RESUMEN
ABSTRACT Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.
RESUMO A doença renal crônica (DRC) representa um dos principais problemas de saúde pública da atualidade. A dosagem da creatinina sérica e a estimativa da taxa de filtração glomerular (TFG) são as principais ferramentas para avaliação da função renal. Para a estimativa da TFG, existem diversas equações, sendo a mais recomendada a CKD-EPI (Chronic Kidney Disease - Epidemiology). Existem ainda algumas controvérsias com relação à dosagem da creatinina sérica e da estimativa da TFG, uma vez que vários fatores podem interferir nesse processo. Uma importante mudança recente foi a retirada da correção por raça das equações para estimativa da TFG, que superestimavam a função renal, e consequentemente retardavam a implementação de tratamentos como diálise e transplante renal. Neste documento de consenso da Sociedade Brasileira de Nefrologia e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial são revisados os principais conceitos relacionados à avaliação da função renal, possíveis controvérsias existentes e recomendações para a estimativa da TFG na prática clínica.
RESUMEN
Abstract Objective: This study aimed to evaluate the diagnostic utility, disease activity, and phenotypic association of serum anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), PR3-ANCA, and MPO-ANCA in pediatric patients with inflammatory bowel disease (IBD). Methods: Pediatric patients diagnosed with IBD were recruited and classified as Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) through full investigation. The Paris classification was used to evaluate disease phenotypes of pediatric CD and UC. Results: In all, 229 pediatric patients with IBD (CD 147, UC 53, IBD-U 29) were included. The ASCA IgG seropositivity significantly differed among the three groups (CD 75.4%, UC 17.5%, and IBD-U 60.0%; p < 0.001). PR3-ANCA positive rates were the highest in UC (24.0%), followed by IBD-U (17.6%), and none in CD (p = 0.002); pANCA-positive rates were higher in IBD-U (33.6%), followed by UC (28.0%) than in CD (1.4%) (p < 0.001). Regarding disease phenotype, perianal disease revealed higher serum ASCA IgG titers (median 36.7 U/mL in P1 vs. 25.2 U/mL in P0, p = 0.019). Serum ASCA IgG and IgA cutoff values to distinguish CD were 32.7 (U/mL) and 11.9 (U/mL), respectively, with a specificity of 80.0%. Conclusion: Serological biomarkers of ASCA IgG and IgA were effective for differentiating CD in pediatric IBD patients, and serum pANCA and PR3-ANCA, but not MPO-ANCA, were effective in distinguishing UC and IBD-U. Furthermore, measuring serological titers of ASCA IgG and IgA may help differentiate CD and evaluate the disease activity and phenotype of pediatric IBD in practice.
RESUMEN
ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.
RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos.
RESUMEN
Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais.
Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.
Asunto(s)
Humanos , Masculino , Femenino , Microbiota , Receptores de Trasplantes , Antiinfecciosos , Pacientes , RiñónRESUMEN
Resumo Fundamento Fibrilação atrial nova (FAN) ocorre em pacientes internados por COVID-19. Há controvérsias quanto ao valor preditivo de dados clínicos e laboratoriais à admissão hospitalar para ocorrência de FAN. Objetivos Analisar, à admissão hospitalar, variáveis com potencial preditivo para ocorrência de FAN em pacientes com pneumonia por COVID-19. Método Estudo observacional, retrospectivo, caso-controle. Foram avaliados prontuários eletrônicos de pacientes consecutivos ≥ 60 anos, hospitalizados com pneumonia por COVID-19 entre 1º de março e 15 de julho de 2020. Comparações feitas pelos testes `t' de Student ou qui-quadrado. Foi empregado modelo de risco proporcional de Cox para identificação de preditores de FAN. Considerou-se o valor de p < 0,05 como estatisticamente significativo. Resultados Entre 667 pacientes internados por COVID-19, 201 (30,1%) foram incluídos. FAN foi documentada em 29 pacientes (14,4%) (grupo 1). Grupo 2 foi composto por 162 pacientes que não apresentaram FAN. Dez pacientes excluídos por estarem em FA na admissão hospitalar. Houve diferenças entre os grupos 1 e 2, respectivamente, no tempo de permanência em UTI (11,1±10,5 dias vs. 4,9±7,5 dias; p=0,004), necessidade de ventilação invasiva (82,9% e 32,7%; p<0,001) e mortalidade hospitalar (75,9% vs. 32,1%; p<0,001). No modelo de Cox, idade > 71 anos (hazard ratio [HR]=6,8; p<0,001), leucometria ≤ 7.720 cels.μL-1 (HR=6,6; p<0,001), natremia ≤ 137 mEq.L-1 (HR=5,0; p=0,001), escore SAPS3 > 55 (HR=5,6; p=0,002) e desorientação (HR=2,5; p=0,04) foram preditores independentes de FAN. Conclusões FAN é uma arritmia comum em idosos hospitalizados com pneumonia por COVID-19. Parâmetros clínicos e laboratoriais avaliados na admissão são preditores de FAN durante internação.
