Relationship of hemoglobin levels with outcomes in deceased donor kidney transplant: a retrospective cohort study / Relação dos níveis de hemoglobina com desfechos em transplante renal de doador falecido: um estudo de coorte retrospectivo

ABSTRACT Introduction: Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. Methods: This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors' and kidney transplant patients' demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. Results: We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159-0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687-0.926; p = 0.003] and death from any cause. Conclusion: An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor.

RESUMO Introdução: A anemia é frequente em pacientes submetidos à terapia substitutiva para insuficiência renal. A anemia nos períodos pré e pós-transplante pode estar relacionada aos desfechos do transplante renal. Portanto, o presente estudo buscou avaliar a relação entre anemia, função retardada do enxerto (FRE), disfunção crônica do enxerto renal (DCE) e óbito por qualquer causa após transplante renal de doador falecido. Métodos: Este foi um estudo retrospectivo com 206 pacientes transplantados renais de doadores falecidos. Analisamos dados demográficos de doadores falecidos e pacientes transplantados renais. Além disso, comparamos parâmetros bioquímicos, status de anemia e medicamentos entre os grupos FRE e não-FRE. Posteriormente, realizamos uma análise multivariada. Também avaliamos desfechos, como DCE em um ano e óbito em dez anos. Resultados: Observamos menor frequência de concentração de hemoglobina (Hb) pré-transplante, mas maior frequência de creatinina sérica do doador e transfusão de hemácias no período de uma semana após o transplante no grupo FRE. Além disso, houve associação independente entre a concentração de Hb antes do transplante e a FRE [OR 0,252; IC 95%: 0,159-0,401; p < 0,001]. Houve também associação entre a concentração de Hb após seis meses de transplante renal e ambos, DCE [OR 0,798; IC95%: 0,687-0,926; p = 0,003] e óbito por qualquer causa. Conclusão: Encontrou-se uma associação entre anemia pré-transplante e FRE e entre anemia seis meses após o transplante e ambos, DCE e óbito por qualquer causa. Assim, a anemia antes ou após o transplante afeta os desfechos de pacientes que foram submetidos a transplante renal de doador falecido.

Pain Patterns of the Temporomandibular Joint Dysfunction and Implications of Stress-Related Behaviors: A Pilot Study / Patrones de Dolor de la Disfunción de la Articulación Temporomandibular e Implicaciones de los Comportamientos Relacionados con el Estrés: Un Estudio Piloto

SUMMARY: Temporomandibular joint dysfunction interferes with the quality of life and activities of daily living among patients. The symptoms of temporomandibular dysfunction, including pain and clicking and popping sounds, are worsened during stressful events, and patients report increased pain around the temporomandibular joint. Stress-related behaviors, such as teeth clenching and teeth grinding, are commonly reported as increasing during stress. The prevalence of temporomandibular dysfunction and stress-related behaviors is reported differently in the literature. Stress in higher education is common. The purpose of this pilot study was to investigate the prevalence of temporomandibular joint dysfunction and stress-related behaviors among staff members at a local University. The study also sought to explore pain patterns described by people experiencing temporomandibular joint dysfunction and the relationship between stress-related behaviors and pain symptoms experienced. Further, the impact of stress on symptoms experienced by people with temporomandibular dysfunction was investigated in this pilot study.

La disfunción de la articulación temporomandibular interfiere con la calidad de vida y las actividades de la vida diaria entre los pacientes. Los síntomas de la disfunción temporomandibular, incluidos el dolor y los chasquidos, empeoran durante los eventos estresantes, y los pacientes informan un aumento del dolor alrededor de la articulación temporomandibular. Los comportamientos relacionados con el estrés, como apretar y rechinar los dientes, suelen aumentar durante el estrés. La prevalencia de la disfunción temporomandibular y los comportamientos relacionados con el estrés se informa de manera diferente en la literatura. El estrés en la educación superior es común. El propósito de este estudio piloto fue investigar la prevalencia de la disfunción de la articulación temporomandibular y los comportamientos relacionados con el estrés entre los miembros del personal de una universidad local. El objetivo del estudio además fue explorar los patrones de dolor descritos por personas que experimentan disfunción de la articulación temporomandibular y la relación entre los comportamientos relacionados con el estrés y los síntomas de dolor experimentados. Además, en este estudio piloto se investigó el impacto del estrés en los síntomas que experimentan las personas con disfunción temporomandibular.

Correlato neurobiológico de los síntomas premotores del parkinson: el origen en la teoría de Braak / Neurobiological correlate of parkinson's premotor symptoms: the origin in Braak's theory / Correlação neurobiológica dos sintomas pré-motores de parkinson: a origem na teoria de Braak

El diagnóstico de enfermedad de Parkinson (ED) se basa en las principales manifestaciones motoras: bradicinesia en combinación con temblor en reposo, rigidez o ambos. Cuando se realiza el diagnóstico basado en la sintomatología motora clínica típica ya se han perdido hasta el 60 % de las neuronas dopaminérgicas de la sustancia negra pars compacta mesencefálica. La identificación de los síntomas premotores son un marcador temprano para sospechar la aparición futura de la enfermedad, así como su progresión y gravedad. La hipótesis sobre la patogénesis que mejor expone la progresión de la enfermedad es la teoría de Braak. Esta se basa en la aparición y presencia de cuerpos de Lewy en diferentes estructuras anatómicas, las cuales representadas en cada uno de sus seis estadios y podrían ser la explicación biológica de los síntomas premotores, motores y no motores. La detección temprana de los síntomas premotores puede tener repercusiones positivas en el enfoque, seguimiento, diagnóstico y tratamiento de la EP. El propósito de este artículo es identificar las aproximaciones neurológicas descritas por la teoría de Braak para los síntomas premotores de la enfermedad de Parkinson de acuerdo con la literatura publicada en los últimos 20 años.

