Inpatient peritoneal dialysis catheters placed across the United States during a 3-year period: Lessons learned from 15,000 patients.

BACKGROUND: Peritoneal dialysis is a popular option for patients with end-stage renal disease. A recent presidential executive order has incentivized in-home end-stage renal disease treatments, leading to an increase in peritoneal dialysis use. Guidelines exist for creating and maintaining peritoneal dialysis access without addressing the optimal technique. This study evaluates nationwide peritoneal dialysis catheter placement practices and their long-term outcomes. METHODS: Retrospective cohort analysis of Nationwide Readmission Database from 2017 to 2019. Patients with end-stage renal disease undergoing inpatient peritoneal dialysis catheter placement were included. Six-month readmissions, mortality, and peritoneal dialysis catheter-specific outcome measures were assessed among survivors of admission, including catheter leakage, mechanical breakdown, displacement, revision or replacement, removal, exit site infections, intra-abdominal abscess, and sepsis. Binary logistic regression analyses were performed. RESULTS: In the study, 14,863 patients with inpatient peritoneal dialysis catheter insertions were identified, of which 7,096 were analyzed (4,150 [59%] laparoscopic, 1,781 [25%] fluoroscopic, 1,165 [16%] open), 847 (12%) had major complications, 931 (13%) were readmitted, and 102 (1.4%) died within 6 months. Univariate analyses demonstrated that laparoscopy had higher mechanical complications, exit-site infections, catheter revision, and removal within 6 months, and fluoroscopy had higher sepsis and mortality. Multivariate analyses showed fluoroscopy was associated with intraabdominal abscess (adjusted odds ratio, 2.36; P = .025), laparoscopy with exit-site infections (adjusted odds ratio, 0.49; P = .005), and open surgery with catheter displacement (adjust odds ratio, 2.95; P = .021). CONCLUSION: This is the first large-scale study on inpatient peritoneal dialysis catheter placement outcomes in the United States. Fluoroscopic and open surgical placements are routinely performed, but laparoscopy remains the mainstay with fewer exit-site infections. Overall, peritoneal dialysis is a safe option, with 1 in 9 patients having an infectious or mechanical complication within 6 months. Furthermore, large-scale prospective studies are warranted to identify the optimal placement technique.

Circumstances and implications of conversion from minimally invasive to open liver resection: a multi-center analysis from the AMILES registry.

BACKGROUND: Minimally invasive approaches to liver resection (MILR) are associated with favorable outcomes. The aim of this study was to determine the implications of conversion to an open procedure on perioperative outcomes. METHODS: Patients who underwent MILR at 10 North American institutions were identified from the Americas Minimally Invasive Liver Resection (AMILES) database. Outcomes of patients who required conversion were compared to those who did not. Additionally, outcomes after conversion due to unfavorable findings (poor visualization/access, lack of progress, disease extent) versus intraoperative events (bleeding, injury, cardiopulmonary instability) were compared. RESULTS: Of 1675 patients who underwent MILR, 102 (6.1%) required conversion. Conversion rate ranged from 4.4% for left lateral sectionectomy to 10% for right hepatectomy. The primary reason for conversion was unfavorable findings in 67 patients (66%) and intraoperative adverse events in 35 patients (34%). By multivariable analysis, major resection, cirrhosis, prior liver surgery, and tumor proximity to major vessels were identified as risk factors for conversion (p < 0.05). Patients who required conversion had higher blood loss, transfusion requirements, operative time, and length of stay, (p < 0.05). They also had higher major complication rates (23% vs. 5.2%, p < 0.001) and 30-day mortality (8.8% vs. 1.3%, p < 0.001). When compared to those who required conversion due to unfavorable findings, patients who required conversion due to intraoperative adverse events had significantly higher major complication rates (43% vs. 14%, p = 0.012) and 30-day mortality (20% vs. 3.0%, p = 0.007). CONCLUSIONS: Conversion from MILR to open surgery is associated with increased perioperative morbidity and mortality. Conversion due to intraoperative adverse events is rare but associated with significantly higher complication and mortality rates, while conversion due to unfavorable findings is associated with similar outcomes as planned open resection. High-risk patients may benefit from early conversion in a controlled fashion if difficulties are encountered or anticipated.

Marginal Ulcer Following Completion Pancreatectomy Complicated by Portal Vein Erosion.

Marginal ulcers, defined as ulcers at the duodenojejunostomy or gastrojejunostomy, are a known late-onset complication of pancreaticoduodenectomy (PD) and total pancreatectomy (TP) with mean incidence ranging from 5.4% to 36% per the literature. These ulcers carry a risk of complications including hemorrhage or perforation which can result in significant mortality. Marginal ulcers from PD and TP causing portal vein erosion are extremely rare and given the high incidence of mortality, it is important to have a multimodal approach to the treatment with awareness that early operative management should be considered if other modalities fail. We discuss the case of a 57-year-old female with history of pancreatic tail intraductal papillary mucinous neoplasm (IPMN) status post distal pancreatectomy/splenectomy and subsequent completion pancreatectomy for pancreatic head IPMN who presented with acute gastrointestinal bleed. The patient was successfully managed operatively with primary repair of the marginal ulcer after multiple failed endoscopic attempts.

