Clozapine clinical toolkit optimizes inpatient clozapine monitoring.

Introduction: Clozapine is the most effective antipsychotic in the management of treatment-resistant schizophrenia; however, its use is challenging due to the risk of severe adverse effects. Despite the risks associated with clozapine, there is no mandatory monitoring in Canada beyond hematologic testing for agranulocytosis surveillance. This study focuses on the development, implementation, and evaluation of a clozapine clinical toolkit (CTK) targeted at optimizing inpatient clozapine use. Methods: A comprehensive literature review was conducted to identify clozapine best practices, experts were consulted, and a comprehensive clozapine CTK was developed and implemented at a large Canadian tertiary hospital in December 2018. To evaluate the CTK, a retrospective chart review was conducted to assess for change in guideline-concordant monitoring pre- and post- CTK implementation. Patients were included if they were > 18 years of age and received clozapine during inpatient admission. Results were analyzed using descriptive and inferential statistics. Results: Among the charts reviewed, 185 and 113 admissions met the pre- and post-CTK inclusion criteria, respectively. Staff used the CTK in the care of 96% of clozapine patients post implementation, and its use resulted in improvements in guideline-concordant monitoring for agranulocytosis and myocarditis. Discussion: Implementation of the clozapine CTK increased the concordance of clozapine monitoring with best practice recommendations. Future research is necessary to assess the impact of the CTK on clinical outcomes and patient satisfaction.

Home-based and community-based activities that can improve mental wellness: a protocol for an umbrella review.

INTRODUCTION: Mental disorders affect about 13% of the world's population. While evidence-based mental health treatments are available, a significant number of persons with mental illnesses are untreated or do not receive adequate mental healthcare due to various reasons, including costs, stigma and the desire to self-manage symptoms. In the past few years, there has been an increase in the body of evidence regarding leisure activities and mental wellness. However, there is currently no published overview of the state of the evidence on these activities and their potential preventive and therapeutic effects on mental health. METHODS AND ANALYSIS: Using Joanna Briggs Institute (JBI) review guidelines, an umbrella review will be undertaken to synthesise findings from systematic reviews and meta-analyses on the mental health benefits of home-based and community-based activities. MEDLINE, PsycInfo, Embase, CINAHL, Web of Science, Epistemonikos, Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Implementation Reports will be searched for potentially relevant systematic reviews and meta-analyses published from January 1991 to present. Title/abstract screening, full-text review, data extraction and assessment of methodological quality will each be performed independently by two reviewers. A third review author will be available to resolve discrepancies in any of the review tasks. To assess the quality of potentially eligible reviews, the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses will be used. Findings will be presented in table form and will be summarised by study population, type of home-based or community-based activity or intervention, and type of mental health outcomes. Overall assessment of the strength of existing evidence from eligible systematic reviews will be provided following the grading of recommendation, assessment, development and evaluation approach. ETHICS AND DISSEMINATION: No ethical approval is required. Results of this umbrella review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021266989.

A rapid review of home-based activities that can promote mental wellness during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, public health measures such as isolation, quarantine, and social distancing are needed. Some of these measures can adversely affect mental health. Activities that can be performed at home may mitigate these consequences and improve overall mental well-being. In this study, home-based activities that have potential beneficial effects on mental health were examined. METHODS: A rapid review was conducted based on a search of the following databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies include randomized controlled trials and non-randomized studies published between 1/1/2000 and 28/05/2020 and that examined the impact of various activities on mental health outcomes in low-resource settings and contexts that lead to social isolation. Studies of activities that require mental health professionals or that could not be done at home were excluded. Two review authors performed title/abstract screening. At the full-text review stage, 25% of the potentially eligible studies were reviewed in full by two review authors; the rest were reviewed by one review author. Risk of bias assessment and data extraction were performed by one review author and checked by a second review author. The main outcome assessed was change or differences in mental health as expressed in Cohen's d; analysis was conducted following the synthesis without meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082. RESULTS: Of 1,236 unique records identified, 160 were reviewed in full, resulting in 16 included studies. The included studies reported on the beneficial effects of exercise, yoga, progressive muscle relaxation, and listening to relaxing music. One study reported on the association between solitary religious activities and post traumatic stress disorder symptoms. While most of the included studies examined activities in group settings, particularly among individuals in prisons, the activities were described as something that can be performed at home and alone. All included studies were assessed to be at risk of bias in one or more of the bias domains examined. CONCLUSIONS: There is some evidence that certain home-based activities can promote mental wellness during the COVID-19 pandemic. Guidelines are needed to help optimize benefits while minimizing potential risks when performing these activities.

Polyphenol profile by UHPLC-MS/MS, anti-glycation, antioxidant and cytotoxic activities of several samples of propolis from the northeastern semi-arid region of Brazil.

