Primary results of the brazilian registry of atherothrombotic disease (NEAT).

There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (± 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease.ClinicalTrials.gov NCT04677725.

Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury: Report of Two Cases.

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19.

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

Desenvolvimento do mapa estratégico como diretriz de gestão em serviço de fisioterapia hospitalar / Development of a strategic map as a management guideline in hospital-based physiotherapy

Trata-se de um relato de caso abordando a experiência de um projeto de gestão desenvolvido na Divisão de Fisioterapia do Instituto Central do Hospital das Clí­nicas da Faculdade de Medicina da Universidade de São Paulo. A gestão de serviços de saúde é complexa e desafiadora, devido a fatores como as constantes transformações tecnológicas e terapêuticas, aumento da população idosa e de doenças crônicas, escassez de recursos e carência de gestão eficiente nas organizações. A definição de objetivos, estratégias e instrumentos de monitoramento para direcionar a organização e promover qualidade são determinantes nas ações gerenciais e no desempenho estratégico da empresa. Neste contexto, o projeto objetivou construir um mapa estratégico considerando o Balanced ScoreCard como diretriz gerencial e instrumento de análise do desempenho da Divisão de Fisioterapia. Reuniões estruturadas com membros da liderança de fisioterapia foram realizadas para definir a visão do futuro e objetivos estratégicos a médio e longo prazo, idealizados pela Divisão de Fisioterapia, tendo como base as perspectivas do Balanced ScoreCard, aprendizado e crescimento, processos internos, clientes, sustentabilidade financeira e social. O mapa estratégico foi construí­do em uma representação gráfica permitindo fácil compreensão da visão do futuro e objetivos estratégicos que irão direcionar o comportamento e o desempenho da Divisão de Fisioterapia, nos próximos anos. Além de direcionar as ações de melhorias da Divisão, o mapa estratégico elaborado também apresenta caracterí­sticas marcantes de alinhamento com o mapa estratégico institucional. (AU)

This is a case report addressing a management project developed in the Physiotherapy Division of the Central Institute of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Managing health services is complex and challenging due to factors such as constant technological and therapeutic changes, increase in the elderly population and chronic diseases, scarcity of resources, and lack of efficient organizational management. The definition of objectives, strategies, and monitoring tools to direct the organization and promote quality help to determine managerial actions and the strategic performance of the service. In this context, this project aimed to build a strategic map using the Balanced Scorecard as a managerial guideline and instrument of performance analysis for the Physiotherapy Division. Structured meetings with members of the physiotherapy leadership team were held to define the vision for the future and strategic medium - and long-term objectives. The strategic map was built as a graphical representation, allowing for easy understanding of the vision for the future and strategic objectives that will guide the behavior and performance of the Physiotherapy Division in the coming years. In addition to directing the improvement actions of the division, the strategic map also presents striking instances of alignment with the institutional strategic map.(AU)

Grandiflorenic acid promotes death of promastigotes via apoptosis-like mechanism and affects amastigotes by increasing total iron bound capacity.

BACKGROUND: American tegumentary leishmaniasis (ATL) is a zoonotic disease caused by protozoa of the genus Leishmania. The high toxicity, high costs and resistance of some strains to current drugs has prompted the search for therapeutic alternatives for the management of this disease. Sphagneticola trilobata is a plant that has diterpenes as main constituents, including grandiflorenic acid (GFA) that has antiinflammatory, antiprotozoal, antibacterial and antinociceptive activity. PURPOSE: The aim of our study was to determine the effect of GFA on both the promastigotes and the amastigotes of Leishmania amazonensis. METHODS: Isolation by chromatographic methods and chemical identification of GFA, then evaluation of the in vitro leishmanicidal activity of this compound against Leishmania amazonensis promastigotes and L. amazonensis infected peritoneal Balb/c macrophages, as well its action and microbicide mechanisms. RESULTS: GFA treatment significantly inhibited the proliferation of promastigotes. This antiproliferative effect was accompanied by morphological changes in the parasite with 25 nM GFA. Afterwards, we investigated the mechanisms involved in the death of the protozoan; there was an increase in the production of reactive oxygen species (ROS), phosphatidylserine exposure, permeabilization of the plasma membrane and decreased mitochondrial depolarization. In addition, we observed that the treatment caused a reduction in the percentage of infected cells and the number of amastigotes per macrophage, without showing cytotoxicity in low doses to peritoneal macrophages and sheep erythrocytes. GFA increased IL-10 and total iron bound to transferrin in infected macrophages. Our results showed that GFA treatment acts on promastigote forms through an apoptosis-like mechanism and on intracellular amastigote forms, dependent of regulatory cytokine IL-10 modulation with increase in total iron bound to transferrin. CONCLUSION: GFA showed in vitro antileishmanial activity on L. amazonensis promastigotes forms and on L. amazonensis-infected macrophages.

