Dopamine D2 receptor antagonist counteracts hyperglycemia and insulin resistance in diet-induced obese male mice.

Obesity leads to insulin resistance (IR) and type 2 diabetes. In humans, low levels of the hormone prolactin (PRL) correlate with IR, adipose tissue (AT) dysfunction, and increased prevalence of T2D. In obese rats, PRL treatment promotes insulin sensitivity and reduces visceral AT adipocyte hypertrophy. Here, we tested whether elevating PRL levels with the prokinetic and antipsychotic drug sulpiride, an antagonist of dopamine D2 receptors, improves metabolism in high fat diet (HFD)-induced obese male mice. Sulpiride treatment (30 days) reduced hyperglycemia, IR, and the serum and pancreatic levels of triglycerides in obese mice, reduced visceral and subcutaneous AT adipocyte hypertrophy, normalized markers of visceral AT function (PRL receptor, Glut4, insulin receptor and Hif-1α), and increased glycogen stores in skeletal muscle. However, the effects of sulpiride reducing hyperglycemia were also observed in obese prolactin receptor null mice. We conclude that sulpiride reduces obesity-induced hyperglycemia by mechanisms that are independent of prolactin/prolactin receptor activity. These findings support the therapeutic potential of sulpiride against metabolic dysfunction in obesity.

Robotic versus laparoscopic gastrectomy for gastric cancer: A Western propensity score matched analysis.

BACKGROUND: Robot-assisted gastrectomy (RG) has been shown to be safe and feasible in the treatment of gastric cancer (GC). However, it is unclear whether RG is equivalent to laparoscopic gastrectomy (LG), especially in the Western world. Our objective was to compare the outcomes of RG and LG in GC patients. METHODS: We reviewed all gastric adenocarcinoma patients who underwent curative gastrectomy by minimally invasive approach in our institution from 2009 to 2022. Propensity score matching (PSM) analysis was conducted to reduce selection bias. DaVinci Si platform was used for RG. RESULTS: A total of 156 patients were eligible for inclusion (48 RG and 108 LG). Total gastrectomy was performed in 21.3% and 25% of cases in LG and RG, respectively. The frequency of stage pTNM II/III was 48.1%, and 54.2% in the LG and RG groups (p = 0.488). After PSM, 48 patients were matched in each group. LG and RG had a similar number of dissected lymph nodes (p = 0.759), operative time (p = 0.421), and hospital stay (p = 0.353). Blood loss was lower in the RG group (p = 0.042). The major postoperative complications rate was 16.7% for LG and 6.2% for RG (p = 0.109). The 30-day mortality rate was 2.1% and 0% for LG and RG, respectively (p = 1.0). There was no significant difference between the LG and RG groups for disease-free survival (79.6% vs. 61.2%, respectively; p = 0.155) and overall survival (75.9% vs. 65.7%, respectively; p = 0.422). CONCLUSION: RG had similar surgical and long-term outcomes compared to LG, with less blood loss observed in RG.

Early estimates of nirsevimab immunoprophylaxis effectiveness against hospital admission for respiratory syncytial virus lower respiratory tract infections in infants, Spain, October 2023 to January 2024.

The monoclonal antibody nirsevimab was at least 70% effective in preventing hospitalisations in infants with lower respiratory tract infections (LRTI) positive for respiratory syncytial virus (RSV) in Spain (Oct 2023-Jan 2024), where a universal immunisation programme began late September (coverage range: 79-99%). High protection was confirmed by two methodological designs (screening and test-negative) in a multicentre active surveillance in nine hospitals in three regions. No protection against RSV-negative LRTI-hospitalisations was shown. These interim results could guide public-health decision-making.

Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban.

BACKGROUND: Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended. HYPOTHESIS: This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain. METHODS: Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation. RESULTS: A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA2 DS2 -VASc was 4.1 ± 1.5, HAS-BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow-up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment. CONCLUSIONS: Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow-up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.

