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Introduction: Cicatricial alopecia (CA) poses a challenge for dermatologists due to irreversible hair follicle damage. While pharmacological treatments offer limited efficacy, surgical interventions aim to improve aesthetic outcomes. This article explores the serial excision technique (SET) as a viable option for stable cases of inflammatory CA. Case Report/Case Presentation: Three adult females with different forms of CA underwent staged surgeries to correct CA patches. Procedures included different incision and closure methods based on individual characteristics such as age, type and extent of alopecia, location, and tissue mobility in the scarred area. Discussion: CA significantly impacts patients' quality of life, demanding comprehensive treatment approaches. SET emerges as an encouraging possibility for stable cases, providing notable cosmetic improvements and enhancing patients' well-being. This technique offers cost-effective benefits with potential standalone efficacy or in combination with hair transplantation, providing promising outcomes for individuals with CA.
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Células Gigantes , Hepatite , Humanos , Masculino , Células Gigantes/patologia , Hepatite/etiologia , Hepatite/diagnóstico , Adulto JovemRESUMO
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, being the third most commonly diagnosed malignancy and the second leading cause of cancer-related deaths globally. Despite the progress in screening, early diagnosis, and treatment, approximately 20%-25% of CRC patients still present with metastatic disease at the time of their initial diagnosis. Furthermore, the burden of disease is still expected to increase, especially in individuals younger than 50 years old, among whom early-onset CRC incidence has been increasing. Screening and early detection are pivotal to improve CRC-related outcomes. It is well established that CRC screening not only reduces incidence, but also decreases deaths from CRC. Diverse screening strategies have proven effective in decreasing both CRC incidence and mortality, though variations in efficacy have been reported across the literature. However, uncertainties persist regarding the optimal screening method, age intervals and periodicity. Moreover, adherence to CRC screening remains globally low. In recent years, emerging technologies, notably artificial intelligence, and non-invasive biomarkers, have been developed to overcome these barriers. However, controversy exists over the actual impact of some of the new discoveries on CRC-related outcomes and how to effectively integrate them into daily practice. In this review, we aim to cover the current evidence surrounding CRC screening. We will further critically assess novel approaches under investigation, in an effort to differentiate promising innovations from mere novelties.
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A 23-year-old male from Brazil presented with bright red hematochezia. Proctological examination revealed grade II internal hemorrhoids, but flexible sigmoidoscopy uncovered a 6 mm-pedunculated polyp in the sigmoid colon, which was found to result from inflammatory reaction to Schistosoma mansoni egg deposition. The patient had no signs of portal hypertension and was successfully treated with praziquantel. This case underscores a rare presentation of chronic intestinal schistosomiasis and emphasizes the role of early diagnosis in preventing severe hepatic sequelae of chronic Schistosoma infection.
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Resumo O presente estudo teve como objetivo comparar os fatores associados à multimorbidade em idosos de 60 a 69 anos, em 2010 e 2021. Trata-se de um estudo transversal comparativo, composto por dois estudos transversais. Ambas as coletas de dados foram realizadas de forma individual por entrevistadores treinados e deu-se por inquérito domiciliar, no município de Coxilha-RS, Brasil. Utilizou-se para análise inferencial bivariada, exato de Fisher e qui-quadrado, e multivariada o teste de regressão de Poisson com variância robusta com nível de significância de p 0,05. Detectou-se que a prevalência de multimorbidade teve uma diminuição significativa, passando de 66,5% em 2010, para 41,6% em 2021. Ser dependente para atividades básicas e instrumentais da vida diária associou-se a maior prevalência para a multimorbidade no ano de 2010, contudo no ano de 2021 o ser dependente para atividades instrumentais, não saber ler/escrever e não trabalhar apresentou maior prevalência para a multimorbidade. Por fim, concluise que as condições de saúde dos idosos diferiram significativamente apontando que os cuidados de saúde também precisam ser reavaliados para tornarem-se mais efetivos
Abstract The present study aimed to compare the factors associated with multimorbidity in older adults aged 60 to 69 years, in 2010 and 2021. This is a comparative cross-sectional study, comprised of other two cross-sectional studies. Both data collections were individually conducted by trained interviewers through household surveys in the municipality of Coxilha-RS, Brazil. Bivariate inferential analysis was conducted using Fisher's exact test and chi-square test, while multivariate analysis employed Poisson regression with robust variance with a significance level of p 0.05. It was observed that the prevalence of multimorbidity significantly decreased, decreasing from 66.5% in 2010 to 41.6% in 2021. Dependency for basic and instrumental activities of daily living was associated with higher prevalence of multimorbidity in the year 2010. However, in 2021, being dependent on instrumental activities, being unable to read/write, and being unemployed showed higher prevalence for multimorbidity. In conclusion, it is evident that the health conditions of older adults differed significantly over the years, highlighting the necessity for a reevaluation of healthcare practices to become more effective
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Humanos , Idoso , Idoso , Atividades Cotidianas , Atenção à Saúde , Qualidade de Vida , Sub-Registro , EscolaridadeRESUMO
BACKGROUND: Polypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years. METHODS: This was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals. RESULTS: The incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093-1.267). CONCLUSIONS: The incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.
