Irradiância1 Irradiância (Irradiância-1 12 s- Irradiância2 (Irradiância-2 (CSS GESS. GESS . (GESS) 18 PN , (PN) LN (LN RN (RN) PH (PH) PD (PD) (LL RL, RL (RL) (TFM %SURV. SURV (%SURV) analisadas C Irradiância- entanto P15 P30 PE15 PE30 (Irradiância- (GESS (PN (RN (PH (PD (RL (%SURV P1 P3 PE1 PE3 (Irradiância

Abstract This study aimed to evaluate the influence of culture media, irradiance, and sealing system on the in vitro and ex vitro growth of Cattleya walkeriana Gardner. We used MS medium as culture medium, supplemented with 30 g L-1 of sucrose and solidified with 7.0 g L-1 of bacteriological agar. This medium served as a control, while for the other treatments we supplemented the media as follows: 2) MS with 150 g L-1 of banana pulp = P150; 3) MS with 300 g L-1 of banana pulp = P300; 4) MS with 150 g L-1 of banana peel = PE150; and 5) MS with 300 g L-1 of banana peel = PE300. The irradiances were provided by 3000K LED lamps: 86 μmol m-2 s-1 (Irradiance-1) and 128 µmol m-2 s-1 (Irradiance-2) and the conventional sealing (CSS) and sealing systems that allow gas exchange (GESS). After 120 (in vitro) and 180 days (ex vitro) of cultivation, we evaluated them for pseudobulb (PN), leaf (LN) and root number (RN), plant height (PH), pseudobulb diameter (PD), longest leaf (LL) and root length (RL), fresh mass (TFM) and survival (%SURV). There was a significant interaction for all the variables analyzed. The CM x SS double interaction was significant for PH, LL, and RL. The CM x I x SS interaction was significant for PN, LN, RN, PD, TFM, and %SURV traits of C. walkeriana grown in vitro. There was a significant interaction between CM x I x SS for all C. walkeriana traits evaluated in ex vitro culture. Using the medium with up to 150 g L-1 of banana pulp combined with Irradiance-2 and CSS provided the highest values for in vitro plant growth. However, prior cultivation in MS medium, Irradiance-1, and CSS provided the greatest survival and establishment of this species plants in ex vitro culture. irradiance Gardner 3 L1 L 1 L- 70 7 0 7. agar control follows 2 15 P150 P P300 4 PE150 PE 5 PE300 K lamps 8 m2 m m- s1 s s- Irradiance1 Irradiance (Irradiance-1 12 Irradiance2 (Irradiance-2 (CSS GESS. GESS . (GESS) 18 PN , (PN) LN (LN RN (RN) PH (PH) PD (PD) LL (LL RL, RL (RL) TFM (TFM %SURV. SURV (%SURV) analyzed C Irradiance- However Irradiance1, 1, Irradiance-1 P15 P30 PE15 PE30 (Irradiance- (GESS (PN (RN (PH (PD (RL (%SURV P1 P3 PE1 PE3 (Irradiance

Resumo: Estudos recentes com Tai-chi mostraram benefícios na funcionalidade, capacidade de exercício e qualidade de vida em pacientes com DPOC. A falta de estudos em nosso meio e a necessidade de novas modalidades de tratamento motivaram o estudo. O objetivo foi avaliar o impacto do Tai-chi em um Programa de Reabilitação Respiratória para DPOC. Método: Estudo piloto, randomizado, prospectivo e aberto, com dois grupos semelhantes de pacientes com DPOC, que receberam um programa de reabilitação respiratória por 12 semanas; um deles com o Tai-chi como intervenção terapêutica. A similaridade das variáveis sociodemográficas e clínicas foi comparada. Resultados: Os grupos analisados foram semelhantes na maioria das variáveis (idade, sexo, dados sociodemográficos, GOLD, Charson, índice de tabagismo IPA). Dentro das variáveis de resultado no índice PROMIS autoadministrado na linha de base, em um mês e em 3 meses, todas as categorias analisadas mostraram uma melhora entre os valores iniciais e finais em ambos os grupos, sendo maior no grupo TCm, embora não estatisticamente significativa com valores de p ≤ 0,05. No questionário SGRQ, a análise dos resultados não mostrou diferenças significativas entre os grupos control e TCm em 1 mês (44±5 vs 46±5, p 0,742) e 3 meses (44±5 vs 40±6, p 0,916), com melhores valores no grupo TCm. O índice BODE registrou valores mais baixos, evidência de uma melhora no grupo TCm aos 3 meses (2±0,6 vs 3±0,4, p 0,889), sem ser estatisticamente significativo (p ≤ 0,05). Conclusões: O benefício do Tai-chi dentro de um programa de reabilitação tradicional mostrou melhorias não significativas na funcionalidade e na qualidade de vida relacionada à saúde; sua inclusão parece promissora e requer mais pesquisas.

