Implementation of AZD7442 (Tixagevimab/Cilgavimab) COVID-19 Pre-exposure Prophylaxis (PrEP) in the Largest Health Maintenance Organization in Israel: Real-world Uptake and Sociodemographic and Clinical Characteristics Across Immunocompromised Patient Groups.

INTRODUCTION: AZD7442 is a combination of two neutralizing antibodies (tixagevimab/cilgavimab) with demonstrated efficacy in reducing the risk of symptomatic coronavirus disease 2019 (COVID-19) among individuals at high risk of severe COVID-19 ≤ 6 months after administration. On February 15, 2022, the Israeli Ministry of Health (IMoH) authorized the administration of 300 mg AZD7442 as pre-exposure prophylaxis (PrEP) against severe acute respiratory syndrome coronavirus 2 infection among immunocompromised individuals aged ≥ 12 years. This study describes the real-world uptake of AZD7442 in Israel. METHODS: This descriptive, observational study analyzed data from Israel's largest health maintenance organization, Clalit Health Services (CHS). Individuals were assessed for AZD7442 eligibility between February 13 and December 11, 2022, and were included if they were aged ≥ 12 years, had ≥ 1 year of continuous CHS membership, had ≥ 1 moderate or severe immunocompromising condition, and were eligible for AZD7442 per IMoH recommendations during this time frame. RESULTS: Overall, 19,161 AZD7442-eligible individuals with immunocompromising conditions were identified during the study period; 2829 (14.8%) received AZD7442. A higher proportion of individuals receiving AZD7442 were older (aged ≥ 65 years), male, not current smokers and residents in large cities; required more physician visits (> 50 visits); and had ≥ 1 COVID-19 hospitalization over 12 months, while uptake was lowest among ultra-orthodox Jewish individuals. AZD7442 uptake was also higher among individuals with multiple comorbidities (Charlson Comorbidity Index ≥ 5), including hypertension, diabetes and chronic kidney disease. In specific immunocompromised types, AZD7442 uptake was highest among individuals with lung transplantation (41%), primary immunodeficiency (32%), bone marrow transplantation (29%) and multiple myeloma (25%) or those receiving anti-CD20 therapy (26%) and was lowest in individuals with lymphoma (8%). CONCLUSION: These results show AZD7442 uptake among the eligible population of Israel in 2022 was relatively low, at 14.8%. Uptake was generally higher among immunocompromised individuals who may be perceived to be frail or at highest risk of COVID-19 infection and complications, although at 25-41%, further improvements in uptake would be more impactful. These results also indicate there is opportunity to expand AZD7442 uptake across immunocompromised groups and ensure more equitable uptake among some other sociodemographic groups. Overall, this study will help inform and reassess future implementation strategies for vulnerable populations.

Relationship between Femur Mineral Content and Local Muscle Strength and Mass.

Among the stimuli able to prevent early decreases in bone mineralization, exercise has a noticeable role per se as the source of mechanical stimulus or through lean tissue enlargement by its increasing of tensional stimulus. However, prevention strategies, including exercise, generally do not establish the moment in life when attention should begin to be paid to bone integrity, according to age group- and sex-related differences. Thus, this study analyzed the relationship between variables from the diagnosis of total and regional body composition, muscle strength, and bone mineral content (BMC) of femurs in young adult males. Thirty-four young Caucasian men (24.9 ± 8.6 years) had their body composition and bone density assessed by dual X-ray absorptiometry. The subjects performed a one-repetition maximum test (1-RM) in a bench press, front pulley, seated-row, push press, arm curl, triceps pulley, leg flexion, leg extension, and 45° leg press for the assessment of muscle strength in upper and lower limbs in single- and multi-joint exercises. Lean tissue mass in the trunk and upper and lower limbs were related to femoral BMC (Pearson coefficient ranging from 0.55 to 0.72, p < 0.01), and 1-RM values for different exercises involving both upper and lower limbs also correlated with femoral BMC (Pearson coefficients ranging from 0.34 to 0.46, p < 0.05). Taken together, these correlations suggest that muscle mass and strength are positively linked with the magnitude of femoral mass in men, even in early adulthood. Hence, the importance of an enhanced muscle mass and strength to the health of femoral bones in young adults was highlighted.

Apple Core Unveiled: Malignant Colonic Obstruction Revealing an Unknown Rectosigmoid Neoplasm With Foreign Body Impaction.