The diagnosis of Parkinson's disease (PD) is based on the main motor manifestations: bradykinesia in combination with tremor at rest, rigidity, or both. When the diagnosis is made based on typical clinical motor symptoms, up to 60 % of the dopaminergic neurons of the mesencephalic substantia nigra pars compacta have already been lost. The identification of premotor symptoms is an early marker to suspect the future appearance of the disease, as well as its progression and severity. The hypothesis about the pathogenesis that best exposes the progression of the disease is Braak's theory. It is based on the appearance and presence of Lewy bodies in different anatomical structures, which are represented in each of its six stages and could be the biological explanation biological of premotor, motor, and non-motor symptoms. Early detection of premotor symptoms can have positive repercussions in the approach, follow-up, diagnosis and treatment of PD. The purpose of this article is to identify the neurological approaches described by Braak's theory for the premotor symptoms of Parkinson's disease according to the literature published in the last 20 years.

O diagnóstico da doença de Parkinson (DP) baseia-se nas principais manifestações motoras: bradicinesia combinada com tremor de repouso, rigidez ou ambos. Quando o diagnóstico é feito com base em sintomas clínicos motores típicos, até 60% dos neurônios dopaminérgicos da substância negra pars compacta mesencefálica já foram perdidos. A identificação de sintomas pré-motores é um marcador precoce para suspeitar do futuro aparecimento da doença, bem como da sua progressão e gravidade. A hipótese sobre a patogênese que melhor expõe a progressão da doença é a teoria de Braak. Isto se baseia no aparecimento e presença de corpos de Lewy em diferentes estruturas anatômicas, que estão representados em cada uma de suas seis etapas e podem ser a explicação biológica dos sintomas pré-motores, motores e não motores. A detecção precoce de sintomas pré-motores pode repercutir positivamente na abordagem, acompanhamento, diagnóstico e tratamento da DP. O objetivo deste artigo é identificar as abordagens neurológicas descritas pela teoria de Braak para os sintomas pré-motores da doença de Parkinson de acordo com a literatura publicada nos últimos 20 anos.

Functional literacy and the assessment process as a diagnostic instrument for temporomandibular disorders: observational study / Alfabetismo funcional e o processo de avaliação como instrumento diagnóstico das disfunções temporomandibulares: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Health literacy is a topic that has been gaining traction in recent years, both on the policy and research agendas of many countries, however there is no evidence about temporomandibular disorders (TMD) and this topic. The objective was to evaluate the association between the level of functional literacy and the understanding of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) through self-report and to associate the time of TMD complaint with the levels of functional literacy. METHODS: This is an observational, cross-sectional study, comprising 56 patients from the Temporomandibular Disorders (TMD) clinic at São Leopoldo Mandic College. The DC/TMD questionnaire - axis I, a sociodemographic questionnaire, and tests of the Indicador de Alfabetismo Funcional (Functional Literacy Indicator - INAF) were applied. RESULTS: The outcomes showed that 85.7% of the sample were females and 14.3% males, mainly white (60.7%), with a schooling degree, predominantly from the 3rd grade of high school and professionally active. It was found that 22.5% of the sample were functionally illiterate and 77.5% were functionally literate, 30.6% of whom had elementary level schooling. There was a significant association between the schooling level and combined INAF (p=0.005), as well as between combined INAF and duration of complaint in intervals for jaw pain (p=0.037) when Chi-square tests were used. There is evidence to establish that the mean duration of headache complaints (in months) between literacy groups are different (p=0.001) when using the Student´s t-test. With these results, it is possible to suggest that lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of TMD. CONCLUSION: Lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of temporomandibular disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: O letramento em saúde é um tema que vem ganhando força nos últimos anos, tanto nas agendas políticas como de investigação de muitos países, no entanto não existem evidências sobre as disfunções temporomandibulares e este tema. O objetivo foi avaliar a associação entre o nível de alfabetismo funcional e a compreensão dos Critérios Diagnósticos para Disfunção Temporomandibular (DC/DTM) por meio do autorrelato e associar o tempo de queixa de DTM com os níveis de letramento funcional. MÉTODOS: Trata-se de um estudo observacional, transversal, realizado com 56 pacientes do ambulatório de Disfunções Temporomandibulares (DTM) da Faculdade São Leopoldo Mandic. Para isso foram aplicados o questionário DC/DTM - eixo I, questionário sociodemográfico e testes do Indicador de Alfabetismo Funcional (INAF). RESULTADOS: Mostraram que 85,7% da amostra era do sexo feminino e 14,3% do sexo masculino, predominantemente brancos (60,7%), com escolaridade superior, predominantemente do 3º ano do ensino médio e profissionalmente ativos (57,1%). Verificou-se que 22,5% da amostra eram analfabetos funcionais e 77,5% eram alfabetizados funcionalmente, sendo que 30,6% possuíam nível fundamental. Houve associação significativa entre escolaridade e INAF combinado (p=0,005), bem como entre INAF combinado e tempo de queixa nos intervalos de dor mandibular (p=0,037) quando foram utilizados testes Qui-quadrado. Há evidências que estabelecem que a duração média das queixas de cefaleia (em meses) entre os grupos de alfabetismo é diferente (p=0,001) quando utilizado o teste t de Student. Com base nesses resultados, é possível sugerir que níveis mais baixos de alfabetismo funcional estariam relacionados a uma percepção pouco detalhada das queixas de DTM quanto à duração da queixa e à associação de cefaleia com queixa de DTM. CONCLUSÃO: Níveis mais baixos de alfabetismo funcional foram relacionados à percepção pouco detalhada das queixas de DTM quanto à duração e, principalmente, à associação de cefaleia com queixa de disfunção temporomandibular.

