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INTRODUCTION: The current definition of acute kidney injury (AKI) includes increased serum creatinine (sCr) concentration and decreased urinary output (UO). Recent studies suggest that the standard UO threshold of 0.5 ml/kg/h may be suboptimal. This study aimed to develop and validate a novel UO-based AKI classification system that improves mortality prediction and patient stratification. METHODS: Data were obtained from the MIMIC-IV and eICU databases. The development process included (1) evaluating UO as a continuous variable over 3-, 6-, 12-, and 24-h periods; (2) identifying 3 optimal UO cutoff points for each time window (stages 1, 2, and 3); (3) comparing sensitivity and specificity to develop a unified staging system; (4) assessing average versus persistent reduced UO hourly; (5) comparing the new UO-AKI system to the KDIGO UO-AKI system; (6) integrating sCr criteria with both systems and comparing them; and (7) validating the new classification with an independent cohort. In all these steps, the outcome was hospital mortality. Another analyzed outcome was 90-day mortality. The analyses included ROC curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and logistic and Cox regression analyses. RESULTS: From the MIMIC-IV database, 35,845 patients were included in the development cohort. After comparing the sensitivity and specificity of 12 different lowest UO thresholds across four time frames, 3 cutoff points were selected to compose the proposed UO-AKI classification: stage 1 (0.2-0.3 mL/kg/h), stage 2 (0.1-0.2 mL/kg/h), and stage 3 (< 0.1 mL/kg/h) over 6 h. The proposed classification had better discrimination when the average was used than when the persistent method was used. The adjusted odds ratio demonstrated a significant stepwise increase in hospital mortality with advancing UO-AKI stage. The proposed classification combined or not with the sCr criterion outperformed the KDIGO criteria in terms of predictive accuracy-AUC-ROC 0.75 (0.74-0.76) vs. 0.69 (0.68-0.70); NRI: 25.4% (95% CI: 23.3-27.6); and IDI: 4.0% (95% CI: 3.6-4.5). External validation with the eICU database confirmed the superior performance of the new classification system. CONCLUSION: The proposed UO-AKI classification enhances mortality prediction and patient stratification in critically ill patients, offering a more accurate and practical approach than the current KDIGO criteria.
Subject(s)
Acute Kidney Injury , Critical Illness , Humans , Acute Kidney Injury/classification , Acute Kidney Injury/diagnosis , Acute Kidney Injury/mortality , Female , Male , Critical Illness/classification , Middle Aged , Aged , Creatinine/blood , Creatinine/analysis , Creatinine/urine , ROC Curve , Hospital Mortality , Urination/physiologyABSTRACT
INTRODUCTION: Cognitive decline is prevalent in maintenance hemodialysis patients. The blood-brain barrier has been implicated in cognitive decline. In this prospective cohort study, we investigated the associations between endothelium-related biomarkers and steeper cognitive decline in this population. METHODS: Cognitive function was assessed using the Portuguese-adapted Cambridge Cognitive Examination (CAMCOG) with items of the Mini-Mental State Examination (MMSE). Endothelium-related biomarkers included syndecan-1, ICAM-1, VCAM-1 and angiopoietin-2 (AGPT2). Patients were followed up for 4 years, and cognitive assessments were repeated. Multinomial regression analyses were performed to evaluate associations between biomarkers and cognitive decline. RESULTS: A total of 216 patients completed the test battery at baseline. After 4 years, 102 patients had follow-up data. There was a significant decrease in cognitive function according to the CAMCOG and MMSE scores: a change of -0.39 (95% CI -0.27 to -0.51) and -0.51 (95% CI -0.27 to -0.76) standard deviation (SD) of the baseline scores. Additionally, executive function but not memory significantly decreased. Syndecan-1 level was independently associated with steeper cognitive decline; each increase in the SD of the syndecan-1 level was associated with a decrease in the CAMCOG of 0.20 (95% CI 0.07-0.33) SD from baseline. Syndecan-1 was associated with a steeper decline in MMSE score (ß 0.54, 95% CI 0.28-0.81) and executive function (ß 0.17, 95% CI 0.02-0.32). Syndecan-1 predicted severe cognitive impairment with an area under the curve for receiver operating characteristic curves of 0.75 (95% CI 0.64-0.83). CONCLUSION: Our findings highlight the potential of syndecan-1, a biomarker of endothelium glycocalyx derangement, as a predictor of steeper cognitive decline in prevalent hemodialysis patients.
