RESUMEN Introducción: Las indicaciones de la Microcirugía Transanal Endoscópica han evolucionado desde la cirugía de tumoraciones rectales hasta otras enfermedades pélvicas. La asociación de esta y la escisión total del mesorrecto transanal ofrece una serie de ventajas. Objetivo: Determinar las indicaciones, describir la técnica quirúrgica y mostrar los resultados a largo plazo obtenidos en la realización de la escisión total del mesorrecto transanal en el tratamiento del cáncer del recto medio y bajo. Métodos: Se realizó un estudio observacional descriptivo y prospectivo de los pacientes con cáncer del recto medio y bajo sometidos a esta técnica quirúrgica en el período comprendido entre febrero de 2017 y febrero de 2022 en el Centro Nacional de Cirugía de Mínimo Acceso. Resultados: Se operaron 13 pacientes, 9 con cáncer del recto bajo y 4 con cáncer del recto medio y un promedio de edad de 56,2 años (rango 28-76). El promedio de tiempo quirúrgico fue de 183 minutos (rango 120-270) y las pérdidas hemáticas estimadas de 68 mililitros. La incidencia de morbilidad mayor fue de 15,4 % y la media de estadía hospitalaria de 5,4 días. La media del período de seguimiento fue de 35 (rango 9-69) meses con una recidiva local de 7,7 % y una supervivencia global a los 5 años de 100 %. Conclusiones: La escisión total del mesorrecto transanal combinado con cirugía laparoscópica es una técnica factible y segura. La introducción de la variante técnica utilizando el instrumental de la Microcirugía Transanal Endoscópica es más ergonómica y disminuye los costos.

ABSTRACT Introduction: The indications for transanal endoscopic microsurgery have evolved from surgery of rectal tumors to other pelvic diseases. The association between this and total excision of the transanal mesorectum offers a series of advantages. Objective: To determine the indications, to describe the surgical technique and to show the long-term outcomes obtained in the performance of total excision of the transanal mesorectum for treating cancer of the middle and lower rectum. Methods: A descriptive and prospective observational study was carried out of patients with cancer of the middle and lower rectum who underwent this surgical technique in the period from February 2017 to February 2022 at Centro Nacional de Cirugía de Mínimo Acceso. Results: Thirteen patients were operated on, 9 with cancer of the lower rectum and 4 with cancer of the middle rectum, as well as an average age of 56.2 years (range 28-76). The average surgical time was 183 minutes (range 120-270) and estimated blood loss was 68 milliliters. The incidence of highest morbidity was 15.4 % and mean hospital stay was 5.4 days. The median follow-up period was 35 (range 9-69) months, with a local recurrence of 7.7 % and an overall 5-year survival of 100 %. Conclusions: Total excision of the transanal mesorectum combined with laparoscopic surgery is a feasible and safe technique. The introduction of the variant technique using the instruments of endoscopic transanal microsurgery is more ergonomic and reduces costs.

ABSTRACT: Reflectance measurements of plants of the same species can produce sets of data with differences between spectra, due to factors that can be external to the plant, like the environment where the plant grows, and to internal factors, for measurements of different varieties. This paper reports results of the analysis of radiometric measurements performed on leaves of vines of several grape varieties and on several sites. The objective of the research was, after the application of techniques of dimensionality reduction for the definition of the most relevant wavelengths, to evaluate four machine learning models applied to the observational sample aiming to discriminate classes of region and variety in vineyards. The tested machine learning classification models were Canonical Discrimination Analysis (CDA), Light Gradient Boosting Machine (LGBM), Random Forest (RF), and Support Vector Machine (SVM). From the results, we reported that the LGBM model obtained better accuracy in spectral discrimination by region, with a value the 0.93, followed by the RF model. Regarding the discrimination between grape varieties, these two models also achieved better results, with accuracies of 0.88 and 0.89. The wavelengths more relevant for discrimination were at ultraviolet, followed by those at blue and green spectral regions. This research pointed toward the importance of defining the wavelengths more relevant to the characterization of the reflectance spectra of leaves of grape varieties and revealed the effective capability of discriminating vineyards by their region or grape variety, using machine learning models.

