Dissecção espontânea da artéria coronária, uma doença multifatorial: perspectivas da experiência de um centro / Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

Introdução: Embora seja uma doença pouco conhecida, a dissecção espontânea da artéria coronária é uma causa importante e frequentemente subdiagnosticada da síndrome coronariana aguda não aterosclerótica, principalmente em mulheres. O objetivo deste estudo foi caracterizar uma amostra consecutiva de pacientes diagnosticados com dissecção espontânea da artéria coronária quanto a fatores predisponentes e desencadeadores; quadro clínico e angiográfico; abordagem terapêutica; ocorrência de eventos cardíacos adversos; recorrência e dissecção espontânea de artéria coronária de novo. Métodos: Estudo retrospectivo observacional longitudinal, unicêntrico, que incluiu pacientes diagnosticados com dissecção espontânea da artéria coronária (n=60) admitidos entre janeiro de 2010 e dezembro de 2020. Resultados: A mediana da idade foi de 55 anos, e 83% eram mulheres. A maioria dos pacientes (60%) não apresentava nenhum ou tinha apenas um fator de risco cardiovascular. O infarto agudo do miocárdio sem supradesnivelamento do segmento ST foi o quadro clínico em 67% dos casos. A artéria coronária mais frequentemente envolvida foi a descendente anterior (47%). A maioria das lesões (77%) aparecia na angiografia como dissecção espontânea da artéria coronária tipo 2. O tratamento conservador foi selecionado como abordagem inicial na maioria dos pacientes (72%). A incidência geral de dissecção espontânea da artéria coronária de novo não foi significativamente diferente entre os pacientes tratados primeiramente com revascularização, em comparação com os que receberam tratamento conservador (p=0,953). No entanto, a recidiva da dissecção espontânea da artéria coronária ocorreu no vaso originalmente envolvido em 3 dos 15 pacientes tratados com revascularização, em comparação com apenas um entre os 43 pacientes que foram tratados de forma conservadora (p<0,05). Conclusão: A dissecção espontânea da artéria coronária é mais frequente em mulheres jovens. O infarto agudo do miocárdio sem supradesnivelamento do segmento ST foi o quadro clínico mais observado, envolvendo principalmente a artéria descendente anterior. A revascularização não protegeu da recorrência.

Background: Although it is a poorly known disease, spontaneous coronary artery dissection is an important and frequently underdiagnosed cause of non-atherosclerotic acute coronary syndrome, particularly in women. The objective of this study was to characterize a consecutive sample of patients diagnosed with spontaneous coronary artery dissection with respect to predisposing and precipitating factors; clinical and angiographic presentation; management; occurrence of adverse cardiac events; recurrence; and de novo spontaneous coronary artery dissection. Methods: Longitudinal, observational, retrospective, single-centre study, including patients diagnosed with spontaneous coronary artery dissection (n=60) admitted between January 2010 and December 2020. Results: Median age was 55 years, and 83% were women. Most patients (60%) presented without any or just one cardiovascular risk factor. Non-ST-segment elevation acute myocardial infarction accounted for 67% of clinical presentations. The most frequently affected coronary artery was the left anterior descending (47%). Most lesions (77%) appeared on angiography as type 2 spontaneous coronary artery dissection. Conservative management was chosen as the initial approach in most patients (72%). The overall incidence of de novo spontaneous coronary artery dissection was not significantly different among patients initially managed with revascularization as compared to conservative treatment (p=0.953). However, spontaneous coronary artery dissection recurrence occurred in the originally involved vessel in 3 of 15 patients initially managed with revascularization, as compared to only one among 43 patients treated conservatively (p<0.05). Conclusion: Spontaneous coronary artery dissection occurs more often in young women. Non- ST-segment elevation acute myocardial infarction was the most frequent clinical presentation involving mainly the left anterior descending artery. Revascularization did not protect from recurrence.

The impact of body mass index on laboratory, clinical outcomes and treatment costs in assisted reproduction: a retrospective cohort study.

BACKGROUND: The aim of this study was to evaluate the influence of the body mass index (BMI) on laboratory, clinical outcomes and treatment costs of assisted reproduction, as there are still controversial and inconclusive studies on this subject. METHODS: This research was retrospective cohort study, including women undergoing assisted reproduction in a Reproductive Medicine Center between 2013 and 2020. The participants were divided into groups according to BMI (kg/m2): Group 1 < 25; Group 2, 25-29.9 and Group 3, ≥ 30. A total of 1753 in vitro fertilization (IVF) fresh embryo transfer (ET) cycles were included for assisted reproduction outcomes analysis and 1869 IVF-ET plus frozen embryo transfer (FET) for cumulative pregnancy analysis. RESULTS: As higher the BMI, higher was the proportion of canceled IVF cycles (G1 (6.9%) vs. G2 (7.8%) vs. G3 (10.4%), p = 0.002) and gonadotropin's total dose (IU) and treatment costs (G1 (1685 ± 595, U$ 683,02) vs. G2 (1779 ± 610, U$ 721,13) vs. G3 (1805 ± 563, U$ 764,09), p = 0.001). A greater number of mature oocytes was observed in G1 and G2 (6 [6.4-7.0] vs. 6 [5.6-6.6] vs. 4 [4.6-6.7], p = 0.011), which was not found in oocyte maturity rate (p = 0.877). A significant linear tendency (p = 0.042) was found in cumulative pregnancy rates, pointing to worse clinical outcomes in overweight and obese patients. CONCLUSION: These findings highlight the importance of considering the higher treatment costs for these patients, beyond all the well-known risks regarding weight excess, fertility, and pregnancy, before starting IVF treatments.

