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Int. j. cardiovasc. sci. (Impr.) ; 35(2): 174-180, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364980


Abstract Background The wide range of clinical presentations of acute coronary syndrome (ACS) makes it indispensible to use tools for risk stratification and for appropriate risks management; thus, the use of prognosis scores is recommended in the immediat clinical decision-making. Objective To validate the Global Registry of Acute Coronary Events (GRACE) score as a predictor of in-hospital and 6-month post-discharge mortality in a population diagnosed with ACS. Methods This is a prospective cohort study of consecutive patients diagnosed with ACS between May and December 2018. GRACE scores were calculated, as well as their predictive value for in-hospital and 6-month post-discharge mortality. The validity of the model was assessed by two techniques: discriminative power using the area under the receiver operating characteristic curve (AUC) and goodness-of-fit, using the Hosmer-Lemeshow (HL) test, at the 5% level of significance. Results A total of 160 patients were included, mean age 64 (±10.9) years; of which 60% were men. The risk model showed to have satisfactory ability to predict both in-hospital mortality, with an area under the curve (AUC) of 0.76 (95% confidence interval [CI], 0.57-0.95; p = 0.014), and 6-month post-discharge mortality, with AUC of 0.78 (95%CI, 0.62-0.94), p = 0.002. The HL test indicated good-fit for both models of the GRACE score. Conclusion In this study, the GRACE risk score for predicting mortality was appropriately validated in patients with ACS, with good discriminative power and goodness-of-fit. The results suggest that the GRACE score is appropriate for clinical use in our setting.

Humans , Male , Female , Middle Aged , Aged , Risk Assessment/methods , Acute Coronary Syndrome/mortality , Prognosis , Predictive Value of Tests , Prospective Studies , Risk Factors , ROC Curve , Follow-Up Studies , Hospital Mortality , Acute Coronary Syndrome/diagnosis
Int. j. cardiovasc. sci. (Impr.) ; 35(1): 14-24, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356322


Abstract Background: The risk of sports-related sudden cardiac arrest after COVID-19 infection can be a serious problem. There is an urgent need for evidence-based criteria to ensure patient safety before resuming exercise. Objective: To estimate the pooled prevalence of acute myocardial injury caused by COVID-19 and to provide an easy-to-use cardiovascular risk assessment toolkit prior to resuming sports activities after COVID-19 infection. Methods: We searched the Medline and Cochrane databases for articles on the prevalence of acute myocardial injury associated with COVID-19 infection. The pooled prevalence of acute myocardial injury was calculated for hospitalized patients treated in different settings (non-intensive care unit [ICU], ICU, overall hospitalization, and non-survivors). Statistical significance was accepted for p values <0.05. We propose a practical flowchart to assess the cardiovascular risk of individuals who recovered from COVID-19 before resuming sports activities. Results: A total of 20 studies (6,573 patients) were included. The overall pooled prevalence of acute myocardial injury in hospitalized patients was 21.7% (95% CI 17.3-26.5%). The non-ICU setting had the lowest prevalence (9.5%, 95% CI 1.5-23.4%), followed by the ICU setting (44.9%, 95% CI 27.7-62.8%), and the cohort of non-survivors (57.7% with 95% CI 38.5-75.7%). We provide an approach to assess cardiovascular risk based on the prevalence of acute myocardial injury in each setting. Conclusions: Acute myocardial injury is frequent and associated with more severe disease and hospital admissions. Cardiac involvement could be a potential trigger for exercise-induced clinical complications after COVID-19 infection. We created a toolkit to assist with clinical decision-making prior to resuming sports activities after COVID-19 infection.

Sports , Heart Disease Risk Factors , COVID-19/complications , Myocarditis/complications , Death, Sudden, Cardiac , Risk Assessment/methods , Evidence-Based Practice/methods , Athletes
Article in English | WPRIM | ID: wpr-928658


To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Birth Weight , Gestational Age , Humans , Infant , Infant, Extremely Low Birth Weight , Infant, Newborn , Infant, Newborn, Diseases/mortality , Predictive Value of Tests , Risk Assessment/methods , Severity of Illness Index
Article in Chinese | WPRIM | ID: wpr-935790


Objective: To explore the applicability of three different kinds of noise occupational health risk assessment methods to the occupational health risk assessment of noise exposed positions in an automobile foundry enterprise. Methods: In July 2020, the occupational-health risk assessment of noise-exposed positions was conducted by using the Guidelines for risk management of occupational noise hazard (guideline method) , the International Commission on Mining and Metals Guidelines for Occupational Health Risk Assessment (ICMM) method and the Occupational-health risk index method (index method) respectively, and the results were analyzed and compared. Results: Through the occupational health field investigation, the noise exposure level of the enterprise's main workstations was between 80.3 and 94.8 dB (A) , among which the noise of the posts of shaking-sand, cleaning and modeling was greater than 85 dB (A) ; The noise risk of each position was evaluated by the three methods, and the adjustment risk level was between 2 and 5 assessed using the guideline method, between 2 and 3 assessed using the index method, and 5 evaluated using the ICMM model. Conclusion: Each of the three risk assessment methods has its own advantages and disadvantages. The ICMM model has a large difference in value assignment, and values in the results are larger than expected. The evaluation results of the guideline method and the index method are consistent in some positions, there is certain subjectivity in the evaluation using the index method, and the guideline method is more objective.

