Resumen Antecedentes: Lycianthes moziniana (Capsiceae, Solanaceae) es endémica y tiene amplia distribución en México. Su apariencia morfológica y la evidencia molecular sugieren tres variedades (L. moziniana var. margaretiana, L. moziniana var. moziniana y L. moziniana var. oaxacana). Hipótesis: Lycianthes moziniana se integra por linajes independientes que corresponden a las tres variedades. Especie de estudio: Lycianthes moziniana (Dunal) Bitter. Sitio de estudio y fechas: México desde 2017 hasta 2021. Métodos: Medimos 11 caracteres de 207 especímenes de herbario. Las diferencias se evaluaron con Análisis Canónico Discriminante (ACD), Distancia al Cuadrado de Mahalanobis (DM) y Análisis Clasificatorio Canónico (ACC). Para las preferencias y divergencias geográficas y climáticas, utilizamos 288 registros y cuatro capas. Resultados: Dos funciones canónicas explicaron el 100 % de la variación morfológica y siete caracteres mostraron poder discriminatorio. Los valores de DM fueron estadísticamente significativos. En tanto, el ACC recuperó tres grupos por encima del 77 %. La evidencia morfológica demostró la distinción de L. moziniana var. moziniana. En contraste, L. moziniana var. margaretiana y L. moziniana var. oaxacana fueron morfológicamente similares. La prueba de identidad mostró diferencias significativas entre los Modelos de Nicho Ecológico (MNE). La evidencia reveló el aislamiento geográfico y climático. Lycianthes moziniana var. moziniana está muy extendida y tiene superposición intermedia con las otras dos variedades. En tanto, Lycianthes moziniana var. margaretiana y L. moziniana var. oaxacana mostraron el menor traslape. Conclusiones: Los datos morfológicos y geográficos sugieren que el proceso de especiación en Lycianthes moziniana es incipiente.

Abstract Background: Lycianthes moziniana (Capsiceae, Solanaceae) is an endemic and widespread species in Mexico. Morphological and molecular evidence suggested three varieties (L. moziniana var. margaretiana, L. moziniana var. moziniana and L. moziniana var. oaxacana). Hypotheses: Lycianthes moziniana is integrated by differentiated lineages corresponding to the three varieties identified. Studied species: Lycianthes moziniana (Dunal) Bitter. Study sites and dates: Mexico from 2017 to 2021. Methods: We measured 11 morphological characters based on 207 herbarium specimens. Discriminant Canonical Analysis (DCA), Mahalanobis Square Distance (MD) and Canonical Classificatory Analysis (CCA) were used to uncover the differences among varieties. For geographic and climatic preferences and divergence, we used 288 records and four climatic layers. Results: Two canonical functions explained 100 % of the morphological variation and seven characters had the highest discriminatory power. In addition, MD was statistically significant. Meanwhile, the CCA recovered three groups at 77 %. The morphological evidence demonstrated the distinctiveness of L. moziniana var. moziniana. In contrast, L. moziniana var. margaretiana and L. moziniana var. oaxacana were morphologically similar. The identity test showed significant differences among Ecological Niche Models (ENMs). The evidence indicates geographic and climatic isolation among the varieties. Lycianthes moziniana var. moziniana is widespread and has intermediate overlap with the other two varieties. Lycianthes moziniana var. margaretiana and L. moziniana var. oaxacana were isolated in different biogeographical provinces and showed the lowest overlap. Conclusions: Morphological and geographic data indicate that incipient speciation is occurring.

Abstract Background: The Mammillaria series Stylothelae (Cactaceae) includes 16 taxa distributed mostly among the limits of the Chihuahuan Desert (CD) with the Sierra Madre Oriental and the Transmexican Volcanic Belt (TVB). In Jalisco, four pink flowered species occur at the southwestern end of the CD where it meets the TVB. The boundaries and recognition of three species related with M. fittkaui (M. fittkaui complex) are debatable. Question: Should the taxa of the Mammillaria fittkaui species complex be considered as species? Studied species: Four pink flowered Mammillaria series Stylothelae (M. fittkaui species complex) and M. zeilmanniana as comparative species. Study site: Western Mexico. Methods: Six morphological characters were sampled in specimens from the type locations of three pink flowered species, one locality of Mammillaria sp., and M. zeilmanniana. We used a permutational multivariate analysis of variance on six characters of each of the groups and a discriminant analysis to evaluate the morphological variation among species and to determine the correct classification of each individual. Results: The analyses identified four well defined morphological groups with statistical significance within the Mammillaria fittkaui complex. We recognized M. fittkaui, M. limonensis, and M. manana as species and here describe M. arreolae as a new species from Jalisco. Conclusions: In Cactaceae, morphometry has been useful to establish species boundaries. The Mammillaria fittkaui complex includes four species. Mammillaria arreolae differs from the other species by the shorter tubercles, flowers, and fruits. In addition, it develops more than one hooked central spine per areole.

