Knowledge, attitudes, and behaviors regarding the use of clinical practice guidelines among spine surgeons in Latin America.

Background: Clinical Practice Guidelines (CPGs) are invaluable tools to assure evidence-based spine surgery care. In this study, we aimed to identify perceptions, barriers, and potential determinants for the use of CPG among Latin American spine surgeons. Methods: A 28-item questionnaire regarding the use of CPGs was sent to the members of AO Spine Latin America. The questionnaire was subdivided into three sections: (1) demographic data; (2) perceptions and awareness of CPGs; (3) and potential barriers to CPG use. Multivariate logistic regression was performed to assess potential associations with CPG use. Results: A total of 304 spine surgeons answered the questionnaire. Most of the participants were male (91.8%) and orthopedic spine surgeons (52.3%) who averaged 45-65 years of age. Most respondents were aware of some CPGs for spine care (68.8%) and reported using them (70.4%); lack of awareness about CPGs was the most frequent barrier to their use (65.1%). Conclusion: Awareness of CPGs in spine surgery is of paramount importance for their use. Educational programs explaining the importance and benefits of spine care CPG surgical and clinical practice would increase the adherence of physicians to the guidelines.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study

ABSTRACT BACKGROUND: Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE: To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING: Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS: Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS: The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS: The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study.

BACKGROUND: Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE: To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING: Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS: Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS: The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS: The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution in a Mildly Affected Symptomatic Patient.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is caused by a respiratory virus with a wide range of manifestations, varying from asymptomatic to fatal cases, with a generally short outcome. However, some individuals present long-term viral shedding. We monitored 38 individuals who were mildly affected by the SARS-CoV-2 infection. Out of the total studied population, three (7.9%) showed atypical events regarding the duration of positivity for viral RNA detection. In one of these atypical cases, a previously HIV-positive male patient presented a SARS-CoV-2 RNA shedding and subgenomic RNA (sgRNA) detected from the upper respiratory tract, respectively, for 232 and 224 days after the onset of the symptoms. The SARS-CoV-2 B.1.1.28 lineage, one of the most prevalent in Brazil in 2020, was identified in this patient in three serial samples. Interestingly, the genomic analyses performed throughout the infectious process showed an increase in the genetic diversity of the B.1.1.28 lineage within the host itself, with viral clearance occurring naturally, without any intervention measures to control the infection. Contrasting widely spread current knowledge, our results indicate that potentially infectious SARS-CoV-2 virus might be shed by much longer periods by some infected patients. This data call attention to better adapted non-pharmacological measures and clinical discharge of patients aiming at preventing the spread of SARS-CoV-2 to the population.

Unraveling the Link Between Mitochondrial Dynamics and Neuroinflammation.

Neuroinflammatory and neurodegenerative diseases are a major public health problem worldwide, especially with the increase of life-expectancy observed during the last decades. For many of these diseases, we still lack a full understanding of their etiology and pathophysiology. Nonetheless their association with mitochondrial dysfunction highlights this organelle as an important player during CNS homeostasis and disease. Markers of Parkinson (PD) and Alzheimer (AD) diseases are able to induce innate immune pathways induced by alterations in mitochondrial Ca2+ homeostasis leading to neuroinflammation. Additionally, exacerbated type I IFN responses triggered by mitochondrial DNA (mtDNA), failures in mitophagy, ER-mitochondria communication and mtROS production promote neurodegeneration. On the other hand, regulation of mitochondrial dynamics is essential for CNS health maintenance and leading to the induction of IL-10 and reduction of TNF-α secretion, increased cell viability and diminished cell injury in addition to reduced oxidative stress. Thus, although previously solely seen as power suppliers to organelles and molecular processes, it is now well established that mitochondria have many other important roles, including during immune responses. Here, we discuss the importance of these mitochondrial dynamics during neuroinflammation, and how they correlate either with the amelioration or worsening of CNS disease.

Effect of combined physical exercise program on improving the functional capacity and the cardiac autonomic modulation of Chagas cardiomyopathy

Abstract Aims: Patients with Chagas cardiomyopathy (ChC) could have a significant reduction in functional capacity (FC). This study aimed to report the effect of a 24-week combined physical exercise program on the FC of a patient with ChC. Methods: A woman, 44 years old, with positive serology for ChC in stage B2 has submitted the following assessments: i) Physical assessment: ii) Cardiopulmonary exercise test; iii) Test of 1-maximum Repetition, iv) Evaluation of cardiac autonomic modulation by heart rate variability (HRV). Results: The results obtained revealed a reduction in the anthropometric parameters and the SBP after training. Additionally, we observed an improvement in FC (aerobic and strength condiction) and cardiac autonomic modulation after 24 weeks of combined training. Conclusion: Our findings show that of a 24-week combined physical exercise program improved either FC or HRVof the patient with ChC.