RESUMO: Medições de refletância de plantas da mesma espécie podem produzir conjuntos de dados com diferenças entre os espectros, devido a fatores que podem ser externos à planta, como o ambiente onde a planta cresce, e fatores internos, para medições com variedades de plantas. Este artigo reporta resultados da análise de medições por espectrorradiometria efetuadas em folhas de vinhas de variedades e em diferentes localidades. O objetivo desta pesquisa foi, após a aplicação de técnicas de redução de dimensionalidade para a definição dos comprimentos de onda mais relevantes, avaliar quatro modelos de aprendizado de máquina aplicados à amostra observacional visando discriminar classes de região e variedade. Os modelos de classificação de aprendizado de máquina testados foram Canonical Discrimination Analysis (CDA), Light Gradient Boosting Machine (LGBM), Random Forest (RF) e Support Vector Machine (SVM). A partir dos resultados, relatamos que o modelo LGBM obteve melhor acurácia na discriminação espectral por região, com valor de 0,93, seguido pelo modelo RF. Relativamente à discriminação entre castas, estes dois modelos também obtiveram melhores resultados, com acurácias de 0,88 e 0,89. Os comprimentos de onda mais importantes para as discriminações procuradas estiveram na região do ultravioleta, seguidos do azul e do verde. Este trabalho aponta para a importância de detectar os comprimentos de onda mais relevantes para a caracterização dos espectros de reflectância das folhas de variedades de vinhas, e revela a capacidade efetiva de discriminar vinhedos por suas regiões ou variedades, usando modelos de aprendizado de máquina.

Abstract Objective: to investigate the association between depressive symptoms and physical inactivity in technical-administrative workers from a public university in the Northeast of Brazil. Methods: cross-sectional study. We assessed depressive symptoms and physical activity using, respectively, the Patient Health Questionnaire-9, and the International Physical Activity Questionnaire. We used Poisson regression analysis, and estimated the prevalence ratios (PR) and their respective 95%CI. Results: 301 workers participated, of which 71.1% were female. The prevalence of depressive symptoms was of 25.7%, and 52.0% of the workers declared being physically inactive. Depressive symptoms and physical inactivity were associated to the effect modifiers “time worked to the institution ≤ 15 years” (PR: 3.03; 95%CI: 1.05;9.16) e “work position at administrative sectors” (PR: 1.90; 95%CI: 1.14;3.18). Conclusion: the results evidence the association between depressive symptoms and physical inactivity in technical-administrative workers of a public university of the state of Bahia. The the main factor associated are time worked to the institution and work position at administrative sectors.

Resumo Objetivo: investigar a associação entre sintomas depressivos e inatividade física em trabalhadores técnico-administrativos de uma universidade pública do Nordeste do Brasil. Métodos: estudo transversal realizado no estado da Bahia. Os sintomas depressivos foram avaliados pelo Patient Health Questionnaire-9 e o nível de atividade física pelo International Physical Activity Questionnaire. Foi realizada análise de regressão de Poisson e estimadas as razões de prevalência (RP) e seus respectivos IC95%. Resultados: 301 servidores participaram do estudo, dos quais 71,1% do sexo feminino. A prevalência de sintomas depressivos foi de 25,7% e 52,0% dos servidores declararam ser fisicamente inativos. Sintomas depressivos e inatividade física se mostraram associados com os modificadores de efeito “tempo de trabalho na instituição ≤ 15 anos” (RP: 3,03; IC95%: 1,05;9,16) e “lotação em setores administrativos” (RP: 1,90; IC95%: 1,14;3,18). Conclusão: os resultados evidenciam a associação entre sintomas depressivos e inatividade física em trabalhadores técnico-administrativos de uma universidade pública do estado da Bahia, tendo como principais fatores associados o tempo de trabalho na instituição e a lotação do servidor.

ABSTRACT Introduction: Minimally invasive pancreatic surgery is framed within the current history of surgery with great impact and development, especially in the field of distal pancreatectomies. Objective: To update the general and current aspects of minimally invasive surgery in pancreatic disorders. Methods: A systematic review was carried out based on the consultation of scientific articles about the subject, indexed in the Pubmed, Ebsco and SciELO databases. The information was analyzed and articles published up to 2020 were selected, related to the indications for laparoscopic and robotic surgery in pancreatic conditions, the variability of laparoscopic surgical procedures, as well as morbidity and mortality. Development: Minimally invasive pancreatic surgery has reached considerable levels of complexity and safety (from diagnostic laparoscopy to large pancreatic resections). The indications for laparoscopic and robotic surgery in pancreatic disorders, together with the variability of laparoscopic surgical procedures, are identified, and the procedures performed at the National Center for Minimally Access Surgery during the last three years by the group dedicated to this entity are presented. Conclusions: Minimally invasive surgery and robotic surgery in pancreatic affections can offer satisfactory outcomes, as long as they are performed by surgeons with experience in hepatobiliopancreatic surgery and laparoscopic surgery. It guarantees a much lower risk of intervention and optimal recovery in the shortest possible time, with similar outcomes in terms of morbidity and mortality to conventional surgery.

