Thoracic ultrasound influences physiotherapist's clinical decision-making in respiratory management of critical care patients: a multicentre cohort study.

BACKGROUND: The potential influence of thoracic ultrasound on clinical decision-making by physiotherapists has never been studied. The aim of this study was to assess the impact of thoracic ultrasound on clinical decision-making by physiotherapists for critical care patients. METHODS: This prospective, observational multicentre study was conducted between May 2017 and November 2020 in four intensive care units in France and Australia. All hypoxemic patients consecutively admitted were enrolled. The primary outcome was the net reclassification improvement (NRI), quantifying how well the new model (physiotherapist's clinical decision-making including thoracic ultrasound) reclassifies subjects as compared with an old model (clinical assessment). Secondary outcomes were the factors associated with diagnostic concordance and physiotherapy treatment modification. RESULTS: A total of 151 patients were included in the analysis. The NRI for the modification of physiotherapist's clinical decisions was-40% (95% CI (-56 to -22%), p=0.02). Among the cases in which treatment was changed after ultrasound, 41% of changes were major (n=38). Using a multivariate analysis, the physiotherapist's confidence in their clinical diagnosis was associated with diagnostic concordance (adjusted OR=3.28 95% CI (1.30 to 8.71); p=0.014). Clinical diagnosis involving non-parenchymal conditions and clinical signs reflecting abolished lung ventilation were associated with diagnostic discordance (adjusted OR=0.06 95% CI (0.01 to 0.26), p<0.001; adjusted OR=0.26 95% CI (0.09 to 0.69), p=0.008; respectively). CONCLUSION: Thoracic ultrasound has a high impact on the clinical decision-making process by physiotherapists for critical care patients. TRIAL REGISTRATION NUMBER: NCT02881814; https://clinicaltrials.gov.

Phase Behavior of Drug-Lipid-Surfactant Ternary Systems toward Understanding the Annealing-Induced Change.

The present study systematically investigates the effect of annealing conditions and the Kolliphor P 407 content on the physicochemical and structural properties of Compritol (glyceryl behenate) and ternary systems prepared via melt cooling (Kolliphor P 407, Compritol, and a hydrophilic API) representing solid-lipid formulations. The physical properties of Compritol and the ternary systems with varying ratios of Compritol and Kolliphor P 407 were characterized using differential scanning calorimetry (DSC), small- and wide-angle X-ray scattering (SWAXS) and infrared (IR) spectroscopy, and hot-stage microscopy (HSM), before and after annealing. The change in the chemical profiles of different Compritol components as a function of annealing was evaluated using 1H NMR spectroscopy. While no change in the polymorphic form of API and Kolliphor P 407 occurred during annealing, a systematic conversion of the α- to ß-form was observed in the case of Compritol. Furthermore, the polymorphic transformation of Compritol was found to be dependent on the Kolliphor P 407 content. As per the Flory-Huggins mixing theory, higher miscibility was observed in the case of monobehenin-Kolliphor P 407, monobehenin-dibehenin, and dibehenin-tribehenin binary mixtures. The miscibility of Kolliphor P 407 with monobehenin and 1,2-dibehenin was confirmed by 1H NMR analysis. The observed higher miscibility of Kolliphor P 407 with monobehenin and 1,2-dibehenin is proposed as the trigger for the physical separation from the 1,3-diglyceride and triglycerides during melt solidification of the formulations. The phase separation is postulated as the mechanism underlying the formation of a stable ß-polymorphic form (a native form of 1,3-diglyceride) of Compritol upon annealing. This finding is expected to have an important implication for developing stable solid-lipid-surfactant-based drug formulations.

Lower urinary tract symptoms in female prison inmates: prevalence and impact on quality of life.

