Risk of deep venous thrombosis associated with peripherally inserted central catheter: A retrospective cohort study of 11.588 catheters in Brazil.

INTRODUCTION: Deep Venous Thrombosis (DVT) due to Peripherally Inserted Central Catheter (PICC) is one of the most threatening complications after device insertion. OBJECTIVE: To assess the rate of PICC-associated DVT and analyze the risk factors associated with this event in cancer and critically ill patients. METHODS: We conducted a descriptive, retrospective cohort study with 11,588 PICCs from December 2014 to December 2019. Patients ≥ 18 years receiving a PICC were included. Pre-and post-puncture variables were collected and a logistic regression was used to identify the independent factors associated with the risk of DVT. RESULTS: The DVT prevalence was 1.8% (n = 213). The median length of PICC use was 15.3 days. The median age was 75 years (18; 107) and 52% were men, 53.5% were critically ill and 29.1% oncological patients. The most common indications for PICC's were intravenous antibiotics (79.1%). Notably, 91.5% of PICC showed a catheter-to-vein ratio of no more than 33%. The tip location method with intracavitary electrocardiogram was used in 43%. Most catheters (67.9%) were electively removed at the end of intravenous therapy. After adjusting for cancer profile ou chemotherapy, regression anaysis revealed that age (OR 1.011; 95% CI 1.002-1.020), previous DVT (OR 1.96; 95% CI 1.12-3.44) and obstruction of the device (OR 1.60; 95% CI 1.05-2.42) were independent factors associated with PICC-associated DVT, whereas the use of an anticoagulant regimen was a protective variable (OR 0.73; 95% CI 0.54-0.99). CONCLUSION: PICC is a safe and suitable intravenous device for medium and long-term therapy, with low rates of DVT even in a cohort of critically ill and cancer patients.

Amazonian earthworm biodiversity is heavily impacted by ancient and recent human disturbance.

Despite the importance of earthworms for soil formation, more is needed to know about how Pre-Columbian modifications to soils and the landscape. Gaining a deeper understanding is essential for comprehending the historical drivers of earthworm communities and the development of effective conservation strategies in the Amazon rainforest. Human disturbance can significantly impact earthworm diversity, especially in rainforest soils, and in the particular case of the Amazonian rainforest, both recent and ancient anthropic practices may be important. Amazonian Dark Earths (ADEs) are fertile soils found throughout the Amazon Basin, created by sedentary habits and intensification patterns of pre-Colombian societies primarily developed in the second part of the Holocene period. We have sampled earthworm communities in three Brazilian Amazonian (ADEs) and adjacent reference soils (REF) under old and young forests and monocultures. To better assess taxonomic richness, we used morphology and the barcode region of the COI gene to identify juveniles and cocoons and delimit Molecular Operational Taxonomic Units (MOTUs). Here we suggest using Integrated Operational Taxonomical units (IOTUs) which combine both morphological and molecular data and provide a more comprehensive assessment of diversity, while MOTUs only rely on molecular data. A total of 970 individuals were collected, resulting in 51 taxonomic units (IOTUs, MOTUs, and morphospecies combined). From this total, 24 taxonomic units were unique to REF soils, 17 to ADEs, and ten were shared between both soils. The highest richness was found in old forest sites for ADEs (12 taxonomic units) and REFs (21 taxonomic units). The beta-diversity calculations reveal a high species turnover between ADEs and REF soils, providing evidence that ADEs and REFs possess distinct soil biota. Furthermore, results suggest that ADE sites, formed by Pre-Columbian human activities, conserve a high number of native species in the landscape and maintain a high abundance, despite their long-term nature.

Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis.

