Análisis mediante variables instrumentales para establecer causalidad en investigaciones observacionales / Analysis through instrumental variables to establish causality in observational research

La identificación de relaciones causales es uno de los problemas fundamentales de la investigación científica en medicina y es necesaria para poder ejercerla en forma efectiva. Sin embargo, desde el punto de vista práctico es difícil establecer la existencia de relaciones causales en estudios de carácter observacional, en gran parte por la presencia de factores de confusión. El análisis a través de variables instrumentales es una de las estrategias que permite controlar el efecto confundidor y documentar la presencia de relaciones causa-efecto en estas situaciones. En este artículo, el autor resume los principales supuestos del análisis a través de variables instrumentales, haciendo foco en la aleatorización mendeliana. (AU)

The identification of causal relationships is one of the fundamental challenges in scientific research in medicine and is necessary for its effective practice. However, from a practical standpoint, establishing the existence of causal relationships in observational studies is difficult, largely due to the presence of confounding factors. Analysis through instrumental variables is one of the strategies that allows to control the confounding effect and documenting the presence of cause-and-effect relationships in these situations. In this article, the author summarizes the main assumptions of analysis through instrumental variables, with a focus on Mendelian randomization. (AU)

Perfil de pacientes com sepse e choque séptico em um hospital de trauma: estudo transversal / Profile of patients with sepsis and septic shock in a trauma hospital: cross-sectional study / Perfil de pacientes con sepsis y shock séptico en un hospital de trauma: estudio transversal

Objetivo: Avaliar o perfil e o desfecho clínico de pacientes com sepse e choque séptico em um hospital de trauma de Belo Horizonte. Métodos: Trata-se de estudo transversal, retrospectivo e descritivo dos casos de sepse e choque séptico. Resultados: Constatou-se que 97 (73%) pacientes eram do sexo masculino, com idade entre 19 e 59 anos, 87 (65%) previamente hígidos. Principal motivo de internação foi queda da própria altura com 23 (17%) casos e 37 (28%) diagnósticos de trauma crânio encefálico. Oitenta e seis (65%) pacientes tiveram diagnóstico de sepse e 47 (35%) choque séptico, o principal foco de infecção foi pulmonar 83 (62%). Obtivemos 88 (66%) resultados de hemoculturas negativas e 45 (34%) positivas, 64 (48%) pacientes receberam antibiótico em até 60 minutos após o diagnóstico e o tempo de internação mais prevalente após o evento séptico foi de 7 dias, representado por 31 (46%) pacientes que já estavam internados em uma Unidade de Terapia Intensiva (UTI). Mortalidade de 37 (28%) e 96 (72%) sobreviventes da população estudada. Conclusão: O evento séptico é um problema de saúde pública e tem alta letalidade em pacientes traumatizados. (AU)

Objective: To evaluate the profile and clinical outcome of patients with sepsis and septic shock in a trauma hospital in Belo Horizonte. Methods: This is a cross-sectional, retrospective and descriptive study of cases of sepsis and septic shock. Results: It was found that 97 (73%) patients were male, aged 19 to 59 years, 87 (65%) were previously healthy. Main reason for hospitalization was a fall from one's own height with 23 (17%) cases and 37 (28%) diagnosis of traumatic brain injury. Eighty-six (65%) patients were diagnosed with sepsis and 47 (35%) septic shock, the main focus of infection was pulmonary 83 (62%). We got 88 (66%) negative blood culture results and 45 (34%) positive, 64 (48%) patients received antibiotics within 60 minutes after diagnosis and the most prevalent hospital stay after septic event was 7 days, represented by 31 (46%) patients who were already hospitalized in an Intensive Care Unit (ICU). Mortality of 37 (28%) and 96 (72%) survivors of the population studied. Conclusion: Septic event is a public health problem and has high lethality in traumatized patients. (AU)

Objetivo: Evaluar el perfil y el resultado clínico de los pacientes con sepsis y shock séptico en un hospital de trauma en Belo Horizonte. Métodos: Este es un estudio transversal, retrospectivo y descriptivo de casos de sepsis y shock séptico. Resultados: Se encontró que 97 (73%) pacientes eran hombres, de 19 a 59 años, 87 (65%) antes estaban sanos. La razón principal de la hospitalización fue una caída desde la propia altura con 23 (17%) casos y 37 (28%) diagnóstico de lesión cerebral traumática. Ochenta y seis (65%) pacientes fueron diagnosticados con sepsis y 47 (35%) shock séptico, el foco principal de infección fue pulmonar 83 (62%). Tenemos 88 (66%) resultados negativos del cultivo sanguíneo y 45 (34%) positivo, 64 (48%) los pacientes recibieron antibióticos dentro de los 60 minutos posteriores al diagnóstico y la estancia hospitalaria más frecuente después del evento séptico fue de 7 días, representados por 31 (46%) pacientes que ya estaban hospitalizados en una Unidad de Cuidados Intensivos (UCI). Mortalidad de 37 (28%) y 96 (72%) sobrevivientes de la población estudiada. Conclusión: El evento séptico es un problema de salud pública y tiene alta letalidad en pacientes traumatizados. (AU)

Método de captura y recaptura: una experiencia de su aplicación para determinar la incidencia de diabetes gestacional / Capture and recapture method: anexperience of itsapplication to estimatetheincidence of gestational diabetes

Los métodos de captura y recaptura (MCR) se emplean en la estimación de poblaciones mediante la utilización de diferentes fuentes de datos, disponibles e incompletas, que registran por separado un mismo evento. En esta metodología, las fuentes son utilizadas para extrapolar el número de individuos no registrados, usando la información recopilada sobre los individuos sí registrados. Este artículo describe todos los pasos de su aplicación práctica, a partir de un ejemplo de estimación de la incidencia de diabetes gestacional en una institución, a partir de cinco fuentes documentales. (AU)

