Regional De Research Articles

Translation and Adaptation of the STOPP/START Criteria Version 3 for Potentially Inappropriate Prescribing in Older People to European Portuguese: A Study Protocol.

As the global population ages, managing medication use in older adults becomes increasingly complex due to polypharmacy and the associated risks of adverse drug events. To improve the safety and appropriateness of medication use in the older population, tools like the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria have been developed. The availability of updated criteria is crucial to better support healthcare professionals in Portuguese-speaking regions. The aim of this study is to translate and validate the STOPP/START version 3 criteria for Portuguese, providing an updated and useful tool for healthcare professionals. This study will be conducted through four phases: I) translation of the STOPP/START version 3 criteria to European Portuguese; II) collection of sociodemographic, clinical, and medication data; III) intrarater reliability study; and IV) interrater agreement study. This study obtained ethics approval by the Ethics Committee of the Administração Regional de Saúde do Centro, Portugal. The availability of the translated criteria will enable the integration of STOPP/START version 3 into clinical practice in Portugal, facilitating improved medication safety and appropriateness. This integration is expected to lead to better management of polypharmacy and a reduction in adverse drug events, ultimately enhancing patient outcomes and supporting evidence-based prescribing practices.

AVALIAÇÃO DA QUALIDADE DE VIDA E APOIO FAMILIAR NO PACIENTE DIAGNOSTICADO COM CÂNCER DE MAMA

Breast cancer is the main cause of death in the female population in almost all regions of Brazil, in addition to being an important global public health problem, due to high incidence and morbidity rates. The aim of the work is to evaluate the quality of life and psychosocial support of patients diagnosed with breast cancer. It refers to an observational study, in which interviews were carried out with women diagnosed with breast cancer treated at the Hospital Regional de Presidente Prudente. It was observed that the more negative the patients' self-perception was in relation to the support they received, their ability to carry out daily activities and their post-surgical mood, the worse their self-perception of quality of life was. This study highlights the importance of adopting multidisciplinary, patient-centered approaches and promoting a support network, which are essential for women to have a better quality of life.

Longitudinal assessment of SNPs rs72552763 and rs622342 in SLC22A1 over HbA1c control among Mexican-Mestizo diabetic type 2 patients.

Background: In Mexico, 75% of diabetes mellitus type 2 (DMT2) patients are not in glycaemic control criteria (HbA1c<7%); this entails a significantly variable drug response. Amongst the factors influencing such variability, are genetics, more specifically, single nucleotide polymorphisms (SNPs). Three genes implied in metformin pharmacokinetics are SLC22A1, SLC22A2, and SLC22A3, which are polymorphic. While there have been cross-sectional studies on their SNPs impact over drug response, a longitudinal study would contribute valuable information on their effect over time. Methods: SNPs of SLC22A1 (rs72552763, rs622342, rs12208357, rs2282143, rs594709, rs628031, and rs683369), SLC22A2 (rs316019), and SLC22A3 (rs2076828), were determined through PCR-TR. The clinical records of 69 patients undergoing metformin monotherapy were retrospectively assessed. Metformin is the first line treatment against DMT2. A level of HbA1c <7% (time 0) was considered as an inescapable inclusion criterion. The study's cases were those patients who reported HbA1c ≥ 7% (time1) after time 0 (t0). Kaplan-Meier curves including a Log-Rank test and a Cox multivariate analysis of proportional risks were performed. Aim: Determining clinical, biochemical, and genetic variables which may affect non-control (HbA1c ≥ 7%) survival time spans amongst DMT2 Mexican-Mestizo patients undergoing metformin monotherapy at Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) between October 2013 and December 2023. Results: All 69 patients were monitored over a median period of 642 days (273-1,134). A comparison between time 0 and time 1 (t1) revealed differences in weight (p = 0.036), metformin dose mg/kg/day (p = 0.003), plasmatic glucose mg/dL (p = 0.048), and HbA1c (p < 0.001). The median non-control survival rate was different across the 3 genotypes of rs62552763 in SLC22A1 (p = 0.0034) and the dominant genotypic model GAT/GAT vs. GAT/del + del/del (p = 0.009). There were differences between rs622342 genotypes as well (p = 0.041). In GAT/GAT the Cox model found HR = 0.407 (IC95%: 0.202-0.818, p = 0.011) in the univariate analysis and HR = 0.418 (IC95%: 0.204-0.856, p = 0.034) in the multivariate analysis, adjusted by initial metformin dose (mg/kg/day), initial weight (kg), and final metformin dose (mg/kg/day). Genotype A/A of rs622342 in SLC22A1, reported HR = 0.392 (IC95%: 0.169-0.910, p = 0.029) in the multivariate analysis as well. Conclusion: Among DMT2 Mexican-Mestizo patients undergoing metformin monotherapy the minor allele del in rs72552763 and the minor allele C in rs622342 reported a significantly shorter survival median respect to the wild type variant. Patients carrying del in rs72552763 or C in rs622342, both in SLC22A1, will reach non-control in less time with respect to other patients. Therefore these genotypes may constitute a therapeutic response biomarker for this population.

