Clinical Characteristics and Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Multicenter Study in a Middle-Income Country.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality and long-term functional impairment. Data on clinical management and functional outcomes from developing countries are scarce. We aimed to define patient profiles and clinical practices and evaluate long-term outcomes after SAH in a middle-income country. METHODS: This was a prospective study including consecutive adult patients admitted with SAH to two reference centers in Brazil from January 2016 to February 2020. The primary outcome was functional status at 6 months using the modified Rankin Scale. Mixed multivariable analysis was performed to determine the relationship between clinical variables and functional outcomes. RESULTS: From 471patients analyzed, the median time from symptom onset to arrival at a study center was 4 days (interquartile range 0-9). Median age was 55 years (interquartile range 46-62) and 353 (75%) patients were women. A total of 426 patients (90%) were transferred from nonspecialized general hospitals, initial computed tomography revealed thick hemorrhage in 73% of patients (modified Fisher score of 3 or 4), and 136 (29%) had poor clinical grade (World Federation of Neurological Surgeons score of 4 or 5). A total of 312 (66%) patients underwent surgical clipping, and 119 (25%) underwent endovascular coiling. Only 34 patients (7%) underwent withdrawal or withholding of life-sustaining therapy during their hospital stay, and in-hospital mortality was 24%. A total of 187 (40%) patients had an unfavorable long-term functional outcome (modified Rankin Scale score of 4 to 6). Factors associated with unfavorable outcome were age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), hypertension (adjusted OR 1.81, 95% CI 1.04-3.16), poor clinical grade (adjusted OR 4.92, 95% CI 2.85-8.48), external ventricular drain (adjusted OR 3.8, 95% CI 2.31-6.24), postoperative deterioration (adjusted OR 2.33, 95% CI 1.32-4.13), cerebral infarction (adjusted OR 3.16, 95% CI 1.81-5.52), rebleeding (adjusted OR 2.95, 95% CI 1.13-7.69), and sepsis (adjusted OR 2.68, 95% CI 1.42-5.05). CONCLUSIONS: Our study demonstrated that SAH management in a middle-income country diverges significantly from published cohorts and current guidelines, despite comparable clinical profiles on presentation and admission to high-volume referral centers. Earlier aneurysm occlusion and increased use of endovascular therapy could potentially reduce modifiable in-hospital complications and improve functional outcomes in Brazil.

Clinical findings and risk factors to oral squamous cell carcinoma in young patients: A 12-year retrospective analysis.

BACKGROUND: In recent years have been observed an increased incidence of OSCC in young individuals. Based on this, the aim this study was to describe the clinical characteristics of all cases of OSCC in younger patients, diagnosed in two oncology referral hospitals, at the northeast region of Brazil within a 12-year period. MATERIAL AND METHODS: Data regarding general characteristics of patients (age, gender and tobacco and/or alcohol habits) and information about the lesions (tumor location, size, regional lymph node metastasis, distant metastasis and clinical stage) were submitted to descriptive and inferential analysis. Statistical analysis included Chi-square and Fisher's exact tests (P<0.05). RESULTS: Out of 2311 registered cases of OSCC, 76 (3.3%) corresponded to OSCC in patients under 45 years old. Most of them were male (n=62, 81.6%) and tobacco and/or alcohol users (n=40, 52.8%). The most frequent site was the tongue (n=31, 40.8%), with predominance of cases classified at advanced clinical stage (III and IV, n = 46, 60.5%). The advanced stage of OSCC (III and IV) was statistically associated with male gender (P=0.035), lower education level (P=0.007), intraoral sites (P<0.001), presence of pain symptomatology (P=0.006), and consumption of tobacco and/or alcohol (P=0.001). CONCLUSIONS: The profile of OSCC in young patients resembles to the commonly characteristics reported for overall population. The late diagnosis in young patients usually results in poor prognosis, associated with gender, harmful habits and tumor location. Although prevalence is low, stimulus to prevention and to early diagnosis should be addressed to young individuals exposed to risk factors.

Promising application of the SsCBF ELISA test to monitor the therapeutic response of feline sporotrichosis caused by Sporothrix brasiliensis from Brazilian epidemics.

Sporotrichosis zoonotic transmission by cats has obtained hyperendemic magnitude in Rio de Janeiro, Brazil. Atypical cases, relapses, and reinfections as well as reduced diagnostic sensitivity of conventional methods have been reported. Previously, the anti-SsCBF enzyme-linked immunosorbent assay (ELISA) test was shown to be useful as a diagnostic tool for human sporotrichosis. Effective diagnosis and treatment are critical to interrupt the chain of transmission of this major pathogen in Brazilian Public Health. To evaluate its applicability for feline sporotrichosis diagnosis and/or therapeutic follow-up, 15 domestic cats from Rio de Janeiro were clinically and laboratory monitored by cytopathology, culture, Sporothrix genotyping, and anti-SsCBF IgG levels. Subsequently, animals were divided into satisfactory and non-satisfactory therapeutic responders. Averages of antibody serum levels obtained for diagnosis (first consultation) compared with the levels found after follow-up (last consultation) were significantly different in both groups (p = 0.0002 and p = 0.038, respectively). We conclude that the SsCBF ELISA test can predict feline sporotrichosis therapeutic responses even for animals with distinct clinical evolutions.

Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is an acute cerebrovascular disease associated with high mortality and long-term functional impairment among survivors. Systemic inflammatory responses after acute injury and nosocomial infections are frequent complications, making the management of these patients challenging. Here, we hypothesized that sepsis might be associated with early and long-term mortality and functional outcomes. Our objective was to define the incidence of sepsis, diagnosed prospectively with the Sepsis-3 criteria, and to determine its impact on mortality and functional outcomes of patients with SAH. METHODS: We prospectively included all adult patients with aneurysmal SAH admitted to the intensive care unit (ICU) of a reference center between April 2016 and May 2018. Daily clinical and laboratory follow-up data were analyzed during the first 14 days, with data collected on sepsis according to the Sepsis-3 criteria. The main outcome was the functional outcome using the Modified Rankin Scale (mRS), which was assessed at hospital discharge and 3, 6 and 12 months post-discharge. RESULTS: In total, 149 patients were enrolled. The incidence of sepsis was 28%. Multivariable logistic regression analysis revealed that death or functional dependence (defined as an mRS score of 4 to 6) at hospital discharge was independently associated with sepsis (OR 3.4, 95% CI 1.16-9.96, p = 0.026) even after controlling for World Federation of Neurological Surgeons (WFNS) Scale (OR 4.66, 95% CI 1.69-12.88, p = 0.003), hydrocephalus (OR 4.55, 95% CI 1.61-12.85, p = 0.004) and DCI (OR 3.86, 95% CI 1.39-10.74, p = 0.01). Long-term follow-up mortality rates were significantly different in the septic and nonseptic groups (log-rank test p < 0.0001). The mortality rate of septic patients was 52.5%, and that of nonseptic patients was 16%. CONCLUSION: Sepsis plays a significant role in the outcomes of patients with SAH, affecting both mortality and long-term functional outcomes. Combining high-level neurocritical care management of neurological complications and the optimal diagnosis and management of sepsis may effectively reduce secondary brain injury and improve patients' outcomes after SAH.

Análise do uso da terapia fotodinâmica no tratamento endodôntico com base em um Congresso Odontológico

Um dos objetivos do tratamento endodôntico é a máxima desinfecção do sistema de canais radiculares, bem como, a prevenção da sua reinfecção. A terapia fotodinâmica surge como um método coadjuvante na etapa de desinfecção obtendo significativa redução microbiana. Objetivo: traçar um panorama do perfil de uso da terapia fotodinâmica na endodontia no Brasil com base num Congresso de Odontologia e analisar o protocolo utilizado na desinfecção do sistema de canais radiculares. Materiais e método: realizou-se um estudo transversal, por meio da observação indireta dos resumos publicados nos anais da Sociedade Brasileira de Pesquisa Odontológica acerca do uso da terapia fotodinâmica na endodontia nos anos de 2013 a 2016. A coleta foi realizada por dois examinadores e as informações foram organizadas e analisadas no programa Statistical Program Software e apresentadas por meio da estatística descritiva. Resultados: foram encontrados 97 trabalhos com 37,1% no ano de 2016; 26,8% no ano de 2014; 18,6% em 2015 e 17,5% em 2013. Observou-se que 40,2% correspondiam a estudos in vitro, 68% tendo finalidade antibacteriana. Em 25,8% associaram o hipoclorito de sódio com outras substâncias químicas auxiliares e 81,4% utilizaram o hidróxido de cálcio como medica- ção intracanal. O azul de metileno foi o fotossensibilizador mais descrito. Conclusão: a terapia fotodinâmica mostra-se promissora como coadjuvante ao tratamento endodôntico convencional. Fazem-se necessárias mais pesquisas, pois ainda não existe um protocolo padrão para o uso da terapia fotodinâmica na endodontia.

Validação de instrumento baseado na sistematização da assistência de enfermagem nos cuidados paliativos / Validation of an instrument based on the systematization of the nursing care in palliative care

Introdução: A necessidade do estudo surgiu na residência de enfermagem, em um Hospital Público Federal no município do Rio de Janeiro, durante experiência no setor Comissão de Cuidados Paliativos, quando um instrumento foi elaborado para auxiliar assistência da enfermagem da comissão, baseando-se na sistematização da assistência de enfermagem e nas orientações de assistência da Academia Nacional de Cuidados Paliativos. Objetivos: Objetivo geral - Validar instrumento de sistematização da assistência de enfermagem em cuidados paliativos; Objetivos específicos: Caracterizar o processo de trabalho da enfermagem na comissão de cuidados paliativos de um Hospital Universitário Público Federal na cidade do Rio de Janeiro ­ RJ e Atualizar instrumento de sistematização da assistência de enfermagem em cuidados paliativos; Metodologia: trata-se de um estudo descritivo de natureza qualitativa, por meio de entrevistas semiestruturadas com as enfermeiras integrantes da comissão de cuidados paliativos de um Hospital Universitário no Rio de Janeiro. E um estudo descritivo transversal, com vistas à validação do instrumento por juízes, por meio da concordância entre as respostas dos juízes obtidas pelo Índice de Validade de Conteúdo. Resultados: O resultado do estudo gerou o artigo 1 com título "Comissão de Cuidados Paliativos: Percepção e Atuação de Enfermeiros" e o artigo 2 "Validação de Instrumento de Processo de Enfermagem nos Cuidados Paliativos", finalizando com a produção do instrumento "Processo de Enfermagem ao Paciente Paliativo". Conclusão: No primeiro artigo, o estudo caracterizou o processo de trabalho das enfermeiras participantes, além de permitir a contribuição para ampliar a concepção da assistência dos enfermeiros em uma CCP, enquanto, o segundo artigo teve como desfecho a validação do instrumento "Processo de Enfermagem ao Paciente Paliativo" para a enfermagem integrante da comissão e aplicável na prática clínica. Desta forma, o instrumento pode ser utilizado no cenário dos serviços hospitalares

Introduction: The need to admit a long-term nurse to a public hospital in Rio de Janeiro during the same year. health care Nursing and nasal health care on the National Care Palliative Care. Objectives: General objective - Validate the nursing care systematization instrument in palliative care; Specific objectives: to characterize the nursing work process in the palliative care room of a Federal public university hospital in the city of Rio de Janeiro - RJ; Methodology: This is a descriptive study of a qualitative nature, through a series of semistructured interviews with nurses on the palliative care committee of a university hospital in Rio de Janeiro. It is a descriptive cross-sectional study, aiming at the validation of the instrument by judges, through the agreement between the judges' responses to the Content Validity Index. Results: The result of the study on article 1 with the title "Palliative Care Commission: Perception and Performance of Nurses" and article 2 "Validation of the Nursing Process Instrument in Palliative Care", ending with a production of the instrument "Process Palliative Patient Nursing ". Conclusion: In the first article, the study characterized the working process of the participating nurses, in addition to allowing the contribution to the assessment of the Palliative Patient instrument "for a commission integrating nursing and applicable in clinical practice. Thus, the instrument can be used in the hospital services scenario

Efeito dos sucos de frutas industrializados na microdureza do esmalte dental permanente / Effect of industrialized fruit juices on permanent tooth enamel microhardness

Objetivo: Analisar in vitro o pH endógeno e o efeito dos sucos de frutas industrializados na microdureza do esmalte dental permanente. Material e Métodos: A amostra foi constituída por 10 bebidas, de duas marcas comerciais e diferentes sabores. Para compor os grupos experimentais selecionou-se aquelas de menor e maior pH, de acordo com a marca. Confeccionou-se 25 corpos de prova a partir de terceiros molares humanos, que foram divididos em cinco grupos: G1: Ades Uva®, G2: Ades Morango®, G3: Kapo Uva®,G4: Kapo Laranja® e G5: Controle (água destilada). Procedeu-se a análise da microdureza Vickers, antes (T1) e após (T2)os ciclos de desmineralização e remineralização, sendo aplicada uma carga de 100 gramas por 15 segundos. A imersão no suco foi realizada por um período de um minuto, seguido de três minutos na saliva artificial. Os dados foram analisados através do teste de Wilcoxon com nível de significância de 0,05 e com 95% de grau de confiança. Resultados: Todas as bebidas apresentaram pH abaixo do considerado crítico para dissolução do esmalte dental, variando de 3,53 a 3,93. A análise da microdureza mostrou haver diferença significativa (p=0,04) em todos os grupos experimentais, sendo a maior redução observada no grupo G1 (190,67). Conclusão: Todas as bebidas analisadas revelaram uma redução significante da microdureza, sendo,portanto, potencialmente erosivas segundo os critérios adotados nesta investigação.

Objective: To analyze in vitro the endogenous pH and theeffect of industrialized fruit juices on the microhardness of permanent tooth enamel. Material and Method: Sample wascomposed of 10 beverages from two commercial brandsand different flavors. Experimental groups were formed byselecting the beverages with lower and higher pHs accordingto the brands. Twenty-five specimens were prepared fromhuman third molars and randomly assigned into five groups:G1: Ades Uva®, G2: Ades Morango®, G3: Kapo Uva®, G4:Kapo Laranja® and G5: Control (distilled water). Vickersmicrohardness was analyzed before (T1) and after (T2) thedemineralization-remineralization cycles by applying a 100 gload during 15 seconds. The specimens were immersed inthe juices during 1 minute, followed by 3 minutes in artificialsaliva. Wilcoxon test was used for statistical analysis with5% significance level and 95% confidence level. Results: Allbeverages presented pH values below the critical value of5.5 for enamel demineralization, varying from 3.53 to 3.93. Microhardness analysis showed statistically significant difference (p=0.04) in all experimental groups, the largestreduction was observed in G1 (190.67). Conclusion: Allbeverages promoted a significant decrease in permanentenamel microhardness, being considered as potentiallyerosive under the conditions of this study.