Intensive care unit improves dialysis care quality while reducing costs.

AIMS AND BACKGROUND: The current report details transition of outsourced conventional dialysis therapy in the ICU services to an in-house prolonged intermittent renal replacement therapy (PIRRT) service model as a quality improvement project using the Tablo Hemodialysis System, Outset Medical, Inc. The goals were aimed at maintaining or improving clinical outcomes, while also reducing dialysis-related nursing staff burden and dialysis-related treatment costs. METHODS: A descriptive comparative analysis was conducted of renal replacement therapy (RRT) of ≥6 hours in duration performed in the 1 year prior and 1 year after the ICU's in-house program launch using a PIRRT model including sequential 24-h treatments when medically necessary. RESULTS: Overall, there were 145 intensive care unit (ICU) stays among 145 patients with 13,641 h of conventional ICU dialysis in the year prior to program transition. In the year post, there were 116 ICU stays among 116 patients with 5,098 h of PIRRT. By employing a PIRRT and sequential 24-h treatment strategy vs. the prior outsourced model, the mean dialysis treatment hours per patient were reduced (Pre, 94.1 h with 214 treatment starts; Post, 43.9 h with 370 treatment starts), increasing ICU nurse productivity by 50.2 h per patient. Overall, ICU length of stay and ICU mortality declined post-service transition by 4.8 days and 9.8 percentage points (pp), respectively, overall, and in the non-COVID subset by 1.6 days and 3.1 pp, respectively. CONCLUSIONS: Insourcing RRT with an innovative technology that can provide both PIRRT and 24-h sequential treatments can maintain or improve clinical outcomes in critically ill patients requiring RRT in the ICU, while reducing dialysis-related costs.

Melipona stingless bees and honey microbiota reveal the diversity, composition, and modes of symbionts transmission.

The Melipona gut microbiota differs from other social bees, being characterized by the absence of crucial corbiculate core gut symbionts and a high occurrence of environmental strains. We studied the microbial diversity and composition of three Melipona species and their honey to understand which strains are obtained by horizontal transmission (HT) from the pollination environment, represent symbionts with HT from the hive/food stores or social transmission (ST) between nestmates. Bees harbored higher microbial alpha diversity and a different and more species-specific bacterial composition than honey. The fungal communities of bee and honey samples are also different but less dissimilar. As expected, the eusocial corbiculate core symbionts Snodgrassella and Gilliamella were absent in bees that had a prevalence of Lactobacillaceae - including Lactobacillus (formerly known as Firm-5), Bifidobacteriaceae, Acetobacteraceae, and Streptococcaceae - mainly strains close to Floricoccus, a putative novel symbiont acquired from flowers. They might have co-evolved with these bees via ST, and along with environmental Lactobacillaceae and Pectinatus (Veillonellaceae) strains obtained by HT, and Metschnikowia and Saccharomycetales yeasts acquired by HT from honey or the pollination environment, including plants/flowers, possibly compose the Melipona core microbiota. This work contributes to the understanding of Melipona symbionts and their modes of transmission.

Machine learning-based soil quality assessment for enhancing environmental monitoring in iron ore mining-impacted ecosystems.

In November 2015, a catastrophic rupture of the Fundão dam in Mariana (Brazil), resulted in extensive socio-economic and environmental repercussions that persist to this day. In response, several reforestation programs were initiated to remediate the impacted regions. However, accurately assessing soil health in these areas is a complex endeavor. This study employs machine learning techniques to predict soil quality indicators that effectively differentiate between the stages of recovery in these areas. For this, a comprehensive set of soil parameters, encompassing 3 biological, 16 chemical, and 3 physical parameters, were evaluated for samples exposed to mining tailings and those unaffected, totaling 81 and 6 samples, respectively, which were evaluated over 2 years. The most robust model was the decision tree with a restriction of fewer levels to simplify the tree structure. In this model, Cation Exchange Capacity (CEC), Microbial Biomass Carbon (MBC), Base Saturation (BS), and Effective Cation Exchange Capacity (eCEC) emerged as the most pivotal factors influencing model fitting. This model achieved an accuracy score of 92% during training and 93% during testing for determining stages of recovery. The model developed in this study has the potential to revolutionize the monitoring efforts conducted by regulatory agencies in these regions. By reducing the number of parameters that necessitate evaluation, this enhanced efficiency promises to expedite recovery monitoring, simultaneously enhancing cost-effectiveness while upholding the analytical rigor of assessments.