Abstract Background New-onset atrial fibrillation (NOAF) occurs in patients hospitalized due to COVID-19. It is still unknown whether clinical and laboratory data assessed upon hospital admission have predictive value for NOAF. Objectives To analyze, upon hospital admission, variables with predictive potential for the occurrence of NOAF in patients with COVID-19 pneumonia. Methods Observational, retrospective, case-control study. Electronic medical reports of consecutive patients, 60 years of age or older, hospitalized due to COVID-19 pneumonia between March 1st and July 15th, 2020, were reviewed. Non-paired Student or chi-squared tests compared variables. A Cox proportional hazard model was employed to identify independent predictors of NOAF. P value < 0.05 was considered statistically significant. Results Among 667 patients hospitalized due to COVID-19, 201 (30.1%) fulfilled the inclusion criteria. NOAF was documented in 29 patients (14.4%), composing group 1. Group 2 was composed of 162 patients without NOAF. Ten patients were excluded due to the AF rhythm upon hospital admission. In groups 1 and 2, there were differences in overall in-hospital survival rate (24.1 % vs. 67.9%; p<0.001), length of stay in ICU (11.1 ± 10.5 days vs. 4.9 ± 7.5 days; p=0.004) and need for mechanical ventilation rate (82.9% vs. 32.7%; p<0.001). In the Cox model, age > 71 y/o (HR=6.8; p<0.001), total leukocyte count ≤ 7,720 cels.μL-¹ (HR=6.6; p<0.001), serum [Na+] ≤ 137 mEq.L-¹ (HR=5.0; p=0.001), SAPS3 score > 55 (HR=5.6; p=0.002), and disorientation (HR=2.5; p=0.04) on admission were independent predictors of NOAF. Conclusion NOAF is a common arrhythmia in elderly hospitalized patients with COVID-19 pneumonia. Clinical and laboratory parameters evaluated on admission have a predictive value for the occurrence of NOAF during hospitalization.
RESUMEN
Objective@#Our study aims to establish interrater reliability in performing the step-by-step procedure of selected pain provocation tests for hamstrings and special tests for lower extremity musculoskeletal injuries. @*Study Design@#An interrater reliability study @*Setting@#University of Santo Tomas - Sports Science Laboratory @*Participants@#Ten healthy adults (five females, five males; age = 22.2 ± 0.42) from the university community. @*Main outcome measures@#Interrater reliability of performing step-by-step procedures for selected pain provocation tests for hamstrings (painful resisted knee flexion 90°, painful resisted knee flexion 30°, active slump test, Puranen-Orava Test, bent knee stretch) and special tests for lower extremity musculoskeletal injuries (Lachman’s test, McMurray’s test, posterior drawer test, valgus, and varus stress test). @*Results@#Fleiss kappa showed perfect agreement (κ = 1.00) for all test procedures except for Lachman’s test procedure 1 (κ= -0.11 [95% CI, -0.36 to 0.14]), active slump test procedure 4 (κ= -0.03 [95% CI, -0.28 to 0.23]), active slump test procedure 5 (κ= -0.11 [95% CI, -0.28 to 0.23]), and active slump test procedure 6 (κ= -0.05 [95% CI, -0.31 to 0.20]), which resulted in negative agreements. @*Conclusions@#The researcher developed protocols for each special and provocative test were consistent in measuring the intended procedures, and the raters were generally consistent with their ability to measure these tests.
