Green Synthesis of Er-Doped ZnO Nanoparticles: An Investigation on the Methylene Blue, Eosin, and Ibuprofen Removal by Photodegradation.

We present a study on the green synthesis of undoped and Er-doped ZnO compounds using Mangifera indica gum (MI). A set of tests were conducted to assess the structure of the material. The tests included X-ray diffraction, Raman, and Fourier-transform infrared spectroscopy. Optical properties were studied using diffuse reflectance and photoluminescence. Morphological and textural investigations were done using SEM images and N2 adsorption/desorption. Furthermore, photocatalytic tests were performed with methylene blue (MB), yellow eosin (EY), and the pharmaceutical drug ibuprofen (IBU) under UV irradiation. The study demonstrated that replacing the stabilizing agent with Mangifera indica gum is an effective method for obtaining ZnO nanoparticles. Additionally, the energy gap of the nanoparticles exhibits a slight reduction in value. Photoluminescence studies showed the presence of zinc vacancies and other defects in both samples. In the photocatalytic test, the sample containing Er3+ exhibited a degradation of 99.7% for methylene blue, 81.2% for yellow eosin, and 52.3% for ibuprofen over 120 min. In the presence of methyl alcohol, the degradation of MB and EY dyes is 16.7% and 55.7%, respectively. This suggests that hydroxyl radicals are responsible for the direct degradation of both dyes. In addition, after the second reuse, the degradation rate for MB was 94.08%, and for EY, it was 82.35%. For the third reuse, the degradation rate for MB was 97.15%, and for EY, it was 17%. These results indicate the significant potential of the new semiconductor in environmental remediation applications from an ecological synthesis.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Facile Synthesis of Ni-Doped ZnO Nanoparticles Using Cashew Gum: Investigation of the Structural, Optical, and Photocatalytic Properties.

This work adopted a green synthesis route using cashew tree gum as a mediating agent to obtain Ni-doped ZnO nanoparticles through the sol-gel method. Structural analysis confirmed the formation of the hexagonal wurtzite phase and distortions in the crystal lattice due to the inclusion of Ni cations, which increased the average crystallite size from 61.9 nm to 81.6 nm. These distortions resulted in the growth of point defects in the structure, which influenced the samples' optical properties, causing slight reductions in the band gaps and significant increases in the Urbach energy. The fitting of the photoluminescence spectra confirmed an increase in the concentration of zinc vacancy defects (VZn) and monovacancies (Vo) as Zn cations were replaced by Ni cations in the ZnO structure. The percentage of VZn defects for the pure compound was 11%, increasing to 40% and 47% for the samples doped with 1% and 3% of Ni cations, respectively. In contrast, the highest percentage of VO defects is recorded for the material with the lowest Ni ions concentration, comprising about 60%. The influence of dopant concentration was also reflected in the photocatalytic performance. Among the samples tested, the Zn0.99Ni0.01O compound presented the best result in MB degradation, reaching an efficiency of 98.4%. Thus, the recovered material underwent reuse tests, revealing an efficiency of 98.2% in dye degradation, confirming the stability of the photocatalyst. Furthermore, the use of different inhibitors indicated that •OH radicals are the main ones involved in removing the pollutant. This work is valuable because it presents an ecological synthesis using cashew gum, a natural polysaccharide that has been little explored in the literature.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study.

BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Relevância das fontes de informação no cenário brasileiro durante a pandemia de covid-19 / Relevance of the information sources in the Brazilian scenario during the covid-19 pandemic / Relevancia de las fuentes de información en el escenario brasileño durante la pandemia del covid-19

Este artigo apresenta os resultados de um estudo sobre a percepção que os usuários têm da relevância das fontes de informação utilizadas por eles para se elucidarem sobre a covid-19 no cenário brasileiro durante a pandemia dessa doença. Os dados coletados para o estudo foram obtidos mediante a aplicação de um questionário distribuído via e-mail, Facebook, Instagram e WhatsApp. Os resultados mostram atribuição de relevância predominante a fontes formais e institucionais, como a Organização Mundial de Saúde (OMS), artigos científicos, universidades, Agência Nacional de Vigilância Sanitária (Anvisa), hospitais e postos de saúde. Dentre as fontes consideradas menos relevantes destacam-se jornais e/ou revistas, o Ministério da Saúde (MS) brasileiro e canais de televisão. As redes sociais (Facebook, Instagram, YouTube, WhatsApp, Twitter etc.), os amigos e/ou colegas, os mecanismos de busca na Internet (Google, Yahoo, Bing etc.) e familiares também se destacam como fontes de informação menos relevantes

