Comparative analysis of the antimicrobial resistance and virulence traits in ESBL-producing-Klebsiella pneumoniae ST307 strains colonizing the gastrointestinal tract and causing a fatal bloodstream infection in a leukemia patient.

Klebsiella pneumoniae is an opportunistic pathogen that can colonize the gastrointestinal tract (GIT) of humans. The mechanisms underlying the successful translocation of this pathogen to cause extra-intestinal infections remain unknown, although virulence and antimicrobial resistance traits likely play significant roles in the establishment of infections. We investigated K. pneumoniae strains isolated from GIT colonization (strains Kp_FZcol-1, Kp_FZcol-2 and Kp_FZcro-1) and from a fatal bloodstream infection (strain Kp_HM-1) in a leukemia patient. All strains belonged to ST307, carried a transferable IncF plasmid containing the blaCTX-M-15 gene (pKPN3-307 TypeA-like plasmid) and showed a multidrug-resistance phenotype. Phylogenetic analysis demonstrated that Kp_HM-1 was more closely related to Kp_FZcro-1 than to the other colonizing strains. The Kp_FZcol-2 genome showed an 81 % coverage with the Kp_HM-1 246,730 bp plasmid (pKp_HM-1), lacking most of the plasmid's putative virulence genes. Searching public genomes with similar coverage, we observed the occurrence of this deletion in K. pneumoniae ST307 strains recovered from human colonization and infection in different countries. Our findings suggest that strains lacking the putative virulence genes found in the pKPN3-307 TypeA plasmid are still able to colonize and infect humans, highlighting the need to further investigate the role of these genes for the adaptation of K. pneumoniae ST307 in distinct human body sites.

Diagnosis and Prevention of Periprosthetic Joint Infections by Staphylococcus aureus after Hip Fracture: A Systematic Review of the Literature.

Hip arthroplasties are surgical procedures widely performed all over the world, seeking to return functionality, relieve pain, and improve the quality of life of patients affected by osteoarthritis, femoral neck fractures, osteonecrosis of the femoral head, among other etiologies. Periprosthetic joint infections are one of the most feared complications due to the high associated morbidity and mortality, with a high number of pathogens that may be associated with its etiology. The aim of the present study was to analyze aspects correlated with the occurrence of infection, diagnosis and prevention of periprosthetic joint infections in the hip associated with Staphylococcus aureus after corrective surgery for hip fractures. This is a systematic review of the literature carried out in the databases indexed in the Medical Literature Analysis and Retrieval System Online (MEDLINE) carried out in accordance with the precepts established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Twenty studies that addressed the diagnosis and prevention of periprosthetic joint infections after hip fractures were selected for analysis. It is observed that there is no consensus in the literature on preventive measures for the occurrence of such infectious processes. Among the risk factors for the occurrence and severity of infections by S. aureus after hip arthroplasties, obesity, longer surgical time, older age, immunosuppression, recent use of antibiotics, and multicomorbidities were mentioned. The use of biomarkers for early diagnosis, as well as screening, decolonization, and antibiotic prophylaxis processes are among the preventive procedures proposed in the literature.

Prevalence of errors causing events allegedly attributable to vaccination/immunization: systematic review and meta-analysis.

OBJECTIVE: To identify the prevalence of errors that caused events supposedly attributable to vaccination or immunization. METHOD: Systematic literature review with meta-analysis carried out on the Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; and Grey Lit databases; with studies that presented the prevalence of immunization errors that caused events or that provided data that allowed this indicator to be calculated. RESULTS: We evaluated 11 articles published between 2010 and 2021, indicating a prevalence of 0.044 errors per 10,000 doses administered (n=762; CI95%: 0.026 - 0.075; I2 = 99%, p < 0.01). The prevalence was higher in children under 5 (0.334 / 10,000 doses; n=14). The predominant events were fever, local pain, edema and redness. CONCLUSION: A low prevalence of errors causing events was identified. However, events supposedly attributable to vaccination or immunization can contribute to vaccine hesitancy and, consequently, have an impact on vaccination coverage.

