Vertebral osteomyelitis associated with single and mixed bacterial infection in broilers.

Vertebral osteomyelitis (VO) is a worldwide emerging disease that affects broilers. The objective of this study was to determine the frequency and aetiology of VO in broilers in a highly productive broiler region. For this, 608 broilers with locomotory problems were analysed from 18 farms. Clinical signs were recorded, necropsy was performed and samples were collected from vertebral bodies with gross changes for molecular and histopathological analysis and for bacterial isolation. From broilers with locomotory changes, 5.1% (31/608) had VO and, of these, 93.5% were 40 days old or older and 89.7% were males. The birds with VO presented varying degrees of limited mobility and this was related to the level of compression to the spinal cord. Bacterial species of the genus Enterococcus (DNA detected in 53.6%) were the aetiological agents involved in most VO cases. Enterococcus faecalis was detected most frequently (35.7%), but Enterococcus hirae was also present in some lesions (7.1%). Escherichia coli was detected in 35.7% of vertebral lesions and co-infection with E. faecalis was confirmed in 7.1% cases. Staphylococcus aureus was involved in 14.3% of the cases, being 7.1% in co-infection with Enterococcus spp. or E. hirae. Our study has indicated that, in Brazil, VO in broilers may not be caused by a single infectious agent and has a lower frequency than recently reported in other countries. This study suggests that there are geographical differences between Brazil and other countries concerning the frequency and aetiology of VO.

Feasibility, safety, and adherence of a remote physical and cognitive exercise protocol for older women.

BACKGROUND: Population aging and the consequences of social distancing after the COVID-19 pandemic make it relevant to investigate the feasibility of remote interventions and their potential effects on averting functional decline. OBJECTIVE: (1) To investigate the feasibility, safety, and adherence of a remote protocol involving physical and cognitive exercises for older women with normal cognition; (2) to examine its effects on cognitive and well-being variables. METHODS: Twenty-nine women (age ≥ 60 years old) were randomized into experimental group (EG; n = 15) and control group (CG; n = 14). The EG performed a 40-minute session of cognitive and physical exercises, and CG performed a 20-minute stretching session. Both groups performed 20 sessions via videoconference and 20 on YouTube twice a week. The Mini-Mental State Examination, Verbal Fluency Test, Digit Span (direct an inverse order), Geriatric Depression Scale (GDS), and Well-being Index (WHO-5) were applied in pre- and post-interventions by phone. RESULTS: Overall adherence was 82.25% in EG and 74.29% in CG. The occurrence of adverse events (mild muscle pain) was 33.3% in EG and 21.4% in CG. The EG improved verbal fluency and attention (p ≤ 0.05); both groups had improved depressive symptoms. CONCLUSION: The present study met the pre-established criteria for feasibility, safety, and adherence to the remote exercise protocol among older women. The results suggest that a combined protocol has more significant potential to improve cognitive function. Both interventions were beneficial in improving the subjective perception of well-being.

ANTECEDENTES: O envelhecimento populacional e as consequências do isolamento social após a pandemia de COVID-19 tornaram relevante investigar a viabilidade, segurança e aderência de intervenções remotas e potenciais efeitos para prevenir declínios funcionais. OBJETIVO: (1) Investigar a viabilidade, segurança e aderência de um protocolo remoto de exercícios físicos e cognitivos; (2) investigar os possíveis efeitos sobre variáveis de cognição e de bem-estar. MéTODOS: Vinte e nove mulheres foram randomicamente divididas em grupo experimental (GE; n = 15) e grupo controle (GC; n = 14). O GE realizou sessões de 40 minutos de exercícios físicos e cognitivos e o GC, 20 minutos de alongamentos. Totalizaram 20 sessões por videoconferência e 20 pelo YouTube, duas vezes por semana. O Teste de Fluência Verbal, o Teste de Dígitos (ordem direta e inversa), a Escala de Depressão Geriátrica (GDS) e o Índice de Bem-Estar (WHO-5) foram aplicados no pré e pós-intervenção, por telefone e formulário digital. RESULTADOS: A aderência geral média foi de 82,25% no GE e 74,29% no GC. A ocorrência de eventos adversos (dores musculares leves) foi de 33,3% no GE e 21,4% no GC. O GE teve melhora em fluência verbal e atenção (p ≤ 0.05) e ambos os grupos tiveram melhora significativa nos sintomas depressivos. CONCLUSãO: O presente estudo atendeu aos critérios preestabelecidos para a viabilidade, segurança e aderência do programa oferecido entre idosas. Os resultados sugerem que o protocolo combinado tenha maior potencial de aprimorar funções cognitivas. Ambas as intervenções foram benéficas para a percepção subjetiva de bem-estar.

Detection of Zika Virus in Aedes aegypti and Aedes albopictus Mosquitoes Collected in Urban Forest Fragments in the Brazilian Amazon.