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Polimedicação , Atenção Primária à Saúde , Idoso , Humanos , Estudos Longitudinais , Incidência , Brasil/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
Introdução: no Brasil, é possível identificar mudanças nas práticas alimentares nas últimas décadas, alimentos tradicionais como arroz e feijão perderam a importância e foram substituídos por alimentos prontos para o consumo. Objetivo: diante disso, o objetivo do estudo foi avaliar as práticas alimentares de professores da rede municipal de educação de Passo Fundo, RS. Metodologia: foi realizado um estudo transversal com professores de ambos os sexos da rede municipal de educação. Os professores foram convidados a participar do estudo por meio de correio eletrônico da prefeitura municipal. A coleta de dados foi mediante formulário eletrônico com questões sobre condições sociodemográficas, saúde e práticas alimentares Resultados: foram avaliados 108 professores, a média de idade foi de 42,81 anos (DP=8,85) e 95,4% eram mulheres. Em relação às práticas alimentares, observou-se que 68,7% (n=71) apresentaram práticas alimentares satisfatórias, sendo que a média de pontuação foi de 45,46 (DP=8,33). Conclusão: apesar do elevado percentual de práticas alimentares excelentes, observa-se práticas alimentares inadequadas que podem contribuir para a ocorrência de excesso de peso ao longo do tempo.
Introduction: in Brazil, it is possible to identify changes in eating practices in recent decades, traditional foods such as rice and beans have lost importance and have been replaced by ready-to-eat foods. Objective: therefore, the objective of the study was to evaluate the eating habits of teachers from the public education system of Passo Fundo, RS. Methodology: a cross-sectional study was carried out with male and female teachers from the municipal public education system. Teachers were invited to participate in the study via e-mail from the municipal government. Data were collected using an electronic form with questions about sociodemographic conditions, health and eating practices. Results: 108 teachers were evaluated; the average age was 42.81 years (SD=8.85) and 95.4% were women. Regarding eating practices, it was observed that 68.7% (n=71) had satisfactory eating practices, with an average score of 45.46 (SD=8.33). Conclusion: despite the high percentage of excellent eating practices, it was be observed that inadequate eating practices can contribute to the occurrence of excess weight over time.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dieta , Comportamento Alimentar , Estudos Epidemiológicos , Estudos TransversaisRESUMO
The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for approximately 6.8 million deaths worldwide, threatening more than 753 million individuals. People with severe coronavirus disease-2019 (COVID-19) infection often exhibit an immunosuppression condition, resulting in greater chances of developing co-infections with bacteria and fungi, including opportunistic yeasts belonging to the Saccharomyces and Candida genera. In the present work, we have reported the case of a 75-year-old woman admitted at a Brazilian university hospital with an arterial ulcer in the left foot, which was being prepared for surgical amputation. The patient presented other underlying diseases and presented positive tests for COVID-19 prior to hospitalization. She received antimicrobial treatment, but her general condition worsened quickly, leading to death by septic shock after 4 days of hospitalization. Blood samples collected on the day she died were positive for yeast-like organisms, which were later identified as Saccharomyces cerevisiae by both biochemical and molecular methods. The fungal strain exhibited low minimal inhibitory concentration values for the antifungal agents tested (amphotericin B, 5-flucytosine, caspofungin, fluconazole and voriconazole), and it was able to produce important virulence factors, such as extracellular bioactive molecules (e.g., aspartic peptidase, phospholipase, esterase, phytase, catalase, hemolysin and siderophore) and biofilm. Despite the activity against planktonic cells, the antifungals were not able to impact the mature biofilm parameters (biomass and viability). Additionally, the S. cerevisiae strain caused the death of Tenebrio molitor larvae, depending on the fungal inoculum, and larvae immunosuppression with corticosteroids increased the larvae mortality rate. In conclusion, the present study highlighted the emergence of S. cerevisiae as an opportunistic fungal pathogen in immunosuppressed patients presenting several severe comorbidities, including COVID-19 infection.
