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Abstract Objective: to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery. Method: integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner. Results: surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted. Conclusion: conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.

Resumen Objetivo: evaluar las evidencias sobre los factores de riesgo para el desarrollo de infección de sitio quirúrgico en cirugía bariátrica. Método: revisión integradora. La búsqueda de estudios primarios se realizó en cuatro bases de datos. La muestra estuvo compuesta por 11 investigaciones. La calidad metodológica de los estudios incluidos se evaluó mediante herramientas propuestas por el Joanna Briggs Institute. El análisis y la síntesis de los datos se realizaron de manera descriptiva. Resultados: las tasas de infección del sitio quirúrgico oscilaron entre 0,4% y 7,6%, considerando los resultados de los estudios primarios, en los que los pacientes fueron sometidos a cirugía mediante laparoscopia. En investigaciones con participantes que se sometieron a procedimientos quirúrgicos con diferentes enfoques (abierto, laparoscópico o robótico), las tasas de infección oscilaron entre el 0,9 % y el 12 %. En cuanto a los factores de riesgo para el desarrollo de este tipo de infección, se destacan la profilaxis antibiótica, el sexo femenino, el Índice de Masa Corporal elevado y la hiperglucemia perioperatoria. Conclusión: la realización de la revisión generó un cuerpo de evidencia que refuerza la importancia de implementar medidas efectivas para la prevención y el control de la infección de sitio quirúrgico, por parte de los profesionales de la salud, después de la cirugía bariátrica, promoviendo la mejora de la atención y la seguridad del paciente en el período perioperatorio.

Resumo Objetivo: avaliar as evidências sobre os fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica. Método: revisão integrativa. A busca dos estudos primários foi realizada em quatro bases de dados. A amostra foi composta por 11 pesquisas. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. A análise e a síntese dos dados foram realizadas de maneira descritiva. Resultados: as taxas de infecção de sítio cirúrgico variaram de 0,4% até 7,6%, considerando os resultados dos estudos primários, cujos pacientes foram submetidos à cirurgia por via laparoscópica. Nas pesquisas com os participantes submetidos aos procedimentos cirúrgicos com diferentes abordagens (aberta, via laparoscópica ou robótica), as taxas de infecção variaram de 0,9% até 12%. Com relação aos fatores de risco para o desenvolvimento deste tipo de infecção, ressaltam-se antibioticoprofilaxia, sexo feminino, Índice de Massa Corporal elevado e hiperglicemia perioperatória. Conclusão: a condução da revisão gerou corpo de evidências que reforça a importância na implementação de medidas efetivas para prevenção e controle de infecção de sítio cirúrgico pelos profissionais de saúde após cirurgia bariátrica, promovendo a melhoria da assistência e da segurança do paciente no perioperatório.

https://doi.org/10.1590/1518-8345.6309.3798

Impacto da Covid-19 na Morbimortalidade da Tuberculose no Brasil
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Oliveira, Gustavo Miranda

; Tolentino, Ana Clara Noleto

; Fagundes, Lucas Lopes

; Santos, Angélica Thaís De Freitas

; Santos, Alice Simões

; Bandeira, Rafaela Zilio

; Prince, Karina Andrade de

; Oliveira, Gustavo Miranda

PsychTech & Health Journal

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jun 2023, Volume 6 N. 2 Pages 18 - 28

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O manejo da Tuberculose (TB) enfrentou barreiras geradas pela pandemia do coronavírus (2020-2021), provocando elevação nas mortes pela doença no mundo. Desse modo, o objetivo do estudo foi analisar o impacto da COVID-19 na morbimortalidade da TB no Brasil. Trata-se de um estudo retrospetivo, observacional e quantitativo, de base documental com procedimento comparativo-estatístico. A coleta de dados teve como universo de pesquisa o Sistema de Informação de Agravos de Notificação (Sinan Net) e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Os resultados demonstraram diminuição no número de notificações da doença entre 2019 e 2021 (10%). No entanto, a taxa de mortalidade aumentou, passando de 7.93% para 11.38%. A doença teve predomínio entre os pacientes do sexo masculino (70.13%), na faixa etária de 20 a 59 anos (77.38%), na cor/raça parda (49.34%) e com baixa escolaridade (41.38%). A maioria dos casos eram pulmonares (84.73%), novos (79.62%) e evoluíram para cura (53.38%). Um pequeno percentual dos casos, eram resistentes (0.48%), principalmente a drogas de primeira linha. O estudo evidenciou o aumento na morbimortalidade da Tuberculose com o avento da pandemia do COVID-19. A co-infeção, a reativação da TB, a desestruturação do esquema de combate a Tuberculose, comprometeu o tratamento, a orientação ao paciente, a deteção precoce o que contribuiu para o aumento da morbidade da Tuberculose no período estudado.

