Abstract Introduction: Screen use among adolescents has increased, with excessive screen time associated with poor sleep. Isolation due to the COVID-19 pandemic may have exacerbated these problems. This study aimed to characterize adolescents’ sleep and screen use behaviors during the COVID-19 pandemic lockdown. Methods: This was a multicenter, cross-sectional, descriptive study of adolescents aged 10 to 18 years evaluated in an Adolescent Medicine outpatient visit of four hospitals in northern Portugal between January and March 2021. Adolescents completed a survey with questions about screen use and sleep and the Pediatric Daytime Sleepiness Scale (Portuguese version). Results: A total of 131 adolescents (66.4% female; median age 15 years) were enrolled during the study period. Participants reported a median sleep duration of nine hours on weekdays and 10 hours on weekends, with 25.9% sleeping less than eight hours on weekdays. Approximately 80% reported good or very good sleep quality. Onset insomnia was identified in 39.7% and excessive daytime sleepiness (EDS) in 13.7%. Most adolescents (74.0%) reported screen time of ≥6 hours/day. Screens were mainly used for attending classes and talking to friends. Smartphones were available in the bedroom at night for 83.2%, while 61.1% had televisions, 57.3% had computers, and 16.0% had gaming consoles in their bedrooms. Fifty-five percent used screens within an hour of bedtime every day. Screen time ≥6 hours/day and having a computer or smartphone in the bedroom at night were associated with shorter sleep duration on weekdays and EDS. Screen use within an hour of bedtime ≥4 times/week was associated with sleep-onset insomnia, shorter weekday sleep duration, and EDS. Discussion: Online classes during the COVID-19 lockdown may explain the use of devices ≥6 hours/day. Although most adolescents reported normal median sleep time and subjective good or very good sleep quality, screen use ≥6 hours/day and within one hour before bedtime was associated with sleep deprivation on weekdays and EDS. Conclusions: Excessive screen time during the pandemic appears to have had a negative impact on adolescents’ sleep. These findings underscore the importance of identifying and intervening in these issues when addressing adolescent global health.

Resumo Introdução: O uso de ecrãs tem vindo a aumentar entre os adolescentes, estando descrita a associação entre tempo excessivo de ecrã e menor quantidade e pior qualidade de sono. A pandemia de COVID-19 poderá ter agravado estes problemas. Este estudo pretendeu caracterizar o comportamento dos adolescentes relativamente ao sono e uso de ecrãs durante o confinamento imposto pela pandemia de COVID-19. Métodos: Estudo descritivo, transversal, multicêntrico de adolescentes dos 10 aos 18 anos avaliados numa consulta externa de Medicina do Adolescente de quatro hospitais do norte de Portugal entre janeiro e março de 2021. Os adolescentes preencheram um questionário com perguntas sobre o uso de ecrãs e o sono e a Pediatric Daytime Sleepiness Scale (versão portuguesa). Resultados: Foram incluídos 131 adolescentes (66,4% do género feminino; idade mediana de 15 anos) durante o período de estudo. Os participantes relataram uma mediana de duração do sono de 9 horas durante a semana e 10 horas ao fim-de-semana, com 25,9% a dormir menos do que oito horas diárias durante a semana. Cerca de 80% referiu ter um sono de boa ou muito boa qualidade. Foi identificada insónia inicial em 39,7% e sonolência diurna excessiva (SDE) em 13,7% dos participantes. A maioria (74,0%) referiu um tempo de ecrã ≥6 horas/dia. Os ecrãs foram usados maioritariamente para assistir a aulas e conversar com amigos. Um total de 83,2% dos adolescentes referiu dormir com o telemóvel no quarto e 61,1% referiu ter televisão, 57,3% computador e 16,0% consola de jogos no quarto. Cinquenta e cinco por cento usava ecrãs todos os dias na hora antes de dormir. Um tempo de ecrã ≥6 horas/dia e ter computador ou telemóvel no quarto durante a noite associou-se a uma menor duração do sono durante a semana e SDE. O uso de ecrãs na hora antes de dormir associou-se a insónia inicial, menor duração do sono durante a semana e SDE. Discussão: As aulas online poderão explicar o uso frequente de ecrãs (≥6 horas/dia). Embora a mediana de duração do sono tenha sido normal e a maioria dos adolescentes tenha referido ter um sono de boa ou muito boa qualidade, o uso de ecrãs ≥6 horas/dia e na hora antes de dormir associou-se a privação de sono durante a semana e SDE. Conclusão: O uso excessivo de ecrãs durante a pandemia parece ter tido um impacto negativo no sono dos adolescentes. Estes dados reforçam a necessidade de identificar e intervir nestes problemas durante a abordagem de saúde global do adolescente.

