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1.
Braz. j. oral sci ; 21: e225042, jan.-dez. 2022. ilus
Article in English | LILACS, BBO | ID: biblio-1354728

ABSTRACT

Aim: Although bulk fill composites have been widely used as restorative material, there is no consensus regarding the best clinical protocol in terms of composite technique and adhesive system. Therefore, this clinical trial evaluated the clinical performance of bulk fill composites for class I restorations under different protocols. Methods: A randomized clinical trial including 155 class I restorations was conducted using different adhesive systems: conventional technique (phosphoric acid + conventional three-step adhesive system) (Group 1, 2 and 3); or self-etching adhesive system (Groups 4, 5 and 6). Control groups 1 and 4 were restored with conventional composite; groups 2 and 5 with low viscosity bulk fill and conventional composite as occlusal coverage; groups 3 and 6 with high viscosity bulk fill. The FDI criteria was used for clinical evaluation at baseline and after 6 months. Results: All groups showed good clinical performance. At baseline, the adhesive system did not affect postoperative hypersensitivity. After 6 months, group 5 showed a significant reduction in color and translucency; group 6 a reduction in terms of anatomical form and for postoperative sensitivity and an improvement in patient satisfaction (p<0.05). Considering the same restorative technique, the use of the self-etching adhesive system showed a significant decrease in color and translucency (p<0.05). Conclusion: All groups showed favorable clinical performance, and promising results were found for the conventional adhesive system and high viscosity bulk fill protocol


Subject(s)
Phosphoric Acids , Adhesives , Composite Resins , Dental Restoration, Permanent , Esthetics, Dental , Clinical Studies as Topic
2.
Rev. enferm. UERJ ; 28: e50255, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1123451

ABSTRACT

Objetivo: sintetizar as evidências científicas acerca de características sociodemográficas, indicadores epidemiológicos de morbidade e manifestações clínicas dos casos associados de tuberculose e diabetes mellitus. Método: revisão integrativa da literatura com buscas realizadas nas bases Scopus, Literatura Latino Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e nos portais National Library of Medicine, Biblioteca Virtual em Saúde Brasil e Scientific Eletronic Library Online, sendo a amostra final foi composta por dezesseis estudos. Resultados: observou-se que a alta prevalência de diabetes contribui para o aumento dos casos de tuberculose. Os pacientes com a comorbidade tendem a apresentar idade avançada, serem do sexo feminino e possuírem renda familiar mais baixa. O diabetes afeta negativamente a gravidade da tuberculose pulmonar, provocando sintomas mais graves. Conclusão: as evidências apontadas têm potencial para guiar as intervenções em saúde e possibilitam a implementação de ações de saúde mais efetivas.


Objective: to summarize the scientific evidence from sociodemographic characteristics, epidemiological indicators of morbidity, and clinical manifestations of cases of tuberculosis associated with diabetes mellitus. Method: this integrative review searched for literature in the Scopus, Latin American and Caribbean Health Sciences Literature, and Medical Literature Analysis and Retrieval System Online databases, and in the National Library of Medicine, Virtual Health Library Brazil and Scientific Electronic Library Online portals. The final sample comprised of sixteen studies. Results: the high prevalence of diabetes was found to contribute to the increase in tuberculosis cases. Patients with comorbidity tended to be older, female and with lower family income. Diabetes affects the severity of pulmonary tuberculosis adversely, causing more severe symptoms. Conclusion: the evidence found has the potential to guide health interventions and enable more effective health actions to be implemented.


Objetivo: resumir la evidencia científica a partir de características sociodemográficas, indicadores epidemiológicos de morbilidad y manifestaciones clínicas de los casos de tuberculosis asociados a diabetes mellitus. Método: esta revisión integradora buscó literatura en las bases de datos Scopus, Latin American and Caribbean Health Sciences Literature y Medical Literature Analysis and Retrieval System Online, y en los portales National Library of Medicine, Virtual Health Library Brasil y Scientific Electronic Library Online. La muestra final estuvo compuesta por dieciséis estudios. Resultados: se encontró que la alta prevalencia de diabetes contribuyó al aumento de casos de tuberculosis. Los pacientes con comorbilidad tendían a ser mayores, mujeres y con menores ingresos familiares. La diabetes afecta negativamente la gravedad de la tuberculosis pulmonar, provocando síntomas más graves. Conclusión: la evidencia encontrada tiene el potencial de orientar las intervenciones de salud y permitir la implementación de acciones de salud más efectivas.