Resumen: Introducción: investigaciones recientes con la práctica del taichí mostraron beneficios en la funcionalidad, capacidad de ejercicio y calidad de vida de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). La falta de estudios en nuestro medio y la necesidad de nuevas modalidades de tratamiento impulsó la realización de este trabajo. El objetivo fue valorar el impacto del taichí en un programa de rehabilitación respiratoria de la EPOC. Material y método: estudio piloto, aleatorizado, prospectivo y abierto. Se trabajó con 17 pacientes portadores de EPOC, 7 en el grupo control (CNTL) y 10 en el grupo tratamiento (TCm). Recibieron un programa de rehabilitación respiratoria durante 12 semanas. El grupo TCm con taichí como intervención terapéutica. Se comparó la similitud de las variables sociodemográficas y clínicas. Resultados: los grupos analizados fueron similares en la mayoría de las variables (edad, sexo, sociodemográficas, Gold, Charson, índice tabáquico IPA). En cuanto a las variables resultado, todas las categorías analizadas en los cuestionarios del índice PROMIS previo al inicio, al mes y a los tres meses, evidenciaron una mejoría entre los valores iniciales y finales en ambos grupos, siendo mayor en TCm, aunque no estadísticamente significativo, con valores p ≤ 0,05. En el cuestionario SGRQ, el análisis de los resultados no mostró diferencias significativas entre CNTL vs TCm al mes (44±5 vs 46±5 p 0,742) y a los tres meses (44±5 vs 40±6 p 0,916), con mejoras a favor en los valores del grupo TCm. El índice BODE registró valores menores, evidencia de una mejoría en grupo TCm a los tres meses (2±0,6 vs 3±0,4 p 0,889), sin ser estadísticamente significativa (p ≤ 0,05). Conclusiones: el beneficio del taichí dentro de un programa de rehabilitación tradicional mostró mejoras no significativas en funcionalidad y calidad de vida relacionada con la salud, su inclusión aparece como promisoria, requiriendo una mayor investigación futura.

Abstract: Recent studies involving Tai Chi have shown benefits in the functionality, exercise capacity, and quality of life of patients with COPD. The lack of studies in our region and the need for new treatment modalities prompted this study. The objective was to assess the impact of Tai Chi in a Pulmonary Rehabilitation Program for COPD. Method: Pilot, randomized, prospective, and open-label study; with two similar groups of patients with COPD, who were included in a Pulmonary Rehabilitation program for 12 weeks; one of them with Tai Chi as a therapeutic intervention. The similarity of sociodemographic and clinical variables was compared. Results: The analyzed groups were similar in most variables (age, sex, sociodemographic, GOLD, Charlson, smoking index IPA). Within the outcome variables in the self-administered PROMIS index prior to the start, at one month, and at three months, all categories analyzed showed an improvement between the initial and final values in both groups, with a greater improvement in the TCm group, although not statistically significant with p-values ≤ 0.05. In the SGRQ questionnaire, the analysis of the results showed no significant differences between the CNTL and TCm groups at one month (44±5 vs. 46±5, p 0.742) and three months (44±5 vs. 40±6, p 0.916); with better values in the TCm group. The BODE Index recorded lower values, indicating an improvement in the TCm group at three months (2±0.6 vs. 3±0.4, p 0.889), although not statistically significant (p ≤ 0.05). Conclusions: The benefit of Tai Chi within a traditional rehabilitation program showed non-significant improvements in functionality and health-related quality of life. Its inclusion appears promising, requiring further future research.

