Cilostazol protects against changes caused by streptozotocin-induced diabetic retinopathy / Cilostazol protege contra as alterações causadas pela retinopatia diabética induzida por estreptozotocina

ABSTRACT Purpose: This study investigates the protective effect of cilostazol on the development and evolution of diabetic retinopathy in rats. Methods: Sixty male rats were divided into four groups: untreated nondiabetic rats, untreated diabetic rats, cilostazol-treated nondiabetic rats, and cilostazol-treated diabetic rats. The thickness of the internal limiting membrane to the outer limiting membrane, inner plexiform layer, inner nuclear layer, and outer nuclear layer were measured. The number of cell nuclei per 50-μm length in retinal sections was counted to quantify the degree of retinal cell loss. Results: The number of nuclei in the ganglion cell layer was significantly higher in untreated nondiabetic rats (p<0.05). The mean number of nuclei in the cilostazol-treated nondiabetic rats was significantly higher than that in the cilostazol-treated diabetic rats (p<0.05). The cilostazol-treated nondiabetic rats had a significantly higher mean nuclei count in the inner nuclear layer and inner plexiform layer as compared with the other groups (p<0.05). The total mean retinal thickness of the cilostazol-treated nondiabetic rats was significantly higher than that of cilostazol-treated diabetic rats and untreated diabetic rats (p<0.05). Conclusion: By decreasing the loss of ganglion cells and reducing the sensorineural atrophy in the internal retinal layers, cilostazol had a protective effect against changes caused by diabetic retinopathy in diabetic rats.

RESUMO Objetivo: O objetivo deste estudo foi investigar o efeito protetor do cilostazol no desenvolvimento e na evolução da retinopatia diabética em ratos. Métodos: Sessenta ratos machos foram divididos em 4 grupos: ratos não-diabéticos não-tratados, ratos diabéticos não-tratados, ratos não-diabéticos tratados com cilostazol e ratos diabéticos tratados com cilostazol. A espessura da membrana limitante interna à membrana limitante externa, a camada plexiforme interna, a camada nuclear interna e a camada nuclear externa foram medidas. Para quantificar o grau de perda de células da retina, foi contado o número de núcleos de células por 50 μm de comprimento em secções retinianas. Resultados: O número de núcleos no GCL foi significativamente maior em Ratos não-diabéticos não-tratados com cilostazol (p<0,05). O número médio de núcleos em Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol (p<0,05). A contagem média de núcleos em camada nuclear interna e camada plexiforme interna de ratos não-diabéticos tratados com cilostazol foi significativamente maior do que nos outros grupos (p<0,05). A espessura retiniana média total de Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol e Ratos diabéticos não-tratados (p<0,05). Conclusão: Os resultados demonstraram que o cilostazol teve um efeito protetor contra as alterações causadas pela retinopatia diabética em ratos diabéticos, diminuindo a perda de células ganglionares e reduzindo a atrofia neurossensorial nas camadas retinianas internas.

Accuracy of Foot Pressure Measurement on Predicting the Development of Foot Ulcer in Patients with Diabetes: A Systematic Review and Meta-Analysis.

OBJECTIVE: Areas of the foot with diabetic ulcers have been observed to have greater plantar pressures compared to non-ulcerated. Pressures play an essential role in the mechanism of lesion, and their reduction is effective in prevention. We conducted a systematic review to evaluate pedobarography as a predictive tool for ulcer development, since there is still no consensus on this aspect. METHODS: We searched PUBMED (MedLine), EMBASE, Scopus, Web of Science, CINAHL and Scielo for cohort studies that measured plantar pressure at baseline and verified ulcer development on follow-up. Pooled effects of accuracy, sensitivity, specificity and relative risk were calculated using the inverse variance method. Risk of bias was assessed using the QUADAS-2 tool. RESULTS: Three studies (n = 2000) had enough information on accuracy to be included into a meta-analysis, and 4 (n = 2651) were analyzed using qualitative methods. Pooled sensitivity and specificity were found to be 0.63 (Confidence Interval (CI) 0.58-0.68) and 0.42 (CI 0.27-0.58), respectively. Pooled relative risk was 1.95 (CI 1.09-3.51). Risk of bias was low to uncertain. CONCLUSIONS: Pedobarography in itself appears to have low accuracy in evaluating risk of ulceration. Several methodological heterogeneities were found, and the most optimal cut-off value is yet to be determined.

Cilostazol protects against changes caused by streptozotocin-induced diabetic retinopathy.

