Resumen : La hiperkalemia es una de las patologías que se pueden encontrar en los escenarios de urgencias, pueden poner en riesgo la vida del paciente generando arritmias fatales. No obstante, la identificación temprana mediante el electrocardiograma y la sospecha clínica hacen que su diagnóstico sea rápido y efectivo y por tal razón el inicio del tratamiento sea precoz. Presentamos un caso clínico de intoxicación por citrato de potasio causante de hiperkalemia severa que fue diagnosticado y tratado en uno de los servicios de urgencias de una clínica de Cali. Se presenta como el primer caso reportado en Colombia de este tipo.

Resumo: A hipercalemia é uma das patologias que podem ser encontradas em ambientes de emergência, podendo colocar em risco a vida do paciente, gerando arritmias fatais. Porém, a identificação precoce através do uso do eletrocardiograma e a suspeita clínica tornam seu diagnóstico rápido e eficaz e por isso o início do tratamento é precoce. Apresentamos um caso clínico de intoxicação por citrato de potássio causando hipercalemia grave que foi diagnosticado e tratado em um dos serviços de emergência de uma clínica em Cali. É discutido como o primeiro caso deste tipo relatado na Colômbia.

Abstract: Hyperkalemia is one of the pathologies that can be found in emergency settings, and can put the patient's life at risk by generating fatal arrhythmias. However, early identification through the use of electrocardiogram and clinical suspicion make its diagnosis fast and effective and therefore the start of treatment is early. We present a clinical case of potassium citrate poisoning causing severe hyperkalemia that was diagnosed and treated in one of the emergency services of a clinic in Cali. It is discussed as the first reported case of this type in Colombia.

Abstract Continuous illumination and increased feeding periods have enhanced growth in commercial fish species. However, oxygen consumption under these conditions has yet to be previously assessed in agastric short-intestine fish. This study evaluated Chirostoma estor (Atherinopsidae) oxygen consumption under three specific feeding and light regimes: resting-unfed, routine-fed, and continuous light/feeding. Fish in the continuous light/feeding condition presented oxygen consumption levels 60 and 20% higher than resting-unfed and routine-fed fish, respectively. The latter implies that constant high oxygen supply levels are required to satisfy the demand for C. estor raised under these high growth rate conditions. The present study shows the relevance of determining oxygen consumption levels during continuous illumination and extended feeding periods to consider optimal oxygen levels required to achieve better performance indicators, such as the growth and welfare of atherinopsids and species with similar digestive configurations.

Resumen La iluminación continua y el aumento de frecuencias alimenticias han mejorado el crecimiento de peces en cultivo. Sin embargo, el consumo de oxígeno en estas condiciones no se ha evaluado en peces agástricos de intestino corto. Este estudio evaluó el consumo de oxígeno de Chirostoma estor bajo tres regímenes específicos de alimentación y luz: reposo sin alimentación, alimentación de rutina y alimentación/luz continua. En este último tratamiento los peces presentaron niveles de consumo de oxígeno de 60 y 20% más altos que los peces en reposo y con alimentación rutinaria, respectivamente. Esto implica que se requieren niveles elevados y constantes de suministro de oxígeno para satisfacer la demanda de C. estor en cultivo en condiciones crecimiento acelerado. El presente estudio muestra la relevancia de determinar los niveles de consumo de oxígeno bajo protocolos de crecimiento acelerado para lograr mejores indicadores de desempeño de otras especies con configuraciones digestivas similares.

ABSTRACT Respiratory syncytial virus (RSV) infections constitute a significant cause of morbidity, hospitalization, school and work absenteeism, as well as mortality worldwide, including in Paraguay. Currently, tools for RSV prevention are available. In 2012, Paraguay approved the use of palivizumab (MedImmune, USA), a monoclonal antibody produced through recombinant DNA technology. This antibody is administered in 5 doses, every 30 days and is indicated in infants born prematurely and those with cardiopulmonary disorders. Furthermore, a novel tool for RSV prevention has recently become available. Nirsevimab, a long-acting monoclonal antibody specific to the prefusion conformation of the F protein, has been approved by both the European Medicines Agency (EMA) and the Food and Drug Administration (FDA). This monoclonal antibody is indicated for the prevention of acute lower respiratory tract infections caused by RSV in newborns and infants born during or entering their first RSV season, as well as in premature infants and infants up to 24 months of age who remain vulnerable to severe RSV disease during their second RSV season. After analyzing the epidemiological situation of RSV in our country and evaluating the evidence of efficacy, efficiency, and effectiveness of this monoclonal antibody, academic institutions, scientific societies, and non-governmental and governmental organizations developed consensus guidelines on a new prevention alternative for the prevention of RSV infections, suggesting the incorporation of Nirsevimab in children under 12 months of age before their first RSV season and replacing Palivizumab. The new monoclonal has the potential to change the panorama of RSV infections in infants and produce an impact on the reduction of infant mortality and morbidity reducing the burden on the health system by decreasing hospital bed occupancy both in wards and in intensive care units, as well as the decrease in the burden on caregivers, physicians and health care providers.

