OCCULT AND SEMI-OCCULT CONSTIPATION IN CHILDREN WITH MONOSYMPTOMATIC OR NON MONOSYMPTOMATIC ENURESIS.

BACKGROUND: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. OBJECTIVE: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). METHODS: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). RESULTS: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. CONCLUSION: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.

Constipação oculta e semi-oculta em crianças com enurese monossintomática ou não monossintomática / Occult and semi-occult constipation in children with monosymptomatic or non monosymptomatic enuresis

ABSTRACT Background: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. Objective: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). Methods: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). Results: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. Conclusion: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.

RESUMO Contexto: Constipação funcional e enurese frequentemente coexistem. Tratamento da constipação geralmente resulta em cura ou melhora da enurese. Entretanto, além da apresentação clássica, pode ocorrer constipação oculta (CO), diagnosticada por exame subsidiário; ademais, ao aplicar questionário detalhado, pode-se detectar constipação semioculta (CSO). Objetivo: Obter as frequências de CO e CSO em crianças com enurese mono- ou não monossintomática (EMN ou ENMN). Métodos: Crianças/adolescentes saudáveis, exceto por enurese refratária à terapia comportamental, e que negavam constipação após perguntas simples, respondiam a questionário estruturado sobre hábito intestinal, e realizavam radiografia simples de abdômen. A constipação foi classificada considerando os critérios diagnósticos de Boston (que permitem diagnóstico em fases iniciais) e retenção fecal na radiografia quantificada ≥10 pelo escore de Barr. As crianças com constipação receberam tratamento padronizado (exceto 26 crianças "piloto"). Resultados: Das 81 crianças, 80 com idade 9,34±2,07 anos, 52,5% masculinas, foram diagnosticadas com constipação: 30 CO, 50 CSO; 63.75% tinham EMN, 36.25% ENMN (6 ENMN sem terapia comportamental). Os dados demográficos e o escore de Barr foram semelhantes para CO e CSO, mas as crianças com CSO apresentaram significativamente mais complicações de constipação (incontinência fecal retentiva e/ou dor abdominal recorrente). A não apresentação da Escala Fecal de Bristol (EFB) para 24 crianças "piloto", ou ausência de sintomas de constipação acompanhando EFB predominantemente do tipo 3, em 13 crianças, não teve impacto significativo na detecção de constipação pelo escore de Barr. Crianças que identificaram EFB 3 ou ≤2 tiveram resultados semelhantes. Vinte e oito crianças, com acompanhamento adequado após o tratamento, melhoraram ou se recuperaram da constipação em 44 de seus 52 retornos. Conclusão: Em pacientes com EMN ou ENMN refratária à terapia comportamental, e que inicialmente negavam constipação após perguntas simples, questionário baseado nos critérios diagnósticos de Boston detectou CSO em 61.7%, e o escore radiológico de Barr revelou retenção fecal (CO) em 37% deles.

Performance of ophthalmic artery Doppler velocimetry in the complementary diagnosis of preeclampsia.

OBJECTIVES: To calculate the accuracy (A) and establish the best cutoff value for ophthalmic artery (OA) Doppler velocimetry indexes in patients diagnosed with preeclampsia (PE), compared with healthy pregnant women. METHODS: This prospective experimental study enrolled 268 women: 133 with PE and 135 healthy pregnant women. All patients were evaluated by OA Doppler sonography, bilaterally, to assess their pulsatility index (PI), resistance index (RI), peak systolic velocity (PVS), second peak systolic velocity (P2), end-diastolic velocity (EDV), and peak ratio (PR). Means were compared using Student's T-test. Receiver Operating Characteristics (ROC) curve was used to establish the cutoff value and estimate the sensitivity (S), specificity (Sp), accuracy (A) of all variables, and a significance of 95% was adopted. RESULTS: ROC curve analysis showed that P2 and PR were superior to the other parameters for PE diagnosis. We tested two cutoff values: (1) using PR ≥0.70, obtained A: 88.72%, S: 81.95%, and Sp: 95.48% and (2) using PR ≥0.75, and A: 86.24%, S: 74.43%, and Sp: 99.24%. By adopting P2 ≥ 21.5 cm/s, we obtained A: 87.59%, S: 84.96%, and Sp: 90.22% and when the cutoff point was P2 ≥ 22 cm/s, there was a slight decrease in A to 86.46% and S to 81.20%, with Sp: 91.89.3%. CONCLUSION: Ophthalmic artery Doppler demonstrated to be an effective and high-performance imaging method for the diagnosis of PE and the indexes P2 and PR demonstrated superior accuracy to the other Doppler parameters assessed. Higher performance occurred when the cutoff values with greater specificity were adopted, PR ≥ 0.75 and P2 ≥ 22 cm/s, considering that the proposed OA Doppler is to be a complementary method for preeclampsia.

Doppler Indices of the Ophthalmic Artery in Pregnant Women With Pregestational Diabetes Mellitus With and Without Retinopathy.