This case report highlights a rare clinical scenario of a 46-year-old male presenting with constipation and fecaloid vomiting due to an impacted chicken bone within an unidentified rectosigmoid neoplasm, leading to acute malignant colonic obstruction. Emergent exploratory laparotomy revealed an impacted chicken bone lodged in a previously unknown rectosigmoid tumor. An anatomopathological examination revealed a mucinous adenocarcinoma with clear margins and one pericolic metastatic lymph node. The postoperative period was uneventful, and the patient was proposed for adjuvant chemotherapy. The abrupt onset of symptoms allowed for an early diagnosis, emphasizing the unexpected association between foreign body impaction and incidental malignant obstruction. This case underscores the complexity of managing foreign body ingestion in the gastrointestinal tract and emphasizes the crucial role of diagnostic imaging in surgical planning. Furthermore, it draws attention to the potential occurrence of colorectal cancer in younger individuals, emphasizing the necessity for clinical vigilance and screening strategies beyond conventional age recommendations.

Comprehensive look at rectal squamous cell carcinoma.

Rectal squamous cell carcinoma (rSCC) is a rare cancer (0.5% of all rectal cancers). It typically presents at an advanced stage and has a poor prognosis. Recently, chemoradiotherapy with organ preservation has become an option for complete response (CR). Surveillance is essential to prompt recognition of recurrence due to its high risk. We present a case of an elderly woman with rSCC stage cT4N1aM0 who underwent a combination of chemotherapy (mitomycin and fluoropyrimidine) and radiotherapy with CR and organ preservation. The patient has been in follow-up for 2 years with digital rectal examination, tumour markers, pelvic MRI, thoracic and upper abdominal CT, proctoscopy and positron emission tomography, with no disease recurrence. This highlights the success of chemoradiotherapy for rSCC treatment, allowing organ preservation.

A Comprehensive Review on Deep Eutectic Solvents and Its Use to Extract Bioactive Compounds of Pharmaceutical Interest.

The extraction of bioactive compounds of pharmaceutical interest from natural sources has been significantly explored in recent decades. However, the extraction techniques used were not very efficient in terms of time and energy consumption; additionally, the solvents used for the extraction were harmful for the environment. To improve the environmental impact of the extractions and at the same time increase the extraction yields, several new extraction techniques were developed. Among the most used ones are ultrasound-assisted extraction and microwave-assisted extraction. These extraction techniques increased the yield and selectivity of the extraction in a smaller amount of time with a decrease in energy consumption. Nevertheless, a high volume of organic solvents was still used for the extraction, causing a subsequent environmental problem. Neoteric solvents appeared as green alternatives to organic solvents. Among the neoteric solvents, deep eutectic solvents were evidenced to be one of the best alternatives to organic solvents due to their intrinsic characteristics. These solvents are considered green solvents because they are made up of natural compounds such as sugars, amino acids, and carboxylic acids having low toxicity and high degradability. In addition, they are simple to prepare, with an atomic economy of 100%, with attractive physicochemical properties. Furthermore, the huge number of compounds that can be used to synthesize these solvents make them very useful in the extraction of bioactive compounds since they can be tailored to be selective towards a specific component or class of components. The main aim of this paper is to give a comprehensive review which describes the main properties, characteristics, and production methods of deep eutectic solvents as well as its application to extract from natural sources bioactive compounds with pharmaceutical interest. Additionally, an overview of the more recent and sustainable extraction techniques is also given.

Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study.

