IMPORTANCE: Early-stage chronic kidney disease (CKD) characterized by microalbuminuria is associated with future cardiovascular events, progression toward end-stage renal disease, and early mortality ...in patients with type 2 diabetes. OBJECTIVE: To compare the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) surgery vs best medical treatment in patients with early-stage CKD, type 2 diabetes, and obesity. DESIGN, SETTING, AND PARTICIPANTS: For this randomized clinical trial, patients with established type 2 diabetes and microalbuminuria were recruited from a single center from April 1, 2013, through March 31, 2016, with a 5-year follow-up, including prespecified intermediate analysis at 24-month follow-up. INTERVENTION: A total of 100 patients with type 2 diabetes, obesity (body mass indexes of 30 to 35 calculated as weight in kilograms divided by height in meters squared), and stage G1 to G3 and A2 to A3 CKD (urinary albumin-creatinine ratio uACR >30 mg/g and estimated glomerular filtration rate >30 mL/min) were randomized 1:1 to receive best medical treatment (n = 49) or RYGB (n = 51). MAIN OUTCOMES AND MEASURES: The primary outcome was remission of albuminuria (uACR <30 mg/g). Secondary outcomes were CKD remission rate, absolute change in uACR, metabolic control, other microvascular complications, quality of life, and safety. RESULTS: A total of 100 patients (mean SD age, 51.4 7.6 years; 55 55% male) were randomized: 51 to RYGB and 49 to best medical care. Remission of albuminuria occurred in 55% of patients (95% CI, 39%-70%) after best medical treatment and 82% of patients (95% CI, 72%-93%) after RYGB (P = .006), resulting in CKD remission rates of 48% (95% CI, 32%-64%) after best medical treatment and 82% (95% CI, 72%-92%) after RYGB (P = .002). The geometric mean uACRs were 55% lower after RYGB (10.7 mg/g of creatinine) than after best medical treatment (23.6 mg/g of creatinine) (P < .001). No difference in the rate of serious adverse events was observed. CONCLUSIONS AND RELEVANCE: After 24 months, RYGB was more effective than best medical treatment for achieving remission of albuminuria and stage G1 to G3 and A2 to A3 CKD in patients with type 2 diabetes and obesity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01821508
Communicable diseases represent a huge economic burden for healthcare systems and for society. Sexually transmitted infections (STIs) are a concerning issue, especially in developing and ...underdeveloped countries, in which environmental factors and other determinants of health play a role in contributing to its fast spread. In light of this situation, machine learning techniques have been explored to assess the incidence of syphilis and contribute to the epidemiological surveillance in this scenario.
The main goal of this work is to evaluate the performance of different machine learning models on predicting undesirable outcomes of congenital syphilis in order to assist resources allocation and optimize the healthcare actions, especially in a constrained health environment.
We use clinical and sociodemographic data from pregnant women that were assisted by a social program in Pernambuco, Brazil, named Mãe Coruja Pernambucana Program (PMCP). Based on a rigorous methodology, we propose six experiments using three feature selection techniques to select the most relevant attributes, pre-process and clean the data, apply hyperparameter optimization to tune the machine learning models, and train and test models to have a fair evaluation and discussion.
The AdaBoost-BODS-Expert model, an Adaptive Boosting (AdaBoost) model that used attributes selected by health experts, presented the best results in terms of evaluation metrics and acceptance by health experts from PMCP. By using this model, the results are more reliable and allows adoption on a daily usage to classify possible outcomes of congenital syphilis using clinical and sociodemographic data.
