Spatial and sociodemographic factors associated with surgical site infection rates in hospitals in inner São Paulo State, Brazil.

Low-to-middle-income countries often have high incidence of surgical site infection (SSI). To assess spatial and sociodemographic predictors of SSI rates, this study analysed and georeferenced governmental surveillance data from 385 hospitals located in inner São Paulo State, Brazil. In multi-variate models, SSI rates were positively associated with distance from the state capital [incidence rate ratio (IRR) for each 100 km 1.19, 95% confidence interval (CI) 1.07-1.32], and were lower for non-profit (IRR 0.95, 95% CI 0.37-0.85) and private (IRR 0.47, 95% CI 0.31-0.71) facilities compared with public hospitals. Georeferencing results reinforced the need to direct SSI-prevention policies to hospitals located in areas distant from the state capital.

Taking the inner route: spatial and demographic factors affecting vulnerability to COVID-19 among 604 cities from inner São Paulo State, Brazil.

Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence rates of COVID-19 and mortality (up to 8 May 2020) among 604 municipalities in inner São Paulo State, Brazil. Socio-demographic indexes, road distance to the state capital and a classification of regional relevance were included in predictive models for time to COVID-19 introduction (Cox regression), incidence and mortality rates (zero-inflated binomial negative regression). In multivariable analyses, greater demographic density and higher classification of regional relevance were associated with both early introduction and increased rates of COVID-19 incidence and mortality. Other predictive factors varied, but distance from the State Capital (São Paulo City) was negatively associated with time-to-introduction and with incidence rates of COVID-19. Our results reinforce the hypothesis of two patterns of geographical spread of SARS-Cov-2 infection: one that is spatial (from the metropolitan area into the inner state) and another which is hierarchical (from urban centres of regional relevance to smaller and less connected municipalities). Those findings may apply to other settings, especially in developing and highly heterogeneous countries, and point to a potential benefit from strengthening non-pharmaceutical control strategies in areas of greater risk.

Frailty Could Predict Death in Older Adults after Admissionat Emergency Department? A 6-month Prospective Study from a Middle-Income Country.

BACKGROUND: The number of older adults attending emergency department (ED) is increasing all over the world. Usually, those patients are potentially more complex due to their greater number of comorbidities, cognitive disorders, and functional or physical disabilities. Frailty is a vulnerable state that could predict adverse outcomes of those patients. There are very few studies that addressed this topic in the ED, and none of them used a simple instrument for frailty assessment. OBJECTIVES: The primary outcome was to evaluate the association between frailty identified through the FRAIL questionnaire at baseline and death after a 6-month follow-up period after hospital discharge from the ED. Secondary outcomes were readmission to the ED and disability after 6 months. METHODS: A 6-month follow-up prospective study (FASES study) was conducted at a university-based trauma-center ED in Jundiaí, southwestern of Brazil. A total of 316 older adults aged 60 or older were randomly included based on a lottery of their medical record admission number. Frailty was evaluated through the FRAIL questionnaire. The association between frailty and death was estimated through a binary logistic regression adjusted for age, sex, and cognitive performance. RESULTS: From the total sample, the mean age was 72.11±8.0 years, and 51.6% were women. Participants presented 2.28±1.4 comorbidities and 25.6% were frail. Mean hospital stay was 5.43±5.6 days. Death occurred in 52 participants, readmission to the emergency in 55, and new disability in 16 after 6 months. Frailty was associated with an odds ratio of 2.18 for death after 6 months (95% CI = 1.10-4.31; p = 0.024). This association lost significance after multivariate analysis taking into account cognitive performance. There was no association between frailty status at baseline and readmission to the ED or disability. CONCLUSION: The identification of frailty using the FRAIL at admission was not predictive of death after a 6-month period after discharge from the ED. Simple frailty assessment could identify patients at higher risk for death in the follow-up.

Polypharmacy but not Potential Inappropriate Prescription Was Associated with Frailty in Older Adults from a Middle-Income Country Outpatient Clinic.