Alpha-lipoic acid does not improve olfactory training results in olfactory loss due to COVID-19: a double-blind randomized trial

Abstract Objectives Olfactory loss is a recognized long-term dysfunction after Coronavirus Disease 2019 (COVID-19) infection. This investigation aimed to assess the effect of alpha-lipoic acid as an adjuvant treatment of olfactory training on the improvement of smell loss in post-COVID-19 patients. Methods This randomized controlled trial included 128 adult outpatients who had persistent smell loss for more than 3-months after COVID-19 infection. The participants were randomly allocated into two groups: the intervention treatment group, which received alpha-lipoic acid associated to olfactory training, and comparison treatment group, which received placebo pills associated to olfactory training. The participants were followed-up for 12-weeks. Olfactory dysfunction was assessed in terms of Visual Analog Scale (VAS), and the Connecticut Chemosensory Clinical Research Center (CCCRC) test for the Brazilian population. Results A total of 100 participants completed the follow-up period and were analyzed in this study. Both groups have improved CCCRC score (p= 0.000), olfactory threshold (p= 0.000), identification score (p= 0.000) and VAS score (p= 0.000) after 12-weeks follow-up. No significant differences were determined between the intervention and comparison treatment groups in CCCRC score (p= 0.63), olfactory threshold (p= 0.50), identification score (p= 0.96) and VAS score (p= 0.97). In all these criteria, comparison treatment group went slightly worse. At the endpoint of the study, the frequency of anosmia reduced to 2% in the intervention treatment group and to 7.8% in the comparison treatment group. Also, 16.8% of the intervention group' subjects, and 15.7% of comparison treatment group's patients reached normosmia. Conclusions Overall, there was a strongly significant difference in olfactory function between baseline and endpoint for both groups. However, based on the lack of significant difference between the intervention treatment and the comparison treatment groups in terms of olfactory changes, our study appoints that the alpha-lipoic acid is not better than olfactory training alone to treat olfactory loss after COVID-19. Level of evidence Level 2.

Cognitive impairment and neuropsychiatric symptoms among individuals with history of symptomatic SARS-CoV-2 infection: a retrospective longitudinal study / Comprometimento cognitivo e sintomas neuropsiquiátricos entre indivíduos com histórico de infecção sintomática por SARS-CoV-2: um estudo longitudinal retrospectivo

ABSTRACT. COVID-19 is a multisystem disease caused by the RNA virus (coronavirus 2 or SARS-CoV-2) that can impact cognitive measures. Objective: To identify the main cognitive and neuropsychiatric symptoms in adults who had no cognitive complaints prior to the infection. Specifically, to observe the trajectory of cognitive and neuropsychiatric performance after 6 months. Methods: This is a retrospective longitudinal study. Forty-nine patients (29 reassessed after 6 months), with a positive PCR test, with no prior cognitive complaints that only presented after the infection and without a history of structural, neurodegenerative or psychiatric neurological diseases. A brief cognitive assessment battery (MoCA), the Trail Making Test (TMT-A, B, ∆), and the Verbal Fluency Test were used, as well as the scales (Hospital Anxiety and Depression Scale-HADS, Fatigue Severity Scale-FSS). Correlation tests and group comparison were used for descriptive and inferential statistics. Level of significance of α=5%. Results: Mean age of 50.4 (11.3), 12.7 (2.8) years of education, higher percentage of women (69.8%). No psycho-emotional improvement (depression and anxiety) was observed between the evaluations, and patients maintained the subjective complaint of cognitive changes. The HAD-Anxiety scale showed a significant correlation with TMT-B errors. The subgroup participating in cognitive stimulation and psychoeducation showed improvement in the global cognition measure and the executive attention test. Conclusion: Our results corroborate other studies that found that cognitive dysfunctions in post-COVID-19 patients can persist for months after disease remission, as well as psycho-emotional symptoms, even in individuals with mild infection. Future studies, with an increase in casuistry and control samples, are necessary for greater evidence of these results.

