Gantenerumab for early Alzheimer's disease: a systematic review and meta-analysis.

INTRODUCTION: Gantenerumab is a monoclonal antibody targeting amyloid ß protein (Aß) in early Alzheimer's disease (AD). The authors sought to evaluate gantenerumab safety and efficacy in early AD patients. METHODS: MEDLINE, Embase, and Cochrane databases were systematically searched until 2 December 2023. Data were examined using the Mantel-Haenszel method and 95% confidence intervals (CIs). Meta-regression analysis was conducted to evaluate a possible link between baseline Clinical Dementia Rating Scale - Sum of Boxes (CDR-SB) and amyloid-related imaging abnormalities (ARIA) at follow-up. R, version 4.2.3, was used for statistical analysis. RESULTS: A total of 4 RCTs and 2848 patients were included, of whom 1580 (55%) received subcutaneous gantenerumab. Concerning clinical scores, the placebo group achieved better rates of change in the Disease Assessment Scale (ADAS-Cog13) (SMD -0.11; 95% CI -0.19- -0.03; p = 0.008569; I2 = 0%). Gantenerumab was strongly associated with the occurrence of ARIA-E and ARIA-H: (19.67% vs. 2.31%; RR 9.46; 95% CI 5.55-16.11; p = <0.000001; I2 = 10%) and (21.95% vs. 12.38%; RR 1.79; 95% CI 1.50-2.13; p = <0.000001; I2 = 0%), respectively. DISCUSSION: In this meta-analysis, consistent results suggest that gantenerumab is not safe and efficient for early AD, showing no improvement in clinical scores for AD and being associated with the occurrence of ARIA-E and ARIA-H.

Dual Antiplatelet Therapy vs Alteplase in Adult Patients with Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis.

The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are insufficiently established. Therefore, we aimed to perform a meta-analysis to compare DAPT with IV alteplase in patients with acute minor stroke. MEDLINE, Embase, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. Functional and safety outcomes in 90 days were analyzed. Statistical analysis was performed using Rstudio 4.3.1. Subanalyses were performed restricted to non-disabling minor strokes and NIHSS score ≤ 3. PROSPERO (CRD42023440986). We included five studies with a total of 6,340 patients, of whom 4,050 (63.9%) received DAPT. The follow-up period for all included studies was 90 days. There was no significant difference for individual outcomes of mRS 0-1 (OR 1.26; 95% CI 0.85-1.89; p = 0.25), mRS 0-2 (OR 0.99; 95% CI 0.69-1.43; p = 0.97), or all-cause mortality (OR 0.80; 95% CI 0.20-3.13; p = 0.75) between groups. Symptomatic intracranial hemorrhage (sICH) was significantly lower (OR 0.11; 95% CI 0.003-0.36; p < 0.001) in patients treated with DAPT compared with IV alteplase. In terms of mRS 0-1 and mRS 0-2, we found no significant difference in both subgroup analyses. We found no statistically significant difference between DAPT and IV alteplase regarding functional outcome (mRS scores of 0-1 and 0-2) or all-cause mortality at 90 days in patients with minor ischemic stroke. Additionally, DAPT was associated with a significantly lower rate of sICH.

Balanced Crystalloids Versus Normal Saline in Kidney Transplant Patients: An Updated Systematic Review, Meta-analysis, and Trial Sequential Analysis.