BACKGROUND: Acute decompensation (AD) of cirrhosis is related to systemic inflammation and elevated circulating cytokines. In this context, biomarkers of inflammation, such as calprotectin, may be of prognostic value. AIM: To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis. METHODS: This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was measured by enzyme-linked immunosorbant assay. RESULTS: Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls. Higher median calprotectin was related to Child-Pugh C, ascites, and hepatic encephalopathy. Higher calprotectin was related to acute-on-chronic liver failure (ACLF) and infection in the bivariate, but not in multivariate analysis. Calprotectin was not associated with survival among patients with ACLF; however, in patients with AD without ACLF, higher calprotectin was associated with a lower 30-d survival, even after adjustment for chronic liver failure-consortium (CLIF-C) AD score. A high-risk group (CLIF-C AD score ≥ 60 and calprotectin ≥ 580 ng/mL) was identified, which had a 30-d survival (27.3%) similar to that of patients with grade 3 ACLF (23.3%). CONCLUSION: Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.

Combined performance of September's Weddell sea ice extent, Southern Annular Mode, and Atlantic SST anomalies over the South American temperature and precipitation.

This paper aims to analyze the relationships among tropical (Atlantic Meridional Mode - AMM), subtropical (South Atlantic Subtropical Gradient - SASG), and extratropical (Southern Annular Mode - SAM) teleconnection patterns, the Weddell Sea (WS) sea ice extents, and the climate in South America. Warm anomalies are observed in most of South America for maximum WS ice extent combinations (negative SAM/positive AMM and negative SAM/positive SASG composites), with an opposite signal at tropical South America for minimum WS ice extent combinations (positive SAM/negative AMM and positive SAM/negative SASG). Over Southern Argentina, colder (warmer) temperatures are seen at the negative SAM/positive SASG (positive SAM/negative SASG). Drier (wetter) conditions are found over most South America at maximum (minimum) WS ice extent combinations. Wavetrains from different Pacific and Indian Oceans regions are related to high-level anomalous cyclonic (anticyclonic) circulation over the continent at maximum (minimum) WS ice extent configuration, which explains the climate impacts found. The SASG signal displaces the anomaly circulations eastward from South America, impacting the adjacent Atlantic Ocean region more intensely concerning the other modes. The results discussed here indicated that these patterns (SAM, AMM, SASG, and sea ice extent) have significant links with the South American climate variability.

Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters.

BACKGROUND: Little is known about peripherally inserted central catheter (PICC) use, appropriateness and device outcomes in Brazil. METHODS: We conducted an observational, prospective, cohort study spanning 16 Brazilian hospitals from October 2018 to August 2020. Patients ≥18 years receiving a PICC were included. PICC placement variables were abstracted from medical records. PICC-related major (deep vein thrombosis (DVT), central line-associated bloodstream infection (CLABSI) and catheter occlusion) and minor complications were collected. Appropriateness was evaluated using the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Devices were considered inappropriate if they were in place for <5 days, were multi-lumen, and/or were placed in patients with a creatinine >2.0 mg/dL. PICCs considered appropriate met none of these criteria. Mixed-effects logistic regression models adjusting for patient-level and hospital-level characteristics assessed the association between appropriateness and major complications. RESULTS: Data from 12 725 PICCs were included. Mean patient age was 66.4±19 years and 51.0% were female. The most common indications for PICCs were intravenous antibiotics (81.1%) and difficult access (62.7%). Most PICCs (72.2%) were placed under ultrasound guidance. The prevalence of complications was low: CLABSI (0.9%); catheter-related DVT (1.0%) and reversible occlusion (2.5%). Of the 12 725 devices included, a total of 7935 (62.3%) PICCs were inappropriate according to MAGIC. With respect to individual metrics for appropriateness, 17.0% were placed for <5 days, 60.8% were multi-lumen and 11.3% were in patients with creatinine >2.0 mg/dL. After adjusting for patient and hospital-level characteristics, multi-lumen PICCs considered inappropriate were associated with greater odds of major complications (OR 2.54, 95% CI 1.61 to 4.02). CONCLUSIONS: Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed.

NEUTROPHIL-LYMPHOCYTE RATIO PREDICTS SHORT-TERM MORTALITY IN PATIENTS HOSPITALIZED FOR ACUTE DECOMPENSATION OF CIRRHOSIS.