Subject(s)
Humans , Male , Female , Tuberculosis/epidemiology , Diabetes Mellitus/epidemiology , Comorbidity , Prevalence , Clinical Studies as Topic
3.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(2): 218-224, Mar.-Apr. 2020.
Article in English | LILACS | ID: biblio-1089257

ABSTRACT

Current pharmacotherapy of Parkinson's disease (PD) is palliative and unable to modify the progression of neurodegeneration. Treatments that can improve patients' quality of life with fewer side effects are needed, but not yet available. Cannabidiol (CBD), the major non-psychotomimetic constituent of cannabis, has received considerable research attention in the last decade. In this context, we aimed to critically review the literature on potential therapeutic effects of CBD in PD and discuss clinical and preclinical evidence supporting the putative neuroprotective mechanisms of CBD. We searched MEDLINE (via PubMed) for indexed articles published in English from inception to 2019. The following keywords were used: cannabis; cannabidiol and neuroprotection; endocannabinoids and basal ganglia; Parkinson's animal models; Parkinson's history; Parkinson's and cannabidiol. Few studies addressed the biological bases for the purported effects of CBD on PD. Six preclinical studies showed neuroprotective effects, while three targeted the antidyskinetic effects of CBD. Three human studies have tested CBD in patients with PD: an open-label study, a case series, and a randomized controlled trial. These studies reported therapeutic effects of CBD on non-motor symptoms. Additional research is needed to elucidate the potential effectiveness of CBD in PD and the underlying mechanisms involved.


Subject(s)
Humans , Animals , Parkinson Disease/drug therapy , Cannabidiol/therapeutic use , Neuroprotective Agents/therapeutic use , Disease Models, Animal , Clinical Studies as Topic
4.
Infectio ; 24(1): 42-49, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1090542

ABSTRACT

Resumen Objetivo: Determinar los mecanismos de resistencia antibiótica y la epidemiología molecular de aislados clínicos de Klebsiella pneumoniae resistentes a carbapenémicos. Materiales y métodos: 30 aislados multirresistentes de K. pneumoniae fueron obtenidos a partir de: urocultivo, aspirado traqueal, secreción de herida, sonda vesical, hemocultivo, líquido peritoneal, punta de catéter, colección abdominal y secreción bronquial. Los aislados fueron colectados de noviembre de 2012 a abril de 2013. La identificación y susceptibilidad antibiótica fue determinada por el sistema automatizado VITEK 2. Para la amplificación de genes de resistencia se empleó PCR, la determinación de las Secuencias Tipo (ST) fue obtenida por tipificación multilocus de secuencias (MLST) y la relación clonal fue establecida por electroforesis en gel de campo pulsado (PFGE). Resultados: Todos los aislados mostraron fenotipos multirresistentes, excepto a colistina y tigeciclina. El 100% de los aislados fue productor de la carbapenemasa KPC-2. La determinación de la presencia de genes codificantes de β-lactamasas de Espectro Extendido mostró que el 67% de los aislados fue positivo para el gen blaCTX-M, el 100% fue positivo para el gen blaSHV y 93% fue positivo para el gen blaTEM. El análisis de la relación clonal de los 30 aislados agrupó a 20 en un mismo pulso tipo. El análisis por MLST demostró que la ST predominante fue ST258 presente en el 60% de la población, seguida de ST1199 presente en el 20% de la población analizada. Conclusiones: Los resultados obtenidos demuestran la importancia de implementar y combinar estudios epidemiológicos, clínicos y moleculares para comprender la distribución de la resistencia entre bacterias de interés clínico.


Abstract Objective: To determine the mechanism of antibiotic resistance and molecular epidemiology of carbapenem resistant isolates of Klebsiella pneumoniae. Materials and Methods: 30 multidrug resistant isolates of K. pneumoniae were obtained from urine culture, tracheal aspirate, wound secretion, bladder catheter, blood culture, peritoneal fluid, catheter tip, abdominal collection, and bronchial secretion. K. pneumoniae isolates were collected between November 2012 and April 2013. Identification and susceptibility were determined by the VITEK 2 system. Resistance genes were identified by PCR, sequence type (ST) was established by multilocus sequence typing (MLST), and clonal relationship was defined by pulsed field gel electrophoresis (PFGE). Results: All isolates were multidrug resistant and susceptible to colistin and tigecycline. 100% of isolates produced KPC-2 carbapenemase. This study detected Extended Spectrum β-Lactamases enconding genes. 67% of isolates were positive for blaCTX-M, 100% were positive for blaSHV, and 93% of isolates were positive for blaTEM. Analysis of the clonal relationship clustered 20 isolates in the same clonal complex. Multilocus sequence typing showed the predominant sequence type ST 258 in 60% of population. ST 1199 were present in 20% of bacterial population. Conclusion: Molecular epidemiology, clinical research and molecular biology studies improve understanding of mechanisms of resistance distribution among bacteria of clinical interest.


Subject(s)
Humans , Carbapenem-Resistant Enterobacteriaceae , Klebsiella pneumoniae , Drug Resistance, Microbial , Epidemiologic Studies , Gene Amplification , Multilocus Sequence Typing , Clinical Studies as Topic
6.
Article in English | LILACS, BBO | ID: biblio-1056879