Influence of overweight and obesity on perinatal outcomes in assisted reproduction: a retrospective cohort study.

BACKGROUND: In spontaneous pregnancies, maternal weight and gestational diabetes are independent risk factors for macrosomia and large-for-gestational-age newborns. Furthermore, maternal body mass index (BMI) of ≥25 kg/m2 is associated with worse neonatal vitality, classified as an Apgar score of < 7 at the fifth minute of life. However, few studies have evaluated the influence of BMI on perinatal outcomes in pregnancies resulting from assisted reproduction. Therefore, this study aimed to analyze whether the perinatal outcomes of assisted reproduction are influenced by BMI. METHODS: This was a retrospective cohort study performed at a reproductive medicine center. Patients undergoing assisted reproduction (2013-2020) were divided into three groups according to their BMI (kg/m2): group 1, < 25; group 2, 25-29.9, and group 3, ≥30. In total, 1753 in vitro fertilization embryo transfer cycles were analyzed. Data were expressed as mean ± standard deviation or frequency (%). The analysis of variance and chi-square test were performed for comparison. To determine the participants and number of cycles for these analyses, generalized estimating equations were used, considering p < 0.05. RESULTS: In groups 1, 2, and 3, the rates of live birth were 33.5, 32.3, and 29.9% (p = 0.668); preeclampsia were 2.9, 6.1, and 6.3% (p = 0.268); small-for-gestational-age newborns were 23, 23.2, and 21.7% (p = 0.965); macrosomia were 1.9, 0.9, and 2.7% (p = 0.708); Apgar score > 7 at the fifth minute were 97.6, 98.2, and 100% (p = 0.616); and preterm birth were 29.6, 30.1, and 35.1% (p = 0.970), respectively. CONCLUSIONS: In conclusion, although the three groups had similar perinatal outcomes in this study, the study population was too small for conclusive results. The higher the BMI, the lower the chances of clinically relevant LBR and the higher the chances of premature labor and preeclampsia.

Patients undergoing elective and oncofertility preservation respond similarly to controlled ovarian stimulation for fertility preservation.

OBJECTIVE: Outcome data for oocyte vitrification for fertility preservation are still scarce despite the scientific and technological advances. Studies suggest that patients with cancer have worse outcomes regarding mature vitrified oocytes when compared to healthy patients. Thus, the objective of this study was to evaluate and compare the oocyte vitrification response in patients undergoing elective and oncofertility preservation. METHODS: The ovarian stimulation response was verified by a cross-sectional and observational study, analyzing data from 367 patients between 2009 and 2018, which were divided into elective group (EG; n=327) and oncofertility group (OFG; n=40). The number of follicles, oocytes, mature oocytes, and duration of the cycle was evaluated, which were compared with clinical and ovarian stimulus data between groups. RESULTS: A significant difference in women's age (31.3±5.8 vs. 37.0±2.9 years; p<0.01) and basal values of Follicle Stimulating Hormone (FSH), (4.0 [3.3 - 6.2] vs. 9.0 [5.4 - 9.9] mIU/mL; p<0.01) were observed. When adjusting data for age, FSH and Gonadotropin-releasing Hormone protocols, no significant difference in the number of vitrified mature oocytes between the two groups were observed (6.0 [3.0-11.0] vs. 7.0 [3.0-12.0]; p=0.11). CONCLUSIONS: Thus, patients undergoing elective and oncofertility preservation seem to respond similarly to controlled ovarian stimulation for fertility preservation. Breast cancer was the most frequent in the OFG (67%).

Entre justiça e gestão: colaboração interinstitucional na judicialização da saúde / Entre justicia y gestión: colaboración interinstitucional en la judicialización de la salud / Between justice and public management: interinstitutional collaboration in health litigation

Resumo O sistema de justiça faz mais do que apenas "controlar" a legalidade de políticas públicas e sua execução. O caso da judicialização da saúde no Brasil ilustra como juízes/as, advogados/as públicos/as e promotores/as se envolvem cada vez mais ativamente com a gestão da política de saúde. Esse envolvimento resulta na reorganização da gestão pública assumindo as ações judiciais ajuizadas contra a administração do Sistema Único de Saúde (SUS) como um "problema social" que merece respostas organizadas e coordenação interinstitucional. Este artigo descreve tais respostas com base em padrões de colaboração interinstitucional entre atores do sistema de justiça e profissionais da gestão da saúde em 4 estados brasileiros: São Paulo, Rio de Janeiro, Santa Catarina e Rio Grande do Sul. A partir de tipologia de McNamara (2012, 2016), o texto compara os diferentes graus de integração dessas respostas entre órgãos e traça o "perfil" colaborativo do estado em relação à judicialização da saúde.

Resumen El sistema de justicia hace más que simplemente "controlar" la legalidad de las políticas públicas y su implementación. El caso de la judicialización de la salud en Brasil ilustra cómo los jueces, los abogados públicos y los fiscales están cada vez más involucrados en la gestión de la política de salud. Esta participación resulta en la reorganización de la gestión pública. Las demandas presentadas contra la administración del Sistema Único de Salud se transforman en un "problema social" que merece respuestas organizadas y coordinación interinstitucional. Este artículo describe esas respuestas con base en estándares de colaboración interinstitucional entre actores del sistema de justicia y gestores de salud pública en cuatro estados brasileños: São Paulo, Río de Janeiro, Santa Catarina y Rio Grande do Sul. Operacionalizando la tipología de McNamara (2012, 2016) este estudio compara el grado de integración de las respuestas entre esos organismos y rastrea el "perfil" colaborativo de cada estado en relación con la judicialización de la salud.