ABSTRACT Vesicular stomatitis virus is the causative agent of the vesicular stomatitis disease, which mainly affects cattle, swine, and horses causing significant economic losses. Many other animal species, including humans, can be also affected by the disease. Up to now, the epidemiology of vesicular stomatitis disease is not well understood. Previous epidemiological studies in Central America described the existence of an association between the presence of vesicular stomatitis New Jersey virus antibodies and environmental risk factors such as mean annual rainfall, temperature, and elevation. Additionally, molecular epidemiology studies revealed that the phylogenetic relationship between vesicular stomatitis New Jersey virus isolates is more related to ecological factors than temporal factors. We have performed a genetic analysis of vesicular stomatitis virus samples isolated from animals in different geographical regions in Venezuela. We sequenced the hypervariable region of the phosphoprotein gene of 51 samples collected over eight years. The virus was found in a wide range of environmental conditions, at high and low altitudes and with variable levels of precipitation and temperatures. In contrast with previous reports, our phylogenetic analysis showed that viruses from different ecological regions did not present significant genetic differences. cattle swine losses species humans now understood rainfall temperature elevation Additionally Venezuela 5 years conditions temperatures reports differences

Resumo: Este artigo faz uma análise genealógica da inclusão da “agressividade infantil” e suas variações no Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) ao longo das suas edições. Começamos por avaliar a relevância da inclusão deste signo clínico nos critérios de diagnóstico, sobretudo a partir de 1980. Em seguida, analisamos as implicações clínicas e políticas desta inclusão, em particular no que concerne à construção de uma psicopatologia da infância e à definição social de normas de conduta. Por fim, analisamos como a ênfase colocada na normatização da agressividade infantil através de discursos normativos, em consonância com as exigências neoliberais de desempenho, contribui para o aumento da expressão da agressividade como forma de lidar com o mal-estar e com o sofrimento subjetivo. Resumo DSM (DSM edições diagnóstico 1980 seguida conduta fim normativos desempenho malestar mal estar subjetivo 198 19 1

Abstract: This article provides a genealogical analysis of the inclusion of “child aggressiveness” and its variations in the Diagnostic and Statistical Manual of Mental Disorders (DSM) throughout its editions. We begin by assessing the relevance of the inclusion of this clinical sign in the diagnostic criteria, especially since 1980. We then analyze the clinical and political implications of this inclusion, particularly regarding the construction of a psychopathology of childhood and the social definition of norms of conduct. Finally, we analyse how the emphasis placed on the normalization of child aggression through normative discourses, in line with neoliberal demands for performance, contributes to an increase in the expression of aggression as a way of dealing with malaise and subjective suffering. Abstract aggressiveness DSM (DSM editions criteria 1980 conduct Finally discourses performance suffering 198 19 1

Resumen: Este artículo realiza un análisis genealógico de la inclusión de la “agresividad infantil” y sus variaciones en el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM) a lo largo de sus ediciones. Comenzamos evaluando la relevancia de la inclusión de este signo clínico en los criterios diagnósticos, especialmente desde 1980. A continuación, analizamos las implicaciones clínicas y políticas de esta inclusión, sobre todo en lo que respecta a la construcción de una psicopatología de la infancia y a la definición social de las normas de comportamiento. Por último, analizamos cómo el énfasis puesto en la normalización de la agresividad infantil a través de discursos normativos, en consonancia con las exigencias neoliberales de rendimiento, contribuye a un aumento de la expresión de la agresividad como forma de afrontar el malestar y el sufrimiento subjetivo. Resumen DSM (DSM ediciones diagnósticos 1980 continuación comportamiento último normativos rendimiento subjetivo 198 19 1

