Gestational Diabetes and C-Reactive Protein/Albumin Ratio in Pregnancy: A Prospective Study

Purpose@#The C-reactive protein/albumin ratio (CAR) has been reported as a novel inflammatory marker to assess inflammation. The aim of this study was to compare the levels of CAR as a inflammatory marker in gestational diabetes mellitus (GDM) and non GDM patients. @*Materials and Methods@#Eight hundred ten pregnant women who applied to our hospital for routine antenatal screening were included in this prospective case-control study. The patients were divided into two groups, as positive and negative diagnosis of GDM. CAR between groups was compared as the primary outcome using statistical methods. @*Results@#The CAR value was significantly higher in pregnancies with GDM compared to healthy controls [1.07 (0.43–1.89) vs. 0.37 (0.12–0.68), p<0.0001]. The Spearman’s correlation analysis revealed that the CAR value had a significant positive correlation with all three steps of 75 gr oral glucose tolerance test (p<0.0001 for each) and neutrophil to lymphocyte ratio value (p=0.011). @*Conclusion@#Considering that laboratory testing is very simple and inexpensive, CAR is an independent predictor that is clinically easy to use for the development of GDM. This report is the first to show the role of CAR in GDM. However, further studies with larger sample sizes are needed to generalize this comment.

Effect of polycystic ovary syndrome on the life quality of young women

SUMMARY OBJECTIVE: The study evaluated the opinions of polycystic ovary syndrome on the life quality of women. METHODS: A total of 249 women with polycystic ovary syndrome participated in this descriptive study between October 2022 and July 2023 in Istanbul, Turkey. FINDINGS: Polycystic Ovary Syndrome and Quality of Life was significantly correlated with age (p=0.000) and frequent weight loss diets (p=0.000) (p<0.01). Among the Polycystic Ovary Syndrome and Quality of Life total score and polycystic ovary syndrome symptoms, those with hormone imbalance and insulin resistance had the highest mean scores, while those with menstrual irregularity and fatigue had the lowest. CONCLUSION: Advancing age changes the quality of life of women with polycystic ovary syndrome. To prevent the negative impact of polycystic ovary syndrome on women's quality of life, it is recommended that health professionals develop effective care plans utilizing available evidence.

Expression of brain-derived neurotrophic factor and formation of migrasome increases in the glioma cells induced by the adipokinetic hormone

SUMMARY OBJECTIVE: It has been previously shown that brain-derived neurotrophic factor is linked with various types of cancer. Brain-derived neurotrophic factor is found to be highly expressed in multiple human cancers and associated with tumor growth, invasion, and metastasis. Adipokinetic hormones are functionally related to the vertebrate glucagon, as they have similar functionalities that manage the nutrient-dependent secretion of these two hormones. Migrasomes are new organelles that contain numerous small vesicles, which aid in transmitting signals between the migrating cells. Therefore, the aim of this study was to investigate the effects of Anax imperator adipokinetic hormone on brain-derived neurotrophic factor expression and ultrastructure of cells in the C6 glioma cell line. METHODS: The rat C6 glioma cells were treated with concentrations of 5 and 10 Anax imperator adipokinetic hormone for 24 h. The effects of the Anax imperator adipokinetic hormone on the migrasome formation and brain-derived neurotrophic factor expression were analyzed using immunocytochemistry and transmission electron microscope. RESULTS: The rat C6 glioma cells of the 5 and 10 μM Anax imperator adipokinetic hormone groups showed significantly high expressions of brain-derived neurotrophic factor and migrasomes numbers, compared with the control group. CONCLUSION: A positive correlation was found between the brain-derived neurotrophic factor expression level and the formation of migrasome, which indicates that the increased expression of brain-derived neurotrophic factor and the number of migrasomes may be involved to metastasis of the rat C6 glioma cell line induced by the Anax imperator adipokinetic hormone. Therefore, the expression of brain-derived neurotrophic factor and migrasome formation may be promising targets for preventing tumor proliferation, invasion, and metastasis in glioma.

Application of the infant and young child feeding index and the evaluation of its relationship with nutritional status in 6-24 months children / Aplicação do índice de alimentação de lactentes e crianças pequenas e avaliação de sua relação com o estado nutricional de crianças de 6 a 24 meses

ABSTRACT Objective To evaluate the complementary feeding practices of mothers in infant and child nutrition using Infant and Young Child Feeding Indicator and Infant and Child Feeding Index and to determine their relationship with nutritional status. Methods Study data were collected through an online questionnaire administered to 141 parents on healthy 6-24 month infants/children. Complementary feeding practices for infants/children were evaluated in line with the Infant and Child Feeding Index and Infant and Young Child Feeding Indicator. In the evaluation of growth, weight for age z-scores, length for age z-scores, and weight for length z-scores of infants/children were calculated with the World Health Organization Anthro program. Results 74.5% of 141 infants and children (71 boys, 70 girls) evaluated in the study are breastfed. The prevalence of stunting, wasted, and underweight was determined as 6.4%, 0.7%, and 4.3%, respectively. When evaluated using Infant and Young Child Feeding Indicator, it was determined that 82.3% of children met the minimum meal frequency, 80.9% met the minimum dietary diversity, and 67.4% met the minimum acceptable diet. Regarding Infant and Child Feeding Index evaluations of the children, while there was no difference between 9-11 and 12-24 month age groups, the mean Infant and Child Feeding Index score in the 6-8 month group was significantly lower than the other age groups (p=0.000). The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were found to be high in most infants/children. No clear relationship was found between stunting and minimum acceptable diet, minimum dietary diversity or minimum meal frequency, which are indicators of both Infant and Child Feeding Index scores and World Health Organization, Infant and Young Child Feeding Indicator. Conclusion The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were high in most infants/children. In addition, the high rates of MMF, minimum dietary diversity, and minimum acceptable diet coverage in evaluating infants/children in terms of World Health Organization indicators show that they have appropriate complementary feeding practices. However, study found no clear relationship between stunting and minimum acceptable diet, minimum dietary diversity or MMF, which are indicators of both Infant and Child Feeding Index I scores and WHO Infant and Young Child Feeding Indicator. It was concluded that World Health Organization Infant and Young Child Feeding Indicator indicators may be better than length for age z-scores in the weight for length z-scores explanation.

