Auxilio Mutuo Hospital

ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental health-adherence link. Cocaine, Amphetamine-type stimulants, inhalants, and opioids directly influenced adherence but did not mediate this relationship. In contrast, no significant effects were observed for tobacco, alcohol, cannabis or sedatives. This large-scale, nurse-led, international study offers critical insights into the roles of social support and substance use as psychosocial influencers in the cascade of care for PLHIV. Clinical implications include prioritizing educative, preventative, and harm-reductive approaches to specific substances that impact ART adherence. Findings may also inform interventions that emphasize strengthening social support to improve adherence in ART and care while addressing substance use as a barrier to care and well-being.

ABSTRACTObjectiveTo evaluate the impact of noninvasive ventilation versus bag-valve-mask ventilation preoxygenation on safety and efficacy outcomes.MethodsPubMed, Embase, and Cochrane databases were searched for randomized controlled trials that compared preoxygenation using noninvasive ventilation and bag-valve-mask ventilation. The reported outcomes were all-cause mortality; hypoxemia during intubation; and regurgitation. We perform frequentist and Bayesian analysis. Heterogeneity was examined with I2 statistics. Statistical analysis was done using RStudio and Review Manager.ResultsWe included 3 randomized controlled trials with 1,555 patients, of whom 771 (49.6%) received preoxygenation with noninvasive ventilation (intervention group). Hypoxemia during intubation was significantly lower in the noninvasive ventilation compared to the bag-valve-mask ventilation group in frequentist with a pooled log RR of −0.94 (log RR −0.94; 95%CI −1.61 − −0.28) and Bayesian pooled log risk ratio of −0.32 (log RR −0.32; 95% credible interval −0.91 − 0.40). Regurgitation was a safety outcome that did not present a difference between the groups in the frequentist or Bayesian models, with log RR −0.50 (log RR −0.50; 95% credible interval −2.09 − 1.01). There was no significant difference between groups in all-cause mortality and other secondary outcomes.ConclusionPreoxygenation with noninvasive ventilation significantly reduces the risk of hypoxemia during emergency intubation compared to bag-valve-mask ventilation. However, there were no significant differences in all-cause mortality or regurgitation rates.

Objectives This study seeks to highlight specific disparities in surgical oncology among Latino/Hispanic/Spanish+ populations. Our goal is to highlight said disparities and how the Hispanic Paradox phenomenon can obscure reporting in this population. Background The Hispanic Paradox is defined as the outcomes of Latino/Hispanic/Spanish+ populations experiencing better health outcomes despite socioeconomic disadvantages. This phenomenon persists in general oncologic and surgical outcomes. While LHS+ patients do have better outcomes in certain instances, in many cases, statistical generalization contributes to obscure disparities, specifically in surgical cancer care. Methods and Design This review synthesized peer-reviewed research published between 2011-2025. We included studies exploring the mechanisms behind the Hispanic Paradox, such as selective migration, the healthy migrant effect, survival bias, cultural protective factors, and lifestyle practices, and those that analyzed disparities in surgical outcomes among Latinos with breast cancer, hepatocellular carcinoma, and prostate cancer. Studies with ethnicity and origin-specific data, such as those on Puerto Rican, Mexican, and Cuban populations, were prioritized. The Institutional Review Board of the Central University of the Caribbean School of Medicine classified this project as exempt. Conclusions While the Hispanic Paradox implies resilience in health outcomes, it should not obscure real disparities in care. Subgroup-specific research and culturally sensitive interventions are critical to achieving equity in surgical oncology for Latino populations. We were able to demonstrate the need for stratified research to avoid generalizations that contribute to the Hispanic Paradox. Continued investigation into the systemic and cultural drivers of these disparities is essential to develop actionable, equity-focused solutions in clinical care and policy.