RESUMO. A COVID-19 é uma doença multissistêmica causada pelo vírus RNA (coronavírus 2 ou SARS-CoV-2) que pode ocasionar repercussão em medidas cognitivas. Objetivo: Identificar os principais sintomas cognitivos e neuropsiquiátricos em adultos sem queixas cognitivas anteriores à infecção. Especificamente, verificar a trajetória do desempenho cognitivo e neuropsiquiátrico após 6 meses. Métodos: Trata-se de um estudo retrospectivo e longitudinal. Foram incluídos 49 pacientes (29 reavaliados após 6 meses), com exame de PCR positivo, sem queixas cognitivas prévias que só se apresentaram após a infecção ou histórico de doenças neurológicas estruturais ou neurodegenerativas. Foram utilizados a bateria de avaliação cognitiva breve (MoCA), o Teste de Trilhas (TMT-A, B e ∆) e o Teste de Fluência Verbal; assim como a Escala Hospitalar de Ansiedade e Depressão (HADS), e a escala de Severidade da Fadiga (ESF/BR). Testes de correlação e comparação de grupos foram utilizados para estatística descritiva e inferencial. Esta ocorreu através de. Nível de significância de α=5%. Resultados: idade média de 50,4 anos (11,3), anos de escolaridade 12,7 (2,8), maior proporção de mulheres (69,8%). Não foi observada melhora psicoemocional (depressão e ansiedade) entre as avaliações, assim como os pacientes mantiveram a queixa subjetiva de alteração cognitiva. A escala HAD-Ansiedade apresentou correlação significativa com os erros do TMT-B. O subgrupo que participou da estimulação cognitiva e psicoeducação apresentou melhora na medida de cognição global e no teste de atenção executiva. Conclusão: Nossos resultados corroboram com os demais estudos que constataram que a disfunção cognitiva em pacientes pós-COVID-19 pode persistir por meses após a remissão da doença, assim como sintomas psicoemocionais, mesmo em indivíduos com quadros leves da infecção. Estudos futuros, com aumento de casuística e amostras de controle, são necessários para maior evidência desses resultados.

Long COVID: neurological manifestations - an updated narrative review / COVID longa: manifestações neurológicas - uma revisão narrativa atualizada

ABSTRACT. Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is more commonly described in young adults and women. This symptomatology can follow severe or mild cases of the disease. The importance of this issue resides in the high prevalence of neurological symptoms in the Long COVID phase, which entails significant morbidity in this population. In addition, such a condition is associated with high health care costs, with some estimates hovering around 3.7 trillion US dollars. In this review, we will sequentially describe the current knowledge about the most prevalent neurological symptoms in Long COVID, as well as their pathophysiology and possible biomarkers.

RESUMO. A infecção pelo vírus SARS-CoV-2 pode levar a sintomas neurológicos na fase aguda e na fase de COVID longa. Esses sintomas geralmente envolvem cognição, sono, distúrbios do olfato, manifestações psiquiátricas, dor de cabeça e outros. Esta condição é mais comumente descrita em adultos jovens e mulheres. A sintomatologia pode acompanhar casos graves ou leves da doença. A importância desta questão reside na elevada prevalência de sintomas neurológicos na fase de COVID longa, o que acarreta morbilidade significativa nesta população. Além disso, tal condição está associada a elevados custos de cuidados de saúde, com algumas estimativas em torno de 3,7 trilhões de dólares americanos. Nesta revisão, descrevemos sequencialmente o conhecimento atual sobre os sintomas neurológicos mais prevalentes na COVID longa, bem como sua fisiopatologia e possíveis biomarcadores.

Sexual dysfunction after open abdominal aortic aneurysm repair: 16 years' experience in a quaternary center and literature review / Disfunção sexual após correção aberta de aneurisma da aorta abdominal: 16 anos de experiência em um centro quaternário e revisão da literatura

Abstract Background Open abdominal aortic aneurysm (AAA) repair can lead to sexual dysfunction (SD) in men. Objectives To determine the prevalence of SD following open AAA repair, explore whether surgical techniques for aortic reconstruction can have a differential impact on the occurrence of SD, and summarize current knowledge in this field. Methods Retrospective review of 100 patients submitted to open AAA repair between 1995 and 2010 in a quaternary center. Sexual dysfunction was assessed according to questions from the modified International Index of Erectile Function (IIEF), considering the condition before surgical repair and 3 months after surgery. The chi-square test, Fisher's exact test, and Student's t test were used for statistical analyses. Results 100 patients were included (mean age = 66.4 years old). Normal sexual activity, no sexual activity, erectile dysfunction, and retrograde ejaculation with preserved erectile function were found in 36%, 21%, 18%, and 24% of patients, respectively. The group of patients with no sexual activity was older (mean age = 72.3 years old vs 64.5 years old, p < 0.001). Erectile dysfunction prevalence was higher in patients submitted to an aorto-bifemoral bypass (p = 0.032). Retrograde ejaculation was more frequent in patients submitted to an aorto-aortic bypass (p = 0.007). Conclusions Sexual function is a frequent condition intimately associated with the aortic reconstruction technique. The literature review found contradictory results regarding whether the endovascular approach is protective compared with open repair, but clearly demonstrated the importance of techniques targeting preservation of the internal iliac artery and the superior hypogastric plexus.

