Evaluation of oxidative stress in an experimental model of Crohn's disease treated with hyperbaric oxygen therapy

Abstract Introduction: Treatments of Inflammatory Bowel Disease (IBD) are able to control symptoms in most cases, however, a fraction of patients do not improve or have a loss of response to treatments, making it important to explore new therapeutic strategies. Hyperbaric oxygen therapy (HBO) may represent one of them. The aim of this study was to evaluate the effects of HBO therapy in an experimental model of IBD. Methods: Sixty male BALBc mice were divided into six groups. Group 1 was colitis-induced with trinitrobenzene sulfonic acid (TNBS) + ethanol, group 2 received TNBS + ethanol plus HBO, group 3 received only ethanol, group 4 received ethanol plus HBO, group 5 received saline solution, and group 6 received saline solution plus HBO. HBO was performed for four days, subsequently, the mice were evaluated daily. At the end of the study, samples from the intestine were collected for histological analysis as well as for measurement of antioxidant enzymes and cytokine levels. Results: HBO significantly improved the clinical and histological status of the animals. Treatment with HBO increased the activity of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) in all of the groups; moreover, the difference was only significant between the TNBS and TNBS + HBO groups and treatments promoted a reduction in the proinflammatory cytokines IFN-γ, IL-12, IL-17 and TNF-α and increased the anti-inflammatory cytokines IL-4 and IL-10, with no changes in IL-13. Conclusion: HBO effectively treats TNBS-induced colitis by increasing the activity of antioxidant enzymes and modulating cytokine profiles.

Pulmonary function and medication effect in mild-stage subjects with Parkinson's disease / Função pulmonar e efeitos da medicação em pessoas com doença de Parkinson em estágio leve

Abstract Background Parkinson's disease (PD) causes a series of movement disorders, many of them starting in the early stage. Objective To analyze the pulmonary function of mild-stage subjects with PD and to investigate the effects of levodopa on it. Methods We included 21 patients with idiopathic PD and 20 healthy control subjects. The participants were submitted to spirometry and impulse oscillometry assessments. The PD patients were evaluated during the "off" and "on" phases of their anti-PD medication, which was was converted to levodopa in an equivalent daily dose. A statistical analysis was performed with cross-sectional (PD patients "off" medication versus controls) and paired (PD patients "off" medication versus PD patients "on" medication) tests. The effect of levodopa was calculated with partial Eta-squared (η2ρ). Significance was set at 5%. Results The PD patients presented normal values in the impulse oscillometry. Regarding spirometry, the results indicated an incipient obstructive ventilatory disorder in the PD group - confirmed by patients' flow-volume curves. The PD patients received a daily dose of 354.7 ± 148.2 mg of levodopa. The paired analyses showed a small effect of anti-PD medication on pulmonary parameters (η2ρ = 0.197 for spirometry and η2ρ = 0.043 for impulse oscillometry). Conclusion Patients with PD in the mild stage of the disease present pulmonary compliance and resistance compatible with normal parameters. The differences regarding the spirometric results indicate an incipient obstructive ventilatory disorder in patients with PD. Levodopa had small effect on pulmonary function in the mild stage of the disease.