Vasoinhibin's Apoptotic, Inflammatory, and Fibrinolytic Actions Are in a Motif Different From Its Antiangiogenic HGR Motif.

Vasoinhibin, a proteolytic fragment of the hormone prolactin, inhibits blood vessel growth (angiogenesis) and permeability, stimulates the apoptosis and inflammation of endothelial cells, and promotes fibrinolysis. The antiangiogenic and antivasopermeability properties of vasoinhibin were recently traced to the HGR motif located in residues 46 to 48 (H46-G47-R48), allowing the development of potent, orally active, HGR-containing vasoinhibin analogues for therapeutic use against angiogenesis-dependent diseases. However, whether the HGR motif is also responsible for the apoptotic, inflammatory, and fibrinolytic properties of vasoinhibin has not been addressed. Here, we report that HGR-containing analogues are devoid of these properties. Instead, the incubation of human umbilical vein endothelial cells with oligopeptides containing the sequence HNLSSEM, corresponding to residues 30 to 36 of vasoinhibin, induced apoptosis, nuclear translocation of NF-κB, expression of genes encoding leukocyte adhesion molecules (VCAM1 and ICAM1) and proinflammatory cytokines (IL1B, IL6, and TNF), and adhesion of peripheral blood leukocytes. Also, intravenous or intra-articular injection of HNLSSEM-containing oligopeptides induced the expression of Vcam1, Icam1, Il1b, Il6, and Tnf in the lung, liver, kidney, eye, and joints of mice and, like vasoinhibin, these oligopeptides promoted the lysis of plasma fibrin clots by binding to plasminogen activator inhibitor-1 (PAI-1). Moreover, the inhibition of PAI-1, urokinase plasminogen activator receptor, or NF-κB prevented the apoptotic and inflammatory actions. In conclusion, the functional properties of vasoinhibin are segregated into 2 different structural determinants. Because apoptotic, inflammatory, and fibrinolytic actions may be undesirable for antiangiogenic therapy, HGR-containing vasoinhibin analogues stand as selective and safe agents for targeting pathological angiogenesis.

Prolactin Inhibits or Stimulates the Inflammatory Response of Joint Tissues in a Cytokine-dependent Manner.

The close association between rheumatoid arthritis (RA), sex, reproductive state, and stress has long linked prolactin (PRL) to disease progression. PRL has both proinflammatory and anti-inflammatory outcomes in RA, but responsible mechanisms are not understood. Here, we show that PRL modifies in an opposite manner the proinflammatory actions of IL-1ß and TNF-α in mouse synovial fibroblasts in culture. Both IL-1ß and TNF-α upregulated the metabolic activity and the expression of proinflammatory factors (Il1b, Inos, and Il6) via the activation of the nuclear factor-κB (NF-κB) signaling pathway. However, IL-1ß increased and TNF-α decreased the levels of the long PRL receptor isoform in association with dual actions of PRL on synovial fibroblast inflammatory response. PRL reduced the proinflammatory effect and activation of NF-κB by IL-1ß but increased TNF-α-induced inflammation and NF-κB signaling. The double-faceted role of PRL against the 2 cytokines manifested also in vivo. IL-1ß or TNF-α with or without PRL were injected into the knee joints of healthy mice, and joint inflammation was monitored after 24 hours. IL-1ß and TNF-α increased the joint expression of proinflammatory factors and the infiltration of immune cells. PRL prevented the actions of IL-1ß but was either inactive or further increased the proinflammatory effect of TNF-α. We conclude that PRL exerts opposite actions on joint inflammation in males and females that depend on specific proinflammatory cytokines, the level of the PRL receptor, and the activation of NF-κB signaling. Dual actions of PRL may help balance joint inflammation in RA and provide insights for development of new treatments.

Effects of Larrea nitida nanodispersions on the growth inhibition of phytopathogens.

