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Congenital heart disease (CHD) is a common structural anomaly, affecting ~ 1% of live births worldwide. Advancements in medical and surgical management have significantly improved survival for children with CHD, however, extracardiac malformations (ECM) continue to be a significant cause of morbidity and mortality. Despite clinical significance, there is limited literature available on ECM in neonates with CHD, especially from Latin America. A cross-sectional study of neonates with severe CHD evaluated by the medical-surgical board team at Fundación Cardiovascular de Colombia from 2014 to 2019 was completed to characterize morbidity, mortality, surgical outcomes, and ECM. Demographics and surgical outcomes were compared between neonates with and without ECM. Medical record data were abstracted and descriptive statistical analysis was performed. Of 378 neonates with CHD, 262 had isolated CHD (69.3%) and 116 had ECM (30.7%). The most common ECM was gastrointestinal (n = 18, 15.5%) followed by central nervous system (n = 14, 12%). Most neonates required a biventricular surgical approach (n = 220, 58.2%). Genetic testing was performed more often for neonates with ECM (n = 65, 56%) than neonates with isolated CHD (n = 14, 5.3%). Neonates with ECM had lower birth weight, longer hospital stays, and higher postsurgical complications rates. There was no difference in survival between groups. Overall, Screening for ECM in neonates with CHD is important and identification of ECM can guide clinical decision-making. These findings have important implications for pediatric healthcare providers, especially in low- and middle-income countries, where the burden of CHD is high and resources for managing CHD and extracardiac malformations may be limited.

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Objetivo: avaliar a associação entre a autopercepção de saúde e a depressão de adultos brasileiros. Método: estudo transversal de base populacional, realizado no ano de 2019 em 26 estados e Distrito Federal, envolvendo 81.851 informantes de adultos respondentes da Pesquisa Nacional de Saúde. Foi adotado o modelo de regressão logística bivariada e múltiplo com medida de associação Odds Ratio (OD) e intervalo de confiança (IC) de 95% no Stata versão 11. Resultado: a prevalência de depressão entre adultos no Brasil foi de 9,01%. Pessoas com autopercepção de saúde ruim tiveram 1,87 vez maior chance de ter a doença quando comparadas àquelas com autopercepção de saúde boa (IC 95%: 1,69- 2,07). Dentre os fatores de risco para depressão, destacaram-se ser mulher, ter idade acima de 30 anos, não ter cônjuge, prática de atividade física semanal inferior a 150 minutos, não fazer esforço físico no trabalho e assistir televisão por mais de duas horas. Conclusão: este estudo apresenta os fatores associados à depressão, o que possibilita implementação de ações de prevenção da doença mental. Recomenda-se a realização de pesquisas longitudinais que propiciem a avaliação causal entre o desfecho e outras exposições.

Objective: to evaluate the association between self-perceived health and depression in Brazilian adults. Method: cross-sectional population-based study, carried out in 2019, in 26 states and the Federal District, involving 81,851 with informants from adult respondents to the National Health Survey. The bivariate and multiple logistic regression model was performed using the Odds Ratio (OD) association measure, and 95% confidence interval (CI) in Stata version 11. Result: the prevalence of depression among adults in Brazil was 9.01%. People with self-perceived poor health were 1.87 times more likely to have depression when compared to those with self-perceived good health (95% CI: 1.69-2.07). Among the risk factors for depression was being a woman, being over 30 years of age, not having a spouse, practicing weekly physical activity of less than 150 minutes, not doing physical effort at work, and watching television for more than two hours. Conclusion: this study presents the factors associated with depression, which makes it possible to implement actions to prevent mental illness. It is recommended to carry out longitudinal studies that provide a causal assessment between the outcome and other exposures.