ABSTRACT

Abstract Objective: To evaluate periodontal tissue condition on systemic lupus erythematosus (SLE) patients and its characteristics. Material and Methods: This descriptive and cross-sectional study involved 61 SLE patients. Clinical examination of the oral cavity was performed using periodontal index (PI), gingival index (GI), clinical attachment loss (CAL) and number of loose teeth. Also, we evaluated SLE duration, treatment duration, ethnics, marital status, educational background, family income, and occupation. Results: In the evaluation of periodontal tissue, 93.4% had bleeding on probing, 80.3% clinical attachment loss, and 16.3% loose teeth. A total of 54 patients (88.5%) with SLE had periodontitis. Seven subjects had no periodontitis, 11 mild periodontitis, 29 moderate periodontitis and 14 severe periodontitis. Mean Periodontal Index score, Gingival Index, Clinical Attachment Loss (mm), and the number of mobility teeth, Plaque Index and Calculus Index respectively were 2.66 ± 1.20, 1.95 ± 1.02, 0.75 ± 0.59 mm, 1,49 ± 1.77. There was a significant difference in periodontal index score, shown periodontitis between employment and unemployment subjects (p=0.004) and a moderate correlation between periodontitis and occupation. Conclusion: Periodontitis found as manifestations SLE patients, followed by bleeding on probing and loose teeth. Its characteristics is playing a role in periodontitis in SLE patients.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Periapical Tissue , Periodontitis/diagnosis , Periodontal Index , Clinical Studies as Topic/methods , Lupus Erythematosus, Systemic , Periodontal Diseases/diagnosis , Cross-Sectional Studies/methods , Data Interpretation, Statistical , Indonesia/epidemiology
7.
Physis (Rio J.) ; 30(2): e300217, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1125354

ABSTRACT

Resumo O artigo apresenta um panorama dos testes clínicos conduzidos em 2020, que visam produzir evidências sobre a eficácia de dois medicamentos utilizados experimentalmente contra a Covid-19 - hidroxicloroquina e cloroquina -, desde que se passou a cogitar eficácia de seu uso, seja no tratamento de doentes graves, de infectados sem quadro clínico importante, ou mesmo como agente preventivo. Foram utilizados dados secundários - bancos de dados de testes clínicos, material da mídia e literatura especializada. Em meio à urgência de tratamentos para contenção da pandemia, o uso experimental gerou controvérsias inicialmente no meio científico, mas que acabaram por ser fortemente capturadas politicamente. Líderes como Trump e Bolsonaro, em discursos mal fundamentados, têm se declarado altamente favoráveis ao uso desses medicamentos, gerando uma minimização da gravidade da epidemia e, simultaneamente, negligenciando a necessidade de elevação importante de gastos públicos em saúde. Face às frágeis evidências científicas produzidas, a euforia social em torno desses medicamentos e sua promoção suscitou exageros e comportamentos irracionais, como automedicação. Esperar-se-ia de governantes e gestores de nações democráticas, muito mais cautela e responsabilidade, que contribuíssem na construção de respostas cientificamente embasadas, racionais e eficazes ao controle da pandemia, protegendo a saúde de suas populações, pressuposto do poder de Estado.


Abstract The article presents an overview of clinical tests conducted in 2020, which aim to produce evidence on the efficacy of two drugs used experimentally against Covid-19 - hydroxychloroquine and chloroquine -, since the effectiveness of their use, whether in the treatment of seriously ill, infected with no significant clinical condition, or even as a preventive agent. Secondary data were used - clinical test databases, media material and specialized literature. Considering the urgency of treatments to contain the pandemic, the experimental use generated controversies initially in the scientific environment, but which ended up being strongly captured politically. Leaders like Trump and Bolsonaro, in ill-founded speeches, have declared themselves highly favorable to the use of these drugs, generating a minimization of the severity of the epidemic and, simultaneously, neglecting the need for significant increase in public spending on health. In view of the fragile scientific evidence produced, the social euphoria surrounding these drugs and their promotion led to exaggerations and irrational behaviors, such as self-medication. It would be expected from governments and managers of democratic nations, much more caution and responsibility, to contribute to the construction of scientifically based, rational and effective responses to the control of the pandemic, protecting the health of their populations, an assumption of state power.


Subject(s)
Drug Prescriptions , Chloroquine , Coronavirus Infections/epidemiology , Evidence-Based Practice , Clinical Studies as Topic , Betacoronavirus , Hydroxychloroquine , Self Medication , Drug Misuse
8.
Rev. Assoc. Med. Bras. (1992) ; 65(8): 1116-1121, Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041063

ABSTRACT

SUMMARY INTRODUCTION The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Studies designed around this fact have shown that moderate cerebral hypothermia, initiated as early as possible, has been associated with potent, long-lasting neuroprotection in perinatal patients. OBJECTIVES To review the benefits of hypothermia in improving cellular function, based on the cellular characteristics of hypoxic-ischemic cerebral injury and compare the results of two different methods of cooling the brain parenchyma. METHODS Medline, Lilacs, Scielo, and PubMed were searched for articles registered between 1990 and 2019 in Portuguese and English, focused on trials comparing the safety and effectiveness of total body cooling with selective head cooling with HIE. RESULTS We found that full-body cooling provides homogenous cooling to all brain structures, including the peripheral and central regions of the brain. Selective head cooling provides a more extensive cooling to the cortical region of the brain than to the central structures. CONCLUSIONS Both methods demonstrated to have neuroprotective properties, although full-body cooling provides a broader area of protection. Recently, head cooling combined with some body cooling has been applied, which is the most promising approach. The challenge for the future is to find ways of improving the effectiveness of the treatment.


