Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study.

BACKGROUND: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.

Decreases in beetle body size linked to climate change and warming temperatures.

Body size is a fundamental ecological trait and is correlated with population dynamics, community structure and function, and ecosystem fluxes. Laboratory data from broad taxonomic groups suggest that a widespread response to a warming world may be an overall decrease in organism body size. However, given the myriad of biotic and abiotic factors that can also influence organism body size in the wild, it is unclear whether results from these laboratory assays hold in nature. Here we use datasets spanning 30 to 100 years to examine whether the body size of wild-caught beetles has changed over time, whether body size changes are correlated with increased temperatures, and we frame these results using predictions derived from a quantitative review of laboratory responses of 22 beetle species to temperature. We found that 95% of laboratory-reared beetles decreased in size with increased rearing temperature, with larger-bodied species shrinking disproportionately more than smaller-bodied beetles. In addition, the museum datasets revealed that larger-bodied beetle species have decreased in size over time, that mean beetle body size explains much of the interspecific variation in beetle responses to temperature, and that long-term beetle size changes are explained by increases in autumn temperature and decreases in spring temperature in this region. Our data demonstrate that the relationship between body size and temperature of wild-caught beetles matches relatively well with results from laboratory studies, and that variation in this relationship is largely explained by interspecific variation in mean beetle body size. This long-term beetle dataset is one of the most comprehensive arthropod body size datasets compiled to date, it improves predictions regarding the shrinking of organisms with global climate change, and together with the meta-analysis data, call for new hypotheses to explain why larger-bodied organisms may be more sensitive to temperature.

AB2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units.

PURPOSE: To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS: This retrospective observational study included consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from September 2021 to July 2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS: From 558 patients, median age was 69 years (IQR 58-78), 56.3 % were men, 19.7 % required mechanical ventilation (MV), and 44.8 % died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95 % CI 0.744 to 0.819), good overall performance (Brier score = 0.191) and an excellent calibration (slope = 1.063, intercept = 0.015, p-value = 0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS: The AB2CO score is a fast and easy tool to be used upon ICU admission.

Application of pH-zone-refining countercurrent chromatography for the separation of indole alkaloids from Aspidosperma rigidum Rusby.

Species of Aspidosperma (Apocynaceae) are characterized by the occurrence of indole alkaloids, but few recent reports on Aspidosperma rigidum Rusby chemical constituents were found. The present work shows the application of pH-zone refining countercurrent chromatography on the separation of alkaloids from the barks of A. rigidum. In this study, the dichloromethane extract was fractionated with the solvent system composed of methyl-tert-butyl ether and water with different concentrations of the retainer triethylamine in the organic stationary phase and formic or hydrochloric acids as eluters in the aqueous mobile phase, in order to evaluate the most suitable condition. In each experiment, from circa 200mg of the dichloromethane extract of A. rigidum, three major alkaloids were isolated and identified as 3α-aricine (circa 17mg), isoreserpiline (ca. 22mg) and 3ß-reserpiline (ca. 40mg), with relative purity of 79%, 89% and 82% respectively, in a one-step separation of 2h. Two of them - 3α-aricine and isoreserpiline - were isolated and identified for the first time in this species.

Avaliação de hábitos obesogênicos em estudantes de medicina: análise do estado nutricional, físico, de ansiedade e depressão entre estudantes de uma faculdade privada do Rio de Janeiro / Evaluation of obesogenic habits in medicine students: analysis of nutritional, physical, anxiety and depression status among students at a private university in Rio de Janeiro

A obesidade é uma condição crônica caracterizada pelo acúmulo excessivo de gordura, repercutindo negativamente na saúde do indivíduo. A graduação pode impactar na vida do estudante, refletindo em mudança de hábitos e alterações psicossociais, contribuindo para o desenvolvimento de obesidade e outras comorbidades. Assim sendo, o presente trabalho avaliou o estado nutricional, físico e de ansiedade e depressão entre os alunos da Faculdade de Medicina da Universidade Estácio de Sá, RJ, por meio de um estudo clínico observacional de corte transversal pela aplicação de questionário composto por 27 itens. A mediana do IMC no 1o período foi 22 Kg/m2, sendo maior que o IMC nos períodos acima, de 23,1 Kg/m2. Não houve variação do IMC no ciclo básico. As medianas de IMC foram maiores nos homens, porém o somatório dos itens de ansiedade e depressão foram maiores tanto em mulheres quanto no ciclo clínico. Houve fraca correlação positiva entre a variação de peso nos homens e o somatório dos itens de ansiedade e depressão. Esse, porém, foi considerado insignificante para as mulheres. Não se observou hábitos obesogênicos relevantes nos estudantes. Portanto, é notável considerar a importância de uma alimentação saudável, prática de atividade física e atenção à saúde mental, bem como a realização de futuros estudos de desenho longitudinal com a proposta de melhor avaliar o peso e os hábitos dos estudantes no curso. [au]