PURPOSE: This study investigates the protective effect of cilostazol on the development and evolution of diabetic retinopathy in rats. METHODS: Sixty male rats were divided into four groups: untreated nondiabetic rats, untreated diabetic rats, cilostazol-treated nondiabetic rats, and cilostazol-treated diabetic rats. The thickness of the internal limiting membrane to the outer limiting membrane, inner plexiform layer, inner nuclear layer, and outer nuclear layer were measured. The number of cell nuclei per 50-µm length in retinal sections was counted to quantify the degree of retinal cell loss. RESULTS: The number of nuclei in the ganglion cell layer was significantly higher in untreated nondiabetic rats (p<0.05). The mean number of nuclei in the cilostazol-treated nondiabetic rats was significantly higher than that in the cilostazol-treated diabetic rats (p<0.05). The cilostazol-treated nondiabetic rats had a significantly higher mean nuclei count in the inner nuclear layer and inner plexiform layer as compared with the other groups (p<0.05). The total mean retinal thickness of the cilostazol-treated nondiabetic rats was significantly higher than that of cilostazol-treated diabetic rats and untreated diabetic rats (p<0.05). CONCLUSION: By decreasing the loss of ganglion cells and reducing the sensorineural atrophy in the internal retinal layers, cilostazol had a protective effect against changes caused by diabetic retinopathy in diabetic rats.

Relation between Selenium and Female Fertility: A Systematic Review / Relação entre o selênio e a fertilidade feminina: Uma revisão sistemática

Abstract Objective To analyze the influence of selenium in female fertility. Data sourceA search was performed in the following databases: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect, and Europe PMC. The descriptors selected were "selenium" AND "female" AND "fertility". The search interval was from 1996 to 2021. Study selectionThe evaluation was performed independently by two reviewers, and a third reviewer confirmed the inclusion of papers in case of divergence between the first two reviewers. Papers were selected after the title and abstract were read, and those that met the eligibility criteria had the full text read. Data collectionThe following data was extracted: author, year of publication, country, type of study, objective, method, sample size, follow-up period, patients' mean age, inclusion and exclusion criteria, and concentration of serum and capillary selenium. The data was organized in chronological order of paper publication. Data synthesisThe number of papers identified totaled 3,800, out of which 7 were included in the systematic review. The studies indicated a positive correlation between serum selenium and antioxidant concentration in the follicular fluid, reduction in antithyroid antibodies, oocyte production and follicle number. Conclusion Selenium supplementation is promising in women with this micronutrient deficiency to promote improvement of the reproductive efficiency and prevent damage to the pregnancy. Further studies on this theme are still required.

Resumo Objetivo Analisar a influência do selênio na fertilidade feminina. Fonte dos dadosUma busca foi realizada nas seguintes bases de dados: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect e Europe PMC. Os descritores selecionados foram "selenium" AND "female" AND "fertility". O intervalo de busca foi de 1996 a 2021. Seleção dos estudosA avaliação ocorreu de maneira independente por dois revisores, sendo que um terceiro corroborou a eleição dos artigos em casos de divergência. Os estudos foram selecionados através da leitura do título e resumo, e aqueles que contemplaram os critérios de elegibilidade foram lidos na íntegra. Coleta dos dadosOs seguintes dados foram extraídos: autor, ano de publicação, país, tipo de estudo, objetivo, método, tamanho da amostra, tempo de acompanhamento, média de idade das pacientes, critérios de inclusão e exclusão, concentração de selênio sérico e capilar. Os dados foram organizados em ordem cronológica de publicação do estudo. Síntese dos dadosForam identificados 3.800 artigos e incluídos 7 estudos na revisão sistemática. Os resultados indicaram correlação positiva entre o nível de selênio sérico e a concentração de antioxidantes no fluido folicular; diminuição dos níveis de anticorpos antitireoidianos; produção de oócitos, e número de folículos. Conclusão A suplementação de selênio é promissora em mulheres com deficiência do micronutriente, a fim de promover melhora na eficiência reprodutiva e prevenir danos na gravidez. Salientou-se a necessidade de realização de mais estudos sobre o tema.

Relation between Selenium and Female Fertility: A Systematic Review.