Ensaios clínicos randomizados sobre procedimentos de enfermagem registrados por enfermeiros no Brasil: estudo bibliométrico / Randomized clinical trials on nursing procedures recorded by nurses in Brazil: bibliometric study

Objetivo: Caracterizar os Ensaios Clínicos Randomizados sobre procedimentos de Enfermagem registrados por enfermeiros no Brasil. Métodos: Estudo bibliométrico, que aconteceu por meio do acesso à plataforma digital de Registro Brasileiro de Ensaios Clínicos entre os anos de 2010 e 2021, no qual foram incluídos 65 ensaios registrados por enfermeiros. A análise dos dados ocorreu com auxílio do software R. Resultados: Constatou-se aumento dos registros acerca dos procedimentos de enfermagem ao longo dos anos, em que a maioria das pesquisas foi oriunda da região Sudeste, por profissionais com titulação de doutor, vinculados a instituições públicas, e sobre a população estudada ocorreu predominância de pacientes. A maior parte dos estudos foi realizada na atenção secundária, com ênfase no procedimento de punção venosa e arterial. Conclusão: A caracterização dos ensaios clínicos randomizados sobre procedimentos de enfermagem pode contribuir para evidenciar os avanços e as lacunas das condutas desses profissionais na assistência à saúde. Verifica-se o crescimento no desenvolvimento de ensaios clínicos randomizados com o passar dos anos, no entanto sua incorporação à prática clínica ainda representa um desafio. Descritores: Ensaios Clínicos Controlados Aleatórios como Assunto; Cuidados de Enfermagem; Pesquisa em Enfermagem Clínica

Objective: To characterize the Randomized Clinical Trials on Nursing procedures registered by nurses in Brazil.Methods: Bibliometric study, which took place through access to the digital platform of the Brazilian Registry of Clinical Trials between the years 2010-2021, in which 65 trials registered by nurses were included. Data analysis occurred with the aid of the software R. Results: There was an increase in records about nursing procedures over the years, in which most of the research came from the southeast region, by professionals with PhD degree, linked to public institutions, and on the population studied there was a predominance of patients. Most studies were conducted in secondary care, with emphasis on venous and arterial puncture. Conclusion: The characterization of randomized clinical trials on nursing procedures can contribute to highlight the advances and gaps in the conduct of these professionals in health care. There is a growth in the development of randomized clinical trials over the years, so its incorporation into clinical practice still represents a challenge. Descriptors: Randomized Controlled Trials as Subject; Nursing care; Clinical Nursing Research

A Blend Consisting of Agaran from Seaweed Gracilaria birdiae and Chromium Picolinate Is a Better Antioxidant Agent than These Two Compounds Alone.

A blend refers to the combination of two or more components to achieve properties that are superior to those found in the individual products used for their production. Gracilaria birdiae agaran (SPGb) and chromium picolinate (ChrPic) are both antioxidant agents. However, there is no documentation of blends that incorporate agarans and ChrPic. Hence, the objective of this study was to generate blends containing SPGb and ChrPic that exhibit enhanced antioxidant activity compared to SPGb or ChrPic alone. ChrPic was commercially acquired, while SPGb was extracted from the seaweed. Five blends (B1; B2; B3; B4; B5) were produced, and tests indicated B5 as the best antioxidant blend. B5 was not cytotoxic or genotoxic. H2O2 (0.6 mM) induced toxicity in fibroblasts (3T3), and this effect was abolished by B5 (0.05 mg·mL-1); neither ChrPic nor SPGb showed this effect. The cells also showed no signs of toxicity when exposed to H2O2 after being incubated with B5 and ChrPic for 24 h. In another experiment, cells were incubated with H2O2 and later exposed to SPGb, ChrPic, or B5. Again, SPGb was not effective, while cells exposed to ChrPic and B5 reduced MTT by 100%. The data demonstrated that B5 has activity superior to SPGb and ChrPic and points to B5 as a product to be used in future in vivo tests to confirm its antioxidant action. It may also be indicated as a possible nutraceutical agent.

Czech dysplasia mimicking rheumatoid arthritis: Case series and literature review.