Resumen Antecedentes: Mammillaria serie Stylothelae (Cactaceae) incluye 16 taxones distribuidos principalmente entre los límites del Desierto Chihuahuense (DC), la Sierra Madre Oriental y el Eje Volcánico Transmexicano (EVT). En Jalisco, cuatro taxones de flores rosas ocurren en el extremo suroeste del DC que confluye con el EVT. Los límites y el reconocimiento de tres especies relacionadas con M. fittkaui (complejo M. fittkaui) son debatibles. Pregunta: ¿Los taxones del complejo de especies Mammillaria fittkaui deberían ser considerados como especies diferentes? Especies estudiadas: Cuatro especies de Mammillaria serie Stylothelae de flores rosas (complejo M. fittkaui) y M. zeilmanniana como grupo comparativo. Sitio de estudio: Occidente de México. Métodos: Seis caracteres morfológicos fueron muestreados en las localidades tipo de las tres especies de flores rosas, una localidad de Mammillaria sp. y M. zeilmanniana. Se utilizó un análisis multivariado de varianza basado en permutaciones en seis caracteres entre los cinco grupos y un análisis discriminante para evaluar la variación morfológica entre especies y determinar la correcta clasificación de cada individuo. Resultados: Los análisis identificaron cuatro grupos bien definidos con significancia estadística dentro del complejo Mammillaria fittkaui. Reconocemos a M. fittkaui, M. limonensis y M. manana y describimos a M. arreolae como una especie nueva de Jalisco. Conclusiones: En Cactaceae, la morfometría es útil para establecer límites entre especies. El complejo Mammillaria fittkaui incluye cuatro especies. Mammillaria arreolae difiere de las otras especies por sus tubérculos, flores y frutos más cortos. Además, desarrolla más de una espina central uncinada por aréola.

ABSTRACT The present study explored the predictive values of milk leukocyte differentials (MLD) as a basis for improving the diagnosis of intramammary infections (IMIs) and subclinical mastitis. Quarter milk samples were collected for bacteriological analysis, quarter somatic cell count (qSCC), and MLD. The MLD were assessed using the cytospin technique, direct microscopic smears, and flow cytometry. The predictive values of each single leukocyte population and useful potential indices that could better reflect immune complexity were also calculated. Changes in the percentage of any leukocyte alone failed to substantially improve the predictive value of qSCC in diagnosing IMIs. Although certain parameters increased the area under the receiver operating characteristic curve (ROC curve) as a result of increased specificity values, a slight reduction in sensitivity was observed. The so-called CD8 complex was a unique parameter which improved both the sensitivity (78.79 %) and the specificity (80.77 %) in IMI diagnosis, resulting in the highest area under the ROC curve (0.87). To diagnose subclinical mastitis, the percentage of macrophages and the sum of the percentage PMNLs and T CD8+ cells divided by the percentage of macrophages showed the highest predictive values (sensitivity = 79.63, specificity = 73.68, and area under the ROC curve = 0.83) in the differentiation of the inflammatory condition status of cows. In conclusion, this study provides further insights into using T CD8+ lymphocytes in diagnosing bovine IMIs, combined with PMNLs and macrophages. The antidromic trend of macrophages vs. PMNLs and T CD8+ lymphocytes due to the increasing qSCCs was crucial to differentiating quarters under both inflammatory and non-inflammatory conditions.