BACKGROUND: Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE: Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS: In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS: In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION: NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

A "Dirty" Footprint: Macroinvertebrate diversity in Amazonian Anthropic Soils.

Amazonian rainforests, once thought to be pristine wilderness, are increasingly known to have been widely inhabited, modified, and managed prior to European arrival, by human populations with diverse cultural backgrounds. Amazonian Dark Earths (ADEs) are fertile soils found throughout the Amazon Basin, created by pre-Columbian societies with sedentary habits. Much is known about the chemistry of these soils, yet their zoology has been neglected. Hence, we characterized soil fertility, macroinvertebrate communities, and their activity at nine archeological sites in three Amazonian regions in ADEs and adjacent reference soils under native forest (young and old) and agricultural systems. We found 673 morphospecies and, despite similar richness in ADEs (385 spp.) and reference soils (399 spp.), we identified a tenacious pre-Columbian footprint, with 49% of morphospecies found exclusively in ADEs. Termite and total macroinvertebrate abundance were higher in reference soils, while soil fertility and macroinvertebrate activity were higher in the ADEs, and associated with larger earthworm quantities and biomass. We show that ADE habitats have a unique pool of species, but that modern land use of ADEs decreases their populations, diversity, and contributions to soil functioning. These findings support the idea that humans created and sustained high-fertility ecosystems that persist today, altering biodiversity patterns in Amazonia.

Razão neutrófilo-linfócito prediz mortalidade em curto prazo em pacientes hospitalizados com cirrose hepática descompensada / Neutrophil-lymphocyte ratio predicts short-term mortality in patients hospitalized for acute decompensation of cirrhosis

ABSTRACT BACKGROUND: Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE: Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS: In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS: In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION: NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

RESUMO CONTEXTO: Na cirrose há um quadro crônico de inflamação sistêmica associada a disfunção imune, que impactam na progressão da doença hepática. A razão neutrófilo-linfócito (RNL) foi proposta como um marcador de resposta inflamatória sistêmica e sobrevida em pacientes com cirrose hepática. OBJETIVO: Avaliar o papel de RNL como marcador prognóstico em portadores de cirrose hepática e sua relação com citocinas inflamatórias (IL-6, IL-10 e IL-17). MÉTODOS: É um estudo prospectivo com duas coortes: 1) pacientes cirróticos estáveis em acompanhamento ambulatorial (n=193); 2) pacientes cirróticos hospitalizados por descompensação aguda por no mínimo 48 horas (n=334) com avaliação de exames de admissão de 48 horas. Citocinas inflamatórias séricas estavam disponíveis em 130 pacientes hospitalizados. RESULTADOS: Nos pacientes ambulatoriais com cirrose estável, RNL se correlacionou com MELD e outras variáveis associadas com gravidade da doença. Entretanto, após uma mediana de 32 meses de seguimento, RNL não apresentou associação com mortalidade (HR 1.058, 95%CI 0.900-1.243; P=0.495). Nos pacientes hospitalizados, RNL de 48 horas após a admissão apresentou associação independente com sobrevida em 90 dias (HR 1.061, 95%CI 1.020-1.103; P=0.003) na regressão multivariada de Cox. A probabilidade de sobrevivência pela curva de Kaplan-Meier em 90 dias foi de 87% em pacientes com RNL de 48 horas <3.6 e 62% nos pacientes com RNL ≥3.6 (P<0.001). A elevação de RNL nas primeiras 48 horas também foi um fator independente associado a mortalidade (HR 2.038, 95%CI 1295-3207; P=0.002). A avaliação de sobrevida em 90 dias pela curva de Kaplan-Meier foi de 83% nos pacientes em que RNL não apresentou elevação e 62% nos que apresentaram elevação de RNL (P<0.001). IL-6, IL-10 e IL-17 na admissão se correlacionaram positivamente com RNL de admissão e de 48 horas. Níveis mais baixos de IL-10 basal foram associados com elevação de RNL nas primeiras 48 horas. CONCLUSÃO: RNL avaliada em 48 horas de hospitalização e sua elevação precoce após a admissão foram fatores independentemente associados a mortalidade em curto prazo nos pacientes hospitalizados com descompensação aguda da cirrose.