Resumo Contexto A correção aberta de aneurisma da aorta abdominal (AAA) pode causar disfunção sexual (DS) em homens. Objetivos Determinar a prevalência de DS após correção aberta de AAA, determinar se a técnica de reconstrução aórtica pode estar correlacionada com o surgimento de DS e resumir os achados mais relevantes da literatura relacionados a esse tema. Métodos Estudo retrospectivo de todos os pacientes submetidos a correção aberta de AAA entre 1995 e 2010 num centro quaternário. A DS foi avaliada por meio de questões baseadas no escore International Index of Erection Function no pré-operatório e 3 meses após a cirurgia. A análise estatística foi realizada com os testes do qui-quadrado, exato de Fisher e t de Student. Resultados Cem pacientes foram incluídos (idade média = 66.4 anos). Atividade sexual normal, atividade sexual ausente, disfunção erétil (DE) e ejaculação retrógrada (ER) com função erétil preservada foram observadas em 36%, 21%, 18% e 24% dos pacientes, respectivamente. O grupo de pacientes com atividade sexual ausente foi significativamente mais velho (idade média = 72.3 anos vs. 64.5 anos, p < 0.001). A DE foi mais prevalente em pacientes submetidos a enxerto aorto-bifemoral (p = 0.032), enquanto a ER foi mais prevalente em pacientes submetidos a enxerto aorto-aórtico (p = 0.007). Conclusões A DS é uma condição frequente e intimamente associada à reconstrução aórtica empregada. A literatura apresenta resultados contraditórios sobre qual correção de AAA (aberta ou endovascular) resulta em mais DS, mas demonstra a importância de técnicas com preservação das artérias hipogástricas e do plexo hipogástrico superior.

Prescrição, oferta e acesso aos medicamentos para disfunção erétil: um paradoxo na saúde pública? / Prescription, offer and access to medications for erectile dysfunction: a paradox in public health?

Resumo Trata-se de um artigo embasado em opinião que procura refletir sobre o antagonismo estabelecido entre a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH) com o recorte específico para DE (Disfunção Erétil) direcionado ao acesso de medicamentos. É notório que a PNAISH apresenta objetivos que vão além da saúde sexual e reprodutiva, sobretudo, mesmo após 13 anos de sua publicação, não houve incorporação de medicamentos para tratar DE no âmbito SUS. O artigo foi desenvolvido com base no cenário observado no dia a dia de atendimento aos pacientes que recebem cuidados no Serviço Ambulatorial da Saúde Masculina de um Hospital de Alta Complexidade. Isto por constatar a dificuldade dos médicos em prescreverem medicamentos para DE, por ausência de padronização no contexto SUS. Importante ressaltar, nesta perspectiva, que a prescrição de medicamentos no âmbito SUS deve seguir fidedignamente a Rename; conforme preconiza o Decreto 7.508 e, se atentar à Resolução SS-83 de 2015, vigente no estado de São Paulo. Ela estabelece que o custo da dispensação de medicamentos não contemplados na Rename, por meio da judicialização, prescritos por médico da rede estadual de saúde, poderá ser custeado pela instituição ao qual este esteja vinculado.

Abstract This is an opinion-based article that aims to reflect on the antagonism established between the National Policy of Integral Attention to Men's Health (PNAISH) with specific focus on ED (Erectile Dysfunction), directed to access to medication. It is well-known that PNAISH presents objectives that go beyond sexual and reproductive health, especially, even after 13 years of its publication, since there was no incorporation of medications to treat ED within the SUS. This article was developed based on the scenario observed in the daily care of patients who undergo treatment in the Men's Health Outpatient Service of a High-Complexity Hospital. According to this perspective, it is important to emphasize, that the prescription of medications within the SUS should faithfully follow the Rename; as recommended by Decree 7,508, observing the Resolution SS-83 of 2015, in the state of São Paulo. This establishes that the cost of dispensing medications not included in the SUS pharmaceutical assistance protocols, through judicialization, prescribed by a physician in the state health network, may be funded by the institution to which this physician is affiliated.

Indicators of functional fitness and cognitive commitment in elderly / Indicadores de aptitud funcional y compromiso cognitivo en ancianos / Indicadores de aptidão funcional e comprometimento cognitivo em idosos

ABSTRACT Introduction: Cognitive losses are among the most prevalent events in the elderly population and can cause functional deficits. Among the available non-drug prevention and treatment alternatives, the increase in functional fitness levels is presented as an important strategy suggesting improvements in the physical and cognitive function of the elderly triggered by exercise. Objective: To determine the predictive power of functional fitness indicators and establish their cutoff points as discriminators of cognitive impairment in the elderly. Methods: The sample comprised 310 elderly people who answered a questionnaire comprising sociodemographic information, lifestyle habits, hospitalization in the last 12 months, presence of comorbidity, and the Mini-Mental State Examination. Functional fitness was assessed using the Hand Grip Strength (HGS) and sitting and rising from a chair tests. To identify predictors of cognitive impairment, analysis of Receiver Operating Characteristic (ROC) curves was adopted, with a confidence interval of 95% (95%CI). Subsequently, the cut-off points with their respective sensitivities and specificities were identified. The analyses were performed respecting the significance level of 5%. Results: It was observed that some functional fitness indicators showed significant Area Under the Curve (AUC), and the sit-and-stand test (AUC=0.72; 95%CI: 0.64-0.77) showed the best results. The best cut-off points for the HGS and sit-and-stand tests were 18,8 kgf and eight repetitions, respectively. Conclusion: The results of the present study allow us to conclude that the sit-to-stand test is moderately efficient in discriminating the presence of cognitive impairment in the elderly. Level of Evidence III; Study Cross-sectional.

