BACKGROUND The incidence of visceral leishmaniasis (VL) has increased in the Southern region of Brazil in recent years, especially in the State of Paraná. New species have been suggested with potential to act as vector in VL endemic areas. OBJECTIVES Identify the Leishmania species in sand fly specimens collected from 2016 to 2018 in the municipality of Itaperuçu, Vale do Ribeira, Paraná, Brazil. METHODS Light traps were used for collections and for the analysis of sand fly were used the multiplex polymerase chain reaction (PCR) methodology and subsequent sequencing. FINDINGS Among the collected specimens, 88.62% were attributed to the species Nyssomyia neivai, which were grouped into 176 pools. Three positive pools were detected: two with Leishmania (Viannia) braziliensis and one with L. (Leishmania) infantum. The positivity rate for the parasite was 0.25% based on the presence of at least one infected insect in the pool. MAIN CONCLUSIONS The detection of L. infantum in Ny. neivai draws attention due to its abundance and anthropophily in the State of Paraná. Moreover, this finding is considered as an alert and suggests that the vector competence of Ny. neivai and the criteria for its incrimination should be carried out, given its wide distribution in southern of Brazil. (VL years Paraná areas 201 Itaperuçu Ribeira PCR (PCR sequencing 8862 88 62 88.62 17 detected Viannia (Viannia L (Leishmania 025 0 25 0.25 pool Ny Moreover out 20 886 8 6 88.6 1 02 2 0.2 88. 0.

Abstract At high temperatures, concrete may exhibit adverse mechanical behavior that compromises the safety of structures. Thus, it is necessary to study and develop concrete that can obtain greater performance in situations of exposure to high temperatures. In this regard, the present study investigates the replacement of 25% of sand by expanded vermiculite in different types of concrete and its performance when subjected to room temperature and punctual temperatures, of little content in literature, such as 200°C, 400°C and 800°C. This study also innovates by proposing the evaluation of prototypes exposed to high temperatures exclusively according to the perspectives of Brazilian technical standards, without resorting to international guidelines. Thus, the consistencies of the mixtures were determined and analyzed, as well as physical and mechanical tests that were carried out with the produced concrete. Among the results found are: vermiculite reduces the workability of the concrete mixture; vermiculite is not recommended for high-performance concrete, as it can significantly reduce its mechanical properties; in general terms, concrete that has a design strength of 50 MPa benefits from replacing the fines aggregate with vermiculite. From 400°C of exposure, all of the concrete samples showed cracks. The spalling phenomenon was also noticed in some specimens. The developed concrete samples cannot be characterized as lightweight concrete according to Brazilian standards, but o can be recommended as structural concrete given that their apparent specific mass is greater than 2000 kg/m3. structures Thus regard 25 literature 200C C 200 200°C 400C 400 800C 800 800°C standards guidelines analyzed are mixture highperformance properties terms 5 cracks specimens kgm3 kgm kg m3 m kg/m3 2 20 40 80 kg/m 4 8

Resumen La inmunonutrición es una ciencia que engloba aspectos relacionados con la nutrición, la inmunidad, la infección, la inflamación y el daño tisular. Las fórmulas inmunomoduladoras han demostrado beneficios en una amplia variedad de situaciones clínicas. El objetivo de este trabajo es revisar la evidencia disponible en inmunonutrición (IN). Para ello, se ha realizado una búsqueda bibliográfica con las palabras clave: inmunonutrición, arginina, glutamina, nucleótidos, ácidos grasos omega-3, ERAS, fast-track. Se han incluido ensayos clínicos, revisiones y guías de práctica clínica. La IN ha demostrado reducir las fístulas en el postoperatorio en pacientes con cáncer de cabeza y cuello. En pacientes con cáncer gástrico y cáncer de esófago, la IN se asocia a una disminución de las complicaciones infecciosas y la estancia hospitalaria. Otras situaciones clínicas que se benefician del uso de la IN son la cirugía del cáncer de páncreas, la cirugía del cáncer colorrectal y los grandes quemados. Son necesarios más estudios controlados, prospectivos y aleatorizados para confirmar los potenciales beneficios de la IN en otras situaciones clínicas como la cirugía torácica no esofágica, el cáncer vesical, la cirugía ginecológica, la fractura de cadera, la patología hepática y la COVID-19, entre otros.