OBJECTIVES: To evaluate ophthalmic Doppler velocimetry patterns in pregnant women with pregestational diabetes mellitus with and without retinopathy in comparison to pregnant women without gestational intercurrences. METHODS: This cross-sectional observational study analyzed Doppler indices of the ophthalmic arteries, including the resistive index (RI), pulsatility index, peak systolic velocity, second peak systolic velocity, peak ratio, and end-diastolic velocity (EDV), in 3 groups of pregnant women: diabetic with retinopathy (n = 12); diabetic without retinopathy (n = 85); and nondiabetic controls (n = 122). The Kruskal-Wallis test was used for the statistical analysis with a probability of 95%. RESULTS: The mean gestational ages ± SDs of pregnant women with and without retinopathy and nondiabetic controls were 29.1 ± 2.2, 29.7 ± 2.7, and 31 ± 1.0 weeks, respectively, with no significant differences between the groups (P > .099). The mean RI in the group with retinopathy was significantly higher (P = .030) than in the control group, but it did not significantly differ compared to the group without retinopathy (P = .204). The RI in the control group did not differ from that in the group without retinopathy (P = .079). The EDV was significantly lower in the group with retinopathy (P = .015) in relation to the control group, but there were no differences compared to the group without retinopathy (P = .217). CONCLUSIONS: Pregnant women with pregestational diabetes mellitus and retinopathy had increased vascular impedance in the ophthalmic artery together with a reduction in the EDV, which was probably related to ischemia, thrombosis, and neovascularization of retinal vessels.

Status and nutritional therapy in elective and emergency neurosurgery patients.

OBJEVECT: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. METHOD: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. RESULTS: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). CONCLUSION: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

The role of the erythrocyte in the outcome of pregnancy with preeclampsia.

The objective of this study was to analyze the relationships of osmotic and mechanical stability of erythrocytes with anthropometric, biochemical, hematologic and hemodynamic variables in pregnant women with preeclampsia (PE). The studied population consisted of 20 normotensive patients and 16 patients with PE. Patients with PE presented worse gestational outcome, greater hematologic impairment, erythrocytes osmotically more stable in vitro, but in conditions of isotonicity with the in vivo medium, in addition to hyperflow in orbital territory, when compared to normotensive patients. The correlation analysis between anthropometric, hematologic and hemodynamic variables in patients with PE indicated that erythrocytes with lower volumes and lower levels of hemoglobin favor the occurrence of a better gestational outcome, because they are more stable and because they are associated with a decrease in the hemodynamic changes present in the disease. This should mean that the tendency to microcytosis, probably due to a mechanism of compensatory mechanical selection, is a desirable characteristic in the disease.

Status and nutritional therapy in elective and emergency neurosurgery patients / Estado y terapia nutricional en pacientes de neurocirugía electiva y urgencia / Estado e terapia nutricional em pacientes de neurocirurgia eletiva e urgência

ABSTRACT Objevect: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. Method: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. Results: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). Conclusion: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

RESUMEN Objetivo: Evaluar el Estado Nutricional (EN) y acompañar la Terapia Nutricional Enteral (TNE) de pacientes en intervención neuroquirúrgica. Método: Estudio tipo cohorte en pacientes de cirugía de urgencia o electiva, con TNE exclusiva. Se midieron medidas antropométricas (Circunferencia del Brazo (CB) y Pliegue Cutáneo Tricipital (PCT)) en el primer, séptimo y decimocuarto días. Para el monitoreo de la TNE: adecuación calórica/proteica, desayuno, salida inadvertida de la sonda enteral y volumen residual gástrico. Resultados: 80 pacientes, 78,7% en cirugía de urgencia y 21,3% en electiva. Hubo reducción de la CB y del Índice Masa Corporal (IMC) (p> 0,01), en especial para el grupo de urgencia. La adecuación calórica/proteica fue superior en el grupo de urgencia (86,7% y 81,8%). Conclusión: La alteración del EN fue más alta en el grupo de urgencia mismo con mejor adecuación de la TNE. La alteración de la composición corporal es frecuente en pacientes neuroquirúrgicos independientemente del tipo de procedimiento.

RESUMO Objetivo: Avaliar o Estado Nutricional (EN) e acompanhar a Terapia Nutricional Enteral (TNE) de pacientes em intervenção neurocirúrgica. Método: Estudo tipo coorte em pacientes de cirurgia de urgência ou eletiva, com TNE exclusiva. Foram aferidas medidas antropométricas (Circunferência do Braço (CB) e Dobra Cutânea Tricipital (DCT)) no primeiro, sétimo e 14º dia. Para o monitoramento da TNE, utilizou-se: adequação calórico/proteica, jejum, saída inadvertida da sonda enteral e volume residual gástrico. Resultados: 80 pacientes, 78,7% em cirurgia de urgência e 21,3% em eletiva. Houve redução da CB e do Índice de Massa Corporal (IMC) (p>0,01), em especial para o grupo de urgência. A adequação calórica/proteica foi superior no grupo de urgência (86,7% e 81,8%). Conclusão: A alteração do EN foi maior no grupo de urgência mesmo com melhor adequação da TNE. A alteração da composição corporal é frequente em pacientes neurocirúrgicos, independentemente do tipo de procedimento.

Are There Differences in the Anthropometric, Hemodynamic, Hematologic, and Biochemical Profiles between Late- and Early-Onset Preeclampsia?

Preeclampsia (PE) is classified as early-onset PE (EOPE) and late-onset PE (LOPE) when present before or after 34 weeks of gestation, respectively. This transversal study aimed to investigate the differences and possible associations existing in the anthropometric, hemodynamic, hematologic, and biochemical profiles of late- and early-onset preeclampsia. The study included 65 volunteers admitted to a tertiary hospital in Brazil: 29 normotensive and 36 with preeclampsia (13 with EOPE and 23 with LOPE). Pregnant women with LOPE presented greater weight gain and borderline increase in body mass index at the end of gestation in relation to the other groups, which is compatible with the metabolic origin, associated with obesity, attributed to this form of the disease. Pregnant women with EOPE presented a borderline reduction in the number of erythrocytes and a significant decrease in the number of platelets, in addition to a significant increase in reticulocytes, serum iron, and ferritin when compared to normotensive pregnant women and pregnant women with LOPE. A significant increase in osmotic stability of erythrocytes was observed in the EOPE group in relation to other groups. Hemodynamic analysis by Doppler ultrasonography of the ophthalmic artery showed that both groups of pregnant women with PE presented alterations compatible with the occurrence of hyperflow in the orbital territory. These hemodynamic changes were associated with changes in hematimetric indices.