Zika virus (ZIKV) is an RNA flavivirus (Flaviviridae family) endemic in tropical and subtropical regions that is transmitted to humans by Aedes (Stegomyia) species mosquitoes. The two main urban vectors of ZIKV are Aedes aegypti and Aedes albopictus, which can be found throughout Brazil. This study investigated ZIKV infection in mosquito species sampled from urban forest fragments in Manaus (Brazilian Amazon). A total of 905 non-engorged female Ae. aegypti (22 specimens) and Ae. albopictus (883 specimens) were collected using BG-Sentinel traps, entomological hand nets, and Prokopack aspirators during the rainy and dry seasons between 2018 and 2021. All pools were macerated and used to inoculate C6/36 culture cells. Overall, 3/20 (15%) Ae. aegypti and 5/241 (2%) Ae. albopictus pools screened using RT-qPCR were positive for ZIKV. No supernatants from Ae. aegypti were positive for ZIKV (0%), and 15 out of 241 (6.2%) Ae. albopictus pools were positive. In this study, we provide the first-ever evidence of Ae. albopictus naturally infected with ZIKV in the Amazon region.

Standardized Brazilian green propolis extract (EPP-AF®) in COVID-19 outcomes: a randomized double-blind placebo-controlled trial.

SARS-CoV-2 and its different variants caused a "wave and wave" pandemic pattern. During the first wave we demonstrated that standardized Brazilian green propolis extract (EPP-AF®) reduces length of hospital stay in adult patients with COVID-19. Afterwards, we decided to evaluate the impact of EPP-AF in hospitalized patients during the third wave of the pandemic. BeeCovid2 was a randomized, double-blind, placebo-controlled clinical trial in hospitalized COVID-19 adult patients. Patients were allocated to receive an oral dose of 900 mg/day of EPP-AF® or placebo for 10 days. The primary outcome was length of hospital stay. Secondary outcomes included safety, secondary infection rate, duration of oxygen therapy dependency, acute kidney injury and need for intensive care. Patients were followed up for 28 days after admission. We enrolled 188 patients; 98 were assigned to the propolis group and 90 to the placebo group. The post-intervention length of hospital stay was of 6.5 ± 6.0 days in the propolis group versus 7.7 ± 7.1 days in the control group (95% CI - 0.74 [- 1.94 to 0.42]; p = 0.22). Propolis did not have significant impact on the need for oxygen supplementation or frequency of AKI. There was a significant difference in the incidence of secondary infection between groups, with 6.1% in the propolis group versus 18.9% in the control group (95% CI - 0.28 [0.1-0.76], p = 0.01). The use of EPP-AF was considered safe and associated with a decrease in secondary infections. The drug was not associated with a significant reduction in length of hospital stay. ClinicalTrials.gov (NCT04800224).

Normal pressure hydrocephalus: an update.

Normal pressure hydrocephalus (NPH) has been a topic of debate since its introduction in publications. More frequent in the elderly population, it is characterized by gait disturbance, urinary urge incontinence and cognitive decline. Therefore, it is a clinical-radiological entity with relatively common findings for the age group, which together may have greater specificity. Therefore, its diagnosis must be careful for an adequate selection of patients for treatment with ventricular shunt, since the symptoms are potentially reversible. The tap test has a high positive predictive value as a predictor of therapeutic response, but a negative test does not exclude the possibility of treatment. Scientific efforts in recent years have been directed towards a better understanding of NPH and this narrative review aims to compile recent data from the literature in a didactic way for clinical practice.

Effects of Standardized Brazilian Green Propolis Extract (EPP-AF®) on Inflammation in Haemodialysis Patients: A Clinical Trial.

Background: Patients on haemodialysis (HD) present a significant inflammatory status, which has a pronounced negative impact on their outcomes. Propolis is a natural resin with anti-inflammatory and immunomodulatory properties. We assessed the safety and impact of a standardized Brazilian green propolis extract (EPP-AF®) on the inflammatory status in patients under conventional HD. Methods: Patients were assigned to receive 200 mg/day of EPP-AF® for 4 weeks followed by 4 weeks without the drug, and changes in plasma levels of interleukins (ILs), interferon gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α), and high-sensitivityc-reactive protein (HsCRP) were measured. A heatmap was used to illustrate trends in data variation. Results: In total, 37 patients were included in the final analysis. Patients presented an exacerbated inflammatory state at baseline. During EPP-AF® use, there was a significant reduction in IFN-γ (p=0.005), IL-13 (p=0.04 2), IL-17 (p=0.039), IL-1ra (p=0.008), IL-8 (p=0.009), and TNF-α (p < 0.001) levels compared to baseline, and significant changes were found in Hs-CRP levels. The heatmap demonstrated a pattern of pronounced proinflammatory status at baseline, especially in patients with primary glomerulopathies, and a clear reduction in this pattern during the use of EPP-AF®. There was a tendency to maintain this reduction after suspension of EPP-AF®. No significant side effects were observed. Conclusion: Patients under haemodialysis presented a pronounced inflammatory status, and EPP-AF® was demonstrated to be safe and associated with a significant and maintained reduction in proinflammatory cytokines in this population. This trial is registered with Clinicaltrials.gov NCT04072341.