Abstract Tuberculosis (TB) management faced challenges caused by the coronavirus pandemic (2020-2021), causing an increase in deaths from this illness worldwide. This study aimed to analyze the impact of COVID-19 on TB morbidity and mortality in Brazil. It is a retrospective, observational, quantitative, documentary-based study with a comparative-statistical approach. The research was based on the Sistema de Informação de Agravos de Notificação (Sinan Net) and Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). These results revealed a decrease in the number of notifications of the disease between 2019 to 2021 (10%). However, the mortality rate increased from 7.93% to 11.38%. There was a predominance of the illness among male patients (70.13%), in the age group of 20 to 59 years (77.38%), of brown color/race (49.34%), and with a poor school education (41.38%). Most cases were pulmonary (84.73%), new ones (79.62%), and progressed to cure (53.38%). A smaller number of cases were resistant (.48%), especially first-line drugs. This study shows the increase in Tuberculosis morbimortality with the advent of the pandemic of COVID-19. The patients’ treatment and orientation were compromised by levels of co-infection, the reactivation of TB, and the dysfunction of the plan to prevent Tuberculosis. Consequently, the early detection of cases has contributed to a rise in Tuberculosis morbimortality in the period studied.

https://doi.org/10.26580/pthj.art47-2023

Dietary evaluation of sodium intake in patients with chronic kidney disease
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Milhomem-dos Santos, Elisangela

; Camões-Cunha, Laísa Cristina

; Carneiro-Dias, Raimunda Sheyla

; Cruz-Diniz, Maria Célia

; de Araújo-Brito, Dyego José

; Sousa-Teixeira, Thaisa Cristina

; Miranda-dos Santos, Alcione

; Teixeira-da Cunha França, Ana Karina

Nutrición Hospitalaria

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feb 2023, Volume 40 N. 1 Pages 96 - 101

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción: la ingesta elevada de sodio es un factor de riesgo para enfermedades como la hipertensión arterial sistémica, el accidente cerebrovascular, la hipertrofia ventricular izquierda y la enfermedad renal crónica (ERC). Objetivo: evaluar la correlación entre la ingesta estimada de sodio y la excreción urinaria de 24 horas en pacientes con ERC sin diálisis. Métodos: estudio transversal con 151 individuos. Se evaluaron datos demográficos, socioeconómicos, clínicos y de estilo de vida. El sodio se cuantificó en orina de 24 horas y se estimó en Food Recall (R24h) de 24 horas. Para evaluar la asociación entre variables demográficas, antropométricas, nutricionales y de laboratorio con la excreción de sodio en orina de 24 horas, se utilizó el análisis de varianza (ANOVA) o la prueba de Kruskal-Wallis. La correlación entre la excreción urinaria de sodio de 24 horas y la ingesta de sodio en la dieta se realizó mediante el coeficiente de correlación de Spearman. Resultados: la edad media fue de 60,8 ± 11,8 años, el 51,7 % eran mujeres. Los pacientes hipertensos eran el 88,9 %; los diabéticos, el 45,0 %, y el 39,1 % se encontraban en estadio 3B de ERC. La mediana de excreción de sodio en orina de 24 horas fue de 112,2 mmol/L y la ingesta de R24h fue de 833,8 mg/día. Los individuos pertenecientes al tercil más alto de excreción de sodio (T3) presentaron valores de PTH más bajos y aquellos con niveles más bajos de tercil (T1), mayores niveles séricos de HDL-c (p < 0,05). No hubo correlación estadística entre la ingesta de sodio en la dieta y la excreción de orina durante 24 horas (valor p = 0,241). Conclusión: la ausencia de correlación entre el sodio obtenido por excreción urinaria de 24 horas y la ingesta dietética demuestra la fragilidad de la estimación de la excreción de sodio a través de la encuesta dietética.