INTRODUCTION AND HYPOTHESIS: The objective was to estimate the prevalence and assess the impact of lower urinary tract symptoms (LUTS) on the quality of life of incarcerated women. METHODS: Cross-sectional study conducted with 307 incarcerated women from the state of Ceará, Brazil, from June to September 2018. To identify the prevalence of symptoms, an instrument was developed according to the recommendations of the International Continence Society. To assess the frequency, intensity, and impact of the identified symptoms on quality of life, the International Consultation on Incontinence Questionnaire-Short Form and King's Health Questionnaire were applied. RESULTS: The profile of the inmates was mostly young women (mean = 32.9 ± 11.8 years), Black, who had been in prison for a mean of 17.3 ± 12.0 months. Approximately half (n = 152, 49.5%) presented with storage complaints, with emphasis on urinary incontinence (n = 61, 19.9%), nocturia (n = 55, 17.9%), and urinary urgency (n = 45, 14.7%). Among the voiding symptoms (n = 71, 23.1%), dysuria (n = 39, 12.7%), and recurrent UTI (n = 44, 14.3%) were the most frequent. The complaint of incomplete bladder emptying (19.5%) was mentioned by 60 of the inmates. Sociodemographic data and environmental conditions were mainly associated with storage symptoms (p = 0.019). Women from prisons 2 and 3 presented with a greater impact on the quality of life. CONCLUSIONS: The high prevalence of LUTS in female inmates, together with unhealthy toileting behaviors within the prison units, indicate that incarceration might play a role in the occurrence of these symptoms, while also affecting quality of life. The acknowledgement and investigation of these symptoms is important for improving health care in prisons.

Knowledge, attitude, and practice instruments for urinary incontinence: A psychometric review.

AIMS: To analyze the psychometric properties of instruments measure knowledge and/or attitude and/or practice related to urinary incontinence (UI). METHODS: This review was conducted in September 2018 without restrictions regarding language and year of publication. DATA SOURCES: MEDLINE/PubMed, CINAHL, SCOPUS, PsycINFO, Web of Science, Cochrane, LILACS, and Google. The psychometric properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement INstruments and the Quality Criteria for Measurement Properties. RESULTS: A total of seven articles published between 1999 and 2018 were included. The evaluation of the psychometric properties showed that the majority of the instruments presented "excellent" or "good" methodological quality; however, the description of aspects related to the validation stages was inadequate in some studies, causing the quality of the results to be evaluated as "indeterminate" in some properties. This review cannot recommend any questionnaire without reservations; however, the Urinary Incontinence Scales and the Barriers Incontinence Care Seeking Questionnaire presented better evaluations, regarding both methodological quality and the quality of the results. CONCLUSION: This review provides a strategy to select the most suitable instrument to assess knowledge, attitude, and practice regarding UI, according to the psychometric properties, guiding their use by researchers in clinical practice.

Bioaccumulation Study of Produced Water Discharges from Southeastern Brazilian Offshore Petroleum Industry Using Feral Fishes.

The main effluent of oil and gas production is the discharge of produced water (PW). Despite the potential environmental impact, the structure of oil and gas platforms can act as artificial reefs. Two species of fish, Caranx crysos and Tylosurus acus, were captured under two discharging platforms at Campos Basin, P19 and P40. A nondischarging platform, P25, was taken as reference. The highest median concentration of PAH in muscle tissue was observed for C. Crysos at P40 (219.38 ng g-1) followed by P19 (68.26 ng g-1). For T. acus, the highest median concentrations were 40.07 and 42.21 ng g-1 from P19 and P40 respectively. P25 presented the smallest recorded concentrations. The results of PAH in the muscle tissue of C. crysos enabled to distinguish the platforms with PW discharge from the platform without discharge. Trace elements concentrations reflected the background levels and were not influenced by the PW release.

Characterization of Azorean Plant Leaves for Sustainable Valorization and Future Advanced Applications in the Food, Cosmetic, and Pharmaceutical Industries.