Identification of flavonoids in Hymenaea martiana Hayne (Fabaceae) by HPLC-DAD-MSn analysis.

Hymenaea martiana is a native tree known in Brazil as 'jatobá' and used in folk medicine to treat pain and inflammation. The aim of this work was to identify the flavonoids present in the crude ethanolic extract and ethyl acetate fraction using HPLC-DAD and LC-MSn analysis. The ethanolic extract was partitioned to obtain the ethyl acetate fraction. The analysis of astilbin content also was carried out by HPLC analysis. HPLC-DAD-ESI/MSn analysis of the ethanolic extract and ethyl acetate fraction revealed the presence of eleven peaks in the chromatograms, and all these peaks were identified: taxifolin, eucryphin, astilbin and 3 diastereoisomers, engeletin and 2 diastereoisomers, quercitrin and 2,6,3',4'-tetrahydroxy-2-benzylcoumaran-3-one. The ethyl acetate fraction had a higher astilbin concentration (151.87 µg/mL) than the ethanolic extract (40.13 µg/mL). In conclusion, the species could be considered a good source of flavonoids, which can be related to the main chemotaxonomic markers for the genus Hymenaea.

Terapia intravenosa: as primeiras atribuições dos enfermeiros no Brasil (1916-1943) / Intravenous therapy: Th e fi rst duties of nurses in Brazil (1916-1943)

Introdução: Para a consolidação da terapia intravenosa no Brasil, houve a necessidade de médicos e enfermeiros desenvolverem técnicas específicas, porém divergentes de atribuições, o que criou uma relação dialética de trabalho. Objetivo: Descrever as primeiras atribuições dos enfermeiros em terapia intravenosa no Brasil. Método: Pesquisa qualitativa, documental e histórica por meio de livros publicados no Brasil, escritos por médicos e enfermeiros, com recorte temporal compreendido entre os anos de 1916 a 1943. As atribuições profissionais foram analisadas sob a ótica do materialismo histórico e dialético. Resultados: Descreveram-se conceitos, atribuições profissionais, materiais, técnicas e cuidados de enfermagem, convergentes e divergentes entre si. Houve riqueza de detalhamento nos conhecimentos técnicos esperados dos enfermeiros: preparo, punção, organização de materiais e instrumentos, vigilância e administração de medicamentos. Conclusão: A construção da terapia de enfermagem intravenosa no Brasil, considerada como prática social do cuidado, consistiu em atender tecnicamente às prescrições médicas com segurança e rigor. As atribuições foram conflituosas, pois os próprios enfermeiros restringiram a sua prática, seja por respeito ou receio do médico.

Elevated neopterin levels are associated with acute-on-chronic liver failure and mortality in patients with liver cirrhosis.

BACKGROUND: Macrophage activation plays a central role in hepatic and systemic inflammation and is involved in the pathogenesis of acute-on-chronic liver failure (ACLF). AIMS: This study aimed to investigate neopterin levels in patients admitted for acute decompensation (AD) of cirrhosis, evaluating its relationship with ACLF and prognosis. METHODS: This prospective cohort study included 205 adult subjects hospitalized for AD of cirrhosis. Twenty-one healthy subjects and 89 patients with stable cirrhosis were evaluated as controls. RESULTS: Circulating neopterin was higher in AD as compared to stable cirrhosis and healthy controls (p<0.001). ACLF was independently associated with higher neopterin levels (OR 1.015, 95% CI 1.002-1.028, p = 0.025). In the multivariate Cox regression analysis, neopterin levels (HR = 1.002, IC 95% 1.000-1.004, p = 0.041), Child-Pugh class C, and ACLF were predictors of 30-day survival. Among patients with ACLF, the Kaplan-Meier survival probability was 71.4% in those with neopterin levels < 25 nmol/L and 31.0% if neopterin ≥ 25 nmol/L (p<0.001). CONCLUSIONS: Higher circulating neopterin was associated with ACLF in patients hospitalized for AD of cirrhosis. Neopterin levels were also independently predictors of high short-term mortality, especially among patients with ACLF, and could represent a useful biomarker of macrophage activation in clinical practice.