Prevalence of errors causing events allegedly attributable to vaccination/immunization: systematic review and meta-analysis / Prevalencia de errores causantes de acontecimientos supuestamente atribuibles a la vacunación/inmunización: revisión sistemática y metanálisis / Prevalência de erros que causaram eventos supostamente atribuíveis à vacinação/imunização: revisão sistemática e metanálise

ABSTRACT Objective: To identify the prevalence of errors that caused events supposedly attributable to vaccination or immunization. Method: Systematic literature review with meta-analysis carried out on the Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; and Grey Lit databases; with studies that presented the prevalence of immunization errors that caused events or that provided data that allowed this indicator to be calculated. Results: We evaluated 11 articles published between 2010 and 2021, indicating a prevalence of 0.044 errors per 10,000 doses administered (n=762; CI95%: 0.026 - 0.075; I2 = 99%, p < 0.01). The prevalence was higher in children under 5 (0.334 / 10,000 doses; n=14). The predominant events were fever, local pain, edema and redness. Conclusion: A low prevalence of errors causing events was identified. However, events supposedly attributable to vaccination or immunization can contribute to vaccine hesitancy and, consequently, have an impact on vaccination coverage.

RESUMEN Objetivo: Identificar la prevalencia de errores que causaron eventos supuestamente atribuibles a la vacunación o inmunización. Método: Revisión sistemática de la literatura con metaanálisis realizada en las bases de datos Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; y Grey Lit; con estudios que presentaran la prevalencia de errores de inmunización que causaron eventos o que aportaran datos que permitieran calcular este indicador. Resultados: Se evaluaron 11 artículos publicados entre 2010 y 2021, indicando una prevalencia de 0,044 errores por cada 10.000 dosis administradas (n=762; IC95%: 0,026 - 0,075; I2 = 99%, p < 0,01). La prevalencia fue mayor en niños menores de 5 años (0,334 / 10.000 dosis; n=14). Los eventos predominantes fueron fiebre, dolor local, edema y enrojecimiento. Conclusión: Se identificó una baja prevalencia de eventos causantes de errores. Sin embargo, los eventos supuestamente atribuibles a la vacunación o inmunización pueden contribuir a la indecisión sobre la vacunación y, en consecuencia, repercutir en la cobertura vacunal.

RESUMO Objetivo: Identificar a prevalência de erros que causaram eventos supostamente atribuíveis à vacinação ou imunização. Método: Revisão sistemática da literatura com metanálise realizada nas bases Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; e Grey Lit; com estudos que apresentassem prevalência de erros de imunização que causaram eventos ou que disponibilizassem dados que permitissem o cálculo deste indicador. Resultados: Avaliou-se 11 artigos publicados entre 2010 e 2021, apontando prevalência de 0,044 erros por 10.000 doses administradas (n=762; IC95%: 0,026 - 0,075; I2= 99%, p < 0,01). A prevalência foi maior em crianças menores de 5 anos (0,334 / 10.000 doses; n=14). Quanto aos eventos, predominou-se: febre, dor local, edema, rubor. Conclusão: Identificou-se uma prevalência baixa de erros que causaram eventos. Entretanto, os eventos supostamente atribuíveis à vacinação ou imunização podem contribuir para a hesitação vacinal e, consequentemente, impactar nas coberturas vacinais.

Performance of Body Fat Percentage, Fat Mass Index and Body Mass Index for Detecting Cardiometabolic Outcomes in Brazilian Adults.

Obesity is a recognized risk factor for the development of cardiometabolic outcomes. Therefore, it is essential to evaluate anthropometric and body composition indicators used for its diagnosis. This study aimed to assess the diagnostic performance of body fat percentage (BF%), fat mass index (FMI) and body mass index (BMI) for detecting cardiometabolic outcomes in adults. A cross-sectional study was conducted involving adults at 30 years of age from Pelotas, RS (n = 3517) and at 37-39 years from Ribeirão Preto, SP (n = 1696). Receiver operating characteristic (ROC) curves were used to determine the cut-off points for predicting cardiometabolic risk factors, including altered blood pressure, blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDDL-c), C-reactive protein and glycated hemoglobin. The cut-off points of BF% ranged from 25.2 to 27.8 in men and from 37.4 to 39.7 in women at 30 years, and from 26.1 to 27.8 in men and from 38.5 to 42.2 in women at 37-39 years. For FMI (kg/m2), the cut-off points ranged from 6.3 to 7.5 in men and from 9.5 to 10.8 in women at 30 years, and from 7.3 to 7.8 in men and from 10.2 to 12.2 in women at 37-39 years. The BMI cut-off points (kg/m2) ranged from 26.3 to 27.3 in men and from 25.4 to 27.2 in women at 30 years, and from 28.3 to 29.0 in men and from 27.2 to 29.6 in women at 37-39 years. The areas under the curve were similar for the three indicators, ranging from 0.523 to 0.746. BMI showed a performance similar to that of the body fat-based indicators in identifying cardiometabolic outcomes. The cut-off points of the three indicators showed acceptable discriminatory power in subjects with cardiometabolic risk factors.