Obesity is a chronic condition characterized by excessive accumulation of fat that negatively affects the health of the individual. The graduation can affect the student's life, which may lead to changes in habits and psychosocial alterations, contributing in the development of obesity and other comorbidities. Consequently, the present study evaluated the nutritional, physical, anxiety and depression status in students from Medical School of Universidade Estácio de Sá, RJ, performing a cross-sectional observational clinical study by applying a questionnaire consisting of 27 items. The median BMI in the first semester was 22 Kg/m2, being higher than the BMI of semesters above, of 23.1 Kg/m2. There was no change in the BMI in the basic cycle. The BMI medians were higher between men, but the sum of the anxiety and depression questions were higher in women as well as in the clinical cycle. There was also a weak positive correlation between the variation of weight in men and the sum of the anxiety and depression results, however, the same correlation was considered insignificant for women. No relevant obesogenic habits were observed in the students. Therefore, it is relevant to consider the importance of healthy eating, physical activity and attention to mental health, as well as elaborating future studies with longitudinal evaluation with the proposal to better assess the weight and habits of students throughout the course. [au]

Avaliação aprofundada da enurese e tratamento com alarme associado à uroterapia

Uma vez que atraves do uso do alarme de urina nem todas as criancas com enurese obtem os criterios definidos para o sucesso (14 noites secas consecutivas), buscou--se investigar procedimentos complementares para potencializar o seu efeito: a) o diario miccional, utilizado como um instrumento de avaliacao diagnostica da enurese e como uma medida dos efeitos de tratamentos e b) a uroterapia, que consiste de um conjunto de medidas comportamentais que tem como objetivo corrigir dificuldades provavelmente relacionadas a enurese nao corrigidas pelo uso do alarme. O diario miccional e o registro do volume de liquidos ingeridos e eliminados no periodo de dois dias pela crianca, que pode indicar, dentre outros padroes, urgencia miccional, hiperatividade detrusora, poliuria, bem como ingestao irregular de liquidos. As medidas comportamentais que compoe a uroterapia podem ser exemplificadas por: miccoes em horarios regulares; aumento da ingesta de liquidos e evitacao de irritantes vesicais. Neste estudo participaram 65 criancas e adolescentes com enurese distribuidas em dois grupos de tratamento. O primeiro grupo foi exposto a uroterapia e ao tratamento com alarme (grupo Uroterapia), enquanto o segundo grupo foi exposto somente ao tratamento com alarme (grupo Alarme). Por volta de 70% dos participantes de ambos os grupos obtiveram sucesso no tratamento, independentemente da realizacao da uroterapia. Os participantes do grupo Uroterapia apresentaram uma melhora mais acentuada no inicio do tratamento, mas esta nao se manteve como tendencia ao longo do tempo. Os participantes de ambos os grupos tiveram um aumento significativo da porcentagem da capacidade volumetrica da bexiga utilizada. Os participantes do grupo Uroterapia tiveram um aumento significativamente maior dos volumes de ingesta de liquidos e miccional

Not all children with enuresis reach 14 consecutive dry nights thought the use of the bell and pad alarm. That considered, we aimed to investigate additional procedures to enhance its success rate: a) the voiding diary, used as a diagnostic tool for evaluating enuresis and to measure overall treatments effects and b) urotherapy, consisting of a set of behavioral measures that aims at problems probably related to enuresis not corrected by the use of the bell and pad alarm. The voiding diary is a two--day record of fluid intake and micturition habits. It may indicate, among other patterns, urgency, detrusor overactivity, polyuria and irregular fluid intake. Urotherapy is composed of behavioral measures such: voiding at regular times; increased fluid intake; and avoidance of bladder irritants. 65 children and adolescents participated in this study. They were assigned to two treatment groups. The first group was exposed to urotherapy and to an alarm treatment (Urotherapy group), while the second was exposed only to an alarm treatment (Alarm group). Around 70% of participants became dry, regardless of the group they were assigned to. Participants from the Urotherapy group showed a more marked improvement early in treatment, but this trend was not maintained over time. Participants from both groups had a significant increase in the percentage of volumetric bladder capacity used and participants from the Urotherapy group had a significantly greater increase of fluid intake and voided volume