RESUMEN Introducción. La salud bucodental de poblaciones vulnerables como aquellas con discapacidad auditiva se enfrenta a barreras de salud por la falta de habilidad para la comunicación resultando en una alta prevalencia de caries, enfermedad periodontal y pérdida dentaria. Objetivo. Disminuir el Índice de O´Leary posterior a talleres de técnica de cepillado monitoreados y supervisados con la técnica “ver-repetir”. Materiales y Métodos. Estudio de intervención en estudiantes de una escuela para personas con discapacidad auditiva de Asunción-Paraguay, durante el 2022-2023. Los participantes recibieron entrenamiento de cepillado con la técnica de Bass en modelos y maquetas previo a cada sesión de cepillado. En cada sesión se proveyó a cada participante de cepillo y pasta dental. Se instruyó a padres y maestros para fomentar la técnica en el hogar y en la escuela. Se estableció el Índice de O´Leary previa aplicación de una sustancia reveladora de placa bacteriana. Resultados. Participaron del estudio, 46 niñas y 25 varones entre 4 a 13 años; 12 con dentición temporaria, 41 mixta y 18 permanente. Se realizaron 11 sesiones, siendo 8 la mediana de participación. El índice de O´leary fue al inicio 81,86% ± 26,09% que se redujo significativamente a 11,69% ± 3,94%; en el 100% se redujo a menos de 25%. Los primeros molares permanentes inicialmente cariados fueron restaurados y permanecieron sin recidivas hasta el final. Conclusión. La cantidad de placa bacteriana oral en niños con discapacidad auditiva se puede mantener bajo control siguiendo estrategias de higiene que sean supervisadas y monitoreadas.

ABSTRACT Introduction. The oral health of vulnerable populations such as the hearing-impaired face barriers due to lack of communication skills resulting in a high prevalence of caries, periodontal disease and tooth loss. Objective. To decrease O'Leary index after monitored and supervised brushing technique workshops with the "see-repeat" technique. Materials and Methods. Intervention study in students of a school for people with hearing disabilities in Asunción-Paraguay, during 2022-2023. The participants received brushing training with the Bass technique on models and mock-ups prior to each brushing session. In each session, each participant was provided with a toothbrush and toothpaste. Parents and teachers were instructed to promote the technique at home and at school. The O'Leary Index was established after applying a substance that reveals bacterial plaque. Results. 46 girls and 25 boys between 4 and 13 years old participated in the study; 12 with temporary teeth, 41 mixed and 18 permanent. 11 sessions were held, with a median participation of 8. The O'leary index was 81.86% ± 26.09% at the beginning, which was significantly reduced to 11.69% ± 3.94%; in 100% it was reduced to less than 25%. The initially decayed first permanent molars were restored and remained recurrence-free until the end. Conclusion. The amount of oral bacterial plaque in hearing impaired children can be kept under control by following hygiene strategies that are supervised and monitored.

ABSTRACT Acute renal failure (ARF) is one of the most frequent complications in hospitalized patients and is a risk factor for mortality. It is extremely important to identify the association of clinical factors that worsen mortality in patients with ARF admitted to an intensive care unit (ICU). A total of 218 patients were included, of which 63.7% (n=139) were men with a mean age of 43±19 years. The correlation analysis of control, dependent, and independent variables was done through Spearman's coefficient and the OR was analyzed through logistic regression. Of the 218 patients, 33% (n=72) died in the ICU. ARF occurred in 28.4% (n=62) of all patients and of these, 61.3% (n=38) died, with an OR of 4.94 (p 0.0001). The highest proportion of deceased patients were in the AKIN 3 category. The clinical variables of mechanical ventilation (PR 3.57, 95% CI, 0.34-37.93), use of vasoactive drugs (PR 8.32, 95% CI, 3.20-21.64), APACHE III score (PR 1.12, 95% CI, 1.03-1.23), age (PR 1.01, 95% CI, 0.99-1.04) and those who underwent surgery (PR 0.28, 95% CI, 0.10-0.80) had a positive association and increased mortality. The presence of clinical variables of mechanical ventilation, the use of vasoactive drugs, sepsis, APACHE III stage, age, AKIN 3 category, and a history of surgery before admission to the ICU significantly increase mortality in patients with ARF in ICU.