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INTRODUCTION: The benefits of exercise in patients with obesity are clear; physical performance and quality of life improve after exercise programs in patients with obesity. Our aim was to evaluate the usefulness of an easy, structured, and home-based exercise program to improve physical performance and quality-of-life in patients with obesity. METHODS: A cohort of patients with obesity (BMI ≥30 kg/m2) was recruited during 2017-2020. Patients who met the inclusion criteria were invited and those who accepted signed informed consent. Patients were evaluated by the same team of physicians who performed the 6-min walking test and collected the clinical and biochemical variables, also applied quality-of-life questionnaire at baseline and 3 months after starting the exercise program that was divided in two levels: level 1: active mobilization of four limbs (15 min) + cardiovascular exercise (15 min walking), 5 days/week; level 2: eight strengthening exercises for upper and lower limbs with an elastic band + cardiovascular exercise (15 min walking), 5 days/week. This study used means (SD), frequencies (percent), Student's t test, and Pearson correlation test. RESULTS: We included 151 patients, mostly women (81.5%), age 46.3 ± 9.8 years old, BMI 40.3 ± 8.56 kg/m2, 34.4% performed some type of exercise, and the most frequents comorbidities were dyslipidemia and diabetes. After 3 months, 86 patients (57%) remained in the study and attended the final evaluation. Evident changes in physical performance were reported (distance traveled, speed walking and VO2max); however, improvement in quality of life was remarkable. CONCLUSION: An easy, structured, and home-based exercise program improves physical performance and quality of life in patients with obesity, without losing its benefits for the health.

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The prediction of the number of infected and dead due to COVID-19 has challenged scientists and government bodies, prompting them to formulate public policies to control the virus' spread and public health emergency worldwide. In this sense, we propose a hybrid method that combines the SIRD mathematical model, whose parameters are estimated via Bayesian inference with a seasonal ARIMA model. Our approach considers that notifications of both, infections and deaths are realizations of a time series process, so that components such as non-stationarity, trend, autocorrelation and/or stochastic seasonal patterns, among others, must be taken into account in the fitting of any mathematical model. The method is applied to data from two Colombian cities, and as hypothesized, the prediction outperforms the obtained with the fit of only the SIRD model. In addition, a simulation study is presented to assess the quality of the estimators of SIRD model in the inverse problem solution.

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BACKGROUND: The profile of changes in airway driving pressure (dPaw) induced by positive-end expiratory pressure (PEEP) might aid for individualized protective ventilation. Our aim was to describe the dPaw versus PEEP curves behavior in ARDS from COVID-19 patients. METHODS: Patients admitted in three hospitals were ventilated with fraction of inspired oxygen (FiO2) and PEEP initially adjusted by oxygenation-based table. Thereafter, PEEP was reduced from 20 until 6 cmH2O while dPaw was stepwise recorded and the lowest PEEP that minimized dPaw (PEEPmin_dPaw) was assessed. Each dPaw vs PEEP curve was classified as J-shaped, inverted-J-shaped, or U-shaped according to the difference between the minimum dPaw and the dPaw at the lowest and highest PEEP. In one hospital, hyperdistention and collapse at each PEEP were assessed by electrical impedance tomography (EIT). RESULTS: 184 patients (41 including EIT) were studied. 126 patients (68%) exhibited a J-shaped dPaw vs PEEP profile (PEEPmin_dPaw of 7.5 ± 1.9 cmH2O). 40 patients (22%) presented a U (PEEPmin_dPaw of 12.2 ± 2.6 cmH2O) and 18 (10%) an inverted-J profile (PEEPmin_dPaw of 14,6 ± 2.3 cmH2O). Patients with inverted-J profiles had significant higher body mass index (BMI) and lower baseline partial pressure of arterial oxygen/FiO2 ratio. PEEPmin_dPaw was associated with lower fractions of both alveolar collapse and hyperinflation. CONCLUSIONS: A PEEP adjustment procedure based on PEEP-induced changes in dPaw is feasible and may aid in individualized PEEP for protective ventilation. The PEEP required to minimize driving pressure was influenced by BMI and was low in the majority of patients.