Background: Immunocompromised individuals are not optimally protected by COVID-19 vaccines and potentially require additional preventive interventions to mitigate the risk of severe COVID-19. We aimed to characterise and describe the risk of severe COVID-19 across immunocompromised groups as the pandemic began to transition to an endemic phase. Methods: COVID-19-related hospitalisations, intensive care unit (ICU) admissions, and deaths (01/01/2022-31/12/2022) were compared among different groups of immunocompromised individuals vs the general population, using a retrospective cohort design and electronic health data from a random 25% sample of the English population aged ≥12 years (Registration number: ISRCTN53375662). Findings: Overall, immunocompromised individuals accounted for 3.9% of the study population, but 22% (4585/20,910) of COVID-19 hospitalisations, 28% (125/440) of COVID-19 ICU admissions, and 24% (1145/4810) of COVID-19 deaths in 2022. Restricting to those vaccinated with ≥3 doses of COVID-19 vaccine (∼84% of immunocompromised and 51% of the general population), all immunocompromised groups remained at increased risk of severe COVID-19 outcomes, with adjusted incidence rate ratios (aIRR) for hospitalisation ranging from 1.3 to 13.1. At highest risk for COVID-19 hospitalisation were individuals with: solid organ transplant (aIRR 13.1, 95% confidence interval [95% CI] 11.2-15.3), moderate to severe primary immunodeficiency (aIRR 9.7, 95% CI 6.3-14.9), stem cell transplant (aIRR 11.0, 95% CI 6.8-17.6), and recent treatment for haematological malignancy (aIRR 10.6, 95% CI 9.5-11.9). Results were similar for COVID-19 ICU admissions and deaths. Interpretation: Immunocompromised individuals continue to be impacted disproportionately by COVID-19 and have an urgent need for additional preventive measures beyond current vaccination programmes. These data can help determine the immunocompromised groups for which targeted prevention strategies may have the highest impact. Funding: This study was funded by AstraZeneca UK.

Subcritical Water Extraction to Valorize Grape Biomass-A Step Closer to Circular Economy.

With the increase in the world population, the overexploitation of the planet's natural resources is becoming a worldwide concern. Changes in the way humankind thinks about production and consumption must be undertaken to protect our planet and our way of living. For this change to occur, sustainable development together with a circular economic approach and responsible consumption are key points. Agriculture activities are responsible for more than 10% of the greenhouse gas emissions; moreover, by 2050, it is expected that food production will increase by 60%. The valorization of food waste is therefore of high importance to decrease the environmental footprint of agricultural activities. Fruits and vegetables are wildly consumed worldwide, and grapes are one of the main producers of greenhouse gases. Grape biomass is rich in bioactive compounds that can be used for the food, pharmaceutical and cosmetic industries, and their extraction from this food residue has been the target of several studies. Among the extraction techniques used for the recovery of bioactive compounds from food waste, subcritical water extraction (SWE) has been the least explored. SWE has several advantages over other extraction techniques such as microwave and ultrasound extraction, allowing high yields with the use of only water as the solvent. Therefore, it can be considered a green extraction method following two of the principles of green chemistry: the use of less hazardous synthesis (principle number 3) and the use of safer solvents and auxiliaries (principle number 5). In addition, two of the green extraction principles for natural products are also followed: the use of alternative solvents or water (principle number 2) and the use of a reduced, robust, controlled and safe unit operation (principle number 5). This review is an overview of the extraction process using the SWE of grape biomass in a perspective of the circular economy through valorization of the bioactive compounds extracted. Future perspectives applied to the SWE are also discussed, as well as its ability to be a green extraction technique.

The Association between Childhood Obesity and Cardiovascular Changes in 10 Years Using Special Data Science Analysis.

The increasing prevalence of overweight and obesity is a worldwide problem, with several well-known consequences that might start to develop early in life during childhood. The present research based on data from children that have been followed since birth in a previously established cohort study (Generation XXI, Porto, Portugal), taking advantage of State-of-the-Art (SoA) data science techniques and methods, including Neural Architecture Search (NAS), explainable Artificial Intelligence (XAI), and Deep Learning (DL), aimed to explore the hidden value of data, namely on electrocardiogram (ECG) records performed during follow-up visits. The combination of these techniques allowed us to clarify subtle cardiovascular changes already present at 10 years of age, which are evident from ECG analysis and probably induced by the presence of obesity. The proposed novel combination of new methodologies and techniques is discussed, as well as their applicability in other health domains.

Research Trends in the Effect of Caffeine Intake on Fat Oxidation: A Bibliometric and Visual Analysis.