Abstract Introduction: high sodium intake is a risk factor for diseases such as systemic arterial hypertension, stroke, left ventricular hypertrophy, and chronic kidney disease (CKD). Objective: to evaluate the correlation between estimated sodium intake by dietary intake and 24-hour urinary excretion in patients with non-dialysis CKD. Material and methods: a cross-sectional study with 151 individuals. Demographic, socioeconomic, clinical and lifestyle data were evaluated. Sodium was dosed in 24-hour urine and estimated by 24-hour Food Recall (R24h). To evaluate the association between demographic, anthropometric, nutritional and laboratory variables with sodium excretion in 24-hour urine, variance analysis (ANOVA) or Kruskal-Wallis test were used. The correlation between 24-hour urinary sodium excretion and dietary sodium intake was performed by Spearman's correlation coefficient. Results: mean age was 60.8 ± 11.8 years, 51.7 % were women. Hypertensive patients, 88.9 %; diabetics, 45.0 %; and 39.1 % were in stage 3B of CKD. Median sodium excretion in 24-hour urine was 112.2 mmol/L and R24h intake was 833.8 mg/day. Individuals belonging to the highest tertile of sodium excretion (T3) presented lower PTH values, and those with lower tertile (T1), higher serum HDL-c levels (p < 0.05). There was no statistical correlation between dietary sodium intake and 24-hour urine excretion (p-value = 0.241). Conclusion: the non-correlation between sodium obtained by 24-hour urinary excretion and dietary intake demonstrates the fragility of the estimation of sodium excretion through the dietary survey.

https://doi.org/10.20960/nh.04255

Appropriate neck circumference and waist-to-height ratio cut-off points as predictors of obesity and cardiovascular risk in adolescents
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Carvalho, Wyllyane Rayana Chaves

; França, Ana Karina Teixeira da Cunha

; Santos, Alcione Miranda dos

; Padilha, Luana Lopes

; Bogea, Eduarda Gomes

Revista de Saúde Pública

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2023, Volume 57 elocation 24

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO OBJETIVO Determinar os pontos de corte da circunferência do pescoço (CP) e da relação cintura-estatura (RCEst) para a predição da obesidade e do risco cardiovascular em adolescentes. MÉTODOS Estudo transversal desenvolvido com uma subamostra de 634 adolescentes de 18 e 19 anos de idade pertencentes à terceira fase da coorte “RPS” (Ribeirão Preto, Pelotas e São Luís) realizada em 2016. Identificou-se a área sob a curva ROC (AUC) para avaliar a capacidade preditiva da CP e RCE em relação ao percentual de gordura corporal (%GC), obtido pela pletismografia por deslocamento de ar (PDA), e do risco cardiovascular estimado pelo Phatobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTADOS A prevalência de obesidade pelo %GC foi de 7,6% no sexo masculino e 39,4% no sexo feminino (p-valor < 0,001) e o alto risco para PDAY foi de 13,8% e 10,9%, respectivamente. Para a CP, o ponto de corte identificado para o sexo masculino foi de 44,0 cm e as AUC foram de 0,70 (IC95% 0,58-0,83) para predição de obesidade e de 0,71 (IC95% 0,62-0,80) para predição do alto risco cardiovascular; e para o sexo feminino foi de 40 cm e as AUC foram de 0,75 (IC95% 0,69-0,80) e de 0,63 (IC95% 0,53-0,73), respectivamente. Para a RCEst, o ponto de corte identificado foi de 0,50 para ambos os sexos e as AUC para a predição da obesidade e do alto risco segundo o PDAY foram de 0,90 (IC95% 0,80-0,99) e 0,73 (IC95% 0,63-0,82), respectivamente, para o sexo masculino; e de 0,87 (IC95% 0,83-0,90) e 0,55 (IC95% 0,45-0,65), respectivamente, para o sexo feminino. CONCLUSÃO RCEst e CP como bons discriminadores para avaliar a obesidade e risco cardiovascular em adolescentes, especialmente no sexo masculino.