BACKGROUND: The use of balanced crystalloids over normal saline for perioperative fluid management during kidney transplantation and its benefits on acid-base and electrolyte balance along with its influence on postoperative clinical outcomes remains a topic of controversy. Therefore, we conducted this review to assess the impact of balanced solutions compared to normal saline on outcomes for kidney transplant patients. METHODS: We searched MEDLINE, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) comparing balanced lower-chloride solutions to normal saline in renal transplant patients. Our main outcome of interest was delayed graft function (DGF). Additionally, we examined acid-base and electrolyte measurements, along with postoperative renal function. We computed relative risk (RR) using the Mantel-Haenszel test for binary outcomes, and mean difference (MD) for continuous data, and applied DerSimonian and Laird random-effects models to address heterogeneity. Furthermore, we performed a trial sequential analysis (TSA) for all outcomes. RESULTS: Twelve RCTs comprising a total of 1668 patients were included; 832 (49.9%) were assigned to receive balanced solutions. Balanced crystalloids reduced the occurrence of DGF compared to normal saline, with RR of 0.82 (95% confidence interval [CI], 0.71-0.94), P = .005; I² = 0%. The occurrence was 25% (194 of 787) in the balanced crystalloids group and 34% (240 of 701) in the normal saline group. Moreover, our TSA supported the primary outcome result and suggests that the sample size was sufficient for our conclusion. End-of-surgery chloride (MD, -8.80 mEq·L -1 ; 95% CI, -13.98 to -3.63 mEq.L -1 ; P < .001), bicarbonate (MD, 2.12 mEq·L -1 ; 95% CI, 1.02-3.21 mEq·L -1 ; P < .001), pH (MD, 0.06; 95% CI, 0.04-0.07; P < .001), and base excess (BE) (MD, 2.41 mEq·L -1 ; 95% CI, 0.88-3.95 mEq·L -1 ; P = .002) significantly favored the balanced crystalloids groups and the end of surgery potassium (MD, -0.17 mEq·L -1 ; 95% CI, -0.36 to 0.02 mEq·L -1 ; P = .07) did not differ between groups. However, creatinine did not differ in the first (MD, -0.06 mg·dL -1 ; 95% CI, -0.38 to 0.26 mg·dL -1 ; P = .71) and seventh (MD, -0.06 mg·dL -1 ; 95% CI, -0.18 to 0.06 mg·dL -1 ; P = .30) postoperative days nor urine output in the first (MD, -1.12 L; 95% CI, -3.67 to 1.43 L; P = .39) and seventh (MD, -0.01 L; 95% CI, -0.45 to 0.42 L; P = .95) postoperative days. CONCLUSIONS: Balanced lower-chloride solutions significantly reduce the occurrence of DGF and provide an improved acid-base and electrolyte control in patients undergoing kidney transplantation.

Hypertonic Saline Solution Versus Mannitol for Brain Relaxation During Craniotomies: A Systematic Review and Updated Meta-Analysis.

BACKGROUND AND OBJECTIVES: The preferred osmotic agent used for brain relaxation during craniotomies remains unclear, either mannitol (MAN) or hypertonic saline (HTS). Hence, we sought to compare these solutions in this population. METHODS: MEDLINE, Embase, and Cochrane databases were systematically searched until August 02, 2023. Data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I2 statistics. Meta-regression analysis was conducted to evaluate a possible link between Brain Relaxation Score and tumor volume. R, version 4.2.3, was used for statistical analysis. RESULTS: A total of 16 randomized controlled trials and 1031 patients were included, of whom 631 (61%) underwent surgery for supratentorial tumor resection. Compared with MAN, HTS achieved better rates of brain relaxation (80% vs 71%; odds ratio [OR] 1.68; 95% CI 1.22-2.33; P = .001; I2 = 0%), which was also demonstrated in the subgroup analysis of patients with supratentorial brain tumor (78% vs 65%; OR 2.02; 95% CI 1.36-2.99; P = .0005; I2 = 0%); a minor number of patients requiring a second dose of osmotic agent (14% vs 28%; OR 0.43; 95% CI 0.27-0.69; P = .0003; I2 = 0%); a lower fluid intake (mean difference -475.9341 mL; 95% CI -818.8952 to -132.9730; P = .007; I2 = 88%); and lower urine output (mean difference -462.0941 mL; 95% CI -585.3020 to -338.8862; P = <.001; I2 = 96%). Hospital length of stay and focal neurological deficits did not reach a statistically significant difference between groups. CONCLUSION: In this updated meta-analysis, consistent results suggest that HTS is associated with more beneficial outcomes than MAN in patients undergoing craniotomy.

Perioperative or Postoperative Probiotics Reduce Treatment-Related Complications in Adult Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-analysis.

PURPOSE: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications in patients undergoing surgery, with or without adjuvant therapy. METHODS: MEDLINE, Embase, and Scopus databases were searched. RESULTS: Ten RCTs with 1276 patients were included. There was a significant decrease in the incidence of diarrhea (odds ratio (OR) 0.42; 95% CI 0.31 to 0.55; p < 0.001), surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p = 0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p < 0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p = 0.004), length of ATB therapy (mean difference (MD) - 1.66 days; 95% CI - 2.13 to - 1.19 days; p < 0.001), and duration of postoperative pyrexia (MD - 0.80 days; 95% CI - 1.38 to - 0.22 days; p = 0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet were not different between groups. CONCLUSION: Our findings suggest that perioperative or postoperative probiotics is effective for reducing treatment-related complications in patients with colorectal cancer undergoing surgery, with a lower rate of adverse events.