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RESUMEN Introducción: Actualmente se ha observado que la hipovitaminosis D y la obesidad pueden influir en el desarrollo de enfermedad cardiovascular en el futuro. Objetivo: Identificar la asociación entre deficiencia de vitamina D y factores de riesgo cardiometabólicos en los pacientes pediátricos del noroeste de México. Materiales y métodos : se incluyeron niños de 6 a 15 años, se les midieron variables somatométricas, niveles séricos de colesterol total, C-HDL, C-LDL, triglicéridos, glucosa, insulina, vitamina D e índice HOMA-IR. Se identificó la asociación de factores de riesgo cardiometabólicos y la deficiencia de vitamina D, mediante la prueba de Chi cuadrado. Resultados: De los 114 pacientes evaluados, se detectó eutrofia en 42.1%, sobrepeso en 12.3%, obesidad en 41.2% y desnutrición en 4.4%. La prevalencia de deficiencia en vitamina D, insuficiencia y suficiencia fueron 18.4%, 27.2% y 54.4% respectivamente. La deficiencia de vitamina D mostró mayor predominio en pacientes con obesidad (27 %). La hipertrigliceridemia se asoció estadísticamente con deficiencia de vitamina D (p 0.041). Se observaron correlaciones inversas entre niveles de vitamina D con HOMA (r=-0.191; p=0.41), score Z IMC (r=-0.210; p=0.025) e insulina (r=-0.227; p=0.015). Conclusiones: La deficiencia de vitamina D se asocia en niños con un IMC elevado y resistencia a la insulina, lo cual puede acelerar el desarrollo de síndrome metabólico, diabetes mellitus tipo 2 y enfermedad cardiovascular.

ABSTRACT Introduction: It has currently been observed that hypovitaminosis D and obesity can influence the future development of cardiovascular disease. Objective: To identify the association between vitamin D deficiency and cardiometabolic risk factors in pediatric patients from northwestern Mexico. Materials and methods: Children aged 6 to 15 years were included, somatometric variables, serum levels of total cholesterol, HDL-C, LDL-C, triglycerides, glucose, insulin, vitamin D and HOMA-IR index were measured. The association of cardiometabolic risk factors and vitamin D deficiency was identified using the Chi square test. Results: Of the 114 patients evaluated, normal body-mass index was detected in 42.1%, 12.3% were overweight, 41.2% were obese and 4.4% were malnourished. The prevalence of vitamin D deficiency, insufficiency and sufficiency were 18.4%, 27.2% and 54.4% respectively. Vitamin D deficiency was more prevalent in obese patients (27%). Hypertriglyceridemia was statistically associated with vitamin D deficiency (p = 0.041). Inverse correlations were observed between vitamin D levels with HOMA (r = -0.191; p = 0.41), BMI Z score (r = -0.210; p = 0.025) and insulin (r = -0.227; p = 0.015). Conclusions: Vitamin D deficiency is associated with a higher BMI and insulin resistance in children, which can accelerate the development of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease.

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A proposta deste trabalho foi avaliar os conhecimentos e atitudes em saúde bucal de mães acompanhadas em serviço de puericultura na atenção primária, particularmente direcionados aos seus bebês. Métodos: Estudo transversal, com a análise descritiva e analítica dos dados, desenvolvido com mães acompanhadas na puericultura de uma Unidade de Saúde da Família do Distrito Sanitário V da cidade do Recife, estado de Pernambuco. A amostra foi do tipo censitária, de acordo com os critérios de inclusão e exclusão adotados. Para a coleta de dados empregou-se a entrevista face a face com a aplicação de questionário, entre os meses de novembro e dezembro do ano de 2018. A margem de erro adotada para os testes estatísticos foi de 5% considerando-se os testes Exato de Fisher e Qui-quadrado de Pearson. O projeto deste estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco, sob CAAE 95992518.8.0000.5208. Resultados: A amostra total foi composta por 77 mães, com sua maior frequência na faixa etária entre 21 e 30 anos, apresentando ensino fundamental incompleto e renda mensal familiar inferior a um salário mínimo. Dessas, a maioria não recebeu orientações sobre saúde bucal no serviço de puericultura. Aproximadamente metade dos bebês com até 24 meses de idade faziam o uso de mamadeira noturna, sem higiene após a mesma e com uma dieta rica em açúcar a partir dos seis meses de idade. Principais conclusões: As pesquisadas detinham um conhecimento insatisfatório, na grande maioria, quanto aos hábitos e cuidados de saúde bucal de seus filhos.