ABSTRACT OBJECTIVE To determine neck circumference (NC) and waist-to-height ratio (WHtR) cut-off points as predictors of obesity and cardiovascular risk in adolescents. METHODS Cross-sectional study developed with a subsample of 634 adolescents aged 18 and 19 years belonging to the third phase of the “RPS” cohort (Ribeirão Preto, Pelotas and São Luís) carried out in 2016. The area under the ROC curve (AUC) was identified to assess the predictive capacity of NC and WHtR in relation to the percentage of body fat (%BF), obtained by air displacement plethysmography (ADP), and the cardiovascular risk estimated by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTS The prevalence of obesity by %BF was 7.6% in males and 39.4% in females (p-value <0.001), and the high PDAY risk was 13.8% and 10.9%, respectively. For males, NC cut-off point was 44.0 cm and the AUCs were 0.70 (95%CI 0.58-0.83) to predict obesity and 0.71 (95%CI 0.62-0.80) to predict high cardiovascular risk; for females, NC cut-off point was 40 cm and the AUCs were 0.75 (95%CI 0.69-0.80) and 0.63 (95%CI 0.53-0.73), respectively. WHtR cut-off point was 0.50 for both sexes; for males, the AUCs to predict obesity and high risk according to PDAY were 0.90 (95%CI 0.80-0.99) and 0.73 (95%CI 0.63-0.82), respectively; for females, they were 0.87 (95%CI 0.83-0.90) and 0.55 (95%CI 0.45-0.65), respectively. CONCLUSION WHtR and NC are good discriminators to assess obesity and cardiovascular risk in adolescents, especially in males.

https://doi.org/10.11606/s1518-8787.2023057004349

Appropriate neck circumference and waist-to-height ratio cut-off points as predictors of obesity and cardiovascular risk in adolescents
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Carvalho, Wyllyane Rayana Chaves

; França, Ana Karina Teixeira da Cunha

; Santos, Alcione Miranda dos

; Padilha, Luana Lopes

; Bogea, Eduarda Gomes

Revista de Saúde Pública

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2023, Volume 57 elocation 24

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.11606/s1518-8787.2023057004349

Chemical composition and biological activities of the essential oils from Lippia alba and Lippia origanoides
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SANTOS FILHO, LUIZ G.A. DOS

; REIS, RENATA B. DOS

; SOUZA, ANA SHEILA Q.

; CANUTO, KIRLEY M.

; BRITO, EDY S. DE

; CASTRO, KARINA N.C.

; PEREIRA, ALITIENE M.L.

; DINIZ, FÁBIO MENDONÇA

Anais da Academia Brasileira de Ciências

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2023, Volume 95 N. 1 elocation e20220359

Abstract: En | Text: En | PDF: En

Abstract There is an increasing interest in essential oils extracted from Verbenaceae plant species as potential sources of biologically active compounds that could provide a starting point for designing novel phyto-pharmaceuticals in aquaculture. The present study was aimed to investigate the chemical composition, antioxidant activity, acute toxicity and antimicrobial effects against Vibrio parahaemolyticus of essential oils extracted from Lippia alba and L. origanoides. Approximately 23 components were identified and quantified by gas chromatography-mass spectrometry and flame ionization detection in each species’ essential oil. The most predominant compounds were geranial (23.0%), limonene (17.0%) and neral (15.5%) in L. alba, and thymol (47.2%), p-cymene (16.0%) and E-caryophyllene (11.3%) in L. origanoides. The essential oils have antibacterial activity against Vibrio parahaemolyticus presenting Minimum Inhibitory Concentration (MIC) and Bactericidal Concentration (MBC) values between 156-625 µg mL-1. The essential oils also show antioxidant potential estimated by 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging assays, presenting IC50 of 60.16 mg mL-1 and 0.22 mg mL-1 for L. alba and L. origanoides EO, respectively. Both oils were classified as toxic to Artemia salina nauplii. Therefore, these essential oils may be useful for controlling pathogenic bacteria important to the aquaculture industry.