Résumé : Cet article propose une analyse généalogique de l’inclusion de l’« agressivité infantile » et de ses variations dans le Manuel diagnostique et statistique des troubles mentaux (DSM) au fil de ses éditions. Nous commençons par évaluer la pertinence de l’inclusion de ce signe clinique dans les critères diagnostiques, en particulier depuis 1980. Nous analysons ensuite les implications cliniques et politiques de cette inclusion, notamment en ce qui concerne la construction d’une psychopathologie de l’enfance et la définition sociale de normes comportementales. Enfin, nous analysons comment l’accent mis sur la normalisation de l’agressivité de l’enfant par les discours normatifs, en accord avec les exigences de performance néolibérales, contribue à l’augmentation de l’expression de l’agressivité comme moyen de faire face au malaise et à la souffrance subjective. linclusion l inclusion l« « l’ DSM (DSM éditions diagnostiques 1980 dune d lenfance enfance comportementales Enfin laccent accent lagressivité lenfant enfant normatifs néolibérales laugmentation augmentation lexpression expression subjective 198 19 1

RESUMEN Reconstruimos la trayectoria de vida de la enfermera y militante popular argentina Irma Carrica, entendida como una experiencia político-profesional ligada a sus redes de sociabilidad y atravesada por conflictos y contradicciones inherentes a su contexto histórico. Desde ese recorte analítico y teniendo en cuenta los recaudos sugeridos por el método biográfico de las ciencias sociales, nos adentramos en los debates político-sanitarios de las décadas de 1960 y 1970, principalmente en lo relativo a las disputas por el sentido de la “comunidad” en el campo de la salud. En particular, nos enfocamos en las contribuciones de un actor histórico colectivo -heterogéneo y plural, pero identificable en sus distintas modulaciones- que hemos denominado izquierda peronista en salud. Al analizar sus redes profesionales e intelectuales, hicimos hincapié en el rol que desempeñó Irma Carrica como referente de esa izquierda peronista en salud, a la hora de construir dinámicas alternativas para el abordaje comunitario en salud, que pusieron en tela de juicio los paradigmas epistemológicos y pedagógicos dominantes.

ABSTRACT We reconstruct the life path of the Argentine nurse and popular activist Irma Carrica, understood as a political-professional experience tied to her social networks and marked by conflicts and contradictions inherent to her historical context. From this analytical perspective and considering the precautions suggested by the biographical method of social sciences, we delve into the political and health debates of the 1960s and 1970s, particularly concerning disputes over the meaning of “community” in the health field. Specifically, we focus on the contributions of a collective historical actor - heterogeneous and plural, yet identifiable in its various forms - that we have termed the Peronist Left in health. By analyzing their professional and intellectual networks, we emphasize the role played by Irma Carrica as a representative of this Peronist Left in health, in constructing alternative dynamics for community health approaches, which challenged the dominant epistemological and pedagogical paradigms.

ABSTRACT Introduction: The bacterium Chlamydia trachomatis causes one of the most common sexually transmitted infections. The World Health Organization reports approximately 131 million cases annually. Objective: To evaluate the performance of the CROMATEST rapid test (Linear Chemicals. S.L. Barcelona Spain) in clinical specimens. Methods: 72 samples were studied: 38 vaginal exudates from adolescents from the Juan Manuel Márquez and El Cerro pediatric hospitals; and 34 urine samples from volunteers from the "Pedro Kourí" Tropical Medicine Institute. The CROMATEST assay was used and the commercial real-time polymerase chain reaction was used as a reference test. Sensitivity, specificity, positive and negative predictive value were calculated. Results: Six samples were positive by the rapid test, five by the real-time polymerase chain reaction and one by the reference test. The negative samples were 66, of which one was negative for the real-time polymerase chain reaction and positive in the CROMATEST. The concordance between both tests was 95 % and the Kappa value 0.8182. A sensitivity of 83.33 %, a specificity of 98.48 % and positive and negative predictive values of 83.33 % and 98.48 %, respectively, were obtained. Conclusions: The CROMATEST rapid test performed excellently against the reference test; therefore, its use is recommended for the detection of Chlamydia trachomatis.