RESUMO INTRODUÇÃO A possibilidade de a hipotermia ter um papel terapêutico durante ou após a reanimação da asfixia perinatal grave tem sido um foco de pesquisa de longa data. Estudos desenhados em torno desse fato mostraram que a hipotermia cerebral moderada, iniciada o mais cedo possível, tem sido associada à neuroproteção potente e duradoura em espécies perinatais. OBJETIVOS Resumidamente, analisar os benefícios da hipotermia na melhoria da função celular, com base nas características celulares da lesão cerebral hipóxico-isquêmica e comparar os resultados de dois métodos diferentes de resfriamento do parênquima cerebral. MATERIAL E MÉTODOS Medline, Lilacs, SciELO e PubMed foram pesquisados para artigos registrados entre 1990 e 2019 nos idiomas português e inglês, com foco em estudos comparando segurança e eficácia do resfriamento corporal total com o resfriamento seletivo da cabeça com EHI. RESULTADOS Descobrimos que o resfriamento de corpo inteiro fornece resfriamento homogêneo para todas as estruturas cerebrais, incluindo as regiões periférica e central do cérebro. O resfriamento seletivo da cabeça fornece um resfriamento mais amplo para a região cortical do cérebro do que para as estruturas centrais. CONCLUSÕES Ambos os métodos demonstraram ter propriedades neuroprotetoras, embora o resfriamento de corpo inteiro forneça uma área mais ampla de proteção. Recentemente, o resfriamento da cabeça combinado com algum resfriamento corporal foi aplicado e essa é a maneira mais promissora. O desafio para o futuro é encontrar formas de melhorar a eficácia do tratamento.


Subject(s)
Humans , Asphyxia Neonatorum/therapy , Hypoxia-Ischemia, Brain/prevention & control , Hypothermia, Induced/methods , Severity of Illness Index , Clinical Studies as Topic , Neuroprotection
9.
J. vasc. bras ; 18: e20190004, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1012624

ABSTRACT

Durante a análise dos dados de uma pesquisa científica, é habitual deparar-se com valores anômalos ou dados faltantes. Valores anômalos podem ser resultado de erros de registro, de digitação, de aferição instrumental, ou configurarem verdadeiros outliers. Nesta revisão, são discutidos conceitos, exemplos e formas de identificar e de lidar com tais contingências. No caso de dados faltantes, discutem-se técnicas de imputação dos valores para evitar a exclusão do sujeito da pesquisa, caso não seja possível recuperar a informação das fichas de registro ou reabordar o participante


During analysis of scientific research data, it is customary to encounter anomalous values or missing data. Anomalous values can be the result of errors of recording, typing, measurement by instruments, or may be true outliers. This review discusses concepts, examples and methods for identifying and dealing with such contingencies. In the case of missing data, techniques for imputation of the values are discussed in, order to avoid exclusion of the research subject, if it is not possible to retrieve information from registration forms or to re-address the participant


Subject(s)
Humans , Male , Female , Clinical Studies as Topic , Data Interpretation, Statistical , Analysis of Variance , Database
10.
Article in Chinese | WPRIM | ID: wpr-774429

ABSTRACT

With the development of the methodology of clinical trials and the appearance of medical big data, the real-world study (RWS) presents its unique advantages, plays a role in clinical practice and research, and its importance is more and more recognized by scholars in recent years. In surgical research field, due to the specificity of surgical diseases and operational procedures, confounding factors and risk of bias are greatly higher than those of traditional medications. Therefore, using unique advantages of the RWS to solve the actual clinical problem in surgical field is the main goal of performing surgical RWS. This article will systematically elucidate how to perform the surgical RWS and the special matters of concern in carrying out surgical RWS.


Subject(s)
Clinical Studies as Topic , Methods , Reference Standards , General Surgery , Reference Standards , Humans , Research Design , Reference Standards , Surgical Procedures, Operative , Reference Standards
11.
Saúde Soc ; 27(4): 1033-1043, Out.-Dez. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-979226

ABSTRACT

Resumo Este estudo trata do recrutamento de sujeitos de pesquisa em ensaios clínicos multicêntricos internacionais financiados pela indústria executados em uma universidade pública brasileira entre janeiro de 2010 e dezembro de 2016. Analisou-se um conjunto de 63 contratos de ensaios clínicos, documentos administrativos e regulatórios. Os resultados demonstraram a participação de 75 países, dos quais 16% são latino-americanos. Foram obtidos dados sobre o recrutamento de sujeitos de pesquisa em âmbito local (356 sujeitos), nacional (3.774 sujeitos) e internacional (82.696 sujeitos), além de informações sobre o número de centros participantes no Brasil e o custo de cada ensaio. A maioria dos ensaios era de fase III (77,78% dos casos) e previa um recrutamento total nacional entre 18 e 80 sujeitos de pesquisa por ensaio (entre 4,42% e 11,46% do recrutamento internacional). Identificou-se forte correlação negativa entre os dados sobre contratos, orçamento e recrutamento e a cotação média anual do dólar. A totalidade dos ensaios adotou método competitivo de recrutamento associado ao pagamento por sujeito incluído na pesquisa. Isso é preocupante e demonstra uma contradição entre essa prática e as recomendações das diretrizes éticas nacionais. A ausência da informação sobre o número de sujeitos a serem recrutados no país revela, em 19% dos casos, um erro recorrente no processo regulatório. Conclui-se que a disponibilidade de informações detalhadas sobre o recrutamento nas pesquisas envolvendo seres humanos é importante para o correto dimensionamento e organização dos esforços de proteção dos sujeitos de pesquisa, e que atualmente essa premissa não está sendo cumprida de modo adequado.