RESUMEN Las infecciones por el VSR en constituyen una causa importante de morbilidad, hospitalización, ausentismo escolar y laboral, así como de mortalidad, en el mundo, así como en el Paraguay.En la actualidad, existen herramientas para la prevención del VSR. En el año 2012, el Paraguay, ha incorporado el palivizumab (MedImmune, EE. UU.), anticuerpo monoclonal, producido por tecnología de DNA recombinante. Este anticuerpo se administra en 5 dosis, cada 30 días y está indicado en lactantes nacidos prematuros y aquellos con trastornos cardiopulmonares. Por otro lado, actualmente se cuenta con una nueva herramienta para la prevención del VSR. El anticuerpo monoclonal de vida media prolongada Nirsevimab, específico para la conformación de prefusión de la proteína F, aprobado por EMA y FDA. Este monoclonal, está indicado para la prevención de las Infecciones respiratorias agudas bajas, causada por VSR en recién nacidos y lactantes nacidos durante o al ingresar a su primera temporada de VSR, en prematuros y lactantes hasta los 24 meses de edad que siguen siendo vulnerables a la enfermedad grave por VSR durante su segunda temporada de VSR. Luego de analizar la situación epidemiológica del VSR en el país así como la evidencia de eficacia, eficiencia y efectividad de este monoclonal; instituciones académicas, sociedades científicas, organizaciones no gubernamentales y gubernamentales se reunieron y elaboraron un consenso interinstitucional para la prevención de las infecciones por VSR, sugiriendo la incorporación del Nirsevimab, en menores de 12 meses de edad antes de su primera temporada de VSR y en reemplazo del Palivizumab, debido a que el nuevo monoclonal tiene el potencial de cambiar el panorama de las infecciones por VSR en el lactante y producir un impacto en la reducción la mortalidad y morbilidad infantil; reduciendo la carga al sistema de salud, en lo que se refiere a la disminución de la ocupación de camas hospitalarias tanto en sala como en unidades de cuidados intensivos, así como la disminución de la carga para los cuidadores, médicos y proveedores de atención médica y la mortalidad infantil.

Resumen Introducción: La mielitis transversa (MT) es una enfermedad inflamatoria desmielinizante que se presenta con disfunción motora, sensitiva y autonómica, de forma aguda o subaguda. La MT asociada al COVID-19 se ha escrito en un escaso número de pacientes. Caso clínico: Se presenta el caso de un masculino de 15 años previamente sano, quien cursaba con un cuadro respiratorio y que desarrollo un deterioro neurológico súbito que involucro un síndrome medular completo localizado en el nivel cérvico dorsal, con paraparesia simétrica que progreso a la paraplejia, con disfunción sensitiva desde el nivel medular de T3, disfunción de esfínteres y deterioro ventilatorio que requirió manejo avanzado de la vía aérea. Su resonancia magnética fue compatible con mielitis transversa aguda. Se descartaron causas inflamatorias y no inflamatorias de la patología. Además, se obtuvo un resultado positivo de SARS-COV-2. Se inició tratamiento con pulsos de metilprednisolona y plasmaféresis, con una evolución insidiosa. Conclusión: El COVID-19 es una causa infrecuente de MT y debe sospecharse cuando otras causas han sido descartadas.

Abstract Background: Transverse myelitis (TM) is a demyelinating inflammatory disease that presents with motor, sensory, and autonomic dysfunction, which may be acute or subacute. COVID-19-associated TM has been described in a scarce number of patients. Clinical case: A 15-year-old previously healthy male patient with respiratory disease before his neurological deterioration presented to the emergency room after developing a complete medullary syndrome located at the cervical-dorsal level, with ascending and symmetric paraparesis that rapidly progressed to paraplegia, with sensory dysfunction from the T3 level, sphincter dysfunction and sudden ventilatory deterioration that required mechanical ventilation. Magnetic resonance imaging was compatible with acute TM. Inflammatory and non-inflammatory etiologies were discarded. In addition, a positive severe acute respiratory syndrome coronavirus 2 test was obtained. Treatment included steroid pulses and plasmapheresis, with an insidious evolution. Conclusion: COVID-19 is an infrequent cause of TM and should be suspected when other etiologies have been ruled out.

RESUMEN El climaterio constituye una etapa del ciclo vital de la mujer caracterizada por síntomas biológicos, psicológicos y sexuales de intensidad variable que pueden agravarse debido a la sobrecarga generada por los múltiples roles que desempeña en la familia y la sociedad, y como consecuencia afectar su bienestar. Partiendo de que el género configura el modo en que se abordan los problemas de salud de hombres y mujeres, en este artículo se fundamenta la importancia de la mirada de género para la compresión y atención a la mujer climatérica, lo que permitirá desarrollar acciones integrales dirigidas a promover su salud y bienestar.

ABSTRACT The climacteric constitutes a stage in a woman's life cycle characterized by biological, psychological and sexual symptoms of varying intensity that can worsen due to the overload generated by the multiple roles she plays in the family and society, and as a consequence affect her well-being. Starting from the fact that gender shapes the way in which the health problems of men and women are addressed, this article bases the importance of the gender perspective for the understanding and care of climacteric women, which will allow the development of comprehensive actions directed to promote their health and well-being.

ABSTRACT This report analyzes the main indicators that characterize Cuba's climate as well as some factors that regulate its variability in the region. Also included are some of the extreme weather and climate phenomena that have a high impact in Cuba. Variables such as temperature and rainfall are particularly important. As the main climate modulating factor, although it is not the only one, the behavior of the El Niño - Southern Oscillation (ENSO) event during 2023 is included. All information is referred to the standard climatological normal from 1991 to 2020, making it possible to compare recent or current observations as well as calculate the deviations or anomalies of a value with respect to that reference value. However, sometimes the period 1961-1990 is used, recommended by the WMO (2017) to evaluate long-term temperature changes, and in the case of bioclimatic conditions, the historical periods 1981-2010 was used.

