Oxidative stress induction by essential oil from Piper alatipetiolatum (Piperaceae) triggers lethality in the larvae of Culex quinquefasciatus (Diptera: Culicidae).

Culex quinquefasciatus is the main vector of lymphatic filariasis in Brazil, which present resistance to commercial insecticides. Nowadays, essential oils (EOs) exhibiting larvicidal activity, such as those derived from Piper alatipetiolatum, provide a promising alternative for vector control, including Culex species. This study aimed to investigate the larvicidal activity and the oxidative stress indicators of the EO from P. alatipetiolatum in Cx. quinquefasciatus larvae. The EO was extracted from P. alatipetiolatum leaves using the hydrodistillation method, resulting in a yield of 7.2 ± 0.1%, analysed by gas chromatography coupled with spectrometry and gas chromatography coupled with flame ionization detector (GC-MS and GC-FID), and evaluated against Cx. quinquefasciatus larvae. Reactive Oxygen and Nitrogen Species (RONS), Catalase (CAT), glutathione-S-transferase (GST), acetylcholinesterase (AChE), and Thiol levels were used as oxidative stress indicators. Analysis by CG-MS and CG-FID revealed that the main compound in the EO was the oxygenated sesquiterpene ishwarone, constituting 78.6% of the composition. Furthermore, the EO exhibited larvicidal activity, ranging from 26 to 100%, with an LC50 of 4.53 µg/mL and LC90 of 15.37 µg/mL. This activity was accompanied by a significant increase in RONS production, alterations in CAT, GST, AChE activity, and thiol levels compared to the control groups (p < 0.05). To the best of our knowledge, this is the first report describing the larvicidal activity and oxidative stress induced by the EO from P. alatipetiolatum against Cx. quinquefasciatus larvae. Therefore, we propose that this EO shows promise as larvicidal agent for the effective control of Cx. quinquefasciatus larvae.

Essential oil from Piper tuberculatum Jacq. (Piperaceae) and its majority compound ß-caryophyllene: mechanism of larvicidal action against Aedes aegypti (Diptera: Culicidae) and selective toxicity.

Synthetic insecticides have been the primary approach in controlling Aedes aegypti; however, their indiscriminate use has led to the development of resistance and toxicity to non-target animals. In contrast, essential oils (EOs) are alternatives for vector control. This study investigated the mechanism of larvicidal action of the EO and ß-caryophyllene from Piper tuberculatum against A. aegypti larvae, as well as evaluated the toxicity of both on non-target animals. The EO extracted from P. tuberculatum leaves was majority constituted of ß-caryophyllene (54.8%). Both demonstrated larvicidal activity (LC50 of 48.61 and 57.20 ppm, p < 0.05), acetylcholinesterase inhibition (IC50 of 57.78 and 71.97 ppm), and an increase in the production of reactive oxygen and nitrogen species in larvae after exposure to the EO and ß-caryophyllene. Furthermore, EO and ß-caryophyllene demonstrate no toxicity to non-target animals Toxorhynchites haemorrhoidalis, Anisops bouvieri, and Diplonychus indicus (100% of survival rate), while the insecticide α-cypermethrin was highly toxic (100% of death). The results demonstrate that the EO from P. tuberculatum and ß-caryophyllene are important larvicidal agents.

Development and validation of predictive model for long-term hospitalization, readmission, and in-hospital death of patients over 60 years old.

OBJECTIVE: To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. METHODS: This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). RESULTS: Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient's adverse health events during hospitalization after admission. CONCLUSION: A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

Development and validation of predictive model for long-term hospitalization, readmission, and in-hospital death of patients over 60 years old

ABSTRACT Objective To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. Methods This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). Results Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient's adverse health events during hospitalization after admission. Conclusion A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

Atuação da equipe de cuidados paliativos frente a pacientes com a covid-19 / Performance of the palliative care team towards patients with covid-19 / Actuación del equipo de cuidados paliativos hacia pacientes con covid-19