Modeling of the early stage of atherosclerosis with emphasis on the regulation of the endothelial permeability.

In this paper, we develop a mathematical model for the early stage of atherosclerosis, as a chronic inflammatory disease. It includes also processes that are relevant for the "thickening" of the vessel walls, and prepares a more complete model including also the later stages of atherosclerosis. The model consists of partial differential equations: Navier-Stokes equations modeling blood flow, Biot equations modeling the fluid flow inside the poroelastic vessel wall, and convection/chemotaxis-reaction-diffusion equations modeling transport, signaling and interaction processes initiating inflammation and atherosclerosis. The main innovations of this model are: a) quantifying the endothelial permeability to low-density-lipoproteins (LDL) and to the monocytes as a function of WSS, cytokines and LDL on the endothelial surface; b) transport of monocytes on the endothelial surface, mimicking the monocytes adhesion and rolling; c) the monocytes influx in the lumen, as a function of factor increasing monocytopoiesis; d) coupling between Navier-Stokes system, Biot system and convection/chemotaxis-reaction-diffusion equations. Numerical simulations of a simplified model were performed in an idealized two-dimensional geometry in order to investigate the dynamics of endothelial permeability, and the growth and spread of immune cells populations and their dependence in particular on low-density-lipoprotein and wall-shear stress.

Recent Advances in Copper Catalyzed Alcohol Oxidation in Homogeneous Medium.

The development of sustainable processes and products through innovative catalytic materials and procedures that allow a better use of resources is undoubtedly one of the most significant issues facing researchers nowadays. Environmental and economically advanced catalytic processes for selective oxidation of alcohols are currently focused on designing new catalysts able to activate green oxidants (dioxygen or peroxides) and applying unconventional conditions of sustainable significance, like the use of microwave irradiation as an alternative energy source. This short review aims to provide an overview of the recently (2015-2020) discovered homogeneous aerobic and peroxidative oxidations of primary and secondary alcohols catalyzed by copper complexes, highlighting new catalysts with potential application in sustainable organic synthesis, with significance in academia and industry.

MicroRNA profiles in serum samples from Acute-On-Chronic Liver Failure patients and miR-25-3p as a potential biomarker for survival prediction.

Acute-on-chronic liver failure (ACLF) is a condition characterized by acute decompensation of cirrhosis, associated with organ failure(s), and high short-term mortality. The microRNAs or miRNAs are small non-coding RNA molecules, stable in circulating samples such as biological fluids, and the difference in expression levels may indicate the presence, absence and/or stage of the disease. We analyzed here the miRNA profiling to identify potential diagnostic or prognostic biomarkers for ACLF. The major miRNAs discovered were validated in a cohort of patients with acute decompensation of cirrhosis grouped in no ACLF or ACLF according to EASL-CLIF definition. Relationship between serum miRNAs and variables associated with liver-damage and survival outcomes were verified to identify possible prognostic markers. Our results showed twenty altered miRNAs between no ACLF and ACLF patients, and twenty-seven in patients who died in 30 days compared with who survived. In validation phase, miR-223-3p and miR-25-3p were significantly altered in ACLF patients and in those who died in 30 days. miR-223-3p and miR-25-3p expression were associated with the lowest survival in 30 days. The decrease in miR-223-3p and miR-25-3p expression was associated with the presence of ACLF and poor prognosis. Of these, miR-25-3p was independently related to ACLF and 30-day mortality.