OBJECTIVES: the aims of the present study were: (1) investigate the prevalence and association of polypharmacy and pre-frailty or frailty in a middle-income country sample of older adults; and (2) evaluate the prevalence of potential inappropriate prescription (PIP) and its association with pre-frailty or frailty. DESIGN: Cross-sectional observational study. SETTING: Outpatient center at a university-based hospital in the state of São Paulo, Brazil. PARTICIPANTS: 629 older adults from both sexes evaluated between June 2014 and July 2016. MEASUREMENTS: Frailty was identified through the FRAIL scale. All medications received were analyzed by research staff. Presence of PIP was evaluated according to the 2015 updated Beers list. Binary logistic regression tested the association between 4 definitions of polypharmacy (≥ 3, 4, 5, and 6 drugs), and presence of PIP, and the dependent variable pre-frailty and frailty. RESULTS: 15.7% of participants were frail. Polypharmacy was present in 219 (34.8%), and PIP was observed in 184 (29.3%) older adults. All definitions of polypharmacy were significantly associated with frailty (OR between 2.05 to 2.34, p < 0.001). Polypharmacy with 4 or 5 or more drugs were associated with pre-frailty (OR 1.53 and 1.47, respectively). PIP was not associated with frailty (OR 1.47, p = 0.149). CONCLUSIONS: Several definitions of polypharmacy were associated with frailty, but only two were associated with pre-frailty. The presence of PIP was not associated with pre-frailty or frailty.

Feed intake and activity level of two broiler genotypes foraging different types of vegetation in the finishing period.

A study was performed with 2 broiler genotypes (slow and medium growth) restricted in supplementary feed and foraging 2 different mixed vegetations (grass/clover or chicory) to identify possible benefits of herbage on nutrition during the finishing period (80 to 113 d of age). Three hundred birds were included in a 2 × 2 factorial design with groups of 25 birds replicated 3 times. The use of outdoor areas, performance, and forage intake were investigated. To identify possible differences in foraging activity, the use of the range was monitored one day per week at 4 different times of the day. Feed intake from foraging was estimated by killing 4 birds per plot (2 males and 2 females) in the morning and in the evening on 3 d during the experiment and measuring crop content. Vegetation type did not influence broiler use of the free-range area, feed intake, or performance. Differences in the use of the range area, activity level, and feed content in the crops were observed in relation to genotype, sex, age of broilers, and also the time of day. Foraging activity was positively correlated with age. Medium-growth broilers spent more time inside and closer to the broiler houses during the day with increased foraging activity during evenings, in contrast to the slow-growing broilers that showed a more uniform activity during the day. Based on the measurement of crop content it was estimated that the slow-growing genotype had a daily intake of 5 to 8 g of forage per day, whereas the medium-growing genotype had an intake of 9 g for females and 20 g for males. In conclusion, limitation of supplemented protein feed in the finishing period may be acceptable for broilers that have access to highly nutritious vegetation.

Evidence of a suffocation alarm system within the periaqueductal gray matter of the rat.

Dyspnea, hunger for air, and urge to flee are the cardinal symptoms of panic attacks. Patients also show baseline respiratory abnormalities and a higher rate of comorbid and antecedent respiratory diseases. Panic attacks are also precipitated by infusion of sodium lactate and inhalation of 5% CO2 in predisposed patients but not in healthy volunteers or patients without panic disorder. Accordingly, Klein [Klein (1993) Arch Gen Psychiatry 50:306-317] suggested that clinical panic is the misfiring of an as-yet-unidentified suffocation alarm system. In rats, selective anoxia of chemoreceptor cells by potassium cyanide (KCN) and electrical and chemical stimulations of periaqueductal gray matter (PAG) produce defensive behaviors, which resemble panic attacks. Thus, here we examined the effects of single or combined administrations of CO2 (8% and 13%) and KCN (10-80 µg, i.v.) on spontaneous and PAG-evoked behaviors of rats either intact or bearing electrolytic lesions of PAG. Exposure to CO2 alone reduced grooming while increased exophthalmus, suggesting an arousal response to non-visual cues of environment. Unexpectedly, however, CO2 attenuated PAG-evoked immobility, trotting, and galloping while facilitated defecation and micturition. Conversely, KCN produced all defensive behaviors of the rat and facilitated PAG-evoked trotting, galloping, and defecation. There were also facilitatory trends in PAG-evoked exophthalmus, immobility, and jumping. Moreover, whereas the KCN-evoked defensive behaviors were attenuated or even suppressed by discrete lesions of PAG, they were markedly facilitated by CO2. Authors suggest that the PAG harbors an anoxia-sensitive suffocation alarm system which activation precipitates panic attacks and potentiates the subject responses to hypercapnia.