This paper presents the results of a study on the users' perception of information of the relevance of infor-mation sources used by them to elucidate about covid-19 in the Brazilian scenario during the pandemic of this disease. The data were collected with use of a questionnaire distributed by email, Facebook, Instagram and WhatsApp. The results demonstrated a predominant attribution of relevance to formal and institution-al information sources, such as the World Health Organization (WHO), scientific papers, universities, the Anvisa ­ Agência Nacional de Vigilância Sanitária (the National Health Surveillance Agency), hospitals, and health centers. Among the sources considered less relevant were highlighted newspapers and/or mag-azines, the Brazilian Ministry of Health, and television channels. Social networks (Facebook, Instagram, YouTube, WhatsApp, Twitter, etc.), friends and/or colleagues, Internet search engines (Google, Yahoo, Bing, etc.) and family members also stand out as less relevant sources of information

Este artículo presenta los resultados de un estudio sobre la percepción que tienen los usuarios de la relevancia de las fuentes de información utilizadas por ellos para enterarse de la covid-19 en el escenario brasileño durante la pandemia de esta enfermedad. Los datos recolectados para el estudio se obtuvieron mediante la aplicación de una encuesta distribuida a través de correo electrónico, Facebook, Instagram y WhatsApp. Los resultados muestran una atribución de relevancia predominante a fuentes formales e institucionales, como la Organización Mundial de la Salud (OMS), artículos científicos, universidades, la Anvisa - Agência Nacional de Vigilância Sanitária (Agencia Nacional de Vigilancia Sanitaria), hospitales y centros de salud. Entre las fuentes consideradas menos relevantes están periódicos y/o revistas, el Ministerio de Salud brasileño y canales de televisión. También se destacan como fuentes de información menos relevantes las redes sociales (Facebook, Instagram, YouTube, WhatsApp, Twitter, etc.), los amigos y/o compañeros, los motores de búsqueda en la Internet (Google, Yahoo, Bing, etc.) y los familiares.

Clear aligners combined with orthognathic surgery: a case series.

The goal of this study was to describe a series of orthognathic surgery cases in which a clear aligner system was used for orthodontic treatment. A total of 16 cases were undertaken. A majority of the patients were female (68.75%), and the mean age of the patients was 26.78 years (SD 10.85 years). The most frequent malocclusion was Class II (56.25%), mainly caused by mandibular retrognathism (80.00%). Most of the patients were treated with single-jaw surgeries (56.15%). Orthodontic buttons and elastics were used for maxillomandibular fixation in 81.25% of the patients. The mean (SD) treatment period was 19.00 (1.11) months, and the postsurgical follow-up varied from 6 months to 10 years. Good results were achieved with orthognathic surgery and the adjunctive use of clear aligners, and no damage was noted during the orthosurgical treatment. Since clear aligners provide an esthetic, removable appliance and may be more acceptable to patients than conventional orthodontic appliances, the use of clear aligners in orthognathic surgery is a promising alternative to traditional orthodontics.

Ecological Design of New Efficient Energy-Performance Construction Materials with Rigid Polyurethane Foam Waste.

