Exploring the clinical features of postpartum obsessive-compulsive disorder- a systematic review

Background and objectives The postpartum period appears to be a vulnerable period for the development of obsessive-compulsive disorder in parents; yet it is often overlooked. This work aims to synthesize clinical data available on Postpartum Obsessive-Compulsive Disorder (PP-OCD) and to highlight its psychopathological significance and implications in clinical practice using a systematic approach. Methods We conducted a systematic research according to PRISMA guidelines in three databases – MEDLINE, Scopus and Web of Science. The references obtained were then screened and scanned for eligibility by two investigators. Risk of bias was assessed for each study with NIH tools. Results The found prevalence of postpartum OCD ranged from 2.43 %-9 % among women and 1,7 % among men. Other epidemiological and clinical data were reviewed including particular symptomatology, characterized by a swift onset of primarily aggressive and contamination obsessions, as well as situational avoidance. Conclusion It is a clinical entity frequently underdiagnosed, which perinatal health practitioners should be familiar with, as it can interfere with parent-infant bonding if left untreated. Mothers with an history of depression, anxiety, insomnia, obsessive compulsive, and avoidant personality disorder or presenting inappropriate interpretation of infant related intrusive thoughts are particularly at risk of developing OCD in the postpartum period. These mothers should be informed about the nature of their infant centered obsessions and could be a target of prevention programs. (AU)

Graft-derived neurons and bystander effects are maintained for six months after human iPSC-derived NESC transplantation in mice's cerebella.

Machado-Joseph disease (MJD) is a neurodegenerative disorder characterized by widespread neuronal death affecting the cerebellum. Cell therapy can trigger neuronal replacement and neuroprotection through bystander effects providing a therapeutic option for neurodegenerative diseases. Here, human control (CNT) and MJD iPSC-derived neuroepithelial stem cells (NESC) were established and tested for their therapeutic potential. Cells' neuroectodermal phenotype was demonstrated. Brain organoids obtained from the Control NESC showed higher mRNA levels of genes related to stem cells' bystander effects, such as BDNF, NEUROD1, and NOTCH1, as compared with organoids produced from MJD NESC, suggesting that Control NESC have a higher therapeutic potential. Graft-derived glia and neurons, such as cells positive for markers of cerebellar neurons, were detected six months after NESC transplantation in mice cerebella. The graft-derived neurons established excitatory and inhibitory synapses in the host cerebella, although CNT neurons exhibited higher excitatory synapse numbers compared with MJD neurons. Cell grafts, mainly CNT NESC, sustained the bystander effects through modulation of inflammatory interleukins (IL1B and IL10), neurotrophic factors (NGF), and neurogenesis-related proteins (Msi1 and NeuroD1), for six months in the mice cerebella. Altogether this study demonstrates the long-lasting therapeutic potential of human iPSC-derived NESC in the cerebellum.

Corrigendum: Methylmercury impact on adult neurogenesis: is the worst yet to come from recent Brazilian environmental disasters?

[This corrects the article DOI: 10.3389/fnagi.2020.591601.].

Suicide Risk in Obsessive-Compulsive Disorder: A Case Report.

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by obsessions and compulsions. It affects about 2.5% of people throughout their life and usually emerges in infancy/adolescence or early adulthood. Despite high levels of suffering and disability, high comorbidity rates, and low treatment response rates, suicidal behavior associated with this disorder was traditionally considered a rare phenomenon. However, recent studies recognize a significant risk of suicidal behavior in obsessive-compulsive patients. As a result, we describe a clinical case of attempted suicide in an obsessive-compulsive patient and discuss risk factors that have been considered predictive of suicide in OCD.

Effects of Citric Acid on the Healing Process of Chronic Wound due to Leprosy.

Objective: The aim was to describe the effects of the use of citric acid in the healing process of chronic leprosy wounds. Approach: This is a case series, carried out with 5 people with chronic leprosy wounds, under continuous care in an outpatient center wound care in the center-south region of Brazil. The intervention protocol consisted of topical application of 3% citric acid (ointment), on the wound bed, in a thin layer of approximately 2 mm, on alternate days, and followed up for a total period of 8 weeks and secondary coverage rayon and gauze. The cases were analyzed regarding wound dimensions, histology and clinical observation. Results: It was observed in all cases better aspect of the wound bed, presence of granulation tissue and decrease of the inflammatory process with predominance of lymphocytes, reduction of bacterial colonies, increase and verticalization of type I collagen fibers, reduction of type III collagen and increased areas of epithelialization. Innovation: There was also a reduction in the level of pain and exudation after the treatment protocol. Conclusions: Therefore, the use of citric acid in leprosy neuropathic wounds is promising and may be a treatment option, considering its cost, clinical management and possible effect on the chronic inflammatory process.