RESUMEN Introducción: La cirugía mínimamente invasiva del páncreas se enmarca dentro de la actual historia de la cirugía con gran impacto y desarrollo, especialmente en el campo de las pancreatectomías distales. Objetivo: Actualizar los aspectos generales y actuales de la cirugía mínimamente invasiva en las afecciones pancreáticas. Métodos: Se realizó una revisión sistemática a partir de la consulta de artículos científicos relacionados con el tema, indexados en las bases de datos Pubmed, Ebsco y SciELO. La información se analizó y se seleccionaron artículos publicados hasta 2020, relacionados con las indicaciones de cirugía laparoscópica y la robótica en las afecciones pancreáticas, la variabilidad de procederes quirúrgicos laparoscópicos y la morbimortalidad. Desarrollo: La cirugía mínimamente invasiva del páncreas ha alcanzado considerables niveles de complejidad y seguridad (desde la laparoscopia diagnóstica hasta las grandes resecciones pancreáticas). Se identifican las indicaciones de cirugía laparoscópica y la robótica en las afecciones pancreáticas, la variabilidad de procederes quirúrgicos laparoscópicos y se exponen los procederes realizados en el Centro Nacional de Cirugía de Mínimo Acceso durante estos últimos 3 años por el grupo dedicado a esta entidad. Conclusiones: La cirugía mínimamente invasiva y la robótica en afecciones pancreáticas son capaces de ofrecer resultados satisfactorios, siempre que sean realizadas por cirujanos con experiencia en cirugía hepato-biliopancreática y cirugía laparoscópica. Garantiza un riesgo de intervención mucho menor y una óptima recuperación en el menor tiempo posible con resultados similares en cuanto a morbimortalidad con la cirugía convencional.

ABSTRACT Introduction: Inguinal hernia has been one of the most controversial surgical diseases throughout history. There are several classifications and countless techniques for inguinal hernia repair. Objective: To show the outcomes of laparoscopic surgical treatment of inguinal hernia at the National Center for Minimal Access Surgery. Methods: A retrospective and descriptive study was carried out of 737 patients with a diagnosis of inguinal hernia operated on by laparoscopic surgery, in the period from January 2011 to December 2018, at the National Center for Minimal Access Surgery. Results: The effectiveness of laparoscopic techniques was shown, with a low recurrence rate of 1.4% and a low conversion rate of 0.5%, while inguinodynia appeared in five patients, accounting for 0.5%, and postoperative seroma was a predominating complication. Conclusions: Laparoscopic surgery is a safe and effective treatment option for in inguinal hernia.

RESUMEN Introducción: La hernia inguinal, es una de las enfermedades quirúrgicas que más polémicas ha provocado a través de la historia, existen disimiles clasificaciones e incontables técnicas para su reparación. Objetivo: Mostrar los resultados del tratamiento quirúrgico laparoscópico de la hernia inguinal en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó un estudio retrospectivo y descriptivo de 737 pacientes intervenidos con el diagnóstico de hernia inguinal por cirugía laparoscópica en el Centro Nacional de Cirugía de Mínimo Acceso, en el período comprendido entre enero del 2011 hasta diciembre el 2018. Resultados: Se mostró la efectividad de las técnicas laparoscópicas, con un bajo índice de recidiva, de 1,4 %, bajo índice de conversión, con 0,5 %, la inguinodinia se presentó en 5 pacientes para un 0,5 % y predominó el seroma entre las complicaciones postoperatorias. Conclusiones: La cirugía laparoscópica en la hernia inguinal es una opción segura y eficaz en el tratamiento de la enfermedad.

ABSTRACT Due to the lack of automatic processing of multi-channel surface electromyographic signals, software for processing these signals was developed and automatic criteria of expertise were applied for the interpretation of quantitative electromyography, which consists of algorithms for characterize the study of tremor and movement disorders. The system determined, for the resting state, the frequency and amplitude of the contractile activity, the timing of the tremor pattern and, depending on this, the presence of the alternating pattern, and the electromyographic activity bursts (trains) were quantitatively characterized. For the states of voluntary contraction, reciprocal inhibition and coactivation parameters were estimated between pairs of agonist and / or antagonist muscles. A validation process was carried out using a sample of records obtained in healthy and sick subjects (parkinsonian syndromes, Parkinson's disease, tremor and dystonias).