Automobiles , Noise, Occupational/adverse effects , Occupational Exposure , Occupational Health , Risk Assessment/methods
Chinese Journal of Epidemiology ; (12): 766-770, 2022.
Article in Chinese | WPRIM | ID: wpr-935457


Risks exist in medicine related fields, which cannot be defined and quantified precisely. It is necessary to adopt a method for the risk assessment of uncertain and fuzzy phenomenon. This paper summarizes the thinking, procedure, advantage and application of fuzzy analytic hierarchy process in the risk assessment in medicine related fields for the purpose of providing reference for its further application.

Analytic Hierarchy Process , Fuzzy Logic , Humans , Risk Assessment/methods
Rev. Col. Bras. Cir ; 49: e20223124, 2022. tab
Article in English | LILACS | ID: biblio-1365398


ABSTRACT The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context, perioperative risk assessment safeguards the optimization of the outcomes sought by the procedures. For this evaluation, anamnesis and physical examination constitute an irreplaceable initial stage which may or may not be followed by complementary exams, interventions for clinical stabilization and application of risk estimation tools. The use of these tools can be very useful in order to obtain objective data for decision making by weighing surgical risk and benefit. Global and cardiovascular risk assessments are of greatest interest in the preoperative period, however information about their methods is scattered in the literature. Some tools such as the American Society of Anesthesiologists Physical Status (ASA PS) and the Revised Cardiac Risk Index (RCRI) are more widely known, while others are less known but can provide valuable information. Here, the main indices, scores and calculators that address general and cardiovascular perioperative risk were detailed.

RESUMO O número de procedimentos cirúrgicos no mundo é amplo e no Brasil vem expressando tendência de crescimento superior ao crescimento populacional. Nesse contexto, a avaliação de risco perioperatório resguarda a otimização dos desfechos buscados pelos procedimentos. Para a realização dessa avaliação, a anamnese e exame físico constituem etapa inicial insubstituível, a qual pode ou não ser seguida de exames complementares, intervenções para estabilização clínica e aplicação de ferramentas de estimativa de risco. A utilização destas ferramentas pode ser bastante útil a fim de se obter um dado objetivo para a tomada de decisão pesando-se risco e benefício cirúrgico. As avaliações de risco global e cardiovascular são as de maior interesse no pré-operatório, entretanto informações sobre seus métodos encontram-se dispersas na literatura. Algumas ferramentas como o American Society of Anesthesiologists Physical Status (ASA PS) e Índice de Risco Cardíaco Revisado (RCRI) são mais amplamente conhecidos, enquanto outros são menos conhecidos em nosso meio mas podem fornecer informações valiosas. Aqui detalhou-se os principais índices, escores e calculadoras que abordam risco perioperatório geral e cardiovascular.

Physical Examination , Heart Disease Risk Factors , Brazil , Risk Assessment/methods
Braz. J. Pharm. Sci. (Online) ; 58: e19803, 2022. tab, graf
Article in English | LILACS | ID: biblio-1394043


Abstract The current investigation entail systematic Quality by Design (QbD)-enabled approach for the development of Sustained released embedded drug delivery systems of L-Arginine employing ionic gelation technique to attain improved patient compliance. Hence, in this QbD enabled systematic approach; quality target product profile (QTTP) was defined and critical quality attributes (CQAs) were identified. Further the risk assessment studies were undertaken through Ishikawa fish bone diagram to locate the critical material attributes (CMAs) and/or critical process parameters (CPPs) for the formulation of beads that may affect CQAs of drug product. A face centered central composite design (CCD) for two factors at three levels each with α =1 was employed for the optimization process to checkout the impact of concentration of sodium alginate and concentration of chitosan as CMAs which wereprior identified from risk assessment study and further evaluated for CQAs viz. bead size, swelling index and percent drug entrapment. The optimum formulation was embarked upon by using mathematical model being developed yielding desired CQAs. Thereby chitosan coated calcium-alginate delivery system was successfully developed by strategically employing QbD approach.In a nutshell, the presentinvestigation reports the successful development of optimized chitosan coated alginate beads employing QbD approach which can serve as a platform for other drugs too.

Patient Compliance , Drug Delivery Systems , Risk Assessment/methods , Chitosan , Methods , Pharmaceutical Preparations , Calcium/adverse effects , Drug Delivery Systems , Total Quality Management , Alginates/adverse effects , Models, Theoretical
Int. j. med. surg. sci. (Print) ; 8(2): 1-17, jun. 2021. tab, ilus, graf
Article in English | LILACS | ID: biblio-1284420