An early Transcriptomic Investigation in Adult Patients with Spinal Muscular Atrophy Under Treatment with Nusinersen

Spinal muscular atrophy (SMA) is a rare degenerative disorder with loss of motor neurons caused by mutations in the SMN1 gene. Nusinersen, an antisense oligonucleotide, was approved for SMA treatment to compensate the deficit of the encoded protein SMN by modulating the pre–mRNA splicing of SMN2, the centromeric homologous of SMN1, thus inducing the production of a greater amount of biologically active protein. Here, we reported a 10-month transcriptomics investigation in 10 adult SMA who received nusinersen to search for early genetic markers for clinical monitoring. By comparing their profiles with age-matched healthy controls (HC), we also analyzed the changes in miRNA/mRNAs expression and miRNA-target gene interactions possibly associated with SMA. A multidisciplinary approach of HT-NGS followed by bioinformatics/biostatistics analysis was applied. Within the study interval, those SMA patients who showed some clinical improvements were characterized by having the SMN2/SMN1 ratio slightly increased over the time, while in the stable ones the ratio decreased, suggesting that the estimation of SMN2/SMN1 expression may be an early indicator of nusinersen efficacy. On the other hand, the expression of 38/147 genes/genetic regions DE at T0 between SMA and HC like TRADD and JUND resulted “restored” at T10. We also confirmed the dysregulation of miR-146a(-5p), miR-324-5p and miR-423-5p in SMA subjects. Of interest, miR-146a-5p targeted SMN1, in line with experimental evidence showing the key role of astrocyte-produced miR-146a in SMA motor neuron loss. Molecular pathways such as NOTCH, NF-kappa B, and Toll-like receptor signalings seem to be involved in the SMA pathogenesis.

Caracterización de los pacientes atendidos con accidente ofídico en el Hospital Regional de la Orinoquía

Introduction: an ophidian accident is an intoxication due to snakebite venom inoculation. In Colombia, venomous snakes belong to the Viperidae, Elpidae and Colubridae genus. The bite causes tissue damage and characteristic clinical manifestations, including variable local and systemic pathophysiological alterations. Objective: to characterize patients with ophidian accidents treated at Hospital Regional de la Orinoquia (HORO) of Yopal, Colombia. Materials and methods: an observational, descriptive, cross-sectional, retrospective study, was conducted. All patients with snakebites who attended HORO between January 1, 2014, and May 30, 2020, were included. Results: 571 patients affected by an ophidian accident were identified; 70.1% were males; the minimum age at occurrence was 2 years and the maximum age, 89 years; most cases occurred in 2018 (19.5%). These accidents happened more often when walking along trails (31.2%) and in agricultural activities (29.6%). Bites predominantly involve the lower limbs (70.2%). Conclusions: ophidian accidents are a major public health problem, due to their frequency and outcomes. They are featured by tissue lesions and pathophysiological alterations, which can lead to critical illness and death.