Microfluidic sperm sorting improves ICSI outcomes in patients with increased values of Double-Strand Breaks in sperm DNA / La selección espermática mediante un dispositivo microfluídico mejora los resultados de ICSI en pacientes con valores elevados de fragmentación de cadena doble en el ADN espermático

Background: Delays in embryo kinetics, implantation failures in ICSI treatments and recurrent miscarriages have been associated with high values of Double-Strand Breaks (DSB) in sperm DNA. While conventional methods for semen preparation have been shown to be inefficient reducing DSB values, Microfluidic Sperm Sorting (MSS) devices are promising tools to reduce this damage. Objective: To study the clinical utility of an MSS device in ICSI treatments when the male partner presents increased DSB values, as compared to the use of conventional methods based on sperm motility. Methods: This retrospective cohort study included 28 infertile couples undergoing ICSI treatments. Only couples where the male partner presented increased values of DSB were included. DSB values were evaluated in semen samples by the Neutral Comet assay. Couples performed a first ICSI cycle using conventional methods for semen preparation (Density Gradients and Swim-up) and a second ICSI cycle using the ZyMōt™ICSI (formerly named FertileChip®) microfluidic device. Embryology and clinical outcomes were compared between ICSI cycles. Results: Semen parameters and the number of obtained and fertilized oocytes did not show differences between ICSI rounds. Clinical outcomes were statistically better when MSS was used: the biochemical pregnancy rate increased 28.31%; the clinical pregnancy rate increased 35.56% and the number of live births increased 35.29%, as compared to the first ICSI cycle in this group of patients. (AU)

Antecedentes: Valores elevados de fragmentación de cadena doble (DSB) en el ADN de los espermatozoides se han asociado con retrasos en la cinética embrionaria, fallos de implantación en ciclos de ICSI y con abortos de repetición. Actualmente no hay evidencias de que los métodos convencionales para la preparación del semen puedan reducir los niveles de DSB. Por el contrario, los nuevos dispositivos microfluídicos de selección espermática (MSS) han mostrado resultados prometedores en cuanto a la reducción de la fragmentación. Objetivo: Evaluar el uso de un dispositivo MSS en ciclos de ICSI donde el varón presenta niveles elevados de DSB, en comparación con el uso de métodos convencionales basados en la selección por motilidad. Métodos: Este estudio retrospectivo ha incluido a 28 parejas infértiles que han realizado ciclos de ICSI y donde se han detectado valores elevados de DSB en la muestra seminal del varón. Los niveles de DSB se han analizado mediante el test Cometa Neutro. Las parejas realizaron un primer ciclo de ICSI utilizando métodos convencionales para la preparación del semen (gradientes de densidad y Swim-up). Posteriormente, las parejas realizaron un segundo ciclo de ICSI utilizando el dispositivo microfluídico ZyMōt™ICSI (antes FertileChip®). Se han comparado los resultados de embriología y los resultados clínicos entre ambos tratamientos. Resultados: No se han encontrado diferencias entre ambos ciclos de ICSI en cuanto a parámetros seminales y el número de ovocitos obtenidos y fecundados. Los resultados clínicos fueron mejores cuando se usó el dispositivo MSS: se observó un incremento del 28,31% en la tasa de embarazo bioquímico, del 35,56% en la tasa de embarazo clínico y del 35,29% en la tasa de nacidos vivos, en comparación con el uso de métodos convencionales. (AU)

Microfluidic sperm sorting improves ICSI outcomes in patients with increased values of Double-Strand Breaks in sperm DNA.

BACKGROUND: Delays in embryo kinetics, implantation failures in ICSI treatments and recurrent miscarriages have been associated with high values of Double-Strand Breaks (DSB) in sperm DNA. While conventional methods for semen preparation have been shown to be inefficient reducing DSB values, Microfluidic Sperm Sorting (MSS) devices are promising tools to reduce this damage. OBJECTIVE: To study the clinical utility of an MSS device in ICSI treatments when the male partner presents increased DSB values, as compared to the use of conventional methods based on sperm motility. METHODS: This retrospective cohort study included 28 infertile couples undergoing ICSI treatments. Only couples where the male partner presented increased values of DSB were included. DSB values were evaluated in semen samples by the Neutral Comet assay. Couples performed a first ICSI cycle using conventional methods for semen preparation (Density Gradients and Swim-up) and a second ICSI cycle using the ZyMot™ICSI (formerly named FertileChip®) microfluidic device. Embryology and clinical outcomes were compared between ICSI cycles. RESULTS: Semen parameters and the number of obtained and fertilized oocytes did not show differences between ICSI rounds. Clinical outcomes were statistically better when MSS was used: the biochemical pregnancy rate increased 28.31%; the clinical pregnancy rate increased 35.56% and the number of live births increased 35.29%, as compared to the first ICSI cycle in this group of patients. CONCLUSIONS: The ZyMot™ICSI microfluidic device improved the reproductive outcomes in couples where the male partner presented increased DSB values, when compared to the use of conventional semen preparation techniques.

Elevated serum uric acid is a facilitating mechanism for insulin resistance mediated accumulation of visceral adipose tissue.

OBJECTIVE: Serum uric acid (SUA) has been associated with cardiometabolic conditions such as insulin resistance (IR) and visceral adipose tissue (VAT) accumulation. Here, we aimed to clarify a unifying mechanism linking elevated SUA to IR and VAT. METHODS: We conducted analyses in 226 subjects from the UIEM cohort with both euglycemic hyperinsulinemic clamp (EHC) and dual X-ray absorptiometry (DXA) measurements for IR and VAT accumulation and explored the role of SUA and adiponectin by developing a network of causal mediation analyses to assess their impact on IR and VAT. These models were then translated to two population-based cohorts comprising 6337 subjects from NHANES 2003-2004 and 2011-2012 cycles in the US and ENSANUT Medio Camino 2016 in Mexico, using HOMA2IR and adipoIR as indicators of peripheral and adipose tissue IR, and METS-VF as a surrogate for VAT accumulation. RESULTS: SUA has a mediating role inside a bidirectional relationship between IR and visceral obesity, which was similar using either gold standard measurements or surrogate measures for IR and VAT. Furthermore, adiponectin acts as a linking mediator between elevated SUA and both peripheral IR and VAT accumulation. The proportion of the mechanism for IR-mediated (in either peripheral or adipose tissue) VAT accumulation was greater, compared to VAT-mediated IR accumulation (10.53% [9.23%-12.00%] to 5.44% [3.78%-7.00%]). Normal-range SUA levels can be used to rule-out underlying cardio-metabolic abnormalities in both men and women. CONCLUSIONS: Elevated SUA acts as a mediator inside the bidirectional relationship between IR and VAT accumulation and these observations could be applicable at a phenotype scale.