Gestão de casos por enfermeiro na redução de complicações neonatais: estudo quase-experimental / Gestión de casos por enfermeros en la reducción de complicaciones neonatales: estudio cuasi experimental / Nurse case management in reducing neonatal complications: a quasi-experimental study

Resumo Objetivo Analisar o efeito da gestão de casos mediada por enfermeiro na prematuridade, baixo peso ao nascer e mortalidade neonatal. Métodos Pesquisa clínica pragmática, de caráter quase-experimental, com braço único, realizada em um município no sul do Brasil, com aplicação interventiva do modelo de gestão de casos mediada por enfermeiro durante dez meses, em amostra composta por 91 gestantes; a intervenção incluiu: consulta de enfermagem e multiprofissional, ações educativas, visita domiciliar e abordagem telefônica. Os dados do grupo intervenção foram comparados aos dados dos nascimentos ocorridos no período de 2016 a 2018 no município do estudo com cálculo do Risco Relativo, Redução do Risco Absoluto e Número Necessário para Tratar. Resultados Identificaram-se 4,4% (IC 95% 0,18%; 8,61%) de partos prematuros. A eficácia da gestão de casos na prematuridade foi de 62%; a cada 14 gestantes do grupo intervenção, um parto prematuro foi evitado. Elas apresentaram uma Redução do Risco Absoluto de 7,3% comparadas aos números anteriores do município. Nasceram com baixo peso (<2500g) 8,9% dos neonatos (p=0,975) e não houve mortalidade neonatal no grupo intervenção (p=0,850). Conclusão A gestão de casos mediada por enfermeiro durante a gestação apresentou-se como estratégia de prevenção da prematuridade e evidenciou a magnitude na mortalidade neonatal. Sobre o peso ao nascer, este modelo não causou efetividade. É fundamental a presença regular do enfermeiro para a melhoria do cuidado durante a gestação. Registro Brasileiro de Ensaios Clínicos - ReBEC: RBR-1073gcfm

Resumen Objetivo Analizar el efecto de la gestión de casos mediada por enfermeros en la prematuridad, bajo peso al nacer y mortalidad neonatal. Métodos Estudio clínico pragmático, de carácter cuasi experimental, de un solo brazo, realizado en un municipio del sur de Brasil, con aplicación de intervención del modelo de gestión de casos mediada por enfermeros durante diez meses, con una muestra compuesta por 91 mujeres embarazadas. La intervención incluyó: consulta de enfermería y multiprofesional, acciones educativas, visita domiciliaria y contacto telefónico. Los datos del grupo experimental fueron comparados con los datos de los nacimientos ocurridos en el período de 2016 a 2018 en el municipio del estudio con cálculo del riesgo relativo, reducción del riesgo absoluto y número necesario para tratar. Resultados Se identificaron 4,4 % (IC 95 % 0,18 %; 8,61 %) de partos prematuros. La eficacia de la gestión de casos en la prematuridad fue del 62 %; de cada 14 mujeres embarazadas del grupo experimental, un parto prematuro fue evitado. Presentaron una reducción del riesgo absoluto del 7,3 % comparado con los números anteriores del municipio. El 8,9 % de los neonatos (p=0,975) nacieron con bajo peso (<2500 g) y no hubo mortalidad neonatal en el grupo experimental (p=0,850). Conclusión La gestión de casos mediada por enfermeros durante la gestación demostró ser una estrategia de prevención de prematuridad y evidenció la magnitud en la mortalidad neonatal. Respecto al peso al nacer, este modelo no causó efectividad. La presencia regular de los enfermeros es fundamental para mejorar los cuidados durante la gestación.

Abstract Objective To analyze the impact of nurse-mediated case management on prematurity, low birth weight, and neonatal mortality. Methods A pragmatic, quasi-experimental, single-arm, clinical trial, conducted in a city in the south of Brazil, with implementation of the nurse-mediated case management model as an intervention during ten months, in a sample of 91 pregnant women. The intervention consisted of nursing and multi-professional appointments, educational actions, home visits, and a telephone call. The data of the intervention group were compared to the data of births from 2016 to 2018 in the city, with calculation of the relative risk, the absolute risk reduction and the number needed to treat. Results Premature births accounted for 4.4% (95% CI 0.18%; 8.61%). Case management effectiveness in prematurity was 62%; for every 14 pregnant women in the intervention group, one premature birth was avoided. An absolute risk reduction of 7.3% was identified compared to previous city numbers. Newborns with low birth weight (<2500g) (p=0.975) were 8.9% of the total of neonates born, and neonatal mortality in the intervention group was not identified (p=0,850). Conclusion Nurse-mediated case management during pregnancy proved to be a strategy for prevention of prematurity and demonstrated the magnitude in neonatal mortality. However, regarding the birth weight, this model had no effectiveness. The regular presence of nurses is fundamental to improve the care during pregnancy. Brazilian Registry of Clinical Trials - ReBEC: RBR-1073gcfm

Mortalidade neonatal precoce e tardia: causas evitáveis e tendências nas regiões brasileiras / Mortalidad neonatal temprana y tardía: causas evitables y tendencias en las regiones brasileñas / Early and late neonatal mortality: preventable causes and trends in Brazilian regions

