Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury.

The objective was to develop an interdisciplinary weaning protocol (IWP) for patients with tracheostomy tubes due to acquired brain injury, and to effect evaluate implementation of the IWP on decannulation rates and weaning duration. An expert panel completed a literature review in 2018 to identify essential criteria in the weaning process. Based on consensus and availability in clinical practice, criteria for guiding the weaning process were included in the protocol. Using the IWP, dysphagia is graded as either severe, moderate, or mild. The weaning process is guided through a protocol which specified the daily duration of cuff deflation until decannulation, along with recommendations for treatment and rehabilitation interventions. Data from 337 patient records (161 before and 176 after implementation) were included for effect evaluation. Decannulation rate during hospitalization was unchanged at 91% vs. 90% before and after implementation (decannulation rate at 60 days was 68% vs. 74%). After implementation, the weaning duration had decreased compared to before implementation, hazard ratio 1.309 (95%CI: 1.013; 1.693), without any increased risk of tube-reinsertion or pneumonia. Furthermore, a tendency toward decreased length of stay was seen with median 102 days (IQR: 73-138) and median 90 days (IQR: 58-119) (p = 0.061) before and after implementation, respectively. Scientific debate on weaning protocols for tracheostomy tubes are encouraged.

Measuring mealtime performance in older adults with suspected oropharyngeal dysphagia: an updated systematic review of psychometric properties.

PURPOSE: To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD). MATERIALS AND METHODS: Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN). RESULTS: Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five. CONCLUSIONS: There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted.Implication for rehabilitationAssessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information.Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable.Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments.Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD.

Adaptation and validation of the Mood Rhythm Instrument for use in Brazilian adolescents

Objective: Adapt and validate the Mood Rhythm Instrument (MRhI), a self-reported questionnaire that assesses self-perceived rhythmicity of mood-related symptoms in adults, into a version that assesses and evaluates perceived mood-related symptoms in adolescents (MRhI-Y). Methods: Adaptation of the Brazilian Portuguese version of the MRhI for an adolescent population followed three steps: review by consultants, analysis by experts, and pilot testing through a visual analogue scale (VAS). The final questionnaire (MRhI-Y) was applied to 171 adolescents aged 12-17 years. Internal consistency was calculated using Cronbach's alpha and McDonald's omega. The psychometric properties of the MRhI-Y were evaluated using exploratory factor analysis (EFA). Results: The MRhI-Y was designed to use wording more appropriate for adolescents than that of the MRhI. Expert agreement about item quality ranged between 82 and 100%. Adolescents' VAS ratings indicated good comprehension of the items. Cronbach's alpha and McDonalds' omega coefficients were 0.71 and 0.74. The EFA resulted in a three-factor solution (affective, cognitive, and somatic). Younger adolescents (ages 12 to 13) reported lower rhythmicity scores than older groups (ages 14 to 15 and 16 to 17), even controlling for chronotype. Conclusions: The Brazilian Portuguese version of the MRhI-Y presented adequate comprehension by adolescents and good internal consistency. The MRhI-Y is a promising tool to improve our understanding of the underlying characteristics of mood fluctuation in adolescence.

Adaptation and validation of the Mood Rhythm Instrument for use in Brazilian adolescents.

