Prediction and validation of the mechanism of Zadi-5 pill in protecting myocardial ischemia-reperfusion injury / 中国药房

OBJECTIVE To explore the mechanism of Zadi-5 pill in improving myocardial ischemia-reperfusion injury （MIRI）. METHODS The targets and pathways of potential effects of Zadi-5 pill improving MIRI were screened based on the network pharmacology. Seventy-two rats were randomly divided into model group， sham operation group， Danshen group [Compound danshen dripping pills 80 mg/（kg·d）] and Zadi-5 pill high-dose， medium-dose and low-dose groups [1.6， 0.8， 0.4 g/（kg·d）]， with 12 rats in each group. The rats in each group were given corresponding drugs intragastrically， once a day， for 14 consecutive days. After the last administration， MIRI model was established by ligating the anterior descending branch of left coronary artery in rats， while rats in the sham operation group were threaded without ligation. The contents of creatine kinase （CK）， lactate dehydrogenase （LDH）， aspartate transaminase （AST）， cardiac troponin T （CTn-T）， apoptotic rate of cardiomyocyte， phosphatidylinositol 3-kinase （PI3K）， protein kinase B （Akt）， B-cell lymphoma-2 （Bcl-2）， Bcl-2 related X protein （Bax） and caspase-3 in myocardial tissue were detected in each group after modeling； the morphological changes of myocardial tissue were observed. RESULTS A total of 177 active ingredients and 220 targets of Zadi-5 pill were obtained， including 51 targets involved in improving myocardial ischemia； the core target of Zadi-5 pill improving MIRI was AKT1， including PI3K-Akt， endoplasmic reticulum and hypoxia-inducible factor-1. Compared with model group， the contents of CK， LDH， AST and CTn-T， the apoptotic rate of cardiomyocyte as well as the protein expressions of caspase-3 and Bax were significantly decreased in Danshen group and Zadi-5 pill high-dose group （P＜0.05 or P＜0.01）， while the protein expressions of PI3K， Akt and Bcl-2 in myocardial tissue were significantly increased （P＜0.05 or P＜0.01）， respectively； the myocardial histopathological changes were significantly improved. The above indicators were improved to varying degrees in Zadi-5 pill low-dose and medium-dose groups， too. CONCLUSIONS Zadi-5 pill may inhibit apoptosis by activating the PI3K-Akt signaling pathway， thus playing a role in improving MIRI.

Temporal analysis and spatial distribution of acquired syphilis in the state of Mato Grosso, Brazil, 2010-2021: an ecological study / Análisis temporal y distribución espacial de la sífilis adquirida en el estado de Mato Grosso, 2010-2021: estudio ecológico / Análise temporal e distribuição espacial da sífilis adquirida no estado de Mato Grosso, 2010-2021: estudo ecológico

Abstract Objective: To analyze the temporal trend and the spatial distribution of acquired syphilis in Mato Grosso, Brazil, between 2010 and 2021. Methods: This was an ecological study using notifications of acquired syphilis held on the Notifiable Health Conditions Information System. Detection rates were calculated by health macro-region and three-year periods (2010-2012, 2013-2015, 2016-2018, 2019-2021). The jointpoint method was used to calculate annual percentage change (APC). Thematic maps of Bayesian rates were built and distribution was analyzed using Local Moran. Results: The detection rate increased from 16.2 per 100,000 inhabitants in the first three-year period (2010-2012) to 70.0 in the last three-year period (2019-2021). The Central-North macro-region had the highest rate in the last three years (94.3/100,000 inhab.), while the highest upward trend occurred in the Central-Northwest macro-region, from 2013 to 2018 (APC = 50.2; 95%CI 26.3;78.6). There was an increase in Bayesian rates in most municipalities. Conclusion: There was a trend towards an increase in acquired syphilis, especially in the last two three-year periods.

Resumen Objetivo: Analizar la tendencia temporal y la distribución espacial de la sífilis adquirida en Mato Grosso, de 2010 a 2021. Métodos: Estudio ecológico utilizando informes de sífilis adquirida del Sistema de Información de Enfermedades de Declaración Obligatoria - Sinan. Las tasas de detección se calcularon por macrorregión de salud y trienios (2010-2012, 2013-2015, 2016-2018, 2019-2021). Se utilizó el método jointpoint para calcular el cambio porcentual anual (CPA). Se construyeron mapas temáticos de tasas bayesianas y se analizó la distribución por Moran Local. Resultados: La tasa de detección aumentó de 16,2 por 100.000 en el primer trienio (2010-2012) a 70,0 en el último trienio (2019-2021). La macrorregión Centro-Norte presentó la tasa más alta en los últimos tres años (94,3/100.000 hab.), mientras que la mayor tendencia al alza se presentó en la macrorregión Centro-Noroeste, de 2013 a 2018 (CPA = 50,2; IC95% 26,3; 78,6). Hubo un aumento en las tasas bayesianas en la mayoría de los municipios. Conclusión: Hubo una tendencia al aumento de la sífilis adquirida, especialmente en los dos últimos trienios.

Resumo Objetivo: Analisar a tendência temporal e a distribuição espacial da sífilis adquirida em Mato Grosso, de 2010 a 2021. Métodos: Estudo ecológico utilizando notificações de sífilis adquirida do Sistema de Informação de Agravos de Notificação. As taxas de detecção foram calculadas por macrorregiões de saúde e triênios (2010-2012, 2013-2015, 2016-2018, 2019-2021). O método jointpoint foi utilizado no cálculo da variação percentual anual (VPA). Foram construídos mapas temáticos das taxas bayesianas e a distribuição analisada por Moran local. Resultados: A taxa de detecção passou de 16,2/100 mil habitantes, no primeiro triênio (2010-2012), para 70, no último triênio (2019-2021). A macrorregião Centro-Norte apresentou a maior taxa no último triênio (94,3/100 mil hab.), enquanto a maior tendência de aumento ocorreu na macrorregião Centro-Noroeste, de 2013 a 2018 (VPA = 50,2; IC95% 26,3;78,6). As taxas bayesianas aumentaram na maioria dos municípios. Conclusão: Houve tendência de aumento da sífilis adquirida, principalmente nos dois últimos triênios.