RESUMEN La insuficiencia renal aguda (IRA) es una de las complicaciones más frecuentes en los pacientes hospitalizados, siendo un factor de riesgo de mortalidad. Es de suma importancia identificar la asociación de factores clínicos que empeoran la mortalidad en pacientes con IRA internados en una unidad de terapia intensiva (UTI). Se incluyeron 218 pacientes, de los cuales el 63,7% (n=139) correspondieron a hombres con un promedio de edad de 43±19 años. El análisis de correlación de variables de control, dependiente e independiente fue a través del coeficiente de Spearman y el OR fue analizado mediante regresión logística. De los 218 pacientes, falleció el 33% (n=72) de los pacientes internados en UTI. La IRA ocurrió en 28,4% (n=62) del total de pacientes y de estos, el 61,3% (n=38) fallecieron, con un OR de 4,94 (p 0,0001). La mayor proporción de fallecidos perteneció a la categoría AKIN 3. Las variables clínicas de ventilación mecánica (PR 3,57, IC 95%, 0,34-37,93), uso de drogas vasoactivas (PR 8,32, IC 95%, 3,20-21,64), puntuación APACHE III (PR 1,12, IC 95%, 1,03-1,23), edad (PR 1,01, IC 95%, 0,99-1,04) y los sometidos a cirugía (PR 0,28, IC 95%, 0,10-0,80) tuvieron asociación positiva y aumentaron la mortalidad. La presencia de variables clínicas de ventilación mecánica, la utilización de drogas vasoactivas, sepsis, el estudio APACHE III, la edad, la categoría AKIN 3, y el antecedente de cirugía previo al ingreso a UTI aumentan significativamente la mortalidad en pacientes con IRA en UTI.

RESUMEN Introducción: el plastrón apendicular es una patología infrecuente ma- nifestada como una tumoración inflamatoria constituida por el apén- dice, vísceras adyacentes y epiplón mayor cuando el organismo logra controlar parcialmente la apendicitis, evitando así una peritonitis. Este trabajo busca determinar características y manejo de pacientes con plas- trón apendicular del Servicio de Cirugía general del Hospital Nacional de Itauguá. Métodos: estudio retrospectivo, descriptivo de corte trans- verso. Resultados: del total de 50 pacientes, 88% consultó por dolor, el promedio de días de enfermedad previo de 9 días y una internación pro- medio de 11 días. Al examen físico 82% presentaba tumoración en fosa iliaca derecha. El 56 % requirió cirugía: 16 fueron lavado de cavidad más drenaje (por plastrón roto y abscedado a cavidad), 1 caso colectomía derecha y 2 casos drenajes percutáneos. Conclusión: Probablemente debido al retraso al acceso del sistema de salud, los pacientes al acudir ya presentan complicaciones del plastrón apendicular que requieren un tratamiento quirúrgico en más de la mitad de los casos.

ABSTRACT Introduction: this study seeks to determine the characteristics and management of patients with appendiceal mass at the General Surgery Service at the Hospital Nacional de Itauguá, an infrequent pathology manifested as an inflammatory tumor consisting of the inflamed appen- dix, adjacent viscera and greater omentum when the organism manages to partially control appendicitis, thus avoiding peritonitis. Methods: retrospective, descriptive study, being variables: reason for consultation, days of illness and hospitalization, treatment, etc. Results: of the total of 50 samples, 88% consulted for pain, the average number of days of illness is 9 days and hospitalization 11 days, on physical examination 82% presented a tumor in the right iliac fossa. 56% required surgery: 16 were cavity lavage plus drainage, 1 case right colectomy and 2 cases percutaneous drainage. Conclusion: According to the bibliographies, in recent years a conservative attitude is spreading. In our work, however, immediate surgery was performed in 56% of the cases, we did not verify the use of delayed surgery, probably due to lack of follow-up. Most come with symptoms of approximately 9 days, already as a ruptured abscess in the cavity, so the most used technique was lavage + cavity drainage.

