Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial / Impacto do posicionamento vertical na aeração pulmonar em pacientes de unidades de terapia intensiva ventilados mecanicamente: um estudo clínico transversal randomizado

ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial.

OBJECTIVE: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. METHODS: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). RESULTS: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). CONCLUSION: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients.ClinicalTrials.gov registry: NCT04176445.

Chlorhexidine mouthwash reduces the salivary viral load of SARS-CoV-2: A randomized clinical trial.

OBJECTIVES: This study aimed to evaluate the effect of 0.12% chlorhexidine gluconate on the salivary load of SARS-CoV-2. MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled trial was performed on 100 participants positive for SARS-CoV-2. In the test group (n = 50), volunteers gargled with a mouthwash containing 15 ml of 0.12% chlorhexidine gluconate for 1 min, while the control group (n = 50) used a placebo. Saliva samples were obtained before (baseline) and 5 and 60 min after using the solutions. Real-time reverse transcription polymerase chain reaction assays (qRT-PCR) were carried out and the cycle threshold (Ct) was computed. The chi-square test and t-test were used for group comparison (p ≤ 0.05). RESULTS: The differences in Ct values between the 5-min evaluation and baseline (test group: 2.19 ± 4.30; control: -0.40 ± 3.87, p = 0.002) and between 60 min and baseline (test group: 2.45 ± 3.88; control: 0.76 ± 4.41, p = 0.05) were significantly greater in the test group, revealing a reduction of viral load. Furthermore, there was a reduction in the load of SARS-CoV-2 in 72% of the volunteers using chlorhexidine versus 30% in the control group (p = 0.001). CONCLUSIONS: Chlorhexidine gluconate (0.12%) was effective in reducing salivary SARS-CoV-2 load for at least 60 min.

Photodynamic Activity on Biofilm in Endotracheal Tubes of Patients Admitted to an Intensive Care Unit.

Ventilator-associated pneumonia (VAP) is an infection that arises after endotracheal intubation affecting patients under intensive care. The presence of the endotracheal tube (ETT) is a risk factor since it is colonized by multispecies biofilm. Antimicrobial photodynamic therapy (aPDT) could be a strategy to decontaminate ETTs. We verify if methylene blue (MB) associated with external illumination of the ETT could be an alternative to destroy biofilm. We performed an in vitro and ex vivo study. In vitro study was performed with P. aeruginosa biofilm grew over ETT for 7 days. After treatment, the surviving cells were cultured for 3 days and the biofilm was analyzed by crystal violet absorbance. Ex vivo study employed ETT obtained from extubated patients. aPDT was performed with MB (100 µm) and red LED (λ = 640±20 nm). We quantified the biofilm thickness and used scanning electron microscopy and fluorescence technique to verify morphological and functional changes after aPDT. Our results showed that bacteria remain susceptible to aPDT after sequential treatments. We also attested that aPDT can reduce biofilm thickness, disrupt biofilm attachment from ETT surface and kill microbial cells. These data suggest that aPDT should be investigated to decrease VAP incidence via ETT decontamination.

Health Interoperability into Practice: Results of the Development of a Consent Form in a Pilot Project in a Health District in São Paulo, Brazil.

Interoperability of health information systems is a centerpiece of the "E-Health" Brazilian Ministry of Health strategy. It aims to solve at least partially the health information technology puzzle that we face today. This paper describes a health information exchange pilot project in a health district of the city of São Paulo. It discusses the results of the development of an informed consent form for health information exchange. This consent form showed excellent results, with median application time of 3 minutes and with 97.8% of patients feeling fully clarified. The patients' perception when faced with options of consent to share their data is also described.

Alterações eletromiográficas e histopatológicas da musculatura de cães naturalmente infectados por Leishmania infantum / Muscular electromyographic and histopathologic changes in dogs naturally infected by Leishmania infantum

O objetivo do presente estudo foi avaliar as alterações eletromiográficas e histopatológicas de músculos estriados esqueléticos de cães naturalmente infectados por Leishmania infantum. Foram selecionados 25 cães adultos, sem raça definida, com diagnósticos parasitológico, molecular e sorológico estabelecidos para a infecção. Os músculos avaliados foram: tríceps braquial, extensor carpo radial, bíceps femoral e gastrocnêmio. Um cão possuía problemas locomotores, com paresia de membros posteriores associada à intensa atrofia muscular. Vinte e três (92%) apresentavam algum tipo de alteração muscular, sendo que em 22 (88%) tais alterações foram identificadas diretamente pela eletromiografia. Mesmo sem sinais clínicos, em dez cães (40%) foram evidenciadas alterações eletromiográficas e histopatológicas. Antígenos de Leishmania foram identificados na musculatura de quatro (16%) cães. Os resultados eletromiográficos indicaram a ocorrência de polimiosite crônica em 13 (52%) cães, presença de músculos com inflamação tanto aguda quanto crônica em quatro (16%), miopatia aguda em dois (8%), e ausência de alterações eletromiográficas em três (12%). As alterações histopatológicas mais frequentemente observadas foram degeneração e necrose de miofibras e presença de infiltrado inflamatório verificadas em 12 (48%) cães. Outras alterações, quando comparado com as amostras de cães normais, foram do tamanho de grupos de fibras musculares em 15 (60%) e fibrose peri ou endomisial em 14 (56%) animais. As alterações observadas no presente estudo permitiram concluir que mesmo na ausência de sinais clínicos de comprometimento muscular, a maior parte dos cães infectados por L. infantum apresenta polimiosite crônica.