OBJECTIVE: To analyze the influence of selenium in female fertility. DATA SOURCE: A search was performed in the following databases: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect, and Europe PMC. The descriptors selected were "selenium" AND "female" AND "fertility". The search interval was from 1996 to 2021. STUDY SELECTION: The evaluation was performed independently by two reviewers, and a third reviewer confirmed the inclusion of papers in case of divergence between the first two reviewers. Papers were selected after the title and abstract were read, and those that met the eligibility criteria had the full text read. DATA COLLECTION: The following data was extracted: author, year of publication, country, type of study, objective, method, sample size, follow-up period, patients' mean age, inclusion and exclusion criteria, and concentration of serum and capillary selenium. The data was organized in chronological order of paper publication. DATA SYNTHESIS: The number of papers identified totaled 3,800, out of which 7 were included in the systematic review. The studies indicated a positive correlation between serum selenium and antioxidant concentration in the follicular fluid, reduction in antithyroid antibodies, oocyte production and follicle number. CONCLUSION: Selenium supplementation is promising in women with this micronutrient deficiency to promote improvement of the reproductive efficiency and prevent damage to the pregnancy. Further studies on this theme are still required.

OBJETIVO: Analisar a influência do selênio na fertilidade feminina. FONTE DOS DADOS: Uma busca foi realizada nas seguintes bases de dados: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect e Europe PMC. Os descritores selecionados foram "selenium" AND "female" AND "fertility". O intervalo de busca foi de 1996 a 2021. SELEçãO DOS ESTUDOS: A avaliação ocorreu de maneira independente por dois revisores, sendo que um terceiro corroborou a eleição dos artigos em casos de divergência. Os estudos foram selecionados através da leitura do título e resumo, e aqueles que contemplaram os critérios de elegibilidade foram lidos na íntegra. COLETA DOS DADOS: Os seguintes dados foram extraídos: autor, ano de publicação, país, tipo de estudo, objetivo, método, tamanho da amostra, tempo de acompanhamento, média de idade das pacientes, critérios de inclusão e exclusão, concentração de selênio sérico e capilar. Os dados foram organizados em ordem cronológica de publicação do estudo. SíNTESE DOS DADOS: Foram identificados 3.800 artigos e incluídos 7 estudos na revisão sistemática. Os resultados indicaram correlação positiva entre o nível de selênio sérico e a concentração de antioxidantes no fluido folicular; diminuição dos níveis de anticorpos antitireoidianos; produção de oócitos, e número de folículos. CONCLUSãO: A suplementação de selênio é promissora em mulheres com deficiência do micronutriente, a fim de promover melhora na eficiência reprodutiva e prevenir danos na gravidez. Salientou-se a necessidade de realização de mais estudos sobre o tema.

Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital.

A retrospective cohort study of hospital-acquired pressure injuries (HAPI) reported an incidence rate of 34.3% based on 582 medical records of adult patients admitted to the intensive care unit (ICU) of a medium-complexity public hospital in 2017 and 2018. Sixty percent of the patients used respirators, 49.3% presented hypotension, and 48.1% used norepinephrine. The main individual predictors of HAPI in the ICU were "days of norepinephrine" with an odds ratio (OR) of 1.625 (95% CI: 1.473-1.792) and concordance statistic (AUC) of 0.818 (95% CI: 0.779-0.857), "days of mechanical ventilation" with an OR of 1.521 (1.416-1.634) and AUC of 0.879 (0.849-0.909), "ICU stay (days)" with an OR of 1.279 (1.218-1.342) and AUC of 0.846 (0.812-0.881), and "Braden's sensory perception" with an OR of 0.345 (95% CI: 0.278-0.429) and AUC of 0.760 (0.722-0.799). The duration of mechanical ventilation, norepinephrine administration, and ICU length of stay presented significant discriminative capacity for HAPI prediction.

Effects of strengthening the surae triceps muscle on venous pump function in chronic venous insufficiency.

BACKGROUND: Chronic venous insufficiency (CVI) is a common disease that causes calf muscle pump dysfunction and has repercussions for the hemodynamics of the structures involved. OBJECTIVES: To analyze the effects on venous hemodynamics of exercises to strengthen the calf muscles in patients with CVI. METHODS: The study analyzed 25 lower limbs with CVI, classified from C1 to C5 according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, in 13 patients recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital Universitário Regional dos Campos Gerais (Brazil). The variables analyzed were collected by isometric dynamometry, goniometry, leg circumference measurement, and adipometry at baseline, after 1 month and 2 months and at the end of the exercise protocol. RESULTS: Dorsiflexion and plantar flexion measurements increased by 5º (p < 0.001). Adipometry detected a reduction in 5 mm (p < 0.001). When grouped by CEAP class, C2 exhibited 5º increases in dorsiflexion (p = 0.02) and plantar flexion (p < 0.001); C3 exhibited a 5ºincrease in dorsiflexion (p = 0.003) and a 1mm reduction in adipometry (p < 0.004); and C1 exhibited a 1.2cm increase in leg circumference (p = 0.04). CONCLUSIONS: Administration of exercise protocols should be considered as a treatment option for CVI, since it has a positive impact on risk factors and on the functions that are impaired by this pathology.

