Circumstances of the ambulatory prescription of quinolones in Urology and opportunities for intervention.

INTRODUCTION AND OBJECTIVES: Antimicrobial stewardship programmes (AMSP) seldom focus on ambulatory prescribing. Our AMSP primarily supervises in-hospital prescribing, but as we aim to include the ambulatory setting, we sought opportunities for intervention on ambulatory quinolone prescription. MATERIALS AND METHODS: We selected the prescriptions made by urologists during 2018 for analysis, and manually checked them for adequacy. RESULTS: We analyzed 237 prescriptions. Of 136 therapeutic prescriptions, 18.4% had no reported diagnosis and 31.6% had no reported symptoms. Most patients (60.3%) did not have any urinalysis or urine culture; among those who had, 27.7% had a urinalysis not suggestive of urinary tract infection and 67.4% had a positive culture, 83.9% of which had a suitable oral alternative to quinolones. Antimicrobial therapy was not indicated in 13.9% of cases; when it was, quinolones were considered inadequate in 67.8% of cases. Incorrect duration was found in 51.1% of cases. Forty-six prescriptions were made for prophylaxis; all of these were considered inadequate. CONCLUSION: We found a high prevalence of inadequate ambulatory quinolone prescriptions in Urology. Many followed incomplete recordings, lack of laboratory use, or inattention to alternatives. Treatment duration and quinolone choice were frequently inadequate. Quinolone prescribing for prophylaxis was always considered inadequate. These prescribing errors could serve as a starting point for future interventions.

Cluster headache in children and adolescents: a systematic review of case reports.

AIM: To describe the clinical characteristics and therapeutic options available to paediatric patients with cluster headache. METHOD: Based on a literature search of the medical databases PubMed, LILACS, and Web of Science and using selected descriptors, we carried out a systematic review of case reports on cluster headache in paediatric patients published from 1990 to 2020. RESULTS: Fifty-one patients (29 males, 22 females) with a mean (SD) age of 9 years 7 months (3y 10mo; range 2-16y) were diagnosed with cluster headache. The mean (SD) diagnosis was made 27.8 months (26.2mo) after the onset of cluster headache. Pain occurred at night or on waking up (76.5%) and consisted of 1 to 3 attacks per day (62.7%) lasting 30 to 120 minutes (68.6%). Headaches were unilateral (90.2%), had a pulsatile character (64.7%), and severe intensity (100%). There were autonomic manifestations (90.2%) predominantly ipsilateral to pain, in this order: lacrimation; conjunctival injection; nasal congestion; ptosis; eyelid oedema; and rhinorrhoea. Sumatriptan and oxygen inhalation were the most effective treatments for acute manifestation. Prophylaxis, corticosteroids, verapamil, and gabapentin were the most effective drugs. INTERPRETATION: Due to the small number of published studies, this review could not provide reliable data; however, it appears that cluster headache in children and adolescents is similar to adults, both in clinical characteristics and treatment. What this paper adds Cluster headache in children and adolescents is poorly studied. Cluster headache is uncommon before 10 years of age and diagnosis is difficult in the first few years of life. Treatment of cluster headache in children and adolescents is similar to that used in adults. The notion of the effectiveness of prophylactic treatment is based only on authors' experience.

Colesterol carregado pela ciclodextrina sobre a criopreservação dos espermatozoides de garanhões da raça Nordestina / Cholesterol-loaded cyclodextrin on the cryopreservation of stallion sperm of the Northeastern breed

Nesta pesquisa avaliou-se o efeito do colesterol sobre o sêmen de garanhões da raça Nordestina sobre a qualidade espermática. Vinte ejaculados de dois garanhões foram diluídos com BotuSemen e colesterol carreado pela ciclodextrina (CCC) adicionado no sêmen: controle, 0,75mg de CCC e 1,0mg de CCC/120x106 sptz/mL, e incubado a 26°C/15min. O sêmen foi diluído 1:5 (v/v) com diluente Lactose-gema de ovo e resfriado a 5°C/2h, envasado em palhetas de 0,5mL, e acondicionado sob vapor de nitrogênio líquido, e depois imersos. As amostras foram descongeladas (37 °C/30s) e avaliadas. As variáveis foram avaliadas com ANOVA e teste de Tukey (P<0,05). A motilidade total e progressiva foi maior (P<0,05) no sêmen tratado com CCC comparado as amostras do grupo controle, e CCC promoveu maior percentual (P<0,05) de motilidade total e progressiva durante as 3 horas de incubação. A percentagem de espermatozoides com viabilidade e integridade foi maior (P<0,05) no sêmen tratado com CCC (81,47 e 86,07%) comparado ao controle (72,12 e 70,19%). O número de espermatozoides reativos ao teste hiposmótico foi maior (P<0,05) nas amostras de sêmen tratadas com CCC comparado ao controle. Adição de colesterol no sêmen de garanhões Nordestino melhora a qualidade espermática apos a criopreservação.(AU)