OBJECTIVE: This study reported a family with most members affected by Czech dysplasia. We examined the patients' clinical, laboratory, and imaging characteristics and evaluated their functional capacity using the Stanford Health Assessment Questionnaire-Disability Index. METHODS: The method used was case series description and literature review. RESULTS: This study showed that the pathogenic variant c.823C>T in the COL2A1 gene, which is a characteristic of Czech dysplasia, was found in 12 Brazilian individuals. Half of the patients in this family met the criteria for rheumatoid arthritis (RA) based on the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria. Patients had arthritis in their hand joints, synovitis detected by ultrasound, and alterations in inflammatory tests. The Stanford Health Assessment Questionnaire-Disability Index assessment revealed that all patients exhibited moderate-to-severe functional disability. What distinguish Czech dysplasia from RA are an autosomal dominant inheritance pattern, platyspondyly, sensorineural hearing loss, and shortening of the metatarsal bones. CONCLUSIONS: It is important to consider Czech dysplasia as a potential differential diagnosis for RA. This autosomal dominant skeletal dysplasia is associated with normal height, short metatarsals, platyspondyly, hearing loss, enlarged epiphyses, and precocious osteoarthritis. Inflammatory findings such as arthritis, synovitis, and alteration of inflammatory markers may also be present in individuals with Czech dysplasia.

Development of a mobile application for health education about sepsis.

OBJECTIVE: To develop and validate a mobile application for health education about sepsis. METHOD: Methodological study composed of two stages. Firstly, information from the Latin American Sepsis Institute and Global Sepsis Alliance was used, followed by putting together, design and layout of the application, according to the agile development model proposed by Sommerville. In the second stage, content validation occurred with 20 health professionals with expertise in the areas of intensive care and sepsis, from the use of the Instrument for Validation of Educational Content in Health through analyzing objectives, structure and relevance; and it was considered valid the item with a minimum agreement of 80%, by binomial test. RESULTS: The app presents 15 screens that encompass prevention measures, recognition and early identification of sepsis, illustrated by interactive images. Out of the 18 items evaluated in the validation process, the minimum agreement obtained was 0.95 and the average validation index was 0.99. CONCLUSION: The application was developed and considered valid by the referees regarding contents. Thus, it is an important technological resource for health education in prevention and early identification of sepsis.

Synthesis and virucide activity on zika virus of 1,2,3-triazole-containing vanillin derivatives.

The Zika virus (ZIKV) is an arbovirus and belongs to the Flaviviridae family and Flavivirus genus, with dissemination in the Americas. In Brazil, the predominant strain is the Asian, promoting outbreaks that started in 2015 and are directly related to microcephaly in newborns and Guillain-Barré syndrome in adults. Recently, researchers identified a new African strain circulating in Brazil at the mid-end of 2018 and the beginning of 2019, with the potential to originate a new epidemic. To date, there is no approved vaccine or drug for the treatment of Zika syndrome, and the development of therapeutic alternatives to treat it is of relevance. A critical approach is to use natural products when searching for new chemical agents to treat Zika syndrome. The present investigation describes the preparation of a series of 1,2,3-triazoles derived from the natural product vanillin and the evaluation of their virucide activity. A series of fourteen derivatives were prepared via alkylation of vanillin followed by CuAAC (the copper(I)-catalyzed azide-alkyne cycloaddition) reaction. The compounds were fully characterized by infrared (I.R.), nuclear magnetic resonance (NMR), and high-resolution mass spectrometry (HRMS) techniques. The cytotoxicity of Vero cells and the effect on the Zika Virus of the vanillin derivatives were evaluated. It was found that the most effective compound corresponded to 4-((1-(4-isopropylbenzyl)-1H-1,2,3-triazol-4-yl)methoxy)-3-methoxybenzaldehyde (8) (EC50 = 27.14 µM, IC50 = 334.9 µM). Subsequent assessments, namely pre and post-treatment assays, internalization and adsorption inhibition assays, kinetic, electronic microscopy analyses, and zeta potential determination, revealed that compound 8 blocks the Zika virus infection in vitro by acting on the viral particle. A molecular docking study was performed, and the results are also discussed.