In the last few decades, numerous studies pertaining to research groups worldwide have investigated the effects of oral caffeine intake on fat oxidation at rest, during exercise, and after exercise. However, there is no bibliometric analysis to assess the large volume of scientific output associated with this topic. A bibliometric analysis of this topic may be used by researchers to assess the current scientific interest in the application of caffeine as a nutritional strategy to augment fat oxidation, the journals with more interest in this type of publication, and to draw international collaborations between groups working in the same area. For these reasons, the purpose of this study was to assess the research activity regarding oral caffeine intake and fat oxidation rate in the last few decades by conducting a bibliometric and visual analysis. Relevant publications from 1992 to 2022 were retrieved from the Web of Science (WoS) Core Collection database. Quantitative and qualitative variables were collected, including the number of publications and citations, H-indexes, journals of citation reports, co-authorship, co-citation, and the co-occurrence of keywords. There were 182 total publications, while the number of annual publications is saw-shaped with a modest increase of 11.3% from 2000 to 2009 to 2010 to 2019. The United States was the country with the highest number of publications (24.17% of the total number of articles), followed by the Netherlands (17.03%). According to citation analyses, the average number of citations per document is 130, although there are 21 documents that have received more than 100 citations; the most cited document reached 644 citations. These citation data support the overall relevance of this topic in the fields of nutrition and dietetics and sport sciences that when combined harbored 85.71% of all articles published in the WoS. The most productive author was Westerterp-Plantenga with 16 articles (8.79% of the total number of articles). Nutrients was the journal that published the largest number of articles on this topic (6.59% of the total number of articles). Last, there is a tendency to include keywords such as "performance", "carbohydrate", and "ergogenic aid" in the newer articles, while "obesity", "thermogenic", and "tea" are the keywords more commonly included in older documents. Although research into the role of caffeine on fat oxidation has existed since the 1970s, our analysis suggests that the scientific output associated with this topic has progressively increased since 1992, demonstrating that this is a nutritional research area with a strong foundational base of scientific evidence. Based on the findings of this bibliometric analysis, future investigation may consider focusing on the effects of sex and tolerance to caffeine to widen the assessment of the effectiveness of oral caffeine intake as a nutritional strategy to augment the use of fat as a fuel, as these terms rarely appear in the studies included in this analysis. Additionally, more translational research is necessary as the studies that investigate the effect of oral caffeine intake in ecologically valid contexts (i.e., exercise training programs for individuals with excessive adiposity) are only a minor part of the studies on this topic.

Body Composition Relationship to Performance, Cardiorespiratory Profile, and Tether Force in Youth Trained Swimmers.

This study sought to analyze the relationship between regional body composition, swimming performance, and aerobic and force profile determined through tethered swimming in well-trained swimmers. Eleven male and five female swimmers were involved in the study and underwent the following evaluations: (1) body composition, assessed by the dual-energy X-ray absorptiometry method (DXA); (2) swimming performance, determined for 200, 400, 800, and 1.500 m front-crawl swimming; (3) a tethered swimming force test to determine maximum and mean force (Fmax and Fmean); and (4) an incremental tethered swimming test for the aerobic profile determination of the swimmers. Oxygen uptake (VO2) was directly measured by an automatic and portable system (K4b2 Cosmed, Italy). The fat-free mass (lean mass + bone mineral content, LM+BMC) in lower and upper limbs (UL_LM+BMC: 6.74 ± 1.57 kg and LL_LM+BMC: 20.15 ± 3.84 kg) positively correlated with all indexes of aerobic conditioning level, showing higher coefficients to the indexes representing the ability to perform at high aerobic intensities (VO2max: 49.2 ± 5.9 mL·kg-1·min-1 and respiratory compensation point (RCP): 43.8 ± 6.0 mL·kg-1·min-1), which attained 0.82 and 0.81 (with VO2max), 0.81 and 0.80 (with RCP). The S200 (1.48 ± 0.13 m·s-1) was significantly correlated to Trunk_LM+BMC (r = 0.74), UL_LM+BMC (r = 0.72), Total_LM+BMC (r = 0.71), and LL_LM+BMC (r = 0.64). This study highlights that regional body composition plays an important role in swimming, and body segment analysis should be considered instead of the total body. Tethered swimming may represent a useful method for force and aerobic assessment, aiming at training control and performance enhancement.

Stroke and physiological relationships during the incremental front crawl test: outcomes for planning and pacing aerobic training.