Prothrombin Complex Concentrate versus Fresh Frozen Plasma in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.

Background: Prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) are commonly used to manage bleeding in patients during cardiac surgery. However, the relative efficacy and safety of these 2 strategies remain uncertain. Methods: MEDLINE, Embase, and Cochrane were searched for studies comparing PCC and FFP in patients who underwent cardiac surgery complicated by bleeding. Review Manager (RevMan) ver. 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration) was used for statistical analysis. Binary and continuous outcomes were compared using pooled risk ratios and mean differences, respectively. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews under protocol number CRD42022379144. Results: We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28 to 90 days. The PCC group had significantly lower chest tube drainage at 24 hours (mean difference [MD], -148.50 mL; 95% CI, -253.02 to -43.99 mL; p=0.005; I2=42%). Fewer units of red blood cells (RBCs) were transfused within the first 24 hours (MD, -1.02 units; 95% CI, -1.81 to -0.24 units; p=0.01; I2=56%), and fewer patients required RBC transfusion within the first 24 hours (risk ratio, 0.85; 95% CI, 0.78-0.93; p<0.007; I2=45%) in the PCC group. There were no statistically significant differences in secondary outcomes. Nonetheless, a subgroup analysis of randomized controlled trials failed to corroborate the results obtained from the main analysis. Conclusion: Our findings suggest that PCC can be effective, without increased adverse events, when compared with FFP in patients undergoing cardiac surgery complicated by bleeding.

Surgical versus non-surgical treatment of flail chest: a meta-analysis of randomized controlled trials.

PURPOSE: Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment. METHODS: Embase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I2 statistics. RESULTS: Six RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD - 4.34, 95% CI - 6.98, - 1.69; p < 0.01; I2 = 87%; GRADE: very low; PI - 13.51, 4.84); length of intensive care unit stay (WMD - 4.62, 95% CI - 7.19, - 2.05; p < 0.01; I2 = 78%; GRADE: low; PI - 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I2 = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I2 = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD - 5.39, 95% CI - 11.38, - 0.60; p = 0.08; I2 = 89%; GRADE: very low; PI - 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I2 = 54%; GRADE: moderate; PI 0.11, 3.24) was found. CONCLUSIONS: Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.

Streptococcus suis meningitis in a COVID-19 patient: A case report.

Streptococcus suis is a Gram-positive, facultative anaerobic bacterium and has its natural reservoir in pigs. Infection by this microorganism usually manifests in humans as meningitis, endocarditis, sepsis, and/or arthritis after contact with pigs or pork. Meningitis is a very common manifestation and Streptococcus suis may be considered its second most common cause. A clinical course may manifest acutely or with a more chronic course. Streptococcus suis is endemic in pork-consuming and pig-rearing countries, but may occur all over the world, especially in individuals with occupational exposure to pigs and/or pork, such as abattoir workers, butchers, and farmers. Most infections are observed in adults without preexisting diseases. We report a case of Streptococcus suis meningitis in a healthy patient with occupational exposure and with an asymptomatic infection by severe acute respiratory syndrome coronavirus 2, who was admitted to an intensive care unit in a tertiary hospital in the North of Portugal.

Anesthesia management of pediatric subglottic stenosis: A case report.

Subglottic stenosis balloon dilation in selected patients may be an option for the treatment of acquired subglottic stenosis, reducing the need for open surgical approaches or tracheostomy. This treatment is a major challenge to otolaryngologists and anesthesiologists, with an interactive collaboration being critical throughout the procedure. When performed, it is fundamental that otolaryngologists and anesthesiologists communicate properly during the procedure to achieve acceptable results. The complex management of the airway and inherent delicacy and risks of the intervention may be challenging. A proper preparation of the procedure and familiarization with the step-by-step technique could optimize the results and prepare the team to deal with intervening complications. We report a case of management and treatment of an 8-month-old baby with subglottic stenosis proposed for endoscopic balloon dilation treatment from Porto, North of Portugal.