The historical use of plants as sources of natural compounds has persisted over time. Increasing the intake of bioactive substances shows significant potential for promoting overall well-being and health. This study delves into the pigments, phenolic composition, and profile, along with antioxidant properties, of leaf extracts rich in bioactives from plants in the Azores region, contributing to sustainable primary food production. Analyses encompassed chlorophylls, carotenoids, total phenols, ortho-diphenols, and flavonoids, as well as antioxidant capacity assessment, polyphenolic profiling, and quantification. Psidium guajava L. and Smallanthus sonchifolius (Poepp.) H.Rob. exhibited elevated chlorophyll content, while Colocasia esculenta (L.) Schott displayed the highest carotenoid levels. Annona cherimola Mill., Eriobotrya japonica (Thunb.) Lindl, and Psidium guajava L. demonstrated pronounced total phenols, ortho-diphenols, and flavonoids. These findings align with heightened antioxidant capacity. HPLC-DAD (high-performance liquid chromatography with diode-array detection) characterization unveiled elevated hydroxycinnamic acids in E. japonica and Ipomea batatas (L.) Lam. compared to A. cherimola Mill., while C. esculenta exhibited increased flavone content. Among the quantified compounds, flavonols were the ones that predominantly demonstrated contribution to the antioxidant capacity of these leaves. This research highlights Azorean leaf plants' antioxidant potential, fostering natural product development for better health.

Assessing the Clinical Impact of the SARS-CoV-2 Gamma Variant on Intensive Care Unit Admissions: Insights from a Reference Hospital in Northeastern Brazil.

The global challenge posed by the prolonged COVID-19 pandemic underscores the critical need for ongoing genomic surveillance to identify emerging variants and formulate effective public health strategies. This retrospective observational study, conducted in a reference hospital in Northeast Brazil and comprising 2116 cases, employed PCR genotyping together with epidemiological data to elucidate the impact of the Gamma variant during its emergence, revealing distinct patterns in hospitalization rates, severity of illness, and outcomes. The study emphasizes the challenges posed by the variant, particularly an increased tendency for ICU admissions and respiratory support, especially among adults aged 18 to 59 without comorbidities. Laboratory analyses further demonstrate elevated inflammatory, coagulation, and hepatic markers in the Gamma variant cohort, suggesting a more severe systemic response. Despite limitations, including a retrospective approach and single-institution data, the study underscores the importance of ongoing genomic surveillance. Overall, this research contributes valuable insights into the impact of the Gamma variant on COVID-19 dynamics, advocating for continued research and surveillance to inform effective public health strategies regarding evolving viral variants.

SARS-CoV-2 Detection via RT-PCR in Matched Saliva and Nasopharyngeal Samples Reveals High Concordance in Different Commercial Assays.

BACKGROUND: Self-collected saliva samples can increase the diagnostic efficiency and benefit healthcare workers, patient care, and infection control. This study evaluated the performance of self-collected saliva samples compared to nasopharyngeal swabs using three commercial kits for the qualitative detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: Matched nasopharyngeal and saliva samples were collected from 103 patients with either asymptomatic or symptomatic COVID-19. Both samples were evaluated using three commercial kits (TaqCheck, Allplex, and TaqPath). To evaluate sample stability, viral RNA extraction was performed in the presence or absence of an RNA-stabilizing solution. Storage conditions, including the duration, temperature, and stability after freezing and thawing of the samples, were also evaluated. RESULTS: All the saliva samples showed 100% concordance with the nasopharyngeal swab results using TaqCheck and Allplex kits, and 93% using TaqPath kit. No difference was observed in the samples that used the RNA-stabilizing solution compared to the group without the solution. The Ct values of the freeze-thawed samples after 30 days were higher than those on day 0; however, the results were consistent the fresh samples. CONCLUSION: The high concordance of SARS-CoV-2 detection via reverse transcription-polymerase chain reaction (RT-PCR) in matched saliva and nasopharyngeal samples using different commercial assays reinforces the concept that self-collected saliva samples are non-invasive, rapid, and reliable for diagnosing SARS-CoV-2 infection.

Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis.

BACKGROUND: Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear. OBJECTIVE: To investigate the effectiveness of PFMT in the prevention of perineal laceration. SEARCH STRATEGY: Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery. SELECTION CRITERIA: We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations. DATA COLLECTION AND ANALYSIS: We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R. MAIN RESULTS: Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration. CONCLUSION: Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.

The (un)shared responsibility in the reverse logistics of portable batteries: A Brazilian case.