Lead deposition in bovine enamel during a pH-cycling regimen simulating the caries process.

Like fluoride, lead (Pb) accumulates on the enamel surface pre-eruptively, but it is not yet known whether it also deposits on enamel while dental caries is developing. This study evaluates Pb distribution in bovine enamel slabs submitted to a pH-cycling regimen simulating the caries process. The slabs were subjected to 8 cycles of de- and remineralizing conditions, and Pb (as acetate salt) was added to the de- and remineralized solutions at concentrations of 30 µg/l (experimental group, E1) and 300 µg/l (experimental group, E2). The control group (C) consisted of solutions to which Pb was not added. After the pH cycling, 100-µm sections of the slabs were analyzed by polarizing microscopy, to observe the extent of caries-like lesions, and these sections were used for Pb estimation by Synchrotron radiation X-ray microfluorescence. Caries lesions were observed along all superficial enamel surfaces to an extent of 120 µm. A Pb concentration gradient was observed in enamel, which decreased toward dentine. The highest Pb signals were observed for group E2, and the differences were statistically significant at enamel depths of 0 (C vs. E2; p = 0.029) and 50 µm (C vs. E2 and E1 vs. E2; p = 0.029). In conclusion, this study suggests that if Pb is present in the oral environment, it may deposit in enamel during the caries process.

Differential toxicity of Disperse Red 1 and Disperse Red 13 in the Ames test, HepG2 cytotoxicity assay, and Daphnia acute toxicity test.

Azo dyes are of environmental concern due to their degradation products, widespread use, and low-removal rate during conventional treatment. Their toxic properties are related to the nature and position of the substituents with respect to the aromatic rings and amino nitrogen atom. The dyes Disperse Red 1 and Disperse Red 13 were tested for Salmonella mutagenicity, cell viability by annexin V, and propidium iodide in HepG2 and by aquatic toxicity assays using daphnids. Both dyes tested positive in the Salmonella assay, and the suggestion was made that these compounds induce mainly frame-shift mutations and that the enzymes nitroreductase and O-acetyltransferase play an important role in the observed effect. In addition, it was shown that the presence of the chlorine substituent in Disperse Red 13 decreased the mutagenicity about 14 times when compared with Disperse Red 1, which shows the same structure as Disperse Red 13, but without the chlorine substituent. The presence of this substituent did not cause cytotoxicity in HepG2 cells, but toxicity to the water flea Daphnia similis increased in the presence of the chlorine substituent. These data suggest that the insertion of a chlorine substituent could be an alternative in the design of dyes with low-mutagenic potency, although the ecotoxicity should be carefully evaluated.

Improved automated perimetry performance following exposure to Mozart.

AIM: To evaluate the performance on automated perimetry (AP) after listening to a Mozart sonata in normal subjects naive to AP. METHODS: 60 naive normal subjects underwent AP (SITA 24-2). The study group (30 subjects) underwent AP after listening to Mozart's Sonata for Two Pianos in D Major and the control group (30 subjects) underwent AP without previous exposure to the music. RESULTS: The study group had significantly less fixation loss, false positive, and false negative rates compared to controls (p < 0.05). CONCLUSION: Listening to Mozart seems to improve AP performance in normal naive subjects.

