ABSTRACT Objective: To analyze the prevalence and factors associated with external causes in elderly people attended by the mobile emergency care service. Method: Cross-sectional study with 1,972 ...pre-hospital care records of elderly victims of external causes from 2019 to 2020. A descriptive and bivariate analysis was performed, with a significance level of 5% (p<0.05). Results: The prevalence of external causes in elderly people attended by the mobile emergency service was 12.2%. Falling was the most frequent occurrence. The associations of the occurrence of falls with age from 90 years old (OR=29.31; p<0.001) and female gender (OR=5.38; p<0.001) stood out, as well as the suspicion of ingestion of alcoholic beverages with occurrence of violence (OR=4.17; p<0.001) and traffic accidents (OR=1.97; p<0.001). Conclusion: The study showed factors associated with injuries due to external causes in theelderly and may support the formulation of coping strategies for this problem.
RESUMO Objetivo: Analisar a prevalência e fatores associados a causas externas em idosos atendidos pelo serviço de atendimento móvel de urgência. Método: Estudo transversal com 1.972 fichas de atendimento pré-hospitalar de idosos vítimas de causas externas no período de 2019 a 2020. Realizou-se análise descritiva e bivariada, com nível de significância de 5% (p<0,05). Resultados: A prevalência de causas externas em idosos atendidos pelo serviço móvel de urgência foi de 12,2%. A queda foi a ocorrência mais frequente. Destacaram-se as associações da ocorrência de queda com a idade a partir de 90 anos (OR=29,31; p<0,001) e o sexo feminino (OR=5,38; p<0,001), bem como da suspeita de ingestão de bebida alcoólica com a ocorrência de violência (OR=4,17; p<0,001) e acidentes de trânsito (OR=1,97; p<0,001). Conclusão: O estudo evidenciou fatores associados aos agravos por causas externas em idosos e poderá subsidiar formulação de estratégias de enfrentamento a essa problemática.
RESUMEN Objetivo: Analizar la prevalencia y los factores asociados a causas externas en ancianos atendidos por el servicio de atención móvil de urgencia. Método: Estudio transversal con 1.972 registros de atención pre hospitalaria de ancianos víctimas de causas externas en el período de 2019 a 2020.Se realizó un análisis descriptivo y bivariado, con un nivel de significación del 5% (p<0,05). Resultados: La prevalencia de causas externas en adultos mayores atendidos por el servicio de emergencia móvil fue de 12,2%. La caída fue la ocurrencia más frecuente. Se destacaron las asociaciones de la ocurrencia de caídas con la edad a partir de 90 años (OR=29,31; p<0,001) y el género femenino (OR=5,38; p<0,001), así como la sospecha de ingesta de bebidas alcohólicas con la ocurrencia de violencia (OR=4,17; p<0,001) y accidentes de tránsito (OR=1,97; p<0,001). Conclusión: El estudio mostró factores asociados a las lesiones por causas externas en ancianos y puede apoyar la formulación de estrategias de enfrentamiento de este problema.
Caffeine and trigonelline are found in Coffea arabica, and show antioxidant roles and growth and development functions. However, there are no reports on trigonelline and caffeine in relation to ...coffee rooting. The aim was to evaluate the impact of application of indole-3-butyric acid (IBA) and melatonin on caffeine and trigonelline at different stages of adventitious rooting in cuttings. In addition, to study the correlation between these metabolites and H2O2, phenols, and antioxidant enzymes. Four treatments (Control, melatonin 21 µM (M21), melatonin 43 µM (M43), and IBA 7380 µM (IBA)) were used, with four replications. The growth and biochemical parameters of the antioxidant system were performed in induction, initiation, and extension rooting stages. Higher concentrations of trigonelline and caffeine quantified in the induction and initiation stages were positively correlated with higher percentage of rooted cuttings. Trigonelline and caffeine were positively correlated with H2O2 in all stages of development of adventitious roots. The correlations of trigoneline and caffeine with phenols and antioxidant enzymes reveal different profiles, depending on the phases. The results indicate that IBA and melatonin increase trigonelline and caffeine during the induction and initiation of adventitious roots in Coffea arabica cuttings, which is correlated with a higher percentage of rooted cuttings.