Parto normal X parto cesáreo: análise epidemiológica em duas maternidades no sul do Brasil / Normal delivery X caesarian delivery: epidemilogic analysis in two maternities in the south of Brazil

Introdução: Os índices de cesariana vêm aumentando consideravelmente nos últimos anos, mesmo com o conhecimento prévio de que o parto normal é mais seguro, tanto para a mãe, quanto para o bebê. Métodos: Em um estudo retrospectivo, foram analisados 1.479 partos ocorridos na Maternidade da Santa Casa de Misericórdia de Pelotas (SCMP) e 1.522 partos na Maternidade do Hospital São Francisco de Paula (HUFSP), no período de 01/01/2007 a 31/12/2007 e comparados com os dados obtidos em estudo anterior com o mesmo objetivo no período de 01/07/1993 a 30/06/1994. Resultados: Foi observado um incremento dos partos cesáreos nas duas instituições, com 41,1% dos partos da SCMP e 40,7% no HUSFP realizados por via alta. Houve similaridade com relação ao peso dos recém-nascidos de gestantes submetidas à via alta de parto, encontrando-se a maioria com peso entre 2.501g e 3.500g, o que foge ao preconizado pela indicação obstétrica que recomenda tal via em fetos macrossômicos diante do maior risco de desproporção cefalopélvica. Também foi observado que a maioria dos partos cesáreos foram realizados em mulheres entre 21 e 30 anos. Em comparação com os dados de 1994, observou-se que houve aumento na proporção de cesarianas em todas as categorias de peso do recém-nascido e idade materna, mas com maior prevalência nos fetos macrossômicos. Conclusão: Este estudo constatou uma incidência aumentada de partos cesáreos nas maternidades estudadas em relação ao preconizado pelo Ministério da Saúde (AU)

Introduction: The rates of caesarian surgeries have been increasing considerably in recent years, despite the awareness that normal delivery is safer both for the mother and for the infant. Methods: In a retrospective study, we evaluated 1,479 deliveries in the Santa Casa de Misericórdia of Pelotas, RS (SCMP) and 1,522 deliveries in the Hospital São Francisco de Paula, RS (HUFSP) from January 1, 2007 to December 31, 2007, which were compared to the data obtained in a previous study carried out for the same purpose from July 1, 1993 to June 30, 1994. Results: An increase in the number of caesarian sections was observed, accounting for 41.1% of the deliveries in the SCMP and for 40.7% in the HUSFP. There was similarity concerning birth weight of pregnant women submitted to caesarian sections, most of them weighing from 2,501g to 3,500g, which is out of the obstetrical recommendation of using such route for macrosomic fetuses because of the greater risk of cephalo-pelvic disproportion. Most of the caesarian deliveries were performed in women between 21 and 30 years of age. As compared to 1994 data, there was an increase in the percentage of caesarian sections in all categories of birth weight and maternal age, but with a greater prevalence in macrosomic fetuses. Conclusions: This study has found an increased incidence of caesarian surgeries in the studied hospitals as compared to what is recommended by the Ministry of Health (AU)

Colonization factors among enterotoxigenic Escherichia coli (ETEC) isolated from diarrheic children in Ouro Preto (Minas Gerais State) and Paulínia (Säo Paulo State), Brazil

Foi pesquisada a presença dos fatores de colonizaçäo CFAI, CFAII (CS1-CS) e CFAIV (CS4-CS6) em 87 amostras estudadas neste trabalho foram isoladas de casos de diarréia e crianças abaixo de 12 anos, nas regiöes de Ouro Preto (MG) e Paulínia (SP). Apenas duas amostras de Ouro Preto (2,3 por cento do total estudado), ambas capazes de produzir STa, apresentaram sorologia positiva para CFAI. Näo foram encontradas amostras com características hemaglutinantes D-manose resistente para uma ou mais das seguintes hemáceas: humanas, bovinas e de galinha