Resumo Antecedentes A doença de Parkinson (DP) causa uma série de distúrbios do movimento, muitos deles se desenvolvendo na fase inicial. Objetivo Analisar função pulmonar de pessoas com DP em estágio leve e investigar o efeito da levodopa nesse processo. Métodos Vinte e um participantes com DP idiopática e vinte controles saudáveis foram incluídos na pesquisa. Todos os sujeitos foram submetidos a avaliações de espirometria e oscilometria de impulso. Participantes com DP foram avaliados nas fases 'on' e 'off' de medicação anti-parkinsoniana. A medicação dos pacientes foi convertida em dose diária de levodopa. A análise estatística foi realizada com testes transversais (Parkinson na fase 'off' da medicação vs controles) e pareados (Parkinson nas fases 'off' vs 'on' da medicação). O efeito da levodopa foi calculado pelo eta ao quadrado parcial (η2ρ). Significância foi estipulada em 5%. Resultados Pacientes com DP apresentaram valores normais na oscilometria de impulso. Na espirometria, os resultados indicaram uma desordem ventilatória obstrutiva incipiente no grupo DP - confirmada pelas curvas fluxo-volume dos pacientes. Pacientes com DP receberam uma dose diária de 354,7 ± 148,2 miligramas de levodopa. Análises pareadas mostraram baixo impacto da medicação anti-parkinsoniana nos parâmetros pulmonares (η2ρ = 0,197 na espirometria e η2ρ = 0,043 na oscilometria de impulso). Conclusão Pacientes com DP na fase leve apresentam complacência e resistência pulmonares compatíveis com parâmetros normais. Diferenças espirométricas indicam distúrbio ventilatório obstrutivo incipiente em pacientes com DP. A administração de levodopa apresentou baixo efeito na função pulmonar na fase leve da doença.

Hospital readmission within 30 days of older adults hospitalized in a public hospital

Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the "Readmission Risk Score - RRS". The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days

O trabalho do psicopedagogo na reabilitação cognitiva do idoso / Psychopedagogue's work in cognitive rehabilitation of the elderly

O presente artigo busca evidenciar a possibilidade de atuação do psicopedagogo no campo da geriatria, especificamente na reabilitação cognitiva de idosos com prejuízos cognitivos decorrentes tanto do processo natural do envelhecimento quanto de doenças e/ou lesões cerebrais. A metodologia adotada para esta pesquisa é a da revisão bibliográfica narrativa e encontra-se ancorada em áreas do conhecimento como a neurociência, a psiquiatria, a neuropsicologia, a análise do comportamento e a neurologia. Conclui-se que o psicopedagogo, por possuir conhecimentos que o levam a ter afinidade com tais áreas e por ser um especialista em processos de aprendizagem, possui competência para colaborar em programas de reabilitação cognitiva de modo a atuar como facilitador na construção e reconstrução de saberes que promovam o restabelecimento da autonomia do idoso e sua plena reinserção ao convívio social.

This article aims to highlight the possibility of psychopedagogy in the field of geriatrics, specifically in the cognitive rehabilitation of the elderly with cognitive impairments arising both from the natural aging process and from brain diseases and/or injuries. The methodology adopted for this research is that of the bibliographic narrative review and is anchored in areas of knowledge such as neuroscience, psychiatry, neuropsychology, behavioral analysis and neurology. It is concluded that the psychopedagogue has the competence to collaborate in cognitive rehabilitation programs to act as a facilitator in the construction and reconstruction of knowledge that promote the restoration of the autonomy of the elderly and their full reintegration into social life. This conclusion is justified by the fact that he has sufficient knowledge in such areas and acts in learning processes.

Esgotamento fí­sico dos profissionais de enfermagem no combate da COVID-19 / Physical exhaustion of nursing professionals in the COVID-19 combat

Objetivo: Averiguar os fatores associados ao esgotamento físico dos profissionais de enfermagem no combate da COVID-19. Método: Trata-se de uma revisão integrativa. Realizou-se a busca por artigos; com delimitação nos últimos 5 anos; nos idiomas português, inglês e espanhol; disponíveis na íntegra. Nas seguintes plataformas de dados: BDENF; LILACS; MEDLINE/BVS; PUBMED; Science Direct e na SciELO. Resultados: Os dados foram organizados e apresentados em figuras e tabelas. Dos 76 estudos encontrados, 2 estava disponível na BDENF; 2 na LILACS; 3 na MEDLINE/BVS; 5 na PUBMED; 61 na Science Direct e 3 na SciELO; contudo, após a leitura permaneceram apenas os que atendiam aos critérios para inclusão e exclusão descritos na metodologia, 8 estudos. Conclusão: A revisão elaborada proporcionou a identificação dos fatores associados ao esgotamento físico e psicológico dos profissionais de enfermagem ao combate da COVID-19; e frequentemente relacionados a sintomas de depressão, ansiedade, insônia e angústia.(AU)