OBJECTIVE: Adapt and validate the Mood Rhythm Instrument (MRhI), a self-reported questionnaire that assesses self-perceived rhythmicity of mood-related symptoms in adults, into a version that assesses and evaluates perceived mood-related symptoms in adolescents (MRhI-Y). METHODS: Adaptation of the Brazilian Portuguese version of the MRhI for an adolescent population followed three steps: review by consultants, analysis by experts, and pilot testing through a visual analogue scale (VAS). The final questionnaire (MRhI-Y) was applied to 171 adolescents aged 12-17 years. Internal consistency was calculated using Cronbach's alpha and McDonald's omega. The psychometric properties of the MRhI-Y were evaluated using exploratory factor analysis (EFA). RESULTS: The MRhI-Y was designed to use wording more appropriate for adolescents than that of the MRhI. Expert agreement about item quality ranged between 82 and 100%. Adolescents' VAS ratings indicated good comprehension of the items. Cronbach's alpha and McDonalds' omega coefficients were 0.71 and 0.74. The EFA resulted in a three-factor solution (affective, cognitive, and somatic). Younger adolescents (ages 12 to 13) reported lower rhythmicity scores than older groups (ages 14 to 15 and 16 to 17), even controlling for chronotype. CONCLUSIONS: The Brazilian Portuguese version of the MRhI-Y presented adequate comprehension by adolescents and good internal consistency. The MRhI-Y is a promising tool to improve our understanding of the underlying characteristics of mood fluctuation in adolescence.

Sífilis na gestação: barreiras na assistência pré-natal para o controle da transmissão vertical / Syphilis in gestation: barriers in prenatal care for the control of vertical transmission

Resumo Introdução A sífilis gestacional é uma doença de transmissão vertical, da mãe para o feto, que se não tratada, pode resultar em inúmeros desfechos negativos para a saúde materna e infantil. Objetivo Avaliar as barreiras na assistência pré-natal para o controle da transmissão vertical da sífilis em gestantes segundo o perfil sociodemográfico, reprodutivo e assistencial em uma metrópole do Nordeste brasileiro. Método Estudo descritivo, conduzido a partir de banco de dados de um estudo caso-controle para sífilis gestacional em maternidades públicas no Nordeste do Brasil, entre 2013 e 2014. As informações do acompanhamento e tratamento foram obtidas pelos registros do cartão do pré-natal e entrevistas. O diagnóstico de sífilis considerou os registros do cartão, anotações em prontuário e resultados do Venereal Disease Research Laboratory (VDRL). Resultados Foram incluídas 1.206 mulheres, 91,7% realizaram pré-natal e se declararam, em maior proporção, como casadas, menor número de filhos e maior escolaridade. O resultado do VDRL do pré-natal foi anotado em 23,9%. Entre as 838 mulheres que receberam o VDRL no pré-natal, 21% eram reagentes e 70,5% trataram a infecção. Destas, 69,4% utilizaram o esquema para sífilis terciária e 8,1% trataram com outras medicações. Conclusão O pré-natal não alcançou a efetividade na prevenção e rastreio da sífilis, uma vez que ocorreram mulheres reagentes para a infecção na admissão à maternidade, ainda que em menor proporção, sendo perdida a oportunidade de alcançar o controle da doença.

Abstract Background Gestational syphilis is a mother-to-fetus mother-to-child disease that, if left untreated, can result in numerous negative outcomes for maternal and child health. Objective Evaluate the barriers in prenatal care for the control of vertical transmission of syphilis in pregnant women according to the sociodemographic, reproductive, and care profile in a metropolis of northeastern Brazil. Method This is a descriptive study, conducted from a database of a case-control study for gestational syphilis in public maternity hospitals in the Northeast of Brazil, between 2013 and 2014. Information on follow-up and treatment was obtained through prenatal card records and interviews. The diagnosis of syphilis considered card records, chart notes, and results from the Venereal Disease Research Laboratory (VDRL). Results A total of 1,206 women were included, 91.7% were prenatal and declared to be married, with fewer children and higher educational levels. The VDRL result of prenatal care was noted at 23.9%. Among the 838 women who received the VDRL in prenatal care, 21% were reactants and 70.5% treated the infection. Of these, 69.4% used the scheme for tertiary syphilis and 8.1% were treated with other medications. Conclusion Prenatal care did not reach effectiveness in the prevention and screening of syphilis since women reacting to the infection on maternity admission occurred, albeit to a lesser extent, and the opportunity to achieve control of the disease was lost.

Poor sleep quality associates with self-reported psychiatric and cardiometabolic symptoms independently of sleep timing patterns in a large sample of rural and urban workers.