Resumo Objetivo Analisar as principais causas e a tendência da mortalidade neonatal precoce e tardia evitável segundo as regiões brasileiras. Métodos Estudo de séries temporais do tipo ecológico realizado com registros dos óbitos neonatais no período de 2000 a 2018 por meio do Sistema de Informação sobre Mortalidade. Para classificação das causas evitáveis utilizou-se a Lista de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. A partir das taxas de mortalidade dos componentes neonatal precoce e tardio foram realizadas regressões por joinpoints das principais causas com indicação da variação percentual anual e variação percentual anual média. Resultados As maiores taxas de mortalidade evitável foram encontradas na fase neonatal precoce. A região Sul apresentou as menores taxas de mortalidade evitável. As principais causas segundo grupos da lista foram tétano do recém-nascido, síndrome da angústia respiratória, asfixia ao nascer, septicemia bacteriana, pneumonia e síndrome da morte súbita. A redução na mortalidade neonatal precoce foi maior de 2000 a 2004 (4,19% ao ano, p<0,001) e menor, entre os anos de 2012 e 2018 (1,80% ao ano, p<0,001). Considerando a mortalidade neonatal tardia houve redução anual média de 2,02% (p<0,001). A região Nordeste apresentou mais de um ponto de inflexão na tendência da mortalidade por desconforto respiratório e asfixia ao nascer e estabilidade por septicemia. Na região Sul foi identificado tendência de redução para todas as causas evitáveis estudadas. Conclusão Houve menor redução na mortalidade neonatal precoce e desigualdades na tendência da mortalidade neonatal evitável segundo causas e regiões de residência.

Resumen Objetivo Analizar las principales causas y la tendencia de la mortalidad neonatal temprana y tardía evitable según las regiones brasileñas. Métodos Estudio de series temporales del tipo ecológico, realizado con registros de las defunciones neonatales en el período de 2000 a 2018, por medio del Sistema de Información sobre Mortalidad. Para la clasificación de las causas evitables, se utilizó la Lista de causas de muertes evitables por intervenciones del Sistema Único de Salud. A partir de las tasas de mortalidad de los componentes neonatal temprano y tardío, se realizaron regresiones joinpoints de las principales causas con indicación de la variación porcentual anual y variación porcentual anual promedio. Resultados Las mayores tasas de mortalidad evitable se encontraron en la fase neonatal temprana. La región Sur presentó las menores tasas de mortalidad evitable. Las principales causas, según los grupos de la lista, fueron: tétanos neonatal, síndrome de dificultad respiratoria, asfixia al nacer, septicemia bacteriana, neumonía y síndrome de la muerte súbita. La reducción de la mortalidad neonatal temprana fue mayor del año 2000 al 2004 (4,19 % al año, p<0,001) y menor entre los años 2012 y 2018 (1,80 % al año, p<0,001). Considerando la mortalidad neonatal tardía, hubo una reducción anual promedio del 2,02 % (p<0,001). La región Nordeste presentó más de un punto de inflexión en la tendencia de la mortalidad por malestar respiratorio y asfixia al nacer y estabilidad por septicemia. En la región Sur se identificó una tendencia de reducción de todas las causas evitables estudiadas. Conclusión Hubo menor reducción de la mortalidad neonatal temprana y desigualdades en la tendencia de la mortalidad neonatal evitable según las causas y la región de residencia.

Abstract Objective To analyze the main causes and trends in preventable early and late neonatal mortality according to Brazilian regions. Methods This is an ecological time series study carried out with records of neonatal deaths from 2000 to 2018 through the Mortality Information System. To classify the avoidable causes, the Unified Health System List of Preventable Causes of Death by Interventions (Lista de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde) was used. From mortality rates of early and late neonatal components, joinpoint regressions of the main causes were performed using the Annual Percentage Change and Average Annual Percentage Change. Results The highest avoidable mortality rates were found in the early neonatal phase. The South had the lowest avoidable mortality rates. The main causes according to groups on the list were tetanus of newborns, respiratory distress syndrome, birth asphyxia, bacterial septicemia, pneumonia and sudden death syndrome. The reduction in early neonatal mortality was higher from 2000 to 2004 (4.19% per year, p<0.001) and lower between 2012 and 2018 (1.80% per year, p<0.001). Considering late neonatal mortality, there was an average annual reduction of 2.02% (p<0.001). The Northeast had more than one turning point in the trend of mortality due to respiratory distress and asphyxia at birth and stability due to septicemia. In the South, a downward trend was identified for all the preventable causes studied. Conclusion There was a lower reduction in early neonatal mortality and inequalities in the trend of preventable neonatal mortality according to causes and regions of residence.

Cerebral Venous Thrombosis Due to Overdrainage in a Patient With Normal Pressure Hydrocephalus: A Case Report.

Mechanical shunting of cerebrospinal fluid (CSF) is an effective treatment for hydrocephalus but is not exempt from complications. A 67-year-old male with a history of normal pressure hydrocephalus (NPH) and ventriculoperitoneal shunting (VPS) one year ago presented with gait disturbance and memory impairment. His head computed tomography (CT) was normal, and the shunting pressure was reduced from 110 to 70 mmH20 with gait and memory improvement. One week later, he reported persistent pressure headaches, which worsen when lying down, accompanied by nausea and vomiting. His neurological examination was notable for a short-stepped wide-based gait. Two generalized seizures were observed. CT cerebral venography revealed sinus venous thrombosis (SVT). After two days, a new CT was performed, and bilateral subdural hygromas were found. The shunting pressure was readjusted to 110 mmH20, and symptom improvement was noted. One week later, CT showed enlargement and bleeding of subdural collections. The drainage system was closed, and the patient continue to recover. The temporal association between pressure adjustment and symptom onset and the evidence of progressive subdural effusions suggest that the decrease of CSF volume by overdrainage led to an increase in cerebral blood volume and the dilatation of the venous sinus, which precipitated thrombus formation.