Background: Echocardiographic predictors for new onset heart failure in patients with ischemic heart disease with reduced left ventricular ejection fraction (HFrEF) or with preserved left ventricular ejection fraction (HFpEF) in Ethiopian and Sub-Saharan African is not well-known.Methods: Two hundred twenty-eight patients with ischemic heart disease were retrospectively recruited and followed. Analysis on baseline clinical and echocardiographic characteristics of patients, and risk factors for new onset HFpEF and new onset HFrEF were done. The exclusion criteria were known heart failure at baseline and those who did not have echocardiography data.Results: During the follow up period, heart failure developed in 62.2% (61/98) of ischemic heart disease patients with preserved left ventricular ejection fraction and in 70.1% (92/130) of ischemic heart disease patients with reduced left ventricular ejection fraction. We did not find significant difference between HFrEF and HFpEF in time to new onset heart failure. Systolic blood pressure, diastolic blood pressure, diabetes, left atrium and diastolic left ventricular dimension had significant association with new onset HFrEF on univariate regression analysis. Whereas new onset HFpEF was significantly associated with age, sex, presence of hypertension, Systolic blood pressure and diastolic left ventricular dimension. On cox regression analysis diastolic left ventricular dimension was associated with both new onset HFpEF and HFrEF. Age, diabetes, and dimension of left atrium were also associated with HFrEF.Conclusion: This cohort study in ischemic heart disease patients suggests a key role for the diastolic left ventricular dimension, left atrium size, diabetes, sex and age as predictors of new onset HFrEF and HFpEF. Strategies directed to prevention and early treatment of diabetes, dilatation of left ventricle and left atrium may prevent a considerable proportion of HFrEF or HFpEF.

Antecedentes: Los predictores ecocardiográficos de nuevos eventos de insuficiencia cardiaca en pacientes con cardiopatía isquémica con fracción de eyección ventricular preservada (HFpEF) o con fracción de eyección ventricular reducida (HFrEF) no son bien conocidos en la Africa etíope y subsahariana.Métodos: Doscientos veintiocho pacientes con cardiopatía isquémica fueron reclutados y seguidos retrospectivamente. Se realizaron análisis sobre las características clínicas y ecocardiográficas basales de los pacientes, así como los factores de riesgo para un nuevo evento de HFpEF y un nuevo evento de HFrEF. Los criterios de exclusión fueron insuficiencia cardíaca conocida al inicio del estudio y aquellos que no tenían datos de ecocardiografía.Resultados: Durante el período de seguimiento, la insuficiencia cardíaca se desarrolló en el 62,2% (61/98) de pacientes con cardiopatía isquémica con fracción de eyección ventricular izquierda preservada y en el 70,1% (92/130) de pacientes con cardiopatía isquémica con fracción de eyección ventricular izquierda reducida. No encontramos diferencias significativas entre HFrEF y HFpEF en el tiempo hasta la nueva aparición de insuficiencia cardíaca. La presión arterial sistólica, la presión arterial diastólica, la diabetes y las dimensiones de la aurícula iquierda y del ventrículo izquierdo en diástole tuvieron una asociación significativa con nuevos eventos de HFrEF en el análisis de regresión univariada. Mientras que un nuevo evento de HFpEF se asoció significativamente con la edad, el sexo, la presencia de hipertensión, la presión arterial sistólica y la dimensión ventricular izquierda diastólica. En el análisis de regresión de cox, la dimensión ventricular izquierda diastólica se asoció con HFpEF de nuevo inicio y HFrEF. La edad, la diabetes y la dimensión de la aurícula izquierda también se asociaron con HFrEF. Conclusión: Este estudio de cohorte en pacientes con cardiopatía isquémica sugiere un papel clave para la dimensión ventricular izquierda diastólica, el tamaño de la aurícula izquierda, la diabetes, el sexo y la edad como predictores de un nuevo evento de HFrEF y HFpEF. Las estrategias dirigidas a la prevención y el tratamiento temprano de la diabetes, la dilatación del ventrículo izquierdo y la aurícula izquierda pueden prevenir una proporción considerable de HFrEF o HFpEF.

Humans , Male , Female , Middle Aged , Aged , Echocardiography/methods , Myocardial Ischemia/diagnostic imaging , Stroke Volume , Tobacco Use Disorder , Multivariate Analysis , Predictive Value of Tests , Regression Analysis , Retrospective Studies , Cohort Studies , Follow-Up Studies , Ventricular Function, Left , Age Factors , Myocardial Ischemia/physiopathology , Risk Assessment/methods , Heart Disease Risk Factors
Säo Paulo med. j ; 139(2): 170-177, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1181006


ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Humans , Male , Female , Aged , Aged, 80 and over , Pneumonia/diagnosis , Pneumonia/epidemiology , Triage/methods , Risk Assessment/methods , Emergency Service, Hospital/statistics & numerical data , Early Warning Score , COVID-19/therapy , Turkey , Uremia/etiology , Uremia/epidemiology , Blood Pressure , Retrospective Studies , Respiratory Rate/physiology , Pandemics , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/epidemiology
Int. j. cardiovasc. sci. (Impr.) ; 34(1): 60-66, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154525