The use of standardized Brazilian green propolis extract (EPP-AF) as an adjunct treatment for hospitalized COVID-19 patients (BeeCovid2): a structured summary of a study protocol for a randomized controlled trial.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic continues to spread and affects large numbers of people with unprecedented impacts. Experimental evidence has already been obtained for use of the standardized extract of Brazilian green propolis (EPP-AF) against viral targets, and clinical rationality has been demonstrated for testing this extract as an adjunct to treatment in patients affected by COVID-19. The BeeCovid2 study aims to assess whether EPP-AF has an impact on the improvement of patients hospitalized with COVID-19 by reducing the length of hospital stay. METHODS: BeeCovid2 is a randomized, double-blinded, placebo-controlled clinical study being conducted in Brazil to provide further evidence on the effectiveness of standardized green propolis extract as an adjunctive treatment for adults hospitalized with COVID-19. Hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 and up to 14 days of symptoms were included. Patients under mechanical ventilation at randomization, pregnant women, cancer patients, transplanted or using immunosuppression, HIV patients, patients who used propolis in the last 30 days, bacterial or fungal infection at randomization, impossibility of using medication orally or enterally, and advanced chronic diseases (e.g., advanced heart failure, severe liver disease, and end-stage chronic kidney disease). Enrolled patients are randomized at a 1:1 ratio to receive placebo or standardized propolis extract (900 mg/day) for 10 days. The study treatments are administered in a double-blinded manner, and patients are followed for 28 days. The primary outcome is the difference in length of hospital stay in days between groups. Secondary outcomes include the need for mechanical ventilation, the rate of secondary infection, rate of acute kidney injury, the need for renal replacement therapy, the requirement for vasoactive drugs, the use of an intra-aortic balloon pump (IABP), and the use of extracorporeal membrane oxygenation (ECMO). DISCUSSION: This trial is very useful and will provide more data on the effectiveness of using the standardized Brazilian green propolis extract as an adjunctive treatment in association with standard care in adults hospitalized with moderate to severe acute COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov NCT04800224 . Registered on March 16, 2021.

Realistic simulation is associated with healthcare professionals' increased self-perception of confidence in providing acute stroke care: a before-after controlled study.

BACKGROUND: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. OBJECTIVE: To assess the impact of a stroke realistic simulation course on clinicians' self-perception of confidence in the management of acute stroke. METHODS: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees' self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. RESULTS: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. CONCLUSIONS: This stroke realistic simulation course was associated with an improvement on trainees' self-perception of confidence in providing acute stroke care.

Efficacy of Brazilian green propolis (EPP-AF®) as an adjunct treatment for hospitalized COVID-19 patients: A randomized, controlled clinical trial.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promotes challenging immune and inflammatory phenomena. Though various therapeutic possibilities have been tested against coronavirus disease 2019 (COVID-19), the most adequate treatment has not yet been established. Propolis is a natural product with considerable evidence of immunoregulatory and anti-inflammatory activities, and experimental data point to potential against viral targets. We hypothesized that propolis can reduce the negative effects of COVID-19. METHODS: In a randomized, controlled, open-label, single-center trial, hospitalized adult COVID-19 patients were treated with a standardized green propolis extract (EPP-AF®ï¸) as an adjunct therapy. Patients were allocated to receive standard care plus an oral dose of 400 mg or 800 mg/day of green propolis for seven days, or standard care alone. Standard care included all necessary interventions, as determined by the attending physician. The primary end point was the time to clinical improvement, defined as the length of hospital stay or oxygen therapy dependency duration. Secondary outcomes included acute kidney injury and need for intensive care or vasoactive drugs. Patients were followed for 28 days after admission. RESULTS: We enrolled 124 patients; 40 were assigned to EPP-AF®ï¸ 400 mg/day, 42 to EPP-AF®ï¸ 800 mg/day, and 42 to the control group. The length of hospital stay post-intervention was shorter in both propolis groups than in the control group; lower dose, median 7 days versus 12 days (95% confidence interval [CI] -6.23 to -0.07; p = 0.049) and higher dose, median 6 days versus 12 days (95% CI -7.00 to -1.09; p = 0.009). Propolis did not significantly affect the need for oxygen supplementation. In the high dose propolis group, there was a lower rate of acute kidney injury than in the controls (4.8 vs 23.8%), (odds ratio [OR] 0.18; 95% CI 0.03-0.84; p = 0.048). No patient had propolis treatment discontinued due to adverse events. CONCLUSIONS: Addition of propolis to the standard care procedures resulted in clinical benefits for the hospitalized COVID-19 patients, especially evidenced by a reduction in the length of hospital stay. Consequently, we conclude that propolis can reduce the impact of COVID-19.

Differential Host Pro-Inflammatory Response to Mycobacterial Cell Wall Lipids Regulated by the Mce1 Operon.

