Search

Prematurity is associated with morbidity and mortality. There is alot of causative factors that involved. One of the contributing factors is the presence of uterine contractions that occur prematurely. This is due to a decrease in progesterone levels. This decrease can be achieved by changing the levels of the progesterone receptor (PR) isoform in the myometrium. Objective: To determine whether there is a connection between changes in progesterone receptor isoform levels on labor. This systematic study was arranged according to Prefered Reporting Items For Systematic Review and Meta-Analysis (PRISMA). The articles studied were observational studies. Each article was tested for the quality of the Newcastle-Ottawa Scale literature because the articles used were of the case-control type. From the search results using the search strategy in PUBMED, there were 190 articles that were then selected based on title, abstract, and inclusion and exclusion criteria obtained 4 articles that fit the criteria desired by the researcher. From the results of a systematic study, it was found that the number of progesterone receptor ratios in pregnant women who had spontaneous labor compared to pregnant women who gave birth via planned cesarean section. Pregnancy within labor experienced an increase in the PR-A/PR-B ratio by 1.12 times compared to that of cesarean section delivery.

During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality.To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital.Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment.One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %).Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.Ante la pandemia de COVID-19, el apego a las medidas de higiene es un objetivo para disminuir la morbimortalidad.Evaluar el apego a la higiene de manos y medidas de protección durante la pandemia de COVID-19 en un hospital de tercer nivel.Estudio transversal acerca del lavado de manos del personal de salud en los cinco tiempos recomendados por la Organización Mundial de la Salud, así como sobre el uso del equipo de protección personal específico.Fueron observadas 117 oportunidades de higiene de manos en personal de salud: 40 (34 %) respecto al lavado de manos y 76 (65 %) respecto a su omisión; sobre el apego al uso de careta en cinco (4 %) y sobre la falta de apego en 112 (96 %). Se identificó apego al uso de mascarilla en 65 profesionales de enfermería (87 %), uso adecuado de mascarilla en 56 de ellos (60 %) y uso de careta en uno (1 %).El personal mostró baja proporción de apego a la higiene de manos y al uso de equipo para la protección específica durante la pandemia de COVID-19.

Introduction We aimed to describe antimicrobial use (AU) and quality of prescriptions (QP) in a 28-bed medical-surgical PICU of a European referral children's hospital during 2019. Methods AU data were expressed as days-of-therapy (DOT) over 100 days-present (DP) and as length-of-treatment (LOT). QP was based on monthly cross-sectional point-prevalence surveys. Length-of-stay (LOS), readmission rates (RR), and mortality rates (MR) were also collected. Results PICU AU accounted for 13.5% of the global hospital AU; the median PICU density of AU was 1.4 (IQR 1.3–1.5) times higher than that of the rest of the hospital areas. Antibacterials represented 88.5% of the overall AU, cefazolin and amoxicillin-clavulanate being the most used drugs. A high QP rate was observed (149/168 optimal, 88.9%), with room for improvement in prophylactic regimens and de-escalation of broad-spectrum regimens. LOT, LOS, RR, and MR remained stable. Conclusions PICU AU represented a major portion of the global hospital AU. Despite high QP rates, prophylactic and broad-spectrum antibiotic regimens were optimizable.

Objective: Symptomatic carotid artery stenosis needs revascularization within 2 weeks by carotid endarterectomy (CEA) to reduce the risk of symptom recurrence; however, the optimal timing of intervention is yet to be defined in patients with large-volume cerebral ischemic lesion (LVCIL) and modified Rankin scale (mRS) score ≥3. The aim of this study was to determine the most appropriate timing for CEA in patients with a recent stroke and LVCIL. Methods: Data from patients with symptomatic carotid stenosis with LVCIL and mRS score of 3 or 4 from 2007 to 2017 were considered. Patients were submitted to CEA if they had a stable clinical condition and life expectancy >1 year. LVCIL was defined as a cerebral ischemic lesion of volume >4000 mm3. Perioperative stroke and death were evaluated by stratifying for timing of CEA by χ2 test and multiple logistic regression. Patients with similar characteristics (LVCIL and mRS score of 3 or 4) unfit for CEA served as the control group for recurrence of stroke at 1-year follow-up. Results: In an 11-year period, of a total 4020 CEAs, 126 (2.9%) were performed in patients with a moderate stroke and LVCIL occurring in the same admission. The patients' median age was 69 years (interquartile range [IQR], 10 years); 72% (91) were male, with mRS score of 3 (IQR, 1) and LVCIL volume of 20,000 mm3 (IQR, 47,000 mm3). The median time elapsed from symptoms to CEA was 7 weeks (IQR, 8 weeks). Overall perioperative stroke/death was 7.3% (eight strokes and one death). By selective timing evaluation of the postoperative events, CEA performed within 4 weeks was associated with a significantly higher rate of stroke/death compared with patients operated on after 4 weeks: 11.9% (8/67) vs 1.7% (1/59; P =.03). By logistic regression, CEA within 4 weeks was an independent (from sex, cerebral ischemic lesion volume, dyslipidemia, and carotid stenosis) predictor of postoperative stroke/death (odds ratio, 8.2; 95% confidence interval, 1.01-73). In the same period, 101 patients were considered unfit for CEA for dementia (n = 22), severe comorbidities (n = 55), or short (4 weeks, its benefit seems significant.

