Scaling-up and scaling-out the Systems Analysis and Improvement Approach to optimize the hypertension diagnosis and care cascade for HIV infected individuals (SCALE SAIA-HTN): a stepped-wedge cluster randomized trial.

BACKGROUND: Undiagnosed and untreated hypertension is a main driver of cardiovascular disease and disproportionately affects persons living with HIV (PLHIV) in low- and middle-income countries. Across sub-Saharan Africa, guideline application to screen and manage hypertension among PLHIV is inconsistent due to poor service readiness, low health worker motivation, and limited integration of hypertension screening and management within HIV care services. In Mozambique, where the adult HIV prevalence is over 13%, an estimated 39% of adults have hypertension. As the only scaled chronic care service in the county, the HIV treatment platform presents an opportunity to standardize and scale hypertension care services. Low-cost, multi-component systems-level strategies such as the Systems Analysis and Improvement Approach (SAIA) have been found effective at integrating hypertension and HIV services to improve the effectiveness of hypertension care delivery for PLHIV, reduce drop-offs in care, and improve service quality. To build off lessons learned from a recently completed cluster randomized trial (SAIA-HTN) and establish a robust evidence base on the effectiveness of SAIA at scale, we evaluated a scaled-delivery model of SAIA (SCALE SAIA-HTN) using existing district health management structures to facilitate SAIA across six districts of Maputo Province, Mozambique. METHODS: This study employs a stepped-wedge design with randomization at the district level. The SAIA strategy will be "scaled up" with delivery by district health supervisors (rather than research staff) and will be "scaled out" via expansion to Southern Mozambique, to 18 facilities across six districts in Maputo Province. SCALE SAIA-HTN will be introduced over three, 9-month waves of intensive intervention, where technical support will be provided to facilities and district managers by study team members from the Mozambican National Institute of Health. Our evaluation of SCALE SAIA-HTN will be guided by the RE-AIM framework and will seek to estimate the budget impact from the payer's perspective. DISCUSSION: SAIA packages user-friendly systems engineering tools to support decision-making by frontline health workers and to identify low-cost, contextually relevant improvement strategies. By integrating SAIA delivery into routine management structures, this pragmatic trial will determine an effective strategy for national scale-up and inform program planning. TRIAL REGISTRATION: ClinicalTrials.gov NCT05002322 (registered 02/15/2023).

Medical Trainees' Knowledge and Attitudes Towards Electronic Cigarettes and Hookah: A Multinational Survey Study.

BACKGROUND: The rising prevalence of electronic cigarette (e-cigarette) and hookah use among youth raises questions about medical trainees' views of these products. We aimed to investigate medical trainees' knowledge and attitudes toward e-cigarette and hookah use. METHODS: We used data from a large cross-sectional survey of medical trainees in Brazil, the United States, and India. We investigated demographic and mental health aspects, history of e-cigarettes and tobacco use, knowledge and attitudes toward e-cigarettes and hookah, and sources of information on e-cigarettes and hookah. Although all medical trainees were eligible for the original study, only senior students and physicians-in-training were included in the present analysis. RESULTS: Of 2,036 senior students and physicians-in-training, 27.4% believed e-cigarette use to be less harmful than tobacco smoking. As for hookah use, 14.9% believed it posed a lower risk than cigarettes. More than a third of trainees did not acknowledge the risks of passive e-cigarette use (42.9%) or hookah smoking (35.1%). Also, 32.4% endorsed e-cigarettes to quit smoking, whereas 22.5% felt ill equipped to discuss these tobacco products with patients. Fewer than half recalled attending lectures on these topics, and their most common sources of information were social media (54.5%), Google (40.8%), and friends and relatives (40.3%). CONCLUSIONS: Medical trainees often reported incorrect or biased perceptions of e-cigarettes and hookah, resorted to unreliable sources of information, and lacked the confidence to discuss the topic with patients. An expanded curriculum emphasis on e-cigarette and hookah use might be necessary because failing to address these educational gaps could risk years of efforts against smoking normalization.

