Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis.

Objective: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection: Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect: We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis: Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion: Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO: CRD42023449655.

Physical and Muscular Performance in a Professional Soccer Player with a Posterior Cruciate Ligament Injury Following an Isokinetic Exercise Program: A Case Report.

Background and Purpose: The comprehensive treatment for an athlete who sustains a complete posterior cruciate ligament (PCL) injury remains unclear. The purpose of this case report is to describe the effects of an isokinetic exercise program on muscle performance and physical function in a professional soccer player with a PCL injury. Study Design: Case Report. Case Description: A 23-year-old male professional soccer player injured his right knee (non-dominant) during a soccer match, with magnetic resonance imaging confirming a complete PCL rupture. The athlete completed 23 sessions of isokinetic treatment over nine weeks to improve physical function and muscle performance. The concentric mode was used to evaluate quadriceps and hamstrings performance isokinetically at angular velocities of 60 °/s, 120 °/s, and 300 °/s. The LEFS questionnaire was used to evaluate physical function. The assessment occurred before starting the treatment and at the end of nine weeks. An athlete with similar anthropometric characteristics was invited to participate and serve as a control, in order to better understand the athlete's assessment results. Outcomes: After nine weeks, peak torque normalized to body mass (PT/BM) improved to 4.0 N.m/kg for knee extensors (control: 3.6 Nm/kg) and 2.3 N.m/kg for knee flexors (control: 1.9 Nm/kg) at 60 °/s. This increase in PT was reflected in the hamstrings-to-quadriceps (H:Q) ratio post-treatment (57 %). At the end of treatment, the athlete returned to sports activities with 98.7 % restored physical function as measured by the LEFS (Score: 79 points). Discussion: The results demonstrated that the isokinetic treatment improved knee functional capacity, with increased PT/BM for knee extensors and flexors and enhanced torque-holding capacity, indicating improved muscle performance. Level of evidence: 5.

Subterranean fauna associated with mesovoid shallow substratum in canga formations from southeastern Brazil: invertebrate biodiversity of a highly threatened ecosystem.

Iron Formations (IF) are threatened by mining, particularly the Mesovoid Shallow Substratum (MSS), an understudied subterranean environment. We evaluate the spatiotemporal patterns of subterranean fauna in MSS of iron duricrust (canga) in the Iron Quadrangle and Southern Espinhaço Range, southeastern Brazil. Samplings took place between July 2014 and June 2022 using five trap types. We sampled 108,005 individuals, 1,054 morphospecies, and seven phyla, globally the largest dataset on MSS in IF. Arthropoda represented 97% of all invertebrates sampled. We identified 31 troglomorphic organisms, primarily Arthropoda and Platyhelminthes. MSS traps were the most efficient method, capturing 80% of all invertebrates. Morphospecies were more prevalent in each locality than shared among localities. Species replacement was the main processes to spatial differences. Over time, we found a decrease of total dissimilarity and importance of species replacement for troglomorphic organisms. A positive correlation between spatial distance and compositional dissimilarity of invertebrates was found. Iron Quadrangle and Southern Espinhaço Range showed marked differences in the spatiotemporal patterns of subterranean fauna. Brazilian IF are threatened, with their biological significance not fully understood but highly endangered due their limited distribution. Conservation efforts require a comprehensive understanding of both biotic and abiotic factors shaping the entire IF ecosystem.

Características epidemiológicas e obstétricas de mulheres com abortamento recorrente e fatores de risco / Epidemiological and obstetric characteristics of women with recurrent miscarriage and risk factors / Características epidemiológicas y obstétricas de mujeres con aborto espontáneo recurrente y factores de riesgo

Apesar de ser uma complicação recorrente em gestações, o abortamento pode gerar consequências bastante danosas à saúde física e mental da gestante, bem como de seu parceiro, especialmente em casos de abortamento recorrente. Este trabalho objetivou revisar as principais características epidemiológicas e fatores de risco descritos em relação ao abortamento recorrente. A respeito da metodologia, foi realizada uma revisão sistemática da bibliografia, tendo como foco os trabalhos que possuíssem os descritores "aborto", "recorrente" e "epidemiologia". Os artigos selecionados foram publicados entre os anos de 2016 e 2023, em português ou inglês. Em nossa pesquisa, observamos que a etiologia dos abortamentos é bastante diversa, incluindo fatores desconhecidos. É válido ressaltar que quanto maior o número de abortos espontâneos recorrentes antecedentes, maior parece ser a chance de nova perda de gestação. Não obstante, existem diferenças regionais determinantes para as etiologias e fatores de risco, sendo necessário compreender qual a causa do abortamento recorrente para que haja tratamento efetivo.