Escala de Identificação de Dotação e Talento: Estrutura e Consistência Internas / Scale of Giftedness and Talent Identification: Internal Structural and Consistency / Escala de Identificación de Dotación y Talento: Estructura y Consistencia Internas

O estudo objetivou analisar a precisão e as evidências de validade com base na estrutura interna da Escala de Identificação de Dotação e Talento (EIDT). A EIDT é respondida por docentes dos 4º, 5º e 6º anos do Ensino Fundamental, sendo que participaram da pesquisa 16 professores, que avaliaram 433 alunos. Os resultados indicaram que 54,8% da variância foi explicada. Por meio da análise fatorial exploratória, a versão final da escala ficou composta por 55 itens divididos em três fatores: 42 itens do Fator 1, capacidades intelectuais, sociais e criatividade; sete do Fator 2, capacidades psicomotoras e seis do Fator 3, capacidades artísticas. O alfa de Cronbach para a escala total foi de 0,97. O Fator 1 apresentou um alfa de 0,97, o Fator 2 de 0,89 e o Fator 3 de 0,83. Destaca-se a necessidade de estudos adicionais que incluam a análise fatorial confirmatória e o estabelecimento de normas.(AU)

The study aimed to analyze the reliability and the evidences of validity based on the internal structure of the Scale of Giftedness and Talent Identification (Escala de Identificação de Dotação e Talento - EIDT). The EIDT is answered by teachers of 4th, 5th and 6th years of elementary school, including 16 teachers who evaluated 433 students. The results indicated that 54.8% of the variance was explained. Exploratory factor analysis was used for the final version of the scale, which was composed of 55 items divided into three factors: 42 items in Factor 1, intellectual abilities, social abilities and creativity; seven in factor 2, psychomotor abilities and six in factor 3, artistic abilities. The Cronbach's alpha for the total scale was 0.97. Factor 1 showed an alpha of 0.97, factor 2 of 0.89, and factor 3 of 0.83. It highlights the need for additional studies including the confirmatory factor analysis and the establishment of standards.(AU)

El objetivo del estudio fue analizar precisión y evidencias de validez basadas en la estructura interna de la Escala de Identificación de Dotación y Talento (EIDT). La EIDT fue respondida por maestros de 4º, 5º y 6º año de Enseñanza Primaria, y participaron en la investigación 16 profesores que evaluaron a 433 alumnos. Los resultados indicaron que el 54,8% de la varianza fue explicada. Por medio de análisis factorial exploratorio, la versión final de la escala quedó compuesta por 55 ítems, divididos en tres factores: 42 ítems del factor 1, capacidades intelectuales, sociales y creatividad; 7 ítems del factor 2, capacidades psicomotoras y 6 del factor 3, capacidades artísticas. El alfa de Cronbach para la escala total fue de 0,97. El factor 1 presentó un alfa de 0,97, el factor 2 de 0,89 y el factor 3 de 0,83. Se destaca la necesidad de estudios adicionales, que incluyan el análisis factorial confirmatorio y el establecimiento de normas.(AU)

Development of direct assays for Toxoplasma gondii and its use in genomic DNA sample.

This work describes an approach for the selection and detection of specific DNA probes related to Toxoplasma gondii, a protozoan parasite responsible for toxoplasmosis. The detection system was developed on graphite carbon electrode modified with poly(3-hydroxybenzoic acid) sensitized with ToxG1 probe. The hybridization of the specific genomic DNA related to T. gondii showed good response by direct detection of guanine residue oxidation using differential pulse voltammetry (DPV). The biosensor was able to distinguish both the complementary and non-complementary targets and detect up to 100ngµL-1 of the T. gondii genomic DNA. The hybridization (ToxG1: T. gondii genomic DNA) was confirmed by optical measurement. Optical assays using gold nanoparticles:ToxG1 probe showed a significant change in the absorbance peak in the presence of the T. gondii genomic DNA according to the electrochemical results. This novel biosensor shows potential as electrochemical transducer and was successfully applied in the biological sample.

Biological Activities of Red Propolis: A Review.

BACKGROUND: The red propolis (RdProp) is a resin produced by Apis mellifera bees, which collect the reddish exudate on the surface of its botanic source, the species Dalbergia ecastophyllum, popularly known in Brazil as "rabo de bugio". Considered as the 13th type of Brazilian propolis, this resin has been gaining prominence due to its natural composition, rich in bioactive substances not found in other types of propolis. OBJECTIVE: This review aims to address the most important characteristics of RdProp, its botanical origin, the main constituents, its biological properties and the patents related to this natural product. METHOD: By means of the SciFinder, Google Patents, Patus® and Spacenet, scientific articles and patents involving the term "red propolis" were searched until August 2017. RESULTS: A number of biological properties, including antimicrobial, anti-inflammatory, antiparasitic, antitumor, antioxidant, metabolic and nutraceutical activities are attributed to RdProp, demonstrating the great potential of its use in the food, pharmaceutical and cosmetics industries. CONCLUSION: The available papers are associated to pharmacological potential of RdProp, but the molecular mechanisms or bioactive compounds responsible for each activity have not yet been fully elucidat ed. The RdProp patents currently found are directed to components for the pharmaceutical industry (EP2070543A1; WO2014186851A1; FR3006589A1; CN1775277A; CN105797149A; CN1879859A), cosmetic (JP6012138B2; JP2008247830A; JP6012138B2) and food (JP5478392B2; CN101380052A; WO2006038690A1).

