Predictors of the Social Participation of Adults with Down Syndrome: An Analysis Based on the Biopsychosocial Model of the International Classification of Functioning, Disability, and Health.

OBJECTIVE: The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health. METHODS: An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level. RESULTS: The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation. CONCLUSIONS: It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

Chylothorax After Heart Surgery in Children.

Chylothorax is a consequence of a thoracic duct injury that can occur during surgical procedures in patients with congenital heart disease. It is associated with high rates of morbimortality and increased use of clinical and hospital resources. The aim of this study was to evaluate the risk factors, distribution, manifestations, complications, and treatments for chylothorax in patients undergoing cardiac surgery in a tertiary pediatric hospital in southern Brazil. This is a retrospective, quantitative study, in which all medical records (n = 166) of patients with chylothorax after pediatric cardiac surgery between January 2014 and December of 2020 and a matched control group (n = 166) were analyzed. Over the study period, there was an increase in incidence of chylothorax from 4.5% in 2014 to 7.6% in 2020, a trend that has been reported in the literature. After multivariate analysis, the following were identified as risk factors for the diagnosis of chylothorax: genetic syndrome (OR 2.298); prolonged cardiopulmonary bypass time (greater than 120 min) (OR 2.410); fluid overload in the immediate postoperative period (OR 1.110); and SIRS (OR 2.527). Mortality was two times greater (p = 0.021) and there was a higher rate (34.4%) of infection (p < 0.001) in patients who developed chylothorax. In addition, a sensitivity analysis was performed comparing patients with low- and high-output chylothorax (> 20 mL/kg), which confirmed unfavorable outcomes for the latter group. Herein, we show that hemodynamic alterations were important factors for diagnosis. Understanding the risk factors, outcomes, and complications helps early identification and enables the reduction of morbidity and mortality.

Adverse effects after vaccination against SARS-CoV-2 (COVID-19) in Down syndrome adults / Efeito adverso pós-vacinação contra a Covid-19 em adultos com síndrome de down

Introduction: Comorbidities in adults with Down syndrome are common making them a risk group for COVID-19. Thus, vaccinating against COVID-19 becomes necessary, but requires care against possible side effects. Objective: To investigate possible adverse effects after vaccination against COVID-19 in adults with Down Syndrome (DS). Methodology: Descriptive study in which ninety-seven adults diagnosed with DS were interviewed using a questionnaire containing seventeen questions related to personal and historical data, and seven questions related to vaccination. Results: The most applied vaccine was AstraZeneca (94%), Pfizer (4%), and CoronaVac (2%); 74% of the subjects had adverse effects, the most frequent after the first dose being pain at the injection site (65.3%), fever (37.9%), muscle pain (37.8%), malaise (29.5%); in the second dose there was a decrease in these adverse effects; 95% of symptoms disappeared after the first 24 hours following application. Conclusion: More than half of the individuals interviewed had adverse effects after the application of the first dose of the vaccine, decreasing with the second dose; the most frequent was pain at the site of application.

Introdução: Comorbidades em adultos com síndrome de Down são comuns tornando-os um grupo de risco para COVID-19. Dessa forma, vacinar contra a COVID-19 torna-se necessária, mas requer cuidados contra possíveis efeitos colaterais. Objetivo: Pesquisar possíveis efeitos adversos após vacinação contra COVID-19 em adultos com Síndrome de Down (SD). Metodologia: Estudo descritivo no qual 97 adultos diagnosticados com SD foram entrevistados por meio de um questionário contendo dezessete questões relacionadas a dados pessoais e histórico, e sete questões relacionadas à vacinação. Resultados: A vacina mais aplicada foi a AstraZeneca (94%), Pfizer (4%) e CoronaVac (2%); 74% dos sujeitos apresentaram efeitos adversos, sendo os mais frequentes após a primeira dose: dor no local da injeção (65,3%), febre (37,9%), dores musculares (37,8%), mal-estar (29,5%); na segunda dose houve diminuição desses efeitos adversos; 95% dos sintomas desapareceram após as primeiras 24 horas após a aplicação. Conclusão: Mais da metade dos indivíduos entrevistados apresentou efeitos adversos após a aplicação da primeira dose da vacina, diminuindo com a segunda dose; a mais frequente foi a dor no local de aplicação.