In the study effect of cholesterol was evaluated on the sperm quality of Nordestina stallion breed. Twenty semen samples were used from two stallions, diluted with BotuSemen extender and cholesterol add as follows: control, 0.75mg of cholesterol-loaded cyclodextrin (CLC) and 1.0mg of CLC/120x106 sperm/mL, and incubated for 15 min at 22°C. The samples were diluted 1:5 with lactose-yolk egg extender and cooled to 5°C over two hours, loaded into 0.5mL straws and frozen in static liquid nitrogen vapor before being plunged into nitrogen. Samples were thawed (37°C/30s) and analyzed. The variables were analyzed by ANOVA and means compared by Tukey test (P<0.05). Higher percentages of total and progressive motile was higher for sperm treated with CLC compared to control, and CLC promoted higher percentages (P<0.05) of total and progressive motility for the 3 hours of incubation. The percentage of viability and plasma membrane integrity of spermatozoa were higher (P<0.05) in sperm treated with CLC compared to the control group. The number of spermatozoa reacted to hypoosmotic test was higher (P<0.05) in sperm treated with CLC than control. Addition of CLC in the semen of Nordestina stallion breed improve the sperm quality after cryopreservation.(AU)

Efeito de diferentes concentrações de melatonina em espermatozoides de carneiros sobre estresse oxidativo após criopreservação / Effect of different concentrations of melatonin to ram spermatozoa on oxidative stress after cryopreservation

Objetivou-se avaliar o efeito da adição de diferentes concentrações de melatonina no sêmen diluído de carneiros após criopreservação. Foram coletados 10 ejaculados de três carneiros adultos (n=30), por meio de vagina artificial para ovinos. Os ejaculados coletados foram diluídos em Tris-Gema de ovo, para a concentração final de 200x106 sptz/mL, mantidos em banho maria a 32°C, e a melatonina adicionada conforme os tratamentos: Controle; 100pM; 100nM; 100µM e 1mM de melatonina. Então, as amostras foram resfriadas em câmara fria a 5°C por duas horas, envasadas em palhetas de 0,5 mL e lacradas. Logo após, foram acondicionadas sob vapores do nitrogênio liquido, por 15 minutos, a 8cm da lâmina líquida e congeladas com nitrogênio líquido. As amostras foram analisadas quanto à motilidade espermática, integridade da membrana plasmática, membrana acrossomal, atividade mitocondrial, quantificação do estresse oxidativo e a capacidade de ligação. As variáveis foram submetidas à análise de variância e as médias foram comparadas pelo teste de Tukey a 5% de probabilidade. A motilidade total e progressiva dos espermatozoides descongelados foi maior nas amostras tratadas com 100pM de melatonina (62,99 e 45,07% respectivamente; P<0,05) quando comparado aos demais tratamentos. A adição das diferentes concentrações de melatonina no sêmen diluído, com exceção da concentração de 1 mM, apresentou maior percentual de células com membrana plasmática íntegra, quando comparadas com o controle (P<0,05). O percentual de espermatozoides com integridade da membrana do acrossoma foi maior no sêmen tratado com 100 pM de melatonina (P<0,05) do que nos demais tratamentos. A alta atividade mitocondrial foi maior nos espermatozoides tratados com 100 pM de melatonina (69,30%; P<0,05). A adição de 100 nM de melatonina reduziu a quantidade de TBARS após a criopreservação (2,84; P<0,05) quando comparado aos demais tratamentos. Após o descongelamento, o número de espermatozoides que se ligaram à membrana perivitelina foi maior nos tratados com 100 pM de melatonina (155,73; P<0,05). Portanto, a adição de melatonina no sêmen diluído pode ser útil para aperfeiçoar a criopreservação do sêmen de ovinos, melhorando as taxas de fertilização por meio da inseminação artificial.(AU)