When radiology determines the success of removal of a retained epidural catheter: A case report.

The epidural block is an anesthetic procedure that can have possible complications upon insertion or removal. Epidural catheter retention is a rare complication; its etiology may come from lateral migration with kinking of the catheter or from involvement with bone, ligamentous, muscular, vascular structures, or nerve roots. Up until today, there is not a standard approach to this complication; however, there are some recommendations for the management of retained epidural catheters. Here, we describe a case report of epidural catheter retention, in which we followed the published recommendations. Although computed tomography scanning may be the best option to visualize the anatomical position of the distal extremity of an epidural catheter, with this case report we intend to reinforce the fundamental contribution of the contrast radiograph in the successful catheter removal. Posteriorly, a protocol for clinical orientation of epidural catheter retention was developed in our institution.

Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of early use of a cycle ergometer, compared to a standard care protocol, in postoperatory in-hospital mobility following cardiac surgery. DESIGN: A randomized controlled trial. SETTING: Tertiary hospital in Salvador, Bahia, Brazil. SUBJECTS: Patients submitted to elective cardiac surgery (valvular or coronary bypass surgery by sternotomy). INTERVENTION: Patients were randomly allocated in two groups: (1) cycle ergometer training group (10-minute session) and (2) control group submitted standard physiotherapy protocol (10-minute session). Training was provided twice a day, immediately following extubation and until patient was discharged from the intensive care. MAIN MEASURES: The primary outcome was the difference in the total number of steps recorded on the pedometer over three days. Secondary outcomes were mobility in different subgroups and the reasons that prevented individuals from walking during early cardiac rehabilitation. RESULTS: A total of 228 participants completed the study. No significant difference was found in the total number of steps between the groups after intervention: 2183 (range: 1729-2772) in the intervention group versus 2006 (1517-2657) in the control group (P = 0.167). However, self-reports indicated better motivation in the intervention group (P = 0.044). No adverse events occurred during the study. CONCLUSION: As a strategy for early mobilization following cardiac surgery, the use of a cycle ergometer failed to increase independent physical activity compared to a standard care protocol. Nevertheless, it was safe and could be an alternative to make rehabilitation more attractive and motivational for this patient population.

Inserção no mercado de trabalho de egressos de um curso de Odontologia do Piauí / Insertion of graduates of a Dentistry course in Piauí in the job market

As transformações e dificuldades que permeiam o mercado de trabalho odontológico despertam questões sobre a inserçãodos cirurgiões-dentistas e sua formação diante do exercício profissional. O objetivo deste trabalho foi avaliar a inserção de egressos do curso de Odontologia da Universidade Federal do Piauí no mercado de trabalho. Neste estudo transversal de caráter quantitativo, um questionário online autoaplicável foi enviado a 76 cirurgiões-dentistas formados entre 2017 e 2018, abordandodados sociodemográficos,investimento em pós-graduação e ingresso no mercado de trabalho.Foi realizada análise descritiva dos dados.A taxa de resposta foi de 92,1%. A maioria dos egressos(88,6%)possuíaou cursavaalgum tipo de pós-graduação, principalmente nas áreas de Cirurgia, Endodontia e Ortodontia. Quanto ao ingresso no mercado, apenas 4,3% nunca exerceram a profissãoe 75,7% se inseriram em até 3meses de formados. Os cirurgiões-dentistas estão divididos de forma equiparável entre os setores público e privado, possuem em sua maioria jornadas de até 40 horas (75,4%) e renda mensal de até 5 salários mínimos (91,3%). Apenas 11,4% nãoestão satisfeitos com a profissão escolhida e 40% julgam o mercado como regular. Entre as dificuldades relatadas no início da profissão, as mais citadas foram baixa remuneração (82,1%) e insegurança na prática clínica (70,1%). Como sugestão para o curso de graduação, indicaram a abordagem de Administração, Marketing e Empreendedorismo. Observou-se que o mercado proporcionou oportunidades para uma inserção rápida, no entanto, com redução do exercício estritamente autônomo. Os egressos valorizam a pós-graduação e apesar das dificuldades, estão satisfeitos com a profissão (AU).