A comprehensive review and meta-regression analysis of randomized controlled trials examining the impact of vitamin B12 supplementation on homocysteine levels.

CONTEXT: Although some research suggests that vitamin B12 (hereafter, B12) supplements can lower homocysteine (Hcy) levels and treat hyperhomocysteinemia, these results are still ambiguous when B12 is taken as an isolated supplement. OBJECTIVE: This study sought to determine how existing randomized controlled trials (RCTs) could be used to examine the effects of B12 supplementation on Hcy. DATA SOURCES: To find pertinent RCTs up to June 2022, databases, including PubMed/Medline, Web of Science, Scopus, Cochrane Library, and Embase, were searched. DATA EXTRACTION: All selected RCTs investigated the impact of B12 supplements on Hcy. A meta-analysis of the eligible studies was performed using the random-effects model. DATA ANALYSIS: This review included a total of 21 RCTs (N = 1625 participants). Hcy levels were significantly lower after B12 supplementation compared with the control group (pooled weighted mean difference, -4.15 µmol/L; 95% confidence interval, -4.86, -3.45; P < 0.001), and this reduction was even greater with intervention durations ≥12 weeks and doses >500 µg/d. Furthermore, the effect of B12 supplementation in the form of hydroxocobalamin on the reduction of Hcy level was greater compared with other forms. CONCLUSION: In conclusion, this meta-analysis shows that B12 supplementation has a positive impact on lowering blood Hcy levels, particularly when administered for a longer period and at a larger dose. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022364066.

Analysis of the epidemiological profile of congenital hip deformities, 2011-2021.

OBJECTIVE: This study aimed to identify the relevance of hospitalizations for congenital hip deformities in Bahia. METHODS: This is a retrospective epidemiological study in public databases. Descriptors in health sciences: "congenital hip dysplasia", "congenital hip dislocation", and "congenital dislocation hip". This is qualitative-quantitative research with the analysis of secondary data and cross-sectional typologies in the databases of the Ministry of Health - Health Information (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS). RESULTS: Bahia was the third Brazilian state with the highest number of hospitalizations, registering 1481 cases. The municipalities in Bahia with the highest prevalence were Itanhém, Salvador, and Barreiras, with 912, 445, and 20 cases, respectively. CONCLUSIONS: The elevated number of congenital hip deformities reflects a public health problem, requiring investments in public policies.

Extracellular Vesicles from Candida haemulonii var. vulnera Modulate Macrophage Oxidative Burst.

Members of the Candida haemulonii species complex are multidrug-resistant emergent yeast pathogens able to cause superficial and invasive infections in risk populations. Fungal extracellular vesicles (EVs) play a critical role in the pathogenicity and virulence of several species and may perform essential functions during infections, such as carrying virulence factors that behave in two-way communications with the host, affecting survival and fungal resistance. Our study aimed to describe EV production from Candida haemulonii var. vulnera and evaluate whether murine macrophage RAW 264.7 cells respond to their stimuli by generating an oxidative response after 24 h. For this purpose, reactive oxygen species detection assays demonstrated that high concentrations of yeast and EVs (1010 particles/mL) of Candida haemulonii did not change macrophage viability. However, the macrophages recognized these EVs and triggered an oxidative response through the classical NOX-2 pathway, increasing O2•- and H2O2 levels. However, this stress did not cause lipid peroxidation in the RAW 264.7 cells and neither lead to the activation of the COX-2-PGE2 pathway. Thus, our data suggest that low concentrations of C. haemulonii EVs are not recognized by the classical pathway of the oxidative burst generated by macrophages, which might be an advantage allowing the transport of virulence factors via EVs, not identified by the host immune system that could work as fine tube regulators during infections caused by C. haemulonii. In contrast, C. haemulonii var. vulnera and high EV concentrations activated microbicidal actions in macrophages. Therefore, we propose that EVs could participate in the virulence of the species and that these particles could be a source of antigens to be exploited as new therapeutic targets.

Tele-assessment of activities and participation in chronic phase of stroke: Is use valid and viable in a developing country?