Abstract Background The European Heart Surgery Risk Assessment System (EuroSCORE) and InsCor have been used to predict complications of cardiac surgery. However, their application to predict lung function and functionality is still uncertain. Objective To correlate surgical risk scales with functional independence and pulmonary function in patients undergoing coronary artery bypass grafting. Methods This was a prospective cohort study. In the preoperative period, the two surgical scales were applied, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF) were measured, and functionality was assessed using the functional independence measure (FIM). On the seventh postoperative day, the pulmonary function and functionality variables were reevaluated, compared with the preoperative values (delta) and correlated with the risk scales. Correlations of pulmonary function, functional independence and muscle strength variables with the surgical scales were made by Pearson correlation test. The significance level adopted was 5%. Results Thirty-one patients were studied; most were male (77%), with a mean age of 56±8 years. Mean EuroSCORE was 2.3±0.5 and mean InsCOR was 1.2±0.5. MIP, MEP, and PEF reduced 30% (p<0.001), 33% (p<0.001) and 10% (p=0.23), respectively. The EuroSCORE correlated with MIP (r-0.78; p = 0.02) and FIM (r-0.79; p <0.01), and the InsCor correlated with MIP (r-0.77), MEP (r-0.73) and MIF (r-0.89; p=0.02). Conclusion The EuroSCORE showed a strong negative correlation with MIP and FIM, while InsCor had a strong negative correlation with MIP, MEP and FIM. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Humans , Male , Middle Aged , Risk Assessment/methods , Functional Status , Myocardial Revascularization , Postoperative Period , Preoperative Care , Cardiovascular Diseases/surgery , Maximal Voluntary Ventilation , Prospective Studies , Muscle Strength
São Paulo; s.n; s.n; 2021. 78 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-1379072


Surtos de salmonelose e listeriose associados ao consumo de frutas inteiras ou minimamente processadas ocorrem com frequência. O objetivo deste estudo foi investigar a capacidade de adesão e internalização de Salmonella spp. e Listeria monocytogenes em mangas (Mangifera indica) variedade Tommy Atkins, em diferentes condições de contaminação experimental e tratamento hidrotérmico, bem como avaliar a multiplicação dos patógenos internalizados na polpa das frutas durante armazenamento em refrigeração (8oC ) e temperatura ambiente (25oC). O estudo foi conduzido com as cepas S. Enteritidis ATCC 13076, S. Thyphimurium ATCC 14028, L. monocytogenes ATCC 7644 e L. monocytogenes Scott A. Inicialmente as cepas foram avaliadas segundo o índice de hidrofobicidade e capacidade de formação de biofilme em poliestireno. A adesão à superfície da manga foi avaliada por técnicas microbiológicas e também pela técnica de microscopia eletrônica de varredura. A internalização foi avaliada a partir de inoculação na cicatriz do pedúnculo (6 log UFC/mL) e após tratamento hidrotérmico e imersão em solução contaminada (6 log UFC/mL), mantidas a 8 °C e a 25 °C por 24h, 5 e 10 dias. A sobrevivência foi avaliada através da inoculação em região demarcada, em cenário de baixo (2 log UFC/mL) e alto nível de contaminação (6 log UFC/mL), a 8 °C e 25 °C, nos tempos 0, 1, 2, 3, 5 e 10 dias. A adesão foi observada nos dois patógenos, mesmo após sucessivas lavagens, com diferença significativa (p<0,05) após 1h de exposição e observou-se presença de estruturas exopolissacarídicas em diferentes tempos e condições de temperatura. A internalização ocorreu em todas as amostras avaliadas e a região do pedúnculo foi a mais afetada pela contaminação, diferindo significativamente na comparação com a região blossom end (p<0,05) a 8 °C e 25 °C. A sobrevivência foi observada nas duas temperaturas até o décimo dia. A multiplicação a 8°C foi significativamente mais baixa (p<0,05). Os resultados demonstraram que a Salmonella spp e L. monocytogenes são capazes de aderir à superfície, de internalizar e se alastrar pela polpa e ainda sobreviverem por períodos consideráveis, em 8 °C e 25 °C. Esses dados poderão auxiliar produtores e órgãos de saúde no desenvolvimento de avaliações quantitativas de risco e no estabelecimento de medidas adequadas para evitar surtos

Outbreaks of salmonellosis and listeriosis associated with the consumption of whole or minimally processed fruits occur frequently. The aim of this study was to investigate the ability of spp. and Listeria monocytogenes to adhere and internalize in mangoes (Mangifera indica) variety Tommy Atkins, under different conditions of experimental contamination and hydrothermal treatment, as well as evaluate the multiplication of the internalized pathogens in the fruit pulp during storage under refrigeration (8oC) and room temperature (25oC). The study was conducted with the strains S. Enteritidis ATCC 13076, S. Thyphimurium ATCC 14028, L. monocytogenes ATCC 7644 and L. monocytogenes Scott A. Initially the strains were evaluated according to the hydrophobicity index and capability to form biofilms on polystyrene surface. Adhesion to the mango surface was evaluated by microbiological techniques and also by scanning electron microscopy. Internalization was evaluated by inoculating the peduncle scar (6 log CFU / mL) and immersion of the fruits in contaminated solution (6 log CFU / mL) after hydrothermal treatment, during storage at 8 °C and 25 °C for 24h, 5 and 10 days. Survival was assessed by inoculation in a demarcated region, using low (2 log CFU / mL) and high level of contamination (6 log CFU / mL), and storage at 8 °C and 25 °C during 0, 1, 2, 3, 5 and 10 days. Adhesion was observed for both pathogens, even after successive washes, with a significant difference (p <0.05) after 1 h of exposure. Adhesion was mediated by exopolysaccharide structures, observed at different times and temperature conditions. Internalization occurred in all samples and the peduncle region was the most affected by the contamination, differing significantly in comparison with the blossom end region (p <0.05) at 8 °C and 25 oC. Survival was observed at both temperatures until the tenth day. The multiplication at 8 °C was significantly lower than at 25 oC (p <0.05). The results showed that Salmonella spp and L. monocytogenes were able to adhere to the surface, to internalize and spread through the pulp and still survive for considerable periods, at 8 °C and 25 °C. This data may help producers and health agencies to develop quantitative risk assessments and to establish appropriate measures to prevent outbreaks