Existent transformations and complexities within dental labor market raise doubts about dentists' inclusion in professional practice, and their training. This research, therefore, aimed to evaluate the entry of Federal University of Piauí dentistry course graduates into the labor-market. This cross-sectional, quantitative study, conducted by sending an online auto-questionnaire to 76 dentists, graduated between 2017 and 2018, addressing sociodemographic data, postgraduate studies and entry into the labor market, receiving response-rate of 92.1%. Descriptive data analysis performed showed the majority of graduates (88.6%) had or were taking a postgraduate course, mainly in Surgery, Endodontics and Orthodontics. Relative to market entry, 4.3% had never practiced the profession, and 75.7% entered within 3 months after graduation. Dentists were equally divided between public and private sectors, primarily working 40 hours/week (75.4%), earning monthly income of up to 5 minimum salaries (91.3%). Only 11.4% were not satisfied with the chosen profession, and 40% judged the level of market difficulty was intermediate. Among the difficulties reported at the beginning of the profession, the majority of dentists cited the low salaries (82.1%) and insecurity in clinical practice (70.1%). As a suggestion for the undergraduate course, they indicated that they could focus on Administration, Marketing and Entrepreneurship. The market was observed to provide opportunities for rapid inclusion, however with a reduction in exercising the profession in a strictly independent manner. Graduates placed value on postgraduate studies, and despite difficulties, they were satisfied with the profession (AU).

Risk factors and survival of patients infected with carbapenem-resistant Klebsiella pneumoniae in a KPC endemic setting: a case-control and cohort study.

BACKGROUND: Many gaps in the burden of resistant pathogens exist in endemic areas of low- and middle-income economies, especially those endemic for carbapenem resistance. The aim of this study is to evaluate risk factors for carbapenem-resistance, to estimate the association between carbapenem-resistance and all-cause 30-day mortality and to examine whether mortality is mediated by inappropriate therapy. METHODS: A case-control and a cohort study were conducted in one tertiary-care hospital in Medellín, Colombia from 2014 to 2015. Phenotypic and genotypic characterization of isolates was performed. In the case-control study, cases were defined as patients infected with carbapenem-resistant K. pneumoniae (CRKP) and controls as patients infected with carbapenem-susceptible K. pneumoniae (CSKP). A risk factor analysis was conducted using logistic regression models. In the cohort study, the exposed group was defined as patients infected with CRKP and the non-exposed group as patients infected with CSKP. A survival analysis using an accelerated failure time model with a lognormal distribution was performed to estimate the association between carbapenem resistance and all-cause 30-day-mortality and to examine whether mortality is mediated by inappropriate therapy. RESULTS: A total of 338 patients were enrolled; 49 were infected with CRKP and 289 with CSKP. Among CRKP isolates CG258 (n = 29), ST25 (n = 5) and ST307 (n = 4) were detected. Of importance, every day of meropenem (OR 1.18, 95%CI 1.10-1.28) and cefepime (OR 1.22, 95%CI 1.03-1.49) use increase the risk of carbapenem resistance. Additional risk factors were previous use of ciprofloxacin (OR 2.37, 95%CI 1.00-5.35) and urinary catheter (OR 2.60, 95%CI 1.25-5.37). Furthermore, a significant lower survival time was estimated for patients infected with CRKP compared to CSKP (Relative Times 0.44, 95%CI 0.24-0.82). The strength of association was reduced when appropriate therapy was included in the model (RT = 0.81 95%CI 0.48-1.37). CONCLUSION: Short antibiotic courses had the potential to reduce the selection and transmission of CRKP. A high burden in mortality occurred in patients infected with CRKP in a KPC endemic setting and CRKP leads to increased mortality via inappropriate antibiotic treatment. Furthermore, dissemination of recognized hypervirulent clones could add to the list of challenges for antibiotic resistance control.