Eficácia das palmilhas customizadas na melhora da distribuição da pressão plantar em pacientes com neuropatia diabética: Protocolo de um ensaio clínico randomizado e controlado / Efficacy of customized insoles in the improvement of plantar pressure in patients with diabetic neuropathy: Protocol of a randomized and controlled clinical trial

OBJETIVO: Avaliar a influência das palmilhas customizadas na pressão plantar de diabéticos com neuropatia em comparação ao grupo sham. MÉTODOS: O método do estudo, devidamente registrado no Registro Brasileiro de Ensaios Clínicos ­ REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, incluiu um ensaio clínico randomizado, controlado, prospectivo, duplo-cego, com uma amostra de 46 voluntários que serão randomizados aleatoriamente numa razão de 1: 1 para serem direcionados aos grupos intervenção e controle. O grupo intervenção receberá palmilhas customizadas, com barra retrocapital e placa de etil vinil acetato (EVA) no mesmo formato da barra retrocapital, com a finalidade de reduzir a pressão no antepé. No grupo controle, as palmilhas planas serão confeccionadas sem nenhum objetivo terapêutico. Este projeto foi conduzido de acordo com o padrão de protocolo para ensaios clínicos randomizados (SPIRIT). Junto com a avaliação clínica, serão coletados dados demográficos da amostra para identificar e confirmar a presença de neuropatia periférica, em seguida, será avaliada a podobarografia e, por fim, os pacientes responderão ao questionário FAAM para avaliação da funcionalidade do pé. O desfecho primário será a análise dos pontos de pressão em KiloPascal (kPa) no pé dos pacientes com neuropatia diabética por meio da podobarografia nos pacientes do grupo intervenção e controle. O desfecho secundário será a funcionalidade do pé nas atividades de vida diária através do questionário FAAM (Foot and Ankle Ability Measure), considerando os voluntários na avaliação inicial, 3º e 6º meses. CONSIDERAÇÕES FINAIS: os futuros resultados deste estudo nos mostrarão principalmente se há ou não uma alteração estrutural na análise da pressão plantar decorrente do uso contínuo da palmilha, além de avaliar se o uso da palmilha terapêutica é eficaz na funcionalidade do pé nos mesmos portadores quando comparado à palmilha sham.

| OBJECTIVE: To evaluate the influence of customized insoles in the plantar pressure of diabetes patients with neuropathy in comparison to the sham group. METHODS: The work method, duly registered at the Registro Brasileiro de Ensaios Clínicos ­ REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, includes a randomized, controlled, prospective, doubleblinded clinical trial, with a sample of 46 volunteers that will be randomly randomized in a 1: 1 ratio to be referred to intervention and control groups. The intervention group will receive customized insoles, with a retrocapital bar and an ethyl vinyl acetate plaque (EVA) in the same shape as the retrocapital bar, in order to reduce the pressure on the forefoot. In the control group, flat insoles will be prepared without any therapeutic objective. This project was developed according to the standard protocol for randomized clinical trials (SPIRIT). Along with the clinical evaluation, demographic data of the sample will be collected to identify and confirm the presence of peripheral neuropathy, next, the pedobarographic will be evaluated, and finally, the patients will answer the FAAM questionnaire to assess foot functionality. The primary outcome will be analyzing pressure points in KiloPascal (kPa) in the patients' feet through pedobarographic of the patients in the intervention and control groups. The secondary outcome will be the foot functionality in activities of daily living through the FAAM (Foot and Ankle Ability Measure), considering the volunteers in the initial evaluation, third and sixth months. FINAL CONSIDERATIONS: Mainly, results of this study will show whether there is a structural alteration in the analysis of the plantar pressure due to the continuous use of insoles and present the evaluation of whether the use of therapeutic insoles improves the foot functionality of the same users when compared to sham insoles.