RESUMO Objetivo Avaliar as práticas de alimentação complementar das mães na nutrição de lactentes e crianças utilizando o Indicador de Alimentação de Lactentes e Crianças Pequenas e o Índice de Alimentação de Lactentes e Crianças e determinar sua relação com o estado nutricional. Métodos Os dados do estudo foram coletados por meio de um questionário online administrado a 141 pais de bebês/crianças saudáveis de 6 a 24 meses. As práticas de alimentação complementar de lactentes/crianças foram avaliadas de acordo com o Índice de Alimentação de Lactentes e Crianças e o Indicador de Alimentação de Lactentes e Crianças Pequenas. Na avaliação do crescimento, os escores z de peso para idade, escores z de comprimento para idade e escores z de peso para comprimento de bebês/crianças foram calculados com o programa Organização Mundial da Saúde Anthro. Resultados Quando avaliadas por meio do Indicador de Alimentação de Lactentes e Crianças Pequenas, constatou-se que 82,3% das crianças atendiam à frequência mínima de refeições, 80,9% atingiam a diversidade alimentar mínima e 67,4% atingiam a dieta mínima aceitável. Em relação às avaliações do Índice de Alimentação de Lactentes e Crianças das crianças, embora não tenha havido diferença entre as faixas etárias de 9 a 11 e 12 a 24 meses, a pontuação média do Índice de Alimentação de Lactentes e Crianças no grupo de 6 a 8 meses foi significativamente menor do que nas outras faixas etárias (p=0,000). Os escores do Índice de Alimentação de Lactentes e Crianças utilizados para avaliar as práticas de alimentação complementar em nosso estudo foram elevados na maioria dos bebês/crianças. Não foi encontrada nenhuma relação clara entre o atraso no crescimento e a dieta mínima aceitável, diversidade alimentar mínima ou frequência mínima de refeição ,que são indicadores tanto das pontuações do Índice de Alimentação de Lactentes e Crianças como do Indicador de Alimentação de Lactentes e Crianças Pequenas da Organização Mundial da Saúde. Conclusão Escores altos do Índice de Alimentação de Lactentes e Crianças na maioria dos bebês/crianças são um bom indicador de Indicador de Alimentação de Lactentes e Crianças Pequenas nessa população. No entanto, nenhuma relação clara foi encontrada entre o déficit de estatura e os escores do Índice de Alimentação de Lactentes e Crianças e do Indicador de Alimentação de Lactentes e Crianças Pequenas neste estudo.

Gastos do próprio bolso de usuários em hemodiálise no sul do Rio Grande do Sul / Gastos de bolsillo de usuarios de hemodiálisis en el sur de Rio Grande do Sul / Out-of-pocket expenses of hemodialysis users in the south of Rio Grande do Sul

Objetivo: relatar os gastos do próprio bolso das pessoas com doença renal crônica em hemodiálise em seis serviços de terapia de substituição renal da metade sul do Rio Grande do Sul, Brasil. Método: estudo descritivo quantitativo, originado de uma macropesquisa, realizado com usuários em hemodiálise, atendidos em seis serviços de terapia renal substitutiva da metade sul do Rio Grande do Sul. As variáveis coletadas do questionário estruturado tiverama finalidade de identificar os gastos do próprio bolso dos usuários. Os dados foram analisados utilizando os softwares Epidata e Stata. Resultados: a maioria dos 336 usuários era sexo masculino, entre 60 e79 anos, com salários-mínimos entre um e dois. Os maiores gastos do próprio bolso encontrados foram o pagamento pelos medicamentos necessários para o tratamento. Conclusões: mesmo com benefícios do sistema de saúde e políticas necessitavam recorrer aos próprios recursos para garantir saúde e uma vida digna.

Objective: to report the out-of-pocket expenses of people with chronic kidney disease undergoing hemodialysis in six renal replacement therapy services in the southern half of Rio Grande do Sul, Brazil. Method: quantitative descriptive studycarried out with hemodialysis users, served in six replacement renal therapy services from the southern half of Rio Grande do Sul. The variables collected from the structured questionnaire had the purpose of identifying the spending of users' own pockets. The data were analyzed using Epidata and Stata software.Results: the majority of the 336 users were male, between 60 and 79 years old, with minimum wages between one and two. The biggest out-of-pocket expenses found were paying for the medicines needed for treatment. Conclusions: even with benefits from the health system and policies, they needed to resort to their own resources to guarantee health and a dignified life.

Objetivo: reportar gastos de bolsillo de personas con enfermedad renal crónica en tratamiento de hemodiálisis en seis servicios de terapia de reemplazo renal en la mitad sur de Rio Grande do Sul, Brasil. Método: estudio descriptivo cuantitativo, originado a partir de una macroinvestigación, realizada con usuarios de hemodiálisis, atendidos en seis servicios de terapia renal de reemplazo. Las variables recolectadas del cuestionario estructurado tenían el propósito de identificarel gasto de los usuarios. Los datos se analizaron utilizando el software Epidata y Stata. Resultados: la mayoría de los 336 usuarios eran hombres, entre 60 y 79 años, con salarios mínimos entre uno y dos. Los mayores gastos de bolsillo encontrados fueron el pago de los medicamentos necesarios para el tratamiento. Conclusiones: incluso con beneficios del sistema y las políticas de salud, necesitaban recurrir a recursos propios para garantizar la salud y una vida digna.