Cateter venoso central de inserção periférica e trombose: experiência em hospital de alta complexidade / Catéter venoso central de inserción periférica y trombosis: una experiencia en un hospital de alta complejidad / Peripherally-inserted central venous catheter: an experience in a high-complexity hospital

RESUMO Objetivo: descrever as variáveis associadas à trombose nos pacientes com cateter venoso central de inserção periférica. Método: estudo de coorte, retrospectivo, com dados coletados em 2016, no sistema de informação Research Eletronic Data Capture de um hospital de alta complexidade em São Paulo, Brasil. Resultados: o paciente crítico foi o que mais apresentou trombose (77,3%). O paciente que tinha o cateter venoso central de inserção periférica com ocupação do vaso sanguíneo maior que 33%, quando puncionado mais de uma vez (15,4%), evoluiu com trombose. Referente à área de punção, não houve resultado significativo já que 96,2% dos pacientes estavam com o cateter na zona ideal de punção no braço. Conclusão: a incidência de pacientes com Cateter Venoso Central de Inserção Periférica que evoluíram com trombose foi de 1,2%, considerada baixa em comparação com outros estudos, contribuindo para fortalecer as políticas de boas práticas para o sucesso da terapia intravenosa com seu uso.

RESUMEN: Objetivo: describir las variables asociadas a la trombosis en pacientes con un catéter venoso central de inserción periférica. Método: estudio de cohorte, retrospectivo, realizado con datos recolectados en el año 2016, en el sistema de información Research Eletronic Data Capture de un hospital de alta complejidad en San Pablo, Brasil. Resultados: los pacientes críticos fueron los que presentaron más casos de trombosis (77,3%). Cuando se realizó más de una punción (15,4%) en pacientes en los que el catéter venoso central de inserción periférica ocupaba más del 33% del vaso sanguíneo, el cuadro clínico evolucionó con trombosis. En relación al área de punción, no se registró un resultado significativo, puesto que el 96,2% de los pacientes tenía el catéter en la zona ideal de punción en el brazo. Conclusión: la incidencia de pacientes con un Catéter Venoso Central de Inserción Periférica que evolucionaron con trombosis fue del 1,2%, considerada baja en comparación con otros estudios, lo que contribuye a fortalecer las políticas de buenas prácticas para el buen resultado de la terapia intravenosa con su uso.

ABSTRACT Objective: to describe the variables associated with thrombosis in patients with peripherally-inserted central venous catheters. Method: a retrospective cohort study with data collected in 2016, in the Research Electronic Data Capture information system of a high-complexity hospital in São Paulo, Brazil. Results: the critical patient was the one who presented more thrombosis (77.3%). The patient who had a peripherally-inserted central venous catheter taking more than 33% of the blood vessel, when punctured more than once (15.4%), evolved with thrombosis. Regarding the puncture area, there was no significant result since 96.2% of the patients had the catheter in the ideal puncture zone in the arm. Conclusion: the incidence of patients with Peripherally-Inserted Central Venous Catheters who evolved with thrombosis was 1.2%, considered low compared to other studies, contributing to strengthen the policies of good practices for the success of the intravenous therapy with its use.

Cervical cancer: knowledge, attitude and practice on the prevention examination.

OBJECTIVE: to evaluate the knowledge, attitude and practice of women on the cervical-uterine cancer screening and to investigate their association with sociodemographic variables. METHOD: a cross-sectional study, carried out from July to September 2015, with 500 women enrolled in the Basic Health Units of the Health District V, of the city of Recife-PE. For data collection, a semi-structured form was used. In statistical analysis, the Chi-square test and Fisher's Exact Test were applied and, in the multivariate analysis, the Poisson model and Wald statistic. RESULTS: the prevalence of adequate knowledge, attitude and practice was 35.2%, 98% and 70.6%, respectively. Adequate knowledge was associated with having no children, having a family income of two minimum wages and Spiritist/Afro-Brazilian religion. CONCLUSION: women carry out the examination, deem it necessary, but do not have adequate knowledge, which demonstrates the need for educational actions by nurses and other health professionals.