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BACKGROUND: The acceptability and preference for clear aligner therapy (CAT) has been increasing among orthodontists, but there is still a lack of consensus regarding CAT best practices. Consequently, this study aimed to investigate CAT practices among orthodontists practicing in Canada. METHODS: The survey was conducted among orthodontists practicing in Canada using a modified previously published survey. Sixty orthodontists participated (6.1% response rate). It consisted of 11 sections with open and closed questions related to demographic information and particularities about using or not using CAT. The survey responses were exported from REDCap to a Microsoft Excel (Microsoft, Redmond, Wash) spreadsheet, then statistically analyzed using SPSS software (SPSS for Windows, version 21.0; IBM Inc., Armonk, NY, USA). The comments were categorized under themes and subthemes. Data were organized in descriptive statistics, expressing frequencies and percentages. RESULTS: Almost 30% of the orthodontist's annual caseload was treated with CAT, most frequently prescribed to adult patients. Case complexity and patient cooperation were the factors that most influenced the decision to prescribe CAT. Almost half of orthodontists reported sometimes combining CAT with adjunctive fixed appliances. CONCLUSIONS: Most orthodontists prescribe CAT, and its use is based on the malocclusion's complexity. Orthodontists who do not prescribe CAT believe that fixed appliance therapy has superior treatment outcomes.
Subject(s)
Orthodontists , Practice Patterns, Dentists' , Humans , Canada , Orthodontists/statistics & numerical data , Practice Patterns, Dentists'/statistics & numerical data , Surveys and Questionnaires , Male , Adult , Female , Malocclusion/therapy , Orthodontic Appliance DesignABSTRACT
Investigation of the biological sex of human remains is a crucial aspect of physical anthropology. However, due to varying states of skeletal preservation, multiple approaches and structures of interest need to be explored. This research aims to investigate the potential use of distances between bifrontal breadth (FMB), infraorbital foramina distance (IOD), nasal breadth (NLB), inter-canine width (ICD), and distance between mental foramina (MFD) for combined sex prediction through traditional statistical methods and through open-access machine-learning tools. Ethical approval was obtained from the ethics committee, and out of 100 cone beam computed tomography (CBCT) scans, 54 individuals were selected with all the points visible. Ten extra exams were chosen to test the predictors developed from the learning sample. Descriptive analysis of measurements, standard deviation, and standard error were obtained. T-student and Mann-Whitney tests were utilized to assess the sex differences within the variables. A logistic regression equation was developed and tested for the investigation of the biological sex as well as decision trees, random forest, and artificial neural networks machine-learning models. The results indicate a strong correlation between the measurements and the sex of individuals. When combined, the measurements were able to predict sex using a regression formula or machine learning based models which can be exported and added to software or webpages. Considering the methods, the estimations showed an accuracy rate superior to 80% for males and 82% for females. All skulls in the test sample were accurately predicted by both statistical and machine-learning models. This exploratory study successfully established a correlation between facial measurements and the sex of individuals, validating the prediction potential of machine learning, augmenting the investigative tools available to experts with a high differentiation potential.
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Exploring children's dental pain experiences helps to develop healthcare policies for improving oral health and quality of life. A cross-sectional study involved 300 parents/caregivers of four- to seven-year-old children using snowball sampling. Parents/caregivers self-completed an online questionnaire on sociodemographic characteristics, parenting styles, their child's oral hygiene practices, free sugar consumption, and dental history. The questionnaire was created using Google Forms and was disseminated to parents/caregivers via E-mail and/or WhatsApp©. Descriptive and Poisson regression analyses were performed (p < 0.05). Children's dental pain experience was reported by 20.3% of the parents. The authoritative parenting style was predominant. The child's mean age at the first consumption of sugar was 1.38 (±0.64) years, and 40.3% of the children had high-free sugar consumption. The mean age for the first dental appointment was 2.26 (±1.31) years, and 24.3% of the children never went to a dental appointment. The prevalence of dental pain experience was higher in children who attended their first dental appointment later (PR: 1.02; CI 95%: 1.01-1.03) and among those with high-free sugar consumption (PR: 1.90; CI 95%: 1.21-3.00). High sugar consumption and delay in the first dental appointment may increase the likelihood that children will experience dental pain.