RESUMEN Se analizan en este reporte los principales indicadores que caracterizan el clima de Cuba así como algunos factores que regulan su variabilidad en la región. Se incluyen además algunos de los fenómenos meteorológicos y climáticos extremos que son de alto impacto en Cuba como la sequía, ciclones tropicales y extremos por calor. Resultan particularmente importante variables como la temperatura y la lluvia. Como principal factor modulador del clima, aunque no es el único, se incluye el comportamiento del evento el Niño - Oscilación del Sur (ENOS) durante el 2023. Toda la información es referida a la normal climatológica estándar 1991-2020, con lo que es posible comparar observaciones recientes o actuales así como el cálculo de las desviaciones o anomalías de un valor respecto a ese valor de referencia. No obstante, en ocasiones, se utiliza el periodo 1961-1990, recomendado por la OMM (2017), para evaluar los cambios de temperatura a largo plazo y en el caso de las condiciones bioclimáticas se empleó como período de referencia la normal climatologica 1981-2010.

RESUMEN Introducción: El incremento del consumo de sustancias psicoactivas (SPA), alcohol y cigarrillo en población joven se ha convertido en un problema de salud pública. La identificación de los factores que aumentan o disminuyen el riesgo de la exposición a estas sustancias y la relación que puede haber entre ellas resulta fundamental para la planificación de estrategias con enfoque de riesgo, razón por la cual se planteó el presente estudio. El objetivo es establecer el perfil de consumo de SPA, alcohol y cigarrillo y los factores asociados con dicho consumo en estudiantes del programa de Enfermería de una institución de educación superior. Métodos: Estudio cuantitativo, observacional y analítico de tipo corte transversal. Resultados: Se incluyó a 310 estudiantes de los semestres I a IX de un programa de Enfermería de una institución privada de educación superior de Bogotá. La prevalencia de consumo de SPA en el último ario fue del 2,96% (IC95%, 1,36-5,54); la marihuana es la sustancia de mayor consumo (55,55%). Las prevalencias de consumo de alcohol y cigarrillo durante los últimos 12 meses se estimaron en el 86,64% (IC95%, 83,24-91,0) y el 12,16% (IC95%, 8,4315,88) respectivamente. Se encontró una asociación estadísticamente significativa entre los consumos: tomar alcohol se asoció con el consumo de cigarrillo (OR = 3,22; p = 0,006) y fumar se asoció con el consumo de SPA (OR = 15,4; p <0,001). Conclusiones: En esta población universitaria, el consumo de alcohol aumenta la posibilidad de consumo de cigarrillo, y este a su vez aumenta la posibilidad del consumo de SPA.

ABSTRACT Background: The increase in the use of psychoactive substances, alcohol and cigarettes in young people has become a public health problem. The identification of factors that increase or reduce the risk of exposure to these substances and the possible relationship between them is essential for planning strategies with a risk approach, hence the reason for this study. The objective was to establish the profile of use of psychoactive substances, alcohol and cigarettes and the factors associated with such use in nursing students of a higher education institution. Methods: Quantitative, observational, analytical cross-sectional study. Results: We included 310 students from 1st to 9th semester of a Nursing programme from a prívate higher education institution in Bogotá. The prevalence of psychoactive substance use in the last year was 2.96% (95%CI, 1.36-5.54), with marijuana being the substance most used (55.55%). The prevalence of alcohol and cigarette use during the last 12 months was estimated at 86.64% (95%CI, 83.24-91.0) and 12.16% (95%CI, 8.43-15.88) respectively. A statistically significant association was found between the use of these substances: alcohol use was associated with cigarette use (OR = 3.22; P = 0.006) and smoking was associated with psychoactive substance use (OR = 15.4; P < 0.001). Conclusions: Alcohol use increases the likelihood of smoking cigarettes, and this in turn increases the likelihood of psychoactive substance use, in this university population.

