INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS.

OBJECTIVE: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. METHODS: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). RESULTS: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). CONCLUSION: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

OBJETIVO: Avaliar o perfil das fraturas de fêmur em idosos no Brasil no período de 2008 a 2018. MÉTODOS: Estudo de série temporal baseado em dados do Departamento de Informática do Sistema Único de Saúde (Datasus), incluindo 480.652 internações de pessoas com idade a partir de 60 anos e com fratura de quadril (ICD10-S72). RESULTADOS: Houve aumento de 76,9% no registro de hospitalização (média de 5,87% por ano) e taxa de incidência média de 19,46 fraturas para cada 10 mil idosos. O estado de São Paulo respondeu por 28% do total de registros, e as internações de pacientes do sexo feminino corresponderam a 68% do total. O tempo médio de permanência foi de 8,9 dias, com maiores índices na Região Norte (11,8) e no Distrito Federal (18,7). A taxa média de mortalidade foi de 5% e atingiu os maiores valores entre os homens (5,45%) e os pacientes com mais de 80 anos. A região Nordeste apresentou a menor taxa de mortalidade (3,54%) e a região Sudeste teve a maior (5,53%). O custo total das internações foi de R$ 1,1 bilhão, com média de R$ 100 milhões ao ano. O custo médio por hospitalização foi maior na região Sul (R$ 2.491,00). CONCLUSÃO: A fratura do fêmur é importante causa de mortalidade em idosos, com maior incidência em mulheres e maior mortalidade em homens, alto custo para o sistema e diferenças regionais. Nível de Evidência II, Análises econômicas e de decisão - desenvolvimento de modelo econômico ou de decisão.

Indicators of morbidity and mortality by femur fractures in older people: a decade-long study in brazilian hospitals / Indicadores de morbidade e mortalidade por fraturas de fêmur em idosos: análise de uma década em hospitais brasileiros

ABSTRACT Objective: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. Methods: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). Results: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). Conclusion: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

RESUMO Objetivo: Avaliar o perfil das fraturas de fêmur em idosos no Brasil no período de 2008 a 2018. Métodos: Estudo de série temporal baseado em dados do Departamento de Informática do Sistema Único de Saúde (Datasus), incluindo 480.652 internações de pessoas com idade a partir de 60 anos e com fratura de quadril (ICD10-S72). Resultados: Houve aumento de 76,9% no registro de hospitalização (média de 5,87% por ano) e taxa de incidência média de 19,46 fraturas para cada 10 mil idosos. O estado de São Paulo respondeu por 28% do total de registros, e as internações de pacientes do sexo feminino corresponderam a 68% do total. O tempo médio de permanência foi de 8,9 dias, com maiores índices na Região Norte (11,8) e no Distrito Federal (18,7). A taxa média de mortalidade foi de 5% e atingiu os maiores valores entre os homens (5,45%) e os pacientes com mais de 80 anos. A região Nordeste apresentou a menor taxa de mortalidade (3,54%) e a região Sudeste teve a maior (5,53%). O custo total das internações foi de R$ 1,1 bilhão, com média de R$ 100 milhões ao ano. O custo médio por hospitalização foi maior na região Sul (R$ 2.491,00). Conclusão: A fratura do fêmur é importante causa de mortalidade em idosos, com maior incidência em mulheres e maior mortalidade em homens, alto custo para o sistema e diferenças regionais. Nível de Evidência II, Análises econômicas e de decisão - desenvolvimento de modelo econômico ou de decisão.

Study of the efficacy of N-methyl glucamine antimoniate (SbV) associated with photodynamic therapy using liposomal chloroaluminium phthalocyanine in the treatment of cutaneous leishmaniasis caused by Leishmania (L.) amazonensis in C57BL6 mice.

BACKGROUND: Pentavalent antimonials remain first-line drugs in the treatment of cutaneous leishmaniasis (CL); however, adverse effects and drug resistance have led to the search for less toxic and more effective treatments. As an alternative, topical phthalocyanine has been studied and its efficacy and low toxicity demonstrated. We aimed to study the in vivo efficacy of N-methyl glucamine antimoniate (NMG) associated with photodynamic therapy (PDT) with topical liposomal chloroaluminium phthalocyanine (AlClPC) in the treatment of experimental CL by L. amazonensis. METHODS: Experimental study with 54 C57BL6 isogenic mice divided into 9 groups including uninfected control, untreated control, PDT with AlClPC + NMG at doses of 10 and 20 mgSbV/Kg/day. The criteria to evaluate the treatment efficacy were: paw diameter, amastigote count, culture, viability test and parasite counts using MTT (3-bromo-4,5-dimethylthiazol-2,5-diphenyl-tetrazolium bromide). RESULTS: Treatment of CL with the association of NMG20 + PDT with AlClPC showed significant reduction of paw diameter, amastigote count, cultures, viability test and parasite counts. Parasite reduction occurred at the 10th and 20th days of treatment and 60 days after treatment ended, indicating that parasites did not multiply again. The NMG10 + PDT group with AlClPC presented results equivalent to gold-standard treatment (20 mgSbV/kg/day). Biochemical and histopathological evaluation showed minor changes. CONCLUSION: Treatment of CL caused by L. amazonensis with NMG20 mgSbV/kg/day + PDT with AlClPC was more effective than the traditional NMG20 mgSbV/kg/day.