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A 27-year-old Nepalese male presented with recurrent abdominal pain accompanied by a lower stool consistency over the past 2 years. These episodes occurred several times a year, lasting 1 to 2 weeks, and resolved spontaneously, after adjustment of diet and/or medication for symptomatic control (e.g., antispasmodics, probiotics). Over the last year, the patient had undergone an extensive diagnostic investigation, which revealed no alterations in the laboratory workup, abdominal scan, esophagogastroduodenoscopy, and colonoscopy, including biopsies of the duodenum, and colon, so the symptoms have been attributed to irritable bowel syndrome. However, the symptoms had become more frequent, so the patient was referred to our gastroenterology department. We repeated and extended the work-up. Laboratory investigations showed an elevated erythrocyte sedimentation rate and faecal calprotectin. The remaining laboratory as well an extensive stool workup for infection were unremarkable. Esophagogastroduodenoscopy and ileocolonoscopy were normal. Small bowel capsule endoscopy revealed jejunal mucosa with lymphangiectasias, pseudopolypoids formations and superficial longitudinal ulcers, these findings were corroborated by the double-balloon enteroscopy, and biopsies showed marked architectural distortion, chronic inflammatory infiltrate, and an epithelioid granuloma. The clinical, endoscopic, biochemical, and histological findings were consistent with isolated jejunal Crohn's disease. The patient started adalimumab with complete remission after one year. We present this case given its exuberant endoscopic findings and due to the difficulty in making the diagnosis due to its rarity, location, and unspecific presentation.
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Este ensaio propõe que a Covid-19 pode operar como um analisador, dentro da perspectiva da análise institucional, iluminando um determinado modo de organização social que promove profundas desigualdades e ameaça a vida em diversos níveis e revelando as condições sociais, institucionais e políticas de produção de sofrimento no corpo profissional de Enfermagem. A pandemia desvelou um conjunto de marcas relacionadas à profissão, agravadas pela crise sanitária, reforçando a naturalização das relações de cuidado atribuídas ao feminino, bem como um conjunto de clivagens e hierarquias internas à profissão a partir da sinergia de marcadores da diferença, como gênero, cor/raça, classe e geração. Além disso, este trabalho mostra a presença de uma necropolítica nas respostas à pandemia que banaliza a vida e permite morrer determinados grupos sociais. A ideia de "profissionais de linha de frente" é criticada em suas metáforas bélicas, mas tomada como figura de linguagem em sua potência para afirmar que existem corpos que, pelas marcas sociais e históricas e pela interdependência do cuidado, são mais presentes e exigidos e, portanto, mais vulneráveis à doença e ao sofrimento dela decorrente.(AU)
The essay proposes that Covid-19 can operate as an analyzer, within the perspective of institutional analysis, illuminating a certain mode of social organization that promotes profound inequalities and threatens life at various levels, revealing the social, institutional and political conditions for the production of suffering in the professional nursing body. The pandemic would unveil a set of marks related to the profession, aggravated by the sanitary crisis, reinforcing the naturalization of the care relations attributed to the feminine, as well as a set of cleavages and internal hierarchies to the profession from the synergy of markers of difference as gender, color/race, class and generation. The work shows the presence of necropolitics in responses to the pandemic, which trivializes life and allows certain social groups to die. The idea of "front-line professionals" is criticized in its war metaphors, but taken as a figure of speech in its potency to affirm that there are bodies that by social and historical marks, and by the interdependence of care, are more present and demanded, and therefore more vulnerable to disease and the resulting suffering.(AU)
El ensayo propone que el Covid-19 puede funcionar como analizador, desde la perspectiva del análisis institucional, revelando las condiciones sociales, institucionales y políticas de producción de sufrimiento de enfermeras. La pandemia revela algunas marcas relacionadas con la profesión, agravadas por la crisis de salud, reforzando la naturalización de la atribución del cuidado a lo femenino y un conjunto de jerarquías internas de la profesión. El trabajo también muestra la presencia de una necropolítica en las respuestas a la pandemia. La idea de "profesionales de primera línea" es criticada, pero tomada como una figura del lenguaje en su potencia para afirmar que hay cuerpos que, por las marcas sociales e históricas y por la interdependencia del cuidado, están más presentes y demandados, y por lo tanto más vulnerables a la enfermedad.(AU)