RESUMEN Introducción: La bacteria Chlamydia trachomatis provoca una de las infecciones de transmisión sexual más frecuente. La Organización Mundial de la Salud reporta aproximadamente 131 millones de casos anuales. Objetivo: Evaluar el desempeño de la prueba rápida CROMATEST (Linear Chemicals. S.L. Barcelona España) en muestras clínicas. Métodos: Se estudiaron 72 muestras: 38 exudados vaginales de adolescentes de los hospitales pediátricos Juan Manuel Márquez y el Cerro; y 34 muestras de orina de voluntarios del Instituto de Medicina Tropical “Pedro Kourí. Se empleó el ensayo CROMATEST y como prueba de referencia la reacción en cadena de la polimerasa en tiempo real comercial. Se calculó sensibilidad, especificidad, valor predictivo positivo y negativo. Resultados: Seis muestras resultaron positivas por el test rápido, cinco por la reacción en cadena de la polimerasa en tiempo real y una por la prueba de referencia. De las 66 muestras negativas, una fue negativa para la reacción en cadena de la polimerasa en tiempo real y positiva en el CROMATEST. El porcentaje de concordancia entre ambas pruebas fue del 95 % y el valor de Kappa 0,8182. Se obtuvo una sensibilidad de 83,33 %, una especificidad del 98,48 % y valores predictivos positivo y negativo de 83,33 % y 98,48 %, respectivamente. Conclusiones: La prueba rápida CROMATEST tuvo un desempeño excelente contra la prueba de referencia; por tanto, se recomienda su utilización para la detección de Chlamydia trachomatis.

Residual stresses exist intrinsically in any manufactured or processed material, significantly influencing its mechanical properties. Shot peening enhances fatigue life by introducing compressive residual stresses at the surface, however, the beneficial effects may be reduced under external loads. This study investigates the behavior of surface residual stresses induced by shot peening in API 5L X80 steel. Specimens underwent tensile monotonic loading cycles below the yield strength, incrementally increasing the load until reaching the yield limit. Residual stresses were measured using the X-ray diffraction by sin2ψ method, revealing a progressive stress relief of compressive residual stresses field induced by shot peening. The development of tensile residual stresses was observed following the monotonic tests. Loads below yield stress were able to completely reverse compressive stresses to tensile stresses. A correlation was observed between residual stresses and magnetic Barkhausen noise, suggesting it as a potential method for analyzing residual stress behavior qualitatively in shoot peened steel samples. material properties however loads L X X8 strength limit Xray ray sinψ sin ψ tests noise samples

RESUMEN Reconstruimos la trayectoria de vida de la enfermera y militante popular argentina Irma Carrica, entendida como una experiencia político-profesional ligada a sus redes de sociabilidad y atravesada por conflictos y contradicciones inherentes a su contexto histórico. Desde ese recorte analítico y teniendo en cuenta los recaudos sugeridos por el método biográfico de las ciencias sociales, nos adentramos en los debates político-sanitarios de las décadas de 1960 y 1970, principalmente en lo relativo a las disputas por el sentido de la “comunidad” en el campo de la salud. En particular, nos enfocamos en las contribuciones de un actor histórico colectivo -heterogéneo y plural, pero identificable en sus distintas modulaciones- que hemos denominado izquierda peronista en salud. Al analizar sus redes profesionales e intelectuales, hicimos hincapié en el rol que desempeñó Irma Carrica como referente de esa izquierda peronista en salud, a la hora de construir dinámicas alternativas para el abordaje comunitario en salud, que pusieron en tela de juicio los paradigmas epistemológicos y pedagógicos dominantes.

ABSTRACT We reconstruct the life path of the Argentine nurse and popular activist Irma Carrica, understood as a political-professional experience tied to her social networks and marked by conflicts and contradictions inherent to her historical context. From this analytical perspective and considering the precautions suggested by the biographical method of social sciences, we delve into the political and health debates of the 1960s and 1970s, particularly concerning disputes over the meaning of “community” in the health field. Specifically, we focus on the contributions of a collective historical actor - heterogeneous and plural, yet identifiable in its various forms - that we have termed the Peronist Left in health. By analyzing their professional and intellectual networks, we emphasize the role played by Irma Carrica as a representative of this Peronist Left in health, in constructing alternative dynamics for community health approaches, which challenged the dominant epistemological and pedagogical paradigms.