The aim was to evaluate the effect of adding different concentrations of melatonin in ram semen diluted after cryopreservation. Ten ejaculates were collected0 from three adult ram (n=30) by means of artificial vagina for sheep. The collected samples were diluted in Tris-egg yolk, to a final concentration 200x106 sptz/mL kept in water bath at 32°C, and melatonin added as treatments: control; 100pM; 100nM; 100µM and 1mM melatonin. Then, the samples were cooled in a cold chamber at 5°C for two hours, in straws of 0.5mL and sealed. They were stored under the liquid nitrogen vapor for 15 minutes to 8cm of liquid blade and frozen with liquid nitrogen. Samples were analyzed for sperm motility, membrane integrity, acrosomal membrane, mitochondrial activity, oxidative stress and quantification of the binding capacity. The variables were subjected to analysis of variance and the means were compared by Tukey test at 5% probability. The total and progressive motility of thawed sperm were higher in samples treated with 100pM melatonin (62.99 and 45.07%, respectively; P<0.05) when compared to other treatments. The addition of different concentrations of melatonin in semen diluted with the exception of 1mM concentration, a higher percentage of cells with intact plasma membrane, as compared with the control (P<0.05). The percentage of sperm with acrosome membrane integrity was higher in the semen with 100pM melatonin (P<0.05) than the other treatments. The high mitochondrial activity was higher in spermatozoa treated with 100pM melatonin (69.30%; P<0.05). Addition of 100nM melatonin reduced the amount of TBARS after cryopreservation (2.84, P<0.05) when compared with the other treatments. After thawing, the number of sperm which bind to the perivitelline membrane was higher in the melatonin treated with 100pM (155,73; P<0.05). Therefore, melatonin addition the semen diluted can be useful to enhance the cryopreservation of sheep semen, improving fertilization rates through artificial insemination.(AU)

The study of headache in the 1950s in Latin America by Edgard Raffaelli Júnior (1930-2006).

The aim of this study was to review the life of Edgard Raffaelli Júnior (1930-2006) and to summarize his important contributions to the study of headaches. He was the first doctor to study headaches in Latin America, and for 50 years he advanced the understanding of headaches worldwide. He was born in São Paulo, Brazil, on March 2, 1930 and died on December 29, 2006. He founded the Brazilian Headache Society and was one of the organizers and founders of the International Headache Society. Following Raffaelli, many Latin American doctors have since been inspired to study headaches.

Comparison of emission of dioxins and furans from gasohol- and ethanol-powered vehicles.

The exhaust emissions of 17 polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) were investigated in two spark-ignition light-duty vehicles, one gasohol-fueled and a flexible-fuel one fueled with hydrated ethanol. Gasohol is a mixture of gasoline and 22% ethanol. The influence of fuel type and quality, lubricant oil type, and use of fuel additives on the formation of these compounds was tested using standardized U.S. Federal Test Procedure (FTP)-75 cycle tests. The sampling of the PCDD/Fs followed the recommendations of a modified U.S. Environmental Protection Agency (EPA) Method 23 ( http://www.epa.gov/ttn/emc/promgate/m-23.pdf ) and the analysis basically followed the U.S. EPA Method 8290 ( http://www.epa.gov/osw/hazard/testmethods/sw846/pdfs/8290a.pdf ). Results showed that emission factors of PCDD/Fs for the gasohol vehicle varied from undetected to 0.068 pg international toxic equivalency (I-TEQ) km-1 (average of 0.0294 pg I-TEQ km-1), whereas in the ethanol vehicle they varied from 0.004 to 0.157 pg (I-TEQ) km-1 (average of 0.031 pg I-TEQ km-1). In the gasohol-powered vehicle, the use of fuel additive diminished the emission of Octachlorodibenzo-p-dioxin (OCDD) significantly, whereas in the ethanol vehicle no significant associations were observed between the investigated variables and the emissions. [Box: see text].

Does nutrition play a role in the quality of life of patients under chronic haemodialysis?