Objetivo: conhecer a atuação da equipe de cuidados paliativos frente a pacientes com a Covid-19. Método: trata-se de pesquisa com abordagem qualitativa, realizada em hospital público terciário de Fortaleza (Ceará), com noves profissionais da equipe multiprofissional consultiva de cuidados paliativos, no período de agosto de 2020 a janeiro de 2021, por meio de entrevistas semiestruturadas. A pesquisa teve aprovação do comitê de ética da referida instituição e os dados foram submetidos a análise categorial temática de Bardin. Resultados: foram elencadas duas categorias: 1) Impacto da pandemia Covid-19 na equipe de cuidados paliativos; como a suspensão das reuniões familiares, distanciamento dos pacientes e da equipe assistencial, aumento demanda de pareceres de pacientes com a covid-19 e a reorganização da equipe; e 2) Atuação da equipe de cuidados paliativos frente aos pacientes com a Covid-19; como orientação a equipe assistente, apoio as famílias, elaboração de estratégias de comunicação à distância. Conclusões: percebeu-se o importante papel da equipe de cuidados paliativos junto aos pacientes com a covid-19 e seus familiares, visando contribuir para o seu maior conforto e sua melhor qualidade de vida, nas situações de maior gravidade desse adoecimento. (AU)

Objective: To know the performance of the palliative care team in relation to patients with COVID-19. Methods: This is a research with a qualitative approach, carried out in a tertiary public hospital in Fortaleza (Ceará), with nine professionals from the multiprofessional consultative team of palliative care, from August 2020 to January 2021, through semi structured interviews. The research was approved by the ethics committee of that institution and the data were submitted to Bardin's thematic categorical analysis. Results: Two categories were listed: 1) Impact of the COVID-19 pandemic on the palliative care team; such as the suspension of family meetings, distance from patients and the healthcare team, increased demand for opinions from patients with the COVID-19 and the reorganization of the team; and 2) Performance of the palliative care team towards patients with COVID-19; as guidance to the assistant team, support to families, development of communication strategies at a distance. Conclusion: The important role of the palliative care team with patients with COVID-19 and their families was perceived, aiming to contribute to their greater comfort and better quality of life, in the most serious situations of this illness. (AU)

Objetivo: Conocer el desempeño del equipo de cuidados paliativos en relación a los pacientes con COVID-19. Métodos: Se trata de una investigación con abordaje cualitativo, realizada en un hospital terciario público de Fortaleza (Ceará), con nueve profesionales del equipo consultivo multiprofesional de cuidados paliativos, de agosto de 2020 a enero de 2021, a través de entrevistas semiestructuradas. La investigación fue aprobada por el comité de ética de esa institución y los datos fueron sometidos al análisis categórico temático de Bardin. Resultados: Se enumeraron dos categorías: 1) Impacto de la pandemia COVID-19 en el equipo de cuidados paliativos; como la suspensión de reuniones familiares, el alejamiento de los pacientes y del equipo de salud, el aumento de la demanda de opiniones de los pacientes con el COVID-19 y la reorganización del equipo; y 2) Desempeño del equipo de cuidados paliativos hacia pacientes con COVID-19; como orientación al equipo asistente, apoyo a las familias, desarrollo de estrategias de comunicación a distancia. Conclusión: Se percibió el importante papel del equipo de cuidados paliativos con los pacientes con COVID-19 y sus familias, con el objetivo de contribuir a su mayor comodidad y mejor calidad de vida, en las situaciones más graves de esta enfermedad. (AU)

Tecnologias educacionais na monitoria acadêmica de Fisiologia Humana e Biofísica na graduação de enfermagem / Educational technologies in the academic tutoring on Human Physiology and Biophysics in nursing undergraduate studies / Tecnologías educativas en la tutoría académica de Fisiología Humana y Biofísica en la graduación en enfermería