Abstract This article aims to present the intercultural experience of Teletandem involving students from two Brazilian federal universities. Following the methodological approach of the experience report (MUSSI; FLORES; ALMEIDA, 2021), we developed a collaborative academic-reflexive essay that emerges from a virtual foreign language practice within the Spanish I course at the Federal University of Campina Grande (UFCG). Inspired by the philosophy of Paulo Freire, we discuss how this tool can foster the teaching and learning of foreign languages, creating authentic interaction scenarios among students and promoting autonomy, reciprocity, and peer collaboration. Simultaneously, we identify some challenges and potential obstacles that may interfere with the activity. We conclude that Teletandem emerges as a powerful intercultural activity capable of fostering exchange and reflection on the demands and challenges faced by rural populations in Latin America.

Resumo Este artigo visa apresentar a experiência intercultural do Teletandem envolvendo estudantes de duas universidades federais brasileiras. Seguindo a abordagem metodológica do relato de experiência (MUSSI; FLORES; ALMEIDA, 2021), elaborou-se de forma colaborativa um ensaio acadêmico-reflexivo que emerge de uma prática virtual de línguas estrangeiras dentro do curso de Espanhol I na Universidade Federal de Campina Grande (UFCG). Inspirados pela filosofia de Paulo Freire, discutimos como essa ferramenta pode fomentar o ensino e a aprendizagem de línguas estrangeiras, criando cenários autênticos de interação entre os/as alunos/as e estimulando a autonomia, a reciprocidade e a colaboração entre pares. Simultaneamente, identificamos alguns desafios e obstáculos potenciais que podem interferir na atividade. Concluímos que o Teletandem se configura como uma poderosa atividade intercultural, capaz de impulsionar a troca e a reflexão sobre as demandas e os desafios dos povos rurais da América Latina.

Abstract Bacteria live in polymicrobial communities and constantly compete for resources. These organisms have evolved an array of antibacterial weapons to inhibit the growth or kill competitors. The arsenal comprises antibiotics, bacteriocins, and contact-dependent effectors that are either secreted in the medium or directly translocated into target cells. During bacterial antagonistic encounters, several cellular components important for life become a weak spot prone to an attack. Nucleic acids and the machinery responsible for their synthesis are well conserved across the tree of life. These molecules are part of the information flow in the central dogma of molecular biology and mediate long- and short-term storage for genetic information. The aim of this review is to summarize the diversity of antibacterial molecules that target nucleic acids during antagonistic interbacterial encounters and discuss their potential to promote the emergence antibiotic resistance. resources competitors antibiotics bacteriocins contactdependent contact dependent cells attack long shortterm short term resistance

Resumo As pesquisas envolvendo o uso de simuladores de chuva datam de 1930. Desde então, a evolução desse equipamento o tornou cada vez mais acessível, prático e preciso. Suas aplicações incluem a avaliação dos impactos da erosão hídrica na degradação do solo em função do uso e ocupação do solo e da taxa de infiltração da água no solo. A reprodução do padrão pluviométrico variando a intensidade da precipitação é uma das principais limitações do uso de simuladores. No entanto, a modificação recente no InfiAsper (Macedo et al., 2021) permite variar instantaneamente a intensidade de aplicação das chuvas e proporciona alta uniformidade nas chuvas de diferentes padrões.

Abstract Research involving the use of rain simulators dates to 1930. Since then, the evolution of this equipment has made it increasingly accessible, practical, and accurate. Its applications include the assessment of the impacts of water erosion on soil degradation as a function of land use and occupation and the rate of water infiltration into the soil. The reproduction of the rainfall pattern by varying the intensity of precipitation is one of the main limitations of the use of simulators. However, the recent modification in InfiAsper (Macedo et al., 2021) allows instantaneous varying the intensity of rainfall application and provides high uniformity in rainfall of different patterns.

RESUMO O presente estudo analisa os efeitos da pandemia de Covid-19 sobre a saúde mental dos estudantes durante parte do período de suspensão das aulas presenciais. Trata-se de estudo transversal, aplicado entre outubro e dezembro de 2020, baseado em questionário on-line de autorrelato respondido por estudantes entre 13 e 20 anos, do 9º ano do Ensino Fundamental e do Ensino Médio, que acompanhavam as atividades escolares remotas em 21 escolas públicas estaduais e municipais, localizadas nas periferias dos municípios de São Paulo e Guarulhos. Para a análise dos dados, utilizaram-se dois modelos de regressão linear múltipla, tendo como variáveis dependentes os escores de depressão pelo Inventário de Depressão Infantil e de ansiedade pelo Scared (Screen for Child Anxiety Related Emotional Disorders). O tempo de exposição às telas, a inversão do sono e o sexo feminino, combinados com as dificuldades do ensino remoto e outros marcadores sociais (como cor/raça e casos de Covid-19 em casa), estão associados a sintomas de depressão e ansiedade durante a primeira onda da Covid-19 na Região Metropolitana de São Paulo, reforçando a importância da rotina escolar na vida desses jovens e os desafios colocados às escolas para a promoção da saúde mental dos estudantes no período pós-pandemia.