In the Americas, P. vivax is the predominant causative species of malaria, a debilitating and economically significant disease. Due to the complexity of the malaria parasite life cycle, a vaccine ...formulation with multiple antigens expressed in various parasite stages may represent an effective approach. Based on this, we previously designed and constructed a chimeric recombinant protein, PvRMC-1, composed by PvCyRPA, PvCelTOS, and Pvs25 epitopes. This chimeric protein was strongly recognized by naturally acquired antibodies from exposed population in the Brazilian Amazon. However, there was no investigation about the induced immune response of PvRMC-1. Therefore, in this work, we evaluated the immunogenicity of this chimeric antigen formulated in three distinct adjuvants: Stimune, AddaVax or Aluminum hydroxide (Al(OH)3) in BALB/c mice. Our results suggested that the chimeric protein PvRMC-1 were capable to generate humoral and cellular responses across all three formulations. Antibodies recognized full-length PvRMC-1 and linear B-cell epitopes from PvCyRPA, PvCelTOS, and Pvs25 individually. Moreover, mice’s splenocytes were activated, producing IFN-γ in response to PvCelTOS and PvCyRPA peptide epitopes, affirming T-cell epitopes in the antigen. While aluminum hydroxide showed notable cellular response, Stimune and Addavax induced a more comprehensive immune response, encompassing both cellular and humoral components. Thus, our findings indicate that PvRMC-1 would be a promising multistage vaccine candidate that could advance to further preclinical studies.
Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with ...access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.
Background & Aim: Providing nursing care occurs through work methods that ensure the organization and implementation of care: the functional work method, the teamwork method, the individual work ...method, or the reference nurse work method. This study aims to identify work methods that nurses adopt in a Portuguese hospital. Methods & Materials: A cross-sectional study was conducted in a hospital in northern Portugal. A non-probabilistic convenience sampling technique was used, and 627 nurses were enrolled. Data were collected between March and April 2023 using the “Nurses’ Work Methods Assessment Scale.” The Statistical Package for the Social Sciences was used to perform descriptive and inferential statistics, using the Mann-Whitney, Kruskal-Wallis, and Spearman’s correlation tests. Results: The individual method predominated, followed by the functional and teamwork methods. A lower adherence to the nurse reference method was observed. The variable “work context” was the most significant for the four working methods. In the individual method, the frequency of the variable “condition in which the profession is practiced” was higher in specialist nurses and, particularly, rehabilitation nursing specialists. The frequency of using the individual method is also higher when nurses have a master’s degree and training in nursing care organization methodology. Conclusion: The highest frequencies of the individual method are related to the level of training, suggesting the influence of training in adopting working methods in clinical practice. Although the reference nurse method points to better satisfaction of clients’ needs, nursing practice environments sometimes have inadequate conditions for its operationalization.
Hyptis martiusii Benth. is an aromatic plant found in abundance in northeastern Brazil that is used in ethnomedicine to treat gastric disorders. The aim of this study was to elucidate the mechanisms ...of action involved in the gastroprotection of the essential oil of Hyptis martiusii (EOHM) and to evaluate its healing capacity. Wistar rats were exposed to different protocols and subsequently were treated with 1% Tween-80 aqueous solution (negative control), pantoprazole, carbenoxolone, N-acetylcysteine (depending on the specificity of each model) or EOHM. The antisecretory activity (basal or stimulated) was determined using the pyloric ligature method. The gastroprotective action of nitric oxide and sulphydryl groups (-SH groups), as well as the quantification of adherent mucus and the levels of malondialdehyde and -SH groups in gastric mucosa, were evaluated using ethanol-induced gastric ulcer model. The healing ability was evaluated using the acetic acid-induced gastric ulcer model and histological and immunohistochemical analysis (HE, PAS and PCNA). EOHM (400 mg/kg) reduced the volume and acidity of gastric secretion stimulated by histamine and pentagastrin. The gastroprotective effect of EOHM involves the participation of endogenous sulfhydryl groups. EOHM increased mucus production (54.8%), reduced levels of MDA (72.5%) and prevented the depletion of -SH groups (73.8%) in the gastric mucosa. The treatment with EOHM reduced in 70.3% the gastric lesion area, promoting significant regeneration of the gastric mucosa, as confirmed by histological analysis and analysis of proliferating cell nuclear antigen. The results show that gastroprotective effect of EOHM is mediated by cytoprotective and antioxidant mechanisms and by their antisecretory activity, and suggest that the essential oil of Hyptis martiusii is a promising candidate for the treatment of gastric ulcers.