Poor sleep associates with mental and cardiometabolic pathological outcomes. The participation of sleep timing features in the pathways by which this relationship occurs is not clear. This study aims to evaluate the interrelationship between sleep quality and self-reported psychiatric/cardiometabolic symptoms, considering mediation and moderation effects of sleep timing patterns, and urban versus rural work environment, respectively; and to verify the association between sleep quality and polymorphisms of AANAT, RORA and TIMELESS genes. An epidemiological survey was performed in a rural area in southern Brazil. Eight-hundred and twenty-nine subjects were evaluated for sleep quality using the Pittsburgh Sleep Quality Index, and sleep timing patterns using the Munich Chronotype Questionnaire. Work characteristics and psychiatric/cardiometabolic symptoms were assessed using a structured self-report questionnaire. Three polymorphisms of AANAT, RORA and TIMELESS (rs3760138, rs782931 and rs774045, respectively) were genotyped in blood samples. We found statistically significant associations of poor sleep quality with self-reported psychiatric symptoms (B = 0.382; 95% CI 0.289-0.476; adjusted p-value <.001), and with self-reported cardiometabolic symptoms (B = 0.079; 95% CI 0.013-0.151; adjusted p-value = .048). The genetic analysis showed that RORA GA/AA genotype was associated to poor sleep quality (B = 0.146, 95% CI 0.054-0.239; adjusted p-value = .004). No moderated mediation effects were observed in the conditional analysis. TIMELESS polymorphism was not included in the analysis due to the low frequency of risk genotypes. These results yield new insights regarding the interrelationship between sleep characteristics and psychiatric/cardiometabolic self-reported symptoms, taking into account genes related to the biological clocks and melatonin pathways.

Risk factors for syphilis in women: case-control study.

OBJECTIVE: To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals. METHODS: This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained. RESULTS: The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors. CONCLUSIONS: Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability. OBJETIVO: Determinar os fatores sociodemográficos, comportamentais e de assistência à saúde relacionados à ocorrência de sífilis em mulheres atendidas em maternidades públicas. MÉTODOS: Trata-se de um estudo caso-controle (239 casos e 322 controles) com mulheres admitidas em sete maternidades do município do Recife, no período de julho de 2013 a julho de 2014. As mulheres elegíveis foram recrutadas após o resultado do VDRL (Venereal Disease Research Laboratory) sob qualquer titulação. A seleção dos casos e controles considerou o resultado da sorologia por ELISA (enzyme-linked immunosorbent assay), variável dependente utilizada como diagnóstico para sífilis neste estudo. As variáveis independentes foram agrupadas em: sociodemográficas; comportamentais; e antecedentes clínicos e obstétricos; e assistência à saúde no pré-natal e na maternidade. As informações foram obtidas por meio de entrevista, durante o internamento, por aplicação de um questionário. Foi calculado odds ratio (OR), intervalo de confiança de 95% e realizada análise de regressão logística para identificar os fatores preditores da variável a ser explicada. RESULTADOS: A análise de regressão logística identificou como fatores determinantes para a sífilis gestacional: nível de escolaridade fundamental incompleto ou analfabeta (OR = 2,02), ausência de acesso a telefone (OR = 2,4), religião católica (OR = 1,70), quatro ou mais gestações (OR = 2,2), três ou mais parceiros sexuais no último ano (OR = 3,1), uso de drogas ilícitas antes dos 18 anos (OR = 3,0) e uso de drogas ilícitas por parte do atual companheiro (OR = 1,7). Além desses, foram observadas a ocorrência de apenas uma a três consultas ao pré-natal (OR = 3,5) e história anterior de infecção sexualmente transmissível (OR = 9,7). CONCLUSÕES: Fatores sociodemográficos, comportamentais e de assistência à saúde estão associados à ocorrência de sífilis em mulheres e devem ser levados em consideração na elaboração de estratégias universais direcionadas à prevenção e controle da sífilis, porém com foco em situações de maior vulnerabilidade.