ABSTRACT This study analyzes the effects of the COVID-19 pandemic on students’ mental health during part of the suspension of in-person classes. The study is a cross-sectional survey carried out from October2020 to December 2020. An online self-report questionnaire was answered by thirteen- to twenty-year old students, from the 9th grade (Middle School) to high school, who followed remote school activities in 21 state and municipal public schools located in peripheral areas of the cities of São Paulo and Guarulhos. Two linear regression models were used in the analysis, considering as dependent variables the depression scores as provided by the Child Depression Inventory and anxiety by the SCARED (Screen for Child Anxiety Related Emotional Disorders). The time of exposure to the screens, the inversion of sleep periods and the female gender, along with the difficulties of remote education and other social markers (such as color/race and cases of COVID-19 at home) are associated with symptoms of depression and anxiety during the first wave of the COVID-19 in the Metropolitan area of São Paulo. The findings reinforce the importance of school routine in the lives of those young people and the challenges posed to schools to promote students’ mental health in the post-pandemic reality.

RESUMEN Introducción: La espondiloartritis axial es una enfermedad reumatológica que afecta a individuos jóvenes y tiene una gran repercusión sociolaboral. El retraso en el diagnóstico y el tratamiento se asocia con un mayor deterioro funcional y un impacto negativo en la calidad de vida, por lo que requiere un abordaje multidisciplinario. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para la detección temprana, el diagnóstico, el tratamiento y el seguimiento de los pacientes adultos con espondiloartritis axial. Métodos: Se configuró un grupo desarrollador, se formularon preguntas clínicas contestables, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado, minimizando el sesgo por conflictos de intereses. Se utilizó la aproximación Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la calidad de la evidencia, al igual que la dirección y la fortaleza de las recomendaciones. Se presentan 11 recomendaciones relacionadas con diagnóstico (n = 2), tratamiento farmacológico (n = 6), tratamiento no farmacológico (n = 2) y seguimiento (n = 1). Resultados: Se recomienda la radiografía de articulaciones sacroilíacas como primer método diagnóstico, y el uso de escalas de actividad para el seguimiento de los pacientes (ASDAS o BASDAI). Los antiinflamatorios no esteroideos son la primera opción de tratamiento; en caso de intolerancia o dolor residual se recomienda acetaminofén u opioides. En pacientes con compromiso axial se recomienda abstenerse de utilizar medicamentos antirreumáticos modificadores de la enfermedad convencionales ni glucocorticoides sistémicos o locales. En pacientes con falla a los antiinflamatorios no esteroideos, se recomienda un anti-TNFα o un anti-IL17A. En pacientes con falla a anti-TNFα, se recomienda iniciar un anti-IL17A. El ejercicio y la terapia física y ocupacional se recomiendan como parte del tratamiento. Se recomienda no utilizar las terapias no convencionales como única opción de tratamiento. Conclusiones: Este conjunto de recomendaciones proporciona una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis axial.

Abstract Introduction: Axial spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. Objective: To develop a set of recommendations based on the best available evidence for the early detection, diagnosis, treatment, and monitoring of adult patients with axial spondy-loarthritis. Methods: A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations on diagnosis (n=2), pharmacological treatment (n=6), non-pharmacological treatment (n=2) and monitoring (n=1) are presented. Results: Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A are recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. Conclusions: This set of recommendations provides an updated guideline for the diagnosis, treatment, and monitoring of patients with axial spondyloarthritis.