Capture-recapture (CRM) methods are widely used to estimate populations by using different data sources, available and incomplete, that record the same event separately. In these methods, the available sources are used to extrapolate the number of unregistered individuals, using the information collected on the individuals that are registered. This article describes all the steps of its practical application, based on an example of estimating the incidence of gestational diabetes in an institution based on five documentary sources. (AU)

Clinical and demographic characterization of the population with osteoporosis in two reference medical centres in Colombia / Caracterización clínica y demográfica de la población con osteoporosis en 2 centros médicos de referencia en Colombia

ABSTRACT Introduction: Osteoporosis is a public health problem. However, there is still a lack of data in Colombia on the characteristics of patients with osteoporosis. Objectives: This study aims to characterize the population with osteoporosis without previous diagnosis. Materials and methods: Observational, retrospective, descriptive study in patients with osteoporosis. Patients diagnosed between 2014 and 2017 were included. The information was obtained from the patient medical records and the densitometry results. Results: Most (92.2%) of the patients came from Medellín, and the rest from Cali. The mean age of the population was 65.1 years (SD: 9.97). As regards the history of fracture, it was reported that 12.0% had suffered from vertebral fractures, 2.3% had a history of fracture in the distal radius, 2.8% in the femoral neck, and 1.4% had had femoral shaft fracture. Bone densitometry showed a mean T-score of -2.90 in the femoral neck; -3.02 in total hip; -3.03 in the lumbar spine, and -3.42 in the 33% radius. In the 602 patients who had a control bone densitometry, an average BMD gain was seen in all the evaluated regions. Conclusions: The present study has enabled the characterizing of patients from 2 Colombian cities with a diagnosis of osteoporosis. The 2 most frequently reported locations for the diagnosis of osteoporosis were lumbar spine and femoral neck. An average BMD gain was also observed.

RESUMEN Introducción: La osteoporosis es un problema de salud pública, sin embargo, en Colombia en la actualidad faltan datos sobre las características de los pacientes con esta enfermedad. Objetivos: Este estudio pretende caracterizar la población con osteoporosis sin diagnóstico previo. Materiales y métodos: Estudio observacional, retrospectivo, descriptivo en pacientes con osteoporosis. Incluyó a pacientes diagnosticados entre el 2014 y el 2017. La información fue obtenida a partir de las historias clínicas de los pacientes y el resultado de la densitometría. Resultados: El 92,2% de los pacientes provenía de Medellín y los restantes de Cali. La edad promedio ± desviación estándar de la población fue 65,1 ± 9,97 arios. En cuanto al antecedente de fractura, se reportó que el 12,0% había presentado fracturas vertebrales, el 2,3% tenía antecedente de fractura en radio distal, el 2,8% en cuello femoral y el 1,4% había tenido fractura de diáfisis femoral. La densitometría ósea (DMO) mostró un T-score promedio de -2,90 en cuello femoral, -3,02 en cadera total, -3,03 en columna lumbar y-3,42 en radio 33%. En los 602 pacientes que contaban con DMO de control se vio una ganancia de la DMO promedio en todas las regiones evaluadas. Conclusiones: El presente estudio permitió caracterizar a pacientes con diagnóstico de osteoporosis en 2 ciudades de Colombia. Las 2 localizaciones más reportadas para el diagnóstico de osteoporosis fueron columna lumbar y cuello femoral; adicionalmente, se observó una ganancia de la DMO promedio.

Relação da condição de cárie da criança com experiência de cárie da mãe / Relationship between the child's caries status and the mother's caries experience

Objetivo: verificar a relação da condição de cárie da criança com a experiência autopercebida de cárie da mãe através de um estudo observacional transversal. Métodos: O estudo foi realizado na Faculdade de Odontologia da Universidade Federal de Pelotas com crianças entre 8 e 11 anos e suas mães. A amostra contou com 105 pares mãe-filho. Os responsáveis responderam um questionário relacionado à situação socioeconômica e demográfica, a mãe respondeu sobre sua saúde bucal: experiência de cárie (restauração ou dente cariado e perda dentária por cárie). Nas crianças os desfechos foram avaliados através de exame clínico com a soma de dentes decíduos e permanentes cariados, perdidos e obturados (ceod/CPOD) e para severidade de cárie foi utilizado Significant Caries Index (SiC), ceod/CPOD≥3. Para testar a associação entre as variáveis relacionadas à mãe e o desfecho severidade de cárie foi realizado o teste Qui-quadrado, para média de cárie na criança (ceod/CPOD) foi utilizado o Teste Mann-Whitney. Resultados: Com relação à severidade de cárie não foi encontrada associação estatisticamente significante. A média do ceod/CPOD foi quase três vezes maior nas crianças cujas mães relataram que haviam tido ou estavam com algum dente cariado ou restaurado em função da cárie em comparação àquelas que não relataram esta experiência. As mães mais jovens apresentaram filhos com maior média de cárie do que as mães mais velhas. Conclusão: Entre as crianças atendidas neste serviço existe uma relação de uma maior média de cárie nas crianças com cujas mães tem ou tiveram experiência de cárie e mais jovens.(AU)

Objective: to verify the relationship between the child's caries condition and the mother's self-perceived caries experience through a cross-sectional observational study. Methods: The study was carried out at the Faculty of Dentistry of the Federal University of Pelotas with children between 8 and 11 years old and their mothers. The sample had 105 mother-child pairs. The guardians answered a questionnaire related to the socioeconomic and demographic situation, the mother answered about her oral health: caries experience (restoration or decayed tooth and tooth loss due to caries). In children, the outcomes were evaluated through clinical examination with the sum of decayed, missing and filled deciduous and permanent teeth (DMFT/DMFT) and for caries severity we used the Significant Caries Index (SiC), DMFT/DMFT≥3. To test the association between the variables related to the mother and the outcome of caries severity, the Chi-square test was performed, for mean caries in children (dmft/DMFT) the Mann-Whitney Test was used. Results: Regarding caries severity, no statistically significant association was found. The mean dmft/DMFT was almost three times higher in children whose mothers reported that they had had or had a decayed or restored tooth due to caries compared to those who did not report this experience. Younger mothers had children with a higher average of caries than older mothers. Conclusion: Among the children assisted in this service, there is a relation of a higher average of caries in children whose mothers have or had caries experience and younger.(AU)