Estresse gravitacional no pós-operatório de cirurgia cardíaca / Gravitational stress in postoperative heart surgery

INTRODUÇÃO: Após a cirurgia cardíaca, a mobilização precoce busca o ganho funcional e um melhor condicionamento para as próximas fases da reabilitação cardiovascular, tendo o estresse gravitacional(EG)um importante papel para o retorno destas atividades, através da integridade dos mecanismos compensatórios cardiovasculares. OBJETIVO: verificar o comportamento de variáveis circulatórias e respiratórias durante o EG no pós-operatório de cirurgia cardíaca. MÉTODOS E MATERIAIS: Estudo observacional, transversal e analítico, composto por 83 indivíduos adultos clinicamente estáveis, submetidos a cirurgia de revascularização do miocárdio ou abordagem valvar. Excluídos aqueles com dificuldade de compreensão das atividades realizadas, além de comprometimento motor e/ou neurológico que impossibilitassem a realização do EG, de forma adaptada. Foram coletados os dados circulatórios e respiratórios no 1° minuto para cada etapa através do monitor multiparamétrico Gemedical Systems@. RESULTADOS: As frequências cardíaca e respiratória apresentaram um aumento com significância estatística (p ≤ 0,01), quando analisado seus valores de variação de decúbito dorsal para sedestação e decúbito dorsal para ortostase. CONCLUSÃO: As variáveis hemodinâmicas e respiratórias se comportam de acordo com a resposta fisiológica durante o EG, sugerindo que esse procedimento é seguro no ambiente da terapia intensiva, mesmo se tratando de um pós-operatório de alta complexidade. [AU]

INTRODUCTION: after cardiac surgery, early mobilization seeks functional gain and better conditioning for the next phases of cardiac rehabilitation, with gravitational stress (GS) playing an important role in the return of these activities through the integrity of cardiovascular compensatory mechanisms. OBJECTIVE: to verify the behavior of circulatory and respiratory variables during (GS) in the postoperative period of cardiac surgery. METHODS AND MATERIALS: observational cross-sectional analytical study, consisted of 83 clinically stable adults undergoing coronary artery bypass or valve surgery approach. Excluded those with difficulty understanding the activities performed, in addition to motor and / or neurological impairment that made it impossible to perform GS, an adapted form. Circulatory and respiratory data were collected in the 1st minute for each stage using the multi-parameter monitor Gemedical Systems@.RESULTS: The heart and respiratory rates showed an increase was statistically significant (p ≤ 0.01) when analyzed their dorsal range of values for sedestation and supine to standing position. CONCLUSION: hemodynamic and respiratory variables behave in accordance with the physiological response during GS, suggesting that this procedure is safe within the intensive care setting, even if a treating postoperative high complexity. [AU]

Práticas de integração ensino-serviço-comunidade e a formação em Odontologia: possíveis conexões e fluxos no ensino na saúde / Practices of teaching-service-community integration and training in Dentistry: possible connections and flows in health education

A pesquisa objetiva compreender, a partir do ponto de vista do preceptor, as práticas de integração ensino-serviço-comunidade vivenciadas durante a formação em Odontologia. Trata-se de um estudo qualitativo, descritivo e exploratório utilizando a técnica de grupo focal. Emergiram da análise dos dados quatro categorias temáticas: a construção da identidade do preceptor da graduação em Odontologia; a preceptoria e sua polissemia; a Estratégia Saúde da Família como campo de práticas; e potencialidades e fragilidades na integração ensino-serviço-comunidade. Os preceptores reconhecem as contribuições da integração ensino-serviço-comunidade para a formação em Odontologia. O papel do preceptor foi apontado como o de facilitador do aprendizado, que ao exercer sua função também vivencia uma constante atualização teórica. A construção da identidade dos preceptores é percebida como um processo inacabado e são pontuadas estratégias para que sejam concretizadas as mudanças almejadas na formação em Odontologia. A Estratégia Saúde da Família foi percebida como campo de práticas que permite aos discentes perceber na realidade como o sistema funciona. Potencialidades foram citadas na integração dos acadêmicos com a Atenção Primária à Saúde, como o contato com o corpo docente e ocorrência de momentos de formativos. Contudo, são necessários maiores esforços de todo o ambiente acadêmico, e maior implicação da gestão para o estímulo a experiências pedagógicas condizentes com as necessidades em saúde do país. A temática abordada na presente pesquisa abre oportunidade para a realização de outros estudos em diferentes instituições de ensino superior no país que contribuam com a compreensão das contribuições da integração ensino-serviço-comunidade para a formação em Odontologia (AU).