Purpose: This study aimed to evaluate the physiological responses associated with the stroke length (SL) and stroke rate (SR) changes as swimming velocity increases during an incremental step-test. Moreover, this study also aimed to verify if SL and SR relationships toward maximal oxygen uptake (V̇O2max), gas respiratory compensation point (RCP), exchange threshold (GET), and swimming cost can be applied to the management of endurance training and control aerobic pace. Methods: A total of 19 swimmers performed the incremental test until volitional exhaustion, with each stage being designed by percentages of the 400 m (%v400) maximal front crawl velocity. V̇O2max, GET, RCP, and the respective swimming velocities (v) were examined. Also, the stroke parameters, SL, SR, the corresponding slopes (SLslope and SRslope), and the crossing point (Cp) between them were determined. Results: GET and RCP corresponded to 70.6% and 82.4% of V̇O2max (4185.3 ± 686.1 mL min-1), and V̇O2 at Cp, SLslope, and SRslope were observed at 129.7%, 75.3%, and 61.7% of V̇O2max, respectively. The swimming cost from the expected V̇O2 at vSLslope (0.85 ± 0.18 kJ m-1), vSRslope (0.77 ± 0.17 kJ m-1), and vCp (1.09 ± 0.19 kJ m-1) showed correlations with GET (r = 0.73, 0.57, and 0.59, respectively), but only the cost at vSLslope and vCp correlated to RCP (0.62 and 0.69) and V̇O2max (0.70 and 0.79). Conclusion: SL and SR exhibited a distinctive pattern for the V̇O2 response as swimming velocity increased. Furthermore, the influence of SL on GET, RCP, and V̇O2max suggests that SLslope serves as the metabolic reference of heavy exercise intensity, beyond which the stroke profile defines an exercise zone with high cost, which is recommended for an anaerobic threshold and aerobic power training. In turn, the observed difference between V̇O2 at SRslope and GET suggests that the range of velocities between SL and SR slopes ensures an economical pace, which might be recommended to develop long-term endurance. The results also highlighted that the swimming intensity paced at Cp would impose a high anaerobic demand, as it is located above the maximal aerobic velocity. Therefore, SLslope and SRslope are suitable indexes of submaximal to maximal aerobic paces, while Cp's meaning still requires further evidence.

Oxygen Uptake Kinetics and Time Limit at Maximal Aerobic Workload in Tethered Swimming.

This study aimed to apply an incremental tethered swimming test (ITT) with workloads (WL) based on individual rates of front crawl mean tethered force (Fmean) for the identification of the upper boundary of heavy exercise (by means of respiratory compensation point, RCP), and therefore to describe oxygen uptake kinetics (VO2k) and time limit (tLim) responses to WL corresponding to peak oxygen uptake (WLVO2peak). Sixteen swimmers of both sexes (17.6 ± 3.8 years old, 175.8 ± 9.2 cm, and 68.5 ± 10.6 kg) performed the ITT until exhaustion, attached to a weight-bearing pulley-rope system for the measurements of gas exchange threshold (GET), RCP, and VO2peak. The WL was increased by 5% from 30 to 70% of Fmean at every minute, with Fmean being measured by a load cell attached to the swimmers during an all-out 30 s front crawl bout. The pulmonary gas exchange was sampled breath by breath, and the mathematical description of VO2k used a first-order exponential with time delay (TD) on the average of two rest-to-work transitions at WLVO2peak. The mean VO2peak approached 50.2 ± 6.2 mL·kg-1·min-1 and GET and RCP attained (respectively) 67.4 ± 7.3% and 87.4 ± 3.4% VO2peak. The average tLim was 329.5 ± 63.6 s for both sexes, and all swimmers attained VO2peak (100.4 ± 3.8%) when considering the primary response of VO2 (A1' = 91.8 ± 6.7%VO2peak) associated with the VO2 slow component (SC) of 10.7 ± 6.7% of end-exercise VO2, with time constants of 24.4 ± 9.8 s for A1' and 149.3 ± 29.1 s for SC. Negative correlations were observed for tLim to VO2peak, WLVO2peak, GET, RCP, and EEVO2 (r = -0.55, -0.59, -0.58, -0.53, and -0.50). Thus, the VO2k during tethered swimming at WLVO2peak reproduced the physiological responses corresponding to a severe domain. The findings also demonstrated that tLim was inversely related to aerobic conditioning indexes and to the ability to adjust oxidative metabolism to match target VO2 demand during exercise.

Lower Limb Unilateral and Bilateral Strength Asymmetry in High-Level Male Senior and Professional Football Players.