Este artigo tem como objetivo identificar as fragilidades ocorridas no serviço realizado pelos profissionais integrantes das equipes de Estratégia Saúde da Família (ESF)em diferentes localidades do mundo. Trata-se de uma revisão sistemática de literatura baseada no método Systematic Search Flow, pelo qual foram considerados os estudos de acordo com o objetivo, independentemente da localidade e do ano de realização. Para verificar a recorrência das fragilidades encontradas, foi utilizado o método de análise de conteúdo. Obteve-se um portfólio bibliográfico de 24 artigos. A partir da análise de conteúdo de cada um deles, foram extraídas as unidades de contexto e categorizadas em cinco unidades de análise, para representar as fragilidades. Independentemente da localidade, ocorreram as mesmas fragilidades, remetendo a uma interpretação de que o caminho para que as equipes de ESF consigam alcançar uma atuação mais efetiva e eficaz, no que se refere ao impacto na redução das taxas de internações evitáveis, poderá ser bastante trabalhoso. Porém, estudos como este podem ajudar a compreender tal cenário de forma mais clara e detalhada, e talvez sejam um atalho na busca por melhorias e avanços na atuação dessas equipes de saúde.

Background Alcohol use during pregnancy has been associated with several birth defects and developmental disabilities generally known as Fetal Alcohol Spectrum Disorders (FASD). Contextual in-depth understanding on why women drink while pregnant is scarce. For this reason, we explored pregnant women’s experiences, knowledge, attitudes as well as provider perceptions regarding prenatal alcohol consumption to inform interventions meant to address alcohol-exposed pregnancies in post-conflict settings. Methods In the months of May and June 2019, 30 in-depth interviews were conducted with pregnant mothers who reported maternal alcohol use during pregnancy. In addition 30 Key informant interviews were carried out with health workers providing Antenatal Care services (ANC) in health facilities in Gulu, Kitgum and Pader districts in Northern Uganda. Data was recorded, transcribed and subjected to thematic content analysis. Results Women reported diverse views regarding maternal alcohol use during pregnancy. Whereas some felt it was favourable, others had misgivings about it. There was marked variability in knowledge on dangers of drinking during pregnancy. In this study, women reported that they found themselves in alluring situations that predisposed them to drinking alcohol. These included brewing alcohol as a source of livelihood, pregnancy-induced craving for alcohol, and participation in cultural festivities that are characterised by eating and drinking alcohol. Nonetheless, women who consume alcohol during pregnancy were not held in high esteem in the Acholi communities. Various prevention interventions reportedly existed in communities to address alcohol use during pregnancy including ANC health education, public debates, radio talk shows, community health worker group and individual counselling, and local council by laws. Conclusions and recommendations Pregnant mothers in post-conflict northern Uganda regard alcohol as a remedy to some of the social, economic and health challenges they face. Hence they continue drinking even during pregnancy because of the existing socio-cultural norms that promote it. The findings of this study demonstrate a need for sensitising communities in which pregnant women live so they can provide a supportive environment for mothers to abstain from alcohol consumption during pregnancy. Health care providers should ensure pregnant women consistently receive accurate and honest messages on the dangers of drinking during pregnancy so they can make informed decisions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents rapid transmission and significant mortality worldwide. It is responsible for coronavirus disease 2019 (COVID-19). The disease presents diverse clinical symptoms, including fever, cough, dyspnea, and pneumonia. However, other manifestations associated with COVID-19 need to be clarified, leading specialists to an early diagnosis and better prognosis. We describe the spectrum of clinicopathologic COVID-19-related oral lesions that can be the first and/or the unique manifestation of the disease. Fourteen patients with a mean age of 58 years (range: 23 to 88 y) with oral lesions were included. All patients were confirmed to be infected with SARS-CoV-2 by reverse transcription polymerase chain reaction testing. Patients demonstrated mild symptoms, including dysgeusia, anosmia, fever, and headache. The lesions were recognized and classified into 2 groups: (1) lesions caused by ischemia and/or hemorrhage and (2) lesions secondary to inflammatory events associated with viral load. The palate was most affected (n=8), followed by the tongue (n=4), and both the lip and palate (n=2). Histologic analysis demonstrated thrombosis of small arteries and capillaries, associated with areas of hemorrhage and chronic inflammatory infiltrate. Immunohistochemistry showed positive staining for spike protein (SARS-CoV and SARS-CoV-2) and angiotensin-converting enzyme 2 in the surface epithelium, salivary glands, inflammatory cells, and endothelial cells. Although the incidence of oral lesions among patients infected with SARS-CoV-2 appears to be uncommon, these findings suggest that the oral mucosa can also be a target organ for SARS-CoV-2.

Genetic variants in genes involved in the distribution, metabolism, accumulation or repair of lesions are likely to influence the response of drugs used in the treatment of Head and Neck Cancer (HNC). We examine the effect of 36 SNPs on clinical outcomes in patients with locally advanced HNC who were receiving platinum-based chemoradiotherapy (CRT). These SNPs were genotyped in 110 patients using the iPLEX Gold assay on the MassARRAY method in blood DNA samples and used Kaplan–Meier and Cox regression analyses to compare genotype groups with the survival. Two SNPs, rs717620 (ABCC2) and rs12934241 (MMP2) were strongly associated with overall survival (OS) and disease-free survival (DFS). At a median follow-up of 64.4 months, the allele A of rs717620 (ABCC2) had an increased risk of disease progression {hazard ratio [HR] = 1.79, p = 0.0018} and death (HR = 2.0, p = 0.00027). ABCC2 was associated with OS after a Bonferroni adjustment for multiple testing. The MMP2 rs12934241‐T allele was associated with an increased risk of worse OS and DFS (p = 0.0098 and p = 0.0015, respectively). One SNP of ABCB1 and three SNPs located in the ERCC2 gene showed an association with response in the subgroup of HNC patients treated with definitive CRT. Our findings highlight the potential usefulness of SNPs in different genes involved in drug metabolism and repair DNA to predict the response and survival to CRT. ABCC2 is a potential predictor of OS in patients with HNC.