The Brazilian National Solid Waste Policy (BNSWP) determines that reverse logistics (RL) of waste batteries is mandatory and adopts the principle of shared responsibility among stakeholders. In this work, we sought to diagnose the current state of the RL chain for batteries in Vale do Aço, Brazil, and identify challenges and potentialities related to its improvement. Data were obtained by means of questionnaires sent to the main stakeholders involved in the batteries RL chain and by consultation of official Brazilian databases. The results showed that the main obstacles to the implementation of the RL of portable batteries in the region are: the lack of information by consumers and retailers regarding the BNSWP and management of waste batteries; the existence of few collection and consolidation points in the region; lack of municipal waste management plans; and lack of sustainability of waste picker organizations. The identified potentialities were: the good receptivity of environmental education actions by the population; the possibility of taking advantage of direct logistics of local retail chains to collect waste; the existence of a special waste management and transportation company in the region; and the existence of waste picker organizations interested in integrating the RL system. Finally, by a SWOT analysis, strategies for the implementation of a more effective RL system were drawn up. This work can serve as a basis for the structuring and implementation of the batteries RL system at the Metropolitan Region of Vale do Aço (MRVA) and can be a reference for other settings.

Are home-based exercises effective to reduce blood pressure in hypertensive adults? A systematic review.

Sedentarism and chronic non-communicable diseases have been a worldwide health problem that is drastically exacerbated by the COVID-19 pandemic social impacts. Home-based exercises are widely encouraged during social isolation to counterbalance the physical inactive impacts. Although, in the context of hypertension, are home-based exercises effective in blood pressure controlling? Our objective is to conduct a systematic review of high-quality controlled trials comparing the possible effects of different types of home-based exercises in hypertensive patients. The literature search was carried out in three scientific databases: Medline, Europe PMC, and Lilacs. Articles were included following three criteria: analyzing the effect of home-based exercise programs on blood pressure in treated and untreated hypertensive patients; exercises must perform at home and on the frequency, intensity, time, and type (FITT) principle, and the articles were published in English. From the qualitative analysis of 27 original trials screened through 451 identified studies, the main results are the following: 1) both endurance, isometric strength, and respiratory home-based exercise programs were efficient to decrease blood pressure in hypertensive patients; 2) differences in methodological approaches regarding FITT components, distinct blood pressure values at baseline and specific underlying mechanisms must be considered as a potential bias of each home-based interventions. In conclusion, endurance, isometric strength, and breathing home-based programs seems to be effective to reduce blood pressure in hypertensive patients. However, further randomized controlled trials and mechanistic studies must be performing to guide evidence-based recommendations of home-based exercises as antihypertensive therapy.

Complete chloroplast genomes and phylogeny in three Euterpe palms (E. edulis, E. oleracea and E. precatoria) from different Brazilian biomes.

The Brazilian palm fruits and hearts-of-palm of Euterpe edulis, E. oleracea and E. precatoria are an important source for agro-industrial production, due to overexploitation, conservation strategies are required to maintain genetic diversity. Chloroplast genomes have conserved sequences, which are useful to explore evolutionary questions. Besides the plastid DNA, genome skimming allows the identification of other genomic resources, such as single nucleotide polymorphisms (SNPs), providing information about the genetic diversity of species. We sequenced the chloroplast genome and identified gene content in the three Euterpe species. We performed comparative analyses, described the polymorphisms among the chloroplast genome sequences (repeats, indels and SNPs) and performed a phylogenomic inference based on 55 palm species chloroplast genomes. Finally, using the remaining data from genome skimming, the nuclear and mitochondrial reads, we identified SNPs and estimated the genetic diversity among these Euterpe species. The Euterpe chloroplast genomes varied from 159,232 to 159,275 bp and presented a conserved quadripartite structure with high synteny with other palms. In a pairwise comparison, we found a greater number of insertions/deletions (indels = 93 and 103) and SNPs (284 and 254) between E. edulis/E. oleracea and E. edulis/E. precatoria when compared to E. oleracea/E. precatoria (58 indels and 114 SNPs). Also, the phylogeny indicated a closer relationship between E. oleracea/E. precatoria. The nuclear and mitochondrial genome analyses identified 1,077 SNPs and high divergence among species (FST = 0.77), especially between E. edulis and E. precatoria (FST = 0.86). These results showed that, despite the few structural differences among the chloroplast genomes of these Euterpe palms, a differentiation between E. edulis and the other Euterpe species can be identified by point mutations. This study not only brings new knowledge about the evolution of Euterpe chloroplast genomes, but also these new resources open the way for future phylogenomic inferences and comparative analyses within Arecaceae.

