The Mulher Study: cervical cancer screening with primary HPV testing in Mozambique.

OBJECTIVE: To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally. METHODS: Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected. RESULTS: Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology. CONCLUSION: It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.

Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer.

PURPOSE: Mozambique has one of the highest burdens of cervical cancer globally. Treatment options are few as most women present with advanced disease, and there are limited trained health professionals and health care resources. The objective of this study was to describe the outcomes of women diagnosed with invasive cancer as part of the Mozambican women undergoing cervical cancer screening with human papillomavirus (HPV) testing in conjunction with family planning services (MULHER) study. MATERIALS AND METHODS: Women age 30-49 years were prospectively enrolled in the MULHER study and offered screening with primary HPV testing followed by treatment of screen-positive women with thermal ablation or excision as appropriate. Women with cervical examination findings suspicious for cancer were referred to one of the three gynecologic oncologists in the country. RESULTS: Between January 2020 and January 2023, 9,014 women underwent cervical cancer screening and 30 women were diagnosed with cervical cancer. In this cohort, four patients (13.3%) had early-stage disease, 18 (60.0%) had locally advanced disease, one (3.3%) had distant metastatic disease, and seven (23.3%) did not have staging information available. Five patients (16.6%) died without receiving oncologic treatment, and seven patients (23.3%) are still awaiting treatment. Of the remaining 18 patients, three (17.6%) underwent surgery and four (23.5%) received radiotherapy. Eleven (36.7%) patients received only chemotherapy. CONCLUSION: As cervical screening programs are implemented in low-resource settings, there will likely be an increase in the number of women diagnosed with invasive cervical cancer. Our results in Mozambique demonstrate the need to increase access to advanced surgery, radiation, and palliative care services.

Ventilatory Parameters in Obstetric Patients With COVID-19 and Impact of Delivery: A Multicenter Prospective Cohort Study.

BACKGROUND: Current evidence on obstetric patients requiring advanced ventilatory support and impact of delivery on ventilatory parameters is retrospective, scarce, and controversial. RESEARCH QUESTION: What are the ventilatory parameters for obstetric patients with COVID-19 and how does delivery impact them? What are the risk factors for invasive mechanical ventilation (IMV) and for maternal, fetal, and neonatal mortality? STUDY DESIGN AND METHODS: Prospective, multicenter, cohort study including pregnant and postpartum patients with COVID-19 requiring advanced ventilatory support in the ICU. RESULTS: Ninety-one patients were admitted to 21 ICUs at 29.2 ± 4.9 weeks; 63 patients (69%) delivered in ICU. Maximal ventilatory support was as follows: IMV, 69 patients (76%); high-flow nasal cannula, 20 patients (22%); and noninvasive mechanical ventilation, 2 patients (2%). Sequential Organ Failure Assessment during the first 24 h (SOFA24) score was the only risk factor for IMV (OR, 1.97; 95% CI, 1.29-2.99; P = .001). Respiratory parameters at IMV onset for pregnant patients were: mean ± SD plateau pressure (PP), 24.3 ± 4.5 cm H2O; mean ± SD driving pressure (DP), 12.5 ± 3.3 cm H2O; median static compliance (SC), 31 mL/cm H2O (interquartile range [IQR], 26-40 mL/cm H2O); and median Pao2 to Fio2 ratio, 142 (IQR, 110-176). Respiratory parameters before (< 2 h) and after (≤ 2 h and 24 h) delivery were, respectively: mean ± SD PP, 25.6 ± 6.6 cm H2O, 24 ± 6.7 cm H2O, and 24.6 ± 5.2 cm H2O (P = .59); mean ± SD DP, 13.6 ± 4.2 cm H2O, 12.9 ± 3.9 cm H2O, and 13 ± 4.4 cm H2O (P = .69); median SC, 28 mL/cm H2O (IQR, 22.5-39 mL/cm H2O), 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O), and 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O; P = .058); and Pao2 to Fio2 ratio, 134 (IQR, 100-230), 168 (IQR, 136-185), and 192 (IQR, 132-232.5; P = .022). Reasons for induced delivery were as follows: maternal, 43 of 71 patients (60.5%); maternal and fetal, 21 of 71 patients (29.5%); and fetal, 7 of 71 patients (9.9%). Fourteen patients (22.2%) continued pregnancy after ICU discharge. Risk factors for maternal mortality were BMI (OR, 1.10; 95% CI, 1.006-1.204; P = .037) and comorbidities (OR, 4.15; 95% CI, 1.212-14.20; P = .023). Risk factors for fetal or neonatal mortality were gestational age at delivery (OR, 0.67; 95% CI, 0.52-0.86; P = .002) and SOFA24 score (OR, 1.53; 95% CI, 1.13-2.08; P = .006). INTERPRETATION: Contrary to expectations, pregnant patient lung mechanics were similar to those of the general population with COVID-19 in the ICU. Delivery was induced mainly for maternal reasons, but did not change ventilatory parameters other than Pao2 to Fio2 ratio. SOFA24 score was the only risk factor for IMV. Maternal mortality was associated independently with BMI and comorbidities. Risk factors for fetal and neonatal mortality were SOFA24 score and gestational age at delivery.

