Fully independent validation and updating of a clinical pharmacy prioritizing risk score in an infectious disease hospital ward.

AIMS: The aim of this study was to validate and update the risk score originally developed at Hospital de Clínicas de Porto Alegre, verifying its performance in an infectious disease population. METHODS: This is an observational study with consecutive selection of admission in a ward of participants with infectious diseases. Predictors were age, number of medications, intravenous drugs, potentially dangerous drugs, renal dysfunction, liver dysfunction, use of nasoenteral tube, nasogastric tube, gastrostomy feeding, jejunostomy feeding, oral enteral tube, total parenteral nutrition, cardiac or pulmonary dysfunction and immunosuppression. Outcome was defined as preventable prescription incidents by a clinical pharmacist. A GEE model was fit to make predictions each week. RESULTS: A total of 219 patients participated in the study, 79.25% of whom had prescription incidents in the first week of admission. Predictors of the updated model were number of drugs prescribed, number of intravenous drugs, use of tubes, truncated age at 36 years and week of hospitalization. The performance of the original model was poor. The updated model's discrimination and calibration were moderate (overall AUC 0.74). A calculator to apply the model is available at https://pedrobrasil.shinyapps.io/INDWELL/. CONCLUSION: The updated risk score enabled the user to make predictions at admission and throughout the weeks, allowing for a prioritized weekly update for clinical pharmacy intervention. The updated model has a moderate and satisfactory performance for infectious disease patients.

Does atopy influence the effectiveness of treatment of adenoid hypertrophy with mometasone furoate?

BACKGROUND: The effect of topical mometasone for adenoid hypertrophy treatment is well established. Nevertheless, the influence of atopy on this treatment remains ill defined. OBJECTIVE: This study aims to compare the effects of topical mometasone furoate treatment on the adenoid tissue between atopic and nonatopic children. METHODS: Fifty-one children with obstructive respiratory complaints underwent a semistructured clinical questionnaire on nasal symptoms, prick test, and nasoendoscopy. Nasoendoscopic images were digitalized, and both adenoid and nasopharyngeal areas were measured in pixels; the relative adenoid/nasopharyngeal area was calculated. Patients were initially treated for 40 days with nasal saline solution. In a subsequent 40-day period, topical mometasone furoate (total dose, 100 µg/day) was used. RESULTS: Topical mometasone significantly improved nasal obstruction, snoring, and apnea and also significantly reduced the adenoid tissue area related to the nasopharynx (p < 0.0001). Treatment with this glucocorticoid was not influenced by atopy, neither for symptoms nor for adenoid area. CONCLUSION: Topical mometasone furoate significantly reduced the adenoid tissue area and led to a supplementary improvement of nasal symptoms. This improvement was similar for atopic and nonatopic patients.

Administração repetida de doses não tóxicas de monofluoroacetato de sódio não protege contra a intoxicação por este composto em ovinos / Repeated administration of non-toxic doses of sodium monofluoroacetate does not protect against poisoning by this compound in sheep

Com o objetivo de avaliar se repetidas doses não tóxicas de monofluoroacetato de sódio (MFA) induzem resistência à intoxicação por essa substância, 18 ovinos foram distribuídos aleatoriamente em dois grupos experimentais de nove animais cada. Os ovinos do Grupo 1 ingeriram doses crescentes não letais de MFA por seis períodos: 0,05mg/kg por 5 dias; 0,08mg/kg por 4 dias; 0,08mg/kg por 4 dias; 0,1mg/kg por 3 dias; 0,1mg/kg por 3 dias e 0,25mg/kg por 3 dias. Entre o primeiro e o segundo período de administração e entre o segundo e o terceiro período os animais não receberam o MFA por 10 dias consecutivos; entre o terceiro e o quarto período e dentre os demais períodos de administração, os ovinos permaneceram 15 dias sem ingerir o MFA. Quinze dias após o último período de administração os ovinos foram desafiados com a dose única de 1mg/kg de MFA. O Grupo 2 não foi adaptado a ingestão de MFA, estes ovinos receberam dose única de 1mg/kg de MFA no mesmo período em que o G1 foi desafiado. No desafio sete ovinos do Grupo 1 apresentaram sinais clínicos da intoxicação e um ovino se recuperou. No Grupo 2 todos os animais manifestaram quadro clínico da intoxicação por MFA, no entanto, dois ovinos se recuperaram. Os coeficientes de mortalidade foram de 66,6 por cento para o Grupo 1 e de 77,7 por cento para o Grupo 2. Os resultados deste trabalho sugerem que a administração repetida de doses não tóxicas de MFA não protege contra a intoxicação aguda por este composto, portanto, outras alternativas para a profilaxia da intoxicação por plantas que contêm MFA deverão ser pesquisadas, principalmente a utilização intraruminal de bactérias que hidrolisam MFA.