Sperm selection during ICSI treatments reduces single- but not double-strand DNA break values compared to the semen sample.

PURPOSE: To detect a possible bias in sperm DNA fragmentation (SDF) testing when performed on semen samples or on those few spermatozoa selected for Intracytoplasmic Sperm Injection (ICSI) treatments. METHODS: A multimethodological analysis of Single- and Double-Strand DNA Breaks (SSB and DSB, respectively) was performed through the Neutral Comet, the Alkaline Comet, the Sperm Chromatin Dispersion (SCD) and the Terminal deoxynucleotidyl transferase dUTP Nick End Labelling (TUNEL) assays. SDF was evaluated in (i) semen samples from 23 infertile patients (not achieving pregnancy or suffering recurrent miscarriage); (ii) samples after a Swim-up and (iii) spermatozoa microselected for ICSI (ICSI-S). RESULTS: The analysis of 3217 ICSI-S revealed a significant reduction of SSB values compared to the Ejaculate and the Swim-up samples. On the contrary, DSB values were not reduced after any sperm selection method. The No-pregnancy group presented poorer semen parameters and higher SSB values. The Recurrent miscarriage group presented better semen parameters but also higher DSB values. CONCLUSION: The analysis of SDF on semen samples may not be fully representative of those few spermatozoa selected for ICSI. Since oxidative stress impairs sperm motility and causes SSB, selecting a motile sperm may intrinsically imply choosing a sperm not affected by this damage. DSB have an enzymatic origin which does not affect motility, making it difficult to select a sperm without this damage. Therefore, ICSI treatments could be effective in patients presenting high SSB values. Patients presenting high DSB values should expect bad ICSI results if this damage is not reduced through other specific methods.

Actividad antiinflamatoria y gastroprotectora del extracto acuoso de capraria biflora l / Anti-inflammatory and gastroprotective activity of the aqueous extract of capraria biflora l

Introducción: Capraria biflora L, es una planta comúnmente empleada en patologías crónicas asociadas a procesos inflamatorios. Objetivo: Evaluar el efecto antiinflamatorio y gastroprotector del extracto acuoso de Capraria biflora L. Métodos: Para el estudio de la actividad antiinflamatoria se utilizó el modelo de inflamación crónica de granulomas inducidos por discos de algodón, mientras que para la actividad gastroprotectora se evaluaron dos técnicas de producción de úlceras agudas utilizando como agentes ulcerogénicos al etanol absoluto (1mL/200g) y la Indometacina (50 mg/Kg). En el diseño experimental se utilizaron dosis de 200, 400 y 800 mg/Kg de peso. Resultados: El extracto de Capraria biflora L, presentó actividad antiinflamatoria a todas las dosis estudiadas, mostrando la dosis de 200 mg/kg resultados estadísticamente comparables a la Indometacina, mientras que las de 400 y 800 mg/kg resultaron significativamente superiores a este control. Adicionalmente se comprobó el efecto gastroprotector del extracto mediante el modelo de úlcera por etanol absoluto, a todas las dosis estudiadas, con porcientos de inhibición comparables al Omeprazol. Similares resultados se obtuvieron con el modelo de úlcera por Indometacina, siendo las dosis más efectivas las de 400 y 800 mg/Kg, con porcientos de inhibición comparables a la Ranitidina. Conclusiones: El extracto de Capraria biflora L presentó actividad antiinflamtoria y gastroprotectora bajo las condiciones evaluadas.

[Índices para la evaluación de la resistencia a la insulina en individuos mexicanos sin diabetes].

OBJECTIVE: To evaluate the correlation between subrogate index for the evaluation of insulin resistance with the M value obtained with the euglycemic-hyperinsulinemic clamp as well as their sensitivity, specificity, and positive and negative predictive values. METHOD: The euglycemic-hyperinsulinemic clamp was performed in subjects having both normal fasting glucose and glycated hemoglobin concentrations. HOMA-IR, QUICKI, HOMA2%S, TyG, TyG*body mass index (BMI) and triglyceride/HDL indexes were calculated. Correlations coefficients were estimated between indexes results and the M-value adjusted by fat-free mass. Areas under the ROC curve were constructed to evaluate overall performance, sensitivity, specificity and predictive values of the subrogate indexes. RESULTS: 57 subjects, 68.4% women, with a mean age of 32.9 ± 11 years-old were included. The subrogate index with the best correlation with the M value was HOMA2%S (r = 0.428), HOMA-IR had the greatest area under the ROC curve (0.683; 95 % confidence interval: 0.503-0.864) and TyG*BMI the best sensitivity (98.2 %) and specificity (51.1 %). CONCLUSIONS: The surrogated indexes for the evaluation of insulin resistance show a significant correlation with the M value obtained with the gold standard. Additional studies are required to determine cut-off values in Mexican population.

OBJETIVO: Evaluar la correlación entre índices subrogados de resistencia a la insulina y el valor M obtenido mediante pinza euglucémica-hiperinsulinémica, así como su sensibilidad, especificidad y valores predictivos positivo y negativo, en mexicanos sin diabetes. MÉTODO: Se realizó una pinza euglucémica-hiperinsulinémica en individuos con glucosa en ayuno y hemoglobina glucosilada normales. Se estimaron los índices HOMA-IR, QUICKI, HOMA2%S, TyG, TyG*índice de masa corporal (IMC) y triglicéridos/colesterol ligado a lipoproteínas de alta densidad. Se estimaron coeficientes de correlación de Pearson entre los resultados y el valor M ajustado por masa libre de grasa. Se construyeron curvas ROC para evaluar su desempeño y se estimaron la sensibilidad, la especificidad y los valores predictivos de los índices. RESULTADOS: Se incluyeron 57 individuos, el 68.4 % mujeres, de 32.9 ± 11 años, con IMC de 26.5 ± 3.9 kg/m2. El índice subrogado con mejor correlación con el valor M fue HOMA2%S (r = 0.428), con la mayor área bajo la curva ROC (0.683; intervalo de confianza del 95 %: 0.503-0.864) HOMA-IR, y con mejor sensibilidad (92.8 %) y especificidad (51.1 %) TyG*IMC. CONCLUSIONES: Los índices subrogados para estimar la resistencia a la insulina muestran una correlación significativa con el valor M obtenido con el método de referencia. Se requieren más estudios para determinar puntos de corte en población mexicana.