CONTEXT: Propolis has promising biological activities. Propolis samples from the Northeast of Bahia, Brazil - sample A from Ribeira do Pombal and B, from Tucano - were investigated, with new information regarding their biological activities. OBJECTIVE: This paper describes the chemical profile, antioxidant, anti-glycation and cytotoxic activities of these propolis samples. MATERIAL AND METHODS: Ethanol extracts of these propolis samples (EEP) and their fractions were analyzed to determine total phenolic content (TPC); antioxidant capacity through DPPH•, FRAP and lipid peroxidation; anti-glycation activity, by an in vitro glucose (10 mg/mL) bovine serum albumine (1 mg/mL) assay, during 7 d; cytotoxic activity on cancer (SF295, HCT-116, OVCAR-8, MDA-MB435, MX-1, MCF7, HL60, JURKAT, MOLT-4, K562, PC3, DU145) and normal cell lines (V79) at 0.04-25 µg/mL concentrations, for 72 h. The determination of primary phenols by ultra high-pressure liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS) and volatile organic compounds content by gas chromatography-mass spectrometry (GC-MS) were also performed. RESULTS: The EEP polar fractions exhibited up to 90% protection against lipid peroxidation. The IC50 value for anti-glycation activity of EEP was between 16.5 and 19.2 µg/mL, close to aminoguanidine (IC50 = 7.7 µg/mL). The use of UHPLC-MS/MS and GC-MS allowed the identification of 12 bioactive phenols in the EEP and 24 volatile compounds, all already reported. CONCLUSIONS: The samples present good antioxidant/anti-glycation/cytotoxic activities and a plethora of biologically active compounds. These results suggest a potential role of propolis in targeting ageing and diseases associated with oxidative and carbonylic stress, aggregating value to them.

Evaluation of the clinical-functional results from repairing extensive rotator cuff injury with inclusion of the tendon of the long head of the biceps

OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001), 3º of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results. .

Evaluation of the Clinical-functional Results from Repairing Extensive Rotator Cuff Injury with Inclusion of the Tendon of the Long Head of the Biceps.

OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33o (p < 0.001), 3o of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.

Síndrome de Sturge-Weber e diabetes mellitus tipo 1 / The Sturge -Weber syndrome and diabetes mellitus type 1

O estudo relata um caso de síndrome de Sturge-Weber, fundamentando-se nos dados clínicos, diagnósticos e terapêuticos, além de atestar a atípica associação entre essa síndrome e diabetes mellitus tipo 1. A síndrome de Sturge-Weber (síndrom e de Sturge-We ber-Dimitri, angiomatose encéfalo-trigeminal ou encéfalo-facial) consiste em uma anomalia vascular neuro-ectodérmica. Caracteriza-se pelo envolvimento leptomeníngeo, ocular, oral e cutâneo. O prognóstico depende do grau de acometimento neurológico, que geralmente é progressivo.

Estudo clínico aberto multicêntrico da efetividade e tolerabiblidade do gel de adapaleno a 0, 1 por cento em pacientes com acne vulgar / Multicentric open clinical study of the efficacy and tolerability of adapalene 0, 1 por cent gel in patients with acne vulgaris

O adapaleno é um derivado do ácido naftóico, com propriedades biológicas similares às do ácido retinóico e utilizado no tratamento da acne vulgar.Avaliar a eficácia e a tolerabilidade do adapaleno 0,1 por cento gel no tratamento da acne vulgar leve à moderada, em pacientes residentes no Brasil. Os pacientes aplicaram o gel à noite, durante 12 semanas, e foram avaliados quanto à efetividade pelo número de lesões em cada visita e quanto à tolerabilidade ao produto nas consultas da segunda e da décima segunda semana. Dos 125 pacientes, 81,6 por centocompletaram as 12 semanas de tratamento, e 10,4 por cento dos casos terminaram o estudo antes do período estabelecido por estarem livres de lesões. Os resultados permitem confirmar a marcante atividade antiinflamatória, antiproliferativa e na diferenciação celular dos ceratinócitos. Houve diminuição dos comedões e das lesões inflamatórias, com resposta satisfatória no eritema, no ressecamento e na descamação da pele. Efeitos adversos pouco graves foram relatados em apenas 9,6 por cento dos pacientes. O adapaleno, neste estudo e nos vários que o antecederam, vem-se mostrando uma das melhores opções de tratamento tópico para os casos leves a moderados de acne vulgar

Perfil epidemiológico do diabetes mellitus auto-referido em uma zona urbana de Juiz de Fora, Minas Gerais / Epidemiologic profile of self-reported diabetes mellitus in a urban zone of Juiz de Fora, state of Minas Gerais, Brazil