With the objective to assess whether repeated non-toxic doses of sodium monofluoroacetate (MFA) induce resistance to poisoning by this compound, 18 sheep were randomly divided into two experimental groups of nine animals each. Sheep from Group 1 ingested non-lethal increasing doses of MFA for six periods: 0.05mg/kg for 5 days; 0.08mg/kg for 4 days; 0.08mg/kg for 4 days; 0.1mg/kg for 3 days; 0.1mg/kg for 3 days and 0.25mg/kg for 3 days. Between the first and second period of administration and between the second and third period the animals did not receive MFA for 10 consecutive days, between the third and fourth period and during the remaining periods of administration the sheep were left 15 days without ingesting MFA. Group 2 was not adapted to the ingestion of MFA and received a single dose of 1mg/kg of MFA at the same time that Group 1 was challenged. After challenge, seven sheep of Group 1 showed clinical signs of poisoning and one sheep recovered. In Group 2, all animals showed clinical signs of poisoning by MFA, however two sheep recovered. The mortality rate was 66.6 percent in Group 1 and 77.7 percent for Group 2. These results suggest that repeated administration of non-toxic doses of MFA does not protect against acute poisoning by this compound; therefore other alternatives of prophylaxis for poisoning by plants containing MFA should be searched, mainly the use of intraruminal bacteria that hydrolyze MFA.

Objective reduction in adenoid tissue after mometasone furoate treatment.

OBJECTIVE: Chronic rhinitis and adenoid hypertrophy are the main causes of nasal obstruction in children and proper treatment of these factors seem essential for controlling nasal obstructive symptoms. This study aims to evaluate the effects of topical mometasone treatment on symptoms and size of adenoid tissue in children with complaints of nasal obstruction and to compare this approach to continuous nasal saline douching plus environmental control alone. METHODS: Fifty-one children with nasal obstructive complaints were submitted to a semi-structured clinical questionnaire on nasal symptoms, prick test and nasoendoscopy. Nasoendoscopic images were digitalized, and both adenoid and nasopharyngeal areas were measured in pixels. The relation adenoid/nasopharyngeal area was calculated. Patients were subsequently re-evaluated in two different periods: following 40 days of treatment with nasal douching and environmental prophylaxis alone; and after an subsequent 40 day-period, when topical mometasone furoate (total dose: 100µg/day) was superposed. RESULTS: Nasal symptoms and snoring significantly improved after nasal douching, and an additional gain was observed when mometasone furoate was included to treatment. Saline douching did not influence the adenoid area, whereas a significant reduction on adenoid tonsil was observed after 40 days of mometasone treatment (P<0.0001). CONCLUSION: Nasal saline douching significantly improved nasal symptoms without interfering in adenoid dimension. In contrast, mometasone furoate significantly reduced adenoid tissue, and led to a supplementary improvement of nasal symptoms.

Insuficiência respiratória aguda secundária a bócio mergulhante da tireoide / Acute respiratory insufficiencysecondary to substernal thyroid goiter

Relato de caso de bócio mergulhante (BM) em idosa com longa história de bócio nodular tóxico (BNT) e que evoluiu com insuficiência respiratória aguda enquanto aguardava cirurgia eletiva para extirpação do bócio. A evolução das complicações respiratórias dessa paciente sugere que o tratamento cirúrgico do BM em idosos deveria ser feito o mais breve possível, após o surgimento de sintomatologia respiratória, para evitar complicações.

Case report of substernal thyroid goiter in an elderly woman with long record of toxic nodular goiter that progressed to acute respiratory insufficiency while waiting for elective surgery for extirpation of goiter. The development of respiratory complications suggests that the surgical treatment of substernal thyroid goiter affecting elderly people should be pursuit as soon as possible after the appearance of respiratory symptomatology as a means of avoiding complications.

Larvae occurrences of Rhamdia quelen (Quoy & Gaimard, 1824) (Siluriformes: Heptapteridae) in an area under dam influence in the upper Paraná River region, Brazil

Rhamdia quelen (Jundiá) is a catfish species of great interest to fish producers and researchers due to several favorable characteristics for inclusion in the Brazilian list of commercially raised fish. It has a wide geographical distribution, with occurrences reported from Central Argentina to South Mexico. Studies on the biological aspects of this species have been limited to captive adult fishes that were researched for farming purposes. Research related to ichthyoplankton has provided valuable information on spawning periods and sites and other aspects of breeding for numerous species of fish. This information is crucial for implementing management and protection strategies for these species. The studied floodplain is located in a lotic remnant between the Reservoirs of Itaipu and Engenheiro Sérgio Motta. This area is located inside a protected area (Ilha Grande National Park) in the last portion of dam-free land along the Paraná River in the Brazilian territory; however, it is still threatened by the negative effects of the dams. We conducted monthly nocturnal collections during four periods from October to March, 2003 to 2007, in 22 locations along the main channel, secondary lakes and main tributaries of the Paraná River. After collection, the individuals were classified according to the degree of development and the notochord flexion and caudal fin support elements. Data were analyzed using principal component analysis (PCA), ANOVA and Pearson correlation to relate abiotic and larval density data. The increase of capture abundances in the four studied stages suggests that R. quelen is finding conditions that are favorable to its reproduction. The increase in captures can generate questions regarding R. quelen reproductive activity, for instance, whether the species is adapting or is influenced by environmental changes created by the Paraná River dams.

