A comparative study of visual outcome in patients with optic neuritis treated with five or seven days of intravenous corticosteroid treatment.

BACKGROUND: Optic neuritis (ON), a major cause of visual impairment in young adults, is generally associated with rapid visual recovery when treated with intravenous methylprednisolone treatment (IVMPT). However, the optimal duration of such treatment is unknown, ranging from three to seven days in clinical practice. We aimed to compare the visual recovery in patients treated with 5-day or 7-day duration IVMPT. METHODS: We performed a retrospective cohort study of consecutive patients with ON in São Paulo, Brazil, from 2016 to 2021. We compared the proportion of participants with visual impairment in 5-day and 7-day treatment schedules at discharge, at 1 month and between 6 and 12 months after the diagnosis of ON. The findings were adjusted to age, severity of the visual impairment, co-intervention with plasma exchange, time from symptom onset to IVMPT and the etiology of the ON to mitigate indication bias. RESULTS: We included 73 patients with ON treated with 5 or 7-day duration of 1 g/d intravenous methylprednisolone therapy. Visual impairment at 6-12 months in the 5-day or the 7-day treatment groups was similar (57% x 59%, p > 0.9, Odds Ratio 1.03 [95% CI 0.59-1.84]). The results were similar after adjusting for prognostic variables and when observed at different time points. CONCLUSION: Visual recovery is similar in patients treated with 5-day and 7-day duration treatments of 1 g/day intravenous methylprednisolone, suggesting a ceiling effect. Limiting the duration of the treatment can reduce hospital stay and costs, without interfering with clinical benefit.

Development of Care and Professional Identity in an Interprofessional Health Team: Graduation, Residency and Professional Practice as a Window of Opportunity / Desarrollo del Equipo Interprofesional de Atención e Identidad Profesional en Salud: Graduación y Posgrado como Ventana de Oportunidad / Desenvolvimento do Cuidado em Equipe Interprofissional e da Identidade Profissional em Saúde: Graduação e Pós-Graduação como Janela de Oportunidade

This integrative review analyzes aspects of professional identity (PI) and its relationship with teamwork, with patient care and safety, in multidisciplinary health teams; from graduation, residency and professional performance. Twenty-two papers were studied, over a period of five years, from the Embase, Scopus and Web of Science databases, classified into eleven professional categories, resulting in six papers with undergraduate students, five with undergraduates in professional internships, and eleven with health professionals, including residents. The construction process of the PI of residents and professionals who work in the hospital environment was analyzed, noting that, for the medical profession, it is necessary to change the paradigm regarding PI and teamwork, while for the other professionals it is that It is necessary to develop the PI process from graduation onwards, as an important factor in the work environment, for the management of conflicts between members of the health teams.

Esta revisión integradora analiza aspectos de la identidad profesional (IP) en equipos multiprofesionales de salud, desde la graduación. Se estudiaron veintidós artículos, en un período de cinco años, de las bases de datos Embase, Scopus y Web of Science, clasificados en once categorías profesionales, resultando seis artículos con estudiantes de pregrado, cinco con prácticas profesionales y once con profesionales de la salud. Se analizó el proceso de construcción de la IP de los residentes y profesionales que actúan en el ámbito hospitalario, observando que, para la profesión médica, es necesario un cambio de paradigma sobre la IP y el trabajo en equipo, mientras que para los demás profesionales es necesario desarrollar la Proceso de PI en el ambiente de trabajo, como factor importante para la gestión de conflictos entre los integrantes de los equipos de salud.

Esta revisão integrativa analisa aspectos da identidade profissional (IP) em equipes multiprofissionais da saúde, desde a graduação. Foram estudados vinte e dois artigos, no período de cinco anos, das bases de dados Embase, Scopus e Web of Science, classificados em onze categorias profissionais, resultando em seis artigos com alunos de graduação, cinco com estágios profissionalizantes e onze com profissionais da saúde. Analisou-se o processo de construção da IP de residentes e profissionais que atuam no ambiente hospitalar, observando-se que, para a profissão médica é necessária a mudança de paradigma sobre IP e trabalho em equipe, enquanto que para os demais profissionais faz-se necessário desenvolver o processo de IP no ambiente de trabalho, como fator importante para a gestão de conflitos entre os integrantes das equipes de saúde.

Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19).

BACKGROUND: A local increase in angiotensin 2 after inactivation of angiotensin-converting enzyme 2 by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce a redox imbalance in alveolar epithelium cells, causing apoptosis, increased inflammation and, consequently, impaired gas exchange. We hypothesized that N-acetylcysteine (NAC) administration could restore this redox homeostasis and suppress unfavorable evolution in patients with coronavirus disease 2019 (COVID-19). METHODS: This was a double-blind, randomized, placebo-controlled, single-center trial conducted at the Emergency Department of Hospital das Clínicas, São Paulo, Brazil, to determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19. We enrolled 135 patients with severe COVID-19 (confirmed or suspected), with an oxyhemoglobin saturation <94% or respiratory rate >24 breaths/minute. Patients were randomized to receive NAC 21 g (~300 mg/kg) for 20 hours or dextrose 5%. The primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), time in ICU, and mortality. RESULTS: Baseline characteristics were similar between the 2 groups, with no significant differences in age, sex, comorbidities, medicines taken, and disease severity. Also, groups were similar in laboratory tests and chest computed tomography scan findings. Sixteen patients (23.9%) in the placebo group received endotracheal intubation and mechanical ventilation, compared with 14 patients (20.6%) in the NAC group (P = .675). No difference was observed in secondary endpoints. CONCLUSIONS: Administration of NAC in high doses did not affect the evolution of severe COVID-19. CLINICAL TRIALS REGISTRATION: Brazilian Registry of Clinical Trials (REBEC): U1111-1250-356 (http://www.ensaiosclinicos.gov.br/rg/RBR-8969zg/).

A randomized crossover trial to assess therapeutic efficacy and cost reduction of acid ursodeoxycholic manufactured by the university hospital for the treatment of primary biliary cholangitis.

BACKGROUND: Health care costs are growing faster than the rest of the global economy, according to the World Health Organization (WHO). Countries' health expenditures include paying for general medicine, diagnostic procedures, hospitalizations and surgeries, as well as medications and prescribed treatment. Primary biliary cholangitis (PBC) is a rare autoimmune liver disease and the first line available treatment is ursodeoxycholic acid (UDCA), however, direct and indirect treatment costs are expensive. Main aim of this trial was to assess if the therapeutic efficacy of UDCA manufactured by the university hospital is equivalent to that of standard UDCA and treatment cost reduction in patients with PBC. METHODS: It is a prospective, interventional, randomized, and crossover study in patients diagnosed with PBC. UDCA 300 mg tablets and capsules were developed and manufactured by the university hospital. Thirty patients under treatment with standard UDCA, in stable doses were randomized in sequence A and B, 15 patients in each arm. The groups were treated for 12 weeks and after, the UDCA formulation was changed, following for another 12 weeks of continuous therapy (tablets and capsules / capsules and tablets). Laboratory tests were performed at time T0 (beginning of treatment), T1 (at the 12 week-therapy, before the crossing-over) and T2 (end of treatment). The evaluation was done by comparing the hepatic parameters ALP, GGT, ALT, AST and total bilirubin, also considering the adverse events. The comparison of costs was based on price of the manufactured UDCA and standard UDCA price of the hospital. RESULTS: Hospital reduced 66.1% the PBC treatment costs using manufactured UDCA. There were no differences in the biochemical parameters between sequence (A and B) and tablets or capsules of UDCA formulations applied in the treatment of PBC. CONCLUSIONS: The study showed that there was no significant difference between manufactured UDCA (capsule and tablet) and standard UDCA. Hospital reduced the PBC treatment costs using the manufactured UDCA by the university hospital. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03489889 retrospectively registered on January 12th, 2018; Ethics Committee approved the study (ID: 1.790.088) on October 25th, 2016.

Low dose capsule based 13c-urea breath test compared with the conventional 13c-urea breath test and invasive tests.