Comparative analysis for quality control of mother tinctures in Brazilian reports

Quality control of ahomeopathic mother tincture begins with the analysis of the raw material. Once the product is obtained, some organoleptic characteristics and Physicochemical properties such as appearance, colour, odour, density, dry residue, alcohol content,and chemicalmarker are evaluated. In Brazil, mother tinctures from different suppliers may have high variability in terms of the specifications described in the homeopathic pharmacopoeia. Objective: The aim of the present study was to compare mother tinctures' quality control from different pharmaceutical suppliers based on Brazilian Homeopathic Pharmacopoeia 3rd edition. Methods: Five mother tinctures were selected according to the high number of requests in the pharmacies, also its monographs are in the Brazilian Homeopathic Pharmacopoeia (FHB) 3rd edition. The report of analysis of the product was provided by three homeopathic pharmacies from the city of Rio de Janeiro. The information in the reports wasevaluated and compared to its monograph. Results and discussion: In this study, it was found that the number of laboratories that provide homeopathic pharmaceutical ingredients is rather low. In addition, in some reports, a number of identification tests werenot described properly when compared to the monograph. Besides that, some information diverges from the pharmacopoeia, for example, absence of dry residue testing, replacement of the part of the plant used to prepare the mother tincture,and results that do not meet pharmacopoeia specifications. As can be seen, the quality and effectiveness of homeopathic medicines prepared from these tinctures may be compromised. Conclusion:In order to guarantee consumer protection and the quality and effectiveness of medicines, governments and regulatory agencies should requirea greater commitment from suppliers in the production of homeopathic inputs.

Chemical prospecting and antioxidant, anticholinesterase and antifungal activity of ethanol extracts from Senna Mill. species. (Fabaceae) / Prospecção química, atividade antioxidante, anticolinesterásica e antifúngica de extratos etanólicos de espécies de Senna Mill. (Fabaceae)

The objective of this work was to evaluate the chemical profile, total phenol content and the antioxidant, antiacetylcholinesterase and antifungal activities of ethanol extracts from leaves (EEF) and stem (EEC) of five species of Senna, as well as to evaluate the correlation between the content of total phenols with the DPPH free radical scavenging activity and with the inhibition of the acetylcholinesterase AChEI enzyme. The phytochemical test showed the presence of secondary metabolites in all extracts. The EEF and EEC of Senna trachypus, stood out for presenting the highest values of total phenols. S. trachypus EEF and EEC showed the best action on the acetylcholinesterase enzyme. All species showed antioxidant activity, especially the EEF from S. trachypus. A strong correlation was observed for the variables total phenols and antioxidant activity (r = -0.71), very strong for total phenols and anti-acetylcholinesterase (r = -0.84) and moderate activity for antioxidant and anti-acetylcholinesterase activity (r = 0.43). Only S. trachypus extracts showed activity against all dermatophytes, when compared to the other species. The species S. trachypus was considered the most promising plant for further studies, in order to find compounds with pharmacological actions.

O objetivo deste trabalho foi avaliar o perfil químico, teor de fenóis totais e as atividades antioxidante, antiacetilcolinesterásica e antifúngica dos extratos etanólicos das folhas (EEF) e do caule (EEC) de cinco espécies de Senna, bem como avaliar a correlação entre o conteúdo de fenóis totais com a atividade sequestradora do radical livre DPPH e com a inibição da enzima acetilcolinesterase AChEI. No teste fitoquímico, evidenciou-se a presença de metabólitos secundários em todos os extratos. Os EEF e EEC de Senna trachypus, destacaram-se por apresentar os maiores valores de fenóis totais. Os EEF e EEC de S. trachypus mostraram a melhor ação sobre a enzima acetilcolinesterase. Todas as espécies apresentaram atividade antioxidante, em especial o EEF de S. trachypus. Foi observado correlação forte para as variáveis fenóis totais e atividade antioxidante (r = -0,71), muito forte para fenóis totais e antiacetilcolinesterase (r = -0,84) e atividade moderada para atividade antioxidante e antiacetilcolinesterase (0,43). Apenas os extratos de S. trachypus apresentaram atividade contra todos os dermatófitos, quando comparado às demais espécies. A espécie S. trachypus foi considerada a planta mais promissora para estudos subsequentes, a fim de encontrar compostos com ações farmacológicas.

Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study.

OBJECTIVES: To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). METHODS: Multicenter, prospective, national cohort study. RESULTS: Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively. CONCLUSIONS: Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.

SARS-CoV-2 em Grávidas e Puérperas no Início da Transmissão Comunitária na Cidade de Maputo / SARS-CoV-2 in Pregnant and Postpartum Women at the Beginning of Transmission Community in Maputo City

A COVID-19 é causada por coronavírus descri to pela primeira vez em 2019, designado SARS- -CoV-2,1 e afectou até ao momento milhões de pessoas em todo o mundo, resultando em milhares de óbitos.2 O quadro patológico pode cursar com síndrome respiratória aguda grave. Nos casos sin tomáticos, os doentes apresentam geralmente febre, tosse, dispneia e cansaço;3 contudo, a infecção as sintomática ocorre em cerca de 87.9% dos infec tados.4 Indivíduos com doenças crónicas e idosos são mais susceptíveis a COVID-19.5 As grávidas são igualmente susceptíveis a contrair o SARS-CoV-2 devido as alterações fisiológicas do seu estado. As mesmas durante a infecção correm o potencial risco de evoluir com pneumonia,6 mesmo que em alguns casos cursem sem sintomas.7 Até Março de 2020 em Singapura, a análise de 55 gestantes infectadas com a COVID-19 e 46 recém-nascidos, não evidenciou transmissão vertical ou maior susceptibilidade de grávidas ao SARS-CoV-2.8 Mesmo assim, no início da pandemia cerca de 10% das grávidas infectadas tiveram insuficiência respiratória grave, e 5% neces sitaram de ventilação.

Avaliação microbiológica da água consumida em bebedouros da Universidade Estadual Vale do Acaraú, Sobral – CE / Microbiological evaluation of the water consumed in drinking of the University Vale do Acaraú, Sobral - CE

A má qualidade dos sistemas de distribuição e de reservatórios proporciona a população uma água contaminada que, serve de veículo para vários agentes infecciosos que provocam danos à saúde humana. O presente trabalho teve por objetivo analisar a qualidade e potabilidade das águas dos bebedouros de uma Universidade do município de Sobral - Ce, por meio da quantificação de coliformes totais e coliformes termotolerantes. As amostras foram avaliadas, segundo os requisitos determinados pelo Ministério da Saúde, por meio da Portaria nº 2914 de 2011. Os resultados apresentados após as análises feitas não atenderam aos parâmetros, desta forma as amostras podem ser classificadas como inadequadas para consumo de acordo com parâmetros para coliformes.

The poor quality of distribution systems and tanks to the population provides a contaminated water that serves as a vehicle for various infectious agents that cause damage to human health. This study aims to analyze the quality and potability of water in the troughs of a University of Sobral - Ce municipality, through the quantification of total coliforms and fecal coliforms. The samples were evaluated, whose requirements are determined by the Ministry of Health, through Ordinance No. 2914 of 2011. The results after the analyzes did not meet the parameters, so samples can be classified as unsuitable for consumption according to parameters coliform.

Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition.