BACKGROUND: SATISPART-Stroke (SATIS-Stroke) is the most complete instrument for the assessment of activity and participation following a stroke. However, its use in a developing country has only been tested through in-person interviews. OBJECTIVE: To determine the validity, reproducibility and viability of the SATIS-Stroke scale administered in two tele-assessment modalities: self-assessment of an electronic form versus videoconference. METHODS: Methodological study with Brazilian chronic stroke survivors was conducted. Stage I comprised an in-person interview to apply the SATIS-Stroke and a self-assessment by completing an electronic form to respond to the SATIS-Stroke items. Step II occurred 6 to 8 months after Step I, during which SATIS-Stroke was administered again in-person and via videoconference. The order was randomized. RESULTS: Ninety-five stroke survivors were recruited, but only 50 answered the electronic form (adherence: 52.6%). Mean scores were higher in the self-administration of electronic form compared to the in-person interview (mean difference = -0.36 ± 0.93; P = 0.009). Adequate reliability was found in the comparison of the in-person and self-assessment of electronic form (ICC2,1 = 0.66; 95%CI: 0.40-0.81). Fifty stroke survivors participated in Step II, during which adequate reliability was found in the comparison of the in-person administration and videoconference (ICC2,1 = 0.55; 95%CI: 0.21-0.74) and a moderate correlation was found between the assessment methods (r = 0.43; P = 0.02). DISCUSSION: Adequate validity and reliability were found in the tele-assessment. Thus, this method is appropriate and viable for use in developing countries. Although reliable, the self-assessment did not have good adherence in the Brazilian population due to internet access problems, lack of familiarity with the digital form and lack of autonomy to answer the questions alone.

Biochemical analysis of oxidative stress and purinergic system in pregnant women with gestational diabetes mellitus / Análise bioquímica do estresse oxidativo e do sistema purinérgico em gestantes com diabetes mellitus gestacional

Background: Pregnancy is characterized as a physiological period with greater sensitivity to insulin resistance and changes in oxidative stress. Purinergic signaling is directly related to diabetes, as this condition modifies the concentration of extracellular ATP and the level of degradation of ATP to adenosine. Objective: Analyze oxidative stress and the purinergic system in pregnant women with Gestational Diabetes Mellitus (GDM) and compare them with low-risk pregnant women (LR). Materials and Methods: The research was of a quantitative approach of an experimental nature. The study was carried out at the Clínica da Mulher, which serves high-risk pregnant women, and at the Family Health Centers, which serves low-risk pregnant women, both located in Chapecó, Santa Catarina, Brazil. Results: From the analysis, it was observed that oxidative stress was increased in pregnant women in LR compared to pregnant women with GDM by increasing the concentration of TBARS and reducing the concentration of Carbonyl Protein in pregnant women with LR. Regarding the purinergic system, there was a significant decrease in the hydrolysis of the nucleotides ATP, ADP, and AMP in pregnant women with GDM, and a significant increase in the hydrolysis of ADA, also in pregnant women with GDM. Conclusion: Therefore, pregnant women with GDM have less oxidative stress compared to pregnant women in LR concerning TBARS and Carbonyl Protein markers, thus allowing a greater antioxidant defense mechanism. Furthermore, concerning the purinergic system, there is an increase in the activity of ADA, which is directly related to the immunosuppression process, a necessary condition for the protection of the fetus during the gestational period (AU).

Introdução: A gravidez é caracterizada como um período fisiológico em que há uma maior sensibilidade a resistência à insulina e alterações no estresse oxidativo. A sinalização purinérgica está diretamente relacionada ao diabetes, pois esta condição modifica a concentração de ATP extracelular e o nível de degradação de ATP em adenosina. Objetivo:Analisar o estresse oxidativo e o sistema purinérgico em gestantes com Diabetes Mellitus Gestacional (DMG) e compará-los com gestantes de baixo risco (BR). Materiais e Métodos: A pesquisa foi de abordagem quantitativa, de caráter experimental. O estudo foi realizado na Clínica da Mulher, que atende gestantes de alto risco, e nas Unidades de Saúde da Família, que atendem gestantes de baixo risco, ambas localizadas no município de Chapecó, Santa Catarina, Brasil. Resultados: A partir das análises, observou-se que o estresse oxidativo apresentou-se aumentado em gestantes de BR quando comparado a gestantes com DMG. No que tange ao sistema purinérgico, houve uma diminuição significativa na hidrólise dos nucleotídeos ATP, ADP e AMP em gestantes com DMG, bem como um aumento significativo na hidrólise de ADA, também em gestantes com DMG. Conclusão: Portanto, gestantes com DMG possuem menor estresse oxidativo quando comparado a gestantes de BR, permitindo assim, um maior mecanismo de defesa antioxidante. Para mais, no que se refere ao sistema purinérgico, verifica-se o aumento da concentração de ADA está diretamente relacionada ao processo de imunossupressão, condição necessária à proteção do feto durante o período gestacional (AU).