Bioética e direito no sistema de saúde brasileiro: a prática do consentimento informado nos cenários da oncologia de um hospital do SUS e um particular / Bioethics and Law in the Brazilian Health System informed consent practice within the oncology setting in a SUS and in a private hospital

Trata-se de pesquisa quali-quantitativa que envolve observação participante, análise de documentos e realização de entrevistas com usuários de um hospital do SUS e um particular. O foco da investigação é o consentimento informado na assistência à saúde, entendido como o processo decisório compartilhado no qual há troca de informações, impressões e valores entre os usuários do serviço e os profissionais de saúde. Objetivou-se verificar sua prática no sistema de saúde brasileiro, com recorte para a área da oncologia. Para a análise estatística, as variáveis categóricas foram avaliadas por meio do teste exato de Fisher e, as variáveis numéricas, comparadas utilizando o teste t, com nível de significância de 5 por cento . Quanto aos termos de consentimento, os testes de Flesch e Flesch-Kincaid apontaram legibilidade inadequada segundo padrões internacionais, bem como diante dos níveis educacionais de fato encontrados nos hospitais. Mais de 70 por cento dos entrevistados do SUS não tinham escolaridade compatível com a exigida para a leitura dos documentos. Apesar de a quase totalidade dos usuários dos hospitais ter relatado satisfação com as informações recebidas sobre o procedimento que iria realizar, apenas 58 por cento souberam elencar ao menos um risco relacionado ao mesmo. Conforme o esperado, houve associação entre nível educacional e renda dos usuários com a compreensão de riscos dos procedimentos. Mesmo que não se tenha notícia da variável renda ter sido considerada em estudos anteriores, por meio de regressão logística múltipla, observou-se que teve peso muito maior do que a escolaridade em predizer a chance de a pessoa citar um dos riscos do procedimento, embora ambos os fatores sejam preditores independentes. Não houve relação entre a compreensão de riscos e se o hospital era SUS ou particular, e nem em relação ao tempo de tratamento. Diferentemente de pesquisas em outros países, tampouco houve associação entre nível educacional e leitura do termo de consentimento. Entretanto, quando foi o médico, dentre os profissionais de saúde, quem entregou o termo, este foi mais lido pelos usuários. Houve associação entre o usuário estar no hospital particular e acreditar que o termo de consentimento serve para proteger os médicos, em contraposição a servir à sua própria garantia. Pela análise qualitativa, os usuários do SUS tiveram maior habilidade que o esperado na compreensão do diagnóstico e histórico da doença. Acredita-se que o bom acolhimento conseguiu superar em parte o nível educacional e de renda que foram detectados como barreiras ao entendimento das informações, de forma que a humanização da saúde parece impactar positivamente na compreensão das informações pelos usuários. Contudo, em ambos os hospitais, apesar de conseguirem relatar bem os procedimentos pretéritos e futuros, muitos usuários pareciam não saber se contextualizar em seus tratamentos e nem entender os motivos e objetivos dos procedimentos realizados. Em geral, tanto usuários como profissionais mostraram não entender o que é o consentimento informado e a diferença deste para os termos de consentimento, comumente tratados como mera burocracia jurídica. Tudo isso pode estar prejudicando os objetivos do consentimento informado e são questões que necessitam ser repensadas no sistema de saúde

This qualitative-quantitative research includes participant observation, document analysis, and interviews with users from both SUS and private hospitals. It focuses the informed consent in the health care, understood as the shared decisionmaking process in which information, opinions, and values are exchanged between the service users and their health professionals. The goal is to analyze the practice of the informed consent within the Brazilian Health Systems oncology field. The evaluations of categorical variables associations used the Fisher\'s exact test, while the numerical variables were compared through a t-test, at the 5 per cent significance level. Through Flesch and Flesch-Kincaid methods, it was found that the hospitals informed consent terms are of inadequate readability according to international standards, and also inappropriate compared to the actual users literacy level: more than 70 per cent of the SUS interviewees do not match the required literacy standard for comprehending the documents. In addition, although almost all users reported satisfaction with the information they received about their procedure, only 58 per cent were able to name at least one related risk. As expected, there was an association between the educational and income levels of the participants and their ability to understand the risks of a medical procedure. It is noteworthy that previous studies, both national and foreign, do not seem to have considered income level as a variable. Although both factors were independent predictors, multiple logistic regressions showed that income level had a greater weight than educational level in predicting a person\'s chance of citing one of the procedural risks. Additionally, no matter the timing of the treatment, there was no relation between knowledge of risks and whether the hospital is SUS or private. Unlike results found in other countries, there appears to be no association between educational level and the reading of consent terms. Nevertheless, when the doctor is the health professional who applies the term, it is read more often by the users. The research demonstrated that there was an association between the user being in the private hospital and believing that the consent term exists to protect the rights of the doctor instead of their rights as health service users. Through qualitative analysis, this study found that the SUS hospital users had greater ability than expected to understand disease diagnosis and history. The hospitals effective patient care appears to have partly overcome the educational barrier that often prevents patients from understanding diagnostic and medical procedures information, so that humanization of healthcare seems to have a positive impact on users understanding of information. Despite of both hospitals users satisfactorily report past and future procedures, several of them appear not to contextualize their treatments either understand the performed procedures reasons and objectives. In general, users and health professionals in both hospitals do not seem to understand the informed consent concept, neither the difference between informed consent and informed consent terms, generally seen as mere legal bureaucracy. All of these issues may jeopardize the goals of informed consent, if they are not addressed properly at the health care