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Humanos , Feminino , Enfermagem , Angústia Psicológica , Identidade de Gênero , Autoteste , COVID-19 , Oxigenoterapia , Dor , Equipe de Assistência ao Paciente , Alta do Paciente , Pacientes , Política , Atenção Primária à Saúde , Psicologia , Garantia da Qualidade dos Cuidados de Saúde , Qualidade de Vida , Relações Raciais , Salários e Benefícios , Mudança Social , Isolamento Social , Ciências Sociais , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos , Mulheres Trabalhadoras , Comportamento e Mecanismos Comportamentais , Características da População , Teoria de Enfermagem , Riscos Ocupacionais , Esgotamento Profissional , Viroses , Vacinas , Pesquisa em Enfermagem , Acidentes de Trabalho , Portador Sadio , Saúde Mental , Mortalidade , Modelos de Enfermagem , Saúde Ocupacional , Carga de Trabalho , Autonomia Profissional , Assistência de Longa Duração , Qualidade, Acesso e Avaliação da Assistência à Saúde , Programas de Imunização , Transmissão de Doença Infecciosa , Continuidade da Assistência ao Paciente , Feminismo , Cuidados Críticos , Vulnerabilidade a Desastres , Risco à Saúde Humana , Acesso à Informação , Atenção à Saúde , Poluição do Ar , Economia e Organizações de Saúde , Emergências , Emprego , Meio Ambiente e Saúde Pública , Funções Essenciais da Saúde Pública , Disparidades nos Níveis de Saúde , Ética Profissional , Vigilância em Saúde do Trabalhador , Programa de Prevenção de Riscos no Ambiente de Trabalho , Efeitos da Contaminação do Ar , Enfermagem Baseada em Evidências , Medo , Remuneração , Intervenção Médica Precoce , Medicalização , Assistência Ambulatorial , Equipamento de Proteção Individual , Sistemas de Apoio Psicossocial , Estresse Ocupacional , Esgotamento Psicológico , Assistência ao Paciente , Sobrecarga do Cuidador , Modelos Biopsicossociais , Teste Sorológico para COVID-19 , Equidade de Gênero , Desenvolvimento de Vacinas , Recursos Comunitários , Enquadramento Interseccional , Racismo Sistêmico , Vulnerabilidade Social , Crise Humanitária , Condições de Trabalho , Síndrome de COVID-19 Pós-Aguda , Prevenção de Acidentes , Ocupações em Saúde , Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Comportamento de Ajuda , Hierarquia Social , Hospitalização , Hospitais , Humanismo , Cuidados para Prolongar a Vida , Máscaras , Tono Muscular , Assistência Noturna , Cuidados de Enfermagem , Enfermagem Prática , Equipe de Enfermagem , Doenças ProfissionaisRESUMO
Background and Objectives: Malnutrition is frequent in hospitalized older adults, favoring nutritional deficiencies, such as anemia. Several studies have associated anemia with reduced performance in daily activities, which may increase morbidity and mortality. This study aimed to assess the relation between anemia and older adults' nutritional status. Methods: This is a cross-sectional study with hospitalized older adults. Anemia was investigated via hemoglobin. The chosen outcome variables were anemia and hemoglobin and the exposure variables gender, age group, skin color, marital status, education, and nutritional status. Variables were described in absolute and relative frequencies. For statistical analysis, the Chi-square and ANOVA tests were used. Results: Overall, we evaluated 272 hospitalized older adults and fund a 65.1% prevalence of anemia. We associated anemia with age group, malnutrition, and decreased muscle mass. Hemoglobin levels decreased as participants' nutritional status worsened, with malnutrition showing the lowest average. Conclusion: Anemia was associated with nutritional status by the evaluated instruments and we observed a reduction in hemoglobin levels as volunteers' nutritional status worsened. Therefore, research must understand the factors associated with anemia, and healthcare providers should investigate anemic older adults' clinical history anemic to search for its basic cause.(AU)