Despite being a recurrent complication in pregnancies, abortions can lead to harmful consequences for the physical and psychological health of the pregnant woman, as well as her partner's, especially in cases of recurrent miscarriage. This article aimed to review the main epidemiological characteristics and risk factors described in relation to recurrent miscarriage. About the methodology, it was developed a systematic review of pre-existing bibliography, focusing on papers that had the descriptors "abortion", "recurrent" and "epidemiology". The selected works were published between the years of 2016 and 2023, in Portuguese or English. In our research, we noticed that the etiology of miscarriages is quite diverse, including unknown factors. It is important to note that the higher the historical number of recurrent spontaneous miscarriages, the greater seems to be the chance of new pregnancy loss. However, there are regional differences that determine etiologies and risk factors. It is essential to understand what is causing the recurrent miscarriage in order to offer effective treatment.

A pesar de ser una complicación recurrente en los embarazos, el aborto puede tener consecuencias perjudiciales para la salud física y mental de la mujer embarazada, así como para su pareja, especialmente en casos de aborto recurrente. Este trabajo tuvo como objetivo revisar las principales características epidemiológicas y factores de riesgo descritos en relación con el aborto recurrente. En cuanto a la metodologia, se realizó una revisión sistemática de la bibliografía, centrándose en los trabajos que tenían los descriptores "aborto", "recurrente" y "epidemiología". Los artículos seleccionados se publicaron entre los años 2016 y 2023, en portugués o inglés. En nuestra investigación observamos que la etiología de los abortos es muy diversa, incluyendo factores desconocidos. Es válido destacar que a mayor número de abortos espontáneos recurrentes previos, parece aumentar la probabilidad de una nueva pérdida del embarazo. Sin embargo, existen diferencias regionales determinantes en las etiologías y factores de riesgo, siendo necesario comprender la causa del aborto recurrente para un tratamiento efectivo.

Transient radiation-induced severe obstructive sleep apnea.

Radiotherapy for head and neck cancer can trigger or worsen obstructive sleep apnea (OSA) due to factors such as neurological impairment, muscle atrophy, edema, and xerostomia. We present a case in which a patient developed severe OSA three months after undergoing radiochemotherapy and neck dissection for squamous cell carcinoma of the right lingual tonsil with regional metastasis. Polysomnography confirmed severe OSA. Unfortunately, the patient did not adhere to the recommended treatment. The symptoms persisted for six months but then, unexpectedly, resolved completely. A follow-up polysomnography conducted one year after radiotherapy showed no evidence of OSA. This case suggests that a recent diagnosis of OSA following head and neck radiotherapy may not be permanent and should not necessarily lead to a lifelong prognosis of sleep-related breathing disorders.

Visual Acuity Thresholds in Preterm Newborns: An Experimental Study.

Purpose: Visual acuity plays a role in mediating neurological development in infants by enabling the differentiation of shapes and discriminating objects. Given the rapid structural development of the brain in the first days of life, this aspect is particularly significant for preterm infants, who typically experience this developmental phase while hospitalized in the neonatal intensive care unit (NICU). Therefore, this study aimed to assess visual acuity thresholds in preterm infants during hospitalization and to evaluate possible correlations between visual acuity and clinical parameters. Methods: A cross-sectional study was conducted in an NICU in Northeast Brazil. The visual acuity thresholds were tested using the Teller Acuity Cards II, comprised of 17 gray cards, with one 4 mm diameter peephole at the center and presented with about 35% reflectance. Preterm infants were positioned supine, at 30° elevation on the laps of their caregivers. The evaluator presented both sides of the cards and observed the eye fixation and reactions on both sides. Results: A total of 42 preterm infants with corrected gestational age between 30 to 36 weeks and 6 days were included. Visual acuity ranged from 0.23 to 0.64 cycle per degree. The mean visual acuity threshold was 0.32 cycles per degree for preterm infants at around 32 weeks of corrected gestational age. The visual acuity was not correlated with gestational age (p = 0.18), and neither were birth weight (p = 0.83) or duration of respiratory support (p = 0.98). However, days of phototherapy were inversely correlated with visual acuity (p = 0.04). Conclusions: Despite the challenges of hospitalization, it was possible to carry out a psychophysical test to assess visual acuity in preterm infants. The visual acuity showed no correlation with clinical parameters such as gestational age, birth weight, and duration of respiratory support. However, there was an inverse correlation between the number of days in phototherapy and visual acuity. Understanding the visual acuity levels in preterm infants during their NICU stay can contribute to tailoring interventions and care strategies that specifically address their visual developmental needs. This knowledge may guide healthcare professionals in optimizing the NICU environment to provide appropriate visual stimuli that support neurological development.

