[Trauma Injuries Associated with Rope Bullfights in the Azores: A Cross-Sectional Study]. / Trauma Associado às Touradas à Corda nos Açores: Um Estudo Transversal.

INTRODUCTION: The aim of the study was to describe trauma injuries associated with rope bullfights in the Azores, Portugal, regarding the cause of the incident, trauma mechanism, most affected anatomical areas, and injury severity. METHODS: Two-year cross-sectional study in the local hospital with prospective data collection. Patients who were consecutively admitted to the local hospital's emergency department with trauma injuries from the bull's direct impact or from falls either during the bull's escape or when handling the rope, were included. Data on general demographics, lesion characteristics, treatments, need for hospitalization and mortality were collected. RESULTS: Fifty-six incidents and 80 trauma injuries were identified. The main cause of trauma was the bull's direct impact (37; 66.07%) and the mechanism of injury was blunt trauma in all patients (100%; 56). Head and neck injuries (27; 33.75%) were the most common. The median Injury Severity Score at the emergency department admission was 4. Major trauma was noted in five patients (8.92%). Ten patients (17.85%) needed hospitalization with a median hospital stay of seven days. Three of the 10 hospitalized patients (30%) were previously admitted to the intensive care unit. Surgery was performed in six patients (10.71%). CONCLUSION: The main cause of trauma was the bull's direct impact, and the mechanism of injury was blunt trauma. The most affected anatomical areas were the head and neck. These findings are a wake-up call to the impact of these events regarding the economic costs they entail, the costs for the health of the local population, the safety measures currently implemented and the availability of the necessary means to treat these patients.

Introdução: O objetivo deste estudo foi caracterizar as lesões traumáticas tauromáquicas ocorridas nas touradas à corda nos Açores no que diz respeito à causa do incidente, mecanismo de trauma, área anatómica mais afetada e gravidade das lesões. Métodos: Estudo unicêntrico, transversal, com a colheita prospetiva de dados realizada durante dois anos. Foram incluídos os doentes que consecutivamente recorreram ao serviço de urgência do hospital local por lesões traumáticas ocorridas por trauma direto com o animal ou quedas aquando da fuga ou manuseio da corda. Foram colhidos dados demográficos gerais, características da lesão, tratamentos efetuados, necessidade de internamento hospitalar e mortalidade. Foi realizada uma análise estatística descritiva com recurso ao software estatístico SPSS. Resultados: Registaram-se 56 admissões hospitalares e 80 lesões traumáticas. A principal causa de traumatismo foi o trauma direto com o animal (37; 66,07%) e o mecanismo de lesão foi o trauma fechado (56; 100%). As áreas anatómicas mais afetadas foram a cabeça e pescoço (27; 33,75%). A mediana de Injury Severity Score foi de 4 à admissão hospitalar. Cinco doentes (8,92%) apresentaram trauma major. Dez doentes (17,85%) necessitaram de internamento hospitalar com uma mediana de dias de internamento de sete (IIQ 4,5 dias). Três (30%) dos doentes internados necessitaram de internamento em unidade de cuidados intensivos. Seis doentes (10,71%) foram submetidos a cirurgia. Conclusão: A principal causa de traumatismo foi o trauma direto com o animal e o mecanismo de lesão foi o trauma fechado. As áreas anatómicas mais afetadas foram a cabeça e pescoço. Estes dados constituem um alerta para o impacto destes eventos no que diz respeito aos custos económicos que acarretam, aos custos para a saúde da população local, às medidas de segurança atualmente implementadas e à disponibilidade dos meios necessários para tratar estes doentes.