Objetivo: Relatar a experiência dos discentes da graduação em enfermagem da Universidade Estadual do Ceará acerca do uso de tecnologias educacionais na monitoria acadêmica de Fisiologia Humana e Biofísica. Método: Relato de experiência, de caráter descritivo, vivenciado por monitores da disciplina Fisiologia Humana e Biofísica, de uma instituição de ensino superior, do munícipio de Fortaleza-CE, Brasil, no período de janeiro de 2019 a maio de 2020, com, aproximadamente, 110 estudantes de enfermagem. Resultados: Inspirados pelo modelo freireano, os monitores utilizaram três metodologias alternativas e ativas durante as monitorias: jogos, uso de imagens (projetadas) ilustrando o conteúdo do texto e confecção de estudos dirigidos. Tais tecnologias demonstraram ser instrumentos úteis no desenvolvimento de habilidades fundamentais para o percurso da graduação e o mercado de trabalho, como liderança, trabalho em equipe, busca ao conhecimento, pensamento crítico e resolução de problemas. A partir do uso das tecnologias educacionais na monitoria acadêmica, os monitores desenvolvem autonomia, discernimento e proatividade, necessários ao perfil formativo do enfermeiro. Conclusão: Observou-se que os estudantes se mostraram participativos e satisfeitos durante as monitorias. Ademais, os monitores puderam desenvolver habilidades relevantes para a docência.(AU)

Objective: To report undergraduate nursing students' experiences at the State University of Ceará regarding educational technologies in the academic tutoring on Human Physiology and Biophysics. Method: This is an experience report using a descriptive approach about the experiences of tutors of the Human Physiology and Biophysics course offered by a higher education institution in Fortaleza, CE, Brazil. The study was conducted from January 2019 to May 2020 with approximately 110 nursing students. Results: Inspired by the Freirean model, the tutors used three alternative and active methodologies: games, use of (projected) images illustrating the textual content, and directed studies. The tutors develop autonomy, discernment, and proactivity from educational technologies in academic tutoring necessary for the nurse's training profile. Conclusion: It was observed that the students were participatory and satisfied during the academic tutoring. Besides, the tutors were able to develop skills relevant to teaching.(AU)

Objetivo: relatar las experiencias de discentes de enfermería de la Universidad Estatal de Ceará sobre tecnologías educativas en la tutoría académica en Fisiología Humana y Biofísica. Método: Informe de experiencia con un enfoque descriptivo sobre las experiencias de tutores del curso de Fisiología Humana y Biofísica ofrecido por una institución de educación superior en Fortaleza, CE, Brasil. El estudio se realizó desde enero de 2019 hasta mayo de 2020 con aproximadamente 110 estudiantes de enfermería. Resultados: Inspirados en el modelo freireano, los tutores utilizaron tres metodologías alternativas y activas: juegos, uso de imágenes (proyectadas) que ilustran el contenido del texto y estudios dirigidos. Los tutores desarrollan autonomía, discernimiento y proactividad a partir de las tecnologías educativas en la tutoría académica, necesarias para el perfil formativo del enfermero. Conclusión: Se observó que los discentes fueron participativos y satisfechos durante el seguimiento. Además, los tutores pudieron desarrollar habilidades relevantes para la enseñanza.(AU)

Não há neurose sem corpo: um estudo sobre o lugar do corpo na histeria e na neurose obsessiva / There is no neurosis without body: a study about the body in hysteria and obsessional neurosis

RESUMO: O corpo é o ponto de partida do presente artigo por considerar que este possui um lugar privilegiado na psicanálise desde os estudos sobre a histeria em Freud até o conceito de gozo em Lacan. Investigando sobre o corpo, encontramos o sujeito, tanto histérico quanto neurótico obsessivo. A partir da relação entre a neurose e o corpo, foi possível constatar que o corpo se encontra tanto na origem do desenvolvimento psicossexual e, portanto, das estruturas clínicas, quanto é, simultaneamente, o local onde os sintomas neuróticos se se manifestam.