The cell wall of wild-type (WT) Mycobacterium tuberculosis (Mtb), an etiologic agent of tuberculosis (TB) and a Mtb strain disrupted in a 13-gene operon mce1 (Δmce1) varies by more than 400 lipid species. Here, we examined Mtb lipid-induced response in murine macrophage, as well as in human T-cell subpopulations in order to gain an insight into how changes in cell wall lipid composition may modulate host immune response. Relative to WT Mtb cell wall lipids, the non-polar lipid extracts from Δmce1 enhanced the mRNA expression of lipid-sense nuclear receptors TR4 and PPAR-γ and dampened the macrophage expression of genes encoding TNF-α, IL-6, and IL-1ß. Relative to untreated control, WT lipid-pre-stimulated macrophages from healthy individuals induced a higher level of CD4-CD8- double negative T-cells (DN T-cells) producing TNF-α. Conversely, compared to WT, stimulation with Δmce1 lipids induced higher mean fluorescence intensity (MFI) in IL-10-producing DN T cells. Mononuclear cells from TB patients stimulated with WT Mtb lipids induced an increased production of TNF-α by CD8+ lymphocytes. Taken together, these observations suggest that changes in mce1 operon expression during a course of infection may serve as a strategy by Mtb to evade the host pro-inflammatory responses.

Feasibility, safety, and adherence of a remote physical and cognitive exercise protocol for older women / Viabilidade, segurança e aderência de um protocolo remoto de exercícios físicos e cognitivos para mulheres idosas

Abstract Background Population aging and the consequences of social distancing after the COVID-19 pandemic make it relevant to investigate the feasibility of remote interventions and their potential effects on averting functional decline. Objective (1) To investigate the feasibility, safety, and adherence of a remote protocol involving physical and cognitive exercises for older women with normal cognition; (2) to examine its effects on cognitive and well-being variables. Methods Twenty-nine women (age ≥ 60 years old) were randomized into experimental group (EG; n= 15) and control group (CG; n= 14). The EG performed a 40-minute session of cognitive and physical exercises, and CG performed a 20-minute stretching session. Both groups performed 20 sessions via videoconference and 20 on YouTube twice a week. The Mini-Mental State Examination, Verbal Fluency Test, Digit Span (direct an inverse order), Geriatric Depression Scale (GDS), and Well-being Index (WHO-5) were applied in pre- and post-interventions by phone. Results Overall adherence was 82.25% in EG and 74.29% in CG. The occurrence of adverse events (mild muscle pain) was 33.3% in EG and 21.4% in CG. The EG improved verbal fluency and attention (p ≤ 0.05); both groups had improved depressive symptoms. Conclusion The present study met the pre-established criteria for feasibility, safety, and adherence to the remote exercise protocol among older women. The results suggest that a combined protocol has more significant potential to improve cognitive function. Both interventions were beneficial in improving the subjective perception of well-being.

Resumo Antecedentes O envelhecimento populacional e as consequências do isolamento social após a pandemia de COVID-19 tornaram relevante investigar a viabilidade, segurança e aderência de intervenções remotas e potenciais efeitos para prevenir declínios funcionais. Objetivo (1) Investigar a viabilidade, segurança e aderência de um protocolo remoto de exercícios físicos e cognitivos; (2) investigar os possíveis efeitos sobre variáveis de cognição e de bem-estar. Métodos Vinte e nove mulheres foram randomicamente divididas em grupo experimental (GE; n= 15) e grupo controle (GC; n= 14). O GE realizou sessões de 40 minutos de exercícios físicos e cognitivos e o GC, 20 minutos de alongamentos. Totalizaram 20 sessões por videoconferência e 20 pelo YouTube, duas vezes por semana. O Teste de Fluência Verbal, o Teste de Dígitos (ordem direta e inversa), a Escala de Depressão Geriátrica (GDS) e o Índice de Bem-Estar (WHO-5) foram aplicados no pré e pós-intervenção, por telefone e formulário digital. Resultados A aderência geral média foi de 82,25% no GE e 74,29% no GC. A ocorrência de eventos adversos (dores musculares leves) foi de 33,3% no GE e 21,4% no GC. O GE teve melhora em fluência verbal e atenção (p ≤ 0.05) e ambos os grupos tiveram melhora significativa nos sintomas depressivos. Conclusão O presente estudo atendeu aos critérios preestabelecidos para a viabilidade, segurança e aderência do programa oferecido entre idosas. Os resultados sugerem que o protocolo combinado tenha maior potencial de aprimorar funções cognitivas. Ambas as intervenções foram benéficas para a percepção subjetiva de bem-estar.

Prognostic ability of quick-SOFA across different age groups of patients with suspected infection outside the intensive care unit: A cohort study.

OBJECTIVES: Sepsis identification in older patients is challenging. We evaluated the performance of qSOFA across different age groups of patients with suspected infection outside the intensive care unit (ICU). METHODS: Retrospective cohort in a tertiary hospital in Brazil, from January 2016 to December 2016. Outcomes were hospital mortality, ICU admission and bacteremia. Performance of qSOFA was compared over three age groups: (1) reference: ≤65 years, (2) old: 65 to 79 years and (3) very old: ≥80 years. RESULTS: There were 420 patients in the study, of which 259 (61.7%) were ≤65 years, 80 (19%) were 65 to 79 years and 81 (19.3%) were ≥80 years. Old and very old patients had higher qSOFA scores and lower SIRS scores. Overall, qSOFA ≥2 was associated to hospital mortality [OR (95% CI) = 5.8 (3.3-10.4), p < 0.001], ICU admission [OR (95% CI) = 2.7 (1.6-4.6), p < 0.001] and bacteremia [OR (95% CI) = 3.1 (1.7-5.8), p < 0.001]. Those associations were stronger in old and very old patients. qSOFA and SIRS demonstrated overall AUROCs for hospital mortality of 0.72 and 0.50, respectively. CONCLUSION: qSOFA demonstrated good overall accuracy and was more strongly associated to outcomes in old and very old patients, when compared to younger patients.