Research opportunities for the primary prevention and management of acute rheumatic fever and rheumatic heart disease: a National Heart, Lung, and Blood Institute workshop report.

Primary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) encompasses the timely diagnosis and adequate treatment of the superficial group A Streptococcus (GAS) infections pharyngitis and impetigo. GAS is the only known inciting agent in the pathophysiology of the disease. However, sufficient evidence indicates that the uptake and delivery of primary prevention approaches in RHD-endemic regions are significantly suboptimal. This report presents expert deliberations on priority research and implementation opportunities for primary prevention of ARF/RHD that were developed as part of a workshop convened by the US National Heart, Lung, and Blood Institute in November 2021. The opportunities identified by the Primary Prevention Working Group encompass epidemiological, laboratory, clinical, implementation and dissemination research domains and are anchored on five pillars including: (A) to gain a better understanding of superficial GAS infection epidemiology to guide programmes and policies; (B) to improve diagnosis of superficial GAS infections in RHD endemic settings; (C) to develop scalable and sustainable models for delivery of primary prevention; (D) to understand potential downstream effects of the scale-up of primary prevention and (E) to develop and conduct economic evaluations of primary prevention strategies in RHD endemic settings. In view of the multisectoral stakeholders in primary prevention strategies, we emphasise the need for community co-design and government engagement, especially in the implementation and dissemination research arena. We present these opportunities as a reference point for research organisations and sponsors who aim to contribute to the increasing momentum towards the global control and prevention of RHD.

The Therapeutic Potential of Angeli's Salt in Mitigating Acute Trypanosoma cruzi Infection in Mice.

Chagas disease (CD), caused by Trypanosoma cruzi, is a neglected tropical disease prevalent in Latin America. Infected patients are treated to eliminate the parasite, reduce the cardiomyopathy risk, and interrupt the disease transmission cycle. The World Health Organization recognizes benznidazole (BZ) and nifurtimox as effective drugs for CD treatment. In the chronic phase, both drugs have low cure rates and serious side effects. T. cruzi infection causes intense tissue inflammation that controls parasite proliferation and CD evolution. Compounds that liberate nitric oxide (NO) (NO donors) have been used as anti-T. cruzi therapeutics. Currently, there is no evidence that nitroxyl (HNO) affects T. cruzi infection outcomes. This study investigated the effects of the HNO donor Angeli's salt (AS) on C57BL/6 mice infected with T. cruzi (Y strain, 5 × 103 trypomastigotes, intraperitoneally). AS reduced the number of parasites in the bloodstream and heart nests and increased the protective antioxidant capacity of erythrocytes in infected animals, reducing disease severity. Furthermore, in vitro experiments showed that AS treatment reduced parasite uptake and trypomastigote release by macrophages. Taken together, these findings from the murine model and in vitro testing suggest that AS could be a promising therapy for CD.

Differential benefits of physical training associated or not with l-arginine supplementation in rats with metabolic syndrome: Evaluation of cardiovascular, autonomic and metabolic parameters.

Metabolic syndrome (MetS) is characterized by endocrine-metabolic and cardiac alterations that increase the risk of cardiovascular disease, dyslipidemia, and type-2 diabetes mellitus. Dietary supplementation with l-Arginine (L-Arg) is beneficial for fat loss, while chronic aerobic exercise has several benefits in reversing cardiovascular, autonomic, and metabolic dysfunctions caused by obesity. However, the association between these two approaches has not yet been described. This study aimed to evaluate the possible benefits of physical training, with or without l-Arg-supplementation, on cardiovascular, autonomic, and metabolic parameters in rats with MetS, which was induced by the subcutaneous administration of monosodium glutamate at 4 mg g-1day-1 in rats from the first to fifth day of life. Physical training on a treadmill and supplementation with l-Arg-in adulthood were carried out concomitantly for 8 weeks. After this, the animals underwent femoral artery catheterization to record their cardiovascular parameters and autonomic modulation. Organs and blood were removed to measure levels of nitrite, glucose, and hepatic steatosis. In adult rats with MetS, supplementation with l-Arg-in combination with physical training reduced hypertension, tachycardia, adipose tissue mass, free fatty acids, and hepatic steatosis. Supplementation with l-Arg-and physical training separately was beneficial in reducing several aspects of MetS, but a combination of both was especially effective in reducing adipose tissue and hepatic steatosis. Together, the two therapies can form a good strategy to combat MetS.