Abstract The Brazilian justice system does more than simply review the legality of public policies and oversee their implementation. Looking at health litigation in Brazil reveals how judges, public lawyers, and prosecutors are increasingly involved in policy management, as they comprehend that the rising number of lawsuits seeking healthcare treatment requires management and inter-organizational coordination. This article explores this phenomenon by assessing initiatives of inter-institutional collaboration between actors in the justice and healthcare systems in four Brazilian states: São Paulo, Rio de Janeiro, Santa Catarina, and Rio Grande do Sul. By operationalizing the typology developed by McNamara (2012, 2016), this study compares the levels of integration in these responses and traces the collaborative "profile" of each state's approach to dealing with health litigation.

Educação alimentar e nutricional melhora conhecimento sobre o tratamento de diabetes mellitus tipo 2: um estudo qualitativo / Food and nutrition education actions based on Pestalozzi's intuitive method

A educação alimentar e nutricional é um fator determinante para a prevenção e controle das doenças crônicas não transmissíveis como o diabetes mellitus tipo 2. Assim, o objetivo deste estudo foi avaliar o efeito de ações de educação alimentar e nutricional na percepção e no conhecimento sobre a doença, seu tratamento e dificuldades enfrentadas por pessoas com diabetes mellitus tipo 2. Estudo longitudinal do tipo quanti-qualitativo, realizado com 10 adultos com diabetesmellitus tipo 2, atendidos pela Liga Acadêmica de Nutrição em Diabetes da Universidade Federal de Sergipe. Os indivíduos foram convidados a participar de ações de educação alimentar e nutricional realizadas semanalmente durante seis semanas. Os participantes foram entrevistados antes (T0) e após (T1) as ações a fim de investigar os conhecimentos obtidos. Utilizou-se a entrevista semiestruturada com duas perguntas para obtenção dos discursos, a primeira relacionou-se com a percepção sobre a doença e tratamento, e a segunda com as dificuldades enfrentadas na busca da alimentação saudável. A análise foi realizada pela técnica de Análise de Conteúdo. Para a primeira pergunta emergiram discursos categorizados em significado emocional, fisiológico e tratamento, já para a segunda emergiram aspectos externos, internos e sem dificuldades. Após as ações, os discursos mostraram-se positivos quanto à adoção de uma alimentação saudável no tratamento. A intervenção permitiu que os indivíduos obtivessem maior conhecimento da doença e dos aspectos relacionados ao tratamento.

Food and nutrition education is a determining factor for the prevention and control of chronic non-communicable diseases such as type 2 diabetes mellitus. Thus, the aim of this study was to evaluate the effect of food and nutrition education actions on the perception and knowledge about the disease, its treatment, and the difficulties faced by people with type 2 diabetes mellitus. Longitudinal quantitative-qualitative study, carried out with 10 adults with type 2 diabetes mellitus, assisted by the Academic Diabetes Nutrition League of the Federal University of Sergipe. Individuals were invited to participate of the food and nutrition education activities carried out weekly for six weeks. Participants were interviewed before (T0) and after (T1) the activities in order to investigate the knowledge obtained. A semi-structured interview with two questions was used to obtain their responses, the first was related to the perception about the disease and treatment, and the second concerned the difficulties faced in the search for healthy eating. The analysis was performed using the Content Analysis technique. For the first question, responses were categorized into emotional, physiological meanings and treatment, while for the second, external, internal aspects and those without difficulties emerged. After the activities, the responses were positive about the adoption of healthy eating in the treatment. The intervention allowed individuals to gain more knowledge of the disease and aspects related to treatment.

Health technology assessment and judicial deference to priority-setting decisions in healthcare: Quasi-experimental analysis of right-to-health litigation in Brazil.

The constitutional right to health in Brazil has entitled patients to litigate against the government-funded national health system (SUS), claiming access to various health treatments including those excluded from the health system's benefits package. Courts have tended to rely on a single medical prescription to judge these cases in favor of individual patients and against the health system. The large volume of cases has had a substantial financial impact on the government's health budget and has created unfairness in accessing healthcare. To change courts' behavior, a new health technology assessment (HTA) body - CONITEC - was created in 2011. Its creation was accompanied by an administrative procedure that made decisions about the health system's benefits package more transparent, accountable, participative and evidence-informed. It was expected that this HTA system would bring more legitimacy to the government's priority-setting decisions and promote deference from the courts. This study tests whether Brazil's new HTA system succeeded in encouraging judicial deference by analyzing a stratified random sample of 13,263 court decisions for whether the existence of a CONITEC report resulted in less frequent court orders to provide treatment for individual litigants. The results show that the creation of CONITEC did not change courts' behavior; courts still decide in favor of patients in most cases. Indeed, even when there was a CONITEC report recommending against government funding for a particular healthcare treatment, the vast majority of the relatively few patients who were unsuccessful in obtaining a health benefit at their first court hearing later obtained a favorable decision after appealing to a higher court. This finding was confirmed through an interrupted time-series analysis that did not find an impact of having a CONITEC report on courts' willingness to override a government priority-setting decision. In fact, CONITEC was rarely cited in court decisions, even when litigants mentioned the existence of a CONITEC report.