Temporary clamping of the uterine arteries versus coventional technique for the prevention of postpartum hemorrage during cesarean section: a randomized controlled trial study

BackgroundCesarean sections are the most common abdominal surgical interventions worldwide, with increasing rates in both developed and developing countries. Postpartum (hemorrhage PPH) during cesarean sections can lead to maternal morbidity, prolonged hospital stays, and increased mortality rates. Although various non-surgical measures have been recommended for PPH prevention, surgical techniques such as uterine artery ligation and embolization have been used to manage PPH effectively.ObjectiveThis study aimed to evaluate the effectiveness of a surgical technique based on the temporary bilateral clamping of uterine arteries to reduce blood loss during cesarean sections.MethodsA longitudinal prospective, randomized, controlled study was conducted with a preliminary population group of 180 patients at the University Hospital Regional de Málaga from November 2023 to January 2024. The study protocol was approved by the Ethics Committee of the Regional University Hospital of Malaga (protocol 1729-N-23 and registred with ISRCTN15307819|| http://www.isrctn.org/, Date submitted 12 June 2023 ISRCTN 15307819). The patients were divided into two groups based on whether the clamping technique was applied during their cesarean sections. The study assessed hemoglobin levels before and after surgery, hospitalization durations, and the prevalence of anemia at discharge as the primary outcomes.ResultsThe patients who underwent the clamping technique demonstrated significant reductions in hemoglobin differences (0.80 g/dL) compared to the control group (1.42 g/dL). The technique also resulted in shorter hospital stays (3.02 days vs. 3.90 days) and a lower prevalence of anemia at discharge (76.2% vs. 60%).ConclusionTemporary clamping of uterine arteries during cesarean sections appears to be an effective measure for preventing postpartum hemorrhaging, reducing hospital stays, and decreasing the prevalence of anemia at discharge. Further research with larger sample sizes and standardized indications is warranted to confirm the benefits and potential broader applications of this technique.Trial registrationISRCTN 15,307,819.

Good Management Practice Is Correlated With Good Performance of Community-Engaged Primary Health Care Facilities in Peru.

Increasing prioritization of quality primary health care (PHC) includes community engagement as a key element to improve PHC performance. We assessed the correlation of good regional management practices with PHC performance in Peru in community-comanaged PHC that is designed with multiple accountability mechanisms. We conducted a secondary analysis of a survey of Dirección Regional de Salud (regional health directorates, DIRESAs) regarding their management of public PHC services with collaborative community involvement by a Comunidad Local de Administración de Salud (Local Community for Health Administration, CLAS). CLAS-run facilities have previously shown evidence of superior performance over standard PHC services. We classified survey questions on 5 management functions of the Primary Health Care Performance Initiative: leadership, information system, financial control, transfer of management and leadership skills to health facilities, and supervision. An expert panel designated management practices as "good" or "less effective." The outcome, PHC service performance, was the percentage of CLAS comanaged facilities in each DIRESA achieving coverage and utilization goals. We correlated frequency of good management practices with PHC service performance. DIRESAs were divided into Group 1, "higher performance," and Group 2, "lower performance," to identify specific practices linked to better performance. We identified 32 good management practices among 52 response options to 17 questions. Correlation between good management practice and good service performance was significant (r=.7266; 12 df; P<.01). An average of 91.1% and 37.6% of CLAS facilities achieved service goals in Groups 1 and 2, respectively. Of all good management practices identified, an average of 40.6% and 24.0% were used by Groups 1 and 2, respectively. Group 1 used 11 specific good practices more frequently than Group 2. Regional management and community-comanaged PHC services designed with accountability mechanisms should be intentionally aligned, incorporating these into policies, budgets, processes, and capacities to strengthen PHC services.

The use of virtualization for the recreation of historical events: The case of the 1562 Auto de Fe of Maní (Yucatan)

Virtual modelling is a growing discipline which has become an important tool in the context of heritage preservation. From this point of view, its usefulness is not limited only to the reconstruction of artifacts and built structures, but it also can be an essential tool for the reconstruction of historical events. Utilizing virtual modeling it is possible to create an interactive educational experience aimed at a large audience. Praeteritas Urbes, in collaboration with the National Institute for Anthropology and History’s (INAH) Museo Regional de Palacio Cantón in Mérida, Yucatán led a multidisciplinary group of researchers in the reconstruction of an important historical event for the history of the colonial period in the Maya area: the Auto de Fe of Maní held on July 12, 1562. This article discusses the methodology and the workflow used to complete the project, starting from the architectural reconstruction of the former convent of St. Michael the Archangel in the Maya town of Mani, as well as the virtual recreation of the historical characters, the built space, and the recreation of the scenario of this historical event. An important part of this project involved the digitalization of the museum’s collection of archaeological pieces used for the special exhibition on the Auto de Fe of Maní entitled, Ídolos: Resistencias y Persistencias.