INTRODUÇÃO: Colelitíase é a presença de cálculos na vesícula biliar e/ou vias biliares; colecistite é a inflamação vesicular, usualmente decorrente de obstrução do ducto cístico por cálculo. Este artigo descreve e discute as internações por essas condições no Brasil entre 2020 e 2024, analisando tendências anuais e diferenças regionais no SUS, à luz de diretrizes contemporâneas e da reorganização assistencial pós-pandemia. OBJETIVO: Este estudo visa quantificar e analisar as taxas de internações por colelitíase e colecistite no Brasil. METODOLOGIA: O estudo retrospectivo com abordagem quantitativa utilizou dados do Sistema de Informações Hospitalares do SUS (SIH/SUS), fornecidos pelo Departamento de Informática do SUS (TABNET/DATASUS). A análise abrangeu internações por colelitíase e colecistite no Brasil de janeiro de 2020 a dezembro de 2024, empregando estatística descritiva e tabulação em planilhas do Microsoft Excel 2016 e Microsoft Word 10. RESULTADOS E DISCUSSÃO: Entre janeiro de 2020 e dezembro de 2024, o Brasil registrou 1.511.217 internações por colelitíase/colecistite no SUS. Após baixa em 2020, houve recuperação parcial em 2021, salto em 2022 (backlog), crescimento moderado em 2023 e estabilização em 2024. O Sudeste manteve liderança; Nordeste e Sul ganharam participação; Norte e Centro-Oeste cresceram, porém com maior variação. A difusão de colecistectomia laparoscópica precoce, integração com CPRE e protocolos padronizados sustentou a resolutividade. CONCLUSÃO: Conclui-se que 2020–2024 compôs três atos: queda/retomada (2020–2021), recomposição com liberação da demanda reprimida (2022) e estabilização elevada (2023–2024). Sudeste lidera; Nordeste e Sul avançam; Norte e Centro-Oeste mostram maior sensibilidade. Priorizar colecistectomia precoce, CPRE e imagem, centros de curta permanência e monitoramento operacional sustenta resolutividade, reduz reinternações e promove equidade assistencial.

INTRODUÇÃO: A pneumonia infantil é uma das principais causas de morbimortalidade em crianças menores de cinco anos, especialmente em países de baixa e média renda. No Brasil, apesar dos avanços na atenção primária e nas campanhas de vacinação, a doença ainda representa um importante desafio de saúde pública. Este estudo analisa a evolução temporal das internações por pneumonia infantil entre 2019 e 2023, considerando as cinco regiões brasileiras, com o objetivo de identificar padrões, variações e possíveis influências da pandemia de COVID-19 sobre esses indicadores. OBJETIVO: Este estudo visa quantificar e analisar as taxas de internações por pneumonia infantil no Brasil. METODOLOGIA: O estudo retrospectivo com abordagem quantitativa utilizou dados do Sistema de Informações Hospitalares do SUS (SIH/SUS), fornecidos pelo Departamento de Informática do SUS (TABNET/DATASUS). A análise abrangeu internações por pneumonia infantil no Brasil de janeiro de 2019 a dezembro de 2023, empregando estatística descritiva e tabulação em planilhas do Microsoft Excel 2016 e Microsoft Word 10. RESULTADOS E RESULTADOS E DISCUSSÃO: Os resultados indicaram uma queda acentuada nas internações por pneumonia infantil em 2020, com 78.674 casos, reflexo das medidas de contenção da COVID-19. A partir de 2021, observou-se um aumento progressivo, chegando a 245.433 internações em 2023, superando os níveis de 2019. As regiões Sudeste e Nordeste concentraram a maior parte dos casos, refletindo desigualdades regionais e desafios no acesso à saúde e prevenção. CONCLUSÃO: A análise das internações por colelitíase e colecistite no Brasil entre 2019 e 2023 evidencia desigualdades regionais no acesso à saúde e na prevalência de fatores de risco. A pandemia de COVID-19 causou uma queda temporária nos casos, mas a recuperação subsequente reforça a importância de políticas públicas voltadas à prevenção e ao tratamento eficaz, com foco nas regiões mais carentes de infraestrutura e serviços médicos adequados.