Effect of the ingestion of vegetable oils associated with energy-restricted normofat diet on intestinal microbiota and permeability in overweight women.

Previous studies suggest that the type of dietary fatty acid may modulate the intestinal bacterial ecosystem. However, this effect is still inconclusive. Thus, the aim of this study was to investigate the effect of the intake of vegetable oils rich in different types of fatty acids, associated with energy-restricted normofat diets, on the composition of intestinal microbiota and permeability, on LPS concentrations, and fecal short chain fatty acids and pH. This was a 9 consecutive weeks (±5 days), randomized, parallel, double-blind clinical trial. Overweight women received daily breakfast containing 25 mL of one of the test oils: soybean oil (n = 17), extra virgin olive oil (n = 19) or coconut oil (n = 16). Blood, fecal and urine samples were collected on the first and last day of the experiment for the analysis of the variables of interest. The consumption of the three oils did not affect the diversity and relative abundance of intestinal bacteria. We observed an increase in bacterial richness estimated by the Chao 1 index, and a reduction in the concentration of isovaleric fatty acid in the group that ingested soybean oil. Paracellular and transcellular permeability increased after the ingestion of extra virgin olive oil and coconut oil. However, LPS concentrations remained unchanged. The intake of different types of fatty acids associated with the energy-restricted normofat diet modestly affected the intestinal microbiota and permeability, without resulting in metabolic endotoxemia in overweight women.

SARS-CoV-2 variant of concern P.1 (Gamma) infection in young and middle-aged patients admitted to the intensive care units of a single hospital in Salvador, Northeast Brazil, February 2021.

OBJECTIVES: To evaluate changes in the characteristics of patients with coronavirus disease 2019 (COVID-19) after the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant of concern (VOC) P.1 (Gamma), by comparing the clinical, demographic, and laboratory profiles of patients hospitalized during the first (May to July 2020) and second (December 2020 to February 2021) pandemic waves. METHODS: Data were collected from the records of COVID-19 patients (n = 4164) admitted to a single hospital in Salvador, Northeast Brazil. SARS-CoV-2 genome sequencing was performed on nasopharyngeal swab samples from 12 patients aged <60 years admitted to the intensive care unit (ICU) in February 2021. RESULTS: Between June 2020 and February 2021, the median age of patients admitted to the ICU decreased from 66 to 58 years (P < 0.05). This was accompanied by an increased proportion of patients without comorbidities (15.32% vs 32.20%, P < 0.0001). A significant reduction in the cycle threshold values of SARS-CoV-2 RT-PCR tests was observed in the second wave (P < 0.0001). Sequencing analysis detected lineage Gamma in all 12 ICU patients sampled in February 2021. CONCLUSIONS: The results of this study demonstrated an increased proportion of younger adults without comorbidities with severe disease during the second COVID-19 wave, shortly after the confirmation of local Gamma circulation.

Novel approach for overcoming the stability challenges of lipid-based excipients. Part 2: Application of polyglycerol esters of fatty acids as hot melt coating excipients.

The application of hot melt coating (HMC) as an economic and solvent-free technology is restricted in pharmaceutical development, due to the instable solid-state of HMC excipients resulting in drug release instability. We have previously introduced polyglycerol esters of fatty acids (PGFAs) with stable solid-state (Part 1). In this work we showed a novel application of PGFAs as HMC excipients with stable performance. Three PGFA compounds with a HLB range of 5.1-6.2 were selected for developing immediate-release formulations. The HMC properties were investigated. The viscosity of molten lipids at 100 °C was suitable for atomizing. The DSC data showed the absence of low solidification fractions, thus reduced risk of agglomeration during the coating process. The driving force for crystallization of selected compounds was lower and the heat flow exotherms were broader compared to conventional HMC formulations, indicating a lower energy barrier for nucleation and lower crystallization rate. Lower spray rates and a process temperature close to solidification temperature were desired to provide homogeneous coating. DSC and X-ray diffraction data revealed stable solid state during 6 months storage at 40 °C. API release was directly proportional to HLB and indirectly proportional to crystalline network density and was stable during investigated 3 months. Cytotoxicity was assessed by dehydrogenase activity and no in vitro cytotoxic effect was observed.

