Impact of active lifestyle on the primary school children saliva microbiota composition.

The aim of the study was to evaluate the effects of Active or Sedentary lifestyle on saliva microbiota composition in Italian schoolchildren. Methods: Male (114) and female children (8-10 years) belonging to five primary schools in the neighborhoods of Turin were classified as active (A) or sedentary (S) based on PAQ-C-It questionnaire. PCR amplification of salivary DNA targeted the hypervariable V3-V4 regions of the 16S rRNA bacterial genes. DADA2 workflow was used to infer the Amplicon Sequence Variants and the taxonomic assignments; the beta-diversity was obtained by PCoA with the UniFrac method; LEfSe algorithm, threshold at 5%, and Log LDA cutoff at ±0.5 were used to identify differently abundant species in A compared to S saliva sample. Daily food intake was assessed by 3-Days food record. The metabolic potential of microbial communities was assessed by PICRUSt. Results: No significant differences were found in individual's gender distribution (p = 0.411), anthropometry, BMI (p > 0.05), and all diet composition between A and S groups (p > 0.05). Eight species were differently abundant: Prevotella nigrescens (LDA score = -3.76; FDR = 1.5×10-03), Collinsella aerofaciens (LDA score = -3.17; FDR = 7.45×10-03), Simonsiella muelleri (LDA score = -2.96; FDR = 2.76×10-05), Parabacteroides merdae (LDA score = -2.43; FDR = 1.3×10-02) are enriched in the A group; Gemella parahaemolysans, Prevotella aurantiaca (LDA score = -3.9; FDR = 5.27×10-04), Prevotella pallens (LDA score = 4.23; FDR = 1.93×10-02), Neisseria mucosa (LDA score = 4.43; FDR = 1.31×10-02; LDA score = 2.94; FDR = 7.45×10-03) are enriched in the S group. A prevalence of superpathway of fatty acid biosynthesis initiation (E. coli) and catechol degradation II (meta-cleavage pathway) was found in saliva from A compared to S children. Conclusion: Our results showed that active children had an enrichment of species and genera mainly associated with a healthier profile. By contrast, the genera and the species enriched in the sedentary group could be linked to human diseases.

Human Competence to Transmit Leishmania infantum to Lutzomyia longipalpis and the Influence of Human Immunodeficiency Virus Infection.

Visceral leishmaniasis (VL) caused by Leishmania infantum is a lethal disease transmitted by sand flies. Although, considered a zoonosis with dogs held as the main reservoirs, humans are also sources of infection. Therefore, control policies currently focused on dog culling may need to consider that VL and human immunodeficiency virus (HIV)/VL patients may also be infectious, contributing to transmission. Reservoir competence of patients with VL without and with HIV infection and of persons asymptomatically infected with Leishmania was assessed by xenodiagnosis with the vector Lutzomyia longipalpis. Parasites in sand fly's guts were identified by using optical microscopy and by conventional polymerase chain reaction (PCR). Leishmania infantum blood parasite burden was determined by quantitative PCR. Among the 61 participants, 27 (44%) infected sand flies as seen by microscopy or PCR. When infectiousness was assessed by microscopy, xenodiagnosis was positive in five (25%) patients not infected with HIV, whereas nine (45%) of those harboring HIV were positive. Among the 19 asymptomatic patients four (21%) infected sand flies only demonstrated by PCR. One (50%) asymptomatic patient with HIV had a positive xenodiagnosis by microscopy. 9/372 (2.4%) and 37/398 (9.2%) sand flies were infected when feeding in patients without and with HIV, respectively. Infectiousness was poorly correlated with quantitative PCR. The study shows that asymptomatic humans are capable of transmitting L. infantum, that ill persons with HIV infection are more infectious to sand flies, and that humans are more important reservoirs than previously thought. This fact may be considered when designing control policies for zoonotic VL.

Conhecimentos e condutas de médicos e profissionais de enfermagem frente aos acidentes de trabalho / Knowledge and conduct of doctors and nurses professionals forward to work accidents

Objetivo: descrever o perfil dos acidentes de trabalho entre médicos e profissionais de enfermagem.Metodologia: estudo exploratório, descritivo e quantitativo, realizado em um hospital-escola público na cidade de Teresina, Piauí, com 67 profissionais de saúde. Os dados foram obtidos nos meses de fevereiro-maiode 2011, por meio de um formulário, e analisados no Programa “Statistical Package for the Social Science”,versão 20.0. Resultados: Verificou-se que 28 profissionais afirmaram ter sofrido acidentes, sendo a categoriade técnico de enfermagem a mais prevalente. Quanto à faixa etária, os mais atingidos estiveram entre 41 e 50 anos. Quanto à frequência, 11 tinham sofrido dois acidentes, 10 apenas um e 2 com três acidentes, somando um total de 34 acidentes. A punção venosa periférica foi a prática mais envolvida nos acidentes, sendo citada por 16 das 28 vítimas. 47 participantes citaram a Comissão Interna de Prevenção de Acidentes como local ao qual deveriam comunicar o acidente. Conclusão: verifica-se a necessidade de cursos de educação continuada sobre o uso de barreiras de contenção e prevenção de acidentes para minimizar riscos e garantir a segurança aos trabalhadores.