COVID-19 in prisons: a study of habeas corpus decisions by the São Paulo Court of Justice / COVID-19 en las prisiones: un estudio de las decisiones sobre habeas corpus en el Tribunal de Justicia de São Paulo / COVID-19 nas prisões: um estudo das decisões em habeas corpus no Tribunal de Justiça de São Paulo

Abstract Brazil has become the epicenter of the COVID-19 pandemic in the Global South-a pandemic that disproportionately affects vulnerable populations, especially those detained and imprisoned. Legal institutions are struggling to respond. In this paper, we focus on the National Council of Justice's Recommendation 62, issued March 17, 2020, which recommends that judges take several measures to reduce the risk of COVID-19 infection in prisons. We test this recommendation's impact by looking at habeas corpus decisions in the São Paulo Court of Justice. The exploratory findings presented here indicate that Recommendation 62 has little impact on habeas decisions. In general, citing the recommendation does not lead the Court to grant early release or house arrest to those detained, and most habeas actions are decided against petitioners. This is true even when petitioners claim to be part of a risk group, or their alleged offense did not involve violence or serious threat-factors that should favor habeas relief under Recommendation 62.

Resumen Brasil se ha convertido en el epicentro de la pandemia de COVID-19 en el Sur global, una pandemia que afecta desproporcionadamente a las poblaciones vulnerables, especialmente a las detenidas y encarceladas. A las instituciones jurídicas les resulta difícil ofrecer una respuesta adecuada. En este artículo, analizamos una de esas respuestas, la Recomendación 62 del Consejo Nacional de Justicia, emitida el 17 de marzo de 2020 y que recomienda que jueces tomen diferentes medidas para reducir el riesgo de infección por COVID-19 en las prisiones. Evaluamos el impacto de esta recomendación analizando las decisiones sobre habeas corpus del Tribunal de Justicia de São Paulo. Los hallazgos exploratorios presentados aquí indican que la Recomendación 62 tiene poco impacto en estas decisiones. En general, citar la recomendación no lleva al Tribunal a conceder la libertad anticipada o el arresto domiciliario a las personas detenidas y la mayoría de los habeas corpus son decididos en contra de los demandantes. Esto es cierto incluso cuando estas personas afirman ser parte de los grupos de riesgo o que su supuesto crimen no implica violencia o amenaza grave, factores que deberían favorecer las decisiones por la concesión de los habeas corpus, de acuerdo con la Recomendación 62.

Resumo O Brasil se tornou o epicentro da pandemia da COVID-19 no Sul Global — uma pandemia que afeta desproporcionalmente populações vulneráveis, especialmente as detidas e presas. As instituições jurídicas encontram dificuldades em oferecer uma resposta adequada. Neste artigo, analisamos uma destas respostas, a Recomendação 62 do Conselho Nacional de Justiça, emitida em 17 de março de 2020 e que recomenda que juízes e juízas adotem diferentes medidas para reduzir o risco de infecção por COVID-19 nas prisões. Testamos o impacto dessa recomendação analisando decisões em habeas corpus junto ao Tribunal de Justiça de São Paulo. Os achados exploratórios aqui apresentados indicam que a Recomendação 62 tem pouco impacto nestas decisões. Em geral, citar a recomendação não leva o Tribunal a conceder liberdade antecipada ou prisão domiciliar às pessoas presas e a maioria dos habeas corpus são decididos contra demandantes. Isso é verdade mesmo quando estas pessoas afirmam fazer parte de algum dos grupos de risco ou que seu suposto delito não envolvera violência ou grave ameaça — fatores que deveriam favorecer decisões pelo provimento do habeas corpus, segundo a Recomendação 62.

Splenic sympathetic signaling contributes to acute neutrophil infiltration of the injured spinal cord.

BACKGROUND: Alterations in the immune system are a complication of spinal cord injury (SCI) and have been linked to an excessive sympathetic outflow to lymphoid organs. Still unknown is whether these peripheral immune changes also contribute for the deleterious inflammatory response mounted at the injured spinal cord. METHODS: We analyzed different molecular outputs of the splenic sympathetic signaling for the first 24 h after a thoracic compression SCI. We also analyzed the effect of ablating the splenic sympathetic signaling to the innate immune and inflammatory response at the spleen and spinal cord 24 h after injury. RESULTS: We found that norepinephrine (NE) levels were already raised at this time-point. Low doses of NE stimulation of splenocytes in vitro mainly affected the neutrophils' population promoting an increase in both frequency and numbers. Interestingly, the interruption of the sympathetic communication to the spleen, by ablating the splenic nerve, resulted in reduced frequencies and numbers of neutrophils both at the spleen and spinal cord 1 day post-injury. CONCLUSION: Collectively, our data demonstrates that the splenic sympathetic signaling is involved in the infiltration of neutrophils after spinal cord injury. Our findings give new mechanistic insights into the dysfunctional regulation of the inflammatory response mounted at the injured spinal cord.

Citalopram Administration Does Not Promote Function or Histological Recovery after Spinal Cord Injury.