Adaptação transcultural e análise da confiabilidade da versão brasileira do questionário de reabilitação para o trabalho - WORQ / Cross-cultural adaptation and reliability analysis of the Brazilian version of the Work Rehabilitation Questionnaire (WORQ)

Resumo Introdução O Work Rehabilitation Questionnaire (WORQ) é um instrumento internacional baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde para avaliar a capacidade funcional em pessoas com deficiência para o trabalho. Objetivo Realizar adaptação transcultural e análise da confiabilidade para a população brasileira. Métodos A adaptação transcultural consistiu em tradução, síntese das traduções, retrotraduções, análise do comitê de juízes, pré-teste e teste piloto. Os resultados foram obtidos pelo cálculo da taxa de concordância para equivalência semântica, idiomática, experiencial e conceitual. A confiabilidade foi testada por análise de estabilidade, equivalência e consistência interna por meio do cálculo de α-Cronbach e Coeficiente de Correlação Intraclasse (ICC). Resultados Participaram da primeira etapa 05 tradutores, 08 juízes e 14 possíveis usuários no pré-teste. A taxa de concordância foi menor que 90% apenas na equivalência idiomática, resultando em ajustes ortográficos sem alterar o construto do instrumento. A confiabilidade foi testada em 34 trabalhadores com deficiência, idade média de 40,3 (±4,2) anos, ambos os sexos, funcionários de uma instituição de ensino de São Paulo inseridos pela lei de cotas (8.213/91). A Consistência Interna apresentou valores superiores a 80% em todos os domínios e foi maior que 90% para o escore total. Após 15 dias da primeira avaliação, foram sorteados 20 desses participantes para reavaliação. O ICC para estabilidade foi 82,5% (p=0,008) e equivalência foi 95,4% (p<0,001). Conclusão O questionário WORQ foi traduzido e adaptado transculturalmente para o português brasileiro e apresentou confiabilidade para responder aos domínios da CIF. A versão brasileira está disponível na home page do WORQ, no endereço eletrônico http://www.myworq.org/questionnaire_en.php.

Abstract Introduction The Work Rehabilitation Questionnaire (WORQ) is an international instrument, based on the International Classification of Functioning, Disability and Health (ICF), used to assess the functional capacity of people with work disabilities. Objective To perform a cross-cultural adaptation and a reliability analysis of this instrument for the Brazilian population. Method The cross-cultural adaptation consisted of translation, synthesis of translations, back translations, analysis by the committee of judges, pre-test, and pilot test. The results were obtained by calculating the agreement rate for semantic, idiomatic, experiential, and conceptual equivalence. Reliability was tested by analysis of stability, equivalence, and internal consistency by calculating Cronbach's Alpha and Intraclass Correlation Coefficient (ICC). Results Five translators, eight judges, and 14 possible users in the pre-test participated in the first stage. The agreement rate was <90% only for idiomatic equivalence, resulting in orthographic adjustments without changing the instrument construct. The reliability was tested on 34 workers with disabilities, with a mean age of 40.3 (±4.2) years, of both sexes, employees of an educational institution in the state of São Paulo, Brazil, hired through the Quotas Law (8,213/91). The internal consistency showed values >80% in all domains and was >90% for the total score. Fifteen days after the first assessment, 20 of these participants were randomly selected for reassessment. The ICC values for stability and equivalence were 82.5% (p=0.008) and 95.4% (p<0.001), respectively. Conclusion The WORQ was translated and cross-culturally adapted to Brazilian Portuguese and reliably responded to the ICF domains. The Brazilian version of the WORQ is available at http://www.myworq.org/questionnaire_en.php.

Density Of Eggs and Larvae of Aedes Spp and the Characteristics of their Larvae Habitat in Endemic Dengue Area of Ternate City

@#Introduction: Dengue Fever (DF) is a disease spread by Aedes spp. caused by dengue virus infection. The study aimed to identify the density of Aedes spp eggs and larvas stages and the characteristics of their habitat in dengue-endemic areas in Ternate City in September-December 2021. Methods: the research was conducted in four dengue-endemic villages in Ternate City, namely Sangaji, Maliaro, Bastiong Karance, and Bastiong Talangame village. In 80 households, egg density was determined by placing 2 ovitraps in each house, one inside and one outside the house. After a week, the filter paper which is a medium mosquito to lay their eggs in the ovitrap was collected, and the ovitrap index value was calculated. The value of the House Index (HI), Container Index (CI), and Breuteu Index (BI) was used to calculate the larval density. The type and materials of the containers were used to assess the parameters of the larval environment. Results: The ovitrap index value in the four villages was categorized as moderate level 3 (27.50% -36.25%). The highest larval density was found in Sangaji Village (HI = 81%), while the lowest was in Bastion Talangame Village (HI = 70%). The highest CI and BI values were found in Bastiong Karance Village (CI=51.5% and BI=190%), and the lowest was in Maliaro Village (CI=37.5% and BI=128%). Density figures in all endemic villages have a high larval density with a value of 8. Conclusion: There was no significant difference (p>0.05) between the types and the materials of containers in each village in Dengue endemic areas. The high density of the egg and larval stage and the information characteristic of habitat Aedes spp. could be considered as basic information for dengue vector control in Ternate City.