An ecological mortar is designed from industrial sub-products, with the objective of utilizing both the slag residues, generated during steel manufacturing processes, and the waste from Polyurethane Foam (PF) panels, generated during refrigerator chamber manufacturing processes. The ecological mortar design involves the dosing of Electric Arc Furnace (EAF) slag, together with finely ground Polyurethane Foam, cement, and additives. An energy efficient prefabricated block is designed with the mortar, for use in construction, and its energy performance is assessed as a material inserted within the envelope of a service sector (hospital) building, either as an exterior skin, or as an enclosing component within the façade interior. The main contribution of this research is the characterization of the thermo-physical and mechanical properties of a new prefabricated panel made with recycled materials. The full characterization of the properties of these new materials is presented and discussed. The new prefabricated panel demonstrates adequate thermo-mechanical characteristics as a substitute for traditional materials, while improving the sustainability of the building. As a secondary objective, the energy behaviour of the new panels when integrated in a real building is presented by means of a case study simulation. The use of computational thermal simulation confirmed that the properties of the prefabricated block influenced the annual thermal demand of the building for heating and cooling. Improvements to the thermal inertia of the building envelope were also confirmed with the inclusion of PF waste, giving the mortar an energy performance that was similar to conventional materials, in such a way that its use in façade construction may be validated, in addition to its environmental benefits, due to it having been manufactured with critical recycled industrial waste such as EAF slag and PF, thereby contributing to both the circular economy and sustainable development.

Importância do planejamento em ações intersetoriais da Secretaria Municipal de Saúde de Moreno-PE / Importance of planning in intersectoral actions of the Municipal Health Department of Moreno-PE / Importancia de la planificación en acciones intersectoriales del Departamento Municipal de Salud de Moreno-PE

Introdução: O setor de planejamento em saúde é um dos mais estratégicos para as ações de saúde municipais, pois a ele estão destinado as operações de coordenação, avaliação, controle, administração, organização e gerenciamento das práticas que serão executadas pelos diversos setores. Objetivo: Este estudo tem por objetivo analisar as potencialidades e limites da articulação intersetorial tendo como exemplaridade as ações de Planejamento em Saúde do município de Moreno-PE 2018/2019, visando a superação da fragmentação das políticas públicas. Metodologia: Trata-se de um estudo descritivo, abordado por métodos de abordagem quali-quantitativa. Para análise dos dados foram utilizados a técnica do Discurso do Sujeito Coletivo e o método da Hermenêutica Dialética. Resultados: Todos os sete sujeitos entrevistados reconhecem a importância do planejamento na saúde no intuito de atingir suas respectivas metas. O SisPlan também demonstrou ser de grande importância nesta direção, ainda que as secretarias do município não utilizem esta ferramenta em sua total plenitude, fato que tem sido um elemento impeditivo para o sucesso da integração das ações de Saúde. Discussão: Recomenda-se aos gestores qualificar o diálogo entre as secretarias, intensificar a alimentação de informações no SisPlan e programar e sistematizar os colegiados internos da Secretaria de Saúde, na perspectiva de contribuir em ações de governo que busquem superar a fragmentação das políticas públicas. (AU)

Introduction: The health planning sector is one of the most strategic for municipal health actions, since coordination, evaluation, control, administration, organization and management of the practices that will be performed by the various sectors are destined for it. Objective: This study aims to analyze the potential and limits of intersectoral articulation with exemplary actions in Health Planning in the municipality of Moreno-PE 2018/2019, aiming to overcome the fragmentation of public policies. Methodology: This is a descriptive study, approached by methods of qualitative and quantitative approach. For data analysis, the Collective Subject Discourse technique and the Dialectic Hermeneutics method were used. Results: All seven subjects interviewed recognize the importance of health planning in order to achieve their respective goals. SisPlan also proved to be of great importance in this direction, even though the municipal secretariats do not use this tool to its fullest extent, a fact that has been an impediment to the success of the integration of health actions. Discussion: It is recommended to managers to qualify the dialogue between the secretariats, to intensify the feeding of information in the SisPlan and to program and systematize the internal collegiate bodies of the Secretariat of Health, with the perspective of contributing to government actions that seek to overcome the fragmentation of public policies. (AU)