The purpose of this study was to evaluate the oral health knowledge and attitudes of mothers accompanied in primary care service, particularly in relation to their babies. Methods: Cross-sectional study, with descriptive and analytical analysis of the data, developed with mothers assisted in childcare at a Family Health Unit in the Health District V of the city of Recife, State of Pernambuco. The sample was of the census type, according to the adopted inclusion and exclusion criteria. Data was collected by conducting face-to-face interviews with the application of a questionnaire between November and December of the year 2018. The margin of error adopted for the statistical tests was 5% considering the Fisher's Exact and Person's Chi- square. The study project was approved by the Research Ethics Committee of the Federal University of Pernambuco under CAAE 95992518.8.0000.5208. Results: The sample consisted of 77 mothers, with the highest frequency in the age group of 21-30 years of age, presenting incomplete elementary education and monthly family income below a minimum wage. Of these, the majority did not receive oral health guidelines in the childcare service. Approximately half of the babies up to 24 months of age had bedtime bottle, with no hygiene after use and a high-sugar diet from six months of age. Main conclusions: The respondents had an unsatisfactory knowledge, in the great majority, on the oral health care and habits of their children.

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The prevalence of sarcopenia in hospitalized people living with HIV is underdiagnosed, as assessment instruments are not always available. This study aimed to identify factors related to sarcopenia, correlating their anthropometric and clinical markers in hospitalized people living with HIV. This was an observational cross-sectional clinical study, carried out from September 2018 through October 2019. Handgrip strength, muscle mass index, calf circumference and gait speed test were evaluated in recruited patients within three days of hospital admission. The sample consisted in 44 patients, mostly men (66%), black (68%), young adults (41.65±12.18 years) and immunodeficient (CD4 cell count 165 cells/mm3 [34.25-295.5]). Sarcopenia was present in 25% of the sample. Calf circumference showed a significant correlation with CD4 cell count and viral load (p<0.05) while handgrip strength and gait speed test did not. Calf circumference>31cm and gait speed test>0.8m/s reduced the chance of sarcopenia by 60% (OR=0.396 [-1.67 to -0.18]; p<0.05) and 98% (OR=0.02 [-8.16 to 0.13]; p<0.05) respectively. Calf circumference>31cm and gait speed test>0.8m/s are associated with a reduced chance of sarcopenia in hospitalized HIV patients.

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Introduction: Environmental conditions and the work process in the Central Sterile Services Department expose workers to many hazards. Objectives: To analyze the working conditions that have an influence on the overall health of workers at a Central Sterile Services Department of a hospital in northern Brazil. Methods: This study used employed the ergonomic analysis of work. Three data collection tools were applied to characterize sociodemographic and occupational profiles. Furthermore, physical environmental hazards were analyzed using specific equipment. Descriptive and bivariate analyses were performed in Stata®13 software. Results: Thirty-five workers participated in the study, most of whom were women, aged above 40 years, and worked as nursing technicians. It became evident that workers were exposed to inappropriate lighting and to noises coming from autoclaves, from the central air conditioning, and from the use of medicinal gas. The risks for musculoskeletal injuries on spine, shoulders, and lower limbos were specifically related to overload resulting from the posture maintained for long periods. Female sex was associated with severe or excruciating pain" (p = 0.04). Conclusions: Sound, mechanical, and visual hazards were found. Most participants complained of musculoskeletal pain, and the cervical spine was the site with the most frequent reports of excruciating pain. These results point out to the need of a policy to improve the quality of work in the health care unit studied; however, these findings may also bring light to the problem in other institutions that have a physical structure similar to that found in this research.