Avaliação do estado nutricional em pacientes hospitalizados com cirrose hepática / Nutritional assessment in hospitalized patients with liver cirrhosis

Introdução: A cirrose surge devido a um processo crônico e progressivo de inflamações. O tipo mais comum é a cirrose hepática (CH). Pacientes com CH apresentam baixa ingestão alimentar, alterações bioquímicas e grande depleção de massa muscular. A avaliação do estado nutricional pode detectar as alterações do estado nutricional e fornecer informação prognóstica. O diagnóstico nutricional dos pacientes com CH representa grande desafio devido à retenção hídrica frequentemente encontrada. Objetivo: Caracterizar o estado nutricional dos pacientes com CH hospitalizados. Método: O método de avaliação utilizado no estudo foi a Avaliação Global do Royal Free Hospital (RFH-GA), um instrumento validado em 2006 no Royal Free Hospital de Londres, que consiste em uma avaliação nutricional específica para pacientes cirróticos. Resultados: Foram avaliados 26 pacientes, predominantemente do sexo masculino, com média de idade de 54,2 anos, sendo a principal etiologia a cirrose hepática alcóolica. As seguintes variáveis foram consideradas: sintomas gastrointestinais, disfunções clínicas, consumo alimentar, avaliação da composição corporal subjetiva e antropometria objetiva. Conclusão: O presente trabalho verificou alta taxa de desnutrição e o instrumento de avaliação do RFH-GA foi adequado para classificação do estado nutricional.(AU)

Introduction: Cirrhosis arises due to a chronic and progressive process of inflammation, the most common type is liver cirrhosis (LC). LC patients have low food intake, biochemical and great loss of muscle mass. The nutritional assessment can detect changes in the nutritional status and provide prognostic information. Nutritional diagnosis of patients with LC is a challenge due to water retention often found. Objective: To characterize the nutritional status of hospitalized patients with LC. Methods: The evaluation method used in the study was the Global Assessment of the Royal Free Hospital (RFH-GA), a nutritional assessment tool validated in 2006 at the Royal Free Hospital in London, that consists of a specific nutritional assessment for cirrhotic patients. Results: We evaluated 26 patients, predominantly male, with an average age of 54.2 years, the main cause being the alcoholic liver cirrhosis. The following variables were considered: gastrointestinal symptoms, clinical disorders, food intake, body composition assessment of subjective and objective anthropometry. Conclusion: The present work verified a high rate of malnutrition and the evaluation tool for the RFH-GA was adequate to assess the nutritional status.(AU)

Avaliação do monitoramento metacognitivo: análise da produção científica / Metacognitive monitoring evaluation: scientific literature analysis / Evaluación del monitoreo metacognitivo: análisis de la producción científica

O presente estudo investigou como o monitoramento metacognitivo foi avaliado nas pesquisas nacionais e internacionais entre 2005 e 2015. Foram analisados 51 artigos e os resultados evidenciaram que os anos mais profícuos foram 2012 e 2014, mas sem qualquer produção nacional. Quanto aos autores dos estudos, de um total de 120, apenas seis publicaram mais de um trabalho. As amostras das pesquisas foram majoritariamente compostas por estudantes universitários. A maior parte dos estudos examinou o monitoramento metacognitivo por meio de outras técnicas que não testes, escalas, inventários e questionários, embora a avaliação realizada com base em instrumentos também tenha sido expressiva. Foram contabilizadas 36 técnicas diferentes para avaliar o monitoramento metacognitivo, sendo as mais utilizadas: Tarefa de Sensação de Conhecimento, protocolos de pensar em voz alta, Julgamentos de Aprendizagem, Metacognitive Awareness Inventory e Met.a.ware. Ressalta-se a necessidade de outras investigações, especialmente sobre a qualidade das técnicas empregadas nos estudos

This study investigated how metacognitive monitoring was evaluated in national and international research between 2005 and 2015. We analyzed 51 articles and results showed that the most prolific years were 2012 and 2014, although there was no national production. Regarding the studies' authors, among 120 total, only six published more than one article. Research samples were composed mainly of college students. Most studies evaluated metacognitive monitoring though techniques other than tests, scales, inventories and questionnaires, although instrument-based assessment was also expressive. A total of 36 different techniques were recorded to assess metacognitive monitoring. The most predominant were: Feeling of Knowing Task, Think Aloud Protocols, Learning Judgments, Metacognitive Awareness Inventory and Met.a.ware. The need for further research, especially on the quality of the techniques used in the studies is acknowledged

Este estudio analizó la forma en cómo fue evaluado el monitoreo metacognitivo en las investigaciones nacionales e internacionales entre los años 2005 y 2015. Se analizaron 51 artículos y los resultados mostraron que los años más fructíferos fueron 2012 y 2014, sin existir producciones nacionales. En cuanto a los autores de los estudios, de un total de 120, sólo seis publicaron más de un trabajo. Las muestras de las investigaciones fueron compuestas en su mayoría por estudiantes universitarios, y la mayoría de los estudios examinaron el monitoreo metacognitivo por medio de otras técnicas diferentes a los tests, escalas, inventarios y cuestionarios, a pesar de que la evaluación realizada con base en instrumentos fue significativa. Fueron contabilizadas 36 técnicas diferentes para evaluar el monitoreo metacognitivo, siendo las más utilizadas: Tarea de Sensación del Conocimiento, protocolos de pensar en voz alta, Juicios de Aprendizaje, Metacognitive Awareness Inventory y Met.a.ware. Se hace mención a la necesidad de otras investigaciones, especialmente sobre la calidad de las técnicas utilizadas en los estudios