This study sought to assess the relationship between different jumping asymmetries and associated performance variables in high-level male senior and professional football players. Nineteen football players with at least 12 years of training experience (23.2 ± 3.1 years of age; 75.2 ± 4.8 kg of body mass and 181 ± 0.06 cm of height) participated in this study performing countermovement jump (CMJ), squat jump (SJ), single-leg CMJ and drop jump (DJ), associated performance variable eccentric utilization ratio (EUR), stretch-shortening cycle (SSC), bilateral deficit (BLD), and limb symmetry index (LSI) were determined. High correlations were observed between different methodologies of jump tests and associated performance indicators (SSC, BLD, EUR), except LSI. Moreover, CMJ and SJ results were different (p < 0.05), but no differences were found between interlimb in CMJ (p = 0.19) and DJ (p = 0.14). Between the same limbs and different jumps differences were detected in CMJ and DJ (p < 0.01), and it has also been found that the laterality effect size on strength was small in CMJ (ES = 0.30) and DJ (ES = 0.35). LSI between CMJ and DJ was not different despite higher mean values in CMJ, and although mean BLD was positive (>100%), the results highlight the need for individual evaluation since eight players scored negatively. An in-depth and accurate analysis of performance in preseason screening jump tests should be considered, aiming to detect injury risk, specifically evaluating different jumping test methodologies, and determining jumping associated performance variables for each test, namely EUR, SSC, BLD, and LSI. Specific muscle-strengthening exercises could be implemented based on this study results and outcomes, aiming to reduce injury risks and lower extremity asymmetries and to enhance individual football performance in high-level male senior and professional football players. Sports institutions should pay special attention regarding potential health problems in athletes exposed to daily high training loads.

Documents Publication Evolution (1990-2022) Related to Physical Activity and Healthy Habits, a Bibliometric Review.

This research aims to provide an overview of the growing number of scientific literature publications related to Physical Activity and Healthy Habits. A bibliometric analysis between 1990 and 2022 in the Web of Science was carried out, following the bibliometric analysis law, using Microsoft Excel and VosViewer Software for analysis and data processing. A total of 276 documents (262 primary studies and 14 revisions) related to the topic under study were located. The results reveal an exponential growth of scientific production by 48% between 2006 and 2022. Public Environmental Occupational Health, Kaprio, J., and the USA were the knowledge field, author, and country most productive, respectively. A great thematic diversity was found related to the most used keywords by the authors, such as "physical activity", "health habits", "exercise", and "obesity". Thus, the research related to this theme is really in an exponential phase, with great interest in the importance of physical activity and healthy habits, implying practical decisions in policies to develop programs to promote physical activity and healthy habits.

Intervenções de Enfermagem na gestão da dor em doentes nos serviços de urgência básica / Nursing Interventions in pain management for patients in basic emergency services

As intervenções de enfermagem (IE) para a Gestão da Dor (GD), assumem particular pertinência em contexto de Serviço de Urgência Básica (SUB), embora, a literatura atual revele que nem sempre a GD seja prioritária pelos enfermeiros, no primeiro momento de atendimento em SUB. Como objetivos deste trabalho foram selecionados os seguintes: identificar as Intervenções de enfermagem (IE) em Gestão de Dor (GD), em SUB; analisar as relações entre as variáveis sociodemográficas e de formação e as IE na GD, em SUB; Como metodologia, foi desenvolvido um estudo transversal, quantitativo, descritivo e correlacional, a partir dos resultados da aplicação da Escala de Práticas de Enfermagem na Gestão da Dor, (António, 2017), numa amostra tipo bola de neve, de 157 enfermeiros a exercerem funções em SUB de Portugal Continental. A análise de resultados, foram identificas as IE em GD, em SUB, donde se verificou que as mais aplicadas são de caráter independente, tal como: a avaliação inicial (X=38,94; δ=5,78) e o planeamento (X=19,67; δ=4,28), seguidas das interdependentes, relativas à execução de intervenções farmacológicas (X=10,83; δ=1,39), e finalmente aparece o registo (X=8,96; δ=2,31), que pese embora independente, é o menos executado. Da análise das relações entre as IE na GD e as variáveis sociodemográficas, de formação e profissionais, verifica-se que, à exceção das variáveis profissionais que não geram diferenças estatisticamente significativas (p>0,05), a formação é variável determinantemente diferenciadora (p<0,05): os enfermeiros pós-graduados aplicam intervenções mais frequentemente: ensino à pessoa com dor e registo. Além disto, os enfermeiros com mais longa (>50 horas) formação e que a consideram adequada, são os que aplicam mais execuções. Concluímos, que a formação como variável determinante na aplicação de IE revela que deve ser o grande e emergente campo de intervenção para os enfermeiros, a nível pessoal, institucional profissional e formativo.