Abstract Introduction: Seat belt aorta is a rare but often severe complication arising from blunt trauma with compression of the abdominal aorta against vertebrae. Seat belt sign is often present as an ecchymosis across the abdomen. The association with abdominal wall disruption and hollow viscus injury has been named seat belt triad; the presence of Chance fracture is sometimes considered a fourth component. Methods: Using Pubmed and Embase databases we reviewed all articles regarding abdominal seat belt aortic injuries and analysed presentation at admission, concomitant lesions, including presence of seat belt triad, treatment and outcomes. Results: Fifty-two cases were reported, from 1968 to 2019. Twenty-nine males (56%), mean age 43 ± 19 years. Most patients were stable at admission, with 29 (55.8%) presenting acute abdomen, 26 (50%) limb ischemia, 9 (17.3%) hypovolemic shock and 2 (3.8%) late-onset claudication. Seat belt sign was identified in 40 patients (76.9%), seat belt triad in 38 (73.1%) and 22 (42.3%) had Chance fractures, of which only 2 were not associated with seat belt triad. Most patients presented with aortic dissection (90.4%), complicated with pseudoaneurysm (11.5%), contained rupture (7.7%) or uncontained rupture (3.8%); 2 patients presented isolated iliac thrombosis and 3 limb ischemia. All patients required immediate surgical intervention, of which 40 (76.9%) required urgent vascular surgery. Forty-eight patients (92.3%) underwent vascular surgery: 39 open revascularizations and 9 endovascular procedures; three were managed conservatively. Ten patients (19.2%) passed away or died, of which 7 had seat belt triad. No patients needed reinterventions for vascular lesions except one, yet 3 required limb amputation. Most patients with seat belt triad required further visceral and abdominal wall repair. Conclusions: Seat belt aorta and especially seat belt triad are severe complications associated with high morbimortality often requiring surgery and multiple interventions. As patients are usually conscious and stable upon admission, this condition should not be disregarded.

Abstract Introduction: The use of statins in hemodialysis patients is a topic of ongoing research and debate. Patients with chronic kidney disease on hemodialysis constitute a large proportion of patients treated in the vascular surgery field. Clinical data of the protective statin effect on this group is scarce and conflicting results exist regarding cardiovascular, cerebrovascular and limb outcomes. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases to understand the relationship between statin effect and cardiovascular, limb outcomes and cerebrovascular outcomes. A narrative review was constructed, based on the obtained literature. Results: Although the use of statins in hemodialysis patients may provide cardiovascular benefits, the optimal dosage and safety profile of these medications in this population remain uncertain. A carefully evaluation of the risks and benefits of statins should be made based on each patient's specific requirements and circumstances. Conclusion: The role of statins for patients with peripheral arterial disease who are on hemodialysis remains unclear. Further analyses should focus on this subgroup of dialysis patients, who are becoming more prevalent on the vascular surgery departments, allowing for an optimized treatment with better patient outcomes.

Abstract Introduction: Diabetes mellitus is one of the main causes of morbi-mortality worldwide. In this study, we aim to verify if the COVID-19 pandemic had repercussions on the metabolic and cardiovascular control of patients with type 2 diabetes at USF Garcia de Orta, from ACeS Porto-Ocidental. Methods: Cross-sectional observational analytical study. The study’s population consists of patients registered at the USF GO with the diagnosis of DM (ICPC-2 code T89 and T90) in the list of active problems. After applying inclusion and exclusion criteria, the sample was obtained by simple randomization. Glycated hemoglobin (HbA1c), LDL-cholesterol, body mass index (BMI), systolic (BP) and diastolic (DP) blood pressure values recorded in a pre-pandemic period were compared with those in a pandemic period. Results: The sample consisted of 218 patients, with a mean age of 70.9 ± 11.1 years. The median of HbA1c (6.75 vs 6.80) and LDL-cholesterol (82.80 vs 91.60) was lower in the pandemic period. The opposite was verified in relation to the BMI, with the highest median in the pandemic period (27.03 vs 26.87). Only the analysis of cholesterol-LDL obtained a statistically significant result. On average, the values of BP (134.06 vs 133.41) and DP (77.97 vs 76.59) were higher in the pandemic period compared to the pre-pandemic period, although without statistical significance. Discussion: With the exception of BMI, BP and DP, there was an improvement in the pandemic period. In the literature found, there are contradictory results on the impact of the pandemic on the variables studied. These results may reflect the quality of the teleconsultations carried out during the pandemic period and/or the effort of diabetics to maintain healthy habits. Conclusion: We cannot conclude that, in the period evaluated, the COVID-19 pandemic had a negative impact on the metabolic and cardiovascular control of patients with DM2 in our population.