Avaliação do monitoramento metacognitivo: análise da produção científica / Metacognitive monitoring evaluation: scientific literature analysis / Evaluación del monitoreo metacognitivo: análisis de la producción científica

O presente estudo investigou como o monitoramento metacognitivo foi avaliado nas pesquisas nacionais e internacionais entre 2005 e 2015. Foram analisados 51 artigos e os resultados evidenciaram que os anos mais profícuos foram 2012 e 2014, mas sem qualquer produção nacional. Quanto aos autores dos estudos, de um total de 120, apenas seis publicaram mais de um trabalho. As amostras das pesquisas foram majoritariamente compostas por estudantes universitários. A maior parte dos estudos examinou o monitoramento metacognitivo por meio de outras técnicas que não testes, escalas, inventários e questionários, embora a avaliação realizada com base em instrumentos também tenha sido expressiva. Foram contabilizadas 36 técnicas diferentes para avaliar o monitoramento metacognitivo, sendo as mais utilizadas: Tarefa de Sensação de Conhecimento, protocolos de pensar em voz alta, Julgamentos de Aprendizagem, Metacognitive Awareness Inventory e Met.a.ware. Ressalta-se a necessidade de outras investigações, especialmente sobre a qualidade das técnicas empregadas nos estudos

This study investigated how metacognitive monitoring was evaluated in national and international research between 2005 and 2015. We analyzed 51 articles and results showed that the most prolific years were 2012 and 2014, although there was no national production. Regarding the studies’ authors, among 120 total, only six published more than one article. Research samples were composed mainly of college students. Most studies evaluated metacognitive monitoring though techniques other than tests, scales, inventories and questionnaires, although instrument-based assessment was also expressive. A total of 36 different techniques were recorded to assess metacognitive monitoring. The most predominant were: Feeling of Knowing Task, Think Aloud Protocols, Learning Judgments, Metacognitive Awareness Inventory and Met.a.ware. The need for further research, especially on the quality of the techniques used in the studies is acknowledged

Este estudio analizó la forma en cómo fue evaluado el monitoreo metacognitivo en las investigaciones nacionales e internacionales entre los años 2005 y 2015. Se analizaron 51 artículos y los resultados mostraron que los años más fructíferos fueron 2012 y 2014, sin existir producciones nacionales. En cuanto a los autores de los estudios, de un total de 120, sólo seis publicaron más de un trabajo. Las muestras de las investigaciones fueron compuestas en su mayoría por estudiantes universitarios, y la mayoría de los estudios examinaron el monitoreo metacognitivo por medio de otras técnicas diferentes a los tests, escalas, inventarios y cuestionarios, a pesar de que la evaluación realizada con base en instrumentos fue significativa. Fueron contabilizadas 36 técnicas diferentes para evaluar el monitoreo metacognitivo, siendo las más utilizadas: Tarea de Sensación del Conocimiento, protocolos de pensar en voz alta, Juicios de Aprendizaje, Metacognitive Awareness Inventory y Met.a.ware. Se hace mención a la necesidad de otras investigaciones, especialmente sobre la calidad de las técnicas utilizadas en los estudios

Subchronic treatment with acai frozen pulp prevents the brain oxidative damage in rats with acute liver failure.

Acai has been used by the population due to its high nutritional value and its benefits to health, such as its antioxidant properties. The aim of this study was to evaluate the protective effect of acai frozen pulp on oxidative stress parameters in cerebral cortex, hippocampus and cerebellum of Wistar rats treated with carbon tetrachloride (CCl4). Thirty male Wistar rats (90-day-old) were orally treated with water or acai frozen pulp for 14 days (7 µL/g). On the 15th day, half of the animals received treatment with mineral oil and the other half with CCl4 (3.0 mL/kg). The cerebral cortex, hippocampus and cerebellum were dissected and used for analysis of creatine kinase activity (CK), thiobarbituric acid reactive substances (TBARS), carbonyl, sulfhydryl, and the activity of antioxidant enzymes catalase (CAT) and superoxide dismutase (SOD). Statistical analysis was performed by ANOVA followed by Tukey's post-test. CCl4 was able to inhibit CK activity in all tissues tested and to provoke lipid damage in cerebral cortex and cerebellum, and protein damage in the three tissues tested. CCl4 enhanced CAT activity in the cerebral cortex, and inhibited CAT activity in the hippocampus and cerebellum and reduced SOD activity in all tissues studied. Acai frozen pulp prevented the inhibition of CK, TBARS, carbonyl and CAT activity in all brain structures and only in hippocampus for SOD activity. Therefore, acai frozen pulp has antioxidant properties and maybe could be useful in the treatment of some diseases that affect the central nervous system that are associated with oxidative damage.

