Burden of disease and costs for the Unified Health System in Brazil due to diseases whose alcohol consumption is a necessary cause: an ecological study.

OBJECTIVE: This study aimed to quantify the health and economic impacts of alcohol consumption in Brazil for 2019. STUDY DESIGN: Ecological study using secondary data sources. METHODS: We calculated the disease burden using estimates from the Global Burden of Disease study, which incorporated data from health surveys and hospital records. Costs were estimated based on direct expenses recorded in the Hospital and Outpatient Information System of the Unified Health System, with data by sex, age group, cause, and Federative Units. RESULTS: Alcohol consumption was a necessary cause for 30,355 deaths and approximately 1.69 million disability-adjusted life years in Brazil, representing 2.2% and 2.6% of the national totals, respectively. The impact was more pronounced among men, in the Northeast region and within the 40- to 64-year-old age group. The total costs attributed to these outcomes reached approximately Int$43.1 million, with hospital admissions accounting for 94.16% of these expenses. CONCLUSION: In 2019, alcohol consumption had a significant impact on both the health of Brazilians and the expenses of the health system. As a preventable risk factor, alcohol consumption necessitates effective intersectoral strategies to mitigate its burden.

Burden of disease and direct costs to the health system attributable to high body mass index in Brazil.

OBJECTIVES: Excess weight, measured by a high body mass index (BMI), is associated with the onset of many diseases, which can, in turn, lead to disability and premature death, subsequently placing a significant burden on healthcare services. This study analysed the burden of disease and the direct costs to the Brazilian Unified Health System (Sistema Único de Saúde [SUS]) attributable to high BMI in the Brazilian population. STUDY DESIGN: Ecological study. METHODS: This ecological study had two components: (1) a time-series assessment to analyse the burden of diseases attributable to high BMI from 1990 to 2019 in Brazil; and (2) a cross-sectional design to estimate the direct costs of SUS hospitalisations and outpatient procedures attributable to high BMI in 2019. Estimates from the Global Burden of Disease study and the costs of hospital admissions and outpatient procedures from the Department of Informatics of the Brazilian Unified Health System were used. Deaths, years of life lost to premature death (YLLs), years lived with disability (YLDs), and years of life lost adjusted for disability (DALYs) were analysed. The direct health cost was obtained in Brazilian Real (R$) and converted in international Dollars (INT$). RESULTS: The current study found a reduction in the number of DALYs, YLLs, and deaths per 100,000 population of cardiovascular disease (CVD) attributable to high BMI and an increase in YLD due to diabetes and cardiovascular disease attributable to high BMI from 1990 to 2019. In 2019, high BMI resulted in 2404 DALYs, 658 YLDs, 1746 YLLs, and 76 deaths per 100,000 inhabitants. In the same year, INT$377.30 million was spent on hospitalisations and high- and medium-complexity procedures to control non-communicable diseases attributable to high BMI. The states in the South and Southeast regions of Brazil presented the highest total cost per 10,000 inhabitants. CVDs and chronic kidney disease showed the highest costs per hospital admission, whereas neoplasms and CVDs presented the highest costs for outpatient procedures. CONCLUSIONS: High BMI causes significant disease burden and financial costs. The highest expenses observed were not in locations with the highest burden of disease attributable to high BMI. These findings highlight the need to improve current public policies and apply cost-effective intervention packages, focussing on equity and the promotion of healthier lifestyles to reduce overweight/obesity, especially in localities with low socioeconomic status.

Burden of non-communicable diseases attributed to alcohol consumption in 2019 for the Brazilian Unified Health System.

OBJECTIVE: To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states. STUDY DESIGN: Observational, descriptive, and ecological study. METHODS: We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019. RESULTS: Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state. CONCLUSION: The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities.

Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019.

OBJECTIVES: The objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. STUDY DESIGN: This is an epidemiological time-series study. METHODS: This study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI. RESULTS: A decrease in the number of deaths (-75 %), mortality rate (-75.1 %), and DALYS (-72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (-9.7) and DALYs (-6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. CONCLUSION: Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.

Economic burden for the Unified Health System attributable to excessive sodium consumption in Brazil.

OBJECTIVES: This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019. STUDY DESIGN: Ecological study. METHOD: This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019. RESULTS: Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium. CONCLUSION: Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality.

Mortality by avoidable causes in Brazil from 1990 to 2019: data from the Global Burden of Disease Study.