Introdução: As condições ambientais e o processo de trabalho no Centro de Material e Esterilização expõem os trabalhadores a diversos riscos. Objetivos: Analisar as condições de trabalho que influenciam a saúde global dos trabalhadores do Centro de Material e Esterilização de um hospital do norte do Brasil. Métodos: Utilizou-se a metodologia de análise ergonômica do trabalho. Foram aplicados três instrumentos de coleta de dados para caracterizar os perfis sociodemográfico e ocupacional. Além disso, foram analisados os riscos físico-ambientais utilizando equipamentos específicos. As análises descritiva e bivariada foram realizadas no software Stata®13. Resultados: Participaram do estudo 35 trabalhadores, sendo a maioria mulheres, com idade acima de 40 anos e técnicos de enfermagem. Evidenciou-se que os trabalhadores eram expostos a iluminância inadequada e ruídos originados das autoclaves, da central do ar-condicionado e do uso do gás medicinal. Os riscos para lesões musculoesqueléticas na coluna, no ombro e nos membros inferiores especificamente se relacionam à sobrecarga exigida pelas posturas assumidas por longos períodos. O sexo feminino foi associado com dor do tipo "bastante ou extrema" (p = 0,04). Conclusões: Foram encontrados riscos sonoros, mecânicos e visuais. A maioria dos participantes apresentou queixas de dores musculoesqueléticas, sendo a coluna cervical o local de maior frequência de dor do tipo extrema. Esses resultados apontam para a necessidade de uma política de melhorias da qualidade do trabalho na unidade estudada; porém, esses achados também podem trazer luz à problemática em outras instituições que possuam estrutura física semelhante à encontrada nesta pesquisa.

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El objetivo de este trabajo fue establecer la relación entre el grado de enfermedad periodontal y el control metabólico de la glucemia en pacientes que padecen diabetes tipo 2. Es un estudio de tipo observacional, descriptivo, transversal. Se seleccionaron 42 pacientes con diagnóstico de diabetes mellitus tipo 2 de ambos sexos, entre 25 y 75. Se realizó odontograma y se evaluó el grado de enfermedad periodontal para determinar el grado de compensación metabólica de los pacientes se tomaron muestras de sangre venosa y se midieron los valores de hemoglobina glicosilada. Un 23,55% de los pacientes no presentaron enfermedad periodontal y el resto se dividió en leve, moderada y severa presentándose la enfermedad leve en primer orden. Los pacientes con mayor grado de enfermedad periodontal presentaron mayor número de piezas dentarias perdidas (p 0,0334). La enfermedad periodontal se distribuye de la misma manera en ambos grupos de control glucémico (p=0,1211). En el grupo estudiado, el grado de enfermedad periodontal es independiente del control glucémico de los pacientes (AU)

The objective of this work was to establish the relationship between the degree of periodontal disease and the metabolic control of glycemia in patients with type 2 diabetes. It is an observational, descriptive, cross-sectional study. 42 patients with a diagnosis of type 2 diabetes mellitus of both sexes, between 25 and 75, were selected. An odontogram was performed and the degree of periodontal disease was evaluated; venous blood samples were taken and glycosylated hemoglobin values were measured to determine the degree of metabolic compensation of the patients. 23.55% of the patients did not present periodontal disease and the rest were divided into mild, moderate, and severe, with mild disease presenting in the first order. The patients with a higher degree of periodontal disease had a higher number of missing teeth (p 0.0334). Periodontal disease is distributed in the same way in both glycemic control groups (p = 0.1211). In the group studied, the degree of periodontal disease is independent of the glycemic control of the patients (AU)

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