Abstract This study concerns the recruitment of research subjects in industry-sponsored multicentric international clinical trials carried out at a Brazilian public university between January 2010 and December 2016. A set of 63 clinical trial agreements, administrative and regulatory documents was analyzed. The results showed that 75 countries were involved in these international trials, of which 16% were Latin American. Data about the recruitment of research subjects at the local (356 subjects), national (3774 subjects) and international (82,696 subjects) levels were obtained, as well as information on the number of Brazilian research centers involved and the costs of each trial. Phase III trials were the most frequent (77.78% of the cases) and they estimated a total national enrollment between 18 and 80 research subjects per trial (which means between 4.42% and 11.46% of international recruitment). A negative correlation was found between agreements, research resources, recruitment data, and yearly average dollar exchange rate. All the trials adopted competitive recruitment method associated with payment for subject included in the research. This is worrying and shows contradiction between this practice and the recommended national ethical guidelines. The lack of data on recruitment at the national level reveals, in 19% of the cases, a frequent regulatory process failure. It is concluded that the availability of detailed data on recruitment for researches involving human beings is important for the accurate sizing and organization of the efforts to protect research subjects, and that currently this premise is not being appropriately followed.


Subject(s)
Humans , Male , Female , Multicenter Studies as Topic , Patient Selection , Research Subjects , Clinical Studies as Topic , International Cooperation
12.
Rev. medica electron ; 40(2): 258-269, mar.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-902287

ABSTRACT

Introducción: el envejecimiento poblacional es preocupación de toda la sociedad, ya que esto implica la creación y mantenimiento de una infraestructura social para lograr la calidad de vida de las personas mayores. Esto constituye un desafío permanente. Objetivo: demostrar cómo la inserción de la gestión por procesos, propicia la mejora de la calidad de vida de los pacientes de un hogar de ancianos. Materiales y métodos: se desarrolló un estudio de intervención, fruto del estudio de 70 procedimientos para la gestión y mejora de procesos. Se utilizaron herramientas estadísticas y se caracterizó la organización con el uso de 13 variables. Resultados: se identificaron reservas de mejoras de tipo organizativo, relativas a la planificación y programación, y al sistema de monitoreo y control de procesos como asistencia y enfermería. Las acciones de mejoramiento provocaron un incremento en el nivel de servicio junto a un comportamiento favorable de los indicadores mortalidad, estadía mayor de 1 año e índice de enfermedades infecciosas. Los elementos anteriores impactan en la calidad de vida para un grupo de pacientes en rehabilitación con funciones físicas reducidas. Conclusiones: la función social y vulnerabilidad propia de los hogares de ancianos hacen relevante la búsqueda de métodos que perfeccionen su gestión, y que a vez, mejoren el desempeño de sus procesos. La gestión por procesos demostró su utilidad y pertinencia al contribuir al incremento del nivel de servicio y la calidad de vida de los pacientes geriátricos (AU).


Introduction: population´s ageing fosters society concern, because it implies the creation and maintenance of a social infrastructure to achieve the life quality of elder people. It is an issue of permanent challenge. Objective: to show how the insertion of management per processes helps improving the life quality of the patients of an elderly nursing home. Materials and methods: an intervention study was carried out as a result of the study of seventy procedures for processes´ management and improvement. Statistical tools were used and the organization was characterized using 13 variables. Results: there they were identified reserves of organizational-kind improvement, related to planning and programming, and to monitoring and controlling processes like health care and nursing. The improving actions induced an increase of the service level and a favorable behavior of indicators like mortality, more than one-year staying, and infection diseases rates. The before-mentioned elements impact on the life quality of a group of patients with reduced physical functions in rehabilitation. Conclusions: the social function and vulnerability that are proper of the elderly people homes make relevant to seek for methods improving their management, and improving the performance of their processes at the same time. Process's management showed its usefulness and pertinence contributing to increase the service level and life quality of geriatric patients (AU).


Subject(s)
Humans , Aged , Quality of Life , Population Dynamics/trends , Population Growth , Health Management , Population Health Management , Homes for the Aged , Nursing Process , Health Services Administration , Indicators of Quality of Life , Surveys and Questionnaires , Process Assessment, Health Care , Total Quality Management , Financial Management , Management Service Organizations , Clinical Studies as Topic , Health Services for the Aged , Health Services Research
13.
Pesqui. vet. bras ; 38(3): 496-501, mar. 2018. ilus, tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-965028