RESUMO Objetivo: Investigar a intenção materna de amamentar exclusivamente (IMA) e variáveis associadas entre as mulheres no terceiro trimestre de gravidez. Métodos: A coleta de dados foi realizada por meio de entrevista e questionário semiestruturado e autoadministrado, entre dezembro/2018 e novembro/2019. As gestantes (n=653) responderam à escala Infant Feeding Intentions (IFI) testada, traduzida e adaptada para o português do Brasil e ao questionário contendo perguntas sobre variáveis sociodemográficas, biológicas e familiares, bem como relacionadas à gestação, ao aleitamento materno, à assistência à saúde e a hábitos. Foram realizadas análises estatísticas descritivas e de regressão logística múltipla hierarquizada, com nível de significância de 5%, para estimar a associação entre as variáveis independentes e o desfecho. A IMA, medida pela escala IFI, foi dicotomizada pela mediana (<16 ou =16). Resultados: A pontuação média±desvio padrão para a escala IFI foi de 14,4±2,6. Os resultados da análise de regressão mostraram que as gestantes que não tinham intenção de oferecer mamadeira (OR=4,33; IC95% 2,79-6,72) ou não sabiam (OR=1,85; IC95% 1,21–2,82), que planejaram a gestação (OR=1,52; IC95% 1,09–2,12), aquelas que acreditavam que teriam ajuda nos cuidados com o bebê (OR=3,60; IC95% 1,51–8,56) ou que não sabiam (OR=3,97; IC95% 1,26–12,51), bem como aquelas que relataram conhecer as recomendações da Organização Mundial de Saúde sobre amamentação (OR=1,73; IC95% 1.13–2.64) tinham mais chances de mostrar uma IMA muito forte. Conclusões: As gestantes no terceiro trimestre de gestação apresentaram forte IMA. A maior IMA esteve significativamente associada aos determinantes estruturais, contextuais e individuais. Objetivo (IMA gravidez Métodos autoadministrado dezembro2018 dezembro 2018 dezembro/201 novembro2019 novembro 2019 novembro/2019 n=653 n653 n 653 (n=653 (IFI testada sociodemográficas familiares materno hábitos hierarquizada 5 5% desfecho <16 16 (<1 =16. =16 . =16) Resultados médiadesvio média desvio 14426 14 4 2 6 14,4±2,6 OR=4,33 OR433 OR 33 (OR=4,33 IC95 IC 2,796,72 279672 2,79 6,72 79 72 2,79-6,72 OR=1,85 OR185 1 85 (OR=1,85 1,21–2,82, 121282 1,21–2,82 , 21 82 1,21–2,82) OR=1,52 OR152 52 (OR=1,52 1,09–2,12, 109212 1,09–2,12 09 12 1,09–2,12) OR=3,60 OR360 3 60 (OR=3,60 1,51–8,56 151856 51 8 56 OR=3,97 OR397 97 (OR=3,97 1,26–12,51, 1261251 1,26–12,51 26 1,26–12,51) OR=1,73 OR173 73 (OR=1,73 1.13–2.64 113264 13 64 Conclusões estruturais individuais dezembro201 201 dezembro/20 novembro201 novembro/201 n=65 n65 65 (n=65 <1 (< =1 1442 14,4±2, OR=4,3 OR43 (OR=4,3 IC9 796 2,796,7 27967 279 2,7 672 6,7 7 2,79-6,7 OR=1,8 OR18 (OR=1,8 12128 1,21–2,8 OR=1,5 OR15 (OR=1,5 10921 1,09–2,1 0 OR=3,6 OR36 (OR=3,6 1,51–8,5 15185 OR=3,9 OR39 9 (OR=3,9 126125 1,26–12,5 OR=1,7 OR17 (OR=1,7 1.13–2.6 11326 dezembro20 20 dezembro/2 novembro20 novembro/20 n=6 n6 (n=6 < ( = 144 14,4±2 OR=4, OR4 (OR=4, 2,796, 2796 27 2, 67 6, 2,79-6, OR=1, OR1 (OR=1, 1212 1,21–2, 1092 1,09–2, OR=3, OR3 (OR=3, 1,51–8, 1518 12612 1,26–12, 1.13–2. 1132 dezembro2 dezembro/ novembro2 novembro/2 n= (n= 14,4± OR=4 (OR=4 2,796 2,79-6 OR=1 (OR=1 121 1,21–2 109 1,09–2 OR=3 (OR=3 1,51–8 151 1261 1,26–12 1.13–2 113 novembro/ (n 14,4 OR= (OR= 2,79- 1,21– 10 1,09– 1,51– 15 126 1,26–1 1.13– 11 14, (OR 1,21 1,09 1,51 1,26– 1.13 1,2 1,0 1,5 1,26 1.1 1, 1.

ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (<16 or =16). Results: Mean±standard deviation score for the IFI scale was 14.4±2.6 (score 0: very strong intention to not breastfeed at all; score 16: very strong EBF intention up to six months). The results from the regression analysis showed that pregnant women who had no intention to bottle feed (OR=4.33; 95%CI 2.79-6.72) or did not know (OR=1.85; 95%CI 1.21–2.82), those who planned the pregnancy (OR=1.52; 95%CI 1.09–2.12), those who believed they would have help to care for the baby (OR=3.60; 95%CI 1.51–8.56) or did not know (OR=3.97; 95%CI 1.26–12.51), and those who reported knowing the World Health Organization recommendations on breastfeeding (OR=1.73; 95%CI 1.13–2.64) were more likely to show a very strong EBF intention. Conclusions: Pregnant women in the third trimester of pregnancy presented a strong EBF intention. The higher EBF intention score was significantly associated with the structural, setting, and individual determinants. Objective (EBF Methods n=653, n653 n n=653 , 653 (n=653) December2018 December 2018 December/201 November2019 November 2019 November/2019 (IFI Portuguese sociodemographic biological family 5 level <16 16 (<1 =16. =16 . =16) Results Meanstandard Mean standard 14426 14 4 2 6 14.4±2. 0 all months. months months) OR=4.33 OR433 OR 33 (OR=4.33 95CI CI 95 2.796.72 279672 2.79 6.72 79 72 2.79-6.72 OR=1.85 OR185 1 85 (OR=1.85 1.21–2.82, 121282 1.21–2.82 21 82 1.21–2.82) OR=1.52 OR152 52 (OR=1.52 1.09–2.12, 109212 1.09–2.12 09 12 1.09–2.12) OR=3.60 OR360 3 60 (OR=3.60 1.51–8.56 151856 51 8 56 OR=3.97 OR397 97 (OR=3.97 1.26–12.51, 1261251 1.26–12.51 26 1.26–12.51) OR=1.73 OR173 73 (OR=1.73 1.13–2.64 113264 13 64 Conclusions structural setting determinants n65 n=65 65 (n=653 December201 201 December/20 November201 November/201 <1 (< =1 1442 14.4±2 OR=4.3 OR43 (OR=4.3 9 796 2.796.7 27967 279 2.7 672 6.7 7 2.79-6.7 OR=1.8 OR18 (OR=1.8 12128 1.21–2.8 OR=1.5 OR15 (OR=1.5 10921 1.09–2.1 OR=3.6 OR36 (OR=3.6 1.51–8.5 15185 OR=3.9 OR39 (OR=3.9 126125 1.26–12.5 OR=1.7 OR17 (OR=1.7 1.13–2.6 11326 n6 n=6 (n=65 December20 20 December/2 November20 November/20 < ( = 144 14.4± OR=4. OR4 (OR=4. 2.796. 2796 27 2. 67 6. 2.79-6. OR=1. OR1 (OR=1. 1212 1.21–2. 1092 1.09–2. OR=3. OR3 (OR=3. 1.51–8. 1518 12612 1.26–12. 1.13–2. 1132 n= (n=6 December2 December/ November2 November/2 14.4 OR=4 (OR=4 2.796 2.79-6 OR=1 (OR=1 121 1.21–2 109 1.09–2 OR=3 (OR=3 1.51–8 151 1261 1.26–12 1.13–2 113 (n= November/ 14. OR= (OR= 2.79- 1.21– 10 1.09– 1.51– 15 126 1.26–1 1.13– 11 (n (OR 1.21 1.09 1.51 1.26– 1.13 1.2 1.0 1.5 1.26 1.1 1.