The research aims to understand, from the point of view of the preceptor, the practices of integration teaching-service-community experienced during the training in the Dentistry program. It is a qualitative, descriptive and exploratory study using the focal group technique. From the analysis of the data emerged four thematic categories: the construction of the identity of the preceptor of the Dentistry program; the preceptorship and its polysemy; the Family Health Strategy as a field of practice; and potentialities and weaknesses in teaching-service-community integration. The preceptors acknowledge the contributions of the teaching-service-community integration for the training in the Dentistry program. The role of the preceptor was pointed out as the facilitator of learning, who in exercising his function also experiences a constant theoretical update. The construction of the identity of the preceptors is realized as an unfinished process and strategies are pointed out so that the desired changes in the formation in Dentistry can be realized. The Family Health Strategy was realized as a field of practices that allows students to realize in reality how the system works. Potentialities were cited in the integration of the academics with Primary Health Care, such as the contact with the teaching staff and the occurrence of formative moments. However, greater efforts are needed throughout the academic environment, and greater involvement of management in stimulating pedagogical experiences consistent with the health needs of the country. The theme addressed in the present research opens the possibility for other studies in different institutions of higher education in the country that contribute to the understanding of the contributions of the teaching-service-community integration for the training in Dentistry (AU).

Growth of children born to renal transplanted women.

Neonates born to transplanted mothers are exposed to immunosuppressive drugs during gestation and have a higher risk of being born prematurely and small for gestational age than the general population. We have prospectively followed up 27 children born to renal transplanted mothers from a single center and 31 healthy children born at term with adequate weight for gestational age. Comparisons of weight and length measurements were made at birth, 1 month (±0.9), 3 months (±1.0), 6 months (±1.0), 9 months (±1.5), and 12 months (±1.49) of age. There were a high rate of prematurity (51.9%) and neonates small for gestational age (40.7%) in the transplant group. At birth, in the transplant group, 28% of neonates had subnormal z-scores for weight and 40%, low z-scores for length. However, at 6 months of age, no significant differences were noticed in mean weight-for-age z-scores between groups (weight -0.43 vs -0.03; length -0.53 vs -0.08). At 12 months of age, comparable mean length-for-age z-scores were observed in both groups (weight 0.01 vs 0.27; length -0.07 vs 0.26). CONCLUSION: Despite high rates of premature births and neonates small for gestational age in the transplant group, there was a good recovery of growth during the first year.. What is Known: • Children born to renal transplanted mothers are exposed to immunosuppressive drugs during gestation [4]. • They have high risk of premature birth and fetal growth restriction, immune alterations at birth, and risk of hospitalization for infection in the first months of life [5]. What is New: • Despite high rates of premature birth and neonates small for gestational age, these infants had good growth recovery by 1 year of age.

Response to immunization in children born to renal transplant recipients using immunosuppressive drugs during gestation.

The use of immunosuppressive drugs can impair vaccination responses. When used during pregnancy, they may interfere with the development of the fetus's immune system. However, little is known regarding their influence on infant's response to vaccinations. Twenty-seven children born to renal transplant mothers (Tx) taking immunosuppressive drugs and 31 healthy children had the humoral immune response and reactogenicity to tetanus, Haemophilus influenzae type b (Hib) and 7 pneumococcal serotypes evaluated. The evolution of BCG vaccine scar was also registered. Antibodies were measured by ELISA. Lymphocyte immunophenotyping was performed on cord blood and at 7-8 months of age. Among Tx neonates, 82.4% had low B lymphocyte numbers at birth, and 29.4% had also low numbers of other lymphocyte subpopulations. Nevertheless, all children developed protective antibodies with similar antibody concentrations to the control group. Vaccine reactogenicity was similar in both groups and BCG healing was uneventful.

Reverberações das experiências extramurais no ensino da odontologia / Reverberations of extramural experiences in dentistry teaching