Abstract Immunonutrition is a science that encompasses aspects related to nutrition, immunity, infection, inflammation and tissue damage. Immunomodulatory formulas have shown benefits in a wide variety of clinical situations. The objective of this work was to review the available evidence in immunonutrition (IN). For this, a bibliographic search has been carried out with the keywords: immunonutrition, arginine, glutamine, nucleotides, omega-3 fatty acids, ERAS, fast-track. Clinical trials, reviews and clinical practice guidelines have been included. IN has been shown to reduce postoperative fistulae in head and neck cancer patients and in gastric and esophageal cancer patients, infectious complications and hospital stay. Other clinical situations that benefit from the use of IN are pancreatic cancer surgery, colorectal cancer surgery and major burns. More controlled, prospective, and randomized studies are necessary to confirm the potential benefits of IN in other clinical situations such as non-esophageal thoracic surgery, bladder cancer, gynecological surgery, hip fracture, liver pathology and COVID-19, among others.

Aim This study, with the aim of checking some of the changes in patients’ daily habits and their reasons for needing restorative treatment was conducted at a public university immediately on return to attendance after the COVID-19 pandemic lockdown. Methods This survey consisted of interviews held by applying 2 questionnaires to students and patients. A single researcher collected data in all the restorative dentistry clinics at the university after the return to face-to-face activities in the period between 02/02/2021 and 07/30/2021. Data obtained by means of the questionnaires were submitted to descriptive analysis. Results Ninety (90) participants answered the patient questionnaire. When considering possible associations between being in social isolation or not, significant values were found for changed type of diet (p=0.0011), frequency of eating (p=0.011) and toothbrushing (p=0.034). Data about 417 restorations were collected and among the reasons for restorative intervention, 33.03% were restoration replacement, 31.87% treatment of primary caries and 24.40% of dental wear/non-carious lesions. Conclusion Patients who isolated themselves during the pandemic tended to change their eating habits and frequency of oral hygiene. Toothache was the main reason for seeking dental treatment and the replacement of pre-existing restorations was the main reason for restorative treatments. study patients COVID19 COVID 19 COVID-1 lockdown facetoface face 02022021 02 2021 02/02/202 07302021 07 30 07/30/2021 analysis 90 (90 questionnaire not p=0.0011, p00011 p p=0.0011 , 0 0011 (p=0.0011) p=0.011 p0011 011 (p=0.011 p=0.034. p0034 p=0.034 . 034 (p=0.034) 41 intervention 3303 33 03 33.03 3187 31 87 31.87 2440 24 40 24.40 wear/noncarious wearnoncarious wear/non carious wear non lesions hygiene preexisting pre existing treatments COVID1 1 COVID- 0202202 202 02/02/20 0730202 3 07/30/202 9 (9 p0001 p=0.001 001 (p=0.0011 p=0.01 p001 01 (p=0.01 p003 p=0.03 (p=0.034 4 330 33.0 318 8 31.8 244 24.4 noncarious wearnon 020220 20 02/02/2 073020 07/30/20 ( p000 p=0.00 00 (p=0.001 p=0.0 p00 (p=0.0 (p=0.03 33. 31. 24. 02022 02/02/ 07302 07/30/2 (p=0.00 p=0. p0 (p=0. 0202 02/02 0730 07/30/ p=0 (p=0 020 02/0 073 07/30 p= (p= 02/ 07/3 (p 07/

ABSTRACT Objectives: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Materials and methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543 Objectives TDM T DM (T2DM MTT. . (MTT) methods drugnaive drug naive 10 qd q d q.d. h composition 70 carbohydrates proteins lipids washout repeated blinded repeatedmeasures measures analysis Results postmeal post areaunderglucosecurve curve 7 15 15% +86% 86 (+86% insulinglucose insulin +25%, 25 +25% , (+25%) glucagonlike glucagon like peptide1/glucose peptide1glucose peptideglucose peptide 1/glucose 1 +46% 46 (+46% curves protein lipidrich lipid rich Cpeptide, Cpeptide C peptide, C-peptide levels Conclusion fatrich fat meals no NCT NCT0088154 (MTT q.d +86 8 (+86 +25 (+25% peptide1 1glucose +46 (+46 NCT008815 +8 (+8 +2 (+25 +4 (+4 NCT00881 + (+ (+2 NCT0088 ( NCT008 NCT00 NCT0