Larrea nitida Cav. (Zygophyllaceae) is a plant endemic to Argentina and Chile, and its extract has been studied over the last years due to the presence of antimicrobial agents that can be used to control the growth of some pathogens in agriculture. However, the extract is highly hydrophobic, which strongly affects its fungicidal activity in aqueous media. In this sense, the solid dispersion technique was used to produce L. nitida extract nanodispersions with polyethylene glycol (PLE) and with polyethylene glycol and zinc acetate (PZLE). In order to further evaluate the activity of the extract in PLE and PZLE, blank nanodispersions containing only polyethylene glycol (PEG) and zinc acetate (PZ) without the addition of the extract were also produced. The fungicidal activity of the water-soluble nanoparticles was evaluated at different concentrations (0.037-0.110 g.mL-1). In general, the nanoparticles were successfully produced on a nanometric size and presented a significant inhibitory activity on the growth of the pathogens Fusarium oxysporum and Fusarium verticillioides in aqueous media. Compared to PLE, PZLE presented increased fungistatic activity, possibly due to their increased solubility in water. Even though their application in agriculture should be further investigated, the nanodispersions present great potential to be applied as a green biotechnological tool.

Patient's safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study.

BACKGROUND: There is a tendency of prompted global health systems to reduce the length of hospital stay without compromising patient safety or satisfaction. We evaluated the safety and viability of early discharge in patients undergoing minimally invasive radical prostatectomy (MIRP), as well as patient satisfaction with this strategy. METHODS: This longitudinal prospective study included 72 patients who underwent MIRP for prostate cancer. Three groups were performed according to the day of hospital discharge following surgery: same day (G1), first day after (G2), and second day after (G3). Satisfaction, adverse events, and readmission were analyzed for each group. Associations between clinicopathologic variables and same-day discharge were analyzed by comparing data between G1 patients who did and did not achieve same-day discharge. RESULTS: 16.7% of patients were not discharged according to randomization (10 randomized to G1). 80% of G1 patients who did not achieve same-day discharge had Gleason scores of 3 + 4 or 4 + 3, which were observed in 35.7% of patients discharged on the same day (P < 0.05). Average prostate weight was significantly lower in patients who achieved same-day discharge than in those who did not (P < 0.01). Univariable logistic regression points to Gleason scores of 3 + 4 or 4 + 3 as the main factors associated with unsuccessful same-day discharge (P < 0.05). There were no significant differences in satisfaction scores. CONCLUSIONS: Same-day discharge was both safe and feasible and does not appear to affect satisfaction in a subset of patients with prostate cancer. Surgeons should consider the Gleason score when determining whether same-day discharge is appropriate.

Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study.

BACKGROUND: Heart failure (HF) and atrial fibrillation (AF) are common and coexistent conditions. HYPOTHESIS: To investigate the adverse events and mortality risk factors in patients with AF and HF treated with rivaroxaban in Spain. METHODS: Multicenter, prospective and observational study with a follow-up of 2 years, that included adults, with a diagnosis of nonvalvular AF and chronic HF, anticoagulated with rivaroxaban at least 4 months before being enrolled. RESULTS: A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, the mean age was 73.7 ± 10.9 years, 65.9% were male, 51.3% had HF with preserved ejection fraction and 58.7% were on New York Heart Association functional class II. CHA2 DS2 -VASc was 4.1 ± 1.5. During the follow-up, 11.6% of patients died and around one-quarter of patients were hospitalized or visited the emergency department, being HF worsening/progression the main cause (51.1%), with a 2.9% of thromboembolic events and 2.0% of acute coronary syndromes. Major bleeding occurred in 3.1% of patients, with 0.5% experiencing intracranial bleeding but no fatalities. Compliance with HF treatment was associated with a lower risk of death (hazard ratio: 0.092; 95% confidence interval: 0.03-0.31). CONCLUSIONS: Among patients with HF and AF anticoagulated with rivaroxaban, incidences of thromboembolic or hemorrhagic complications were low. The most important factor for improving survival was compliance with HF drugs, what strengths the need for early treatment with HF disease-modifying therapy and anticoagulation.