Undernutrition is a stressor with long-term consequences, and the effect of nutritional recovery on cortisol and thyroid hormone status is unknown. To investigate basal thyroid hormones and the cortisol response to a cold pressor test in children recovered from undernutrition, a cross-sectional study was undertaken on children (6-16 years) separated into four groups: control (n 41), stunted (n 31), underweight (n 27) and recovered (n 31). Salivary cortisol was collected over the course of 10 h: upon awakening, before and after an unpleasant and a pleasant stimulus. Cortisol upon awakening was highest in the stunted and lowest in the underweight groups: control=5·05 (95% CI 3·71, 6·89) nmol/l, stunted=6·62 (95% CI 3·97, 11·02) nmol/l, underweight=2·51 (95% CI 1·75, 3·63) nmol/l and recovered=3·46 (95% CI 2·46, 4·90) nmol/l (P=0·005). Girls had higher cortisol concentrations upon awakening compared with boys (P=0·021). The undernourished groups showed an elevated cortisol response both to the unpleasant stimulus and at the last measurement (16.00 hours) compared with that of the recovered group: AUC, control=2·07 (95% CI 1·69, 2·45) nmol/l×30 min, stunted=2·48 (95% CI 1·91, 3·06) nmol/l×30 min, underweight=2·52 (95% CI 2·07, 2·97) nmol/l×30 min, recovered=1·68 (95% CI 1·26, 2·11) nmol/l×30 min (P=0·042); and control=2·03 (95% CI 1·75, 2·39) nmol/l×30 min, stunted=2·51 (95% CI 1·97, 3·19) nmol/l×30 min, underweight=2·61 (95% CI 2·16, 3·16) nmol/l×30 min, recovered=1·70 (95% CI 1·42, 2·03) nmol/l×30 min (P=0·009). Lower free thyroxine (T4) was found in the recovered and stunted groups: control=1·28 (95% CI 1·18, 1·39) pmol/l, stunted=0·98 (95% CI 0·87, 1·10) pmol/l, underweight=1·10 (95% CI 1·01, 1·21) pmol/l and recovered=0·90 (95% CI 0·83, 0·99) pmol/l (P<0·001). Multivariate analysis showed a lower cortisol concentration along 10 h (06.00-16.00 hours) in the recovered compared with the other groups (P=0·017), and similar concentrations between the recovered and control group. In conclusion, the children with recovery in weight and height had a cortisol stress response similar to control but a lower basal free T4. Longitudinal studies are warranted to determine the extent of these endocrine changes after recovery of undernutrition and in adulthood.

Characteristics, Outcomes, and Predictability of Critically Ill Obstetric Patients: A Multicenter Prospective Cohort Study.

OBJECTIVE: To evaluate pregnant/postpartum patients requiring ICUs admission in Argentina, describe characteristics of mothers and outcomes for mothers/babies, evaluate risk factors for maternal-fetal-neonatal mortality; and compare outcomes between patients admitted to public and private health sectors. DESIGN: Multicenter, prospective, national cohort study. SETTING: Twenty ICUs in Argentina (public, 8 and private, 12). PATIENTS: Pregnant/postpartum (< 42 d) patients admitted to ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three hundred sixty-two patients were recruited, 51% from the public health sector and 49% from the private. Acute Physiology and Chronic Health Evaluation II was 8 (4-12); predicted/observed mortality, 7.6%/3.6%; hospital length of stay, 7 days (5-13 d); and fetal-neonatal losses, 17%. Public versus private health sector patients: years of education, 9 ± 3 versus 15 ± 3; transferred from another hospital, 43% versus 12%; Acute Physiology and Chronic Health Evaluation II, 9 (5-13.75) versus 7 (4-9); hospital length of stay, 10 days (6-17 d) versus 6 days (4-9 d); prenatal care, 75% versus 99.4%; fetal-neonatal losses, 25% versus 9% (p = 0.000 for all); and mortality, 5.4% versus 1.7% (p = 0.09). Complications in ICU were multiple-organ dysfunction syndrome (34%), shock (28%), renal dysfunction (25%), and acute respiratory distress syndrome (20%); all predominated in the public sector. Sequential Organ Failure Assessment (during first 24 hr of admission) score of at least 6.5 presented the best discriminative power for maternal mortality. Independent predictors of maternal-fetal-neonatal mortality were Acute Physiology and Chronic Health Evaluation II, education level, prenatal care, and admission to tertiary hospitals. CONCLUSIONS: Patients spent a median of 7 days in hospital; 3.6% died. Maternal-fetal-neonatal mortality was determined not only by acuteness of illness but to social and healthcare aspects like education, prenatal control, and being cared in specialized hospitals. Sequential Organ Failure Assessment (during first 24 hr of admission), easier to calculate than Acute Physiology and Chronic Health Evaluation II, was a better predictor of maternal outcome. Evident health disparities existed between patients admitted to public versus private hospitals: the former received less prenatal care, were less educated, were more frequently transferred from other hospitals, were sicker at admission, and developed more complications; maternal and fetal-neonatal mortality were higher. These findings point to the need of redesigning healthcare services to account for these inequities.

Symptom burden and health-related quality of life among intensive care unit survivors in Argentina: A prospective cohort study.