RESUMO O presente estudo analisa os efeitos da pandemia de Covid-19 sobre a saúde mental dos estudantes durante parte do período de suspensão das aulas presenciais. Trata-se de estudo transversal, aplicado entre outubro e dezembro de 2020, baseado em questionário on-line de autorrelato respondido por estudantes entre 13 e 20 anos, do 9º ano do Ensino Fundamental e do Ensino Médio, que acompanhavam as atividades escolares remotas em 21 escolas públicas estaduais e municipais, localizadas nas periferias dos municípios de São Paulo e Guarulhos. Para a análise dos dados, utilizaram-se dois modelos de regressão linear múltipla, tendo como variáveis dependentes os escores de depressão pelo Inventário de Depressão Infantil e de ansiedade pelo Scared (Screen for Child Anxiety Related Emotional Disorders). O tempo de exposição às telas, a inversão do sono e o sexo feminino, combinados com as dificuldades do ensino remoto e outros marcadores sociais (como cor/raça e casos de Covid-19 em casa), estão associados a sintomas de depressão e ansiedade durante a primeira onda da Covid-19 na Região Metropolitana de São Paulo, reforçando a importância da rotina escolar na vida desses jovens e os desafios colocados às escolas para a promoção da saúde mental dos estudantes no período pós-pandemia.

ABSTRACT This study analyzes the effects of the COVID-19 pandemic on students’ mental health during part of the suspension of in-person classes. The study is a cross-sectional survey carried out from October2020 to December 2020. An online self-report questionnaire was answered by thirteen- to twenty-year old students, from the 9th grade (Middle School) to high school, who followed remote school activities in 21 state and municipal public schools located in peripheral areas of the cities of São Paulo and Guarulhos. Two linear regression models were used in the analysis, considering as dependent variables the depression scores as provided by the Child Depression Inventory and anxiety by the SCARED (Screen for Child Anxiety Related Emotional Disorders). The time of exposure to the screens, the inversion of sleep periods and the female gender, along with the difficulties of remote education and other social markers (such as color/race and cases of COVID-19 at home) are associated with symptoms of depression and anxiety during the first wave of the COVID-19 in the Metropolitan area of São Paulo. The findings reinforce the importance of school routine in the lives of those young people and the challenges posed to schools to promote students’ mental health in the post-pandemic reality.

ABSTRACT This study aimed to assess the effect of rootstocks (IAC 572 and IAC 766) and potassium fertilization at different concentrations (0, 75, 150 and 300 kg·ha-1 K2O) on the phenology and thermal demand of the Niagara Rosada grapevine, and to evaluate the development of chemical traits during maturation stage. The length of the main phenological stages was recorded within two production seasons. Total thermal demand was calculated using the degree-day concept. The berries’ titratable acidity and soluble solids contents were determined during maturation. Results indicated that IAC 572 and IAC 766 rootstocks along with potassium fertilization had no influence on the phenological cycle or thermal demand of the Niagara Rosada grapevine. The production cycle lasted 144 to 148 days with thermal demands ranging from 1,465.2 to 1,615.1 degree-days. For better grape quality, i.e., with a balance between soluble solids and acidity levels, it is estimated that the grape harvest is carried out around 21 to 24 days after the veraison.

ABSTRACT This study aimed to evaluate the productive performance and physicochemical traits of wine grape cultivars (Cabernet Sauvignon, Syrah, Cabernet Franc, Merlot, and Sauvignon Blanc) grafted on two different rootstocks (IAC 766 Campinas, and 106-8 Mgt) under subtropical conditions. The productive components (number of bunches, production per vine, yield, number of berries per bunch, fresh mass, length, and width of berries) and the grape must physicochemical composition (pH, titratable acidity, soluble solids, and maturation index) were determined after four consecutive harvest seasons. Results from analysis of variance and principal component analysis showed that Cabernet Franc and Syrah were generally more productive than the other ones. In addition to that, Cabernet Sauvignon presented the lowest production and the smallest grape berries of all. With regards to rootstocks, IAC 766 induced higher scions yield than 106-8 Mgt; besides that, IAC 766 had greater affinity with Cabernet Franc and Merlot, which was observed by the increase in the number of bunches per vine, larger and heavier bunches, as well as higher soluble solids content and pH value than the ones in 106-8 Mgt. Furthermore, IAC 766 also induced higher soluble solids content and pH value for Cabernet Sauvignon. Results showed similar effects for Syrah and Sauvignon Blanc, regardless of the rootstocks.