Vaping and Hookah Use Among Medical Trainees: A Multinational Survey Study.

The increased use of E-cigarettes and hookah among young consumers represents a public health concern. This study aimed to investigate the frequency and patterns of use of E-cigarettes and hookah among medical trainees. This cross-sectional multinational online survey included medical students, residents, and fellows in Brazil, the U.S., and India between October 2020 and November 2021. Information on sociodemographics; mental health; and E-cigarettes, hookah, tobacco, marijuana, and alcohol use were collected. Generalized structural equation models were used in 2022 to explore the factors associated with current vaping and current hookah use (ongoing monthly/weekly/daily use). People reporting previous sporadic/frequent use or those who never used/only tried it once were the reference group. Overall, 7,526 participants were recruited (Brazil=3,093; U.S.=3,067; India=1,366). The frequency of current vaping was 20% (Brazil), 11% (U.S.), and <1% (India), and current hookah use was 10% (Brazil), 6% (U.S.), and 1% (India). Higher family income (OR=6.35, 95% CI=4.42, 9.12), smoking cigarettes (OR=5.88, 95% CI=4.88, 7.09) and marijuana (OR=2.8, 95% CI=2.35, 3.34), and binge drinking (OR=3.03, 95% CI=2.56, 3.59) were associated with current vaping. The same was true for hookah use: higher family income (OR=2.69, 95% CI=1.75, 4.14), smoking cigarettes (OR=3.20, 95% CI=2.53, 4.06), smoking marijuana (OR=4.17, 95% CI=3.35, 4.19), and binge drinking (OR=2.42, 95% CI=1.96, 2.99). In conclusion, E-cigarettes and hookah were frequently used by Brazilian and American trainees, sharply contrasting with data from India. Cultural aspects and public health policies may explain the differences among countries. Addressing the problems of hookah and E-cigarette smoking in this population is relevant to avoid the renormalization of smoking.

Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil.

OBJECTIVE: • Neurology trainees and program directors recognized a lack of structured breaking bad news training. • Program directors reported that many factors hinder the implementation of breaking bad news education. • Trainees felt capable of breaking bad news, but most did not have lectures, simulations, nor feedback. • Trainees acknowledged negative feelings when breaking bad news, including sadness and helplessness. We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. METHODS: We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. RESULTS: We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. CONCLUSION: This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.

Sleep quality and perception of quality of life of undergraduate nursing students / Calidad del sueño y la percepcion de la calidad de vida de estudiantes de graduaci´ón en enfermería / Qualidade do sono e percepção da qualidade de vida de estudantes de graduação em enfermagem

During graduation, students face several situations that, although promoting personal growth, can compromise well-being, sleep, health and quality of life. This study aimed to analyze the relationship between individual characteristics, sleep quality and the perception of quality of life of undergraduate nursing students. This is a cross-sectional study with a quantitative, analytical and comparative approach, carried out with 187 nursing students at a private institution in the city of Poços de Caldas, Minas Gerais, Brazil. The data collection instruments were an individual characterization questionnaire, the Pittsburgh Sleep Quality Index and the WHOQOL-Bref instrument for quality of life analysis. There was a predominance of women, adults, young, without children, who worked, and who did not practice physical activity. Work, cost of study and female gender were associated with shorter sleep duration and worse quality of life. The worst perception in the physical domain of quality of life was related to the worst quality of sleep. Bad sleep quality was obtained for all years of the course, sleep duration of less than 7 hours a day and complaints of daytime sleepiness. Therefore, sleep alterations with impairments in quality of life were observed. Educational strategies are suggested for sleep hygiene and stimulation of health-promoting behaviors to improve general health, academic health and quality of life in this population.