Efeitos do fortalecimento muscular do tríceps sural na função da bomba venosa na insuficiência venosa crônica / Effects of strengthening the surae triceps muscle on venous pump function in chronic venous insufficiency

Resumo Contexto A insuficiência venosa crônica (IVC) é uma doença comum, uma disfunção da bomba muscular da panturrilha que repercute na hemodinâmica das estruturas. Objetivos Analisar os efeitos dos exercícios de fortalecimento muscular da panturrilha na hemodinâmica venosa em pacientes com IVC. Métodos O estudo contou com a participação de 13 pacientes e 25 membros inferiores com IVC, classificados entre C1 e C5 da classificação Clínica, Etiologia, Anatomia e Fisiopatologia (CEAP), oriundos do ambulatório de cirurgia vascular do Hospital Universitário Regional dos Campos Gerais. As variáveis analisadas foram dinamometria isométrica, goniometria, perimetria, adipometria no início, primeiro mês, segundo mês e final da aplicação do protocolo de exercícios. Resultados Os valores da dorsiflexão e da plantiflexão aumentaram 5º (p < 0,001). Na adipometria notou-se uma redução de 5 mm (p < 0,001). Quando separados em grupos pela CEAP, na C2 houve aumento de 5º na dorsiflexão (p = 0,02) e na plantiflexão (p < 0,001); na C3 houve aumento de 5º na dorsiflexão (p = 0,003) e redução de 1 mm na adipometria (p < 0,004); na C1 houve aumento da perimetria de 1,2 cm (p = 0,04). Conclusões A aplicação de protocolos de exercícios deveria ser considerada como uma forma de tratamento para IVC, pois impacta positivamente em fatores de risco e nas funções que estão deterioradas pela patologia.

Abstract Background Chronic venous insufficiency (CVI) is a common disease that causes calf muscle pump dysfunction and has repercussions for the hemodynamics of the structures involved. Objectives To analyze the effects on venous hemodynamics of exercises to strengthen the calf muscles in patients with CVI. Methods The study analyzed 25 lower limbs with CVI, classified from C1 to C5 according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, in 13 patients recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital Universitário Regional dos Campos Gerais (Brazil). The variables analyzed were collected by isometric dynamometry, goniometry, leg circumference measurement, and adipometry at baseline, after 1 month and 2 months and at the end of the exercise protocol. Results Dorsiflexion and plantar flexion measurements increased by 5º (p < 0.001). Adipometry detected a reduction in 5 mm (p < 0.001). When grouped by CEAP class, C2 exhibited 5º increases in dorsiflexion (p = 0.02) and plantar flexion (p < 0.001); C3 exhibited a 5ºincrease in dorsiflexion (p = 0.003) and a 1mm reduction in adipometry (p < 0.004); and C1 exhibited a 1.2cm increase in leg circumference (p = 0.04). Conclusions Administration of exercise protocols should be considered as a treatment option for CVI, since it has a positive impact on risk factors and on the functions that are impaired by this pathology.

Predictive model for Covid-19 incidence in a medium-sized municipality in Brazil (Ponta Grossa, Paraná) / Modelo predictivo de la ocurrencia de Covid-19 en un municipio de tamaño medio en Brasil (Ponta Grossa-Paraná) / Modelo preditivo da ocorrência de Covid-19 em município de médio porte no Brasil (Ponta Grossa-Paraná)

ABSTRACT Objective: to produce a predictive model for the incidence of COVID-19 cases, severity and deaths in Ponta Grossa, state of Paraná. Methods: this is an ecological study with data from confirmed cases of COVID-19 reported between March 21, 2020 and May 3, 2020 in Ponta Grossa and proportion of severity, hospitalization and lethality in the literature. A susceptible-infected-recovered (SIR) epidemic model was developed, and reproduction rate (R0), duration of epidemic, peak period, number of cases, hospitalized patients and deaths were estimated. Deaths were calculated by age group and in three scenarios: at day 24, at day 34, and at day 44 of the epidemic. Results: in the three scenarios assessed in this study, the variation in the number of cases was explained by an exponential curve (r2=0.74, 0.79 and 0.89, respectively, p<0.0001 in all scenarios). The SIR model estimated that, in the best scenario, the peak period will be around 120 days after the first case (between July 11, 2020 and July 25, 2020), estimated R0 will be 1.07 and will infect 0.23% of the population. In the worst scenario, peak period will involve 4,375 (95% CI; 4156-4594) cases and 825 (95% CI; 700-950) cases in the best scenario. Most cases and hospital admissions will involve patients aged 20 to 39 years, the number of deaths will be higher among the elderly and more pronounced among patients aged ≥80 years. Conclusion: this is the first study that provides COVID-19 projections for a municipality that is not a large capital. It shows a peak period at a later moment; therefore, the municipality will have more time to prepare and adopt protective measures to reduce the number of simultaneous cases.