Municipal solid waste management with recyclable potential in developing countries: Current scenario and future perspectives.

Municipal solid waste (MSW) is a complex challenge to be solved worldwide, intensified in developing countries since in addition to economic and environmental aspects there is also the social aspect represented by the collector individual. From an integrative bibliographic review this study longitudinally analyses the socio-productive inclusion of collectors in the municipal solid waste management (MSWM) at an international level. Aiming: (a) to identify relevant articles describing/studies on MSWM with social inclusion of scavengers around the world; (b) to analyse these articles in order to present its main characteristics; (c) to describe municipal solid waste management with recyclable potential (MSWRP) with socio-productive inclusion of collectors; (d) the study provides a more detailed summary of MSWRP management in some developing countries: Brazil, China, India, Indonesia, Mexico, Nigeria and Pakistan; and (e) to provide a framework indicating the future practices and perspectives of MSWRP. As result, this study presents the paradigms and future questions for an effective improvement of WSWM, such as: Professional Training of Scavengers, Cultural Issues, Empowerment of Scavenger, Recycling Cooperatives and Cooperativism, Policy Issues and Recycling Chain, Management Systems and Process Improvement, Quality of Services Provided, Circular Economy and Informal Sector, Health Quality and Safety at Work, Barriers and Solutions for the Inclusion of the Informal Sector, Environmental, Economic and Social Benefits.

Effectiveness of Epidermal Growth Factor Loaded Carboxymethylcellulose (EGF-CMC) Hydrogel in Biofilm Formation in Wounds of Diabetic Patients: A Randomized Clinical Trial.

Diabetic patients frequently develop wounds, which can be colonized by bacteria, mainly Staphylococcus aureus and Pseudomonas aeruginosa, with the ability to form biofilms. This study aimed to evaluate the colonization and biofilm formation of Staphylococcus aureus and Pseudomonas aeruginosa in chronic wounds of diabetic patients treated with a bioactive dressing (EGF-CMC), which consisted of a 2% carboxymethylcellulose (CMC) hydrogel loaded with epidermal growth factor (EGF). This randomized clinical trial was conducted with 25 participants: 14 treated with EGF-CMC hydrogel and 11 treated with CMC hydrogel for 12 weeks. Participants with type 2 diabetes mellitus were selected. All had diabetic foot ulcers or chronic venous ulcers. Swab collections were performed on weeks 1, 6, and 12. The laboratory analyses included the identification of strains, microbial quantification, virulence gene investigation, and the evaluation of biofilm formation. In total, 13 S. aureus strains and 15 P. aeruginosa strains were isolated. There were no statistically significant differences regarding bacterial loads and virulence genes. However, EGF-CMC-hydrogel-treated wounds were colonized by strains with lower biofilm formation abilities. The probability of isolating biofilm-producing strains from CMC-hydrogel-treated wounds was 83% greater than the probability of isolating biofilm-producing strains from EGF-CMC-treated wounds.

Technological aspects and health effects of hydrolyzed collagen and application in dairy products.

With the rise of a consumer market increasingly concerned with food and healthy lifestyle habits, the search for functional products has increased in the last years. In this context, dairy products are relevant since they are already included in the consumer's diet. Furthermore, hydrolyzed collagen stands out among products with bioactive action, as it promotes the reduction of the incidence of arthritis, osteoporosis, hypertension, obesity, and premature aging and contains healing, antioxidant and antimicrobial properties. In addition to health benefits, the addition of these ingredients to dairy products can influence physical, chemical, rheological, microbiological, and sensory characteristics, such as: decreased syneresis and improved texture of fermented milks; viscosity increase in dairy beverage; increased proteolytic activity in cheeses; and increasing the viability of probiotics, without significantly altering the quality standards of the legislation. Despite the benefits described, more studies are needed to evaluate these effects in different dairy products.