Durante la graduación, los estudiantes enfrentan varias situaciones que, sin embargo promueven el crecimiento personal, pueden comprometer el bienestar, el sueño, la salud y la calidad de vida. Este estudio tuvo como objetivo analizar la relación entre las características individuales, la calidad del sueño y la percepción de la calidad de vida de los estudiantes de graduación en enfermería. Se trata de un estudio transversal con enfoque cuantitativo, analítico y comparativo, realizado con 187 estudiantes de enfermería de una institución privada de la ciudad de Poços de Caldas, Minas Gerais, Brasil. Los instrumentos de recolección de datos fueron un cuestionario de caracterización individual, el Índice de Calidad del Sueño de Pittsburgh y el instrumento de calidad de vida WHOQOL-Bref. Hubo predominio de mujeres, adultas, jóvenes, sin hijos, que trabajaban y que no practicaban actividad física. El trabajo, el costo de los estudios y el género femenino se asociaron con menor duración del sueño y peor calidad de vida. La peor percepción en el dominio físico de la calidad de vida se relacionó con la peor calidad del sueño. Se obtuvo mala calidad del sueño para todos los años del curso, duración del sueño inferior a 7 horas diarias y quejas de somnolencia diurna. Por lo tanto, se observaron alteraciones del sueño con deterioro de la calidad de vida. Se sugieren estrategias educativas para la higiene del sueño y la estimulación de conductas promotoras de salud para mejorar la salud académica y general, y la calidad de vida de esta población.

Durante a graduação, os estudantes enfrentam diversas situações que, embora, promovam o crescimento pessoal, podem comprometer o bem-estar, o sono, a saúde e a qualidade de vida. Este estudo objetivou analisar a relação entre as características individuais, a qualidade do sono e a percepção da qualidade de vida de estudantes de graduação em enfermagem. Trata-se de um estudo transversal de abordagem quantitativa, analítica e comparativa, desenvolvido com 187 graduandos de enfermagem numa instituição particular, na cidade de Poços de Caldas, Minas Gerais, Brasil. Os instrumentos de coleta de dados foram um questionário de caracterização individual, o Índice de Qualidade do Sono de Pittsburgh e o instrumento para análise de qualidade de vida WHOQOL-Bref. Houve predomínio de mulheres, adultas, jovens, sem filhos, que trabalhavam, e que não praticavam atividade física. Trabalho, custeio dos estudos e gênero feminino associaram-se à menor duração do sono e pior qualidade de vida. A pior percepção no domínio físico da qualidade de vida esteve relacionada à pior qualidade do sono. Obteve-se qualidade de sono ruim para todos os anos do curso, duração do sono inferior a 7h por dia e queixas de sonolência diurna. Constatou-se, portanto, alterações do sono com prejuízos na qualidade de vida. Sugere-se estratégias educativas para a higiene do sono e estímulo de comportamentos promotores de saúde para melhorias na saúde geral, acadêmica e de qualidade de vida nesta população.

Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil

ABSTRACT Objective We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. Methods We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. Results We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. Conclusion This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.

Professores de ensino médio, características do sono e sinais de burnout: revisão integrativa / High school teachers, sleep characteristics and burnout signs: integrative review / Profesores de secundaria, características del sueño y signos del burnout: revisión integradora

Objetivo: identificar estudos que avaliaram alterações do sono e Burnout em professores de ensino médio. Método: revisão integrativa, com busca de artigos em português, inglês e espanhol, publicados nas bases de dados National Library of Medicine (PubMed), Biblioteca Virtual em Saúde (BVS), Scopus, Web of Science e EBSCOHOST, utilizando os descritores Sleep, Burnout Psychological e School Teachers, e seus sinônimos. A busca e seleção de evidências científicas foi realizada por três revisores, de forma simultânea. Resultados: foram selecionados três artigos que avaliaram sono e Burnout para docentes, realizados no continente europeu (66,7%) e Estados Unidos, publicados a partir de 2018, que utilizaram três instrumentos distintos para avaliação de variáveis relacionadas ao sono e Burnout. Conclusão: Esgotamento, fadiga, carga de trabalho, comprometimento excessivo, podem ser fontes geradoras de alterações de sono e presença de Burnout na profissão docente, justificando a implementação de programas que promovam a promoção da saúde dessa classe. (AU).