Development of a mobile application for health education about sepsis / Desarrollo de una aplicación móvil para la educación en salud sobre sepsis / Desenvolvimento de aplicativo móvel para educação em saúde sobre sepse

ABSTRACT Objective: To develop and validate a mobile application for health education about sepsis. Method: Methodological study composed of two stages. Firstly, information from the Latin American Sepsis Institute and Global Sepsis Alliance was used, followed by putting together, design and layout of the application, according to the agile development model proposed by Sommerville. In the second stage, content validation occurred with 20 health professionals with expertise in the areas of intensive care and sepsis, from the use of the Instrument for Validation of Educational Content in Health through analyzing objectives, structure and relevance; and it was considered valid the item with a minimum agreement of 80%, by binomial test. Results: The app presents 15 screens that encompass prevention measures, recognition and early identification of sepsis, illustrated by interactive images. Out of the 18 items evaluated in the validation process, the minimum agreement obtained was 0.95 and the average validation index was 0.99. Conclusion: The application was developed and considered valid by the referees regarding contents. Thus, it is an important technological resource for health education in prevention and early identification of sepsis.

RESUMEN Objetivo: Desarrollar y validar una aplicación móvil para la educación sanitaria sobre la sepsis. Método: Estudio metodológico compuesto por dos etapas. En la primera, se utilizó información del Instituto Latinoamericano de Sepsis y de la Global Sepsis Alliance, seguida del montaje, diseño y diagramación de la aplicación, según el modelo de desarrollo ágil propuesto por Sommerville. En la segunda etapa, se realizó la validación del contenido con 20 profesionales de la salud expertos en las áreas de cuidados intensivos y sepsis, a partir del uso del Instrumento de Validación de Contenidos Educativos en Salud que analiza objetivos, estructura y relevancia y se consideró válido el ítem con un acuerdo mínimo de 80%, mediante prueba binomial. Resultados: La app presenta 15 pantallas que contemplan medidas de prevención, reconocimiento e identificación precoz de la sepsis, ilustradas por imágenes interactivas. De los 18 ítems evaluados en el proceso de validación, el acuerdo mínimo obtenido fue de 0,95 y el índice medio de validación fue de 0,99. Conclusión: La aplicación ha sido desarrollada y considerada válida en lo que respecta al contenido por los jueces. Por lo tanto, es un importante recurso tecnológico para la educación sanitaria en la prevención e identificación precoz de la sepsis.

RESUMO Objetivo: Desenvolver e validar aplicativo móvel para educação em saúde sobre sepse. Método: Estudo metodológico composto por duas etapas. Na primeira, foram utilizadas informações do Instituto Latino-Americano de Sepse e Global Sepsis Alliance, seguidos da montagem, design e layout do aplicativo, conforme modelo de desenvolvimento ágil proposto por Sommerville. Na segunda etapa, ocorreu a validação do conteúdo com 20 profissionais de saúde com expertise nas áreas de terapia intensiva e sepse, a partir da utilização do Instrumento de Validação de Conteúdo Educativo em Saúde que analisa objetivos, estrutura e relevância e foi considerado válido o item com concordância mínima de 80%, por teste binomial. Resultados: O aplicativo apresenta 15 telas que contemplam medidas de prevenção, reconhecimento e identificação precoce de sepse, ilustrados por imagens interativas. Dos 18 itens avaliados no processo de validação, a concordância mínima obtida foi 0,95 e o índice de validação médio foi 0,99. Conclusão: O aplicativo foi desenvolvido e considerado válido pelos juízes quanto ao conteúdo. Assim, consiste em importante recurso tecnológico para educação em saúde que contemple a prevenção e identificação precoce da sepse.

Extension of Tablo TrEatmeNt Duration (XTEND) study: successful 24 h prolonged therapy with Tablo in critical patients.