Acute Kidney Injury (AKI) is the main systemic complication and cause of death in viperid envenomation. Although there are hypotheses for the development of AKI, the mechanisms involved are still not ...established. The aim of this study was to evaluate the clinical-laboratorial-epidemiological factors associated with AKI in victims of Bothrops sp envenomation. This is an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. AKI was defined according to the guidelines of the Acute Kidney Injury Network (AKIN). Among the 186 patients evaluated, AKI was observed in 24 (12.9%) after 48 hours of admission. Stage I was present in 17 (70.8%) patients, II in 3 (12.5%) and III in 4 (16.7%). Epidemiological characterization showed predominance of men, occurrence in rural areas, aged between 16-60 years, feet as the most affected anatomical region, and time to medical assistance less than 3 hours. Hypertension and diabetes were the comorbidities identified. Most of the accidents were classified as moderate, and clinical manifestations included severe pain, mild edema, local bleeding and headache. Laboratory results showed blood uncoagulability, hypofibrinogenemia, leukocytosis, increase of creatine kinase, and high lactate dehydrogenase levels. Multivariate analysis showed an association with high LDH levels AOR = 1.01 (95% CI = 1.01-1.01, p<0.002), local bleeding AOR = 0.13 (95%CI = 0.027-0.59, p<0.009), and the presence of comorbidities AOR = 60.96 (95%CI = 9.69-383.30; p<0.000). Herein, laboratory markers such as high LDH levels along with local bleeding and comorbidities may aid in the diagnosis of AKI.
Abstract
Background
Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on ...health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact of the time between JIA onset and the initiation of a bDMARD in achieving clinical remission, on physical disability and health-related quality of life (HRQoL).
Methods
Adult JIA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) and ever treated with bDMARD were included. Data regarding socio-demographic, JIA-related characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), and treatments were collected at the last visit. Patients were divided into 3 groups (≤ 2 years, 2–5 years, or > 5 years), according to the time from disease onset to bDMARD initiation. Regression models were obtained considering remission on/off medication, HAQ-DI, SF-36, and joint surgeries as outcomes and time from disease onset to bDMARD start as an independent variable.
Results
Three hundred sixty-one adult JIA patients were evaluated, with a median disease duration of 20.3 years (IQR 12.1; 30.2). 40.4% had active disease, 35.1% were in remission on medication, and 24.4% were in drug-free remission; 71% reported some degree of physical disability. Starting a bDMARD > 5 years after disease onset decreased the chance of achieving remission off medication (OR 0.24; 95% CI 0.06, 0.92;
p
= 0.038). Patients who started a bDMARD after 5 years of disease onset had a higher HAQ and worse scores in the physical component, vitality, and social function domains of SF-36, and more joint surgeries when compared to an earlier start.
Conclusion
Later initiation of bDMARDs in JIA is associated with a greater physical disability, worse HRQoL, and lower chance of drug-free remission in adulthood.
Purpose
To compare lung ultrasound (US) and computed tomography (CT) in the assessment of pregnant women with COVID‐19.
Methods
Prospective study comprising 39 pregnant inpatients with COVID‐19 who ...underwent pulmonary assessment with CT and US with a maximum span of 48 h between the exams. The thorax was divided into 12 regions and assessed in terms of the following: the presence of B‐lines (>2), coalescent B‐lines, consolidation on US; presence of interlobular thickening, ground glass, consolidation on CT. The two methods were scored by adding up the scores from each thoracic region.
Results
A significant correlation was found between the scores obtained by the two methods (rICC = 0.946; p < 0.001). They were moderately in agreement concerning the frequency of altered pulmonary regions (weighted kappa = 0.551). In US, a score over 15, coalescent B‐lines, and consolidation were predictors of the need for oxygen, whereas the predictors in CT were a lung score over 16 and consolidation. The two methods, US (p < 0.001; AUC = 0.915) and CT (p < 0.001; AUC = 0.938), were fairly accurate in predicting the need for oxygen.
Conclusion
In pregnant women, lung US and chest CT are of similar accuracy in assessing lungs affected by COVID‐19 and can predict the need for oxygen.
Lung ultrasound may be satisfactorily incorporated into the obstetricians' clinical practice to evaluate pregnant women with COVID‐19. It is an alternative method which is more accessible, less expensive, faster to learn, which can be used at the bedside and repeatedly without running the risk of exposing the fetus to radiation.