Objective: identifing studies that evaluated sleep disorders and burnout in high school teachers. Method: integrative review, with search for articles in Portuguese, English and Spanish, published in the National Library of Medicine (PubMed), the Virtual Health Library (VHL), Scopus, Web of Science and EBSCOHOST databases, using the descriptors Sleep, Burnout, Psychological and School Teachers, and their synonyms. The search and selection of scientific evidence was carried out by three reviewers, simultaneously. Results: three articles were selected that evaluated sleep and Burnout for teachers, carried out in the European continent (66.7%) and the United States, published from 2018 onwards, which used three different instruments to assess variables related to sleep and Burnout. Conclusion: Exhaustion, fatigue, workload, excessive commitment, can be sources of sleep alterations and the presence of Burnout in the teaching profession, justifying the implementation of programs that promote the health promotion of this class. (AU).

Objetivo: identificar estudios que evaluaron alteraciones del sueño y Burnout en docentes de enseñanza media. Método: revisión integradora, búsqueda de artículos en portugués, inglés y español, publicados en las bases de datos de la Biblioteca Nacional de Medicina (PubMed), Biblioteca Virtual en Salud (BVS), Scopus, Web of Science y EBSCOHOST, utilizando los descriptores Sueño, Burnout Psicológico y Escolar Maestros, y sus sinónimos. La búsqueda y selección de evidencia científica fue realizada por tres revisores, simultáneamente. Resultados: se seleccionaron tres artículos que evaluaron el sueño y el Burnout para docentes, realizados en el continente europeo (66,7%) y Estados Unidos, publicados a partir de 2018, que utilizaron tres instrumentos diferentes para evaluar variables relacionadas con el sueño y el Burnout. Conclusión: El agotamiento, la fatiga, la carga de trabajo, el compromiso excesivo, pueden ser fuentes de alteraciones del sueño y la presencia de Burnout en la profesión docente, justificando la implementación de programas que promuevan la promoción de la salud de esta classe. (AU).

Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin's lymphoma.

Visceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin's lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression.

Hyperammonemia syndrome post-lung transplantation: Case series and systematic review of literature.

BACKGROUND: Hyperammonemia syndrome (HS) is a rare post-transplant complication associated with high morbidity and mortality. Its incidence appears to be higher in lung transplant recipients and its pathophysiology is not well understood. In addition to underlying metabolic abnormalities, it is postulated that HS may be associated with Ureaplasma or Mycoplasma spp. lung infections. Management of this condition is not standardized and may include preemptive antimicrobials, renal replacement, nitrogen scavenging, and bowel decontamination therapies, as well as dietary modifications. METHODS: In this case series, we describe seven HS cases, five of whom had metabolic deficiencies ruled out. In addition, a literature review was performed by searching PubMed following PRISMA-P guidelines. Articles containing the terms "hyperammonemia" and "lung" were reviewed from 1 January 1997 to 31 October 2021. RESULTS: All HS cases described in our center had positive airway samples for Mycoplasmataceae, neurologic abnormalities and high ammonia levels post-transplant. Mortality in our group (57%) was similar to that published in previous cases. The literature review supported that HS is an early complication post-transplant, associated with Ureaplasma spp. and Mycoplasma hominis infections and of worse prognosis in patients presenting cerebral edema and seizures. CONCLUSION: This review highlights the need for rapid testing for Ureaplasma spp. and M. hominis after lung transplant, as well as the necessity for future studies to explore potential therapies that may improve outcomes in these patients.

Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study. / Síndrome do T3 baixo como fator prognóstico em pacientes na unidade de terapia intensiva: estudo de coorte observacional.

OBJECTIVE: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. METHODS: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. RESULTS: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. CONCLUSION: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

OBJETIVO: Avaliar a síndrome do doente eutireóideo como fator prognóstico em pacientes na unidade de terapia intensiva, detectar fatores que possam influenciar a mortalidade e desenvolver uma equação para calcular a probabilidade de morte. MÉTODOS: Este foi um estudo de coorte longitudinal, observacional e não concorrente realizado na unidade de terapia intensiva da Fundação Santa Casa de Misericórdia do Pará. Realizou-se coleta de 20mL de sangue em 100 adultos sem endocrinopatia previamente documentada para a dosagem do hormônio estimulante da tireoide, da tetraiodotironina livre, da tri-iodotironina livre e da tri-iodotironina reversa. RESULTADOS: A maioria dos pacientes era do sexo feminino, com idades entre 20 e 29 anos. A maioria dos pacientes que morreram era mais velha (idade mediana de 48 anos), e 97,5% deles possuíam a síndrome do doente eutireóideo.A síndrome do doente eutireóideo esteve relacionada à morte, às comorbidades, à idade e ao tempo de internação (mediana de 7,5 dias) na unidade de terapia intensiva. A baixa dosagem de hormônio estimulante da tireoide estava associada à morte. Os pacientes com dosagem da tri-iodotironina livre menor que 2,9pg/mL tinham maior probabilidade de morrer e, naqueles que morreram, a dosagem de tri-iodotironina reversa era maior que 0,2ng/mL. A tri-iodotironina livre apresentou maior sensibilidade e acurácia, e a tri-iodotironina reversa teve maior especificidade para prever a mortalidade. Com base nos resultados e pontos de corte, desenvolveu-se uma fórmula de regressão logística múltipla para calcular a probabilidade de morte. CONCLUSÃO: Sugere-se verificar oportunamente a dosagem da triiodotironina livre e reversa em pacientes graves e aplicar a equação proposta.

Effects of Myofascial Mobilization on Flexibility in Young Men Adults / Efeito da Mobilização Miofascial na Flexibilidade em Homens Adultos Jovens

The aim of the study is to control the effect of myofascial mobilization on flexibility values ​​in young men. 23 young adult men, aged between 18 and 30 years (74.8 ± 9.8 kg; 1.74 ± 0.06 cm; 24.7 ± 3.0 kg/m2), participated in the study, separated into experimental and control groups. Participants of the experimental group received an instrument assisted soft-tissue mobilization (IASTM) session, bilateral, in the muscular region of the quadriceps femoris, hamstrings and triceps surae. The rectus femoris, vastus lateralis and medial, biceps femoris, semitendinosus, semimembranosus, gastrocnemius and soleus muscles were mobilized for a period of 60 seconds. In the control session, participants remained at rest for a period of 15 minutes. The flexibility assessments were performed pre- and- immediately, 24 hours, and 48 hours post-sessions of both groups. The myofascial mobilization session promoted percentage increases in flexibility significantly higher at 24 hours when compared to values ​​immediately after, 24 hours and 48 hours after the control session (P < 0.05). The percentage increases in flexibility 48 hours after the myofascial mobilization session were significantly greater when compared to values ​​immediately post and 24 hours after the control session (P < 0.05). The findings of the present study suggest that an instrument assisted soft-tissue mobilization (IASTM) session promotes increases in flexibility in young adults one and two days after the intervention. (AU)