The AMPA receptor positive allosteric modulator S 47445 rescues in vivo CA3-CA1 long-term potentiation and structural synaptic changes in old mice.

Positive allosteric modulators of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) are small molecules that decrease deactivation of AMPARs via an allosteric site. These molecules keep the receptor in an active state. Interestingly, this type of modulator has been proposed for treating cognitive decline in ageing, dementias, and Alzheimer's disease (AD). S 47445 (8-cyclopropyl-3-[2-(3-fluorophenyl)ethyl]-7,8-dihydro-3H-[1,3]oxazino[6,5-g][1,2,3]benzotriazine-4,9-dione) is a novel AMPAR positive allosteric modulator (AMPA-PAM). Here, the mechanisms by which S 47445 could improve synaptic strength and connectivity were studied and compared between young and old mice. A single oral administration of S 47445 at 10 mg/kg significantly increased long-term potentiation (LTP) in CA3-CA1 hippocampal synapses in alert young mice in comparison to control mice. Moreover, chronic treatment with S 47445 at 10 mg/kg in old alert animals significantly counteracted the deficit of LTP due to age. Accordingly, chronic treatment with S 47445 at 10 mg/kg seems to preserve synaptic cytoarchitecture in old mice as compared with young control mice. It was shown that the significant decreases in number and size of pre-synaptic buttons stained for VGlut1, and post-synaptic dendritic spines stained for spinophilin, observed in old mice were significantly prevented after chronic treatment with 10 mg/kg of S 47445. Altogether, by its different effects on LTP, VGlut1-positive particles, and spinophilin, S 47445 is able to modulate both the structure and function of hippocampal excitatory synapses known to be involved in learning and memory processes. These results open a new window for the treatment of specific age-dependent cognitive decline and dementias such as AD.

Risk factors for syphilis in women: case-control study / Fatores de risco para sífilis em mulheres: estudo caso-controle

ABSTRACT OBJECTIVE To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals. METHODS This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained. RESULTS The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors. CONCLUSIONS Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability.

RESUMO OBJETIVO Determinar os fatores sociodemográficos, comportamentais e de assistência à saúde relacionados à ocorrência de sífilis em mulheres atendidas em maternidades públicas. MÉTODOS Trata-se de um estudo caso-controle (239 casos e 322 controles) com mulheres admitidas em sete maternidades do município do Recife, no período de julho de 2013 a julho de 2014. As mulheres elegíveis foram recrutadas após o resultado do VDRL (Venereal Disease Research Laboratory) sob qualquer titulação. A seleção dos casos e controles considerou o resultado da sorologia por ELISA (enzyme-linked immunosorbent assay), variável dependente utilizada como diagnóstico para sífilis neste estudo. As variáveis independentes foram agrupadas em: sociodemográficas; comportamentais; e antecedentes clínicos e obstétricos; e assistência à saúde no pré-natal e na maternidade. As informações foram obtidas por meio de entrevista, durante o internamento, por aplicação de um questionário. Foi calculado odds ratio (OR), intervalo de confiança de 95% e realizada análise de regressão logística para identificar os fatores preditores da variável a ser explicada. RESULTADOS A análise de regressão logística identificou como fatores determinantes para a sífilis gestacional: nível de escolaridade fundamental incompleto ou analfabeta (OR = 2,02), ausência de acesso a telefone (OR = 2,4), religião católica (OR = 1,70), quatro ou mais gestações (OR = 2,2), três ou mais parceiros sexuais no último ano (OR = 3,1), uso de drogas ilícitas antes dos 18 anos (OR = 3,0) e uso de drogas ilícitas por parte do atual companheiro (OR = 1,7). Além desses, foram observadas a ocorrência de apenas uma a três consultas ao pré-natal (OR = 3,5) e história anterior de infecção sexualmente transmissível (OR = 9,7). CONCLUSÕES Fatores sociodemográficos, comportamentais e de assistência à saúde estão associados à ocorrência de sífilis em mulheres e devem ser levados em consideração na elaboração de estratégias universais direcionadas à prevenção e controle da sífilis, porém com foco em situações de maior vulnerabilidade.