https://doi.org/10.1590/0001-3765202320220359

Evaluation of potential biomaterials for application in guide bone regeneration from Bacterial Nanocellulose/Hydroxyapatite
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Gaulke, Elouise

; Garcia, Michele Cristina Formolo

; Segat, Bruna

; Apati, Giannini Pasiznick

; Schneider, Andréa Lima dos Santos

; Pezzin, Ana Paula Testa

; Cesca, Karina

; Porto, Luismar Marques

Polímeros

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2023, Volume 33 N. 3 elocation e20230034

Abstract: En | Text: En | PDF: En

Abstract Bacterial nanocellulose (BNC) membranes have interconnected porous nanostructures and excellent biocompatibility. Functionalizing these with calcium phosphate sources and metal ions confers optimized properties to the biomaterial. This study aims to synthesize BNC membranes, functionalize them with copper and magnesium apatites, characterize and evaluate their cytotoxicity and antimicrobial potential. Membranes were synthesized for 8 days in Mannitol Medium. The biocomposite production was by immersion cycles. The biocomposites were characterized by porosity and swelling capacity, Fourier transforms infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermogravimetric analysis (TGA), antimicrobial properties and cytotoxicity assays. The FTIR and SEM results showed that phosphate groups were incorporated into the BNC. The TGA analysis also indicated the incorporation of the inorganic phase. The membrane functionalization with Cu promoted the antimicrobial properties of the biomaterial. However, functionalization with Mg had a more positive behavior on cell viability, proving to be more suitable for use as an implantable material.

https://doi.org/10.1590/0104-1428.20220121

Testicular biometry and hierarchy of dominance of the white-lipped peccary (Mammalia, Tayassuidae)
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Vieira, Renan Luiz Albuquerque

; Santos, Marilucia Campos dos

; Leonardo, Danilo Evaristo

; Barros, Celso Henrique Souza Costa

; Pedroso, Pedro Miguel Ocampos

; Feliciano, Marcus Antônio Rossi

; Cavalcante, Ana Karina da Silva

Ciência Animal Brasileira

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2023, Volume 24 elocation e-75078

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract The objective of this study was to obtain data on the testicular biometry of the white-lipped peccary (Tayassu pecari) and to verify if there is a correlation between the individual’s biometric data with their dominance rank. Data were collected from 16 adult males, aged between two and seven years, who made up the same group. By the agonistic interactions analyses we calculated the linearity indexes (h') of the dominance hierarchy and dominance rank. At the end of the behavioral observations, males were captured to collect biometric data from the testis. White-lipped peccaries showed testicles located in a perineal position, inclined cranio-ventrally with oval shape, flattened laterally and with tenso-elastic consistency (2.54±0.07). There was variance in the means (± standard deviation) of testis length (5.88±1.05cm), width (4.24 ± 0.98cm), height (4.44±0.86cm), and total scrotal width (8.78±17.05). The linear dominance hierarchy described the social structure of the males of this group (h'>0.9), with probability of linearity in the hierarchy greater than chance (P = 0.02). There was a correlation between dominance rank with the body mass, length and volume of the testicles. As in general the dimensions of the testicles are directly correlated with sperm production and also testosterone, this characteristic favors the reproductive performance of dominant white-lips males. Therefore, the characteristics of testicular biometry of white-lips should be considered for the selection of individuals more likely to reproduce in captivity favoring the conservation of this vulnerable species.