Subject(s)
Parents , Toothache , Humans , Brazil/epidemiology , Child , Female , Male , Cross-Sectional Studies , Parents/psychology , Toothache/epidemiology , Child, Preschool , Surveys and Questionnaires , Parenting/psychology , PrevalenceABSTRACT
Objective: To compare the frequency of underweight and obesity among previously hospitalized older adults and analyze their association with malnutrition, sarcopenia, frailty, inflammatory markers, and adverse outcomes both during hospitalization and after discharge. Methods: This secondary analysis of a prospective study, conducted at Hospital das Clínicas da Universidade Federal de Pernambuco, Brazil, included hospitalized older patients (age ≥ 60 y). Nutritional status, body composition, sarcopenia, frailty, and outcomes were assessed. Cox regression was performed to evaluate the impact of the body mass phenotypes on clinical outcomes. Results: This secondary analysis included one hundred patients. The prevalence of obesity was 22.10%, while that of underweight was 34.60%. Individuals with underweight had a higher frequency of weaker immune response, worse inflammatory profile, higher nutritional risk, higher frequency of sarcopenia and malnutrition, longer hospital stay, and a higher incidence of mortality when compared to those with obesity. Being underweight was independently associated with higher mortality rates, even after adjustment for age, sex, muscle mass, malnutrition, and diagnosis of malignancy [adjusted HR = 2.82 (95% confidence interval 1.03 7.72), p = 0.044]. Conclusion: The underweight phenotype represented a worst-case scenario in hospitalized older patients. (AU)
Subject(s)
Humans , Aged , Aged, 80 and over , Body Mass Index , Obesity , Mortality , Health Services for the AgedABSTRACT
A endodontia e medicina regenerativa têm demonstrado grande interesse no potencial proliferativo e de diferenciação das Células-tronco de Papila Apical (SCAP), sendo que muitos estudos têm sido direcionados a avaliar as citocinas produzidas por tal população celular. No entanto, o suplemento mais comumente utilizado nos meios de cultura, o Soro Bovino Fetal (SBF), apresenta uma composição complexa e não totalmente conhecida, podendo interferir em diferentes fenômenos, sendo um deles a produção in vitro de citocinas pelas células. Portanto, este estudo teve como proposição: 1. avaliar a interferência do SBF na viabilidade celular das SCAP ativadas ou não por lipopolissacarídeo de Escherichia Coli (LPS) e 2. verificar a interferência de diferentes concentrações de SBF na produção das citocinas Interleucina (IL)-6, Fator de Crescimento Transformador (TGF)-1, Osteoprotegerina (OPG) e a quimiocina CCL2 no sobrenadante das SCAP ativadas por LPS. As células, previamente caracterizadas, obtidas do Biobanco da FOUSP, foram cultivadas em meio -MEM a 10% de SBF, plaqueadas e, após 24h, 48h, 72h, 7 e 14 dias de estímulo, foram então submetidas ao ensaio de MTT para a avaliação da viabilidade celular. A quantificação das citocinas foi realizada através do ensaio de imunoabsorção enzimática (ELISA), no tempo experimental de 24h. Os grupos foram organizados em triplicata de acordo com a concentração de SBF e presença ou não de LPS (1 g/mL). A análise estatística foi executada aplicando-se a análise de variância a dois critérios (two-way ANOVA) seguida de pós-teste de Tukey com nível de significância de 5%. Em 24h, as SCAP cultivadas em meio suplementado com qualquer concentração de SBF apresentaram maior metabolismo celular comparadas àquelas na ausência de soro. Para os tempos experimentais mais longos, de 7 e 14 dias, as SCAP ativadas por LPS mostraram um aumento significativo na viabilidade celular quanto cultivadas sob 10 e 15% de SBF. As duas concentrações testadas de SBF (1 e 10%) interferiram na produção de todas as citocinas avaliadas no presente estudo. Esse resultado enfatiza a importância de evitar a suplementação com SBF em estudos de detecção de citocinas envolvendo SCAP.