Salmonella/isolation & purification , Salmonella Infections , Mangifera/adverse effects , Virus Internalization , Fruit , Listeria monocytogenes/isolation & purification , Microscopy, Electron, Scanning/methods , Microbiological Techniques/instrumentation , Risk Assessment/methods , Listeriosis/complications
São Paulo; s.n; s.n; 2021. 166 p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1390829


A avaliação do risco é um processo científico e sistemático que incorpora quantitativamente o perigo e a exposição a diversos agentes. O processo de avaliação do risco tem evoluído nos últimos anos, indo além da exposição a únicos agentes e vias de exposição para a caracterização do risco cumulativo a múltiplos agentes. As metodologias para avaliação do risco cumulativo não são harmonizadas o que pode tornar o processo complexo. Nesta linha, a abordagem do RISK21 promovida pelo Health Environmental Science Institute (HESI) pode contribuir para desmistificar o tema. A exposição combinada da ingestão de resíduos de praguicidas através da dieta e do uso residencial de produtos a base de piretróides pela população brasileira não são conhecidas. Os piretróides são praguicidas utilizados na lavoura, bem como em ambiente doméstico no controle de pragas. O mecanismo de toxicidade destes agentes é bem conhecido e de relevância para a saúde humana, pois atuam sobre a permeabilidade iônica dos canais de sódio sensíveis a voltagem (CSSV), produzindo efeitos na excitabilidade das terminações nervosas. Como os seres humanos são potencialmente expostos a estes agentes, portanto, torna-se importante compreender os riscos cumulativos da exposição a estes praguicidas pela população brasileira. O objetivo deste trabalho foi conduzir a avaliação do risco dos piretróides registrados no Brasil com base nos princípios do RISK21. A abordagem em etapas proposta pelo RISK21 demonstrou que o risco da ingestão crônica e aguda de resíduos de piretróides foi considerado aceitável. Além disso, não foi observada qualquer preocupação toxicológica decorrente da exposição residencial a estes agentes. Quando combinados os cenários da dieta aguda e residencial, também não foram observados níveis de preocupação, portanto, o risco foi considerado aceitável. A avaliação do risco dos piretróides registrados para o uso agrícola e residencial no Brasil com base nos principios do RISK21 foi uma importante etapa neste trabalho, uma vez que foi possível avaliar o risco e preocupações para cada um dos praguicidas de maneira rápida e visual. Além disso, mesmo considerando premissas altamente conservadoras, observou-se que a população exposta de maneira combinada a estes agentes não demonstrou um nível de preocupação para o cenário brasileiro

Risk assessment is a scientific and systematic approach that quantitatively incorporates hazard and exposure to agents' evaluation. The risk assessment process has evolved in recent years, going beyond exposure to single agents and pathways to characterize multiple agents' cumulative risk. Cumulative risk assessment methodologies are not harmonized, which can make the process complex. In this line, the RISK21 approach promoted by the Health Environmental Science Institute (HESI) can demystify the subject. The combined exposure of residue intake through diet and residential use of pyrethroid-based products by the Brazilian population is unknown. Pyrethroids are pesticides used in the crop as well as in a domestic environment in pest control. The mechanism of toxicity of these agents is well known and relevant to human health, as they act on the ionic permeability of voltage-sensitive sodium channels (VSSC), producing effects on the excitability of nerve endings. As human beings are potentially exposed to these agents, it is essential to understand the cumulative risks derived from the exposure to these pesticides by the Brazilian population. The objective of this research was to conduct the risk assessment based on the principles of RISK21 of pyrethroids registered in Brazil. The stepwise approach proposed by RISK21 demonstrated that the risk of chronic and acute ingestion of pyrethroid residues was considered acceptable. Furthermore, no toxicological concern stemming from residential exposure to these agents was observed. When acute and residential diet scenarios were combined, no levels of concern were also observed, so the risk was considered acceptable. The risk assessment based on the principles of RISK21 of pyrethroids registered for agricultural and residential use in Brazil was an essential step in this research since it was possible to assess the risk and concerns for each of the pesticides in a fast and visual way. Moreover, from highly conservative premises, it was observed that the population exposed in combination with these agents did not demonstrate a level of concern for the Brazilian scena

Pyrethrins/classification , Pesticide Residues/adverse effects , Risk Assessment Methodologies , Insecticides/agonists , Pesticides/adverse effects , Pest Control/methods , Risk Assessment/methods , Diet , Environment
Dental press j. orthod. (Impr.) ; 26(5): e2120218, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1345935