Development and characterization of lactose-free probiotic goat milk beverage with bioactive rich jambo pulp.

Goat milk is considered a suitable matrix for the successful incorporation of probiotics, also obtaining new lactose-free fermented products can expand its use. This study aimed to develop and characterize formulations of lactose-free probiotic fermented goat dairy beverages as well as to determine the most appropriate concentration of red jambo pulp to be added. The beverages were developed with different concentrations of lactose-free goat milk and frozen jambo pulp (12, 15 and 18% w/v) and lyophilized (3, 6 and 9% w/v), corresponding to formulations F1 to F6, respectively, as source of bioactive compounds. Probiotics counts decreased significantly (from 8.58 to 7.38 log CFU mL-1). The formulation with a higher proportion of lyophilized (F6) pulp showed the highest levels of phenolic compounds (72.08 mg GAE 100 g-1), anthocyanins (50.80 mg cyanidin-3-glycoside 100 g-1), ascorbic acid (41.68 mg 100 g-1), and antioxidant activity (16.21 µmol TE g-1) (P < 0.05). On the other hand, F3 presented the highest global acceptance and purchase intention (P < 0.05). However, the principal component analysis (PCA) indicated that the components related to bioactive compounds (PC1) stood out on sensory attributes (PC3 and PC4) and, therefore, F6 was most appropriate for obtaining a lactose-free goat probiotic fermented milk with improved bioactive properties targeting lactose intolerant consumers and those who are allergic to bovine milk proteins. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-022-05399-z.

Prevalencia de infección por SARS-coV-2 en una universidad pública de Paraná: un estudio observacional / Prevalência de infecção por SARS-coV-2 em uma universidade pública do Paraná: um estudo observacional

Introducción: COVID-19 es una enfermedad causada por el virus SARS-CoV-2 que se propagó por todo el mundo a principios de 2020. Un año y siete meses después del inicio de la propagación mundial de la enfermedad, el número de casos confirmados en Brasil supera los 21 millones y 601 mil muertes registradas. El objetivo de este estudio fue evaluar la prevalencia de la infección por SARS-CoV-2 en una comunidad académica. Método: Estudio observacional, con diseño transversal, realizado en la comunidad académica de una Universidad Pública Estadual del Norte de Paraná. Participaron 157 personas, entre profesores, alumnos y agentes universitarios. La variable dependiente fue la presencia de anticuerpos totales contra el SARS-CoV-2. Resultados: La prevalencia de anticuerpos contra el SARS-CoV-2 en estudiantes y empleados de una universidad pública de la región Norte de Paraná fue del 7%. En el análisis bivariado de factores asociados a la presencia de anticuerpos, docentes, personas que tuvieron contacto cercano con caso confirmado de COVID-19, fiebre, dolor muscular, tos, dolor de garganta, anosmia y ageusia, fueron las características que más se asociaron con la enfermedad presencia de anticuerpos. Conclusión: Se encontró que el 7% de la comunidad académica estudiada tenía anticuerpos contra el COVID-19. (AU)

Introdução: A COVID-19 é uma doença causada pelo vírus SARS-CoV-2 que se espalhou mundialmente no início de 2020. Após um ano e sete meses do início da disseminação mundial da doença, o número de casos confirmados no Brasil, ultrapassam 21 milhões e 601 mil óbitos registrados. O objetivo deste estudo foi avaliar a prevalência de infecção por SARS-CoV-2 em uma comunidade acadêmica. Método: Estudo observacional, com delineamento transversal, realizado na comunidade acadêmica de uma Universidade Estadual Pública do Norte do Paraná. Participaram 157 pessoas, incluindo professores, acadêmicos e agentes universitários. A variável dependente foi a presença de anticorpos totais contra SARS-CoV-2. Resultados: A prevalência de anticorpos contra SARS-CoV-2 em acadêmicos e servidores de uma universidade pública da região Norte do Paraná foi de 7%. Na análise bivariada dos fatores associados a presença de anticorpos, professores, pessoas que tiveram contato próximo com caso confirmado para COVID-19, febre, dor muscular, tosse, dor de garganta, anosmia e ageusia, foram as características que mais apresentaram associação com a presença de anticorpos.Conclusão: Foi constatado que 7% da comunidade acadêmica estudada apresentaram anticorpos contra a COVID-19. (AU)

Introduction: COVID-19 is a disease caused by the SARS-CoV-2 virus that spread worldwide in early 2020. One year and seven months after the beginning of the global spread of the disease, the number of confirmed cases in Brazil exceeds 21 million and 601 thousand deaths recorded. The aim of this study was to assess the prevalence of SARS-CoV-2 infection in an academic community. Method: Observational study, with a cross-sectional design, carried out in the academic community of a Public State University in Northern Paraná. 157 people participated, including professors, academics and university agents. The dependent variable was the presence of total antibodies against SARS-CoV-2. Results: The prevalence of antibodies against SARS-CoV-2 in academics and employees of a public university in the North region of Paraná was 7%. In the bivariate analysis of factors associated with the presence of antibodies, teachers, people who had close contact with a confirmed case of COVID-19, fever, muscle pain, cough, sore throat, anosmia and ageusia, were the characteristics that were most associated with the disease. presence of antibodies. Conclusion: It was found that 7% of the academic community studied had antibodies against COVID-19. (AU)

Bauhinia forficata Link Infusions: Chemical and Bioactivity of Volatile and Non-Volatile Fractions.