Objective: To investigate the factors associated with the physical exhaustion of nursing professionals in the fight against COVID-19. Method: This is an integrative review. The search for articles was carried out; with delimitation in the last 5 years; in Portuguese, English and Spanish; available in full. On the following data platforms: BDENF; LILACS; MEDLINE/VHL; PUBMED; Science Direct and SciELO. Results: The data were organized and presented in figures and tables. Of the 76 studies found, 2 were available from BDENF; 2 at LILACS; 3 at MEDLINE/VHL; 5 at PUBMED; 61 at Science Direct and 3 at SciELO; however, after reading, only those that met the inclusion and exclusion criteria described in the methodology remained, 8 studies. Conclusion: The elaborated review provided the identification of factors associated with the physical and psychological exhaustion of nursing professionals to combat COVID-19; and often related to symptoms of depression, anxiety, insomnia and distress.(AU)

Objetivo: Investigar los factores asociados al agotamiento físico de los profesionales de enfermería en la lucha contra el COVID-19. Método: Esta es una revisión integradora. Se realizó la búsqueda de artículos; con delimitación en los últimos 5 años; en portugués, inglés y español; disponible en su totalidad. En las siguientes plataformas de datos: BDENF; LILACS; MEDLINE/VHL; PUBMED; Science Direct y SciELO. Resultados: Los datos fueron organizados y presentados en figuras y tablas. De los 76 estudios encontrados, 2 estaban disponibles en BDENF; 2 en LILACS; 3 en MEDLINE/VHL; 5 en PUBMED; 61 en Science Direct y 3 en SciELO; sin embargo, después de la lectura, solo quedaron aquellos que cumplieron con los criterios de inclusión y exclusión descritos en la metodología, 8 estudios. Conclusión: La revisión elaborada proporcionó la identificación de factores asociados al agotamiento físico y psicológico de los profesionales de enfermería para combatir el COVID-19; ya menudo se relaciona con síntomas de depresión, ansiedad, insomnio y angustia.(AU)

The proportion of fine particles in pelleted diets does not affect the performance of slow-growing broiler chickens / La proporción de partículas finas en dietas peletizadas no afecta el desempeño del pollo de engorde de lento crecimiento / Proporção de partículas finas em dietas peletizadas não afeta o desempenho de frangos de corte com crescimento lento

Abstract Background: The slow-growing chicken strains have particular nutritional and digestive needs, so they may digest pelleted feeds differently compared to commercial strains. Objective: To evaluate performance, digestibility, serum biochemical profile, digestive morphometry, carcass and cut yields of slow-growing broiler chickens fed pelleted feed with different concentrations of fine particles. Methods: A total of 180 slow-growing broiler chicks (Isa Label strain) aged one day were used. The animals were distributed in a completely randomized design with a 2 x 3 factorial scheme (Sex: male or female; Proportion of fine particles: 0, 50, or 100%), with six repetitions of five birds/cage. The birds received water and feed ad libitum during the 28-day experimental period. Results: The proportion of fine particles did not affect the metabolic, digestive or productive variables evaluated. Males showed better overall performance, while females produced better thigh and liver yields. Conclusion: The proportion of fine particles in pelleted feeds did not affect productive or metabolic parameters. Thus, improving pellet quality for slow-growing broilers during the initial rearing phase may not be justified.

