Impact of an intervention program on drug adherence in patients with ulcerative colitis: Randomized clinical trial.

AIMS: Evaluate the impact of an intervention program in non-adherent patients with ulcerative colitis. METHODS: Parallel controlled randomized clinical trial (1:1), approved by the ethics committee (No. 3.068.511/2018) and registered at The Brazilian Clinical Trials Registry (No. RBR-79dn4k). Non-adherent ulcerative colitis patients according to the Morisky-Green-Levine-test were included. Recruitment began in August 2019 until August 2020, with 6-month follow-up. All participants received standard usual care, and additionally the intervention group received educational (video, educational leaflet, verbal guidance) and behavioral interventions (therapeutic scheme, motivational and reminder type short message services). Researchers were blinded for allocation prior to data collection at Visits 1 and 2 (0 and 6 months). Primary outcome: 180-day adherence rate, with relative risk 95%CI. Secondary outcome: 180-day quality of life according to SF-36 domains, using Student's t test. Variables with p<0.20 were selected for regression. Analysis included data from August/2019 to May/2021. RESULTS: Forty-six and 49 participants were allocated in control and intervention groups, respectively. Two were excluded due to intervention refusal, and 4 and 6 were lost to follow-up in control and intervention groups. There was no post-intervention adherence rate difference, even after adjustment for type of non-adherence (unintentional/both/intentional) as confounder, or if considered as adherent the intervention group participants lost in follow-up. Interventions promoted better quality of life scores even after multivariate analysis for "Pain", when adjusted for ulcerative colitis severity, sex, and marital status (ß = 18.352, p = 0.004), "Vitality", when adjusted for ulcerative colitis severity (ß = 10.568, p = 0.015) and "Emotional Aspects", when adjusted for disease severity, income, and education (ß = 24.907, p = 0.041). CONCLUSIONS: The intervention program was not able to produce a significant medication adherence rate difference between comparative groups, however, there was a significant improvement in quality of life. Study limitations may include: sample size calculated to identify differences of 30%, leading to a possible insufficient power; non blinded participants, exposing the results to the risk of performance bias; outcomes based on self-reported data.

The role of glyphosate-resistant weeds and starvation on biological, reproductive, and preference parameters of Chrysodeixis includens (Lepidoptera: Noctuidae).

Glyphosate-resistant weeds are difficult to manage and can serve as hosts for pests that threaten cultivated crops. Chrysodeixis includens (Walker) (Lepidoptera: Noctuidae) is one of the main polyphagous pests of soybean in Brazil that can benefit from weeds' presence during season and off-season. Despite its pest status, little is known about C. includens survival and development on alternative hosts, including those resistant to glyphosate. Therefore, we assessed the biology, reproduction, preference, and survival at different feeding periods of C. includens on seven glyphosate-resistant weeds (Sumatran fleabane, Italian ryegrass, sourgrass, goosegrass, smooth pigweed, wild poinsettia, hairy beggarticks) commonly found in Brazilian agroecosystems, under laboratory conditions. Our results showed that C. includens survival and reproduction were similar on soybean and wild poinsettia. Survival and reproduction were lower on smooth pigweed and hairy beggarticks. Also, these plants prolonged the larval stage. Larvae did not pupate when fed on sourgrass, goosegrass, Italian ryegrass, and Sumatran fleabane. However, on Sumatran fleabane their biomass was higher. The mean generation time was lower on wild poinsettia. This weed was preferred to soybean. An antifeeding factor was observed on Sumatran fleabane. Larvae fed for 11 days on soybean, wild poinsettia and smooth pigweed developed into pupae. In agricultural systems, farmers must pay attention to the management of these weeds, especially wild poinsettia, smooth pigweed, and hairy beggarticks, to interrupt the cycle of this pest, since these plants can serve as main sources of infestation for the soybean crop.

Sentimentos dos Estudantes de Medicina e Médicos Residentes ante a Morte: uma Revisão Sistemática / Feelings of Medical Students and Resident Doctors Facing Death: a Systematic Review

