Breaking-Up Sedentary Behavior and Detraining Effects on Glycemic Control: A Randomized Crossover Trial in Trained Older Adults.

In a randomized crossover trial, we examined the effects of interrupting sedentary behavior on glycemic control in trained older adults, before and after 2 weeks of detraining. Fourteen participants (65-90 years old) completed two 7-hr conditions before and after 2 weeks of detraining: (a) uninterrupted sitting (SIT) and (b) sitting plus 2 min of moderate-intensity activity every 30 min (INT). Both before and after detraining, no differences were observed for 7-hr glucose area under the curve (7 hr AUC) and mean glucose between sitting plus 2 min of moderate-intensity activity and uninterrupted sitting conditions. After detraining and for the SIT condition, higher values of 7-hr AUC (p = .014) and mean glucose (p = .015) were observed, indicating worsened glycemic control. No changes were observed in INT condition between both time points. Frequent interruptions in sedentary behavior had no effect on glycemic control, prior to or after detraining. Even so, older adults experiencing a short-term detraining period should avoid prolonged bouts of sedentary behavior that may jeopardize their glycemic control.

Dynamic Ex Vivo Porcine Eye Model to Measure Ophthalmic Drug Penetration under Simulated Lacrimal Flow.

Animal models are still used in the research and development of ophthalmic drug products, mainly due to the difficulty in simulating natural physiological conditions with in vitro models, as there is a lack of dynamic protection mechanisms. Therefore, developing alternative ophthalmic models that evaluate drug penetration in the cornea while applying dynamic protection barriers is a contemporary challenge. This study aimed to develop a dynamic ex vivo model using porcine eyes with a simulated lacrimal flow to evaluate the performance of pharmaceutical drug products. A glass donor cell to support a simulated tear flow was designed, optimized, and custom-made. The system was challenged with different formulations (with fluconazole) including excipients with different viscosities (poloxamer 407) and mucoadhesive properties (chitosan). The results were compared to those obtained from a conventional excised cornea model mounted in Franz-type diffusion cells. The dynamic model could differentiate formulations, while the static model did not, overestimating ex vivo drug penetrated amounts. Hence, the dynamic model with simulated tear flow showed to be a simple and promising new alternative method for the drug penetration of ophthalmic formulations that ultimately can reduce the number of animals used in research.

The impact of 2 weeks of detraining on phase angle, BIVA patterns, and muscle strength in trained older adults.

BACKGROUND: An intermission in the training routine, in which older adults refrain from regular structured exercise, may have deleterious effects on muscle performance and bioelectric phase angle (PhA), which is a predictive marker for cellular integrity. PURPOSE: To determine the effects of a 2-week detraining period on PhA and muscular strength (MS) in trained older adults. METHODS: A total of 14 trained older adults (6 females) aged ≥65 years (77.2 ± 6.6) were assessed at baseline (i.e. trained condition) and after 2 weeks of detraining, where they refrained from their usual participation in structured exercise sessions. Whole-body resistance (R), reactance (Xc), and PhA were assessed using bioelectrical impedance analysis (BIA, single frequency, 50 kHz ± 1%, NutriLab, Akern). MS was assessed on both lower and upper limbs under isometric conditions. Differences between moments were examined using ANOVA for repeated measures, while adjusting for sex. Bioimpedance vector analysis (BIVA) was performed to evaluate changes in cellular function and body fluid content. RESULTS: Detraining resulted in declines in PhA (-4.34%) (p = 0.017). There was a significant difference in the mean impedance vectors from baseline to post-detraining (p < 0.05), which were driven by decreases in reactance (Xc) relative to height (Xc/H) with little change in resistance (R) relative to height (R/H) for both males and females. No differences were found in MS for both the leg press (p = 0.992) and bench press (p = 0.166) tests. CONCLUSION: A detraining period as short as 2-weeks is enough to cause alterations in the bodies bioelectrical properties, resulting in detrimental changes in PhA, due to alterations in cellular integrity, but not in MS. These results highlight the importance of maintaining structured exercise sessions in older adults, and reinforce the potential role of PhA as a sensitive predictor to detect acute changes in muscle cell integrity following alterations in exercise training.

Nosocomial infections in Brazilian pediatric patients: using a decision tree to identify high mortality groups.

Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were: invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified: one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.

Nosocomial infections in brazilian pediatric patients: using a decision tree to identify high mortality groups

Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were: invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified: one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.