Resumen Antecedentes: Los linajes de pollo de crecimiento lento presentan particularidades nutricionales y digestivas; por lo tanto, es posible que aprovechen los alimentos peletizados de manera diferente a los linajes comerciales. Objetivo: evaluar el desempeño, digestibilidad, perfil sérico bioquímico, morfometría digestiva, rendimiento de la carcasa y los cortes de pollos de engorde de crecimiento lento alimentados con raciones peletizadas con diferentes concentraciones de partículas finas. Métodos: Se utilizaron 180 pollitos machos y hembras, de crecimiento lento, de un día de edad, del linaje Isa Label. Los animales se distribuyeron en un diseño completamente aleatorizado y en un esquema factorial 2 x 3 (Sexo: macho y hembras; Proporción de partículas finas en la ración: 0, 50, y 100%) con seis repeticiones de cinco aves/jaula. Las aves recibieron agua y ración ad libitum durante el período de prueba de 28 días. Resultados: la proporción de partículas finas no afectó las variables metabólicas, digestibles y productivas evaluadas. Los machos presentaron mejor desempeño, mientras que las hembras tuvieron mayor rendimiento de muslos e hígado. Conclusión: la proporción de partículas finas en raciones peletizadas no afecta los parámetros productivos y metabólicos. Por lo tanto, probablemente no se justifica mejorar la calidad del pelet para pollos de crecimiento lento en la fase inicial de cría.

Resumo Antecedentes: linhagens de crescimento lento apresentam particularidades nutricionais e digestivas, portanto é possível que aproveitem os alimentos peletizados de maneira diferente das linhagens comerciais. Objetivo: avaliar o desempenho, digestibilidade dos alimentos, o perfil sérico bioquímico, a morfometria digestiva, rendimento de carcaça e cortes de frangos de corte com crescimento lento alimentados com rações peletizadas com diferentes concentrações de partículas finas. Métodos: Foram utilizados 180 pintos de corte, machos e fêmeas de crescimento lento, com um dia de idade, da linhagem Isa Label. Os animais foram distribuídos em delineamento inteiramente casualizado em esquema fatorial 2 x 3 (Sexo: macho e fêmeas; Proporção de partículas finas na ração: 0, 50, e 100%) com seis repetições de cinco aves/gaiola. As aves receberam água e ração ad libtum durante o período experimental de 28 dias. Resultados: a proporção de partículas finas não afetou as variáveis metabólicas, digestórias e produtivas avaliadas. Os machos apresentaram melhor desempenho, enquanto as fêmeas tiverem maior rendimento de coxas e fígado. Conclusão: a proporção de partículas finas nas rações peletizadas não afetaram os parâmetros produtivos e metabólicos e, portanto, não justifica-se melhorias na qualidade de peletes de rações para frangos de crescimento lento na fase inicial de criação.

Lipoma Arborescente: uma causa de sinovite crônica? / Lipoma Arborescens: a cause of chronic synovitis?

O lipoma arborescente é uma causa incomum de lesão intra-articular que se apresenta como aumento de volume articular indolor, lentamente progressivo, que persiste por muitos anos e é acompanhado por derrames articulares intermitentes. O envolvimento de sítios extra-articulares é incomum, mas pode ocorrer em bainhas tendíneas e bursas. A ressonância magnética é o melhor exame para o diagnóstico, embora a biópsia sinovial possa ser necessária em alguns casos. Relatamos três casos com o objetivo de destacar o espectro clínico da doença, as características da imagem e a resposta ao tratamento imunossupressor.

Lipoma arborescens is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. Extra-articular site(s) involvement is unusual, but can occur in tendon sheaths and bursas. Magnetic resonance imaging is the best diagnostic exam, although synovial biopsy may be necessary. We report three cases in order to highlight the clinical spectrum and imaging features of the disease, so that early diagnosis and appropriate treatment can be given.

Rapid detection of Mycobacterium tuberculosis in children using blood and urine specimens

Abstract INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

Importation and early local transmission of COVID-19 in Brazil, 2020

We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil. (AU)

Taxas de cesárea no Estado de São Paulo: desigualdades regionais na assistência obstétrica prestada pelo SUS / Cesarean rates in the State of São Paulo: regional inequalities in care obstetric provided by SUS