Outcome measures for adults with down syndrome based on the international classification of functioning, disability, and health model: a systematic review

INTRODUCTION: Adults with Down syndrome (DS) have functional disabilities due to the extra presence of chromosome 21. OBJECTIVE: To identify the functionality and disability assessment instruments used in research involving adults with DS and associate them with the components of the International Classification of Functioning (ICF). METHODS: Two independent researchers analyzed articles from PubMed, Lilacs, SciELO, Science Direct, and Cochrane databases, including cross sectional and clinical studies whose results involved functionality and disability for individuals with DS (≥18 years), with no publication date limit for the studies. The methodological quality of the studies was analyzed by the Downs & Black Checklist; descriptive analysis was used for the results. This review was registered in PROSPERO (CRD42021234012). RESULTS: 15 articles were analyzed in which 48 instruments were identified for the assessment of adults with DS (36.42±10.62 years); the quality of the articles was considered "good". Of these 48 instruments, 41 were associated with bodily function, 5 instruments were associated with the activity component, one instrument was associated with social participation and one instrument was associated with the environment. CONCLUSION: Of the 48 instruments identified to assess adults with DS, most were for the Body Function and Structure component; only the 6MWT and CAMDEX-SD have been validated for this population. LIFE-H and MQE were used to assess Social Participation and the Environment, but they cannot be considered dependable, as they have not been confirmed for individuals with DS.

Síndrome de Stevens-Johnson, necrólise epidérmica tóxica e eritema multiforme major são a mesma doença? / Syndrome Stevens-Johnson, toxic epidermal necrolysis and erythema multiforme major are the same disease?

O objetivo do presente estudo é descrever as diferentes classificações e expressões da síndrome de Stevens-Johnson (SSJ), necrólise epidérmica tóxica (NET) e eritema multiforme major (EMM). Fizemos uma revisão bibliográfica abordando os aspectos históricos sobre os conceitos referentes a essas patologias mucocutâneas. Artigos experimentais, descritivos, de revisão e relatos de caso, obtidos da plataforma de pesquisa Pubmed (US National Library of Medicine / National Institute of Health), foram selecionados com o intuito de elucidar as diferentes manifestações de doenças que já provocaram contradições em relação aos diagnósticos, tratamentos e prognósticos. Evidenciou-se a diferenciação entre as doenças SSJ e EMM, ao passo que a SSJ e a NET foram consideradas uma extensão da mesma patologia.

Avaliação da qualidade do preparo de canais de dentes decíduos artificiais utilizando o sistema de rotação recíproca / Evaluation of the quality of preparation of artificial deciduous teeth canal using the reciprocal system of rotation canal preparation

O objetivo deste estudo foi comparar o preparo de canais radiculares dedentes decíduos artificiais com o uso dos sistemas manual, rotatório e de rotaçãorecíproca, no que diz respeito ao desgaste promovido após a instrumentação doscanais radiculares e o tempo necessário para a realização da instrumentação. Osfatores em estudo foram técnica de instrumentação em três níveis e área deavaliação no canal radicular em três níveis. Foram utilizados apenas os dentesmultiradiculares (primeiro molar superior, segundo molar superior, primeiro molarinferior e segundo molar inferior), compondo 24 dentes os quais foramaleatoriamente divididos entre as três técnicas de instrumentação em estudo:manual, Sistema rotatório Mtwo e Sistema de rotação recíproca Reciproc. A unidadeamostral foi conduto radicular (n=20). Os condutos radiculares foram escaneados notomógrafo de TCFC (Accuitomo). Após a instrumentação dos dentes novas imagensforam realizadas, avaliações quantitativas foram feitas medindo-se nas imagensaxiais dos canais radiculares, a espessura das paredes em três diferentes regiões:terços apical, médio e cervical. As variáveis de resposta analisadas foram cálculo dotransporte do canal, cálculo da descentralização e tempo de instrumentação. Tantopara a avalição da descentralização, quanto para a avaliação do transporte, osdados foram transformados e analisados por ANOVA a 2 critérios e Teste de Tukey,para os dados da comparação dos tempos foi utilizado o teste de Kruskal-Wallis eTeste de Tukey (p<0,05). Para a avaliação do transporte do canal e dadescentralização não foi encontrada diferença estatística significativa entre os tiposde instrumentação e terços radiculares (p>0,05). Na avaliação do tempo de preparo,o grupo do sistema reciprocante apresentou menor tempo de preparo emcomparação com o sistema manual e rotatório (p<0,05). Desta forma conclui-se queos tipos de instrumentação avaliados promoveram um preparo similar dos canais...