This study aimed to evaluate Bauhinia forficata infusions prepared using samples available in Rio de Janeiro, Brazil. As such, infusions at 5% (w/v) of different brands and batches commercialized in the city (CS1, CS2, CS3, and CS4) and samples of plant material botanically identified (BS) were evaluated to determine their total phenolic and flavonoid contents (TPC and TFC), antioxidant capacity (ABTS•+, DPPH•, and FRAP assays), phytochemical profile, volatile compounds, and inhibitory effects against the α-amylase enzyme. The results showed that infusions prepared using BS samples had lower TPC, TFC and antioxidant potential than the commercial samples (p < 0.05). The batch averages presented high standard deviations mainly for the commercial samples, corroborating sample heterogeneity. Sample volatile fractions were mainly composed of terpenes (40 compounds identified). In the non-volatile fraction, 20 compounds were identified, with emphasis on the CS3 sample, which comprised most of the compounds, mainly flavonoid derivatives. PCA analysis demonstrated more chemical diversity in non-volatile than volatile compounds. The samples also inhibited the α-amylase enzyme (IC50 value: 0.235−0.801 mg RE/mL). Despite the differences observed in this work, B. forficata is recognized as a source of bioactive compounds that can increase the intake of antioxidant compounds by the population.

Establishment and characterization of human pluripotent stem cells-derived brain organoids to model cerebellar diseases.

The establishment of robust human brain organoids to model cerebellar diseases is essential to study new therapeutic strategies for cerebellum-associated disorders. Machado-Joseph disease (MJD) is a cerebellar hereditary neurodegenerative disease, without therapeutic options able to prevent the disease progression. In the present work, control and MJD induced-pluripotent stem cells were used to establish human brain organoids. These organoids were characterized regarding brain development, cell type composition, and MJD-associated neuropathology markers, to evaluate their value for cerebellar diseases modeling. Our data indicate that the organoids recapitulated, to some extent, aspects of brain development, such as astroglia emerging after neurons and the presence of ventricular-like zones surrounded by glia and neurons that are found only in primate brains. Moreover, the brain organoids presented markers of neural progenitors proliferation, neuronal differentiation, inhibitory and excitatory synapses, and firing neurons. The established brain organoids also exhibited markers of cerebellar neurons progenitors and mature cerebellar neurons. Finally, MJD brain organoids showed higher ventricular-like zone numbers, an indication of lower maturation, and an increased number of ataxin-3-positive aggregates, compared with control organoids. Altogether, our data indicate that the established organoids recapitulate important characteristics of human brain development and exhibit cerebellar features, constituting a resourceful tool for testing therapeutic approaches for cerebellar diseases.

Three-dimensional multilayer concentric bipolar electrodes restrict spatial activation in optic nerve stimulation.

Objective.Intraneural nerve interfaces often operate in a monopolar configuration with a common and distant ground electrode. This configuration leads to a wide spreading of the electric field. Therefore, this approach is suboptimal for intraneural nerve interfaces when selective stimulation is required.Approach.We designed a multilayer electrode array embedding three-dimensional concentric bipolar (CB) electrodes. First, we validated the higher stimulation selectivity of this new electrode array compared to classical monopolar stimulation using simulations. Next, we compared themin-vivoby intraneural stimulation of the rabbit optic nerve and recording evoked potentials in the primary visual cortex.Main results.Simulations showed that three-dimensional CB electrodes provide a high localisation of the electric field in the tissue so that electrodes are electrically independent even for high electrode density. Experimentsin-vivohighlighted that this configuration restricts spatial activation in the visual cortex due to the fewer fibres activated by the electric stimulus in the nerve.Significance.Highly focused electric stimulation is crucial to achieving high selectivity in fibre activation. The multilayer array embedding three-dimensional CB electrodes improves selectivity in optic nerve stimulation. This approach is suitable for other neural applications, including bioelectronic medicine.

Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial.