Subject(s)
Serum Albumin, Bovine , CytokinesABSTRACT
INTRODUCTION: The global health crisis caused by the COVID-19 pandemic has resulted in severe mortality and morbidity. Immunosuppressed patients, such as kidney transplant recipients, are particularly susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. OBJECTIVE: The aim of this cohort study was to evaluate the impact of COVID-19 vaccination on clinical outcomes in patients with kidney transplants. MATERIALS AND METHODS: In this retrospective study, 254 patients with kidney transplants were vaccinated against SARS-CoV-2 and a fraction of these contracted COVID-19. The diagnosis of COVID-19 was carried out by reverse transcriptase-polymerase chain reaction testing, and the patients received treatment involving immunosuppressive and COVID-19-specific protocols. RESULTS: SARS-CoV-2 infection was diagnosed in 38 (14.96%) patients before the COVID-19 vaccine was administered. After vaccination, an additional 29 (11.42%) patients were diagnosed with COVID-19. Risk factors for hospitalization included age, body mass index (BMI), comorbidities, and time elapsed since renal transplantation (p = 0.025, 0.038, 0.012, and 0.046, respectively). COVID-19 vaccination resulted in a significant decrease in the rate of hospital-acquired SARS-CoV-2 infection from 63.16% to 34.48% (p = 0.020). The proportion of patients from this cohort placed in intensive care units decreased from 23.68% to zero. Allograft rejections exhibited a decreasing trend from 13.16% to 6.90% (p = 0.690). This patient cohort displayed 15.79% mortality prior to COVID-19 vaccination that was reduced to nil after immunization. CONCLUSION: COVID-19 vaccination significantly reduced COVID-19 severity and mortality in this cohort of patients with kidney transplants. The risk factors for hospitalization were determined to be age, BMI, comorbidities, and time since renal transplantation. COVID-19 vaccination resulted in a clinical outcome of reduced hospitalization and a decrease in clinical complications. The COVID-19 vaccination-derived adverse effects in this cohort were found to be comparable to those in the immunocompetent population.
Subject(s)
COVID-19 Vaccines , COVID-19 , Kidney Transplantation , SARS-CoV-2 , Vaccination , Humans , COVID-19/prevention & control , COVID-19/epidemiology , Male , Female , Middle Aged , Retrospective Studies , SARS-CoV-2/immunology , Adult , Aged , Risk Factors , Immunocompromised Host , Hospitalization/statistics & numerical data , Treatment OutcomeABSTRACT
PURPOSE: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. METHODS: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." RESULTS: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). CONCLUSIONS: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.
Subject(s)
Antibiotic Prophylaxis , Device Removal , Prostatectomy , Urinary Tract Infections , Humans , Prostatectomy/adverse effects , Prostatectomy/methods , Antibiotic Prophylaxis/methods , Male , Urinary Tract Infections/prevention & control , Urinary Tract Infections/etiology , Catheters, Indwelling/adverse effects , Urinary Catheterization/adverse effects , Urinary Catheters/adverse effects , Catheter-Related Infections/prevention & control , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/administration & dosageABSTRACT
Acute kidney injury (AKI) is a common condition in hospitalized patients who often requires kidney support therapy (KST). However, predicting the need for KST in critically ill patients remains challenging. This study aimed to analyze endothelium-related biomarkers as predictors of KST need in critically ill patients with stage 2 AKI. A prospective observational study was conducted on 127 adult ICU patients with stage 2 AKI by serum creatinine only. Endothelium-related biomarkers, including vascular cell adhesion protein-1 (VCAM-1), angiopoietin (AGPT) 1 and 2, and syndecan-1, were measured. Clinical parameters and outcomes were recorded. Logistic regression models, receiver operating characteristic (ROC) curves, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used for analysis. Among the patients, 22 (17.2%) required KST within 72 h. AGPT2 and syndecan-1 levels were significantly greater in patients who progressed to the KST. Multivariate analysis revealed that AGPT2 and syndecan-1 were independently associated with the need for KST. The area under the ROC curve (AUC-ROC) for AGPT2 and syndecan-1 performed better than did the constructed clinical model in predicting KST. The combination of AGPT2 and syndecan-1 improved the discrimination capacity of predicting KST beyond that of the clinical model alone. Additionally, this combination improved the classification accuracy of the NRI and IDI. AGPT2 and syndecan-1 demonstrated predictive value for the need for KST in critically ill patients with stage 2 AKI. The combination of AGPT2 and syndecan-1 alone enhanced the predictive capacity of predicting KST beyond clinical variables alone. These findings may contribute to the early identification of patients who will benefit from KST and aid in the management of AKI in critically ill patients.