ABSTRACT

Demodicose é uma afecção cutânea causada pelo ácaro Demodex sp. diagnosticada com frequência na rotina clínica veterinária. Objetivou-se descrever as manifestações clínicas e histológicas de cães com demodicose nas formas localizada e generalizada, relacionando a quantidade de ácaros e os achados microscópicos ao quadro clínico. Foram estudados 46 cães, sendo 28 com demodicose generalizada e 18 com a forma localizada da doença, dos quais todos possuíam raspados de pele positivo. Destes caninos foram anotados dados de lesões macroscópicas em ficha dermatológica e coletaram-se amostras de pele para estudo microscópico. A análise histológica foi realizada por três avaliadores e os dados registrados sem comunicação entre os mesmos, sendo considerado o resultado que mais ocorreu. Alopecia, descamação, eritema e crostas foram lesões clínicas comuns às duas formas de apresentação da doença que mais ocorreram. Inflamação histológica dermal grave ocorreu especialmente nos cães com doença localizada e generalizada que possuíam piodermite concomitante e ácaros Demodex sp. foram visualizados com intensidade entre moderada e acentuada na maioria dos cães com ambas as formas da enfermidade. Perifoliculite foi a alteração folicular microscópica mais evidenciada nos caninos deste estudo, seguida por foliculite mural e furunculose que tiveram maior ocorrência relativa nos cães com demodicose localizada. De acordo com os resultados obtidos verificou-se que a gravidade das lesões histológicas não corresponde necessariamente à forma de apresentação clínica da enfermidade, além disso, a quantidade de ácaros não demonstrou ser indicativa de lesões clínicas localizadas ou generalizadas, bem como não é possível diferenciar a doença clínica através do exame histopatológico.(AU)


Demodicosis is a skin condition caused by Demodex mite, frequently diagnosed in clinical routine. The purpose of this study was to compare the clinical and histological manifestations of localized and generalized demodicosis in dogs, relating the amount of mites and microscopic lesions. The study group was formed by 46 dogs, 28 with generalized demodicosis, and 18 with the localized form of the disease, all of them with positive skin scrapings. Macroscopic lesions data in dermatological form were noted, and skin samples were collected for microscopic study. The histopathological analysis was individually performed by three reviewers without intercommunication, being considered the result that more occurred. Alopecia, scaling, erythema, and crusting were the most common clinical lesions in both forms of the disease. Histological severe dermatitis occurred especially in dogs with localized and generalized disease that had concomitant pyoderma and Demodex sp. mites were visualized with intensity moderate and severe in the most dogs with both forms of the diseases. Perifolliculitis was the most evident microscopic follicular change in this study, followed by folliculitis and furunculosis wall, which had higher relative occurrence in dogs with localized demodicosis. According to the results obtained, the severity of histologic lesions does not necessarily correspond to the clinical presentation of the disease, in addition to the amount of mites that apparently is not indicative of localized or generalized clinical lesions, and cannot differentiate clinical disease by histopathology.(AU)


Subject(s)
Animals , Dogs , Dermatology , Dogs/anatomy & histology , Clinical Studies as Topic/veterinary , Mites/pathogenicity , Histology
14.
Rev. Kairós ; 20(2): 135-160, jun. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-884011

ABSTRACT

A Síndrome da Paralisia Supranuclear Progressiva (PSP) é doença neurodegenerativa do Sistema Nervoso Central (SNC), rara, e de difícil diagnóstico, afetando principalmente o tronco cerebral e os núcleos da base. O quadro clínico se caracteriza por oftalmoparesia supranuclear, instabilidade postural e demência. O objetivo do estudo foi investigar a fisiopatologia, diagnóstico, tratamento e assistência da equipe multidisciplinar às pessoas com PSP. Revisão integrativa de 15 artigos publicados na base de dados da Biblioteca Virtual da Saúde, BVS, envolvendo estudos de casos e pesquisa de campo. O estudo revelou pouca publicação acerca da doença e, por ser rara, não existe fármaco eficiente e eficaz; o diagnóstico é limitado nas primeiras manifestações, e somente possível por meio de exames mecanicistas. Em razão de existir parco material sobre a assistência a estes casos, sugere-se que os Conselhos, Associações de Neurologia e demais especialidades envolvidas no tratamento desenvolvam, divulguem mais detalhes sobre a doença, a fim de se criar um protocolo de atendimento integral aos afetados pela síndrome, bem como o necessário apoio aos familiares e cuidadores, que auxilie nas práticas da assistência ambulatorial e familiar.


Progressive Supranuclear Palsy Syndrome (PSP) is a rare and difficult diagnosis of the central nervous system (CNS) neurodegenerative disease that mainly affects the brainstem and nuclei of the base. The clinical picture is characterized by supranuclear ophthalmoparesis, postural instability and dementia. Objective: to investigate the pathophysiology, diagnosis, treatment and assistance of the multidisciplinary team to PSP users. Integrative review of 15 articles published in the database of the Virtual Health Library, VHL, involving case studies and field research. Results: the study revealed little publication about the disease and, because it is rare, there is no efficient and effective drug; The diagnosis is limited in the first manifestations, and it is only possible by means of mechanistic examinations. Because there is little material on the assistance to these cases, it is suggested that the Neurology Councils and Associations and other specificities involved in the treatment develop and disseminate more details about the disease, in order to create a protocol for comprehensive care Affected by this syndrome, as well as the necessary support for family members and caregivers, to assist in outpatient and family care practices.