Funcionalidade renal em pacientes hipertensos de um município do centro-sul do Piauí / Renal functionality in hypertensive patients in a municipality of Centro-Southern Piauí

Introdução: A Hipertensão Arterial é determinada pelo aumento da pressão sanguínea exercida nos vasos e pode alterar o equilíbrio homeostático cardiorrenal e a filtração glomerular, gerando desenvolvimento de Insuficiência Renal Crônica com progressão para Doença Renal Crônica. Objetivo: Verificar a funcionalidade renal em hipertensos de um município do centro-sul do Piauí. Métodos: Estudo transversal, explicativo e quantitativo, com 40 hipertensos, registrados no Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (HIPERDIA), de uma Unidade Básica de Saúde na cidade de Picos/PI, que foram avaliados quanto a funcionalidade renal, a partir da coleta sanguínea, segundo as dosagens de ureia e a creatinina sérica, assim como o valor de clearance de creatinina pela equação de Crockcroft-Gault, avaliando a Taxa de Filtração Glomerular e classificando em cinco estágios de filtração. Resultados: Os resultados evidenciaram que 59% dos avaliados apresentaram redução da filtração glomerular, sendo 30,80% de forma leve, e 28,20% moderada. Perceptível, também, normalidade nos níveis de creatinina sérica (0,9 (±0,3) mg/dl), e ureia (37 (±13) mg/dl), porém achados próximos do modificável. Conclusão: Os resultados da pesquisa ressaltaram a predisposição que pacientes hipertensos apresentam para alterações na funcionalidade renal, evidenciadas a partir da redução da taxa de filtração glomerular identificada. (AU)

Introduction: Arterial Hypertension is determined by the increase in blood pressure exerted on the vessels and can alter the cardiorenal homeostatic balance and glomerular filtration, generating the development of Chronic Kidney Failure with progression to Chronic Kidney Disease. Objective: To verify renal function in hypertensive patients in a city in the central south of Piauí. Methods: Cross-sectional, explanatory and quantitative study, with 40 hypertensive patients, registered in the Registration and Monitoring System for Hypertensive and Diabetics (HIPERDIA), of a Basic Health Unit in the city of Picos/PI, evaluated for renal functionality, from blood collection, according to urea and serum creatinine levels, as well as the creatinine clearance value by the Crockcroft-Gault equation, evaluating the glomerular filtration rate and classifying it into five filtration stages. Results: The results showed that 59% of those evaluated had reduced glomerular filtration, with 30.80% being mild, and 28.20% moderate. Perceptible, also, normality in the levels of serum creatinine (0.9 (± 0.3) mg / dl), and urea (37 (± 13) mg / dl), although these findings are close to modifiable. Conclusion: The results highlighted the predisposition of the hypertensive patients to present changes in renal functionality, evidenced by the reduction of the identified glomerular filtration rate. (AU)

Remote Patient Monitoring: A Systematic Review.

Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient-physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.

INFLUENCE OF SPLENIC IMPLANTS IN THE SUBCUTANEOUS TISSUE ON ASPLENIC ANIMALS SURVIVAL.

BACKGROUND: The best site for splenic implant was not defined, mainly evaluating the functionality of the implant. AIM: To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats. METHOD: Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively. RESULTS: There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817). CONCLUSION: The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.

Influence of splenic implants in the subcutaneous tissue on asplenic animals survival / Influência de implante esplênico em subcutâneo na sobrevida de animais esplenectomizados

ABSTRACT Background: The best site for splenic implant was not defined, mainly evaluating the functionality of the implant. Aim: To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats. Method: Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively. Results: There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817). Conclusion: The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.

