Perfil clínico dos pacientes internados por Covid-19 na unidade de terapia intensiva / Clinical profile of patients hospitalized for Covid-19 in the intensive care unit

Objetivo: identificar o perfil clínico dos pacientes internados por COVID-19 na Unidade de Terapia Intensiva (UTI) de um hospital privado. Métodos: trata-se deum estudo de caráter descritivo, documental, retrospectivo, de corte transversal e análise quantitativa, conduzido em um hospital, no município de Montes Claros, MG, por meio da análise de prontuários de 142 pacientes da UTI com diagnóstico de COVID-19 no período de janeiro de 2020 a abril de 2021. Resultados: dos 142 indivíduos, a média de idadefoi de 64,1 anos, com 58,5% do sexo masculino. Das comorbidades prévias, as que tiveram maior prevalência foram a hipertensão arterial sistêmica com 26,8% e diabetes mellitus com 9,2%. Destes, 133 indivíduos utilizaram ventilação mecânica, com a prevalência de 47,9% no modo ventilação com volume controlado. O tempo médio de internação foi de 6 dias, sendo que 93,7% dos indivíduos foram a óbito, 4,9% receberam alta e 1,4% transferidos para outro hospital. Conclusão: evidenciou-se predominância do sexo masculino, com média de idade de 64,1 anos, o modo ventilatório mais utilizado foi o controlado o volume, com tempo de uso médio de uso 7,9 dias, ou seja, pouco tempo, fato que pode ser justificado pelo alto índice de óbitos na amostra estudada.

Objective: to identify the clinical profile of patients hospitalized for COVID-19 in the Intensive Care Unit (ICU) of a private hospital. Methods: this is a descriptive, documentary, retrospective, cross-sectional study with quantitative analysis conducted in a hospital in the city of Montes Claros, MG, through the analysis of medical records of 142 ICU patients diagnosed with COVID-19 from January 2020 to April 2021. Results: of the 142 individuals, the mean age was 64.1 years, with 58.5% male. Of the previous comorbidities, those with the highest prevalence were systemic arterial hypertension at 26.8% and diabetes mellitus at 9.2%. Of these, 133 individuals used mechanical ventilation, with a prevalence of 47.9% using volume-controlled ventilation. The average length of stay was 6 days, with 93.7% of the individuals dying, 4.9% being discharged, and 1.4% being transferred to another hospital. Conclusion: there was a predominance of males, with an average age of 64.1 years, the most used ventilatory mode was volume-controlled, with an average use time of 7.9 days, that is, a short time, a fact that can be justified by the high rate of deaths in the studied sample.

Development and validation of a D-loop mtDNA SNP assay for the screening of specimens in forensic casework.

Mitochondrial DNA (mtDNA) analysis is usually a last resort in routine forensic DNA casework. However, it has become a powerful tool for the analysis of highly degraded samples or samples containing too little or no nuclear DNA, such as old bones and hair shafts. The gold standard methodology still constitutes the direct sequencing of polymerase chain reaction (PCR) products or cloned amplicons from the HVS-1 and HVS-2 (hypervariable segment) control region segments. Identifications using mtDNA are time consuming, expensive and can be very complex, depending on the amount and nature of the material being tested. The main goal of this work is to develop a less labour-intensive and less expensive screening method for mtDNA analysis, in order to aid in the exclusion of non-matching samples and as a presumptive test prior to final confirmatory DNA sequencing. We have selected 14 highly discriminatory single nucleotide polymorphisms (SNPs) based on simulations performed by Salas and Amigo (2010) to be typed using SNaPShot(TM) (Applied Biosystems, Foster City, CA, USA). The assay was validated by typing more than 100 HVS-1/HVS-2 sequenced samples. No differences were observed between the SNP typing and DNA sequencing when results were compared, with the exception of allelic dropouts observed in a few haplotypes. Haplotype diversity simulations were performed using 172 mtDNA sequences representative of the Brazilian population and a score of 0.9794 was obtained when the 14 SNPs were used, showing that the theoretical prediction approach for the selection of highly discriminatory SNPs suggested by Salas and Amigo (2010) was confirmed in the population studied. As the main goal of the work is to develop a screening assay to skip the sequencing of all samples in a particular case, a pair-wise comparison of the sequences was done using the selected SNPs. When both HVS-1/HVS-2 SNPs were used for simulations, at least two differences were observed in 93.2% of the comparisons performed. The assay was validated with casework samples. Results show that the method is straightforward and can be used for exclusionary purposes, saving time and laboratory resources. The assay confirms the theoretic prediction suggested by Salas and Amigo (2010). All forensic advantages, such as high sensitivity and power of discrimination, as also the disadvantages, such as the occurrence of allele dropouts, are discussed throughout the article.

DRD2 haplotype is associated with dyskinesia induced by levodopa therapy in Parkinson's disease patients.

AIM: Dyskinesia and motor fluctuation are frequent and serious complications of chronic levodopa therapy in patients with Parkinson's disease. Since genetic factors could play a role in determining the occurrence of these problems, the aim of the present study was to investigate whether possible functional polymorphisms among DRD2 and ANKK1 genes are associated with the risk of developing dyskinesia and motor fluctuations in Parkinson's disease patients. PATIENTS & METHODS: One hundred and ninety nine patients in treatment with levodopa were genotyped for the -141CIns/Del, rs2283265, rs1076560, C957T, TaqIA and rs2734849 polymorphisms at the DRD2/ANKK1 gene region. RESULTS: Carriers of the TTCTA haplotype showed an increased risk for the presence of dyskinesia (p = 0.007; 1.538 [95% CI: 1.126-2.101]). CONCLUSION: Our data suggest an influence of the DRD2/ANKK1 gene region on levodopa-induced dyskinesia.

Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device).

BACKGROUND: A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A. STUDY DESIGN: This study has a prospective clinical trial design. RESULTS: There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women. CONCLUSION: The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion.

Effect of the copper-intrauterine device (TCu 380A) on subendometrial microvascularization and uterine artery blood flow.

During this cohort study, the copper-intrauterine device (IUD) did not modify subendometrial microvascularization. However, subendometrial blood flow increased in patients who experienced IUD-induced side effects.

Evaluation of social disablement, psychiatric symptoms and autonomy in long-stay psychiatric patients

INTRODUÇAO: No Brasil ainda são escassos os dados sobre limitacões no comportamento social, sintomas psiquiátricos e habilidades de vida independente. Nesse sentido foi realizado um estudo seccional em uma populacão de 881 pacientes psiquiátricos de longa permanência. METODOLOGIA: Foram coletados dados de todos os pacientes residentes no Instituto Municipal Juliano Moreira, utilizando três instrumentos: Avaliacão das Limitacões no Comportamento Social (SBS-BR), Brief Psychiatric Rating Scale (BPRS) e o Inventário de Habilidades de Vida Independente para Pacientes Psiquiátricos - (ILSS-BR). RESULTADOS: Do total de pacientes, 75% apresentaram pouca habilidade de vida independente, score < 2, e limitacões no comportamento social, especialmente nos itens: cuidados pessoais (50,9%), comunicacão espontânea (46,2%) e retardo psico-motor (hipoatividade) (37,5%); 15.1% dos pacientes com esquizofrenia apresentaram sintomas graves de alucinacões, delírios e desorganizacão conceitual; 11.5% dos pacientes esquizofrênicos não apresentaram sintomatologia psiquiátrica, no último mês, e 16% não apresentaram limitacões no comportamento social. CONCLUSAO: 50% dos pacientes têm mais de 65 anos e vivem na Instituicão por mais de 38 anos. Apresentam altas taxas de problemas no comportamento e pouca autonomia. Os dados sugerem a importância de programas específicos para estes pacientes. Além disso, existe um grupo de pacientes sem sintomas psiquiátricos, com bom grau de autonomia e sem limitacões no comportamento social que poderia viver em residências terapêuticas na comunidade.

Avaliaçäo das limitaçöes no comportamento social em pacientes psiquiátricos de longa permanência / The assessment of social role functioning impairments in long-stay psychiatric patients

Trata de uma avaliaçäo do comportamento social de pacientes psiquiátricos de longa permanência. Estudos recentes concentram-se nesse tema, considerando-o relevante na transferência do eixo da atençäo do hospital para a comunidade. Para avaliar dificuldades e limitaçöes de uma populaçäo com longo período de institucionalizaçäo, utiliza-se a Social Behavioural Schedule (SBS), que cobre áreas do comportamento referentes às principais dificuldades de pacientes crônicos. Selecionou-se uma amostra de 46 pacientes de uma populaçäo de 200 mulheres, com longa história de internaçäo psiquiátrica, residentes em duas moradias protegidas e quatro pavilhöes do Núcleo Franco da Rocha (NFR), do Instituto Municipal Juliano Moreira, no Rio de Janeiro. Os resultados obtidos foram comparados aos dados de uma amostra de moradores em um albergue de sem tetos e aos de pacientes de um hospital psiquiátrico, ambos situados em Londres. Os resultados sugerem que significativo percentual dos pacientes que vivem longo tempo em hospitais teriam condiçöes de viver em residências na comunidade.

Desinstitucionalizaçäo da assistência psiquiátrica - Algumas questöes cruciais / Deinstitutionalization of the psychiatric care - Some crucial questions

O artigo comenta a tendência observada no Brasil, à semelhança de outros países, de implementaçäo de políticas de Saúde Mental que objetivem a reduçäo de leitos hospitalares e a implantaçäo de estruturas assistenciais que possam substituir a internçäo psiquiátrica tradicional. Discute como a literatura internacional percebe duas questöes relacionadas com o tema: a efetividade do modelo extra-hospitalar e os custos comparativos entre as duas modalidades de atençäo. Em relaçäo ao sistema público brasileiro, aponta para a necessidade da ampliaçäo dos mecanismos de suporte social para o sucesso da alocaçäo em comunidade dos pacientes com distúrbios mentais graves e persistentes

Desinstitucionalizacao da assistencia psiquiatrica: algumas questoes cruciais

O artigo comenta a tendencia observada no Brasil, a semelhanca de outros paises, de implementacao de politicas de Saude Mental que objetiveram a reducao de leitos hospitalares e a implantacao de estruturas assistenciais que possam substituir a internacao psiquiatrica tradicional. Discute como a literatura internacional percebe duas questoes relacionamento com o tema: a afetividade do modelo extra-hospitalar e os custos comparativos entre as duas modalidades de atencao. Em relacao ao sistema publico brasileiro, aponta para a necessidade da ampliacao dos mecanismos de suporte social para o sucesso da alocacao em comunidade dos pacientes com disturbios mentais graves e persistentes.