NETO2 promotes melanoma progression via activation of the Ca2+/CaMKII signaling pathway / 医学前沿

Melanoma is the most aggressive cutaneous tumor. Neuropilin and tolloid-like 2 (NETO2) is closely related to tumorigenesis. However, the functional significance of NETO2 in melanoma progression remains unclear. Herein, we found that NETO2 expression was augmented in melanoma clinical tissues and associated with poor prognosis in melanoma patients. Disrupting NETO2 expression markedly inhibited melanoma proliferation, malignant growth, migration, and invasion by downregulating the levels of calcium ions (Ca2+) and the expression of key genes involved in the calcium signaling pathway. By contrast, NETO2 overexpression had the opposite effects. Importantly, pharmacological inhibition of CaMKII/CREB activity with the CaMKII inhibitor KN93 suppressed NETO2-induced proliferation and melanoma metastasis. Overall, this study uncovered the crucial role of NETO2-mediated regulation in melanoma progression, indicating that targeting NETO2 may effectively improve melanoma treatment.

FVIII inhibitor surveillance in children with hemophilia A in Indonesia:a report from the Indonesian Pediatric Hematology-Oncology Working Group

Background@#Factor VIII (FVIII) inhibitor diagnosis and surveillance in Indonesia are challenging owing to geographic conditions and the lack of laboratory facilities nationwide for inhibitor assays. This study aimed to determine the prevalence of FVIII inhibitors in children diagnosed with hemophilia A (HA) in Indonesia. @*Methods@#A cross-sectional study was conducted in 12 hospitals in eight provinces of Indonesia between 2020 and 2021. Factor VIII inhibitor screening was performed in a central hemostasis laboratory for all children with HA (≤18 yr) who had received a minimum of 10 exposure days to clotting factor concentrates. The FVIII inhibitor titer was determined using the Bethesda assay. @*Results@#Children (388) were enrolled in this study, including 219 (56.4%), 131 (33.8%), and 38 (9.4%) with severe, moderate, and mild HA, respectively. The prevalence of children who developed FVIII inhibitors was 37 out of 388 (9.6%). Factor VIII inhibitors were found in 25/219 (11.4%) severe, 11/131 (8.3%) moderate, and 1/38 (2.6%) children with mild HA. Thirteen children had low-titer inhibitors and 24 had high-titer inhibitors, with a median of 9.44 (1.48‒412.0) Bethesda Units. Among 13 children with low-titer inhibitors, eight underwent a confirmation test, of which five tested negative and were classified as transient. A significant difference in annual joint bleeding rate was found between patients with low and high inhibitor titers and those without inhibitors (P ＜0.001). @*Conclusion@#Factor VIII inhibitor prevalence in Indonesia was relatively low. However, the risk factors that may contribute to FVIII inhibitor development among Indonesian patients require further study.

An Exploration of Family Members’ Roles in the Context of Breast Cancer: A Narrative Study in Malaysia

@#Introduction: Breast cancer is a significant health problem that affects patients and their family members. Family members are often key to supporting the patient. However, there is an inadequate understanding of the role of female breast cancer patients’ family members in Malaysia. This study aimed to explore the roles of family members of female breast cancer patients from symptom appraisal until the patient treatment commences. Methods: Snowball sampling was applied and 14 participants were recruited through the nomination of the female breast cancer patients. The participants took part in in-depth, face-to-face, and audio-recorded one-time interviews. All of the interviews were subsequently transcribed verbatim and analysed using narrative analysis. Results: Five themes were identified with regard to the roles of family members: 1) confirming breast changes; 2) managing personal emotions; 3) seeking the information; 4) seeking alternative forms of treatment; and 5) advocating for conventional treatment. Conclusion: This study discovered that family members play an important role in the journey of women with breast cancer from the time an abnormality is discovered to the time the patient receives treatment. During this time, many of them suppressed their emotions in order to focus on the women suffering from breast cancer. Healthcare professionals working with breast cancer should recognise and support the key role of family members in supporting women to get treatment. It is important to take a proactive approach in recognising the early signs of stress for family members and, when appropriate, offering them additional sources of support.

Density Of Eggs and Larvae of Aedes Spp. and the Characteristics of their Larvae Habitat in Endemic Dengue Area In Ternate City

@#Introduction: Dengue Fever (DF) is a disease spread by Aedes spp. caused by dengue virus infection. The study aimed to identify the density of egg and larval Aedes spp. stages and the characteristics of their habitat in dengue-endemic areas in Ternate City in September 2021. Methods: the research was conducted in four dengue-endemic villages in Ternate City, including Sangaji, Maliaro, Bastiong Karance, and Bastiong Talangame. In 80 households, egg density was determined utilizing ovitrap placement of up to two pieces per dwelling, one inside and one outside the house. After a week of ovitrap installation, the filter paper was collected, and the ovitrap index value was calculated. The value of the House Index (HI), Container Index (CI), and Breuteu Index (BI) was used to calculate the larval density. The type and materials of the containers were used to assess the parameters of the larval environment. Results: The ovitrap index value in the four sub-districts was categorized as moderate level 3 (27.50% -36.25%). The highest larval density was found in Sangaji Village (HI = 81%), while the lowest was in Bastion Talangame Village (HI = 70%). The highest CI and BI values were found in Bastiong Karance Village (CI=51.5% and BI=190%), and the lowest was in Maliaro Village (CI=37.5% and BI=128%). Density figures in all endemic villages have a high larval density with a value of 8. Conclusion: There was no significant difference (p>0.05) between the types and the materials of containers in each village in DF endemic areas. The high density of the egg and larval stage and the information characteristic of habitat Aedes spp. Could be considered the basis of information dengue vector prevention and control in Ternate City.

Preservation of sugarcane silage with urea and calcium oxide: performance and metabolic efficiency of dairy cows / Conservación del ensilaje de caña de azúcar con urea y óxido de calcio: rendimiento y eficiencia metabólica en vacas lecheras / Preservação da silagem de cana-de-açúcar com ureia e óxido de cálcio: desempenho e eficiência metabólica de vacas leiteiras

Abstract Background: Inclusion of urea and calcium oxide (CaO) during sugarcane ensilage has been hypothesized to improve dairy cow performance. Objective: To evaluate the use of urea and calcium oxide as additives to preserve sugarcane silage quality and determine whether they improve dairy cow performance and metabolic efficiency. Methods: Four diets were used: sugarcane silage without additive (SS), sugarcane silage with 10 g/kg urea (SU), sugarcane silage with 5 g/kg urea + 5 g/kg CaO (SUC), and sugarcane silage with 10 g/kg CaO (SC). Eight crossbred cows at approximately 100 days of lactation were distributed in two 4x4 Latin squares, and their diets were formulated to reach an average milk production of 15 kg/day. Results: Dry matter, non-fibrous carbohydrates, organic matter, total carbohydrates, and total digestible nutrient intake were the highest (p<0.05) for the cows fed SC. Urinary excretion of nitrogen was higher (p<0.05) for cows fed diets based on SUC than those fed diets with SC. Milk urea nitrogen content was the highest (p<0.05) in animals fed SU diets. Nitrogen balance was positive in all treatments; however, the microbial protein synthesis was low for all diets. Conclusions: The diet with SU showed the highest nitrogen loss through the milk. Among the evaluated silages, those with SC and SUC are recommended to promote a high intake of nutritional components.

Resumen Antecedentes: La hipótesis fue que una dieta con combinación de urea y óxido de calcio (CaO) para el ensilaje de caña de azúcar, puede mejorar la producción de vacas lecheras cruzadas. Objetivo: Evaluar la urea y el óxido de calcio como aditivos para preservar la calidad del ensilaje de caña de azúcar y determinar si mejoran el rendimento y la eficiencia metabólica de vacas lecheras. Métodos: Cuatro dietas fueron utilizadas: ensilaje de caña de azúcar sin aditivo (SS), ensilaje de caña de azúcar con 10 g/kg de urea (SU), ensilaje de caña de azúcar con 5 g/kg de urea + 5 g/kg de CaO (SUC) y ensilaje de caña de azúcar con 10 g/kg de CaO (SC). Ocho vacas cruzadas fueron evaluadas con una producción media de leche de 15 kg/día y aproximadamente 100 días de lactación, distribuidas en dos cuadrados latinos 4x4. Resultados: El consumo de materia seca, carbohidratos no fibrosos, materia orgánica, carbohidratos totales y nutrientes digestibles totales fue mayor (p<0,05) cuando las vacas fueron alimentadas con dietas conteniendo SC. La excreción de nitrógeno en la orina fue mayor (p<0,05) cuando las vacas fueron alimentadas con dietas basadas en SUC que las alimentadas con dietas SC. El nitrógeno ureico de la leche fue mayor (p<0,05) en animales alimentados con dietas con SU. El balance de nitrógeno fue positivo en todos los tratamientos, sin embargo, la síntesis de proteína microbiana fue baja para todas las dietas. Conclusión: La dieta con SU presentó la mayor pérdida de nitrógeno por medio de la leche. Entre los ensilajes evaluados, aquellos con SC y SUC son recomendados por promover un mayor consumo de componentes nutricionales.

Resumo Antecedentes: A hipótese foi que uma dieta com a mistura de ureia e óxido de cálcio (CaO) para a ensilagem de cana de açúcar, poderia melhorar a produção de vacas leiteiras mestiças. Objetivo: Avaliar ureia e óxido de cálcio como aditivos para preservar a qualidade da silagem de cana de açúcar: melhoria da produção e eficiência metabólica de vacas leiteiras. Métodos: Quatro dietas foram utilizadas: silagem de cana de açúcar sem aditivo (SS), silagem de cana de açúcar com 10 g/kg de ureia (SU), silagem de cana de açúcar com 5 g/kg de ureia + 5 g/kg de CaO (SUC) e silagem de cana de açúcar com 10 g/kg de CaO (SC). Oito vacas mestiças foram avaliadas com uma produção media de 15 kg/dia e aproximadamente 100 dias de lactação, distribuídas em dois quadrados latinos 4x4. Resultados: O consumo de matéria seca, carboidratos não fibrosos, matéria orgânica, carboidratos totais e nutrientes digestíveis totais foi maior (p<0,05) quando as vacas foram alimentadas com dietas contendo SC. A excreção de nitrogênio na urina foi maior (p<0,05) quando as vacas foram alimentadas com dietas baseadas em SUC do que aqueles animais alimentados com dietas SC. O nitrogênio ureico do leite foi maior (p<0,05) em animais alimentados com dietas com SU. O balanço de nitrogênio foi positivo em todos os tratamentos, no entanto, a síntese de proteína microbiana foi baixa para todas as dietas. Conclusão: A dieta com SU apresentou maior perda de nitrogênio por meio do leite. Entre as silagens avaliadas, aquelas com SC e SUC são recomendadas por promover maior consumo de componentes nutricionais.

Prevalence and clinical significance of fetal tricuspid regurgitation during the third trimester of pregnancy / Prevalência e significado clínico da regurgitação tricúspide em fetos no terceiro trimestre da gestação

Abstract Objectives: the aim of this study was to determine the prevalence of fetal tricuspid valve regurgitation (TR) during the third trimester of low-risk pregnancies and to assess its clinical significance on neonates. Methods: this is a cross-sectional study including 330 singleton fetuses referred for routine fetal echocardiography during 3rd trimester in a fetal medicine center in Recife, Brazil. The presence and degree of tricuspid regurgitation were analyzed. Whenever TR was identified on fetal echocardiography, postnatal data, including the results of postnatal echocardiography were reviewed. Results: the prevalence of tricuspid regurgitation was 10.0% (n=33) in the study population. Regarding regurgitation degree, 90.9% (n=30) presented mild regurgitation and none presented important TR. Postnatal data was obtained from 21 neonates. Twenty of them were discharged without any complications, and one presented respiratory distress due to prematurity. Transthoracic echocardiography was performed in 66.7% (n=14) of the neonates and it was normal in 92.9% (n=13) of them. One neonate, 7.1%, persisted with tricuspid regurgitation, but had no other findings. Conclusions: tricuspid regurgitation in fetuses with normal cardiac anatomy during the 3rd trimester is a common condition in low-risk pregnancies, and is not associated with cardiac abnormalities or need for neonatal intervention.

Resumo Objetivos: determinar a prevalência da regurgitação tricúspide (RT) em fetos no terceiro trimestre de gestações de baixo risco e investigar sua repercussão clínica nos recémnascidos. Métodos: trata-se de um estudo transversal incluindo 330 fetos encaminhados para realização de ecocardiograma fetal de rotina no terceiro trimestre da gestação num centro de medicina fetal em Recife, Brasil. A presença e o grau de insuficiência tricúspide foram estudados. Quando RT estava presente ao ecocardiograma fetal dados pós-natais, incluindo ecocardiograma, também foram analisados. Resultados: a prevalência de RT foi de 10,0% na população estudada, sendo que 90,9% (n=30) dos casos foram classificados como RT leve, e nenhum caso de RT importante foi identificado. Foram obtidos dados pós-natais de 21 recém-nascidos. Destes, 20 receberam alta hospitalar sem nenhuma complicação, enquanto 1 apresentou desconforto respiratório associado à prematuridade. Ecocardiograma transtorácico foi realizado em 66.7% (n=14) dos recém-nascidos avaliados, e foi normal em 92.9% (n=13) deles. Apenas 1 recém-nascido, 7.1%, persistiu com RT mas sem outros achados significativos. Conclusões: a RT em fetos com anatomia cardíaca normal é comum no terceiro trimestre de gestações de baixo risco e não parece associar-se a anomalias cardíacas ou necessidade de intervenção no período neonatal.

Protocolo de exercícios terapêuticos em grupo para pessoas com doença de Alzheimer / Protocol of group therapeutic exercises of people with Alzheimer's Disease

O envelhecimento gera diversas alterações biológicas que dão origens a condições de saúde como a Doença de Alzheimer (DA) que pode prejudicar a funcionalidade dos idosos. OBJETIVO: Verificar o efeito de um programa de exercícios fisioterapêuticos sobre a saúde dos idosos com DA. MÉTODOS: Foi realizado um estudo longitudinal, em idosos com DA frequentadores de um Centro-Dia. Os participantes foram selecionados por meio de características demográficos e condições de saúde. Para análise das variáveis de desfecho foram avaliados pré e pós intervenção com os testes: Timed Up and Go (TUG), Caixa e Blocos, Escala de Berg e Alcance funcional em pé e sentado. Em seguida foram submetidos a um protocolo de intervenção em grupo dividido em três fases: fase preparatória, fase ativa e fase de desaquecimento. Utilizou-se para análise estatística o Teste T-Student Pareado e a correlação de Pearson. Foi estabelecido Intervalo de Confiança (IC) e p<0,05. RESULTADOS: Foram realizadas 28 sessões com 11 idosas, com idade média de 88 (± 4) anos, frequência semanal no Centro Dia de 4 (± 1) vezes e pontuação média no MEEM de 12 (± 5). Obtiveram significância estatística no teste Alcance Sentado pré 22,3 (±10,4) e pós 28,2 (±9,0), com p = 0,003 e, no teste de TUG pré 16,9 (±5,8) e pós 2,5 (± 3,9), com p = 0,009. Além disso, o teste Berg e TUG apresentaram correlação negativa, classificada como boa p= 0,020. CONCLUSÃO: O protocolo proposto contribuiu para melhora na saúde funcional observadas no aumento do alcance funcional e da mobilidade das idosas.

Aging generates several biological changes that give rise to diseases such as Alzheimer's Disease (AD) that can result in the functionality of the elderly. OBJECTIVE: To verify the effect of a physical therapy exercise program on the health of elderly people with AD. MATERIALS AND METHODS: A longitudinal study was carried out in elderly people with AD who attended a Day Care Center. Participants were selected using demographic characteristics and health conditions. For the analysis of the outcome variables, the pre and post intervention were evaluated with the tests: Timed Up and Go (TUG), Box and Blocks, Berg Scale and Functional reach in standing and sitting. Then they underwent a group intervention protocol divided into three phases: the preparatory phase, the active phase and the cooling down phase. Paired T-Student Test and Pearson's correlation were used for statistical analysis. Confidence Interval (CI) was established and p <0.05. RESULTS: We performed 28 sessions, with 11 elderly women, mean age of 88 (± 4) years, weekly attendance at the Center on Day 4 (± 1) times and mean score on the MMSE of 12 (± 5). They obtained statistical significance in the Seated Reach test pre 22.3 (± 10.4) and post 28.2 (± 9.0), with p = 0.003 and, in the TUG test pre 16.9 (± 5.8) and powders 2.5 (± 3.9), with p = 0.009. In addition, the Berg and TUG test showed a negative correlation, classified as good p = 0.020. CONCLUSION: The proposed protocol contributed to the improvement in functional health observed in the increase in the functional range and mobility of the elderly.

Mortality Due to COVID-19 in the Elderly: Integrative Literature Review

Aims: Explore national and international literature about mortality in elderly caused by COVID-19. Methodology:An integrative literature review was performed using the databases: Virtual Health Library (VHL), PubMed/Medline (National Library of Medicine and National Institutes of Health/Medical Literature Analyzes Sand Retrieval System Online) and Cochrane Library. The selection of articles occurred from the combination of the descriptors: “Coronavirus Infections”; “Aged” and “Mortality” mediated by the Boolean operator “AND”. After evaluating and synthesizing the articles, the data were analyzed using the IRaMuTeQsoftware, a program that is anchored in the R software.Results:After analyzing the identification of textual domains and interpretation, 4 classes emerged: 1) The importance of tests for the control and good prognosis of infection in the elderly; 2) Predictors related to high mortality in the elderly; 3) Comorbidities associated with a high mortality rate; 4) The reasons for the transmission of the virus are more worrying in the elderly.Conclusion: The elderly population presents different risks for mortality, an example of physiological changes such as immune senescence, critical, social and psychological factors and the presence of comorbidities

Relationship of Age, Body Mass Index, Bone Density, and Menopause Duration with Alveolar Bone Resorption in Postmenopausal Women

Objective: To analyze the relationship between age, body mass index (BMI), bone mineral density (BMD), and alveolar bone resorption with menopause duration in postmenopausal women. Material and Methods: A cross-sectional study was developed involving 59 subjects, aged 45 to 80 years and categorized the duration of menopause as ≤5 years and >5 years. Body mass index measurement and menopause duration were collected. Bone loss seen on radiography was measured by drawing a vertical line from the cementoenamel in the distal part of the 36 teeth and the mesial portion of 46 teeth to the base of the bone marked by the lamina dura intact. Categorical determinations of age, BMI, BMD, and alveolar bone resorption were based on receiver operating characteristic (ROC) curves. Were used Pearson correlation and Spearman correlation tests with the significance level set at 5%. Results: The majority of subjects (54.2%) with menopause duration >5 years were aged >54.5 years, most had BMI >24.2 kg/m2 (39%), had bone resorption >2.95 mm (52.5%), and had bone density ≤73.89 (49.2%). Pearson and Spearman correlation tests showed no significant correlation between age, BMI, bone density, and alveolar bone resorption (p>0.05). Conclusion: The longer the duration of menopause showed a tendency for lower bone density and higher age, BMI, and bone resorption.

Differences in Periodontal Severity Between Perimenopausal and Postmenopausal Women with Chronic Periodontitis

Abstract Objective: To analyze the differences in periodontal severity between perimenopausal and postmenopausal women with chronic periodontitis. Material and Methods: A cross-sectional study with 63 subjects, comprising 27 perimenopausal and 36 postmenopausal women, aged 45-59 years, was conducted in East Jakarta. The women were interviewed regarding their perimenopausal and postmenopausal status; they underwent a periodontal examination for periodontal pockets, attachment loss, gingival recession, plaque index, debris index, calculus index, oral hygiene index, papilla bleeding index, and tooth mobility. Independent T-test and Mann-Whitney U test were used for bivariate analysis Results: There were significant differences (p<0.05) in age between perimenopausal and postmenopausal women (p=0.01); however, no significant differences (p>0.05) in gingival recession (p=0.33) or tooth mobility (p=0.84) were observed. Independent t-test revealed no significant differences in pocket depth (p=0.95), attachment loss (p=0.71), plaque index (p=0.89), debris index (p=0.52), calculus index (p=0.46), oral hygiene index (p=0.48), or papilla bleeding index (p=0.63) between perimenopausal and postmenopausal women Conclusion: There was no difference in periodontal severity between perimenopausal and postmenopausal women; however, the current study obtained valuable information regarding periodontal severity in perimenopausal and postmenopausal women.

Avaliação pré e pós-operatória do efeito da cirurgia reparadora na qualidade de vida e da autoestima do paciente: um estudo prospectivo envolvendo 52 pacientes / Pre- and postoperative evaluation of the effect of reconstructive surgery on patient quality of life and self-esteem: a prospective study of 52 patients

Introdução: As lesões de pele benignas e malignas podem afetar a qualidade de vida (QV) e a autoestima dos pacientes, tendo a cirurgia plástica reparadora im-portante papel nesses indivíduos. O objetivo é estudar o efeito da cirurgia plástica reparadora sobre a QV e a autoestima de pacientes. Métodos: Foi realizado um estudo quase-experimental (antes e de-pois). A QV foi medida pelo questioná-rio SF-36. Para a medida da autoestima, foi utilizada a escala de autoestima de Rosemberg. Alterações nos escores de ambos os instrumentos foram medidas antes e após o procedimento cirúrgico e a significância estatística da diferença foi avaliada pelo teste t. A proporção de indivíduos com aumento de escore de QV e autoestima, segundo as categorias de variáveis sociodemográficas, caracte-rísticas da lesão ou da doença, classifica-ção do tratamento cirúrgico e eventos estressantes, foi medida, e a significância estatística foi avaliada pelo teste do Qui-quadrado. Resultados: Foram entrevis-tados 52 pacientes. Após a intervenção cirúrgica, houve melhora significativa no escore de QV na maioria dos domínios de SF-36 (aspectos emocionais, físicos, sociais, dor, estado geral de saúde e saú-de mental) e melhora na escala de autoes-tima de Rosemberg. Os fatores associa-dos a maior probabilidade de melhora na QV e autoestima após a cirurgia foram idade igual ou superior a 60 anos, cor de pele branca, maior escolaridade, ocorrên-cia de evento estressante e tipo maligno de neoplasia. Conclusões: A cirurgia reparadora teve um impacto positivo em vários domínios de QV e autoestima, mostrando outras melhorias na saúde do paciente, além dos benefícios clínicos.

Introduction: Benign and malignant skin lesions can affect patients' quality of life and self-esteem; thus, reconstructive plastic surgery is important for these individuals. The objective is to assess the effect of reconstructive plastic surgery on the quality of life (QoL) and self-esteem in patients with benign or malignant skin lesions. Methods: This quasi-experimental "prepost study" measured QoL using the 36-Item Short Form Health Survey (SF-36) questionnaire. For the measure of self-esteem, the Rosenberg Self-Esteem Scale was used. The changes in scores of both instruments were measured before and after surgery, and the statistical significance of the difference was evaluated using a paired sample t test. The proportion of individuals with an increased QoL score and self-esteem according to sociodemographic variables, lesion or disease characteristics, surgical treatment classification, and stressful events was measured, whereas the statistical significance was assessed using the chi-square test. Results: Fifty-two patients were interviewed. After the surgical intervention, significant improvement in QoL score in most SF-36 domains (emotional, physical, social, pain, general health, and mental health aspects) and improvement in the Rosenberg Self-Esteem Scale score were noted. The factors associated with a higher probability of improvements in QoL and self-esteem after surgery were age ≥60 years, white skin color, higher education level, occurrence of a stressful event, and malignant neoplasia. Conclusions: Reconstructive surgery positively affected several domains of QoL and self-esteem, showing other improvements in patient health beyond its technical and clinical benefits.

Disponibilidade de recursos dos serviços ambulatoriais do Sistema Único de Saúde destinados a pessoas vivendo com HIV em Mato Grosso, 2016 / La disponibilidad de recursos de los servicios ambulatorios del Sistema Único de Salud que asisten a las personas que viven con HIV en Mato Grosso, Brasil, 2016 / Availability of resources in Brazilian National Health System outpatient services for people living with HIV in Mato Grosso, Brazil, 2016

Objetivo: avaliar a disponibilidade de recursos dos serviços ambulatoriais do Sistema Único de Saúde (SUS) destinados a pessoas vivendo com HIV no estado de Mato Grosso, Brasil. Métodos: trata-se de estudo avaliativo com delineamento transversal descritivo realizado em 2016; os dados foram coletados mediante aplicação do Sistema de Avaliação da Qualidade de Serviços de HIV em todos os 15 serviços ambulatoriais existentes, analisados por frequência das respostas. Resultados: cinco dos 15 serviços possuiam número suficiente de médicos; os antirretrovirais faltaram por mais de sete dias em metade dos serviços; outros medicamentos para infecções sexualmente transmissíveis, infecções oportunistas, hepatites B e C e distúrbio metabólico estavam disponíveis em menos de 1/3 dos serviços nos prazos preconizados. Conclusão: constatou-se deficiência de recursos nos serviços ambulatoriais do SUS destinados a pessoas vivendo com HIV em Mato Grosso, principalmente quanto à disponibilidade de profissionais e medicamentos.

Objetivo: evaluar la disponibilidad de recursos de los servicios ambulatorios del Sistema Único de Salud (SUS) destinados a personas viviendo con VIH en el estado de Mato Grosso, Brasil. Métodos: se trata de estudio evaluativo con delineamiento transversal descriptivo realizado en 2016; los datos fueron colectados mediante la aplicación del Sistema de Evaluación de la Calidad de Servicios de VIH en los 15 servicios ambulatorios existentes. Resultados: cinco de los 15 servicios poseían suficiente número de médicos; los antirretrovirales faltaron por más de siete días en la mitad de los servicios; otros medicamentos para infecciones sexualmente transmisibles, infecciones oportunistas, Hepatitis B y C y trastorno metabólico estaban disponibles en menos de 1/3 de los servicios en los plazos preconizados. Conclusión: se constató deficiencia de recursos en los servicios destinados a personas viviendo con VIH en Mato Grosso, principalmente en cuanto a la disponibilidad de profesionales y medicamentos.

Objective: to evaluate the availability of Brazilian National Health System (SUS) outpatient services for people living with HIV in Mato Grosso state, Brazil. Methods: this is an evaluative study with descriptive cross-sectional design carried out in 2016; data were collected via the HIV Services Quality Assessment System in all 15 outpatient services; data were analyzed by frequency of answers. Results: five of the 15 services had a sufficient number of physicians; antirretroviral drugs were out of stock for more than seven days in half of the services; other medications for sexually transmitted infections, opportunistic infections, Hepatitis B and C, and metabolic disorders were available in less than 1/3 of the services within the recommended timeframe. Conclusion: resources were found to be deficient in services for people living with HIV in Mato Grosso, mainly regarding the availability of professionals and drugs.

Emergency management of upper GI variceal bleeding

Background: Upper gastrointestinal bleeding is the most common gastrointestinal cause of admission in emergency departments worldwide with about 10% inpatient mortality rate that has not decreased during the last three decades

Aim: In this review, we aim to study the pathophysiology behind the development of upper gastrointestinal bleeding, and explore the approach to its management in emergency situation

Materials and Methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 2001, through February 2017. The following search terms were used: upper gastro intestinal bleeding, variceal bleeding, emergency management of gastrointestinal hemorrhage, varices, esophageal bleeding

Results: Managing patients with bleeding varices must have two goals that should be considered: to stop the bleeding, and to prevent rebleeding since 60% of patients will rebleed after the acute bleeding was stopped leading to a mortality rate of 33%, unless adequately treated

Conclusion: Bleeding varices are always considered urgent emergencies due to associated morbidity and mortality. Moreover, bleeding varices can cause hemodynamic instability and end-organ failure. The most important intervention is therapeutic endoscopy. Other approaches include vasoactive drugs, and prophylactic antibiotics. After acute management of the bleeding, patients should undergo further evaluation and treatment to prevent the recurrence of another bleeding

General background and attitude of the Saudi population towards mental illness

Mental illnesses or psychiatric disorders are very common worldwide although, a lot of patients might go undiagnosed and untreated due to the stigma towards mental illness that drives the patients away from seeking medical help

Aim of the work: this study aimed to evaluate the background and attitude of the general population throughout Saudi Arabia about mental illnesses

Method: a cross sectional study analyzed data from 5850 participants aged 18 and up. From all 13 districts of Saudi Arabia. The data were collected using self-administered anonymous electronically distributed questionnaire, between the months of April- May of 2017. The data were analyzed using the statistical analysis system [SAS version 9.1; SAS Institute, Cary, NC]. Crude associations were assessed using Pearson Chi -square test. P value of less than 0.05 was used to indicate statistically significant differences

Result: the mean age of the studied subjects was 28.7 +/- 9.8 years. Subject's background about the general nature of psychiatric disorders was high and exceeding 90% regarding the nature of psychiatric disorders and whether they were similar or not, a very low percent [7%] showed that psychiatric patients cannot socially adapt, while 96.9% believed that psychiatric patients were considered insane. [52%] believed psychiatrists are affected by their patients on long term exposure