Internações na infância por doenças do aparelho respiratório no Brasil de 2013 a 2022 / Hospitalizaciones infantiles por enfermedades del sistema respiratorio en Brasil de 2013 a 2022 / Hospitalizations during childhood due to respiratory system diseases in Brazil from 2013 to 2022

Introdução: As doenças do sistema respiratório se mostram como uma das causas mais preocupantes de internações hospitalares no país. Nessa perspectiva, o perfil das internações por doenças respiratórias em crianças permite observar os parâmetros desta problemática, fornecendo um conhecimento amplo acerca do processo saúde e doença nessa população. Objetivo: Analisar o perfil epidemiológico das internações hospitalares por causas do aparelho respiratório em crianças de 0 a 9 anos no Brasil e regiões, entre os anos de 2013 e 2022. Metodologia: Trata-se de um estudo ecológico, realizado no Brasil, a partir de dados secundários do Sistema de Informações Hospitalares. A população escolhida para este estudo foram crianças de 0 a 9 anos deidade. Os dados foram coletados em 26 de novembro de 2022. As variáveis dependentes do estudo são as internações de crianças de 0 a 9 anos por doenças do aparelho respiratório no Brasil e suas regiões. Já, como variáveis independentes, tem-se o tempo, do período de janeiro de 2013 a setembro de 2022, regiões e faixa etária. Resultados: Há uma tendência de queda das internações por causa respiratória até o ano de 2016, seguido de um crescimento gradativo até 2019. Entretanto, em 2020, a taxa de hospitalização reduziu drasticamente em todas as localidades. As regiões Sul, Norte e Centro-Oeste permaneceram com taxas maiores que o Brasil em todo o período estudado. A internação em menores de 1 ano representa o maior quantitativo de internações sendo a pneumonia a causa mais prevalente. Conclusões: As taxas de internação infantil por doenças respiratórias representam importante preocupação para saúde pública. Assim, destaca-se a relevância da efetividade da Atenção Primária à Saúde, que possui grande impacto no desfecho dos adoecimentos em crianças, especialmente das doenças respiratórias (AU).

Introduction: Respiratory system diseases are one of the most worrying causes of hospital admissions in the country. From this perspective, the profile of hospitalizations for respiratory diseases in children allows us to notice the parameters of this problem, providing a broad understanding of the health and disease process in this population.Objective: To analyze the epidemiological profile of hospital admissions due to respiratory causes in children aged 0 to 9 in Brazil and its regions between 2013 and 2022. Methodology: This is an ecological study held in Brazil using secondary data from the Hospital Information System. The population chosen for this study consisted of children aged 0 to 9. Data were collected on November 26, 2022. The dependent variables of this study are hospitalizations of children aged 0 to 9 due to respiratory diseases in Brazil and its regions. The independent variables are time, from January 2013 to September 2022, regions, and age group.Results: There was a downward trend in hospitalizations due to respiratory causes until 2016, followed by a gradual increase until 2019. Nonetheless, in 2020, the hospitalization rate fell dramatically in all locations. The South, North and Mid-West regions remained with higher rates than Brazil throughout the studied period. Hospitalization of children under 1 year old represents the largest number of admissions, with pneumonia being Revista Ciência Plural. 2024; 10(1): e31414 3the most prevalent cause.Conclusions: Hospitalization rates during childhood due to respiratory diseases represent a major public health concern. Thus, one can highlight the importance of the effectiveness of Primary Health Care, which has a major impact on the outcome of illnesses in children, especially respiratory diseases (AU).

