The aim of the present study was to compare pulmonary function among patients with different clinical forms and scores for risk of death and stroke. Patients were recruited from the Chagas Disease ...Ambulatory Service at the University of Rio Grande do Norte State (Mossoro, Brazil). The evaluation of pulmonary function was performed through spirometry techniques using a digital spirometer, and information about the clinical forms (cardiac, cardiodigestive, digestive and undetermined) and scores for risk of death (Rassi's risk-of-death score) and stroke was subsequently collected. Upon completion of the evaluation, comparisons of the values obtained between the groups for different clinical forms, risk stratification of stroke and Rassi's risk-of-death were made. The study cohort consisted of 72 patients. Individuals with a low risk of death had significantly higher values in the Tiffeneau index and individuals with a low risk of stroke presented with higher percentage values for forced vital capacity and forced expiratory volume in 1 sec. In addition, individuals with heart disease had worse percentage values for FVC and FEV.sub.1. In conclusion, the results showed that spirometry was an effective analytical technique and was associated with clinical forms, and death and stroke risk scores, in patients with Chagas disease, adding an important prognostic tool to those currently available.
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In addition to respiratory failure, another important outcome presented by patients hospitalized with coronavirus disease 2019 (COVID-19) is renal failure, which is related to increased severity of ...infection and a greater risk of mortality. Severity is often represented by the need for respiratory and/or life support, which can range from oxygen therapy to invasive mechanical ventilation. This study aimed to determine the association between the degree of renal and inflammatory impairment in patients with the need for advanced respiratory support and mortality. Included in the present study were 79 critically ill patients with COVID-19 on different days, who required a nasal cannula and/or orotracheal intubation. Data from laboratory tests, arterial blood gases and information on their clinical evolution were collected. The results obtained showed that the biochemical markers of renal function, as well as the inflammatory markers and the partial pressure of carbon dioxide, were significantly increased in patients who succumbed to the infection. Similarly, these markers were higher amongst patients who required increased respiratory assistance.
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Introdução: A meditação pode ser uma estratégia para lidar com comorbidades psicoemocionais e físicas que afetam pessoas vivendo com HIV (PVH) e que podem ser exacerbadas durante a pandemia de ...Covid-19. Objetivo: Avaliar os níveis de linfócitos TCD4+ e TCD8+, carga viral e parâmetros metabólicos de PVH submetidos a sessões de meditação. Procedimento experimental: Estudo de caso-crossover no qual sete participantes frequentaram sessões de meditação guiadas remotamente entre julho e agosto de 2020 (oito semanas), uma sessão por semana, com duração média de uma hora cada. A quantificação de linfócitos TCD4+ e TCD8+ foi realizada por citometria de fluxo; a carga viral foi detectada pela técnica de reação em cadeia da polimerase e os parâmetros metabólicos por quimiluminescência. Resultados: A meditação manteve constantes os níveis de linfócitos TCD4+ (p=0,93) e TCD8+ (p=0,37) e a carga viral (<40). Foi observado um aumento no colesterol de lipoproteína de alta densidade (HDL-c) (p=0,01*), no entanto glicose (p=0,15), triglicerídeos (p=0,43), colesterol total (p=0,18), Transaminase Glutâmica Oxalacética (p=0,46) e Transaminase Glutâmica Pirúvica (p=0,36) não sofreram alterações. Conclusão: A meditação aumenta o HDL-c em PVH. Os níveis de linfócitos TCD4+ e TCD8+ e a carga viral permaneceram constantes durante a intervenção. A adesão à prática da meditação pode se traduzir em um maior comprometimento com a busca pela saúde e, assim, melhorar a qualidade de vida desses indivíduos.