ABSTRACT This study investigated the effects of burning on the richness, abundance, and community structure of necrophagous flies in southern Brazil. Flies were collected over a period of seven days in the field, and were subsequently observed for 60 days in the laboratory. There were three bovine liver treatments: unburnt, burnt, and gasoline-treated (control). A total of 2,501 flies, representing 14 families and 41 species, were identified, including Chrysomya albiceps, Fannia subgroup pusio, Synthesiomyia nudiseta, and Fannia femoralis. While the abundance of flies was similar across the three treatments, exhibiting a quadratic distribution, species richness displayed a quadratic trend with a significant temporal shift; peak richness occurred 20 hours earlier in the unburnt liver than in the burnt or the control treatments. Both total abundance and patterns of community composition in our analysis indicated important factors to take into account. Total abundances were similar between the burnt and unburnt treatments, demonstrating a uniform ecological response to burning, irrespective of the condition of the liver. In contrast, the community composition of these treatments showed a significant divergence from the control treatment, which was distinctively dominated by Drosophilidae and Phoridae. These findings are crucial for accurate postmortem Interval (PMI) estimations in forensic entomology, particularly in cases involving burnt remains, and highlight the significant impact of fire on necrophagous fly communities. Brazil field 6 laboratory gasolinetreated gasoline treated control. . (control) 2501 2 501 2,50 1 4 identified albiceps pusio nudiseta femoralis distribution shift account contrast treatment Phoridae PMI (PMI entomology remains communities (control 250 50 2,5 25 5 2,

Abstract Antimicrobial resistance in bacteria isolated from horses represents a threat to global health due to the close relationship of these animals with humans. This study aimed to elucidate the antimicrobial susceptibility profiles of bacteria with pathogenic and zoonotic potential, isolated from the respiratory and genital tracts of horses in Mayabeque, Cuba. Nasal and genital exudates were collected from twenty-three horses, and the isolates obtained were identified using the analytical profile index and mass spectrometry. The minimum inhibitory concentration (MIC) of thirteen antibiotics was determined for the isolates. Twenty-three bacterial isolates, including one Streptococcus uberis, sixteen Enterococcus spp., three Staphylococcus sciuri, one Morganella morganii, and two Stenotrophomonas maltophilia, were obtained. S. uberis showed resistance to gentamicin, enrofloxacin, and doxycycline, while enterococci isolates displayed resistance to doxycycline (n=16), rifampicin (n=8), erythromycin (n=7), enrofloxacin (n=3), and chloramphenicol (n=1). All S. sciuri isolates were resistant to at least six antibiotics, including methicillin, with high MIC values for erythromycin (>8192 µg/ml), doxycycline (128 µg/ml), and gentamicin (64 µg/ml). M. morganii isolate was resistant to three antibiotics, with MICs of 128 μg/ml and 256 μg/ml for cefquinome and doxycycline, respectively. S. maltophilia isolates exhibited resistance to cefquinome, with MIC values of 512 μg/ml and 128 μg/ml, respectively. The 91.3% of the isolates were multiresistant to antimicrobials, which represents the first detection in Cuba of bacteria with multiresistance phenotypes, isolated from samples of the nasal and genital mucosa of horses.

Resumen La resistencia a antimicrobianos en bacterias aisladas de caballos representa una amenaza para la salud mundial debido al estrecho vínculo de estos animales con los humanos. El objetivo de este estudio fue describir los perfiles de susceptibilidad a antimicrobianos de bacterias con potencial patogénico y zoonótico, aisladas de los tractos respiratorio y genital de caballos procedentes de Mayabeque, Cuba. Se recopilaron exudados nasales y genitales de veintitrés caballos, y se utilizó el índice de perfil analítico y espectrometría de masas para realizar la identificación de los aislados obtenidos. Se determinó la concentración mínima inhibitoria (CMI) de trece antibióticos, frente a los aislados. Se obtuvieron veintitrés aislados bacterianos (un Streptococcus uberis, dieciséis Enterococcus spp., tres Staphylococcus sciuri, un Morganella morganii y dos Stenotrophomonas maltophilia). S. uberis mostró resistencia a gentamicina, enrofloxacina y doxiciclina. Los aislados de enterococci fueron resistentes a doxiciclina (n=16), rifampicina (n=8), eritromicina (n=7), enrofloxacina (n=3) y cloranfenicol (n=1). Todos los aislados de S. sciuri fueron resistentes al menos a seis antibióticos incluyendo meticilina, con altos valores de CMI para eritromicina (>8192 µg/ml), doxiciclina (128 µg/ml) y gentamicina (64 µg/ml). El aislado de M. morganii fue resistente a tres antibióticos con CMIs de 128 μg/ml y 256 μg/ml para cefquinoma y doxiciclina, respectivamente. Los aislados de S. maltophilia mostraron resistencia a cefquinoma con valores de CMI de 512 y 128 μg/ml respectivamente. El 91,3% de los aislados resultaron multirresistentes a antimicrobianos, lo cual representa la primera detección en Cuba de bacterias con fenotipos de multirresistencia, aisladas de muestras de la mucosa nasal y genital de caballos.