Objective: describe the profile of occupational accidents among doctors and nurses. Methodology: exploratory, descriptive and quantitative study, conducted at a public teaching hospital in the city of Teresina, Piauí, with 67 health professionals. Data were obtained in the months from February to May 2011,through a form, and analyzed the program "Statistical Package for the Social Sciences", version 20.0. Results: It was found that 28 professionals reported injuries, being the most prevalent category of nursing technician. As to age, the most affected were between 41 and 50 years. Regarding frequency, 11 had suffered two accidents, only one 10 and 2 with three accidents, with a total of 34 accidents. Peripheral venous puncturewas practicing more involved in accidents, being mentioned by 16 of the 28 victims. 47 participants cited the Internal Commission for Accident Prevention as a place you should report the accident. Conclusion: verifies the need for continuing education courses on the use of containment barriers and accident prevention tominimize risk and ensure the safety of workers.

Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery.

INTRODUCTION: Delirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients. METHODS: This prospective study was conducted over a 10-month period in a SICU. Postoperative delirium was diagnosed in accordance with the Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality at 6-month follow-up. Hospital mortality and becoming dependent were considered as secondary outcomes, on the basis of the evaluation of the patient's ability to undertake both personal and instrumental activities of daily living (ADL) before surgery and 6 months after discharge from the SICU. For each dichotomous outcome - hospital mortality, mortality at 6-month follow-up, and becoming dependent - a separate multiple logistic regression analysis was performed, which included delirium as an independent variable. Another outcome analyzed was changes in health-related quality of life, as determined using short-form 36 (SF-36), which was administered before and 6 months after discharge from the SICU. Additionally, for each SF-36 domain, a separate multiple linear regression model was used for each SF-36 domain, with changes in the SF-36 domain as a dependent variable and delirium as an independent variable. RESULTS: Of 775 SICU-admitted adults, 562 were enrolled in the study, of which 89 (16%) experienced postoperative delirium. Delirium was an independent risk factor for mortality at the 6-month follow-up (OR = 2.562, P <0.001) and also for hospital mortality (OR = 2.673, P <0.001). Delirium was also an independent risk factor for becoming dependent for personal ADL (P-ADL) after SICU discharge (OR = 2.188, P <0.046). Moreover, patients who experienced postoperative delirium showed a greater decline in SF-36 domains after discharge, particularly in physical function, vitality, and social function, as compared to patients without postoperative delirium. CONCLUSIONS: Postoperative delirium was an independent risk factor for 6-month follow-up mortality, hospital mortality, and becoming independent in P-ADL after SICU discharge. It was also significantly associated with a worsening in the quality of life after surgery.

Congestive heart failure as a determinant of postoperative delirium.

BACKGROUND: Postoperative delirium (POD) is a frequent post-surgical complication that is associated with increased mortality and poor patient outcomes. POD is a complex disorder with multiple risk factors such as pre-existing patient comorbidities and perioperative complications. The aim of this study was to evaluate the incidence of POD and to identify risk factors for the development of POD in a post-anesthesia care unit (PACU). METHODS: We enrolled 97 adult patients admitted to a PACU over a five-day period (start date September 6, 2010). Patient demographics and intraoperative and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist. Descriptive analyses of variables were used to summarize data, and the Mann-Whitney U test was used to compare continuous variables; the chi-square or Fisher's exact test was used for comparisons. Univariate analysis was performed using simple binary logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). The significance level for multiple comparisons was controlled by applying the Bonferroni correction for multiple comparisons and variables were deemed significant if p≤0.0025. RESULTS: Six percent of patients developed POD. These patients were older and more likely to have higher American Society of Anesthesiologists (ASA) physical status (83 vs. 22% with ASA III/IV, p=0.004) as well as a higher frequency of congestive heart failure (50 vs. 3%, p=0.003) and a higher Revised Cardiac Risk Index (RCRI) score (33 vs. 6% with RCRI ≥2, p=0.039). The duration of anesthesia for patients with POD was also longer and they received a greater volume of crystalloids, colloids, and erythrocytes during surgery. Congestive heart disease was an independent risk factor for POD (OR 29.3, 95% CI 4.1-210.6; p<0.001). In addition, patients who developed POD had higher in-hospital mortality and longer PACU and hospital stays. CONCLUSIONS: Patients who developed POD had longer hospital and PACU stays and higher in-hospital mortality. Congestive heart disease was considered an independent risk factor for POD.