The objective of this study was to compare the preparation of root canalsof artificial deciduous teeth with the use of the manual systems, rotational andreciprocal rotation, with regard the detrition promoted after instrumentation of rootcanals and the time necessary for the realization of instrumentation. The factors instudy were the techniques of instrumentation in tree levels and the area of root canalin tree levels. Have been used only teeth multirooted (first molar, second molar, lowerfirst molar and second molar), composing 24 teeth which were randomly dividedamong the three instrumentation techniques under study: manual, rotational systemMtwo and reciprocal rotation system Reciproc. The sample unit was root canal (n =20). The root canals were scanned in tomographer CBCT (Accuitomo). Afterinstrumentation of new images teeth were conducted quantitative evaluations weremade by measuring the axial images of the root canals, the wall thickness at threedifferent regions: apex, middle and cervical thirds. Response variables analyzedwere calculating the channel transport, decentralization and calculation timeinstrumentation. Both for the evaluation of decentralization, as for the evaluation oftransportation, data were processed and analyzed by ANOVA and Tukey 2 criteriatest to the data comparing the times we used the Kruskal-Wallis test and Tukey test (p <0.05). For the evaluation of the channel transport and decentralization was nostatistically significant difference between the types of instrumentation and root thirds(p> 0.05). In assessing the preparation time, the reciprocating system group showedless preparation time compared to the manual system and rotary (p <0.05). Thus it isconcluded that the types of instrument reviews promoted a similar preparation ofchannels, no difference between the cervical, middle and apical thirds, and thereciprocal rotation resulted in a shorter time instrumentation.

The ethanol extract of the inner bark of Caesalpinia pyramidalis (Tul.) reduces urinary bladder damage during cyclophosphamide-induced cystitis in rats.

Hemorrhagic cystitis (HC) is a common side effect of cyclophosphamide therapy, which deserves new therapeutic strategies, such as those based on natural products. The ethanol extract of the inner bark of Caesalpinia pyramidalis (Tul.) (EECp) possesses anti-inflammatory, antinociceptive, and antioxidant activities as previously showed by our group. We have investigated the effect of EECp on the cyclophosphamide-induced HC. Cystitis was induced in male Wistar rats by the injection of cyclophosphamide. These animals were pretreated with EECp (100-400 mg/kg), vehicle, or mesna. Myeloperoxidase activity and malondialdehyde formation were measured in urinary bladder and other tissues. Bladder edema and histopathological alterations and serum nitric oxide metabolites concentration NOx- were also evaluated. Treatment with EECp (100-400 mg/kg) or mesna impaired the increase of myeloperoxidase activity in urinary bladder and the serum NOx- induced by cyclophosphamide but did not reduce edema in this tissue, as did mesna. Total histological score was reduced by EECp (100 mg/kg). Lung myeloperoxidase activity, which was increased by cyclophosphamide, was decreased significantly by EECp (400 mg/kg). EECp also diminished the malondialdehyde formation in bladder, lung, and spleen, although these parameters were not affected by cyclophosphamide. These results indicate that EECp reduced urinary bladder damage during cyclophosphamide-induced HC in rats.

Prognostic implications of the difference between left ventricular ejection fractions after stress and at rest in addition to the quantification of myocardial perfusion abnormalities obtained with gated SPECT.

BACKGROUND: The prognostic significance of the difference between poststress and at rest left ventricular ejection fraction (ΔLVEF) in patients sent for diagnostic myocardial perfusion study (MPS) is not well characterized. The purpose of this study was to prospectively evaluate the ability of ΔLVEF in further risk stratifying these patients in addition to the severity/extent of myocardial perfusion abnormalities expressed as the total perfusion deficit at stress (sTPD), according to the type of stress used. METHODS AND RESULTS: Two-day 99mTc-MIBI MPS after stress and rest were obtained for 507 patients subdivided according to the type of stress used, sTPD values, and ΔLVEF. Subsequent cardiac events were determined through a standardized questionnaire applied 1, 2, and 6 years after MPS. Independent of the type of stress used, the 6-year event rate with progressive perfusion and functional abnormalities combined was significant for total events, all-cause death, cardiac death, and revascularization but not for myocardial infarct. When ΔLVEF decreased by more than -10%, only those individuals with sTPD of 5% or less had increased 6-year total event rates [5.9% vs 15% for those submitted to treadmill test (P < 0.001) and 8.3% vs 19% when submitted to pharmacological stress (P = 0.001)]. An sTPD greater than 5% was the only variable predictive of total events when multivariate analysis was applied (P < 0.001 for treadmill exercise and P = 0.033 for dipyridamole). CONCLUSIONS: Estimation of ΔLVEF in addition to sTPD seems to improve risk stratification for future events when ΔLVEF decreases by more than -10% for those individuals with normal or near-normal myocardial perfusion (sTPD ≤ 5%). An sTPD greater than 5% was a better prognostic indicator of future events when compared with ΔLVEF for individuals with greater perfusion abnormality at stress.