Objetivo: Delinear um perfil epidemiológico do diabetes mellitus (DM) em uma zona urbana de Juiz de For a usando os dados obtidos no cadastramento do Programa de Saúde da Família da Prefeitura Municipal de Juiz de For a. Metodologia: Foram colhidas informações em 12.695 domicílios através da aplicação de um questionário baseado no Programa Avançado de Gerência em Atenção Primária a Saúde. A aplicação foi realizada por 180 entrevistadores acadêmicos da área de saúde. Os dados foram transferidos para o programa epidemiológico EPI-INFO versão 6.03. A análise do banco de dados referentes a população entre 30 e 69 anos permitiu a elaboração de um estudo sobre a prevalência do DM e sua relação com outros fatores. Resultados: A prevalência do DM auto-referido foi de 4,2 por cento (861 pessoas) e variou de 0,9 por cento (76) entre 30 e 39 anos a 11,6 por cento (297) entre 60 e 69 anos. 17,1 por cento (147) relataram não tratar ou tratar irregularmente. Nos homens, a idade não interferiu no tratamento; nas mulheres, quanto menor a faixa etária, menor a adesão ao tratamento. O DM estava relacionado com outros agravos à saúde: cardiopatia (r=4,8), hipertensão arterial sistêmica (r=4,7), cegueira (r=3,1) e incapacidade de locomoção (r=3,9). Conclusão: A prevalência da DM auto-referido foi semelhante a de outros estudos nacionais. O índice de diabéticos com tratamento irregular foi muito alto e relaciona-se com baixa renda e faixas etárias mais jovens no sexo feminino. O DM apresentou alta correlação com outros agravos à saúde: cardiopatia, hipertensão arterial sistêmica, cegueira e incapacidade de locomoção.

As supra-renais na hanseniase virchowiana. Avaliação funcional. Estudo tomografico e ultrassonografico / ?

O objetivo do estudo foi avaliar a função supra-renal (glico e mineralocorticoide) em pacientes com hanseniase virchowiana (HV) de longa duração, tratados como mono ou poliquimioterapia matriculados no Hospital de Dermatologia Sanitaris Padre Damião, Tocantins, MG. Foram estudados 20 hansenianos virchowianos (hv) voluntarios e 10 individuos higidos voluntarios da mesma comunidade. Foram realizadas dosagens do ACTH plasmatico basal e do cortisol e aldosterona plasmaticos basais e apos ACTH 1-24 e imagens das supra-renais pela tomografia computadorizada (TC) e ultrassonografia (US).Os resultados mostraram 2 hv com ACTH elevado e 2 outros com cortisol basal diminuido, todos sem doença de Addison. Apos o ACTH 1-24 11/20 hv(55%) não atingiram o Valor Maximo (VMax) do cortisol esperado; 8/20(40%) não alcançaram o delta cortisol de 7 microgramas e 7/20(35%)não atenderam as duas condições. 7 hv(35%) não alcançaram o delta de 4 ng/dL para a aldosterona. Quatorze (70%) hv apresentaram alteração de pelo menos um dos 5 indicadores funcionais pesquisados (ACTH plasmático, cortisol e aldosterona basais, VMax cortisol, cortisol e aldosterona ). Pela analise destes indicadores foi feito o estadiamento de I a IV da deficiencia supra-renal dos hv estudados. O volume das supra-renais pela TC foi significativamente maior nos hv (4185 e 3963mm3) do que nos individuos controle (1917 e 2769mm3). O estudo pela TC teve sensibilidade maior do que pela US. Dada a alta prevalencia do comprometimento da função supra-renal demonstrado na HV, recomenda-se esta avaliação funcional em todos os hv e o estudo pela TC nos hv dos estadios I A V.

Avaliaçao funcional da córtex supra-renal em pacientes com Morbus Hansen

O objetivo do estudo foi avaliar o estado funcional do córtex supra-renal de hansenianos, com mais de cinco anos de doença, internados no Hospital de Dermatologia Sanitária Padre Damiao (HDSPD), de Tocantins, Minas Gerais. A hipótese substantiva foi a existência de correleçao entre hanseníase virchowiana e diminuiçao da funçao da cótex supra-renais. Foram estudados 30 hansenianos virchowianos do HDSPD no Hospital Escola de UFJF, de Juiz de Fora, Minas Gerais. Foi realizado amplo estudo dos pacientes, que incluiu as dosagens basais de 17 OHS, 17 CTS e 17 CGS na urina de 24 horas e o rítmo de cortisol plasmático. Foram feitos de estímulo com infusao de ACTH 1-24, lisina-vasopressina (LVP) IM, insulina IV e metopirona oral

Avaliaçao dos fatores de risco da hipertensão arterial no municipio Santo Antonio de Aventurero, Minas Gerais

Este projeto de intervenção tem como objetivo promover atividades de educação em saúde sobre os principais fatores de risco para a hipertensão arterial, modificáveis pela atuação da Estratégia Saúde da Família. Foi utilizado o planejamento estratégico situacional e os registros nos prontuários dos pacientes diagnosticados com hipertensão, O projeto foi desenvolvido no período de, julho de 2015 a dezembro de 2015 . Os resultados apontam que a educação em saúde na atenção Básica, especialmente na Estratégia de Saúde da Família (ESF) constitui-se em um instrumento de intervenção importante, pois conhecendo a realidade da população que assistem, as intervenções propostas pela equipe multiprofissional podem produzir resultados positivos. Observou-se a necessidade de valorização de novos conceitos de saúde-doença e participação do usuário de saúde na elaboração do seu plano de intervenção, com estímulo à cessação do tabagismo e do uso abusivo de álcool, redução do peso entre aqueles com sobrepeso, implementação de atividades físicas, redução do consumo de sal, aumento do consumo de hortaliças e frutas, além da diminuição de alimentos gordurosos, entre outros, com o intuito de estimular o auto-cuidado promovendo uma melhoria da qualidade de vida da população