Acidentes ocupacionais com material potencialmente contaminado envolvendo trabalhadores de enfermagem / Occupational accidents with potentially contaminated material involving nursing Workers / Accidentes ocupacionales con material potencialmente contaminado involucrando Trabajadores de enfermería

Objetivou-se descrever os acidentes ocupacionais envolvendo material biológico com trabalhadores da equipe de enfermagem. Estudo descritivo, retrospectivo, com abordagem quantitativa, realizado em um hospital do Centro-Oeste Mineiro. Os dados foram coletados por meio de consulta às fichas de comunicado de acidente de trabalho e prontuários, resguardando todos os aspectos éticos. No período de outubro de 2014 a maio de 2016, 61 trabalhadores sofreram 71 exposições; 56 (91,8%) são mulheres, 32 (52,5%) técnicos de enfermagem, 31 (50,8%) que atuavam nas enfermarias. Houve predomínio de exposições percutâneas 37 (60,7%), em punção venosa 17 (27,9%). Conclui-se que tais exposições poderiam ser evitadas, o que evidencia a necessidade de educação continuada para esses profissionais e a implantação de dispositivos com engenharia de segurança (AU).

The objective was to describe the occupational accidents involving biological material involving nursing team workers. Descriptive and retrospective study with a quantitative approach, undertaken at a hospital in the Central-West of the state of Minas Gerais. The data were collected by consulting the occupational accident reporting forms and histories, safeguarding all ethical aspects. Between October 2014 and May 2016, 61 workers were victims of 71 cases of exposure; 56 (91.8%) are women, 32 (52.5%) nursing technicians, 31 (50.8%) working in clinical nursing services. Percutaneous exposure 37(60.7%) during venipuncture 17(27.9%) was predominant. In conclusion, these cases of exposure could be avoided, which evidences the need for continuing education for these professionals and the implementation of devices with safety engineering (AU).

La finalidad fue describir los accidentes ocupacionales con material biológico involucrando trabajadores del equipo de enfermería. Estudio descriptivo, retrospectivo con aproximación cuantitativa, desarrollado en un hospital del Centro-Oeste del estado de Minas Gerais. Los datos fueron recolectados mediante consulta de las fichas de informe de accidente ocupacional y archivos, salvaguardando todos los aspectos éticos. En el período de octubre del 2014 a mayo del 2016, 61 trabajadores fueron víctimas de 71 exposiciones; 56 (91,8%) son mujeres, 32 (52,5%) técnicos de enfermería, 31 (50,8%) actuaban en las enfermarías. Predominaron exposiciones percutáneas 37(60,7%), en punción venosa 17(27,9%). Se concluye que tales exposiciones podrían ser evitadas, lo que evidencia la necesidad de educación continuada para esos profesionales y la implantación de dispositivos con ingeniería de seguridad (AU).

New Parameter for In-Office Dental Bleaching.

Dental bleaching is considered a conservative and biologically safe treatment for discolored teeth. Despite this, one of the major undesirable effects of bleaching is dentin sensitivity which may occur during and after treatment. To address these sensitivity issues, new dental bleaching preparations with lower concentrations of hydrogen peroxide (H2O2) have recently been introduced to the market. This paper presents a clinical case report of a 20-year-old female patient admitted to the Araraquara Dental School, UNESP, Brazil. The patient underwent dental bleaching using one of the new products with reduced hydrogen peroxide concentration, Lase Peroxide Lite 6%, a 6% H2O2 gel containing titanium oxide nanoparticles doped with nitrogen (6% H2O2/N-doped TiO2).

Epilepsy and anesthesia.

BACKGROUND AND OBJECTIVES: Epilepsy is one of the most frequent chronic neurological diseases. Although anesthesia for epilepsy patients is more common in neurosurgery, this group of patients needs, just as the general population, anesthesia for different diagnostic and therapeutic procedures. This article aims to address the issues of greatest interest to the anesthesiologist in the perioperative management of epileptic patients undergoing anesthesia for non-neurosurgical procedures. CONTENT: We discuss relevant aspects of pathophysiology, classification and diagnosis of epilepsy; anticonvulsant therapy and interactions with anesthetic drugs; surgery and the ketogenic diet; pro-and anticonvulsant effects of drugs used in anesthesia; preoperative evaluation, intra- and postoperative conduct in epileptic patients, as well as the diagnosis and treatment of perioperative seizures. CONCLUSIONS: In the perioperative management of epileptic patients is important for anesthesiologists to identify the type of epilepsy, the frequency, severity and the factors triggering the epileptogenic crises; the use of anticonvulsant drugs and possible interactions with drugs used in anesthesia; the presence of ketogenic diet and stimulatory of the vagus nerve, and its implications in anesthetic techniques. It is essential the understanding of pro- and anticonvulsant properties of drugs used in anesthesia, minimizing the risk of seizure activity in the intra- and postoperative. Finally, it is important to outline the diagnosis and initiate treatment of seizures, perioperative, which offers lower both morbidity and mortality.