RESUMO Os agentes anestésicos representam uma causa importante de anafilaxia a fármacos, sendo os relaxantes neuromusculares (RNM) dos principais responsáveis pelos casos de anafilaxia perioperatória. O cisatracúrio é o RNM mais recente, sendo um estereoisómero do atracúrio que se acreditava não ter potencial de libertação de histamina e, consequentemente, causar menos reações alérgicas do que os outros RNM. No entanto, têm sido relatados vários casos de reação anafilática grave após administração de cisatracúrio, não existindo, do nosso conhecimento, registo na literatura de nenhum em Portugal. As autoras apresentam dois casos de anafilaxia perioperatória grave (grau 4 na escala de Ring & Messmer) com paragem cardiorrespiratória. Na investigação alergológica foram realizados testes cutâneos, cujos intradérmicos se revelaram positivos para o cisatracúrio (1:100) em ambos os doentes. É importante alertar que este RNM não será tão desprovido de potencial alergénico como previamente pensado e esse facto deve ser considerado na investigação de uma reação alérgica que ocorra durante a indução anestésica.

ABSTRACT Anesthetic agents are an important cause of drug anaphylaxis, with neuromuscular blocking agents (NMBA) being a common cause of intraoperative anaphylaxis. Cisatracurium, a stereoisomer of atracurium, is the most recent NMBA, which was believed to have no histamine-releasing potential, and therefore, cause less allergic reactions than other NMBA. Although there have been several cases of severe anaphylactic reactions to cisatracurium reported worldwide, there are no known published cases in Portugal, to the best of our knowledge. The authors present two cases of severe perioperative anaphylaxis (grade 4 according to Ring & Messmer Classification) with cardiorespiratory arrest. In the allergological work-up, a positive intradermal skin test for cisatracurium (1: 100) was found in both patients. It is important to emphasize that this NMBA is not exempt of allergenic potential as previously thought. Thus, it should be taken into account when assessing an allergic reaction that occurred during anesthetic induction.

Abstract INTRODUCTION Anemia is a public health problem worldwide and is most prevalent in preschool children, for whom it is the most frequent cause of nutritional deficits. In turn, iron deficiency is the main cause of anemia, affecting 43% of children globally. Previous studies in Cuba show rates of iron deficiency in preschool children between 38.6% and 57.6%, higher in infants (71.2% to 81.1%). WHO recommends using serum ferritin as an indicator of iron deficiency accompanied by acute (C-reactive protein) and chronic (α1-acid glycoprotein) inflammation biomarkers. OBJECTIVE Assess how inflammation affects measuring and reporting of iron-deficiency anemia rates in Cuban preschool children. METHODS Data were obtained from serum samples contained in the National Anemia and Iron Deficiency Survey, and included presumably healthy preschool Cuban children (aged 6–59 months). Serum samples were collected from 1375 children from randomly selected provinces in 4 regions of the country from 2014 through 2018. We examined the association between ferritin and two inflammatory biomarkers: C-reactive protein and α1-acid glycoprotein. Individual inflammation-adjusted ferritin concentrations were calculated using four approaches: 1) a higher ferritin cut-off point (<30 g/L); 2) exclusion of subjects showing inflammation (C-reactive protein >5 mg/L or α1-acid glycoprotein >1 g/L); 3) mathematical correction factor based on C-reactive protein or α1-acid glycoprotein; and 4) correction by regression with the method proposed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia Group. We estimated confidence intervals of differences between unadjusted prevalence and prevalence adjusted for inflammation by each method. RESULTS The proportion of children with inflammation according to C-reactive protein concentrations >5 mg/L was lower (11.1%, 153/1375) than the proportion measured according to the concentrations of α1-acid glycoprotein, at >1 g/L (30.8%, 424/1375). The percentage of children with high concentrations of at least one of the aforementioned biomarkers was 32.7% (450/1375). Thus, each correction method increased the observed prevalence of iron deficiency compared to unadjusted estimates (23%, 316/1375). This increase was more pronounced when using the internal regression correction method (based only on C-reactive protein) or the method based on a higher cut-off point. Adjustment using all four methods changed estimated iron deficiency prevalence, increasing it from 0.1% to 8.8%, compared to unadjusted values. CONCLUSION One-third of preschool children had biomarkers indicating elevated inflammation levels. Without adjusting for inflammation, iron deficiency prevalence was underestimated. The significant disparity between unadjusted and inflammation-adjusted ferritin when using some approaches highlights the importance of selecting the right approach for accurate, corrected measurement. The internal regression correction approach is appropriate for epidemiological studies because it takes into account inflammation severity. However, other models should be explored that account for inflammation and also provide better adjusted ferritin concentrations.