Resumen: Introducción: la concentración y velocidad en la administración de la anestesia multimodal intratecal con fentanilo en cesáreas mejoran la eficacia anestésica manteniendo buen control hemodinámico. Objetivo: evaluar si algunos cambios en la anestesia multimodal intratecal mejoran su eficacia y seguridad en cesáreas. Material y métodos: ensayo clínico, controlado, aleatorizado, doble ciego en mujeres embarazadas programadas para cesárea, distribuidas en tres grupos: grupo F6B2: fentanilo 65 μg + bupivacaína hiperbárica 2.5 mg + morfina 10 μg + dexmedetomidina 5 μg; grupo F6B3: fentanilo 60 μg + bupivacaína hiperbárica 3 mg+ morfina 100 μg+ dexmedetomidina 5 μg; y grupo F7B2: fentanilo 70 μg + bupivacaína hiperbárica 2 mg + morfina 100 μg + dexmedetomidina 5 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la revisión de correderas parietocólicas y en el postquirúrgico inmediato, así como los signos vitales. Resultados: los grupos F6B2 y F6B3 resultaron tener mayor eficacia anestésica en la revisión de correderas parietocólicas (p = 0.02) y el grupo F7B2 el de mayor seguridad con mejor control hemodinámico a los minutos 1 y 10 (p = 0.03 y p = 0.03 respectivamente). Conclusiones: los cambios en la administración de la anestesia multimodal intratecal con fentanilo mejoraron la eficacia anestésica, pero disminuyen la seguridad sobre el control hemodinámico.

Abstract: Introduction: the concentration and speed in the administration of intrathecal multimodal anesthesia with fentanyl in cesareans section improve anesthetic efficacy while maintaining good hemodynamic control. Objective: to evaluate if some changes in intrathecal multimodal anesthesia improve its efficacy and safety in cesareans section. Material and methods: clinical trial, controlled, randomized, double blind; in pregnant women scheduled for cesarean section, divided into 3 groups: group F6B2: fentanyl 65 μg + hyperbaric bupivacaine 2.5 mg+ morphine 100 μg+ dexmedetomidine 5 μg; group F6B3: fentanyl 60 μg + hyperbaric bupivacaine 3 mg + morphine 100 μg + dexmedetomidine 5 μg; and group F7B2: fentanyl 70 μg + hyperbaric bupivacaine 2 mg + morphine 100 μg + dexmedetomidine 5 μg. The anesthetic efficacy was evaluated prior to the incision, during the dissection of the abdominal wall, upon the admission to the abdominal cavity, in the review of paracolic slides and in the immediate postoperative period, as well as the vital signs. Results: the F6B2 and F6B3 groups turned out to have greater anesthetic efficacy in the revision of paracolic slides (p = 0.02) and the F7B2 group had the highest safety with better hemodynamic control at 1 and 10 minutes (p = 0.03 and p = 0.03, respectively). Conclusions: changes in the administration of intrathecal multimodal anesthesia with fentanyl improved anesthetic efficacy, but decreased safety over hemodynamyc control.