Objetivos: analisar a relação entre as taxas de cesárea, segundo grupos da classificação de Robson, dos estabelecimentos que prestam assistência ao parto no SUS no estado de São Paulo e as condições de urbanização. Métodos: foram analisados dados de 2016 do Sistema de Informação sobre Nascidos Vivos e do Cadastro Nacional de Estabelecimentos de Saúde. O desfecho estudado foi a taxa de cesárea dos estabelecimentos, agrupados por tipo de administração (pública ou por entidades filantrópicas) e por condição de urbanização. Resultados: a taxa de cesárea dos serviços que prestam assistência ao parto no SUS no estado de São Paulo foi de 50,5%, variando de 41,1% nas regiões metropolitanas até 75,2% nas regiões de baixa urbanização. As taxas de cesárea dos estabelecimentos de administração pública (38,2%) foram significativamente menores que dos estabelecimentos administrados por entidades filantrópicas (62,3%). Os grupos de Robson que mais contribuíram na taxa global de cesárea foram o 5 (36,6%) e o 2 (21,5%). Conclusões: as regiões menos urbanizadas apresentaram taxas de cesárea significativamente maiores que as regiões metropolitanas e de alta urbanização. As taxas de cesárea dos estabelecimentos públicos foram significativamente menores que dos filantrópicos, entretanto, quando separados por condição de urbanização, essa diferença só foi observada nas regiões metropolitanas.

Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge / Fatores associados ao uso de medicamentos potencialmente inapropriados para idosos na alta hospitalar

ABSTRACT Objective To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors. Methods Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient's electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition. Results A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513). Conclusion The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.

RESUMO Objetivo Analisar a frequência de uso de medicamentos potencialmente inapropriados para idosos na prescrição de alta hospitalar de idosos de um hospital público, considerando o Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos, e identificar os fatores associados. Métodos Pacientes com idade ≥60 anos, internados nas unidades de clínica médica e geriátrica de um hospital público, foram convidados para participar do estudo. As informações sobre o uso de medicamentos foram coletadas do prontuário eletrônico do paciente e confirmadas por contato telefônico. O Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos independente da condição clínica foi utilizado para a classificação dos medicamentos. Resultados Foram incluídos no estudo 255 idosos. A frequência de uso de medicamentos potencialmente inapropriados para idosos foi de 58,4%. O uso de medicamentos potencialmente inapropriados para idosos foi associado positivamente à presença de depressão (razão de chance de 2,208) e polifarmácia (razão de chance de 2,495). A internação em unidade de geriatria apresentou associação inversa com uso de medicamentos potencialmente inapropriados para idosos (razão de chance de 0,513). Conclusão A frequência de prescrição de medicamentos potencialmente inapropriados para idosos na alta hospitalar foi alta. Depressão e polifarmácia estiveram diretamente associadas ao uso de medicamentos potencialmente inapropriados para idosos. Ficar internado na clínica geriátrica mostrou-se fator protetor para uso de medicamentos potencialmente inapropriados para idosos. Estratégias para melhorar a farmacoterapia do idoso devem ser implementadas, visando à qualidade assistencial e à segurança na transição do cuidado.

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective / Visitas de idosos a departamentos de emergência em até 30 dias após a alta hospitalar: análise na perspectiva da farmacoterapia