Abstract: The body is the starting point of this article because it has a privileged place in psychoanalysis from studies on hysteria in Freud to the concept of jouissance in Lacan. Investigating the body, we find the subject, both hysterical and obsessive neurotic. From the relation between the neurosis and the body, it was possible to verify that the body is at the origin of the psychosexual development and, therefore, of the clinical structures, but at the same time the place where the neurotic symptoms are manifested.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals.

OBJECTIVE: To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. METHODS: The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. RESULTS: Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). CONCLUSION: Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

Depression and cancer were independently associated with quality of life in Brazilian older people.

OBJECTIVE: To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. METHODS: In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. RESULTS: After adjusting for potential confounders, we found that GDS score (ß = -0.07; P = 0.04) and cancer (ß = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. CONCLUSION: Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals / Associação entre capacidade respiratória, qualidade de vida e cognição em idosos

ABSTRACT Objective To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. Methods The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. Results Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). Conclusion Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

RESUMO Objetivo Investigar a associação entre capacidade respiratória, qualidade de vida e função cognitiva em idosos. Métodos A amostra incluiu 386 idosos (232 mulheres). A capacidade respiratória foi avaliada pela pressão expiratória máxima obtida no pico de fluxo expiratório. Com base nos resultados máximos de fluxo expiratório, os indivíduos foram classificados de acordo com o valor previsto para sexo, idade e estatura em capacidade respiratória normal (curva de fluxo expiratório de pico inferior a 80% e superior a 60%) ou capacidade respiratória reduzida (curva de fluxo expiratório de pico menor que 60%). O questionário World Health Organization Quality of Life e o Miniexame do Estado Mental foram utilizados para avaliar a qualidade de vida e a função cognitiva, respectivamente. Resultados Em comparação com mulheres idosas com capacidade respiratória normal, as pessoas com capacidade respiratória reduzida apresentaram escores mais baixos para o Miniexame do Estado Mental (p=0,048) e qualidade de vida (p=0,040). Nos homens, não foram observadas diferenças (p>0,05). Conclusão Capacidade respiratória reduzida foi associada à pior qualidade de vida e à função cognitiva em mulheres idosas. Essas associações não foram observadas em idosos do sexo masculino.

Health-related quality of life in Brazilian community-dwelling and institutionalized elderly: Comparison between genders.

OBJECTIVE: To compare the health-related quality of life (HRQL) indicators between institutionalized and community-dwelling elderly men and women. METHOD: This was a cross-sectional study with a sample of 496 elderly men and women, surveyed by researchers at a private hospital that attends institutionalized and community-dwelling elderly. HRQL (World Health Organization Quality of Life), daily living activities (Katz questionnaire), and instrumental daily living activities (Lawton questionnaire), mini-mental state examination, handgrip strength test, and function capacity (timed up and go test) were obtained. RESULTS: Institutionalized men presented higher scores in physical and psychological domains of HRQL compared to elderly men living alone (p<0.05). Among women, the scores in all domains (physical, psychological, relationship, and environment) were similar between institutionalized and community-dwelling individuals. CONCLUSION: Institutionalized elderly men reported better scores in physical and psychological domains of HRQL compared to their community-dwelling pairs, while both institutionalized and community-dwelling elderly women presented similar HRQL.

Health-related quality of life in Brazilian community-dwelling and institutionalized elderly: Comparison between genders / Qualidade de vida relacionada à saúde em idosos brasileiros residentes em comunidade e institucionalizados: comparação entre gêneros

SUMMARY Objective To compare the health-related quality of life (HRQL) indicators between institutionalized and community-dwelling elderly men and women. Method This was a cross-sectional study with a sample of 496 elderly men and women, surveyed by researchers at a private hospital that attends institutionalized and community-dwelling elderly. HRQL (World Health Organization Quality of Life), daily living activities (Katz questionnaire), and instrumental daily living activities (Lawton questionnaire), mini-mental state examination, handgrip strength test, and function capacity (timed up and go test) were obtained. Results Institutionalized men presented higher scores in physical and psychological domains of HRQL compared to elderly men living alone (p<0.05). Among women, the scores in all domains (physical, psychological, relationship, and environment) were similar between institutionalized and community-dwelling individuals. Conclusion Institutionalized elderly men reported better scores in physical and psychological domains of HRQL compared to their community-dwelling pairs, while both institutionalized and community-dwelling elderly women presented similar HRQL.