OBJECTIVES: The aim of this study was to analyse the trends of avoidable mortality in Brazil from 1990 to 2019 and its correlation with sociodemographic indexes (SDIs). STUDY DESIGN: Epidemiological mortality trends. METHODS: This study analysed data from the Global Burden of Disease database. The list of causes of avoidable death, as proposed by Nolte and McKee, was applied and included 32 causes. The current study used age-standardised mortality rates and the rates of change, in addition to a correlation analysis between avoidable death and the SDI. RESULTS: Mortality rates decreased from 343.90/100,000 inhabitants in 1990 to 155.80/100,000 inhabitants in 2019. Infectious diseases showed the largest decline in mortality rates, but notable decreases were also found for diarrhoeal diseases (-94.9%), maternal conditions (-66.5%) and neonatal conditions (-60.5%). Mortality rates for non-communicable diseases (NCDs) also decreased (-48%) but maintained a similar absolute number of deaths in 2019 compared with 1990. Decreased mortality rates were also found for ischaemic heart disease (-49.1%), stroke (-61.4%) and deaths due to adverse effects caused by medical treatments (-26.2%). Avoidable mortality rates declined in all of the 27 Brazilian states, and a high correlation was found between deaths and SDI (R = -0.74; P < 0.000001). CONCLUSIONS: A reduction in avoidable deaths was found throughout Brazil over the study period, although major regional inequalities were revealed. Richer states presented the best overall reduction in mortality rates. The biggest decreases in mortality were seen in maternal and paediatric infectious diseases in the poorest states due to the expansion of the Primary Health System and improvements in sanitation. Today, NCDs predominate and efforts should be made to formulate public policies for the prevention and control of NCDs.

Resistance profile of Rhipicephalus (Boophilus) microplus to diazinon and cypermethrin and first report of sodium channel mutation - domain III S6 - T2134A, in field samples from the state of São Paulo, Brazil / Perfil de resistência do Rhipicephalus (Boophilus) microplus ao diazinon e à cipermetrina e primeiro relato de mutação no canal de sódio - domain III S6 - T2134A em amostras de campo, no estado de São Paulo - Brasil

Rhipicephalus (Boophilus) microplus is one of the parasites that has an impact on livestock farming in Brazil. Bioassays using the larval packet test (LPT) impregnated with cypermethrin and diazinon at different concentrations were performed to characterize phenotypic resistance (resistance level, RL), molecular resistance (mutation in domain III - S6 T2134A) and enzymatic metabolism of diazinon and cypermethrin in some populations of R. microplus that were collected in different regions of the state of São Paulo. Among the 40 farms analyzed, 18 of them presented resistance factors for cypermethrin, with RL I (53%) and RL II (47%). Mutation of domain III T2134A was found for the first time in Brazil, on seven farms. Heterozygous larvae were found on six of them and resistant homozygous larvae on four. No differences (p>0.05) in enzymatic activity of α-esterase and ß-esterase were found in tests with live and dead larvae at a cypermethrin concentration of 409.6µg/cm2. Ninety percent of the farms showed resistance to the active agent diazinon: RL I in 6%, RL II in 30% and RL III in 64%. There were significant differences (p<0.05) in enzymatic activity at the highest concentration (3.2µg/cm2).

Rhipicephalus (Boophilus) microplus (Canestrini) é um dos parasitas que mais impactam a pecuária de países tropicais e subtropicais, incluindo o Brasil, com perdas em torno de US$ 3,24 bilhões por ano. Ocorrências de populações resistentes a diferentes classes de acaricidas e suas associações têm sido amplamente diagnosticadas em todo o Brasil. Para isso, bioensaios utilizando o teste de pacote larval (LPT) impregnado com cipermetrina e diazinon em diferentes concentrações foram realizados para caracterizar a resistência fenotípica (nível de resistência, RL), a resistência molecular (mutação no domínio III - S6 T2134A) e o metabolismo enzimático do diazinon e da cipermetrina em algumas populações de R. (Boophilus) microplus coletadas em diferentes regiões do estado de São Paulo. Dentre as 40 propriedades analisadas, 18 delas apresentaram fatores de resistência à cipermetrina, sendo RL I (53%) e RL II (47%). A mutação do domínio III T2134A foi encontrada pela primeira vez no Brasil, em sete fazendas. Larvas heterozigotas foram constatadas em seis delas, e larvas homozigotas resistentes em quatro. Nenhuma diferença (P>0,05) na atividade enzimática de α-esterase e ß-esterase foi observada em testes com larvas vivas e mortas em uma concentração de cipermetrina de 409,6µg/cm2. Noventa por cento das propriedades apresentaram resistência ao agente ativo diazinon: RL I em 6%, RL II em 30% e RL III em 64%. Houve diferenças significativas (P<0,05) na atividade enzimática na concentração mais elevada (3,2µg/cm2) entre os grupos de larvas vivas e mortas.