Recognition of phenylthiocarbamide (PTC) in taste test is related to blood group B phenotype, females, and risk of developing food allergy: a cross-sectional Brazilian-based study.

Anti-nutritional factors, including hemagglutinins, are natural substances that reduce nutritional bioavailability and/or generate adverse physiological effects. Most are bitter toxic compounds, but present chemo-protective properties at low concentrations. Responses to phenylthiocarbamide (PTC) allow for an evaluation of humans' perception of bitter taste, a perception that has evolutionary advantages. Therefore, we hypothesized that relationships between food preference, dietary exposures and disease risk could reflect possible associations not only with the recognition threshold for the bitter taste of PTC, but also with ABO/Rh blood group phenotypes. To test this hypothesis, 375 volunteers of both genders, aged 16-49 years, were recruited. Data were obtained from laboratory tests and questionnaires. PTC test followed literature; blood typing used commercially available sera. Allele frequencies calculated from phenotypes were: T=0.51, t=0.49 (PTC); IA=0.22, IB=0.08, i=0.70 (ABO); D=0.57, d=0.43 (Rh). Associations with the recognition threshold for bitter taste were found for blood group B, females, and risk of developing food allergy for bitter taste at PTC dilution 1 (the highest concentration) (OR=3.862; 95%CI=1.387-10.756; p=0.016); for each more diluted PTC solution, the chance of food allergy fell 25.2% (95%CI = 0.764-0.836), while for each more concentrated solution the chance of food allergy increased 20.1% (p=0.000). There were also nominally significant differences among PTC tasting, ABO/Rh, genders and age-groups in relation to food preferences. Results demonstrated that the ability to recognize PTC in taste test is related to blood group B, females, and risk of developing food allergy, thus confirming the research hypothesis, and presenting original and important associations.

Evaluation of the efficacy of systemic miltefosine associated with photodynamic therapy with liposomal chloroaluminium phthalocyanine in the treatment of cutaneous leishmaniasis caused by Leishmania (L.) amazonensis in C57BL/6 mice.

BACKGROUND: The shortage of drugs is a concern and has become the object of studies to discover effective alternatives for cutaneous leishmaniasis (CL) treatment. A topical formulation has been sought due to its low toxicity. Development of alternative therapies, such as multimodal ones, is important in confronting drug resistance. This study aims to compare the in vivo efficacy of topical photodynamic therapy (PDT) using liposomal chloroaluminium phthalocyanine (AlClPC) in the treatment of CL, isolated and associated with systemic therapy with miltefosine. METHODS: Five groups were adopted, each one with six isogenic adult female mice C57BL/6: (1) Negative Control-non-infected and non-treated; (2) Positive Control (PBS)-infected and non-treated; (3) Miltefosine-infected and treated with oral miltefosine 200 mg/kg/day; (4) Infected and treated with PDT with topical AlClPC (500 µL) on alternate days; (5) Oral Miltefosine 200 mg/kg/day and PDT with topical AlClPC (500 µL) on alternate days. Therapeutic schemes lasted 20 days. Infection was confirmed by culture in Nove-McNeal-Nicolle medium (NNN) of lymph collected from the animal paw, and animals were evaluated by paw measurement and parasitological criteria. RESULTS: Miltefosine associated with PDT with AlClPC promoted a significant reduction in parasite number and viability when compared to the other infected groups, also returning the paw diameter to a size similar to the negative control group after 20 days of treatment. CONCLUSIONS: Association of miltefosine with PDT mediated by topical AlClPC represents hopes for CL treatment, an increasing dermatological disease in some countries.

Axonal electrovisiogram as an electrophysiological test to evaluate optic nerve and inner retina electrical potentials: findings in normal subjects.