BACKGROUND: In patients with chronic renal failure under haemodialysis, we investigated the inter-relationships and relative contributions of disease, haemodialysis and of nutrition related factors on the patients' Quality of Life. METHODS: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight loss since haemodialysis, nutrient intake derived from diet history analysis (DIETPLAN5 2003, UK). The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. RESULTS: Estimates of effect size attributed to each variable included in the general linear model revealed that 47% of patients' mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss =10%. Poor performance of usual activities was attributed in 45% to duration of haemodialysis and of disease, 70% to protein/energy/vitamin B12/zinc/iron deficits, and 20% to weight loss =10%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease, and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/energy/selenium & vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss =10%, and in 3% to co-morbidities. Likewise, 47% of poor overall health was determined by protein/energy/vitamin B12/ zinc/selenium & vitamin C deficits, 25% by weight loss =10%, 10% by disease duration, and 7% by co-morbidities. CONCLUSION: Protein, antioxidants and key micronutrients involved in protein metabolism, did exert a major effect on patients' Quality of Life. Given the prevalence of nutrient deficits, the ensuing impaired functional capacity is likely to compromise QoL, timely nutrition is thus warranted.

Does nutrition play a role in the quality of life of patients under chronic haemodialysis? / ¿Desempeña la nutrición un papel en la calidad de vida de los pacientes con hemodiálisis crónica?

Background: In patients with chronic renal failure under haemodialysis, we investigated the inter-relationships and relative contributions of disease, haemodialysis and of nutrition related factors on the patients' Quality of Life. Methods: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight loss since haemodialysis, nutrient intake derived from diet history analysis (DIETPLAN5 2003, UK). The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. Results: Estimates of effect size attributed to each variable included in the general linear model revealed that 47% of patients' mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss=10%. Poor performance of usual activities was attributed in 45% to duration of haemodialysis and of disease, 70% to protein/energy/vitamin B12/zinc/iron deficits, and 20% to weight loss =10%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease,and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/energy/selenium & vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss =10%, and in 3% to co-morbidities. Likewise, 47% of poor overall health was determined by protein/energy/vitamin B12/zinc/selenium & vitamin C deficits, 25% by weight loss=10%, 10% by disease duration, and 7% by co-morbidities. Conclusion: Protein, antioxidants and key micronutrients involved in protein metabolism, did exert a major effect on patients' Quality of Life. Given the prevalence of nutrient deficits, the ensuing impaired functional capacity is likely to compromise QoL, timely nutrition is thus warranted (AU)

Antecedentes: en pacientes con insuficiencia renal crónica y en hemodiálisis, investigamos las relaciones y contribuciones relativas de la enfermedad, hemodiálisis y factores nutricionales del paciente sobre la calidad de vida (QOL). Métodos: los datos recogidos de 60 pacientes adultos incluían: comorbilidades (múltiples fármacos, otras enfermedades crónicas), duración de la insuficiencia renal y hemodiálisis (en meses), % pérdida de peso desde la hemodiálisis, ingestión de nutrientes derivada del análisis de la historia dietética (DIETPLAN5, 2003, RU). La escala EuroQOL que incluye 5 dimensiones de movilidad, autocuidado, actividades, dolor / malestar, ansiedad/depresión, y una escala analógica visual sobre salud global, evaluó la QOL. Resultados: las estimaciones del efecto del tamaño atribuido a cada variable incluida en el modelo linear general mostraron que el 47% de las puntuaciones de los pacientes sobre movilidad/pérdida de peso empeoraban con una ingestión de deficiente de proteínas / energía y el 30% por una pérdida de peso ≥ 10%. El bajo rendimiento en las actividades habituales se atribuyó en un 45% a la duración de la hemodiálisis y de la enfermedad, el 70% a deficiencias de proteínas/energía/vitamina B12/cinc/hierro, y el 20% a una pérdida de peso ≥ 10%. El dolor/ansiedad empeoraban en un 45% por la duración de la hemodialysis y de la enfermedad, y en un 15% por comorbilidades. La mayor ansiedad/depresión se relacionó en un 43% con deficiencias de proteínas / energía/selenio y vitamina C, en un 40% por la duración de la hemodialysis y la enfermedad, en un 10% por una pérdida de peso ≥ 10%, y en un 3% a las comorbilidades. Asimismo, el 47% de la salud global mala vino determinado por deficiencias de proteína/energía/vitamina B12/cinc/selenio y vitamina C, 25% por pérdida de peso ≥ 10%, el 10% por la duración de la enfermedad, y el 7% por las comorbilidades. Conclusiones: las proteínas, los antioxidantes y los micronutrientes clave implicados en el metabolismo proteico ejercieron un efecto principal sobre la calidad de vida de los pacientes. Dada la prevalencia de las deficiencias nutricionales, la alteración resultante de la capacidad funcional probablemente comprometa la calidad de vida, por lo que se debe garantizar una nutrición adecuada (AU)