RESUMO Objetivo comparar os indicadores de qualidade de saúde de vida (QV) entre idosos homens e mulheres institucionalizados e aqueles que vivem na comunidade sozinhos ou com a família. Método estudo transversal com amostra composta por 496 idosos homens e mulheres, entrevistados por pesquisadores em um hospital privado que atende idosos institucionalizados e da comunidade. Os indicadores de QV (World Health Organization Quality of Life), atividades da vida diária (Katz questionnaire), atividades instrumentais da vida diária (Lawton questionnaire), exame do estado mental (mini-mental), teste de força de preensão manual (Handgrip) e capacidade funcional (Timed up to go) foram obtidos. Resultados homens institucionalizados apresentaram maiores escores de QV no domínio físico e psicológico em relação aos idosos que vivem na comunidade sozinhos (p<0,05). Nas mulheres, os escores em todos os domínios de QV (físico, psicológico, relações sociais e ambientais) foram semelhantes entre as idosas institucionalizadas e as residentes na comunidade, que vivem sozinhas ou com a família. Conclusão homens idosos institucionalizados relataram melhores escores de QV nos domínios físico e psicológico em comparação com pares que vivem na comunidade, enquanto, em mulheres, resultados similares foram observados nas idosas institucionalizadas e da comunidade.

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men.

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

Influence of peripheral arterial disease on daily living activities in elderly women.

Aging has been associated with decreases in physical and cognitive functions. Peripheral artery disease (PAD) has been associated with further impairments in these functions, especially in women. However, no detailed information is available indicating whether PAD leads to further impairment in these functions in elderly women. Thus, the aims of this study were 1) to compare the capacity to perform daily living activities between elderly women with and without PAD and 2) to identify the factors related with the performance in daily activities. Twenty-seven elderly women with PAD and 22 elderly non-PAD women were surveyed in a geriatric hospital. Women aged ≥65 years and with no signal of dementia were included. PAD was identified by the ankle-brachial index ≤0.90, whereas elderly non-PAD women presented ankle-brachial index >1.0. Patients were interviewed to obtain information regarding basic (Katz questionnaire) and instrumental daily living activities (Lawton-Brody scale) and performed the mini-mental state examination, handgrip strength test, and timed up and go tests. PAD and non-PAD women had similar age, clinical characteristics, handgrip strength test, and cognitive function (P > 0.05). The capacity to perform basic and instrumental daily living activities was similar between PAD and non-PAD women (P > 0.05). In PAD and non-PAD, the instrumental daily living activities were significantly correlated with cognitive function (r = 0.44, P < 0.05 and r = 0.74 and P < 0.05, respectively). PAD elderly women present similar capacity to perform basic and instrumental daily activities than non-PAD women. In addition, in both groups, the capacity to perform instrumental daily activities was related with cognitive function.

Perfil dos pacientes chagásicos portadores de cardioversor-desfibrilador implantável (CDI) / Profile of chagasic patients with implantable cardioverter cefibrillators (ICD)