BACKGROUND: Patients hospitalised with COVID-19 are at risk for thrombotic events after discharge; the role of extended thromboprophylaxis in this population is unknown. METHODS: In this open-label, multicentre, randomised trial conducted at 14 centres in Brazil, patients hospitalised with COVID-19 at increased risk for venous thromboembolism (International Medical Prevention Registry on Venous Thromboembolism [IMPROVE] venous thromboembolism [VTE] score of ≥4 or 2-3 with a D-dimer >500 ng/mL) were randomly assigned (1:1) to receive, at hospital discharge, rivaroxaban 10 mg/day or no anticoagulation for 35 days. The primary efficacy outcome in an intention-to-treat analysis was a composite of symptomatic or fatal venous thromboembolism, asymptomatic venous thromboembolism on bilateral lower-limb venous ultrasound and CT pulmonary angiogram, symptomatic arterial thromboembolism, and cardiovascular death at day 35. Adjudication was blinded. The primary safety outcome was major bleeding. The primary and safety analyses were carried out in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT04662684. FINDINGS: From Oct 8, 2020, to June 29, 2021, 997 patients were screened. Of these patients, 677 did not meet eligibility criteria; the remaining 320 patients were enrolled and randomly assigned to receive rivaroxaban (n=160 [50%]) or no anticoagulation (n=160 [50%]). All patients received thromboprophylaxis with standard doses of heparin during hospitalisation. 165 (52%) patients were in the intensive care unit while hospitalised. 197 (62%) patients had an IMPROVE score of 2-3 and elevated D-dimer levels and 121 (38%) had a score of 4 or more. Two patients (one in each group) were lost to follow-up due to withdrawal of consent and not included in the intention-to-treat primary analysis. The primary efficacy outcome occurred in five (3%) of 159 patients assigned to rivaroxaban and 15 (9%) of 159 patients assigned to no anticoagulation (relative risk 0·33, 95% CI 0·12-0·90; p=0·0293). No major bleeding occurred in either study group. Allergic reactions occurred in two (1%) patients in the rivaroxaban group. INTERPRETATION: In patients at high risk discharged after hospitalisation due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. FUNDING: Bayer.

Evaluation of the antioxidant capacity, volatile composition and phenolic content of hybrid Vitis vinifera L. varieties sweet sapphire and sweet surprise.

Bioactive compounds were extracted using two different extraction solvents (acetone and water) from pulp and whole grape berries derived from hybrid Vitis vinifera L. varieties Sweet sapphire (SP) and Sweet surprise (SU) and were characterised based on a comprehensive metabolomic approach by chromatography coupled with mass spectrometry (UPLC-QTOF-MSE and GC-FID/MS). GC-FID/MS analysis was performed with two different extraction methods (solvent extraction method and solid-phase extraction). Anthocyanins were characterised and quantified by HPLC-UV. The antioxidant potential was assessed by different assays. SP acetone extract from grape skin had the highest mean to DPPH, FRAP, ORAC and phenolic content SP samples, also showed higher anthocyanin content. Globally, 87 phenolic compounds were identified. The relative quantification by UPLC-MSE showed flavonoids the most abundant class. Forty two compounds were found in the volatile fraction of SU, while only thirty one volatile compounds were found in the SP samples.

Prevalence and factors associated with chronic critical disease in hospitalized for trauma in intensive care / Prevalencia y factores asociados a enfermedad crónica crítica en hospitalizados por trauma en cuidados intensivos / Prevalência e fatores associados à doença crítica crônica em hospitalizados por trauma em terapia intensiva

ABSTRACT Objective to identify the prevalence of chronic critical disease and associated factors in patients hospitalized for trauma in the Intensive Care Unit. Method case-control study, with data from medical records of adults hospitalized for trauma in an Intensive Care Unit, between 2013 and 2019. Data were collected from the patient admission book, the electroni cmedical records and the records of the Hospital Infection Control Service. The dependent variable was the occurrence of chronic critical disease, and the independent variables were related to sociodemographic characteristics, comorbidities, trauma, pre-hospital care, prognostic indices, procedures and complications. Multiple logistic regression analysis was performed, which estimated the Ods Ratio (OR) and respective confidence intervals (CI). Results chronic critical disease occurred in 150 patients (24.2%), of the 619 patients studied. The factors associated with CCD were organic dysfunction (OR=1.09) and gastrointestinal complications (OR=2.71). Patients with chronic critical disease, in addition to proseeding for surgical procedures, developed organic dysfunctions in different systems, presenting high scores in prognostic indexes, i.e., a worse prognosis, in addition to developing complications. Conclusion the identification of gastrointestinal complications and the increase in organic dysfunction as factors associated with chronic critical patients become useful to compose the clinical profile of patients and to plan intensive care for the traumatized patients, thus contributing to the prevention and management of these patients by nurses.

RESUMEN Objetivo identificar la prevalencia de enfermedad crítica crónica y factores asociados en pacientes hospitalizados por trauma en la Unidad de Cuidados Intensivos. Método estudio de casos y controles, con datos de las historias clínicas de adultos internados por trauma en una Unidad de Cuidados Intensivos, entre 2013 y 2019. Los datos fueron recolectados del libro de ingreso de pacientes, la historia clínica electrónica y los formularios del Servicio de Control de Infecciones Hospitalarias. . La variable dependiente fue la ocurrencia de enfermedad crítica crónica, y las variables independientes se relacionaron con características sociodemográficas, comorbilidades, traumatismos, atención prehospitalaria, índices pronósticos, procedimientos y complicaciones. Se realizó análisis de regresión logística múltiple, que estimó el Ods Ratio (OR) y los respectivos intervalos de confianza (IC). Resultados la enfermedad crítica crónica se presentó en 150 pacientes (24,2%), de los 619 estudiados. Los factores asociados a CC fueron disfunción orgánica (OR=1,09) y complicaciones gastrointestinales (OR=2,71). Los pacientes con enfermedad crítica crónica, además de requerir procedimientos quirúrgicos, desarrollaron disfunciones de órganos en diferentes sistemas, presentando puntuaciones altas en los índices pronósticos, o sea, peor pronóstico, además de desarrollar complicaciones. Conclusión La identificación de las complicaciones gastrointestinales y el aumento de la disfunción orgánica como factores asociados a los pacientes críticos crónicos se vuelven útiles para componer el perfil clínico de los pacientes y planificar la terapia intensiva para pacientes traumatizados, contribuyendo así a la prevención y manejo de estas condiciones. pacientes por la enfermera.