Myelin imaging measures as predictors of cognitive impairment in MS patients: A hybrid PET-MRI study.

BACKGROUND: Cognitive impairment is one of the concerns of Multiple Sclerosis (MS) and has been related to myelin loss. Different neuroimaging methods have been used to quantify myelin and relate it to cognitive dysfunctions, among them Magnetization Transfer Ratio (MTR), Diffusion Tensor Imaging (DTI), and, more recently, Positron Emission Tomography (PET) with 11C-PIB. OBJECTIVE: To investigate different myelin imaging modalities as predictors of cognitive dysfunction. METHODS: Fifty-one MS patients and 24 healthy controls underwent clinical and neuropsychological assessment and MTR, DTI (Axial Diffusion-AD and Fractional Anisotropy-FA maps), and 11C-PIB PET images in a PET/MR hybrid system. RESULTS: MTR and DTI(FA) differed in patients with or without cognitive impairment. There was an association of DTI(FA) and DTI(AD) with cognition and psychomotor speed for progressive MS, and of 11C-PIB uptake and MTR for relapsing-remitting MS. MTR in the Thalamus (ß= -0.51, p = 0.021) and Corpus Callosum (ß= -0.24, p = 0.033) were predictive of cognitive impairment. DTI-FA in the Caudate (ß= -26.93, p = 0.006) presented abnormal predictive result. CONCLUSION: Lower myelin content by 11C-PIB uptake was associated with worse cognitive status. MTR was predictive of cognitive impairment in MS.

Nevo epidérmico verrucoso inflamatório linear e diagnóstico diferencial com a psoríase linear: a respeito de um caso / Inflammatory linear verrucous epidermal nevus and differential diagnosis with linear psoriasis: about a case

Nevo epidérmico verrucoso inflamatório linear e diagnóstico diferencial com a psoríase linear: a respeito de um caso RELATO DE CASOMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,O nevo epidérmico verrucoso inflamatório linear (NEVIL) é uma variedade clínica rara de nevo epidérmico verrucoso, que se manifesta no início da infância, como lesões inflamatórias de superfície ceratósica, que coalescem e se distribuem em faixa, acompanhando as linhas de Blaschko. Faz diagnóstico diferencial com a psoríase linear, sendo difícil a diferenciação, dado os aspectos clínicos e histopatológicos comuns aos dois, enfantizando-se a necessidade de conhecer as características específicas de cada um. O objetivo deste relato é demonstrar uma afecção relativamente rara, descrita em uma menina de 5 anos, evoluindo desde os primeiros dias de vida com placas papuloceratósicas dispostas linearmente, acompanhadas de sinais inflamatórios e áreas erosadas ocupando grandes lábios, períneo e face interna e superior da coxa esquerda. Também pápulas e placas ceratósicas na região cervical posterior e borda lateral externa da planta do pé esquerdo, ascendendo ao longo da região posterior deste membro. Os critérios clínicos e histopatológicos corroboram o diagnóstico de NEVIL na diferenciação com a psoríase linear, ressaltando a importância do estabelecimento de critérios/ ferramentas que auxiliem na diferenciação destas duas dermatoses visando agilizar o diagnóstico, otimizar o tratamento e minimizar o desconforto para esses pacientes. O acompanhamento a longo prazo dos portadores é sugerido pela possibilidade ainda que mínima de malignização do NEVIL. (AU)