Clinical and immunogenetic characteristics of European multicase rheumatoid arthritis families.

OBJECTIVE: To describe the characteristics of a new set of European families with affected sib pairs (ASP) collected by the European Consortium on Rheumatoid Arthritis Families (ECRAF) to replicate the results of our first genome scan. Potential gradients for disease severity in Europe and concordance within families were studied. PATIENTS AND METHODS: From 1996 to 1998 European white families with at least two affected siblings were enrolled in the study. Demographic (sex, age at onset), clinical data (rheumatoid factor (RF), disease duration, erosive disease, extra-articular features (EF)), and HLA-DRB1 oligotyping were analysed. RESULTS: 565 patients with rheumatoid arthritis (RA), belonging to 271 families including 319 affected sib pairs (ASP) were collected. Belgium, France, Italy, the Netherlands, Portugal, and Spain contributed 20, 96, 52, 24, 9, and 70 families, respectively. Sex (78% women), age at onset (mean 44 years), and RF positivity (79%) were similar among the countries. Differences were found in disease duration (11-18 years) and in the prevalence of erosive disease (70-93%), nodules (15-44%), subjective Sjögren's syndrome (5-38%), and EF (3-16%) (p<0.05 in all cases). A total of 22% RA sibs were shared epitope (SE) negative, whereas 47% and 30% carried one and two SE alleles respectively. Carriage of SE differed widely among countries (p<0.0001): no SE alleles (6-36%), one allele (43-60%), and two alleles (20-39%). SE encoding alleles were mainly DRB1*04 in the Netherlands and Belgium, whereas SE carriage was less common and evenly distributed between DRB1*01, *04, and *10 in Mediterranean countries. No concordance within families was found either in age/calendar year of onset (intraclass correlation coefficient <0.50) or in clinical and radiological features (kappa<0.22). CONCLUSIONS: The differences in RA characteristics between European countries and within families underline the heterogeneity of the disease. No clear cut gradient of disease severity was seen in Europe.

[Morbid obesity in women - eating style and quality of life]. / Obesidade mórbida em mulheres--estilos alimentares e qualidade de vida.

Morbid obesity has been widely studied due to its high incidence and its bad consequences to health. Studies about obesity have been emphasized some important aspects such as eating styles and quality of life. This study aim to investigate the eating styles and the quality of life of women with morbid obesity, patients in treatment at the Ambulatory of Eating Disorders, University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Sixty women were assessed, 30 obese (Body Mass Index--BMI > or = 40 kg/m2) and 30 nonobese (BMI 20 to 25 kg/m2). A semi-structured interview, the Dutch Eating Behaviour Questionnaire and the Short-form Health Survey: Medical Outcomes Study were used for the assessment, after translate to portuguese and adapted. The data were rated and quantified and the groups were statistically analyzed through the Tests of Mann-Whitney. The groups differed significantly as for restrained (p < or = 0.001) and emotional eating (p < or = 0.01), and did not differ as for external eating. The groups also differed in quality of life, concerning physical and social limitations (p < or = 0.001), the presence of emotional indicators (p < or = 0.001) and general health condition (p < or = 0.001). Findings suggest that eating styles contribute to explain the difficult of eating control--but are not only factor in the obesity characterization. Moreover, morbidly obese women presented a quality of life more compromised and have an adequate perception of their physical, social and emotional limitations. That might favor a therapeutic approach to them.

Noninherited maternal antigens do not play a role in rheumatoid arthritis susceptibility in Europe. European Consortium on Rheumatoid Arthritis Families.