Subject(s)
Acute Kidney Injury , Syndecan-1 , Adult , Humans , Critical Illness/therapy , Biomarkers , Acute Kidney Injury/therapy , Endothelium/chemistry , ROC Curve , Kidney/chemistryABSTRACT
The triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis is a rare presentation of diabetes mellitus type 2 in adults. We report a case of a 41-year-old male who presented at the emergency department with a sudden onset of severe abdominal pain. Diagnosis of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis was made. Triglyceride level was 6056 mg/dL and glycated hemoglobin was 12.6%. Vigorous fluid therapy and continuous infusion of insulin were started, but due to maintained symptoms, a single plasmapheresis session was performed, with significant clinical improvement. This case emphasizes the diagnostic challenges of the triad and highlights the potential role of plasmapheresis in rapidly reducing triglyceride levels.
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A co-delivery system based on multilayer microparticles was developed and characterized for the sequential release of phenolic compounds (PCs) using different encapsulation processes (spray drying: SD and drying-chilling spray: SDC) and wall materials to improve the stability and bioavailability of PCs. Samples were characterized in terms of process yield (PY%), phenolic retention efficiency (PRE%), chemical structure and crystallinity (NMR, FTIR, DXR), thermal stability (DSC and FT-IR), anti-radical capacity (ORAC and ABTS) and in vitro digestion. PRE% of samples by SD were higher (p < 0.05) than SDC due to the formation of PCs from CRF (cará-roxo flour). NMR, FTIR, DXR confirmed the presence of key components and interactions for the formation of the advanced co-delivery system. The SDC particles showed crystalline regions by XRD and were stable at â¼47 °C. All samples showed good release of PC in the intestinal phase, and antiradical capacity that reached 23.66 µmol TE g-1.
Subject(s)
Eugenia , Spectroscopy, Fourier Transform Infrared , Biological Availability , Phenols , DesiccationABSTRACT
Root canal treatment addresses infectious processes that require control. Occasionally, the radicular pulp is vital and inflamed, presenting a superficial infection. To preserve pulpal remnants, conservative procedures have gained favor, employing anti-inflammatory medications. This study investigated the effects of propolis (PRO), and copaiba oil-resin (COR) associated with hydrocortisone (H) and compared their impact to that of Otosporin® concerning cytotoxic and genotoxic activity, cytokine detection, and toxicity in the Galleria mellonella model. Human periodontal ligament fibroblasts (PDLFs) were exposed to drug concentrations and evaluated by the MTT assay. Associations were tested from concentrations that did not compromise cell density. Genotoxicity was evaluated through micronucleus counting, while cytokines IL-6 and TGF-ß1 were detected in the cell supernatant using ELISA. Molecular docking simulations were conducted, considering the major compounds identified in PRO, COR, and H. Increasing concentrations of PRO and COR were assessed for acute toxicity in Galleria mellonella model. Cellular assays were analyzed using one-way ANOVA followed by Tukey tests, while larval survivals were evaluated using the Log-rank (Mantel-Cox) test (α = 0.05). PRO and COR promoted PDLFs proliferation, even in conjunction with H. No changes in cell metabolism were observed concerning cytokine levels. The tested materials induce the release of AT1R, proliferating the PDFLs through interactions. PRO and COR had low toxicity in larvae, suggesting safety at tested levels. These findings endorse the potential of PRO and COR in endodontics and present promising applications across medical domains, such as preventive strategies in inflammation, shedding light on their potential development into commercially available drugs.