PURPOSE: Our goal was to describe the evolution of selected physical and psychologic symptoms and identify the determinants of health-related quality of life (HRQOL) after intensive care unit (ICU) discharge. METHODS: The study is a prospective cohort of consecutive adult patients admitted to a mixed ICU in a university-affiliated hospital, mechanically ventilated for more than 48 hours. During ICU stay, epidemiological data and events probably associated to worsening outcomes were recorded. After discharge, patients were interviewed at 1, 3, 6, and 12 months. Health-related quality of life was assessed with EuroQoL Questionnaire-5 Dimensions, which includes the EQ-index and EQ-Visual Analogue Scale. RESULTS: One hundred twelve patients were followed up, aged 33 [24-49] years, 68% male, 76% previously healthy, and cranial trauma was the main diagnosis. Physical and psychologic symptoms and moderate/severe problems according to the EQ index progressively decreased after discharge, yet were still highly prevalent after 1 year. EQ index improved from 0.22 [0.01-0.69] to 0.52 [0.08-0.81], 0.66 [0.17-0.79], and 0.68 [0.26-0.86] (P < .001, for all vs month 1). EQ-Visual Analogue Scale remained stable, within acceptable values. Independent determinants of EQ-index were time, duration of mechanical ventilation, shock, weakness, and return to study/work. CONCLUSIONS: Determinants of HRQOL after ICU discharge were both related to late sequelae of critical illness and to some events occurring in the ICU. Notwithstanding the high symptom burden, patients still perceived their HRQOL as good.

Hypertensive disease of pregnancy in the ICU: a multicenter study.

OBJECTIVE: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina. METHODS: Case-series multicenter study. RESULTS: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6-14]; SOFA24 2[1-4]; ICU-LOS 3[2-6] days and hospital-LOS 8[5-12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) - 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02-1.13], gestational age (OR 1.14 [1.04-1.24]) and nulliparity (OR 2.40 [1.19-4.85]). CONCLUSIONS: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.

Impact of nutritional recovery with linear growth on the concentrations of adipokines in undernourished children living in Brazilian slums.

Undernutrition in early life has been reported to be closely associated with the development of non-communicable diseases in adulthood. Adequate treatment is important for reversing these effects. In the present study, we investigated the effects of undernutrition and anthropometric recovery on the weights and heights of children in relation to the concentrations of leptin, adiponectin and plasminogen activator inhibitor-1 (PAI-1). A total of 119 children (aged 6-16 years) from the slums of São Paulo were selected according to their nutritional status and divided into three groups as follows: control (healthy without intervention, n 38) with a height-for-age Z score (HAZ) and a BMI-for-age Z score (BAZ) > -1·6; undernourished (HAZ and/or BAZ < -1·6, n 54); recovered from undernutrition (after treatment in a rehabilitation centre; HAZ and BAZ > -1·6, n 27). Blood samples were collected to determine insulin, glucose, leptin, adiponectin and PAI-1 concentrations. Leptin concentrations in the undernourished group were lower than those in the control and recovered groups (mean 0·92 (95% CI 0·67, 1·25), 2·03 (95% CI 1·46, 2·82) and 1·66 (95% CI 1·15, 2·44) ng/ml, P=0·003), which had similar leptin concentrations. There were no differences in adiponectin and PAI-1 concentrations among the groups. A positive correlation between waist circumference and leptin concentrations was observed in all the girls and boys of the control group (control: r 0·729, P<0·01; undernourished: r 0·490, P<0·05; and recovered: r 0·829, P<0·01; r 0·673, P<0·05). Stronger correlations between leptin and insulin concentrations were observed in the recovered group. The results of the present study indicate that normal leptin concentrations are found when normal height and weight are achieved.

[Practice of compounding parenteral nutrition in Portugal; comparison with the Spanish guidelines]. / Prácticas de preparación de nutrición parenteral neonatal en Portugal; comparación con las recomendaciones Españolas.

OBJECTIVE: To evaluate the practices of neonatal parenteral nutrition (PN) compounding in Portugal and the agreement to the recommendations from the Spanish Consensus on Compounding of Parenteral Nutrition Mixtures 2008. METHODS: Survey based on an electronic questionnaire on PN preparation emailed, between July and October 2009, to the pharmacists or nurses responsible for preparing neonatal PN in the 50 public and private Portuguese hospitals with neonatal special care units. RESULTS: From the 30 hospitals where neonatal PN was prepared, 22 (73%) responded to the questionnaire. In 76.7% hospitals the PN was prepared in the hospital pharmacy and the remaining in the neonatal unit. In most hospitals the PN was only prepared in the working days. In half of cases the professional responsible for the preparation received the prescription in electronic support. The problems related with interpretation and validations of the prescriptions were not unusual (14-41%). Most of the Portuguese hospitals referred practices in agreement with the main recommendations from the Spanish Consensus regarding the documentation, equipment and facilities, human resources and labeling. In relation to PN admixtures, most hospitals follow the recommendations on deadlines to use, protection from light, use of terminal filters for infusion, and physical and chemical control by visual inspection and microbiological control. CONCLUSIONS: The results from this study provide a good insight of the practice of preparation of neonatal NP in Portugal. The comparison with the Spanish Consensus contributes to identify weaknesses.