Introducción: El sector de la planificación de la salud es uno de los más estratégicos para las acciones municipales de salud, ya que la coordinación, evaluación, control, administración, organización y gestión de las prácticas que realizarán los diversos sectores están destinados a ello. Objetivo: Este estudio tiene como objetivo analizar el potencial y los límites de la articulación intersectorial con acciones ejemplares en Planificación de la Salud en el municipio de Moreno-PE 2018/2019, con el objetivo de superar la fragmentación de las políticas públicas. Metodología:Este es un estudio descriptivo, abordado por métodos de enfoque cualitativo y cuantitativo. Para el análisis de los datos, se utilizaron la técnica del discurso del sujeto colectivo y el método de la dialéctica hermenéutica. Resultados: Los siete sujetos entrevistados reconocen la importancia de la planificación de la salud para lograr sus respectivos objetivos. SisPlan también demostró ser de gran importancia en esta dirección, aunque las secretarías municipales no utilizan esta herramienta en toda su extensión, un hecho que ha sido un impedimento para el éxito de la integración de las acciones de salud. Discusión: Se recomienda a los gerentes calificar el diálogo entre las secretarías, intensificar el suministro de información en el Programa y el SisPlan y sistematizar los órganos colegiados internos de la Secretaría de Salud, con la perspectiva de contribuir a las acciones gubernamentales que buscan superar la fragmentación de las políticas públicas. (AU)

A Brazilian cohort of individuals with Phelan-McDermid syndrome: genotype-phenotype correlation and identification of an atypical case.

BACKGROUND: Phelan-McDermid syndrome (PMS) is a rare genetic disorder characterized by global developmental delay, intellectual disability (ID), autism spectrum disorder (ASD), and mild dysmorphisms associated with several comorbidities caused by SHANK3 loss-of-function mutations. Although SHANK3 haploinsufficiency has been associated with the major neurological symptoms of PMS, it cannot explain the clinical variability seen among individuals. Our goals were to characterize a Brazilian cohort of PMS individuals, explore the genotype-phenotype correlation underlying this syndrome, and describe an atypical individual with mild phenotype. METHODOLOGY: A total of 34 PMS individuals were clinically and genetically evaluated. Data were obtained by a questionnaire answered by parents, and dysmorphic features were assessed via photographic evaluation. We analyzed 22q13.3 deletions and other potentially pathogenic copy number variants (CNVs) and also performed genotype-phenotype correlation analysis to determine whether comorbidities, speech status, and ASD correlate to deletion size. Finally, a Brazilian cohort of 829 ASD individuals and another independent cohort of 2297 ID individuals was used to determine the frequency of PMS in these disorders. RESULTS: Our data showed that 21% (6/29) of the PMS individuals presented an additional rare CNV, which may contribute to clinical variability in PMS. Increased pain tolerance (80%), hypotonia (85%), and sparse eyebrows (80%) were prominent clinical features. An atypical case diagnosed with PMS at 18 years old and IQ within the normal range is here described. Among Brazilian ASD or ID individuals referred to CNV analyses, the frequency of 22q13.3 deletion was 0.6% (5/829) and 0.61% (15/2297), respectively. Finally, renal abnormalities, lymphedema, and language impairment were found to be positively associated with deletion sizes, and the minimum deletion to cause these abnormalities is here suggested. CONCLUSIONS: This is the first work describing a cohort of Brazilian individuals with PMS. Our results confirm the impact of 22q13 deletions on ASD and several comorbidities, such as hypotonia. The estimation of a minimal deletion size for developing lymphedema and renal problem can assist prediction of prognosis in PMS individuals, particularly those diagnosed in early infancy. We also identified one atypical individual carrying SHANK3 deletion, suggesting that resilience to such mutations occurs. This case expands the clinical spectrum of variability in PMS and opens perspectives to identify protective mechanisms that can minimize the severity of this condition.

Prevalence of fasciolosis in slaughtered dairy cattle from São Miguel Island, Azores, Portugal.

Fasciolosis, caused by the trematode Fasciola hepatica, is considered one of the most important parasitosis in dairy cattle due to significant economic losses. The main objectives of this study were to determine the prevalence of fasciolosis in dairy cattle slaughtered at São Miguel Island (SMI) slaughterhouse and to ascertain areas (parishes and dairy herds), within the island, with highest risk for fasciolosis. The association among cattle age and weight with the occurrence of fasciolosis was also determined. From a sample of 24,389 cattle slaughtered in two years (2015-2016), a total of 1134 dairy cattle livers were inspected and, during this period, 531 were positive to fasciolosis and 603 presented no typical fasciolosis lesions. This study showed that fasciolosis has a broad geographical distribution on SMI and that is also found in cattle from other islands of the Azores archipelago, namely Flores Island. Although there were no significant differences in weight between healthy animals and parasitized ones, we observed that the older animals present a greater level of liver lesions and a higher level of parasitization, reflecting their longer period of exposure to the risk factor (ingestion of metacercariae in pastures infested by Galba truncatula).