Nursing interventions (ND) for Pain Management (DM) are particularly relevant in the Basic Emergency Department (BED), although the current literature shows that nurses do not always prioritize DM at the first moment of care in the BED. The objective of this work is identify Nursing Interventions (ND) in Pain Management (DM) in an ED; and analyze the relationships between the sociodemographic and training variables and ND in ND in an ED; As a methodology, cross-sectional, quantitative, descriptive and correlational study based on the results of the application of the Pain Management Nursing Practice Scale, validated for the Portuguese population by António (2019), in a snowball sample of 157 nurses working in MBUs in Mainland Portugal. The analysis of the results we identified the RUs in GD in SW, and found that the most commonly applied RUs were of an independent nature, such as: initial assessment (M=38.94 δ= 5.78) and planning (M=19.67 δ=4.28), followed by the interdependent ones, related to the implementation of pharmacological interventions (M=10.83 δ=1.39), and, finally, registration (M=8.96 δ=2.31), which, although independent, is the least implemented. From the analysis of the relationships between GD EI and the sociodemographic, training and professional variables, we found that, except for the professional variables that do not generate statistically significant differences (p>0.05), training is a determining differentiating variable (p<0.05): postgraduate nurses implement interventions more often: they plan their executions more often, teach the person more and record pain more often, and reassess and perform pharmacological interventions. In addition, nurses with longer (>50 hours) training and who consider it adequate are those who apply more interventions. In conclusion, Training as a determinant variable in the application of EI reveals that it should be the major and emerging field of intervention for nurses, at a personal, institutional, professional and training level.

Misdiagnosis of Clostridioides difficile Infections by Standard-of-Care Specimen Collection and Testing among Hospitalized Adults, Louisville, Kentucky, USA, 2019-20201.

Although Clostridioides difficile infection (CDI) incidence is high in the United States, standard-of-care (SOC) stool collection and testing practices might result in incidence overestimation or underestimation. We conducted diarrhea surveillance among inpatients >50 years of age in Louisville, Kentucky, USA, during October 14, 2019-October 13, 2020; concurrent SOC stool collection and CDI testing occurred independently. A study CDI case was nucleic acid amplification test‒/cytotoxicity neutralization assay‒positive or nucleic acid amplification test‒positive stool in a patient with pseudomembranous colitis. Study incidence was adjusted for hospitalization share and specimen collection rate and, in a sensitivity analysis, for diarrhea cases without study testing. SOC hospitalized CDI incidence was 121/100,000 population/year; study incidence was 154/100,000 population/year and, in sensitivity analysis, 202/100,000 population/year. Of 75 SOC CDI cases, 12 (16.0%) were not study diagnosed; of 109 study CDI cases, 44 (40.4%) were not SOC diagnosed. CDI incidence estimates based on SOC CDI testing are probably underestimated.

Medição da temperatura corporal em crianças: Estudo comparativo entre o método de medição axilar e timpânico / Child body thermometry: A comparative study of axillary and tympanic thermometry / Medición de la temperatura corporal en niños: Estudio comparativo entre el método de medición axilar y timpânico

Resumo Enquadramento: A temperatura corporal é um dos sinais vitais mais avaliados nos cuidados de saúde pediátricos para avaliação e orientação clínica. Objetivos: Avaliar a concordância entre a medição da temperatura por via axilar e timpânica em crianças dos 6 aos 36 meses. Metodologia: Estudo observacional e descritivo desenvolvido num hospital de nível II, em Portugal. O protocolo de medição da temperatura seguiu as orientações da Direção-Geral da Saúde. Resultados: Participaram no estudo 331 crianças. A diferença entre a temperatura timpânica e axilar variou entre os 0,00ºC e os 1,40ºC com uma média de 0,45ºC ± 0,30ºC e uma mediana de 0,50ºC, com uma concordância quase perfeita entre os dois métodos. Observou-se um efeito no valor da temperatura consoante o método utilizado em todas as variáveis estudadas. Conclusão: Existe uma concordância quase perfeita entre estes dois métodos de medição da temperatura, não influenciando a tomada de decisão clínica. Dado a maior facilidade de implementação e exequibilidade, as vantagens do método de avaliação via timpânica são superiores ao método tradicional via axilar, pelo que poderá ser implementado como rotina na avaliação da temperatura em crianças dos 6 aos 36 meses.