Discriminações e preconceitos: temas que precisam de muito debate na formação dos profissionais de saúde / Discrimination and prejudice: topics that require extensive debate in the training of healthcare professionals

Conteúdos curriculares relativos às Ciências Humanas e Sociais têm muita importância no desenvolvimento de habilidades que vão construir competências relacionadas ao comportamento dos egressos. O curso de Odontologia da Univates aborda, desde o início da formação temáticas relacionadas a discriminação e ao preconceito de forma integrada no seu currículo. O trabalho apresenta relatos de experiências de quatro estudantes durante os estágios com o objetivo de identificar, reconhecer e discutir questões relacionadas ao preconceito e discriminação no desenvolvimento do estágio extramuros, apresentando os desafios e dificuldades encontradas nesse processo. Através de relatos subjetivos podemos perceber os diferentes itinerários de formação que os estudantes percorrem, além da ampliação das oportunidades de contato com essas temáticas. Nos relatos são descritas atividades de aprendizagem realizadas durante o curso e que são retomadas no enfrentamento das situações vivenciadas nos estágios. Dramatizações, leitura de materiais, desafios propostos no CBL (Challenge Based Learning), produções de resumoseparticipações em congressos vão sendo elencadas como referências importantes no atendimento de populações específicas como indígenas, imigrantes, pessoas com pele preta e que fazem uso de tornozeleiras eletrônicas, além de contatos com pessoas transexuaise portadores de necessidades especiais. Essas experiências, muitas vezes, são possíveis pela presença dos estudantes nas redes de saúde. O estágio extramuros amplia as experiências de atendimento aos estudantes, contribuindo para uma formação mais generalista e humanista. O contato dos estudantes com diferentes realidades é benéfico para o desenvolvimento de novas perspectivas a partir dos conteúdos trabalhados de forma teórica e, quando integrados, podem contribuir para uma formação mais cidadã (AU).

Curriculum subjects related to Human and Social Sciences are important to the development of skills that will build the abilities related to the behavior of graduates. From the beginning of training, the Univates Dentistry course addresses themes related to discrimination and prejudice in an integrated way in its curriculum. This academic project features reports of four students during their internships, aiming to identify, recognize and discuss issues related to prejudice and discrimination in the development of the internship, presenting the challenges encountered in this process. Through subjective reports it is possible to understand the different paths that graduation students go through, and the expansion of opportunities to get in touch with these themes. In the reports, the students describe many learning activities applied during the course that later were used in situations experienced in the internships. Acting, relevant paper reading, challenges proposed in the CBL (Challenge Based Learning), production of overviews and reports and participation in conferences are some of the important references in the care of specific populations such as indigenous people, immigrants, people with black skin, convicted people with electronic anklets, transsexuals and individuals with special needs. These experiences are often only possible due to the presence of students in the public health and care systems. The internship expands the student service experiences, contributing for a more humanized and real graduation. The contact of students with different realities is beneficial for the development of new perspectives from the content learned theoretically and, when combined, can build up to a more humanized graduation (AU).

Normal pressure hydrocephalus: an update / Hidrocefalia de pressão normal: uma atualização

ABSTRACT Normal pressure hydrocephalus (NPH) has been a topic of debate since its introduction in publications. More frequent in the elderly population, it is characterized by gait disturbance, urinary urge incontinence and cognitive decline. Therefore, it is a clinical-radiological entity with relatively common findings for the age group, which together may have greater specificity. Therefore, its diagnosis must be careful for an adequate selection of patients for treatment with ventricular shunt, since the symptoms are potentially reversible. The tap test has a high positive predictive value as a predictor of therapeutic response, but a negative test does not exclude the possibility of treatment. Scientific efforts in recent years have been directed towards a better understanding of NPH and this narrative review aims to compile recent data from the literature in a didactic way for clinical practice.

RESUMO A hidrocefalia de pressão normal (HPN) é tema de debate desde sua introdução na literatura. Mais frequente na população idosa, caracteriza-se por distúrbio de marcha, urge-incontinência urinária e declínio cognitivo. Portanto, trata-se de uma entidade clínico-radiológica com achados relativamente comuns para a faixa etária, que em conjunto, podem ter maior especificidade. Sendo assim, seu diagnóstico deve ser criterioso para uma adequada seleção de pacientes para tratamento com a derivação ventricular, uma vez que os sintomas são potencialmente reversíveis. O tap test possui valor preditivo positivo alto preditor de resposta terapêutica, mas um teste negativo não exclui a possibilidade de tratamento. Esforços científicos nos últimos anos têm sido direcionados para melhor entendimento da HPN e essa revisão narrativa se propõe a compilar dados recentes da literatura de forma didática para a prática clínica.