Do irrigation solutions used during root canal instrumentation influence the adhesion of glass fiber posts? A systematic review / As soluções de irrigação usadas durante a instrumentação do canal radicular influenciam a adesão de pinos de fibra de vidro? Uma revisão sistemática

Statement of problem: the bond strength between adhesive cement and root dentin can be affected by irrigation protocols. Purpose: therefore, the objective of this systematic review was to answer the following question: Do irrigation solutions used during root canal instrumentation influence the adhesion of glass fiber posts to root dentin? Material and Methods: this study followed the recommendations of PRISMA 2020 for writing. PubMed, Scopus, Web of Science, and LILACS databases were searched for articles published until 26 January, 2022. Grey literature and a manual search were also performed. The inclusion criteria were based on the PICO strategy: permanent human or animal teeth (P), which were irrigated during root canal instrumentation with endodontic substances (I) and compared to irrigation with sodium hypochlorite at various concentrations (C) to analyze the bond strength of glass fiber posts (O). Two authors independently performed data extraction and the risk of bias. Results: eight articles were included. Four articles were classified as having a high risk of bias, where the others as medium risk. Studies have reported conflicting results regarding the influence of irrigating solutions and the different concentrations of sodium hypochlorite on the adhesion of glass fiber posts to root dentin. Conclusion: the heterogeneity between studies did not allow the conclusion of a true estimate regarding this topic, and further well-designed studies are needed to clarify this issue. Register: CRD42020221835. (AU)

Definição do problema: a resistência de união entre o cimento adesivo e a dentina radicular pode ser afetada pelos protocolos de irrigação. Objetivo: portanto, o objetivo desta revisão sistemática foi responder à seguinte questão: As soluções de irrigação usadas durante a instrumentação do canal radicular influenciam a adesão de pinos de fibra de vidro à dentina radicular? Material e Métodos: este estudo seguiu as recomendações do PRISMA 2020 para sua redação. As bases de dados PubMed, Scopus, Web of Science e LILACS foram pesquisadas para artigos publicados até 26 de janeiro de 2022. A literatura cinza e uma pesquisa manual também foram realizadas. Os critérios de inclusão foram baseados na estratégia PICO: dentes humanos ou animais permanentes (P), que foram irrigados durante a instrumentação do canal radicular com substâncias endodônticas (I) e comparados à irrigação com hipoclorito de sódio em várias concentrações (C) para analisar a resistência de união de pinos de fibra de vidro (O). Dois autores realizaram independentemente a extração de dados e o risco de viés. Resultados:oito artigos foram incluídos. Quatro artigos foram classificados como de alto riscode viés, enquanto os demais como de médio risco. Estudos relataram resultados conflitantes sobre a influência de soluções irrigadoras e as diferentes concentrações de hipoclorito de sódio na adesão de pinos de fibra de vidro à dentina radicular. Conclusão: a heterogeneidade entre os estudos não permitiu a conclusão de uma estimativa verdadeira sobre este tópico, sendo necessários mais estudos bem delineados para esclarecer esta questão. Registo: CRD42020221835 (AU)

Prevalence and Factors Associated With Will-to-Live in Patients With Advanced Disease: Results From a Portuguese Retrospective Study.

CONTEXT: Will-to-live (WtL) is a complex and multifactorial dimension of end-of-life experience. Health care decisions on assisted suicide and euthanasia are rarely based on WtL evidence-based discussions. OBJECTIVES: To inform the debate, we aimed to evaluate the prevalence of WtL and its associations within a tertiary home-based palliative care unit. METHODS: Retrospective analysis of all WtL entries registered in our anonymized clinical registry, from October 2018 to September 2020. RESULTS: One-hundred and twelve patients were included: 53% were male, average age was 66 years old; 88% had malignancies, with a mean performance status of 55%. Mean for WtL of was 3.26 (SD = 3.87) with a prevalence of 60.7% strong, 8.9% moderate and 30.4% weak WtL. Weaker WtL was observed among patients who were not well adapted to their disease (P = .001), felt a burden to others (P< .001), were depressed (P = .001), anxious (P< .001) and endorsed a desire for death (P< .001). Weaker WtL was associated with pain (P = .002) and lower well-being (P = .001). Results from the logistic regression model found that the adaptation to disease emerged as a significant predictor of WtL (P = .025), and burden to others remained marginally significant (P = .087). CONCLUSION: The factors associated with lower WtL scores are consistent with previous studies, indicating that these patients experience a myriad of physical, psychological and existential symptoms requiring an interdisciplinary palliative care approach. These factors pertaining to WtL should be made known, as Portugal considers how to navigate death-hastening legislation.