Resumo O objetivo neste estudo foi obter dados sobre a biometria testicular do queixada (Tayassu pecari) e verificar se há correlação entre os dados biométricos do indivíduo com seu posto de dominância. Os dados foram coletados de 16 queixadas adultos, com idades entre dois e sete anos, que compunham o mesmo grupo. Por meio de análises das interações agonísticas foram calculados os índices de linearidade (h') da hierarquia de dominância e determinado o rank dos indivíduos. Ao final das observações comportamentais, os machos foram capturados para coleta de dados biométricos do testículo. Os queixadas apresentaram testículos localizados em posição perineal, inclinados cranioventralmente com formato oval, achatados láterolateralmente e com consistência tensoelástica (2,54±0,07). Houve variação nas médias (± desvio padrão) do comprimento testicular (5,88±1,05cm), largura (4,24±0,98cm), altura (4,44±0,86cm) e largura escrotal total (8,78±17,05). A hierarquia de dominância linear descreveu a estrutura social dos machos desse grupo (h'>0,9), com probabilidade de linearidade na hierarquia maior que o acaso (P = 0,02). Houve correlação entre a classificação de dominância com a massa corporal, comprimento e volume dos testículos. Como em geral as dimensões dos testículos estão diretamente correlacionadas com a produção de esperma e também de testosterona, essa característica favorece o desempenho reprodutivo de machos de queixadas brancos dominantes. Portanto, as características da biometria testicular de queixadas devem ser consideradas para a seleção de indivíduos com maior probabilidade de reprodução em cativeiro favorecendo a conservação desta espécie vulnerável.

https://doi.org/10.1590/1809-6891v24e-75078e

10.

Atualização da Recomendação para Avaliação da Doença das Artérias Carótidas e Vertebrais pela Ultrassonografia Vascular: DIC, CBR, SBACV – 2023
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Albricker, Ana Cristina Lopes

; Freire, Claudia Maria Vilas

; Santos, Simone Nascimento dos

; Alcantara, Monica Luiza de

; Cantisano, Armando Luis

; Porto, Carmen Lucia Lascasas

; Amaral, Salomon Israel do

; Veloso, Orlando Carlos Glória

; Morais Filho, Domingos de

; Teodoro, José Aldo Ribeiro

; Petisco, Ana Cláudia Gomes Pereira

; Saleh, Mohamed Hassan

; Barros, Marcio Vinícius Lins de

; Barros, Fanilda Souto

; Engelhorn, Ana Luiza Dias Valiente

; Engelhorn, Carlos Alberto

; Nardino, Érica Patrício

; Silva, Melissa Andreia de Moares

; Biagioni, Luisa Ciucci

; Souza, Adriano José de

; Sarpe, Anna Karina Paiva

; Oliveira, Arthur Curtarelli de

; Moraes, Marcelo Rodrigo de Souza

; Francisco Neto, Miguel José

; Françolin, Peter Célio

; Rochitte, Carlos Eduardo

; Iquizli, Rogerio

; Santos, Alair Augusto Sarmet Moreira Damas dos

; Muglia, Valdair Francisco

; Naves, Bruno de Lima

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 10 elocation e20230695

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20230695

11.

Decreasing delays in the diagnosis and treatment of rheumatoid arthritis in Brazil: a nationwide multicenter observational study
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Albuquerque, Cleandro Pires de