CONTEXT: One of the limitations of 13C-urea breath test for Helicobacter pylori infection diagnosis in Brazil is the substrate acquisition in capsule presentation. OBJECTIVES: The purpose of this study was to evaluate a capsule-based 13C-urea, manipulated by the Pharmacy Division, for the clinical practice. METHODS: Fifty patients underwent the conventional and the capsule breath test. Samples were collected at the baseline and after 10, 20 and 30 minutes of 13C-urea ingestion. Urease and histology were used as gold standard in 83 patients. RESULTS: In a total of 50 patients, 17 were positive with the conventional 13C-urea (75 mg) breath test at 10, 20 and 30 minutes. When these patients repeated breath test with capsule (50 mg), 17 were positive at 20 minutes and 15 at 10 and 30 minutes. The relative sensitivity of 13C-urea with capsule was 100% at 20 minutes and 88.24% at 10 and at 30 minutes. The relative specificity was 100% at all time intervals. Among 83 patients that underwent capsule breath test and endoscopy the capsule breath test presented 100% of sensitivity and specificity. CONCLUSIONS: Capsule based breath test with 50 mg 13C-urea at twenty minutes was found highly sensitive and specific for the clinical setting.

Low dose capsul based 13c-urea breath test comared with the conventional 13c--urea breath test and invasive tests / Teste respiratório com 13C-uréia em cápsula de baixa dose em comparação com o teste respiratório com 13C-uréia convencional e testes invasivos

Context One of the limitations of 13C-urea breath test for Helicobacter pylori infection diagnosis in Brazil is the substrate acquisition in capsule presentation. Objectives The purpose of this study was to evaluate a capsule-based 13C-urea, manipulated by the Pharmacy Division, for the clinical practice. Methods Fifty patients underwent the conventional and the capsule breath test. Samples were collected at the baseline and after 10, 20 and 30 minutes of 13C-urea ingestion. Urease and histology were used as gold standard in 83 patients. Results In a total of 50 patients, 17 were positive with the conventional 13C-urea (75 mg) breath test at 10, 20 and 30 minutes. When these patients repeated breath test with capsule (50 mg), 17 were positive at 20 minutes and 15 at 10 and 30 minutes. The relative sensitivity of 13C-urea with capsule was 100% at 20 minutes and 88.24% at 10 and at 30 minutes. The relative specificity was 100% at all time intervals. Among 83 patients that underwent capsule breath test and endoscopy the capsule breath test presented 100% of sensitivity and specificity. Conclusions Capsule based breath test with 50 mg 13C-urea at twenty minutes was found highly sensitive and specific for the clinical setting. HEADINGS- Helicobacter pylori. Breath Test. Urea, analysis. .

Contexto Uma das limitações para o teste respiratório com 13C-uréia ser incorporado na prática clínica no Brasil para diagnóstico de infecção pelo Helicobacter pylori (H. pylori) é a aquisição do substrato em apresentação de cápsula. Objetivos O objetivo deste estudo foi avaliar a utilidade de 13C-uréia em cápsula, manipulada pela Divisão de Farmácia de um Hospital terciário para a prática clínica. Métodos Cinquenta pacientes foram submetidos ao teste respiratório convencional com 75mg de 13C-uréia e ao teste com cápsula de 50 mg de 13C-uréia. Amostras de ar expirado foram coletadas no basal e após 10, 20 e 30 minutos da ingestão de 13C-uréia para definição do melhor tempo de coleta. A urease e a histologia foram usadas como padrão ouro em 83 pacientes que se submeteram ao teste respiratório com único ponto de coleta. Resultados Num total de 50 pacientes, 17 foram positivos com teste respiratório convencional com 75 mg de 13C-uréia aos 10, 20 e 30 minutos. Quando esses pacientes repetiram o teste respiratório com 13C-uréia em cápsulas de 50 mg, 17 foram positivos aos 20 minutos (Índice Kappa 1,0; P<0,05) e 15 aos 10 e 30 minutos (Índice Kappa 0,90; P<0,05). A sensibilidade relativa da 13C-uréia em cápsulas de 50 mg foi 100% aos 20 minutos e 88,24% aos 10 e 30 minutos. A especificidade relativa foi de 100% em todos os intervalos de tempo. Entre 83 pacientes que se submeteram ao teste respiratório com cápsula e endoscopia, aqueles que eram H. pylori positivos tiveram teste respiratório positivo e aqueles H. pylori negativo tiveram teste respiratório negativo, mostrando sensibilidade e especificidade de 100%. Conclusões O teste respiratório com cápsula de 50 mg de 13C-uréia ...