ABSTRACT Objective: This study evaluated the effectiveness of preventive strategies on caries risk reduction in patients undergoing orthodontic treatment, using the Cariogram program. Methods: In this quasi-experimental study, samples were selected using a convenience quota sampling technique, in a public dental school. At first, caries risk profile was determined for each subject using the Cariogram before brackets bonding. The sample size consisted of 36 patients. The intervention group (n = 18) received preventive programs, and the control group (n = 18) was trained based on the routine oral health education by means of pamphlets. Then, Cariogram parameters were calculated for patients in both groups after six months. Results: The age range of participants was from 12 to 29 years. The mean percentage of the "Actual chance of avoiding new cavities" section in the intervention group increased from 45.72 ± 21.64 to 62.50 ± 17.64. However, the mean percentage of other parameters - such as "Diet", "Bacteria" and "Susceptibility" - decreased after six months (p< 0.001). Besides, the differences in the mean percentage between intervention and control group at the end of the study period (T1) related to the Cariogram parameters were statistically significant (p< 0.001). Accordingly, the mean percentage of 'Actual chance of avoiding new cavities'' parameter in the intervention group (62.50) was statistically higher than in the control group (42.44) (p< 0.001). Conclusion: Implementing different preventive approaches is able to reduce the caries risk in patients undergoing fixed orthodontic treatment, which can be clearly demonstrated using Cariogram program.

RESUMO Objetivo: O presente estudo usou o software Cariogram para avaliar a eficácia de estratégias preventivas para redução do risco de cáries em pacientes sob tratamento ortodôntico. Métodos: Nesse estudo quase-experimental, as amostras foram selecionadas por meio de uma técnica de amostragem por cota de conveniência, em uma faculdade pública de Odontologia. Inicialmente, o perfil de risco de cárie foi determinado para cada indivíduo usando o Cariogram antes da colagem dos braquetes. A amostra consistiu de 36 pacientes: o grupo experimental (n = 18) recebeu programas preventivos, e o grupo controle (n = 18) recebeu orientações sobre a saúde bucal por meio de folhetos. Após seis meses, os parâmetros obtidos por meio do Cariogram foram calculados novamente para os pacientes de ambos os grupos. Resultados: A faixa etária dos participantes foi de 12 a 29 anos. A porcentagem média da seção "Probabilidade real de prevenir novas cáries" no grupo experimental aumentou de 45,72 ± 21,64 para 62,50 ± 17,64. Por outro lado, a porcentagem média de outros parâmetros - como "Dieta", "Bactérias" e "Suscetibilidade" - diminuiu após seis meses (p< 0,001). Além disso, as diferenças nas porcentagens médias entre o grupo experimental e o grupo controle ao fim do estudo (T1), relacionadas aos parâmetros do Cariogram, foram estatisticamente significativas (p< 0,001). Assim, a porcentagem média do parâmetro "Probabilidade real de prevenir novas cáries" no grupo experimental (62,50) foi estatisticamente maior do que no grupo controle (42,44) (p< 0,001). Conclusão: A implementação de diferentes abordagens preventivas pode reduzir o risco de cárie em pacientes sob tratamento ortodôntico com aparelhos fixos, o que pode ser observado claramente por meio do software Cariogram.

Humans , Child , Adolescent , Adult , Young Adult , Dental Caries/prevention & control , Dental Caries Susceptibility , Preventive Health Services , Computers , Risk Assessment/methods , Risk Reduction Behavior
Int. j. morphol ; 38(6): 1645-1650, Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1134492


RESUMEN: El aumento sostenido en la prevalencia de sobrepeso y obesidad en niños, niñas y adolescentes, causa alarma en la comunidad científica, que observa incrementos importantes en las enfermerdades asociadas a Síndrome Metabólico (SM), en la vida adulta. Chile presenta un 75 % con sobrepeso y obesidad en la población adulta y un 50,9 % en la población estudiantil, con un 66,2 % de sedentarismo. Los objetivos de este trabajo fueron determinar los perfiles antropométricos y su asociación a riesgo metabólico en adolescentes de colegio particular subvencionado de Arica-Chile. El total de los alumnos de enseñanza media, n= 810 (mujeres n= 437 y hombres n= 373), fueron evaluados según: peso, talla, perímetro de cintura, índice cintura-talla (ICT), índice de masa corporal (IMC). A todos ellos se les calculó el riesgo metabólico según protocolos de Ashwell & Gibson (2016) y el IMC según fórmula de Quetelet. Los datos fueron analizados en estadístico para tendencia central, dispersión y porcentajes. Para correlación se utilizó test de Pearson (r>0,5). Los resultados muestran que un 44,1 % de las mujeres y un 37,2 % de los hombres presentan sobrepeso y obesidad. El riesgo metabólico general de la población en estudio fue de 24,6 % (24,7 % y 24,4 % en mujeres y hombres respectivamente). Se observó una alta correlación entre PC / ICT (r= 0,92), IMC / ICT (r= 0,86) y Peso / PC (r= 0,87). Se concluye que las y los adolescentes presentan valores antropométricos alterados que indican altos índices de riesgos metabólicos. Los parámetros más alterados se observan en el segundo año de enseñanza media con porcentajes de sobrepeso y obesidad de 49,1 % en las mujeres versus 33,8 % en los hombres. Independientemente, los hombres presentaron mejores índices morfométricos que las mujeres. Se observaron altas correlaciones (r> 0,5) en todos los parámetros en estudio, asociados a riesgo metabólico. Se sugiere enfocar las intervenciones educativas según sello de vida saludable, incentivando la actividad física y mejorar los hábitos alimenticios en las y los adolescentes escolarizados.