BACKGROUND: The Tablo® Hemodialysis System (Tablo) is an all in one, easy-to-learn device featuring integrated water purification, on demand dialysate production and two-way wireless data transmission and is approved for use in the acute, chronic, and home settings. Prior reports have demonstrated Tablo's ability to achieve clinical goals, seamlessly integrate into hospitals and reduce cost across a wide range of treatment times. Extension of the Tablo cartridge to 24 h allows prolonged therapy and even greater flexibility for prescribers in the acute setting. The objective is to report on the first ever experience with Tablo prolonged therapy between 12 and 24 h in critically ill patients treated at a single-center ICU. METHODS: Nursing staff were trained during a single training session on Tablo prolonged therapy. After a run-in period of five treatments, Tablo data were collected via real-time transmission to a cloud-based, HIPAA compliant platform and reviewed by site staff. Dialysis treatment delivery, clinically significant alarms, and clotting events were recorded. Sub-group analysis between COVID-19 positive and negative patients were reported. RESULTS: One hundred (100) consecutive Tablo prolonged treatments had a median prescribed treatment time of 24 h and a median achieved treatment time of 21.3 h. Median cartridge usage was 1.3 per treatment. The dialysis treatment time was delivered in 91% of treatments, with 6% ending early due to an alarm, and 3% ending due to clotting. Clinically significant alarms occurred at a median rate of 0.5 per treatment hour with a resolution time of 18 s. Median blood pump stoppage time related to these alarms was 2.3 min per treatment. Blood pump stoppage time was higher in the COVID-19 subgroup when compared to the non-COVID-19 subgroup. CONCLUSION: Tablo successfully achieves prescribed treatment time with minimal therapy interruptions from alarms or cartridge changes. This data demonstrates the effectiveness of Tablo in achieving personalization of treatments necessary for unstable patients and enabling successful delivery of extended therapy with minimal clotting. Tablo's prolonged therapy meets the needs of critically patients, including COVID-19 positive patients, requiring renal replacement therapy for greater than 12 h.

Young Adults With Hereditary Tubular Diseases: Practical Aspects for Adult-Focused Colleagues.

Recent advances in the management of kidney tubular diseases have resulted in a significant cohort of adolescents and young adults transitioning from pediatric- to adult-focused care. Most of the patients under adult-focused care have glomerular diseases, whereas rarer tubular diseases form a considerable proportion of pediatric patients. The purpose of this review is to highlight the clinical signs and symptoms of tubular disorders, as well as their diagnostic workup, including laboratory findings and imaging, during young adulthood. We will then discuss more common disorders such as cystinosis, cystinuria, distal kidney tubular acidosis, congenital nephrogenic diabetes insipidus, Dent disease, rickets, hypercalciuria, and syndromes such as Bartter, Fanconi, Gitelman, Liddle, and Lowe. This review is a practical guide on the diagnostic and therapeutic approach of tubular conditions affecting young adults who are transitioning to adult-focused care.

Parents and school-aged children's mental well-being after prolonged school closures and confinement during the COVID-19 pandemic in Mexico: a cross-sectional online survey study.

OBJECTIVE: This study aimed to determine parents' and school-aged children's mental well-being after experiencing confinement and prolonged school closures during the COVID-19 pandemic. DESIGN: Using a cross-sectional design, an online survey was applied to parents of school-aged children inquiring about their mental well-being and COVID-19 pandemic changes in their home and working lives. To assess the presence of depression, anxiety and stress in parents, the participants responded to the Depression, Anxiety and Stress Scale - 21 scale. To assess psychosocial dysfunction and sleep disturbances in children, participants responded to the Pediatric Symptom Checklist and the Children Sleep Habits Questionnaire. RESULTS: A total of 209 parents answered the questionnaire, most of them were female (87.1%) with a mean age of 40 years. The prevalence of anxiety, stress and parental depression symptoms were 35.9%, 28.2% and 25.4%, respectively. Children's mean age was 8.9 years, the prevalence of children's psychosocial dysfunction was 12%, while their sleep disturbance symptoms were 59.8%. 10.5% of children were suffering both outcomes. We found a bidirectional relationship between parents' and children's mental health outcomes. Parental depression symptoms were associated with experiencing COVID-19 infection within the household, having children with pre-existing medical diagnoses, children's psychosocial dysfunction and sleep disturbances. Children's psychosocial dysfunction was associated with parental depression and changes in their school routine. Children's sleep disturbances were associated with parental anxiety, younger age, increased use of electronic devices, night-time awakenings and shorter sleep time. CONCLUSION: Our results support the impact of long confinement and school closure due to the COVID-19 pandemic in Mexican children and parents' mental well-being. We advocate for specific mental health interventions tailored to respond to parents and children at risk of mental well-being distress.

Correlation Between CD133+ Stem Cells and Clinical Improvement in Patients with Autism Spectrum Disorders Treated with Intrathecal Bone Marrow-derived Mononuclear Cells.