IMPORTANCE: The effectiveness of checklists, daily goal assessments, and clinician prompts as quality improvement interventions in intensive care units (ICUs) is uncertain. OBJECTIVE: To determine ...whether a multifaceted quality improvement intervention reduces the mortality of critically ill adults. DESIGN, SETTING, AND PARTICIPANTS: This study had 2 phases. Phase 1 was an observational study to assess baseline data on work climate, care processes, and clinical outcomes, conducted between August 2013 and March 2014 in 118 Brazilian ICUs. Phase 2 was a cluster randomized trial conducted between April and November 2014 with the same ICUs. The first 60 admissions of longer than 48 hours per ICU were enrolled in each phase. INTERVENTIONS: Intensive care units were randomized to a quality improvement intervention, including a daily checklist and goal setting during multidisciplinary rounds with follow-up clinician prompting for 11 care processes, or to routine care. MAIN OUTCOMES AND MEASURES: In-hospital mortality truncated at 60 days (primary outcome) was analyzed using a random-effects logistic regression model, adjusted for patients’ severity and the ICU’s baseline standardized mortality ratio. Exploratory secondary outcomes included adherence to care processes, safety climate, and clinical events. RESULTS: A total of 6877 patients (mean age, 59.7 years; 3218 46.8% women) were enrolled in the baseline (observational) phase and 6761 (mean age, 59.6 years; 3098 45.8% women) in the randomized phase, with 3327 patients enrolled in ICUs (n = 59) assigned to the intervention group and 3434 patients in ICUs (n = 59) assigned to routine care. There was no significant difference in in-hospital mortality between the intervention group and the usual care group, with 1096 deaths (32.9%) and 1196 deaths (34.8%), respectively (odds ratio, 1.02; 95% CI, 0.82-1.26; P = .88). Among 20 prespecified secondary outcomes not adjusted for multiple comparisons, 6 were significantly improved in the intervention group (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate), whereas there were no significant differences between the intervention group and the control group for 14 outcomes (ICU mortality, central line–associated bloodstream infection, ventilator-associated pneumonia, urinary tract infection, mean ventilator-free days, mean ICU length of stay, mean hospital length of stay, bed elevation to ≥30°, venous thromboembolism prophylaxis, diet administration, job satisfaction, stress reduction, perception of management, and perception of working conditions). CONCLUSIONS AND RELEVANCE: Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01785966
Role of lncRNA Alterations in Cervical Oncogenesis de Oliveira, Alan Lopes; de Almeida, Valeria Duarte; Pereira, Taue Posada ...
Eurasian Journal of Medicine and Oncology,
01/2022, Volume:
6, Issue:
2
Journal Article
A existência de mosaicismo cromossômico tem sido apontada como um fator determinante para a viabilidade das pacientes portadoras da Síndrome de Turner (ST), tendo em vista que apenas 1% dos fetos com ...o cariótipo 45,X são nativivos, pois 99% são abortados espontaneamente Diversos casos de mosaicismo cromossômico têm sido descritos, com as mais variadas constituições celulares associadas à linhagem clássica para a ST (45,X). Essa coexistência de linhagens pode resultar na maior parte dos casos no abrandamento dos sintomas que caracterizam a síndrome, sendo as consequências fenotípicas decorrentes do mosaicismo dependentes da proporção de células alteradas Esse estudo teve como objetivo determinar a prevalência de mosaicismo cromossômico em portadores da Síndrome de Turner e verificar possíveis associações entre os fenótipos e cariótipos dessas pacientes oriundas do Estado de Pernambuco. Para o desenvolvimento da investigação foram coletadas amostras de sangue periférico em pacientes que foram recrutadas do Serviço de Genética Médica do Instituto Materno Infantil Prof. Fernando Figueira (IMIP) e Serviço de Endocrinologia Pediátrica do Hospital das Clínicas (HC), entre outubro de 2006 e agosto de 2016. O cultivo de linfócitos de sangue periférico foi realizado para cada paciente e, posteriormente, um bandeamento G foi utilizado para identificação cromossômica e detecção das alterações encontradas. A análise citogenética detectou cariótipos compatíveis com a ST em 84 pacientes, O cariótipo 45,X foi observado em 58,3% da amostra, seguido de indivíduos portadores de mosaicismo, que representaram 33,3% dos casos. Entre as pacientes portadoras de mosaicismo, o cariótipo 46,X,i(Xq)/45,X foi o mais prevalente, representando 16,6% da amostra. Linhagens celulares contendo cromossomo em anel (46,X,r(X)/45,X) e o cromossomo Y (45,X/46,XY) também foram detectadas. As manifestações clínicas mais incidentes nas pacientes com ST foram a baixa estatura e amenorréia primária, sendo constatado a ocorrência de 89,2% e 64,3%, respectivamente, em pacientes com mosaicismo confirmado. Os resultados obtidos confirmaram a necessidade de investigação de mosaicismo cromossômico, para determinar uma relação entre a expressão fenotípica específica e cada tipo de associação de linhagens cromossômicas diferentes. Além disso, a avaliação precisa da constituição cromossômica irá proporcionar às portadoras da ST um diagnóstico conclusivo, prognóstico adequado e tratamento com terapias específicas.Auxílio financeiro: FACEPE, UFPE
Background
Survival benefit from low tidal volume (
V
T
) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could ...also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV.
Methods
Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a
V
T
≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV.
Results
The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% 95% confidence interval 0.61–14.24%;
p
= 0.038), use of structured checklist during multidisciplinary rounds (5.10% 0.55–9.81%;
p
= 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% 0.85–33.60%;
p
= 0.045) were the only three factors that had an independent association with adherence to LTVV.
Conclusions
Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients.