Reference ranges for ultrasound measurements of fetal kidneys in a cohort of low-risk pregnant women.

PURPOSE: Alterations in renal dimensions may be an early manifestation of deviation from normality, with possible repercussions beyond intrauterine life. The objective of this study was to establish reference curves for fetal kidney dimensions and volume from 14 to 40 weeks of gestation. METHODS: This is a prospective longitudinal study of 115 Brazilian participants in the "WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component". Pregnant women with clinical and sociodemographic characteristics allowing the full potential fetal growth were followed up from the first trimester until delivery. These women underwent serial sonographic evaluation of fetal kidneys. The longitudinal, anteroposterior and transverse diameters of both fetal kidneys were measured, in addition to calculation of kidney volume. By quantile regression analysis, reference curves of renal measurements related to gestational age were built. RESULTS: Standard normal sonographic values of renal biometry were defined during pregnancy. Reference values for the 10th, 50th and 90th centiles of different fetal kidney measurements (longitudinal, anteroposterior, transverse and volume) from the 14th to the 40th week of gestation were fitted. CONCLUSION: The reference curves presented should be of the utmost importance for screening and diagnosis of alterations in renal development during the intrauterine period.

Updated Review of Traumatic Dislocation of the Mandibular Condyle Into the Middle Cranial Fossa.

PURPOSE: Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event after maxillofacial trauma. Treatment may be performed with closed or open reduction (with or without craniotomy), and arthroplasty procedures might be necessary for long-standing cases. The aims of this study were to perform an integrative review of traumatic DMCCF cases reported in an electronic database and to report a case in which cerebrospinal fluid leakage occurred after open treatment. PATIENTS AND METHODS: The study was carried out in 2 phases. In the first part, an electronic search was undertaken in MEDLINE (via PubMed) in April 2018, with 52 articles being included. In the second, we report a case in which cerebrospinal fluid leakage occurred through the external auditory canal after open reduction of the mandibular condyle into the middle cranial fossa in a 22-year-old male patient, with a follow-up of 5 months. RESULTS: A total of 59 cases were included. Most patients were female patients (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. Closed treatment was ideally performed within 2 weeks of intrusion. Open treatment was required for cases with 2 or more weeks of impaction. The types of open treatment were open reduction, condylectomy, condylotomy, and temporomandibular joint reconstruction with alloplastic implants. The glenoid fossa was reconstructed in 28 cases, and a temporalis muscle flap with or without bone grafts was the main choice. Despite the treatment option used, mandibular deviation during opening occurred in 41% of cases. Rare complications included persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus. CONCLUSIONS: Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurologic surgeons. Close monitoring is extremely important to mitigate complications.

Incidence and characteristics angiographic of patients with acute myocardial / Incidência e características angiográficas de pacientes com doença miocárdica aguda

Background: Acute myocardial infarction (AMI) is defined as the death of cardiomyocytes due to prolonged ischemia, caused by thrombosis and / or vasospasm on an atherosclerotic plaque. Objective: To determine the incidence of patients with myocardial infarction undergoing primary angioplasty; characterize the anthropometric variables and identify the risk factors in this population. Methods: This was a cross-sectional, observational, retrospective study in which we collected secondary data from medical records of a hospital in a city in the state of São Paulo, where the largest number of interventions is via Public Health System, patients with a diagnosis of Myocardial Infarction, undergoing primary coronary angioplasty, from January 2011 to December 2013. Results: The total sample consisted of 437 subjects, 282 male and 155 female. In this study, there was predominance of myocardial infarction in the anterior descending artery ADA (45.51%), followed by right coronary artery RCA (38.46%), in carrying out the rescue angioplasty and stent implantation in 96.62% of cases. There was a predominance of high blood pressure as risk factors for 73.71%, followed by smoking with 41.66% of the sample. Conclusion: According to the present study data, it appears a higher prevalence of infarction occurred in the ADA, with individuals performing the rescue angioplasty procedure and the placement of the stent, and a growing incidence of drug stent placement. We observed a high incidence of risk factors, prevailing hypertension

Application of a pharmacokinetics-pharmacodynamics approach to the free propofol plasma levels during coronary artery bypass grafting surgery with hypothermic cardiopulmonary bypass.