RESUMEN
Biochemical liver function tests are important methods to determine liver function in clinical practice， but abnormal liver biochemical parameters are not completely equivalent to liver damage. Some genetic and immune factors can also cause abnormal liver biochemical parameters， but with good prognosis in most cases. This article summarizes the causes of some benign abnormal liver biochemical parameters， so as to help clinicians to broaden their thinking of diagnosis and treatment， take into account genetic and immune factors， and avoid misdiagnosis and mistreatment.
RESUMEN
Abstract@#In low-resource settings such as Melanesia, gestational diabetes often goes undiagnosed due to many factors, including the unsuitability of current tests. Ideally a gestational diabetes test for low-resource settings should meet criteria related to acceptability, test performance and operational characteristics, with minimal impositions on individual patients or the wider health system. None of the six tests recommended in country-specific gestational diabetes guidelines in Melanesia (2-hour oral glucose tolerance test, glucose challenge test, fasting plasma glucose, random plasma glucose, 2-hour postprandial glucose and glycated haemoglobin) meet criteria related to these attributes. Additionally, each Melanesian country has different, complex algorithms that use multiple tests in different combinations. With a high and increasing burden of diabetes mellitus (and therefore assumed gestational diabetes), Melanesian health practitioners and policymakers should be aware of the limitations of recommended tests for gestational diabetes and be open to alternative technologies that may be more appropriate.
RESUMEN
Abstract Managing coagulation disorders and potential bleeding risks, especially in the context of anticoagulant medications, is of immense value both clinically and prior to surgery. Coagulation disorders can lead to bleeding complications, affecting patient safety and surgical outcomes. The use of Patient Blood Management protocols offers a comprehensive, evidence-based approach that effectively addresses these challenges. The problem is to find a delicate balance between preventing thromboembolic events (blood clots) and reducing the risk of bleeding. Anticoagulant medications, although crucial to preventing clot formation, can increase the potential for bleeding during surgical procedures. Patient blood management protocols aim to optimize patient outcomes by minimizing blood loss and unnecessary transfusions.
RESUMEN
Abstract Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective To eval uate the ef ficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performeda prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction (p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement (p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short-and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.
RESUMEN
Abstract Introduction Peripheral hearing loss, besides causing inadequate auditory input, can lead to distortions in the tonotopic auditory map and reorganization of neural networks. Therefore, the processing of temporal aspects of a sound stimulus and, consequently, the effectiveness of human communication can be negatively impacted. Objective To test the temporal ordering and auditory resolution of people with mild and moderate sensorineural hearing loss and to compare them with the those of people with normal hearing. Methods A total of 19 right-handed individuals aged 16 to 59 years with mild to moderate postlingually acquired symmetric bilateral sensorineural hearing loss participated in the study. They were submitted to frequency and duration pattern tests and a random gap detection test. Results The mean correct response rate in the frequency pattern test was of 66.3%, and, in the duration pattern test, 71.7%. The mean threshold in the random gap detection test was of 14.1 ms. A comparison with the criteria established for normal subjects without peripheral hearing loss revealed that more than half the subjects had abnormal results in the temporal ordering test, while a smaller fraction had reduced temporal resolution. Conclusions The performance of the subjects with acquired sensorineural hearing loss was poorer than that of the participants without peripheral hearing loss. Their results on the temporal ordering test were also poorer than in the temporal resolution test, demonstrating the importance of analyzing both these auditory skills in people with peripheral hearing loss.
RESUMEN
Abstract Introduction NB CE-Chirp LS was developed to improve the audiogram estimation by auditory brainstem response (ABR) thresholds during audiological assessment of infants and difficult to test children. However, before we know how the stimulus behaves in several types of hearing loss, it is important we know how the stimulus behaves in normal hearing infants. Objective To describe ABR thresholds with NB CE-Chirp LS stimulus for 500, 1,000, 2,000, and 4,000 Hz, as well as the amplitude and absolute latency for ABR thresholds. Methods Auditory brainstem response thresholds were evaluated with the Eclipse EP25 system. NB CE-Chirp LS was presented using an ER-3A insert earphone. EEG filter was 30 Hz high-pass and 1,500 Hz low-pass. The ABR threshold was defined as the lowest intensity capable of clearly evoke wave V, accompanied by an absent response 5 dB below. Results Eighteen normal hearing infants were evaluated. The mean and standard deviation (SD) of the ABR threshold (dB nHL) were: 23.8 (±4.2); 14.4 (±5.7); 6.0 (±5.0); and 7.0 (±5.9). The mean and SD of the absolute latency (ms) were: 8.86 (±1.12); 9.21 (±0.95); 9.44 (±0.78); and 9.64 (±0.52). The mean amplitude (nV) and SD were: 0.123 (±0.035); 0.127 (±0.039); 0.141 (±0.052); and 0.105 (±0.028), respectively, for 500, 1,000, 2,000 and 4,000 Hz. Conclusion Auditory brainstem response threshold with NB CE-Chirp LS reaches low levels, in special for high frequencies. It provides absolute latencies similar between frequencies with robust amplitude. The results obtained brings to the examiner more confidence in the results registered.