RESUMO Objetivo: Avaliar os resultados clínicos, em mundo real, de efetividade e segurança em longo prazo do uso isolado ou em combinação com a cirurgia de catarata do implante trabecular de segunda geração iStent inject®. Métodos: Foi realizado um estudo retrospectivo e longitudinal de uma série de casos submetidos ao implante trabecular iStent inject® de maneira isolada e associada à cirurgia de catarata. Além dos dados sociodemográficos, os parâmetros avaliados incluíram pressão intraocular, número de medicamentos, acuidade visual e possíveis complicações das intervenções cirúrgicas ao longo do acompanhamento. A efetividade do procedimento foi mensurada por meio das taxas de sucesso absoluto (sem uso de medicação hipotensora) e de sucesso relativo (com ou sem uso de medicação adjuvante) para diferentes pressões intraoculares-alvos (18, 15 e 12mmHg). A segurança levou em conta a incidência de complicações e as reintervenções ao longo do período avaliado. Uma análise comparativa foi realizada nos olhos submetidos à cirurgia isolada versus cirurgia combinada com catarata. Resultados: A idade média foi 68,7 anos, com tempo médio de acompanhamento de 40 meses (12 a 72 meses). Considerando toda a população estudada, observou-se redução média na pressão intraocular de 16,5% ao fim do acompanhamento (pressão intraocular média final: 13,8mmHg; p<0,001 em relação à pressão intraocular basal). O número final de medicações necessárias também foi menor, com redução média de 72,8% (p<0,001). Não houve diferenças na pressão intraocular média final entre os grupos, porém a cirurgia combinada proporcionou média final significativamente menor no número de medicações (0,4 versus 1,5; p<0,001). Ambos os grupos alcançaram taxas elevadas de sucesso, com a cirurgia combinada mostrando tendência de superioridade. Conclusão: O iStent inject® se mostrou alternativa segura e eficaz como possibilidade terapêutica para olhos com glaucoma de ângulo aberto quando implantado de forma independente ou associado à cirurgia de catarata. Além disso, demonstrou resposta sustentada em até 72 meses de acompanhamento. Objetivo clínicos real inject Métodos sociodemográficos medicamentos hipotensora adjuvante intraocularesalvos intraoculares alvos 18, 18 (18 1 12mmHg. 12mmHg mmHg . 12mmHg) avaliado Resultados 687 68 7 68, anos 4 12 (1 meses. meses) estudada observouse observou 165 16 5 16,5 13,8mmHg 138mmHg 13 8mmHg p0001 p 0 001 p<0,00 basal. basal basal) 728 8 72,8 p<0,001. (p<0,001) 0,4 04 (0, 1,5 p<0,001) superioridade Conclusão disso 6 ( 16, p000 00 p<0,0 72, (p<0,001 0, (0 1, p00 p<0, (p<0,00 p0 p<0 (p<0,0 p< (p<0, (p<0 (p< (p

ABSTRACT Objective: To evaluate the real-world long-term effectiveness and safety of the standalone use or in combination with cataract surgery of the second-generation trabecular implant, iStent inject®. Methods: A retrospective longitudinal study was carried out on a series of cases that underwent iStent inject® trabecular implantation alone and associated with cataract surgery. In addition to sociodemographic data, the parameters evaluated included intraocular pressure, number of medications, visual acuity, and possible complications from surgical interventions throughout follow-up. The effectiveness of the procedure was measured through absolute success rates (without the use of hypotensive medication) and relative success (with or without the use of adjuvant medication) for different IOP targets (18, 15 and 12 mmHg). Safety considered the incidence of complications and reinterventions throughout the evaluated period. A comparative analysis was performed on eyes undergoing surgery alone versus surgery combined with cataract. Results: The average age was 68.7 years with an average follow-up time of 40 months (12-72 months). Considering the entire studied population, an average reduction in IOP of 16.5% was observed at the end of follow-up (mean final IOP: 13.8 mmHg, p<0.001 in relation to baseline IOP). The final number of medications needed was also lower, with an average reduction of 72.8% (p<0.001). There were no differences in the final mean IOP between the groups; however, the combined surgery provided a significantly lower final mean number of medications (0.4 versus 1.5, p<0.001). Both groups achieved high success rates, with combined surgery showing a trend toward superiority. Conclusion: The iStent inject® proved to be a safe and effective alternative as a therapeutic possibility for eyes with open-angle glaucoma when implanted independently or associated with cataract surgery. Furthermore, it demonstrated a sustained response up to 72 months of follow-up. Objective realworld real world longterm long term secondgeneration second generation implant inject Methods data pressure acuity followup. followup follow up. medication 18, 18 (18 1 mmHg. mmHg . mmHg) period Results 687 68 7 68. 4 1272 (12-7 months. months) population 165 16 5 16.5 138 13 8 13. p0001 p 0 001 p<0.00 IOP. IOP) 728 72.8 p<0.001. (p<0.001) however 0.4 04 (0. 1.5 p<0.001) superiority Conclusion openangle open angle Furthermore (1 6 127 (12- 16. p000 00 p<0.0 72. (p<0.001 0. (0 1. ( (12 p00 p<0. (p<0.00 p0 p<0 (p<0.0 p< (p<0. (p<0 (p< (p