Adapting the Portuguese dignity question framework for adolescents: ages 10-18.

OBJECTIVE: Dignity therapy (DT) is well established in adult populations, and it is likely that it could benefit younger people. This study aimed to adapt the adult Portuguese DT question framework for adolescents (DT-QF-Adol) (ages 10-18). METHOD: Five stages were followed: (1) the Portuguese DT-QF for adults was adapted for adolescents with the original author's collaboration, (2) an expert committee provided feedback on the adapted version, (3) an initial consensus version of the DT-QF-Adol was created, (4) expert committee consult affirmed final consensus, and (5) validation stage with a sample of 17 adolescents followed in ambulatory psychology clinic. RESULTS: DT's original author endorsed the final Portuguese DT-QF-Adol, reinforcing that it captures the fundamental dimensions of DT. There was 100% agreement on the final consensus version and defined age group (10-18 years old). Twenty adolescents were invited to participate, and 17 were included after informed consent was obtained; 53% were female. The average age was 12.7 years. The interviewed adolescents reported that the DT-QF-Adol was clear, and they did not identify any ambiguity or difficulty in answering any of the questions. They assumed that this information could positively affect the way parents and friends see and cared for them, permitting others to understand their concerns and preferences. Participants felt that the DT-QF-Adol could be a good starting point for a conversation with their loved ones. Although they did not consider vital for health professionals to access their answers, they strongly felt that the DT-QF-Adol might be essential to sick adolescents and they would recommend it to others. SIGNIFICANCE OF RESULTS: We developed a DT-QF of nine questions for Portuguese adolescents (DT-QF-Adol), coined Protocolo de Perguntas da Terapia da Dignidade para Adolescentes - 10-18 anos. This tool can potentially be considered a good addition for pediatric palliative care.

Violência contra a mulher em tempos de pandemia da COVID-19 no Brasil: uma revisão integrativa / Violence against women in covid-19 pandemic times in Brazil: literature narrative review

Objetivo: sintetizar as informações contidas em artigos originais publicados no ano de 2020 sobre violência doméstica em tempos de pandemia da COVID-19 no Brasil e identificar que medidas, inclusive jurídicas, podem ser tomadas para amparar a mulher frente a essa situação. Método: revisão integrativa de literatura realizada por meio de buscas entre os meses de abril e julho de 2020 nas bases de dados LILACS, BDENF, MEDLINE, no motor de buscas PUBMED, e em um buscador acadêmico (Google Scholar). Utilizou-se palavras chaves presentes nos Descritores em Ciências da Saúde (DeCS) e no Medical Subject Headings (MeSH), bem como revisão legislativa sobre a temática. Foram incluídos no estudo artigos originais que abordaram o tema violência doméstica em tempos de pandemia. Resultados: dos estudos encontrados, dois atenderam aos critérios pré-estabelecidos para a inclusão neste estudo. Após análise dos textos foi possível organizar as informações obtidas em duas abordagens: o que já se sabe sobre o aumento da violência doméstica em tempos de pandemia e o que pode ser feito, considerando medidas jurídicas, para amparar as mulheres vítimas de violência doméstica durante a pandemia da COVID-19. Conclusão: foram selecionados dois artigos originais cujos resultados e conclusões associados às produções científicas, legislações e relatórios de organizações nacionais e internacionais, consideradas na revisão podem subsidiar a prática de gestores e profissionais de saúde no enfrentamento da violência contra a mulher no Brasil em tempos de pandemia. Ficou evidente a necessidade de estudos originais sobre o tema.