Resumo Nos sistemas corporatistas prevalecentes na ue, a concertação social é a instância que promove o consenso a nível nacional entre sindicatos, empregadores e governos. Perante a persistente desigualdade do mercado de trabalho, perguntámo-nos qual tem sido o seu contributo para as políticas de igualdade de gênero. Respondemos a esta pergunta com a análise de conteúdo dos pactos sociais assinados em Portugal ao longo de mais de trinta anos de tripartismo (1984-2019). Os resultados mostram que a igualdade de gênero tem um peso reduzido nos pactos sociais e que o quadro normativo europeu é determinante nos avanços feitos. Nosso estudo reforça assim a literatura existente que aponta para a necessidade de uma reforma do tripartismo.

Abstract Within the corporatist systems of the eu, social concertation is the body that promotes the national consensus among trade unions, employers and governments. Given the persistent inequality of the labour market, we have wondered what contribution it has been making to gender equality policies. We responded to this question by analysing the content of the social pacts signed in Portugal over more than 30 years of tripartism (1984-2019). The results show that gender equality has little weight in social pacts and that the European regulatory framework is decisive in the progress made. Our study thus reinforces the existing literature which points to the need for a reform of tripartism.

ABSTRACT Objectives: To assess the prevalence of peripheral artery disease in kidney transplant patients and the validity of intermittent claudication for its diagnosis. Methods: Setting and period: Nephrology Department of the University Hospital A. Coruña, 2013-2017. Inclusion criteria: transplant patients with functioning grafts who gave their consent to participate in the study. Sample size rationale: n=371 patients (confidence interval= 95%; precision= ± 4.25%). Measurements: age, age at the time of transplant, sex, dyslipemia, body mass index, smoking, diabetes, sign of Godet, perimalleolar edema, ankle-brachial index and the Edinburgh Questionnaire. Cardiovascular risk was measured with these scores: Framingham-Wilson, Regicore, SCORE and Dorica. Results: The mean age at the time of transplant was 47.86±12.62; 65.5% of patients were men and 8.7% of them had an ankle-brachial index of <0.90. When answering the Edinburgh Questionnaire, 16.2% of subjects reported suffering from intermittent claudication. Concordance between these two diagnostic tests is poor (kappa index= 0.34). The Edinburgh Questionnaire showed a sensitivity of 59.38% in predicting the ankle-brachial index (<0.90) and specificity (88.10%). The variables associated with the presence of artery disease are age at the time of transplant (OR=1.07) and smoking (OR=6.17), dyslipidemia being at the limit of statistical significance. Conclusions: A tenth part of the patients have peripheral artery disease. Concordance between the Edinburgh Questionnaire and the ankle-brachial index is poor; therefore, the latter should be used as diagnostic method. Clinical signs and symptoms underestimate the prevalence of artery disease. Age, smoking and dyslipidemia increase the risk of this disease. Artery disease patients have a higher cardiovascular risk.