Outcome after hepatectomy-delirium as an independent predictor for mortality.

BACKGROUND: Most studies that follow up hepatectomy cases are limited in scope to an investigation of mortality and morbidity rates or the costs and length of hospital stay. In this study the authors aimed to characterize the quality of life and to evaluate mortality and its determinants after hepatectomy. METHODS: This prospective study was carried in a Post-Anaesthesia Care Unit (PACU) over 15 months, and 70 patients submitted to hepatectomy were enrolled. Demographic and peri-operative characteristics were evaluated for associations with mortality. At admission and 6 months after discharge, patients completed a Short Form-36 questionnaire (SF-36) and have their independence in Activities of Daily Living (ADL) was evaluated. Binary and multiple logistic regression analyses were used to evaluate of associations with mortality, and the Wilcoxon signed rank test was used to compare SF-36 scores before and after 6 months after hepatectomy. RESULTS: The mortality rate was 19% at 6 months. Multivariate analysis identified postoperative delirium as an independent determinant for mortality. Six months after discharge, 46% patients stated that their health in general was better or much better than that 1 year previously. Six months after hepatectomy, patients had worse scores in the physical function domain of SF-36; however, scores for all the other domains did not differ. At this time point, patients were more dependent in instrumental ADL than before surgery (32% versus 7%, p = 0.027). CONCLUSION: This study identified postoperative delirium as an independent risk factor for mortality 6 months after hepatectomy. After 6 months, survivors were more dependent in instrumental ADL tasks and had worse scores in the physical function domain of SF-36.

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados / Postoperative delirium in intensive care patients: factores de riesgo y resultados / risk factors and outcome / Delirio postoperatorio en pacientes en cuidados intensivos

JUSTIFICATIVA E OBJETIVOS: O delirium pós-operatório (DPO) em pacientes cirúrgicos em terapia intensiva é um resultado independente importante e determinante. O objetivo do nosso estudo foi avaliar a incidência e os determinantes do DPO. MÉTODOS: Estudo prospectivo de coorte realizado durante um período de 10 meses em uma unidade de recuperação pós-anestesia (URPA) com cinco leitos especializados em terapia intensiva. Todos os consecutivos pacientes adultos submetidos à cirurgia de grande porte foram incluídos. Os dados demográficos, as variáveis perioperatórias, o tempo de internação (TI) e a mortalidade na URPA, no hospital e nos 6 meses de acompanhamento foram registrados. Delirium pós-operatório foi avaliado utilizando o Checklist para triagem de delirium em terapia intensiva (Intensive Care Delirium Screening Checklist - ICDSC). Análises descritivas foram realizadas e o teste de Mann-Whitney, qui-quadrado ou teste exato de Fisher foram usados para comparações. Análise de regressão logística avaliou os fatores determinantes do DPO com o cálculo da razão de chances (RC) e seu intervalo de confiança de 95% (IC 95%). RESULTADOS: Houve admissão de 775 pacientes adultos na URPA e 95 pacientes não atenderam aos critérios de inclusão. Dos 680 pacientes restantes, 128 (18,8%) desenvolveram DPO. Os determinantes independentes de DPO identificados foram a idade, ASA-PS, cirurgia de emergência e a quantidade total de plasma fresco congelado (PFC) administrada durante a cirurgia. Os pacientes com delirium tiveram taxas mais elevadas de mortalidade, estavam mais gravemente doente e permaneceram mais tempo na URPA e no hospital. DPO foi um fator de risco independente para mortalidade hospitalar. DISCUSSÃO: A incidência de delirium foi elevada nos pacientes cirúrgicos em terapia intensiva. DPO foi associado a uma pior pontuação de gravidade da doença, tempo de permanencia mais longo no hospital e na URPA e a taxas mais elevadas de mortalidade. Os fatores de risco independentes para DPO foram a idade, ASA-PS, cirurgia de emergência e quantidade de plasma administrado durante a cirurgia.

BACKGROUND AND OBJECTIVES: Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. METHODS: Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). RESULTS: There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality DISCUSSION: There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASA-PS, emergency surgery and the amount of plasma administered during surgery.