Predictive factors for cranioplasty complications - A decade's experience.

Introduction: Cranioplasty (CP) following craniectomy provides cerebral protection, improves cerebrospinal fluid dynamics, and restores cosmesis. Although often viewed as minor, CP can have major complications. Research question: This study aims to identify the predictive factors for post-operative complications in patients undergoing CP after decompressive craniectomy. Methods: We conducted a retrospective study at a tertiary hospital, analyzing patients who underwent CP after decompressive craniectomy (DC) from 2008 to 2019. Patient demographics, medical history, and surgery details were retrieved from hospital records. Complications included symptomatic intracerebral haemorrhage, extradural or subdural haemorrhage, hydrocephalus, infection, or bone resorption. Results: The study included 168 patients: 139 adults (mean age 47.6 ± 12.68 years) and 29 pediatric patients (mean age 11.8 ± 5.62 years), with a slight male predominance. The overall complication rate was 26.2%, with infection being the most common (8.9%). Predictive factors for CP complications identified by binomial logistic regression, controlling for age and sex, included primary coagulopathy (14.3-fold risk increase, p = 0.034), intraoperative ventricular puncture (7.9-fold risk increase, p = 0.009), and intraoperative dural layer breach (2.8-fold risk increase, p = 0.033). Pre-CP home living was a protective factor. Conclusions: CP requires vigilant management to prevent complications. Primary coagulopathy, intraoperative ventricular puncture, and dural layer breach are significant risk factors for complications.

Symbolic information approach applied to human intracranial data to characterize and distinguish different congnitive processes.

How the human brain processes information during different cognitive tasks is one of the greatest questions in contemporary neuroscience. Understanding the statistical properties of brain signals during specific activities is one promising way to address this question. Here we analyze freely available data from implanted electrocorticography (ECoG) in five human subjects during two different cognitive tasks in the light of information theory quantifiers ideas. We employ a symbolic information approach to determine the probability distribution function associated with the time series from different cortical areas. Then we utilize these probabilities to calculate the associated Shannon entropy and a statistical complexity measure based on the disequilibrium between the actual time series and one with a uniform probability distribution function. We show that an Euclidian distance in the complexity-entropy plane and an asymmetry index for complexity are useful for comparing the two conditions. We show that our method can distinguish visual search epochs from blank screen intervals in different electrodes and patients. By using a multiscale approach and embedding time delays to downsample the data, we find important timescales in which the relevant information is being processed. We also determine cortical regions and time intervals along the 2-s-long trials that present more pronounced differences between the two cognitive tasks. Finally, we show that the method is useful to distinguish cognitive processes using brain activity on a trial-by-trial basis.

Advancements in understanding the mechanisms of lung-kidney crosstalk.