Justificativa e Objetivos: A desnutrição é frequente em idosos hospitalizados, favorecendo deficiências nutricionais, como a anemia. Diversos estudos associaram a anemia com a redução do desempenho nas atividades diárias, podendo aumentar a morbidade e mortalidade. Este estudo objetivou avaliar a relação entre anemia e estado nutricional de idosos hospitalizados. Métodos: Estudo transversal com idosos hospitalizados. A anemia foi investigada através da hemoglobina. As variáveis desfecho foram a anemia e a hemoglobina; e as variáveis de exposição foram: gênero, faixa etária, cor da pele, situação conjugal, escolaridade e estado nutricional. As variáveis foram descritas em frequência absoluta e relativa. Para análise estatística, utilizou-se os Testes Qui-quadrado e Anova. Resultados: Foram avaliados 272 idosos hospitalizados, nos quais a prevalência de anemia foi de 65,1%. Verificou-se associação dessa condição com a faixa etária, desnutrição e massa muscular diminuída. Os níveis de hemoglobina diminuíram conforme a piora do estado nutricional, sendo que os desnutridos tiveram a menor média. Conclusão: A anemia foi associada com o estado nutricional pelos instrumentos avaliados, também se observou a redução dos níveis de hemoglobina conforme a piora do estado nutricional. Portanto, a compreensão dos fatores associados à anemia é necessária, sendo fundamental que os profissionais de saúde investiguem a história clínica do idoso anêmico em busca de sua causa básica.(AU)
Justificación y Objetivos: La desnutrición es frecuente en los adultos mayores hospitalizados, favoreciendo deficiencias nutricionales como la anemia. Varios estudios han asociado la anemia a un rendimiento reducido en las actividades diarias, lo que predispone a un aumento de la morbilidad y la mortalidad. Este estudio tuvo como objetivo evaluar la relación entre anemia y estado nutricional de los adultos mayores hospitalizados. Métodos: Estudio transversal con adultos mayores hospitalizados. La anemia se investigó a través de la hemoglobina. Las variables de resultado fueron la anemia y la hemoglobina; y las variables de exposición fueron sexo, grupo de edad, color de piel, estado civil, educación y estado nutricional. Las variables se describieron en frecuencias absolutas y relativas. Para el análisis estadístico se utilizaron las pruebas de Chi-cuadrado y ANOVA. Resultados: Se evaluaron a 272 adultos mayores hospitalizados, en los cuales la prevalencia de anemia fue del 65,1%. Se encontró que la anemia estaba asociada al grupo de edad, la desnutrición y la disminución de la masa muscular. Los niveles de hemoglobina disminuyeron a medida que empeoraba el estado nutricional, con un promedio más bajo en los desnutridos. Conclusión: La anemia se asoció al estado nutricional en los instrumentos evaluados, se observó también una reducción en los niveles de hemoglobina a medida que empeoraba el estado nutricional. Por tanto, es necesario conocer los factores asociados a la anemia, y los profesionales de la salud necesitan investigar la historia clínica del adulto mayor anémico en busca de su causa básica.(AU)
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Humanos , Idoso , Idoso de 80 Anos ou mais , Idoso , Estado Nutricional , Anemia , Saúde do Idoso , Deficiências Nutricionais , Desnutrição , HematologiaRESUMO
A População em Situação de Rua (PSR) é constituída por um grupo complexo que apresenta necessidades heterogêneas para a sobrevivência nos espaços públicos, aspecto que demanda a abordagem de diversos campos do conhecimento. No âmbito da saúde, conhecer a perspectiva dos profissionais que prestam auxílio a essas pessoas pode contribuir para a melhoria da assistência ofertada. O objetivo desse estudo é conhecer as percepções dos profissionais das Unidades Básicas de Saúde (UBS) e Unidades Básicas de Saúde da Família (UBSF) do município de Araguari (MG) acerca do atendimento da PSR por meio de um instrumento quantitativo. Foi realizado um estudo descritivo com profissionais de saúde da atenção primária do município que realizaram assistência à PSR nos últimos três anos e os resultados foram apresentados por meio da estatística descritiva. Dos 103 profissionais, 55,30% são agentes de saúde que já atenderam pessoas em situação de rua (51,50%). Os profissionais, em sua maioria, se sentem capacitados (53,40%) e satisfeitos (46,60%) com a assistência realizada, apesar de não terem frequentado nenhuma capacitação para esse atendimento (68,70%). Eles sentem empatia (42,37%), e acreditam que as equipes que destinam esse auxílio devem ser multidisciplinares. Conclui-se que os profissionais de saúde da atenção primária de Araguari, por considerarem importante a multidisciplinaridade, realçam um olhar cuidadoso quanto às diversas necessidades demandadas pela condição de vida nas ruas. Apesar de se sentirem preparados e demonstrarem sentimentos positivos em relação à PSR, sinalizam a carência de capacitação profissional voltada para o atendimento a esse grupo específico no município.