PURPOSES: To standardize and validate the technique of axonal electrovisiogram (AxEvg), defining its normative values and parameters and characterizing its findings in normal individuals. METHODS: We enrolled 140 normal individuals (280 eyes) divided into seven groups according to age, each one with 10 males and 10 females. The technique was based on monocular visual stimulation by a 0 dB intensity bright flash on Ganzfeld bowl at a presentation rate of 1.4 Hz. Golden cup electrodes were used and electrical waves were acquired after artifact rejection. For each amplitude and implicit time peak we calculated the mean, median, pattern deviation, minimum and maximum values and 95% confidence interval. RESULTS: Monocular visual stimulation with bright flash under mesopic conditions was the standard technical procedure established. The normal AxEvg waveform consists of an initial positive wave (named P1, with mean amplitude of 2.0 mV and mean implicit time peak of 23.1 ms) followed by a negative wave (named N1, with mean amplitude of -3.9 mV and mean implicit time peak of 41.4 ms). No significant differences were observed between males and females or between right and left eyes, but there was an increased P1 and N1 implicit time peaks according to age. Implicit time characteristics suggest that P1 wave represents an optic nerve electrical potential and N1 wave represents an inner retinal layers potential. CONCLUSIONS: AxEvg can be considered a pre-chiasmatic visual evoked potential capable to reliably record the electrical activity of optic nerve and inner retina. The findings suggest that AxEvg may be useful as an electrophysiological test in the diagnosis of neuroretinal diseases.

Axonal electrovisiogram as an electrophysiological test to evaluate optic nerve and inner retina electrical potentials: findings in normal subjects / Eletrovisuograma axonal como teste eletrofisiológico na avaliação dos potenciais de ação do nervo óptico e da retina interna: achados em indivíduos normais

PURPOSES: To standardize and validate the technique of axonal electrovisiogram (AxEvg), defining its normative values and parameters and characterizing its findings in normal individuals. METHODS: We enrolled 140 normal individuals (280 eyes) divided into seven groups according to age, each one with 10 males and 10 females. The technique was based on monocular visual stimulation by a 0 dB intensity bright flash on Ganzfeld bowl at a presentation rate of 1.4 Hz. Golden cup electrodes were used and electrical waves were acquired after artifact rejection. For each amplitude and implicit time peak we calculated the mean, median, pattern deviation, minimum and maximum values and 95 percent confidence interval. RESULTS: Monocular visual stimulation with bright flash under mesopic conditions was the standard technical procedure established. The normal AxEvg waveform consists of an initial positive wave (named P1, with mean amplitude of 2.0 mV and mean implicit time peak of 23.1 ms) followed by a negative wave (named N1, with mean amplitude of -3.9 mV and mean implicit time peak of 41.4 ms). No significant differences were observed between males and females or between right and left eyes, but there was an increased P1 and N1 implicit time peaks according to age. Implicit time characteristics suggest that P1 wave represents an optic nerve electrical potential and N1 wave represents an inner retinal layers potential. CONCLUSIONS: AxEvg can be considered a pre-chiasmatic visual evoked potential capable to reliably record the electrical activity of optic nerve and inner retina. The findings suggest that AxEvg may be useful as an electrophysiological test in the diagnosis of neuroretinal diseases.

OBJETIVOS: Padronizar e validar a técnica de realização do eletrovisuograma axonal (EVA), definir seus valores normativos e caracterizar os achados em indivíduos normais. MÉTODOS: Estudo descritivo com 140 indivíduos (280 olhos) normais. Os participantes foram divididos em sete grupos de acordo com a idade, cada qual com 10 indivíduos do sexo masculino e 10 do sexo feminino. Definiu-se como técnica de exame a estimulação monocular por flash luminoso com intensidade de 0 dB na cúpula de Ganzfeld a uma frequência de 1,4 Hz. Foram utilizados eletrodos com cúpula de ouro e foram analisados os traçados elétricos obtidos após rejeição de artefatos. Para cada amplitude e tempo de culminação foram calculados a média, a mediana, o desvio-padrão, os valores mínimo e máximo e o intervalo de confiança de 95 por cento representando uma faixa de normalidade para os valores. RESULTADOS: A técnica de exame padronizada foi a estimulação visual monocular por flash em condições mesópicas. O traçado normal do eletrovisuograma axonal consistiu numa onda positiva inicial (P1, com amplitude média de 2,0 mV e tempo de culminação médio de 23,1 ms) seguida de uma onda negativa (N1, com amplitude média de -3,9 mV e tempo de culminação médio de 41,4 ms). Não foram observadas diferenças significativas entre os sexos e entre os olhos direito e esquerdo, mas os tempos de culminação de P1 e de N1 aumentaram proporcionalmente com a idade. CONCLUSÕES: O eletrovisuograma axonal é um exame de potencial visual evocado pré-quiasmático, capaz de registrar de forma confiável e reprodutível a atividade elétrica do nervo óptico e da retina interna, podendo ser utilizado na propedêutica eletrofisiológica na investigação de lesões neurorretinianas.