Intercambialidade entre medicamentos genéricos e similares de um mesmo medicamento de referência / Interchangeability among generic and similar drug products of a same reference drug product

A implementação de medicamentos genéricos no Brasil e de programas e políticas para garantir o acesso da população a medicamentos com qualidade, segurança e eficácia resultaram em mais de 3.800 medicamentos genéricos de 445 fármacos registrados na Agência Nacional de Vigilância Sanitária (ANVISA) desde 1999. Os medicamentos genéricos comprovaram a sua equivalência terapêutica e, portanto, intercambialidade com seus respectivos medicamentos de referência por meio de estudos de bioequivalência. Em 2014, a ANVISA estendeu a intercambialidade aos medicamentos similares, aumentando o número de medicamentos intercambiáveis para cada medicamento de referência. As normas para prescrição e dispensação permitem apenas a substituição de medicamento de referência por seu medicamento genérico ou similar intercambiável e vice-versa. Entretanto, o que se observa na prática é a substituição entre medicamentos genéricos e similares de um mesmo fármaco, tanto na rede privada onde os descontos chegam até 90% do preço estabelecido para a venda, como na rede pública, em função da disponibilidade dos medicamentos, visto que as compras públicas se baseiam no menor preço ofertado pelos fabricantes. Entretanto, a bioequivalência e a intercambialidade entre os medicamentos genéricos ou similares de um mesmo referência não pode ser garantida pois os mesmos não foram testados entre si. A ausência de bioequivalência entre medicamentos substituídos pode provocar ineficácia terapêutica ou aparecimento de eventos adversos ou até mesmo intoxicação em pacientes. Consequentemente, podem ocorrer desperdício, gastos com tratamento de eventos adversos, abandono do tratamento e adoção de segunda linha de tratamentos. Este trabalho avaliou a bioequivalência entre os medicamentos genéricos e similares de um mesmo medicamento de referência por meio do método de metanálise, empregando dados de estudos de bioequivalência realizados para o registro de medicamentos genéricos e similares na ANVISA. Foram incluídos na análise estudos de aciclovir, amoxicilina, cefalexina, doxazosina, fenitoína, fluoxetina, levofloxacino e quetiapina. Os resultados demonstraram a ausência de bioequivalência entre a maioria dos medicamentos genéricos e similares contendo o mesmo fármaco. os resultados comprovam que medicamentos genéricos e similares de mesmo fármaco não são obrigatoriamente intercambiáveis e a substituição, principalmente para aqueles usados no tratamento de doenças crônicas, podem trazer graves consequências clínicas. Esta preocupação é aumentada para os fármacos com estreita faixa terapêutica e aqueles com alta variabilidade no processo de absorção. A adoção de uma lista de medicamentos não substituíveis, a exemplo de outros países, e o investimento na divulgação de informações sobre intercambialidade de medicamentos, tanto para profissionais de saúde como para a população, podem contribuir para a redução da substituição entre medicamentos não intercambiáveis, a promoção do uso racional dos medicamentos, a redução de gastos com medicamentos e tratamento de eventos adversos e o aumento da adesão do paciente ao tratamento

The implementation of generic drugs in Brazil, as well as programs and policies to ensure access to medicines with quality, safety and efficacy to the overall population, resulted in more than 3,800 generic drug products of 445 drugs registered in the National Health Surveillance Agency (ANVISA) since 1999. Generic drug products proved their therapeutic equivalence in bioequivalence studies and, therefore, the interchangeability with their respective reference drug product. In 2014, ANVISA expanded the interchangeability to similar drug products, increasing the number of interchangeable drug products for each reference drug product. Regulations for the prescription and dispensation of medicine only allow the substitution of a reference drug product for a generic or an interchangeable similar drug product or vice versa. However, in practice, it appears that there is a substitution between generic and similar drug products of a same reference drug product in private pharmacy chains - where discounts reach up to 90% of the selling price - as well as in public pharmacy, depending on the medicine availability, because public purchases are based on the lower price offered by the manufacturers. Nevertheless, the bioequivalence and interchangeability between generic and similar drug products of the same reference drug product cannot be guaranteed because they haven't been evaluated. Lack of bioequivalence between substituted drug products may result in therapeutic ineffectiveness or the occurrence of adverse events and even to patient intoxication. As a consequence, there might be waste, expenses due to adverse events treatment, no adherence to the treatment or the adoption of second-line treatment. This study evaluated the bioequivalence between generic and similar drugs of the same reference drug product through a meta-analysis, using data from bioequivalence studies carried out for the registration of generic and similar drug products at ANVISA. The drugs included in the study were acyclovir, amoxicillin, cephalexin, doxazosin, phenytoin, fluoxetine, levofloxacin and quetiapine. Results showed lack of bioequivalence between most of the generic and similar drugs containing the same drug and prove that generic and similar drug products of the reference drug product are not necessarily interchangeable. Moreover, the substitution of drugs used for chronic illnesses could lead to serious clinical consequences. This concern increases for drugs with narrow therapeutic index and those with high variable absorption process. The adoption of a list of non-interchangeable medicines - like in other countries - and investment in the dissemination of information about interchangeability between drug products to health professionals and to the population may contribute to reduce the substitution of drugs which are not interchangeable, promote a rational use of medicines, the reduction of expenses with drugs and adverse effects treatment and to improve treatment adherence

Intercambialidade entre medicamentos genéricos e similares de um mesmo medicamento de referência / Interchangeability among generic and similar drug products of a same reference drug product

