Abstract
Background
Clinical decisions are mainly driven by the ability of physicians to apply risk stratification to patients. However, this task is difficult as it requires complex integration of ...numerous parameters and is impacted by patient heterogeneity. We sought to evaluate the ability of transplant physicians to predict the risk of long-term allograft failure and compare them to a validated artificial intelligence (AI) prediction algorithm.
Methods
We randomly selected 400 kidney transplant recipients from a qualified dataset of 4000 patients. For each patient, 44 features routinely collected during the first-year post-transplant were compiled in an electronic health record (EHR). We enrolled 9 transplant physicians at various career stages. At 1-year post-transplant, they blindly predicted the long-term graft survival with probabilities for each patient. Their predictions were compared with those of a validated prediction system (iBox). We assessed the determinants of each physician’s prediction using a random forest survival model.
Results
Among the 400 patients included, 84 graft failures occurred at 7 years post-evaluation. The iBox system demonstrates the best predictive performance with a discrimination of 0.79 and a median calibration error of 5.79%, while physicians tend to overestimate the risk of graft failure. Physicians’ risk predictions show wide heterogeneity with a moderate intraclass correlation of 0.58. The determinants of physicians’ prediction are disparate, with poor agreement regardless of their clinical experience.
Conclusions
This study shows the overall limited performance and consistency of physicians to predict the risk of long-term graft failure, demonstrated by the superior performances of the iBox. This study supports the use of a companion tool to help physicians in their prognostic judgement and decision-making in clinical care.
Enteric adenovirus (AdV), sapovirus (SaV), and human astrovirus (HAstV) are important pathogens involved in the gastroenteritis etiology. In this study, a total of 219 fecal samples and sera were ...collected from children hospitalized for acute gastroenteritis (AGE) in two large pediatric hospitals in Belém, from March 2012 to April 2015. The samples were analyzed by polymerase chain reaction (PCR) for AdV and HAstV (astrovirus) detection, and Nested‐PCR and qPCR for SaV detection. AdV was detected in 50.2% (110/219) of the cases, with 42.7% (47/110) being sequenced and classified as: species F (63.9% – 30/47), A (4.2% – 2/47), B (6.4% – 3/47), C (17.1% – 8/47), D (4.2% – 2/47), and E (4.2% – 2/47). Of the 110 AdV‐positive feces samples, 80 paired sera presented sufficient amounts and were also tested for this virus, of which 51 (63.7%) showed positive results and 26 (70.3%) pairs (feces plus sera) presented concordant results after sequencing being classified as: species F (21/26; 80.8%), A (1/26; 3.8%), B (1/26; 3.8%), and C (3/26; 11.5%). Overall, HAstV rate in the feces samples was 1.8% (4/219), including both HAstV‐1a (2/4; 50%) and HAstV‐2c (2/4; 50%). SaV was detected in 4.6% (10/219) of the fecal samples, out of which 50% (5/10) of the positive samples were characterized into the genogroups GI.1 (1), GI.2 (2), and GII.4 (2). These findings highlighted the important contributions of AdV, HAstV, and SaV in the enteric virus spectrum in our region and showed the high genetic diversity of AdV. In addition, it demonstrated for the first time in Brazil, the circulation of AdV in the serum of hospitalized children with AGE.
1.Detection of enteric adenoviruses in samples of blood and feces of children.
2.First detection of adenovirus viremia in blood of children hospitalized for gastroenteritis.
3.Detection of adenovirus types F40/41 in blood and fecal samples.
4.Genetic diversity of adenovirus in serum and fecal samples.
Justificativa e Objetivos: Os antimicrobianos estão entre os medicamentos mais preocupantes dentro do ambiente hospitalar por conta de erros relacionados ao seu uso. Priorizando a segurança do ...paciente, além do aprimoramento das equipes multiprofissionais envolvidas, o presente estudo tem por objetivo verificar os principais erros descritos na literatura relacionados ao uso de antibiótico em pacientes hospitalizados. Conteúdo: Trata-se de uma revisão sistemática de caráter exploratório e abordagem descritiva. Os dados forma buscados nas bases eletrônicas: PubMed, Literatura Latino-Americana e do Caribe, Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SCIELO), utilizando os Descritores em Ciência da Saúde (Decs): “erros de medicação”, “segurança do paciente” e “antibiótico”, entre os anos de 2013 e 2017. Foram encontrados 25 artigos, destes, 14 foram selecionados, catalogados e analisados, a partir de uma comparação sobre os principais tipos de erros de medicamentos, intervenções realizadas e custos dos principais desfechos. Conclusão: Embora os estudos analisados não abordem especificamente os erros de medicação, pode-se constatar que os principais erros consistem na prescrição dos antibióticos. Reforça-se, portanto, a necessidade de educação continuada dos profissionais envolvidos e o uso da tecnologia na forma de sistemas informatizados para reduzir os erros deste e dos demais tipos de medicação em hospitais.
Descritores: Erros de medicação; Segurança do paciente; Antibióticos.
•This study showed the effects of DqV in chemically induced seizure models.•The i.p. treatment showed neuroprotective effects on seizures induced by PTZ.•The e.v. treatment showed neurotoxic effects ...on seizures induced by PTZ.