Subject(s)
Anti-Infective Agents , Moths , Propolis , Animals , Humans , Propolis/pharmacology , Molecular Docking Simulation , Periodontal Ligament , Anti-Infective Agents/pharmacology , Larva , Cytokines/metabolism , FibroblastsABSTRACT
SpliceProt 2.0 is a public proteogenomics database that aims to list the sequence of known proteins and potential new proteoforms in human, mouse, and rat proteomes. This updated repository provides an even broader range of computationally translated proteins and serves, for example, to aid with proteomic validation of splice variants absent from the reference UniProtKB/SwissProt database. We demonstrate the value of SpliceProt 2.0 to predict orthologous proteins between humans and murines based on transcript reconstruction, sequence annotation and detection at the transcriptome and proteome levels. In this release, the annotation data used in the reconstruction of transcripts based on the methodology of ternary matrices were acquired from new databases such as Ensembl, UniProt, and APPRIS. Another innovation implemented in the pipeline is the exclusion of transcripts predicted to be susceptible to degradation through the NMD pathway. Taken together, our repository and its applications represent a valuable resource for the proteogenomics community.
Subject(s)
Proteogenomics , Proteomics , Rats , Mice , Humans , Animals , Databases, Protein , Knowledge Bases , Proteome/geneticsABSTRACT
BACKGROUND: Given the impact of the pandemic in Brazil, vaccination is essential to prevent illness and death. Thus, this study sought to compare, after vaccination, the circulation of SARS-CoV-2 and the response to vaccination in the least and most vaccinated municipalities of a Brazilian state during the height of the pandemic when the Omicron variant was dominant. METHODS: We tested for the SARS-CoV-2 antigen and confirmed infection using an RT-qPCR and measured IgM and IgG antibodies in fully vaccinated participants from municipalities with higher and lower vaccination rates. RESULTS: We showed that participants from the least vaccinated municipalities were more likely to have detectable IgM antibodies and a positive antigen/RT-qPCR result for SARS-CoV-2 than participants from the most vaccinated municipalities. There were no differences between the vaccines used (BNT162b2, Ad26.COV2.S, AZD1222, and CoronaVac) and antibody production. CONCLUSIONS: Our study evaluated municipal vaccination coverage and its effects on mortality, infections, and anti-SARS-CoV-2 antibodies during a critical phase of the pandemic. The results suggest that higher vaccination coverage reduces acute cases and confers higher memory antibody levels against SARS-CoV-2. Even with a full vaccination schedule, individuals living in places with low vaccination rates are more susceptible to infection.
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BACKGROUND: Celiac trunk compression by the median arcuate ligament (MAL) increases the risk of ischemic complications following gastrointestinal surgical procedures. Previous studies suggest increased risk of hepatic artery thrombosis (HAT) in orthotopic liver transplant (OLT) recipients. The aim of this study is to investigate the impact of untreated MAL compression (MAL-C) on biliary complications in OLT. METHODS: Contrast-enhanced imaging was used to classify celiac trunk stenosis by MAL-C. Medical records were reviewed to extract pre-transplant, transplant and post-transplant data. Patients were divided into two groups: no MAL compression (nMAL-C) and MAL-C. The primary endpoint was biliary complications. Secondary endpoints were HAT and graft survival. RESULTS: 305 OLT were performed from 2010 to 2021, of which 219 were included for analysis: 185 (84.5%) patients without and 34 (15.5%) with MAL-C. The incidence of HAT was 5.9% in both groups. Biliary complications were more common in the MAL-C group (35.3% vs. 17.8%, p = 0.035). Graft survival was decreased in patients with MAL-C (p = 0.035). CONCLUSIONS: MAL-C of the celiac trunk was associated with increased risk of biliary complications and inferior graft survival in OLT patients. These findings highlight the importance of preoperative screening and treatment of MAL in this population.