Prevalence and factors associated to back pain in adults from the northeast of São Paulo, Brazil: a population-based study / Prevalência e fatores associados à dor na coluna vertebral em adultos do noroeste de São Paulo, Brasil: estudo de base populacional

Abstract Introduction: Back pain has become a serious public health problem. Objective: To determine the prevalence of back pain in a population-based sample of subjects over 20 years old living in the city of Bauru (São Paulo, Brazil) and to analyze the associations to variables- sociodemographic, ergonomic and lifestyle-related - and to morbidity. Methods: a cross-sectional study which evaluated 600 adults over 20 years old, both gender and living in the city. We used a structured protocol and the Nordic questionnaire. Also, we developed a descriptive analysis, bivariate and multivariate by binary logistic regression. Results: The prevalence of back pain was of 50.3% (CI 46.3 to 54.3), since 42.3% (CI 36.9 to 48.0) in men and 57.6% (CI 51.9 to 63.0) in women, with statistical significant difference (p = 0.001). Different variables remained in final models when assessed by gender. For male to be widowed and divorced and smoking habits and, for women to be widowed and divorced, to work in seated position and to perform occupational activities that demand carrying and lifting weight. Conclusion: We verified high prevalence in back pain in the population of Bauru and high association to widowed/divorced in both gender, with women performing occupational activities usually or always in seated position, those who carry or lift weight in work and men who smoke.

Resumo Introdução: As dores na coluna vertebral tornaram-se um grave problema de saúde pública. Objetivo: Verificar a prevalência de dor na coluna vertebral em uma amostra de base populacional de indivíduos com idade superior a 20 anos residentes na cidade de Bauru (São Paulo, Brasil) e analisar as associações as variáveis sociodemográficas, ergonômicas, relacionadas ao estilo de vida e a morbidade referida. Métodos: Estudo transversal que avaliou 600 adultos com idade superior a 20 anos, de ambos os sexos, moradores da zona urbana do município. Utilizou-se um protocolo estruturado e o questionário Nórdico. Realizou-se uma análise descritiva, bivariada e multivariada por regressão logística binária. Resultados: A prevalência de dor nas costas foi 50,3% (IC95% 46,3 a 54,3), sendo que, 42,3% (IC95% 36,9 a 48,0) nos homens e 57,6% (IC95% 51,9 a 63,0) nas mulheres com diferença estatisticamente significativa (p = 0,001). Diferentes variáveis permaneceram nos modelos finais ao se considerarem, em separado, o sexo masculino e o feminino. Ser viúvo e separado e tabagismo para o sexo masculino e, para o feminino, ser viúva e separada, trabalho na postura sentada e exercer atividades ocupacionais que exigem transporte e carregamento de peso. Conclusão: Verificou uma prevalência alta de dor na coluna vertebral na população de Bauru e marcante associação com marcante associação com os viúvos/separados, em ambos os sexos, com as mulheres que exercem suas atividades ocupacionais, geralmente ou sempre, na postura sentada, naqueles que transportam e carregam pesos regulamente no trabalho e nos homens tabagistas.

Morbidades referidas e qualidade de vida: estudo de base populacional / Morbilidades referidas y calidad de vida: estudio de base poblacional / Reported morbidities and quality of life: population-based study

RESUMO O objetivo deste trabalho foi verificar o nível de qualidade de vida relacionada à saúde (QVRS) em uma amostra de base populacional de adultos de 20 anos ou mais, residentes na cidade de Bauru, São Paulo, e sua associação com a quantidade de morbidades referidas. Foi realizado um inquérito populacional, por meio de uma amostragem complexa em dois estágios, totalizando 600 participantes da zona urbana de Bauru. Para a coleta de dados foram utilizados os seguintes instrumentos: 1. caracterização dos participantes (aspectos demográficos, socioeconômicos, nível de atividade física e hábito de fumar); 2. morbidade (referida por meio da pergunta: "No último ano, o (a) sr. (a) recebeu diagnóstico médico de alguma doença?"); 3. qualidade de vida (utilizando o questionário Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36). Foram realizadas análises descritiva e bivariada, por meio do teste t de Student e ANOVA. Observou-se que 70,5% apresentaram pelo menos uma doença, e as principais referidas foram a hipertensão, as artroses, a depressão e o diabetes. Quanto à associação entre os números de doenças, as pessoas mais idosas e as que referiram três ou mais doenças apresentaram piores escores de QVRS em todos os domínios físicos e nas limitações por aspectos sociais e emocionais. O maior número de morbidades associou-se aos menores escores de qualidade de vida relacionada à saúde.

RESUMEN El objetivo de este estudio fue verificar el nivel de calidad de vida relacionada a la salud (QVRS) en una muestra de base poblacional de adultos de 20 años o más, residentes de la ciudad de Bauru, São Paulo, y su asociación con la cantidad de morbilidades referidas. Se realizó una encuesta poblacional mediante una muestra compleja en dos estadios, con un total de 600 participantes de la zona urbana de Bauru. Para la recolección de datos se utilizó los siguientes instrumentos: 1. caracterización de los participantes (aspectos demográficos, socioeconómicos, nivel de actividad física y hábito de fumar); 2. morbilidades (referida mediante la pregunta: "En el último año, usted ha recibido el diagnóstico médico de alguna enfermedad?"); 3. calidad de vida (utilizando el cuestionario Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36). Se realizó análisis descriptivos y bivariados, mediante la prueba T de Student y Anova. Se observó que 70,5% presentaron por lo menos una enfermedad, y las principales referidas fueron la hipertensión, la artrosis, la depresión y la diabetes. En relación a la asociación entre los números de enfermedades, las personas mayores y las que refirieron tres o más enfermedades presentaron peores scores de QVRS en todos los dominios físicos y en las limitaciones por aspectos sociales y emocionales. El mayor número de morbilidades se asoció a los menores scores de calidad de vida relacionada a la salud.