Investigation of the protective effect of boric acid against hepatotoxic and nephrotoxic injury induced by acrylamide in rats / Investigación del efecto protector del ácido bórico contra lesiones hepatotóxicas y nefrotóxicas inducidas por acrilamida en ratas

SUMMARY: To investigate if the administration of boric acid (BA) would exert any protective effect against possible nephrotoxicity and hepatotoxicity induced by the exposure to acrylamide (ACR) in rats. In our study, we used a total of 28 rats that were divided into four equal groups. Group 1: the control group which was not treated with any procedure. Group 2: the ACR group that was administered ACR 50 mg/kg/day via intraperitoneal (i.p) route for 14 days. Group 3: the BA group that was administered BA 200 mg/kg/ day via gavage via peroral (p.o) route for 14 days. Group 4: the ACR+BA group that was administered BA simultaneously with ACR. Total antioxidant and oxidant (TAS/TOS) capacities were measured in all groups at the end of the experiment. In addition, the specimens obtained were evaluated with histopathological examination. Studies showed that the ACR and ACr+BA groups were not significantly different in terms of hepatic TAS level while the TOS level was higher in the ACR group than the ACR+BA group. The groups did not show any significant difference regarding renal TAS and TOS levels. In the histopathological examination of the hepatic tissue, the histopathological injury score of the ACR group was significantly higher than those of the other groups whereas it was significantly lower in the ACR+BA group than the ACR group. Our study concluded that Boric acid had a protective effect against acrylamide- induced hepatotoxicity, but not against nephrotoxicity.

El objetivo de este estudio fue investigar si la administración de ácido bórico (BA) ejercería algún efecto protector frente a la posible nefrotoxicidad y hepatotoxicidad inducida por la exposición a acrilamida (ACR) en ratas. En nuestro estudio, utilizamos un total de 28 ratas que se dividieron en cuatro grupos iguales. Grupo 1: grupo control que no fue tratado. Grupo 2: grupo ACR al que se le administró ACR 50 mg/kg/día por vía intraperitoneal (i.p) durante 14 días. Grupo 3: grupo BA al que se le administró BA 200 mg/kg/día por sonda por vía peroral (p.o) durante 14 días. Grupo 4: grupo ACR+BA al que se administró BA simultáneamente con ACR. Las capacidades antioxidantes y oxidantes totales (TAS/TOS) se midieron en todos los grupos al final del experimento. Además, los especímenes obtenidos fueron evaluados con examen histopatológico. Los estudios demostraron que los grupos ACR y ACr+BA no fueron significativamente diferentes en términos del nivel hepático de TAS, mientras que el nivel de TOS fue mayor en el grupo ACR que en el grupo ACR+BA. Los grupos no mostraron ninguna diferencia significativa con respecto a los niveles renales de TAS y TOS. En el examen histopatológico del tejido hepático, la puntuación de lesión histopatológica del grupo ACR fue significativamente mayor que la de los otros grupos, mientras que fue significativamente menor en el grupo ACR+BA que en el grupo ACR. Nuestro estudio concluyó que el ácido bórico tiene un efecto protector contra la hepatotoxicidad inducida por acrilamida, pero no contra la nefrotoxicidad.

Serum Amyloid A Levels and Severity of COVID-19 in Children

Objective: The aim of this study was to determine the availability of serum amyloid A (SAA) in the diagnosis of coronavirus disease 2019 (COVID-19), to asses disease severity and to predict hospitalization status. Methods: Between March, 2020 and March, 2021, a total of 80 children (40 cases with COVID-19 and 40 cases in healthy group) were included in this study. Patients were divided into two groups (mild and moderate/severe) to evaluate SAA levels in terms of clinical severity and also hospitalization status. Results: Comparisons between the two groups revealed that median SAA values were significantly higher in children with COVID-19 than in their healthy peers (21.45vs3.05 mg/L, P=0.002). There was no significant difference in the median serum SAA levels between mild and moderate/severe clinical disease (P=0.837). The SAA difference between the two groups with regards to hospitalization was not statistically significant (P=0.098). Conclusions: Although SAA level was found to be higher in children with COVID 19 compared to healthy controls, the sensitivity of SAA for the disease was found to be low. In addition, there was no difference between the groups in terms of clinical severity.

Medical and non-medical factors that influence the kidney transplantation technical registry: a cross-sectional study / Fatores clínicos e não clínicos que influenciam o cadastro técnico para transplante renal: estudo transversa

INTRODUCTION: Chronic kidney disease is a worldwide public health problem, because of its association with an elevated risk of mortality, low quality of life, and prohibitive cost to the health system. OBJECTIVE: To identify the factors that might influence the kidney transplantation technical registry. METHODS: Cross-sectional study of descriptive analysis conducted in six dialysis health care centers in the south of Rio Grande do Sul, Brazil. Patients over 18 years of age were included in this study in 2016 and 2017. The demographic and clinical variables were subjected to Pearson's chi-square test using Stata Software for statistical analysis. Research approved by the Ethics Committee 1386385. RESULTS: Of 314 participants, 228 (72.6%) were not on the kidney transplantation technical registry. The medical and non-medical factors with statistical significance were age (p<0.01), income (p<0.01), having children (p=0.01), time since diagnosis (p=0.01), and time on hemodialysis (p=0.01). CONCLUSION: There is a substantial proportion of 72.6% of hemodialysis patients not registered on the kidney transplantation technical registry. The identification of factors that influence the kidney transplantation technical registry contributes both theoretically and to healthcare management, by the health team and government who can direct strategies towards the most appropriate health care. Health professionals should be aware of the impact of these factors and how the factors might pose a risk of complications that make it impossible to register on the kidney transplantation waiting list.