This work aims to synthesize the alloy Co64Nb30B6 through mechanical alloying using a planetary ball mill. A disc rotation per minute and a ball/powder weight ratio of 300 rpm and 10:1 were used, ...with a milled time of 10 h, respectively. The characterization of the Co64Nb30B6 alloy was performed by X-ray diffraction (XRD), examined by scanning electron microscope-energy dispersive X-ray spectroscopy (SEM-EDS), thermoanalytical techniques (TGA/DTA), vibrating sample magnetometer (VSM) and confirmed by Braunauer, Emmet e Teller (BET) method type IV isotherms with a hysteresis loop for mesoporous materials. The results indicated that the evolution of the amorphous phase in the Co64Nb30B6 composition through the mechanical alloying process exhibited good soft magnetic properties with the addition of the metalloid element B and its excellent unique ferromagnetic properties. Through thermoanalytical analysis (TGA/DTA), it was shown that at higher temperatures, Co and Nb ions are oxidized by the environment and, therefore, the mass can be slightly increased to 14.9% and a probable contribution of boron in evolution stability thermal and magnetic in the amorphous phase, respectively. This suggests that the newly developed high-performance amorphous alloy Co64Nb30B6 has great application potential.
To develop and validate the content of the Nurses' Work Methods Assessment Scale.
Methodological study conducted between January and February 2022, based on the Quality Standards for Nursing Care and ...Imogene King's framework. A literature review was previously undertaken to design the scale. The content validation was carried out by 23 experts.
The initial version consisted of 40 items organized in four work methods identified in the literature. In the first dimension, from ten items, seven were considered, and one was reformulated. Seven of the initial ten items were considered in the second version. The third dimension consisted of seven items. In the fourth dimension, three items were reformulated, and three were excluded, leaving seven items. The final version ended with 28 items, whose Content Validity Index ranged between 0.83 and 1.
The involvement of experts has become pivotal in the development and validation of the items, providing confidence to the continuity of psychometric procedures.
This study evaluated if coatings with chitosan (Chi) and phenolic-rich extract from acerola (Malpighia emarginata D.C., PEA) or jabuticaba (Plinia jaboticaba (Vell.) Berg, PEJ) processing by-products ...are effective to control the development of rot caused by Lasiodiplodia pseudotheobromae, L. viticola, L. euphorbicola, L. theobromae and L. hormozganensis in papaya (Carica papaya L.) fruit. Effects of formulated coatings on some physicochemical parameters indicative of postharvest quality of papaya were investigated. Twenty-six different phenolics were found in PEA and PEJ, including flavonoids, stilbenes, tannins and phenolic acids. Chi (1–5 mg/mL), PEA and PEJ (25–100 mg/mL) separately caused mycelial growth inhibition on all isolates. Combinations of Chi (3 and 4 mg/mL) and PEA (50 and 75 mg/mL) or PEJ (75 and 100 mg/mL) had additive interactions. Coatings with Chi (4 mg/mL) and PEA (50 or 75 mg/mL) or PEA (75 or 100 mg/mL) inhibited rot development in papaya fruit infected with Lasiodiplodia isolates during 8 days of room temperature storage. Coatings with 4 mg/mL Chi and 75 mg/mL PEA or 100 mg/mL PEJ were the most effective to control rot development. These coatings did not affect negatively physicochemical parameters indicative of postharvest quality of papaya fruit during storage. Coatings with combined Chi and PEA or PEJ could be novel strategies to control postharvest rot caused by Lasiodiplodia in papaya fruit.
•Coatings with chitosan (Chi) and fruit phenolic-rich extracts were formulated.•Chi and fruit phenolic-rich extracts had additive effects against Lasidiplodia.•Coatings with Chi and fruit phenolic-rich extract reduced rot severity in papaya.•Coatings with Chi and fruit phenolic-rich extract maintained papaya quality.•Formulated coatings should be novel strategies to control rot in papaya.
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