Autism spectrum disorders (ASDs) are a group of neurodevelopmental pathologies characterized by social and communication deficits, for which treatments are limited. Cell therapies, including intrathecal (IT) administration of bone marrow (BM) mononuclear cells (BM-MNC), improves symptoms in patients with ASD. Twenty-four patients diagnosed with ASD, according to the Diagnostic and Statistical Manual of Mental Disorders Text Revision Fourth Edition (DSM-IV-TR) criteria, were autologously treated with IT BM-MNC, and the clinical effect was evaluated using the Childhood Autism Rating Scale (CARS) on Days 30 (n=24) and 180 (n=14) post-treatment. IT BM-MNC improved clinical outcomes by Day 30 (p=0.0039), and those benefits remained and were further accentuated by Day 180 post-treatment (n=14; p=<0.0001). Clinical benefit at Days 30 (p=0.001; r= -0.51) and 180 (p=0.01; r= -0.60) posttreatment positively correlated with the enrichment of a putative BM stem cell population expressing the cluster of differentiation 133+ (CD133+) surface marker.

Zika Virus Envelope Protein Domain III Produced in K. phaffii Has the Potential for Diagnostic Applications.

Zika virus (ZIKV) represents a global human health threat and it is related to severe diseases such as congenital Zika syndrome (CZS) and Guillain-Barré syndrome (GBS). There is no vaccine available nor specific antiviral treatment, so developing sensitive, specific, and low-cost diagnostic tests is necessary. Thus, the objective of this work was to produce the Zika virus envelope protein domain III (ZIKV-EDIII) in Komagataella phaffii KM71H and evaluate its potential for diagnostic applications. After the K. phaffii had been transformed with the pPICZαA-ZIKV-EDIII vector, an SDS-PAGE and Western Blot were performed to characterize the recombinant protein and an ELISA to evaluate the antigenic potential. The results show that ZIKV-EDIII was produced in the expected size, with a good purity grade and yield of 2.58 mg/L. The receiver operating characteristic (ROC) curve showed 90% sensitivity and 87.5% specificity for IgM, and 93.33% sensitivity and 82.76% specificity for IgG. The ZIKV-EDIII protein was efficiently produced in K. phaffi, and it has the potential for diagnostic applications.

Characterization of the biofilm structure and microbial diversity of sulfate-reducing bacteria from petroleum produced water supplemented by different carbon sources.

Colonization by sulfate-reducing bacteria (SRB) in environments associated with oil is mainly dependent on the availability of sulfate and carbon sources. The formation of biofilms by SRB increases the corrosion of pipelines and oil storage tanks, representing great occupational and operational risks and respective economic losses for the oil industry. The aim of this study was to evaluate the influence of the addition of acetate, butyrate, lactate, propionate and oil on the structure of biofilm formed in carbon steel coupons, as well as on the diversity of total bacteria and SRB in the planktonic and sessile communities from petroleum produced water. The biofilm morphology, chemical composition, average roughness and the microbial diversity was analyzed. In all carbon sources, formation of dense biofilm without morphological and/or microbial density differences was detected, with the most of cells observed in the form of individual rods. The diversity and richness indices of bacterial species in the planktonic community was greater than in the biofilm. Geotoga was the most abundant genus, and more than 85% of SRB species were common to all treatments. The functional predicted profile shown that the observed genres in planktonic communities were related to the reduction of sulfate, sulfite, elementary sulfur and other sulfur compounds, but the abundance varied between treatments. For the biofilm, the functions predicted profile for the oil treatment was the one that most varied in relation to the control, while for the planktonic community, the addition of all carbon sources interfered in the predicted functional profile. Thus, although it does not cause changes in the structure and morphology biofilm, the supplementation of produced water with different carbon sources is associated with changes in the SRB taxonomic composition and functional profiles of the biofilm and the planktonic bacterial communities.

Comparison of the effectiveness of two educational interventions on sleep quality in older adults: a randomized clinical trial.

OBJECTIVE: to compare the effectiveness of an educational intervention mediated by a booklet with verbal nursing guidelines in improving sleep quality in older adults. METHOD: this is a randomized, single-blind clinical trial, carried out with 126 older adults, of which 62 were allocated in group 1, who received health education using an educational booklet, and 64 in group 2, who were exposed to health education with verbal nursing guidelines. Sleep quality was verified by the Pittsburgh Index, Epworth Sleepiness Scale and variable minutes that it takes to sleep. In order to compare the pre and post-tests, within the group, the Wilcoxon and chi-square tests were used. Status change was assessed using McNemar's chi-square test. To compare groups, Mann-Whitney and chi-square were used. The significance level was 5%. RESULTS: older adults in both groups showed improvement in sleep quality (p > 0.05) after the interventions. There was no statistically significant difference between the interventions. CONCLUSION: the educational intervention mediated by a booklet and verbal nursing guidelines were equally effective in improving older adults' sleep quality. RBR-993xf7.

