Association of education with occurrence of delirium in patients from an emergency department / Associação da Educação com a Ocorrência de Delirium em Pacientes de um Serviço de Emergência

ABSTRACT. Background: Delirium is a neuropsychiatric syndrome with multiple etiological factors. Evaluation of delirium in different settings, especially the Emergency Department (ED) pertaining to different regions of the world with patients from different cultural and educational backgrounds is needed. Objective: To determine the prevalence of delirium and its association with education in an ED in Brazil during a 6-month period. Methods: Patients aged >18 years were randomly selected from ED admissions. The instruments Confusion Assessment Method (CAM) scale, Mini-Mental State Examination (MMSE), Wechsler Logical Memory (WLM) and Charlson comorbidity score were applied to evaluate delirium, cognitive status, and comorbidities. Results: The prevalence of delirium was10.7%. Delirium patients had significantly lower education, MMSE and WLM (immediate and delayed) scores, with 97.4% presenting episodic memory impairment. Patients with delirium had more history of neurological disorders. Three logistic regression models evaluating the association of variables with delirium were developed. Age and MMSE were retained in the first model, WLM scores in the second, and education in the third. Conclusion: To the best of our knowledge, this is the first study estimating the prevalence of delirium in a Brazilian ED. Lower education was associated with the occurrence of delirium.

RESUMO Introdução: Delirium é uma síndrome neuropsiquiátrica, com fatores etiológicos múltiplos. A avaliação de delirium em diferentes ambientes, especialmente no Serviço de Emergência (SE) de diferentes regiões do mundo e com diferentes características culturais e educacionais é necessária. Objetivo: Determinar a prevalência de delirium e associação com educação em um SE no Brasil, durante seis meses. Métodos: Foram randomizados aleatoriamente no SE os pacientes com idade acima de 18 anos. Escala Confusion Assessment Method (CAM), Mini Exame do Estado Mental (MEEM), o teste de Memória Lógica de Wechsler (MLW), e o escore de comorbidade de Charlson foram aplicados para avaliar delirium, status cognitivo, e comorbidades. Resultados: A prevalência de delirium foi 10,7%. Os pacientes com delirium apresentaram significativamente menor escolaridade, escores mais baixos no MEEM e MLW (imediato e tardio), sendo que 97,4% apresentava comprometimento de memória episódica. Pacientes com delirium apresentaram mais história de transtorno neurológico prévio. Três modelos de regressão logística para delirium foram realizados. No primeiro, idade e MEEM foram mantidos no modelo final. No segundo, MLW imediato e tardio; e no terceiro, apenas educação. Conclusão: Este é o primeiro estudo brasileiro, de acordo com nosso melhor conhecimento, a estimar a prevalência de delirium em serviço de emergência. Nível educacional mais baixo foi associado com ocorrência de delirium.

Replication Study of Polymorphisms Associated With Brain Arteriovenous Malformation in a Population From South of Brazil.

INTRODUCTION: The aim of this study was to reproducibly determine if any of the polymorphisms were associated with the susceptibility to brain arteriovenous malformations (BAVM) or the risk of intracranial hemorrhage (ICH) presentation. METHODS: We recruited 63 BAVM patients and 96 controls. The polymorphisms selected for evaluation were apolipoprotein E (APOE), tumor necrosis factor alpha (TNF 238G>A - rs361525), interleukin 1 beta (IL1B 511C>T - rs16944 and IL1B -31T>C - rs1143627), activin-like kinase 1 (ACVRL1 IVS3-35A>G - rs2071219), endoglin (ENG 207G>A - rs11545664), and interleukin 6 (IL6 174G>C - rs1800795). RESULTS: In the single analysis, we observed statistically significant differences in the allele distributions for IL1B -31T>C (rs1143627) between the BAVM patients and control subjects (P = 0.02). There was a trend toward significance for the association between the IL1B 511C>T (rs16944) allele and BAVM risk (P = 0.07). In further logistic regression analysis, no polymorphism was significantly associated with the risk of BAVM. No polymorphisms were associated with hemorrhage presentation according to both single and multivariable analyses. CONCLUSIONS: In our sample from a south Brazil population, we found no association between the risks of BAVM and ICH presentation with any of the selected polymorphisms.

Association of education with occurrence of delirium in patients from an emergency department.