Geopropolis gel for the adjuvant treatment of candidiasis - formulation and in vitro release assay

ABSTRACT The geopropolis produced by the stingless bee Melipona subnitida (popularly called "jandaíra" in Brazil) is a mixture of resin, wax, and mud. This study analyzed the antifungal activity of the geopropolis extract from Candida spp., developed a gel formulation with this extract and analyzed the delivery of bioactives (kinetics release) in the formulation and their chemical profile by UHPLC-PDA-qTOF-MS/MS. Three different gels were prepared using the geopropolis extract, carbomer, propylene glycol, and water. Formulations with different amounts of propylene glycol were investigated. Physical, visual, pH, viscosity, adhesion, spreadability, leakage, and in vitro release tests were performed in the proposed formulations. Antifungal tests with the geopropolis ethanolic extract were carried out against six Candida species. The chemical profile of the geopropolis extract and compounds released from the formulations were analyzed after the release test. The formulations had a pH between 4.6 and 4.8 and viscosity between 535,600 and 920,400 cPs. The geopropolis extract presented excellent antifungal activity against the tested yeasts. The results of the release test in semipermeable cellulose membrane showed that all formulations containing 5%, 10% and 40% propylene glycol presented release of geopropolis extract. For adhesion and leakage tests, the gel formulation with 5% propylene glycol was more effective. Both geopropolis ethanolic extract and the liquid obtained in the release test showed the presence of flavonoids (flavonol/flavone, flavanone, and chalcones). Gel formulations with geopropolis extract that are rich in flavonoids are promising as an adjuvant treatment of vaginal candidiasis.

Serial assessment of hepatic encephalopathy in patients hospitalised for acute decompensation of cirrhosis.

INTRODUCTION AND AIM: Hepatic encephalopathy (HE) is a frequent complication of cirrhosis, but the clinical and prognostic significance of the progression of mental status in hospitalised cirrhotics is unknown. We aimed to investigate the prognostic significance of serial evaluation of HE in patients hospitalised for acute decompensation (AD) of cirrhosis. MATERIALS AND METHODS: Patients (n=293) were evaluated for HE (West-Haven criteria) at admission and at day-3 and classified in two groups: (1) Absent or improved HE: HE absent at admission and at day-3, or any improvement at day-3; (2) Unfavourable progression: Development of HE or HE present at admission and stable/worse at day-3. RESULTS: Unfavourable progression of HE was observed in 31% of patients and it was independently associated with previous HE, Child-Pugh C and acute-on-chronic liver failure (ACLF). MELD score and unfavourable progression of HE were independently associated with 90-day mortality. The 90-day Kaplan-Meier survival probability was 91% in patients with MELD<18 and absent or improved HE and only 31% in subjects with both MELD≥18 and unfavourable progression of HE. Unfavourable progression of HE was also related to lower survival in patients with or without ACLF. Worsening of GCS at day-3 was observed in 11% of the sample and was related with significantly high mortality (69% vs. 27%, P<0.001). CONCLUSION: Among cirrhotics hospitalised for AD, unfavourable progression of HE was associated with high short-term mortality and therefore can be used for prognostication and to individualise clinical care.

Sambucus australis Modulates Inflammatory Response via Inhibition of Nuclear Factor Kappa B (NF-kB) in vitro.

Medicinal plants have long been used as an alternative to traditional drugs for the treatment of inflammatory conditions due to the classical side effects and restricted access of various commercially available drugs, such as steroids (GCs) and nonsteroidal anti-inflammatory drugs (NSAIDs). Sambucus australis is a Brazilian herb that is commonly used to treat inflammatory diseases; however, few studies have examined the use of this species in the treatment of inflammatory conditions. The present study aims to evaluate the potential anti-inflammatory activity of S. australis in vitro. We established spleen cell cultures stimulated with pokeweed mitogen (PWM) to evaluate the production of proinflammatory cytokines, such as IL-4, IL-5, IFN-y, and IL-10 (by ELISA), and the expression of the transcription factor NF-kB (by RT-PCR). In addition, we evaluated the levels of nitric oxide in macrophage cultures and the membrane-stabilizing activity of S. australis methanolic extract (EMSA). Treatment with EMSA at concentrations of 100, 50, 25 and 12.5 µg/ml significantly decreased IL-4 (p<0.001) and IL-5 (p<0.001) levels. Treatment with 100 µg/ml EMSA reduced IFN-у (p<0.001) levels. Moreover, at 100 mg/ml, EMSA also increased IL-10 production and reduced NF-kB expression (p<0.01). In macrophage cultures stimulated with LPS, EMSA decreased nitric oxide levels (p<0.001) at all concentrations tested (100, 50, 25 and 12.5 µg/ml). Additionally, EMSA had a protective effect in the erythrocyte membrane stabilization assay. Taken together, these results suggest that S. australis has anti-inflammatory potential in vitro, characterized by the reduction of both inflammatory cytokines and the expression of NF-kB along with the up-regulation of IL-10.