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ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects' CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman's rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.
RESUMO O déficit cognitivo pode ser triado pelo teste do desenho do relógio (TDR), que tem várias versões. Objetivo: Esta pesquisa visou avaliar a concordância entre dois métodos simples de TDR. Métodos: Estudo transversal, aninhado na coorte Elo-Creati de Passo Fundo, Brasil, que incluiu 404 sujeitos. Dois avaliadores previamente treinados analisaram o TDR dos participantes de acordo com os sistemas de Pfizer e de Shulman. A concordância inter e intraobservador foi analisada com o teste de coeficiente de correlação de postos de Spearman, assim como a concordância pela estatística kappa dos escores entre os métodos. Idade e escolaridade também foram correlacionados com os escores. Resultados: A maioria dos participantes era de mulheres (93,8%) e caucasianos (84,6%), com média de idade de 66,9±7,8 anos e de escolaridade de 10,9±5,6 anos. Houve significativa correlação interobservador (Pfizer: r=0,739, p£0,001; Shulman: r=0,727, p£0,001) e intraobservador (Pfizer: avaliador 1, r=0,628, p≤0,001; avaliador 2, r=0,821, p≤0,001; Shulman: avaliador 1, r=0,843, p≤0,001; avaliador 2: r=0,819; p≤0,001). Correlação intraobservador significativa também foi evidenciada comparando-se os sistemas de Pfizer e Shulman (avaliador 1: r=0,744; p≤0,001; avaliador 2: r=0,702; p≤0,001). Houve fraca correlação dos escores com escolaridade (Pfizer: r=0,283, p£0,001; Shulman: r=0,244, p£0,001) e idade (Pfizer: r=-0,174, p£0,001; Shulman: r=-0,170, p£0,001). Mais participantes foram classificados com declínio cognitivo com o sistema de Pfizer (avaliador 1: 44,3 vs. 26,5%; avaliador 2: 42,1 vs. 16,3%; p≤0,001). Conclusões: Nossos resultados sugerem que, para essa população, o sistema de Pfizer para avaliar o TDR é mais adequado para a triagem cognitiva.
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Humanos , Feminino , Pessoa de Meia-Idade , IdosoRESUMO
Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia. It predominantly affects the vertex and occipital regions of Afro-descendent men. Female DC is uncommon, and little is known about this condition in childhood. This paper reports a pediatric female case of DC with an excellent therapeutic response to low-dose oral isotretinoin.
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Isotretinoína , Dermatoses do Couro Cabeludo , Alopecia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Criança , Doença Crônica , Feminino , HumanosRESUMO
Poor adherence to hypertension treatment increases complications of the disease and is characterized by a lack of awareness and acceptance of ongoing treatment. Mobile health (mHealth) apps can optimize processes and facilitate access to health information by combining treatment methods with attractive solutions. In this study, we aimed at verifying the influence of using an mHealth app on patients' adherence to hypertension treatment, also examining how user experience toward the app influenced the outcomes. A total of 49 participants completed the study, men and women, diagnosed with hypertension and ongoing medical treatment. For 12 weeks, the control group continued with conventional monitoring, while the experimental group used an mHealth app. From the experimental group, at baseline, 8% were non-adherent, 64% were partial adherents and 28% were adherent to the treatment. Baseline in the control group indicated 4.2% non-adherents, 58.3% partial adherents, and 37.5% adherents. After follow-up, the experimental group had an increase to 92% adherent, 8% partially adherent, and 0% non-adherent (P < 0.001). In the control group, adherence after follow-up remained virtually the same (P ≥ 0.999). Results of user experience were substantially positive and indicate that the participants in the experimental group had a satisfactory perception of the app. In conclusion, this study suggests that using an mHealth app can empower patients to manage their own health and increase adherence to hypertension treatment, especially when the app provides a positive user experience.