RESUMEN Debido a que no se dispone de un procesamiento automático de las señales electromiográficas de superficie de múltiples canales, se desarrolló un software de procesamiento de dichas señales y se aplicaron criterios de experticia automáticos para la interpretación de la electromiografía cuantitativa, que consta de algoritmos para caracterizar el estudio del temblor y trastornos del movimiento. El sistema determina, para el estado de reposo, la frecuencia y amplitud de la actividad contráctil, la sincronización del patrón del temblor y en dependencia de este la presencia del patrón alternante y se caracterizan cuantitativamente las salvas (trenes) de actividad electromiográfica. Para los estados de contracción voluntaria se estimaron parámetros de inhibición recíproca y coactivación entre pares de músculos agonistas y/o antagonistas. Se realizó un proceso de validación utilizando una muestra de registros obtenidos en sujetos sanos y enfermos (síndromes parkinsonianos, enfermedad de Parkinson, temblor y distonías).

ABSTRACT Introduction: Autologous hematopoietic stem cell transplantation is a therapy used in certain situations to patients with Hodgkin's Lymphoma. Objective: To evaluate the influence of selected prognostic factors on the results of autologous hematopoietic stem cell transplantation in patients with Hodgkin's Lymphoma. Methods: A retrospective study of 57 patients with a diagnosis of Hodgkin Lymphoma transplanted at Hermanos Ameijeiras Clinical Surgical Hospital from 1991 to 2018 was carried out. The influence of several unfavorable factors was evaluated according to univariate and multivariate disease-free survival at five years. Results: A lower disease-free survival was found for all groups with unfavorable categories. Univariate analysis indicated that receiving three or more previous lines of treatment increased the probability of relapse on average 3.48 times. In the multiple evaluation, the probability of relapse was significantly increased by the existence of active disease at the time of transplantation (p = 0.023) and by not receiving radiotherapy in the conditioning treatment (p = 0.010). Conclusions: The importance of knowing the unfavorable factors was established. It was of noteworthy importance to avoid active disease at transplantation and to carry out a correct evaluation of risks and benefits regarding the possible inclusion of radiotherapy in the conditioning treatment.

RESUMEN Introducción: El trasplante autólogo de progenitores hematopoyéticos es una terapéutica aplicable en determinadas situaciones a pacientes con Linfoma de Hodgkin. Objetivo: Evaluar la influencia de factores pronósticos seleccionados en los resultados del trasplante autólogo de progenitores hematopoyéticos en pacientes con Linfoma de Hodgkin. Métodos: Se realizó un estudio retrospectivo de 57 pacientes con diagnóstico de Linfoma de Hodgkin trasplantados en el Hospital Clínico Quirúrgico “Hermanos Ameijeiras” entre 1991 y 2018. La influencia de varios factores desfavorables fue evaluada según sobrevida libre de enfermedad a los cinco años de forma univariada y multivariada. Resultados: Se comprobó una sobrevida libre de enfermedad menor para todos los grupos con las categorías desfavorables. El análisis univariado indicó que el haber recibido tres o más líneas de tratamiento previas, aumentó como promedio 3,48 veces la probabilidad de recaída. En la evaluación múltiple, aumentó de forma significativa la probabilidad de recaída la existencia de enfermedad activa al momento del trasplante (p= 0,023) y el no recibir radioterapia en el tratamiento acondicionante (p= 0,010). Conclusiones: Se demostró la importancia de conocer los factores desfavorables. Notable importancia tuvo evitar enfermedad activa al trasplante y realizar una correcta evaluación de riesgos y beneficios en cuanto a la posible inclusión de la radioterapia en el tratamiento acondicionante.

ABSTRACT Introduction: Within the Trypanosomatidae family, there are two genera of medical importance for their role as human pathogens, Trypanosoma and Leishmania. Within these genera are species and subspecies that cause leishmaniasis, American Trypanosomiasis and Human African Trypanosomiasis. Objective. In this study, we investigated the phylogenetic relationships of the genus Leishmania and Trypanosoma using the cytoplasmic hsp70 gene and we discussed the implications for species definitions, evolution and taxonomy of these genera. Methods: The hsp70 gene from 44 strains from 11 Leishmania species and 41 strains from 9 Trypanosoma species from different geographical origins were sequenced. The sequences obtained were aligned with the sequences previously published in the databases. The MEGA program was used for the construction of different phylogenetic trees based on distance and character parameters. The support of the monophyletic groups was determined by the "boostrap" method. Results: For the first time, the cytoplasmic hsp70 gene was used in phylogenetic studies of the Leishmania and Trypanosoma genus and, with the results obtained, it was demonstrated that it is convenient to use it as a molecular marker for molecular methods design for detection, identification and differentiation of Leishmania and Trypanosoma species and lineages. Evidence is provided that supports the hypothesis that the genus Leishmania originated in South America (“New World”), thus contributing to the general discussion about the origin of this genus. Conclusion: This study actively contributed to discussing the implications of this analysis for the taxonomic framework for the Leishmania and Trypanosoma genera.