Arthropod venoms are potential sources of neuroactive substances, providing new tools for the design of drugs. The aim of this study was to evaluate the effects of Dinoponera quadriceps venom (DqV) on seizure models in mice induced by pentylenetetrazole (PTZ), pilocarpine, and strychnine. In the PTZ model, intraperitoneal treatment with DqV (0.5mg/kg) increased the time until the first seizure and the percentage of survival (155.4±27.7s/12.5%, p<0.05) compared to the control group (79.75±3.97s/0%), whereas endovenous treatment (0.1 and 0.5mg/kg) decreased the time until the first seizure (0.1mg/kg: 77.83±5.3s versus 101.0±3.3s in the control group; 0.5mg/kg: 74.43±3.9s versus 101.0±3.3s for the control group, p<0.05). We did not observe significant changes in the pilocarpine- and strychnine-induced seizure models. In assays that measured oxidative parameters in the PTZ model, intraperitoneal treatment with DqV (0.5 and 2.0mg/kg) only decreased the levels of MDA and nitrite in the cortex. However, endovenous treatment with DqV (0.1 and 0.5mg/kg) increased the levels of MDA in the cortex and hippocampus and at a dose of 0.5mg/kg in the striatum. Moreover, increased in nitrite content was observed in all three of the brain regions analyzed. Taken together, the D. quadriceps venom caused both neuroprotective and neurotoxic effects in a PTZ-induced seizure model, and this effect was dependent on the route of administration used.
Arthropod venoms are potential sources of neuroactive substances, providing new tools for the design of drugs. The aim of this study was to evaluate the effects of Dinoponera quadriceps venom (DqV) ...on seizure models in mice induced by pentylenetetrazole (PTZ), pilocarpine, and strychnine. In the PTZ model, intraperitoneal treatment with DqV (0.5 mg/kg) increased the time until the first seizure and the percentage of survival (155.4 plus or minus 27.7 s/12.5%, p < 0.05) compared to the control group (79.75 plus or minus 3.97 s/0%), whereas endovenous treatment (0.1 and 0.5 mg/kg) decreased the time until the first seizure (0.1 mg/kg: 77.83 plus or minus 5.3 s versus 101.0 plus or minus 3.3 s in the control group; 0.5 mg/kg: 74.43 plus or minus 3.9 s versus 101.0 plus or minus 3.3 s for the control group, p < 0.05). We did not observe significant changes in the pilocarpine- and strychnine-induced seizure models. In assays that measured oxidative parameters in the PTZ model, intraperitoneal treatment with DqV (0.5 and 2.0 mg/kg) only decreased the levels of MDA and nitrite in the cortex. However, endovenous treatment with DqV (0.1 and 0.5 mg/kg) increased the levels of MDA in the cortex and hippocampus and at a dose of 0.5 mg/kg in the striatum. Moreover, increased in nitrite content was observed in all three of the brain regions analyzed. Taken together, the D. quadriceps venom caused both neuroprotective and neurotoxic effects in a PTZ-induced seizure model, and this effect was dependent on the route of administration used.
O aleitamento materno deve ser exclusivo até aos seis meses de vida. Logo, o hábito do Aleitamento Materno Exclusivo (AME) auxilia para a saúde não somente da criança, mas também da mãe, que se ...beneficia de boa parte das vantagens. Diversas mulheres se deparam com desafios relacionados à produção de leite, questões emocionais e sociais, estado nutricional e o bem-estar do bebê, estilo de vida em geral, além de desconforto e dificuldade na amamentação e posicionamento correto do bebê no seio, o que pode levar à interrupção desse comportamento protetor. É essencial que os profissionais de saúde que trabalham na atenção básica recebam uma formação adequada e sejam atualizados por meio de cursos, a fim de oferecerem assistência adequada às gestantes, mães e crianças em relação ao aleitamento materno na Atenção Primária. O objetivo deste estudo é propor que os profissionais de saúde forneçam orientações sobre o aleitamento materno durante o pré-natal e previnam complicações na amamentação. Esta pesquisa é baseada em uma revisão integrada da literatura científica. A coleta de dados foi realizada nas bases de dados BVS (Biblioteca Virtual em Saúde), SciELO e PUBMED, entre os meses de outubro e novembro de 2022. Foram relacionados diversos artigos da bibliografia atual, utilizando palavras-chave como: “Aleitamento Materno”, “Cuidado Pré-natal”, “Papel do Enfermeiro” e “Educação em Saúde”, previamente consultados no DEC’s (Descritores em Ciências da Saúde). Resultados e discussão:Seguindo de acordo com as análises da base de dados e descritores, foram selecionados 10 estudos para avaliação dos textos completos e foram utilizados para criação da presente pesquisa, e assim foram discutidos os seguintes temas: As vantagens da alimentação infantil com leite materno; orientação sobre a saúde na amamentação e a participação do enfermeiro e também da equipe multidisciplinar no acompanhamento pré-natal. Em síntese, ressalta-se também as contribuições referentes ao assunto em discussão que serão extremamente úteis para o futuro desempenho profissional na área da saúde, em que o aprendizado adquirido certamente terá influência no estabelecimento de um cuidado eficaz e comprometido, priorizando orientações abrangentes sobre a alimentação com leite materno.
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