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BACKGROUND: The current standard of treatment in primary biliary cholangitis (PBC) is ursodeoxycholic acid (UDCA), although a considerable proportion of patients show incomplete response resulting in disease progression. OBJECTIVE: This study aimed to assess the prevalence of incomplete response to UDCA and determine associated patients' characteristics. METHODS: Patients with PBC as main diagnosis were included from a national multicentric patient registry-Liver.pt. Main endpoints included incomplete response to UDCA treatment according to Barcelona, Paris I and Paris II criteria, Globe and UK PBC scores and the association between baseline characteristics and incomplete response according to Paris II criteria. RESULTS: A total of 434 PBC patients were identified, with a mean age of 55 years and 89.2% females. Nearly half of patients were asymptomatic at diagnosis and 93.2% had positive anti-mitochondrial antibodies. Almost all patients (95.6%) had been prescribed at least one drug for PBC treatment. At the last follow-up visit, 93.3% were under treatment of which 99.8% received UDCA. Incomplete response to UDCA was observed in 30.7%, 35.3%, 53.7% and 36.4% of patients according to Barcelona, Paris I, Paris II criteria and Globe score, respectively. After adjusting for age and sex, and accordingly to Paris II criteria, the risk for incomplete biochemical response was 25% higher for patients with cirrhosis at diagnosis (odds ratio [OR] = 1.25; 95% confidence interval [95%CI]: 1.02-1.54; p = 0.033) and 35% (95%CI:1.06-1.72; p = 0.016) and 5% (OR = 1.05; 95%CI:1.01-1.10; p = 0.013) for those with elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP). CONCLUSION: A considerable proportion of patients showed incomplete biochemical response to UDCA treatment according to Paris II criteria. Cirrhosis, elevated GGT and ALP at diagnosis were identified as associated risk factors for incomplete response. Early identification of patients at risk of incomplete response could improve treatment care and guide clinical decision to a more careful patient monitorization.
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Progressão da Doença , Cirrose Hepática Biliar/tratamento farmacológico , Índice de Gravidade de Doença , Ácido Ursodesoxicólico/uso terapêutico , Adulto , Idoso , Fosfatase Alcalina/sangue , Feminino , Humanos , Cirrose Hepática Biliar/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Portugal , Valor Preditivo dos Testes , Sistema de Registros , Fatores de Risco , Falha de Tratamento , gama-Glutamiltransferase/sangueRESUMO
Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects' CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman's rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.
O déficit cognitivo pode ser triado pelo teste do desenho do relógio (TDR), que tem várias versões. Objetivo: Esta pesquisa visou avaliar a concordância entre dois métodos simples de TDR. Métodos: Estudo transversal, aninhado na coorte Elo-Creati de Passo Fundo, Brasil, que incluiu 404 sujeitos. Dois avaliadores previamente treinados analisaram o TDR dos participantes de acordo com os sistemas de Pfizer e de Shulman. A concordância inter e intraobservador foi analisada com o teste de coeficiente de correlação de postos de Spearman, assim como a concordância pela estatística kappa dos escores entre os métodos. Idade e escolaridade também foram correlacionados com os escores. Resultados: A maioria dos participantes era de mulheres (93,8%) e caucasianos (84,6%), com média de idade de 66,9±7,8 anos e de escolaridade de 10,9±5,6 anos. Houve significativa correlação interobservador (Pfizer: r=0,739, p£0,001; Shulman: r=0,727, p£0,001) e intraobservador (Pfizer: avaliador 1, r=0,628, p≤0,001; avaliador 2, r=0,821, p≤0,001; Shulman: avaliador 1, r=0,843, p≤0,001; avaliador 2: r=0,819; p≤0,001). Correlação intraobservador significativa também foi evidenciada comparando-se os sistemas de Pfizer e Shulman (avaliador 1: r=0,744; p≤0,001; avaliador 2: r=0,702; p≤0,001). Houve fraca correlação dos escores com escolaridade (Pfizer: r=0,283, p£0,001; Shulman: r=0,244, p£0,001) e idade (Pfizer: r=-0,174, p£0,001; Shulman: r=-0,170, p£0,001). Mais participantes foram classificados com declínio cognitivo com o sistema de Pfizer (avaliador 1: 44,3 vs. 26,5%; avaliador 2: 42,1 vs. 16,3%; p≤0,001). Conclusões: Nossos resultados sugerem que, para essa população, o sistema de Pfizer para avaliar o TDR é mais adequado para a triagem cognitiva.