New nitrosyl ruthenium complexes with combined activities for multiple cardiovascular disorders.

Nitrosyl ruthenium complexes are promising platforms for nitric oxide (NO) and nitroxyl (HNO) release, which exert their therapeutic application. In this context, we developed two polypyridinic compounds with the general formula cis-[Ru(NO)(bpy)2(L)]n+, where L is an imidazole derivative. These species were characterized by spectroscopic and electrochemical techniques, including XANES/EXAFS experiments, and further supported by DFT calculations. Interestingly, assays using selective probes evidenced that both complexes can release HNO on reaction with thiols. This finding was biologically validated by HIF-1α detection. The latter protein is related to angiogenesis and inflammation processes under hypoxic conditions, which is selectively destabilized by nitroxyl. These metal complexes also presented vasodilating properties using isolated rat aorta rings and demonstrated antioxidant properties in free radical scavenging experiments. Based on these results, the new nitrosyl ruthenium compounds showed promising characteristics as potential therapeutic agents for the treatment of cardiovascular conditions such as atherosclerosis, deserving further investigation.

Bacterial cellulose production by Komagataeibacter hansenii can be improved by successive batch culture.

Bacterial cellulose (BC) is a biopolymer principally synthetized by strains of the genus Komagataeibacter. However, high costs and low production yield make large-scale application difficult. The aim of this work was to evaluate the effects of successive batch culture before fermentation on the ability to increase the capacity of bacterial cellulose biosynthesis by a low-producing strain. The Komagataeibacter hansenii strain ATCC 23,769 was initially cultivated in fermentation broth for two periods of 35 or 56 days under static conditions. At the end of each period of time, they were transferred to new broth to be cultivated again (new batch culture cycle) for 35 or 56 days and carried out in parallel with a 10-day fermentation to determine the quantity of BC produced. As a result, a greater increase was observed after the end of the second and third batch cultures of 56 days (increases of 137% and 187% in relation to the nonbatch cultured strain, respectively). The produced samples presented higher crystallinity and thermal properties but lower water holding capacity. Through this work, it was concluded that the longer the batch culture time was, the greater the increase in the capacity of cellulose biosynthesis, which also depended on the number of successive batch culture cycles carried out.

[Descriptive study about non-formal sex education resources available in Spain.] / Estudio descriptivo de los recursos sobre Educación Sexual en el ámbito no-formal disponibles en España.

OBJECTIVE: Sex education (SE) is a fundamental element of a fulfilling and safe life. Currently, education is understood beyond what happens inside the classroom. The aim of this research was to describe and to compare sex education resources available in official webs of Autonomous Communities of Spain (ACS) that to could be used in non-formal educational context. METHODS: A review of the ACS official web pages related to healthcare, education, youth, family and equality was made. Finally, 216 resources were selected for descriptive analysis. The resources were classified based on United Nations Educational, Scientific and Cultural Organization's (UNESCO) Technical Guidelines. RESULTS: 64% of resources were targeted at young people/adolescents. 80% dealt some specific issues, the most frequent being Reproductive Health, Violence and Gender. Values and Rights related to sexuality, Skills for Health and Well-being and Sexual behaviour are issues rarely addressed. Only 6 ACS were a social network profile related to SE. ACS with the widest diversity of issues addressed were Andalusia, Asturias and the Canary Islands. CONCLUSIONS: Homogeneity in the kind of resources and issues disparity reveals potential inequities in SE access in Spain. To enhance out-of-school environments learning can provide better successful health promotion. UNESCO's guidelines can be used to classify educational resource content and to identify the institutions that have best integrated actual SE paradigm.