JUSTIFICATIVA Y OBJETIVOS: El delirio postoperatorio (DPO) en pacientes quirúrgicos en cuidados intensivos es un resultado independiente y un importante determinante. El objetivo de nuestro estudio fue evaluar la incidencia y los determinantes del DPO. MÉTODOS: Estudio prospectivo de cohorte realizado durante un período de 10 meses en una unidad de recuperación de postanestesia (URPA) con cinco camas especializadas en cuidados intensivos. Todos los pacientes adultos consecutivos que fueron sometidos a cirugía mayor fueron incluidos. Los datos demográficos, las variables perioperatorias, el tiempo de ingreso (TI) y la mortalidad en la URPA en el hospital y en los 6 meses de seguimiento quedaron registrados. El delirio postoperatorio se evaluó utilizando el Checklist para la selección de delirio en cuidados intensivos (Intensive Care Delirium Screening Checklist - ICDSC). Los análisis descriptivos fueron realizados y el test de Mann-Whitney, Xi-Cuadrado (Xi²) y el test exacto de Fisher fueron usados para las comparaciones. El análisis de regresión logística evaluó los factores determinantes del DPO con el cálculo de la razón de chances (RC) y su intervalo de confianza de 95% (IC 95%). RESULTADOS: La admisión fue de 775 pacientes adultos en la URPA y 95 pacientes no respetaron los criterios de inclusión. De los 680 pacientes restantes, 128 (18,8%) desarrollaron DPO. Los determinantes independientes de DPO identificados fueron la edad, ASA-PS, cirugía de emergencia y la cantidad total de plasma fresco congelado (PFC) administrado durante la cirugía. Los pacientes con delirio tuvieron tasas más elevadas de mortalidad, estaban más gravemente enfermos y permanecieron más tiempo en la URPA y en el hospital. El DPO fue un factor de riesgo independiente para la mortalidad hospitalaria. DISCUSIÓN: La incidencia de delirio fue elevada en los pacientes quirúrgicos en cuidados intensivos. El DPO estuvo asociado con una peor puntuación de gravedad de la enfermedad, tiempo de permanencia más largo en el hospital y en la URPA y tasas más elevadas de mortalidad. Los factores de riesgo independientes para DPO fueron la edad, ASA-PS, cirugía de emergencia y cantidad de plasma administrado durante la cirugía.

Postoperative delirium in intensive care patients: risk factors and outcome.

BACKGROUND AND OBJECTIVES: Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. METHODS: Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). RESULTS: There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality DISCUSSION: There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASAPS, emergency surgery and the amount of plasma administered during surgery.

Estudo quimiométrico qualitativo da polimerização de resina composta / A qualitative chemometric study of resin composite polymerization

Objetivo: O experimento objetivou avaliar o efeito que diferentes técnicas de polimerização produzem na cor da resina composta quando esta é submetida à pigmentação por solução de café. Métodos: Corpos de prova de resina TPH Spectrum foram confeccionados, polimerizando-se a resina com equipamentos de luz halógena convencional, por dois períodos de tempo (10 e 40 segundos), a zero e dez milímetros de distância da superfície da resina. Após a confecção, alguns corpos de prova foram imersos em solução de café por 24 horas, e outros, por sete dias, para avaliar a suscetibilidade ao manchamento. Dez avaliadores classificaram os corpos de prova em ordem decrescente de manchamento. Resultados: Os corpos de prova que foram polimerizados por 10 segundos mostraram-se mais suscetíveis ao manchamento pelo café que aqueles que foram polimerizados por 40 segundos. Os corpos de prova que ficaram imersos em café por sete dias mostraram-se mais suscetíveis ao manchamento pelo café que aqueles cujo período de imersão foi de 24 horas. Conclusão: As variáveis tempo de polimerização e tempo de imersão em café foram determinantes na estabilidade de cor da resina composta estudada. Entretanto, a distância entre a ponta emissora da fonte de luz e a superfície da resina não se mostrou significativa quanto à estabilidade de cor

Objective: An experiment was carried out to assess the effect produced by different polymerization techniques on resin composite color after it has been immersed in coffee. Methods: Samples were manufactured using TPH Spectrum composite. It was polymerized for 10 or 40 seconds, with the light tip at one or zero millimeters from the resin surface, and afterwards the samples were immersed in coffee for 24 hours or 7 days. Ten different evaluators classified the samples according to their degree of staining. Results: The samples that were polymerized for 10 seconds were more susceptible to staining than the ones polymerized by 40 seconds. Samples immersed in coffee for 7 days were more susceptible to staining than the ones immersed for 24 hours. Conclusion: The variables polymerization time and immersion time were determinant in the staining susceptibility of the studied composite by coffee. However, there was no significant difference, irrespective of whether the resin was polymerized 10 or zero millimeters away from the resin surface.