BACKGROUND Hypercalciuria is the most common metabolic risk factor for calcium urolithiasis and is associated with bone loss in adult patients. Reduced bone mineral density (BMD) was already described in idiopathic hypercalciuria (IH) children, but the precise mechanisms of bone loss or inadequate bone mass gain remain unknown. Life-long hypercalciuria might be considered a risk to change bone structure and determine low bone mass throughout life. The peak of bone mass should occur without interferences. A beneficial effect of citrate formulations and thiazides on bone mass in adult and pediatric patients with IH have been shown. AIM To evaluate whether pharmacological therapy has a beneficial effect on bone mass in children and adolescents with IH. METHODS This retrospective cohort study evaluated 40 hypercalciuric children non-responsive to lifestyle and diet changes. After a 2-mo run-in period of citrate formulation (Kcitrate) usage, the first bone densitometry (DXA) was ordered. In patients with sustained hypercalciuria, a thiazide diuretic was prescribed. The second DXA was performed after 12 mo. Bone densitometry was performed by DXA at lumbar spine (L2-L4). A 24-h urine (calcium, citrate, creatinine) and blood samples (urea, creatinine, uric acid, calcium, phosphorus, magnesium, chloride, hemoglobin) were obtained. Clinical data included age, gender, weight, height and body mass index. RESULTS Forty IH children; median age 10.5 year and median time follow-up 6.0 year were evaluated. Nine patients were treated with Kcitrate (G1) and 31 with Kcitrate + thiazide (G2). There were no differences in age, gender, body mass index z-score and biochemical parameters between G1 and G2. There were no increases in total cholesterol, kalemia and magnesemia. Calciuria decreased in both groups after treatment. Lumbar spine BMD z-score increased after thiazide treatment in G2. There was no improvement in G1. CONCLUSION Results point to a beneficial effect of thiazide on lumbar spine BMD z-score in children with IH. Further studies are necessary to confirm the results of the present study.

Background: Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening. Objective: To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda. Methods: A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal ‘yes’ or ‘no’ questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda. Results: Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. Conclusion: A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.

Background Lymphomas in the oral and oropharyngeal regions are relatively uncommon, and their diagnosis is challenging and complex due to the myriad histopathological subtypes. Herein, we report a large series of oral and oropharyngeal lymphomas and compare our data with the currently available literature. Methods All cases diagnosed as lymphomas affecting the oral and oropharyngeal regions were retrospectively retrieved from seven Brazilian institutions. Clinicodemographic data and histopathological features were evaluated and described, while a comprehensive literature review was undertaken in order to compare our findings. Results A total of 304 cases of oral and oropharyngeal lymphomas were obtained, mostly affecting individuals aged 60-69 years (n = 68) with a mean age at diagnosis of 54.2 ± 20.1 years. Males and females were equally affected. Mature B-cell neoplasms (87.2%) were the most common group, followed by mature T- and NK-cell neoplasms (11.2%) and precursor lymphoid neoplasms (1.6%). The most frequent subtypes in each group were diffuse large B-cell lymphomas, not otherwise specified (n = 99), extranodal NK/T-cell lymphomas, nasal type (n = 12), and B-lymphoblastic leukaemia/lymphomas, not otherwise specified (n = 4). The most commonly involved sites were the palate (26.3%), mandible (13%), and maxilla (10.5%). Conclusion Diffuse large B-cell lymphoma, not otherwise specified, remains the most common subtype of lymphomas in the oral and oropharyngeal region. Older patients are the most affected, with no gender predilection and the palate and jaw are usually affected.

Background Plasma cell neoplasms are characterized by the proliferation of a single clone of plasma cells with production of a monoclonal immunoglobulin. They can manifest as a single lesion (plasmacytoma) or as multiple lesions (multiple myeloma). Methods Paraffin-embedded tissue blocks of patients microscopically diagnosed with plasma cell neoplasms in the jaws were retrieved from five pathology files. Data including clinical, radiographic, microscopic and immunohistochemical findings, treatment employed, and follow-up status were retrieved from the pathology reports. Results Fifty-two cases were retrieved (mean age: 59.4 years) without sex predilection. The mandible was the most affected site (67.3%), usually associated with pain and/or paresthesia (53.8%). Lesions in other bones besides the jaws were reported for 24 patients (46.2%). Radiographically, tumors usually presented as poorly defined osteolytic lesions with unilocular or multilocular images, while microscopy revealed diffuse proliferation of neoplastic plasma cells with nuclear displacement and abundant eosinophilic cytoplasm. Two cases were classified as anaplastic, and amyloid deposits were found in two other cases. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, and monoclonality for kappa light chain predominated. The overall survival rate after 5-years of follow-up was 26.6%. Conclusion Plasma cell neoplasms are aggressive tumors with a poor prognosis and involvement of the jaws may be the first complaint of the patient. Thus, oral pathologists, head and neck surgeons and dentists should be aware of their clinical, radiographic and microscopic manifestations.