The Council on Foreign Relations, the Israel Lobby, and the War on Gaza

As dangerous trans-Atlantic crossings between Africa and Europe continue to rise, Hannah Cross examines the roots of the ongoing crisis. The discussion around migration, she notes, "overlooks the imperial role of Europe and the United States over borders, migration regimes, regional (de-)integration, and national development projects within Africa." The solution, therefore, can only be found through genuine liberation and autonomy across the continent, rather than internationally imposed mechanisms benefitting the powerful in the Global North.

Return of the Atlantic Route from West Africa to Europe

As dangerous trans-Atlantic crossings between Africa and Europe continue to rise, Hannah Cross examines the roots of the ongoing crisis. The discussion around migration, she notes, "overlooks the imperial role of Europe and the United States over borders, migration regimes, regional (de-)integration, and national development projects within Africa." The solution, therefore, can only be found through genuine liberation and autonomy across the continent, rather than internationally imposed mechanisms benefitting the powerful in the Global North.

“Cansada, agobiada, frustrada”: Desafíos emocionales de docentes de inglés en primaria durante la pandemia: Estudio de caso en San Carlos, Costa Rica

Introduction. COVID-19’s health crisis put a hold on all educational processes worldwide. This was not the exception for Costa Rica at the Ministry of Education. In March 2020, it was proposed that distance education was going to be put into practice. Purpose. This paper focuses on the feelings the participants communicated during the study. This was part of a principal investigation that used a case study methodology based on inductive qualitative research. It had the purpose of describing the perceptions of four English primary school teachers from the Dirección Regional de Educación San Carlos (San Carlos Regional Education Office) regarding distance education during the sanitary emergency of COVID-19. Methodology. Data were collected through in-depth interviews, lesson plans, and video recordings of pedagogical mediation and professional contexts. The data were analyzed using semantic categories from content analysis (Hatch, 2002) and the Web Qualitative Data Analysis (webQDA) software (Costa et al., 2019). Results. Results suggest that teachers reported experiencing a range of emotions before and during the pandemic, with the majority being negative in nature. Among the most notable were uncertainty, stress, confusion, overwork, a sense of difficulty, sadness, and worry. Other feelings included discrimination, impotence, and disrespect towards the teachers and the families’ specific contexts. This study presents the teachers from their human dimension as professionals who endured the pandemic within their own educational contexts. The study also shows the importance of effective communication and taking into consideration psychological support to strengthen the emotional integrity of the teachers.

AN EXPLORATORY STUDY OF THE EVOLUTION OF URBAN GREEN SPACES IN LISBON USING DIACHRONIC ANALYSIS OF ORTHOPHOTO MAPS

Green urbanism, namely in the form of consolidated urban green spaces (UGSs), has gained traction along with the reformist impetus of urban design, based on the ideal of efficient, functional, sustainable cities that promote a better quality of life for their citizens and on the notion of making urban expansion compatible with natural resources. Using a diachronic analysis (1995–2020) of the orthophoto maps of 38 UGSs included in the last version of the main municipality’s legislation, framed within the Plano Director Municipal (PDM), whose first version was approved in 1994, we assessed the situation and evolution of the UGSs in the centre of Lisbon, Portugal. We conclude that with fewer or more incidences, depending on the periods analysed, the structure of UGSs in the centre of Lisbon has undergone significant changes, whether in terms of the implementation and requalification of existing UGSs or in terms of the increment and quality of UGSs (space created), thus respecting to a lesser or greater degree the strategic lines defined in various plans, as is the case of the PDM itself, but also of other important documents, such as the Carta Estratégica 2010–2024, Estratégia de Reabilitação Urbana 2011–2024 and Estratégia Regional de Lisboa 2030.