Abstract Background: Body temperature is one of the most evaluated vital signs in pediatric health care for clinical assessment and guidance. Objectives: To evaluate the agreement between axillary and tympanic thermometry in children aged 6 to 36 months. Methodology: An observational and descriptive study was carried out in a level II hospital in Portugal. The thermometry protocol followed the guidelines of the Portuguese Directorate-General of Health. Results: A total of 331 children participated in the study. The difference between tympanic and axillary temperatures ranged from 0.00ºC to 1.40ºC, with a mean of 0.45ºC ± 0.30ºC and a median of 0.50ºC, an almost perfect agreement between both methods. An effect on the temperature value was observed according to the technique used in all variables studied. Conclusion: There is an almost perfect agreement between these two thermometry methods, not influencing clinical decision-making. Advantages of the tympanic method over the traditional axillary method include easy implementation and feasibility. Therefore, it can be routinely implemented in assessing temperature in children aged 6 to 36 months.

Resumen Marco contextual: La temperatura corporal es una de las constantes vitales más valoradas en los cuidados de salud pediátricos para la evaluación y orientación clínica. Objetivos: Evaluar la concordancia entre la medición de la temperatura axilar y la timpánica en niños de 6 a 36 meses. Metodología: Estudio observacional y descriptivo desarrollado en un hospital de nivel II de Portugal. El protocolo de medición de la temperatura siguió las directrices de la Dirección General de Sanidad. Resultados: Un total de 331 niños participaron en el estudio. La diferencia entre la temperatura timpánica y la axilar varió entre 0,00ºC y 1,40ºC con una media de 0,45ºC ± 0,30ºC y una mediana de 0,50ºC, con una concordancia casi perfecta entre los dos métodos. En todas las variables estudiadas se observó un efecto sobre el valor de la temperatura según el método utilizado. Conclusión: Existe una concordancia casi perfecta entre estos dos métodos de medición de la temperatura, sin influencia en la toma de decisiones clínicas. Dada la mayor facilidad de aplicación y viabilidad, las ventajas del método de evaluación timpánica son superiores a las del método tradicional a través de la axila, por lo que puede aplicarse de forma rutinaria en la evaluación de la temperatura en niños de 6 a 36 meses.

Chronic thromboembolic pulmonary hypertension: A 10-year analysis from a Portuguese referral center.

INTRODUCTION AND OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive, but potentially curable, form of pulmonary hypertension. Pulmonary endarterectomy (PEA) is a complex surgery that frequently achieves hemodynamic normalization and symptom resolution, although not all patients are suitable for the procedure. We aimed to assess long-term outcomes of CTEPH, namely all-cause mortality and hospital admission for decompensated heart failure, according to treatment modalities in patients who underwent PEA or non-surgical therapy. METHODS: A 10-year retrospective study of patients with CTEPH at a referral center was conducted. Forty-five patients were included and median follow-up time was 57 (IQR 24-93) months. Survival analysis was performed and a multivariate Cox regression model was used to identify independent predictors of outcomes. RESULTS: Patients were mostly female (59%) and mean age was 63±16 years. Two-thirds were severely symptomatic at diagnosis, with 62.2% of patients presenting in WHO functional class (WHO FC) III or IV. One-, two- and three-year survival was 93.3%, 82.4% and 75.9%, respectively. Serum BNP (HR 1.003; 95% CI: 1.001-1.005; p=0.003) and creatinine (HR 12.092; 95% CI: 1.121-130.390; p=0.040) were predictors of death. Mortality was numerically lower in those who underwent PEA (p=0.135). PEA was associated with decreased risk of the combined endpoint of all-cause mortality and hospital admission for decompensated heart failure (HR 0.198; 95% CI: 0.040-0.982; p=0.047), as were lower serum BNP (HR 1.003; 95% CI: 1.001-1.005; p=0.008) and mPAP (HR 1.073; 95% CI: 1.022-1.128; p=0.005) at diagnosis. Most patients who underwent PEA presented improved WHO FC (92.9%) and post-surgical residual pulmonary hypertension was identified in only 21.4%. CONCLUSION: PEA provided a better overall prognosis than non-surgical therapy, improving symptoms and frequently achieving hemodynamic normalization, with a numerical trend for lower mortality. Higher serum BNP, creatinine and mPAP at diagnosis were independently associated with worse outcomes.