Prevalence of latent Mycobacterium tuberculosis infection in prisoners.

OBJECTIVE:: To determine the prevalence of and the factors associated with latent Mycobacterium tuberculosis infection (LTBI) in prisoners in the state of Minas Gerais, Brazil. METHODS:: This was a cross-sectional cohort study conducted in two prisons in Minas Gerais. Tuberculin skin tests were performed in the individuals who agreed to participate in the study. RESULTS:: A total of 1,120 individuals were selected for inclusion in this study. The prevalence of LTBI was 25.2%. In the multivariate analysis, LTBI was associated with self-reported contact with active tuberculosis patients within prisons (adjusted OR = 1.51; 95% CI: 1.05-2.18) and use of inhaled drugs (adjusted OR = 1.48; 95% CI: 1.03-2.13). Respiratory symptoms were identified in 131 (11.7%) of the participants. Serological testing for HIV was performed in 940 (83.9%) of the participants, and the result was positive in 5 (0.5%). Two cases of active tuberculosis were identified during the study period. CONCLUSIONS:: Within the prisons under study, the prevalence of LTBI was high. In addition, LTBI was associated with self-reported contact with active tuberculosis patients and with the use of inhaled drugs. Our findings demonstrate that it is necessary to improve the conditions in prisons, as well as to introduce strategies, such as chest X-ray screening, in order to detect tuberculosis cases and, consequently, reduce M. tuberculosis infection within the prison system. OBJETIVO:: Determinar a prevalência e os fatores associados à infecção latente por Mycobacterium tuberculosis (ILTB) em pessoas privadas de liberdade no Estado de Minas Gerais. MÉTODOS:: Estudo de coorte transversal realizado em duas penitenciárias em Minas Gerais. Foi realizada a prova tuberculínica nos indivíduos que aceitaram participar do estudo. RESULTADOS:: Foram selecionados 1.120 indivíduos para a pesquisa. A prevalência da ILTB foi de 25,2%. Na análise multivariada, a ILTB esteve associada com relato de contato com caso de tuberculose ativa dentro da penitenciária (OR ajustada = 1,51; IC95%: 1,05-2,18) e uso de drogas inaláveis (OR ajustada = 1,48; IC95%: 1,03-2,13). Foram identificados 131 pacientes sintomáticos respiratórios (11,7%). O teste anti-HIV foi realizado em 940 (83,9%) dos participantes, sendo positivo em 5 indivíduos (0,5%). Dois casos de tuberculose ativa foram identificados no período do estudo. CONCLUSÕES:: A prevalência de ILTB dentro das penitenciárias estudadas foi alta. Além disso, a ILTB estava associada ao relato de contato com casos de tuberculose e ao uso de drogas inaláveis. Nossos achados demonstram que é necessária a melhoria das condições de encarceramento e a utilização de outras estratégias, como a triagem por radiografia de tórax, para a descoberta de casos de tuberculose e redução da infecção pelo M. tuberculosis no sistema penitenciário.

Prevalence of latent Mycobacterium tuberculosis infection in prisoners / Prevalência da infecção latente por Mycobacterium tuberculosis em pessoas privadas de liberdade