Comparison of eight prehospital early warning scores in life-threatening acute respiratory distress: a prospective, observational, multicentre, ambulance-based, external validation study

A myriad of early warning scores (EWSs) exist, yet there is a need to identify the most clinically valid score to be used in prehospital respiratory assessments to estimate short-term and midterm mortality, intensive-care unit admission, and airway management in life-threatening acute respiratory distress. This is a prospective, observational, multicentre, ambulance-based, external validation study performed in 44 ambulance services and four hospitals across three Spanish provinces (ie, Salamanca, Segovia, and Valladolid). We identified adults (ie, those aged 18 years and older) discharged to the emergency department with suspected acute respiratory distress. The primary outcome was 2-day all-cause in-hospital mortality, for all the patients or according to prehospital respiratory conditions, including dyspnoea, chronic obstructive pulmonary disease (COPD), COVID-19, other infections, and other conditions (asthma exacerbation, haemoptysis, and bronchoaspirations). 30-day mortality, intensive-care unit admission, and invasive and non-invasive mechanical ventilation were secondary outcomes. Eight EWSs, namely, the National Early Warning Score 2, the Modified Rapid Emergency Medicine Score, the Rapid Acute Physiology Score, the Quick Sequential Organ Failure Assessment Score, the CURB-65 Severity Score for Community-Acquired Pneumonia, the BAP-65 Score for Acute Exacerbation of COPD, the Quick COVID-19 Severity Index, and the Modified Sequential Organ Failure Assessment (mSOFA), were explored to determine their predictive validity through calibration, clinical net benefit as determined through decision curve analysis, and discrimination analysis (area under the curve of the receiver operating characteristic [AUROC], compared with Delong's test). Between Jan 1, 2020, and Nov 31, 2022, 902 patients were enrolled. The global 2-day mortality rate was 87 (10%); in proportion to various respiratory conditions, the rates were 35 (40%) for dyspnoea, nine (10%) for COPD, 13 (15%) for COVID-19, 28 (32%) for other infections, and two (2%) for others conditions. mSOFA showed the best calibration, a higher net benefit, and the best discrimination (AUROC 0·911, 95% CI 0·86-0·95) for predicting 2-day mortality, and its discrimination was statistically significantly more accurate (p<0·0001) compared with the other scores. The performance of mSOFA for predicting 2-day mortality was higher than the other scores when considering the prehospital respiratory conditions, and was also higher for the secondary outcomes, except for non-invasive mechanical ventilation. Our results showed that mSOFA outperformed other EWSs. The inclusion of mSOFA in prehospital decision making will entail a quick identification of patients in acute respiratory distress at high risk of deterioration, allowing prioritisation of resources and patient care. Gerencia Regional de Salud, Public Health System of Castilla y León (GRS Spain). For the Spanish translation of the abstract see Supplementary Materials section.

Multiple sclerosis: A descriptive series

IntroductionMultiple sclerosis (MS) is a chronic multifocal inflammatory demyelinating disease that progresses with neurodegeneration and is associated with a high risk of disability. ObjectivesWe describe a series of patients diagnosed with MS in the past 10 years at a secondary hospital in Colombia. MethodsWe conducted a descriptive, retrospective study of a series of patients attended at the outpatient clinic of the neurology department of Hospital Regional de la Orinoquía, in Colombia, between 2013 and 2022, and who were diagnosed with MS according to the McDonald criteria. ResultsWe included 15 patients with a confirmed diagnosis of MS; 66.7% were women, with a mean age of 42 years (range, 16–71). Mean time from symptom onset to inclusion in the study was 87.4 months; 20% of patients presented disability. The distribution by type of MS was as follows: 20% patients had primary progressive MS, 20% had secondary progressive MS, 40% had clinically isolated syndrome, and 20% had relapsing–remitting MS. The mortality rate was 20%, with a median survival time of 89.83 months. ConclusionsAlthough treatment achieves significant improvements in symptoms and quality of life at every stage of the disease, early diagnosis is essential to prevent progression to disability.