Objective:to synthesize the information contained in scientific productions, legislation and reports of national and international organizations published in the year 2020 on domestic violence in the pandemic times of COVID-19 in Brazil and to identify what measures, including legal ones, can be taken to support women in this situation. Method:literature narrative review carried out through searches between the months of April and July 2020 in the LILACS, BDENF, MEDLINE databases, in the PUBMED search engine, and in an academic search engine (Google Scholar). Keywords used in the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used, as well as a legislative review on the subject. Scientific productions, legislation and reports of national and international organizations that addressed the issue of domestic violence in times of pandemic were included in the study. Results:of the studies found, eighteen met the pre-established criteria for inclusion in this study. After analyzing the texts, it was possible to organize the information obtained in two approaches: what is already known about the increase in domestic violence in times of pandemic and what can be done, considering legal measures, to support women victims of domestic violence during the COVID-19 pandemic. Conclusion:The scientific productions, legislation and reports of national and international organizations considered in the review can support the practice of managers and health professionals in confronting violence against women inBrazil in times of pandemic. The need for original studies on the topic was evident.

Valuing Attributes of Home Palliative Care With Service Users: A Pilot Discrete Choice Experiment.

CONTEXT: Discrete choice experiment (DCE) is a quantitative method that helps determine which service attributes are most valued by people and consequently improve their well-being. OBJECTIVES: The objective of this study was to test a new DCE on home palliative care (HPC). METHODS: Cross-sectional survey using the DCE method with adult patients and their family caregivers, users of three HPC services in Portugal. Service attributes were based on a Cochrane review, a meta-ethnography, and the few existing DCEs on HPC: 1) team's availability, 2) support for family caregivers, 3) homecare support, 4) information and planning, and 5) waiting time. The experimental design consisted in three blocks of eight choice sets where participants chose between two service alternatives that combined different levels of each attribute. We piloted the DCE using cognitive interviewing. Interviews were analyzed for difficulties using Tourangeau's model of information processing. RESULTS: The DCE was conducted with 21 participants of 37 eligible (10 patients with median Palliative Performance Scale score = 45, 11 caregivers). Most participants found the DCE easy (median 2 from 1 to 5), although two patients did not finish the exercise. Key difficulties related to comprehension (e.g., waiting time sometimes understood as response time for visit instead of time from referral to care start) and judgment (e.g., indecision due to similar service alternatives). CONCLUSION: The DCE method is feasible and acceptable but not all patients are able to participate. In the main study phase, we will give more attention to the explanation of the waiting time attribute.

Effectiveness of Emergency Department Based Palliative Care for Adults with Advanced Disease: A Systematic Review.

BACKGROUND: Emergency departments (EDs) are seeing more patients with palliative care (PC) needs, but evidence on best practice is scarce. OBJECTIVES: To examine the effectiveness of ED-based PC interventions on hospital admissions (primary outcome), length of stay (LOS), symptoms, quality of life, use of other health care services, and PC referrals for adults with advanced disease. METHODS: We searched five databases until August 2014, checked reference lists/conference abstracts, and contacted experts. Eligible studies were controlled trials, pre-post studies, cohort studies, and case series reporting outcomes of ED-based PC. RESULTS: Five studies with 4374 participants were included: three case series and two cohort studies. Interventions included a screening tool, traditional ED-PC, and integrated ED-PC. Two studies reported on hospital admissions: in one study there was no statistically significant difference in 90-day readmission rates between patients who initiated integrated PC at the ED (11/50 patients, 22%) compared to those who initiated PC after hospital admission (179/1385, 13%); another study showed a high admission rate (90%) in 14 months following ED-PC, but without comparison. One study showed an LOS reduction (mean 4.32 days in ED-initiated PC group versus 8.29 days in postadmission-initiated group; p < 0.01). There was scarce evidence on other outcomes except for conflicting findings on survival: in one study, ED-PC patients were more likely to experience an interval between ED presentation and death >9 hours (OR 2.75, 95% CI 2.21-3.41); another study showed increased mortality risk in the intervention group; and a case series described a higher in-hospital death rate when PC was ED-initiated (62%), compared to ward (16%) or ICU (50%) (unknown p-value). CONCLUSIONS: There is yet no evidence that ED-based PC affects patient outcomes except for indication from one study of no association with 90-day hospital readmission but a possible reduction in LOS if integrated PC is introduced early at ED rather than after hospital admission. There is an urgent need for trials to confirm these findings alongside other potential benefits and survival effects.