SUMMARY: The sustained increase in the prevalence of overweight and obesity in children and adolescents causes alarm in the scientific community, who observe significant increases in diseases associated with Metabolic Syndrome (MS), in adult life. Chile presents 75 % with overweight and obesity in the adult population and 50.9 % in the student population and with 66.2 % of sedentary lifestyle. The objectives of this work were to determine the anthropometric profiles and their association with metabolic risk in adolescents from a subsidized private school in Arica-Chile. The total of high school students, n = 810 (women n = 437 and men n = 373), were evaluated according to: weight, height, waist circumference, waist-height index (WHI), body mass index (BMI). Metabolic risk was calculated for all of them according to Ashwell & Gibson protocols and BMI according to Quetelet's formula. The data were analyzed in statistics for central tendency, dispersion, and percentages. Pearson test (r> 0.5) was used for correlation. The results show that 44.1 % of women and 37.2 % of men are overweight and obese. The general metabolic risk of the study population was 24.6 % (24.7 % and 24.4 % in women and men, respectively). A high correlation was observed between WC / WHI (r = 0.92), BMI / WHI (r = 0.86) and Weight / WC (r = 0.87). It is concluded that adolescents present altered anthropometric values that indicate high rates of metabolic risks. The most altered parameters were observed in the second year of secondary education with percentages of overweight and obesity of 49.1 % in women versus 33.8 % in men. Regardless, males presented better morphometric indices than females. High correlations (r> 0.5) were observed in all the parameters under study, associated with metabolic risk. It is suggested to focus educational interventions according to the seal of healthy living, encouraging physical activity and improving eating habits in school adolescents.

Humans , Male , Female , Adolescent , Anthropometry , Risk Assessment/methods , Sedentary Behavior , Metabolic Diseases/etiology , Body Mass Index , Chile , Cross-Sectional Studies , Risk Factors , Education, Primary and Secondary , Overweight , Obesity
Gac. méd. Méx ; 156(6): 502-508, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249959


Resumen Introducción: Con la escala de Glasgow-Blatchford (EG-B) se califica mediante datos clínicos, el riesgo de resangrado después de hemorragia del tubo digestivo alto (HTDA); y con las escalas de Forrest y Dagradi, mediante endoscopia. Objetivo: Evaluar la capacidad de la EG-B para identificar riesgo de resangrado a 30 días después de una HTDA; el estándar de oro de comparación fue la endoscopia. Método: Se analizaron 129 expedientes de pacientes con HTDA y endoscopia. Se cuantificaron las escalas de Glasgow-Blatchford, Forrest y Dagradi; se calculó sensibilidad, especificidad y área bajo la curva ROC (ABC-ROC) del riesgo de resangrado reportado por EG-B. Resultados: La EG-B identificó a 53 pacientes con riesgo bajo de resangrado (41.09 %) y 76 con riesgo alto (58.91 %). Con la endoscopia se identificó a 107 pacientes con hemorragia no variceal (82.94 %), 98 con riesgo bajo (89.9 %) y 11 con riesgo alto (10.09 %); además, 22 pacientes con hemorragia variceal (17.05 %), 12 con riesgo bajo (54.54 %) y 10 con riesgo alto (45.45 %). La EG-B mostró sensibilidad de 0.857, especificidad de 0.462 y ABC-ROC de 0.660. Conclusiones: La EG-B es sencilla, objetiva y útil para identificar riesgo de resangrado después de HTDA; se sugiere como herramienta de triaje en urgencias.

Abstract Introduction: The Glasgow-Blatchford scale (GBS) classifies the risk of re-bleeding after upper gastrointestinal bleeding (UGIB) using clinical data, whereas the Forrest and Dagradi scales do it by endoscopy. Objective: To assess GBS’s ability to identify re-bleeding risk within 30 days of an UGIB, using endoscopy as the gold standard for comparison. Method: 129 medical records of patients with UGIB and endoscopy were analyzed. The Glasgow-Blatchford, Forrest and Dagradi scales were quantified; sensitivity, specificity and area under the ROC curve (AUC-ROC) of GBS-reported re-bleeding risk were calculated. Results: GBS identified 53 patients with low re-bleeding risk (41.09 %) and 76 with high risk (58.91 %). Endoscopy identified 107 patients with non-variceal bleeding (82.94 %): 98 with low risk (89.9 %) and 11 with high risk (10.09 %); in addition, it identified 22 patients with variceal hemorrhage (17.05 %): 12 with low risk (54.54 %) and 10 with high risk (45.45 %). GBS showed a sensitivity of 0.857, specificity of 0.462 and an AUC-ROC of 0.660. Conclusions: GBS is simple, objective and useful to identify the risk of re-bleeding after UGIB; it is suggested as a triage tool in the emergency department.