Dermatophytoses in patients attended from a private clinical analysis laboratory in João Pessoa-PB, between 2015 to 2019 / Dermatofitoses em pacientes atendidos em um laboratório privado de João Pessoa-PB, entre 2015 a 2019

Introduction: dermatophytoses or "tineas" are characterized by being mycoses caused by fungi of the genera Epidermophyton, Trichophyton and Microsporum. These mycotic infections can present themselves as a form of lesions that affect the skin, hair and nails of individuals of both genders and all ages. Objective: to elucidate the epidemiological profile of dermatophytoses in patients examined by a private clinical analysis laboratory in João Pessoa-PB, between 2015 and 2019. Methodology: this is an epidemiological, analytical, retrospective and documentary study, in which data collection took place at the Clinical Pathology Laboratory ­ "HEMATO", located in João Pessoa ­ PB. Results: the profile of those affected was predominantly female (58.5%), 18 to 59 years old (38.4%), white (53.6%) and with lesions, mainly in skin glabrous (38.5%), feet (33.3%) and nails (12.8%). When relating the age group to the injury site, it was noticed that injuries on glabrous skin, feet and nails, were more frequent in individuals aged 18 to 59 years, while injuries to the scalp were mostly found in individuals younger than 18 years old. The most prevalent species were M. canis (31.9%) and T.rubrum (31.9%). When correlating the fungal species with the lesion site, it was noted that M. canis was the main agent responsible for lesions in glabrous skin, scalp and hands, while T. rubrum was predominantly observed in nails and T. mentagrophytes in feet. Conclusion: it is concluded that the data present in this research can promote the development of indicators and public policies for the population most susceptible to dermatophytosis.

Introdução: dermatofitoses ou tineas se caracterizam por serem micoses causadas por fungos dos gêneros Epidermophyton, Trichophyton e Microsporum. Essas infecções micóticas podem se apresentar na forma de lesões que acometem pele, pelo e unhas de indivíduos de ambos os gêneros e todas as idades. Objetivo: elucidar o perfil epidemiológico de dermatofitoses de pacientes atendidos por um laboratório privado de análises clínicas em João Pessoa-PB, entre 2015 a 2019. Metodologia: trata-se de um estudo epidemiológico, analítico, retrospectivo e documental, em que a coleta de dados ocorreu no Laboratório de Patologia Clínica ­ HEMATO, localizado em João Pessoa ­ PB. Resultados: o perfil de acometidos foi predominantemente de indivíduos do sexo feminino (58,5%), com 18 a 59 anos de idade (38,4%), brancos (53,6%) e com lesões, principalmente, em pele glabra (38,5%), pés (33,3%) e unhas (12,8%). Ao relacionar a faixa etária com o local da lesão, percebeu-se que lesões em pele glabra, pés e unhas, foram mais frequentes em indivíduos de 18 a 59 anos, enquanto que lesões no couro cabeludo foram majoritariamente encontradas em indivíduos menos de 18 anos. As espécies mais prevalentes foram M. canis (31,9%) e T. rubrum (31,9%). Ao correlacionar a espécie fúngica com o local da lesão, notou-se que M. canis foi o principal agente responsável por lesões em pele glabra, couro cabeludo e mãos, enquanto T. rubrum foi predominantemente observado em unhas e T. mentagrophytes em pés. Conclusão: os dados obtidos nesta pesquisa podem fomentar o desenvolvimento de indicadores e políticas públicas para a população mais susceptível às dermatofitoses.

Historia familiar de enfermedad tiroidea y riesgo de hipotiroidismo congénito en neonatos con síndrome de Down / Family history of thyroid disease and risk of congenital hypothyroidism in neonates with Down syndrome

Resumen Introducción: La historia familiar de enfermedad tiroidea (HFET) como factor de riesgo para hipotiroidismo congénito (HC), en síndrome de Down (SD) aún no ha sido explorada. Objetivo: Determinar si la HFET está asociada a mayor riesgo de HC en neonatos con SD. Método: Estudio de casos y controles en 220 neonatos con SD. Se compararon las pruebas de función tiroidea (PFT) de 37 con SD e HFET (casos), frente a las PFT de 183 recién nacidos con SD sin HFET (grupo de referencia). Se realizó análisis de regresión logística multivariante y se calculó la razón de momios (RM) y sus respectivos intervalos de confianza del 95 % (IC 95 %). Resultados: Nueve casos HC (4.1 %). El HC mostró asociación con la HFET (RMa = 8.3, IC 95 %: 2.0-34.3), particularmente en los varones (RMa = 9.0, IC 95 %: 1.6-49.6). La ausencia de HFET tuvo una RM de protección para HC (RMa = 0.4, IC 95 %: 0.1-0.8). Conclusiones: La HFET puede es una estrategia fácil y accesible para identificar pacientes con SD con mayor riesgo de HC.