RESUMEN Objetivos: Determinar en pacientes trasplantados renales la prevalencia de enfermedad arterial periférica y la validez de las manifestaciones clínicas de claudicación intermitente para su diagnóstico. Material y métodos: Ámbito y período: Servicio de Nefrología del Complejo Hospitalario Universitario A Coruña, 2013-2017. Criterios inclusión: pacientes trasplantados renales con injerto funcionante que consientan participar en el estudio. Justificación del tamaño muestral: n=371 pacientes (seguridad= 95% y precisión= ± 4,25%). Mediciones: edad, edad al trasplante, sexo, dislipemia, índice de masa corporal, tabaquismo, diabetes, signo de Godet, edema perimaleolar, índice tobillo-brazo y cuestionario Edimburgo. El riesgo cardiovascular se midió mediante los scores Framingham-Wilson, Regicor, SCORE y Dorica. Resultados: La edad media al trasplante fue de 47,86 ± 12,62 años, 65,5% hombres. El 8,7% de los pacientes presentan un índice tobillo-brazo <0,90. El 16,2% de los pacientes manifiestan claudicación intermitente según el cuestionario Edimburgo. La concordancia entre ambas pruebas diagnósticas es débil (índice de Kappa=0,34). El cuestionario de Edimburgo mostró sensibilidad del 59,38% para predecir índice tobillo-brazo <0,90 y especificidad del 88,10%. Las variables asociadas a la presencia de arteriopatía son la edad al trasplante (OR=1,07) y el tabaquismo (OR=6,17), encontrándose la dislipemia en el límite de la significación estadística. Conclusiones: Una décima parte de los pacientes presentan arteriopatía periférica. La concordancia entre el cuestionario Edimburgo y el índice tobillo-brazo es débil. Por lo que debería usarse el índice tobillo-brazo como método diagnóstico. Las manifestaciones clínicas infraestiman la prevalencia de arteriopatía. La edad, el tabaquismo y la dislipemia incrementan su riesgo. Los pacientes con arteriopatía presentan riesgo cardiovascular más elevado.

Resumo Com a transição democrática iniciada em Portugal em 1974, também a polícia procurou organizar-se em sindicatos. Mas esta aspiração só foi alcançada no início do século XXI, quando se abriu caminho à proliferação sindical, tendo-se atingido as 19 organizações em 2019. Este artigo mostra que a instrumentalização da forma legal pelos polícias levou ao desvirtuamento da natureza da ação sindical. Com base em entrevistas e na análise documental, conclui-se que o sistema de aferição de representatividade sindical deve implicar critérios objetivos e previsíveis para que haja condições mínimas (não suficientes) para o diálogo social.

Abstract With the democratic transition that began in Portugal in 1974 the police, too, sought to organize into unions. But this aspiration was achieved only at the beginning of the 21st century, when the path to union proliferation was opened, with 19 organizations having been reached in 2019. This article shows that the instrumentalization of the legal form by the police led to the distortion of the nature of union action. Based on interviews and document analysis, we conclude that the assessment system of union representativeness requires objective and predictable criteria to have minimum (not sufficient) conditions for social dialog.

Abstract The Revista de Historia de América began publication in 1938, thanks to the initiative and tesson of the Mexican historian Silvio Zavala, and the support of the Pan American Institute of Geography and History. This article is part of a major research project that analyzes the first ten years of the journal. It aims to be a contribution to the studies of cultural journals from a methodological perspective that opens up new ways of understanding this object of study. Its main contribution lies in exposing the way in which a publication was analyzed and the intellectual networks that made it possible through datification, a term by which we refer to the way in which relational scaffolding of significant data was built, for recombination and subsequent integration.

Resumen La Revista de Historia de América comenzó a publicarse en 1938, gracias a la iniciativa y el tesón del historiador mexicano Silvio Zavala, y al apoyo del Instituto Panamericano de Geografía e Historia. Este artículo es parte de un proyecto mayor de investigación que analiza los diez primeros años de la revista. Pretende ser un aporte a los estudios de las revistas culturales desde una perspectiva metodológica que abra nuevas formas de entender este objeto de estudio. Su principal aportación radica en exponer la manera como se analizó una publicación y las redes intelectuales que la hicieron posible mediante la datificación, término con el cual nos referimos a la manera en que se construyó el andamiaje relacional de los datos significativos, para su recombinación e integración posterior.