ABSTRACT Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

RESUMO Objetivo Analisar, da perspectiva da farmacoterapia, os fatores associados à visita de idosos a departamentos de emergência em até 30 dias após a alta da internação índice. Métodos Foi realizado estudo transversal em hospital público geral, com idosos. Visita a departamento de emergência foi definido como a permanência do idoso nesse serviço por até 24 horas. A complexidade da farmacoterapia foi determinada usando o Medication Regimen Complexity Index. Os medicamentos potencialmente inapropriados para idosos foram classificados segundo os critérios American Geriatric Society/Beers , de 2015. O desfecho investigado foi a frequência de visita a departamento de emergência em 30 dias após a alta hospitalar. Regressão logística multivariada foi realizada para identificar os fatores associados à visita a departamento de emergência. Resultados No estudo, foram incluídos 255 idosos; 67 (26,3%) visitaram departamento emergência em 30 dias após a alta hospitalar. Polifarmácia e medicamentos potencialmente inapropriados para idosos não apresentaram associação estatística significante. O diagnóstico de insuficiência cardíaca e o índice da complexidade da farmacoterapia >16,5 apresentaram associação positiva com visita a departamento de emergência (RC=2,3; IC95%: 1,04-4,94; p=0,048; e RC=2,1; IC95%: 1,11-4,02; p=0,011), respectivamente. Ainda, o diagnóstico de diabetes mellitus e a doença renal crônica foram fatores de proteção para o desfecho (RC=0,4; IC95%: 0,20-0,73; p=0,004; e RC=0,3; IC95%: 0,13-0,86; p=0,023). Conclusão O diagnóstico de insuficiência cardíaca e o índice da complexidade da farmacoterapia >16,5 apresentaram associação positiva com ocorrência de visita a departamento de emergência dentro de 30 dias após a alta.

Potential drug interactions in drug therapy prescribed for older adults at hospital discharge: cross-sectional study

ABSTRACT BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES: To establish the frequency of potential drug interactions in prescriptions at hospital discharge among older adults and to identify the associated factors. DESIGN AND SETTING: Cross-sectional study conducted in a public hospital. METHODS: An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were identified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS: Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 older adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug interactions that should be avoided among older adults, those that increase the risk of falls were the most frequent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION: The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.

Analysis of monitored cases of acquired syphilis in Porto Alegre, Rio Grande do Sul / Análise de casos monitorados de sífilis adquirida em Porto Alegre, Rio Grande do Sul

Introduction: Syphilis is a systemic and curable sexually transmitted infection, exclusive to humans. Brazil is experiencing an increasing incidence of syphilis in recent years. Porto Alegre has an incidence rate of acquired syphilis (AS) four times higher than the national one. Objective: To describe the epidemiological profile of monitored cases of AS, through rapid tests, in the city of Porto Alegre/Rio Grande do Sul in the first semester of 2018. Methods: The study has a cross-sectional, observational, epidemiological, and analytical design, and the study population was included in the Porto Alegre AS monitoring spreadsheet in the first semester of 2018, totaling 1,453 participants. We performed descriptive analyses with absolute and relative frequencies to develop the profile. The χ2 test for bivariate analysis verified the association between sociodemographic variables and the adequate treatment outcome, with a 95% significance level. Results: The profile found had a predominance of males, white people, individuals aged 20 to 29, with incomplete elementary school, and not homeless. We identified an association in the bivariate analysis between the adequate treatment outcome and the variables schooling, gender, age, and homelessness. Conclusion: Actions that seek to structure and organize the processes related to AS monitoring are important, especially due to the association of sociodemographic variables that indicate social vulnerability with the adequate treatment outcome.

Introdução: A sífilis é uma Infecção Sexualmente Transmissível de caráter sistêmico, curável, e exclusiva do ser humano. O Brasil vive um período de crescimento dos casos de sífilis nos últimos anos. Porto Alegre possui um coeficiente de incidência de sífilis adquirida quatro vezes maior que o nacional. Objetivo: O objetivo deste estudo foi descrever o perfil epidemiológico dos casos monitorados para sífilis adquirida, por meio de testes rápidos, no município de Porto Alegre/RS, no primeiro semestre de 2018. Métodos: O delineamento é epidemiológico observacional analítico transversal, sendo todos os casos inseridos na planilha de monitoramento da SA de Porto Alegre no primeiro semestre de 2018, que totalizou 1.453 usuários. Análises descritivas foram realizadas com frequência absoluta e relativa para caracterizar o perfil. Foi utilizado o teste de χ2 em análise bivariada para verificar a associação das variáveis sociodemográficas com o desfecho do tratamento adequado, com nível de significância de 95%. Resultados: O perfil encontrado foi predominância do sexo masculino, brancos, na faixa etária de 20 a 29, ensino fundamental incompleto e não estar em situação de rua. Houve associação na análise bivariada entre os desfechos do tratamento adequado e as variáveis escolaridade, sexo, faixa etária e situação de rua. Conclusão: Ações que buscam estruturar e organizar os processos relativos ao monitoramento da SA são importantes, especialmente por haver associação de variáveis sociodemográficas que indicam vulnerabilidade social com o desfecho de tratamento adequado da sífilis.