RESUMEN Introducción: Dentro de la familia Trypanosomatidae hay dos géneros de importancia médica por su papel como patógenos humanos, Trypanosoma y Leishmania. Dentro de estos géneros se encuentran especies y subespecies causantes de la leishmaniasis, la tripanosomiasis americana y la tripanosomiasis africana humana. Objetivos: En este estudio investigamos las relaciones filogenéticas de los géneros Leishmania y Trypanosoma utilizando la secuencia del gen hsp70 citoplasmática y discutimos las implicaciones para las definiciones de especies, la evolución y la taxonomía de estos géneros. Métodos: Se secuenció el gen de la HSP70 de 44 cepas de 11 especies de Leishmania y 41 cepas de 9 especies de Trypanosoma de diferentes orígenes geográficos. Las secuencias obtenidas se alinearon con las secuencias publicadas previamente en las bases de datos. El programa MEGA se utilizó para la construcción de distintos árboles filogenéticos basados en parámetros de distancia y caracteres. El soporte de los grupos monofiléticos se determinó por el método de boostrap. Resultados: En el presente trabajo se utilizó por primera vez el gen de la hps70 citoplasmática para estudios filogenéticos de los géneros Leishmania y Trypanosoma y con ello se demostró la utilidad de utilizarlo como marcador molecular en el diseño de métodos para la detección, identificación y diferenciación de especies y linajes de Leishmania y Trypanosoma. Los resultados proporcionan evidencias que soportan la hipótesis de que el género Leishmania es originario del “nuevo mundo”. Conclusiones: Los resultados de los estudios, basados en el análisis filogenético del gen que codifica las hps70, contribuyeron a la discusión sobre de un marco general de consenso taxonómico para los géneros Leishmania y Trypanosoma.

ABSTRACT Given the representativeness of Brazil's youth population and the various socioeconomic vulnerabilities they face, the present study aims to provide a multidimensional measure of poverty for this population group across the country's five macroregions. To this end, the Alkire-Foster method is used along with a database from the National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios, PNAD, 2015). The sample consists of 85,388 individuals, analyzed across four dimensions and twelve indicators of deprivation. The results indicate that the incidence of poverty among Brazilian youth is 11.4% and that the country's MPI is 4.5%, with the North and Northeast macroregions presenting deprivation indices higher than the national average. The indicators that most contributed to deprivation are internet access, educational level, access to a sewerage network, and garbage collection.

RESUMEN Debido a las diversas vulnerabilidades socioeconómicas y la representatividad de la juventud brasileña, este estudio tuvo como objetivo estimar una medida multidimensional de la pobreza para este público en las cinco principales regiones del país. Para ello, se utilizó el método Alkire-Foster con la base de datos recopilada en la PNAD (2015). La muestra fue compuesta por 85.388 individuos, investigados en cuatro dimensiones y 12 indicadores de privación. Los resultados señalaron que la incidencia de pobreza afecta al 11,4% de los jóvenes brasileños y el IPM del país fue del 4,5%, donde los mayores índices de privación correspondieron a las regiones Norte y Nordeste, mayores que el promedio nacional. Los indicadores que más contribuyeron para este estado de privación fueron: acceso a internet, grado educativo, acceso a la red de alcantarillado y recolección de basura.