Community strategies for health promotion and prevention of chronic non-communicable diseases with a focus on physical activity and nutrition: the URO/FOCOS study protocol.

Non-communicable diseases (NCDs) account for 71% of all annual deaths, totaling 41 million people worldwide. The development and progression of these diseases are highly related to the environment and lifestyle choices, among which physical inactivity and excess malnutrition stand out. Currently, in Chile, there is no evidence at the regional and local level on the impact of physical activity and healthy nutrition plans and interventions on health promotion, prevention, and timely treatment of NCDs. The following protocol delineates the URO/FOCOS (Universidad Regional de O'Higgins/FOrtaleciendo COmunidades Saludables- Regional University of O'Higgins/Strengthening Healthy Communities) study, which will assess pilot community intervention strategies using a participatory action research approach by identifying barriers and facilitators on the practice of physical activity and healthy eating habits. In this project, the community from the O'Higgins region will be involved throughout the entire research process to develop strategies that promote regular physical activity and healthy eating practices. We propose three interrelated strategies: (1) Participatory Action Research, (2) Community interventions for promoting physical activity and healthy nutrition practices, and (3) health education. The URO/FOCOS study offers a unique opportunity in the O'Higgins region to develop participatory strategies and interventions based on the community's needs and motivations with regard to physical activity and healthy eating habits. We believe these strategies will help to improve the community's overall health through effective changes in their decision and preferences toward a more active lifestyle and healthier nutrition practices.

Doenças de pele diagnosticadas em bovinos na região sul do Rio Grande do Sul

ABSTRACT: A retrospective study of skin diseases diagnosed in cattle from 2000 to 2022 was performed at the “Laboratório Regional de Diagnóstico” of the “Faculdade de Veterinária” of the “Universidade Federal de Pelotas” (LRD-UFPel) to determine the main skin diseases that affect cattle in southern Brazil. Information regarding epidemiological data, lesions and diagnosis was collected. The diseases were grouped into infectious/inflammatory, toxic, nonneoplastic proliferative and neoplastic. The macroscopic aspects, distribution, histopathology, and evolution of the lesions were obtained in the protocols, and the original diagnosis was preserved. The main skin diseases diagnosed during this period occurred during outbreaks. They were infectious, with an emphasis on dermatophilosis, papillomatosis and dermatophytosis, followed by hepatogenous photosensitization, which was included in the group of toxic diseases. Among the neoplasms, squamous cell carcinoma stood out, occurring in isolated cases, reflecting an irrelevant cause of economic losses.

Clinical and radiological manifestations associated with triple-negative breast cancer in women from northern Peru. A case-control study.

Triple-negative breast cancer (TNBC) has an aggressive clinical behaviour, with advanced stages at initial diagnostic evaluation, early recurrences and poor survival, so the purpose was to determine the clinical and radiological manifestations associated with TNBC. A case-control study in women diagnosed with breast cancer from January 2015 to August 2022 at the 'Instituto Regional de Enfermedades Neoplásicas del Norte'. We classified cases (Triple Negative subtype) and controls (Luminal A, Luminal B and HER2) according to immunohistochemistry ical analysis. Bivariate and multivariate logistic regression models were used to calculate the odds ratio (OR) with their respective 95% confidence intervals (CIs). The medical reports of 88 cases and 236 controls were reviewed. Cases were more likely to report pain (p = 0.001), nodules on ultrasound (p = 0.01) and mammography (p = 0.003), superior median size (p < 0.05), posterior enhancement (p = 0.001) and moderate density (p = 0.003). Multivariate analysis identified that TNBC was more likely to have a nodular type lesion by ultrasound (OR: 9.73, 95% CI: 1.10-86.16; p = 0.04), ultrasound lesion larger than 36 mm (OR: 4.99, 95% CI: 1.75-14.17; p = 0.003) and moderate density (OR: 3.83, 95% CI: 1.44-10.14; p = 0.007). There are particular clinical and imaging manifestations of TNBC, showing that radiological lesions that presented characteristics in ultrasound as nodular type lesions larger than 36 mm and in mammography moderate grade density, were associated with this subtype of breast tumours in a Peruvian population.