; Reis, Ana Paula Monteiro Gomides

; Santos, Ana Beatriz Vargas

; Bértolo, Manoel Barros

; Louzada Júnior, Paulo

; Giorgi, Rina Dalva Neubarth

; Radominski, Sebastião Cezar

; Guimarães, Maria Fernanda B. Resende

; Bonfiglioli, Karina Rossi

; Sauma, Maria de Fátima L. da Cunha

; Pereira, Ivânio Alves

; Brenol, Claiton Viegas

; Mota, Licia Maria Henrique da

; Santos Neto, Leopoldo

; Pinheiro, Geraldo R. Castelar

Advances in Rheumatology

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2023, Volume 63 elocation 3

Abstract: En | Text: En | PDF: En

Abstract Background Management delays imply worse outcomes in rheumatoid arthritis (RA) and, therefore, should be minimized. We evaluated changes in diagnostic and treatment delays regarding RA in the last decades in Brazil. Methods Adults fulfilling the ACR/EULAR (2010) criteria for RA were assessed. Delays in diagnosis and treatment, and the frequencies of early management initiation within thresholds (windows of opportunity) of 3, 6, and 12 months from symptoms onset were evaluated. The Mann–Kendall trend test, chi-squared tests with Cramer’s V effect sizes and analysis of variance were conducted. Results We included 1116 patients: 89.4% female, 56.8% white, mean (SD) age 57.1 (11.5) years. A downward trend was found in diagnostic (tau = - 0.677, p < 0.001) and treatment (tau = - 0.695, p < 0.001) delays from 1990 to 2015. The frequency of early management increased throughout the period, with ascending effect sizes across the 3-, 6-, and 12-month windows (V = 0.120, 0.200 and 0.261, respectively). Despite all improvements, even in recent years (2011–2015) the diagnostic and treatment delays still remained unacceptably high [median (IQR): 8 (4–12) and 11 (5–17) months, respectively], with only 17.2% of the patients treated within the shortest, 3-month window. Conclusion The delays in diagnosis and treatment of RA decreased during the last decades in Brazil. Improvements (effect sizes) were greater at eliminating extreme delays (≥ 12 months) than in attaining really short management windows (≤ 3 months). Very early treatment was still an unrealistic goal for most patients with RA.

https://doi.org/10.1186/s42358-022-00265-0

12.

Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study
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Albuquerque, Cleandro Pires

; Reis, Ana Paula Monteiro Gomides

; Santos, Ana Beatriz Vargas

; Bértolo, Manoel Barros

; Louzada Júnior, Paulo

; Giorgi, Rina Dalva Neubarth

; Radominski, Sebastião Cezar

; Guimarães, Maria Fernanda B. Resende

; Bonfiglioli, Karina Rossi

; Sauma, Maria de Fátima L Cunha

; Pereira, Ivânio Alves

; Brenol, Claiton Viegas

; Mota, Licia Maria Henrique

; Santos Neto, Leopoldo

; Pinheiro, Geraldo Rocha Castelar

Advances in Rheumatology

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2023, Volume 63 elocation 17

Abstract: En | Text: En | PDF: En

Abstract Background Early rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions. Methods Adults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed “early” when the rheumatologist was the first or second physician consulted after symptoms onset, and “late” when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent. Results We included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6–36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (≤ 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: −0.25 [−0.46, −0.04] and − 0.196 [−0.306, −0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample. Conclusions Early diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.

https://doi.org/10.1186/s42358-023-00301-7

13.

Benznidazole treatment decreases IL-6 levels in Trypanosoma cruzi-infected human adipocytes differentiated from adipose tissue-derived stem cells
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Moreira, Leyllane Rafael

; Silva, Ana Carla

; Costa Oliveira, Cíntia Nascimento da

; Silva Júnior, Claudeir Dias da

; Nascimento, Amanda Vasconcelos

; Oliveira, Kamila Kássia dos Santos

; Soares, Ana Karine de Araújo

; Saraiva, Karina Lidianne Alcântara

; Paiva Cavalcanti, Milena de

; Lorena, Virginia Maria Barros de

Memórias do Instituto Oswaldo Cruz

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2023, Volume 118 elocation e220295

Abstract: En | Text: En | PDF: En

BACKGROUND Trypanosoma cruzi, which causes Chagas disease (CD), is a versatile haemoparasite that uses several strategies to evade the host’s immune response, including adipose tissue (AT), used as a reservoir of infection. As it is an effective barrier to parasite evasion, the effectiveness of the drug recommended for treating CD, Benznidazole (BZ), may be questionable. OBJECTIVE To this end, we evaluated the parasite load and immunomodulation caused by BZ treatment in the culture of adipocytes differentiated from human adipose tissue-derived stem cells (ADSC) infected with T. cruzi. METHODS The ADSC were subjected to adipogenic differentiation. We then carried out four cultures in which we infected the differentiated AT with trypomastigote forms of the Y strain of T. cruzi and treated them with BZ. After the incubation, the infected AT was subjected to quantitative polymerase chain reaction (qPCR) to quantify the parasite load and transmission electron microscopy (TEM) to verify the infection. The supernatant was collected to measure cytokines, chemokines, and adipokines. FINDINGS We found elevated secretion of IL-6, CXCL-10/IP-10, CCL2/MCP-1, CCL5/RANTES, and leptin in infected fat cells. However, treatment with BZ promoted a decrease in IL-6. MAIN CONCLUSION Therefore, we believe that BZ has a beneficial role as it reduces inflammation in infected fat cells.

https://doi.org/10.1590/0074-02760220295

14.

Alterações Hematológicas durante um Período de Sete Dias de Internação em Pacientes com Infarto Agudo do Miocárdio
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Martins, Cyntia Maria de Holanda

; Monteiro Júnior, José Gildo de Moura

; Torres, Dilênia de Oliveira Cipriano

; Sobral Filho, Dario Celestino

; Morais, Maria Clara Santos

; Montarroyos, Ulisses Ramos

; Silva, Izadora Karina da

; Santos, Ana Célia Oliveira dos

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 11 elocation e20230045

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Acute myocardial infarction is a major cause of mortality worldwide, and atherosclerotic plaque formation is the main pathophysiological mechanism, which results in chronic inflammation that induces erythrocyte maturation and may cause an increase in the red cell distribution width (RDW) index. Objective Evaluate the role of the anisocytosis index in patients with acute myocardial infarction in both types of infarctions as a predictor of severity. Methods Patients were included in the study according to the inclusion/exclusion criteria, following the hospital routine based on their clinical and laboratory history. Statistical analyzes were performed according to each variable. All conclusions were drawn considering the significance level of 5%. Results During the follow-up period, in the 349 patients analyzed, the mortality rate was associated with the variables RDW (CV) and RDW (SD), in those patients who died, an increase was noted, as demonstrated in the multivariate model, for the effects of an acute ST elevation myocardial infarction and the RDW, adjusted for confounding factors (p-value = 0.03 and 0.04). In contrast, the total number of erythrocytes (p-value = 0.00) and hemoglobin (p-value = 0.03) showed a decrease during severe patients’ hospitalization. Conclusion The anisocytosis index was a predictive factor of mortality and can be used as an indicator of worse prognosis in patients with acute myocardial infarction.

Resumo Fundamento O infarto agudo do miocárdio é uma das principais causas de mortalidade em todo o mundo e a formação de placa aterosclerótica é o principal mecanismo fisiopatológico, que resulta em inflamação crônica e induz a maturação eritrocitária, podendo causar aumento no índice de amplitude de distribuição dos glóbulos vermelhos (RDW). Objetivo Avaliar o papel do índice de anisocitose em pacientes com infarto agudo do miocárdio em ambos os tipos de infarto como preditor de gravidade. Métodos Os pacientes foram incluídos no estudo de acordo com os critérios de inclusão e exclusão, seguindo a rotina hospitalar baseada na história clínica e laboratorial. As análises estatísticas foram realizadas de acordo com cada variável. Chegou-se a todas as conclusões considerando o nível de significância de 5%. Resultados Durante o período de acompanhamento, nos 349 pacientes analisados, a taxa de mortalidade esteve associada às variáveis RDW (CV) e RDW (SD). Nos pacientes que foram a óbito, notou-se aumento, conforme demonstrado no modelo multivariado, nos efeitos de um infarto agudo do miocárdio com supradesnivelamento do segmento ST e RDW, ajustado para fatores de confusão (valor-p = 0,03 e 0,04). Em contrapartida, o número total de eritrócitos (valor-p = 0,00) e hemoglobina (valor-p = 0,03) apresentou diminuição durante a internação de pacientes graves. Conclusão O índice de anisocitose foi fator preditivo de mortalidade e pode ser utilizado como indicador de pior prognóstico em pacientes com infarto agudo do miocárdio.

https://doi.org/10.36660/abc.20230045

15.

Biases in association with complications in puerperae during the pandemic
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Leite, Milena Oliveira

; Matheus, Ana Paula Rabelo

; Alves, Matheus Porto

; Sobral, Letícia Rocha

; Silva, Karina Santos

; Lopes, Johnnatas Mikael

Revista Brasileira de Saúde Materno Infantil

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2023, Volume 23 elocation e20230151

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1806-9304202300000151-en

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