Objetivo: Evaluar la práctica de preparación de nutrición parenteral (NP) neonatal en Portugal y su concordancia con las recomendaciones del Consenso Español sobre Preparación de Mezclas Nutrientes Parenterales 2008. Métodos: Cuestionario electrónico sobre elementos relativos a la preparación de la NP, enviado entre junio y octubre 2009 a los farmacéuticos o enfermeros responsables de la preparación de la NP neonatal en los 50 hospitales (públicos y privados) de Portugal con unidades de cuidados especiales neonatales. Resultados: Se preparaba NP neonatal en 30 hospitales, de los que 22 (73,3%) respondieron la encuesta. En el 77% de los hospitales, la NP neonatal se preparaba en los servicios farmacéuticos y en la propia unidad neonatal en el resto. En la mayoría de hospitales se preparaba apenas en los días laborables, y la en la mitad de los casos la prescripción llegaba a los responsables en soporte digital. Los responsables identificaron diversos problemas asociados a la interpretación de la prescripción (14-41% de las NP). La práctica de la mayoría de los hospitales portugueses estaba en concordancia con el Consenso Español en documentación, instalaciones y equipamientos, recursos humanos y etiquetado. En cuanto a las soluciones, la mayoría estaba en concordancia con los plazos límite de utilización, fotoprotección, utilización de filtros terminales, control físico-químico por inspección visual y control microbiológico. Conclusiones: Los resultados del presente estudio proporcionan un buen panorama de la práctica de preparación de la NP neonatal en Portugal. La comparación con el Consenso Español permitió identificar los puntos débiles y de mejora.

Prácticas de Preparación de Nutrición Parenteral Neonatal en Portugal; comparación con las recomendaciones españolas / Practice of compounding parenteral nutrition in Portugal; comparison with the Spanish guidelines

Objetivo: Evaluar la práctica de preparación de nutrición parenteral (NP) neonatal en Portugal y su concordancia con las recomendaciones del Consenso Español sobre Preparación de Mezclas Nutrientes Parenterales 2008. Métodos: Cuestionario electrónico sobre elementos relativos a la preparación de la NP, enviado entre junio y octubre 2009 a los farmacéuticos o enfermeros responsables de la preparación de la NP neonatal en los 50 hospitales (públicos y privados) de Portugal con unidades de cuidados especiales neonatales. Resultados: Se preparaba NP neonatal en 30 hospitales, de los que 22 (73,3%) respondieron la encuesta. En el 77% de los hospitales, la NP neonatal se preparaba en los servicios farmacéuticos y en la propia unidad neonatal en el resto. En la mayoría de hospitales se preparaba apenas en los días laborables, y la en la mitad de los casos la prescripción llegaba a los responsables en soporte digital. Los responsables identificaron diversos problemas asociados a la interpretación de la prescripción (14-41% de las NP). La práctica de la mayoría de los hospitales portugueses estaba en concordancia con el Consenso Español en documentación, instalaciones y equipamientos, recursos humanos y etiquetado. En cuanto a las soluciones, la mayoría estaba en concordancia con los plazos límite de utilización, fotoprotección, utilización de filtros terminales, control físico-químico por inspección visual y control microbiológico. Conclusiones: Los resultados del presente estudio proporcionan un buen panorama de la práctica de preparación de la NP neonatal en Portugal. La comparación con el Consenso Español permitió identificar los puntos débiles y de mejora (AU)