Resumo: Introdução: Como os profissionais da área médica terão que lidar com a questão da morte, este trabalho teve como objetivos identificar os sentimentos dos estudantes de Medicina e dos médicos residentes do Brasil ante o morrer e a morte, e compreender como eles vivenciam a própria formação durante a graduação e a especialização para esse enfrentamento. Método: Trata-se de uma revisão sistemática da literatura feita com base na metodologia PRISMA. A revisão foi conduzida entre agosto e dezembro de 2019 com os descritores "estudantes de medicina", "medical students", "morte" e "death", pesquisados na Biblioteca Virtual de Saúde (BVS). Resultados: Dos 372 artigos identificados na busca, 18 estudos publicados atendiam a todos os critérios de inclusão e exclusão estabelecidos. Quanto à análise dos artigos em relação aos sentimentos dos estudantes de Medicina e dos médicos residentes perante situações de morte, percebeu-se que a maioria dos estudos relatou experiências negativas, como medo, insegurança, tristeza, raiva e culpa. Apesar de ainda serem incipientes as disciplinas e estratégias institucionalizadas, parece que, com o decorrer do curso e da prática profissional, os sentimentos negativos são amenizados, porque se vivenciam com mais frequência contextos de terminalidade e morte, oportunizando, assim, o aprendizado por meio da observação e postura perante essas situações práticas, visto que a morte e suas interfaces fazem parte do cotidiano médico. Conclusões: Os estudantes de Medicina e os médicos residentes do Brasil apresentam desconforto e dificuldade em lidar com os processos de morte e do morrer. Para modificar esse cenário de despreparo, é consenso entre eles a necessidade de incluir disciplinas teórico-práticas de Tanatologia, Cuidados Paliativos e Psicologia Médica no currículo das faculdades de Medicina e reformular o conteúdo delas de forma a abordar mais profundamente o processo de morte no contexto prático.

Abstract: Introduction: Most professionals in the medical field will have to deal with the issue of death. This paper aims to describe the feelings of Brazilian medical students and resident doctors regarding end of life and death, as well as to understand how they experience their undergraduate training and specialization in dealing with this process. Method: This is a systematic literature review based on the PRISMA methodology, conducted between August and December 2019 with the descriptors "medical students" and "death," in both English and Portuguese, in papers indexed in the Virtual Health Library (VHL). Results: 372 papers were identified in the search; 18 were published studies that met all the established inclusion and exclusion criteria. Analysis of the articles concerning the feelings of medical students and resident doctors facing situations involving death revealed that most studies reported negative experiences, such as fear, insecurity, sadness, anger, and guilt. Despite the subjects and institutionalized strategies still being relatively new, it would seem that as their training and professional practice progress, the young doctors' negative feelings are attenuated as they experience end-of-life and death situations more frequently, thus learning through observation and posture in these practical situations, seeing as death and dealing with it is part of everyday medical work. Conclusions: Medical students and medical residents in Brazil experience discomfort and difficulty in dealing with the processes of death and dying. To improve their preparedness in this respect, there is a consensus among them about the need to include the theoretical/practical disciplines of Thanatology, Palliative Care and medical psychology in the medical curriculum and to reformulate the content in order to approach the subject of death in a more practical context.

Knowledge of oral hygiene of patients attended in a Dentistry Program as a precursor of changes in teaching paradigms / Conhecimentos sobre higiene bucal de pacientes atendidos em um curso de Odontologia como precursor de mudanças de paradigmas de ensino

The practice of healthcare education aims at contributing to healthcare assistance and promotion, providing health-disease control and its management through knowledge. This study aims to compare the degree of knowledge of oral hygiene of individuals who are undergoing treatment at the Integrated Clinic of the Dentistry Program of the Federal University of Espírito Santo (UFES) with individuals who are not undergoing dental treatment. This is a cross-sectional, exploratory study in which we evaluated 174 individuals, of whom 87 were undergoing dental treatment and 87 were in the waiting room accompanying the patients, but who were not undergoing treatment. Regarding the sample profile, women were predominant in both groups (71.26%). As for oral hygiene performed 3 times a day, it corresponded to 50.57% for the group under treatment and 54.02% for the control group. We may conclude that teaching was not highlighted in the prevention, thus justifying the need for changing the paradigm of teaching to a model focused on the person. To do so, we proposed the implementation of a preventive protocol in the teaching Dental Clinic (AU).

A prática de educação em saúde tem como propósito contribuir no cuidado e na promoção da saúde, fornecendo o controle saúde-doença e a condução de seus hábitos por meio da inserção de conhecimento. Este estudo tem por objetivo comparar o grau de conhecimento sobre higiene bucal de indivíduos que estão em tratamento na clínica integrada do Curso de Odontologia da Universidade Federal do Espírito Santo (UFES) com indivíduos que não estão realizando tratamento odontológico. Trata-se de um estudo transversal do tipo exploratório que avaliou 174 indivíduos, dos quais 87 estavam em tratamento odontológico e 87 estavam na sala de espera acompanhando os pacientes atendidos, mas não faziam tratamento odontológico. Em relação ao perfil da amostra, o gênero feminino foi predominante em ambos os grupos (71,26%). Em relação à higiene bucal realizada 3 vezes ao dia correspondeu a 50,57% para o grupo em tratamento e 54,02% para o grupo controle. Pode-se concluir que o ensino não apresentou ênfase na prevenção, justificando a necessidade de mudança de paradigma de ensino para um modelo voltado para a pessoa, e com esta finalidade foi proposta a implementação de um protocolo preventivo na Clínica Odontológica de ensino (AU).