RESUMEN Introducción: Las pérdidas cognitivas se encuentran entre los eventos más prevalentes en la población anciana y pueden causar déficits funcionales. Entre las alternativas de prevención y tratamiento no farmacológico disponibles, el aumento de los niveles de condición física funcional se presenta como una estrategia importante que sugiere mejoras en la función física y cognitiva de los ancianos, desencadenada por la práctica de ejercicios. Objetivo: Determinar el poder predictivo de los indicadores de aptitud funcional y establecer sus puntos de corte como discriminadores del deterioro cognitivo en adultos mayores. Métodos: La muestra estuvo compuesta por 310 ancianos que respondieron un cuestionario que comprendía información sociodemográfica, hábitos de vida, hospitalización en los últimos 12 meses, presencia de comorbilidad y el Mini-Examen del Estado Mental. La condición física funcional se evaluó utilizando la fuerza de agarre manual (FAM) y las pruebas de sentarse y levantarse de una silla. Para identificar predictores de deterioro cognitivo, se adoptó el análisis de curvas Receiver Operating Characteristic (ROC), con intervalo de confianza del 95% (IC95%). Posteriormente se identificaron los puntos de corte con sus respectivas sensibilidades y especificidades. Los análisis se realizaron respetando el nivel de significancia del 5%. Resultados: Se observó que algunos indicadores de aptitud funcional mostraron un Área Bajo la Curva (ABC) significativa, y la prueba de sentarse y pararse (ABC=0,72; 95%IC: 0,64-0,77) mostró los mejores resultados. Los mejores puntos de corte para el test FAM y el sit-and-stand test fueron 18,8 kgf y 8 repeticiones, respectivamente. Conclusión: Los resultados del presente estudio permiten concluir que el test sit-to-stand es moderadamente eficiente para discriminar la presencia de deterioro cognitivo en adultos mayores. Nivel de Evidencia III; Estudio Transversal.

RESUMO Introdução: As perdas cognitivas estão entre os eventos mais prevalentes na população idosa, podendo causar déficits funcionais. Dentre as alternativas de prevenção e tratamento não medicamentosos disponíveis, o aumento dos níveis de aptidão funcional apresenta-se como uma estratégia importante sugerindo melhorias na função física e na função cognitiva de idosos, desencadeadas através da prática de exercícios. Objetivo: Determinar o poder preditivo dos indicadores de aptidão funcional e estabelecer seus pontos de corte como discriminadores do comprometimento cognitivo em idosos. Métodos: A amostra compreendeu 310 idosos que responderam a um questionário composto por informações sociodemográficas, hábitos de vida, hospitalização nos últimos 12 meses, presença de comorbidade e o Mini-Exame do Estado Mental. A aptidão funcional foi avaliada por meio dos testes de Força de Preensão Manual (FPM) e o de sentar e levantar da cadeira. Para identificação dos preditores do comprometimento cognitivo, foi adotada a análise das curvas Receiver Operating Characteristic (ROC), com intervalo de confiança de 95% (IC95%). Posteriormente, identificaram-se os pontos de corte com as respectivas sensibilidades e especificidades. As análises foram efetuadas respeitando-se o nível de significância de 5%. Resultados: Observou-se que alguns indicadores de aptidão funcional apresentaram Área Sob a Curva (ASC) significativas, sendo que o teste de sentar e levantar da cadeira (ASC=0,72; IC95%= 0,64-0,77) apresentou os melhores resultados. Os melhores pontos de corte para o teste de FPM e o teste de sentar e levantar da cadeira foram de 18,8 kgf e 8 repetições respectivamente. Conclusão: Os resultados do presente estudo permitem concluir que o teste de sentar e levantar da cadeira apresenta moderada eficiência para discriminar a presença de comprometimento cognitivo em idosos. Nível de Evidência III; Estudo Transversal.

When the fever will not stop, stop the pills! A case report

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

Case report of scrub typhus complicated by hypokalemia and multiple organ dysfunction syndrome

ABSTRACT CONTEXT: Scrub typhus, caused by Orientia tsutsugamushi, has a wide range of clinical manifestations, including meningoencephalitis, acute renal failure, pneumonitis, myocarditis, and septic shock. However, there are no documented cases of scrub typhus with hypokalemia. In this report, we present a case of scrub typhus with hypokalemia and multiple organ failure syndrome, highlighting the importance of electrolyte imbalance in patients with scrub typhus. CASE REPORT: A 59-year-old woman presented to the emergency department with abdominal pain that had been present for 1 day. On admission, the physical examination and laboratory test results indicated that the patient had renal, liver, and circulatory failure, and hypokalemia. She developed meningitis and disseminated intravascular coagulation during hospitalization. She recovered with appropriate management, and was discharged on day 17. CONCLUSION: This report highlights the potential for atypical presentations of scrub typhus, including a previously undocumented association with hypokalemia. Although the contribution of hypokalemia to the patient's clinical course remains uncertain, this case underscores the importance of considering electrolyte imbalance in the management of patients with scrub typhus. Further research is warranted to better understand the relationship between scrub typhus and electrolyte imbalance.