Subject(s)
Biliary Tract , Liver Transplantation , Thrombosis , Humans , Liver Transplantation/adverse effects , Liver Transplantation/methods , Hepatic Artery/diagnostic imaging , Hepatic Artery/surgery , Constriction, Pathologic/complications , Constriction, Pathologic/surgery , Celiac Artery/diagnostic imaging , Celiac Artery/surgery , Ligaments/diagnostic imaging , Ligaments/surgeryABSTRACT
BACKGROUND: We tested the hypothesis that children of non-depressed mothers perform better in a developmental test at 3 years than children of depressed mothers. METHOD: Longitudinal analysis from a trial to assess the impact of a child development promotion program in 30 Brazilian municipalities. Mothers and children were appraised at first-year post-partum, 1 and 3 years after enrollment. Child development was assessed through the Ages and Stages Questionnaire (ASQ3) and maternal depression through the Edinburgh Postnatal Depression Scale (EPDS). Crude and adjusted beta coefficients were obtained by linear regression before and after multiple imputation. RESULTS: In total, 2098 mother/child dyads were included and 8.2% of the mothers had persistent depressive symptoms. There was a decrease in ASQ3 as the number of follow-ups with EPDS ≥ 10 increased (p for trend <0.001). In adjusted analysis, the direction of the association persisted but lost statistical significance. After multiple imputation, children from mothers with EPDS ≥ 10 in three follow-ups presented a decrease of about 14 points in ASQ3 (adjusted beta coefficient = -13.79; -22.59 to -5.00) (p for trend = 0.001). CONCLUSIONS: Identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil. IMPACT: In our population study, almost one in every ten women presented persistent depression symptoms across the first 3 years postpartum. In adjusted analysis there was a detrimental impact of persistent maternal depression on child development at 3 years of age. The persistent exposure to maternal depression across early childhood negatively influences children's development. Considering its prevalence, identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.
Subject(s)
Child Development , Depression, Postpartum , Child , Humans , Female , Child, Preschool , Longitudinal Studies , Depression/epidemiology , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Brazil/epidemiology , Mothers , Surveys and QuestionnairesABSTRACT
Resumo: Introdução: Como um componente substancial na relação médico-paciente, a comunicação pode ser determinante na construção da hipótese diagnóstica e na adesão ao tratamento por parte do paciente, e, por isso, há a necessidade de compreender os fatores que influenciam no processo comunicativo e descrever a efetividade dele. Objetivo: Este estudo teve como objetivo avaliar os impactos da comunicação inadequada na relação médico-paciente. Método: Vinte e três pacientes voluntários com a maioridade atingida preencheram questionários de informações socioeconômicas, uso da linguagem e impressões da consulta médica. O médico preencheu um questionário sobre a experiência da consulta. Resultado: Os resultados indicaram que os pacientes apresentaram alguma dificuldade em comunicar ao médico o que sentiam, e, de modo complementar, os médicos, em 20% dos casos, tiveram algum grau de dificuldade de chegar à hipótese diagnóstica a partir do relato do paciente, o que se relaciona com a linguagem pouco descritiva utilizada pela maior parte dos pacientes. Conclusão: Dada a necessidade da qualidade da comunicação entre o médico e o paciente, conhecer os fatores que impactam o processo comunicativo é o primeiro passo para a garantia de um atendimento eficaz com autonomia do paciente e maior adesão ao plano terapêutico.
Abstract: Introduction: As a substantial component of the doctor-patient relationship, communication can be crucial in the construction of a diagnostic hypothesis and patient adherence to treatment. It is therefore necessary to understand the factors that influence the communicative process and describe the effectiveness of the communication. Objective: The aim of this study is to evaluate the impacts of inadequate communication in the doctor-patient relationship. Method: Twenty-three voluntary patients of legal age completed questionnaires on socioeconomic information, language use, and impressions of the medical consultation. The doctor filled out a questionnaire regarding their experience of the consultation. Result: The results indicated that patients experienced some difficulty in communicating their feelings to the doctor, and furthermore, in 20% of cases, doctors encountered some degree of difficulty in reaching a diagnostic hypothesis based on the patient's report, which is related to the predominantly non-descriptive language used by most patients. Conclusion: Given the need for high quality communication between the doctor and the patient, understanding the factors that impact the communicative process is the first step towards ensuring effective care with patient autonomy and improved adherence to the treatment plan.
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Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.