RESUMO Racional: O melhor sítio para implante esplênico não foi definido, principalmente avaliando a funcionalidade do implante. Objetivo: Avaliar os efeitos do implante esplênico autógeno subcutâneo na sobrevida de ratos esplenectomizados. Métodos: Foram estudados 21 ratos alocados aleatoriamente em três grupos (n=7): grupo 1 - manipulação da cavidade abdominal e preservação do baço; grupo 2 - esplenectomia total; grupo 3 - esplenectomia e implante do tecido retirado no subcutâneo. Os animais foram acompanhados por 90 dias pós-operatórios. Resultados: Houve mortalidade maior nos grupos 2 (p=0,0072) e 3 (p=0,0172) em relação ao grupo 1. Não houve diferença entre os grupos 2 e 3 (p=0,9817). Conclusão: O implante esplênico no subcutâneo é ineficaz na sobrevida de ratos submetidos à esplenectomia.

Tratamento de pênfigo vulgar com imunoglobulina humana como adjuvante ao corticoide oral: um relato de caso / Pemphigus vulgaris treatment with human immunoglobulin as adjuvant to oral corticoid: a case report

Introdução: o pênfigo vulgar é uma doença de caráter autoimune, que leva à formação de bolhas locais ou generalizadas causadas pelo ataque de autoanticorpos às estruturas da epiderme. A terapêutica Recebido em: 25/09/2018 com imunoglobulina humana como adjuvante é uma excelente opção para os casos em que há resistência ao tratamento habitual, além de poder diminuir o tempo de tratamento com imunossupressores. Objetivo: descrever um relato de caso sobre um paciente portador de pênfigo vulgar submetido ao tratamento com imunoglobulina humana como adjuvante ao corticoide oral. Relato do caso: paciente 49 anos, foi internado apresentando lesões erosivas em mucosa oral e conjuntival, com piora sistêmica após início de tratamento com antibióticos e anti-inflamatório. Inicialmente realizou-se o tratamento convencional com corticoterapia, porém sem resultados satisfatórios. Devido ao agravamento da clínica, e ao estabelecimento do diagnóstico de pênfigo vulgar, foi incluída no tratamento a imunoglobulina humana como adjuvante, o que culminou em uma melhora progressiva do paciente. Conclusão: apesar de o tratamento do pênfigo vulgar ter os corticoides como primeira opção, é importante conhecer tratamentos adjuvantes e/ou alternativos, como as imunoglobulinas humanas, para auxiliar no tratamento dos pacientes que não respondem ao corticoide.

Introduction: Pemphigus Vulgaris is an autoimmune disease that leads to the formation of local or generalized blisters as a result of autoantibodies against epidermal structures. Therapy with human immunoglobulin as an adjuvant is an excellent option for cases where there is resistance to usual treatment, in addition to being able to reduce the time of treatment with immunosuppressant. Thus, it is an alternative treatment for patients with severe infections or immunological deficiencies. Aim: to describe a case report about a carrier patient of pemphigus vulgaris treated with human immunoglobulin as adjuvant to oral corticosteroids. Case report: patient with 49 years old, was hospitalized in the city of Belo Horizonte (MG) presenting erosive lesions in the oral and conjunctival mucosa, with systemic worsening after starting treatment with antibiotics and anti-inflammatory. Initially, conventional steroid therapy was performed, but with no satisfactory results. Due to worsening symptoms and the diagnosis of Pemphigus Vulgaris, human immunoglobulin was included in the treatment as an adjuvant, which resulted in a progressive improvement of the patient. Conclusion: although treatment of Pemphigus Vulgaris has steroids as the first option, it is vital that the physician knows adjuvant and/or alternative therapies, such as human immunoglobulins, to assist in the treatment of patients who do not respond to steroids.

Phytochemistry Profile, Nutritional Properties and Pharmacological Activities of Mauritia flexuosa.

Mauritia flexuosa L. (Arecaceae) is a popular Brazilian fruit known as "buriti" and belonging to the category of functional foods. This work reviewed the phytochemistry profile, nutritional and pharmacological activities of M. flexuosa. The main bioactive compounds reported to buriti were carotenoids, tocopherols, ascorbic acid, phenolic compounds, fiber, phytosterols, and mono- and poly-unsaturated fatty acids. These compounds were mainly related to antioxidant, hypolipemiant, photoprotector, antiaggregant, antithrombotic, anti-inflammatory, hypoglycemiant, antimicrobial, and antitumor activities. Furthermore, some compounds present in buriti fruit and its properties were tested in vitro and in vivo and showed biotechnology applications, especially for extraction of fiber, polysaccharides, pigments, antioxidants, and oil. Howerer, the buriti fruit shows great relevance to the development of new products in food, pharmaceutical and chemical industry, this fruit is still underexploited and it has need to expand its production chain and processing to encourage their consumption and utilization.