Resumo A Evapotranspiração (ET) é a segunda variável mais importante do ciclo hidrológico e influencia inúmeros processos da atmosfera. Desta forma, é interessante estudar as mudanças desta variável sob o contexto das mudanças climáticas antropogênicas e da constante ocorrência de secas no Nordeste Brasileiro (NEB). Foram analisadas as tendências da ET no NEB entre 1980 e 2016 a partir de dados em grade com alta resolução de 0.25° x 0.25º, constituindo 2071 pontos no NEB. Uma análise de agrupamentos mostrou que é plausível dividir a região em quatro grupos homogêneos. O grupo 1 é referente a área do semiárido na porção central do NEB. O grupo 2 é a faixa que circunda o semiárido. O grupo 3 localiza-se ao norte do Maranhão e o 4 na costa e noroeste do NEB. Analisando-se a tendência média da ET, observa-se que os grupos 2, 3 e 4 apresentaram tendências significativas de aumento da ET de 2,7 mm/ano, 3,51 mm/ano e 2,57 mm/ano, respectivamente. Em análise ponto por ponto, a porção central do NEB e semiárido apresentaram tendências positivas de ET anual (~0.8 mm/ano), enquanto o litoral noroeste e uma parte da região central da Bahia apresentaram tendências negativas (~1 mm/ano). Tais resultados devem estar associados as recentes tendências de temperatura e chuvas observadas no NEB, com impactos importantes nos núcleos de desertificação observados em muitas áreas da região, servindo de alerta a gestores ambientais e de recursos hídricos.

Abstract Evapotranspiration (ET) is the second most important variable in the hydrological cycle and influences several atmospheric processes. Therefore, the scientific interest in studying changes in that variable under the context of climate change and the usual occurrence of droughts in the Northeast of Brazil (NEB) is particularly valid. ET trends in the NEB were analysed from high resolution grid data (0.25°x0.25°) for the period between 1980 and 2016, comprising 2071 points in the NEB. A cluster analysis has shown that the region is climatically divisible into four homogenous groups. Group 1 represents the semiarid area in the central portion of the NEB. Group 2 is formed by the non-contiguous lands that surround the semiarid region. Group 3 is located in the north of Maranhão, whereas Group 4 is composed of patches spreading mostly over the eastern coast and the northwest of the NEB. By analysing the mean ET trend, it is possible to observe that groups 2, 3 and 4 show significant upward trends of 2.7 mm/year, 3.51 mm/year and 2.57 mm/year, respectively. According to a step-by-step analysis, the central (semiarid) area of the NEB presented a positive ET trend (~0.8 mm/year), whilst the northwestern coast and part of central Bahia showed negative trends (~ -1 mm/year). Such results may be linked to recent temperature and rainfall trends observed in the NEB, with important impacts for the desertification nuclei observed in many parts of the region, which represent a warning for environmental and water resources managers.

Marco contextual: Las infecciones de transmisión sexual son un problema de salud pública entre los jóvenes. Objetivos: Evaluar la eficacia de un programa educativo para reducir los comportamientos sexuales de riesgo. Metodología: Estudio de cohorte prospectivo y casi experimental. Muestra constituida por 1.303 estudiantes de enseñanza superior, de 18 a 24 años de edad. Se realizaron 8 horas de sesiones en grupo, con pretest y postest. Seguimiento a los 6 y 36 meses. Grupo de control evaluado en un primer momento (base de referencia) y 36 meses después. Resultados: En la base de referencia, el 69,38 % es sexualmente activo, parejas sexuales una media de 2,26. Utilizaron preservativo en la última relación sexual, con una pareja estable el 72,8 %, con parejas casuales el 82,2 %. El 10,2% mencionó las ITS. El 10,7% hizo la prueba del VIH. El 21,6 % tuvo relaciones sexuales bajo la influencia del alcohol u otras drogas. Después de la intervención, tienen más probabilidades de usar el condón en la última relación sexual con pareja estable (ORa: 4,61: [1,31-16,20]), de realizar la prueba del VIH (ORa: 7,59: [3,33 -17,35]), y el sexo con pareja casual en los últimos 12 meses es menos frecuente en las chicas. Conclusión: Se constató la utilidad de la intervención de grupo de corta duración.