Objective: To evaluate the practices of neonatal parenteral nutrition (PN) compounding in Portugal and the agreement to the recommendations from the Spanish Consensus on Compounding of Parenteral Nutrition Mixtures 2008. Methods: Survey based on an electronic questionnaire on PN preparation emailed, between July and October 2009, to the pharmacists or nurses responsible for preparing neonatal PN in the 50 public and private Portuguese hospitals with neonatal special care units. Results: From the 30 hospitals where neonatal PN was prepared, 22 (73%) responded to the questionnaire. In 76.7% hospitals the PN was prepared in the hospital pharmacy and the remaining in the neonatal unit. In most hospitals the PN was only prepared in the working days. In half of cases the professional responsible for the preparation received the prescription in electronic support. The problems related with interpretation and validations of the prescriptions were not unusual (14-41%). Most of the Portuguese hospitals referred practices in agreement with the main recommendations from the Spanish Consensus regarding the documentation, equipment and facilities, human resources and labeling. In relation to PN admixtures, most hospitals follow the recommendations on deadlines to use, protection from light, use of terminal filters for infusion, and physical and chemical control by visual inspection and microbiological control. Conclusions: The results from this study provide a good insight of the practice of preparation of neonatal NP in Portugal. The comparison with the Spanish Consensus contributes to identify weaknesses (AU)

Health insurance status and outcomes of critically ill obstetric patients: a prospective cohort study in Argentina.

PURPOSE: In Argentina, uninsured patients receive public health care, and the insured receive private health care. Our aim was to compare different outcomes between critically ill obstetric patients from both sectors. METHODS: This is a prospective cohort, including pregnant/postpartum patients requiring admission to 1 intensive care unit in the public sector (uninsured) and 1 in the private (insured) from January 1, 2008, to September 30, 2011. RESULTS: A total of 151 patients were included in the study. In uninsured (n = 63) vs insured (n = 88) patients, Acute Physiology and Chronic Evaluation II (APACHE II) and Sequential Organ Failure Assessment scores were 11 ± 6.5 vs 8 ± 4 and 3 (2-7) vs 1 (0-2), respectively, and 84% vs 100% received prenatal care (P = .001 for all). Multiple organ dysfunction syndrome (MODS) was present in 32 (54%) uninsured vs 9 (10%) insured patients (P = .001), and acute respiratory distress syndrome developed in 18 (30.5%) of 59 vs 2(2%) of 88 (P = .001). Neonatal survival was 80% vs 96% (P = .003). Variables independently associated with the development of MODS were APACHE II (odds ratio, 1.30 [1.13-1.49]), referral from another hospital (odds ratio, 11.43 [1.86-70.20]), lack of health insurance (odds ratio 6.75 [2.17-20.09]), and shock (odds ratio 4.82 [1.54-15.06]). Three patients died, all uninsured. CONCLUSIONS: Uninsured critically ill obstetric patients (public sector) were more severely ill on admission and experienced worse outcomes than insured patients (private sector). Variables independently associated with MODS were APACHE II, shock, referral from another hospital, and lack of insurance.

Dipyrone attenuates acute sickness response to lipopolysaccharide in mice.

Sickness behavior appears to be the expression of a central motivational state that reorganizes the organism's priorities to cope with infectious pathogens. To evaluate the effect of dipyrone in lipopolysaccharide (LPS)-induced sickness behavior, mice were subjected to the forced swim test (FST), tail suspension test (TST), dark-light box test, open field test, sucrose preference intake test and food intake test. LPS administration increased the immobility time in the TST, increased the time spent floating in the FST, and depressed locomotor activity in the open field test. Treatment with LPS decreased the total number of transitions made between the dark and light compartments of the apparatus and induced anhedonia and anorexia. Pre-treatment with dipyrone (10, 50, or 200 mg/kg) attenuated behavioral changes induced by LPS in the FST, TST, open field and light-dark box tests. In addition, dipyrone prevented anhedonia and anorexia in mice challenged with LPS. Considering that dipyrone attenuates LPS-induced behavioral changes, it is proposed that LPS-induced sickness behavior is dependent on the COX pathway.

Critical care providers' opinion on unsafe abortion in Argentina.

OBJECTIVE: To survey the opinion of critical care providers in Argentina about abortion. METHODS: An anonymous questionnaire was distributed to critical care providers attending the 20th National Critical Care Conference in Argentina. RESULTS: 149 of 1800 attendees completed the questionnaire, 69 (46.3%) of whom were members of the Argentine Society of Critical Care (ASCC). 122 (81.9%) supported abortion decriminalization in situations excluded from the current law; 142 (95.3%) in cases of congenital defects; 133 (89.3%) in cases of rape; 115 (77.2%) when women's mental health is at risk; 71 (47.7%) when pregnancy is unintended; and 61 (40.9%) for economic reasons. 126 (84.6%) supported abortion in public and private institutions, and 121 (81.2%) before 12 weeks of pregnancy. Variables independently associated with abortion support among female versus male attendees were abortion to preserve women's mental health (OR 4.47; 95% CI, 1.61-12.42; P=0.004) and abortion before 12 weeks of pregnancy (OR 3.93; 95% CI, 1.29-11.94; P=0.015). Abortion at request was independently associated with ASCC membership (OR 2.63; 95% CI, 1.07-6.45; P=0.034). CONCLUSION: Critical care providers would support abortion in situations excluded from the current abortion law and before 12 weeks of pregnancy, in both public and private hospitals.