RESUMEN
ABSTRACT Objective: To evaluate symptoms, lung function, and quality of life of a cohort of patients hospitalized for severe COVID-19 12 months after hospital admission. Methods: This was a cross-sectional study. We included severe COVID-19 survivors hospitalized in one of three tertiary referral hospitals for COVID-19 in the city of Belo Horizonte, Brazil. Participants were submitted to lung function and six-minute walk tests and completed the EQ-5D-3L questionnaire. Results: The whole sample comprised 189 COVID-19 survivors (mean age = 59.6 ± 13.4 years) who had been admitted to a ward only (n = 96; 50.8%) or to an ICU (n = 93; 49.2%). At 12 months of follow-up, 43% of patients presented with dyspnea, 27% of whom had a restrictive ventilatory disorder and 18% of whom presented with impaired DLCO. There were no significant differences in FVC, FEV1, and TLC between the survivors with or without dyspnea. However, those who still had dyspnea had significantly more impaired DLCO (14.9% vs. 22.4%; p < 0.020) and poorer quality of life. Conclusions: After one year, survivors of severe COVID-19 in a middle-income country still present with high symptom burden, restrictive ventilatory changes, and loss of quality of life. Ongoing follow-up is needed to characterize long COVID-19 and identify strategies to mitigate its consequences.
RESUMEN
Abstract Research has shown that personality develops over time, generating changes and continuity in the pattern of functioning across the lifespan. We investigated the evidence of consistency in the ranking of personality traits over time. A group of 170 adults between the ages of 51 and 93 participated in the study (M = 69, SD = 9.05) and retrospectively answered the Big Five Inventory-2 and the Big Five Inventory. We performed test-retest correlation and the ANOVA procedure with repeated measures. We found that personality scores at 30-35 years of age are associated with the scores at age 70-80, indicating stability in the pattern of individual functioning in the long term. This research complements the few studies on personality development in Brazil.
Resumo Evidências indicam que a personalidade se desenvolve ao longo do tempo, gerando mudanças e continuidade no padrão de funcionamento ao longo da vida. Investigamos a evidência de consistência no ranqueamento dos traços de personalidade ao longo do tempo. Participaram 170 adultos, com idade entre 51 e 93 anos (M = 69; DP = 9,05), que responderam o Big Five Inventory-2 e a Big Five Inventory, retrospectivamente. Realizamos correlação teste-reteste e o procedimento ANOVA com medidas repetidas. Constatamos que os escores em personalidade aos 30-35 anos de idade estão associados com os escores aos 70-80 anos, indicando estabilidade no padrão de funcionamento em longo prazo. Esta pesquisa complementa os poucos estudos sobre o desenvolvimento da personalidade no Brasil.
RESUMEN
O estudo objetivou reunir evidências de precisão e validade da Escala Comportamental De Ansiedade Aos Exames (ECAE) em contexto brasileiro. Especificamente, verificou-se o padrão de relação com ansiedade cognitiva de provas. Realizaram-se dois estudos com estudantes universitários. No primeiro (n = 223; M idade = 21,57; DP = 5,35), foi realizada a adaptação da ECAE e uma análise fatorial exploratória, sugerindo-se uma estrutura bifatorial. No segundo (n = 239; M idade = 21,68; DP = 3,71), por meio de uma análise fatorial confirmatória a estrutura teórica composta por dois fatores foi corroborada. Ademais, realizou-se a correlação de Pearson (r), evidenciando relações positivas entre os fatores da ECAE (dificuldade de execução e conduta de evitação) e a ansiedade cognitiva de provas, indicando validade convergente. Conclui-se que a ECAE reuniu adequadas evidências psicométricas, podendo ser uma ferramenta útil na avaliação de estudantes universitários com elevada ansiedade de provas, além de contribuir para a compreensão e desenvolvimento de estratégias interventivas relacionadas à temática da ansiedade de provas.