Humans , Male , Female , Middle Aged , Esophageal and Gastric Varices/diagnosis , Triage/methods , Endoscopy, Gastrointestinal/standards , Gastrointestinal Hemorrhage/diagnosis , Recurrence , Sensitivity and Specificity , Risk Assessment/methods , Area Under Curve
Rev. bras. ginecol. obstet ; 42(6): 349-355, June 2020. tab
Article in English | LILACS | ID: biblio-1137837


Abstract The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARSCoV- 2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.

Resumo O novo coronavírus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV- 2) é umvírus que causa uma doença respiratória potencialmente grave que se espalhou por vários países, acometendo seres humanos de todas as faixas etárias, incluindo gestantes. O propósito deste protocolo é fornecer apoio técnico e científico aos obstetras brasileiros com relação aos cuidados no parto, pós-parto e aborto durante a pandemia.

Humans , Female , Pregnancy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Pneumonia, Viral/epidemiology , Infection Control/methods , Infection Control/organization & administration , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Perinatal Care/methods , Disease Transmission, Infectious/prevention & control , Clinical Laboratory Techniques/methods , Delivery, Obstetric/methods , Pandemics/prevention & control , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/epidemiology , Brazil , Comorbidity , Abortion, Legal/methods , Risk Assessment/methods , Betacoronavirus/isolation & purification , COVID-19 Testing , SARS-CoV-2 , COVID-19
Rev. chil. enferm. respir ; 36(2): 85-93, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138539


INTRODUCCIÓN: En Chile, se estima que 8,5% de los adultos tiene riesgo elevado de síndrome de apnea e hipopnea obstructiva del sueño (SAHOS). OBJETIVO: Estimar el riesgo de SAHOS en funcionarios de la salud. MATERIAL Y MÉTODO: Se consignaron los datos clínicos, antropométricos, presión arterial, cuestionarios STOP-Bang (CSB), índice de Flemons y escalas de Epworth y de Thornton en trabajadores de Clínica Dávila, Santiago, Chile. RESULTADOS: Se evaluaron 1.332 funcionarios, 77,1% mujeres, circunferencia de cuello: 35,7 ± 3,7 cm (26-54), circunferencia de cintura: 89,3 ± 3,7 cm, e índice de masa corporal: 27,5 ± 4,5 (17,5-49,4) kg/m2; 42% tenía sobrepeso y 26% obesidad. El Cuestionario SB los clasificó en tres categorías: Riesgo alto (RA): 43 funcionarios (3,2%), 50 ± 10,5 años; riesgo moderado: 215 (16,1%), 45,6 ± 11,4 años y riesgo bajo: 1.074 (80,6%), 36,2 ± 10,6 años. En hombres, la edad y los puntajes de los cuestionarios de sueño fueron diferentes en las tres categorías de riesgo (p = 0,003 y 0,001). En mujeres, los puntajes de los cuestionarios fueron distintos en los tres grupos de riesgo, no hubo diferencias en la escala de Epworth (p = 0,274), ni en la edad (p = 0,08). La escala Mallampati no permitió predecir el riesgo de SAHOS en ambos sexos. CONCLUSIONES: El cuestionario SB identificó a 9,8% de los hombres con riesgo alto de SAHOS. En los hombres, la edad, cuestionario SB, Flemons, Epworth y Thornton, fueron diferentes en las tres categorías de riesgo de SAHOS. En las mujeres, la edad y escala de Epworth fueron similares en las tres categorías de riesgo.

INTRODUCTION: In Chile, it is estimated that 8.5% of adults are at high risk of Obstructive Sleep Apnea (OSA). OBJECTIVE: To estimate the risk of OSA in health workers. MATERIAL AND METHOD: clinical and anthropometric data, blood pressure, STOP-Bang (CSB) questionnaires, Flemons index and Epworth and Thornton scales were assessed in workers from Clínica Dávila, Santiago, Chile. RESULTS: 1,332 workers were evaluated, 77.1% women, neck circumference: 35.7 ± 3.7 cm (26-54), waist circumference: 89.3 ± 3.7 cm, and body mass index: 27.5 ± 4.5 (17.5-49.4) kg/m2; 42% were overweight and 26% obese. The SB Questionnaire classified them into three risk categories: High risk (HR): 43 workers (3.2%), 50 ± 10.5 years-old; moderate risk: 215 (16.1%), 45.6 ± 11.4 years-old and low risk: 1,074 (80.6%), 36.2 ± 10.6 years-old. In men, age and sleep questionnaire scores were different in the three risk categories (p = 0.003 and 0.001). In women, the sleep questionnaire scores were different in the three risk groups, there were no differences in the Epworth scale (p = 0.274), nor in age (p = 0.08). The Mallampati scale did not allow predict OSA risk in both sexes. CONCLUSIONS: The SB questionnaire identified 9.8% of the men with high risk of OSA. In men, age, SB questionnaire, Flemons index, Epworth and Thornton scale, were different in the three OSA risk categories. In women, the age and Epworth scale were similar in the different risk categories.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Health Personnel , Sleep Apnea, Obstructive/epidemiology , Body Mass Index , Logistic Models , Chile , Anthropometry , Prevalence , Prospective Studies , Surveys and Questionnaires , Risk Factors , Age Factors , Risk Assessment/methods , Forecasting