O objetivo do presente estudo foi verificar o efeito da mobilização miofascial nos valores da flexibilidade em homens jovens. Participaram do estudo 23 homens adultos jovens, com idade entre 18 e 30 anos (74,8 ± 9,8 kg; 1,74 ± 0,06 cm; 24,7 ± 3,0 kg/m2), separados em grupo experimental e controle. Os participantes do grupo experimental receberam uma sessão mobilização miofascial assistida por instrumento (IASTM), bilateralmente, na região muscular do quadríceps femural, isquiotibiais e tríceps sural. Os músculos reto femural, vasto lateral e medial, bíceps femoral, semitendinoso, semimembranoso, gastrocnêmio e sóleo foram mobilizados por um período de 60 segundos. Na sessão controle, os participantes permaneceram em repouso por um período de 15 minutos. As avaliações da flexiblidade foram realizadas pré, imediatamente após, 24 horas e 48 horas após as sessões de ambos os grupos. A sessão de mobilização miofascial promoveu aumentos percentuais da flexibilidade 24 horas significativamente maiores quando comparado aos valores imediatamente pós, 24 horas e 48 horas da sessão controle (P < 0,05). Os aumentos percentuais da flexibilidade 48 horas após a sessão mobilização miofascial foram significativamente maiores quando comparado aos valores imediatamente pós e 24 horas da sessão controle (P < 0,05). Os achados do presente estudo sugerem que uma sessão de mobilização miofascial assistida por instrumento promove aumentos da flexibilidade em adultos jovens após um e dois dias à intervenção.(AU)

Síndrome do T3 baixo como fator prognóstico em pacientes na unidade de terapia intensiva: estudo de coorte observacional / Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study

RESUMO Objetivo: Avaliar a síndrome do doente eutireóideo como fator prognóstico em pacientes na unidade de terapia intensiva, detectar fatores que possam influenciar a mortalidade e desenvolver uma equação para calcular a probabilidade de morte. Métodos: Este foi um estudo de coorte longitudinal, observacional e não concorrente realizado na unidade de terapia intensiva da Fundação Santa Casa de Misericórdia do Pará. Realizou-se coleta de 20mL de sangue em 100 adultos sem endocrinopatia previamente documentada para a dosagem do hormônio estimulante da tireoide, da tetraiodotironina livre, da tri-iodotironina livre e da tri-iodotironina reversa. Resultados: A maioria dos pacientes era do sexo feminino, com idades entre 20 e 29 anos. A maioria dos pacientes que morreram era mais velha (idade mediana de 48 anos), e 97,5% deles possuíam a síndrome do doente eutireóideo. A síndrome do doente eutireóideo esteve relacionada à morte, às comorbidades, à idade e ao tempo de internação (mediana de 7,5 dias) na unidade de terapia intensiva. A baixa dosagem de hormônio estimulante da tireoide estava associada à morte. Os pacientes com dosagem da tri-iodotironina livre menor que 2,9pg/mL tinham maior probabilidade de morrer e, naqueles que morreram, a dosagem de tri-iodotironina reversa era maior que 0,2ng/mL. A tri-iodotironina livre apresentou maior sensibilidade e acurácia, e a tri-iodotironina reversa teve maior especificidade para prever a mortalidade. Com base nos resultados e pontos de corte, desenvolveu-se uma fórmula de regressão logística múltipla para calcular a probabilidade de morte. Conclusão: Sugere-se verificar oportunamente a dosagem da triiodotironina livre e reversa em pacientes graves e aplicar a equação proposta.

ABSTRACT Objective: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. Methods: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. Results: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days). There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. Conclusion: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

Early discharge for patients with benign pleural effusions using a Wayne catheter (pigtail) chest drain - analysis of safety, complications, and quality of life.

OBJECTIVE: to assess safety, efficacy and quality of life in patients with benign pleural effusions undergong pleural drainage with Wayne pleural catheter (DW) in an outpatient setting. METHOD: this is a prospective study, in which 47 patients were evaluated between July 2017 and October 2018. Patients with non-malignant pleural effusions underwent pleural drainage with clinical evolution compatible with outpatient care were included. Patients who underwent drainage due to other conditions and patients were excluded. RESULTS: after catheter placement, the mean length of hospital stay was 3.14 (± 3.85) days, and 21 patients (44.68%) were discharged within 24 hours. The mean time with the catheter was 12.63 (± 7.37) days. The analysis of the pleural fluid was transudate in 87.3% of cases and exudate in 12.3%. The causes of pleural effusion were heart failure (72.3%), renal failure (19.1%), liver failure (6.3%) and pneumonia (8.5%). The quality of life, analyzed according to the parameters of the questionnaire SF 36, showed low average values when compared to other studies. Analyzing each descriptor, the average was greater only in the limitation related to physical aspects. In the other descriptors, the results were similar, but smaller. CONCLUSION: the outpatient use of pleural catheters of the Wayne type (pigtail) proved to be feasible, safe and with a low associated infection rate. This is a viable option for selected patients.