Abstract Introduction: Neuronal ceroid lipofuscinosis (NCLs) is an autosomal recessive neurodegenerative disorders group. We report the first case in Colombia involving a new genetically confirmed variant of a homozygous CLN6 mutation. Case report: 12-year-old male, history of blood parents and average growth until 5 years of age. At this age began focal crises, progressive regression of neurodevelopment, severe cognitive deficit, and swallowing disorder that led to gastrostomy. Clinical exome + CNVs + mitochondrial DNA genetic study identified variant NM_017882.3 (CLN6): c. 22C>T, p. (Gln8*) in homozygous, deleterious. Late-onset infantile neuronal ceroid lipofuscinosis was diagnosed. Discussion: Mutations in the CLN6 gene are associated with late-onset infantile lipofuscinosis of autosomal recessive inheritance. This variant has not been previously described in the medical literature nor is it listed in the population databases, which indicates that it is extremely rare. The treatment focuses on the control of seizures, sleep disturbances, extrapyramidal symptoms, behavioral disorders, anxiety, and psychosis. Conclusion: To date, this variant of the CLN6 gene has not been reported in the world. There are currently no etiological or disease-specific therapeutic approaches. The use of exome/whole genome sequencing can be very useful for etiological diagnosis and differential diagnosis. An early diagnosis opens the door to future care and treatment.

Abstract The research addresses the study carried out in the annexed classrooms of "Caxila I", of the Comandante Cowboy School, Ondjiva Commune, Cunene Province, with the aim of developing educational actions to strengthen sexual education in 8th grade students. Among the shortcomings detected in the diagnosis are the few sexual education actions carried out with adolescents who are the most vulnerable to contracting sexually transmitted diseases. 12 educational actions are proposed to promote communication, weighting and promotion of knowledge and habits in the training of students on sexual education. During the research, methods were used: historical-logical, analytical-synthetic, inductive-deductive, observation, interviews, statistical-mathematical and documentary review.

Resumen La investigación aborda el estudio realizado en las aulas anexas de “Caxila I”, de la Escuela Comandante Cowboy, Comuna de Ondjiva, Provincia Cunene, con el objetivo de elaborar acciones educativas para fortalecer la educación sexual en los alumnos de 8vo grado. Dentro de las insuficiencias detectadas en el diagnóstico se encuentran las pocas acciones de educación sexual que se realizan con los adolescentes que son los más vulnerables a contraer enfermedades de transmisión sexual. Se proponen 12 acciones educativas que permiten fomentar la comunicación, ponderación y promoción de los conocimientos y hábitos en la formación de los alumnos sobre la educación sexual. Durante la investigación fueron utilizados métodos: histórico-lógico, analítico-sintético, inductivo-deductivo, observación, entrevistas, estadístico-matemático y Revisión documental.

Abstract Aim of the study: Laparoscopic adhesiolysis in small bowel obstruction (SBO) is getting increasingly normal. In patients with multiple adhesive SBOs (MASBO), laparoscopic approaches might increase the risk of bowel injury due to the distended and potentially compromised small bowel. It remains a challenge to the surgeons, entails an interdisciplinary team, trying to achieve the least complications as possible. The study aimed to compare surgical outcomes of laparoscopic procedures (multi-port vs. single-port) in the management of MASBO. Patients and Methods: Comparative study of 68 patients with post-operative MASBO treated with Single-Port single incision laparoscopic surgery (SILS) and Multi-port Laparoscopic Surgery in two centers of Bogota, Colombia between January 2013 and June 2018. Results: All patients underwent laparoscopic management, 27 patients by SILS, and 41 patients by multi-port. The average surgical time in the multiport approach was 167 min versus SILS with 129 min. Laparoscopic intestinal resection was performed in 4.4% of patients, through multi-port using intracorporeal anastomosis. Mean hospital stay of 3.2 days for the SILS approach versus multi-port in 2.2 days. Conclusions: Both laparoscopic approaches, in MASBO treatment is feasible in qualified hands. Patient selection and medical judgment seem to be the most essential factors for a positive result.