Parálisis Supranuclear Progresiva Syndrome (PSP) es una enfermedad neurodegenerativa del sistema nervioso central (SNC), una rara y difícil de diagnosticar, que afecta principalmente el tronco cerebral y los ganglios basales. El cuadro clínico se caracteriza por oftalmoparesia supranuclear, inestabilidad postural y demencia. Investigar la fisiopatología, diagnóstico, tratamiento y atención del equipo multidisciplinario para llevar a la PSP. Revisión integradora de 15 artículos publicados en la Biblioteca Virtual en Salud Base de datos, BVS, que incluye casos de estudio y la investigación de campo. El estudio mostro poca publicación de la enfermedad y, debido a que es raro, no hay ningún fármaco eficaz y eficiente; el diagnóstico es limitada en las primeras manifestaciones, y sólo es posible a través de pruebas mecanicistas. Dado que el material que hay escasa la ayuda a estos casos, se sugiere que las juntas y asociaciones de neurología y otras especilidades implicados en el tratamiento desarrollan y dan a conocer más detalles acerca de la enfermedad, de manera que se crea un protocolo de tratamiento integral para afectadas por este síndrome, así como el apoyo necesario a las familias y cuidadores para ayudar en las prácticas de atención ambulatoria y la familia.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Central Nervous System Diseases , Clinical Studies as Topic , Parkinsonian Disorders , Supranuclear Palsy, Progressive
16.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(1): 49-53, jan.-mar. 2017. ilus, tab
Article in Portuguese | LILACS | ID: biblio-836961

ABSTRACT

A fibrilação atrial (FA) está associada ao acidente vascular cerebral (AVC) embólico fatal ou de grande repercussão clínica. Apesar da eficácia da anticoagulação oral, muitos pacientes não podem ser tratados por apresentarem sangramento importante. Pacientes com FA e alto risco de AVC embólico e história de hemorragia intracraniana, doença renal crônica terminal e sangramento gastrintestinal recorrente são candidatos para oclusão do apêndice atrial esquerdo (AAE). Estudos clínicos controlados adicionais serão necessários para identificar as melhores técnicas e os pacientes que terão maior benefício com a oclusão do AAE. Apesar da necessidade de mais dados, a oclusão do AAE deve ser atualmente considerada em pacientes com FA, alto risco de AVC e contraindicação para anticoagulação oral. Neste artigo existe uma revisão do racional, das indicações e das próteses para oclusão do AAE disponíveis no Brasil


Atrial fibrillation (AF) is associated with disabling or fatal thromboembolic stroke. Despite the efficacy of oral anticoagulation, many patients are not treated due to significant bleeding. Patients with AF and high risk of stroke, and prior intracranial bleeding, end-stage renal disease and recurrent gastrointestinal bleeding are candidates for left atrial appendage (LAA) occlusion. Additional randomized trials are needed to identify the best methods and the patients who will benefit from LAA occlusion. Despite the need for more data, LAA occlusion should currently be considered in patients with AF, high risk of stroke and contraindications to long-term oral anticoagulation. In this article, we review the rationale, indications, and prostheses for LAA occlusion available in Brazi


Subject(s)
Humans , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Appendage/physiopathology , Catheters , Clinical Studies as Topic/methods , Prostheses and Implants/trends , Brazil , Magnetic Resonance Spectroscopy/methods , Risk Factors , Echocardiography, Transesophageal/methods , Stroke , Guidelines as Topic/methods , Heart Atria , Hemorrhage/complications
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(1): 20-25, jan.-mar. 2017. tab
Article in Portuguese | LILACS | ID: biblio-836939

ABSTRACT

A estenose aórtica (EA) é uma doença frequente na população idosa e, quando sintomática, tem prognóstico desfavorável, sendo recomendada nesta situação a substituição valvar cirúrgica. Embora o tratamento cirúrgico seja o padrão para a correção da EA muitos pacientes não são candidatos adequados, devido ao risco perioperatório muito elevado. O implante da valva aórtica transcateter (TAVI) surgiu como interessante alternativa, principalmente nos casos de pacientes inoperáveis, demonstrando melhora significativa na sobrevida com relação ao tratamento clínico. Nos pacientes com risco cirúrgico elevado apresentou resultados equivalentes à troca valvar aórtica cirúrgica, com taxas de sobrevivência equivalentes ou até superiores. Os resultados clínicos encorajadores somados aos rápidos avanços da tecnologia geraram interesse no uso desses dispositivos em pacientes de risco intermediário. Atualmente já existem evidências demonstrando a não inferioridade da TAVI com relação à cirurgia para a correção da EA em pacientes de médio risco e esses dispositivos já estão aprovados nos Estados Unidos e Europa para o tratamento desse grupo de pacientes. No presente artigo são sumarizados os principais estudos que foram fundamentais para a implementação da TAVI na prática clínica atual e para aprovação pelos principais órgãos reguladores mundiais