Introducción: Las enfermedades del sistema respiratorio son una de lascausas más preocupantes de hospitalizaciones en el país. Desde esta perspectiva, el perfil de hospitalizaciones por enfermedades respiratorias en niños permite observar los parámetros de este problema, proporcionando una amplia comprensión del proceso de salud y enfermedad en esta población.Objetivo: Analizar el perfil epidemiológico de las internaciones por causas respiratorias en niños de 0 a 9 años en Brasil y sus regiones entre 2013 y 2022. Metodología: Se trata de un estudio ecológico conducido en Brasil a partir de datos secundarios del Sistema de Información Hospitalaria. La población elegida para este estudio fueron los niños de 0 a 9 años. Los datos se recogieron el 26 de noviembre de 2022. Las variables dependientes del estudio son las hospitalizaciones de niños de 0 a 9 años por enfermedades respiratorias en Brasil y sus regiones. Las variables independientes son el tiempo, de enero de 2013 a septiembre de 2022, las regiones y la franja etaria.Resultados: Se nota una tendencia a la baja de las hospitalizaciones por causas respiratorias hasta 2016, seguida de un aumento gradual hasta 2019. Sin embargo, en 2020, la tasa de hospitalización cayó drásticamente en todas las localidades. Las regiones Sur, Norte y Medio Oeste se mantuvieron con tasas másaltas que Brasil durante todo el período estudiado. Las hospitalizaciones en niños menores de 1 año representan el mayor número de internaciones, siendo la neumonía la causa más prevalente.Conclusiones: Las tasas de hospitalización infantil por enfermedades respiratorias representan un importante problema de salud pública. Así, se subraya la importancia de la eficacia de la Atención Primaria de Salud, que tiene un gran impacto en el resultado de las enfermedades en los niños, especialmente las respiratorias (AU).

Rating organ failure via adverse events using data mining in the intensive care unit.

OBJECTIVE: The main intensive care unit (ICU) goal is to avoid or reverse the organ failure process by adopting a timely intervention. Within this context, early identification of organ impairment is a key issue. The sequential organ failure assessment (SOFA) is an expert-driven score that is widely used in European ICUs to quantify organ disorder. This work proposes a complementary data-driven approach based on adverse events, defined from commonly monitored biometrics. The aim is to study the impact of these events when predicting the risk of ICU organ failure. MATERIALS AND METHODS: A large database was considered, with a total of 25,215 daily records taken from 4425 patients and 42 European ICUs. The input variables include the case mix (i.e. age, diagnosis, admission type and admission from) and adverse events defined from four bedside physiologic variables (i.e. systolic blood pressure, heart rate, pulse oximeter oxygen saturation and urine output). The output target is the organ status (i.e. normal, dysfunction or failure) of six organ systems (respiratory, coagulation, hepatic, cardiovascular, neurological and renal), as measured by the SOFA score. Two data mining (DM) methods were compared: multinomial logistic regression (MLR) and artificial neural networks (ANNs). These methods were tested in the R statistical environment, using 20 runs of a 5-fold cross-validation scheme. The area under the receiver operator characteristic (ROC) curve and Brier score were used as the discrimination and calibration measures. RESULTS: The best performance was obtained by the ANNs, outperforming the MLR in both discrimination and calibration criteria. The ANNs obtained an average (over all organs) area under the ROC curve of 64, 69 and 74% and Brier scores of 0.18, 0.16 and 0.09 for the dysfunction, normal and failure organ conditions, respectively. In particular, very good results were achieved when predicting renal failure (ROC curve area of 76% and Brier score of 0.06). CONCLUSION: Adverse events, taken from bedside monitored data, are important intermediate outcomes, contributing to a timely recognition of organ dysfunction and failure during ICU length of stay. The obtained results show that it is possible to use DM methods to get knowledge from easy obtainable data, thus making room for the development of intelligent clinical alarm monitoring.

Mortality assessment in intensive care units via adverse events using artificial neural networks.