INTRODUÇÃO: A doença renal crônica é um problema de saúde pública mundial, pois está associada ao alto risco de mortalidade, baixa qualidade de vida e elevado custo ao sistema de saúde. OBJETIVO: Identificar os possíveis fatores que podem influenciar o acesso ao cadastro técnico para transplante renal. MÉTODO: Estudo transversal de análise descritiva realizado em seis serviços de diálise da Metade Sul do Rio Grande do Sul, Brasil. Participaram desse estudo pacientes maiores de 18 anos nos anos de 2016 e 2017. As variáveis demográficas e clínicas foram submetidas ao teste qui-quadrado de Pearson utilizando o Software Stata para a análise estatística. Pesquisa aprovada pelo Comitê de Ética 1.386385. RESULTADOS: dos 314 pacientes em hemodiálise 228 (72,6%) não estavam no cadastro técnico para transplante renal. Os fatores clínicos e não clínicos que apresentaram significância estatística foram: idade (p<0,01), renda (p<0,01) possuir filhos (p=0,01), tempo de diagnóstico (p=0,01) e tempo em hemodiálise (p=0,01). CONCLUSÃO: Há uma proporção substancial de 72,6% pacientes em hemodiálise que não estão no cadastro técnico para transplante renal. A identificação dos fatores que influenciam no cadastro contribui tanto gerencial quanto teoricamente pois, possibilita que a equipe de saúde e os gestores possam direcionar estratégias para o cuidado em saúde mais adequado. Os profissionais de saúde devem estar cientes do impacto que esses fatores exercem e que podem oferecer risco de complicações que inviabilizem o cadastro técnico para transplante renal.

Association of socio-demographic factors and likelihood of depression with family function among community – dwelling elderly

Background and Objective@#A positive family functionality is a significant factor to a good quality of life in the elderly. This study sought to determine the factors that contribute to family dysfunction among community-dwelling older persons.@*Methods@#A cross-sectional study was done among community-dwelling elderly ages 60 years old and above through the outpatient department of a tertiary government hospital. A researcher-assisted interview was done to gather socio-demographic factors such as age, sex, family type, and, GDS-S score, and family APGAR. Multiple linear regression analysis was done to determine the association of the said socio-demographic factors and likelihood of depression through GDS-S with family function through family APGAR.@*Results@#Among the 309 respondents, the average age of respondents was 69 years(SD=6.53), with female predominance of 61.8%, and a higher frequency of older persons belonging to an extended family. The mean GDS-S score is 1.69(SD=1.83), with a frequency of 13.9%. A very minimal percentage of 8.06% (25, N=309) showed to exhibit family dysfunction. Regression studies revealed association of advancing age, and female sex with family dysfunction. The type of family, and GDS-S are not significantly associated with family dysfunction.@*Conclusion@#Advancing age and female sex are associated with family dysfunction. There is no specific family type that is significantly associated with family dysfunction. Likelihood of depression does not necessarily imply family dysfunction in an elderly.

A new hematologic predictor of major adverse events after cardiac surgery: red cell distribution width to lymphocyte ratio

Background@#The perioperative risk factors that cause severe morbidity and prolongation of postoperative hospital stay after cardiac surgery should be determined. Various scores have been used to predict morbidity and mortality. Preoperative blood counts are considered potential biomarkers of inflammation and oxidative stress. Inflammatory and immune imbalances may have a significant impact on postoperative adverse events. The present study aimed to investigate the association and potential predictive properties of red cell distribution width/ lymphocyte ratio (RLR) for major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. @*Methods@#After approval from the ethics committee, pre- and post-operative data of 700 patients were obtained from the electronic database of the hospital, intra- and post-operative anesthesia, and intensive care unit follow-up charts. We performed a stepwise multiple logistic regression analysis to investigate the association of RLR with major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. @*Results@#Among 700 patients, 47 (6.7%) had major adverse events after surgery. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03–1.12; P < 0.001), mean platelet volume (OR, 1.49; 95% CI, 1.07–2.06; P = 0.017), and RLR (OR, 1.21; 95% CI, 1.02–1.43; P = 0.026) were significantly associated with major adverse events. @*Conclusions@#RLR indicates the balance between inflammatory and immune responses. Therefore, it can be used to predict adverse events following coronary surgery.

Hemangioma of the mandible in a 12-year-old boy

@#Intraosseous hemangioma is a benign, rare neoplasm that accounts to 0.5 - 1% of all benign tumors of bones.1, 2 While most hemangiomas arise from soft tissues, it is uncommon for it to arise from bones.2 The most common sites of growth are in the vertebral body and the calvarium with frontal bone making up approximately 45% of calvarial cases.2,3 However, they are also encountered in the head and neck with sites such as the skull (53%), mandible (10.7%), nasal bones (9%), and cervical spine (6%).4 In the mandible, the body is mostly affected and 65% are found in the molar and premolar region.1 They are more common in adult females with peaks at the second and fifth decades of life.1-3 Hemangioma of the mandible is difficult to diagnose due to its nonspecific clinical presentation and radiographic features. It mimics various mass lesions in the mandible such as giant cell granuloma, fibrous dysplasia, multiple myeloma, osteosarcoma, ameloblastoma and keratocysts. Therefore, a comprehensive history taking and physical examination plus examination of the imaging studies available and tissue biopsy all play important roles in arriving at the final diagnosis.5 We present the case of an aggressive mandibular hemangioma in a young boy and our management involving a failed fibular free flap reconstruction.