Young soccer players with higher somatic maturation are stronger, more powerful and faster than those with lower maturation / Jovens futebolistas de maior maturação somática são mais fortes, potentes e velozes que os de menor maturação

ABSTRACT The identification of young soccer players' maturation level throughout puberty is crucial to verify the influence of aspects that interfere on sport performance, such as body height and physical capacities. The aim of the present study was to verify the differences in physical performance of young soccer players in maturation stages before and after peak height velocity. This study comprised 49 soccer players (14.49 ± 1.00 yrs) belonging to the youth teams of a club in the city of Fortaleza. Body weight, height and trunk-cephalic height were measured. Somatic maturation was estimated using distance in years from peak height velocity (DPHV). 10 Meters Sprint and 20 Meter Flying Sprint, Modified Illinois, Jump Height (CMJ), RAST and Yo Yo IRT 1 tests were applied. Standardized Mean Difference (SMD) and Confidence Intervals (CI = 90%) were used to compare the study variables (PRE-PHV vs POST-PHV). Our findings showed that POST-PHV group showed higher values in CMJ (3/3/97, Very likely) and RAST (peak, average, minimum power) and lower in the 20 Meter Flying Sprint (100/0/0, Most Likely) when compared to the PRE-PHV group. We concluded that young soccer players with somatic maturation after peak height velocity presented better capacity of lower limb strength, anaerobic power and speed.

RESUMO A identificação do nível maturacional de futebolistas em formação, ao longo da puberdade, é fundamental para verificar a influência de aspectos que interferem no desempenho esportivo, tais como o tamanho corporal e as capacidades físicas. O objetivo do presente estudo foi verificar as diferenças de desempenho físico de jovens futebolistas em estágios maturacionais pré e pós pico de velocidade de crescimento. Participaram do estudo 49 futebolistas (14,49 ± 1,00 anos) das categorias de base de um clube da cidade de Fortaleza. Foram aferidas a massa corporal, a estatura e a altura tronco-cefálica. A maturação somática foi estimada por meio da distância ao pico de velocidade de crescimento (DPVC). Foram realizados os testes Sprint 10 metros e 20 metros lançado, Illinois modificado, Altura do salto (CMJ), RAST e o Yo Yo IRT 1. As Diferenças de Média Estandardizada (DME) e Intervalo de Confiança (IC = 90%) foram utilizados para comparar as variáveis do estudo (PRÉ-PVC vs PÓS-PVC). Os nossos achados mostraram que o grupo PÓS-PVC apresentou valores mais elevados no CMJ (0/3/97, Very likely) e no RAST (potência máxima, média, mínima) e inferiores no Sprint 20m L (100/0/0, Most Likely), quando comparado ao grupo PRÉ-PVC. Concluimos que jovens futebolistas com maturação somática pós pico de velocidade de crescimento apresentam melhor capacidade de força de membros inferiores, potência anaeróbia e velocidade.

Realistic simulation is associated with healthcare professionals' increased self-perception of confidence in providing acute stroke care: a before-after controlled study / Simulação realística é associada a aumento na autopercepção de segurança de profissionais de saúde no atendimento a pacientes com acidente vascular cerebral agudo: um estudo antes-depois controlado

ABSTRACT Background: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. Objective: To assess the impact of a stroke realistic simulation course on clinicians' self-perception of confidence in the management of acute stroke. Methods: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees' self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. Results: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. Conclusions: This stroke realistic simulation course was associated with an improvement on trainees' self-perception of confidence in providing acute stroke care.

RESUMO Introdução: Simulações são amplamente utilizadas na educação médica, mas há pouca evidência de sua eficácia no tratamento de pacientes neurocríticos. Como o acidente vascular cerebral agudo (AVC) é uma patologia que requer atendimento imediato, o uso de simulação pode ser uma ferramenta útil no treinamento do manejo desses pacientes. Objetivo: Avaliar o impacto do uso de simulação realística na autopercepção de segurança no atendimento a pacientes vítimas de AVC agudo. Métodos: Estudo antes-depois controlado. No grupo da intervenção, 17 profissionais da área de saúde participaram de um curso de simulação realística de atendimento a pacientes com AVC. Como controles, os participantes foram escolhidos a partir de uma amostra de conveniência composta por 18 participantes do curso Emergency Neurologic Life Support (ENLS) e 20 participantes de um curso de Neurossonologia. Foram respondidos questionários antes e após o curso para avaliar a autopercepção de segurança no atendimento a pacientes vítimas de AVC agudo, variando de 10 a 50 pontos. Foi avaliada a variação entre os resultados pré- e pós-teste, para avaliar a mudança na autopercepção de confiança do trainee no manejo do AVC agudo. Análise multivariada foi realizada para controlar possíveis fatores de confusão. Resultados: Quarenta e seis (83,63%) participantes responderam aos questionários. A pontuação no questionário pós-curso foi maior do que a obtida no questionário pré-curso no grupo de participantes do curso de simulação realística em AVC [mediana do questionário pré-curso: 41,5 (36,7-46,5) e mediana do questionário pós-curso: 47,0 (44,7-48,0); p=0,033]. Essa diferença não foi observada no curso de Neurossonologia [mediana pré-curso (IQR): 46,0 (44,0-47,00), mediana pós-curso (IQR): 46,0 (44,0-47,0); p=0,739] nem no ENLS [mediana pré-curso (IQR): 46,5 (39,0-48,2) mediana pós-curso (IQR): 47,0 (40,2-49,0); p=0,317]. Esses resultados persistiram após ajuste das variáveis. Conclusão: O curso de simulação realística em AVC foi associado a um aumento na autopercepção de segurança dos participantes em atender pacientes vítimas de AVC agudo.