This narrative review delves into the intricate interplay between the lungs and the kidneys, with a focus on elucidating the pathogenesis of diseases influenced by immunological factors, acid-base regulation, and blood gas disturbances, as well as assessing the effects of various therapeutic modalities on these interactions. Key disorders, such as anti-glomerular basement membrane (anti-GBM) disease, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and Anti-neutrophil Cytoplasmic Antibodies (ANCA) associated vasculitis (AAV), are also examined to shed light on their underlying mechanisms. This review also explores the relationship between acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), emphasizing how inflammatory mediators can lead to systemic damage and impact multiple organs. In ARDS, fluid overload exacerbates pulmonary edema, while imbalances in blood volume, such as hypovolemia or hypervolemia, can precipitate renal dysfunction. The review highlights how mechanical ventilation strategies can compromise renal blood flow, trigger systemic inflammation, and induce hemodynamic and neurohormonal alterations, all contributing to lung and kidney damage. The impact of extracorporeal membrane oxygenation (ECMO) on lung-kidney interactions is evaluated, highlighting its role in severe respiratory failure and its renal implications. Emerging therapies, such as mesenchymal stem cells and extracellular vesicles, are discussed as promising avenues to mitigate organ damage and enhance outcomes in critically ill patients. Overall, this review offers a nuanced exploration of lung-kidney dynamics, bridging historical insights with contemporary perspectives. It underscores the clinical significance of these interactions in critically ill patients and advocates for integrated management approaches to optimize patient outcomes.

Sedentary behavior and self-harm in adolescents with asthma, rhinitis and eczema.

OBJECTIVE: To investigate the association between allergic diseases and the tendency to self-harm in adolescents, considering the role of sedentary behavior. METHODS: This was a population-based cross-sectional study, carried out in 2022, with 727 adolescents aged 12 to 19 years, from a capital in the Northeast of Brazil. The authors evaluated the association between each allergic disease (asthma, rhinitis and eczema) and self-harm, sedentary behavior and other variables. The authors performed an adjusted analysis of the associations between each allergy disease and the tendency to self-harm and then adjusted to the presence of family members and sedentary behavior. RESULTS: The prevalence of asthma, rhinitis and eczema were 18.76%, 36.21% and 12.86%, respectively. Sedentary behavior and tendency to self-harm were more frequently reported in asthmatics (PR 2.16; 95% CI: 1.55 - 3.00 and PR 1.98; 95% CI: 1.47 - 2.68, for sedentary behavior and self-harm respectively), rhinitis (PR 1.53; 95% CI: 1.25 - 1.88 and PR 1.33; 95% CI: 1.09 - 1.62, respectively) and eczema (PR 2.35; 95% CI: 1.54 - 3.58 and PR 1.55; 95% CI: 1.05 - 2.28, respectively). There was a reduction in the strength of this association in the three conditions, which included a loss of association. CONCLUSION: High rates of sedentary behavior and self-harm in those with asthma, rhinitis and eczema. Physical activity attenuated the risk for self-harm. It warns about the urgency in detecting these factors, whether in the diagnosis or in the implementation of therapy, seeking to reduce their harmful consequences in the short and long term.

Ocular pharmacokinetics of acetazolamide from intravitreal implants by high-performance liquid chromatography coupled to tandem mass spectrometry.

Glaucoma, a leading cause of irreversible blindness, affects about 70 million people globally. Its treatment focuses on reducing intraocular pressure. Acetazolamide, a potent anti-glaucoma drug, is currently used only systemically due to low solubility and permeation, which cause severe side effects. Developing topical medications with acetazolamide requires robust analytical methods for its detection in biological samples. In this context, this study aimed to develop a method to quantify acetazolamide in rabbit vitreous humor samples. The method involved a simple, fast, inexpensive, and environmentally friendly protein precipitation step for sample preparation, needing just 50 µL of sample and 200 µL of organic solvent, with adequate recovery. This was combined with high-performance liquid chromatography coupled to tandem mass spectrometry, enabling highly sensitive (LOQ of 5 ng/mL) quantification within only 5 min. The method proved to be selective, precise, and accurate, with well-fitted analytical curves, with no carryover, and no matrix effect impacting reliability. The method was successfully applied to analyze vitreous humor samples from rabbits in pharmacokinetic studies, monitoring drug release from intravitreal implants. Results showed a controlled release profile, with a maximum drug concentration (Cmax) of 426.01 ± 64.57 ng/mL, time to reach Cmax (Tmax) of 28 days, and area under the curve (AUC0-42 and AUC0-∞) of 7722.66 ± 1125.96 ng days/mL and 8998.11 ± 1311.92 ng days/mL, respectively. The device demonstrated significantly slower elimination, ensuring therapeutic levels for an extended period when compared to intravitreal injection.

Association of colchicine use with cardiovascular and limb events in peripheral artery disease: Insights from a retrospective cohort study.

BACKGROUND AND AIMS: Colchicine has demonstrated efficacy in treating coronary artery disease, but its efficacy in peripheral artery disease (PAD) remains uncertain. This study aims to address this gap in knowledge. METHODS: A retrospective cohort study was conducted using the TriNetX Network, selecting patients with lower limb PAD between January 1, 2011, and January 1, 2024. Colchicine users were matched 1:1 with non-users through propensity score matching, considering demographics, medical conditions, medications, and psychosocial factors. The primary outcome was a composite of major adverse cardiovascular and limb events (MACLE) - including lower limb amputation, revascularization for lower limb ischemia, acute myocardial infarction, ischemic stroke, and all-cause mortality - over a ten-year follow-up. RESULTS: From 53,568 colchicine-treated and 1,499,969 untreated patients with lower limb PAD, 52,350 pairs were successfully matched. Over ten years, colchicine was associated with a significant reduction in MACLE (hazard ratio, [HR] 0.90, 95% CI 0.88-0.92, p < 0.001), any lower limb amputation (HR 0.84, 95% CI 0.75-0.94, p = 0.002), revascularization for lower limb ischemia (HR 0.85, 95% CI 0.82-0.88, p < 0.001), major adverse cardiovascular events (HR 0.93, 95% CI 0.91-0.95, p < 0.001), and all-cause mortality (HR 0.90, 95% CI 0.87-0.92, p < 0.001). It also result in a reduced risk of ischemic stroke (HR 0.95, 95% CI 0.92-0.98, p = 0.001), but not of acute myocardial infarction (HR 0.98, 95% CI 0.95-1.01, p = 0.24). CONCLUSIONS: Colchicine significantly reduced major adverse cardiovascular and limb events in patients with lower limb PAD, supporting the need for further investigation.

Diathermy Versus Scalpel in Midline Abdominal Incision: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Our study aimed to compare the midline abdominal incision with scalpel and diathermy. METHODS: PubMed, EMBASE, and Cochrane were searched through January 2024 following PRISMA guidelines (PROSPERO, ID: CRD42024516771), and only randomized controlled trials were included. Heterogeneity was assessed using Cochran's Q test and the I2 heterogeneity index. Statistical analysis was performed using Review Manager 5.4 software. RESULTS: Six randomized controlled trials were included, from which 469 patients (51.5%) received diathermy incision and 442 patients (48.5%) underwent the scalpel technique. Patients treated with the electrocautery approach had less incision blood loss (MD -17.57 mL; P < .01). No statistically significant differences were found between groups regarding wound infection incidence, incision time, incision area or first-day postoperative pain. CONCLUSION: Diathermy use in midline abdominal incision may be advocated as it demonstrated a significant reduction in incision-related blood loss, with no differences in wound infection or early postoperative pain incidences compared to the scalpel.

Endoscopic submucosal dissection vs. endoscopic mucosal resection in the treatment of early Barrett's neoplasia: Systematic review and meta-analysis.

OBJECTIVES: Endoscopic resection is the preferred approach to treat early Barrett's neoplasia, reducing the need for surgical interventions. However, the best choice between endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) remains unclear. The study aimed to compare the efficacy and safety of EMR vs. ESD for early Barrett's neoplasia. METHODS: An electronic search was conducted in MEDLINE, Central Cochrane, EMBASE, and LILACS until November 2023. Studies comparing ESD vs. EMR in the treatment of patients with early Barrett's neoplasia were included. This study was performed according to the Preferred Report Items for Systematic Reviews and Meta-Analyses guidelines. The ROBIN-I tool was used to analyze the risk of bias and GRADE to measure the quality of the evidence. RESULTS: A total of 9352 patients from 15 observational studies were included. Patients undergoing ESD had significantly higher rates of en-bloc (odds ratio [OR] 25.96, 95% confidence interval [CI] 13.82, 48.74; I2 = 52%; P < 0.00001) and R0 (OR 5.10, 95% CI 3.29, 7.91; I2 = 73%; P < 0.00001) with a higher risk of adverse events, including bleeding, stricture formation, and perforation. In a subgroup analysis of patients who did not receive radiofrequency ablation, ESD had a lower recurrence rate than EMR (OR 0.22, 95% CI 0.05, 0.94; I2 = 88%; P = 0.04). CONCLUSION: Endoscopic submucosal dissection is more effective than EMR in treating early Barrett's neoplasia at the expense of higher adverse events rates.

Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade / More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

Resumo Fundamento Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. Objetivo Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. Métodos Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. Resultados Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). Conclusões Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

Invisibilidades das Práticas Integrativas e Complementares na Atenção Primária à Saúde / The Invisibility of Integrative and Complementary Practices in Primary Healthcare

Resumo A invisibilidade é uma questão que necessita de maior atenção entre os profissionais de saúde, pois algumas atividades na Atenção Primária passam despercebidas. Um exemplo é a oferta de terapias complementares, cuja implementação tem sido frágil e, consequentemente, pode ser invisibilizada no Sistema Único de Saúde. Este estudo visa compreender os fatores que contribuem para a invisibilidade pública das Práticas Integrativas e Complementares na Atenção Primária. Trata-se de uma pesquisa descritiva, exploratória e qualitativa, envolvendo entrevistas semiestruturadas com 20 profissionais na Região Metropolitana de Goiânia. A análise de conteúdo temática foi aplicada às entrevistas, revelando elementos que indicam a invisibilidade pública dessas práticas, como a falta de discussão nas reuniões de equipe, a desuniformidade no registro nos prontuários dos usuários e a baixa priorização na implementação. Nas entrevistas, a humilhação social, produto da invisibilidade pública, também pode ser percebida devido à sobrecarga, constrangimentos e falta de espaço físico para a oferta das práticas aos usuários. Conclui-se que as Práticas Integrativas e Complementares são frequentemente invisibilizadas na Atenção Primária.

Abstract Invisibility is an issue that requires more attention among healthcare professionals, as some activities in Primary Care go unnoticed. One example is the offer of complementary therapies, whose implementation has been frail and, consequently, can be overlooked in the Unified Health System. This study aims to understand the factors contributing to the public invisibility of Integrative and Complementary Practices in Primary Care. It is a descriptive, exploratory, and qualitative research involving semi-structured interviews with 20 professionals in the Metropolitan Region of Goiânia. Thematic content analysis was applied to the interviews, revealing elements indicating the public invisibility of these practices, such as insufficient discussion in team meetings, inconsistency in the recording in user files, and low prioritization in implementation. In the interviews, social humiliation, a product of public invisibility, can also be perceived due to overload, embarrassments, and lack of physical space for the provision of practices to the users. It is concluded that Integrative and Complementary Practices are often overlooked in Primary Care.

Restrictive Versus Liberal Transfusion in Patients with Type 1 or Type 2 Myocardial Infarction: A Prespecified Analysis of the Myocardial Ischemia and Transfusion (MINT) Trial.

BACKGROUND: The MINT trial raised concern for harm from a restrictive versus liberal transfusion strategy in patients with acute myocardial infarction (MI) and anemia. Type 1 and type 2 MI are distinct pathophysiological entities that may respond differently to blood transfusion. This analysis sought to determine if the effects of transfusion varied among patients with a type 1 or a type 2 MI and anemia. We hypothesized that the liberal transfusion strategy would be of greater benefit in type 2 than in type 1 MI. METHODS: We compared rates of death or MI at 30 days in patients with type 1 (n=1460) and type 2 (n=1955) MI and anemia who were randomly allocated to a restrictive (threshold of 7 to 8 g/dL) or a liberal (threshold of 10 g/dL) transfusion strategy. RESULTS: The primary outcome of death or MI was observed in 16% of type 1 MI and 15.4% of type 2 MI patients. The rate of death or MI was higher in patients with type 1 MI randomized to a restrictive (18.2%) versus liberal (13.2%) transfusion strategy (RR 1.32, 95% CI 1.04 - 1.67) with no difference observed between the restrictive (15.8% ) and liberal (15.1% ) transfusion strategies in patients with type 2 MI (RR 1.05 95% CI 0.85-1.29). The test for a differential effect of transfusion strategy by MI type was not statistically significant (P-interaction = 0.16). CONCLUSIONS: The concern for harm with a restrictive transfusion strategy in patients with acute MI and anemia raised in the MINT primary outcome manuscript may be more apparent in patients with type 1 than type 2 MI. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02981407.

Diffusion tensor metrics, motor and non-motor symptoms in de novo Parkinson's disease.

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative disorder characterized by dopaminergic neurons' degeneration of the substantia nigra, presenting with motor and non-motor symptoms. We hypothesized that altered diffusion metrics are associated with clinical symptoms in de novo PD patients. METHODS: Fractional Anisotropy (FA) and Mean (MD), Axial (AD), and Radial Diffusivity (RD) were assessed in 55 de novo PD patients (58.62 ± 9.85 years, 37 men) and 55 age-matched healthy controls (59.92 ± 11.25 years, 34 men). Diffusion-weighted images and clinical variables were collected from the Parkinson's Progression Markers Initiative study. Tract-based spatial statistics were used to identify white matter (WM) changes, and fiber tracts were localized using the JHU-WM tractography atlas. Motor and non-motor symptoms were evaluated in patients. RESULTS: We observed higher FA values and lower RD values in patients than controls in various fiber tracts (p-TFCE < 0.05). No significant MD or AD difference was observed between groups. Diffusion metrics of several regions significantly correlated with non-motor (state and trait anxiety and daytime sleepiness) and axial motor symptoms in the de novo PD group. No correlations were observed between diffusion metrics and other clinical symptoms evaluated. CONCLUSION: Our findings suggest microstructural changes in de novo PD fiber tracts; however, limited associations with clinical symptoms reveal the complexity of PD pathology. They may contribute to understanding the neurobiological changes underlying PD and have implications for developing targeted interventions. However, further longitudinal research with larger cohorts and consideration of confounding factors are necessary to elucidate the underlying mechanisms of these diffusion alterations in de novo PD.

Temporal trends in female firearm homicides across states in the Northeast of Brazil during the period 2000-2019. / Tendência temporal da mortalidade por homicídios femininos por arma de fogo nos estados da região Nordeste do Brasil no período 2000-2019.

This article aims to analyze temporal trends in female firearm homicides in the Northeast of Brazil during the period 2000-2019. We conducted an ecological study using data on firearm homicides of women aged 10 years and over obtained from the Mortality Information System. The population data were taken from the 2010 Census. Homicide rates were calculated after correcting the data to account for differences in the quality and coverage of death records. Trends were assessed using negative binomial regression and described using relative risk and p values. Average annual percentage changes in homicide rates were also calculated. The regional firearm homicide rate during the study period was 4.40 per 100,000 women. Rates were highest in the state of Alagoas (5.40), the 15-19 age group (5.84) and in public thoroughfares (1.58). Trends were upward across all states except Pernambuco, where they were downward, and Alagoas, where rates were stationary. The place of occurrence with the highest percentage increase in firearm homicides over the study period was public thoroughfares. Female firearm homicides showed an upward trend across most northeastern states.

O objetivo deste artigo é analisar a tendência temporal dos homicídios femininos perpetrados por arma de fogo nos estados nordestinos, no período de 2000 a 2019. Estudo ecológico, com dados de homicídios por arma de fogo em mulheres com 10 ou mais anos, registrados no Sistema de Informação Sobre Mortalidade. Os dados de mortalidade e os dados populacionais foram obtidos junto ao Departamento de Informática do Sistema Único de Saúde. Após a correção dos registros de óbito para qualidade e cobertura dos óbitos, as taxas de mortalidade foram calculadas Tendências foram avaliadas por regressão binomial negativa, classificadas de acordo com o valor do risco relativo e valor de p. Calculou-se a variação percentual anual média das taxas de mortalidade. A região apresentou 4,40 homicídios por arma de fogo por 100 mil mulheres no período do estudo, maiores coeficientes em Alagoas (5,40), na faixa etária de 15-19 anos (5,84), e via pública (1,58). As tendências foram ascendentes, com exceção de Pernambuco em que foi descendente, e estacionárias em Alagoas. Os homicídios por arma de fogo em via pública apresentaram maior percentual de aumento no período estudado. Observou-se tendência ascendente nos homicídios femininos perpetrados por arma de fogo na maioria dos estados nordestinos.

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement. / Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade.

BACKGROUND: Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. OBJECTIVE: To compare adjusted hospital outcomes between men and women undergoing CABG. METHODS: From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. RESULTS: After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). CONCLUSIONS: Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

FUNDAMENTO: Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. OBJETIVO: Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. MÉTODOS: Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. RESULTADOS: Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). CONCLUSÕES: Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.