OBJECTIVES: The objective of this study was to apply a pharmacokinetics-pharmacodynamics approach to investigate the free propofol plasma levels in patients undergoing coronary artery bypass grafting under hypothermic conditions compared with the off-pump procedure. METHODS: Nineteen patients scheduled for on-pump coronary artery bypass grafting under hypothermic conditions (n=10) or the equivalent off-pump surgery (n=9) were anesthetized with sufentanil and propofol target-controlled infusion (2 µg/mL) during surgery. The propofol concentration was then reduced to 1 µg/mL, and a pharmacokinetics-pharmacodynamics analysis using the maximum-effect-sigmoid model obtained by plotting the bispectral index values against the free propofol plasma levels was performed. RESULTS: Significant increases (two- to five-fold) in the free propofol plasma levels were observed in the patients subjected to coronary artery bypass grafting under hypothermic conditions. The pharmacokinetics of propofol varied according to the free drug levels in the hypothermic on-pump group versus the off-pump group. After hypothermic coronary artery bypass was initiated, the distribution volume increased, and the distribution half-life was prolonged. Propofol target-controlled infusion was discontinued when orotracheal extubation was indicated, and the time to patient extubation was significantly higher in the hypothermic on-pump group than in the off-pump group (459 versus 273 min, p=0.0048). CONCLUSIONS: The orotracheal intubation time was significantly longer in the hypothermic on-pump group than in the off-pump group. Additionally, residual hypnosis was identified through the pharmacokinetics-pharmacodynamics approach based on decreases in drug plasma protein binding in the hypothermic on-pump group, which could explain the increased hypnosis observed with this drug in this group of patients.

Application of a pharmacokinetics-pharmacodynamics approach to the free propofol plasma levels during coronary artery bypass grafting surgery with hypothermic cardiopulmonary bypass

OBJECTIVES: The objective of this study was to apply a pharmacokinetics-pharmacodynamics approach to investigate the free propofol plasma levels in patients undergoing coronary artery bypass grafting under hypothermic conditions compared with the off-pump procedure. METHODS: Nineteen patients scheduled for on-pump coronary artery bypass grafting under hypothermic conditions (n=10) or the equivalent off-pump surgery (n=9) were anesthetized with sufentanil and propofol target-controlled infusion (2 μg/mL) during surgery. The propofol concentration was then reduced to 1 μg/mL, and a pharmacokinetics-pharmacodynamics analysis using the maximum-effect-sigmoid model obtained by plotting the bispectral index values against the free propofol plasma levels was performed. RESULTS: Significant increases (two- to five-fold) in the free propofol plasma levels were observed in the patients subjected to coronary artery bypass grafting under hypothermic conditions. The pharmacokinetics of propofol varied according to the free drug levels in the hypothermic on-pump group versus the off-pump group. After hypothermic coronary artery bypass was initiated, the distribution volume increased, and the distribution half-life was prolonged. Propofol target-controlled infusion was discontinued when orotracheal extubation was indicated, and the time to patient extubation was significantly higher in the hypothermic on-pump group than in the off-pump group (459 versus 273 min, p=0.0048). CONCLUSIONS: The orotracheal intubation time was significantly longer in the hypothermic on-pump group than in the off-pump group. Additionally, residual hypnosis was identified through the pharmacokinetics-pharmacodynamics approach based on decreases in drug plasma protein binding in the hypothermic on-pump group, which could explain the increased hypnosis observed with this drug in this group of patients.

Comparação entre gravidade do paciente e carga de trabalho de enfermagem antes e após a ocorrência de eventos adversos em idosos em cuidados críticos / Comparación entre la gravedad del paciente y la carga de trabajo de la enfermería antes y después de la ocurrencia de eventos adversos en ancianos con cuidados críticos / Comparison between patient severity and nursing workload before and after the occurrence of adverse events in elderly in critical care

RESUMO Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.