O transplante de células-tronco hematopoéticas (TCTH), também conhecido como transplante de medula óssea (TMO), é fundamental no tratamento de doenças hematológicas. O procedimento visa restaurar a produção de células sanguíneas por meio da infusão de células-tronco hematopoéticas (CTH), obtidas da medula óssea, sangue periférico ou cordão umbilical. As modalidades de transplante incluem o alogênico, autólogo e singênico. No Brasil, o TCTH é regulamentado pela ANVISA, garantindo segurança e qualidade. Este artigo relata a experiência do Hospital Naval Marcílio Dias (HNMD) na implantação do TCTH e suas perspectivas futuras em terapias celulares no contexto da Marinha. Trata-se de um relato descritivo e retrospectivo baseado em registros institucionais. Em julho de 2013, o HNMD foi credenciado para realizar transplantes autólogos, mas enfrentava limitações de infraestrutura e equipe qualificada para criopreservação. Para superar esses desafios, firmou parceria com o Instituto Nacional de Câncer (INCa), que possibilitou o treinamento de profissionais e a realização da criopreservação das CTH. Em 2021, após investimento institucional e licenciamento sanitário, o HNMD inaugurou seu próprio laboratório de criopreservação, alcançando a autossuficiência no processo. Essa trajetória evidencia a superação de barreiras operacionais por meio de parcerias estratégicas, capacitação e infraestrutura. A conquista representa um marco pioneiro na Marinha do Brasil, ampliando o acesso a terapias avançadas e contribuindo para a qualidade de vida dos pacientes. Além disso, fortalece a base técnica da instituição e abre caminho para futuras iniciativas em terapias celulares no ambiente militar.

La presente publicación surge del II Encuentro de Líderes de Investigación de la Asociación Colombiana de Facultades y Programas de Publicidad en Colombia, AFAP, espacio donde diferentes universidades nacionales reflexionaron en torno a los enfoques, metodologías, herramientas y tendencias de investigación en el campo publicitario. De esta manera, nace el libro “Experiencias para pensar la publicidad, la profesión y la formación”, que agrupa ocho textos recopilados en tres partes. La primera, da cuenta de las experiencias para pensar la investigación formativa en la publicidad. La segunda parte retoma experiencias para pensar el lenguaje publicitario y aborda temáticas relacionadas con la escritura creativa como metáfora de la publicidad y los imaginarios en el diseño del póster publicitario. Finalmente, en la tercera parte se incluye el tema de la complejidad como paradigma emergente en la literatura sobre comunicación de la responsabilidad social.

Abstract Background Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. Objective To assess TAVR’s LC in Brazil over time. Methods We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. Results A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. Conclusion A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.

Osteoporosis is a serious systemic disease that can lead to fragility fractures, contributing to early mortality, loss of autonomy, and independence in some cases.Romosozumab is a humanized monoclonal antibody that inhibits sclerostin, with a dual effect of increasing bone formation and decreasing bone resorption, resulting in reduced risk of vertebral and non-vertebral fractures. CASE REPORTAn 86-year-old female patient diagnosed with osteoporosis since 2000, without history of hormone replacement therapy postmenopause at age 50, malignancies, chronic corticosteroid use, smoking, or prior fractures.She started weekly treatment with alendronate sodium in April 2000, along with calcium and vitamin D supplementation.In October 2003, she experienced a right femoral neck fracture after a fall from standing height.She received annual zoledronic acid in 2007 and 2008.Due to worsening bone mass and high fracture risk, she initiated teriparatide therapy in July 2009 until April 2011, with slight improvement in bone mass, followed by maintenance therapy with biannual denosumab after completing 18 months of teriparatide.Despite this, there was continued bone loss with high fracture risk by FRAX assessment.Romosozumab was introduced monthly for 12 months, resulting in significant bone mass gain across all analyzed sites, meeting the minimal clinically significant change criteria (Tables 1 and2).Post-treatment, she continues biannual denosumab to maintain the gained bone mass.Table 1.Bone densitometry before romosozumab (August 2022).Region BMD (g/cm 2 ) YA T-score AM Z-score L1 0.832 -2.5 -0.6 L2 0.774 -3.6 -1.6 L3 0.789 -3.4 -1.6 L4 0.832 -3.1 -1.5 L1-L2 0.