OBJETIVO: La educación sexual (ES) es fundamental para una vida plena y segura. Actualmente, la educación es entendida más allá de lo que ocurre dentro de las aulas. El objetivo de este trabajo fue describir y comparar los materiales disponibles en las distintas webs oficiales de las comunidades y ciudades autónomas de España (CC. AA.) sobre ES y que puedan ser utilizados en contextos educativos no-formales. METODOS: Se realizó una revisión de las webs oficiales de las CC. AA. relacionadas con salud, educación, juventud, familia y/o igualdad. Se seleccionaron 216 recursos para su análisis descriptivo. Siguiendo las Orientaciones Técnicas de la Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura (UNESCO), se clasificaron los recursos en función de los temas que abordaban. RESULTADOS: El 64% de los recursos estaba dirigido a jóvenes/adolescentes. El 80% trataba algún tema en específico, siendo los más frecuentes Reproducción, Violencia y Género. Los temas: Valores y derechos relacionados con la sexualidad, Habilidades para la salud y bienestar y Conducta sexual fueron contenidos raramente tratados. Sólo 6 CC. AA. contaban con un perfil en redes sociales relacionado con ES. Las CC. AA. con mayor diversidad de temas abordados fueron Andalucía, Asturias y Canarias. CONCLUSIONES: La homogeneidad en el tipo de recursos y la disparidad de temáticas revela potenciales inequidades en el acceso a la ES en España. Potenciar medios de aprendizaje fuera de las escuelas puede lograr una promoción de la salud más efectiva. Las orientaciones de la UNESCO pueden servir para clasificar los contenidos e identificar las instituciones que mejor han integrado el actual paradigma que la ES propone.

Estudio descriptivo de los recursos sobre Educación Sexual en el ámbito no-formal disponibles en España / Descriptive study about non-formal sex education resources available in Spain

FUNDAMENTOS: La educación sexual (ES) es fundamental para una vida plena y segura. Actualmente, la educación es entendidamás allá de lo que ocurre dentro de las aulas. El objetivo de este trabajo fue describir y comparar los materiales disponibles en lasdistintas webs oficiales de las comunidades y ciudades autónomas de España (CC. AA.) sobre ES y que puedan ser utilizados encontextos educativos no-formales. MÉTODOS: Se realizó una revisión de las webs oficiales de las CC. AA. relacionadas con salud, educación, juventud, familia y/o igual-dad. Se seleccionaron 216 recursos para su análisis descriptivo. Siguiendo las Orientaciones Técnicas de la Organización de las Nacio-nes Unidas para la Educación, la Ciencia y la Cultura (UNESCO), se clasificaron los recursos en función de los temas que abordaban.RESULTADOS: El 64% de los recursos estaba dirigido a jóvenes/adolescentes. El 80% trataba algún tema en específico, siendo losmás frecuentesReproducción,Violencia yGénero. Los temas:Valores y derechos relacionados con la sexualidad,Habilidades para lasalud y bienestar yConducta sexual fueron contenidos raramente tratados. Sólo 6 CC. AA. contaban con un perfil en redes socialesrelacionado con ES. Las CC. AA. con mayor diversidad de temas abordados fueron Andalucía, Asturias y Canarias.CONCLUSIONES: La homogeneidad en el tipo de recursos y la disparidad de temáticas revela potenciales inequidades en el ac-ceso a la ES en España. Potenciar medios de aprendizaje fuera de las escuelas puede lograr una promoción de la salud más efectiva.Las orientaciones de la UNESCO pueden servir para clasificar los contenidos e identificar las instituciones que mejor han integradoel actual paradigma que la ES propone.(AU)