Efeitos do ultrassom terapêutico no ingurgitamento mamário: estudo piloto / Effects of therapeutic ultrasound in mammary engagement: pilot study

INTRODUÇÃO: A amamentação constitui uma importante etapa no processo reprodutivo, oferecendo benefícios tanto para mãe como para a criança. O Ingurgitamento mamário é uma complicação que ocorre do terceiro ao quinto dia de pós-parto. O Ultrassom Terapêutico (UST) é amplamente utilizado, e consiste em um aparelho capaz de produzir energia acústica de alta frequência. OBJETIVO: verificar o efeito agudo do ultrassom no processo terapêutico do ingurgitamento mamário. METODOLOGIA: Estudo transversal, que avaliou a mama e classificou o ingurgitamento, além de realizar avaliação da dor e da percepção subjetiva das mamas. Foi administrado o protocolo com ultrassom terapêutico na frequência de 1Mh, modo pulsado, intensidade/ dose de 0,5w/cm2, ciclo ativo de 20% com tempo de aplicação de 02 minutos por área de radiação efetiva (ERA). Após aplicação, a lactente foi submetida à amamentação e realizada nova avaliação das mamas. RESULTADOS: A amostra foi composta por 4 mulheres entre 20 e 30 anos com quadro de ingurgitamento mamário. O valor inicial do ingurgitamento mamário foi de 2 a mediana e a final foi de 1 a mediana. Em relação à dor mamária, inicialmente foi de 5 mediana e a final 2 a mediana. Em todos os casos analisados houve melhora na dor, na disponibilidade do leite e no aspecto de ingurgitamento da mama. CONCLUSÃO: O ultrassom terapêutico se mostrou eficaz na redução da dor, no aumento da disponibilidade do leite e na melhora do enrijecimento característico do ingurgitamento mamário.

INTRODUCTION: Breastfeeding is an important step in the reproductive process, providing benefits for both mother and child. Breast engorgement is a complication that occurs from the third to the fifth postpartum day. Therapeutic Ultrasound (UST) is widely used, and consists of an apparatus capable of producing high frequency acoustic energy. OBJECTIVE: to verify the acute effect of ultrasound in the therapeutic process of breast engorgement. METHODOLOGY: Cross-sectional study, which evaluated the breast and classified the engorgement, besides evaluating the pain and the subjective perception of the breasts. The protocol with therapeutic ultrasound was administered at a frequency of 1Mh, pulsed mode, intensity / dose of 0.5w / cm2, active cycle of 20% with application time of 02 minutes per effective Radiation Area (ERA). After application, the infant was submitted to breastfeeding and a new breast evaluation was performed. RESULTS: The sample consisted of 4 women between 20 and 30 years of age with breast engorgement. The initial value of breast engorgement was 2 the median and the final value was 1 to median. Regarding breast pain, it was initially 5 median and the final 2 median. In all the analyzed cases there was improvement in pain, milk availability and breast engorgement aspect. CONCLUSION: Therapeutic ultrasound has been shown to be effective in reducing pain, increasing milk availability and improving the stiffness characteristic of breast engorgement.