Effect of laboratory and chairside polishing methods on the surface topography of occlusal splint materials manufactured using conventional, subtractive and additive digital technologies / Efeito de métodos de polimento em laboratório e em consultório na topografia de superfície de materiais de splint oclusal fabricados usando tecnologias digitais convencionais, subtrativas e aditivas

Objetivo: Este estudo avaliou as propriedades de polimento dos materiais de splint oclusal obtidos usando métodos de fabricação subtrativos e aditivos com os procedimentos de polimento laboratorial (LP) e polimento em consultório (CP). Material e Métodos: As amostras (N=180, n=60 para cada grupo) foram fabricadas usando um dos seguintes métodos: método de fabricação subtrativo (SMM) (M-PM Disc, Merz Dental GmbH), método de fabricação aditivo (AMM) (Freeprint Splint 2.0, DETAX GmbH & Co. KG) e o método de fabricação convencional (CMM) (Promolux HC, Merz Dental GmbH). Seguindo os procedimentos de LP e CP, a rugosidade da superfície dos espécimes foi medida usando um perfilômetro de superfície digital. Um espécime representativo foi selecionado de cada grupo, e uma imagem de microscópio eletrônico de varredura (SEM) foi obtida. Resultados: Tanto o método de fabricação quanto os procedimentos de polimento afetaram significativamente os resultados (P<0,01). Os termos de interação também foram significativos (P<0,001). Conclusão: Com ambos os métodos de polimento, a rugosidade superficial do grupo AMM foi a maior e a do grupo CMM a menor. Embora o procedimento CP tenha sido mais eficaz do que LP com ambos os métodos, a rugosidade da superfície ficou abaixo do limite de 0,2 µm após ambos os procedimentos de polimento testados (AU)

Objective: This study evaluated the polishing properties of the occlusal splint materials obtained using subtractive and additive manufacturing methods with the laboratory-type polishing (LP) and chairside-type polishing (CP) procedures. Material and Methods: Specimens (N=180, n=60 each group) were manufactured using one of the following methods: subtractive manufacturing method (SMM) (M-PM Disc, Merz Dental GmbH), additive manufacturing method (AMM) (Freeprint Splint 2.0, DETAX GmbH & Co. KG), and the conventional manufacturing method (CMM) (Promolux HC, Merz Dental GmbH). Following LP and CP procedures, surface roughness of the specimens was measured using a digital surface profilometer. One representative specimen was selected from each group, and a scanning electron microscope (SEM) image was made. Results: Both the manufacturing method and the polishing procedures significantly affected the results (P<0.01). Interaction terms were also significant (P<0.001). Conclusion: With both polishing methods, surface roughness of the AMM group was the highest and the CMM group the least. Although the CP procedure was more effective than LP with both methods, surface roughness was below the 0.2 µm threshold after both polishing procedures tested. (AU)

The Challenges of Implementing a Text Message Intervention to Promote Behavioral Change in Primary Care Patients With Hypertension and Diabetes

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program's long-term effects on clinical outcomes.

Reasons referred by individuals who were not on kidney transplantation waiting lists / Razones referidas por individuos que no estaban en lista de espera de trasplante renal / Motivos referidos pelos indivíduos que não estavam em lista de espera para o transplante renal

ABSTRACT Objective: To describe the reasons reported by individuals in hemodialysis that were not registered on kidney transplantation waiting lists. Methods: Cross-sectional study conducted in six renal replacement therapy services in Rio Grande do Sul, Brazil with 214 individuals undergoing hemodialysis who reported the reasons for not being registered on kidney transplantation waiting lists. The data collection was carried out through a questionnaire from March 2016 to March 2017. The Stata software was used to the statistical analysis and independence test. Results: The main reasons reported by the 214 individuals who were not registered on kidney transplantation waiting lists were due to the lack of information of the individuals, not wanting to be on list, due to morbidities and age. Conclusions: The lack of information was associated with the variables low education, male, ≤ 5 years of time since diagnosis and ≤ 5 years in renal replacement therapy. The reason for not wanting to be on the list was associated with the variables illiteracy and age.

RESUMEN Objetivo: Describir las razones informadas por personas en hemodiálisis que no estaban registradas en lista de espera para trasplante renal. Métodos: Estudio transversal realizado en Rio Grande do Sul, Brasil en seis servicios de terapia sustitutiva renal con 214 individuos en hemodiálisis que informaron los motivos de no estar registrados en listade espera para trasplante renal. La recolección de datos se realizó mediante un cuestionario entre marzo de 2016 y marzo de 2017. Para el análisis estadístico descriptivo y test de independencia se utilizó el software Stata. Resultados: Las principales razones reportadas por las 214 personas que no estaban inscritas en listade espera para trasplante renal fueron la falta de información de las personas, no querer estar en lista, impedimento por multimorbilidad y edad. Conclusiones: La falta de información se asoció con las variables baja escolaridad, género masculino, ≤ 5 años de tiempo desde el diagnóstico y ≤ 5 años en terapia de reemplazo renal. El motivo de no querer estar en la lista estuvo asociado a las variables no saber leer y edad.

RESUMO Objetivo: Descrever os motivos referidos pelos indivíduos em hemodiálise que não estavam cadastrados em lista de espera para o transplante renal. Métodos: Estudo transversal realizado no Rio Grande do Sul, Brasil em seis serviços de terapia de substituição renal com 214 indivíduos em hemodiálise que referiram os motivos de não estarem cadastrados em lista de espera para o transplante renal. A coleta de dados foi realizada por meio de questionário entre março de 2016 e março de 2017. Para a análise estatística descritiva e do teste de independência, utilizou-se o software Stata. Resultados: Os principais motivos referidos pelos 214 indivíduos que não estavam cadastrados em lista de espera para o transplante renal foram: a falta de informação dos indivíduos, não desejar estar em lista, o impedimento por multimorbidade e a idade. Conclusões: A falta de informação apresentou associação com as variáveis baixa escolaridade, sexo masculino, ≤ 5 anos de tempo de diagnóstico e ≤ 5 anos em terapia de substituição renal. O motivo não desejar estar em lista esteve associado com as variáveis não saber ler e idade.