Dimensionamento do quadro de pessoal de enfermagem na atenção básica no distrito de Cacau Pirêra, Amazonas / Sizing of the nursing staff in basic care in the district of Cacau Pirêra, Amazonas / Tamaño del marco del personal de enfermería en la atención básica del distrito de Pyrêra Cococoa, Amazonas

Objetivo: Descrever o dimensionamento do quadro de pessoal de Enfermagem na atenção básica em um município do Amazonas. Metodologia: Método qualitativo de caráter descritivo, com investigação do objeto fundamentada no Estudo de Casos Múltiplos, segundo Yin (2015). A pesquisa foi realizada em duas Unidades Básicas de Saúde ­ UBS, localizadas no distrito do Cacau Pirêra, município de Iranduba, no estado do Amazonas. Aprovada pelo Comitê de Ética em Pesquisa da Universidade Paulista ­ CEP/UNIP, sob o Parecer de nº 5.968.666 e CAAE 67017022.1.0000.5512. Resultados: Conforme Resolução COFEN n° 543 de 2017, as unidades em estudo obtiveram quantidade insuficiente de profissionais de determinadas categorias que resulta em pressão da carga de trabalho, porém também obtiveram números de profissionais de outras categorias em equilíbrio conforme suas respectivas demandas. Considerações Finais: Percebe-se o quão importante é essa ferramenta de gestão, que permite ampliar a visão para as condições de trabalho da equipe no momento atual, uma vez que projeta o quantitativo adequado de profissionais para favorecer assistência qualificada. Espera-se, portanto, que essa pesquisa estimule futuras investigações que levem em consideração o dimensionamento para além do ambiente intra-hospitalar e subsidie políticas que efetivem esse olhar mais ampliado sobre o tema.

Objective: To describe the dimensioning of nursing staff in primary care in a municipality of Amazonas. Methodology: Qualitative method of descriptive character, with investigation of the object based on the Multiple Case Study, according to Yin (2015). The research was carried out in two Basic Health Units - UBS, located in the district of Cacau Pirêra, Iranduba municipality, in the state of Amazonas. Approved by the Research Ethics Committee of Universidade Paulista - CEP/UNIP, under the Opinion No. 5.968.666 and CAAE 67017022.1.0000.5512. Results: According to COFEN Resolution n° 543 of 2017, the units under study obtained an insufficient number of professionals of certain categories that results in workload pressure, but also obtained numbers of professionals of other categories in balance according to their respective demands. Final Considerations: We realize how important this management tool is, which allows us to broaden the vision for the working conditions of the team at the current moment, since it designs the appropriate number of professionals to favor qualified assistance. It is hoped, therefore, that this research will stimulate future investigations that take into consideration the dimensioning beyond the intra-hospital environment and will provide input for policies that will make this broader view of the theme effective.

Propósito: Describir el tamaño del personal de enfermería en la atención básica de un municipio de Amazonas. Metodología: Método cualitativo de carácter descriptivo, con investigación de objetos basada en el estudio de casos múltiples según Yin (2015). La investigación se llevó a cabo en dos Unidades Básicas de Salud ­ UBS, ubicadas en el distrito de Cacau Pirêra, en el municipio de Iranduba, en el estado de Amazonas. Aprobado por el Comité de Ética de la Investigación de la Universidad Paulista (CEP/UNIP), con arreglo a los dictámenes no 5.968.666 y CAAE 67017022.1.000.5512. Resultados: De acuerdo con la Resolución 543 de la COFEN de 2017, las unidades estudiadas obtuvieron un número insuficiente de profesionales de ciertas categorías que resultan en presión de la carga de trabajo, pero también obtuvieron un número de profesionales de otras categorías en equilibrio de acuerdo con sus respectivas demandas. Consideraciones finales: Se puede ver lo importante que es esta herramienta de gestión, que permite ampliar la visión de las condiciones de trabajo del equipo en este momento, ya que proyecta la cantidad apropiada de profesionales para favorecer la asistencia calificada. Por lo tanto, se espera que esta investigación estimule futuras investigaciones que tengan en cuenta la dimensión más allá del entorno intrahospitalario y subvencionen políticas que lleven a cabo este enfoque más amplio sobre el tema.