RESUMEN Objetivo: comparar la gravedad del paciente y la carga de trabajo en enfermería antes y después de ocurrir un evento adverso moderado y grave en ancianos internados en unidades de terapia intensiva. Método: estudio comparativo realizado en nueve unidades de terapia intensiva de un Hospital Universitario de São Paulo. Los eventos fueron obtenidos a través de los prontuarios de los pacientes y clasificados en moderados y graves según la Organización Mundial de la Salud. El análisis sobre la gravedad fue realizado de acuerdo al Symplified Acute Physiologic Score II y la carga de trabajo se hizo conforme al Nursing Activities Score, 24 horas antes y después del evento moderado y grave. El test t, con una significancia del 5%, fue utilizado para la comparación de los promedios de la gravedad clínica y de la carga de trabajo antes y después del evento. Resultados: la muestra incluyó 315 ancianos, siendo que 94 (29,8%) sufrieron eventos moderados y graves en las unidades. De los 94 eventos, predominó el tipo de proceso clínico y el procedimiento (40,0%). La instalación y mantenimiento de artefactos terapéuticos y catéteres fueron las intervenciones prevalentes que resultaron en daños fisiopatológicos (66,0%) y de grado moderado (76,5%). El promedio de puntuación de la carga de trabajo (75,19%) disminuyó 24 horas después de ocurrido el evento (71,97%, p=0,008) y la gravedad, representada por la probabilidad de muerte, aumentó de 22,0% para 29,0% después del evento (p=0,045). Conclusion: en el contexto de seguridad del paciente, la identificación de las alteraciones en las condiciones clínicas y en la carga de trabajo de enfermería en los ancianos que sufren eventos subsidia la prevención de tales ocurrencias.

ABSTRACT Objective: to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units. Method: comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event. Results: the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045). Conclusion: in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences.

Haemodialysis, nutritional disorders and hypoglycaemia in critical care.

This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level. Incidence of hypoglycaemia was 14.2%. Hypoglycaemia was higher in the group of patients on catecholamines (p=0.040), with higher glycaemic variability (p<0.001) and death in the intensive care unit (p=0.008). Risk factors were identified as absence of oral diet (OR 5.11; 95% CI 1.04-25.10) and haemodialysis (OR 4.28; 95% CI 1.16-15.76). Patients on haemodialysis and with no oral diet should have their glycaemic control intensified in order to prevent and/or manage hypoglycaemic episodes.

Nursing practice environment and work satisfaction in critical units. / Ambiente das práticas de enfermagem e satisfação profissional em unidades críticas.

OBJECTIVE:: to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU). METHOD:: a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively. RESULTS:: a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. "Environment of practices", "length of work in the ICU" and "willingness to work" were associated with work satisfaction. CONCLUSION:: to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.

Ambiente das práticas de enfermagem e satisfação profissional em unidades críticas / El ambiente de la práctica de enfermería y la satisfacción profesional en unidades críticas / Nursing practice environment and work satisfaction in critical units

RESUMO Objetivo: analisar a associação entre ambiente das práticas de enfermagem e satisfação profissional em Unidades de Terapia Intensiva (UTI). Método: estudo transversal, realizado em 8 UTIs adulto de um hospital público universitário, no período entre 2012 e 2015. Para investigar o ambiente das práticas de enfermagem e satisfação profissional, foram aplicados, respectivamente, os instrumentos Nursing Work Index-Revised (NWI-R), nas versões resumidas, e Índice de Satisfação Profissional (ISP). Resultados: participaram do estudo 100 (34,84%) enfermeiros e 187 (65,15%) técnicos/auxiliares de enfermagem. O ambiente foi favorável para autonomia e relações e apresentou fragilidade para controle das práticas e suporte organizacional. O escore ISP indicou baixa satisfação profissional. As variáveis "ambiente das práticas", "tempo de trabalho em UTI" e "disposição para o trabalho" foram associadas à satisfação profissional. Conclusão: investir no ambiente das práticas, nos fatores que promovem a disposição e o tempo de experiência na UTI aumenta a satisfação profissional de enfermagem.