RESUMEN Objetivo: obtener un modelo predictivo para la ocurrencia de casos, severidad y muertes por COVID-19 en Ponta Grossa-Paraná. Métodos: estudio ecológico con datos de casos confirmados de COVID-19 notificados del 21/03/2020 al 3/3/2020 en Ponta Grossa y proporción de severidad, hospitalización y letalidad en la literatura. Se construyó un modelo epidemiológico (SIR) infectado-recuperado susceptible y tasa de reproducción estimada (R0), duración de la epidemia, fecha pico, número de casos, hospitalizaciones y muertes. Este último por grupo de edad y en tres escenarios: a los 24 días, a los 34 días y a los 44 días de epidemia. Resultados: en los tres escenarios evaluados, la variación en el número de casos se explicó por una curva exponencial (r2 = 0.74, 0.79 y 0.89, respectivamente y p <0.0001 en total). El modelo SIR estimó que, en el mejor escenario, el pico ocurrirá alrededor de 120 días después del primer caso (entre el 7/11/2020 y el 25/7/2020), el R0 estimado será de 1.07 y alcanzará 0.23 % de habitantes infectados. En el peor de los casos, el pico estimado será de 4375 (IC del 95%: 4156-4594) y 825 (IC del 95%: 700-950) en el mejor de los casos. El mayor número estimado de casos y hospitalizaciones estará en el rango entre 20 y 39 años, el número de muertes será mayor entre los ancianos y más pronunciado entre ≥ 80 años. Conclusión: este es el primer estudio con proyecciones para COVID-19 en un municipio fuera de las grandes capitales y demostró que el pico llegará tarde, por lo tanto, el municipio tendrá más tiempo de preparación y que las medidas de protección pueden reducir el número simultáneo de casos.

RESUMO Objetivo: obter um modelo preditivo da ocorrência de casos, gravidade e óbitos por COVID-19 em Ponta Grossa-Paraná. Métodos: estudo ecológico com dados de casos confirmados de COVID-19 notificados de 21/03/2020 a 03/05/2020 em Ponta Grossa e proporção de gravidade, hospitalização e letalidade da literatura. Um modelo epidemiológico suscetível-infectado-recuperado (SIR) foi construído e estimadas taxa de reprodução (R0), duração da epidemia, data do pico, número de casos, hospitalizações e óbitos. Estas últimas por faixa etária e em três cenários: aos 24 dias, aos 34 dias e aos 44 dias de epidemia. Resultados: nos três cenários avaliados, a variação no número de casos foi explicada por uma curva exponencial (r2=0,74, 0,79 e 0,89, respectivamente e p<0,0001 em todos). O modelo SIR estimou que, no melhor cenário, o pico ocorrerá em torno de 120 dias após o primeiro caso (entre 11/07/2020 e 25/07/2020), o R0 estimado será 1,07 e chegará a 0,23% dos habitantes infectados. No pior cenário, o pico estimado será de 4375 (IC 95% 4156-4594) casos e 825 (IC 95% 700-950) no melhor cenário. O maior número estimado de casos e hospitalizações será na faixa entre 20 e 39 anos, o número de óbitos será maior entre idosos e mais acentuado entre ≥ 80 anos. Conclusão: este é o primeiro estudo com projeções para a COVID-19 em um município fora das grandes capitais e mostrou que o pico será tardio, portanto, o município terá mais tempo de preparo e que medidas protetivas podem reduzir o número simultâneo de casos.

Coronary Endarterectomy: a Case Control Study and Evaluation of Early Patency Rate of Endarterectomized Arteries.

OBJECTIVE: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. METHODS: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. RESULTS: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. CONCLUSION: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Coronary endarterectomy: a case control study and evaluation of early patency rate of endarterectomized arteries

Abstract Objective: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. Methods: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. Results: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. Conclusion: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Venous revascularization to treat posterior nutcracker syndrome by transposition of the left gonadal vein: case report.

The Nutcracker Syndrome is manifest in the presence of a symptomatic entrapment of the left renal vein between the abdominal aorta and the superior mesenteric artery. In a more ephemeral variation of this disorder, called the Posterior Nutcracker Syndrome, the renal vein is not compressed anterior to the aorta, but posteriorly, between the artery and the spine. Although there are multiple treatment options, current techniques aim to relieve the symptoms and reduce venous pressure on the left renal vein. This report describes a case of Posterior Nutcracker Syndrome in which the management approach chosen was open surgery, transposing the gonadal vein distally, to the inferior cava vein.

Prevalence of carotid stenosis and incidence of ischemic stroke in patients undergoing non-coronary cardiac surgery

Abstract Introduction: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. Objectives: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. Objectives: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. Results: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. Conclusion: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Ankle joint mobility as a predictor of treatment prognosis in patients with chronic venous insufficiency with venous ulcers.

