Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: a randomized double-blind clinical trial.

BACKGROUND: Excisional hemorrhoidectomy remains the most effective treatment for a significant group of patients with hemorrhoids, despite the potential for postoperative pain. The purpose of this study was to evaluate the effects of flavonoid and metronidazole use in the postoperative period on patients undergoing excisional hemorrhoidectomy. METHODS: A double-blind randomized clinical study was performed. Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each to receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period. A standard analgesic protocol was offered equally for all groups. Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated during the following three periods: from immediately after the operation until postoperative day (POD)7, from POD 8 to POD 14, and from POD 15 to POD 30. The patients were required to complete symptom questionnaires and to attend postoperative follow-up on PODs 7, 14 and 30. The effect of each drug was assessed for each symptom, and the groups were compared with each other and over time. RESULTS: There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001), with an observed synergistic effect of flavonoids combined with metronidazole during the first 14 days after surgery (p < 0.0001). Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks CONCLUSIONS: The use of flavonoids alone and in combination with metronidazole resulted in a reduction of most symptoms, particularly pain, after excisional hemorrhoidectomy. TRIAL REGISTRATION: The present study was registered in the SISNEP (document CAAE-0035.0.240.000-11), after approval by the research ethics committee (CEP) of the Hospital Felício Rocho (protocol nº393 / 11).

One Hundred Consecutive Liver Transplants Using Institutes Georges Lopez-1 Preservation Solution: Outcomes and Prognostic Factors.

BACKGROUND: There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death. METHODS: Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures. RESULTS: Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18-71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29-430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%. CONCLUSIONS: LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes.

Effects of competition on fitness-related traits.

While interspecific competition is prevalent in natural systems, we do not yet understand how it can influence an individual's phenotype within its lifetime and how this might affect performance. Morphology and swimming performance are two important fitness-related traits in fishes. Both traits are essential in acquiring and defending resources as well as avoiding predation. Here, we examined if interspecific competition could induce changes in morphology and affect the swimming performance of two strains of juvenile Atlantic salmon (Salmo salar). We imposed competitive scenarios on the fish using artificial streams containing different combinations of four interspecific competitors. Exposure to interspecific competitors induced morphological changes over time, through the development of deeper bodies, whereas controls free of interspecific competitors developed more fusiform body shapes. Furthermore, swimming performance was correlated to fusiform morphologies and was weaker for Atlantic salmon in competitive scenarios vs. CONTROLS: This implies that interspecific competition has direct effects on these fitness-related traits in Atlantic salmon. To the best of our knowledge, this is the first time that morphology, an important fitness-related trait linked to swimming performance, has been shown to be negatively impacted through interactions with an interspecific competitor.

Fatores interferentes na taxa de adesão à farmacoterapia em idosos atendidos na rede pública de saúde do Município de Salto Grande - SP, Brasil / Factors interfering with the medication adherence rate of elderly patients in the public health system in the town of Salto Grande, São Paulo State, Brazil

O objetivo deste estudo foi determinar a taxa de adesão à farmacoterapia e identificar os fatores que interferem nesta taxa em pacientes idosos atendidos em uma Unidade Básica de Saúde (UBS) no município de Salto Grande, São Paulo. Foram recrutados 120 pacientes idosos para participar de estudo transversal, desenvolvido no período de maio a setembro de 2009. Foi aplicado questionário para determinar a taxa de adesão (MMAS-8) e identificar as características sócio-econômicas, de saúde autorreferidas, da farmacoterapia utilizada e da satisfação dos pacientes com os serviços de saúde da UBS estudada. Um total de 102 pacientes completo o estudo, sendo que a maioria dos indivíduos apresentou taxa de adesão insatisfatória (14,7% alta adesão, 48,0% adesão média e 37,3% baixa adesão). Apresentaram forte correlação com adesão, satisfação com os serviços de saúde (r= 0,884; p < 0,0001) e o Índice de Complexidade da Farmacoterapia (ICFT) (r= - 0,705; p < 0,001). O número de medicamentos consumidos (r= - 0,604; p < 0,001), número de doenças relatadas (r = - 0,604; p < 0,001) e número de moradores por residência (r= 0,428; p < 0,001) apresentaram correlação intermediária com adesão. Foi encontrada uma correlação fraca entre adesão e escolaridade (r= 0,263; p < 0,001), raça (r= 0,090; p < 0,001), sexo (r= 0,080; p < 0,001), renda familiar (r= 0,054; p < 0,001) e idade (r= -0,090; p < 0,001). Esses resultados indicam que a população estudada não adere adequadamente à farmacoterapia, com forte influência da satisfação dos pacientes com os serviços de saúde e ICFT nesses resultados.