The study aimed to gather evidence of accuracy and validity of the Behavioral Test Anxiety Scale (BTAS) in the Brazilian context. Specifically, the study examined its relationship with cognitive test anxiety. Two studies were conducted with university students. In the first study (n = 223; Mage = 21.57; SD = 5.35), the ECAE was adapted, and an exploratory factor analysis was performed, suggesting a bifactorial structure. In the second study (n = 239; Mage = 21.68; SD = 3.71), a confirmatory factor analysis confirmed the theoretical structure composed of two factors. Additionally, Pearson correlation (r) was used, showing positive relationships between the factors of the ECAE (execution difficulty and avoidance behavior) and cognitive test anxiety, indicating convergent validity. It can be concluded that the ECAE gathered adequate psychometric evidence and can be a useful tool in assessing university students with high-test anxiety, as well as contributing to the understanding and development of intervention strategies related to the theme of test anxiety.
El estudio tuvo como objetivo reunir evidencias de precisión y validez de la Escala Conductual de Ansiedad Frente a los Exámenes (ECAE) en el contexto brasileño. Específicamente, se examinó su relación con la ansiedad cognitiva en pruebas. Se llevaron a cabo dos estudios con estudiantes universitarios. En el primer estudió (n = 223; Medad = 21,57; DE = 5,35), se adaptó la ECAE y se realizó un análisis factorial exploratorio, sugiriendo una estructura bifactorial. En el segundo estudió (n = 239; Medad = 21,68; DE = 3,71), a través de un análisis factorial confirmatorio, se confirmó la estructura teórica compuesta por dos factores. Además, se realizó la correlación de Pearson (r), evidenciando relaciones positivas entre los factores de la ECAE (dificultad de ejecución y conducta de evitación) y la ansiedad cognitiva en pruebas, lo que indica validez convergente. Se concluye que la ECAE reunió adecuadas evidencias psicométricas y puede ser una herramienta útil en la evaluación de estudiantes universitarios con elevada ansiedad en pruebas, además de contribuir a la comprensión y desarrollo de estrategias de intervención relacionadas con la temática de la ansiedad en pruebas.
RESUMEN
ABSTRACT Objective: To investigate the effect of bronchodilator on the respiratory mechanics and pulmonary function of children and adolescents with cystic fibrosis. Methods: Cross-sectional study on clinically stable children and adolescents with cystic fibrosis aged from six to 15 years. Participants underwent impulse oscillometry and spirometry evaluations before and 15 minutes after bronchodilator inhalation. The Kolmogorov-Smirnov test was applied to verify the sample distribution, and the Student's t-test and Wilcoxon test were used to compare the data before and after bronchodilator inhalation. Results: The study included 54 individuals with a mean age of 9.7±2.8 years. The analysis showed a statistically significant improvement in impulse oscillometry and spirometry parameters after bronchodilator inhalation. However, according to the American Thoracic Society (ATS) and European Respiratory Society (ERS) recommendations (2020 and 2021), this improvement was not sufficient to classify it as a bronchodilator response. Conclusions: The use of bronchodilator medication improved respiratory mechanics and pulmonary function parameters of children and adolescents with cystic fibrosis; however, most patients did not show bronchodilator response according to ATS/ERS recommendations.
RESUMO Objetivo: Investigar o efeito do broncodilatador na mecânica respiratória e função pulmonar de crianças e adolescentes com fibrose cística. Métodos: Estudo transversal em crianças e adolescentes com fibrose cística clinicamente estáveis, com idade entre seis e 15 anos. Os participantes realizaram avaliações por meio do sistema de oscilometria de impulso e espirometria antes e 15 minutos depois da inalação de broncodilatador. Foi aplicado o teste Kolmogorov-Smirnov para verificar a distribuição da amostra. Para comparar os dados antes e depois do broncodilatador foram utilizados os testes t de Student e Wilcoxon. Resultados: Participaram do estudo 54 indivíduos com média de idade de 9,7±2,8 anos. Houve melhora estatisticamente significativa nos parâmetros do oscilometria de impulso e espirometria após a inalação com broncodilatador. No entanto, de acordo com recomendações da American Thoracic Society (ATS) e European Respiratory Society (ERS) (2020 and 2021), essa melhora não foi suficiente para classificar como reposta broncodilatadora. Conclusões: O uso de medicamento broncodilatador melhorou a mecânica respiratória e função pulmonar de crianças e adolescentes com fibrose cística, no entanto a maioria da amostra não apresentou resposta ao broncodilatador de acordo com as recomendações da ATS/ERS.