ABSTRACT The purpose was to verify the level of health-related quality of life in a population-based sample of adults aged 20 years or more living in the city of Bauru, São Paulo, Brazil, and its association with the amount of reported morbidities. A population survey was conducted through a complex sampling in two stages, totaling 600 participants in the urban area of Bauru, São Paulo. To collect data, the following instruments were used: 1. Characterization of participants (demographic and socio-economic aspects, physical activity level and smoking habit); 2. reported morbidity through the following question: "Last year, did you receive a diagnosis of any illness from a doctor?; 3. Quality of Life, using the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) questionnaire. Descriptive and bivariate analyses were carried out using the Student's t-test and ANOVA. It was noted that 70.5% had at least one disease, and the most common morbidities reported were hypertension, osteoarthritis, depression, and diabetes. The association between the number of diseases, those who reported three or more diseases, and older age had worse HRQOL scores in all physical domains and limitations by social and emotional aspects. A greater number of comorbidities was associated with the lower scores of health-related quality of life.

Educação continuada em gerontologia para agentes comunitários de saúde / Continuing Education in gerontology for community health agent / Educación continua en gerontología para los agentes comunitarios de salud

Objetivo: avaliar o efeito de um Programa de Educação em Gerontologia desenvolvido à Agentes Comunitários de Saúde. Métodos: estudo de intervenção (comparação antes e depois) com participação de 111 agentes comunitários, com perda de 25 (22,5%), atuantes nas 12 unidades de saúde da família de um município do interior paulista, em 2012. Os dados foram coletados por meio de questionário sociodemográfico, instrumento de avaliação do contato dos agentes comunitários com idosos e questionário para avaliação de conhecimentos gerontológicos (Questionário Palmore-Neri-Cachioni). Foi desenvolvido um Programa de Educação em Gerontologia junto aos agentes comunitários, no período de 5 dias: encontros com duração de 90 minutos cada um, abordando temas relacionados à velhice e envelhecimento. Para análise dos dados, foi utilizado o programa SAS versão 9.2 para Windows. Resultados: prevaleceram entre os agentes os adultos jovens, do sexo feminino, casados, com ensino médio completo e inseridos na atividade há mais de dois anos e meio. A maioria dos agentes expôs sempre ter contato com idosos, cultivado em âmbito do trabalho e intrafamiliar e relatou experiência com a população dessa faixa etária, mais da metade referiu ter participado de educação gerontológica. O maior número de acertos ao questionário de avaliação sobre conhecimentos gerontológicos, aplicado antes, imediatamente após e depois de três meses ao desenvolvimento do Programa de Educação em Gerontologia, demonstrou melhor desempenho dos agentes na segunda e terceira aplicações desse instrumento realizadas após o programa, tornando evidente a importância de educação em gerontologia para esse público. Conclusão: promover educação em gerontologia para agentes comunitários de saúde é fundamental, pois providos de conhecimentos podem reforçar seu papel mediante a equipe de saúde e população, dentre ela, os idosos.

Objective: to evaluate the effect of an education program in gerontology for community health agents. Methods: this intervention study (before and after comparison) included 111 community agents, lossy 25 (22.5%), from 12 family health centers from city in the state of São Paulo in 2012. Data were collected through a sociodemographic questionnaire, to determine the formal and informal contact of the elderly group with the community health agents, as well as through a questionnaire that evaluated gerontological knowledge (Questionnaire Palmore-Neri-Cachioni). Moreover, an education program in gerontology was conducted for community agents, including 90-minute sessions over a 5-day period, which focused on topics related to old age and aging. Data analysis was performed using the SAS version 9.2 for Windows. Results: young adults, female sex, married status, high school education, and activity for more than two and a half years were common characteristics associated with community agents. Most of the agents were in contact with the elderly, to cultivate of work and within the family, and reported to have experience in dealing with this age group. Moreover, more than half of the community agents reported to have participated in gerontological education. The questionnaire assessing the knowledge on gerontology, which was applied before, immediately after, and three months after the education program in gerontology indicated better responses among the community health agents immediately after and three months after the program, thus suggesting that education in gerontology is important among these individuals. Conclusion: promoting education in gerontology among community health agents is essential, as the knowledge provided can strengthen the role of health care staff and the population in caring for the elderly.

Objetivo: evaluar el efecto de un Programa de Educación en Gerontología desarrollado para Agentes Comunitarios de Salud. Métodos: un estudio de intervención (en comparación antes y después) con 111 agentes comunitarios, con una pérdida de 25 (22,5%), que trabajan en 12 unidades de salud de la familia en ciudad en el estado de São Paulo en el 2012. Los datos fueron recogidos a través de cuestionarios: sociodemográficos, contacto con los profesionales con los mayores y la evaluación del conocimiento en gerontología (Palmore-Neri-Cachioni). Programa de Educación en Gerontología desarrollado abarca temas relacionados con el envejecimiento. Para el análisis de los datos se utilizó SAS versión 9.2. Resultados: prevalecieron entre estos profesionales, adultos, femenino, casado, completado la escuela secundaria. Mayoría siempre tienen contacto con los mayores y reportaron haber participado de educación gerontológica. El mayor número de respuestas correctas al cuestionario sobre conocimiento gerontológico, aplicado antes, inmediatamente después y tres meses después de que el desarrollo del Programa de Educación en Gerontología, mostró mejor rendimiento en la segunda y tercera solicitudes después del programa. Conclusión: educación en gerontológica para agentes comunitarios es fundamental, conforme a lo dispuesto conocimiento puede fortalecer su papel por parte del personal de salud y población, entre sus mayores.