Analysis of the epidemiological profile of congenital hip deformities, 2011-2021 / Análise do perfil epidemiológico das deformidades congênitas de quadril, 2011-2021

ABSTRACT Objective: This study aimed to identify the relevance of hospitalizations for congenital hip deformities in Bahia. Methods: This is a retrospective epidemiological study in public databases. Descriptors in health sciences: "congenital hip dysplasia", "congenital hip dislocation", and "congenital dislocation hip". This is qualitative-quantitative research with the analysis of secondary data and cross-sectional typologies in the databases of the Ministry of Health - Health Information (TABNET), made available by the Department of Informatics of the Unified Health System (DATASUS). Results: Bahia was the third Brazilian state with the highest number of hospitalizations, registering 1481 cases. The municipalities in Bahia with the highest prevalence were Itanhém, Salvador, and Barreiras, with 912, 445, and 20 cases, respectively. Conclusions: The elevated number of congenital hip deformities reflects a public health problem, requiring investments in public policies.

RESUMO Objetivo: Identificar a relevância das internações por deformidades congênitas do quadril na Bahia. Métodos: Este é um estudo epidemiológico retrospectivo, feito em bases de dados públicas. Descritores em ciências da saúde: "displasia congênita de quadril", "Hip Dislocation Congenital" AND "Luxação congênita de quadril". Trata-se de uma pesquisa qualiquantitativa, com análise de dados secundários e tipologia transversal nas bases de dados do Ministério da Saúde — Informações de Saúde (TABNET), disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: A Bahia foi o terceiro estado brasileiro com maior número de internações, registrando 1.481 casos. Os municípios baianos com maiores prevalências foram Itanhém, Salvador e Barreiras, com 912, 445 e 20 casos, respectivamente. Conclusão: O elevado número de deformidades congênitas do quadril reflete um problema de saúde pública, necessitando de investimentos em políticas públicas.

Participação parental na divulgação científica sobre transtorno do espectro autista (tea) / Parental participation in science communication about autism spectrum disorder (asd)

RESUMO A participação de familiares de pessoas com Transtorno do Espectro Autista (TEA), em especial as mães, na busca e na utilização de informações sobre o tema para melhoria da qualidade de vida é reconhecida. Entretanto, pouco se sabe sobre os modos de participação, os conhecimentos, as ferramentas de circulação de informação, as representações envolvidas ou as determinações decorrentes desses processos. Com o objetivo de compreender os modos de participação de familiares de pessoas com TEA em ações comunicacionais sobre o tema bem como os elementos culturais relacionados, utilizou-se, como ferramenta teórico-metodológica, o Circuito da Cultura. Aplicou-se um questionário online destinado a familiares de pessoas com TEA, divulgado via associações. A partir de uma análise quali-quantitativa, percebeu-se que a divulgação científica sobre o TEA pode constituir-se como uma importante ferramenta para a comunicação entre sujeitos e coletivos envolvidos com o tema. A busca e a produção de informações e a formação de redes de apoio entre familiares e especialistas promovem transformações em percepções, atitudes e valores no grupo familiar e, muitas vezes, em contextos extrafamiliares.

ABSTRACT The participation of family members of people with Autism Spectrum Disorder (ASD), especially mothers, in the search and use of information on the subject to improve life quality is recognized. However, little is known about the participation ways, the knowledge, the tools for information circulation, the representations involved or the determinations arising from these processes. In order to understand the participation of family members of people with ASD in communicational actions on the theme as well as the related cultural elements, the Culture Circuit was used as a theoretical and methodological tool. An online questionnaire aimed at family members of people with ASD was applied, disseminated via associations. From a qualitative and quantitative analysis, it was realized that the science communication about ASD can be an important tool for communication between subjects and collectives involved with the theme. The search and production of information and formation of supportive networks between family members and specialists promote changes in perceptions, attitudes and values in the family group and often out of familiar contexts.

Predição de choque séptico e hipovolêmico em pacientes de unidade de terapia intensiva com o uso de machine learning / Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning

RESUMO Objetivo: Criar e validar um modelo de predição de choque séptico ou hipovolêmico a partir de variáveis de fácil obtenção coletadas na admissão de pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo de modelagem preditiva com dados de coorte concorrente realizada em um hospital do interior do nordeste brasileiro. Foram incluídos pacientes com 18 anos ou mais sem uso de droga vasoativa no dia da admissão e que foram internados entre novembro de 2020 e julho de 2021. Foram testados os algoritmos de classificação do tipo Decision Tree, Random Forest, AdaBoost, Gradient Boosting e XGBoost para a construção do modelo. O método de validação utilizado foi o k-fold cross validation. As métricas de avaliação utilizadas foram recall, precisão e área sob a curva Receiver Operating Characteristic. Resultados: Foram utilizados 720 pacientes para criação e validação do modelo. Os modelos apresentaram alta capacidade preditiva com área sob a curva Receiver Operating Characteristic de 0,979; 0,999; 0,980; 0,998 e 1,00 para os algoritmos de Decision Tree, Random Forest, AdaBoost, Gradient Boosting e XGBoost, respectivamente. Conclusão: O modelo preditivo criado e validado apresentou elevada capacidade de predição do choque séptico e hipovolêmico desde o momento da admissão de pacientes na unidade de terapia intensiva.