Prognostic factors of postoperative morbidity in surgery for resectable pancreatic cancer. Regional institute of neoplastic diseases 'Dr. Luis Pinillos Ganoza' IREN Norte. 2007-2022.

To determine the prognostic factors associated with postoperative morbidity for resectable pancreatic cancer at the Instituto Regional de Enfermedades Neoplásicas del Norte 'Dr. Luis Pinillos Ganoza' - IREN Norte. 2007-2022. A study was conducted with a case-based (22 patients) and control (14 patients) design nested in a cohort that included 36 patients who underwent proximal duodenopancreatectomy (Whipple) or distal pancreatectomy for pancreatic cancer. In the present study, it was found that the total number of living patients represents 86.1% of the total (36 patients). Of the total population, patients who presented only 1 complication were 13.6% and more than 1 complication were 86.4%. It was also found that the most frequent complication in the general population was gastric emptying syndrome, which was present in 50% of all patients. In the bivariate analysis, a highly significant association was observed between the low prognostic nutritional index (p < 0.001, OD = 20.400, CI = 95%: (3.377-123.245)), the type of pancreatic resection (p < 0.001, OR = 52.500, CI = 95%: (5.174-532.669)) and postoperative morbidity. In contrast, no significant association was found between age ≥65 (p = 0.062), diabetes mellitus (p < 0.908), Wirsung diameter (p < 0.432), hospital stay (p < 0.075) and postoperative morbidity. In the multivariate analysis, serum total bilirubin level ≥20 μmol/L (p = 0.778), use of preoperative biliary drainage (p = 0.176), type of pancreatojejunal anastomosis (p = 0.533) and pancreaticogastric anastomosis (p = 0.504) were not statistically significantly associated with postoperative morbidity. The type of pancreatic resection and the nutritional prognostic index <40.5 are prognostic factors of postoperative morbidity in postoperative patients for resectable pancreatic cancer.

Desde las regiones: respuesta a la epidemia del COVID-19 de organizaciones indígenas regionales de la Amazonía peruana

The objective of this article is to point out the responses to covid-19 epidemic implemented by two Amazonian indigenous organizations at the regional level, orpio (Organización Regional de Pueblos Indígenas del Oriente) in the department of Loreto and fenamad (Federación Nativa of Madre de Dios) in the department of Madre de Dios, during the years 2020 to 2021, for which a qualitative study was carried out in which representatives of the aforementioned indigenous organizations were interviewed. The results reveal new forms of indigenous agency and advocacy on indigenous health issues, not only to claim the right to health care from the State, but also for the right to participate and be included in decision-making to face the epidemic. in indigenous peoples.

Magnitude and Determinants of Long-term Use of Proton Pump Inhibitors Among Portuguese Older Adults in Primary Health Care

PurposeProton Pump Inhibitors (PPIs) have been associated with several adverse effects of particular concern in older populations. Their use for a period longer than 8 weeks is not recommended for older adults. Strategies to discontinue PPIs have been offered; however, their use remains high. This study aims to characterize PPI use in Portuguese older people and to identify the factors associated with potentially inappropriate use. MethodsA cross-sectional study was conducted on 1200 randomly selected older adults (≥65 years of age), users of primary health care facilities in the Regional Health Administration (Administração Regional de Saúde of Centro [ARSC]) of Portugal between April 2021 and August 2022. Data concerning their characteristics and PPI use were provided by the Shared Services of the Health Ministry (Serviços Partilhados do Ministério da Saúde) and collected retrospectively. Associations between independent variables and PPI use were investigated by logistic regression analysis. FindingsOf the older adults, 37.92% were receiving PPIs and 78.68% of them were taking them for a longer period than recommended; 49.79% were taking PPIs without having any digestive system–related disease. Multivariate analysis showed that the prolonged use of PPIs was not associated with any specific pattern, although inappropriate PPI use is high among Portuguese older adults. ImplicationsLong-term PPI use in older adults is widespread and does not fit any particular patient profile; therefore, cross-cutting educational interventions should be designed independently of the patient's pathologic condition or treatment.