RESUMO Objetivo: Avaliar os resultados clínicos e refrativos em longo-prazo da correção cirúrgica da presbiopia em portadores de catarata e glaucoma de ângulo aberto inicial a moderado por meio da cirurgia combinada de facoemulsificação com implante de lente intraocular multifocal e da cirurgia angular com implante trabecular. Métodos: Trata-se de estudo longitudinal retrospectivo de mundo real de uma série de casos submetidos à cirurgia combinada de catarata e antiglaucomatosa com implante trabecular de segunda geração, iStent inject® (Glaukos Inc., Califórnia, Estados Unidos). Realizou-se análise estatística de toda a população de estudo, além de avaliação comparativa dos olhos, de acordo com o tipo de lente intraocular, categorizada em monofocal (Grupo Monofocal) e multifocal (Grupo Multifocal). Resultados: Foram identificados 214 olhos. O tempo médio de seguimento foi 38,4 meses. A pressão intraocular média pré-operatória era de 16,0mmHg e, no fim do acompanhamento, de 13,6mmHg (p<0,001). No fim do acompanhamento, 75,7% dos olhos estavam com pressão intraocular <18mmHg, sem necessidade de medicamentos para glaucoma. Nos dois grupos, entre o pré-operatório e o fim do acompanhamento, houve melhora significativa da acuidade visual e do equivalente esférico; porém a proporção de independência dos óculos foi significativamente maior no grupo submetido à lente intraocular multifocal. Conclusão: Observou-se melhora da acuidade visual e alta proporção de independência dos óculos no Grupo Multifocal. Paralelamente à melhora da capacidade visual, observou-se melhora significativa dos parâmetros de controle do glaucoma (redução da pressão intraocular e da quantidade de medicações hipotensoras oculares). Objetivo longoprazo longo prazo Métodos Tratase Trata se geração inject Glaukos Inc Inc. Califórnia Unidos. Unidos . Unidos) Realizouse Realizou Monofocal Multifocal Multifocal) Resultados 21 384 38 4 38, meses préoperatória pré operatória 160mmHg mmHg 16 0mmHg acompanhamento 136mmHg 13 6mmHg p<0,001. p0001 p p<0,001 0 001 (p<0,001) 757 75 7 75,7 18mmHg <18mmHg grupos préoperatório operatório esférico Conclusão Observouse Observou observouse observou redução oculares. oculares oculares) 2 3 1 p000 p<0,00 00 (p<0,001 75, p00 p<0,0 (p<0,00 p0 p<0, (p<0,0 p<0 (p<0, p< (p<0 (p< (p

ABSTRACT Objective: To evaluate the long-term clinical and refractive results of surgical correction of presbyopia in patients with cataracts and initial to moderate open-angle glaucoma through combined phacoemulsification surgery with multifocal intraocular lens implantation and angular surgery with trabecular implant. Methods: This is a real-world retrospective longitudinal study of a series of cases undergoing combined cataract surgery and anti-glaucoma surgery with a second-generation trabecular implant, iStent inject® (Glaukos Inc., California, USA). A statistical analysis of the entire study population was carried out, in addition to a comparative assessment of the eyes according to the type of IOL, categorized into monofocal (Monofocal Group) and multifocal (Multifocal Group). Results: 214 eyes were identified. The average follow-up time was 38.4 months. The mean preoperative IOP was 16.0 mmHg and at the end of follow-up it was 13.6 mmHg. (p<0.001). At the end of follow-up, 75.7% of eyes had IOP < 18 mmHg, without the need for glaucoma medications. In both groups, between the preoperative period and the end of follow-up, there was a significant improvement in visual acuity and spherical equivalent; however, the proportion of spectacle independence was significantly higher in the group that underwent multifocal IOL. Conclusion: An improvement in visual acuity and a high proportion of spectacle independence were observed in the Multifocal Group. In parallel with the improvement in visual capacity, a significant improvement in glaucoma control parameters was observed (reduction in IOP and the amount of ocular hypotensive medications). Objective longterm long term openangle open angle implant Methods realworld real world antiglaucoma anti secondgeneration second generation inject Glaukos Inc Inc. California USA. USA . USA) out IOL Monofocal Group Results 21 identified followup follow up 384 38 4 38. months 160 16 0 16. 136 13 6 13. p<0.001. p0001 p p<0.001 001 (p<0.001) followup, up, 757 75 7 75.7 1 medications groups equivalent however Conclusion capacity reduction medications) 2 3 p000 p<0.00 00 (p<0.001 75. p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

ABSTRACT This case report discusses the migration of a foreign body from the breast to the mediastinum, which is rarely reported, and highlights complications associated with Okibari acupuncture. This technique involves the insertion of metal fragments into the skin. A 53-year-old woman underwent mammography showing acupuncture-related metallic fragments in the breast. Cardiac evaluation revealed the presence of metallic fragments in the right ventricle and myocardium. Despite the fragments‘ location in the mediastinum, the patient remained asymptomatic, leading us to take a conservative approach. This case highlights the importance of awareness of the potential complications of foreign bodies and emphasizes the need for careful monitoring. mediastinum reported acupuncture skin 53yearold yearold 53 year old acupuncturerelated related myocardium asymptomatic approach monitoring 5

Objective: To associate abandonment of tuberculosis treatment with the variables of access to health services in the state of São Paulo was estimated. Methods: was an epidemiological observational study with data to individuals diagnosed with tuberculosis, residing in the state of São Paulo in the period 2012 to 2017. Generalized Estimating Equations models were used to analyze the relationships between independent variables and noncompliance with tuberculosis treatment over time. Results: A prevalence of over 12% of noncompliance with tuberculosis treatment was identified. Individuals residing in medium and large-sized municipalities had, 2.64 (95% CI: 2.15-3;24) and 4.48 (CI 95%: 4.62-5.55) times more risk, respectively, of abandoning TB treatment when compared with those living in small cities (p&lt;0.05). Moreover, presence of Psychosocial Care Centers did not contribute to the reduction of treatment abandonment [1.20 (1.03-1.40) p&lt;0.05]. Conclusions: Was an association between municipal size and abandonment of tuberculosis treatment.