BACKGROUND: Delirium is a neuropsychiatric syndrome with multiple etiological factors. Evaluation of delirium in different settings, especially the Emergency Department (ED) pertaining to different regions of the world with patients from different cultural and educational backgrounds is needed. OBJECTIVE: To determine the prevalence of delirium and its association with education in an ED in Brazil during a 6-month period. Methods: Patients aged >18 years were randomly selected from ED admissions. The instruments Confusion Assessment. METHOD: (CAM) scale, Mini-Mental State Examination (MMSE), Wechsler Logical Memory (WLM) and Charlson comorbidity score were applied to evaluate delirium, cognitive status, and comorbidities. RESULTS: The prevalence of delirium was10.7%. Delirium patients had significantly lower education, MMSE and WLM (immediate and delayed) scores, with 97.4% presenting episodic memory impairment. Patients with delirium had more history of neurological disorders. Three logistic regression models evaluating the association of variables with delirium were developed. Age and MMSE were retained in the first model, WLM scores in the second, and education in the third. CONCLUSION: To the best of our knowledge, this is the first study estimating the prevalence of delirium in a Brazilian ED. Lower education was associated with the occurrence of delirium.

INTRODUÇÃO: Delirium é uma síndrome neuropsiquiátrica, com fatores etiológicos múltiplos. A avaliação de delirium em diferentes ambientes, especialmente no Serviço de Emergência (SE) de diferentes regiões do mundo e com diferentes características culturais e educacionais é necessária. OBJETIVO: Determinar a prevalência de delirium e associação com educação em um SE no Brasil, durante seis meses. MÉTODOS: Foram randomizados aleatoriamente no SE os pacientes com idade acima de 18 anos. Escala Confusion Assessment Method (CAM), Mini Exame do Estado Mental (MEEM), o teste de Memória Lógica de Wechsler (MLW), e o escore de comorbidade de Charlson foram aplicados para avaliar delirium, status cognitivo, e comorbidades. RESULTADOS: A prevalência de delirium foi 10,7%. Os pacientes com delirium apresentaram significativamente menor escolaridade, escores mais baixos no MEEM e MLW (imediato e tardio), sendo que 97,4% apresentava comprometimento de memória episódica. Pacientes com delirium apresentaram mais história de transtorno neurológico prévio. Três modelos de regressão logística para delirium foram realizados. No primeiro, idade e MEEM foram mantidos no modelo final. No segundo, MLW imediato e tardio; e no terceiro, apenas educação. CONCLUSÃO: Este é o primeiro estudo brasileiro, de acordo com nosso melhor conhecimento, a estimar a prevalência de delirium em serviço de emergência. Nível educacional mais baixo foi associado com ocorrência de delirium.

Helicobacter species detection and histopathological changes in stray cats from Niterói, Brazil.

Tightly coiled bacteria are common inhabitants of the gastric mucosae of cats and there is considerable debate whether feline helicobacters are commensal or pathogenic organisms. To determine the prevalence of Helicobacter species and gastric histopathological findings, gastric mucosa samples of 56 stray cats were collected from cardia, fundus, body, antrum and pylorus at necropsy. The samples were examined by urease test, cytology, histopathology and culture. Helicobacter species were detected in 53 cats (94.6%) by at least one detection method. Urease test results were positive in gastric samples from 50 (89.3%) cats. Cytological and histological evaluations revealed Helicobacter species in 52 (92.8%) and 50 (89.2%) cats, respectively. Helicobacter species organisms were not cultured from any cat. Regardless of the presence of gastric bacteria, most of the cats had mild to moderate gastritis. These data reveal a high prevalence of Helicobacter species in stray cats from Niterói, Brazil.

Helicobacter spp na mucosa gástrica de cães (canis familiaris) - utilização de diferentes métodos de diagnóstico e avaliação dos achados histopatológicos / Helicobacter spp in the gastric mucosa of dogs (Canis familiaris) - use of different methods of diagnosis and evaluation of histopathological findings

A infecção por Helicobacter spp em cães possui alta prevalência, variando de 61% a 100% em vários estudos, entretanto, a relação destas bactérias com as patologias gástricas caninas ainda não está estabelecida. Os objetivos desta pesquisa foram descrever os achados macroscópicos e microscópicos da mucosa gástrica, avaliar a presença de Helicobacter spp na mucosa gástrica de cães, comparar os diferentes testes de diagnóstico, determinar a correlação entre eles e a colonização bacteriana e descrever as alterações histopatológicas..Observou-se percentuais de concordância entre os testes utilizados. O alto percentual de cães infectados por Helicobacter spp e ausência de correlação com as patologias gástricas nesses animais, indicam a necessidade de mais estudos, visando estabelecer o verdadeiro papel desta infecção com as gastropatias caninas. Devido à possibilidade de transmissão zoonótica, torna-se impostante pesquisar a patogenicidade das espécies que infectam o homem e o cão.