Introduction: Pediatric chronic kidney disease interferes with weight growth, psychosocial status, and also affects quality of life. Objectives: To outline the clinical, epidemiological, social and economic profile of children and adolescents undergoing renal replacement therapy (RRT) at Santa Casa de Belo Horizonte, Minas Gerais - Brazil. Methods: Observational and cross-sectional study. 82 children and adolescents from 0 to 17yrs of age who had undergone RRT with at least three months of registration were included. Patients who died in the first three months on RRT, acute patients, and those older then 18yrs were excluded. Anthropometric analysis was performed and qualitative variables were expressed in absolute frequencies and percentage. Results: 63.5% were male; median age of 9.25yrs at the beginning of RRT. 57% were short, and the BMI was normal in 88%. 82% were followed by nephrologists before RRT, 64.5% had residual diuresis. Hemodialysis was the main initial modality of RRT. Long-term double-lumen catheter was the most widely used vascular access. 85% of those who were at school age were attending school. Most patients lived in the countryside, used public transport, and had a low per capita income. SUS (Health Unic System) was the paying source and were registered at UBS (Basic Health Unity). The mother was the caregiver in 80.5%, 36.6% had glomerulopathy and 26.8% CAKUT uropathy. Sepsis was the main cause of death. 34 patients were transplanted. Discussion and Conclusion: To know the clinical, epidemiological, social, and economic profile of pediatric patients in RRT is important in order to increase the chances of successful treatment and a better quality of life.

INTRODUÇÃO: Os benefícios da ventilação mecânica em neonatos prematuros se complementam com o sucesso na sua retirada. OBJETIVO: Avaliar os parâmetros ventilatórios e gasométricos pré extubação e identificar possíveis fatores que possam contribuir na decisão da extubação endotraqueal em recém-nascidos prematuros até 32 semanas. MÉTODOS: Trata-se de um estudo prospectivo, de caráter observacional. A amostra do estudo foi selecionada de forma não probabilística. Foram incluídos prematuros com idade gestacional até 32 semanas, e em ventilação mecânica invasiva por no mínimo 24 horas. E os critérios de exclusão foram recém-nascidos com malformações, cardiopatias e os transferidos para outros hospitais antes da primeira extubação eletiva. Os dados sobre o diagnóstico clínico, dados vitais, parâmetros da ventilação mecânica e gasometria arterial, registrado em uma ficha elaborada pelos pesquisadores e coletados diariamente, uma vez por dia desde o primeiro dia de ventilação mecânica invasiva até o momento de retirada do tubo endotraqueal, sendo o recém-nascido acompanhado até 7 dias após a extubação. O desmame e a extubação seguiu o protocolo da Unidade de Terapia Intensiva Neonatal (UTIN) (presença de respiração espontânea regular e com reflexo de tosse, FiO2 < 40% para manter saturação 90%; pressão inspiratória entre 15 – 18 cmH2O; FR=15 a 20 ipm; pH > 7,25 mmHg e PaCO2 < 50 mmHg). RESULTADOS: Dos 20 recém-nascidos prematuros incluídos no estudo, 14 eram do sexo masculino, a média de idade gestacional foi de 28,9± 2,12 semanas e a média do peso ao nascimento foi 1069,5g ± 375,5. Em 75% dos casos a intubação foi devido a síndrome do desconforto respiratório neonatal. Do total da amostra, 40% apresentaram. Não houve diferença significativa entre os grupos sucesso e falha na extubação, quanto aos dados ventilatórios e gasométricos analisados pré e pós extubação (p>0,05). Na regressão logística observou-se que a fração inspirada de oxigênio (p= 0,03) e a pressão média de vias aéreas (p= 0,03) apresentaram significância como preditor para extubação. O tempo de uso da ventilação mecânica invasiva não apresentou significância estatística (p=0,06), para o desfecho avaliado. CONCLUSÃO: Neste estudo os parâmetros mínimos ventilatórios como FiO2 e MAP se relacionam diretamente com o sucesso da extubação, bem como estar atento as condições clínicas do paciente auxiliam a equipe a nortear o desmame e programar uma extubação mais criteriosa e segura.

Given the increasing private and public cost of university education, households and nations are getting more interested in that type of education which has high potential for employment. This study explores how the expansion of the university sector in Uganda is related to graduates’ employability. The study was guided by three objectives, namely: To find out whether expansion of the university sector in Uganda is related to available options of employment for graduates; To establish whether the expansion of the university sector in Uganda is related to adequacy of skills which graduates need in the world of work; To examine whether the expansion of the university sector in Uganda is related to the duration which graduates take before getting employed after graduation. Mainly relying on the constructivist research paradigm, the study used a cross sectional and correlational research design. Both qualitative and quantitative approaches were used in data collection and data analysis. Using a questionnaire and interviews, data were collected from 244 university lecturers, 9 Deans of Faculty, 18 Heads of Department, and 9 Human Resource Managers who represented employers. The study found out that expansion of the university sector in Uganda has a relationship with options for employment of graduates in the world of work. The expansion of the university sector in Uganda is associated with adequacy of skills for employment which are acquired by university graduates. These findings also show that expansion of the university sector in Uganda is related to the duration which graduates take to get employment after graduation. Key words: Expansion, university sector, graduates’ employability, labour markets.