Analysis of malaria clinical-epidemiological predictors in individuals from Brazilian Amazon.

This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.

Early discharge for patients with benign pleural effusions using a Wayne catheter (pigtail) chest drain - analysis of safety, complications, and quality of life / Alta precoce para pacientes com derrames pleurais benignos em uso de dreno pleural de Wayne (pigtail) - análise de segurança, complicações e qualidade de vida

ABSTRACT Objective: to assess safety, efficacy and quality of life in patients with benign pleural effusions undergong pleural drainage with Wayne pleural catheter (DW) in an outpatient setting. Method: this is a prospective study, in which 47 patients were evaluated between July 2017 and October 2018. Patients with non-malignant pleural effusions underwent pleural drainage with clinical evolution compatible with outpatient care were included. Patients who underwent drainage due to other conditions and patients were excluded. Results: after catheter placement, the mean length of hospital stay was 3.14 (± 3.85) days, and 21 patients (44.68%) were discharged within 24 hours. The mean time with the catheter was 12.63 (± 7.37) days. The analysis of the pleural fluid was transudate in 87.3% of cases and exudate in 12.3%. The causes of pleural effusion were heart failure (72.3%), renal failure (19.1%), liver failure (6.3%) and pneumonia (8.5%). The quality of life, analyzed according to the parameters of the questionnaire SF 36, showed low average values when compared to other studies. Analyzing each descriptor, the average was greater only in the limitation related to physical aspects. In the other descriptors, the results were similar, but smaller. Conclusion: the outpatient use of pleural catheters of the Wayne type (pigtail) proved to be feasible, safe and with a low associated infection rate. This is a viable option for selected patients.

RESUMO Objetivo: avaliar a segurança, a eficácia, as complicações e a qualidade de vida da alta precoce e acompanhamento ambulatorial de pacientes com derrames pleurais benignos submetidos à drenagem pleural com dreno de Wayne (DW). Método: estudo prospectivo, em que foram avaliados 47 pacientes entre julho de 2017 e outubro de 2018. Foram incluídos os pacientes com derrames pleurais não malignos, submetidos a drenagem pleural com evolução clínica compatível com o cuidado ambulatorial. Foram excluídos os pacientes submetidos a drenagem por outras afecções. Resultados: após a drenagem, a média do tempo de internação dos pacientes foi de 3,14 (±3,85) dias, sendo que 21 pacientes (44,68%) tiveram alta em até 24 horas após a drenagem. O tempo médio de permanência com o dreno foi de 12,63 (±7,37) dias. A análise do líquido pleural mostrou tratar-se de transudato em 87,3% dos casos e de exsudato em 12,3%. Dentre as causas do derrame pleural, destacaram-se insuficiência cardíaca (72,3%), insuficiência renal (19,1%), hepatopatias (6,3%) e pneumonias (8,5%). A qualidade de vida, analisada segundo os parâmetros do questionário SF 36, teve valores médios baixos, principalmente em relação a outros estudos. Na análise de cada descritor, a média apresentou-se maior somente na limitação por aspectos físicos. Nos demais descritores, os resultados foram semelhantes, mas menores. Conclusão: o uso ambulatorial de cateteres pleurais do tipo Wayne (pigtail) mostrou-se factível, seguro e com baixa taxa de infecções associadas. Trata-se de opção viável para pacientes selecionados.

Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin's lymphoma

ABSTRACT Visceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin's lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression.