Oral motor assessment in individuals with Moebius syndrome.

BACKGROUND: Moebius syndrome (MS) is a rare congenital condition that is characterised by facial hypomimia and congenital strabismus caused by complete or partial impairment of the 6th and 7th cranial nerves. MS may be further associated with other nerves or malformations, mainly involving the extremities. The objective of this study was to quantify the decrease in oral motor performance in people with MS compared with normoreactive individuals using the Oral Motor Assessment Scale (OMAS). METHODS: The study group comprised 33 subjects between the ages of 2 and 20 years (average age: 10 ± 5 years) with MS along with 46 age- and gender-matched control subjects. RESULTS: The study group displayed a lower average functional score than the control group (P < 0.0001). A significant lack of lip closure (P = 0.03) and anterior lingual seal during swallowing (P = 0.03) occurred in the study group; in most cases, the individuals with MS were classified as 'subfunctional'. In addition, individuals with MS in the older age group displayed better functional scores than those in the younger group (P = 0.05). CONCLUSIONS: Functional damage to oral motor function in individuals with MS is evident, but differs among patients with respect to severity and the movements that are compromised. However, overall, improvements in the functional patterns of these individuals can be observed as they mature in age.

[Reasons for non-elective removal of epicutaneous catheters in neonates]. / Causas de remoção não eletiva do cateter epicutâneo em neonatos.

This study aimed to describe the incidence and reasons for nonelective removal of epicutaneous catheters in neonates, identifying its association with the catheter insertion site. This was a prospective cohort study, conducted in a neonatal intensive care unit of a private tertiary hospital in the city of São Paulo, Brazil. We analyzed 266 epicutaneous catheter insertions. The incidence of non-elective removal was 39.1%. The most frequent post-insertion complications were suspicion of catheter-related bloodstream infection (25%) and rupture (23.1%). Most catheters were inserted through the right side of the body (65%), in upper limbs (77.1%), and using the axillary veins (31.2%). The findings did not suggest association between the incidence of non-elective removal and the insertion site of the epicutaneous catheter in neonates. Nurses should implement strategies to improve care and decrease incidence of non-elective epicutaneous catheter removals among neonates.

[Analgesia and sedation during placement of peripherally inserted central catheters in neonates]. / Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos.

This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.

[Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates]. / Prevalência e motivos de remoção não eletiva do cateter central de inserção periférica em neonatos.

This is a cross sectional study conducted with 67 newborns admitted at the neonatal intensive care unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line) placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1671.6 g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3%) catheters, 18.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspected infection, 1.2% accidental dislodgement 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.

Pulmonary Vascular Volume Estimated by Automated Software is a Mortality Predictor after Acute Pulmonary Embolism. / Volume Vascular Pulmonar Estimado por Software Automatizado é um Preditor de Mortalidade após Embolia Pulmonar Aguda.

BACKGROUND: Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis. OBJECTIVE: To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE. METHODS: Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm3)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant. RESULTS: Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm3/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm3/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died. CONCLUSION: PVV<23cm3/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818).

FUNDAMENTO: A embolia pulmonar aguda (EPA) tem desfecho clínico variável. A angiotomografia computadorizada (angio-CT) é considerada o padrão-ouro para o diagnóstico. OBJETIVO: Avaliar se o volume vascular pulmonar (VVP) quantificado por software automatizado é um preditor de mortalidade após EPA. MÉTODOS: Estudo de coorte retrospectivo no qual a imagem da angio-CT de 61 pacientes com EPA foi reanalisada. O VVP e o volume pulmonar (VP) foram estimados automaticamente pelo software Yacta. Calculamos o VVP ajustado pela razão: VVP(cm3)/VP(litros). Parâmetros prognósticos clássicos da angio-CT (carga embólica; razão do diâmetro do ventrículo direito/ventrículo esquerdo; razão do diâmetro da artéria pulmonar/aorta; desvio do septo interventricular; infarto pulmonar e refluxo de contraste na veia hepática) foram avaliados. A mortalidade em 1 mês foi o desfecho analisado. Consideramos um valor de p <0,05 como estatisticamente significativo. RESULTADOS: Sete mortes (11%) ocorreram entre os 61 pacientes durante 1 mês de seguimento. O VVP ajustado <23cm3/L foi um preditor independente de mortalidade na análise univariada (odds ratio [OR]: 26; intervalo de confiança de 95% [IC95%]: 3-244; p=0,004) e na análise multivariada (OR ajustado: 19 [IC95%: 1,3-270]; p=0,03). Os parâmetros clássicos da angio-CT não foram associados à mortalidade em 1 mês nesta amostra. O VVP ajustado <23cm3/L apresentou sensibilidade de 86%, especificidade de 82%, valor preditivo negativo de 94% e valor preditivo positivo de 64% para identificação dos pacientes que morreram. CONCLUSÃO: VVP ajustado <23cm3/L foi um preditor independente de mortalidade após EPA. Esse parâmetro mostrou melhor desempenho prognóstico do que os outros achados clássicos da angio-CT. (Arq Bras Cardiol. 2020; 115(5):809-818).

A novel Sporothrix brasiliensis genomic variant in Midwestern Brazil: evidence for an older and wider sporotrichosis epidemic.

Sporotrichosis is a subcutaneous infection caused by fungi from the genus Sporothrix. It is transmitted by inoculation of infective particles found in plant-contaminated material or diseased animals, characterizing the classic sapronotic and emerging zoonotic transmission, respectively. Since 1998, southeastern Brazil has experienced a zoonotic sporotrichosis epidemic caused by S. brasiliensis, centred in the state of Rio de Janeiro. Our observation of feline sporotrichosis cases in Brasília (Midwestern Brazil), around 900 km away from Rio de Janeiro, led us to question whether the epidemic caused by S. brasiliensis has spread from the epicentre in Rio de Janeiro, emerged independently in the two locations, or if the disease has been present and unrecognized in Midwestern Brazil. A retrospective analysis of 91 human and 4 animal cases from Brasília, ranging from 1993 to 2018, suggests the occurrence of both sapronotic and zoonotic transmission. Molecular typing of the calmodulin locus identified S. schenckii as the agent in two animals and all seven human patients from which we were able to recover clinical isolates. In two other animals, the disease was caused by S. brasiliensis. Whole-genome sequence typing of seven Sporothrix spp. strains from Brasília and Rio de Janeiro suggests that S. brasiliensis isolates from Brasília are genetically distinct from those obtained at the epicentre of the outbreak in Rio de Janeiro, both in phylogenomic and population genomic analyses. The two S. brasiliensis populations seem to have separated between 2.2 and 3.1 million years ago, indicating independent outbreaks or that the zoonotic S. brasiliensis outbreak might have started earlier and be more widespread in South America than previously recognized.

Oral characteristics and medical considerations in the dental treatment of individuals with Williams syndrome.

AIM: The aim of this study was to evaluate oral characteristics and comorbidities that may affect dental treatment of individuals with Williams syndrome (WS). METHODS AND RESULTS: Fifty-two subjects diagnosed with WS were included in this observational study. Demographic data and medical history were compiled. Facial aspects, tooth abnormalities and oral characteristics were obtained through clinical and radiographic evaluation by a researcher/dentist. Among 52 subjects, 25 were also evaluated for temporomandibular and occlusal disorders, caries and periodontal disease. From the 52 subjects, 23 (44.2%) were female and the average age was of 20 years old (range from 4 to 35 years old). Cognitive impairment and congenital heart disease were the most common medical disorders found in all 52 (100%) and in 41 (78.8%) subjects, respectively. Among the 52 subjects, 51 (98%) presented at least one dental developmental abnormality, with generalized diastemas (72.5%) and hypodontia (50.9%) being the most frequent ones. Angle class III malocclusion was observed in 52% (13/25) of the subjects. CONCLUSIONS: The dentist should be aware of the medical conditions of individuals with WS and thus offer an adequate dental treatment. The high prevalence of tooth abnormalities and occlusal disorders requires an early dental treatment planning.

Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil.

OBJECTIVE: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. METHODS: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. RESULTS: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). CONCLUSIONS: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.

The use of gamification to teach in the nursing field.

OBJECTIVES: To investigate whether the course offer with elements of gamification contributes to the formation of competences in Informatics in Nursing; and evaluate it based on teaching and learning criteria and content structure. METHOD: Exploratory, applied and technological innovation research, with a qualitative and quantitative approach, developed at a university in the southern region of the country between February and November 2016. Participants were professors (5) and nursing students (10). RESULTS: The adoption of gamification was considered an interesting and innovative approach, as an alternative to traditional practices and applicable to Nursing teaching. In the quantitative analysis, it was observed that the course contemplates the set of evaluated criteria. Final considerations: Gamification contributes to the formation of competences among Nursing students for positively influencing the teaching-learning process. It can be understood as one more resource in the teaching work with a view to student motivation and meaningful learning.

Consentimento livre e esclarecido em participantes de pesquisa clínica / Free and informed consent in clinical research participants / Consentimiento libre e informado en participantes de investigación clínica

Objetivo: avaliar o processo de consentimento dos participantes de pesquisa clínica. Método: estudo exploratório, retrospectivo e quantitativo, desenvolvido em hospital de referência nacional em oncologia entre maio de 2016 e janeiro de 2017. Foi elaborado formulário e submetido a teste piloto. Utilizou-se o índice de legibilidade de Flesch-Kincaid (ILFK) na avaliação dos Termos de Consentimento Livre e Esclarecido (TCLE). Realizou-se análise descritiva e univariada. Resultados: o cálculo do ILFK revelou que 100% dos TCLEs apresentaram leitura muito difícil. A idade do participante foi estatisticamente significante nas questões sobre ajuda na leitura do TCLE antes da assinatura (p=0,02), dificuldade de leitura do TCLE (p=0,04) e se assinou o TCLE antes de iniciar a participação (p=0,02). A escolaridade apresentou significância quanto à questão sobre indenizações (p=0,02), e o sexo, quanto à questão de ajuda de familiar para a leitura do TCLE (p=0,01). Conclusão: percebeu-se a necessidade em estabelecer padrões que proporcionem tomada de decisão consciente e própria do participante, considerando a escolaridade, necessidades pessoais, crenças e costumes.

Objective: to evaluate the consent process of clinical research participants. Method: exploratory, retrospective and quantitative study, developed in a national reference hospital in oncology between May 2016 and January 2017. Form was prepared and submitted to pilot test. The Flesch-Kincaid readability index (FKRI) was used in the evaluation of the Informed Consent Forms (ICF). Descriptive and univariate analysis was performed. Results: the calculation of the FKRI revealed that 100% of ICFs had very difficult reading. The age of the participant was statistically significant in questions about help in reading the ICF before signing (p=0.02), difficulty reading the ICF (p=0.04) and signed the ICF before starting the participation (p=0.02). Education was significant in relation to the issue of compensation (p=0.02), and sex to the question of family help for reading the ICF (p=0.01). Conclusion: it was perceived the need to establish standards that provide conscious decision making of the participant, considering education, personal needs, beliefs and customs.

Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia.

Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10-year-old female patient presented with a 1-month history of an asymptomatic, firm, and pinkish-red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.

Rapid diagnosis of Zika virus through saliva and urine by Loop-mediated isothermal amplification (LAMP).

Background: Zika virus (ZIKV) is a single-stranded RNA virus and member of the Flaviviridae family. Recent studies have reported that saliva can be an important alternative to detect ZIKV. Saliva requires less processing than blood greatly simplifying the assay. Loop-mediated Isothermal Amplification (LAMP) is a rapid assay that detects nucleic acids, including ZIKV RNA. Aim: The aim of this study was to evaluate the efficacy of saliva and urine to diagnose ZIKV infection in subjects during the acute phase, through ZIKV RNA detection by LAMP. Method: A total of 131 samples (68 saliva and 63 urine samples) from 69 subjects in the acute phase of ZIKV infection, and confirmed positive for ZIKV by blood analysis through real time-PCR, were collected and analyzed by Reverse Transcriptase Loop-mediated Isothermal Amplification (RT-LAMP). Results: From the 68 saliva samples, 45 (66.2%) were positive for ZIKV with an average time to positivity (Tp) of 13.5 min, and from the 63 urine samples, 25 (39.7%) were positive with the average Tp of 15.8 min. Saliva detected more samples (p = 0.0042) and had faster Tp (p = 0.0176) as compared with urine. Conclusion: Saliva proved to be a feasible alternative to diagnose ZIKV infection during the acute phase by LAMP.

Detection of Zika virus using reverse-transcription LAMP coupled with reverse dot blot analysis in saliva.

In recent years, there have been increasing numbers of infectious disease outbreaks that spread rapidly to population centers resulting from global travel, population vulnerabilities, environmental factors, and ecological disasters such as floods and earthquakes. Some examples of the recent outbreaks are the Ebola epidemic in West Africa, Middle East respiratory syndrome coronavirus (MERS-Co) in the Middle East, and the Zika outbreak through the Americas. We have created a generic protocol for detection of pathogen RNA and/or DNA using loop-mediated isothermal amplification (LAMP) and reverse dot-blot for detection (RDB) and processed automatically in a microfluidic device. In particular, we describe how a microfluidic assay to detect HIV viral RNA was converted to detect Zika virus (ZIKV) RNA. We first optimized the RT-LAMP assay to detect ZIKV RNA using a benchtop isothermal amplification device. Then we implemented the assay in a microfluidic device that will allow analyzing 24 samples simultaneously and automatically from sample introduction to detection by RDB technique. Preliminary data using saliva samples spiked with ZIKV showed that our diagnostic system detects ZIKV RNA in saliva. These results will be validated in further experiments with well-characterized ZIKV human specimens of saliva. The described strategy and methodology to convert the HIV diagnostic assay and platform to a ZIKV RNA detection assay provides a model that can be readily utilized for detection of the next emerging or re-emerging infectious disease.

Polyomavirus BK and JC in individuals with chronic kidney failure, kidney transplantation, and healthy controls.

BACKGROUND: New clinical approaches to diagnose and monitor individuals with systemic diseases have been employed through the use of oral fluids. Polyomavirus BK (BKPyV) and JC (JCPyV) infect asymptomatically around 80% of general population worldwide remaining latent in the body. In case of immunosuppression, a replication can occur, leading to diseases. OBJECTIVE: The aim of this study was to detect and quantify BKPyV and JCPyV in oral fluids of individuals with chronic kidney failure (CKF), kidney transplantation (KT) and controls compared with their detection in blood and urine, traditionally used for this test. STUDY DESIGN: Forty six subjects were included and distributed into 3 groups: 14 with CKF (Group 1), 12 with KT (Group 2) and 20 healthy individuals (Group 3). In a total, 315 samples were collected and analyzed through RT-PCR, being 151 of gingival crevicular fluid, 46 of saliva, 46 of mouthwash, 43 of blood and 29 of urine. RESULTS: All subjects from group 1 were positive for BKPyV in at least one collected samples and 14% were positive for JCPyV. In Group 2, 91.7% were positive for BKPyV and 51.7% for JCPyV. Among subjects of Group 3, 80% were positive for BKPyV and 45% for JCPyV. CONCLUSIONS: Oral fluids exhibited high prevalence of BKPyV and JCPyV and were equally efficient compared to urine and blood. The use of oral fluids to detect these polyomaviruses enhances positivity in screening, even in cases of absence of viremia and especially in individuals who are not able to urinate.

Caries Experience in Individuals with Moebius Syndrome.

PURPOSE: Moebius syndrome (MS) is a rare congenital facial diplegia characterized by partial or complete sixth and seventh cranial nerve palsy. Orofacial manifestations include micrognathia, increased overbite, high arched palate, morphological changes in the tongue, and dental crowding. Case reports and small case series have shown a high prevalence of caries in MS patients. The purpose of this study was to compare the prevalence of caries between individuals with Moebius syndrome and controls using the International Caries Detection and Assessment System (ICDAS). METHODS: A total of 90 participants were divided into two groups: (1) the study group, comprising 34 individuals with MS; and (2) the control group, comprising 56 age- and gender-matched healthy subjects without MS. All individuals were evaluated for the presence of caries using the ICDAS. For statistical analysis, different ICDAS scores were used as cutoff points. RESULTS: The number of carious lesions in the MS group was higher only for early-stage caries (i.e., ICDAS scores of 1 and 2; 27.0±23.0 versus 16.0±14.1 and 26.3±23.2 versus 15.2±13.6, respectively). CONCLUSION: Moebius syndrome patients have more early carious lesions than controls without the syndrome.

Avaliação da influência dos marcadores inflamatórios na mortalidade de pacientes com AVC isquêmico / Evaluation of the influence of inflammatory markers on the mortality of patients with ischemic stroke

INTRODUÇÃO: À medida que a população envelhece e a expectativa de vida aumenta, a incidência global e a prevalência de AVC isquêmico tendem a aumentar significativamente. Nesse contexto, surge a necessidade de avaliar novos marcadores preditores de mortalidade, como a contagem absoluta de monócitos, relação linfócitos sobre monócitos, relação neutrófilos sobre linfócitos e níveis de proteína C reativa ultrassensível, que além de serem de fácil acesso e baixo custo, sugerem indicar desfecho no paciente com AVC agudo. OBJETIVOS: o objetivo deste estudo foi avaliar a associação dos marcadores inflamatórios com a mortalidade de pacientes com AVC isquêmico. MÉTODOS: trata-se de um estudo retrospectivo observacional a partir de prontuários eletrônicos e exames laboratoriais de pacientes com AVC isquêmico em uma unidade hospitalar de Cascavel/PR. Uma análise estatística descritiva foi conduzida para determinar o perfil dos pacientes segundo o desfecho e aplicado um modelo de regressão logística para verificar as variáveis associadas a mortalidade. Foram considerados significativos apenas os dados com p-valor <0,05. RESULTADOS: Dos 65 pacientes que foram admitidos no estudo, 50 receberam alta hospitalar e 15 foram a óbito no hospital. Entre os marcadores inflamatórios, a relação de neutrófilos sobre linfócitos (OR 1,55; p-valor <0,01) mostrou-se significativamente associada a maior chance de óbito. Os pacientes que faleceram apresentaram níveis superiores de PCR ultrassensível, maior contagem absoluta de monócitos, relação linfócitos sobre monócitos diminuída, e relação neutrófilos sobre linfócitos elevada. CONCLUSÃO: a relação de neutrófilos sobre linfócitos elevada pode estar significativamente associada ao desfecho desfavorável após um AVC isquêmico

IINTRODUCTION: As the population ages and life expectancy increases, the global incidence and prevalence of ischemic stroke tends to rise significantly. In this context, the need arises to evaluate new predictive markers of mortality, such as absolute monocyte count, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) levels which, besides being easily accessible and affordable, manage to predict the outcome in patients with acute stroke. OBJECTIVES: the aim of this study was to evaluate the association between inflammatory markers and the mortality in ischemic stroke patients. METHODS: this is a retrospective observational study based on the analysis of electronic medical records and laboratory tests of in-patients who suffered an ischemic stroke in Cascavel/PR. A descriptive statistical analysis was conducted to determine patients´ profile according to the outcome and a logistic regression model was applied in order to verify the variables associated with mortality. Only data with a p-value <0,05 was considered. RESULTS: Out of the 65 patients who suffered an ischemic stroke included in the study, 50 were discharged and 15 died in hospital. Among the inflammatory markers, the neutrophil-tolymphocyte ratio (OR 1.55; p-value <0,01) was associated with a greater chance of death. Patients who died presented with higher levels of ultra-sensitive CRP, higher absolute monocyte count, lower lymphocyte-to-monocyte ratio and higher neutrophil-to- lymphocyte ratio. CONCLUSION: the elevated neutrophil-to-lymphocyte ratio may be significantly associated with negative outcomes following an ischemic stroke

Salivary parameters and oral health in the Moebius syndrome.

PURPOSE: To evaluate salivary characteristics, such as flow rate, buffering capacity and amylase activity, and associate these parameters with oral health in individuals with Moebius syndrome (MS) and controls. METHODS: The researchers assessed caries (ICDAS), periodontal disease (PSR), and plaque (Silness Löe) indexes in both groups. Unstimulated, stimulated, and bilateral parotid saliva were also collected. The salivary flow (milliliters/minute) and α-amylase activity were measured in all samples. The α-amylase activity was determined by maltose production. The buffering capacity was measured in stimulated saliva by titration of 0.01N HCl. RESULTS: The occurrence of carious lesions, related to cut-off 2, as well as the occurrence of periodontal disease, was significantly higher (p > 0.05) in participants with MS when compared to the control group. Also, MS individuals presented decreased salivary flow, decreased buffering capacity, and amylase activity. CONCLUSIONS: MS individuals present salivary alterations, which can be related to higher risk for caries.

Computer Experience of Nurses.

This study aimed to identify the computing experience of nurses in southern Brazil, through exploratory survey research. The results, which were obtained from the application of The Staggers Nursing Computer Experience Questionnaire®, were analyzed by statistical tests. The survey was conducted with nurses working both in hospitals, as in public health, in a capital in southern Brazil. There is the predominance of novice nurses in the application of computer tools in their practices but most often declare the use the computers to develop their professional and also personal life activities. We conclude that the computer and health information systems are part of the working reality of the participants, being considered indispensable resources his activity, while noting limitations on the potential use of these tools. This study reflects on how the issue has been addressed in educational schools and the challenges of inclusion of the theme of Nursing Informatics in the curricula in Brazil.

Volume Vascular Pulmonar Estimado por Software Automatizado é um Preditor de Mortalidade após Embolia Pulmonar Aguda / Pulmonary Vascular Volume Estimated by Automated Software is a Mortality Predictor after Acute Pulmonary Embolism

Resumo Fundamento: A embolia pulmonar aguda (EPA) tem desfecho clínico variável. A angiotomografia computadorizada (angio-CT) é considerada o padrão-ouro para o diagnóstico. Objetivo: Avaliar se o volume vascular pulmonar (VVP) quantificado por software automatizado é um preditor de mortalidade após EPA. Métodos: Estudo de coorte retrospectivo no qual a imagem da angio-CT de 61 pacientes com EPA foi reanalisada. O VVP e o volume pulmonar (VP) foram estimados automaticamente pelo software Yacta. Calculamos o VVP ajustado pela razão: VVP(cm3)/VP(litros). Parâmetros prognósticos clássicos da angio-CT (carga embólica; razão do diâmetro do ventrículo direito/ventrículo esquerdo; razão do diâmetro da artéria pulmonar/aorta; desvio do septo interventricular; infarto pulmonar e refluxo de contraste na veia hepática) foram avaliados. A mortalidade em 1 mês foi o desfecho analisado. Consideramos um valor de p <0,05 como estatisticamente significativo. Resultados: Sete mortes (11%) ocorreram entre os 61 pacientes durante 1 mês de seguimento. O VVP ajustado <23cm3/L foi um preditor independente de mortalidade na análise univariada (odds ratio [OR]: 26; intervalo de confiança de 95% [IC95%]: 3-244; p=0,004) e na análise multivariada (OR ajustado: 19 [IC95%: 1,3-270]; p=0,03). Os parâmetros clássicos da angio-CT não foram associados à mortalidade em 1 mês nesta amostra. O VVP ajustado <23cm3/L apresentou sensibilidade de 86%, especificidade de 82%, valor preditivo negativo de 94% e valor preditivo positivo de 64% para identificação dos pacientes que morreram. Conclusão: VVP ajustado <23cm3/L foi um preditor independente de mortalidade após EPA. Esse parâmetro mostrou melhor desempenho prognóstico do que os outros achados clássicos da angio-CT. (Arq Bras Cardiol. 2020; 115(5):809-818)

Abstract Background: Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis. Objective: To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE. Methods: Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm3)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant. Results: Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm3/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm3/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died. Conclusion: PVV<23cm3/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818)

Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil / Validação do Pulmonary Embolism Severity Index para a estratificação de risco após tromboembolia pulmonar aguda em uma coorte no Brasil

ABSTRACT Objective: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. Methods: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. Results: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). Conclusions: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.

RESUMO Objetivo: Pulmonary Embolism Severity Index (PESI) foi desenvolvido para a estratificação de risco após tromboembolia pulmonar (TEP) aguda. Nosso objetivo foi validá-lo para uso no Brasil. Métodos: Estudo retrospectivo unicêntrico incluindo pacientes com TEP admitidos numa unidade de emergência. O PESI (versão original e simplificada) foi calculado utilizando-se dados dos prontuários na admissão hospitalar. O desfecho analisado foi mortalidade geral em 30 dias (MG30). Resultados: Foram incluídos 123 pacientes, com média de idade de 57 ± 17 anos, predomínio do sexo feminino (60%) e MG30 de 28 óbitos (23%). Na análise agrupada, a MG30 (classes I-II vs. III-IV-V) foi de 2,40% vs. 20,00% (risco relativo [RR] = 5,9; IC95%: 1,88-18,51; p = 0,0002). A MG30 na versão simplificada (0 vs. ≥ 1 ponto) foi de 3,25% vs. 19,51% (RR = 2,38; IC95%: 0,89-6,38; p = 0,06). A análise da sobrevida mostrou que as curvas de Kaplan-Meier foram semelhantes nas classes I e II (p = 0,59) e entre as classes III, IV e V (p = 0,25). A curva da versão original agrupada mostrou que a MG30 foi significativamente maior no grupo III-IV-V que no grupo I-II (RR = 7,63; IC95%: 2,29-25,21; p = 0,0001). A análise agrupada da versão original mostrou área sob a curva ROC maior que a da versão simplificada (0,70; IC95%: 0,62-0,77 vs. 0,60; IC95%: 0,51-0,67; p = 0,05). Conclusões: O PESI mensurou adequadamente o prognóstico de MG30 após TEP aguda nesta amostra da população brasileira. A utilização da versão original agrupada foi a mais adequada nesse cenário.