Citalopram is a selective serotonin reuptake inhibitor, and although widely used as an antidepressant, this drug has also demonstrated interesting repairing properties leading to motor recovery and pathology amelioration in animal models of stroke and degeneration. Here, we tested the efficacy of both 7-day and 8-week citalopram treatment in a contusive spinal cord injury (SCI) rat model. A combination of behavioral tests, histological and serum cytokine analysis was used to assess overall recovery. Despite promoting a mild reduction of inflammatory cells as well as an early, but transient increase of specific serum cytokines, citalopram administration showed no overall beneficial effects on motor performance or lesion extension. Our results do not support citalopram treatment as a therapeutic strategy for SCI.

Effect of different dietary patterns on glycemic control in individuals with type 2 diabetes mellitus: A systematic review.

Different dietary patterns have been positively related to the glycemic control of individuals with type 2 diabetes mellitus. However, consensual dietary pattern for these individuals is not established. We aimed to evaluate the effects of adopting different dietary patterns on glycemic control markers of individuals with type 2 diabetes mellitus. PubMed, Scopus, MEDLINE, Lilacs, Open Thesis and Google Scholar databases were searched using the Medical Subject Headings and terms related to dietary pattern and glycemic control in individuals with type 2 diabetes mellitus. Interventional studies with adults of this population without diabetes-related complications, presenting data on percentage of glycated hemoglobin, and dietary patterns were included. In vitro, animal, reviews, observational, and studies with children, adolescents, pregnant and breastfeeding women were excluded. The time of adoption dietary patterns ranged from eight weeks to four years in randomized clinical trials, and six months in the cohort study. Vegetarian, vegan, Mediterranean, and Dietary Approaches to Stop Hypertension dietary patterns reduced 0.8% on average of percentage of glycated hemoglobin, considering all included studies. It was also observed reduction in fasting glycemia and improvement in Homeostasis Model Assessment of Insulin Sensitivity. However, more randomized clinical trials are required for a full elucidation of these questions.

Oxidative stress among informal caregivers / Estresse oxidativo em cuidadores informais

ABSTRACT OBJETIVE: to evaluate oxidative stress and non-enzymatic antioxidant defenses in informal caregivers, and correlations with anxiety, health satisfaction and quality of life. METHOD: a case-control analytical study was performed, where the case was represented by the main informal caregiver and the control was paired with individuals with identical characteristics to the case, but who were not informal caregivers. The following instruments were used: a sociodemographic questionnaire, the Beck anxiety scale and the WHOQoL-Bref. Oxidative stress was measured through blood by analysis of the Ferric Reducing Ability of Plasma (FRAP) and Thiobarbituric Acid Reactive Substances (TBARS) markets. RESULTS: most informal caregivers were females. There was no difference in the degree of anxiety between the Case and Control groups. Among informal caregivers, 9.4% said they were very dissatisfied and 53.1% dissatisfied with their health. Most caregivers (43.8%) rated their quality of life as poor and 12.5% ​​as very poor, while most controls rated it as good (68.8%). The TBARS and FRAP values ​​were lower in the Case group than in the Control group. CONCLUSION: The informal caregivers, who were mostly women, defined themselves as dissatisfied or very dissatisfied with their health. Nevertheless, they did not manifest a higher degree of anxiety in comparison with the control population. In addition, they presented a lower degree of oxidative stress than the non-caregiving participants, perhaps due to a greater mobilization of the non-enzymatic antioxidant defenses present in the body.

OBJETIVO: Avaliar o estresse oxidativo e as defesas antioxidantes não enzimáticas em cuidadores informais, comparando os dados obtidos com indivíduos não cuidadores, correlacionando ao grau de ansiedade, satisfação com a saúde e qualidade de vida. MÉTODO: Estudo analítico caso-controle, onde o caso é representado pelo cuidador informal principal e o controle é pareado por indivíduos com características idênticas ao caso, exceto pelo fato de não desempenhar o papel de cuidador informal. Instrumentos utilizados: questionário sociodemográfico, escala de ansiedade de Beck e WHOQOL-bref. O estresse oxidativo foi medido por meio do sangue, com marcadores Ferric Reducing Ability of Plasma (FRAP) e Thiobarbituric Acid Reactive Substances (TBARS). Resultados: O cuidador informal é representado em sua maioria por indivíduos do sexo feminino. Não houve diferença no grau de ansiedade entre os grupos caso e controle. Dentre os cuidadores informais, 9,4% disseram estar muito insatisfeitos e 53,1% insatisfeitos com sua saúde. Referente à qualidade de vida, a maioria dos cuidadores (43,8%) classificou como ruim e 12,5% como muito ruim, enquanto a maior parte dos controles a classificou como boa (68,8%). Os valores de TBARS e FRAP foram menores no grupo caso em relação ao grupo controle. CONCLUSÃO: O cuidador informal, em sua maioria mulheres, se definem insatisfeitos ou muito insatisfeitos com sua saúde. Apesar disso, não manifestaram grau de ansiedade maior em relação à população controle. Apresentaram grau de estresse oxidativo menor em relação aos participantes não cuidadores, talvez, devido a maior mobilização das defesas antioxidantes não enzimáticas presentes no organismo.

Intakes of Zinc, Potassium, Calcium, and Magnesium of Individuals with Type 2 Diabetes Mellitus and the Relationship with Glycemic Control.

The role of the concomitant intake of zinc, potassium, calcium, and magnesium in the glycemic control of individuals with type 2 diabetes mellitus (T2DM) has not been extensively discussed. We evaluated the relationship between the dietary intake of these micronutrients and glycemic markers in 95 individuals with T2DM (mean age 48.6 ± 8.4 years). Hierarchical grouping analysis was used to divide the individuals into two clusters according to their micronutrient intake, and differences between clusters were statistically assessed. Effects of individual and combination intake of micronutrients on glycated hemoglobin percentage (%HbA1c) were assessed using multiple linear regression and binary logistic regression analysis. We observed a high likelihood of inadequate intake of the four micronutrients. The group with lower micronutrient intake (cluster 1) displayed higher %HbA1c (p = 0.006) and triglyceride (p = 0.010) levels. High %HbA1c showed an association with cluster 1 (odds ratio (OR) = 3.041, 95% confidence interval (CI) = 1.131; 8.175) and time of T2DM diagnosis (OR = 1.155, 95% CI = 1.043; 1.278). Potassium (ß = -0.001, p = 0.017) and magnesium (ß = -0.007, p = 0.015) intakes were inversely associated with %HbA1c. Reduced concomitant intake of the four micronutrients studied proved to be associated with risk of increased %HbA1c in individuals with T2DM, which was particularly predicted by magnesium and potassium intakes.

Systemic Interleukin-4 Administration after Spinal Cord Injury Modulates Inflammation and Promotes Neuroprotection.

Traumatic spinal cord injury (SCI) causes dramatic disability and dysfunction in the motor, sensory and autonomic systems. The severe inflammatory reaction that occurs after SCI is strongly associated with further tissue damage. As such, immunomodulatory strategies have been developed, aimed at reducing inflammation, but also at shaping the immune response in order to protect, repair and promote regeneration of spared neural tissue. One of those promising strategies is the intraspinal administration of the cytokine interleukin-4 (IL-4) that was shown to promote a phenotype on specific immune cells associated with neuroprotection and repair. In this work, we evaluated if a systemic delivery of IL-4 for a 7-days period was also capable of promoting neuroprotection after SCI by analyzing different neural cells populations and motor recovery. IL-4 treatment promoted an elevation of the anti-inflammatory cytokine IL-10 in the serum both at 24 h and 7 days after injury. Locally, treatment with IL-4 led to a reduction on cells expressing markers associated with inflammation, CD11b/c and iNOS. Importantly, IL-4 treatment increased the neuronal markers ßIII-tubulin and NeuN, and the oligodendrocyte marker O4, suggesting a neuroprotective effect. Moreover, 100% of the animals treated with IL-4 were able to recover weight support against only 33% of saline treated animals. Overall, these results show that systemic administration of IL-4 positively impacts different aspects of spinal cord injury, creating a more favorable environment for recovery to take place.

Avaliação clínica e topográfica dos pacientes diagnosticados com acidente vascular cerebral no serviço de emergência / Clinical and topographic evaluation of patients diagnosed with stroke in an emergency uinit

Introdução: O Acidente Vascular Cerebral (AVC), conhecido como derrame, é considerado a primeira causa de mortes no mundo e de incapacidade permanentes em adultos, o que demanda que seja identificado e tratado o mais precocemente possível. Existem estudos que descrevem os fatores de risco no AVC, mas não está claro como esses fatores de risco interferem no prognóstico dos pacientes. Objetivo: O presente estudo objetivou traçar o perfil epidemiológico dos pacientes admitidos na unidade de pronto atendimento (UPA) de uma cidade do Centro Oeste de Minas Gerais, com diagnóstico de AVC. Materiais e Métodos: Foi avaliado o prognóstico clínico desses pacientes relacionando esses dados com as lesões nas imagens de tomografia computadorizada (TC), quando existentes, através das escalas NIHSS e ASPECTS. Resultados: Foram examinados 59 pacientes, sendo observada uma alta incidência de hipertensão arterial (89,8%) e sedentarismo (40,3%). A TC foi realizada em 27,6% dos pacientes admitidos na UPA com AVC e o predomínio da lesão no cérebro foi o hemisfério cerebral direito (44%). A avaliação do prognóstico dos pacientes pela escala NIHSS demonstrou que 33,9% dos pacientes apresentaram escore entre 0 a 7 (bom prognóstico). Os pacientes que apresentaram AVC/AIT prévio como fator de risco tiveram o pior prognóstico na escala NIHSS. Cerca de 20,3% dos pacientes chegaram na UPA com menos de 4 horas e 30 minutos do ictus. Conclusão: Conclui-se que existe uma alta prevalência de pacientes hipertensos, sedentários, dislipidêmicos, diabéticos, tabagistas, etilistas e com AVC/AIT prévio, na cidade em estudo, indicando a necessidade de intervenções na atenção primária local, além do acompanhamento dos pacientes após a alta hospitalar. (AU) Introduction: Stroke is considered the first cause of death worldwide and of permanent incapacity in adults, which demands it to be detected and treated as soon as possible. There are studies describing risk factors for stroke, but it is not clear how these risk factors interfere with the patients' outcomes. Objective: To characterize the epidemiological profile of patients admitted to an emergency unit of a city on the Central-West region of Minas Gerais (Brazil) and diagnosed with stroke. Material and Methods: The clinical prognosis of these patients was evaluated and correlated with the lesions shown (if present) by computed tomography (CT) images through the ASPECT score and NIH Stroke Scale. Results: A total of 59 patients were examined, being observed a high incidence of arterial hypertension (89,8%) and sedentarism (40,3%). CT was undertaken in 27.6% of the admitted patients and the most frequent damaged area was the right brain hemisphere (44%). Patient prognosis evaluated through NIHSS demonstrated that 33.9% of the patients had a score between 0 and 7 (good prognosis). Patients who had a previous history of stroke showed a worse prognosis based on the NIHSS. About 20.3% of the patients were admitted to the emergency unit less than 4 hours and 30 minutes after the ictus. Conclusion: There is a high prevalence of hypertensive, sedentary, dyslipidemic, diabetic, smoker, and alcoholic patients, with previous history of stroke, in the city under study. This profile indicates the need for interventions in the local primary care, in addition to patient follow-up after discharge. (AU)

Bioengineered cell culture systems of central nervous system injury and disease.