INTRODUÇÃO: O perfil do cirurgião-dentista, eminentemente técnico, resulta de uma formação voltada à clínica dentária - cosmética e descontextualizada. Nesse cenário, surgem as Diretrizes Curriculares Nacionais, as quais trazem em seu bojo, dentre outras recomendações, a ampliação dos espaços de ensino-aprendizagem com base em cenários reais de prática, possibilitando experiências concretas na realidade social. OBJETIVO: Identificar, nas oportunidades pedagógicas propostas pelo curso, aspectos capazes de influenciar transformações no processo de ensino-aprendizagem em Odontologia. Métodos: Trata-se de um estudo qualitativo, descritivo e com abordagem sociopoética para a produção e análise dos dados. Participaram do estudo graduandos em Odontologia inseridos em atividades pedagógicas extramurais. Quatro oficinas sociopoéticas foram realizadas e serviram de instrumento para o desenvolvimento de narrativas sobre as experiências de ensino-aprendizagem. RESULTADOS: Três linhas de pensamentos emergiram a partir da análise sociopoética dos dados: tempo para viver as experiências de ensino-aprendizado; coexistência de novas e velhas abordagens pedagógicas e desafios decorrentes dos projetos de mudanças. CONCLUSÃO: A despeito dos desafios enfrentados, admite-se a importância dos extramuros, curriculares ou não, no ensino odontológico. Tais vivências levam os alunos a compartilharem o espaço das práticas no Sistema Único de Saúde com outros atores; assim, ao transitarem pelo mundo do trabalho e do ensino, eles criam um modelo mental de seu processo de ensino-aprendizagem, influenciado pelos referenciais teóricos, pelas oportunidades de vivências no campo das práticas e pelos interesses individuais. Esses elementos interferem e ampliam a percepção de si e do mundo, na medida em que percorrem o caminho da formação, construindo um trajeto singular.

INTRODUCTION: A dentist's profile, which is predominantly technical, results from a training focused on dental, cosmetics and decontextualized clinics. Hence, the Brazilian National Curriculum Guidelines arouse, comprising, among other recommendations, the expansion of teaching and learning spaces based on real settings of practice that enable concrete experiences in the social reality. OBJETIVE: To identify, in the pedagogical opportunities proposed for the course, aspects that may influence changes on the teaching-learning process in Dentistry. METHODS: This is a qualitative and descriptive study, based on socio-poetics approach to produce and analyze data. Undergraduates in Dentistry inserted in extramural pedagogicalactivities took part in the study. Four socio-poetics workshops were conducted, and they were used as an instrument to develop narratives on the teaching-learning experiences. Results: Three lines of thought emerged from the socio-poetics data analysis: time to live the teaching-learning experiences; coexistence of old and new pedagogical approaches; andchallenges arising from change projects. CONCLUSION: Despite the faced challenges, the importance of curricular or non-curricular extramural is assumed in Dentistry teaching. These experiences lead students to share spaces of practices in the Brazilian Unified Health System with other actors; thus, by moving in the world of work and teaching, students create a mental model of the teaching-learning process, which is influenced by the theoretical framework, by opportunities of experiences in the of practice, and by personal interests. Such elements interfere and increase the perception of themselves and of the world, since they advance in the training process, building a singular way.

Maternally acquired IgG immunity in neonates born to renal transplanted women.

Neonates born to renal transplanted women are exposed in utero to immunosuppressors and to antenatal conditions that may predispose the neonate to a high risk of prematurity and intrauterine growth retardation. These factors might interfere with the transfer of maternal IgG immunity. Total IgG levels and specific antibodies to measles, varicella, tetanus, Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (serotypes 4,6B,9V,14,18C,19F and 23F) were evaluated on maternal and cord blood samples of 23 sets of renal transplanted women and their newborns and 32 sets of healthy women-newborns at term. Total IgG levels were measured by nephelometry and specific antibodies, by ELISA. Renal transplanted mothers had lower median tetanus antibodies (0.67IU/mL) than controls (1.53IU/mL; p=0.017). Neonates from renal transplanted mothers had lower median tetanus antibodies (0.95IU/mL) than controls (1.97IU/mL, p=0.008). Antibodies to measles, varicella, Hib and the 7 serotypes of S. pneumoniae were similar between groups. Maternal antibodies were associated with an increase in neonatal antibodies for all antigens; gestational age was associated with an increase in Hib neonatal antibodies. Preeclampsia was associated with a decrease in neonatal total IgG and serotype 4 S. pneumoniae antibodies; chronic hypertension was associated with a decrease in neonatal serotype 6B S. pneumoniae antibodies. As neonates from transplanted women may be born with lower tetanus antibodies than controls, efforts should be made to keep maternal vaccines up-to-date. Clinical antenatal care with control of preeclampsia, chronic hypertension and prevention of premature delivery might also contribute to neonatal antibody levels to specific antigens at birth.