Avaliação de níveis lipêmicos e glicêmicos pré e pós-cirurgia bariátrica / Evaluation of serum lipid levels and blood glucose before and after bariatric surgery

Justificativa e objetivos: Nas últimas décadas a obesidade tornou-se um relevante problema de saúde pública. É uma doença de elevada morbiletalidade, associada à comorbidades como dislipidemias e diabetes mellitus. A cirurgia bariátrica surgiu como uma opção de tratamento, indicada em casos específicos. O objetivo do presente estudo foi comparar os níveis lipídicos e glicêmicos pré e pós-cirurgia bariátrica. Método: Estudo descritivo, do tipo transversal, revisando-se os prontuários de 17 pacientes submetidos à técnica mista (restritiva e parcialmente disabsortiva) de cirurgia bariátrica. Foram analisados os níveis lipídicos e glicêmicos antes e depois do procedimento cirúrgico. Dados como sexo, idade e índice de massa corpórea (IMC) foram também incluídos. Resultados: Houve redução na média de todos os parâmetros estudados (IMC, glicemia, colesterol total (CT), LDL-c, HDL-c, VLDL-c e triglicérides (TG)). No entanto, é desejável o aumento do HDL-c. Conclusão: A cirurgia bariátrica, proporciona redução do peso e melhora de parâmetros metabólicos dos pacientes. Tem hoje o seu papel em diminuir a morbiletalidade associada à obesidade.

Background and objectives: In the last decades obesity has developed into a relevant health care problem. It is a high morbiletality disease associated to comorbidities such as dyslipidemias and diabetes mellitus. Bariatric surgery has emerged as an acceptable treatment, indicated in some specific cases. The purpose of this study was to compare blood lipids and sugar rates of patients before and after bariatric surgery. Method: A descriptive study, transversal type, in which 17 surgical patients submitted to mixed techniques (restrictive and partially malabsorptive) of bariatric surgery had their medical history revised. Serum lipid levels and blood glucose were evaluated before and after surgical procedure. Data such as age, gender and body mass index (BMI) where also included. Results: It was found a reduction in all parameters analysed (BMI, glycemia, TC, LDL-c, HDL-c, VLDL-c and TG). Nevertheless, it is expected an increase in HDL-c. Conclusion: Bariatric surgery, leading to weight reduction and improved metabolic parameters, has today its role in decreasing morbiletality associated to obesity.

Doses baixas de dobutamina e fluidos no pós-operatório de pacientes de alto risco: efeitos sobre a oxigenação tecidual, resposta inflamatória e morbidade / Low-doses dobutamine and fluids in high-risk surgical patients: effects on tissue oxygenation, inflammatory response and morbidity

JUSTIFICATIVA E OBJETIVOS: A dobutamina é um agente inotrópico com propriedade adrenérgica beta-1 predominante e freqüentemente usado para aumentar o fluxo sanguíneo em pacientes críticos. Dobutamina pode ter um papel no aumento da perfusão esplâncnica, desse modo protegendo esta área de lesão isquêmica. O objetivo deste estudo foi investigar os efeitos de baixas doses de dobutamina (5 mig/kg/min) sobre a oxigenação tecidual, resposta inflamatória e complicações pós-operatória em pacientes de alto risco. MÉTODO: Estudo prospectivo, aleatório, encoberto e placebo-controlado. Cem pacientes cirúrgicos admitidos em Unidade Semi-Intensiva foram avaliados e 82 pacientes foram incluídos, 42 pacientes no grupo controle (solução fisiológica) e 40 no grupo tratamento (5 mig/kg/min) de dobutamina por 24 horas). Os mesmos procedimentos terapêuticos foram usados nos dois grupos. A infusão de líquidos deveria ser realizada em caso de taquicardia ou hipotensão após a infusão de dobutamina, pela possibilidade de hipovolemia. RESULTADOS: O volume total de fluidos administrado foi significativamente maior no grupo dobutamina do que no grupo controle (7351 ± 2082 mL versus 6074 ± 2386 mL, respectivamente, p < 0,05). Saturação venosa central de oxigênio (SvcO2), lactato sérico e proteína C-reativa foram similares em ambos os grupos. Complicações ocorreram em 35 por cento e 50 por cento dos pacientes nos grupos dobutamina e controle, respectivamente (RR 0,70 IC 95 por cento 0,41 - 1,17; NS). CONCLUSÕES: Baixas doses de dobutamina e fluidos após trauma cirúrgico não tiveram efeitos na prevalência de complicações pós-operatória em pacientes cirúrgicos de alto risco.