Aortic stenosis (AS) is a common disease in the elderly population; when symptomatic, it has an unfavorable prognosis and aortic valve replacement is recommended. Although surgical replacement is the standard treatment for AS, many patients are not suitable candidates because of high perioperative risk. Transcatheter aortic valve implantation (TAVI) has emerged as an interesting alternative, especially in inoperable cases, showing significant improvements in survival over clinical treatment. In patients with high surgical risk TAVI has demonstrated results equivalent to surgical aortic valve replacement with similar or even higher survival rates. These encouraging clinical results coupled with advances in technology have generated interest in using TAVI in lower-risk populations. There is currently evidence showing that TAVI is not inferior to surgical treatment of AS in intermediate-risk patients, and these devices have already been approved in the United States and Europe for treating this group of patients. This article summarizes the main studies that were fundamental in implementing TAVI into current clinical practice and approval by the main global regulatory agencies


Subject(s)
Humans , Male , Female , Aged, 80 and over , Prostheses and Implants/adverse effects , Transcatheter Aortic Valve Replacement/methods , Clinical Studies as Topic/methods , Aortic Valve/surgery , Aortic Valve Stenosis/therapy , Pacemaker, Artificial , Patients , Prospective Studies , Treatment Outcome , Evidence-Based Medicine , Stroke , Hemorrhage/complications
18.
Pakistan Journal of Medical Sciences. 2017; 33 (4): 798-803
in English | IMEMR | ID: emr-188589

ABSTRACT

Background and Objective: Hip fracture is common osteoporotic fracture associated sometimes with failed internal fixation. Joint replacement is commonly used to salvage failed internal fixation of hip fractures [FIFHF].Our objective was to present the outcome of Arthroplasty after FIFHF in our patients


Methods: A prospective analysis was made on consecutive patients who underwent prosthetic replacements for FIFHF in Orthopaedics Department of Xuanwu Hospital between June 2012 and January 2015. Fifty six patients were included. There were 32 cases of failed internal fixation of femoral neck fracture [FIFFNF] and 24 cases of failed internal fixation of intertrochanteric fracture [FIFIF]. The reoperations included 36 cases of total hip replacements, and 20 cases of bipolar femoral head replacements. Cemented prostheses were used in 19 patients [long-stems in 7 patients], and uncemented prostheses in 37 patients [long-stems in 12 patients]. The patients were followed up for a minimum of 12 months or until their death


Results: Two patients died of pulmonary infection in the perioperative period, two died of myocardial infarction in two months after the operation, and the rest survived 12 month follow-up at the least. The mean Harris hip scores of the patients were 47 and 85 before and after the operation, respectively. The rate of Excellent and Good results is 82.7%. T tests showed that difference between pre and post-operation Harris hip scores is statistically significant [p <0.001]


Conclusions: Arthroplasty may serve as a suitable salvage technique for FIFHF, and long-stem prosthesis replacement is proved to obtain reliable curative effect, especially in FIFIF


Subject(s)
Humans , Female , Male , Middle Aged , Aged , Aged, 80 and over , Fracture Fixation, Internal/adverse effects , Arthroplasty/statistics & numerical data , Review Literature as Topic , Clinical Studies as Topic , Prostheses and Implants/adverse effects , Cementation
19.
Pakistan Journal of Medical Sciences. 2017; 33 (4): 891-894
in English | IMEMR | ID: emr-188607

ABSTRACT

Objective: To investigate the Clinical practice value of nitrous oxide inhalation and intravenous propofol and midazolam sedation in transnasal gastroscopy


Method: From December 2012 to April 2014, two hundred patients receiving painless transnasal gastroscopi on a voluntary basis were selected in Endoscopy center, The First People's Hospital of GuiYang. Patients were divided into two groups: Group-1 consisted of one hundred patients sedated by nitrous oxide inhalation and Group-2 consisted of one hundred patients sedated by intravenous propofol and midazolam, Patients were then examined by transnasal gastroscopy. Patient blood pressure, heart rate, pulse rate and oxygen saturation before, during and after gastroscopy were recorded for both groups. The duration of to gastroscopy and the time of awakening were also recorded. After examination, the patients were askedto assess the level of discomfort experiences during the gastroscopy procedure


Results: All patients successfully underwent the transnasal gastroscopy. There were 57 males and 43 females in the nitrous oxide inhalation group with an average age of 43.11 +/-8.27 years. The average duration of examination and time of awaking in the nitrous oxide inhalation group was of 152.7+/-9.80sea and 50+/-7.89 sees respectively. For the intravenous propofol and midazolam sedation group, there were 53 males and 47 females with an average age of 41.26+/-7.98 years. The average duration of examination and time of awaking in the intravenous propofol and midazolam sedation group was of 149.07+/-10.25 seconds and 390+/-20.89 seconds respectively. The two groups showed no significant difference in the duration of examination. There was no difference in the age or sex. The former had a less significant impact heart rate, oxygen saturation and blood pressure, while the intravenous propofol and midazolam sedatioi decreased blood pressure dramatically and this effect persisted after examination


Conclusion: Nitrous oxide inhalation has higher safety and tolerance with a brighter application prosp for transnasal gastroscopy


Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Nitrous Oxide/administration & dosage , Anesthetics, Intravenous , Propofol/administration & dosage , Deep Sedation , Midazolam , Clinical Studies as Topic
20.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.99-103.
Monography in Portuguese | LILACS | ID: biblio-848463
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