ABSTRACT Objective: To create and validate a model for predicting septic or hypovolemic shock from easily obtainable variables collected from patients at admission to an intensive care unit. Methods: A predictive modeling study with concurrent cohort data was conducted in a hospital in the interior of northeastern Brazil. Patients aged 18 years or older who were not using vasoactive drugs on the day of admission and were hospitalized from November 2020 to July 2021 were included. The Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost classification algorithms were tested for use in building the model. The validation method used was k-fold cross validation. The evaluation metrics used were recall, precision and area under the Receiver Operating Characteristic curve. Results: A total of 720 patients were used to create and validate the model. The models showed high predictive capacity with areas under the Receiver Operating Characteristic curve of 0.979; 0.999; 0.980; 0.998 and 1.00 for the Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost algorithms, respectively. Conclusion: The predictive model created and validated showed a high ability to predict septic and hypovolemic shock from the time of admission of patients to the intensive care unit.

The Frequency of Daily Consumption of Sugar-Sweetened Beverages Is Associated with Reduced Muscle Mass Index in Adolescents.

The consumption of sugar-sweetened beverages (SSBs) has increased in recent years and has become a cause of concern because these beverages pose a risk to human health. Thus, we evaluated the association between SSBs consumption and muscle mass index (MMI) in adolescents. This cross-sectional study evaluated 2393 adolescents (18/19-years-old). Consumption of SSBs was analyzed based on the frequency of daily consumption and energy contribution categorized into tertiles. MMI was examined using the ratio of muscle mass (kilograms) to height (meters squared). The highest tertile of the frequency of daily SSB intake was associated with a reduced MMI in men (ß = -0.31; 95%CI: -0.60, -0.01) and women (ß = -0.24; 95%CI: -0.45, -0.02). However, these associations were not observed after adjusting for sugar contained in SSBs in men (ß = -0.26; 95%CI: -0.69, 0.17) and for carbohydrate, lipid, and protein intake in women (ß = -0.19; 95%CI: -0.42, 0.04). The highest energy contribution tertile of SSBs was associated with a reduced MMI in male adolescents (ß = -0.34; 95%CI: -0.64, -0.04). This association was not observed after adjusting for intake of sugar in SSBs (ß = -0.38; 95%CI: -0.75, 0.01). The frequency of daily consumption of SSBs was considered a risk factor for decreased MMI in both sexes, and the energy contribution of these drinks was a risk factor for MMI reduced only in male adolescents.

Ultra-processed food consumption is associated with increase in fat mass and decrease in lean mass in Brazilian women: A cohort study.

Objective: To investigate the association between ultra-processed food consumption at 23-25 years of age and measurements of body composition-fat mass, fat mass distribution and lean mass at 37-39 years of age in Brazilian adults. Methods: 1978/1979 birth cohort study conducted with healthy adults from Ribeirão Preto, São Paulo, Brazil. A total of 1,021 individuals participated in the fat mass analysis (measured by air displacement plethysmography) and 815 in the lean mass analysis and fat mass distribution (assessed by dual energy X-ray absorptiometry). Food consumption was evaluated by a food frequency questionnaire. Food items were grouped according to the level of processing as per the NOVA classification. Ultra-processed food consumption was expressed as a percentage of total daily intake (g/day). Linear regression models were used to estimate the effect of ultra-processed food consumption (g/day) on body mass index, body fat percentage, fat mass index, android fat, gynoid fat, android-gynoid fat ratio, lean mass percentage, lean mass index and appendicular lean mass index. Marginal plots were produced to visualize interactions. Results: The mean daily ultra-processed food consumption in grams was 35.8% (813.3 g). There was an association between ultra-processed food consumption and increase in body mass index, body fat percentage, fat mass index, android fat and gynoid fat and decrease in lean mass percentage, only in women. Conclusion: A high ultra-processed food consumption is associated with a long-term increase in fat mass and a decrease in lean mass in adult women.

Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.