Perfil sociodemográfico e clínico de usuários em hemodiálise no sul do Rio Grande do Sul, Brasil / Sociodemographic and clinical profile of hemodialysis users in the south of Rio Grande do Sul, Brazil

Objetivo: Caracterizar o perfil sociodemográfico e clínico das pessoas em tratamento hemodialítico no Sul do Rio Grande do Sul, Brasil. Metodologia: Estudo quantitativo, descritivo de corte transversal, realizado com aplicação de um questionário estruturado e revisão de prontuário de 335 adultos, em tratamento hemodialítico, provenientes de sete clínicas de Hemodiálise, distribuídas em cinco municípios do Rio Grande do Sul, no período de março de 2016 a março de 2017. Foram avaliados os dados sociodemográficos, história familiar, hábitos de vida, etiologia da doença e comorbidades. Para análise, utilizou-se estatística descritiva. Resultados: Do total de 335 adultos em tratamento hemodialítico, 59% eram homens, 47% idosos, 59% com baixa renda familiar. O diabetes mellitus foi a principal etiologia da doença renal 28%, 50%, referiram dieta sem restrições, 59,8% ingerir diariamente mais de 800 ml de líquidos, incluindo bebidas alcoólicas em 10%, e 77,0% referiram anúria, 42% eram tabagistas pregressos e 24% relataram história familiar da doença, e em relação aos gastos como tratamento hemodialítico 80,3% referiram algum tipo de gasto, especialmente, com remédios para 88,4% e verificou-se a ocorrência de doenças infectocontagiosas, tais como hepatite B, C e HIV foi encontrado, respectivamente, em 3,9%, 7,5% e 2,1% da amostra. Conclusão: Os achados apontaram para necessidade de reorganização da atenção à doença renal crônica no âmbito dos serviços de atenção primária e secundária, visando a detecção precoce da doença e o controle clínico dos fatores de risco, incluindo o diabetes, principalmente em grupos socioeconômicos menos favorecidos, facilitando o acesso desta população aos serviços da rede de atenção à saúde.

Objetivo: caracterizar el perfil sociodemográfico y clínico de personas en hemodiálisis en el sur de Rio Grande do Sul, Brasil. Metodología: Estudio cuantitativo, descriptivo, transversal. Se realizó con la aplicación de un cuestionario estructurado y la revisión de historias clínicas de 335 personas adultas en hemodiálisis, de siete clínicas de hemodiálisis, distribuidas en cinco ciudades de Rio Grande do Sul, de marzo de 2016 a marzo de 2017. Se evaluaron datos sociodemográficos, antecedentes familiares, estilo de vida, etiología de la enfermedad y comorbilidades. Para el análisis, se utilizó estadística descriptiva. Resultados: Del total de 335 personas adultas con hemodiálisis, 59 % eran hombres, 47 % personas adultas mayores, 59 % tenían bajos ingresos familiares. La diabetes mellitus fue la principal etiología de la enfermedad renal (28 %), un 50 % refirió una dieta sin restricciones, 59.8 % ingirió más de 800 ml de líquidos al día, incluidas bebidas alcohólicas (10 %), un 77 % refirió anuria, un 42 % refirió fumar anteriormente y un 24 % indicó antecedentes familiares de la enfermedad. En relación a los gastos por el tratamiento de hemodiálisis, un 80.3 % reportó algún tipo de gasto, especialmente, con medicamentos (88.4 %). Adicionalmente, se encontró la ocurrencia de enfermedades infecciosas, como hepatitis B, C y VIH, respectivamente, en 3.9 %, 7.5 % y 2.1 % de la muestra. Conclusión: Los hallazgos apuntaban a la necesidad de reorganizar la atención de la enfermedad renal crónica, en el ámbito de los servicios de atención primaria y secundaria. Lo anterior, con el objetivo de detectar en una etapa temprana la enfermedad, así como controlar factores de riesgo, incluida la diabetes, principalmente, en los grupos socioeconómicos menos favorecidos. De esta forma, se facilita el acceso de la población a los servicios de la red asistencial.

Aim: to characterize the sociodemographic and clinical profile of people undergoing hemodialysis in the south of Rio Grande do Sul, Brazil. Methods: This was a descriptive, quantitative, and cross-sectional study carried out with the application of a structured questionnaire and the review of the medical records of 335 adults undergoing hemodialysis from seven hemodialysis clinics distributed in five municipalities in Rio Grande do Sul from March 2016 to March 2017. The researchers evaluated the sociodemographic data, family history, lifestyle, etiology of the disease, and comorbidities; descriptive statistics were used for the analysis. Results: Of the 335 adults undergoing hemodialysis, 59% were men, 47% elderly, and 59% with low family income. Diabetes mellitus was the main etiology of kidney disease (28%); 50% reported an unrestricted diet and 59.8% ingested more than 800 ml of liquids daily, including 10% alcoholic beverages, and 77.0% reported anuria, 42% were previous smokers and 24% reported family history of the disease. In regards to expenses related to the hemodialysis treatment, 80.3% reported some type of expenditure, especially with medicines for 88.4%; the occurrence of infectious diseases, such as hepatitis B, C and HIV was found, respectively, in 3.9%, 7.5 % and 2.1% of the sample. Conclusion: The findings pointed to the need to reorganize the care for chronic kidney disease within the scope of primary and secondary care services; this with the aim of early detection of chronic kidney disease and the clinical control of risk factors, including diabetes, in in less favored socioeconomic groups mainly. This would facilitate the population's access to the services of the healthcare network.