Resumo Introdução: A diabetes mellitus é uma das principais causas de morbimortalidade em todo o mundo. Pretende-se verificar se a pandemia COVID-19 teve repercussões no controlo metabólico e cardiovascular dos doentes com diabetes mellitus tipo 2 (DM2) da USF Garcia de Orta (GO), do ACeS Porto Ocidental. Método: Estudo observacional, transversal, analítico. A população do estudo corresponde aos utentes inscritos na USF GO com o diagnóstico de DM (código T89 e T90 da ICPC-2) na lista de problemas ativos. Depois de aplicados os critérios de inclusão e exclusão obteve-se a amostra por aleatorização simples. Foram comparados valores de hemoglobina glicada (HbA1c), colesterol-LDL, índice de massa corporal (IMC), pressão arterial sistólica (PAs) e diastólica (PAd), registados num período pré-pandémico com os de um período pandémico. Resultados: A amostra foi de 218 pacientes, com média de idades de 70,9 ±11,1 anos. Na amostra a mediana de HbA1c (6,75 vs 6,80) e do colesterol-LDL (82,80 vs 91,60) foi inferior no período pandémico. Verificando-se o oposto em relação ao IMC, com a mediana superior no período pandémico (27,03 vs 26,87). Apenas na análise do colesterol-LDL se obteve um resultado estatisticamente significativo. Na análise do controlo tensional, em média, os valores de PAs (134.06 vs 133.41) e PAd (77.97 vs 76.59) foram superiores no período pandémico face ao pré-pandémico, mas sem significado estatístico. Discussão: No estudo encontrou-se, à exceção do IMC, da PAs e da PAd, uma melhoria dos valores no período pandémico. Em relação ao impacto da pandemia nas variáveis estudadas estão descritos na literatura resultados contraditórios. Estes resultados podem refletir a qualidade das teleconsultas realizadas no período pandémico e/ou no esforço dos diabéticos por manter hábitos saudáveis. Conclusão: Não se pode afirmar que, no período avaliado, a pandemia COVID-19 teve impacto negativo no controlo metabólico e cardiovascular dos pacientes com DM2 da população estudada.

Resumen: La diabetes mellitus, un padecimiento crónico y progresivo, ocupó el tercer lugar en defunciones durante el período comprendido de enero a junio de 2021 en México. Su complicación crónica más frecuente es la neuropatía diabética que tiene un impacto importante en el sistema nervioso. En la Ciudad de México se reunió un grupo multidisciplinario de expertos para establecer un algoritmo de tratamiento que considere los aspectos sintomáticos y etiopatogénicos de la neuropatía diabética. Se utilizó un método Delphi en tiempo real con dos rondas de preguntas interactivas. La implementación del algoritmo propuesto permitirá abordar de manera integral al paciente diabético con neuropatía dolorosa y no dolorosa, tanto en el terreno de los síntomas como en la etiopatogenia. Este abordaje brinda la oportunidad de mejorar la calidad de vida y lograr la reinserción a la vida familiar y laboral. El panel de expertos recomienda al ácido tióctico como tratamiento etiopatogénico de primera línea en la neuropatía diabética.

Abstract: Diabetes mellitus, a chronic and progressive condition, was the third most common cause of death in Mexico between January and June 2021. Its most frequent chronic complication is diabetic neuropathy, which has a major impact on the nervous system. A multidisciplinary group of experts met in Mexico City to establish a treatment algorithm considering the symptomatic and etiopathogenic aspects of diabetic neuropathy. A real-time Delphi method with two rounds of interative questions was used. The implementation of the proposed algorithm will allow a comprehensive approach to the diabetic patient with painful and non-painful neuropathy, both in terms of symptoms and etiopathogenesis. This approach provides the opportunity to improve quality of life and achieve reintegration into family and work life. The expert panel recommends thioctic acid as the first line etiopathogenic treatment for diabetic neuropathy.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