Patterns of Weight Loss Response Following Gastric Bypass and Sleeve Gastrectomy.

BACKGROUND: Despite the health benefits of bariatric surgery (BS) extend beyond WL, better understanding of the WL response may help improve the outcomes of BS. In this context, we aimed to assess patterns within the variability of weight loss (WL) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: WL data from 658 subjects that underwent RYGB (n = 464) or SG (n = 194) as first BS were analyzed. Based on excess WL (EWL), subjects were categorized as good WL responders (EWL ≥ 50 % at nadir weight and throughout follow-up), primarily poor WL responders (1-PWL:EWL < 50 % at nadir weight and thereafter), and secondarily poor WL responders (2-PWL:EWL ≥ 50 % at nadir weight, but <50 % at last follow-up visit). Predictors associated with different WL outcomes were ascertained using regression analysis. RESULTS: Median follow-up was 55.7 months. Nadir EWL ranged 12.4-143.6 %; last follow-up visit EWL ranged -22.1-143.6 % and weight regain (WR) ranged 0-64.1 kg. Good WL was found in 75.7 of the cohort. 1-PWL response (4.7 %) was characterized by lesser WL but similar WR as compared to good WL and was associated with larger BMI and diabetes prior to surgery. 2-PWL response (19.6 %) was characterized by larger WR as compared to the other groups and was more common following SG. Lesser percentage of medical appointments kept was associated with 1-PWL and 2-PWL. CONCLUSION: Our data show the high inter-individual variability of the WL response at mid-term after RYGB and SG and that poor WL after BS could be illustrated by two different patterns, characterized either by sustained limited WL (1-PWL), or pronounced weight regain (2-PWL).

Chronic administration of nicotine enhances NMDA-activated currents in the prefrontal cortex and core part of the nucleus accumbens of rats.

Nicotine is an addictive substance of tobacco. It has been suggested that nicotine acts on glutamatergic (N-methyl-d-aspartate, NMDA) neurotransmission affecting dopamine release in the mesocorticolimbic system. This effect is reflected in neuroadaptative changes that can modulate neurotransmission in the prefrontal cortex (PFC) and nucleus accumbens (NAcc) core (cNAcc) and shell (sNAcc) regions. We evaluated the effect of chronic administration of nicotine (4.23 mg/kg/day for 14 days) on NMDA activated currents in dissociated neurons from the PFC, and NAcc (from core and shell regions). We assessed nicotine blood levels by mass spectrophotometry and we confirmed that nicotine increases locomotor activity. An electrophysiological study showed an increase in NMDA currents in neurons from the PFC and core part of the NAcc in animals treated with nicotine compared to those of control rats. No change was observed in neurons from the shell part of the NAcc. The enhanced glutamatergic activity observed in the neurons of rats with chronic administration of nicotine may explain the increased locomotive activity also observed in such rats. To assess one of the possible causes of increased NMDA currents, we used magnesium, to block NMDA receptor that contains the NR2B subunit. If there is a change in percent block of NMDA currents, it means that there is a possible change in expression of NMDA receptor subunits. Our results showed that there is no difference in the blocking effect of magnesium on the NMDA currents. The magnesium lacks of effect after nicotinic treatment suggests that there is no change in expression of NR2B subunit of NMDA receptors, then, the effect of nicotine treatment on amplitude of NMDA currents may be due to an increase in the quantity of receptors or to a change in the unitary conductance, rather than a change in the expression of the subunits that constitute it.

Satisfação com a Vida na Percepção dos Idosos / Satisfaction with Life Seniors' Perception

Foi realizada uma pesquisa qualitativa à luz da Grounded Theory, objetivando compreender os fatores associados à satisfação com a vida, em idosos, no município de Barreiras (BA). A metodologia escolhida foi qualitativa. Como pergunta norteadora, foi solicitado ao entrevistado que falasse espontaneamente sobre satisfação com a vida. Foram entrevistados vinte e um idosos, escolhidos por conveniência, provenientes de classes socioeconômicas e culturais e idades diversificadas. As entrevistas foram gravadas e registradas em mp3 e o conteúdo transcrito na íntegra. A análise dos dados foi realizada à luz da teoria fundamentada em dados (Grounded Theory) e representada através do Simbolismo Teórico. Os resultados estão representados na descrição de três fenômenos que se integraram e interrelacionaram ao longo da experiência vivida, no que tange à satisfação com a vida. Estes constituíram os vértices na base do tripé que convergiram para o que aparenta ser o sentido da satisfação com a vida, entre eles: “Elegendo as Relações de Afeto e Cumplicidade com a Família, Amigos e Lazer”; “Encontrando a Felicidade na Vida, como a Construiu”; Compreendendo as Condições de Saúde e as Necessidades da sua Prevenção como seus Determinantes”. Desse modo, a satisfação com a vida entre os idosos não apareceu apenas como um recorte de um ponto específico, mas sim como uma trajetória ao longo da vida que lhes proporcionou momentos de felicidade, atitudes e vontades, indo além dos desdobramentos e implicações que a idade avançada lhes reserva. Depois de descobertos esses fenômenos, buscamos padrões de conectividade entre seus componentes para conceitualizar a categoria central e conseguimos entender os pontos-chave que nos permitiram retratar a experiência dos idosos do município de Barreiras (BA), durante sua vida, associada com o grau de satisfação.(AU)