The present study arose from the need to improve treatment of patients with chronic venous insufficiency (CVI) who present with venous ulcers. A total of 40 lower limbs were assessed from 20 patients with healed venous ulcers (C5) or active venous ulcers (C6) who had undergone varicose vein surgery. The relationship between the range of motion of the ankle joint and presence of C5 or C6 venous ulcer was analyzed. For this purpose, normal goniometry findings for this joint were used as a predictor of venous ulcer healing, defined as the outcome. Thus, when identifying reduced ankle joint movement or immobility in these patients, new treatment options could be offered in order to increase joint mobility and prevent or delay CVI complications.

O Professor e a Arte de Avaliar no Ensino Médico de uma Universidade no Brasil / The Teacher and the Art of Evaluating in Medical Teaching at a University in Brazil

RESUMO A avaliação é intrínseca ao ato de ensinar e uma possibilidade de ampliar e melhorar o conhecimento adquirido pelo aluno. No ensino na área da saúde, a avaliação possui peculiaridades e requer constante diálogo com os docentes e discentes a fim de receber aprimoramentos. O objetivo deste estudo foi traçar um diagnóstico inicial do processo avaliativo no curso de Medicina de uma instituição de ensino superior pública no Estado do Paraná, sob a perspectiva de professores e alunos. Trata-se de um estudo exploratório, de abordagem metodológica qualitativa, de natureza interpretativa, realizado com 22 professores e 20 alunos do internato de Clínica Médica. A coleta de dados deu-se de novembro de 2015 a fevereiro de 2016, com entrevista semiestruturada, de caráter individual, que foi gravada e transcrita literalmente. Foi empregada análise de conteúdo para examinar os dados, que foram decodificados e agrupados por similaridade de assuntos, tendo emergido quatro categorias de análise. Os resultados mostram que os participantes do estudo apontaram dificuldades na avaliação. Em relação aos docentes, foi mencionada a necessidade de formação didático-pedagógica e em avaliação de habilidades, estratégias para aprimoramentos em feedback, em autoavaliação do aluno e na padronização do processo avaliativo realizado pelos docentes. O médico professor percebe-se como aprendiz neste processo e tem a percepção de que a falta de domínio pedagógico para aprender e melhorar sua avaliação gera a necessidade de formação. Conclui-se que, na arte de avaliar, a participação dos professores e alunos se torna importante estratégia para ajustes e melhorias. As reflexões sobre o papel dos atores no cenário do ensino são benéficas para a formação de ambos, pois juntos compartilham olhares, percepções e sugestões, rumo ao ensino e ao aprendizado de excelência. O feedback, a autoavaliação e a padronização constituem elementos singulares e colaboram com o processo avaliativo.

ABSTRACT Evaluation is intrinsic to the act of teaching and a possibility to increase and improve the knowledge acquired by the student. In health education, assessment has peculiarities and requires constant dialogue between teachers and students in order to achieve improvements. The objective of this study was to draw up an initial diagnosis of the evaluation process in the medical course of a Public Higher Education Institution of the State of Paraná, from the perspective of teachers and students. This was an exploratory study, with a qualitative methodological approach, and of an interpretative nature, performed with twenty-two (22) teachers and twenty (20) medical intern students. Data collection took place from November 2015 to February 2016, with a semi-structured interview of an individual character that was recorded and transcribed verbatim. The data were analyzed by content analysis, which were decoded and grouped by subject similarity, from which four categories of analysis emerged. The results show that the study participants pointed out difficulties in the evaluation; teachers were mentioned: the need for didactic-pedagogical training and the evaluation of skills, strategies for improvements in feedback, self-assessment of the student and the standardization of the evaluation process conducted by the teachers. It is concluded that in the art of evaluation, the participation of teachers and students becomes na important strategy for adjustments and improvements. Reflections on the role of actors in the educational setting are beneficial to the formation of both. The inclusion of feedback, self-assessment and standardization are unique elements and collaborate with the evaluation process.

Prevalence of Carotid Stenosis and Incidence of Ischemic Stroke in Patients Undergoing Non-Coronary Cardiac Surgery.

INTRODUCTION: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. OBJECTIVES: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. OBJECTIVES: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. RESULTS: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. CONCLUSION: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Long-lasting anti-platelet activity of cilostazol from poly(ε-caprolactone)-poly(ethylene glycol) blend nanocapsules.