Enquadramento: Infeções sexualmente transmissíveis são um problema de saúde pública entre os jovens. Objetivos: Avaliar a eficácia de um programa educacional de redução dos comportamentos sexuais de risco. Metodologia: Estudo de coorte prospetivo e quasi-experimental. Amostra constituída por 1.303 estudantes do ensino superior, dos 18 aos 24 anos de idade. Realizadas 8 horas de sessões em grupo, com pré e pós-teste. Seguimento aos 6 e 36 meses. Grupo de controlo avaliado num primeiro momento (baseline) e 36 meses depois. Resultados: Na baseline, sexualmente ativos são ٦٩,38%, parceiros sexuais em média 2,26. Usaram preservativo na última relação sexual, com parceiro estável 72,8%, com parceiros casuais 82,2%. Referiram IST, 10,2%. Fizeram o teste VIH 10, 7%. Relações sexuais sob influência de álcool ou outras drogas, 21,6 %. Após intervenção, têm maior probabilidade de usar preservativo na última relação sexual com parceiro estável (ORa:4,61: [1,31-16,20]), de realizar o teste VIH (ORa:7,59:[3,33-17,35]), e o sexo com parceiro casual nos últimos 12 meses é menos frequente nas raparigas. Conclusão: Foi constatada a utilidade de intervenção de grupo de curta duração.

Background: Sexually transmitted infections are a public health issue among young people. Objectives: To assess the effectiveness of an educational program to reduce risky sexual behaviors. Methodology: Prospective and quasi-experimental cohort study. The sample consisted of 1,303 higher education students, aged between 18 and 24 years. Eight hours of group sessions were held, with pre- and post-test assessment, and a follow-up took place at 6 and 36 months. The control group was evaluated at baseline and after 36 months. Results: In this sample, 69.38% of students were sexually active, with a mean of 2.26 sexual partners; 72.8% used a condom in the last sexual intercourse with a stable partner, 82.2% used it with occasional partners; 10.2% tested positive for STIs; 10.7% took an HIV test; 21.6% had sex under the influence of alcohol or other substances. The intervention group is more likely to use a condom in the last sexual intercourse with a stable partner (ORa: 4.61: [1.31-16.20]) and take an HIV test (ORa: 7.59: [3.33-17.35]). Sex with an occasional partner in the past 12 months was less frequent in the female group. Conclusion: Short-term group interventions proved to be useful.

Introduction: Dietary fiber is an important component of human diet. Since each fiber type has specific metabolic and gastrointestinal function effects, in each specific pathology we will have to choose the optimum type of fiber, considering its chemical, physical and physiological properties. Objective: to put partially hydrolyzed guar gum in its place in the complex framework of dietary fiber, to review its physicochemical properties and possible mechanisms of action; as well as its potential usefulness in different clinical situations in adult patients. Methods: non-systematic review in Medline. Results: Partially hydrolyzed guar gum (PHGG) is obtained from a partial enzymatic hydrolysis of guar gum by the enzyme β-endo-mannanase. It is a soluble, highly fermentable fiber with low viscosity. The fermentation of GGPH in colon produces short chain fatty acids, implicated in the main pathophysiological mechanisms responsible for their clinical effects. Its use in enteral nutrition associated diarrhea is supported by several studies and by the recommendations of scientific societies such as the European Society for Clinical Nutrition and Metabolism and the American Society for Parenteral and Enteral Nutrition. The usefulness of GGPH has been studied in many other clinical situations, such as diabetes, hypercholesterolemia, bacterial overgrowth, etc. with promising results. Conclusions: GGPH is useful in the management of enteral nutrition associated diarrhea. In other clinical situations, more quality studies would be necessary in order to make concrete recommendations.