Cell culture systems, either 2D or explant based, have been pivotal to better understand the pathophysiology of several central nervous system (CNS) disorders. Recently, bioengineered cell culture systems have been proposed as an alternative to the traditional setups. These innovative systems often combine different cell populations in 3D environments that more closely recapitulate the different niches that exist within the developing or adult CNS. Given the importance of such systems for the future of CNS-related research, we discuss here the most recent advances in the field, particularly those dealing with neurodegeneration, neurodevelopmental disorders, and trauma.

Combining neuroprotective agents: effect of riluzole and magnesium in a rat model of thoracic spinal cord injury.

BACKGROUND CONTEXT: Damage to the spinal cord can result in irreversible impairments or complete loss of motor, sensory, and autonomic functions. Riluzole and magnesium have been widely investigated as neuroprotective agents in animal models of spinal cord injury. As these drugs protect the injured spinal cord through different mechanisms, we aimed to investigate if their neuroprotective efficacy could be cumulative. PURPOSE: This study aimed to investigate the neuroprotective efficacy of combined administration of riluzole and magnesium chloride in a contusive model of thoracic spinal cord injury. STUDY DESIGN: An in vivo experiment was set using female Wistar Han rats that underwent a thoracic spinal cord contusion (T8) using a weight drop method. An hour after injury, animals were randomly distributed to receive (1) saline, (2) riluzole (2.50 mg/kg), (3) magnesium chloride (24.18 mg/kg) in a polyethylene glycol formulation, or (4) a combined treatment (riluzole and magnesium). Subsequent treatments were given in four intraperitoneal injections (spaced 12 hours apart). METHODS: The Basso, Beattie, and Bresnahan locomotor rating scale, an activity box test, and a swimming test were used to evaluate behavioral recovery over a 4-week period. Histologic analysis of the spinal cords was performed to measure the extent and volume of the lesion, axonal preservation, serotonergic and glutamatergic fiber sparing, motor neuron survival, and inflammation. RESULTS: Our results show that only the riluzole treatment significantly improved behavioral recovery up to 4 weeks after injury when compared with saline controls (6.2±1.8), with animals achieving weight-supported stepping (9.1±1.2). Riluzole also promoted tissue sparing with significant differences achieved from 200 to 600 µm (caudally to the lesion epicenter), and reduced lesion volume, with animals presenting a significantly smaller lesion (3.23±0.26 mm(3)) when compared with the saline-treated group (4.74±0.80 mm(3)), representing a 32% decrease in lesion volume. Riluzole treatment induced significant axonal preservation, as well as serotonergic fiber sparing, caudally to the injury epicenter. CONCLUSIONS: Our results suggest that the combined treatment, although simultaneously targeting two excitotoxic-related mechanisms, did not further improve behavioral and histologic outcome when compared with riluzole given alone.

Os impactos da judicialização da saúde no município de São Paulo: gasto público e organização federativa / Los impactos de la judicialización de la salud en el municipio de São Paulo: gasto público y organización federativa / The impacts of health care judicialization in the city of Sao Paulo: public expenditure and federal organization

Nos últimos anos constata-se no Brasil um aumento do número de decisões judiciais obrigando o poder público a fornecer medicamentos, insumos, equipamentos e cirurgias. Os juízes tendem a desconsiderar o impacto orçamentário de suas decisões e entendem que todos os entes da federação podem ser igualmente responsabilizados pelo fornecimento de qualquer item pedido pelo paciente. O presente estudo analisa o impacto dessas decisões para a gestão orçamentária da política de saúde no município de São Paulo por meio de uma estimativa de gastos com a judicialização para o ano de 2011 a partir dos dados disponibilizados pelo município e as publicações no Diário Oficial concernentes à compra de medicamentos e insumos sem licitação pela Secretaria Municipal de Saúde. De acordo com as estimativas do presente trabalho, o gasto do município com judicialização da saúde em 2011 é o equivalente a 6% do que o município gastou com sua política de assistência farmacêutica e 10% do total gasto com fornecimento de medicamentos e material hospitalar, ambulatorial e odontológico. Além do mais, cerca de 55% desse gasto são destinados ao fornecimento de medicamentos de responsabilidade de estados ou União, e por volta de 45% para tratamentos não contemplados pelo Sistema Único de Saúde.