RESUMEN Objetivo: analizar la asociación entre el ambiente de la práctica de enfermería y la satisfacción profesional en Unidades de Cuidados Intensivos (UCI). Método: estudio transversal realizado en ocho unidades de cuidados intensivos de adultos de un hospital universitario público entre 2012 y 2015. Para investigar el ambiente de la práctica de enfermería y la satisfacción profesional, se aplicaron respectivamente a los instrumentos Nursing Work Index-Revised (NWI-R) en la versión resumida, y el Índice de Satisfacción Profesional (ISP). Resultados: en el estudio, participaron 100 enfermeros (34.84%) y 187 asistentes/técnicos de enfermería (65.15%). El ambiente era favorable a la autonomía y las relaciones y mostró debilidad por las prácticas de control y apoyo organizativo. La puntuación ISP ha indicado baja satisfacción profesional. Las variables "ambiente de las prácticas", "tiempo de trabajo en la UCI" y "disposición para el trabajo" se asociaron con la satisfacción profesional. Conclusión: al investir en el ambiente de la práctica, en los factores que promueven la disposición y la duración de la experiencia en la UCI, se aumenta la satisfacción profesional de la enfermería.

ABSTRACT Objective: to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU). Method: a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively. Results: a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. "Environment of practices", "length of work in the ICU" and "willingness to work" were associated with work satisfaction. Conclusion: to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.

Arbuscular mycorrhizal fungi and colonization stimulant in cotton and maize / Fungos micorrízicos arbusculares e estimulante da colonização na cultura do algodoeiro e do milho

ABSTRACT: The objective of this study was to evaluate the effects of inoculation with different arbuscular mycorrhizal fungi native to Cerrado, associated with the application of colonization stimulant (7-hydroxy, 4’-methoxy-isoflavone) at the initial growth of cotton and maize plants in a greenhouse. The experiment was carried out in a completely randomized design and 7x2 factorial scheme, with five species of arbuscular mycorrhizal fungi and combined inoculation (uniting all species in equal proportion) and native fungi, in the presence and absence of colonization stimulant in maize and cotton crops. Shoots dry matter (SDM), roots dry matter (RDM), mycorrhizal colonization and accumulation of calcium, zinc and phosphorus in the SDM were evaluated at flowering. Inoculation of arbuscular mycorrhizal fungi and the use of colonization stimulant at low density of arbuscular mycorrhizal fungi propagules was beneficial to plant development. Inoculation with mycorrhizal fungi demonstrated different effects for the various parameters evaluated in cotton and maize, and the application of colonization stimulant promoted higher mycorrhizal colonization and initial growth in cotton, when associated with native AMF, and in corn, when associated with inoculation with Dentiscutata heterogama, Gigaspora margarita and Rhizophagus clarus.

RESUMO: O objetivo deste estudo foi avaliar os efeitos da inoculação com diferentes fungos micorrízicos arbusculares nativos do Cerrado, associados à aplicação de estimulante de colonização (7-hidroxi, 4’-metoxi-isoflavona) no crescimento inicial de plantas de algodão e milho em casa de vegetação. O experimento foi conduzido em delineamento inteiramente casualizado e esquema fatorial 7x2, com cinco espécies de fungos micorrízicos arbusculares e inoculação combinada (unindo todas as espécies em proporção igual) e fungos nativos, na presença e ausência de estimulante de colonização em culturas de milho e algodão. Avaliou-se a massa de matéria seca (SDM), matéria seca de raízes (RDM), colonização micorrízica e acúmulo de cálcio, zinco e fósforo na SDM. A inoculação com fungos micorrízicos arbusculares e o uso de estimulante de colonização em baixa densidade de propágulos de fungos micorrízicos arbusculares foi benéfico para o desenvolvimento da planta. A inoculação com fungos micorrízicos mostrou efeitos diferentes para os vários parâmetros avaliados no algodão e no milho, e a aplicação de estimulante de colonização promoveu maior colonização micorrízica e crescimento inicial no algodão quando associado à fungos micorrízicos arbusculares nativa e no milho quando associado à inoculação com Dentiscutata heterogama, Gigaspora margarita e Rhizophagus clarus.