BACKGROUND: Sex education (SE) is a fundamental element of a fulfilling and safe life. Currently, education is understood beyondwhat happens inside the classroom. The aim of this research was to describe and to compare sex education resources available inofficial webs of Autonomous Communities of Spain (ACS) that to could be used in non-formal educational context.METHODS: A review of the ACS official web pages related to healthcare, education, youth, family and equality was made. Finally,216 resources were selected for descriptive analysis. The resources were classified based on United Nations Educational, Scientific andCultural Organization’s (UNESCO) Technical Guidelines.RESULTS // 64% of resources were targeted at young people/adolescents. 80% dealt some specific issues, the most frequentbeingReproductive Health,Violence andGender.Values and Rights related to sexuality,Skills for Health and Well-being andSexualbehaviour are issues rarely addressed. Only 6 ACS were a social network profile related to SE. ACS with the widest diversity of issuesaddressed were Andalusia, Asturias and the Canary Islands.CONCLUSIONS: Homogeneity in the kind of resources and issues disparity reveals potential inequities in SE access in Spain. Toenhance out-of-school environments learning can provide better successful health promotion. UNESCO’s guidelines can be used toclassify educational resource content and to identify the institutions that have best integrated actual SE paradigm.(AU)

Efectos psicológicos del distanciamiento social en estudiantes de medicina / Efeitos psicológicos do distanciamento social em estudantes de medicina / Psychological effects of social distancing on medical students

Objetivo:Estimar la prevalencia de síntomas de ansiedad y depresión en estudiantes. Metodología: Estudio transversal, descriptivo y observacional, con enfoque cuantitativo, realizado en un Centro Universitario con la aplicación de un formulario electrónico en línea con 170 estudiantes universitarios, utilizando el Cuestionario de Salud del Paciente-9, instrumento que evalúa el trastorno depresivo, y el Trastorno de Ansiedad General- 7, que evalúa y monitorea la ansiedad. Resultados: Se encontró que el 42,9% de los estudiantes tenían ansiedad moderada y el 37,0% de los participantes tenían trastorno depresivo moderado. Los estudiantes de medicina con edades entre 25 y 29 años, sin trastorno psicológico previo, fueron los más propensos a mostrar mayores signos de depresión y ansiedad durante la pandemia, y los estudiantes informaron que les hubiera gustado recibir apoyo psicológico de la universidad durante este período. Conclusión: Las instituciones educativas deben brindar apoyo multilateral, incluidas las intervenciones tempranas de salud mental, especialmente durante tiempos de pandemia. (AU)

Objetivo: Estimar a prevalência de sintomas de ansiedade e depressão em estudantes. Método: Estudo de natureza transversal, descritivo e observacional, com abordagem quantitativa, realizado em um Centro Universitário com a aplicação de um formulário eletrônico online com 170 universitários, utilizando o Patient Health Questionnaire-9, instrumento que avalia transtorno depressivo, e o General Anxiety Disorder-7, que avalia e monitora a ansiedade. Resultados: Verificou-se que 42,9% dos estudantes se encontravam com ansiedade na fase moderada e 37,0% dos participantes possuíam transtorno depressivo moderado. Asestudantes de medicina na faixa etária de 25 a 29 anos, sem transtorno psíquico prévio foram os mais susceptíveis a apresentarem maiores indícios de depressão e ansiedade durante a pandemia e os discentesrelataram que gostariam de ter recebido suporte psicológico da universidade durante esse período. Conclusões: As instituições de ensino necessitam fornecer apoio multilateral, incluindo intervenções precoces de saúde mental, principalmente em momentos pandêmicos. (AU)

Objective: To estimate the prevalence of anxiety and depression symptoms in students. Method: A cross-sectional, descriptive and observational study with a quantitative approach, carried out in a University Center by applying an online electronic form to 170 university students, using the Patient Health Questionnaire-9, an instrument that assesses depressive disorder, and the General Anxiety Disorder-7 scale, which assesses and monitors anxiety. Results: It was verified that 42.9% of the students had moderate anxiety and 37.0% of the participants had moderate depressive disorder. Medical students aged between 25 and 29 years old with no previous psychological disorder were the most susceptible to presenting greater signs of depression and anxiety during the pandemic, and the students reported that they would have liked to have received psychological support from the university during this period. Conclusions: Educational institutions need to provide multilateral support, including early mental health interventions, especially during pandemic times. (AU)

Feasibility and outcomes of transjugular intrahepatic portosystemic shunts in infants.