A research was conducted aiming to understand the factors associated with life satisfaction in the elderly, in Barreiras (BA). The methodology chosen was qualitative. As a guiding question it was asked to the interviewed to talk freely about life satisfaction. Twenty-one seniors were interviewed, chosen by convenience, from different socioeconomic and cultural classes and several ages. The interviews were recorded and registered in mp3 format and it content was transcript in full. Data analysis was conducted considering the Grounded Theory and represented by Symbolism Theory. The results are shown in the description of three phenomena that were interrelated and integrated throughout the experience of life, when it comes to life satisfaction. These were the vertices in the base of the tripod that converged to what appears to be a sense of satisfaction with life, among them "Electing Affection Relations And Complicity With The Family, Friends And Leisure"; "Finding Happiness In Life, As It Was Built"; "Understanding Health Conditions And The Requirements Of Its Prevention As Their Determinants." Thus, satisfaction with life among the elderly, not only appeared as a clipping of a specific point, but as a lifelong path that gave moments of happiness, attitudes and desires, beyond the ramifications and implications that old age holds. After discovered these phenomena, we seek for patterns of connectivity between their components to conceptualize the core category and we understood the key points that allowed us to portray the experience of elderly in Barreiras - BA, during their lifetime, associated with the degree of satisfaction.(AU)

Satisfação com a vida na percepção dos idosos / Satisfaction with life seniors perception

Foi realizada uma pesquisa qualitativa à luz da Grounded Theory, objetivando compreender os fatores associados à satisfação com a vida, em idosos, no município de Barreiras (BA). A metodologia escolhida foi qualitativa. Como pergunta norteadora, foi solicitado ao entrevistado que falasse espontaneamente sobre satisfação com a vida. Foram entrevistados vinte e um idosos, escolhidos por conveniência, provenientes de classes socioeconômicas e culturais e idades diversificadas. As entrevistas foram gravadas e registradas em mp3 e o conteúdo transcrito na íntegra. A análise dos dados foi realizada à luz da teoria fundamentada em dados (Grounded Theory) e representada através do Simbolismo Teórico. Os resultados estão representados na descrição de três fenômenos que se integraram e interrelacionaram ao longo da experiência vivida, no que tange à satisfação com a vida. Estes constituíram os vértices na base do tripé que convergiram para o que aparenta ser o sentido da satisfação com a vida, entre eles: “Elegendo as Relações de Afeto e Cumplicidade com a Família, Amigos e Lazer”; “Encontrando a Felicidade na Vida, como a Construiu”; Compreendendo as Condições de Saúde e as Necessidades da sua Prevenção como seus Determinantes”. Desse modo, a satisfação com a vida entre os idosos não apareceu apenas como um recorte de um ponto específico, mas sim como uma trajetória ao longo da vida que lhes proporcionou momentos de felicidade, atitudes e vontades, indo além dos desdobramentos e implicações que a idade avançada lhes reserva. Depois de descobertos esses fenômenos, buscamos padrões de conectividade entre seus componentes para conceitualizar a categoria central e conseguimos entender os pontos-chave que nos permitiram retratar a experiência dos idosos do município de Barreiras (BA), durante sua vida, associada com o grau de satisfação.

A research was conducted aiming to understand the factors associated with life satisfaction in the elderly, in Barreiras (BA). The methodology chosen was qualitative. As a guiding question it was asked to the interviewed to talk freely about life satisfaction. Twenty-one seniors were interviewed, chosen by convenience, from different socioeconomic and cultural classes and several ages. The interviews were recorded and registered in mp3 format and it content was transcript in full. Data analysis was conducted considering the Grounded Theory and represented by Symbolism Theory. The results are shown in the description of three phenomena that were interrelated and integrated throughout the experience of life, when it comes to life satisfaction. These were the vertices in the base of the tripod that converged to what appears to be a sense of satisfaction with life, among them "Electing Affection Relations And Complicity With The Family, Friends And Leisure"; "Finding Happiness In Life, As It Was Built"; "Understanding Health Conditions And The Requirements Of Its Prevention As Their Determinants." Thus, satisfaction with life among the elderly, not only appeared as a clipping of a specific point, but as a lifelong path that gave moments of happiness, attitudes and desires, beyond the ramifications and implications that old age holds. After discovered these phenomena, we seek for patterns of connectivity between their components to conceptualize the core category and we understood the key points that allowed us to portray the experience of elderly in Barreiras - BA, during their lifetime, associated with the degree of satisfaction.

Espectro de tomografía computarizada e imágenes por resonancia magnética de la esteatosis hepática / Imaging Patterns in Liver Steatosis, CT and MRI Maurizio Massaro Ceballos1

La esteatosis hepática es un hallazgo frecuente en los estudios de imagen; bien sea aislada o asociada a diferentes etiologías. Es conocido que la esteatosis hepática puede desencadenar hepatopatía crónica y tener diferentes espectros en su presentación. El propósito de este artículo es realizar una revisión de las características por imagen en la esteatosis hepática, así como las diferentes lesiones focales que se pueden presentar concomitantemente con esta entidad.

Liver steatosis is a common finding in abdominal imaging, either as an isolated finding or associated with diverse pathologies. In addition, it is a known cause of chronic liver disease. Different patterns of this entity are reported. Our purpose is to describe the imaging characteristics of liver steatosis, as well as describe the different focal liver lesions associated with this disease.

Síndrome de "gloria de la mañana": presentación de caso / Morning Glory Syndrome: Case Report

Se presenta el caso de una mujer con disminución de la agudeza visual y con excavación posterior del globo ocular que compromete el disco óptico. El síndrome de "gloria de la mañana" es una displasia del disco óptico asociada con otras alteraciones oculares, con defectos de línea media cráneo-facial, con anomalías renales y con posibles lesiones vasculares cerebrales.

We report the case of a woman with a decrease in visual acuity and with an excavation of the eyeball which jeopardizes the optic disc. The Morning Glory syndrome is a congenital optic disc dysplasia associated with other ocular abnormalities, with midline craniofacial defects, kidney abnormalities, and cerebrovascular disorders.

[Community health workers' attitudes and beliefs toward the elderly]. / Atitudes e conhecimentos de agentes comunitários de saúde e suas relações com idosos.