ABSTRACT Objective: To determine the prevalence of and the factors associated with latent Mycobacterium tuberculosis infection (LTBI) in prisoners in the state of Minas Gerais, Brazil. Methods: This was a cross-sectional cohort study conducted in two prisons in Minas Gerais. Tuberculin skin tests were performed in the individuals who agreed to participate in the study. Results: A total of 1,120 individuals were selected for inclusion in this study. The prevalence of LTBI was 25.2%. In the multivariate analysis, LTBI was associated with self-reported contact with active tuberculosis patients within prisons (adjusted OR = 1.51; 95% CI: 1.05-2.18) and use of inhaled drugs (adjusted OR = 1.48; 95% CI: 1.03-2.13). Respiratory symptoms were identified in 131 (11.7%) of the participants. Serological testing for HIV was performed in 940 (83.9%) of the participants, and the result was positive in 5 (0.5%). Two cases of active tuberculosis were identified during the study period. Conclusions: Within the prisons under study, the prevalence of LTBI was high. In addition, LTBI was associated with self-reported contact with active tuberculosis patients and with the use of inhaled drugs. Our findings demonstrate that it is necessary to improve the conditions in prisons, as well as to introduce strategies, such as chest X-ray screening, in order to detect tuberculosis cases and, consequently, reduce M. tuberculosis infection within the prison system.

RESUMO Objetivo: Determinar a prevalência e os fatores associados à infecção latente por Mycobacterium tuberculosis (ILTB) em pessoas privadas de liberdade no Estado de Minas Gerais. Métodos: Estudo de coorte transversal realizado em duas penitenciárias em Minas Gerais. Foi realizada a prova tuberculínica nos indivíduos que aceitaram participar do estudo. Resultados: Foram selecionados 1.120 indivíduos para a pesquisa. A prevalência da ILTB foi de 25,2%. Na análise multivariada, a ILTB esteve associada com relato de contato com caso de tuberculose ativa dentro da penitenciária (OR ajustada = 1,51; IC95%: 1,05-2,18) e uso de drogas inaláveis (OR ajustada = 1,48; IC95%: 1,03-2,13). Foram identificados 131 pacientes sintomáticos respiratórios (11,7%). O teste anti-HIV foi realizado em 940 (83,9%) dos participantes, sendo positivo em 5 indivíduos (0,5%). Dois casos de tuberculose ativa foram identificados no período do estudo. Conclusões: A prevalência de ILTB dentro das penitenciárias estudadas foi alta. Além disso, a ILTB estava associada ao relato de contato com casos de tuberculose e ao uso de drogas inaláveis. Nossos achados demonstram que é necessária a melhoria das condições de encarceramento e a utilização de outras estratégias, como a triagem por radiografia de tórax, para a descoberta de casos de tuberculose e redução da infecção pelo M. tuberculosis no sistema penitenciário.

Troubleshooting of single port video-assisted thoracoscopic lung resection.

By now single port video-assisted thoracoscopic surgery is in full swing all over the world. Series of papers have been proved its safety and feasibility. There are still some tricks which could help beginner to overcome the obstacle of operation. In this article, we tried to focus on how to retrieve the specimen from chest wall cavity simply and how to deal with the bleeding episode during operation.

Factores de riesgo relacionados con bajo peso al nacer en el municipio Cienfuegos / Risk Factors Related to Low Birth Weight in Cienfuegos Municipality

Fundamento: el bajo peso al nacer aún constituye un complejo problema de salud. Está determinado por varios factores y es el índice predictivo más importante de la mortalidad infantil. Objetivo: identificar los factores de riesgo relacionados con el bajo peso al nacer. Métodos: se realizó un estudio descriptivo. Se analizaron los 77 nacimientos de niños con peso inferior a 2 500 g, ocurridos en el año 2010 en el municipio Cienfuegos, lo que incluyó a las puérperas, madres de esos niños. Se revisaron las tarjetas de seguimiento del embarazo e historias clínicas de las pacientes y las estadísticas municipales y provinciales. Además de las características sociodemográficas, se analizó estado nutricional, número de embarazos, ganancia de peso durante el embarazo, edad gestacional al parto y hábitos tóxicos y enfermedades asociadas al embarazo. Resultados: el índice de nacidos bajo peso se osciló entre 3,6 y 6,7 por mes. El 52 % de las madres de recién nacidos bajo peso tenían nivel escolar universitario. El 74 % de las madres eran trabajadoras. El 70,1 % eran fumadoras y el 57, 1% desarrolló enfermedad hipertensiva gravídica. Conclusiones: los factores que más se asociaron al bajo peso de los recién nacidos, fueron el hábito de fumar en las madres, así como las enfermedades que afectaron a estas durante el embarazo, fundamentalmente la enfermedad hipertensiva del embarazo y la sepsis vaginal.