Comparison of the effectiveness of two educational interventions on sleep quality in older adults: a randomized clinical trial / Comparación de la efectividad de dos intervenciones educativas sobre la calidad del sueño en ancianos: un ensayo clínico aleatorizado / Comparação de eficácia de duas intervenções educativas na qualidade do sono de idosos: ensaio clínico randomizado

ABSTRACT Objective: to compare the effectiveness of an educational intervention mediated by a booklet with verbal nursing guidelines in improving sleep quality in older adults. Method: this is a randomized, single-blind clinical trial, carried out with 126 older adults, of which 62 were allocated in group 1, who received health education using an educational booklet, and 64 in group 2, who were exposed to health education with verbal nursing guidelines. Sleep quality was verified by the Pittsburgh Index, Epworth Sleepiness Scale and variable minutes that it takes to sleep. In order to compare the pre and post-tests, within the group, the Wilcoxon and chi-square tests were used. Status change was assessed using McNemar's chi-square test. To compare groups, Mann-Whitney and chi-square were used. The significance level was 5%. Results: older adults in both groups showed improvement in sleep quality (p > 0.05) after the interventions. There was no statistically significant difference between the interventions. Conclusion: the educational intervention mediated by a booklet and verbal nursing guidelines were equally effective in improving older adults' sleep quality. RBR-993xf7.

RESUMEN Objetivo: comparar la efectividad de una intervención educativa mediada por un cuadernillo con orientaciones verbales de enfermería en la mejora de la calidad del sueño en ancianos. Método: ensayo clínico aleatorizado, simple ciego, realizado con 126 ancianos, de los cuales 62 fueron asignados al grupo 1, que recibieron educación en salud mediante cartilla educativa, y 64 al grupo 2, que fueron expuestos a la educación en salud con orientaciones verbales de enfermería. La calidad del sueño se evaluó mediante el Índice de Pittsburgh, la Escala de Somnolencia de Epworth y la cantidad variable de minutos que se tarda en dormir. Para comparar las pruebas previas y posteriores, dentro del grupo, se utilizaron las pruebas de Wilcoxon y Chi-Cuadrado. El cambio de estado se evaluó mediante la prueba Chi-Cuadrado de McNemar. Para la comparación de grupos se utilizaron las Pruebas de Mann-Whitney y Chi-Cuadrado. El nivel de significación fue del 5%. Resultados: los ancianos de ambos grupos mostraron mejoría en la calidad del sueño (p > 0,05) después de las intervenciones. No hubo diferencias estadísticamente significativas entre las intervenciones. Conclusión: la intervención educativa mediada por cuadernillo y orientaciones verbales de enfermería fueron igualmente efectivas en la mejora de la calidad del sueño de los ancianos. RBR-993xf7.

RESUMO Objetivo: comparar a eficácia de intervenção educativa mediada por cartilha com orientações verbais de enfermagem na melhora da qualidade do sono de idosos. Método: ensaio clínico randomizado, simples-cego, realizado com 126 idosos, dos quais 62 foram alocados no grupo 1, que recebeu educação em saúde com uso de cartilha educativa, e 64 no grupo 2, que foram expostos à educação em saúde com orientações verbais de enfermagem. A qualidade do sono foi verificada pelo Índice de Pittsburgh, Escala de Sonolência de Epworth e variável minutos que leva para dormir. Para comparar os pré e pós-testes, intragrupo, utilizaram-se os Testes de Wilcoxon e Qui-Quadrado. A mudança de status foi avaliada pelo Teste Qui-Quadrado de McNemar. Para comparar grupos, utilizou-se Mann-Whitney e Qui-Quadrado. O nível de significância foi de 5%. Resultados: os idosos de ambos os grupos apresentaram melhora na qualidade do sono (p > 0,05) após as intervenções. Não houve diferença estatisticamente significativa entre as intervenções. Conclusão a intervenção educativa mediada por cartilha e as orientações verbais de enfermagem foram igualmente eficazes na melhora da qualidade do sono de idosos. RBR-993xf7.