Impacto de la internación en terapia intensiva en la calidad de vida después de 1, 3, 6 y 12 meses / The impact of hospitalization in intensive care units on quality of life after 1, 3, 6 and 12 months

INTRODUCCION: A medida que más pacientes sobreviven a una internación en Unidades de Terapia Intensiva (UTI), se hace necesario conocer las secuelas a largo plazo. La calidad de vida relacionada a la salud tras la enfermedad crítica se mantiene por debajo de la media de la población general aún cinco años después del alta.OBJETIVO: Evaluar la calidad de vida de los pacientes a egreso de UTI mediante el cuestionario EuroQol 5D y predictores de mala evolución. Evaluar secuelas psíquicas y físicas una vez transcurridos 1, 3, 6 y 12 meses después del alta de UTI.METODOS: Se realizó un estudio descriptivo en un Hospital Interzonal de la Provincia de Buenos Aires (estudio prospectivo de serie de casos). Fueron incluidos aquellos pacientes sometidos a asistencia respiratoria mecánica invasiva por un período ≥ 48 horas que egresaron de UTI entre el 01/04/2010 y el 01/04/2011.RESULTADOS: Los criterios de inclusión fueron cumplidos por 51 pacientes. Se entrevistó a 36/46 pacientes (tras un mes), 25/34 pacientes (a los 3 meses), 12/15 pacientes (a los 6 meses) y 5/7 pacientes (a los 12 meses). Los datos demográficos reflejaron edad 33 [25-50] años, 71% de los pacientes de sexo masculino, 57% sin comorbilidades y con un puntaje APACHE II de 14,6 ± 6. El principal motivo de ingreso fue el trauma (50%). La dimensión más afectada fue la realización de actividades cotidianas, seguida de dolor/malestar y movilidad. La incidencia de ansiedad/depresión y estrés postraumático fue la reportada en otros estudios. La anemia, la traqueostomía y la alimentación enteral al alta fueron predictores de mala evolución según el índice EuroQol.CONCLUSIONES: La calidad de vida al alta de UTI se encontró muy deteriorada en la mayoría de las dimensiones. Las secuelas psíquicas se presentaron dentro del rango esperado. El índice EuroQol fue bajo en el primer mes, pero evolucionó favorablemente junto a la percepción de la propia calidad de vida medida por Escala Visual Análoga EuroQol.

INTRODUCTION: As more and more patients survive their hospitalization in Intensive Care Units (ICU), it is of utmost importance to find out and understand the long-term outcomes. Health-related quality of life after a critical illness is still below the average, even five years after discharge.OBJECTIVE: To assess patients quality of life after ICU discharge using the EuroQol-5D score and predictors of unfavorable prognosis. To assess psychological after-effects like anxiety, depression and post-traumatic stress disorder (PTSD), along with physical morbodity at 1, 3, 6 and 12 months after ICU discharge.METHODS: A descriptive study was conducted in a public hospital located in the province of Buenos Aires (prospective case study). It included all patients treated with invasive mechanical ventilation for at least 48 hours that survived ICU from April 1, 2010 through April 1, 2011.RESULTS: 51 patients qualified for inclusion in this study. Interviews were made to 36/46 patients after 1 month; 25/34 patients after 3 months; 12/15 patients after 6 months and 5/7 patients after 12 months. The demographic data showed age 33 [25-50], 71% male, 57% with no comorbidities and 14,6 ± 6,4 points in APACHE II score. The main reason for ICU admission was trauma (50%). The most affected dimension, as measured by EQ-5D, was usual activities, followed by pain/discomfort and self-care or morbility. The incidence of PTSD and anxiety/depression was similar was to what was reported in other studies. Anemia, tracheostomy and enteral feeding at discharge were predictors of unfavorable prognosis as indicated by the EuroQol index.CONCLUSIONS: The quality of life after ICU discharge was severely deteriorated in most dimensions. Psychological after-effects were within the expected values. The EuroQol index was low in the first month, but then it improved along with the quality of life as measured by the EuroQol Visual Analogue Scale.