Risk factors for the progression of chronic kidney disease after acute kidney injury.

INTRODUCTION: The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear. OBJECTIVE: To investigate the association between AKI and its progression to CKD and the risk factors involved. METHODS: An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearson's correlation, were performed using SPSS. RESULTS: The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of the male patients exhibited decreased renal function and CKD (vs. 60.4% of the female patients). The progression of AKI to CKD was more frequent in patients admitted to wards (63.8%), cancer patients (74.19%), patients with sepsis (67.18%) and patients with obstruction (91.66%). Dialyses were performed in 16.4% of the patients, but this was not correlated with the progression of CKD. CONCLUSIONS: Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.

Risk factors for the progression of chronic kidney disease after acute kidney injury / Fatores de risco para a progressão da doença renal crônica após a lesão renal aguda

Abstract Introduction: The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear. Objective: To investigate the association between AKI and its progression to CKD and the risk factors involved. Methods: An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearson's correlation, were performed using SPSS. Results: The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of the male patients exhibited decreased renal function and CKD (vs. 60.4% of the female patients). The progression of AKI to CKD was more frequent in patients admitted to wards (63.8%), cancer patients (74.19%), patients with sepsis (67.18%) and patients with obstruction (91.66%). Dialyses were performed in 16.4% of the patients, but this was not correlated with the progression of CKD. Conclusions: Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.

Resumo Introdução: A incidência da doença renal crônica (DRC) está aumentando com o aumento da idade da população e o número crescente de idosos sobreviventes da lesão renal aguda (LRA). Os fatores de risco para a progressão da DRC após a lesão renal aguda (LRA) não são claros. Objetivos: Investigar a associação entre a LRA e sua progressão para a DRC e os fatores de risco envolvidos. Métodos: Foi realizado estudo observacional, retrospectivo de pacientes com LRA acompanhados de 2009 a 2012. Foram avaliados a etiologia da LRA, o uso de drogas vasoativas, ventilação mecânica, necessidade de diálise, presença de morbidades associadas, ritmo de filtração glomerular estimado (eGFR), duração da internação e a progressão da DRC. As análises estatísticas incluíram o teste Qui-quadrado e a correlação de Pearson utilizando o programa do SPSS. Resultados: Os 207 pacientes analisados apresentaram idade de 70,1 ± 13,1 anos, 84,6% eram do sexo masculino e que apresentaram redução da função renal e DRC (vs. 60,4% dos pacientes do sexo feminino). A progressão da LRA para DRC foi mais frequente em pacientes internados em enfermarias (63,8%), pacientes com câncer (74,19%), com sepse (67,18%) e com obstrução do trato urinário (91,66%). As dialises foram realizadas em 16,4% dos pacientes, mas isso não foi correlacionado com a progressão da DRC. Conclusões: Pacientes idosos com LRA devido à sepse e obstrução do trato urinário foram correlacionados com a progressão para DRC após a alta.

Reativação da doença de Chagas com envolvimento do sistema nervoso central durante tratamento de linfoma não Hodgkin / Reactivation of Chagas' disease with central nervous system invoklvement during the treatment of non-Hodgkin lymphoma

Estados de imunossupressão têm provocado mudanças na história natural da doença de Chagas com descrição de reativação da doença em pacientes com a Síndrome de Imunodeficiência Adquirida (AIDS), durante transplantes de órgãos e em quimioterapia de malignidades hematológicas. É relatado caso de reativação de doença de Chagas com meningoencefalite durante quimioterapia de linfoma não Hodgkin não relacionado a transplante de células-tronco hematopoéticas com tardia detecção de Trypanosoma cruzi em sangue e líquido cefalorraquidiano. Apesar de tratamento específico com benzonidazol, paciente morreu após oito dias. Alta suspeição clínica com abordagens diagnósticas sensíveis é fundamental para diagnóstico precoce e início de tratamento com objetivo de diminuir mortalidade.

Immunosuppression has caused changes in the natural history of Chagas' disease with reports of reactivation of the disease in acquired immune deficiency syndrome (AIDS) and organ transplant patients and during chemotherapy treatment in patients with hematological malignances. We report on a case of reactivation of Chagas' disease in a patient with meningoencephalitis during chemotherapy for non-Hodgkin's lymphoma without any relation to hematopoietic stem-cell transplantation and with late detection of Trypanosoma cruzi in blood and cerebrospinal fluid. Despite specific treatment with benznidazole, the patient died 8 days later. High clinical suspicion and sensitive diagnostic methods are fundamental for early diagnosis and initiation of treatment in order to minimize mortality.