Ciência, medicina e sociedade: a tarefa de mudar o rumo / Science, medicine and society: the task of changing directions

O século XX trouxe a perspectiva da revolução tecnológica. O computador tornou o mundo pequeno e aumentou o acesso às informações. No entanto, apesar das tecnologias sofisticadas, persiste o desafio básico das doenças infecciosas e da melhoria das condições sanitárias. Os microrganismos driblam o homem no jogo pela vida ao desenvolverem mecanismos engenhosos de defesa, capazes de resistirem à ação dos antimicrobianos de última geração. A revolução pasteuriana foi um turning-point na história da medicina. Se a época anterior a Pasteur desconhecia a teoria infecciosa das doenças e valorizava tão somente o ambiente ou teoria miasmática; a revolução bacteriana da segunda metade do século XIX revelou as causas microbiológicas das doenças e como preveni-Ias. No entanto, urge um novo turning-point qual seja, o resgate da perspectiva trazida pela epidemiologia a partir desse século: a interação existente entre o homem e o seu meio ambiente, dentro de uma visão integral e valorativa das tríades: "pessoas-tempo-lugar" e "agente-hospedeiro-ambiente". As comissões de controle de infecções hospitalares são agentes inovadores e atraem a intolerância dos que resistem ao novo. De forma inter e multiprofissional, atuam em educação continuada de toda a equipe de saúde e de leigos, em medidas preventivas, criando perspectivas para a construção do conhecimento e compartilhando a possibilidade de educar através de diversas metodologias.

The 20th century have brought a technological revolution. The computer turned out the world into a very small one and has enlarged our access to information. Besides the sophisticated technology, there is still the basic challenge of the infectious diseases and the need for improving the sanitary conditions. Microbes have been dribbling human beings during the game for life as they develop intricate mechanisms of resistance, capable of overcoming the action of last generation antibiotics. The Bacteriological Revolution that Pasteur had brought was a turning point in the history of medicine. Before Pasteur's era, the infectious theory of diseases was unknown and only the miasmatic theory and the environment were taken into consideration; The Bacteriological Revolution of the second half of the nineteenth century brought into found out the microbiological causes of diseases and how to prevent them. It is high time for a new turning point that is to bring back the perspective of this century epidemiology: the interaction between human populations and the environment from a whole point of view that values the tripods "time-place-persons" and "agent-host-environment". The nosocomial infection committees are agents of changes and attract the intolerance of those who oppose to the new. They act on continuous education for the whole health team and for the community, on preventive measures, engendering perspectives to build the knowledge and sharing the possibility to educate by means of several methodologies.

Esforço conjunto para melhoria de qualidade em hospital público pediátrico brasileiro através do controle de infecçäo hospitalar / Joint effort to improve quality in a Brazilian pediatric public hospital through cross-infection control

Objetivo: Verificar o papel do laboratório de microbiologia no controle de infecçöes hospitalares ao longo do período de janeiro de 1993 a dezembro de 1996 no Centro Geral de Pediatria da Fundaçäo Hospitalar do Estado de Minas Gerais. Métodos: Seguimento de 101.139 pacientes-dia (11.147 saídas = altas - óbitos + transferências) das unidade de internaçäo e de tratamento intensivo através da metodologia do National Nosoco-Control (CDC) de Atlanta - EUA, através de seus componentes global (desde 1992) e de Unidade de Tratamento Intensivo (desde 1996), exercida através de busca-ativa e prospectiva de infecçöes hospitalares em todos os sítios, segundo critérios diagnósticos e definiçöes do CDC e Portaria 930 do Ministério da Saúde Brasileiro, de 1992. Resultados: Os cindo agentes etiológicos mais freqüentes (de um total de 139 isolados de infecçöes hospitalares) foram Klebsiella sp=24,5 por cento; S. aureus = 18 por cento; P. aeruginosa = 13,7 por cento; E. coli = 12,9 por cento; S. epidermidis = 12,2 por cento. A porcentagem de identificaçäo de patógenos isolados de sítios topográficos de infecçöes hospitalares aumentou de 6,2 por cento em 1993 para 13,3 por cento em 95 e 28,2 por cento em 96 (p < 0,001). A porcentagem de identificaçäo do germe aumentou de 7,5 por cento em 93 para 16,1 por cento em 95 e 33,8 por cento em 96 (p <0,001). O intervalo de tempo da coleta do material até o resultado microbiológico declinou de média de dez dias em 1993 para seis dias em 96 (p = 0,001). Conclusöes: A educaçäo continuada e a melhoria de comunicaçäo entre a comissäo de controle de infecçöes hospitalares, pediatras, cirurgiöes e membros do laboratório têm exercido um papel importante na determinaçäo do perfil etiológico das infecçöes hospitalares no Centro Geral de Pediatria. A necessidade de um esforço conjunto para se determinar a etiologia microbiológica dessas infecçöes está sendo cada vez mais incorporadas por todos. A metodologia NNIS para controle de infecçöes hospitalares aplicada a hospitais brasileiros traduz seu impacto também no laboratório de microbiologia