RESUMEN
ABSTRACT Objective: To evaluate the association of TSH, free T3 (FT3), free T4 (FT4), and conversion (FT3:FT4) ratio values with incident hypertension. Materials and methods: The study included data from participants of the ELSA-Brasil study without baseline hypertension. Serum TSH, FT4 and FT3 levels, and FT3:FT4 ratio values were assessed at baseline, and incident hypertension (defined by blood pressure levels ≥ 140/90 mmHg) was estimated over a median of 8.2 years of follow-up. The risk of incident hypertension was evaluated considering a 1-unit increase in TSH, FT4, FT3, and conversion ratio values and after dividing these variables into quintiles for further analysis using Poisson regression with robust variance. The results are presented as relative risks (RR) and 95% confidence intervals (CIs) before and after adjustment for multiple variables. Results: The primary analysis incorporated data from 5,915 euthyroid individuals, and the secondary analysis combined data from all euthyroid individuals, 587 individuals with subclinical hypothyroidism, and 31 individuals with subclinical hyperthyroidism. The rate of incident hypertension was 28% (95% CI: 27%-29.3%). The FT4 levels in the first quintile (0.18-1.06 ng/dL) were significantly associated with incident hypertension (RR: 1.03, 95% CI: 1.01-1.06) at follow-up. The association between FT4 levels in the first quintile and incident hypertension was also observed in the analysis of combined data from euthyroid individuals and participants with subclinical thyroid dysfunction (RR: 1.04, 95% CI: 1.01-1.07). The associations were predominantly observed with systolic blood pressure levels in euthyroid individuals. However, in the combined analysis incorporating euthyroid participants and individuals with subclinical thyroid dysfunction, the associations were more pronounced with diastolic blood pressure levels. Conclusion: Low FT4 levels may be a mild risk factor for incident hypertension in euthyroid individuals and persons with subclinical thyroid dysfunction.
RESUMEN
Abstract This study aimed to evaluate volumetric polymerization shrinkage, degree of conversion and Vickers hardness of four bulk-fill resin composites light-activated with their dedicated light curing units (LCUs). Four groups were evaluated, according to the type of composite and curing mode: Tetric EvoCeram Bulk-fill (TEBO) and Tetric EvoFlow Bulk-fill (TEBF) were light-activated with Bluephase Style 20i (20s, in high-mode), while Tetric Powerfill (TEPO) and Tetric Powerflow (TEPF) were light-activated with Bluephase PowerCure (3s). Volumetric polymerization shrinkage test (n = 6) was performed in standardized box-shaped class-I cavities of extracted third molars (4 x 4 x 4 mm). Teeth were scanned before and after resin composite application by micro-computed tomography, and acquired data were evaluated with Amira software. Degree of conversion (n = 5) was evaluated at the top and bottom surfaces of composite cylindric samples (4 mm diameter, 4 mm thickness) using an FT-IR spectrometer (spectra between 1,500 and 1,800 cm-1, 40 scans at a resolution of 4 cm-1). Three Vickers indentations (50 g / 15 s), spaced 500 μm apart, were performed on the top and bottom composite surfaces and averaged. One-way ANOVA was used for data evaluation. TEPF showed the lowest volumetric polymerization shrinkage (p < 0.05), while the other composites were not significantly different within each other (p > 0.05). All materials presented a significant decrease in degree of conversion and Vickers hardness when compared top to bottom surfaces (p < 0.05). Bottom to top surface ratios for degree of conversion ranged from 0.8 (TEBO and TEPO) to 0.9 (TEBF and TEPF), and from 0.4 (TEPO) to 0.7 (TEBF and TEPF) for hardness. In conclusion, resinous materials present a decrease in hardness and degree of conversion from top to bottom even when a higher power is used, while the flowable material TEPF showed the lowest volumetric shrinkage values compared to the other materials.