RESUMO Objetivo identificar a prevalência de doença crítica crônica e fatores associados em pacientes hospitalizados por trauma em Unidade de Terapia Intensiva. Método estudo de caso-controle, com dados de prontuários de adultos hospitalizados por trauma em uma Unidade de Terapia Intensiva, entre 2013 e 2019. Os dados foram coletados do livro de admissão de pacientes, do prontuário eletrônico e das fichas do Serviço de Controle de Infecção Hospitalar. A variável dependente foi a ocorrência de doença crítica crônica e as variáveis independentes relacionavam-se às características sociodemográficas, comorbidades, trauma, atendimento pré-hospitalar, índices prognósticos, procedimentos e complicações. Realizou-se análise de regressão logística múltipla, que estimou o Ods Ratio (OR) e respectivos intervalos de confiança (IC). Resultados a doença crítica crônica ocorreu em 150 pacientes (24,2%), dos 619 estudados. Os fatores associados à DCC foram disfunção orgânica (OR=1,09) e complicações gastrointestinais (OR=2,71). Os pacientes com doença crítica crônica, além de demandarem por procedimentos cirúrgicos, desenvolveram disfunções orgânicas em diferentes sistemas, apresentando altas pontuações nos índices de prognósticos, ou seja, um pior prognóstico, além de desenvolverem complicações. Conclusão a identificação das complicações gastrointestinais e o aumento da disfunção orgânica como fatores associados ao paciente crítico crônico tornam-se úteis para compor perfil clínico de pacientes e para planejar a assistência intensiva ao traumatizado, contribuindo, assim, para a prevenção e o manejo desses pacientes pelo enfermeiro.

Efeitos de intervenção educativa no letramento em saúde e no conhecimento sobre diabetes: estudo quase-experimental / Efectos de la intervención educativa en la alfabetización en salud y el conocimiento sobre la diabetes: estudio cuasiexperimental / Effects of educational intervention on health literacy and knowledge about diabetes: a quasi-experimental study

RESUMO Objetivo Analisar os efeitos de intervenção educativa no letramento em saúde e no conhecimento sobre diabetes em adultos atendidos na atenção primária à saúde. Método Trata-se de estudo quase-experimental com intervenção educativa durante a consulta de enfermagem, atividade em grupo e acompanhamento telefônico com 33 adultos diagnosticados com diabetes mellitus tipo 2, cadastrados em uma Unidade Estratégia Saúde da Família no Sul do Brasil. Aplicaram-se instrumentos sociodemográfico e clínico (Spoken Knowledge in Low Literacy Patients with Diabetes e Eight-Item Health Literacy Assessment Tool) antes e após a intervenção. Os dados foram analisados pelos testes de Wilcoxom, coeficiente de correlação de Spearman e McNemar. Resultados A maioria dos participantes eram mulheres (69,7%), com idade média de 57,0 anos, tempo de escolaridade inferior a nove anos (69,7%) e tempo de diagnóstico ≤10 anos (51,5%). Após a intervenção, obteve-se aumento do conhecimento sobre a diabetes (p = 0,001), correlacionado ao letramento em saúde (r = 0,494; p = 0,001) e ao tempo do diagnóstico (r = 0,455; p = 0,001). Conclusão e implicação para a prática A utilização de instrumentos para mensurar o letramento em saúde e o conhecimento sobre diabetes possibilitou a construção de estratégias educativas voltadas para as lacunas existentes, promovendo aumento do conhecimento, o qual favorece o desenvolvimento das habilidades para a autogestão.

RESUMEN Objetivo Analizar los efectos de la intervención educativa sobre la alfabetización en salud y el conocimiento sobre diabetes en adultos tratados en la Atención Primaria de Salud. Método Se trata de un estudio cuasiexperimental, con intervención educativa, durante la consulta de enfermería en 33 adultos diagnosticados de Diabetes Mellitus tipo 2 registrados en una Unidad de Estrategia de Salud Familiar en el sur de Brasil, con actividades grupales y seguimiento telefónico. Antes y después de la intervención, se aplicaron instrumentos sociodemográficos y clínicos: Spoken Knowledge in Low Literacy Patients with Diabetes and the Eight-Item Health Literacy Assessment Tool. Los datos se analizaron mediante las pruebas de coeficiente de correlación de Wilcoxom, Spearman y McNemar. Resultados La mayoría fueron mujeres (69,7%), con una edad media de 57,0 años, menos de nueve años de escolaridad (69,7%) y tiempo de diagnóstico ≤ 10 años (51,5%). Después de la intervención, hubo un aumento en el conocimiento sobre diabetes (p = 0,001), correlacionado con la alfabetización en salud (r = 0,494 p = 0,001) y el tiempo desde el diagnóstico (r = 0,455 p = 0,001). Conclusión e implicaciones para la práctica El uso de instrumentos para medir la alfabetización en salud y el conocimiento sobre la diabetes permitieron la construcción de estrategias educativas orientadas a las brechas existentes, aumentando su conocimiento, lo que favorece el desarrollo de habilidades para el autocuidado.