OBJECTIVE: It has been proposed that noninherited maternal antigens (NIMA) (HLA-DR antigens) might play a role in susceptibility to rheumatoid arthritis (RA), especially in patients who are not genetically predisposed, such as those who are HLA-DR4 and/or shared epitope (SE) negative. The present study was undertaken to test the NIMA hypothesis in a large cohort of European RA patients assembled by the European Consortium on RA Families (ECRAF). METHODS: HLA-DRB1 oligotyping was performed in families of European RA patients for whom both parents were alive. These families were consecutively recruited by the ECRAF between 1996 and 1998, for association studies. The frequencies of HLA-DR NIMA were compared with those of the noninherited paternal antigens (NIPA) after stratification for HLA-DR*04, *0401 and/or *0404, and SE status. NIMA or NIPA that coincided with inherited HLA-DR antigens were considered redundant and excluded from analysis. Calculations concerning the whole group and restricted to patients lacking parental RA were performed. RESULTS: One hundred seventy families from France (n = 81), Belgium (n = 23), Spain (n = 24), Italy (n = 19), Portugal (n = 14), and The Netherlands (n = 9) were oligotyped. The group of probands was predominantly female (88%), positive for rheumatoid factor, DR*04, and SE (71%, 58%, and 75%, respectively), and had erosive disease (75%). Parental RA was reported in 21 families. Using the NIPA as control, the frequency of HLA-DRB1*04, *0401 and/or *0404-, or SE-positive NIMA was not found to be increased in patients lacking these susceptibility alleles. The same was true when the 21 probands with parental RA were excluded from analysis. In DRB1*04-positive patients, we found no evidence of a relevant effect of HLA-DR3 or DR6 in the NIMA. CONCLUSION: Our results do not support the notion that noninherited maternal antigens have a role in susceptibility to RA in the offspring.

Association of plasma levels of human immunodeficiency virus type 1 RNA and oropharyngeal Candida colonization.

The pathophysiology of oropharyngeal candidiasis in patients infected with human immunodeficiency virus (HIV) type 1 is poorly understood. Association between oropharyngeal yeast carriage and various clinical factors in HIV-1-infected patients was studied in 83 patients with no clinical evidence of thrush and no recent antifungal use. Of the clinical factors measured, the only correlate of yeast colonization was with plasma HIV-1 RNA levels (P=.001), whereas the correlation with CD4 cell count was poor (P=.36). By multivariable regression modeling, plasma HIV-1 RNA was the only parameter that correlated with the extent of colonization with Candida infection (P=.003). These data indicate that the presence and amount of asymptomatic oropharyngeal yeast carriage in persons with HIV-1 infection is more significantly correlated with plasma HIV-1 RNA levels than with CD4 cell count. Further studies on the effect of HIV-1 on oropharyngeal yeast colonization, infection, and local immunity are warranted.

Perfil dos pacientes com ceratocone atendidos no serviço de córnea do Hospital Säo Geraldo (UFMG) nos últimos cinco anos / Characteristics of Keratoconus patients registered at Hospital Säo Geraldo (UFMG) during the last five years

Estudaram-se, retrospectivamente, todos os prontuári,os dos pacientes com diagnóstico de ceratocone atendidos nos últimos cinco anos no Serviço de Córnea do Hospital Säo Geraldo (HSG) da UFMA. Foram analisados os prontuários de 107 pacientes (203 olhos) quantoa idade à admissäo no serviço, idade do diagnóstico, tempo de diagnóstico, sewxo, cor da pele, bilateralidade, uso prévio de lentes de contato, doenças associadas, localizaçäo e classificaçäo do ceratocone. Os resultados encontrados revelam o perfil predominante dos paciwentes com ceratocone e as condutas tomadas no serviço. Trantam-se de pacientes apresentando ceratocone em fase mais avançada, geralmente referidos de outras instituiçöes ou encaminhados pelo Serviço de Lentes de Contato do HSG (ufmg). A indicaçäo de ceratoplasia penetrante foi 72,9 (por cento), maior quando comparada coma populaçäo geral dos pacientes com ceratocone

In vitro and in vivo efficacy of the triazole TAK-187 against Cryptococcus neoformans.