Introdução: Estimou-se a associação entre o abandono do tratamento da tuberculose com variáveis de acesso ao serviço de saúde no estado de São Paulo. Métodos: Trata-se de um estudo epidemiológico ecológico com fonte de dados secundários de indivíduos diagnosticados com tuberculose, no período de janeiro/2012 a dezembro/2017 residentes no estado de São Paulo. A variável desfecho é o abandono do tratamento da tuberculose. Foram efetuadas análises e considerada a distribuição de Poisson, estimados os riscos relativos brutos e ajustados, dispostas em dois blocos de variáveis considerando nível de significância de 5%. Resultados: Identificou-se uma prevalência superior a 12% no abandono do tratamento da TB no estado de São Paulo no período estudado. Indivíduos residentes em municípios de médio e grande porte têm, respectivamente, 2,64 (IC95%: 2,15-3,24) e 4,48 (IC95%: 4,62-5,55) vezes mais risco de abandonar o tratamento da TB quando comparados ao que vivem em municípios pequeno porte (p&lt;0,05), bem como, municípios com a presença do CAPS não contribuíram para a diminuição do abandono [1,20 (1,03-1,40) p&lt;0,05]. Conclusão: houve associação entre o porte municipal e o abandono do tratamento de Tuberculose.

Abstract Introduction: External cephalic version (ECV) is a procedure to change the presentation of the fetus from breech, transverse, or oblique to vertex by applying pressure externally to the fetus through the gravid abdomen. Aim: To evaluate the use of external cephalic version (ECV) among the portuguese obstetric community and the reasons for not performing this procedure. Study design: Cross-sectional study. Population: Doctors attending the 5th national Congress of Obstetrics and Maternal-Fetal Medicine in 2019. Methods: A cross-sectional survey using self-administered questionnaires was conducted among doctors attending the national obstetrics congress in 2019. The survey evaluated the local of work, the level of experience, motivation, and capability of performing an ECV by the participants as well as the reasons for not suggesting or performing an ECV. The statistical analysis included descriptive and comparative analysis. The chi-square test was used with a significance level < 0,05. Results: Ninety-nine clinicians answered the questionnaire; fifty-two worked in a differentiated perinatal hospital. ECV was mainly recommended by doctors from differentiated perinatal hospital (n=29) when compared to doctors from private hospitals (n=2) and perinatal hospitals (n=10) (p =0,010). Most clinicians (n=58) would not recommend this procedure to pregnant women. The main reasons for this were the lack of clinical experience (n=39) and the fact that participants believed that cesarean was a more adequate procedure (n=15). Eighty-one participants were interested in attending training sessions to learn how to perform an EVC in safe conditions. Conclusion: Overall, ECV is not widely practiced in Portugal despite being a safe procedure recommended by the Portuguese Society of Obstetrics and Maternal-Fetal Medicine. Efforts should be done to implement this safe technique among clinicians through training sessions or to enhance referral of these patients to institutions where ECV is performed.

Resumo Introdução: A versão cefálica externa (VCE) permite, utilizando manobras externas sobre o abdómen materno, converter um feto em apresentação não cefálica num feto em apresentação cefálica. Objetivo: Avaliar a opinião da comunidade obstétrica nacional sobre a VCE e quais os condicionantes para a sua não realização. Desenho do estudo: Estudo transversal. População: Médicos que participaram no V Congresso Nacional de Obstetrícia e Medicina Materno-Fetal em 2019. Métodos: Distribuição de questionários anónimos aos participantes do congresso. O questionário avaliou o local de trabalho habitual, o nível de experiência clínica do inquirido, a experiência, motivação, e capacidade de realização da VCE e as razões apresentadas pelos clínicos para não proporem/realizarem a manobra. A análise estatística incluiu a analise descritiva e comparativa. Foi utilizado o teste qui-quadrado e considerou-se um nível de significância de p<0,05. Resultados: Noventa e nove médicos responderam ao questionário. A maioria dos participantes (n=58) não proporia a VCE às grávidas. As principais razões apontadas foram a falta de experiência na realização da manobra (n=39) e o facto de os participantes considerarem a cesariana um procedimento mais adequado (n=15). Cinquenta e dois pertenciam a um hospital de apoio perinatal diferenciado. A VCE foi proposta com maior frequência nos hospitais de apoio perinatal diferenciado (n=29) face aos hospitais de apoio perinatal (n=10) e hospitais privados (n=2), (p=0,010). A maioria dos participantes (n=81) estaria interessado em participar em sessões de treino sobre a execução da manobra. Conclusão: A VCE não parece ser amplamente realizada nos hospitais portugueses, apesar de ser uma manobra segura e recomendada pela Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal. É fundamental difundir a VCE na comunidade obstétrica nacional, investir em sessões de formação para que os clínicos adquiram competências na sua execução e fomentar a referenciação destas doentes para centros onde a VCE seja realizada.