Abstract Introduction: Family history of thyroid disease (FHTD) as risk factor for congenital hypothyroidism (CH) in patients with Down syndrome (DS) has not yet been explored. Objective: To determine whether FHTD is associated with an increased risk for CH in DS. Method: Case-control study in 220 neonates with DS. Thyroid function tests of 37 infants with DS and FHTD (cases) were compared with those of 183 DS newborns without FHTD (reference group). Data were analyzed using multivariate logistic regression analysis and adjusted odds ratios (aORs) with their respective 95 % confidence intervals (CI) were calculated. Results: Nine newborns with DS in our sample had CH (4.1 %). FHTD showed an association with CH in neonates with DS (aOR = 8.3, 95 % CI: 2.0-34.3), particularly in males (aOR = 9.0, 95 % CI: 1.6-49.6). In contrast, newborns with DS without FHTD were less likely to suffer from CH (aOR = 0.4, 95 % CI: 0.1-0.8). Conclusions: FHTD detailed evaluation can be an easy and accessible strategy to identify those newborns with DS at higher risk for CH.

Assessing the methodological quality of systematic reviews using the AMSTAR tool / ¿Cómo evaluar la calidad metodológica de las revisiones sistemáticas a través de la herramienta AMSTAR?

Abstract Introduction Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using "AMSTAR" and "Systematic Reviews" as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of a SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.

Resumen Introducción Tomar decisiones basadas en la evidencia ha sido un reto para profesionales de la salud; se requiere tener herramientas y habilidades para apreciar la evidencia críticamente y evaluar la validez de los resultados. Las revisiones sistemáticas de la literatura (RSL) han sido muy usadas para dar respuesta a preguntas del ámbito clínico. Se han desarrollado herramientas que apoyan la apreciación de la calidad de los estudios. El AMSTAR es una de estas, validada y soportada por evidencia reproducible que orienta la calidad metodológica de las RSL. Objetivos Mostrar un abordaje histórico, teórico y de guía práctica para la apreciación crítica de las revisiones sistemáticas con el AMSTAR, orientar las bases argumentales para su uso, según los componentes de esta estructura metodológica en investigación en salud, y proporcionar ejemplos prácticos sobre cómo aplicar esta lista de chequeo. Métodos Realizamos una revisión no exhaustiva de literatura en PubMed y The Cochrane Library con los términos libres "AMSTAR" y "revisiones sistemáticas'', sin límite de idioma o año de publicación; también, recolectamos información de expertos en evaluación de la calidad de la evidencia. Conclusiones El AMSTAR es un instrumento validado y soportado por evidencia reproducible para la evaluación de la validez interna de las revisiones sistemáticas de la literatura. Consiste en 16 ítems que evalúan de manera global la calidad metodológica de una RSL. Actualmente, se usa de manera indiscriminada y predilecta, pero no está exenta de limitaciones y futuras actualizaciones basadas en nuevos estudios de reproducibilidad y validación.

Identificación de clústeres de casos de COVID-19 en la provincia Santiago de Cuba / Identification of clusters in COVID-19 cases in the Santiago de Cuba province

Introducción: A partir de la aparición de la epidemia COVID-19 se conforma un equipo multidisciplinario en Santiago de Cuba con participación de varias instituciones y activado por el Consejo de defensa provincial. El análisis integrado epidemiológico, la gestión gubernamental y la respuesta social resultarían determinantes en el control de la enfermedad. Objetivos: Identificar posibles grupos de casos con COVID-19 en la provincia Santiago de Cuba y caracterizar su transmisión según variables epidemiológicas. Métodos: Se desarrolló un estudio ecológico, comparándose los clústeres de transmisión de COVID-19. Se resumieron variables de interés y se realizó análisis de redes sociales desde el punto de vista de las relaciones entre casos y contactos, así como análisis espacial. Resultados: Se identificaron cinco grupos espaciales de transmisión en los municipios, uno en Palma Soriano, uno en Contramaestre y tres en Santiago de Cuba. Los antecedentes patológicos personales (hipertensión y procesos respiratorios), el sexo femenino, los casos sintomáticos y el promedio de 22 a 27 contactos por cada confirmado fueron las variables más relevantes. Se identificó fuente de infección introducida en 51 por ciento (25/49). Además, se identificaron redes sociales complejas en la transmisión de la enfermedad. Conclusiones: La transmisión de COVID-19 en la provincia Santiago de Cuba mostró grupos de casos y contactos con redes sociales epidemiológicas características para cada municipio, así como el modo de transmisión de acuerdo a la fuente de infección, relaciones de familiaridad o cercanía social y la relación de distancia espacial entre contactos, aspectos que influyeron en las bajas tasas de incidencia de la enfermedad, con predominio en su forma sintomática, edades jóvenes y en mujeres(AU)

Introduction: From the onset of COVID-19 epidemic, a multidisciplinary team is formed in Santiago de Cuba with the participation of several institutions and activated by the Provincial Defense Council. Integrated epidemiological analysis, government management and social response would be decisive in controlling the disease. Objectives: To identify possible groups of COVID-19 cases in the Santiago de Cuba province and to describe the transmission according to epidemiological variables. Methods: An ecological study was carried out, comparing COVID-19 transmission clusters. Variables of interest were summarized and analysis of social contact networks was carried out from the point of view of the relationships between cases and contacts, as well as spatial analysis. Results: Five spatial transmission groups were identified in the municipalities, one in Palma Soriano, one in Contramaestre and three in Santiago de Cuba. The personal pathological antecedents (hypertension and respiratory processes), female sex, symptomatic cases and the average of 22 to 27 contacts for each confirmed were the most relevant variables. A source of introduced infection was identified in 51 percent (25/49). In addition, complex social networks were identified in the transmission of the disease. Conclusions: The transmission of COVID-19 in Santiago de Cuba province showed groups of cases and contacts with characteristic epidemiological social networks for each municipality, as well as the mode of transmission according to the source of infection, relationships of familiarity or social closeness and the relationship of spatial distance between contacts, which influenced on the low incidence rates of the disease, with predominance of symptomatic form, young ages and in women(AU)

Preditores de transtornos mentais comuns e do uso de psicofármacos em docentes universitários / Predictors of common mental disorders and the use of psychotropic drugs in university professors

O objetivo do presente estudo foi identificar, entre os docentes de diferentes unidades de ensino de uma universidade pública paulista, a prevalência e fatores associados aos Transtornos Mentais Comuns (TMC) e consumo de psicofármacos. Trata-se de estudo epidemiológico, transversal e de caráter correlacional-descritivo, desenvolvido em um Campus Universitário de uma universidade pública, localizado no interior paulista. O total de 252 docentes participaram do estudo. Foram utilizados os seguintes instrumentos para a coleta online de dados: questionário sobre dados sociodemográficos, econômicos, histórico de saúde, trabalho docente e uso de psicofármacos; o Self-Reporting Questionnaire - (SRQ-20) para estimar a prevalência de TMC, a Escala de Estresse no trabalho - (ETT) para avaliar a presença de estresse e o Teste para Identificação de Problemas Relacionados ao Álcool (AUDIT). Para análise dos dados referentes aos TMC e uso de psicofármacos como variáveis desfecho, foram realizadas análises univariadas e modelos de regressão logística multivariada, sendo consideradas significativas as associações com valor de p <0,05. A prevalência de TMC foi de 18,7% e a de uso de psicofármacos 13%. Na análise univariada houve associação entre TMC e transtornos mentais/ distúrbios do sono, uso de psicofármacos, uso de antidepressivos, situação conjugal, filhos e atividade física. No modelo de regressão logística para predição de TMC, foram identificados como fatores de risco a ausência de companheiro, de filhos e da prática de atividade física. Na análise univariada, identificou-se associação entre uso de psicofármacos e as variáveis problemas clínicos de saúde, uso de medicamentos não psicofármacos, quantidade de medicamentos utilizados, orientação sexual, área de conhecimento do curso que o docente ministra aula, uso de medicamentos para o trato urinário e hormônios sexuais e para o trato alimentar e metabolismo, diagnóstico de transtorno mental/distúrbios do sono e TMC. No modelo de regressão logística para predição do uso de psicofármacos, foram fatores de risco: orientação sexual homossexual, ministrar aulas na área de ciências biológicas, uso de medicamentos para o trato urinário e hormônios sexuais, apresentar diagnóstico de transtorno mental/distúrbios do sono e ser positivo para TMC. Os preditores para TMC e uso de psicofármacos em docentes universitários identificados nesta pesquisa podem subsidiar intervenções mais efetivas voltadas para proteção à saúde e prevenção de agravos nestes profissionais, bem como medidas para promoção de mudanças no contexto do trabalho universitário

The aim of this study was to identify, among faculty members from different teaching units of a public university in São Paulo, the prevalence and factors associated with Common Mental Disorders (CMD) and consumption of psychotropic drugs. This is an epidemiological, cross-sectional and correlational-descriptive study, developed on a University Campus of a public university, located in the interior of São Paulo. A total of 252 faculty members participated in the study. The following instruments were used for online data collection: a questionnaire on sociodemographic, economic, health history, teaching work and use of psychoactive drugs; the Self-Reporting Questionnaire - (SRQ- 20) to estimate the prevalence of CMD, the Work Stress Scale - (ETT) to assess the presence of stress and the Test for Identification of Alcohol Related Problems (AUDIT). Univariate analyzes and multivariate logistic regression models were used to analyze data related to CMD and use of psychotropic drugs as outcome variables, with associations with a p value <0.05 being considered significant. The prevalence of CMD was 18.7% and the use of psychotropic drugs 13%. In the univariate analysis, there was an association between CMD and mental disorders and sleep disorders, use of psychotropic drugs, use of antidepressants, marital status, children and physical activity. In the logistic regression model for predicting CMD, the absence of a partner, children and the practice of physical activity were identified as risk factors. In the univariate analysis, an association was identified between the use of psychotropic drugs and the variables clinical health problems, use of non-psychotropic drugs, number of drugs used, sexual orientation, area of knowledge of the course that the teacher teaches, use of drugs for the urinary tract and sex hormones and for the alimentary tract and metabolism, diagnosis of mental disorder / sleep disorder and CMD. In the logistic regression model for predicting the use of psychoactive drugs, the following risk factors were: homosexual sexual orientation, teaching classes in the area of biological sciences, use of medication for the urinary tract and sex hormones, presenting a diagnosis of mental disorder / sleep disorder and be positive for CMD. The predictors for CMD and use of psychotropic drugs in faculty members identified in this research can support more effective interventions aimed at protecting health and preventing injuries in these professionals, as well as measures to promote changes in the context of university work

Qualidade de vida e risco de depressão em idosos institucionalizados / Quality of life and risk of depression in institutionalized elderly / Calidad de vida y riesgo de depresión en personas institucionalizadas

Objetivo: verificar a prevalência de sintomas depressivos e associação com qualidade de vida em idosos institucionalizados. Métodos: estudo descritivo realizado com idosos de duas instituições de longa permanência do Paraná. Os dados foram coletados entre junho e setembro de 2018, mediante entrevista estruturada, utilizando o The World Health OrganizationQualityof Life (WHOQOL ­ bref) e a Escala de Depressão Geriátrica. Os dados foram analisados por meio de estatística descritiva e inferencial no software R. Resultados: a maioria dos idosos (62%) tinha algum grau de sintomas depressivos - leve ou severo. A qualidade de vida apresentou correlação com características sociodemográficas, condição de saúde, estilo de vida e presença de sintomas depressivos. Conclusão: a prevalência de sintomas depressivo na amostra estudada foi alta, o que indica a necessidade de maior atenção para a saúde mental de idosos residentes em instituições de longa permanência

Objective: to verify the prevalence of depressive symptoms and to evaluate the quality of life in institutionalized elderly. Methods: descriptive study carried out with elderly people from two long-term institutions in Paraná. Data were collected between June and September 2018, through a structured interview, using The World Health Organization Quality of Life (WHOQOL ­ bref ) and the Geriatric Depression Scale - GDS. The data were analyzed using descriptive and inferential statistics in the R software. Results: most of the elderly (62%) had some degree of depressive symptoms ­ mildor severe. Quality of life was correlated with sociodemographic characteristics, health condition, life style and presence of depressives ymptoms. Conclusion: the prevalence of depressive symptoms in the sample studied was high, which indicates the need for greater attention to the mental healt hof elderly people living in long-term institutions

Objetivo: verificar La prevalencia de sintomas depresivos y evaluar La calidad de vida em ancianos institucionalizados. Métodos: Estudio descriptivo realizado con personas mayores de dos instituciones de larga duración en Paraná. Los datos se recopilaron entre junio y septiembre de 2018, através de una entrevista estructurada, utilizando La Calidad de vida de La Organización Mundial de La Salud (WHOQOL) y la Escala de depresión geriátrica (GDS). Los datos se analizaron mediante estadísticas descriptivas e inferencial esen el software R. Resultados: La mayoría de losancianos (62%) tenían algún grado de sintomas depresivos, leves o graves. La calidad de vida se correlaciono com las características sociodemográficas, el estado de salud, el estilo de vida y la presencia de sintomas depresivos. Conclusión: la prevalencia de sintomas depresivos em La muestra estudiada fue alta, lo que indica La necesidad de una mayor atención a La salud mental de las personas mayores que viven em instituciones a largo plazo

Evaluation of actions of the official veterinary service to mitigate outbreaks of infectious laryngotracheitis and improve biosecurity on laying hen farms / Avaliação de ações do serviço veterinário oficial para bloqueio de foco de laringotraqueite infecciosa e melhoria da biosseguridade em granjas de postura

Infectious laryngotracheitis (ILT), caused by an Alphaherpesvirus (Gallid herpesvirus-1; GaHV-1), has been noticed in the region of the Terras Altas da Mantiqueira, Minas Gerais. From 2010 to 2018, the "Serviço Veterinário Oficial" (SVO) of the "Instituto Mineiro Agropecuário" (IMA), implemented measures to prevent spread of the virus to other regions and control the disease in the area. Due to the close proximity and consequent epidemiological link among farms, the region was considered a unique epidemiological unit. To check the efficiency of the ILT control measures, we carried out: (1) a seroepidemiological survey, (2) questionnaires for evaluating biosecurity measures; and (3) an evaluation of the influence of farm population density on the occurrence of ILT. In 2016, 2017, and 2018, ILT was investigated using epidemiological and clinicopathological methods, along with GaHV-1 molecular detection. Serological survey was carried out on 24 farms in the quarantined region and on 13 farms from other regions of the state. In 2010 and 2018, questionnaires were applied to collect data and determine indicators of biosecurity practices in all farms of the quarantined area. The differences were then assessed (Wilcoxon's p<0.05). The results indicated positive serology throughout the region, although only on four farms (16.6%) the chickens have clinical signs, macroscopic and histological lesions of ILT. The prevalence of viral infection increased from 2016 (27%) to 2017 (50%) and was higher in farms with a high stock density (p=0.033). No disease, virus or antibodies were detected in the farms outside of the quarantined area. Although the biosecurity indicators had improved on all farms in the quarantined area (p<0.05), the virus was active and circulating in the region. The contingency measures have contained the outbreak, but biosecurity practices are paramount in the control of new outbreaks. Official control will be maintained in the region, including surveillance of new cases and biosecurity procedures to mitigate the risk of the virus reaching other regions.(AU)

Laringotraqueíte infecciosa (LTI), causada por um alfaherpesvírus (herpesvírus Gallid-1; GaHV-1), foi observada na região das Terras Altas da Mantiqueira, Minas Gerais. De 2010 a 2018, o Serviço Veterinário Oficial (SVO) do Instituto Mineiro Agropecuário (IMA) implementou medidas para impedir a disseminação do vírus para outras regiões do estado e controlar a doença na região interditada. Devido à proximidade e consequente vínculo epidemiológico entre as granjas, a região foi considerada uma unidade epidemiológica única. Para verificar a eficiência das medidas de controle de LTI, foram realizados: (1) pesquisa soroepidemiológica, (2) questionários para avaliar medidas de biosseguridade; e (3) avaliação da influência da densidade populacional da granja na ocorrência de LTI. Em 2016, 2017 e 2018, a LTI foi investigada usando métodos epidemiológicos e clínico-patológicos, com a detecção molecular de GaHV-1. O levantamento sorológico foi realizado em 24 granjas da região interditada e em 13 granjas de outras regiões do estado. Em 2010 e 2018, foram aplicados questionários para coletar dados e determinar indicadores de medidas de biosseguridade em todas as granjas da área interditada. As diferenças foram avaliadas (p<0,05 de Wilcoxon). Os resultados indicaram sorologia positiva em toda a região, embora apenas em quatro granjas (16,6%) as galinhas apresentaram sinais clínicos, lesões macroscópicas e histológicas da LTI. A prevalência de infecção viral aumentou de 2016 (27%) para 2017 (50%) e foi maior em fazendas com alta densidade de alojamento (p=0,033). Presença da doença, vírus ou anticorpos foram detectados nas granjas fora da área interditada. Embora os indicadores de biosseguridade tenham melhorado em todas as fazendas da área interditada (p<0,05), o vírus está ativo e circulava na região. As medidas de contingência contiveram o surto, mas as práticas de biosseguridade são fundamentais para o controle de novos surtos. O controle oficial será mantido na região, incluindo a vigilância de novos casos e procedimentos de biosseguridade para mitigar o risco de transmissão do vírus para outras regiões.(AU)

Variability of anesthetic depth in total intravenous anesthesia vs balanced anesthesia using entropy indices: a randomized, crossover, controlled clinical trial / Variabilidad de la profundidad anestésica en anestesia total intravenosa vs. anestesia general balanceada usando índices de entropía. Un ensayo clínico aleatorizado, cruzado y controlado

Abstract Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening. Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5 µg/mL for 15 minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t-test. Results: The treatment effect showed no significant difference in the average values of RE, during TIVA = 97.23 vs BA 97.04 (P = 0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different. Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.

Resumen Introducción: La anestesia total intravenosa (TIVA, por sus siglas en inglés) y la anestesia balanceada (AB) son las técnicas anestésicas más comúnmente utilizadas. La diferencia está en la variabilidad de la profundidad de la anestesia entre estas dos técnicas, lo cual pudiera predecir cuál es más segura para los pacientes y representar un menor riesgo de despertar intraoperatorio. Objetivo: Determinar si existe alguna diferencia en la variabilidad de la profundidad de la anestesia obtenida según los índices de entropía de respuesta (ER). Métodos: Se llevó a cabo un estudio clínico cruzado en 20 pacientes sanos que se sometieron a cirugía ortopédica ambulatoria de miembros superiores o inferiores. Los pacientes se asignaron aleatoriamente así: a) infusión controlada por objetivo (TCI, por sus siglas en inglés) de propofol, utilizando el modelo Schnider a una concentración objetivo de 2,5 µg/mL durante 15 min y un período de lavado de 10 minutos, seguido de la administración de sevoflurano a 0,8 de concentración alveolar mínima (CAM) durante el tiempo restante de la cirugía; o b) la secuencia inversa. Las diferencias en la variabilidad de la profundidad de la anestesia utilizando entropía de respuesta se evaluaron utilizando la prueba t pareada. Resultados: El efecto del tratamiento no mostró ninguna diferencia significativa en los valores promedio de entropía de respuesta (ER) durante TIVA = 97,23 vs. AB 97,04 (P = 0,39). Los efectos de arrastre (-4,98 vs. 4,08) y período (100,3 vs. 94,68) no fueron significativamente diferentes. Conclusiones: El presente estudio sugiere que ambas técnicas anestésicas son equivalentes en términos de estabilidad de la profundidad de la anestesia. Es importante continuar probando los factores determinantes de eficacia en las distintas poblaciones, ya que el comportamiento individual de cada paciente pudiera finalmente inclinar la balanza.

La Eficacia de la Homeopatía en el Tratamiento Epidemiológico / The Efficacy of Homeopathy in the Epidemiological Treatment

Pandemia de consecuencias sanitarias, sociales y económicas incalculables, la enfermedad COVID-19 parece haber llegado para quedarse mucho tiempo entre nosotros, y cuando decimos "nosotros" nos referimos a los 7,700 millones de habitantes del planeta. (au)

Overall survival predictors in hepatocellular carcinoma patients treated with sorafenib

SUMMARY Malignant liver tumors are the fourth leading cause of cancer death worldwide. Hepatocellular carcinoma (HCC) accounts for 75-85% of these. Most patients are diagnosed at incurable stages. Palliative care is the appropriate treatment course in these circumstances (chemoembolization and sorafenib). There are few national studies on sorafenib. The objective is to evaluate survival predictors of HCC patients treated with sorafenib and evaluate the compliance of its indication in relation to BCLC recommendations. METHODS A total of 88 patients with an indication of sorafenib from 2010 to 2017 at the ISCMSP were retrospectively analyzed. Univariate and multivariate analyzes were performed in the search for predictors of survival. RESULTS The mean age was 61.2 years, 70.5% were men, most were classified as Child-Pugh A (69.3%), and BCLC C (94.3%). Cirrhosis was present in 84.6% and portal hypertension in 55.7%. Hepatitis C virus was the most common etiology (40.9%). Sixty-nine (78.4%) patients received the medication, with the average duration of treatment being 9.7 months. The mean overall survival was 16.8 months. Significant differences were observed in the multivariate analysis: ECOG PS (p = 0.024): Child-Pugh (p = 0.013), time of medication use (p <0.001), clinical worsening (p = 0.031) and portal thrombosis (p = 0.010). CONCLUSION Absence of portal thrombosis, Child-Pugh A, longer time of medication use, ECOG PS 0, and absence of suspension due to clinical worsening were predictors of better overall survival in the study. The drug's indication complies with BCLC guidelines in 94% of patients.

RESUMO Tumores malignos do fígado são a quarta maior causa de morte por câncer, sendo que o carcinoma hepatocelular (CHC) corresponde a 85-90% desses casos. A maioria dos doentes apresenta-se, ao diagnóstico, sem possibilidade de tratamento curativo, restando apenas as opções paliativas (quimioembolização e sorafenibe). Há poucos estudos nacionais acerca do sorafenibe. OBJETIVO Avaliar fatores preditivos de sobrevida em pacientes com CHC que tiveram indicação de tratamento com sorafenibe na Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP) e avaliação da conformidade da indicação da medicação em relação às recomendações do BCLC. MÉTODOS Foram analisados retrospectivamente os dados de 88 pacientes que tiveram indicação de tratamento com sorafenibe no período de 2010 a 2017 na ISCMSP. Análises univariada e multivariada foram realizadas na busca de preditores de sobrevida global nos pacientes que receberam a medicação. RESULTADOS Idade média de 61,2 anos, sendo 70,5% homens. A maioria (69,3%) foi classificada como Child Pugh A e BCLC C (94,3%). A cirrose esteve presente em 84,6% e a hipertensão portal em 55,7% desses. O vírus da hepatite C foi a etiologia mais comum (40,9%) do CHC. Sessenta e nove (78,4%) pacientes receberam a medicação, sendo o tempo médio de duração do tratamento 9,7 meses e a sobrevida global média, 16,8 meses. Diferenças significativas foram observadas na análise multivariada: Ecog PS (p=0,024), CP (p=0,013), tempo de uso de medicação (p<0,001), suspensão por piora clínica (p=0,031) e trombose portal (p=0,010). CONCLUSÃO Ausência de trombose portal, Child Pugh A, Ecog PS 0, tempo maior de uso de medicação e ausência de suspensão por piora clínica foram fatores preditores de melhor sobrevida global e a indicação da medicação esteve em conformidade com as orientações do BCLC em 94% dos pacientes.

Clinical Consequences of Untreated Dental Caries among Primary School Children: A Cross-Sectional Study

Abstract Objective: To evaluate the dental caries experience and clinical consequences of untreated dental caries (UDC) among primary school children of Al Jouf region, Saudi Arabia and to determine the correlation between dental caries experience and clinical consequences of UDC. Material and Methods: A 250 primary school children 6-7 years were recruited using systematic random sampling. The prevalence of dental caries in deciduous dentition was assessed by following WHO criteria using the dmft index and the clinical consequence of UDC was assessed with the pufa index. The pufa score was calculated cumulatively following the pufa diagnostic criteria. The Student's t-test was used to equate the mean dmft and pufa scores between boys and girls. The correlation between the dmft and the pufa scores was evaluated using Pearson's correlation coefficient (r), and the p-value was set at 0.05 for statistical significance. Results: Out of which 154 (61.60%) boys and 94 (37.60%) were girls. The mean (SD) values of dmft for boys reported to be 5.37 (± 3.31) and for girls 6.35 (± 3.27), which was statistically significant with gender (p<0.001). Statistically, significant mean values of pufa were 1.20 (± 1.37) in boys and 1.71 (± 1.58) in girls, respectively was observed (p<0.001). The Pearson correlation between dmft and pufa values showed a highly significant positive correlation among dmft and pufa values (r= 0.635, p<0.001). Conclusion: The present study revealed that high caries prevalence and experience of the clinical consequences of UDC in the primary dentition, and there was a strong positive correlation between dmft and pufa score values.

Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents from a Brazilian metropolis (1978-2017)

Abstract INTRODUCTION: Prevalence of human immunodeficiency virus among adolescents is increasing. This study aimed to analyze this current situation in Rio de Janeiro City. METHODS: This was a retrospective longitudinal study using secondary data from the National System of Notifiable Diseases database of cases in adolescents aged 13-19 years. RESULTS: There were 885 acquired immunodeficiency syndrome cases from 1978 to 2017 and 445 human immunodeficiency virus new cases from 2014 to 2017. Over time, sexually transmitted human immunodeficiency virus/acquired immunodeficiency syndrome cases increase. CONCLUSIONS: Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents requires novel prevention policies.

Increase in the risk of snakebites incidence due to changes in humidity levels: A time series study in four municipalities of the state of Rondônia

Abstract INTRODUCTION: Snakebites represent a serious global public health problem, especially in tropical countries. In Brazil, the incidence of snakebites ranges from 19 to 22 thousand cases per 100000 persons annually. The state of Rondônia, in particular, has had an increasing incidence of snakebites. METHODS: A retrospective cross-sectional study on snakebites was conducted from January 2007 to December 2018. Brazil's Information System for Notifiable Diseases was queried for all snakebites reported in Porto Velho, Ariquemes, Cacoal, and Vilhena. Data on land surface temperatures during the day and night, precipitation, and humidity were obtained using the Google Earth Engine. A Bayesian time series model was constructed to describe the pattern of snakebites and their relationship with climate data. RESULTS: In total, 6326 snakebites were reported in Rondônia. Accidents were commonly caused by Bothrops sp. (n=2171, 81.80%). Snakebites most frequently occurred in rural areas (n=2271, 85.5%). Men, with a median age of 34 years (n=2101, 79.1%), were the most frequent bitten. Moderate clinical manifestation was the most common outcome of an accident (n=1101, 41.50%). There were clear seasonal patterns with respect to rainfall, humidity, and temperature. Rainfall and land surface temperature during the day or night did not increase the risk of snakebites in any city; however, changes in humidity increased the risk of snakebites in all cities. CONCLUSION: This study identified the population exposed to snakes and the influence of anthropic and climatic factors on the incidence of snakebites. According to climate data, changes in humidity increased the risk of snakebites.

Assessment of the Need for Dental Treatment Resulting From Dental Trauma in 12-Year-Old Brazilian Schoolchildren: A Cross-Sectional Study

Abstract Objective: To identify the need for restorative treatment in 12-year-old Brazilian schoolchildren with dental trauma and its association with clinical and socioeconomic factors. Material and Methods: A cross-sectional population-based study was carried out with sample composed of 588 12-year-old students from the city of Diamantina, Minas Gerais, Brazil. Data were collected from August to November 2016 through clinical examination, adopting the Andreasen classification and semi-structured questionnaire to verify the etiology and location of the accident that resulted in dental trauma. Statistical analysis included the frequency distribution and bi and multivariate analysis, with 5% significance level. Results: The presence of 219 traumatized teeth in 176 students was observed (29.9%). The main lesion was enamel fracture (41.4%), followed by enamel and dentin fracture (39.4%). The presence of restorative treatment was observed only in 11.5% of students. Fall (43.5%) was the most frequent etiology, followed by accidents on the streets (35.8%). Need for treatment was present in 53.4% of adolescents. Statistically significant association between males (p=0.010), severe overjet (p<0.0001) and inadequate lip protection (p<0.0001) and presence of dental trauma was observed. Maternal schooling over 8 years of study was statistically associated with need for restorative treatment (OR = 2.047; CI: 1.099-3.813; p=0.023). Conclusion: Prevalence of dental trauma, need for restorative treatment and number of adolescents with no access to restorative treatment in this study were high, point out that the health system is unable to satisfactorily prevent dental trauma and absorb all dental treatment demand resulting from dental trauma.