Objetivos Determinar la mortalidad al año de seguimiento de pacientes con trastorno mental grave (TMG) y multimorbilidad en Atención Primaria (AP). Material y métodos Diseño: estudio descriptivo, longitudinal y prospectivo. Ámbito: centros de salud de AP. Criterios de selección: adultos con diagnóstico de TMG con presencia de una o más enfermedades no psiquiátricas en la hoja de problemas de la historia clínica electrónica Diraya. Criterios de exclusión: cuidados paliativos. Muestra: pacientes seleccionados por muestreo consecutivo. Variables: variable dependiente: mortalidad. Variables independientes: sociodemográficas, clínicas. Análisis estadístico: descriptivo, univariante y bivariante según naturaleza de las variables. Limitaciones: falta de información de asistencia privada y registro en historia de salud digital. Aspectos éticos-legales: conformidad del Comité de Ética local. Resultados 113 pacientes con edad media de 53 años (DE 13, 8); 53% hombres. Los TMG más frecuentes fueron: 40,9% trastorno esquizofrénico y 19% trastorno bipolar. La comorbilidad asociada presentó como mediana 2 [4], siendo las más frecuentes las patologías endocrinas (42,5%), traumatológicas (32,7%) y digestivas (31,9%). El consumo de tóxicos estaba presente en el 54% de la muestra. La mortalidad al año fue del 0,9% por causa no relacionada con el TMG y sin relación estadísticamente significativa con la morbilidad asociada. Conclusiones Según la literatura, las personas con TMG muestran mayor morbimortalidad y menor esperanza de vida respecto a la población general. Sin embargo, en este estudio, la muestra —pese a presentar una elevada morbilidad asociada— no nos permite estudiar factores relacionados con la mortalidad, posiblemente por el breve periodo de seguimiento. Es por ello que se amplía el seguimiento a cuatro años. CEI El Comité de Ética de la Investigación Clínica de los hospitales universitarios Virgen Macarena-Virgen del Rocío.
Objective: The purpose of this research is to examine whether low-dose methylprednisolone or metoclopramide is more effective in preventing post-adenotonsillectomy nausea, vomiting, and respiratory problems. Study Design: Retrospective study Place and Duration: Tertiary Care Hospital of Punjab Pakistan Methods: This research included 200 adenotonsillectomy patients of both sexes. The patients were 2-12 years old. After informed written agreement, patients' age, sex, and weight were recorded. Patients were divided in half. Group A had 100 patients and received 1 mg/kg IV methylpredinosolone and group B were given 0.15 mg/kg metoclopramide. Post-operative effects on PONV were compared in terms of oral intake time, vomiting episodes, respiratory problems, and side effects. VAS used to rate mean pain score. SPSS 24.0 examined all data. Results: Among two hundred cases, 120 (60%) patients were males and 80 (40%) patients were females. There was no any significant difference observed in operative time among both groups. We found higher frequency of post-operative nausea and vomiting in group B 26 (26%) and 31 (31%) as compared to group A 17 (17%) and 21 (21%). Significantly low pain score was found in group A 1.17±4.6 as compared to group B 4.0±1.2 with p value <0.004. Those in Group B took longer to start eating than those in Group A (1.2±0.8 vs 3.13±4.30 hours). We found significantly higher complications in group B as compared to group A with p value <0.005. Conclusion: In this study, we found that methylpredinosolone was beneficial in reducing the incidence of postoperative nausea and vomiting (PONV), pain, and respiratory problems and side effects among patients who had had adenotonsillectomy. This modest dosage of methylprednisolone was effective in promoting oral tolerance at an early time. Metoclopramide, Adenotonsillectomy, Oral Intake, Methylpredinosolone
Background: Vitamin D deficiency is increasingly recognized as an emerging metabolic risk factor in patients with type 2 diabetes mellitus. Its potential role in glucose regulation, insulin secretion, and insulin sensitivity has gained clinical relevance, particularly in regions where deficiency is widespread. Objective: To evaluate the impact of vitamin D deficiency on glycemic control among individuals with type 2 diabetes mellitus attending tertiary care hospitals in Punjab, Pakistan. Methods: This cross-sectional study was conducted from January 2024 to March 2025, including 160 adults diagnosed with type 2 diabetes mellitus. Participants were recruited from tertiary care hospitals across Punjab using consecutive sampling. Serum 25-hydroxyvitamin D, fasting blood glucose, HbA1c, fasting insulin, and HOMA-IR were measured. Vitamin D status was categorized as deficient, insufficient, or sufficient. Glycemic control was assessed according to HbA1c levels. Statistical analysis included ANOVA, chi-square tests, and Pearson correlation, with significance set at p < 0.05. Results: Vitamin D deficiency was highly prevalent, affecting 64 percent of participants. Patients with deficiency exhibited significantly elevated fasting glucose and HbA1c compared with those with sufficient vitamin D levels. Mean fasting glucose was highest in the deficient group (173.2 ± 31.6 mg/dL), and mean HbA1c was highest among deficient participants (8.7 ± 1.0%). Poor glycemic control was observed in 76.5 percent of vitamin D-deficient patients versus 27.3 percent of vitamin D-sufficient participants. Serum 25-hydroxyvitamin D demonstrated a strong inverse correlation with both fasting glucose and HbA1c. Conclusion: Vitamin D deficiency is strongly associated with poor glycemic control and increased insulin resistance in patients with type 2 diabetes mellitus. Routine assessment and correction of vitamin D levels may serve as an effective adjunct in improving metabolic outcomes. Vitamin D deficiency, Type 2 diabetes mellitus, Glycemic control, HbA1c, Insulin resistance, 25-hydroxyvitamin D, Punjab Pakistan
The essay analyzes the relationships between Marxism, art, and education in digital capitalism, highlighting how Big Techs control access to culture and restrict the democratization of knowledge. It also discusses the impact of artificial intelligence (AI), addressing risks such as the replacement of human authorship and algorithmic biases, which reinforce gender inequalities and political exclusion. Furthermore, the study emphasizes the need for internet regulation, citing legislative proposals under discussion in Brazil, such as Bill 2630/2020 (platform transparency) and Bill 2338/2023 (AI regulation). The essay concludes that digital governance must ensure transparency, equity, and rights protection, preventing technology from being used as a tool for exploitation and social control.
Em 1979, Cláudio Torres publicava o primeiro desiderato do que veio depois a ser conhecido como o projeto “Mértola Vila Museu” (TORRES, 1979), bastante antes das Convenções de La Valletta e de Faro. Ao longo destas quatro décadas, algumas das propostas que pareciam, na altura, sonhos foram tomando corpo, mas outras permaneceram inalcançáveis juntando-se a novas utopias que, entretanto, apareceram no horizonte. O projeto sempre teve a flexibilidade suficiente para resistir e para se reinventar, enfrentando um dos mais difíceis desafios: a continuidade. A valorização do património, a sua importância para a comunidade e a crescente premência de idealizar e persistir nos caminhos da investigação e da divulgação são os pilares que sustentam o sonho “que comanda a vida”.