BACKGROUND: Experience with transjugular intrahepatic portosystemic shunts (TIPS) in the pediatric population, especially in infants, is limited. OBJECTIVE: To evaluate the feasibility, efficacy and safety of TIPS placement in infants. MATERIALS AND METHODS: This retrospective non-comparative observational cohort study analyzed all pediatric patients < 12 months of age treated with TIPS while waiting for liver transplant between October 2018 and April 2021. The sample consisted of 10 infants with chronic liver disease. All had refractory ascites and decreased portal vein size. Their mean age ± standard deviation was 5 ± 1 months and their mean weight was 5.4 ± 1.0 kg. We calculated the pediatric end-stage liver disease score and portosystemic gradients before and after TIPS placement. We used ultrasound to check for complications and to assess the presence of ascites. We used paired-sample t-test for the mean comparison of paired variables. RESULTS: Ten TIPS procedures were performed that were technically and hemodynamically successful except for one, in which an extrahepatic portal puncture required surgical repair. Ascites resolved in three infants and was reduced in six. The portal vein size remained stable after TIPS placement. Four infants had early stent thrombosis and two had late stent thrombosis treated with angioplasty or covered stents. CONCLUSION: TIPS placement in infants is a feasible, safe and effective procedure.

Barreiras e facilitadores para adesão à prática de exercícios por pessoas com dor crônica na Atenção Primária à Saúde: estudo qualitativo / Barriers and facilitators for adherence to exercise practice by people with chronic pain in Primary Health Care: Qualitative study

Resumo Introdução Exercícios e atividades físicas são um dos principais componentes no tratamento de pessoas com dores crônicas, sendo incentivados pelos profissionais da Atenção Primária à Saúde. Entretanto, sua adesão é frequentemente baixa. Objetivo Analisar a percepção dos participantes de grupos de dor crônica na Atenção Primária, sobre as barreiras e facilitadores para adesão à prática de exercícios. Metodologia Estudo qualitativo, descritivo, realizado através de entrevistas com 16 participantes de grupos de dor crônica ofertados por Unidades Básicas de Saúde no município de Florianópolis. Utilizou-se a Análise de conteúdo para interpretação dos dados. Resultados Foram verificados como facilitadores: resultados percebidos, acompanhamento profissional, prazer na atividade física e grupos de exercício como apoio social. Como barreiras foram observadas: exacerbação da dor, medo de lesão ou piora dos sintomas e condição financeira. O ambiente físico e as demandas e rotinas diárias encaixaram-se em ambos - barreiras e facilitadores. Conclusão Os resultados forneceram subsídios para que os profissionais da Atenção Primária possam planejar e desenvolver estratégias que assegurem o engajamento das pessoas com dor crônica em programas de exercícios e/ou atividade física.

Abstract Background Exercise and physical activity are main components in the treatment of people with chronic pain, being encouraged by professionals in Primary Health Care. However, their adherence is often low. Objective To analyze the participant's perception in chronic pain groups about barriers and facilitators for adherence to exercise. Methods Qualitative, descriptive study conducted through interviews with 16 participants in groups of chronic pain offered by Basic Health Units in the city of Florianópolis, Brazil. Content analysis was used to interpret the data. Results The facilitators were perceived results, professional monitoring, pleasure in physical activity and exercise groups as social support. As barriers: exacerbation of pain, fear of injury or worsening of symptoms and financial resources. The physical environment and the daily demands and routines fit into both - barriers and facilitators. Conclusion The results provided subsidies for Primary Care professionals to plan and develop strategies that ensure the engagement of people with chronic pain in exercise and/or physical activity programs.

Impact of an Electronic Alert in Combination with a Care Bundle on the Outcomes of Acute Kidney Injury.