Influence of social determinants of health in family-effectiveness / Influencia de los determinantes sociales de la salud en la eficacia familiar / Influência dos determinantes sociais da saúde na eficácia familiar / Influence of social determinants of health in family-effectiveness

Introduction: The Social Determinants of Health are defined by the living conditions of the population, how they are born, grow, live, work and age, and are considered as the main responsible for the health of populations. Objective: To evaluate the influence of social determinants of health on effectiveness of family functioning. Materials and Methods: A quantitative study was carried out with 200 participants between 2017 and 2018. To assess the correlation between proximal, intermediate and distal social determinants of health and the level of effectiveness of family functioning, home visits were made to 100 families who responded the Assessment of strategies in Family Effectiveness instrument and a sociodemographic questionnaire. Data were analyzed by simple frequency, Spearman's correlation coefficient (ρ) (p <0.05), and subjected to descriptive analysis from the perspective of systemic organization. Results: The social determinants that showed a positive correlation coefficient with the level of effectiveness of family functioning were the years of study and the fixed family income. There was a negative correlation with the main source of income (number of occupations) or source of income and the presence of other members or relatives in the family. Discussion: Investments in education can improve the family's ability to organize, solve or prevent adverse events, increase income and provide more time for family relationships and the achievement of congruence, as evidenced by other authors. Conclusions: The proximal and intermediate social determinants of health influenced the level of effectiveness of family functioning.

Introducción: Los Determinantes Sociales de la Salud están definidos por las condiciones de vida de la población, cómo nacen, crecen, viven, trabajan y envejecen, y son considerados como los principales responsables de la salud de las poblaciones. Objetivo: Evaluar la influencia de los determinantes sociales de la salud en la efectividad del funcionamiento familiar. Materiales y Métodos: Se realizó un estudio cuantitativo con 200 participantes entre 2017 y 2018. Para evaluar la correlación entre los determinantes sociales de salud proximales, intermedios y distales y el nivel de efectividad del funcionamiento familiar, se realizaron visitas domiciliarias a 100 familias que respondieron el instrumento Evaluación de estrategias en Efectividad Familiar y un cuestionario sociodemográfico. Los datos fueron analizados por frecuencia simple, coeficiente de correlación de Spearman ( ρ ) (p <0,05 ), y sometidos a análisis descriptivo desde la perspectiva de la organización sistémica. Resultados: Los determinantes sociales que mostraron un coeficiente de correlación positivo con el nivel de efectividad del funcionamiento familiar fueron los años de estudio y el ingreso familiar fijo. Hubo una correlación negativa con la principal fuente de ingresos (número de ocupaciones) o fuente de ingresos y la presencia de otros miembros o familiares en la familia. Discusión: Las inversiones en educación pueden mejorar la capacidad de la familia para organizarse, solucionar o prevenir eventos adversos, aumentar los ingresos y brindar más tiempo para las relaciones familiares y el logro de la congruencia, como lo evidencian otros autores. Conclusiones: Los determinantes sociales proximales e intermedios de la salud influyeron en el nivel de efectividad del funcionamiento familiar.

Introdução: Os Determinantes Sociais da Saúde são definidos pelas condições de vida da população, como nascem, crescem, vivem, trabalham e envelhecem, sendo considerados como os principais responsáveis pela saúde das populações. Objetivo: Avaliar a influência dos determinantes sociais da saúde na eficácia do funcionamento familiar. Materiais e Métodos: Foi realizado um estudo quantitativo com 200 participantes entre 2017 e 2018. Para avaliar a correlação entre os determinantes sociais proximais, intermediários e distais da saúde e o nível de eficácia do funcionamento familiar, foram realizadas visitas domiciliares a 100 famílias que responderam o instrumento Avaliação de estratégias em eficácia familiar e um questionário sociodemográfico. Os dados foram analisados por frequência simples, coeficiente de correlação de Spearman ( ρ ) (p < 0,05 ), e submetidos à análise descritiva sob a ótica da organização sistêmica. Resultados: Os determinantes sociais que apresentaram um coeficiente de correlação positiva com o nível de efetividade do funcionamento familiar foram os anos de estudo e a renda familiar fixa. Houve correlação negativa com a principal fonte de renda (número de ocupações) ou fonte de renda e a presença de outros membros ou parentes na família. Discussão: Investimentos em educação podem melhorar a capacidade da família de se organizar, resolver ou prevenir eventos adversos, aumentar a renda e proporcionar mais tempo para as relações familiares e para o alcance da congruência, conforme evidenciado por outros autores. Conclusões: Os determinantes sociais proximais e intermediários da saúde influenciaram o nível de efetividade do funcionamento familiar.

Características clínicas del estado epiléptico en niños de un hospital de tercer nivel de Lima / Clinical characteristics of status epilepticus in children in a third level hospital of Lima

RESUMEN El estado epiléptico (EE) en niños exhibe altos niveles de morbi-mortalidad y ha sido poco estudiado en el Perú. Objetivo: Describir la frecuencia y características clínicas de niños con estado epiléptico, atendidos en el Hospital Cayetano Heredia de Lima. Material y métodos: Estudio retrospectivo y observacional, tipo serie de casos de niños menores de 14 años con diagnóstico de estado epiléptico, atendidos entre enero y diciembre de 2021. Resultados: Se registró EE en un 28,8% de todos los niños atendidos por crisis epilépticas durante el año 2021. Se incluyeron 23 niños que presentaron 46 EE, varones (73,9%), con una mediana de la edad de 2 años, diagnóstico subyacente de epilepsia o malformación cerebral (21,7%), atendidos en emergencia pediátrica (91%). El tipo semiológico predominante fue el EE motor generalizado (52,2%), con etiología sintomática remota (87%) y EEG registrado en un 63% de los casos, predominantemente de tipo normal (75,9%). La mediana de duración fue de 22 minutos, de resolución total, 7 minutos y resolución parcial, 2 minutos. Se empleó midazolam (78%) como primera línea de tratamiento y fenitoína (85%), como segunda línea. Conclusiones: El EE en niños fue una emergencia prevalente durante el año 2021. La mayoría fueron varones, cuya etiología predominante fue sintomática remota y el tipo semiológico más común fue el motor generalizado. Los niños fueron atendidos de acuerdo con las guías internacionales de manejo. Se insiste en la necesidad de un sistemático afronte de vigilancia epidemiológica.