Abstract Objective : To evaluate the effect of biotype on the productive performance and beef quality of bulls under silvopastoral system of Leucaena leucocephala (Lam.) de Witt variety Perú. Materials and Methods : Fifteen animals were used per treatment during 195 days of the dry season (October-May). Two treatments were designed: 1) genetic group Zebu under grazing ad libitum + energy complementation, 2) genetic group Siboney de Cuba under grazing ad libitum + energy complementation. A mixed linear model was applied, in which the biotype was included as fixed effect, and the system and residual error as random effects. The live weight, average daily gain, weight increase and yield per hectare were determined. On the samples taken from the Longissimus dorsis muscle, the beef color, as well as water holding capacity and acidity, were measured. Results : Differences were found (p < 0,05) for the weight at slaughter, mean daily gain, weight increase and yield per hectare, in favor of the Zebu biotype. The acidity, luminosity, red and yellow pigmentation of the beef did not differ from one group to the other. Differences were found (p < 0,001) in the concentration of acids C18:0 and C18:1, with the highest values in the Zebu biotype. Significant differences were also observed (p < 0,001) in the concentration of myristic and palmitic acid (C14:0 and C16:0, respectively). However, the highest amount was obtained in Siboney de Cuba. Conclusions : The Zebu group, under the conditions of this research, showed better productive performance, although between both groups there were instrumental values of beef quality which were close; nevertheless, in both genotypes, the percentage values of saturated, unsaturated and polyunsaturated fatty acids were similar.

Resumen Objetivo Evaluar el efecto del biotipo en el comportamiento productivo y la calidad de la carne de toros en silvopastoreo de Leucaena leucocephala (Lam.) de Witt variedad Perú. Materiales y Métodos: Se utilizaron 15 animales por tratamiento durante 195 días del período poco lluvioso (octubre-mayo). Se diseñaron dos tratamientos: 1) grupo genético Cebú en pastoreo ad libitum + complementación energética, 2) grupo genético Siboney de Cuba en pastoreo ad libitum + complementación energética. Se aplicó un modelo lineal mixto, en el que se incluyó como efecto fijo el biotipo, el sistema y el error residual como aleatorios. Se determinó el peso vivo, la ganancia media diaria, el incremento de peso y el rendimiento por hectárea. A las muestras tomadas del musculo Longissimus dorsis, se midió el color de la carne, así como su capacidad de retención de agua y acidez. Resultados Se encontraron diferencias (p < 0,05) para el peso de sacrificio, la ganancia media diaria, el incremento de peso y el rendimiento por hectárea, a favor del biotipo Cebú. La acidez, luminosidad, pigmentación roja y amarilla de la carne no difirieron de un grupo a otro. Sin embargo, sí se observaron diferencias (p < 0,05) para el grupo Cebú en la capacidad de retención de agua. Se encontraron diferencias (p < 0,001) en la concentración de los ácidos C18:0 y C18:1, con los mayores valores en el biotipo Cebú. También se hallaron diferencias significativas (p < 0,001) en la concentración del mirístico y el palmítico (C14:0 y C16:0, respectivamente). Sin embargo, la mayor cuantía se obtuvo en el Siboney de Cuba. Conclusiones El grupo genético Cebú, en las condiciones específicas específicas de esta investigación, manifestó mejor comportamiento productivo que los animales mestizos; sin embargo, en ambos genotipos, los valores porcentuales de ácidos grasos saturados, insaturados y poli-insaturados resultaron similares.

ABSTRACT Introduction: The recent advances in the management of multiple myeloma (MM) during the last years have included the autologous hematopoietic stem cell transplantation (auto-HSCT) to the treatment strategy of these patients. Objective: To present the first results in the "Hermanos Ameijeiras" hospital (HAH) with the application of auto-HSCT in patients with monoclonal gammopathies (MG) using high doses of melphalan (HD-Mel) as conditioning regimen (CR) and its impacton overall survival (OS). Methods: A retrospective study of all patients with MG who underwent auto-HSCT in the Hematology Service of the HAH in the period between 2009 and 2018 wasmade. The final sample comprised 14 cases. Results: The average age was 53.5 years; the majority had diagnosis of MM (85.7%) and all of them were diagnosed in stage III of Durie-Salmon; as CR 64.2% received HD-mel, at 200 mg/m2. The recovery of neutrophil and platelet counts occurred on average at 11.4 and 12 days respectively. Transplant related mortality (TRM) at day +30 was 7.1%. The probability of OS at 2 years was higher than 90% and at 5 years of 68%. Conclusions: It was verified that the performance of auto-HSCT with the use of HD-Mel as CR in patients with MG is a feasible procedure in our country with a relatively low TRM. It was possible to demonstrate that the inclusion of auto-HSCT in the treatment considerably improves the survival expectations of these patients.