Multiple isolates of Cryptococcus neoformans, including those with fluconazole resistance, were tested to assess the in vitro activity of the new triazole TAK-187. MICs of TAK-187 were at least eightfold lower than those of fluconazole, and fungicidal concentrations for most isolates were 4 microg/ml or less. TAK-187 also was evaluated as intermittent therapy using two dosages in a rabbit model of experimental cryptococcal meningitis. Compared to daily treatment with fluconazole, as little as two doses of TAK-187 given 7 days apart were found to be effective. Plasma and cerebrospinal fluid TAK-187 concentrations were many times higher than MICs and fungicidal concentrations. Based upon its therapeutic efficacy and long half-life in the rabbit model, TAK-187 should be investigated for intermittent dosing in treatment or suppression of cryptococcal infections in humans.

Retrobulbar anesthesia with a flexible catheter.

BACKGROUND AND OBJECTIVES: The authors describe a method that seeks to improve the administration of local anesthesia for intraocular surgery, avoiding the risk of potential complications associated with retrobulbar and peribulbar techniques and eliminating the inconveniences of the new methods such as subconjunctival and limbal infiltration. PATIENTS AND METHODS: The authors demonstrate the safety and effectiveness of this technique in 50 consecutive cases. This technique consists of a small, blunt dissection of the conjunctiva, Tenon's capsule, and intermuscular septum in the inferior nasal quadrant, followed by the insertion of a flexible catheter that is guided to the retrobulbar space, where 3.0 ml of anesthetic solution is injected. RESULTS: All of the patients (100%) felt that this procedure was comfortable and painless. No complications were observed. Ultrasonography demonstrated the exact catheter position in the retrobulbar space; therefore, the authors could be sure that this anesthetic infiltration was done in the appropriate and safe place. CONCLUSIONS: This is a direct sub-Tenon's technique that is simple, effective, and safe and that avoids introducing a sharp or metallic instrument into the orbit.

[Rabies control in Brazil from 1980 to 1990]. / Controle da raiva no Brasil de 1980 a 1990.

The epidemiological situation of rabies in Brazil at the period of 1980 to 1990, when the National Program for Rabies Prevention was implemented on a national scale, and which yielded positive results, is presented. The main controlling actions carried out in order to achieve these results are also described. Rabies in Brasil registered a considerable decrease in human and canine cases (78% and 90%, respectively), half way through the series of analyses undertaken for this study. Towards the end of the decade, the disease began to recrudesce, several cases occurring in some parts of the country, mainly in the northeastern region, where 70% of the total number of infections for 1990 was recorded. Moreover, human rabies transmitted by bats experienced a considerable increase, accounting for 15.1% of the total. The Program, which is implemented by State and Municipal authorities. Covers the 350,000 people who are attacked by animals, and vaccinates approximately 9,000,000 animals every annually year. Epidemiological control is considered to be of basic importance, so that indicators for the definition of the areas of risk have been developed.

A apatia infantil e suas relacoes com o fracasso escolar

Este trabalho descreve uma analise sobre conceito e diagnostico do termo 'apatia'. O objetivo do estudo foi explicar a apatia como variavel associada ao fracasso escolar, mostrando algumas formas de diagnostica-la e sugerindo estrategias metodologicas de controlar e/ou superar o comportamento apatico. O trabalho foi realizado na instituicao da APAE - Municipio de Sao Carlos, SP, por meio de entrevistas com 26 profissionais que atendem uma clientela portadora de dificuldades educacionais especiais. Os resultados indicaram a necessidade da construcao de uma metodologia de ensino que favoreca a crianca a acreditar na sua capacidade de resolver situacoes conflitantes, evitando o desenvolvimento do comportamento apatico e, consequentemente, historias de fracasso escolar.

Chronic spinal subdural hematoma.

A 55-year-old woman with chronic spinal subdural hematoma, diagnosed by magnetic resonance (MR) is presented. There was no coagulation defect, anticoagulant therapy, or trauma.