Inflammatory linear verrucous epidermal nevus and differential diagnosis with linear psoriasis: about a caseCASE REPORTMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) is a rare clinical variety of verrucous epidermal nevus that manifests in early childhood as inflammatory lesions of keratosis surface, which coalesce and spread in band, following Blaschko lines. It makes a differential diagnosis with Linear Psoriasis; it is difficult to differentiate them given the clinical and histopathological aspects common to both, emphasizing the need to know the specific characteristics of each. The purpose of this report is to demonstrate a relatively rare affection, expressed in a 5-year-old girl, evolving from the first days of life with papulokeratosic plaques arranged linearly, followed by inflammatory signs and eroded areas, placed linearly, overtaking labia majora, perineum, the inner and upper face of the left thigh. Also, the patient showed keratotic papules and plaques in the posterior cervical region and external lateral border of the left foot plant, ascending along the posterior region of this limb. The clinical and histopathological criteria corroborate the diagnosis of ILVEN in differentiation with linear psoriasis, emphasizing the importance of establishing criteria/instruments to assist in distinguishing these two dermatoses in order to expedite the diagnosis, to optimize the treatment and minimize patients' discomfort. Long-term follow-up of patients with this disease is suggested due to the possibility, albeit minimal, of ILVEN malignancy. (AU)

Evaluating performance and determining optimum sample size for regression tree and automatic linear modeling / [Avaliando o desempenho e determinando o tamanho ideal da amostra para árvore de regressão e modelagem linear automática]

This study was carried out for two purposes: comparing performances of Regression Tree and Automatic Linear Modeling and determining optimum sample size for these methods under different experimental conditions. A comprehensive Monte Carlo Simulation Study was designed for these purposes. Results of simulation study showed that percentage of explained variation estimates of both Regression Tree and Automatic Linear Modeling was influenced by sample size, number of variables, and structure of variance-covariance matrix. Automatic Linear Modeling had higher performance than Regression Tree under all experimental conditions. It was concluded that the Regression Tree required much larger samples to make stable estimates when comparing to Automatic Linear Modeling.(AU)

Este estudo foi realizado com dois objetivos: comparar os desempenhos da Árvore de Regressão e da Modelagem Linear Automática e determinar o tamanho ideal da amostra para estes métodos sob diferentes condições experimentais. Um abrangente Estudo de Simulação de Monte Carlo foi projetado para estes propósitos. Os resultados do estudo de simulação mostraram que a porcentagem de estimativas de variação explicada tanto da Árvore de Regressão como da Modelagem Linear Automática foi influenciada pelo tamanho da amostra, número de variáveis e estrutura da matriz de variância-covariância. A Modelagem Linear Automática teve um desempenho superior ao da Árvore de Regressão em todas as condições experimentais. Concluiu-se que a Árvore de Regressão exigia amostras muito maiores para fazer estimativas estáveis quando comparada à Modelagem Linear Automática.(AU)

Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis.

BACKGROUND: There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. MATERIAL AND METHODS: PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper's title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54-14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30-28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. CONCLUSIONS: Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery.

Linear modeling analysis using for determining the factors affecting 305-day milk yield / [Análise de modelagem linear usado para determinar os fatores que afetam o rendimento leiteiro de 305 dias]

The purpose of this study was to model the factors affecting the 305-day milk yield of dairy cows by using Automatic Linear Modeling Technique (ALM). The data set of this study consisted of eight different cow breeds grown in eight province of Turkey. Results of ALM showed that the accuracy of the model was 64.2 % means that 64.2% of the variation in the 305-day milk yield could be explained by the constructed model. Created model was consisted of four factors namely the Breed, Lactation Length, Parity, and Province. Therefore, those selected factors were more efficient than the others in predicting the 305-day milk yield.(AU)

O objetivo deste estudo foi modelar os fatores que afetam a produção de leite das vacas leiteiras em 305 dias, utilizando a Técnica de Modelagem Linear Automática (ALM). O conjunto de dados deste estudo consistia em oito raças diferentes de vacas cultivadas em oito províncias da Turquia. Os resultados da ALM mostraram que a precisão do modelo era de 64,2% significa que 64,2% da variação na produção de leite de 305 dias poderia ser explicada pelo modelo construído. O modelo criado consistia de quatro fatores: Raça, Comprimento da Lactação, Paridade e Província. Portanto, esses fatores selecionados foram mais eficientes do que os outros na previsão da produção de leite de 305 dias.(AU)

Avaliação do impacto do tempo de espera para admissão em Unidade de Terapia Intensiva no desfecho clínico do paciente crítico / Assessment of the impact of waiting time until admission in the Intensive Care Unit on the clinical outcome of critical patients