Non-linear association between long-term air pollution exposure and risk of metabolic dysfunction-associated steatotic liver disease

BACKGROUND@#Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) has become a global epidemic, and air pollution has been identified as a potential risk factor. This study aims to investigate the non-linear relationship between ambient air pollution and MASLD prevalence.@*METHOD@#In this cross-sectional study, participants undergoing health checkups were assessed for three-year average air pollution exposure. MASLD diagnosis required hepatic steatosis with at least 1 out of 5 cardiometabolic criteria. A stepwise approach combining data visualization and regression modeling was used to determine the most appropriate link function between each of the six air pollutants and MASLD. A covariate-adjusted six-pollutant model was constructed accordingly.@*RESULTS@#A total of 131,592 participants were included, with 40.6% met the criteria of MASLD. "Threshold link function," "interaction link function," and "restricted cubic spline (RCS) link functions" best-fitted associations between MASLD and PM2.5, PM10/CO, and O3 /SO2/NO2, respectively. In the six-pollutant model, significant positive associations were observed when pollutant concentrations were over: 34.64 µg/m3 for PM2.5, 57.93 µg/m3 for PM10, 56 µg/m3 for O3, below 643.6 µg/m3 for CO, and within 33 and 48 µg/m3 for NO2. The six-pollutant model using these best-fitted link functions demonstrated superior model fitting compared to exposure-categorized model or linear link function model assuming proportionality of odds.@*CONCLUSION@#Non-linear associations were found between air pollutants and MASLD prevalence. PM2.5, PM10, O3, CO, and NO2 exhibited positive associations with MASLD in specific concentration ranges, highlighting the need to consider non-linear relationships in assessing the impact of air pollution on MASLD.

Biological principles for "homotherapy for heteropathy" / 药学学报

Non-infectious chronic diseases in human including diabetes, non-alcoholic fatty liver disease (NAFLD), atherosclerosis (AS), neurodegenerative diseases, osteoporosis, as well as malignant tumors may have some common pathogenic mechanisms such as non-resolved inflammation (NRI), gut microbiota dysfunction, endoplasmic reticulum stress, mitochondria dysfunction, and abnormality of the mammalian target of rapamycin (mTOR) pathway. These pathogenic mechanisms could be the basis for "homotherapy for heteropathy" in clinic. Some commonly used clinical drugs, such as metformin, berberine, aspirin, statins, and rapamycin may execute therapeutic effect on their targeted diseases,and also have the effect of "homotherapy for heteropathy". The mechanisms of the above drugs may include anti-inflammation, modulation of gut microbiota, suppression of endoplasmic reticulum stress, improvement of mitochondria function, and inhibition of mTOR. For virus infectious diseases, as some viruses need certain commonly used replicases, the inhibitors of the replicases become examples of "homotherapy for heteropathy" for antiviral therapy in clinic (for example tenofovir for both AIDS and HBV infection). Especially, in case of outbreak of new emerging viruses, these viral enzyme inhibitors such as azvudine and sofibuvir, could be rapidly used in controlling viral epidemic or pandemic, based on the principle of "homotherapy for heteropathy". In this review article, we show the research progress of the biological basis for "homotherapy for heteropathy" and the possible mechanisms of some well-known drugs, in order to provide insights and new references for innovative drug R&D.

Advances in Neuromuscular Electrical Stimulation in Post-Stroke Movement Disorders / 中山大学学报(医学科学版)

In recent years， the incidence of stroke patients in China is increasing， and the motor dysfunction caused by it often seriously affects the quality of daily life of the patients， Neuromuscular electrical stimulation （NMES）， as an emerging rehabilitation therapy， is widely used in the treatment of motor dysfunction in stroke patients. This paper summarizes the parameters and mechanisms of the role of NMES in motor function rehabilitation after stroke and its use in clinical practice. In the future， the specific mechanism of NMES action and efficient and safe therapeutic options should be further explored.

Research on the dynamic changes of neurological dysfunction and cognitive function impairment in traumatic brain injury / 解剖学报

Objective To explore the dynamic changes and mechanisms of neurological and cognitive functions in mice with traumatic brain injury (TBI). Methods Totally 60 12⁃month⁃old Balb/ c mice were divided into control group (10 in group) and TBI group (50 in group). TBT model mice were divided into 5 subgroups according to the time of model construction, including model 1 day, model 1 day, model 3 day, model 7 day, model 14 days and model 28 days group with 10 in each group. At the 29th day of the experiment, neurological scores and step down tests were carried out. After the test, the mice were sacrificed for brains which were detected by immunohistochemistry staining, inflammatory cytokine tests and Western blotting. Results Compared with the control group, the neurological scores of mice in TBI group increased, and then decreased after the 7th day when the scores reached the peak. However, the latency of step down errors was lower than control group, and the number of step down errors was higher than control group which had no changes. Compared with the control group, the expression of lonized calcium⁃binding adapter molecule 1(IBA1), chemokine C⁃X3⁃C⁃motif ligand1 (CX3CL1), C⁃X3⁃C chemokine receptor 1(CX3CR1), NOD⁃like receptor thermal protein domain associated protein 3 (NLRP3), and phosphorylation nuclear factor(p⁃NF)⁃κB in TBI group increased and reached to the peak at the 7th day, and then started to decrease. At the same time, the levels of inflammatory cytokines interleukin⁃6(IL⁃6) and tumor necrosis factor⁃α(TNF⁃α) first increased to the peak, and then began to decrease. However, compared with the control group, the expression of amyloid β(Aβ) protein and p⁃Tau protein in the model group continued to increase at all time. Conclusion The TBI model caused continuous activation of microglia along with inflammatory response, which first increased and then decreased, resultsing in neurological scores changes. In addition, the inflammatory response may act as a promoter of Aβ protein deposition and Tau protein phosphorylation, leading to cognitive impairment in mice.