Background: the low birth weight still constitutes a complex a complex health problem. It is determined by some factors and it is the most important predictive index of infantile mortality. Objective: identifying the risk factors related to low birth weight. Methods: a descriptive study was conducted. There were analyzed the 77 birth of children with inferior weigh to 2500g, occurred in 2010 at the municipality of Cienfuegos, puerperas were included, mothers of those children. The pregnancy’s follow-up cards, patient’s clinical records and municipal and provincial statistics were checked. In addition to the socio-demographic characteristics, the nutritional state, numbers of pregnancies, heavy profit during pregnancy, age, toxic habits and diseases correlated to pregnancy were analyzed. Results: the index of low birth weigh oscillated between 3.6 and 6.7 per month. The 52% of low birth weight newborn’s mothers had school university level. The 74 % of mothers work. The 70.1 % were smokers and the 57, 1 % developed a gravidum hypertensive disease. Conclusions: the most associated factors to low birth weight were, the mother’s habit to smoke, as well as the diseases that affected them during pregnancy, fundamentally the hypertensive disease and the vaginal sepsis.

Cognition and hippocampal plasticity in the mouse is altered by monosomy of a genomic region implicated in Down syndrome.

Down syndrome (DS) is due to increased copy number of human chromosome 21. The contribution of different genetic regions has been tested using mouse models. As shown previously, the Abcg1-U2af1 genetic region contributes to cognitive defects in working and short-term recognition memory in Down syndrome mouse models. Here we analyzed the impact of monosomy of the same genetic interval, using a new mouse model, named Ms2Yah. We used several cognitive paradigms and did not detect defects in the object recognition or the Morris water maze tests. However, surprisingly, Ms2Yah mice displayed increased associative memory in a pure contextual fear-conditioning test and decreased social novelty interaction along with a larger long-term potentiation recorded in the CA1 area following stimulation of Schaffer collaterals. Whole-genome expression studies carried out on hippocampus showed that the transcription of only a small number of genes is affected, mainly from the genetic interval (Cbs, Rsph1, Wdr4), with a few additional ones, including the postsynaptic Gabrr2, Gabbr1, Grid2p, Park2, and Dlg1 and the components of the Ubiquitin-mediated proteolysis (Anapc1, Rnf7, Huwe1, Park2). The Abcg1-U2af1 region is undeniably encompassing dosage-sensitive genes or elements whose change in copy number directly affects learning and memory, synaptic function, and autistic related behavior.

Mujer de 38 años con poliglobulia y una masa abdomina / A 38-year-old woman with polyglobulia and a abdominal mass

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Caracterização Sócio demográfica de Idosos com Doença Renal Crônica Submetidos a Tratamento Dialítico em um Hospital Filantrópico / Socio-Demographic Characterization of Elderly with Chronic Kidney Disease on Dialysis in a Charity Hospital

Caracterizar o perfil sóciodemográfico de idososcom Doença Renal Crônica submetido a tratamento Dialíticono Hospital São Vicente de Paulo (HSVP) em João Pessoa-Paraíba-Brasil. Material e Métodos: Foram analisados 103prontuários, referente ao período de fevereiro a agosto de2010 cadastrados no Serviço de Nefrologia do HSVP. A análisedos dados constituiu-se em estatística descritiva einferencial (t-Student e Kolmogorov-Smirnov com nível designificância 5%). Resultados: Os dados demonstraram que57,3% eram do gênero masculino, na faixa etária 60 a 69anos (59,2%), idade média de 68,38 ± 7,76 anos,predominantemente solteiros (66,0%), procedentes de JoãoPessoa (71,8%), em relação à naturalidade 69,9% eram dointerior do Estado, 55,3% com ensino fundamental incompleto,a renda familiar mensal predominante de 1 salário mínimo(79,6%), a totalidade possuía beneficio previdenciário; 56,3%aposentados por tempo de serviço e 43,7% por invalidez.Em relação à modalidade de diálise, 88,3% realizavahemodiálise. Com relação às comorbidades notou-se um altoíndice de hipertensão arterial sistêmica (64,1%), seguida deDiabetes Mellitus (43,7%). Quanto aos hábitos de vidarelacionados à saúde, observou-se que a maioria dos idososnão possuía vícios (78,6%) e 39,8% dos idosos praticavamexercícios terapêuticos. Conclusão: Dados demonstram queidosos com Doença Renal Crônica em tratamento dialíticocom níveis sócio-demográficos baixos. A realização de açõespreventivas poderia minimizar a morbidade melhorando aqualidade de vida...