The aim of this study was to determine the rate of adherence to pharmacotherapy and to identify the factors that interfere with this adherence in elderly patients attended at a local Health Center (BHU) in Salto Grande, a country town in Sao Paulo. One hundred and twenty patients were recruited to participate in a cross-sectional study, conducted from May to September 2009. A questionnaire was used to determine the adherence rate (MMAS-8) and to identify the socio-economic factors, health condition (self-reported), medication used and satisfaction of the patients with the health services provided at the BHU. A total of 102 patients completed the study, most of whom showed unsatisfactory adherence rates (14.7% high adherence, 48.0% mean adherence and 37.3% poor adherence). Adherence was strongly correlated with patient satisfaction with health services (r= 0.884; p < 0.0001) and the Medication Regimen Complexity Index (MRCI) (r= - 0.705; p < 0.001). The number of drugs consumed (r = - 0.604, p <0.001), number of reported diseases (r = - 0.604, p <0.001) and number of residents per house (r = 0.428, p <0.001) showed intermediate correlation with intermediate adherence. Weak correlation was found between adherence and education level (r = 0.263, p <0.001), race (r = 0.090, p <0.001), sex (r = 0.080, p <0.001), family income (r = 0.054, p <0.001 ) and age (r = -0.090, p <0.001). These results indicate that the population does not adhere adequately to medication prescribed at the BHU and that patients? satisfaction with health services and the MRCI influence these results strongly.

Avaliação da farmacoterapia anti-hipertensiva em pacientes diabéticos atendidos no Sistema Único de Saúde (SUS) na rede municipal de saúde de Salto Grande, SP / Assessment of anti-hypertensive pharmacotherapy given to diabetic patients attended by the Brazilian National Health Service at the municipal health care center of Salto Grande, SP

Este trabalho objetivou avaliar o padrão de prescrição de medicamentos anti-hipertensivos e os níveis pressóricos de pacientes diabéticos hipertensos atendidos na Unidade Básica de Saúde "Cidinha Leite" do município de Salto Grande, interior do Estado de São Paulo. Trata-se de um estudo de caráter descritivo, transversal utilizando cópias das receitas e prontuários dos pacientes com idade > 40 anos atendidos na UBS estudada, com pressão arterial >130/80mmHg e/ou utilizando medicamentos anti-hipertensivos concomitantemente com medicamentos antidiabéticos (antidiabéticos orais e parenterais), tendo sido excluídos todos os indivíduos com queixas associadas ao aparelho cardiovascular, com encaminhamentos para serviços de cardiologia, que pudessem influenciar no padrão de prescrição de medicamentos anti-hipertensivos. Duzentos e quatorze (67,5%) indivíduos atenderam aos critérios de inclusão do estudo, sendo 143 (66,8%) pessoas do sexo feminino; com idade média de 59,44 anos, com 45 (21,0%) destes pacientes apresentando valores de PA <130/80mmHg. O padrão de prescrição de anti-hipertensivos para estes pacientes segue parcialmente as recomendações baseadas em evidências existentes, ocorrendo algumas escolhas de monoterapia, posologia de medicamentos e terapias medicamentosas em associação irracionais, sendo extremamente importante a adoção de estratégias educativas junto aos clínicos gerais para melhorar o tratamento medicamentoso dos diabéticos hipertensos atendidos na UBS "Cidinha Leite".

This article reviews critically the prescription patterns of antihypertensive drugs and the recorded blood pressure levels in diabetic hypertensive patients treated at the "Cidinha Leite" Primary Healthcare Center in the city of Salto Grande, in upstate Sao Paulo, Brazil. This is a descriptive, cross-sectional survey based on copies of medical records of patients aged > 40 years treated at this public health clinic, with blood pressure levels > 130/80 mmHg and/or taking antihypertensive drugs concomitantly with (oral and parenteral) antidiabetic drugs. All individuals with complaints associated with the cardiovascular system, with referrals to cardiology services, which could influence the pattern of prescription of antihypertensive drugs, were excluded. Two hundred and fourteen (67.5%) individuals met the inclusion criteria of the survey, 143 (66.8%) of whom were female; the average age of the patients was 59.44 years and 45 (21.0%) had BP values < 130/80mmHg. The prescription patterns of antihypertensive drugs for these patients partially followed the recommendations based on available evidence, but some choices of monotherapy, drug doses and drug combinations were irrational, making it extremely important to introduce educational programs for the general practitioners, so as to improve the drug treatment of diabetic hypertensive patients at the "Cidinha Leite" clinic.

Amisulpride augmentation after the failure of citalopram for depression: a case report.

This case report describes a 35-year-old woman with a first depressive episode. She was treated with the serotonergic antidepressant citalopram for 12 weeks without therapeutic response. Low-dose amisulpride augmentation resulted in a significant clinical improvement. We hypothesize that the dopaminergic properties of amisulpride might augment the effects of serotonergic antidepressants in refractory patients.