Resumen El objetivo fue evaluar el impacto de una intervención educativa en el conocimiento de la prevención de la neoplasia del cuello uterino en un grupo de estudiantes de enfermería y sus familias bajo el modelo de Nola Pender. El método fue un estudio cuasi-experimental con muestra no probabilística; se evaluó el conocimiento sobre la prevención y el control de la neoplasia del cuello uterino antes y después de una intervención educativa utilizando la encuesta validada por la Dra. Dina Rubio en 2009 con su previo consentimiento. La información fue tabulada mediante una hoja de cálculo del programa Microsoft Excel; se calcularon frecuencias específicas y frecuencias absolutas, y para el análisis se tomó el modelo de Nola Pender. Los resultados desde el punto de vista estadístico fueron que hay una información instalada en la estructura mental de las participantes sobre lo que es, implica y comporta como riesgo la neoplasia del cuello uterino. La percepción que está en el fondo de sus creencias denota un nivel favorable de conciencia y claridad, lo que posibilita que en las prácticas de autocuidado y la aplicación de la citología se reconozca frecuencia de uso, regularidad en el tiempo y atención a los resultados. En conclusión, al evaluar el impacto de la intervención educativa a través del modelo de Nola Pender se encontraron cambios en los conocimientos y un modelo ideal para utilizarse en grupos poblacionales heterogéneos en edades, niveles educativos, formación profesional y hábitos sexuales, porque integra la experiencia personal, el entorno y las prácticas de salud como tres elementos sin los cuales no es posible practicar el autocuidado y la cultura de intervención.

Abstract A large number of factors influence the level of information that people may have regarding cervical cancer and the way to prevent it, since education is not only provided by health personnel but also by the family. When making important decisions regarding self-care, people must have effective sex education, in which protection is of vital importance, since misinformation is one of the main factors that promotes cervical cancer. The objective of this study was to evaluate the impact of an educational intervention on the knowledge of cervical cancer prevention in a group of nursing students and their families under the Nola Pender model. The method used in the study was a quasi-experimental, non-probabilistic sample; the knowledge about cervical cancer prevention and control was evaluated before and after the intervention, using the survey validated by Dr. Dina Rubio in 2009 (with her consent). The information was included in a Microsoft Excel spreadsheet: the items were placed in columns and the subjects were included in the rows. Specific frequencies and absolute frequencies were calculated, the Nola Pender model was used for the analysis. The units of analysis were selected manually or randomly and these selections do not depend on probability but are generated based on the criteria of the researcher or the specific needs of the research. From a statistical point of view, information about what cervical cancer is, what it implies and how it behaves as a risk is engrained in the mental structure of the participants. To these implications of a technical and methodological nature, others of a structural and conceptual nature are added to build an integrative analysis of the results obtained in the field work. In this case, they include opinions, appraisals, judgments, and evaluations about cervical cancer. This research was organized in the following stages: (1) Evaluation of prior knowledge on cervical cancer prevention and control. The starting point of the investigation was the recognition that the participating women had a basic conceptual scaffolding, acquired through their own experience and self-training or by going to sources such as academia, social networks, specialized magazines, health institutions, medical staff and other specialists who help in the creation of an important background to consolidate an individual perspective. (2) Application of an educational intervention. In this stage, designed workshops were implemented and evaluated by the students with the advice of a teacher, and included the following topics: general concepts, signs and symptoms, associated risk factors, screening techniques, benefits, and exam precautions. The students contributed a theoretical, methodological and evaluative foundation to the design of each workshop, considering the expected training objectives, the characteristics included in its development, and a diversity of pedagogical actions that guarantee the efficiency of the transmitted message. (3) Reevaluation of the knowledge acquired. By applying a post-test, the knowledge acquired during the implementation of the workshops was recovered and resized. In this stage, the variability of the responses measured the transforming effect of the training, either by improving the knowledge acquired or by introducing new knowledge into the participant’s cognitive model. The perception that participants have about self-care practices is linked to their beliefs, denoting a favorable level of awareness and clarity, which makes it possible for the application of cytology to recognize the frequency of use, regularity over time, and attention to the results. In conclusion, when evaluating the impact of educational intervention through the Nola Pender model, changes in knowledge were found. Results also indicate that this is an ideal model for employees in heterogeneous popu lation groups in ages, educational levels, professional training, and sexual habits, because it integrates personal experience, the environment and health practices as three elements without which it is not possible to practice self-care and the culture of intervention.