Early diagnosis is essential for the appropriate management of acute kidney injury (AKI). We evaluated the impact of an electronic AKI alert together with a care bundle on the progression and mortality of AKI. This was a single-center prospective study that included AKI patients aged ≥ 18 years, whereas those in palliative care, nephrology, and transplantation departments were excluded. An AKI alert was issued in electronic medical records and a care bundle was suggested. A series of classes were administered to the multidisciplinary teams by nephrologists, and a clinical pharmacist audited prescriptions. Patients were categorized into pre-alert and post-alert groups. The baseline characteristics were comparable between the pre-alert (n = 1613) and post-alert (n = 1561) groups. The 30-day mortality rate was 33.6% in the entire cohort and was lower in the post-alert group (30.5% vs. 36.7%; p < 0.001). Age, pulmonary disease, malignancy, and ICU admission were associated with an increase in 30-day mortality. The electronic AKI alert together with a care bundle and a multidisciplinary education program was associated with a reduction in 30-day mortality in patients with AKI.

Epidemiological study on the lip and oral cavity cancer in Brazil: connecting science and clinical applicability.

OBJECTIVE: The aim of this study was to describe and discuss the epidemiological indicators of lip and oral cavity cancer in Brazil, in 2017, according to data from the Global Burden of Disease data. METHODS: This is a descriptive study reported according to STROBE guidelines. We identified epidemiological indicators using the Global Burden of Disease results tool. Mortality/incidence rates were described per 100,000 population. Global Burden of Disease 2017 reviews were completed using Python version 2.7, Stata version 13.1, and R version 3.3. RESULTS: In 2017, there were 5,237 deaths from the lip or oral cavity cancer in Brazil, most of them were males aged between 50 and 69 years (2,730 cases, which was equivalent to 52% of the universe of deaths resulting from this cause). Regarding the burden of lip and oral cavity cancer, per 100,000 Brazilians, we observed an incidence of 3.99, prevalence of 15.46, and mortality of 2.29 (with higher indicators in the South and Southeast regions of the country). CONCLUSIONS: Epidemiological indicators of lip and oral cavity cancer were higher in men, with higher mortality indicators in individuals aged 50-69 years, and higher rates (incidence, prevalence, and mortality) in the South and Southeast regions of Brazil. From 2002-2015, there was a reduction in mortality; however, in the period from 2015-2017, there was a resumption in the growth of this indicator.

Ecological risk of imidacloprid on the Brazilian non-target freshwater organisms Chironomus sancticaroli and Poecilia reticulata.

Imidacloprid (IMI) is a neonicotinoid insecticide widely used in agriculture worldwide. This pesticide has been found in freshwater ecosystems, including Brazilian freshwaters. For this reason, studies are being conducted to detect the presence of IMI in freshwater and understand its effects on the aquatic biota. In the present study, the acute toxic effect of the imidacloprid commercial formulation (ICF) Galeão® on the Brazilian non-target aquatic organisms Chironomus sancticaroli and Poecilia reticulata was evaluated. Enzymatic activities (glutathione S-transferase (GST), catalase (CAT), and ascorbate peroxidase (APX)) were also determined. Moreover, we considered 11 studies that detected IMI concentrations up to 3.65 µg.L-1 in 28 different Brazilian freshwaters to evaluate the acute ecological risk of IMI in these environments. From the ecotoxicological assays, we determined the LC50 values for C. sancticaroli (LC50-48 h 1.52 µg.L-1) and P. reticulata (LC50-96 h 122.65 mg.L-1). The high sensitivity of C. sancticaroli demonstrates that this species could be used as a bioindicator in studies investigating the contamination of freshwater by IMI. Enzymatic activity changes were observed in both organisms and offered sublethal responses to the effects of the pollution by IMI on aquatic biota. Our results suggest that the presence of IMI in Brazilian aquatic ecosystems can represent a potential ecological risk for the aquatic insect populations and, consequently, cause an imbalance in these ecosystems. The present study provides relevant and comparable toxicity information that may be useful to develop public policies to protect the Brazilian aquatic ecosystem from IMI contamination.