Intervenções para perda auditiva sensorioneural: o que mostram as revisões sistemáticas Cochrane? / Interventions for hearing loss sensorineural: what do the Cochrane systematic reviews?

A perda auditiva sensorioneural é condição de elevada prevalência mundial, constituindo problema socioeconômico relevante e preocupante atualmente. Atrelada a muitos fatores de risco, os esforços voltam-se à redução de seu impacto para o futuro. Objetivos: Este estudo avaliou a efetividade das intervenções preventivas e terapêuticas para perda auditiva sensorioneural, segundo as revisões sistemáticas da Colaboração Cochrane. Métodos: Trata-se de overview de revisões sistemáticas Cochrane. Procedeu-se à busca na Cochrane Library (2022), sendo utilizado o termo MeSH "HEARING LOSS". Todos os estudos relacionados à prevenção e tratamento de perda auditiva sensorioneural foram incluídos. O desfecho primário de análise foi a melhora clínica. Resultados: Seis estudos foram incluídos, totalizando 26 ensaios clínicos randomizados (ECRs) (n = 2.139 participantes). Esteroides, antivirais, vasodilatadores, oxigenioterapia hiperbárica e prótese auditiva (aparelho de amplificação sonora individual, AASI) foram avaliados. Nenhuma intervenção medicamentosa mostrou efetividade. Apenas o uso de AASI mostrou melhora na qualidade de vida no que tange à audição. Discussão: Todos os estudos encontrados são de cunho terapêutico, não havendo análises de prevenção da perda auditiva. Em geral, trata-se de estudos com baixa amostragem e alta heterogeneidade, sendo que apenas o uso de AASI pode ser recomendado no momento. Sugere-se a realização de novos ECRs, de qualidade, para intervenções cuja efetividade é ainda incerta, seguindo-se as recomendações do CONSORT (Consolidated Standards of Reporting Trials) Statement. Conclusão: Apenas o uso de AASI apresenta evidência de melhora na qualidade de vida de pacientes com perda auditiva sensorioneural. Nenhuma intervenção medicamentosa apresenta evidência de efetividade atualmente para essa finalidade.

Carbapenem-resistant Pseudomonas aeruginosa: association with virulence genes and biofilm formation

Abstract Pseudomonas aeruginosa is an opportunistic pathogen that causes frequently nosocomial infections, currently becoming more difficult to treat due to the various resistance mechanisms and different virulence factors. The purpose of this study was to determine the risk factors independently associated with the development of bacteremia by carbapenem-resistant P. aeruginosa, the frequency of virulence genes in metallo-β-lactamases producers and to evaluate their ability to produce biofilm. We conducted a case–control study in the Uberlândia Federal University – Hospital Clinic, Brazil. Polymerase Chain Reaction was performed for metallo-β-lactamases and virulence genes. Adhesion and biofilm assays were done by quantitative tests. Among the 157 strains analyzed, 73.9% were multidrug-resistant, 43.9% were resistant to carbapenems, 16.1% were phenotypically positive for metallo-β-lactamases, and of these, 10.7% were positive for blaSPM gene and 5.3% positive for blaVIM. The multivariable analysis showed that mechanical ventilation, enteral/nasogastric tubes, primary bacteremia with unknown focus, and inappropriate therapy were independent risk factors associated with bacteremia. All tested strains were characterized as strongly biofilm producers. A higher mortality was found among patients with bacteremia by carbapenem-resistant P. aeruginosa strains, associated independently with extrinsic risk factors, however it was not evident the association with the presence of virulence and metallo-β-lactamases genes.

Risk factors for indications of intraoperative blood transfusion among patients undergoing surgical treatment for colorectal adenocarcinoma / Fatores de risco para indicação de transfusão sanguínea intraoperatória em doentes operados por adenocarcinoma colorretal

CONTEXT: Identification of risk factors for requiring transfusions during surgery for colorectal cancer may lead to preventive actions or alternative measures, towards decreasing the use of blood components in these procedures, and also rationalization of resources use in hemotherapy services. This was a retrospective case-control study using data from 383 patients who were treated surgically for colorectal adenocarcinoma at "Fundação Pio XII", in Barretos-SP, Brazil, between 1999 and 2003. OBJECTIVE: To recognize significant risk factors for requiring intraoperative blood transfusion in colorectal cancer surgical procedures. METHODS: Univariate analyses were performed using Fisher's exact test or the chi-squared test for dichotomous variables and Student's t test for continuous variables, followed by multivariate analysis using multiple logistic regression. RESULTS: In the univariate analyses, height (P = 0.06), glycemia (P = 0.05), previous abdominal or pelvic surgery (P = 0.031), abdominoperineal surgery (P<0,001), extended surgery (P<0.001) and intervention with radical intent (P<0.001) were considered significant. In the multivariate analysis using logistic regression, intervention with radical intent (OR = 10.249, P<0.001, 95 percent CI = 3.071-34.212) and abdominoperineal amputation (OR = 3.096, P = 0.04, 95 percent CI = 1.445-6.623) were considered to be independently significant. CONCLUSION: This investigation allows the conclusion that radical intervention and the abdominoperineal procedure in the surgical treatment of colorectal adenocarcinoma are risk factors for requiring intraoperative blood transfusion.