ABSTRACT Objective To analyze the effects of educational intervention on health literacy and knowledge about diabetes in adults assisted in primary health care. Method This is a quasi-experimental study with educational intervention during the nursing consultation with 33 adults diagnosed with type 2 diabetes mellitus registered in a Family Health Strategy Unit in southern Brazil and involving group activity and telephone follow-up. Sociodemographic and clinical instruments were applied before and after the intervention; these instruments included the Spoken Knowledge in Low Literacy Patients with Diabetes and the Eight-Item Health Literacy Assessment Tool. Data were analyzed using the Wilcoxon, Spearman, and McNemar correlation coefficient tests. Results Most participants were women (69.7%), with a mean age of 57.0 years, less than nine years of schooling (69.7%), and ≤10 years of diagnosis (51.5%). After the intervention, there was an increase in knowledge about diabetes (p = 0.001), correlated with health literacy (r = 0.494; p = 0.001) and the time of diagnosis (r = 0.455; p = 0.001). Conclusion and implications for practice The instruments to measure health literacy and knowledge about diabetes enabled the construction of educational strategies aimed at existing gaps, increasing the knowledge, thereby favoring the development of skills for self-management.

Extracellular Vesicles Physiological Role and the Particular Case of Disease-Spreading Mechanisms in Polyglutamine Diseases.

Recent research demonstrated pathological spreading of the disease-causing proteins from one focal point across other brain regions for some neurodegenerative diseases, such as Parkinson's and Alzheimer's disease. Spreading mediated by extracellular vesicles is one of the proposed disease-spreading mechanisms. Extracellular vesicles are cell membrane-derived vesicles, used by cells for cell-to-cell communication and excretion of toxic components. Importantly, extracellular vesicles carrying pathological molecules, when internalized by "healthy" cells, may trigger pathological pathways and, consequently, promote disease spreading to neighboring cells. Polyglutamine diseases are a group of genetic neurodegenerative disorders characterized by the accumulation of mutant misfolded proteins carrying an expanded tract of glutamines, including Huntington's and Machado-Joseph disease. The pathological spread of the misfolded proteins or the corresponding mutant mRNA has been explored. The understanding of the disease-spreading mechanism that plays a key role in the pathology progression of these diseases can result in the development of effective therapeutic approaches to stop disease progression, arresting the spread of the toxic components and disease aggravation. Therefore, the present review's main focus is the disease-spreading mechanisms with emphasis on polyglutamine diseases and the putative role played by extracellular vesicles in this process.

[The relationship between the assessment of performance of primary health care and infant mortality in Brazil]. / Relação entre a avaliação de desempenho da atenção básica e a mortalidade infantil no Brasil.

The article assesses the relationship between the Infant Mortality Rate (IMR) and the percentage of health units that obtained good performance ratings in the appraisal by the National Program to Improve Access and Quality (PMAQ) of Primary Care in Brazilian states and the relation to the variables involved. Using a descriptive study, the results of the performance assessment of the participating units of the third cycle of PMAQ (2015-2017) and the relationship with the IMR (2015-2017) were analyzed. Descriptive, Pearson correlation, and cluster analysis were performed. The results revealed that there is a negative and moderate correlation (-0.534) between the IMR and the units with a good and statistically significant (p=0.005) performance rating. With cluster analysis, it was possible to confirm that Brazilian states from different regions reveal similarities in the variables of the study. Thus, there is a relationship between IMR and units with a good performance rating. The results also showed that the similarities between the states are not restricted to the region in which they are located. Therefore, the importance of investing in primary care training is paramount in terms of an effective impact on the health of the population.

O artigo verifica se há relação entre a Taxa de Mortalidade Infantil (TMI) e o percentual de unidades de saúde que obtiveram boa classificação de desempenho na avaliação do Programa Nacional de Melhoria do Acesso e da Qualidade da atenção básica (PMAQ) nos estados brasileiros, e a similaridade entre estes estados em relação a essas variáveis. Utilizando-se de um estudo descritivo, foram analisados os resultados da avaliação de desempenho das unidades participantes do 3º ciclo do PMAQ (2015-2017) e a relação com a TMI (2015-2017). Foram realizadas análises descritivas, de correlação de Pearson e análise de cluster. Os resultados demonstraram que há correlação negativa e moderada (-0,534) entre a TMI e as unidades com boa classificação de desempenho e estatisticamente significante (p=0,005). Com a análise de cluster, foi possível verificar que estados de diferentes regiões apresentam similaridade nas variáveis do estudo. Enfim, existe relação entre a TMI às unidades com boa classificação de desempenho, além disso, verificou-se que a similaridade entre os estados vai além da região a que pertencem. Portanto, fica evidente a importância do investimento na qualificação da AB para o impacto efetivo na saúde da população.