Fundamentos: A morte súbita é responsável por 55-65% dos óbitos na doença de Chagas, e o cardioversor desfibrilador implantável (CDI) é a terapêutica mais efetiva para evitar morte súbita em pacientes com taquiarritmias ventriculares. Objetivo: Descrever o perfil clínico dos pacientes portadores de cardiopatia chagásica crônica com CDI internados em hospital de referência.Métodos: Foram avaliados 75 pacientes chagásicos, portadores de CDI, internados na Santa Casa de Misericórdia de Goiânia no período de janeiro de 2011 a dezembro de 2013, mediante revisão de prontuários. Resultados: A amostra (n=75) se constituiu de 57 (76,0%) pacientes do sexo masculino e 18 (24,0%) do sexo feminino. As internações clínicas representaram 60,0% da amostra e as de causas cirúrgicas 40,0%. Das causas clínicas, 40 (89,0%) foram de origem cardíaca: insuficiência cardíaca (IC) com 13 (32,0%) pacientes e a tempestade elétrica (TE) com 12 (30,0%) pacientes. Das 30 causas cirúrgicas, 17 (56,66%) se deveram a desgaste da bateria.Conclusão: O perfil clínico encontrado em pacientes portadores de cardiopatia chagásica crônica com CDI apresenta as seguintes características: sexo masculino, faixa etária entre 51-60 anos, presença de dispositivos de dupla-câmara, uso adequado de antiarrítmico e beta bloqueador, presença de hipertensão arterial sistêmica (HAS), fração de ejeção do ventrículo esquerdo (FEVE) entre 35-45%, internações clínicas por causas cardíacas (em especial IC e TE), e número de internações pós-implante entre zero e três.

Background: Sudden death accounts for 55-65% of the deaths from Chagas disease, and the implantable cardioverter-defibrillator (ICD) is the most effective therapy to prevent sudden death in patients with ventricular tachyarrhythmias. Objective: To describe the clinical profile of patients with chronic Chagas disease with ICD admitted to a referral hospital. Methods: 75 chagasic patients with ICD, admitted to Santa Casa de Misericórdia de Goiânia, from January 2011 to December 2013, were evaluated by means of medical record review.Results: The sample (n=75) was composed of 57 (76.0%) male patients and 18 (24.0%) female patients. Clinical admissions accounted for 60.0% of the sample, while surgical ones accounted for 40.0%. Out of all clinical admissions, 40 (89.0%) were due to heart problems: heart failure (HF), with 13 (32.0%) patients, and electrical storm (ES), with 12 (30.0%) patients. Out of the 30 surgical admissions, 17 (56.66%) were due to battery depletion.Conclusion: The clinical profile of patients with chronic Chagas disease with CDI is characterized as follows: male, aged 51-60, presence of dual-chamber devices, appropriate use of antiarrhythmic drugs and beta-blockers, presence of systemic hypertension (SH),left ventricular ejection fraction (LVEF) of 35-45%, clinical admissions due to heart problems (particularly HF and ES), and zero to three post-implantation admissions.

Healthcare-associated infections among neonates in Brazil.

OBJECTIVE: To describe the epidemiology of healthcare-associated infections (HAIs) among neonates. DESIGN: Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI. SETTING: Seven neonatal units located in three Brazilian cities. PATIENTS: All admitted neonates were included and observed until discharge. RESULTS: Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, < or = 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, < or = 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14). CONCLUSIONS: The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.

Levantamento de rotinas de reprocessamento de endoscópios em hospitais do munícipio de Säo Paulo / Survey of digestive endoscope disinfection in hospitals of the Municipality of Säo Paulo

Embora seja descrita comm pouca freqüência, a transmissäo de infecçao por endoscopia é preocupaçäo crescente. Muitos säo os fatores que podem dificultar a realizaçäo da desinfecçäo de alto nível, que é preconizada para os endoscópicos: configuraçäo do equipamento, necessidade de pessoal especializado e relaçäo entre o número de endoscópios disponíveis e o número de exames realizados no serviço. Baseados em estudos recentes, elaboramos um questionário que foi encaminhado a 83 hospitais da cidade de säo Paulo, com o intuito de avaliar como é feito o reprocessamento desse material. Para nossa surpresa, em apenas um hospital as recomendaçöes da literatura médica säo seguidas, embora a maioria deles apresentasse infra-estrutura que permitiria a realizaçäo da desinfecçäo de alto nível. As falhas estiveram presentes em todas as etapas: limpeza, desinfecçäo, enxágüe e estocagem. Podemos concluir que divulgaçäo das medidas a serem seguidas e educaçäo continuada dos profissionais responsáveis por esses serviços säo fundamentais para que possamos atingir padröes internacionais no que diz respeito à desinfecçäo do equipamento utilizado em endoscopia digestiva.