Research progress of targeted pulmonary vascular endothelial dysfunction in treatment of pulmonary hypertension / 中国药理学通报

Pulmonary hypertension (PH) is a progressive and fatal disease. The dysfunction of pulmonary artery endothelial cells (PAECs) is one of its important pathogenic factors. PAECs are monolayer flat epithelial cells, which play an important role in maintaining pulmonary vascular homeostasis. Studies have found that PAECs show damage and apoptosis at the early stage of PH development, while PAECs show anti-apoptotic characteristics at the late stage of PH development. The transition of PAECs into mesenchymal cells induced by hypoxic and inflammatory factors is also involved in the pathogenesis of PH. Carcinoid metabolism and mitochondrial dysfunction, bone mor- phogenic type 2 receptor mutation, epigenetic changes and inflammation of PAECs are the main pathogenesis of pulmonary vascular endothelial dysfunction in PH patients. New therapeutic measures targeting PAECs dysfunction are expected to play an important role in the treatment of PH in the future.

Advances of pathogenesis and drug development in amyotrophic lateral sclerosis / 中国药理学通报

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease affecting both upper and lower motor neurons. ALS patients develop progressive muscle atrophy, muscle weak and paralysis, finally died of respiratory failure. ALS is characterized by fast aggression and high mortality. What' s more, the disease is highly heterogeneous with unclear pathogenesis and lacks effective drugs for therapy. In this review, we summarize the main pathological mechanisms and the current drugs under development for ALS, which may provide a reference for the drug discovery in the future.

Related factors of post-stroke depression in patients with cerebral infarction during hospitalization in rehabilitation department / 中国康复理论与实践

ObjectTo explore the risk factors related to the intensity of post-stroke depression in patients with cerebral infarction during hospitalization in the rehabilitation department. MethodsThe hospital consultation records of cerebral infarction patients in Beijing Bo'ai Hospital from December, 2019 to February, 2023 were reviewed from the hospital information system, and those who were diagnosed as depression visited the department of psychology were selected. It was collected including general information of sexes, ages, education levels, matrimony; medical features of course, location, affected side, sensory disorders, aphasia, agrypnia, dysphagia, hand-shoulder syndrome, constipation; functioning of muscle strength and Brunnstrom stages; and scores of Mini-Mental State Examination (MMSE), National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Fugl-Meyer Assessment-Balance (FMA-B), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Patients with HAMD scores ≤ 20 were as the low group, and those > 20 were as the high group. ResultA total of 2 403 hospitalized stroke patients were included, out of which 269 patients with cerebral infarction were diagnosed as depression and visited the department of psychology; while 103 cases were in the low group and 166 cases were in the high group. The incidence of constipation was less, and the incidence of dysphagia and shoulder-hand syndrome was higher in the high group (χ2 > 5.379, P < 0.05), with weaker strength of iliopsoas muscle and quadriceps muscle, earlier of Brunnstrom stage of lower extremities and hands, and worse scores of NIHSS, MMSE, FMA, FMA-B and MBI (|Z| > 2.020, t > 2.171, P < 0.05). Logistic regression showed that constipation (OR = 0.435), quadriceps muscle strength (OR = 0.782) and dysphagia (OR = 2.602) related to the intensity of post-stroke depression in convalescent patients (P < 0.05). ConclusionPost-stroke dysphagia and poor quadriceps muscle strength may exacerbate post-stroke depression; however, constipation may not.

Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury / 中国康复理论与实践

ObjectiveTo observe the therapeutic effect of early postoperative comprehensive rehabilitation on elbow joint dysfunction and ulnar nerve injury in children and adolecents with supracondylar fracture of humerus complicated with ulnar nerve injury. MethodsA total of 49 children with supracondylar fracture of humerus complicated with ulnar nerve injury after operation were selected from January, 2016 to December, 2021 in Wangjing Hospital, which were randomly divided into control group (n = 24) and treatment group (n = 25). The control group accepted wax therapy and acupuncture, and the treatment group accepted medicine fumigation, joint mobilization and electromyographic biofeedback, for twelve weeks. They were assessed with The Hospital for Special Surgery Elbow score (HSS) and Medical Research Neurotrauma Society Report (MCRR) before and after treatment. ResultsAfter treatent, the HSS scores increased in both groups (|t| > 8.345, P < 0.001). The HSS score was significantly higher in the treatment group than in the control group (t = 4.536, P < 0.001). The d-value of HSS scores before and after treatment was significantly higher in the treatment group than in the control group (t = 3.717, P < 0.05). The rate of excellent recovery of ulnar nerve function was significantly higher in the treatment group than in the control group (χ2 = 5.975, P < 0.05). ConclusionEarly postoperative comprehensive rehabilitation could romote the recovery of elbow function and ulnar nerve injury in children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury.