Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Comparaison de deux équations de référence pour le diagnostic des anomalies spirométriques à Cotonou / NA

Introduction : L'interprétation de la spirométrie se base sur des équations de référence, prenant en compte l'âge, le sexe, la taille et la race. Au CNHU-PPC, deux équations ont été utilisées ces dernières années : celles de l'American Thoracic Society/European Respiratory Society "ATS/ERS" (publiées en 1983, actualisées en 1993), et celles du Global Lung Initiative (GLI) 2012, désormais recommandées par plusieurs sociétés savantes. Notre étude visait à comparer les interprétations de spirométries basées sur ces équations. Matériel et méthodes : Nous avons mené une étude rétrospective descriptive, avec recrutement exhaustif des spirométries réalisées au CNHU-PPC du 1er Janvier 2018 au 31 Mars 2020. Les données recueillies furent analysées avec le logiciel R. Le coefficient Kappa a été calculé pour apprécier la performance des équations ATS/ERS par rapport au GLI 2012. Pour tous les tests statistiques, la différence était statistiquement significative pour une p-value inférieure à 0,05. Résultats : Les 955 spirométries recensées concernaient une population majoritairement féminine (sex-ratio=0,7) et jeune (âge moyen=44±20 ans). Il y avait plus de spirométries normales selon les équations ATS/ERS (53,6%, versus 53,0% selon GLI 2012 ; Kappa=0,71). Un TVO était objectivé dans 18,6% des cas selon l'ATS/ERS (versus 18,0% selon GLI 2012, Kappa=0,90). Il y avait moins de TVR selon l'ATS/ERS (21,3%, versus 29 % selon GLI 2012 ; Kappa=0,72), et moins de TVM selon l'ATS/ERS (5,3%, versus 6,6% selon GLI 2012 ; Kappa=0,79). Les proportions d'asthmatiques étaient identiques (12,3%). Les équations ATS/ERS ont objectivé moins de BPCO et de maladies restrictives (respectivement 4,6% et 21,3%) que le GLI 2012 (respectivement 5,8% avec Kappa=0,74, et 29% avec Kappa =0,72). Conclusion : Les équations ATS/ERS objectivent moins d'anomalies spirométriques que celles du GLI 2012 au CNHU-PPC. Des études ultérieures s'imposent pour intégrer les valeurs de référence béninoises au GLI 2012, actuellement récommandées pour l'interprétation de la spirométrie

Introduction: Spirometry's interpretation is based on reference equations, taking into account age, sex, height and race. At the CNHU-PPC, two equations have been used in recent years: those of the American Thoracic Society / European Respiratory Society "ATS/ERS"(published in 1983, updated in 1993), and more recently, those of the Global Lung Initiative (GLI) 2012, now recommended by several learned societies. Objectives: Our study aimed to compare interpretations of spirometry based on these equations. Material and methods: We carried out a descriptive retrospective study, with exhaustive recruitment of the spirometry done at the CNHU-PPC from January 1, 2018, to March 31, 2020. The data collected were analyzed with the software R. The Kappa coefficient was calculated to assess the performance of the ATS/ERS equations compared to GLI 2012. Results: The 955 spirometries recorded concerned a predominantly female (sex ratio=0.7) and young (mean age=44±20 years) population. There was more normal spirometry according to the ATS/ERS (53.6%, vs 53.0% according to GLI 2012; Kappa=0.71). An obstructive ventilatory disorder was objectified in 18.6% of cases according to ATS/ERS (vs 18.0% for GLI 2012, Kappa=0.90). There was less restrictive ventilation disorder according to ATS/ERS (21.3%, vs 29% for GLI 2012; Kappa=0.72), and less mixed ventilatory disorder according to ATS/ERS (5.3%, vs 6.6% for GLI 2012; Kappa=0.79). The proportions of asthma patients were identical (12.3%). ATS/ERS objectified less COPD and restrictive diseases (respectively 4.6% and 21.3%) than GLI 2012 (respectively 5.8% with Kappa=0.74, and 29% with Kappa=0.72).

Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.

Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.

Morphophysiological changes of Acca sellowiana (Myrtaceae: Myrtoideae) saplings under shade gradient

Abstract Understanding morphological and physiological changes under different light conditions in native fruit species in juveniles stage is important, as it indicate the appropriate environment to achieve vigorous saplings. We aimed to verify growth and morphophysiological changes under shade gradient in feijoa (Acca sellowiana (O. Berg) Burret) to achieve good quality saplings adequate to improve cultivation in orchards. The saplings were grown for twenty-one-month under four shading treatments (0%, 30%, 50%, and 80%). Growth, photosynthetic pigments, gas exchanges, chlorophyll fluorescence, and leaf anatomy parameters were evaluated. Saplings under full sun and 30% shade had higher height and diameter growth and dry mass accumulation due to higher photosynthesis rate. As main acclimatization mechanisms in feijoa saplings under 80% shade were developed larger leaf area, reduced leaf blade thickness, and enhanced quantum yield of photosystem II. Even so, the net CO2 assimilation and the electron transport rate was lower and, consequently, there was a restriction on the growth and dry mass in saplings under deep shade. Therefore, to obtain higher quality feijoa saplings, we recommend that it be carried out in full sun or up to 30% shade, to maximize the sapling vigor in nurseries and, later, this light environment can also be used in orchards for favor growth and fruit production.

Resumo A verificação de mudanças morfológicas e fisiológicas sob diferentes condições luminosas em espécies frutíferas nativas em estágio juvenil é importante, uma vez que indicam o ambiente adequado para a formação de mudas com alto vigor. Objetivou-se verificar o crescimento e as alterações morfofisiológicas sob gradiente de sombreamento em mudas de feijoa (Acca sellowiana (O. Berg) Burret) para obter mudas de boa qualidade, adequadas para fomentar os plantios da espécie em pomares. As mudas foram cultivadas por vinte e um meses sob quatro tratamentos de sombreamento (0%, 30%, 50% e 80%). Foram avaliados parâmetros de crescimento, pigmentos fotossintéticos, trocas gasosas, fluorescência da clorofila e anatomia foliar. Mudas a pleno sol e 30% de sombra apresentaram maior crescimento em altura, diâmetro e acúmulo de massa seca, devido à maior taxa de fotossíntese. Como principais mecanismos de aclimatação sob 80% de sombra, as mudas desenvolveram maior área foliar, redução da espessura do limbo foliar e aumento do rendimento quântico do fotossistema II. Mesmo assim, a assimilação líquida de CO2 e a taxa de transporte de elétrons foram menores e, consequentemente, houve restrição ao crescimento e acúmulo de massa seca das mudas no maior nível de sombreamento. Portanto, para a obtenção de mudas de feijoa de maior qualidade, recomendamos que seja realizada a pleno sol ou até 30% de sombra, para maximizar o vigor das mudas em viveiros e, posteriormente, este ambiente de luz também pode ser utilizado em pomares para favorecer o crescimento e a produção de frutos.

Quality of life of women from a quilombola community in northeastern Brazil

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil / Características microbiológicas de infecções da corrente sanguínea em hospital de referência no nordeste do Brasil

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.

Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.

Morphophysiological changes of Acca sellowiana (Myrtaceae: Myrtoideae) saplings under shade gradient / Alterações morfofisiológicas em mudas de Acca sellowiana (Myrtaceae: Myrtoideae) sob gradiente de sombreamento

Abstract Understanding morphological and physiological changes under different light conditions in native fruit species in juveniles' stage is important, as it indicate the appropriate environment to achieve vigorous saplings. We aimed to verify growth and morphophysiological changes under shade gradient in feijoa (Acca sellowiana (O. Berg) Burret) to achieve good quality saplings adequate to improve cultivation in orchards. The saplings were grown for twenty-one-month under four shading treatments (0%, 30%, 50%, and 80%). Growth, photosynthetic pigments, gas exchanges, chlorophyll fluorescence, and leaf anatomy parameters were evaluated. Saplings under full sun and 30% shade had higher height and diameter growth and dry mass accumulation due to higher photosynthesis rate. As main acclimatization mechanisms in feijoa saplings under 80% shade were developed larger leaf area, reduced leaf blade thickness, and enhanced quantum yield of photosystem II. Even so, the net CO2 assimilation and the electron transport rate was lower and, consequently, there was a restriction on the growth and dry mass in saplings under deep shade. Therefore, to obtain higher quality feijoa saplings, we recommend that it be carried out in full sun or up to 30% shade, to maximize the sapling vigor in nurseries and, later, this light environment can also be used in orchards for favor growth and fruit production.

Resumo A verificação de mudanças morfológicas e fisiológicas sob diferentes condições luminosas em espécies frutíferas nativas em estágio juvenil é importante, uma vez que indicam o ambiente adequado para a formação de mudas com alto vigor. Objetivou-se verificar o crescimento e as alterações morfofisiológicas sob gradiente de sombreamento em mudas de feijoa (Acca sellowiana (O. Berg) Burret) para obter mudas de boa qualidade, adequadas para fomentar os plantios da espécie em pomares. As mudas foram cultivadas por vinte e um meses sob quatro tratamentos de sombreamento (0%, 30%, 50% e 80%). Foram avaliados parâmetros de crescimento, pigmentos fotossintéticos, trocas gasosas, fluorescência da clorofila e anatomia foliar. Mudas a pleno sol e 30% de sombra apresentaram maior crescimento em altura, diâmetro e acúmulo de massa seca, devido à maior taxa de fotossíntese. Como principais mecanismos de aclimatação sob 80% de sombra, as mudas desenvolveram maior área foliar, redução da espessura do limbo foliar e aumento do rendimento quântico do fotossistema II. Mesmo assim, a assimilação líquida de CO2 e a taxa de transporte de elétrons foram menores e, consequentemente, houve restrição ao crescimento e acúmulo de massa seca das mudas no maior nível de sombreamento. Portanto, para a obtenção de mudas de feijoa de maior qualidade, recomendamos que seja realizada a pleno sol ou até 30% de sombra, para maximizar o vigor das mudas em viveiros e, posteriormente, este ambiente de luz também pode ser utilizado em pomares para favorecer o crescimento e a produção de frutos.

Quality of life of women from a quilombola community in northeastern Brazil / Qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire - bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL - bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

COMPARATIVE ANALYSIS OF HAEMATOLOGICAL PARAMETERS AMONG INFREQUENT AND REGULAR REPEAT WHOLE BLOOD DONORS IN A TERTIARY CARE CENTRE-A PILOT STUDY

Blood transfusion service is a vital part of our health care system. Stringent blood donor screening and medical examination plays a vital role in maintaining the quality and safety of blood components. Voluntary non-remunerated blood donors form the backbone of blood transfusion services. However, regular donation by such voluntary donors may cause significant depletion of iron stores in the body. This has the potential to adversely affect the donor's health, and also to lower the quality of blood being collected subsequently. Even though a pre-donation hemoglobin estimation is routinely done in blood centres, it may fail to recognize subclinical iron store depletion. Testing Ferritin level of all donors is not cost effective and practical in resource limited centres. This study was aimed to identify any significant changes in hematological parameters over repeated blood donations, that may point towards a potential Iron deficiency in an otherwise healthy donor. This was a cross sectional study involving 138 whole blood donors who had attended the blood centre, Department of Transfusion Medicine, Government Medical college, Thiruvananthapuram. The study subjects were categorized into 2 groups based on the number of donations and a Complete blood count (CBC) was done for each group. Data was analyzed using SPSS software, quantitative variables expressed as Mean and Standard Deviation, p value <0.05 was considered statistically significant. Results were analysed by Independent Samples T test. Statistically significant variables were further analysed using Kruskal-Wallis test. Second time blood donors constituted major part of sample size (20/138). Mean Hemoglobin value showed no significant change among the two donor categories. Mean corpuscular volume (MCV) of repeat whole blood donors is significantly lower than infrequent donors independent samples T test, tvalue=3.309. (p-value=0.001). Donors were further subdivided into 5 groups in the order of increasing number of donations and significant difference was observed in MCV and proved by Kruskal-Wallis test(H=19.1344) As per our study, a significant reduction in MCV among repeat donors with a normal hemoglobin value compared to infrequent donors. This might point towards an impending Iron deficiency anemia in near future. A prompt detection of subclinical iron deficiency in voluntary blood donors is the need of the hour since it can cause adverse consequences in donor health and can considerably lower the donor availability as well. Blood centres should take measures like routine Iron stores evaluation of regular repeat donors, educating donors regarding the importance of maintaing a healthy diet, Iron tablet supplementation to prevent donor Iron deficiency anemia (IDA) etc.

Enumeration of Salmonella Species Isolated in Ready–to–Eat Fruits Vended in Bukuru Market, Jos South, Plateau State

Background: Despite control measures to curtailed salmonella fruit contamination over the years, pathogenic disease outbreaks caused by the ingestion of Salmonella contaminated fresh-cut-fruits pose a significant problem to human health by the consumption of fresh and minimally processed fruits. This study aimed to enumerate and determine the prevalence of Salmonella species isolated in ready-to-eat fruits vended in Bukuru Market Jos South, Plateau state. Methodology: A total of seventy-eight ready-to-eat vended fruit samples were purchased and cultured for the enumeration of bacterial isolates according to National Food Safety Standard for Microbiological Examination. Pulp pH value of each fruit was obtained by immersing litmus paper into the pulp and results recorded. Results: Of the 78 fruits specimen, 22 (28.2%) were Salmonella positive. The prevalence rates of salmonella isolated were found to be higher (22.7%) in both coconut and avocado followed by watermelon (18.2%) and sweetmelon (13.6%) as compared with other fruits in the study area. Lower rates of 4.5% were found in banana, pawpaw, and dates with a rise in apple with 9.1% respectively. Conclusion: The study showed a high p<0.05 (7.811) prevalence of pathogenic Salmonella species isolated in ready-to-eat fruits in the study area revealing that the spread of salmonella is not independent of fruits thereby suggestive of contamination made available by fruit vendors in this part of the world. Thus, epidemiological traceability and significant measures must be taken to check the safety of these vended products before consumption.

An Update on the Pharmacological Aspects of Vaccines and Antivirals for the Management of Monkeypox

Monkeypox is a self-limiting zoonotic disease caused by the monkeypox virus belonging to the genus of orthopox viruses. Initially considered an ‘African disease’, this infection has crossed the boundaries to affect other continents and it has raised tremendous concerns among the general public as well as the medical fraternity all over the world, particularly because of the lack of specific vaccinations and drugs for the management of the illness. Epidemiological evaluation of the current infection has reported that it is mainly transmitted through sexual contact in bisexual men, mostly whites, and in those with pre-existing human immunodeficiency virus infection. The most common presentations were skin rash, anogenital lesions, or mucosal lesions along with systemic symptoms. It has been established that the vaccines and drugs approved for the management of smallpox could be used for the management of the current monkeypox outbreak. Vaccinia Immune Globulin (VIG) and vaccines like JYNNEOS and ACAM2000 and antiviral drugs like tecovirimat, cidofovir (CDV), and brincidofovir are being considered for those patients with serious diseases. It is imperative for physicians to understand the pharmacological aspects of these drugs for delivering better care to patients with monkeypox, which is eventually essential for the containment of this infection. This review covers updates on vaccines as well as drugs for the prevention and management of monkeypox.

Proposal for Educational Intervention in People Living with Type 2 Diabetes Mellitus and in their Family Caregiver

Objective: Design a proposal of educational intervention for both, people who live with Diabetes Mellitus type 2 and their family caregiver. Methodology: Methodology. A case series study was conducted with the participation of 12 people living with type 2 diabetes mellitus and attending a Mutual Help Group in Pachuquilla, Hidalgo. Sociodemographic data, somatometric measurements (weight, height, BMI, waist circumference), blood pressure, and capillary blood samples for glycosylated hemoglobin were collected. Results: The mean age was 64 and range of 39-79 years, O.D. of 12; 67% women; 25% finished secondary school, 50% worked at home, 17% in commerce, 33% unemployed; 58% married, 25% widowed, and 17% divorced and in common law; 33.% with less than 5 years diagnosed, 67% have been diagnosed for more than 5 years; 75% depend economically; 67% have complications, 75% with family support, in diabetes knowledge 33% obtained intermediate score and 67% inadequate score; the weight average was of 77 kg and range of 57-116.5 kg, and O.D. 17 kg; in waist circumference, 100% exceed the recommended limit, in BMI, 50% is classified as overweight and 50% as obese; in blood pressure 50% > 130/80 mmHg and in glycosylated hemoglobin 75% > 7% mg/dl. Conclusion: The currently implemented strategy does not reflect good knowledge and control of the disease. This study invites us to continue with research where an educational intervention is implemented in which family caregivers are included and active participation is encouraged, in addition to implementing the IEP as a theoretical basis for the intervention.

Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.

Extract of Cimicifuga racemosa (L.) Nutt protects ovarian follicle reserve of mice against in vitro deleterious effects of dexamethasone

The present study aims to investigate if Cimicifuga racemosa (L.) Nutt extract (CIMI) reduces deleterious effects of dexamethasone (DEXA) in ovaries cultured in vitro. Mouse ovaries were collected and cultured in DMEM+ only or supplemented with 5 ng/mL of CIMI, or 4 ng/mL DEXA, or both CIMI and DEXA. The ovaries were cultured at 37.5°C in 5% CO2 for 6 days. Ovarian morphology, follicular ultrastructure, and the levels of mRNA for Bax, Bcl-2, and Caspase-3 were evaluated. The results showed that DEXA reduced the percentage of morphologically normal follicles, while CIMI prevented the deleterious effects caused by DEXA. In addition, DEXA negatively affected the stromal cellular density, while CIMI prevented these adverse effects. Ovaries cultured with DEXA and CIMI showed similar levels of mRNA for Bax, Bcl-2, and Caspase-3 compared to those cultured in control medium, while ovaries cultured with DEXA had increased expression of the above genes. Additionally, the ultrastructure of the ovaries cultured with CIMI was well preserved. Thus, the extract of CIMI was able to prevent the deleterious effects caused by DEXA on cultured mouse ovaries.

Alignment efficiency and three-dimensional assessment of root resorption after alignment with conventional and copper-nickel-titanium archwires: A randomized controlled trial

ABSTRACT Objective: To compare alignment efficiency and root resorption between nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) archwires after complete alignment in mandibular anterior region. Methods: In this two-arm parallel single-blind randomized controlled trial, forty-four patients with Class I malocclusion with mandibular anterior crowding were recruited form orthodontic clinic of All India Institute of Medical Sciences (Jodhpur, India). Patients were randomly allocated into NiTi and CuNiTi groups, with a 1:1 allocation. Alignment was performed using 0.014-in, 0.016-in, 0.018-in, 0.019x0.025-in archwire sequence in the respective groups, which terminated in 0.019 x 0.025-in stainless-steel working archwire. The primary outcome was alignment efficiency, measured on study models from baseline (T0) to the first, second, third, fourth and fifth-month (T5). Secondary outcome was root resorption, measured from CBCT scans taken at T0 and T5. Mixed-factorial ANOVA was used to compare Little's Irregularity Index (LII). For assessing the proportion of patients with complete alignment at the end of each month, Kaplan-Meier survival curve was built and time to treatment completion was compared between groups using log rank test. Paired t-test was used to assess external apical root resorption (EARR) within groups, whereas independent t-test was used to evaluate LII and EARR between the groups. Results: Twenty-two patients were recruited in each group. One patient was lost to follow-up in the CuNiTi group. No statistically significant differences were observed in alignment efficiency between the groups (p>0.05). Intergroup comparison revealed that the changes in root measurement in three-dimensions were not statistically significant (p>0.05), except for mandibular right central incisor, which showed increased resorption at root apex in NiTi group (p<0.01). Conclusion: The two alignment archwires showed similar rate of alignment at all time points. Root resorption measurement did not differ between the NiTi and CuNiTi groups, except for the mandibular right central incisor, which showed more resorption in NiTi group.

RESUMO Objetivo: Comparar os fios de níquel-titânio (NiTi) e de cobre-níquel-titânio (CuNiTi) quanto à eficiência do alinhamento e quantidade de reabsorção radicular, após alinhamento completo dos dentes da região anterior inferior. Métodos: Neste estudo clínico randomizado, cego, paralelo, de dois braços, quarenta e quatro pacientes com má oclusão Classe I e apinhamento anterior inferior foram recrutados na clínica ortodôntica do All India Institute of Medical Sciences (Jodhpur, India). Os pacientes foram alocados aleatoriamente nos grupos NiTi e CuNiTi, na proporção de 1:1. O alinhamento foi realizado usando a sequência de fios 0,014", 0,016", 0,018" e 0,019" x 0,025" nos respectivos grupos, finalizando com o arco de trabalho 0,019" x 0,025" de aço inoxidável. O desfecho primário foi a eficiência do alinhamento, medida nos modelos de estudo nos tempos inicial (T0) e após um, dois, três, quatro e cinco meses (T5). O desfecho secundário foi a reabsorção radicular, medida a partir de tomografias computadorizadas realizadas em T0 e T5. ANOVA fatorial mista foi utilizada para comparar o Índice de Irregularidade de Little (IIL). Para avaliar a proporção de pacientes com alinhamento completo ao fim de cada mês, foi construída uma curva de sobrevida pelo método de Kaplan-Meier, e o tempo até o fim do tratamento foi comparado entre os grupos por meio do teste log-rank. Um teste t pareado foi utilizado para avaliar a reabsorção radicular apical externa (RRAE) dentro dos grupos, enquanto um teste t independente foi utilizado para avaliar o IIL e a RRAE entre os grupos. Resultados: Vinte e dois pacientes foram recrutados em cada grupo. Um paciente perdeu o acompanhamento no grupo CuNiTi. Não foram observadas diferenças estatisticamente significativas entre os grupos quanto à eficiência do alinhamento (p>0,05). A comparação intergrupos revelou que as alterações na RRAE medida em três dimensões não foram estatisticamente significativas (p>0,05), exceto para o incisivo central inferior direito, que apresentou aumento da RRAE no grupo NiTi (p<0,01). Conclusão: Os dois tipos de fios de alinhamento apresentaram taxa de alinhamento semelhante em todos os momentos. A medida da reabsorção radicular não diferiu entre o grupo NiTi e CuNiTi, exceto para o incisivo central inferior direito, que apresentou maior reabsorção no grupo NiTi.

Is domestic polyester suitable for plastination of thin brain slices?

Plastination is a technique used to preserve biological tissues while retaining most of their original appearance. In the technique, developed by Dr. Gunther von Hagens in 1977, specimens were impregnated with a polymer, such as silicone, epoxy, or polyester. Considered the most suitable material for brain plastination, polyester has a wide application in teaching and research compared with imaging techniques. The materials for plastination are usually imported from Germany and more expensive than domestic products. If domestic polymers were to enter the market it would favor the expansion of plastination in Brazil. Hence, this study evaluated the feasibility of using domestic polyesters to replace the usual Biodur® (P40) in plastination of brain slices. For this evaluation, 2-mm-thick sections of bovine brains were prepared and plastinated with domestic polyester. Slices were compared before impregnation and after curing using standardized photographs taken after dehydration and after curing. Plastination followed the standard protocol: fixation, dehydration, forced impregnation, and curing. Fifteen brain slices were plastinated with each polyester (P40, P18, and C1-3). There was no significant difference in the percent shrinkage between groups after plastination of P18 and P40, but the curing time of Cristalan© polymer was too short for impregnation. Therefore, no initiator was used for C polymers impregnation. Thus, domestic polyester P18 was a viable option for the process.

Predictors of mortality in critically ill patients with COVID-19 and diabetes

The COVID-19 pandemic has challenged the entire world, and patients with diabetes mellitus (DM) have been particularly affected. We aimed to evaluate predictors of mortality during the first 30 days of hospitalization in critically ill patients with COVID-19 and comorbid DM. This prospective study included 110 critically ill patients admitted with COVID-19 infection. Thirty-two (29%) patients had a previous diagnosis of DM. Clinical variables, laboratory tests, and vascular biomarkers, such as VCAM-1, syndecan-1, ICAM-1, angiopoietin-1, and angiopoeitin-2, were evaluated after intensive care unit (ICU) admission. A comparison was made between patients with and without DM. No difference in mortality was observed between the groups (48.7 vs 46.9%, P=0.861). In the multivariate Cox regression analysis, VCAM-1 levels at ICU admission (HR: 1 [1-1.001], P<0.006) were associated with death in patients with DM. Among patients with DM, advanced age (HR 1.063 [1.031-1.096], P<0.001), increased Ang-2/Ang-1 ratio (HR: 4.515 [1.803-11.308] P=0.001), and need for dialysis (HR: 3.489 [1.409-8.642], P=0.007) were independent predictors of death. Higher levels of VCAM-1 in patients with DM was better at predicting death of patients with severe COVID-19 and comorbid DM, and their cut-off values were useful for stratifying patients with a worse prognosis. Vascular biomarkers VCAM-1 and Ang-2/Ang-1 ratio were predictors of death in patients with severe COVID-19 and comorbid DM and those without DM. Additionally, kidney injury was associated with an increased risk of death.

Psychometric Properties of The Malay Version of The Personal Wellbeing Index: A Preliminary Study Among Caregivers of Children with Autism Spectrum Disorder (Ciri-ciri Psikometrik Indeks Kesejahteraan Diri Versi Bahasa Melayu: Kajian Awal di Kalangan Penjaga Kanak-Kanak Autisme Spectrum Disorder) / Jurnal Sains Kesihatan Malaysia

@#Caregivers of children with Autism Spectrum Disorder (ASD) can have a compromised quality of life due to caregiving burden and parenting stress. The Personal Wellbeing Index (PWI) is one of the instruments that measure the subjective wellbeing dimension. This study intended to explore this instrument’s construct validity and reliability and compare the subjective wellbeing among caregivers based on sociodemographic characteristics. A cross-sectional study was conducted on 53 caregivers of children with ASD recruited from occupational therapy clinics at Hospital Canselor Tuanku Muhriz (HCTM) and the Faculty of Health Sciences, UKM. The PWI has one global life satisfaction construct (1 item) and subjective wellbeing (8 items). The rating scale is anchored from 0 (no satisfaction at all) to 10 (completely satisfied). The statistical analysis indicated that the Malay version of PWI has acceptable unidimensionality (outer loadings >0.5 for all items), convergence validity (Average Variance Extracted (AVE)=0.5781), constructs validity (r=0.812, p<0.001), and construct reliability (ρA=0.8864, ρc=0.9046, α=0.8761). Marital status is significant in achieving life and personal relationships while health issues are significant only in personal health. The Malay version has good construct validity and reliability and can measure the subjective wellbeing of the caregivers of children with autism in Malaysia. The psychometric properties of the PWI Malay version can be further established with a larger sample size. In the future, a national norm of Malaysians’ wellbeing could be developed to interpret their wellbeing level.

Indicators of Nurse Leadership in Disaster Management: A Qualitative study

@#Introduction: Nurses play critical roles in disaster management and are required to demonstrate leadership by dealing with disaster events effectively. This study aimed to identify the nurse leadership indicators at each phase of disaster management. Methods: A qualitative descriptive study was conducted in two phases between November 2017 -January 2018 at two regional hospitals and one central hospital in Yogyakarta. The first phase involved semi-structured in-depth interviews with seven emergency nurses, and the second was a focus group discussions with five nurses’ managers or lecturers. Participants were selected using a purposive sampling technique. Data Analyze used a modified version framework method. Results: We found 49 indicators of nurse leadership in disaster management. We grouped indicators into two major groups: common indicators (27 indicators) and specific indicators (22 indicators). Four themes were obtained according to the disaster management phases: nurse leadership in the mitigation phase, the preparedness phase, the response phase, and the recovery/rehabilitation phase. Each theme contains three main sub-themes (3Cs): character, competence, and the central role of the leader. Conclusion: Using the International Council of Nurses (ICN) framework’s disaster phase as a conceptual basis, 49 nurse leadership indicators were identified as potential information for future items candidates of the instrument for measuring nurse leadership in disaster management.

Variations in heterochromatin content reveal important polymorphisms for studies of genetic improvement in garlic (Allium sativum L) / Conteúdo de heterocromatina revela polimorfismos importantes para o melhoramento genético do alho (Allium sativum L)

Allium sativum L. is an herb of the Alliaceae family with a specific taste and aroma and medicinal and nutraceutical properties that are widely marketed in several countries. Brazil is one of the largest importers of garlic in the world, despite of its production is restricted and limited to internal consumption. Thus, explore the genetic diversity of commercial garlic conserved at germplasm banks is essential to generate additional genetic information about its economically important crop. A suitable tool for this purpose is the cytogenetic characterisation of these accessions. This study aimed to characterise the cytogenetic diversity among seven accessions of garlic from a Germplasm Bank in Brazil. The karyotypes were obtained by conventional staining and with chromomycin A3 (CMA) and 4,6-diamidino-2-phenylindole (DAPI) fluorochromes. All accessions analysed showed chromosome number 2n= 16, karyotype formula 6M+2SM, symmetrical karyotypes, reticulate interphase nuclei, and chromosomes with uniform chromatin condensation from prophase to metaphase. The fluorochromes staining showed differences in the amount and distribution of heterochromatin along the chromosomes and between accessions studied. Based on the distribution pattern of these small polymorphisms, it was possible to separate the seven accessions into three groups. It was also possible to differentiate some of the accessions individually. One of the results obtained showed a heteromorphic distension of the nucleolar organiser region observed on the chromosome pairs 6 or 7 with peculiar characteristics. It was suggested for example, that the heteromorphic block of heterochromatin (CMA+++/DAPI-) on chromosome 6 of the "Branco Mineiro Piauí" accession can be used as a marker to identify this genotype or may be associated with some character of economic interest.

Allium sativum L. é uma erva da família Alliaceae com sabor e aroma específicos e propriedades medicinais e nutracêuticas amplamente comercializada em diversos países. O Brasil é um dos maiores importadores de alho do mundo, apesar da sua produção ser restrita e limitada ao consumo interno. Assim, explorar a diversidade genética do alho comercial conservado em bancos de germoplasma é essencial para fornecer informações genéticas adicionais acerca dessa cultura economicamente importante. Uma ferramenta adequada para esse fim é a caracterização citogenética desses acessos. Este estudo teve como objetivo caracterizar a diversidade citogenética entre sete acessos de alho de um Banco de Germoplasma no Brasil. Os cariótipos foram obtidos por coloração convencional e com os fluorocromos de cromomicina A3 (CMA) e 4,6-diamidino-2-fenilindol (DAPI). Todos os acessos analisados apresentaram número cromossômico 2n = 16, fórmula cariotípica 6M + 2SM, cariótipos simétricos, núcleos reticulados em intérfase e cromossomos com condensação uniforme da cromatina da prófase para a metáfase. A coloração com fluorocromos mostrou diferenças na quantidade e distribuição de heterocromatina ao longo dos cromossomos e entre os acessos estudados. Com base no padrão de distribuição desses pequenos polimorfismos, foi possível separar os sete acessos em três grupos. Também foi possível diferenciar individualmente alguns dos acessos. Um dos resultados obtidos mostrou distensão heteromórfica da região organizadora nucleolar observada nos pares dos cromossomos 6 ou 7 com características peculiares. Foi sugerido, por exemplo, que o bloco heteromórfico de heterocromatina (CMA +++ / DAPI-) no cromossomo 6 do acesso “Branco Mineiro Piauí” pode ser usado como um marcador para identificar esse genótipo ou pode estar associado a algum caráter de interesse econômico.