RESUMEN
Abstract Objectives Evaluate the reliability test-retest (intra and inter-examiner) and construct validity of the Long Version of Disability Assessment for Dementia (Brazilian Version - DADL-BR). Methods The DADL-BR was applied to 58 caregivers/family of older adults with dementia. The inter-examiner (n = 30) and intra-examiner (n = 28) reliability was assessed using the kappa test and Pearson's correlation coefficient, and the internal consistency was assessed using Cronbach's alpha. The construct validity (n = 48) was performed by comparing DADL-BR with MMSE. Results The results of the intra and inter-examiner demonstrated good reliability (0.72 and 0.74), as well as nearly perfect correlations (0.99) for both inter- and intra-examiner reliability. The internal consistency was excellent (0.87) and the results demonstrated a good correlation (0.74) between DADL-BR and MMSE in construct validity analysis. Conclusions DADL-BR can be considered reliable instrument and with good construct validity, considering internal consistency and test-retest reliability and may be constitute a useful instrument for assessing the occupational performance profile of older adults with dementia.
Resumo Objetivos Avaliar a confiabilidade teste-reteste (intra e inter-examinadores) e a validade de construto da Versão Longa da Escala de Avaliação de Incapacidade na Demência - Versão Longa (DADL-BR). Métodos O DADL-Br foi aplicado em 58 cuidadores/familiares de idosos com demência. A confiabilidade inter-examinadores (n = 30) e intrae-xaminadores (n = 28) foi avaliada pelo teste kappa e coeficiente de correlação de Pearson, e a consistência interna foi avaliada pelo Alfa de Cronbach. A validade de construto (n = 48) foi realizada comparando-se o DADL-BR com o Mini Exame do Estado Mental (MEEM). Resultados Os resultados intra e inter-examinadores demonstraram boa confiabilidade (0,72 e 0,74), bem como correlações quase perfeitas (0,99) tanto para confiabilidade inter quanto intra-examinadores. A consistência interna foi excelente (0,87) e os resultados demonstraram boa correlação (0,74) entre o DADL-BR e o MEEM na análise de validade de constructo. Conclusões O DADL-BR pode ser considerado um instrumento confiável e com boa validade de constructo, considerando-se a consistência interna e a confiabilidade teste-reteste, e útil para avaliar o perfil de desempenho ocupacional de idosos com demência.
RESUMEN
RESUMO Objetivo Investigar a confiabilidade do Teste de Palavras no Ruído em um grupo de adultos normo-ouvintes. Método Participaram da pesquisa 45 sujeitos adultos normo-ouvintes. O intervalo entre a primeira e a segunda avaliação foi de 14 a 28 dias, realizadas no mesmo turno do dia e pelo mesmo avaliador. A análise de comparação entre teste e reteste foi realizada considerando o resultado geral das orelhas, totalizando 90 orelhas avaliadas. A análise inferencial incluiu a comparação das situações na primeira e segunda avaliação por meio do Teste de Wilcoxon, cálculo e interpretação do Índice de Correlação Intraclasse. Resultados Houve diferença estatisticamente significante entre os desempenhos no teste e reteste. Os coeficientes de correlação intraclasse obtidos foram indicativos de boa confiabilidade (r=0,759; p<0,001) para o estímulo monossilábico e de moderada confiabilidade (r=0,631; p<0,001) para o dissilábico. Conclusão O Teste de Palavras no Ruído demonstrou satisfatória confiabilidade tanto para o estímulo monossilábico, quanto para o dissilábico.
ABSTRACT Purpose To investigate the reliability of the Word-with-Noise Test in a group of normal-hearing adults. Methods Forty-five normal-hearing adult subjects participated in the research. The interval between the first and second assessment was 14 to 28 days, performed during the same time of the day and by the same evaluator. The comparison analysis between the test and the retest was performed considering the general result of the ears, totaling 90 ears evaluated. The inferential analysis included the comparison of the situations in the first and second assessment using the Wilcoxon Test, calculation, and interpretation of the Intraclass Correlation Index. Results There was a statistically significant difference between the test and retest performances. The intraclass correlation coefficients obtained were indicative of good reliability (r=0.759; p<0.001) for the monosyllabic stimulus and moderate reliability (r=0.631; p<0.001) for the disyllabic stimulus. Conclusion The Word-with-Noise Test demonstrated satisfactory reliability for both the monosyllabic and disyllabic stimuli.