Barrierless Photoisomerization of 11-cis Retinal Protonated Schiff Base in Solution.

A hallmark of the primary visual event is the barrierless, ultrafast, and efficient 11-cis to all-trans photoisomerization of the retinal protonated Schiff base (RPSB) chromophore. The remarkable reactivity of RPSB in the visual pigment rhodopsin has been attributed to potential energy surface modifications enabled by evolution-optimized chromophore-protein interactions. Here, we use a combined synthetic and ultrafast spectroscopic approach to show that barrierless photoisomerization is an intrinsic property of 11-cis RPSB, suggesting that the protein may merely adjust the ratio between fast reactive and slow unreactive decay channels. These results call for a re-evaluation of our understanding and theoretical description of RPSB photochemistry.

Adult derived mononuclear bone marrow cells improve survival in a model of acetaminophen-induced acute liver failure in rats.

INTRODUCTION: Acute liver failure (ALF) is characterized by a rapid loss of hepatic function, with high mortality. Acetaminophen (APAP) intoxication and viral hepatitis are common causes of ALF. Several studies have shown the capacity of adult bone marrow cells to differentiate in hepatocytes, suggesting their use for treating ALF. AIM: In the present study, we tested the use of adult derived mononuclear bone marrow fraction to improve the survival of Wistar rats with APAP-induced ALF. METHODS: Forty-eight female Wistar rats pre-induced with phenobarbital were given APAP in a single dose of 1g/kg via intraperitoneal injection. Bone marrow mononuclear cells were purified from male rats using FICOLL gradient and injected through the portal vein in a volume of 0.2mL containing 1x10(6) cells stained with DAPI. Treatment was administered 24h after APAP injection. The sham group (n=24), received 0.2mL of saline through the portal vein 24h after APAP administration. Survival, liver histology and ALT levels were observed. RESULTS: Survival 72h post-APAP administration was 33% in the sham group and 70.8% in the group receiving bone marrow cells. Liver histology in treated animals showed less intense necrosis and the presence of DAPI-positive cells. CONCLUSIONS: We have shown that bone marrow derived cells are capable of significantly increasing the survival rate of APAP-induced ALF in 37.5% (95% CI, 27.8-40.3%).

Enfermidades do trato respiratório posterior em eqüinos de equitação no Rio de Janeiro: prevalência e aspectos clínico-laboratoriais

Enfermidades do trato respiratório posterior em eqüinos estabulados em grandes centros urbanos são uma realidade emvários locais do mundo. Com o objetivo de verificar a prevalência e discutir aspectos clínico-laboratoriais relevantes para odiagnóstico das enfermidades do trato respiratório posterior, foram examinados 23 eqüinos, regularmente utilizados paraequitação, pertencentes ao Regimento Escola de CavalariaAndrade Neves EB/ME/RJ, com sintomas sugestivos de doençarespiratória, sendo 14 machos e 09 fêmeas, com idades variando de 03 a 22 anos e pesando entre 400 e 530 kg. Realizaramseexame físico, endoscopia, hemograma, dosagem de fibrinogênio plasmático e citologia do lavado broncoalveolar. Considerando-se o total de animais examinados encontrou-se 4,3% de doença pulmonar obstrutiva crônica, 8,7% de broncopneumonias,17,4% de doença inflamatória de vias aéreas, 47,8% de hemorragia pulmonar induzida pelo exercício e 4,3% de doençapulmonar indiferenciada.