We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m2; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, P < .001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, P = .02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, P = .02). In Cox’s regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: P = .03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men.

Objetivo: Estudar de forma longitudinal o impacto do acompanhamento nutricional nas medidas antropometricas, no perfil lipidico, glicidico e no consumo dietetico de diabetes mellitus tipo 2 (DM2) idosos. Metodo: Foi realizado um estudo de coorte retrospectivo com DM2 nos idosos, do ambulatorio de nutricao/diabetes, do nucleo de atendimento ao idoso (NAI/UFPE), com pacientes admitidos para o tratamento dietoterapico no periodo de 2012 a 2018. Dados antropometricos, bioquimicos e de consumo alimentar foram coletados das fichas de acompanhamento nutricional e/ou do prontuario do NAI. Resultados: A amostra era formada predominantemente por idosos na faixa etaria de 60 a 74 anos, maioria residente no Recife e regiao metropolitana, com 81,72% dos pacientes pertencentes ao sexo feminino. Quanto as patologias houve prevalencia de hipertensao, nos paramentos antropometricos o Indice massa corporal, circunferencia da panturrilha estavam dentro dos limites acetaveis, ja a circunferencia da cintura estava elevada. Os parâmetros bioquimicos se revelaram dentro da meta aceitavel para idosos DM2. O perfil dietetico apresentou reducao do consumo de alimentos preditores de risco de Doencas Cardiovasculares (DCV), com excecao dos embutidos, que apresentou elevacao. Alem disso, houve aumento de consumo de alimentos protetores de DCV. Conclusao: Observa-se que tanto os dados antropometricos, bioquimicos e dieteticos estavam dentro da faixa aceitavel para idosos DM2; com excecao da circunferencia da cintura que se manteve em niveis elevados apresentando risco para DCV.

Background: Focal segmental glomerulosclerosis (FSGS) is an important cause of end-stage kidney disease in children and adults. Although most cases are sporadic (s), familial (f) presentation is also described. The purpose of the present study was to establish clinical and laboratory profiles of fFSGS vs. primary sFSGS, contributing to the distinguishing diagnosis in clinical practice and best management, in particular when mutation analysis is not available. Methods: Demographic, clinical and laboratorial parameters were studied in 124 patients 12 years and older with FSGS, subdivided in sFSGS (n=89) and fFSGS (n=35). Results: General and clinical features were similar, as well as serum creatinine at disease presentation. Proteinuria levels were more frequently ≥ 3g/day in sFSGS (63.8%) than in fFSGS (44%, p=0.080), and serum albumin levels were < 3.0 g/dL in 45.8% and 20%, respectively (p=0.046). The groups were statistically different regarding steroid resistance, corresponding to 60% in sFSGS and 100% in fFSGS (p=0.001). Conclusions: The studied groups were clinically similar, except that proteinuria tended to be higher (nephrotic range) and serum albumin was lower in sFSGS vs. fFSGS. In addition, all treated fFSGS patients were steroid resistant. At presentation it is important to characterize if the patient has fFSGS, that will contribute to further disease management, and disease history will be the first clue for such differential diagnosis.

Background Alcohol use during pregnancy has been associated with several births and developmental disorders. This study set out to determine the various forms of alcohol consumption among pregnant women and their predictors in post conflict Northern Uganda. Methods In the months of May to June 2019, we conducted a cross sectional study among 420 pregnant women seeking antenatal care services at both Government and private health facilities in Gulu, Kitgum and Pader districts in Northern Uganda. We asked them about consumption of various alcoholic beverages. A three stage stratified cluster sampling approach was used and study participants randomly selected from health facilities of interest. We used descriptive statistics to estimate the prevalence of various forms of alcohol use. The chi- square test and logistic regression were used to assess associations of alcohol use among respondents and their socio - demographic and other characteristics. Results Overall 99 women (23.6%) reported current alcohol use (any amount). Up to 11% (N = 11) of all drinkers were identified by the AUDIT to be women with problem drinking behavior, 8% (N = 8) of women reported hazardous drinking and only four (4%) were women with active alcohol dependent behavior. Predictors of maternal alcohol use included pre-pregnancy alcohol consumption, knowledge, attitude, education level, parity and residence. Conclusions This study indicates that alcohol use (any mount) during pregnancy is high while alcohol dependence, problematic and hazardous drinking is low. Knowledge and attitude were important predictors of alcohol use. While alleviating alcohol use, development partners and relevant government departments should consider communication and other interventions that increase knowledge and risk perception on maternal drinking. Other risk factors that predict maternal drinking such as prior alcohol use, residence and parity should be mitigated or eliminated.

This study investigated the relationship between the rapid and continuous growth of the Higher Education Sector and graduate productivity in the Ugandan Labor Market. The study was guided by three objectives, namely; to find out how rapid transformation of the HE sector is related to graduates’ confidence at their places of work; to establish how rapid transformation of the HE sector is related to graduates’ timely accomplishment of tasks and to examine how rapid transformation of the HE sector in Uganda is related to graduates ability to work in a team. The study employed a correlational cross-sectional survey design; both quantitative and qualitative approaches were adopted for data collection and analysis from the targeted sample of 90 university lecturers, 6 deans of faculties and schools, 12 heads of departments as well as 3 HR managers. Results revealed a positive significant correlation between rapid transformation of the HE sector and graduates productivity. The study also established that universities are greatly lacking in the quality of training resources. The study concludes that improving the quality of university facilities will improve teaching and learning efficiency which in turn will enhance the quality of university graduates.

INTRODUÇÃO: Os recém-nascidos prematuros frequentemente passam por longos períodos internados em unidades de terapia intensiva neonatal. Nesses pacientes, a dor, resultado das intervenções intrusivas é motivo de preocupação das equipes multidisciplinares. OBJETIVO: Identificar a melhor intervenção para alívio da dor durante a aspiração de vias aéreas superiores, comparando posicionamento no ninho com contenção em cueiro. MÉTODO: Foi realizado um estudo do tipo Antes e Depois em recém-nascidos prematuros com menos de 32 semanas de idade gestacional ao nascimento e que necessitassem de aspiração de vias aéreas na primeira semana de vida. No Grupo Antes, os pacientes foram posicionados no ninho, e no Grupo Depois, permaneciam contidos com cueiro. O desenho do estudo permitiu que os pacientes fossem controles deles mesmos e participassem do estudo mais de uma vez, conforme a necessidade de aspiração. O estudo teve aprovação do Comitê de Ética em Pesquisa com Seres Humanos. RESULTADOS: Participaram 22 recém-nascidos prematuros que foram submetidos a 100 procedimentos de aspiração do trato respiratório. Conforme análise estatística dependente constatou-se que os indivíduos que haviam pontuado dor no momento em que estavam posicionados no ninho, passaram a não pontuar quando contidos, pela Neonatal Infant Pain Scale (p=0,001) e Premature Infant Pain Profile (p=0,01). Observou-se uma menor variação da frequência cardíaca no grupo contenção. CONCLUSÃO: A dor está presente na aspiração de secreções das vias aéreas. A frequência cardíaca variou percentualmente menos no grupo contenção. Os pacientes posicionados em contenção passaram a não pontuar escore positivo para dor.

Diabetic foot ulceration (DFU) is a severe complication of diabetes mellitus associated with a high morbidity and mortality rate, whose treatment requires considerable financial costs. This paper describes a test of the efficacy of proactive screening – autonomously managed by nurses in a community setting – in detecting patients at high risk of DFU, as an integrated part of a chronic care model strategy.

INTRODUÇÃO: Intubação endotraqueal é procedimento comum nas Unidades de Terapia Intensiva Neonatais e tem como evento adverso a extubação não planejada, um incidente grave, associado a morbidade neonatal. OBJETIVO: Verificar a prevalência de extubação não planejada e fatores associados em recém-nascidos submetidos à ventilação mecânica na unidade de terapia intensiva neonatal por condições respiratórias, cardíacas ou por pós-operatório. MATERIAIS E MÉTODOS: Estudo transversal, retrospectivo realizado entre março a dezembro de 2017. Os dados foram coletados da ficha de notificação do serviço e incluíram: sexo, peso no momento do evento, comorbidades do paciente, data e hora de ocorrência, condições associadas e conduta pós-extubação. RESULTADOS: Em 38 recém-nascidos em ventilação mecânica foram registrados 72 eventos, a prevalência da extubação não planejada de 4,6%. Entre os fatores identificados, peso inferior a 1.500g foi observado em 20 recém-nascidos (52,6%) e prematuridade em 25 (65,8%). Em 15 recém-nascidos (39,5%) houve mais de um evento/paciente. Peso inferior a 2.500g esteve associado a um risco 6 vezes maior de recorrência do incidente. As condições associadas aos eventos foram agitação motora do recém-nascido (50%), manuseio da cânula endotraqueal (28,3%) e durante procedimentos de rotina do recém-nascido (21,7%). Reintubação foi necessária em 58 casos (80,5%), sendo imediata em 20 (34,5%). CONCLUSÃO: A agitação motora e o manuseio da cânula endotraqueal, portanto, foram os fatores mais associados aos eventos, a recorrência foi mais frequente em recém-nascido com peso inferior a 2.500g. Medidas de prevenção devem incluir o manejo adequado da agitação motora do recém-nascido e implementação de protocolos de manuseio da cânula endotraqueal.

Introduction The impact of the new coronavirus (SARS-COV-2) and its worldwide clinical manifestations (COVID-19) imposed specific regional recommendations for populations in need of specialized care, such as children and adolescents with kidney diseases, particularly in renal replacement therapies (RRT). We present the recommendations of the Brazilian Society of Nephrology regarding the treatment of pediatric patients with kidney diseases during the COVID-19 pandemic. Methods Articles and documents from medical societies and government agencies on specific recommendations for children on RRT in relation to COVID-19 as well as those focused on epidemiological aspects of this condition in Brazil Were evaluated and analyzed. Results We present recommendations on outpatient care, transportation to dialysis centers, peritoneal dialysis, hemodialysis, and kidney transplantation in children and adolescents during the COVID-19 pandemic in Brazil. Discussion Despite initial observations of higher mortality rates in specific age groups (the elderly) and with comorbidities (obese, diabetics, and those with cardiovascular diseases), patients with chronic kidney disease (CKD) on RRT are particularly prone to develop COVID-19. Specific measures must be taken to reduce the risk of contracting SARS-CoV-2 and developing COVID-19, especially during transport to dialysis facilities, as well as on arrival and in contact with other patients.