OBJECTIVE: To describe community health workers' attitudes and beliefs toward the elderly. METHODS: Cross-sectional descriptive study conducted in with 213 community health workers (CHWs) at 12 primary care units and 29 family health centers in the city of Marília, State of São Paulo, Southeastern Brazil, in 2010. Data were collected by means of a sociodemographic questionnaire, a scale of attitudes toward aging (Neri Scale), and a questionnaire to assess gerontological knowledge (the Palmore-Neri-Cachioni Aging Quiz). The Statistical Package for the Social Sciences v. 16.0 was used for data analysis. RESULTS: Community health workers predominantly consisted of young female adults, married, with more than 12 years of schooling and who worked in this activity for over 6 years. Most CHWs reported having experience with elderly people and having elderly people in the family. However, less than half of them received training on the topic of aging. As for attitudes towards the elderly, CHWs stressed both positive aspects such as their wisdom and generosity and negative aspects such as slowness and strictness. They showed low gerontological knowledge, which was directly associated with the training received. Many CHWs stereotyped the elderly as dissatisfied and dependent. CONCLUSIONS: Changing attitudes and improving knowledge on aging are critical for meeting health care demands of elderly people. More appropriate training of CHWs is key for providing adequate primary care to elderly population.

Atitudes e conhecimentos de agentes comunitários de saúde e suas relações com idosos / Community health workers' attitudes and beliefs toward the elderly / Actitudes y conocimientos de agentes comunitarios de salud y sus relaciones con ancianos

OBJETIVO: Analisar as relações entre agentes comunitários de saúde e os cuidados prestados a idosos. MÉTODOS: Estudo transversal descritivo, com 213 agentes comunitários das 12 unidades básicas de saúde e das 29 unidades de saúde da família de Marília em 2010. Os dados foram coletados por meio de um questionário sociodemográfico, um instrumento de escala de atitudes em relação à velhice (Escala de Neri) e um questionário para avaliar conhecimentos gerontológicos (Questionário Palmore-Neri-Cachioni). Para a análise dos dados, foi utilizado o programa Statistical Package for the Social Sciences versão 16.0 para Windows. RESULTADOS: Predominaram no quadro dos agentes comunitários os adultos jovens, do sexo feminino, casados, escolaridade > 12 anos e inseridos na atividade há mais de seis anos. A maioria dos agentes relatou experiência com grupo de idosos e convivência intradomiciliar com pessoas dessa faixa etária, porém menos da metade referiu capacitação no tema envelhecimento. As avaliações positivas dos agentes quanto às atitudes perante a velhice ocorreram principalmente em aspectos como a sabedoria e generosidade dos idosos, porém foram marcantes as atitudes negativas para "lentidão e rigidez". O número de acertos sobre gerontologia foi baixo e esteve diretamente associado às capacitações recebidas pelos agentes. Foram observados estereótipos em relação ao idoso, na medida em que muitos agentes os consideravam insatisfeitos e dependentes. CONCLUSIONES: Mudar as atitudes e melhorar o conhecimento que se tem acerca do envelhecimento é essencial no enfrentamento das demandas advindas dessa fase da vida. Qualificar a formação do agente comunitário de saúde é fundamental no cuidado ao idoso na atenção primária.

OBJECTIVE: To describe community health workers' attitudes and beliefs toward the elderly. METHODS: Cross-sectional descriptive study conducted in with 213 community health workers (CHWs) at 12 primary care units and 29 family health centers in the city of Marília, State of São Paulo, Southeastern Brazil, in 2010. Data were collected by means of a sociodemographic questionnaire, a scale of attitudes toward aging (Neri Scale), and a questionnaire to assess gerontological knowledge (the Palmore-Neri-Cachioni Aging Quiz). The Statistical Package for the Social Sciences v. 16.0 was used for data analysis. RESULTS: Community health workers predominantly consisted of young female adults, married, with more than 12 years of schooling and who worked in this activity for over 6 years. Most CHWs reported having experience with elderly people and having elderly people in the family. However, less than half of them received training on the topic of aging. As for attitudes towards the elderly, CHWs stressed both positive aspects such as their wisdom and generosity and negative aspects such as slowness and strictness. They showed low gerontological knowledge, which was directly associated with the training received. Many CHWs stereotyped the elderly as dissatisfied and dependent. CONCLUSIONS: Changing attitudes and improving knowledge on aging are critical for meeting health care demands of elderly people. More appropriate training of CHWs is key for providing adequate primary care to elderly population.

OBJETIVO: Analizar las relaciones entre agentes comunitarios de salud y los cuidados prestados a los ancianos. MÉTODOS: Estudio transversal descriptivo, con 213 agentes comunitarios de las 12 unidades básicas de salud y de las 29 unidades de salud de la familia de Marília, Sudeste de Brasil, en 2010. Los datos se colectaron por medio de un cuestionario sociodemográfico, un instrumento de escala de actitudes con relación a la vejes (Escala de Neri) y un cuestionario para evaluar conocimientos gerontológicos (Cuestionario Palmore-Neri-Cachioni). Para el análisis de los datos, se utilizó el programa Statistical Package for the Social Sciences versión 16.0 para Windows. RESULTADOS: Predominaron en la plantilla de los agentes comunitarios los adultos jóvenes, del sexo femenino, casados, con escolaridad > 12 años e insertados en la actividad por más de seis años. La mayoría de los agentes narró experiencia con grupo de ancianos y convivencia intra-domiciliar con personas de dicho grupo etario, sin embargo, menos de la mitad refirió capacitación en el tema del envejecimiento. Los agentes tuvieron evaluaciones positivas con respecto a las actitudes frente a la vejez en aspectos como la sabiduría y generosidad de los ancianos, por otro lado, resaltaron las actitudes negativas para "lentitud y rigidez". El número de aciertos sobre gerontología fue bajo y estuvo directamente asociado con las capacitaciones recibidas por los agentes. Se observaron estereotipos con relación al anciano, en la medida en que muchos agentes los consideraban insatisfechos y dependientes. CONCLUSIONES: Cambiar las actitudes y mejorar el conocimiento que se tiene sobre el envejecimiento es esencial en el enfrentamiento de las demandas que advienen en la vida. Calificar la formación del agente comunitario de salud es fundamental en el cuidado del anciano en la atención primaria.