Introducción: la fibra dietética es un componente importante de la dieta humana. Cada tipo de fibra tiene efectos específicos a nivel metabólico y en el funcionamiento gastrointestinal, por lo que en cada patología concreta habremos de elegir la fibra óptima teniendo en cuenta sus propiedades químicas, físicas y fisiológicas. Objetivo: encuadrar la goma guar parcialmente hidrolizada en su lugar en el complejo marco de la fibra dietética, revisar sus propiedades físico-químicas y posibles mecanismos de acción; así como su potencial utilidad en distintas situaciones clínicas en pacientes adultos. Métodos: revisión no sistemática en Medline. Resultados: la goma guar parcialmente hidrolizada (GGPH) se obtiene a partir de una hidrólisis enzimática parcial de la goma guar mediante la enzima β-endo-mananasa. Se trata de una fibra soluble, altamente fermentable y de baja viscosidad. La fermentación de la GGPH a nivel colónico produce ácidos grasos de cadena corta, implicados en los principales mecanismos fisiopatólogicos responsables de sus efectos a nivel clínico. Su uso en la diarrea asociada a la nutrición enteral está avalada por diversos estudios y por la recomendaciones de sociedades científicas como la European Society for Clinical Nutrition and Metabolism y la American Society for Parenteral and Enteral Nutrition. Se ha estudiado la utilidad de la GGPH en otras muchas situaciones clínicas, como diabetes, hipercolesterolemia, sobrecrecimiento bacteriano, etc. con resultados prometedores. Conclusiones: la GGPH es útil en el manejo de la diarrea asociada a nutrición enteral. Respecto a otras situaciones clínicas, serían necesarios más estudios de calidad para poder hacer recomendaciones concretas.

Resumen Introducción: Existe una gran variabilidad en las mediciones para el diagnóstico de la patología biomecánica. El objetivo de este estudio fue determinar la concordancia entre el ángulo de Clarke y el índice de Chippaux-Smirak, para determinar la validez del ángulo de Clarke utilizando como referencia el índice de Chippaux-Smirak. Métodos: Se realizó un estudio observacional en una muestra aleatoriamente seleccionada (n= 1,002) en A Coruña (España). Tras el consentimiento informado del paciente y la aprobación del comité de ética, se estudiaron variables, antropométricas, índice de comorbilidad de Charlson y un examen podológico (ángulo de Clarke, índice de Chippaux-Smirak). Se realizó un estudio descriptivo y un análisis multivariado de regresión logística. Resultados: La prevalencia de pie plano utilizando el podoscopio fue de 19.0% (pie izquierdo) y 18.9% (pie derecho), incrementándose con la edad. La prevalencia de pie plano según el índice Chippaux-Smirak o el ángulo de Clarke se incrementan considerablemente llegando a 62.0% y 29.7%. La concordancia (kappa I) entre los índices según grupos de edad oscila entre 0.25-0.33 (pie izquierdo) y 0.21-0.30 (pie derecho). El coeficiente de correlación intraclase (CCI) entre el índice de Chippaux-Smirak y el ángulo de Clarke es -0.445 (pie izquierdo) y 0.424 (pie derecho). Tras ajustar por edad, índice de masa corporal (IMC), score de comorbilidad y sexo la única variable con un efecto independiente para predecir discordancia es el IMC (OR= 0.969; IC 95%: 0.940-0.998). Conclusiones: La concordancia entre los índices estudiados para el diagnóstico de la patología del arco plantar es reducida. Existe a su vez una reducida sensibilidad del ángulo de Clarke para el diagnóstico de pie plano, utilizando como referencia el índice de Chippaux-Smirak. Esta discordancia disminuye con valores más altos de IMC.

Abstract Background: The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke's angle and Chippaux-Smirak index, and to determine the validity of Clarke's angle using the Chippaux-Smirak index as a reference. Methods: Observational study in a random population sample (n= 1,002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination (Clarke's angle and Chippaux-Smirak index). Descriptive analysis and multivariate logistic regression were performed. Results: The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke's angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25-0.33 (left foot) and 0.21-0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke's angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR= 0.969; 95% CI: 0.940-0.998). Conclusion: There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke's angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values.