Método para o estudo in vivo da angiogênese: indução de neovascularização na córnea de coelho / Method for in vivo study of angiogenesis: induction of neovascularization in the rabbit cornea

A angiogênese é um processo de múltiplos degraus que conduz a formação de novos vasos sangüíneos a partir de capilares preexistentes e que participa em diversos processos fisiológicos e patológicos incluindo o crescimento tumoral e de metástases. Vários métodos têm sido desenvolvidos para estudar a angiogênese. A técnica de indução de vascularização na córnea do coelho foi uma das primeiras a serem desenvolvidas pelo grupo de Gimbrone e colaboradores. O principal objetivo deste trabalho foi descrever a técnica de indução de angiogênese na córnea do coelho, através do implante cirúrgico de "pellets" de polimetilmetacrilato (PMMA) contendo fator básico de crescimento fibroblástico (FCFb). Um "pellet" contendo 0.1 mig de FCFb foi implantado em uma das córneas e outro, sem FCFb, na córnea contralateral, como controle. A atividade angiogênica foi expressa por um índice, resultado da contagem do número de vasos e da medição de seu comprimento em milímetros. Os resultados mostraram que o FCFb induz crescimento vascular significativo a partir do sexto dia após o implante do "pellet" com atividade máxima no 15º dia. O PMMA sem FCFb não estimulou significativamente a vascularização. Esta técnica fornece uma nova opção de modelo para o estudo da biologia da angiogênese e para avaliação de drogas antiangiogênicas, usando "pellets" de polimetilmetacrilato (PMMA).

Aspectos epidemiológicos, sociais e sanitários em áreas do médio Solimöes: I - Estudo das localidades de Säo Francisco do Laranjal, Aranaí e Säo Lázaro do Surubim, município de Coari, Amazonas / Epidemiological, social and sanitary aspects in area of Médio Solimöes: I - Study of localities of Säo Francisco do Laranjal, Aranaí and Säo Lázaro do Surubim, municipality of Coari, State of Amazonas

Um estudo seccional foi realizado em 1991 nas localidades de Säo Francisco do Laranjal, Aranaí e Säo Lázaro, no município de Coari, localizado no Médio Solimöes, no Estado do Amazonas, envolvendo 406 pessoas residentes, visando determinar as condiçöes sociais e sanitárias e indicaçöes epidemiológicos e laboratoriais específicos sobre a prevalência de anemia, parasitoses intestinais, malária, toxoplasmose, hepatite B e hanseníase. No inquérito foram aplicadas duas fichas padronizadas, uma domiciliar para avaliaçäo das condiçöes econômicas e sanitárias e outra individual para anamnese e exame físico. De cada pessoa foi solicitado amostra de fezes para exames pelos métodos de Lutz (sedimentaçäo) e de Baerman, e colhido sangue para dosagem de hemoglobina e micro-hematócrito, gota, gota expessa e esfregaço para a malária, sorologia para toxoplasmose e para hepatite por vírus B (HBsAg e Anti-HBs). A principal atividade econômica da populaçäo é a agricultura de subsistência e a pesca. Nas três localidades existe escola de 1§ grau mas em nenhuma existe posto de saúde. O índice de aglomeraçäo foi em média 5,3 pessoas por domicílio dos quais 84,2 por cento säo construídos de madeira e 77,5 por cento têm apenas um dormitório para toda a família. O abastecimento de água é feito diretamente do rio; em 89,4 por cento das casas näo existem instalaçöes sanitárias e em sua totalidade o lixo é abandonado ou jogado no próprio rio. A anemia esteve presente em 56,4 por cento dos examinados, 16,2 por cento com menos de 10g/Hg por cento. O exame de fezes revelou 81,9 por cento com um ou mais parasitos (72,6 por cento com mais de um parasito), com predomínio do Ascaris lumbricoides. Chama a atençäo a E. histolytica com 15,6 por cento, diagnósticada com métodos näo específicos. Surpeendentemente todas as lâminas foram negativas para malária; 65,8 por cento dos soros foram reagentes para toxoplasmose, 10,6 por cento com títulos iguais ou superiores a 1: 1024. No exame físico foram diagnósticados três casos de hanseníase (7,38 por 1.000). Apenas 1,9 por cento dos soros foram HBSAg positivos porém 34,3 por cento tinham anticorpos Anti-HBs