A implementação de medicamentos genéricos no Brasil e de programas e políticas para garantir o acesso da população a medicamentos com qualidade, segurança e eficácia resultaram em mais de 3.800 medicamentos genéricos de 445 fármacos registrados na Agência Nacional de Vigilância Sanitária (ANVISA) desde 1999. Os medicamentos genéricos comprovaram a sua equivalência terapêutica e, portanto, intercambialidade com seus respectivos medicamentos de referência por meio de estudos de bioequivalência. Em 2014, a ANVISA estendeu a intercambialidade aos medicamentos similares, aumentando o número de medicamentos intercambiáveis para cada medicamento de referência. As normas para prescrição e dispensação permitem apenas a substituição de medicamento de referência por seu medicamento genérico ou similar intercambiável e vice-versa. Entretanto, o que se observa na prática é a substituição entre medicamentos genéricos e similares de um mesmo fármaco, tanto na rede privada onde os descontos chegam até 90% do preço estabelecido para a venda, como na rede pública, em função da disponibilidade dos medicamentos, visto que as compras públicas se baseiam no menor preço ofertado pelos fabricantes. Entretanto, a bioequivalência e a intercambialidade entre os medicamentos genéricos ou similares de um mesmo referência não pode ser garantida pois os mesmos não foram testados entre si. A ausência de bioequivalência entre medicamentos substituídos pode provocar ineficácia terapêutica ou aparecimento de eventos adversos ou até mesmo intoxicação em pacientes. Consequentemente, podem ocorrer desperdício, gastos com tratamento de eventos adversos, abandono do tratamento e adoção de segunda linha de tratamentos. Este trabalho avaliou a bioequivalência entre os medicamentos genéricos e similares de um mesmo medicamento de referência por meio do método de metanálise, empregando dados de estudos de bioequivalência realizados para o registro de medicamentos genéricos e similares na ANVISA. Foram incluídos na análise estudos de aciclovir, amoxicilina, cefalexina, doxazosina, fenitoína, fluoxetina, levofloxacino e quetiapina. Os resultados demonstraram a ausência de bioequivalência entre a maioria dos medicamentos genéricos e similares contendo o mesmo fármaco. os resultados comprovam que medicamentos genéricos e similares de mesmo fármaco não são obrigatoriamente intercambiáveis e a substituição, principalmente para aqueles usados no tratamento de doenças crônicas, podem trazer graves consequências clínicas. Esta preocupação é aumentada para os fármacos com estreita faixa terapêutica e aqueles com alta variabilidade no processo de absorção. A adoção de uma lista de medicamentos não substituíveis, a exemplo de outros países, e o investimento na divulgação de informações sobre intercambialidade de medicamentos, tanto para profissionais de saúde como para a população, podem contribuir para a redução da substituição entre medicamentos não intercambiáveis, a promoção do uso racional dos medicamentos, a redução de gastos com medicamentos e tratamento de eventos adversos e o aumento da adesão do paciente ao tratamento

The implementation of generic drugs in Brazil, as well as programs and policies to ensure access to medicines with quality, safety and efficacy to the overall population, resulted in more than 3,800 generic drug products of 445 drugs registered in the National Health Surveillance Agency (ANVISA) since 1999. Generic drug products proved their therapeutic equivalence in bioequivalence studies and, therefore, the interchangeability with their respective reference drug product. In 2014, ANVISA expanded the interchangeability to similar drug products, increasing the number of interchangeable drug products for each reference drug product. Regulations for the prescription and dispensation of medicine only allow the substitution of a reference drug product for a generic or an interchangeable similar drug product or vice versa. However, in practice, it appears that there is a substitution between generic and similar drug products of a same reference drug product in private pharmacy chains - where discounts reach up to 90% of the selling price - as well as in public pharmacy, depending on the medicine availability, because public purchases are based on the lower price offered by the manufacturers. Nevertheless, the bioequivalence and interchangeability between generic and similar drug products of the same reference drug product cannot be guaranteed because they haven't been evaluated. Lack of bioequivalence between substituted drug products may result in therapeutic ineffectiveness or the occurrence of adverse events and even to patient intoxication. As a consequence, there might be waste, expenses due to adverse events treatment, no adherence to the treatment or the adoption of second-line treatment. This study evaluated the bioequivalence between generic and similar drugs of the same reference drug product through a meta-analysis, using data from bioequivalence studies carried out for the registration of generic and similar drug products at ANVISA. The drugs included in the study were acyclovir, amoxicillin, cephalexin, doxazosin, phenytoin, fluoxetine, levofloxacin and quetiapine. Results showed lack of bioequivalence between most of the generic and similar drugs containing the same drug and prove that generic and similar drug products of the reference drug product are not necessarily interchangeable. Moreover, the substitution of drugs used for chronic illnesses could lead to serious clinical consequences. This concern increases for drugs with narrow therapeutic index and those with high variable absorption process. The adoption of a list of non-interchangeable medicines - like in other countries - and investment in the dissemination of information about interchangeability between drug products to health professionals and to the population may contribute to reduce the substitution of drugs which are not interchangeable, promote a rational use of medicines, the reduction of expenses with drugs and adverse effects treatment and to improve treatment adherence

Linear setting expansion of different gypsum products

Introduction:Stone casts are used in dentistry to allow the confection of indirect restorations. Thus, gypsum dimensional stability is fundamental in order to achieve a precise fit between dental structure and restorative material.Objective: The purpose of the present study was to evaluate the hygroscopic linear expansion of commercially available gypsum products. Material and methods: Fifteen dental stones were analyzed (4 type II, 5 type III, 4 type IV and 2 type V), with n = 5. One hundred grams of each gypsum product were mixed following the respective manufacturers' recommendations for powder/water ratio and poured into a V-shape mold, connected to an expansion-measuring device. The hygroscopic expansion was evaluated during 120 min and the collected data was converted into percentage and compared to initial dimensions of the specimen. Results: All type II and V dental stones showed expansion values compatible to the ADA and ISO recommendations. Considering type III stones, only Rutenium 3 was compatible with the recommendations. For type IV, only Durone IV showed expansion values higher than that recommended by ADA, but lower than that of ISO recommendations.Conclusion: The hygroscopic linear expansion of gypsum products should be periodically controlled in order to ensure their precision and reliability to dental practice.