Objective To present the adaptations to treatment protocols made in a child and adolescent eating disorders (ED) unit during the eight-week confinement period mandated in response to the COVID-19 pandemic and examine clinical and treatment variables in the outpatient, day hospital, and inpatient care programs. Method Description of the implementation of a combined teletherapy program for outpatient and day-hospital patients and the adaptations made to the inpatient protocol. Retrospective review of medical records and analysis of general and specific variables related to the pandemic and confinement. Results We held 1,329 (73.10%) telehealth consultations and 489 (26.9%) face-to-face outpatient visits with 365 patients undergoing treatment in the outpatient clinic or day hospital. Twenty-eight (7.67%) were initial evaluations. Twenty-two patients were newly admitted and 68 ED-related emergencies were attended. Almost half of the children and adolescents studied experienced reactivation of ED symptoms despite treatment, and severe patients (25%) presented self-harm and suicide risk. Conclusions The implementation of a combined teletherapy program has enabled continuity of care during confinement for children and adolescents with ED. Delivery of treatment to adolescents in the day hospital program posed the biggest challenge due to their greater degrees of severity and higher hospitalization rates. An adapted inpatient program should be maintained throughout confinement, as the need for hospitalization of children and adolescents with ED does not decrease with lockdown.

OBJECTIVE In the present study, we aimed to investigate the prognostic value of RUNX1 expression in 76 patients with adenoid cystic carcinoma (ACC). MATERIALS AND METHODS All cases were arranged in tissue microarray blocks and submitted to immunohistochemistry against RUNX1. These results were statistically correlated with clinicopathologic features, including age, gender, tumour site, tumour size, lymph node status, AJCC clinical stage, distant metastasis, treatment, recurrences, follow-up, histologic pattern, vascular and neural invasion, all of which obtained from patient's medical records. RESULTS RUNX1 was expressed in the nuclei of tumour cells, with a mean of 18.1% of positivity. Nuclear RUNX1 expression was significantly associated with AJCC clinical stage (p

The study aimed at establishing the influence of human resource practices on quality assurance among secondary school teachers in the central region of Uganda. It was guided by the objective of establishing the relationship between on-job training, off-job training, and promotions on quality assurance among teachers in the central region of Uganda. It was a desktop content review of literature journal articles and research dissertations that was thematically analysed. The findings obtained showed that to a great extent, the provision of on-job training, off-job training and promotions to teachers enhances the quality assurance in secondary schools. Thus, it was concluded that the professional development of teachers is a critical aspect that all administrators should not neglect. Consequently, it was recommended that junior teachers should be assigned to senior teachers who should act as coaches, supervisors and mentors. Also, off-job training policies should be developed to enhance teachers’ teaching skills and once trained; the teachers have to be promoted.

The formation of human capital is key to countries’ social, cultural, and economic development. The current literature review pays considerable attention to the ever-increasing proliferation of technology in the careers of college and school graduates. While the presence of educational technology in higher education offers multiple benefits, its implementation also presents challenges. In that sense, the literature has considered multiple tools for improving learning processes. However, the results of such tools vary and are difficult to measure in terms of quality. In this literature review, we analyze the issues surrounding educational technology in higher education. La formación de capital humano es clave para el desarrollo social, cultural y económico de los países. Esta revisión de literatura presta una atención considerable a la introducción cada vez mayor de la tecnología en las carreras universitarias y en las escuelas de posgrados. Si bien la presencia de tecnología educativa en la educación superior ofrece múltiples beneficios, su implementación también presenta desafíos. En ese sentido, la literatura ha considerado múltiples herramientas para mejorar los procesos de aprendizaje. Ahora bien, los resultados de estas herramientas varían y son difíciles de medir en términos de calidad. En esta revisión de la literatura, analizamos los problemas que rodean la tecnología educativa en la educación superior A formação de capital humano é fundamental para o desenvolvimento social, cultural e econômico dos países. Esta revisão de literatura presta uma atenção considerável à introdução cada vez maior da tecnologia nas carreiras universitárias e nas escolas de pós-graduações. Embora a presença de tecnologia educativa na educação superior ofereça múltiplos benefícios, sua implementação também apresenta desafios. Nesse sentido, a literatura tem considerado múltiplas ferramentas para melhorar os processos de aprendizagem. Agora bem, os resultados destas ferramentas variam e são difíceis de medir em termos de qualidade. Nesta revisão da literatura, analisamos os problemas que rodeiam a tecnologia educativa na educação superior

To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.

Interleukin-18 (IL-18), a proinflammatory and proatherogenic cytokine, has been associated with type 2 diabetes, metabolic syndrome, stroke and coronary artery disease. Some studies have indicated that the IL-18 promoter -137 G/C polymorphism seems to be associated with changes in the IL-18 expression and may contribute to the development of cardiovascular disease (CVD). The aim of this study was to evaluate the association between -137 G/C polymorphism and the levels of IL-18, biochemical markers for cardiovascular disorders, anthropometric profile and cardiovascular disease in Brazilian patients with type 2 diabetes (T2DM).Study subjects comprised 125 T2DM patients undergoing follow-up at a reference endocrinology service in northeastern Brazil. The -137G/C polymorphism in the IL-18 gene and serum IL-18 levels were determined by using allele-specific polymerase chain reaction (PCR) and enzyme-linked immune assay (ELISA), respectively. The anthropometric parameters were assessed using a Body Composition Monitor with Scale, and the laboratory data were measured using an automatic analyzer as well as spectrophotometric analysis.The genotype distribution of IL-18 -137 G/C genetic polymorphism was significantly different among T2DM patients with and without CVD. The results show an association between the CC genotype of -137G/C polymorphism and CVD in T2DM patients (p 0.001). Serum levels of IL-18 were significantly higher in CC carriers (843.1 pg/mL) compared with GG or GC carriers (303.6 pg/mL and 292.0 pg/mL, respectively). In addition, the present study showed that carriers of the CC genotype also had significantly higher concentrations of creatinine and albuminuria than carriers of the GG or GC genotypes (p 0.05 in both).These results suggest that Brazilian T2DM patients with the CC genotype seem to show a predisposition to CVD, as well as an elevation in markers of renal function.