Enhanced Recovery After Surgery (ERAS) protocol is composed by evidence-based interventions that aim to improve recovery through a reduction in surgical stress response. Although ERAS protocols have ...been introduced across the globe, exhaustive implementation is not as common. We aimed to study the ERAS protocol compliance in colorectal surgery, assessing the relationship between compliance and postoperative complications.
A single-center cohort study was conducted. All consecutive patients admitted to elective colorectal surgery were included. We assessed study endpoints according to ERAS protocol perioperative compliance score above 75%. Our primary endpoint was a composite of postoperative events, which includes in-hospital postoperative complications and need for reoperation after 30 days and need for readmission after discharge. Secondary endpoints were surgery-to-discharge time, postoperative use of only non-opioid adjuvants and the individual components of the primary endpoint.
A total of 224 colorectal patients were included. The primary endpoint occurred in 59.2% (n.á=.á58) of non-compliant patients comparing to 34.1% (n.á=.á43) in compliant patients. In univariate analysis, compliance to ERAS protocol had an inferior risk for the primary endpoint (p.á<.á0.001). In a logistic regression model, compliance was independently associated with a reduced risk for the primary endpoint with a odds-ratio of 0.42 (95% CI 0.23.Çô0.75, p.á=.á0.004).
Compliance with the ERAS protocol is associated with less complications, a reduced surgery-to-discharge time and use of only non-opioid adjuvants in the postoperative period. More studies are needed to target the most appropriate compliance goal.
to identify in the scientific literature the technologies developed to promote health education for the community elderly.
integrative review that included original articles indexed by Latin American ...and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Science Direct, and Cochrane databases, without restriction of time and language. Results were analyzed descriptively, in five analytical categories.
Fifteen articles published on national and international journals were selected, with predominance of experimental studies that tested the effects of such technologies. The types of educational technology developed were printed materials, software and video, as well as mock-up and telephone support. Falls in the elderly were the most discussed theme. The studies have shown that the types of technology found are feasible to promote health education for the community elderly.
The technologies developed to promote health education for the elderly were multiple and proved effective for use in community interventions.
Glassy carbon electrodes (GCE) were modified with poly(glutamic acid) acid films prepared using three different procedures: glutamic acid monomer electropolymerization (MONO), evaporation of ...poly(glutamic acid) (PAG) and evaporation of a mixture of poly(glutamic acid)/glutaraldehyde (PAG/GLU). All three films showed good adherence to the electrode surface. The performance of the modified GCE was investigated by cyclic voltammetry and differential pulse voltammetry, and the films were characterized by atomic force microscopy (AFM) and electrochemical impedance spectroscopy (EIS). The three poly(glutamic acid) modified GCEs were tested using the electrochemical oxidation of ascorbic acid and a decrease of the overpotential and the improvement of the oxidation peak current was observed. The PAG modified electrode surfaces gave the best results. AFM morphological images showed a polymeric network film formed by well-defined nanofibres that may undergo extensive swelling in solution, allowing an easier electron transfer and higher oxidation peaks.
Human ascariasis is the most prevalent but neglected tropical disease in the world, affecting approximately 450 million people. The initial phase of Ascaris infection is marked by larval migration ...from the host's organs, causing mechanical injuries followed by an intense local inflammatory response, which is characterized mainly by neutrophil and eosinophil infiltration, especially in the lungs. During the pulmonary phase, the lesions induced by larval migration and excessive immune responses contribute to tissue remodeling marked by fibrosis and lung dysfunction. In this study, we investigated the relationship between SIgA levels and eosinophils. We found that TLR2 and TLR4 signaling induces eosinophils and promotes SIgA production during Ascaris suum infection. Therefore, control of parasite burden during the pulmonary phase of ascariasis involves eosinophil influx and subsequent promotion of SIgA levels. In addition, we also demonstrate that eosinophils also participate in the process of tissue remodeling after lung injury caused by larval migration, contributing to pulmonary fibrosis and dysfunction in re-infected mice. In conclusion, we postulate that eosinophils play a central role in mediating host innate and humoral immune responses by controlling parasite burden, tissue inflammation, and remodeling during Ascaris suum infection. Furthermore, we suggest that the use of probiotics can induce eosinophilia and SIgA production and contribute to controlling parasite burden and morbidity of helminthic diseases with pulmonary cycles.