Pancreatic endosonographic findings and clinical correlation in Crohn's disease

OBJECTIVES: We aimed to evaluate the incidence of pancreatic alterations in Crohn's disease using endoscopic ultrasound (EUS) and to correlate the number of alterations with current clinical data. METHODS: Patients diagnosed with Crohn's disease (n=51) were examined using EUS, and 11 variables were analyzed. A control group consisted of patients with no history of pancreatic disease or Crohn's disease. Patients presenting with three or more alterations underwent magnetic resonance imaging (MRI). Pancreatic function was determined using a fecal elastase assay. RESULTS: Two of the 51 patients (3.9%) presented with four EUS alterations, 3 (5.9%) presented with three, 11 (21.5%) presented with two, and 13 (25.5%) presented with one; in the control group, only 16% presented with one EUS alteration (p<0.001). Parenchymal abnormalities accounted for 39 of the EUS findings, and ductal abnormalities accounted for 11. Pancreatic lesions were not detected by MRI. Low fecal elastase levels were observed in 4 patients, none of whom presented with significant pancreatic alterations after undergoing EUS. Ileal involvement was predictive of the number of EUS alterations. CONCLUSION: A higher incidence of pancreatic abnormalities was found in patients with Crohn's disease than in individuals in the control group. The majority of these abnormalities are related to parenchymal alterations. In this group of patients, future studies should be conducted to determine whether such morphological abnormalities could evolve to induce exocrine or endocrine pancreatic insufficiency and, if so, identify the risk factors and determine which patients should undergo EUS.

Reduction of relative handgrip strength and cardiometabolic risk in individuals with HIV/AIDS

Abstract INTRODUCTION: Low handgrip strength (HS) is associated with cardiometabolic alterations that have affected people with HIV/AIDS. METHODS: This was a cross-sectional study performed in adults receiving antiretroviral treatment. HS was evaluated using a dynamometer and divided by body weight to obtain the relative strength. The association between relative HS and overweight, increased waist circumference (WC), high body fat percentage, glycemia, and lipid ratios were assessed using logistic regression. RESULTS: Low relative HS was identified in 35% of participants and associated with increased WC (odds ratio = 9.7; 95% confidence interval = 2.8-33.0). CONCLUSIONS: The prevalence of low HS was high and associated with increased WC.

Performance of the IS6110-TaqMan® assay in the diagnosis of extrapulmonary tuberculosis from different biological samples

Abstract INTRODUCTION: This study evaluated the performance of the IS6110-TaqMan® assay in different types of biological samples and tissues for laboratory diagnosis of extrapulmonary tuberculosis. METHODS: 143 biological samples and tissues from patients with suspected extrapulmonary tuberculosis from the health services of Recife/Pernambuco/Brazil were evaluated with the IS6110-TaqMan® assay. RESULTS: The sensitivities of the IS6110-TaqMan® assay calculated for blood, urine, both blood and urine samples, tissue biopsies, extrapulmonary body fluid samples, and all samples from patients calculated together were 55.9%, 33.3%, 68.8%, 43.8%, 29.6%, and 73.7%, respectively, and the specificities were 80%, 100%, 78.6%, 100%, 100%, and 84.2%, respectively. CONCLUSIONS The accuracy of qPCR was high in various clinical sample types. The analysis of more than one type of clinical sample collected from the same patient with extrapulmonary tuberculosis enhances the diagnostic power of the IS6110-TaqMan® assay when compared with the use of only one clinical sample.

Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases / Tratamento endovascular de pseudoaneurisma decorrente de pancreatite crônica: relato de dois casos

Abstract Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.

Resumo O pseudoaneurisma decorrente de pancreatite crônica consiste em complicação rara, porém com alta taxa de mortalidade. Está etiologicamente associado à pancreatite crônica, e seu diagnóstico é feito mais comumente após ruptura, manifestando-se através de sinais clínicos de hemorragia aguda. A tomografia computadorizada desempenha papel importante no diagnóstico; contudo, a angiografia por subtração digital mantém-se como método padrão-ouro para confirmação diagnóstica e direcionamento do tratamento. O presente artigo relata dois casos de pseudoaneurisma em pacientes com pancreatite crônica alcoólica, sendo um da artéria esplênica e outro da artéria gastroduodenal, complicados com sangramento torácico e abdominal respectivamente. Ambos foram submetidos a tratamento endovascular minimamente invasivo com sucesso, através de implante de molas e de stent-grafts.