RESUMO: Este estudo tem por base a premissa de que com um maior número de leitos de Unidade de Terapia Intensiva (UTI) disponíveis o tempo de espera para admissão em UTI é menor, o que resulta no melhor desfecho clínico, justifi-cando, portanto, a importância do presente estudo. Objetivo: Avaliar se o tempo de espera no Departamento de Emergência até a admissão em UTI tem influência no desfecho clínico do paciente crítico. Metodologia: Estudo ob-servacional, retrospectivo, do tipo antes e depois, realizado em um hospital público do município de Joinville/SC no ano de 2019. Foram incluídos os dados referentes aos pacientes adultos admitidos na UTI com até 72 horas de es-pera no Departamento de Emergência desde a chegada ao hospital. Comparou-se o último trimestre de 2017 (fase 1), período durante o qual havia 14 leitos de UTI no hospital, e último trimestre de 2018 (fase 2), período durante o qual havia 30 leitos de UTI. Resultados: Analisaram-se 173 prontuários elegíveis de 2017 e 2018. Houve diferen-ça estatisticamente significativa no tempo decorrido na emergência até a admissão em UTI entre 2017 e 2018 (me-diana de 22 vs. 15; p=0,0002). A diferença estatística também foi relevante para a mortalidade em até 24 horas após a admissão em UTI, comparando-se os dois anos em questão (9,61% vs. 2,47%; p=0,04). Não houve diferen-ça estatística significante na mortalidade hospitalar entre 2017 e 2018 (34,6% vs. 35,5%; p=0,57). Também não houve diferença estatisticamente relevante entre os demais parâmetros analisados. Conclusão: Comparando-se 2017 a 2018, percebeu-se que o tempo de espera pelo leito de UTI diminuiu, bem como a mortalidade em até 24h da admissão intensiva. No entanto, isto não se refletiu na mortalidade hospitalar. (AU)

ABSTRACT: The premise that underpins this study is that the more Intensive Care Unit (ICU) beds available, the shorter the waiting time for ICU admission, resulting in better clinical outcomes, which justifies the relevance of this study. Objective: Assess if the waiting time in the Emergency Room until ICU admission influences on the clinical outcome of critical patients. Methods: An observational longitudinal retrospective study performed in a public hospital in Joinville/SC in 2019. This study analyzed data from patients admitted to the ICU with up to 72h of waiting time in the Emergency Room. It compares Q4'2017 (phase 1), when there were 14 ICU beds in the hospital vs. Q4'2018 (phase 2), when there were 30 ICU beds. Results: 173 medical records were analyzed in 2017-2018. There was a statistically significant difference in the time for ICU admission between 2017 and 2018 (median 22h vs. 15h; p=0.0002). There was also a statistically significant difference for mortality rates up to 24h of admission (9.61% vs. 2.47%; p=0.04). There was no statistically significant difference for hospital mortality rates (34.6% vs. 35.5%; p=0.57). There was also no statistically significant difference between the other parameters analyzed. Conclusion:Comparing 2017 and 2018, waiting time for an ICU bed was shorter in 2018, and the mortality rates up to 24 hours of ICU admission were lower. However, waiting time in the Emergency Room until ICU admission did not show as-sociation with hospital mortality rates. (AU)

Intraocular pressure and pupil diameter in healthy cats anesthetized with isoflurane and pre-medicated with isolated acepromazine or in combination with tramadol / [Pressão intraocular e diâmetro pupilar em gatos saudáveis anestesiados com isoflurano e pré-medicados com acepromazina isolada ou em combinação com tramadol]

The objective of this study was to determine changes on intraocular pressure (IOP) and pupil diameter (PD) in healthy cats anesthetized with isoflurane, and premedicated with acepromazine alone or in combination with tramadol. Thirty cats were allocated in two groups (n=15/each) and were treated with acepromazine (AG) or acepromazine/tramadol (ATG). PD and IOP were assessed before and following 30 (PM1), and 40 minutes (PM2) of treatments. Anesthesia was induced with propofol, and IOP and DP were recorded (A10) at 10 minute intervals until the end of anesthesia (A40). IOP decreased in AG and ATG, when comparing baseline with PM1. IOP decreased only in AG, in comparisons between baseline and PM2. During anesthesia, IOP did not change within and between groups. Comparisons between baseline with those recorded at PM1 and 2 showed that PD increased in the ATG. During anesthesia, PD decreased significantly in AG and ATG. Both protocols maintained the IOP within the reference range to perform corneal or intraocular surgery in healthy cats but did not sustain pre-anesthetic pupil dilation observed in ATG.(AU)