BACKGROUND AND OBJECTIVES: Dobutamine is an inotropic agent with predominant beta1- adrenergic properties frequently used to increase blood flow in critically ill patients. Dobutamine may have a role in increasing splanchnic perfusion, thereby protecting this area from further injury. We investigated the effects of low doses dobutamine (5 mug/kg/min) on tissue oxygenation, inflammatory response and postoperative complications in high-risk surgical patients. METHODS: Prospective, randomized, blinded and placebo-controlled study. One hundred surgical patients admitted in a step-down unit were evaluated and 82 patients were enrolled, 42 in the control group (saline) and 40 in the treatment group (5 mug/kg/h) during 24 hours. Similar therapeutic goals were applied to both groups. Fluids were given whenever tachycardia or hypotension developed after study drug infusion. RESULTS: The total volume of fluids given was significantly higher in treatment than in control group (7351 ± 2082 mL versus 6074 ± 2386 mL, respectively, p < 0.05). Central venous oxygen saturation (ScvO2), serum lactate and C-reactive protein were similar in both groups. Complications occurred in 35 percent and 50 percent of the patients in the treatment and control groups, respectively (RR 0, 70 IC 95 percent 0.41 - 1.17; NS). CONCLUSIONS: Low-doses dobutamine and fluids after surgical trauma has no effects on the prevalence of postoperative complications in high-risk surgical patients.

[Low-doses dobutamine and fluids in high-risk surgical patients: effects on tissue oxygenation, inflammatory response and morbidity]. / Doses baixas de dobutamina e fluidos no pós-operatório de pacientes de alto risco: efeitos sobre a oxigenação tecidual, resposta inflamatória e morbidade.

BACKGROUND AND OBJECTIVES: Dobutamine is an inotropic agent with predominant beta1- adrenergic properties frequently used to increase blood flow in critically ill patients. Dobutamine may have a role in increasing splanchnic perfusion, thereby protecting this area from further injury. We investigated the effects of low doses dobutamine (5 mug/kg/min) on tissue oxygenation, inflammatory response and postoperative complications in high-risk surgical patients. METHODS: Prospective, randomized, blinded and placebo-controlled study. One hundred surgical patients admitted in a step-down unit were evaluated and 82 patients were enrolled, 42 in the control group (saline) and 40 in the treatment group (5 mug/kg/h) during 24 hours. Similar therapeutic goals were applied to both groups. Fluids were given whenever tachycardia or hypotension developed after study drug infusion. RESULTS: The total volume of fluids given was significantly higher in treatment than in control group (7351 ± 2082 mL versus 6074 ± 2386 mL, respectively, p < 0.05). Central venous oxygen saturation (ScvO2), serum lactate and C-reactive protein were similar in both groups. Complications occurred in 35% and 50% of the patients in the treatment and control groups, respectively (RR 0, 70 IC 95% 0.41 - 1.17; NS). CONCLUSIONS: Low-doses dobutamine and fluids after surgical trauma has no effects on the prevalence of postoperative complications in high-risk surgical patients.

Assistência prestada na Unidade de Terapia Intensiva Adulto: visão dos clientes / Assistance offering at adult ITU: clients view

O presente estudo tem como objetivo verificar a percepção dos pacientes sobre o atendimento recebido na UTI adulto e elaborar uma proposta de atendimento visando a qualidade do serviço prestado. A metodologia adotada foi à pesquisa quantitativa descritiva. Os dados foram coletados através de um questionário contendo 12 questões, sendo 11 fechadas e 1 aberta. Os dados apontaram que a maioria dos pacientes gostou do atendimento oferecido, mas apesar disto a unidade foi reformada à partir das colocações dos clientes na tentativa de melhorar a qualidade da assistência prestada pela equipe multiprofissional.

I UNIPAR Solidária Mariluz: vivenciando a realidade / Solidary UNIPAR Mariluz: experiencing the reality

O presente estudo foi desenvolvido pela equipe do 1º UNIPAR SOLIDÁRIA realizado no perí-odo de 24 de janeiro a 07 de fevereiro de 1999, no Município de Mariluz - Pr. As atividades visaram o atendi-mento básico a hipertensäo, diabetes, a saúde bucal, higiene geral, prevençäo de Ca de colo uterino e mama, planejamento familiar, prevençäo de DST, saúde da gestante, do idoso, saúde mental (rua de recreio, pintura em muro, dança, canto), prevençäo de acidentes no trabalho com agrotóxico, teste de acuidade visual e treinamento de merendeiras.