Latent tuberculosis screening before kidney transplantation in the South of Brazil / Rastreamento de tuberculose latente antes do transplante renal no Sul do Brasil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Resumo Histórico: Tuberculose (TB) é uma infecção relativamente comum pós-transplante renal (TR) em países com alta prevalência da doença. O rastreamento de infecção latente por tuberculose (ILTB) inclui histórico prévio de TB, achados de radiografia do tórax, resultados do teste tuberculínico (TT) e/ou de ensaio de liberação de interferon-gama (IGRAs). Nosso objetivo foi comparar nossa avaliação de rotina de candidatos ao TR e doadores vivos (DV) com seus resultados de IGRA, avaliando se aumentaria o encaminhamento para tratamento com isoniazida (INH). Métodos: Avaliamos candidatos adultos ao TR e DV com rastreamento para ILTB de rotina completo e coleta de testes QuantiFERON-TB® Gold In-Tube (QFT). Coletamos amostras sanguíneas de 4 de Abril, 2014 - 31 de Outubro, 2018, com acompanhamento até 31 de Outubro, 2019. Resultados: Avaliamos 116 receptores de TR, 30% sendo QFT-positivo. QFT positivo foi associado ao histórico prévio de TB (p=0,007), TT positivo (p<0,0001), lesões radiográficas residuais (p=0,003), diabetes (p=0,035). Avaliamos 25 DV, 40% apresentaram QFT positivo. QFT positivo foi associado a TT positivo (p=0,002). Resultados positivos do QFT aumentaram o encaminhamento para INH em 80%. A incidência de TB pós-transplante foi 2,6% em uma mediana de acompanhamento de 2 (1-33) meses. Nenhuma variável foi associada à TB pós-transplante. Pacientes com TB tiveram sobrevida do enxerto em 5 anos inferior, embora não-significativa (66,7% vs. 76,5%) (p = 0,402). Conclusão: Neste estudo, a associação do QFT à nossa avaliação de ILTB de rotina aumentou o encaminhamento para tratamento com INH, mas ainda houve alta incidência de TB pós-transplante, possivelmente relacionada a outras formas de infecção, como nova exposição e transmissão pelos doadores.

Evaluation of Antiviral Activity of Cyclic Ketones against Mayaro Virus.

Mayaro virus (MAYV) is a neglected arthropod-borne virus found in the Americas. MAYV infection results in Mayaro fever, a non-lethal debilitating disease characterized by a strong inflammatory response affecting the joints and muscles. MAYV was once considered endemic to forested areas in Brazil but has managed to adapt and spread to urban regions using new vectors, such as Aedes aegypti, and has the potential to cause serious epidemics in the future. Currently, there are no vaccines or specific treatments against MAYV. In this study, the antiviral activity of a series of synthetic cyclic ketones were evaluated for the first time against MAYV. Twenty-four compounds were screened in a cell viability assay, and eight were selected for further evaluation. Effective concentration (EC50) and selectivity index (SI) were calculated and compound 9-(5-(4-chlorophenyl]furan-2-yl)-3,6-dimethyl-3,4,5,6,7,9-hexahydro-1H-xanthene-1,8(2))-dione (9) (EC50 = 21.5 µmol·L-1, SI = 15.8) was selected for mechanism of action assays. The substance was able to reduce viral activity by approximately 70% in both pre-treatment and post-treatment assays.

A Rapid Method for Performing a Multivariate Optimization of Phage Production Using the RCCD Approach.

Bacteriophages can be used in various applications, from the classical approach as substitutes for antibiotics (phage therapy) to new biotechnological uses, i.e., as a protein delivery vehicle, a diagnostic tool for specific strains of bacteria (phage typing), or environmental bioremediation. The demand for bacteriophage production increases daily, and studies that improve these production processes are necessary. This study evaluated the production of a T4-like bacteriophage vB_EcoM-UFV09 (an E. coli-infecting phage with high potential for reducing environmental biofilms) in seven types of culture media (Luria-Bertani broth and the M9 minimal medium with six different carbon sources) employing four cultivation variables (temperature, incubation time, agitation, and multiplicity of infection). For this purpose, the rotatable central composite design (RCCD) methodology was used, combining and comparing all parameters to determine the ideal conditions for starting to scale up the production process. We used the RCCD to set up the experimental design by combining the cultivation parameters in a specific and systematic way. Despite the high number of conditions evaluated, the results showed that when specific conditions were utilized, viral production was effective even when using a minimal medium, such as M9/glucose, which is less expensive and can significantly reduce costs during large-scale phage production.