Prevalência de automedicação e os fatores associados entre os usuários de um Centro de Saúde Universitário / Prevalence of self-medication and associated factors among patients of a University Health Center

JUSTIFICATIVA E OBJETIVOS: A automedicação difundiu-se no mundo, tornando-se um problema de saúde pública. Se por um lado tal prática pode, de certa forma, trazer benefícios ao aliviar a demanda do saturado Sistema Único de Saúde, por outro, pode trazer sérios risco à saúde, que vão desde as mais simples reações adversas até as mais graves intoxicações. Desta maneira, considerando a automedicação como um problema de saúde pública e a importância de conhecê-la e combatê-la, este estudo objetivou avaliar a prevalência de automedicação e os fatores associados a esta prática entre os usuários atendidos no Centro de Saúde Escola do Marco. MÉTODO: O estudo foi realizado a partir de entrevistas com 288 usuários atendidos nesta unidade de saúde no mês de novembro de 2011, destes 197 eram do sexo feminino e 91 do sexo masculino, de acordo com a demanda do centro. Todos os entrevistados possuíam mais de 18 anos e foram escolhidos aleatoriamente. RESULTADOS: Observou-se maior prevalência de automedicação entre as mulheres (66,5%) versus (59,3%) entre os homens,72,5% dos usuários apresentavam renda mensal inferior a dois salários mínimos e 69,0% costumavam guardar remédios não receitados em casa. Além disso, os anti-inflamatórios não esteroides, remédios naturais e caseiros foram os fármacos não prescritos mais consumidos. CONCLUSÃO: Dessa forma, constatou-se que a automedicação é uma prática comum entre os usuários atendidos nesta unidade de saúde como mecanismo para tentar suprir as deficiências do serviço e, por se tratar de uma prática potencialmente danosa à saúde, merece especial atenção das autoridades.

BACKGROUND AND OBJECTIVES: Self-medication has spread worldwide, becoming a problem of public health. On one hand, such practice may somehow provide benefits to ease the demand of the saturated Unified Health System (SUS). On the other hand, it can lead to serious health risks ranging from the simplest adverse reactions to severe poisoning. Thus, considering the self-medication as a public health problem and the importance of knowing it and fighting against it, this study had as objective to evaluate the prevalence of self-medication and the factors associated with this practice among patients treated at the Escola do Marco Health Center. METHOD: The study was based on interviews with 288 patients seen in the clinic in November 2011. Among them, 197 were females and 91 males, according to the center's demand. All respondents were over 18 years old and chosen randomly. RESULTS: A higher prevalence of self-medication was observed among women (66.5%) compared to men (59.3%). 72.5% of patients had a monthly income below two minimum wages and 69.0% used to keep non-prescription drugs at home. In addition, NSAIDs and natural and home-made remedies were themost used non-prescription drugs. CONCLUSION: Thus, it was concluded that self-medication is a common practice among patients seen in the clinic as a mechanism to try to address the weaknesses of the public service. Because it is a practice potentially harmful to health, it requires special attention from the authorities.

Partidos políticos, preferência partidária e decisão eleitoral no Brasil (1989/2002) / Political parties, party preference, and voters' decisions in Brazil (1989/2002)

This study analyzes the party preferences of Brazilian voters from 1989 to 2002 and some data on party rejection, relating these manifestations to votersÆ decisions. There is a non-negligible share of voters who vote according to their party preferences, as well as a significant contingent of voters who express rejection of some party and do not vote for any of its candidates. The conclusions point to the need to reformulate the way Brazilian votersÆ party inclinations are measured, including party rejection as a component of this measurement.

Dans ce travail, on analyse les préférences électorales des Brésiliens pendant la période 1989-2002, ainsi que quelques chiffres du rejet visant ces partis, afin d'établir un rapport entre ces résultats et le choix de l'électeur à l'heure du vote. Les résultats indiquent qu'une part considérable des électeurs votent selon leur préférence pour un parti, de même qu'une autre bonne part, manifestant leur rejet à un parti donné, ne lui accordent pas leurs voix. Pour conclure, on montre le besoin de revoir la façon de mesurer les préférences des électeurs pour les partis, tout en incluant le rejet des partis comme un élément de cette estimation.