RESUMEN Introducción: Los avances en el manejo del mieloma múltiple (MM) durante los últimos años incluyen la incorporación del trasplante de progenitores hematopoyéticos autólogo (TPHa) a la estrategia de tratamiento de estos pacientes. Objetivo: Dar a conocer los primeros resultados en el hospital “Hermanos Ameijeiras” (HHA) con la aplicación del TPHa en pacientes con gammapatías monoclonales (GM), empleando las altas dosis de melfalán (AD-Mel) como tratamiento acondicionante (TA) y su impacto en la sobrevida global (SG). Métodos: Se hizo un estudio retrospectivo de todos los pacientes con GM sometidos a TPHa en el Servicio de Hematología del HHA en el período comprendido entre 2009 y 2018. La muestra final comprendió 14 casos. Resultados: La edad promedio fue de 53,5 años; la mayoría tenía como diagnóstico MM (85,7 %) y todos ellos debutaron en estadio III de Durie-Salmon; como TA el 64,2 % recibió AD-mel, en dosis de 200 mg/m2. La recuperación de las cifras de neutrófilos y plaquetas ocurrieron como promedio a los 11,4 y 12 días, respectivamente. La mortalidad relacionada con el trasplante (MRT) al día +30 fue del 7,1 %. La probabilidad de SG a los 2 años fue superior al 90 % y a los 5 años del 68 %. Conclusiones: Se comprobó que la realización del TPHa con el empleo de AD-Mel como TA en pacientes con GM es un proceder realizable en nuestro país con una MRT relativamente baja. Se logró demostrar que la inclusión del TPH en el tratamiento mejora considerablemente las expectativas de sobrevida de estos pacientes.

ABSTRACT Ocular toxoplasmosis is the most frequent cause of posterior uveitis in many countries. Correct diagnosis is mainly based on the clinical characteristics of the disease, but in atypical forms of posterior uveitis laboratory support is required to confirm the diagnosis and not indicate inappropriate treatments. Evidence is provided of the usefulness of polymerase chain reaction in ocular fluids from patients with serum serological titers positive for toxoplasma and atypical presentations of posterior uveitis. A clinical case is presented of a female patient with systemic toxoplasmosis confirmed by positive serum serological titers and concomitant bilateral posterior uveitis without typical features of ocular toxoplasmosis, in which polymerase chain reaction in ocular fluids was essential for the diagnosis. Polymerase chain reaction in ocular fluids is an unequivocal tool for the correct diagnosis of atypical forms of posterior uveitis.

RESUMEN La toxoplasmosis ocular es la causa de uveítis posterior más frecuente en muchos países. El diagnóstico correcto se basa principalmente en las características clínicas de la enfermedad; pero en las formas de uveítis posterior atípicas se necesita el apoyo del laboratorio para confirmar el diagnóstico y no indicar tratamientos inapropiados. Se resalta el valor de la reacción en cadena de la polimerasa en fluidos oculares en pacientes con títulos serológicos en suero positivos para toxoplasma y presentaciones atípicas de uveítis posterior. Se presenta un caso clínico de una paciente con toxoplasmosis sistémica, confirmada con títulos serológicos en suero positivos, quien concomitó con uveítis posterior bilateral sin características típicas de toxoplasmosis ocular, en la cual la reacción en cadena de la polimerasa de fluidos oculares fue esencial en el diagnóstico. La reacción en cadena de la polimerasa en fluidos oculares constituye una herramienta inequívoca en el diagnóstico correcto de las formas atípicas de uveítis posteriores.

Abstract It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.

ABSTRACT Introduction: Laparoscopic ultralow anterior rectal resection with coloanal anastomosis prevents the performance of a definitive colostomy. Objective: To determine the indications, describe the surgical technique and show the long-term outcome of performing this procedure in the treatment of cancer of the lower rectum. Method: A descriptive and prospective observational study of 53 patients with low rectal cancer was carried out in the period between October 2007 and November 2018, at the National Center for Minimum Access Surgery. All resections were carried out by a group dedicated to colorectal surgery. In all cases, the total mesorectal excision was performed. Results: 53 patients (30 males and 23 females), with an average age of 57 years (range 23-81) and 42 (79.2%) after neoadjuvant therapy were operated using this technique. The average surgical time was 195 min (range 90-360) and the estimated blood loss was 72 mL. The incidence of major morbidity was 16.9% (9/53) and the average hospital stay was 6.3 days. The mean follow-up period was 40 months (range 1-132), with a local relapse of 9.4% (5/53) and a 5-year overall survival of 80.3%. Conclusions: Laparoscopic ultralow anterior resection of the rectum with coloanal anastomosis is a safe technique with excellent outcomes in terms of local relapse and overall survival.