SUMMARY Status Epilepticus (SE) in children exhibits high levels of morbidity and mortality and has been poorly studied in Perú. Objective: To describe the frequency and clinical characteristics of children with Status Epilepticus treated at Cayetano Heredia Hospital in Lima. Material and Methods: Retrospective and observational study, case series type, in children under 14 years of age, with Status Epilepticus treated between January and December of 2021. Results: SE was recorded in 28.8% of children with epileptic seizures seen during 2021. Twenty-three children presenting 46 SEs were included. The median age was 2 years, the majority (73,9%) being males, with diagnosis of epilepsy or brain malformation (21.7%) and treated in the pediatric emergency (91%). The predominant semiological pattern was of generalized motor type (52.2%), with remote symptomatic etiology (73.9%), and EEG recorded in a 63% of all cases, mainly reported as normal (75,9%). The median duration was 22 minutes of total resolution, 7 minutes, and of partial resolution, 2 minutes. Midazolam was used as the first line of treatment (78%), and phenytoin as the second line (85%). Conclusions: SE was a frequent condition observed in children throughout the year 2021. Most affected children were male, the predominant etiology was remote symptomatic, and the most common semiological type was the generalized motor. The children were treated according to international management guidelines. Asystematic epidemiological surveillance approach is highly encouraged.

Síndrome de MELAS como causa de estado epiléptico en niños: Reporte del caso de dos hermanos en Perú / MELAS syndrome as a cause of status epilepticus in children: Report on two brothers' case in Peru

RESUMEN El Síndrome de MELAS, es una enfermedad mitocondrial asociada a crisis epilépticas. Se presenta el caso de dos hermanos portadores de MELAS, confirmado genéticamente, con historia de estados epilépticos recurrentes, acompañados de déficit neurológico, fallas de crecimiento, hiperlactacidemia y lesiones que simulan infartos cerebrales. Se destaca la presentación neurológica con estado epiléptico que permita tenerla presente en el correspondiente diagnóstico diferencial en salas de emergencia y hospitales pediátricos.

SUMMARY MELAS Syndrome is a mitochondrial disease associated with epileptic seizures. The case of two siblings with genetically confirmed MELAS is presented, with a history of recurrent status epilepticus accompanied by neurological deficits, failure to thrive, hyperlacticaemia, and brain lesions resembling strokes. The neurological presentation with epileptic status is highlighted to be considered in the corresponding differential diagnosis in emergency rooms and pediatric hospitals.

Omalizumab versus cyclosporin-A for the treatment of chronic spontaneous urticaria: can we define better-responding endotypes?

Abstract Background: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. Objective: To determine indicators of response to Oma or Cs-A in CSU patients. Methods: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. Results: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). Study Limitations: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. Conclusions: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success. © 2022 Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

Família, tomada de decisão e apoio dos profissionais nas unidades de terapia intensiva: revisão integrativa / Familia, toma de decisiones y apoyo de profesionales en unidades de cuidados intensivos: revisión integradora / Family, decision-making and support of professionals in intensive care units: an integrative review

Objetivo: analisar a produção científica sobre condutas de apoio dos profissionais às famílias e a participação destas no processo de tomada de decisão diante da internação de um dos seus integrantes. Método: revisão integrativa nas bases Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e COCHRANE com os descritores: Intensive Care Units, Decision making, Family e Personal Satisfaction entre 2015 e 2019. Resultados: selecionados 17 artigos em três categorias: "aspectos relacionados com o apoio dos profissionais à família"; "Voz dos familiares como tomadores de decisões"; e "Estresse pós-traumático do familiar ao tomar decisões difíceis". Conclusão: evidenciou-se a importância do apoio dos profissionais por meio de comunicação clara e honesta, valorizando a família como participantes do cuidado no processo de tomadas de decisões na Unidade de Terapia Intensiva.(AU)

Objective: to analyze the scientific production on support behaviors of professionals to families and their participation in the decision-making process before the hospitalization of one of their members. Method: integrative review in the Latin American and Caribbean bases in Health Sciences, Medical Literature Analysis and Retrieval System Online and COCHRANE with the descriptors: Intensive Care Units, Decision making, Family, Personal Satisfaction between 2015 and 2019. Results: 17 articles were selected in three categories: "Aspects related to the support of professionals to the family"; "Voice of family members as decision makers"; and "Post-traumatic stress of the family member when making difficult decisions". Conclusion: the importance of support from professionals through clear and honest communication was evidenced, valuing the family as participants in the process of decision-making in the Intensive Care Unit.(AU)

Objetivo: analizar la producción científica sobre las conductas de apoyo de los profesionales a las familias y su participación en la toma de decisiones cuando se hospitaliza a uno de sus miembros. Método: revisión integradora en las bases latinoamericanas y caribeñas en Ciencias de la Salud, Análisis de la Literatura Médica y Sistema de Retrieval Online y COCHRANE con los descriptores: Unidades de Cuidados Intensivos, Toma de Decisiones, Familia, Satisfacción Personal entre 2015 y 2019. Resultados: Se seleccionaron 17 artículos en tres categorías: "Aspectos relacionados con el apoyo de los profesionales a la familia"; "Voz de los familiares como tomadores de decisiones"; y "Estrés postraumático del familiar al tomar decisiones difíciles". Conclusión: se evidenció la importancia del apoyo de los profesionales a través de una comunicación clara y honesta, valorando a la familia como partícipe del cuidado en el proceso de toma de decisiones en la Unidad de Cuidados Intensivos.(AU)