Association between resilience and quality of life related to oral health in the elderly.

OBJECTIVE: To evaluate the association between psychological resilience and oral health related to quality of life through a hierarchical approach based on a conceptual theoretical model in a cohort of elderly residents in Rio Grande do Sul, Brazil. METHODS: We conducted a cross-sectional study nested in a cohort study in 2008. We evaluated 498 elderly residents in Carlos Barbosa, Rio Grande do Sul. The measures included sociodemographic questionnaire, health behavior, quality of life related to oral health (OHRQOL), measured by the Oral Health Impact Profile (OHIP-14), Resilience Scale, and DMFT. The association between resilience and potential impacts on perceptions of oral health-related quality of life was assessed through negative binomial regression. Mean ratios (MR) are presented with 95% confidence intervals (95%CI). RESULTS: Higher means of OHIP were found in women 6.7 ± 6.3; p = 0.011), in rural dwellers (7.3 ± 6.7; p = 0.004) and singles (8.0 ± 6.3; p = 0.032). The final model of multivariate analysis showed that being a rural dweller (MR = 1.32; 95%CI 1.06 - 1.65) and being married (MR = 1.36; 95%CI 1.07 - 1.72) were independently associated with OHRQOL. There was no association between resilience and OHRQOL. CONCLUSION: The results suggest that factors such as sociodemographic variables are associated with OHRQOL. The hypothesis that resilience might play a role in the outcome has not been confirmed.

Associação entre resiliência e qualidade de vida relacionada à saúde bucal em idosos / Association between resilience and quality of life related to oral health in the elderly

OBJETIVO: Avaliar a associação entre resiliência e qualidade de vida relacionada à saúde bucal, por meio de uma abordagem hierárquica baseada em um modelo teórico conceitual em uma coorte de idosos do Rio Grande do Sul. MÉTODOS: Foi conduzido um estudo transversal aninhado a um estudo de coorte, em 2008. Foram avaliados 498 idosos de Carlos Barbosa, Rio Grande do Sul. As medidas avaliadas foram sociodemográficas, comportamentos de saúde, qualidade de vida relacionada à saúde bucal, medida pelo Oral Health Impact Profile (OHIP-14), Escala de Resiliência e CPOD. A associação entre o potencial de resiliência e os impactos na percepção de saúde bucal relacionados à qualidade de vida foi verificada por meio de regressão binomial negativa. Razões das médias (RM) são apresentadas com seus intervalos de confiança de 95% (IC95%). RESULTADOS: Maiores médias do OHIP foram encontradas entre mulheres (6,7 ± 6,3; p = 0,011), moradores da zona rural (7,3 ± 6,7; p = 0,004) e solteiros (8,0 ± 6,3; p = 0,032). O modelo final da análise multivariada mostrou que ser morador da zona rural (RM = 1,32; IC95% 1,06 - 1,65) e casado (RM = 1,36; IC95% 1,07 - 1,72) foram variáveis independentemente associadas à qualidade de vida relacionada à saúde bucal. Não houve associação entre resiliência e qualidade de vida relacionada à saúde bucal. CONCLUSÃO: Os resultados sugerem que variáveis sociodemográficas estão associados à qualidade de vida relacionada à saúde bucal. A hipótese de que a resiliência pudesse exercer um papel importante no desfecho não foi confirmada. .

OBJECTIVE: To evaluate the association between psychological resilience and oral health related to quality of life through a hierarchical approach based on a conceptual theoretical model in a cohort of elderly residents in Rio Grande do Sul, Brazil. METHODS: We conducted a cross-sectional study nested in a cohort study in 2008. We evaluated 498 elderly residents in Carlos Barbosa, Rio Grande do Sul. The measures included sociodemographic questionnaire, health behavior, quality of life related to oral health (OHRQOL), measured by the Oral Health Impact Profile (OHIP-14), Resilience Scale, and DMFT. The association between resilience and potential impacts on perceptions of oral health-related quality of life was assessed through negative binomial regression. Mean ratios (MR) are presented with 95% confidence intervals (95%CI). RESULTS: Higher means of OHIP were found in women 6.7 ± 6.3; p = 0.011), in rural dwellers (7.3 ± 6.7; p = 0.004) and singles (8.0 ± 6.3; p = 0.032). The final model of multivariate analysis showed that being a rural dweller (MR = 1.32; 95%CI 1.06 - 1.65) and being married (MR = 1.36; 95%CI 1.07 - 1.72) were independently associated with OHRQOL. There was no association between resilience and OHRQOL. CONCLUSION: The results suggest that factors such as sociodemographic variables are associated with OHRQOL. The hypothesis that resilience might play a role in the outcome has not been confirmed. .