ABSTRACT Introduction: The alterations caused by the new coronavirus, as well as other factors such as age, personal pathological history and certain laboratory results, contribute to the state of shock. Objective: To determine if there is a relationship between the state of shock caused by the COVID-19 infection with the personal pathological history, the INL indices and the qSOFA scale. Material and Methods: Prospective longitudinal cohort study conducted on 302 patients with a positive diagnosis of COVID-19 who were admitted to Manuel Fajardo Hospital in Havana, Cuba between March and October 2021. Results: Our results show that 27.8% of the patients evolved to shock, mainly septic shock (25.2%); the median age was 69-years (RIC: 57-77), while the most frequent personal histories were: arterial hypertension (71.5%), obesity (29.5%), and diabetes mellitus (24.8%), respectively. Logistic regression analyses identified the history of heart disease (RR= 2.16; (95 % CI: 1.15-4.04; p= 0.02) and the creatinine value (RR: 1,01: (95 % CI: 1.00-1.01; p= 0,03) as predictive variables for shock. Conclusions: The history of ischemic heart disease and the creatinine value represent independent predictive variables for the occurrence of shock; on the other hand, the survival of patients with a positive diagnosis of COVID-19 who develop a state of shock during their hospitalization is significantly lower.

RESUMEN Introducción: Las alteraciones provocadas por el nuevo coronavirus, así como otros factores como la edad, sus antecedentes patológicos personales y determinados resultados de laboratorio, contribuyen al estado de choque. Objetivo: Determinar si existe relación entre el estado de choque provocado por la infección por la COVID-19 con los antecedentes patológicos personales, los índices de INL y la escala qSOFA. Material y Método: Estudio de cohorte longitudinal prospectivo en 302 pacientes con el diagnóstico positivo de la COVID-19 que ingresaron en el Hospital Docente Clínico-Quirúrgico Comandante Manuel Fajardo (La Habana, Cuba) entre marzo y octubre de 2021. Resultados: El 27,8 % de los pacientes evolucionó al choque, principalmente el choque séptico (25,2 %), la mediana de edad fue de 69 con RIC (57-77), mientras los antecedentes personales más frecuentes fueron: hipertensión arterial (71,5 %), obesidad (29,5 %) y Diabetes Mellitus (24,8 %), respectivamente. Los análisis de regresión logística identificaron como variables predictoras de choque los antecedentes de cardiopatía con un RR: 2,16; (IC 95 %: 1,15-4,04; p= 0,02) y el valor de la creatinina con un RR: 1,01; (IC 95 %: 1,00-1,01; p= 0,03). Conclusiones: Los antecedentes de cardiopatía isquémica y el valor de la creatinina representan variables predictoras independientes de la ocurrencia de choque; por otro lado, la supervivencia de los pacientes con diagnóstico positivo de la COVID-19 que desarrollan un estado de choque durante su hospitalización, es significativamente menor.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Introduction: Recently published studies on peripheral arterial occlusive disease (PAOD) have revealed marked sex disparities in patient selection and treatment outcomes. In a recent retrospective study with data from 11 different countries, Portugal was highlighted as one of the countries with greater sex discrepancies related to PAOD treatment. We aimed to analyze sex specific differences in the treatment of symptomatic PAOD, concerning different variables, in a single hospital center, in Portugal. Methods: Data on treatment of symptomatic PAOD patients from October 1st, 2020, to December 31st, 2021, were retrospectively collected from clinical registries from a single hospital center in Portugal. Different variables and post-operative outcomes were analyzed dichotomized by sex, with descriptive statistics. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software v28. Results: A total of 220 patients, 15,9% female and 84,1% male, were treated for PAOD, in the selected period, in a hospital center from Portugal. Female patients were older (mean age of 73.8 years versus 69.5 years in male); were less likely to be treated for intermittent claudication (3% versus 6% of men); more often treated at a more advanced stage of the disease with trophic lesions (91% versus 74% of men); more likely to be offered primary major amputation (14% versus 3% of male patients); less likely to be taking statins as part of PAOD medical management (65.7% versus 77.8% of male); and had a higher 90-day mortality rate (17.1% versus 6.5% in men). They were also more frequently treated with endovascular procedures (40%) than with OSR (26%). Conclusion: Remarkable sex discrepancies in the treatment of PAOD were found in our hospital center. This study brings awareness to the scientific medical community for sex disparities in the management of patients with PAOD.