The aim of this study was to evaluate the electromyographic and histopathological changes in skeletal muscles of dogs naturally infected by L. infantum. Twenty five mixed breed adult dogs with parasitological, molecular and serological diagnosis were selected. The evaluated muscles were: triceps brachial, extensor carpi radialis, biceps femoris and gastrocnemius. One dog had locomotor clinical signs with hind limbs paresis associated with severe muscle atrophy. Twenty-three (92%) had some type of muscular change, and in 22 (88%) such changes were directly identified by electromyography. Even without any clinical signs of the disease, 10 (40%) dogs had electromyographic and histopathological changes. Leishmania antigens were detected in muscles of four (16%) dogs. The electromyographic evaluation indicated the occurrence of chronic polymyositis in 13 (52%) dogs, the presence of both acute and chronic muscle inflammation four (16%), acute myopathy in two (8%) and absence of electromyographic abnormalities in three (12%) dogs. The most frequently observed histopathological changes were degeneration and necrosis of myofibers and inflammatory infiltration observed in 12 (48%) dogs. Other changes were decreased diameter of muscle fibers in 15 (60%) and peri or endomysial fibrosis in 14 (56%) animals. The changes observed in the present study showed that even in the absence of clinical signs, most dogs infected by Leishmania infantum have chronic polymyositis.

Envelhecimento acelerado em sementes de alface / Accelerated aging in lettuce seeds

Objetivou-se adequar a metodologia do teste de envelhecimento acelerado para avaliação do potencial fisiológico de sementes de quatro lotes dos genótipos de alface 'Babá de verão', 'Tainá' e 'Vera', aplicando-se o método tradicional e com o uso de solução saturada de NaCl. Para tal, as sementes foram submetidas à determinação do teor de água, testes de germinação e vigor (primeira contagem, condutividade elétrica, emergência em bandeja, índice de velocidade de emergência) incluindo o teste de envelhecimento acelerado, conduzido nos períodos de 24, 48, e 72 horas, a 41°C com e sem solução saturada de NaCl. O experimento foi conduzido em delineamento inteiramente casualizado com quatro repetições. Os procedimentos tradicional e com o uso da solução saturada de NaCl por 72 horas foram sensíveis em estratificar os lotes em níveis de vigor, além de estarem de acordo com os demais testes utilizados. Portanto, o envelhecimento acelerado de sementes de alface deve ser feito utilizando o período de 72 horas, podendo ser realizado tanto pelo método tradicional quanto pelo método da solução saturada de NaCl.

The objective was to adapt the methodology of the accelerated aging test to evaluate the physiological potential of seeds of four lots of lettuce genotypes 'Babá de verão', 'Tainá' and 'Vera' applying the traditional method and using a saturated NaCl solution. So, the seeds were subjected to determination of water content, seed germination and vigor (first count, electrical conductivity, speed emergency index, emergency tray) including the accelerated aging test conducted in periods of 24, 48, 72 hours at 41°C with and without saturated solution of NaCl. The experiment was conducted in a randomized design with four replications. The accelerated aging traditional and saturated solution of NaCl by 72h was more sensitive to stratify the lots in vigor levels. Therefore, accelerated aging of seeds of lettuce should be made using the period of 72h and can be accomplished either by the traditional method and by the saturated NaCl solution method.

Comportamento da proteína c reativa em pacientes com doença periodontal / Serum levels of c-reactive protein in patients with periodontal disease

A proteína C reativa (PCR) é um marcador inflamatório que vem sendo utilizado na cardiologia para avaliar o risco de eventos ateroscleróticos. Estudos demonstram que a doença periodontal, uma infecção crônica, leva a alterações sistêmicas pela produção de citocinas e lipopolissacarídeos liberados para a corrente sanguínea. Estas substâncias, ao atuarem nos hepatócitos, promovem a resposta da fase aguda com consequente produção de biomarcadores como a PCR que, por sua vez, se relaciona com alterações no endotélio vascular. O objetivo desta revisão de literatura é relacionar a doença periodontal com os níveis séricos da PCR.

The C- reactive protein (PCR) is a serum marker of inflammatory has been used in cardiology to evaluate the risk of atherosclerotic complications. Studies have suggested that the periodontal disease, as chronic infection, promotessystemic implications by cytokines and lipopolysaccharides production released to the blood peripheral. When thesesubstances act in the hepatocytes, induce the acute-phase response, producing biomarkers as C-reactive protein that affect the vascular endothelium. The aim of this literaturereview is relate the periodontal disease with the serum levels of C- reactive protein.