Observatório de custos em saúde: a implantação do sistema de gerenciamento dos custos hospitalares e o uso da meta-informação custo / Observatory on health costs: implementation of management system of hospital costs and the use of meta-information cost

Este artigo apresenta os resultados da construção de uma base de conhecimento a partir da gestão de custos na Fundação Hospitalar de Minas Gerais (FHEMIG). A base de conhecimento proposta se apoiou em outra pesquisa aplicada, ou seja, a do Observatório de Custos em Saúde, ferramenta de organização estratégica na Rede FHEMIG. A importância deste trabalho fundamenta-se na inovação no uso e na aplicação da gestão de custos hospitala-res em 21 Unidades Assistenciais públicas e no expressivo volume de recursos gastos no setor saúde. O trabalho, metodologicamente, constituiu- -se inicialmente num estudo multi-caso para a validação e geração de consistência quanto à criação do Observatório de Custos em Saúde. Esta pesquisa aplicada envolveu pesquisadores da FHEMIG e da Universidade Federal de Minas Gerais (UFMG). Deve-se ressaltar, como sendo um dos primeiros resultados obtidos, a disponibilização aos gestores da meta-informação custos. A meta-informação é a informação sobre as informações. Este é um conceito central uma vez que inova o gerenciamento de custos, ou seja, os custos deixam de ser apontadores triviais de gastos e passam a ser usados como indicadores de resultados, de processo e de desempenho. Para tanto, os custos devem ser tratados como um "sumário" de quais e como os recursos são consumidos em um proces-so. Assim, o Observatório de Custos e a base conhecimento gerada são altamente inovadores quanto ao mapeamento, identificação e quantificação do consumo de recursos no setor saúde. Em uma visão geral, permite identificar como os custos retratam os recursos utilizados (humanos, materiais, serviços e tecnologia); os serviços/bens prestados/produzidos em hospitais públicos; rastrear custos por unidades operacionais (departamentos, divisões) e por objeto (paciente e tipo de serviço); construir um arcabouço de informações suficiente para a compreensão dos processos gerenciais internos na perspectiva dos custos e sua correlação com os serviços prestados e com os demais indicadores assistenciais. Enfim, este trabalho subsidia o debate da utilização da informação de custos muito além do tradicional 'cortar custos' e, sim, incentiva seu uso como ferramenta de suporte da qualidade do gasto público no setor saúde ­ gestão hospitalar. Além disto, o Observatório de Custos em Saúde, por sua importância, obteve o apoio institucional de outras entidades representativas no cenário da saúde no Brasil, como Organização Pan-Americana de Saúde, Ministério da Saúde, Banco Mundial. Ao mesmo tempo, sustenta melhores práticas, benchmarking, desenvolvimento científico e tecnológico e principalmente, ainda, transparência dos gastos públicos. Pode-se concluir que a criação do Observatório de Custos em Saúde e a utilização da meta-informação custos podem constituir ainda como subsídio estratégico na definição de políticas públicas de saúde e marcos regulatórios do setor.(AU)

This article presents the results of building a knowledge base from the cost management in the Hospital Foundation of the State of Minas Gerais (FHEMIG). The proposed knowledge base was supported by another applied research, i.e. The Observatory on Health Costs, a strategic organization tool of FHEMIG Network. The importance of this work is based on the innovative use and application of cost management in 21 facilities of hospital public care and in the significant amount of resources spent on health industry. The work, methodologically, was formed initially in a multi-case study for the validation and generation of consistency regarding the establishment of the Observatory on Health Costs. This applied research involved researchers from FHEMIG and Federal University of Minas Gerais (UFMG). It should be emphasized, as one of the first results, the availability for managers of the meta-information of costs. The meta-information is information about information. This is a central concept once it innovate the cost management, i.e. the costs are no longer trivial spending markers and become to be used as outcome indicators, process and performance. For both, the costs should be treated as a "summary" of what and how resources are consumed in a process. Thus, the Observatory on Health Costs and the generated knowledge base are highly innova-tive regarding to mapping, identification and quantification of the consumption of resources in the health industry. In an overview, it's possible to identifies how costs reflects the resources used (human, material, services, and technology), services / goods rendered / produced in public hospitals; track costs by operational units (departments, divisions) and object (patient and type of service), build a framework of enough information to understand the internal management processes, from the costs perspective and its correlation with the services rendered and the others health care indicators. Finally, this work subsidizes the discussion of the use of cost information far beyond the traditional 'cut costs' and, yes, it encourages its use as a tool to support the quality of public expenditure in health industry - hospital management. Moreover, the Observatory on Health Costs, given its importance, had the institutional support of other representative bodies in the health scenario in Brazil, as the Pan American Health Organization, Ministry of Health, and the World Bank. At the same time, it supports the best practices, benchmarking, scientific and technological development and above all, still, transparency in public spending. It can be concluded that the establish-ment of the Observatory on Health Costs and use of meta-information of costs may be even an strategic subsidize for public health policies setting as well as regulatory milestones of the industry.(AU)