O objetivo do presente artigo é determinar possíveis alterações na pressão intraocular (PIO) e no diâmetro pupilar (DP) em gatos saudáveis anestesiados com isoflurano e pré-medicados com acepromazina isolada ou em combinação com acepromazina/tramadol. Trinta gatos saudáveis foram distribuídos aleatoriamente em dois grupos (n=15/cada) e tratados com acepromazina (GA) ou acepromazina/tramadol (GAT). DP e PIO foram avaliadas antes (basal) e após 30 (PM1) e 40 minutos (PM2) dos tratamentos. A anestesia foi induzida com propofol, e a PIO e o DP foram registrados (A10) a cada 10 minutos até o final da anestesia com isoflurano (A40). Ao se compararem os valores obtidos no basal com PM1, a PIO diminuiu em GA e GAT; com PM2, a PIO reduziu apenas no GA. Durante a anestesia, a PIO não diferiu dentro e entre os grupos. Comparações entre os valores basais e os registrados em PM1 e em PM2 mostraram que a DP aumentou significativamente no GAT. Durante a anestesia, o DP diminuiu significativamente em GA e GAT. Ambos os protocolos mantêm a PIO dentro dos valores de referência para realizar cirurgias corneanas ou intraoculares em gatos saudáveis, mas não sustentam a dilatação pupilar pré-anestésica observada em GAT.(AU)

Microbiological quality and safety of minimally processed parsley (Petroselinum crispum) sold in food markets, southeastern Brazil.

AIMS: This study evaluated the microbiological quality and safety of minimally processed parsley sold in southeastern Brazilian food markets. METHODS AND RESULTS: One hundred samples were submitted to the enumeration of Enterobacteriaceae by plating on MacConkey agar. Colonies of Enterobacteriaceae were randomly selected and identified by MALDI-TOF MS. Samples were also tested for Listeria monocytogenes and Salmonella sp. The mean count of Enterobacteriaceae was 6·0 ± 1·0 log CFU per gram, while 18 genera (including 30 species) of bacteria belonging to this family were identified. Salmonella and L. monocytogenes were not detected, while L. innocua was found in two samples and L. fleischmannii was found in one sample. Moreover generic Escherichia coli was found in three samples, all from different brands of minimally processed parsley. CONCLUSIONS: Even though microbial pathogens were not isolated, a variety of indicator micro-organisms were identified, including vegetable spoilers and species capable of causing human opportunistic infections. These results suggest hygienic failures and/or lack of temperature control during processing and storage of these ready-to-eat products. SIGNIFICANCE AND IMPACT OF STUDY: This study highlights the need for control measures during the production chain of minimally processed parsley in order to reduce microbial contamination and the risks of foodborne diseases.

Assessment of the microbiological quality and safety of minimally processed vegetables sold in Piracicaba, SP, Brazil.

The present study shows the results of the microbiological quality and safety of minimally processed vegetables sold in supermarkets and grocery stores located in the city of Piracicaba, SP, Brazil. A total of 100 samples were collected and submitted to enumeration of total coliforms, coliforms at 45°C and generic Escherichia coli using the standard most probable number (MPN) method, in addition to enumeration of total Enterobacteriaceae by plating on MacConkey agar. Moreover, colonies of Enterobacteriaceae were randomly selected and submitted to identification on a MALDI-TOF MS Biotyper™. Samples were also tested for Salmonella spp. according to the ISO 6579:2002 method. The mean count of total coliforms was 2·9 ± 0·5 log MPN per g. For coliforms at 45°C, 20 samples were positive (mean 1·5 ± 1·0 log MPN per g). Generic E. coli was detected in 16 samples (mean 1·4 ± 0·9 log MPN per g) and only one was positive for Salmonella. The mean count of total Enterobacteriaceae was 6·5 ± 1·2 log CFU per g and the most frequent genera identified by MALDI-TOF were Enterobacter (25·9%), Pantoea (9·6%) and Rahnella (9·0%). Overall, results point to poor microbiological quality of a few samples, indicating hygiene failure during their processing. This can pose health risks to consumers, mainly because these products were labelled as sanitized and marketed as ready-to-eat. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, the microbiological quality and safety of minimally processed vegetables sold in the city of Piracicaba, SP, Brazil, were evaluated through the detection of Salmonella spp., generic Escherichia coli and other Enterobacteriaceae. The results obtained point to poor microbiological quality and safety of a few samples, as generic E. coli was detected in 16 out of 100 samples and Salmonella was isolated from one of them. This indicates hygiene failures during their processing and health risk to consumers, since these products are usually sold as ready-to-eat and typically require no further heat treatment before consumption.