Rhamdia quelen (jundiá) é uma espécie de bagre que tem despertado grande interesse dos piscicultores e pesquisadores devido a várias características favoráveis a sua inclusão na lista de peixes criados comercialmente no país. Apresenta ampla distribuição geográfica, tendo sua ocorrência registrada desde a região central da Argentina até o sul do México, entretanto, os aspectos de sua biologia que foram estudados são em sua a maioria direcionada aos adultos e em cativeiro, com fins aquícolas. Pesquisas relacionadas ao ictioplâncton têm-se mostrado de grande importância por fornecer informações valiosas sobre a época, locais de desova e de criadouros naturais de várias espécies de peixes. Essas informações são fundamentais para a implementação de medidas de ordenamento e proteção dessas áreas. A planície de inundação estudada está localizada em um remanescente lótico, entre os reservatórios de Itaipu e Engenheiro Sérgio Motta. Apesar da unidade de conservação existente nesse trecho (Parque Nacional de Ilha Grande) e de estar localizada no último trecho livre de barramentos do rio Paraná em território brasileiro, a área é especialmente impactada pelos efeitos negativos dos barramentos. Foram realizadas coletas mensais noturnas durante quatro etapas entre os meses de outubro a março dos anos de 2003 a 2007 em 22 estações no leito principal do rio Paraná, lagoas marginais e principais afluentes. Após as triagens, as larvas foram classificadas de acordo com o grau de flexão da notocorda e desenvolvimento dos elementos de suporte da nadadeira caudal. Os dados foram submetidos à Análise de Componentes Principais (ACP), Análise de Variância e correlação de Pearson para sumarizar os dados abióticos e as densidades de larvas. O aumento da abundância de captura, nas quatro fases estudadas sugere que R. quelen tem encontrado condições favoráveis à sua reprodução. O aumento na captura pode gerar dúvidas sobre a atividade reprodutiva de R. quelen, por exemplo, se a espécie se adapta ou é influenciada por alterações no ambiente criado pelas barragens do rio Paraná.

Exercícios físicos nas valvopatias esquerdas: quando indicar e como prescrever / Exercise in valvular left: indicate when and how to prescribe

O exercício físico regular tem se mostrado como parte integrante da prevenção e do tratamento das doenças cardiovasculares de um modo geral, além de trazer diversos outros benefícios ao organismo humano. Dentre eles destacam a melhora do perfil lipídico, redução da pressão arterial, diminuição do risco de diabetes do tipo 2, manutenção do peso ótimo, ganho de densidade óssea, melhora da capacidade funcional...

Right ventricular dysfunction is an independent predictor of survival in patients with dilated chronic Chagas' cardiomyopathy.

BACKGROUND: Right ventricular (RV) involvement is a typical feature of Chagas' disease. In patients with congestive heart failure of other etiologies, RV dysfunction is a strong indicator of poor prognosis. However, the prognostic value of RV dysfunction in patients with Chagas' cardiomyopathy has not been reported. This study sought to investigate the prognostic value of RV dysfunction, apart from other well established risk factors, in patients with Chagas' cardiomyopathy. METHODS: The study enrolled 158 patients (99 men; mean age of 48+/-12 years) from a tertiary center for Chagas' disease. Patients were selected if found to have both the diagnosis of Chagas' disease and cardiomyopathy. All patients underwent a comprehensive Doppler echocardiogram and the global RV function was quantitatively assessed using the RV index of myocardial performance (Tei index). RESULTS: Most of the patients were in NYHA classes I and II (79%). During a mean follow up of 34+/-23 months, 44 patients (28%) died: 24 (55%) patients died of progressive heart failure and 16 (36%) of sudden death. RV Tei index emerged as an independent predictor of survival (hazard ratio 5.75, 95% confidence interval 1.69 to 19.51). Kaplan-Meier survival curves showed a higher cumulative mortality among patients in the highest quartile of RV Tei index, compared with other 3 quartiles (log-rank statistic 21.87, p<0.001). After adjustment for clinical data and LV ejection fraction, RV Tei index in the highest quartile (>0.56) remained a significant predictor of death (hazard ratio 5.29, 95% confidence interval 2.43 to 11.52). CONCLUSIONS: RV function assessed by the Tei index added significant prognostic information, incremental to the NYHA clinical classification and to the standard echocardiographic evaluation of LV systolic function. A simple measure of a Doppler index, which allows analysis of both systolic and diastolic function of the RV, appears to be a useful non-invasive tool for risk stratification in patients with dilated chronic Chagas' cardiomyopathy.