OBJECTIVE: This work presents a novel approach for the prediction of mortality in intensive care units (ICUs) based on the use of adverse events, which are defined from four bedside alarms, and artificial neural networks (ANNs). This approach is compared with two logistic regression (LR) models: the prognostic model used in most of the European ICUs, based on the simplified acute physiology score (SAPS II), and a LR that uses the same input variables of the ANN model. MATERIALS AND METHODS: A large dataset was considered, encompassing forty two ICUs of nine European countries. The recorded features of each patient include the final outcome, the case mix (e.g. age) and the intermediate outcomes, defined as the daily averages of the out of range values of four biometrics (e.g. heart rate). The SAPS II score requires 17 static variables (e.g. serum sodium), which are collected within the first day of the patient's admission. A nonlinear least squares method was used to calibrate the LR models while the ANNs are made up of multilayer perceptrons trained by the RPROP algorithm. A total of 13,164 adult patients were randomly divided into training (66%) and test (33%) sets. The two methods were evaluated in terms of receiver operator characteristic (ROC) curves. RESULTS: The event based models predicted the outcome more accurately than the currently used SAPS II model (P<0.05), with ROC areas within the ranges 83.9-87.1% (ANN) and 82.6-85.2% (LR) versus 80% (LR SAPS II). When using the same inputs, the ANNs outperform the LR (improvement of 1.3-2%). CONCLUSION: Better prognostic models can be achieved by adopting low cost and real-time intermediate outcomes rather than static data.

Myocardial bridging: retrospective analysis and scintigraphic testing of patients with no angiographically significant atherosclerotic coronary disease.

INTRODUCTION AND OBJECTIVE: The clinical relevance of myocardial bridging (MB) is a matter of debate. The objective of this work was to examine its prevalence, clinical presentation, prognosis, and functional features on scintigraphy in a group of patients with no significant atherosclerotic coronary disease. METHODS: We retrospectively examined 7039 consecutive cardiac angiograms performed between January 1994 and December 2004, selecting cases in which MB was not accompanied by significant coronary disease (defined as luminal stenosis > 50%), valvular heart disease or cardiomyopathy. Patient characteristics such as age, gender, vascular risk factors and clinical presentation were recorded. We then contacted these patients by telephone to determine cardiovascular events since diagnosis (hospitalization, infarction, death) or symptoms of angina, and to invite them for myocardial perfusion scintigraphy (MPS) with stress testing. RESULTS: The prevalence of MB was 0.97% (68 patients). The study population without significant coronary disease, valvular heart disease or cardiomyopathy was composed of 31 subjects, mean age 51.45 +/- 13.77 years, 94% (29 patients) male. Clinical presentations were: non-ST elevation acute coronary syndromes with or without biomarkers of necrosis 34% (14 patients), stable angina 23% (7 patients), atypical chest pain 16% (5 patients), ST-elevation myocardial infarction 13% (4 patients), other 3% (1 patient). Left ventricular function was normal in all patients, and angiography showed MB of the left anterior descending artery, 63% (19 patients) in the mid portion, and 33% (12 patients) in the distal portion. All subjects were treated medically. We were able to contact 24 (77%) of the 31 patients, all of whom underwent MPS; mean time since angiography was 61.25 months, with no cardiovascular events (hospitalization, infarction, death) or symptomatic angina. MPS only identified three patients with findings consistent with anterior wall ischemia. CONCLUSIONS: In this series, 58% of the patients with MB and no significant atherosclerotic coronary disease presented with acute coronary syndromes. In all the subjects contacted, the prognosis had been good during the time since diagnosis. In the majority of them, no signs of ischemia were detected on MPS.

Noncompaction of ventricular myocardium.

Noncompaction of ventricular myocardium is a rare cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium; its true prevalence is still uncertain. A strong association between noncompaction and neuromuscular disorders has been described. Its major clinical manifestations are heart failure, arrhythmias and systemic embolic events. Diagnosis of noncompaction of ventricular myocardium can be made by conventional two-dimensional and color Doppler echocardiography. Recently contrast echocardiography has been used to provide a definitive diagnosis in most cases in which conventional echocardiography could not do so. We describe the case of a patient with clinical suspicion of noncompaction of ventricular myocardium established by conventional two-dimensional and color Doppler echocardiography and definitive diagnosis, as well as additional information, obtained by cardiac magnetic resonance imaging. We also discuss the difficulties in defining the therapeutic approach.