Conclusion: he background of Saudi population regarding mental illnesses is considered fair, the attitude towards psychiatric patients need further education to minimize the stigma towards them

Características de la infección por Clostridium difficile en una institución de alta complejidad y reporte de la circulación en Colombia de la cepa hipervirulenta NAP1/027 / Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia

Resumen Introducción. Clostridium difficile es el principal responsable de la diarrea asociada al uso de antibióticos. En Colombia y en Latinoamérica, el conocimiento sobre el comportamiento epidemiológico de la infección por C. difficile todavía es limitado. Objetivo. Describir las características de una serie de pacientes con infección por C.difficile . Materiales y métodos. Se hizo un estudio descriptivo de una serie de casos de pacientes con infección por C. difficile atendidos en la Fundación Clínica Shaio, entre enero de 2012 y noviembre de 2015. Resultados. Se estudiaron 36 pacientes con una edad promedio de 65 años. Se determinaron los siguientes factores relacionados con la infección por C. difficile: uso previo de antimicrobianos (94,4 %), hospitalización en los últimos tres meses (66,7 %) y uso de inhibidores de la bomba de protones (50 %). Las comorbilidades más comunes fueron la enfermedad renal crónica (41,7 %) y la diabetes mellitus (30,6 %). Los síntomas más frecuentes fueron más de tres deposiciones diarreicas (97,1 %) y dolor abdominal (42,9 %). En cuanto a la gravedad de los casos, 44,4 % se clasificó como leve a moderado, 38,9 % como grave, y 11,1 % como complicado o grave. El método de diagnóstico más utilizado (63,8% de los pacientes) fue la identificación de la toxina mediante reacción en cadena de la polimerasa (PCR). La mortalidad global durante la hospitalización fue de 8 %. Se identificaron cuatro cepas del serotipo NAP1/027 y nueve muestras fueron positivas para la toxina binaria. Conclusión. La infección por C. difficile debe sospecharse en pacientes con deposiciones diarreicas y factores asociados tradicionalmente a esta enfermedad. Se reportó la circulación de cepas hipervirulentas del serotipo NAP1/027 en Colombia, lo cual debe enfrentarse con la vigilancia epidemiológica y el diagnóstico temprano.

Abstract Introduction: Clostridium difficile is the main pathogen related to healthcare-associated diarrhea and it is the cause of 20 to 30% of diarrhea cases caused by antibiotics. In Colombia and Latin America, the knowledge about the epidemiological behavior of this infection is limited. Objective: To describe the characteristics of a series of patients with C. difficile infection. Materials and methods: We performed a descriptive case series study of patients with C. difficile infection hospitalized in the Fundación Clínica Shaio from January, 2012, to November, 2015. Results: We analyzed 36 patients. The average age was 65 years. The risk factors associated with the infection were: previous use of antibiotics (94.4%), prior hospitalization in the last three months (66.7%) and use of proton pump inhibitors (50%). The most common comorbidities were chronic kidney disease (41.7%) and diabetes mellitus (30.6%). The most frequent symptoms were more than three loose stools per day (97.1%) and abdominal pain (42.9%). According to the severity of the disease, 44.4% of cases were classified as mild to moderate, 38.9% as severe, and 11.1% as complicated or severe. The detection of the toxin by PCR (GeneXpert) was the most common diagnostic procedure (63.8%). Global mortality during hospitalization was 8%. We identified four strains with serotype NAP1/027 and nine samples positive for binary toxin. Conclusion: Clostridium difficile infection should be suspected in patients with diarrhea and traditional risk factors associated with this disease. We report the circulation of the hypervirulent strain serotype NAP1/027 in Colombia, which should be countered with epidemiological surveillance and a prompt diagnosis.

ASSESSMENT OF FEMALE SEXUAL FUNCTION AND QUALITY OF LIFE AMONG BREAST CANCER SURVIVORS WHO UNDERWENT HORMONE THERAPY / Avaliação da função sexual e da qualidade de vida de mulheres sobreviventes do câncer de mama submetidas a hormonioterapia

Objective: The aim of this study was to investigate the sexual function and quality of life of breast cancer survival women. Methods: This is a cross-sectional study including 36 women who underwent breast cancer surgery (17 mastectomies and 19 quadrantectomies), sexually active, undergoing hormone therapy, aged 37 to 60 years old. Data were collected through the Female Sexual Function Index (FSFI) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: In this study, 61.1% of the women had sexual dysfunction. Regarding quality of life, younger women were more impacted in their functional capacity (p=0,049). Conclusion: The prevalence of sexual dysfunction is higher in breast cancer survival women, with hypoactive desire and dyspareunia. Regarding quality of life, greater impairment of functional capacity was observed in young women.

Objetivo: O intuito deste trabalho foi investigar a função sexual e a qualidade de vida das mulheres sobreviventes do câncer de mama. Métodos: Trata-se de um estudo de corte transversal, incluindo 36 mulheres submetidas à cirurgia de câncer de mama (17 mastectomias e 19 quadrantectomias), sexualmente ativas, em tratamento hormonioterápico, com idade entre 37 e 60 anos. O instrumento utilizado para avaliar a função sexual foi o Female Sexual Function Index (FSFI) e, para a qualidade de vida, o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Resultados: Neste estudo, 61,1% das mulheres apresentaram disfunção sexual. Em relação à qualidade de vida, mulheres mais jovens foram mais impactadas em sua capacidade funcional (p=0,049). Conclusão: A prevalência de disfunção sexual é elevada nas mulheres sobreviventes do câncer de mama, destacando-se o desejo hipoativo e a dispareunia. Em relação à qualidade de vida, foi observado mais prejuízo da capacidade funcional nas mulheres jovens.