To identify the socio-demographic profile of elderlywith chronic kidney disease on dialysis at the Hospital SãoVicente de Paulo (HSVP) in João Pessoa-Paraíba-Brazil.Methods: We analyzed 103 medical records for the periodfrom February to August 2010 registered in the Departmentof Nephrology HSVP. Data analysis consisted of descriptiveand inferential statistics (t-test and Kolmogorov-Smirnov testwith a significance level of 5%). Results: The data showedthat 57.3% were male, aged 60 to 69 years (59.2%), meanage 68.38 ± 7.76 years, predominantly unmarried (66.0%),from João Pessoa (71.8%) compared to 69.9% that werefrom others cities of the state, 55.3% with incomplete primaryeducation, monthly family income of a prevailing basic salary(79.6%), all had social security benefit, 56.3% retired forlength of service and 43.7% for disability. According to themodality of dialysis, 88.3% were undergoing hemodialysis.With respect to the comorbidities it was noted a high rate ofhypertension (64.1%), followed by diabetes mellitus (43.7%).With regards to lifestyle habits related to health, it wasobserved that most elderly had no addiction (78.6%) and39.8% of the elderly participated of therapeutic exercises.Conclusion: Data have showed elderly patients with chronickidney disease on dialysis presenting low sociodemographiclevels. The implementation of preventive actions could reducemorbidity by improving the quality of life...

Má oclusão e saúde coletiva: relação entre a classificação normativa, a autopercepção e o desejo de tratamento em adolescentes / Malocclusion and public health: the relationship between the classification standards, the self and the desire for treatment in adolescents

O objetivo desse estudo transversal foi o de avaliar a concordância entre a classificação normativa e a autopercepção da oclusão dentária e da face, e o desejo de tratamento ortodôntico em adolescentes de 12 anos matriculados em escolas públicas e privadas da rede de ensino fundamental da cidade do Recife/PE...

The objective of this cross-study was to evaluate the concordance between the normative classification and self-perception of dental occlusion and of the face, and the desire for orthodontic treatment in 12 year-old adolescents enrolled in public and private basic education schools, in the city of Recife/PE...

Peritonitis due to Penicillium and Enterobacter in a patient receiving continuous ambulatory peritoneal dialysis.

Infectious peritonitis is a common complication of continuous ambulatory peritoneal dialysis (CAPD). Polymicrobial peritonitis accounts for about 8% of the peritonitis episodes and involves fungi in 9% to 33% of cases. We report the known first case of polymicrobial peritonitis in which Penicillium sp. was one of the organisms cultured and the ninth case of Penicillium peritonitis in CAPD.

Peritonitis due to Penicillium and Enterobacter in a patient receiving continuous ambulatory peritoneal dialysis

Infectious peritonitis is a common complication of continuous ambulatory peritoneal dialysis (CAPD). Polymicrobial peritonitis accounts for about 8 percent of the peritonitis episodes and involves fungi in 9 percent to 33 percent of cases. We report the known first case of polymicrobial peritonitis in which Penicillium sp. was one of the organisms cultured and the ninth case of Penicillium peritonitis in CAPD.