Resumen Objetivos del estudio: Cada día es más frecuente la adherensiolisis laparoscópica en obstrucción del intestino delgado. En pacientes con obstrucciones debidas a múltiples adherencias del intestino delgado (OMAID), los abordajes laparoscópicos pueden incrementar el riesgo de daño de víscera hueca debido a la presencia de asas distendidas. Continúa siendo un reto para el cirujano, requiriendo un grupo interdisciplinario para disminuir las posibles complicaciones. Este estudio busca comparar los desenlaces de abordajes laparoscópicos (Multipuerto vs. monopuerto) en el manejo del OMAID. Pacientes y métodos: Se realizó un estudio de 68 pacientes con OMAID postoperatorio tratado con cirugía laparoscópica de monopuerto y múltipuerto en dos centros de Bogotá, Colombia entre enero de 2013 y junio de 2018. Resultados: Pacientes llevados a manejo laparoscópico, 27 por monopuerto y 41 por múltipuerto, con tiempo quirúrgico promedio de 129 y 167 minutos respectivamente. 4.1% de los pacientes requirieron resección intestinal, todas en pacientes con abordaje múltipuerto con anastomosis intracorpóreas. El tiempo medio de hospitalización fue de 3.2 días para monopuerto y 2.2 días para multipuerto. Conclusiones: Ambos abordajes laparoscópicos son factibles para el manejo del OMAID en manos calificadas. La selección del paciente y el juicio médico parecen ser factores fundamentales en el resultado positivo.

RESUMO Objetivo: Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a melhora do estado funcional físico em longo prazo de pacientes sobreviventes à unidade de terapia intensiva. Métodos: Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de 2018, em um ambulatório pós-unidade de terapia intensiva, 32 sobreviventes à unidade de terapia intensiva. Foram inscritos consecutivamente os pacientes com permanência na unidade de terapia intensiva acima de 72 horas (para admissões emergenciais) ou acima de 120 horas (para admissões eletivas) que compareceram ao ambulatório pós-unidade de terapia intensiva 4 meses após receberem alta da unidade de terapia intensiva. A associação entre a distância percorrida no Teste de Caminhada de 6 Minutos realizado na avaliação inicial e a evolução do estado funcional físico foi avaliada durante 8 meses, com utilização do Índice de Barthel. Resultados: A distância média percorrida no Teste de Caminhada de 6 Minutos foi significantemente mais baixa nos sobreviventes à unidade de terapia intensiva do que na população geral (405m versus 557m; p < 0,001). A idade (β = -4,0; p < 0,001) e a fraqueza muscular (β = -99,7; p = 0,02) se associaram com a distância percorrida no Teste de Caminhada de 6 Minutos. A distância percorrida no Teste de Caminhada de 6 Minutos se associou com melhora do estado funcional físico no período de 8 meses de acompanhamento desses pacientes (razão de chance para cada 10m: 1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva Característica de Operação do Receptor para predição da melhora funcional física pelo Teste de Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88). Conclusão: O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da unidade de terapia intensiva, predisse com precisão moderada a melhora do estado funcional físico de sobreviventes à unidade de terapia intensiva.

ABSTRACT Objective: To evaluate the ability of the 6-Minute Walk Test to predict long-term physical functional status improvement among intensive care unit survivors. Methods: Thirty-two intensive care unit survivors were prospectively evaluated from February 2017 to August 2018 in a post-intensive care unit outpatient clinic in Brazil. Individuals with intensive care unit stays > 72 hours (emergency admissions) or > 120 hours (elective admissions) attending the post-intensive care unit clinic four months after intensive care unit discharge were consecutively enrolled. The association between the 6-Minute Walk Test distance at baseline and physical functional status was assessed over 8 months using the Barthel Index. Results: The mean 6-Minute Walk Test distance was significantly lower in intensive care unit survivors than in the general population (405m versus 557m; p < 0.001). Age (β = -4.0; p < 0.001) and muscle weakness (β = -99.7; p = 0.02) were associated with the 6-Minute Walk Test distance. A 6-Minute Walk Test distance was associated with improvement in physical functional status over the 8-month follow-up (odds ratio for each 10m of 1.07; 95%CI 1.01 - 1.16; p = 0.03). The area under the Receiver Operating Characteristic curve for the 6-Minute Walk Test prediction of physical functional status improvement was 0.72 (95%CI 0.53 - 0.88). Conclusion: The 6-Minute Walk Test performed 4 months after intensive care unit discharge predicted long-term physical functional status among intensive care unit survivors with moderate accuracy.