OBJETIVO: Identificar fatores de risco de indicação de transfusão sanguínea intraoperatória em doentes submetidos a tratamento cirúrgico por adenocarcinoma colorretal. MÉTODOS: Estudo retrospectivo, tipo caso-controle, realizado na Fundação Pio XII, em Barretos, SP, utilizando-se base de dados de prontuários de 383 pacientes admitidos entre 1999 e 2003. Utilizou-se teste exato de Fischer ou qui ao quadrado para variáveis dicotômicas e t de Student para variáveis contínuas, na análise univariada, adotando-se nível de significância de 10 por cento (P<0,10); na análise multivariada foi aplicado o teste de regressão logística múltipla, com nível de significância de 5 por cento (P<0,05); as razões de chances e os respectivos intervalos de confiança de 95 por cento foram calculados. RESULTADOS: Nas análises univariadas foram consideradas significantes as variáveis altura (P = 0,06), glicemia (P = 0,05), antecedente de cirurgia abdominal ou pélvica (P = 0,031), operação abdominoperineal (P<0,001), cirurgia ampliada (P<0,001) e intervenção com intuito radical (P<0,001). Na análise multivariada por regressão logística foram considerados independentemente significantes, quando analisadas em conjunto, intervenção com intuito radical (OR = 10,249, P<0,001, IC95 por cento = 3,071-34,212) e amputação abdominoperineal (OR = 3,906, P = 0,04, IC95 por cento = 0,151-0,692). CONCLUSÃO: Esta investigação permitiu concluir que a intervenção radical e o procedimento abdominoperineal, no tratamento cirúrgico do adenocarcinoma colorretal, constituem fatores de risco independentes para a transfusão sanguínea intraoperatória.

Ascaridíase hepatobiliar complicada por pneumonia lipoídica / Hepatobiliary ascariasis complicated by lipoid pneumonia

OBJETIVO: Apresentar um caso de ascaridíase hepatobiliar complicado por pneumonia lipoídica e discutir as implicações anestésicas envolvidas. DESCRIÇÃO DO CASO: Menina de dois anos de idade com ascaridíase hepatobiliar complicada por pneumonia lipoídica por aspiração e desnutrição grave, advinda de família em condições sociais precárias em zona rural, com quatro irmãos. Foi tratada com sucesso por uma combinação de lavados broncopulmonares sucessivos e cirurgia. COMENTÁRIOS: Ascaridíase biliar corresponde a cerca de 10 por cento dos casos de complicações de ascaridíase. Apenas uma minoria precisa de tratamento cirúrgico. O uso de óleo mineral por via oral é um tratamento tradicional para a suboclusão intestinal pelo Ascaris lumbricoides, mas a broncoaspiração do óleo e a conseqüente pneumonia lipoídica representam um risco alto para o seu uso. Anestesia geral para laparotomia exploradora em pré-escolar desnutrido com pneumonia lipóide e ascaridíase biliar é uma situação pouco contemplada na literatura médica, o que exigiu um planejamento terapêutico específico.

OBJECTIVE: To present a case of hepatobiliary ascariasis complicated by exogenous lipoid aspirative pneumonia and the anesthetic implications involved. CASE DESCRIPTION: We present a case of hepatobiliary ascariasis complicated by exogenous lipoid aspirative pneumonia and severe undernourishment in a two-year-old female from a five-children poor family from the Brazilian rural area. She was successfully treated by the association of repeated bronchopulmonary lavage and surgery. COMMENTS: Biliary ascariasis corresponds roughly to 10 percent of complicated ascariasis cases. Only a minority requires surgery. Mineral oil is a traditional treatment for intestinal Ascaris lumbricoides subocclusion, but oil aspiration and lipoid pneumonia remain a highly morbid risk of this practice. General anesthesia and laparotomy in an undernourished small child with lipoid pneumonia and biliary ascariasis were rarely addressed in the medical literature. Therefore, the therapeutic planning of this case was difficult.

Interaction between estrogen receptor and retinol-binding protein-4 polymorphisms as a tool for the selection of prolific pigs

The aim of the present study was to investigate the association of the estrogen receptor (ER-PvuII) and retinol-binding protein 4 (RBP4-MspI) gene polymorphisms and their interactions with prolificacy in a commercial synthetic pig line reared in Brazil. A total of 10,374 piglet records from 218 sows and 817 litters were used for litter size analysis. Only females with three or four farrowings were included in the analysis. The mean litter size ranged from 5.0 to 19.5 piglets. DNA was extracted from leukocytes by a standard method, and ER-PvuII and RBP4-MspI polymorphisms were characterized by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The association between alleles or genotypes and reproductive performance was analyzed using a general linear model including the interaction between the ER-PvuII and RBP4-MspI genotypes. For the ER-PvuII gene, the allele frequencies of allele A and allele B were 0.56 and 0.44, respectively. For the RBP4-MspI gene, the frequencies of alleles A1 and A2 were 0.29 and 0.71, respectively. The total number of piglets born (TNB), born alive (NBA), or number of mummies and stillborn piglets (NMUM and NSB) per litter did not differ between the various ER-PvuII and RBP4-MspI genotypes. However, when the ER-PvuII and RBP4-MspI genotypes were considered together in each sow, TNB and NBA were 1.4 (p = 0.0026) and 0.9 (p = 0.019) higher in AA/A1 and AB/A1 animals, respectively, than in AA/A2 and BB/A1 animals. Likewise, TNB and NBA were 0.9 (p = 0.0258) and 0.8 (p = 0.0168) higher in BB/A2 and AB/A2 sows, respectively, than in AA/A2 and BB/A1 animals, but no difference was observed compared to AA/A1 and AB/A1 animals. The results showed larger litter sizes (TNB and NBA) for sows carrying the ER-PvuII allele A and the RBP4-MspI genotype A1, and for animals carrying the ER-PvuII allele B and the RBP4-MspI genotype A2. In conclusion, the interaction between genotypes ER-PvuII...