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INTRODUCTION: Objective: to identify the prevalence of sarcopenia in elderly primary care users, and the relationship of nutritional status with sarcopenia. Material and methods: the study was a cross-sectional study with elderly users of the primary health care network. The participants were evaluated for the diagnosis of sarcopenia, which involved calculation of muscle mass, grip strength, and walking speed, as well as sociodemographic, anthropometric and nutritional variables. Nutritional status was evaluated through the body mass index (BMI) and the Mini Nutritional Assessment (MNA) instrument. The study was conduted at eleven family health centers in Marau, Rio Grande do Sul, and included elderly subjects aged 65 years and over (n = 148). Results: of the elderly subjects evaluated, 72.3% were female; mean age was 73.6 years (SD: 5.5), ranging from 65 to 89 years. The prevalence of sarcopenia was 14.2%, 47.3% of the sample had low manual grip strength, and 53.7% had inadequate walking speed. Regarding BMI, 10.8% of participants were classified as underweight, and 75% of these were diagnosed with sarcopenia. Sarcopenia was significantly associated with the oldest age group (p = 0.046) and with higher BMI (p < 0.001). Conclusions: results show the importance of assessing nutritional status and a potential diagnosis of sarcopenia, mainly since this syndrome is highly associated with inappropriate food intake, which is often impaired among the elderly because of economical and/or physiological reasons.
INTRODUCCIÓN: Objetivo: identificar la prevalencia de la sarcopenia en personas mayores de atención primaria y la relación entre el estado nutricional y la sarcopenia. Material y métodos: el estudio fue un estudio transversal de usuarios mayores de la red de atención primaria de salud. Los ancianos se evaluaron para ver si tenían diagnóstico de sarcopenia, lo que implica calcular la masa muscular, la fuerza de agarre y la velocidad al caminar, así como variables sociodemográficas, antropométricas y nutricionales. El estado nutricional se evaluó a través del índice de masa corporal (IMC) y el instrumento Mini Evaluación Nutricional (MNA). El estudio se llevó a cabo en once centros de salud familiar de Marau, Rio Grande do Sul, Brasil, y contó con ancianos de 65 o más años de edad (n = 148). Resultados: de los ancianos evaluados, el 72,3% eran mujeres; la edad media fue de 73,6 años (DE: 5,5) con un rango de 65 a 89 años. La prevalencia de la sarcopenia fue del 14,2%, el 47,3% de los ancianos tenían una fuerza de agarre manual baja y el 53,7% tenían una velocidad de marcha insuficiente. Con respecto al IMC, el 10,8% de los ancianos se clasificaron como de bajo peso y el 75% de estos se diagnosticaron de sarcopenia. La sarcopenia se asoció significativamente al grupo de mayor edad (p = 0,046) y al de mayor IMC (P < 0,001). Conclusiones: estos resultados muestran la importancia que tiene evaluar el estado nutricional junto con al posible diagnóstico de sarcopenia, principalmente porque el síndrome está relacionado con la ingesta inapropiada de alimentos, que muchas veces aparece deteriorada en las personas mayores por motivos económicos y/o fisiológicos.
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Atenção Primária à Saúde , Sarcopenia/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antropometria , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Força Muscular , Músculos/anatomia & histologia , Avaliação Nutricional , Estado Nutricional , Prevalência , Fatores Socioeconômicos , Magreza/epidemiologia , Velocidade de CaminhadaRESUMO
Brazil's Family Health Strategy (FHS) leads public health policies and actions regarding community health, addressing arterial hypertension (AH) in primary care settings. In this scenario, the use of communication technologies becomes appropriate for the monitoring of patients with AH. To preliminary verify the intervention approach and the effects of using an m-Health application on the health conditions of patients with AH for a future study, we conducted a non-randomized, controlled, non-blind trial (N = 39), comparing the use of a mobile health app (m-Health) with conventional AH monitoring over 3 months. During the study, we promoted health information workshops to engage patients from both intervention and control groups. Pre and post-intervention, we compared measurements of systolic and diastolic blood pressure; food frequency questionnaire; Appraisal of Self-Care Agency Scale; blood tests of hemogram, creatinine, uric acid, sodium, potassium, lipid profile, and glycemia. Improvements were identified in both groups due to the workshops, including the reduction in total and non-HDL cholesterol, healthier consumption of salads and sugary drinks, and increased self-care scores. Exclusively in the intervention group, which used the m-Health app, there was a change in systolic and diastolic pressure towards more adequate levels. In addition, the intervention group had improved levels of glucose and HDL cholesterol and reduced consumption of ultra-processed foods. In conclusion, the use of an m-Health app had positive effects on the health conditions of patients with AH under treatment within FHS, especially when combined with health information. On the context of FHS, the use of technology is encouraging supporting better health conditions.