Cervical cancer: knowledge, attitude and practice on the prevention examination / Cáncer de cuello uterino: conocimiento, actitud y práctica sobre el examen de prevención / Câncer cervico-uterino: conhecimento, atitude e prática sobre o exame de prevenção

ABSTRACT Objective: to evaluate the knowledge, attitude and practice of women on the cervical-uterine cancer screening and to investigate their association with sociodemographic variables. Method: a cross-sectional study, carried out from July to September 2015, with 500 women enrolled in the Basic Health Units of the Health District V, of the city of Recife-PE. For data collection, a semi-structured form was used. In statistical analysis, the Chi-square test and Fisher's Exact Test were applied and, in the multivariate analysis, the Poisson model and Wald statistic. Results: the prevalence of adequate knowledge, attitude and practice was 35.2%, 98% and 70.6%, respectively. Adequate knowledge was associated with having no children, having a family income of two minimum wages and Spiritist/Afro-Brazilian religion. Conclusion: women carry out the examination, deem it necessary, but do not have adequate knowledge, which demonstrates the need for educational actions by nurses and other health professionals.

RESUMEN Objetivo: evaluar el conocimiento, actitud y práctica de mujeres sobre el examen de prevención del cáncer de cuello uterino e investigar su asociación con las variables sociodemográficas. Método: estudio transversal, realizado de julio a septiembre 2015, con 500 mujeres inscritas en las Unidades Básicas de Salud del Distrito Sanitario V, del municipio de Recife, Pernambuco, Brasil. Para la recolección de datos se utilizó un formulario semiestructurado. En el análisis estadístico, se aplicó el test de Chi-Cuadrado, la Prueba Exacta de Fisher y, en el análisis multivariada, el modelo de Poisson y la estadística de Wald. Resultados: la prevalencia de conocimiento, actitud y práctica adecuados fue de 35,2%, 98% y 70,6%, respectivamente. El conocimiento adecuado fue asociado a no tener hijos, tener una renta familiar de dos salarios mínimos y religión espírita/afrobrasileña. Conclusión: las mujeres realizan el examen, lo juzgan necesario, pero no tienen conocimiento adecuado, lo que demuestra la necesidad de acciones educativas por los enfermeros y demás profesionales de salud.

RESUMO Objetivo: avaliar o conhecimento, atitude e prática de mulheres sobre o exame preventivo do câncer cervico-uterino e investigar sua associação com as variáveis sociodemográficas. Método: estudo transversal, realizado de julho a setembro de 2015, com 500 mulheres cadastradas nas Unidades Básicas de Saúde do Distrito Sanitário V, do município de Recife-PE. Para a coleta de dados utilizou-se um formulário semiestruturado. Na análise estatística, foi aplicado o teste Qui-Quadrado, Teste Exato de Fisher e, na análise multivariada, o modelo de Poisson e estatística de Wald. Resultados: a prevalência de conhecimento, atitude e prática adequados foi de 35,2%, 98% e 70,6%, respectivamente. O conhecimento adequado foi associado a não ter filhos, ter renda familiar de dois salários mínimos e religião espírita/afro-brasileira. Conclusão: as mulheres realizam o exame, julgam-no necessário, mas não têm conhecimento adequado, o que demonstra a necessidade de ações educativas pelos enfermeiros e demais profissionais de saúde.