RESUMEN Introducción: La resección anterior del recto ultrabaja laparoscópica con anastomosis coloanal evita la realización una colostomía definitiva. Objetivo: Determinar las indicaciones, describir la técnica quirúrgica y mostrar los resultados a largo plazo obtenidos en la realización de este proceder en el tratamiento del cáncer del recto bajo. Método: Se realizó un estudio observacional descriptivo y prospectivo de 53 pacientes con cáncer del recto bajo en el período comprendido entre octubre 2007 y noviembre 2018 en el Centro Nacional de Cirugía de Mínimo Acceso. Todas las resecciones fueron llevadas a cabo por un grupo dedicado a la cirugía colorrectal, en todos los casos se realizó la excisión total del mesorrecto. Resultados: Se operaron mediante esta técnica 53 pacientes, 30 masculinos y 23 femeninos con un promedio de edad de 57 años (rango 23-81) y de ellos 42 (79,2 %) después de terapia neoadyuvante. El promedio de tiempo quirúrgico fue de 195 min (rango 90-360) y las pérdidas hemáticas estimadas, de 72 mL. La incidencia de morbilidad mayor fue de 16,9 % (9/53) y la media de estadía hospitalaria de 6,3 días. La media del periodo de seguimiento fue de 40 meses (rango 1-132) con una recidiva local de 9,4 % (5/53) y una supervivencia global a los 5 años de 80,3 %. Conclusiones: La resección anterior del recto ultrabaja laparoscópica con anastomosis coloanal es una técnica segura con excelentes resultados en cuanto a recidiva local y supervivencia global.

Introdução: A lesão hepática induzida por drogas é uma consequência cada vez mais prevalente da diversificação de armas terapêuticas disponíveis. São principalmente reacções idiossincráticas, com vários mecanismos possíveis e padrões de danos específicos de cada droga. O carvedilol, bloqueador alfa e beta não seletivo amplamente utilizado, leva, em casos muito raros, a lesão dos canalículos biliares por metabólitos tóxicos, resultando numa hepatite padrão misto com possível progressão a síndrome colestática crónica e potencialmente cirrose. Os autores relatam o segundo caso conhecido desta importante toxicidade. Caso clínico: Uma mulher idosa foi admitida na enfermaria de Medicina Interna para esclarecimento etiológico de uma hepatite de padrão misto. Esta investigação que incluiu uma extensa pesquisa de antecedentes, exclusão de causas estruturais, infecciosas e auto-imunes por análises sanguíneas e exames de imagem, levou ao diagnóstico de uma hepatite tóxica, confirmada por biópsia hepática com achados morfológicos de um padrão misto de lesão hepática. O carvedilol, introduzido 6 meses antes, foi considerado o agente causal dado ser a única substância com padrão clínico, temporal, analítico e histológico compatível. A retirada do medicamento resultou na reversão lenta das referidas anormalidades. Discussão: Em casos muito raros, o carvedilol pode causar toxicidade hepática importante sob a forma de síndrome colestástica crónica que pode evoluir até uma cirrose hepática. Deve ser tomado em consideração como potencial agente causal em casos semelhantes e retirado imediatamente após suspeita, sendo que a suspensão atempada resulta na reversão completa dos achados patológicos.

Introduction: Drug-induced liver injury is an increasingly prevalent consequence of the diversification of available therapeutic weapons, mostly idiosyncratic and with several possible mechanisms and patterns of specific damage for each drug. Carvedilol, a widely used non-selective alpha and beta blocker leads, in very rare cases, to injury of the bile ducts by toxic metabolites, resulting in a mixed-pattern hepatitis with possible progression to chronic cholestatic syndrome and cirrhosis. The authors report the second known case of this important toxicity. Clinical Case: An 83-year-old woman was admitted to the Internal Medicine ward for etiological clarification of a mixed-pattern hepatitis. Clinical history was unremarkable and structural, infectious, and autoimmune causes were excluded by blood tests and imaging exams, ultimately leading to the diagnosis of toxic hepatitis that was further confirmed by liver biopsy with morphologic findings of mixed-pattern liver injury. Carvedilol, started 6 months before, was deemed the causal agent since it was the only drug with a clinically, temporally, analytically, and histologically compatible pattern. The withdrawal of the drug resulted in slow reversal of the referred abnormalities. Conclusion: In very rare cases, carvedilol can cause important liver toxicity as a chronic cholestatic syndrome which can evolve to cirrhosis. It should be taken in consideration as causal agent in similar cases and stopped immediately upon suspicion, as the timely withdrawal results in reversion of the pathological findings.