En los últimos años puede ser visto en Brasil un incremento en el número de decisiones judiciales obligando al Gobierno a proporcionar medicamentos, productos y procedimientos de salud. Los jueces normalmente ignoran el impacto presupuestario de sus decisiones y entienden que toda entidade federativa puede ser responsable para suministrar cualquier tratamiento solicitado por el paciente. Este estudio analiza el impacto de estas decisiones para la gestión del presupuesto de la política de salud en la Municipalidad de São Paulo. El gasto presupuestario fue calculado con información proveída por la Municipalidad de São Paulo y disponible en el Diario Oficial. Según las estimaciones del presente trabajo, el gasto del municipio con la judicialización de la salud en 2011 es equivalente a 6% del presupuesto de su política de asistencia farmacéutica y 10% del total gastado en el suministro de medicamentos y material hospitalar. Además, alrededor de 55% de este gasto es para el suministro de medicamentos de la responsabilidad de los Estados o del Gobierno Federal y 45% para los tratamientos que no pertenecen a la política pública de salud.

During the last years, the number of judicial decision ordering the provision of health treatments, equipment and surgeries by the public health system has increased. Judges tend to ignore their decisions’ budgetary impact and to consider that the Federal Government entities can be considered equally responsible by the supply of any item ordered by the patient. This paper analyzes the impact of these judicial decisions for the budgetary management of health policy in the City of Sao Paulo. It was considered an estimate with the expenses on the judicialization for the year of 2011, taking into consideration the data made available by the city and the publications in the official gazette about the acquisition of medications without bidding by the Municipal Health Department. According to the estimate of this article, the expenses of the city with health judicialization in 2011 is equivalent to 6% of the amount that the city spent with its policy of pharmaceutical assistance, and 10% of the total amount spent with the supply of medications, and hospital, dental and outpatient care material. Moreover, around 55% of the total amount is spent with drugs supply which are responsibility from the states and the union, and around 45% is spent with treatments that are not included in the Unified Public System (known as SUS).

Disabling hearing loss prevalence in Juiz de Fora, Brazil.

UNLABELLED: Data on the prevalence of disabling hearing loss (DHL) in Brazil is scarce, which impacts healthcare professionals' knowledge on the extent of the problem. OBJECTIVES: This study aimed at estimating DHL prevalence in the municipality of Juiz de Fora, Minas Gerais, to identify individual-related variables and find risk areas. MATERIALS AND METHODS: This was a descriptive sectional population study held from January to October of 2009. We randomly selected 349 households with 1,050 individuals who with ages ranging between 4 days and 95 years. The data collection instruments were: WHO structured questionnaire, ENT examination and laboratory tests. Chi-square and Poison regression models were used for analyses. RESULTS: DHL prevalence was estimated at 5.2% (95% CI = 3.1 to 7.3) which was classified as moderate in 3.9% (95% CI = 0.001 to 0.134), severe in 0.9% (95% CI = 0.001 to 0.107) and profound in 0.4% (95% CI = 0.001 to 0.095). We found correlation between DHL and tinnitus; age over 60 years and low educational level. CONCLUSIONS: Our data obtained pointed to the need to create hearing health programs targeted to specific risk groups, promoting quality of life for hearing impaired patients.

Prevalência de perda auditiva incapacitante em Juiz de Fora, Brasil / Disabling hearing loss prevalence in Juiz de Fora, Brazil

No Brasil, dados de prevalência da perda auditiva incapacitante (PAI) são escassos, o que impacta o conhecimento dos profissionais da saúde sobre a extensão desse problema. OBJETIVOS: O presente estudo visou estimar a prevalência da PAI no município de Juiz de Fora, MG, identificar possíveis variáveis individuais relacionadas e verificar áreas de risco. MATERIAL E MÉTODOS: Trata-se de estudo descritivo populacional seccional realizado de janeiro a outubro de 2009. Foram selecionados, aleatoriamente, 349 domicílios com 1.050 indivíduos com idade entre 4 dias e 95 anos. Os instrumentos de coleta foram: questionário estruturado da OMS, exame otorrinolaringológico e exames complementares. Teste de qui-quadrado e modelos de regressão de Poisson foram utilizados para análise. RESULTADOS: A prevalência da PAI foi estimada em 5,2% (95% CI = 3,1-7,3) a qual foi classificada como moderada em 3,9% (95% IC = 0,001-0,134), grave em 0,9% (95% IC = 0,001-0,107) e profunda em 0,4% (95% IC = 0,001-0,095). Foi verificada correlação entre PAI e zumbido, idade acima de 60 anos e baixa escolaridade. CONCLUSÕES: Os dados obtidos apontam para a necessidade de se criar programas de saúde auditiva direcionados aos grupos de risco, promovendo qualidade de vida em pacientes com surdez.

Data on the prevalence of disabling hearing loss (DHL) in Brazil is scarce, which impacts healthcare professionals' knowledge on the extent of the problem. OBJECTIVES: This study aimed at estimating DHL prevalence in the municipality of Juiz de Fora, Minas Gerais, to identify individual-related variables and find risk areas. MATERIALS AND METHODS: This was a descriptive sectional population study held from January to October of 2009. We randomly selected 349 households with 1,050 individuals who with ages ranging between 4 days and 95 years. The data collection instruments were: WHO structured questionnaire, ENT examination and laboratory tests. Chi-square and Poison regression models were used for analyses. RESULTS: DHL prevalence was estimated at 5.2% (95% CI = 3.1 to 7.3) which was classified as moderate in 3.9% (95% CI = 0.001 to 0.134), severe in 0.9% (95% CI = 0.001 to 0.107) and profound in 0.4% (95% CI = 0.001 to 0.095). We found correlation between DHL and tinnitus; age over 60 years and low educational level. CONCLUSIONS: Our data obtained pointed to the need to create hearing health programs targeted to specific risk groups, promoting quality of life for hearing impaired patients.