On March 24, 2020, a partial lockdown was decreed in the state of São Paulo, Brazil, as a measure to hinder the spread of COVID-19, which consisted in prohibiting crowding and advising people to stay ...home, except for urgent or extremely necessary matters. Based on studies performed in other countries, this study aims to assess the impacts of the lockdown on the air quality of five cities in the state of São Paulo. Our study was conducted by using particulate matter and nitrogen dioxide as air quality indicators, and by correlating the contaminants concentrations with weather data. The results showed an increase in these contaminants in all cities within the first weeks after the lockdown compared with the weeks before the decree and with the same period in previous years. This result is inconsistent with the literature. Therefore, a secondary goal was set to investigate the possible cause (or causes) of such deterioration in air quality, which led to the increased number of wildfires. The anomalous dry weather favored the burning of vegetation in agricultural rural areas and in small, vegetated areas near the municipalities, and limited pollution scavenging by rainfall, both of which contributed to higher pollution concentration. We hypothesize the possible effects of worse air quality on the aggravation of COVID-19, but further research is necessary to obtain a complete assessment.
El 24 de marzo de 2020 se decretó un confinamiento parcial en el estado de São Paulo, Brasil, como medida para evitar la propagación de la COVID-19, que consistió en prohibir aglomeraciones de personas y avisar a la gente que permaneciera en casa, salvo para asuntos urgentes o extremadamente necesarios. Siguiendo algunos estudios realizados en otros países, el objetivo de este trabajo es evaluar los impactos del confinamiento en la calidad del aire de ciudades en el estado de São Paulo. Nuestro estudio fue realizado usando material particulado y dióxido de nitrógeno, como indicadores de la calidad del aire, y mediante la correlación de las concentraciones de contaminantes con los datos meteorológicos. Los resultados mostraron un incremento en estos contaminantes en todas las ciudades dentro de las primeras semanas tras el confinamiento, comparando las semanas antes del decreto y dentro del mismo periodo en los años previos. Este resultado es inconsistente con aquellos que han sido informados en otros estudios. Por ello, un objetivo secundario fue investigar la posible causa (o causas) de tal deterioro en la calidad del aire, que conduce a un incremento en el número de incendios. La climatología seca anómala favoreció la quema de vegetación en las áreas rurales agrícolas, y en áreas con poca vegetación cerca de las ciudades, y la eliminación limitada de la contaminación gracias a la lluvia, ambos contribuyeron a una mayor concentración de contaminación. Se especula que los posibles efectos de esta situación de una peor calidad del aire podrían afectar en el agravamiento de los casos de COVID-19, pero son quizás necesarias más investigaciones para conseguir una evaluación completa.
Em 24 de março de 2020, foi decretado confinamento parcial no Estado de São Paulo, Brasil, como medida para desacelerar a disseminação da COVID-19. O decreto consistia na proibição de aglomerações e na recomendação para as pessoas permanecerem em casa, exceto em situações urgentes ou de extrema necessidade. Na esteira de estudos realizados em outros países, o artigo busca avaliar os impactos do confinamento na qualidade do ar em cinco cidades no Estado de São Paulo. Nosso estudo foi realizado com o material particulado e dióxido de nitrogênio enquanto indicadores da qualidade do ar e pela correlação das concentrações dos contaminantes com dados meteorológicos. Os resultados mostraram um aumento desses contaminantes em todas as cinco cidades dentro das primeiras semanas depois do confinamento, comparado às semanas que antecederam o decreto e com o mesmo período em anos anteriores. O resultado é inconsistente com os achados usualmente relatados em outros estudos. Portanto, foi definido um objetivo secundário a fim de investigar a possível causa (ou causas) da piora na qualidade do ar, o que revelou um aumento no número de incêndios. O tempo anormalmente seco favoreceu a queima de vegetação nas áreas agrícolas rurais e em pequenas áreas de vegetação próximas às cidades, além do limitado escoamento da poluição pela chuva, o que contribuiu à maior concentração de poluentes. Os achados sugerem hipóteses sobre os possíveis efeitos dessa situação de pior qualidade do ar sobre o agravamento de casos de COVID-19, porém são necessários mais estudos para uma avaliação completa.
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