Cilostazol (CLZ) acts as a vasodilator and antiplatelet agent and is the main drug for the treatment of intermittent claudication (IC) related to peripheral arterial disease (PAD). The usual oral dose is 100 mg twice a day, which represents a disadvantage in treatment compliance. CLZ presents several side effects, such as headache, runny nose, and dizziness. This paper aimed to obtain novel polymeric nanocapsules prepared from poly(ε-caprolactone)-poly(ethylene glycol) (PCL-PEG) blend containing CLZ. Nanocapsules showed pH values between 6.1 and 6.3, average size lower than 137 nm, low polydispersity index (<0.22) and negative zeta potential. These nanoformulations demonstrated spherical shape with smooth surface. Results achieved by X-ray diffraction (XRD) and differential scanning calorimetry (DSC) indicated drug amorphization compared to pure CLZ. Fourier-transformed infrared spectroscopy (FTIR) showed no chemical bonds between drug and polymers. Formulations presented suitable stability for physical parameters. The in vitro drug release demonstrated prolonged release with no burst effect. Drug release was controlled by both mechanisms of polymer relaxation/degradation and Fickian diffusion. Moreover, chosen CLZ-loaded nanocapsules provided an in vivo prolonged antiplatelet effect for CLZ statistically similar to aspirin. These formulations can be further used as a feasible oral drug delivery carrier for controlled release of CLZ in order to treat PAD and IC events.

Mobilidade da articulação talocrural como fator preditor no prognóstico de cicatrização em portadores de insuficiência venosa crônica com úlcera venosa / Ankle joint mobility as a predictor of treatment prognosis in patients with chronic venous insufficiency with venous ulcers

O presente trabalho surgiu da necessidade de aprimorar o tratamento de pacientes com insuficiência venosa crônica (IVC) que apresentam úlcera venosa. Foram avaliados os 40 membros inferiores de 20 pacientes portadores de úlcera venosa cicatrizada (C5) ou ativa (C6) que foram submetidos ou não à cirurgia de varizes. Foi estabelecida a relação entre a amplitude de movimento da articulação talocrural e a presença de úlcera venosa C5 ou C6, sendo para isso utilizada a goniometria dessa articulação dentro da normalidade como preditor de cicatrização e tendo como desfecho a cicatrização ou não da úlcera venosa. Dessa forma, ao se identificar redução ou imobilidade talocrural em pacientes com úlcera venosa, poderão ser oferecidas novas formas terapêuticas, a fim de aumentar a mobilidade dessa articulação para prevenir ou retardar complicações da IVC

The present study arose from the need to improve treatment of patients with chronic venous insufficiency (CVI) who present with venous ulcers. A total of 40 lower limbs were assessed from 20 patients with healed venous ulcers (C5) or active venous ulcers (C6) who had undergone varicose vein surgery. The relationship between the range of motion of the ankle joint and presence of C5 or C6 venous ulcer was analyzed. For this purpose, normal goniometry findings for this joint were used as a predictor of venous ulcer healing, defined as the outcome. Thus, when identifying reduced ankle joint movement or immobility in these patients, new treatment options could be offered in order to increase joint mobility and prevent or delay CVI complications

Revascularização venosa via transposição de veia gonadal esquerda em síndrome de nutcracker posterior: relato de caso / Venous revascularization to treat posterior nutcracker syndrome by transposition of the left gonadal vein: case report

A síndrome de nutcracker é manifesta na presença de um aprisionamento sintomático da veia renal esquerda entre a aorta abdominal e a artéria mesentérica superior. Uma variação mais efêmera desta desordem é dita síndrome de nutcracker posterior, quando a compressão da veia renal não mais ocorre frontalmente à aorta, mas posteriormente a ela, entre esta e a coluna vertebral. A despeito de variáveis opções terapêuticas, as técnicas presentes visam aliviar os sintomas e diminuir a pressão venosa da veia renal esquerda. Este relato descreve um caso de Síndrome de nutcracker posterior, em que a abordagem de escolha foi a cirurgia aberta, transpondo distalmente a veia gonadal esquerda na veia cava inferior

The Nutcracker Syndrome is manifest in the presence of a symptomatic entrapment of the left renal vein between the abdominal aorta and the superior mesenteric artery. In a more ephemeral variation of this disorder, called the Posterior Nutcracker Syndrome, the renal vein is not compressed anterior to the aorta, but posteriorly, between the artery and the spine. Although there are multiple treatment options, current techniques aim to relieve the symptoms and reduce venous pressure on the left renal vein. This report describes a case of Posterior Nutcracker Syndrome in which the management approach chosen was open surgery, transposing the gonadal vein distally, to the inferior cava vein