Osteosarcoma is the most common primary malignant bone tumor, mainly affecting children, young adults, and the elderly. It is an aggressive cancer with a poor prognosis, exhibiting low survival rates ...even with standard treatment. Recently, circular RNA molecules capable of influencing gene expression through various functions, with their main role being acting as microRNA sponges and reducing their intracellular expression, have been identified. Recent studies have linked circular RNAs to osteosarcoma development and progression. Therefore, the present study aimed to investigate the alteration in circular RNA expression during osteosarcoma development and progression.
An integrative literature review was conducted from September 10th to November 12th, 2021, using the following databases: PubMed/MEDLINE, SCOPUS, Web of Science, OVID, and EMBASE. 129 full articles were included in the review. The obtained data were organized using a standardized data collection instrument, which included the following information: altered expression profile of circular RNAs, associated cancer hallmarks, clinical-pathological relationships of circular RNAs, and perspectives on the studied circular RNAs.
A total of 94 distinct circular RNAs were identified, predominantly showing an increased expression pattern. Approximately 91% of the studies that aimed to identify the mechanisms of action of circular RNAs highlighted the function of circular RNAs as microRNA sponges. The most associated cancer hallmarks with the identified circular RNAs were proliferative signaling induction, invasion and metastasis, and resistance to cell death. The altered expression of these circular RNAs generally correlated with a worse prognosis for patients, as evidenced by clinical features such as shorter survival, advanced Enneking and/or TNM stage, higher incidence of metastasis, larger tumor size, and increased chemoresistance.
These findings indicate the significance of circular RNA molecules in osteosarcoma carcinogenesis, suggesting their potential as new prognostic and/or diagnostic biomarkers, as well as alternative therapeutic targets in the fight against osteosarcoma.
Purpose
The prospective assessment of
Clostridium difficile
infection (CDI) impact in inflammatory bowel disease (IBD) flare in outpatient setting has been poorly investigated. We aimed to evaluate ...the prevalence and the associated factors with CDI in IBD outpatients presenting colitis flares as well as the outcomes following treatment.
Methods
In this prospective cohort study, conducted from October, 2014, to July, 2016, 120 IBD patients (55% presenting colitis flare) and 40 non-IBD controls were assessed for CDI. Multivariate regression analysis was performed to identify predictors of CDI. Outcome analysis was estimated for recurrent CDI, hospitalization, colectomy, and CDI-associated mortality.
Results
The number of patients with CDI was significantly higher in IBD patients experiencing flares than in both inactive IBD and non-IBD groups (28.8 vs. 5.6 vs. 0%, respectively;
p
= 0.001). Females (OR = 1.39, 95% CI, 1.13–17.18), younger age (OR = 0.77, 95% CI, 0.65–0.92
)
, steroid treatment (OR = 7.42, 95% CI, 5.17–40.20), and infliximab therapy (OR = 2.97, 95% CI, 1.99–24.63) were found to be independently associated with CDI. There was a dose-related increase in the risks of CDI on patients which had taken prednisone. Those treated with vancomycin had a satisfactory response to therapy, but 21% presented recurrent CDI and 16% were hospitalized. Neither necessity of colectomy nor mortality was noticed in any patient during the investigation.
Conclusions
In IBD outpatients presenting colitis flares, CDI is highly prevalent. Females, younger age, infliximab, and notably steroid therapy were independently associated with CDI. Most patients with CDI experienced mild-to-moderate disease, and prompt treatment with vancomycin was highly effective, which seems to reduce the serious complication risks.
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EMUNI, FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The etiopathogenesis of type 1 diabetes mellitus (T1DM) is a complex multifactorial process that involves an intricate network of genetic, epigenetic, immunological, and environmental factors. ...Despite the advances in recent years, some aspects of the mechanisms involved in triggering the disease are still unclear. Infections with certain viruses have been suggested as possible environmental triggers for the autoimmune process that leads to selective and progressive destruction of pancreatic β-cells and insufficiency of insulin production, which is its hallmark. In this review, advances in knowledge and evidence that suggest the participation of certain viruses in the mechanisms of disease initiation and progression are described. It has been accepted that environmental factors, including viruses, can initiate and possibly sustain, accelerate, or slow down the autoimmune process and consequently damage insulin-producing pancreatic β-cells. Although the role of these agents, especially human enteroviruses, has been exhaustively studied as the most likely triggers of the activation of autoimmunity that destroys pancreatic islets and leads to T1DM, certain doubts remain. Clinical epidemiological and experimental studies in humans and animals provide consistent and increasing evidence that persistent viral infections, especially with human enteroviruses and rotavirus infections, are associated with an increased risk of the disease in individuals genetically predisposed to autoimmunity.
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