Objective: To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding. Methods: This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test). Results: The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410 mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p = 0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p = 0.028). Conclusion: Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important. Resumo Objetivo: Caracterizar o frênulo lingual de recém-nascidos a termo, utilizando dois protocolos diferentes e verificar a relação do frênulo lingual com o aleitamento materno. Método: A amostra não probabilística foi constituída por 449 binômios mãe/bebê. Para a avaliação anatomofuncional do frênulo, utilizou-se o protocolo de avaliação do frênulo lingual para bebês “Teste da Linguinha” e o Bristol Tongue Assessment Tool. A mamada foi avaliada com o protocolo proposto pelo UNICEF. Foram criados escores (bom, regular, ruim) para avaliar cada aspecto da mamada a ser observada. Os resultados foram analisados através de estatísticas descritivas e inferenciais e testes de associação (Qui-quadrado de Pearson e Exato de Fisher). Resultados: O estudo mostrou que 14 bebês apresentaram alteração de frênulo lingual, nos quais três com dificuldade durante a sucção, necessitando de frenotomia na primeira semana de vida e 11 sem dificuldades durante a amamentação. Quanto à avaliação da mamada, 410 binômios mãe/bebê apresentaram o escore bom, 36 regular e 3 ruim. Houve associação estatisticamente significativa entre o protocolo “Teste da Linguinha” e amamentação (p = 0,028) e entre o protocolo Bristol Tongue Assessment Tool e amamentação (p = 0,028). Conclusão: Alterações no frênulo lingual estão associadas a interferências na qualidade da amamentação, sendo importante a avaliação do frênulo lingual em recém-nascidos.

Objective: To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. Methods: Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. Results: 40 individuals were analyzed. Mean age at diagnosis was 7.2 ± 4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64 g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79 g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. Conclusion: Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications. Resumo Objetivo: Descrever o padrão alimentar e a ocorrência de distúrbios metabólicos em crianças e adolescentes portadoras de urolitíase acompanhadas em hospital de referências no sul do Brasil a fim de conhecer as particularidades da urolitíase nessa população para melhor desenvolver ações de prevenção. Métodos: Estudo observacional descritivo realizado entre 2016 e 2017 em centro de referência em atenção terciária. Foram selecionados 40 pacientes de dois a 19 anos com urolitíase comprovada por exame de imagem. Dados clínicos e alimentares foram obtidos através de prontuário e entrevista. Para análise estatística, utilizou-se o teste qui-quadrado. Resultados: Foram analisados 40 indivíduos, 55% masculinos. Idade média ao diagnóstico 7,2 ± 4 anos; 25% tinham sobrepeso ou obesidade; 95% tinham distúrbios metabólicos, predominou a hipocitratúria. O consumo proteico e de carboidratos foi adequado em 100% e 70% dos participantes, respectivamente, 37,5% apresentaram ingestão de lipídeos acima do recomendado e 65% apresentaram ingestão de fibras alimentares abaixo do recomendado. O consumo diário médio de sódio foi de 2,64 g (± 1,74), com 55% acima do recomendado; 52,5% apresentaram baixa ingestão de potássio com média de 4,79 g/dia (± 2,49). O consumo de cálcio foi adequado em 27,5%. Não foram identificadas diferenças significativas em relação ao consumo médio diário dos nutrientes entre os participantes com ou sem os diversos distúrbios metabólicos. Conclusões: A urolitíase pediátrica é frequentemente acompanhada de distúrbios metabólicos, o que confirma a necessidade de avaliação metabólica adequada ao diagnóstico e análise do padrão alimentar a fim de identificar erros alimentares, aprimorar o tratamento desses distúrbios e prevenir recorrências e complicações.

A significant proportion of patients with multiple sclerosis (MS) show cognitive impairment. To evaluate the effect of 2-year treatment with oral dimethyl fumarate (DMF) on cognition in relapsing remitting MS (RRMS). In this prospective single-arm study RRMS patients treated with DMF underwent a wide battery of tests, including an extensive neuropsychological evaluation, clinical and patient-reported outcomes (PROs) and quality of life (QoL). Primary endpoints were the proportion of patients with cognitive impairment at baseline and of patients with cognitive worsening over 2 years. Overall, 217 patients (74.2% females, mean age 37.3 years) receiving DMF were recruited, and 156 (67.2%) completed the study. Of the 49 patients with cognitive impairment at baseline, 34 had 2-year data: 15 (44.1%) patients worsened and 19 (55.9%) did not. The cognitive impairment index improved in one third of patients at 2 years. Less than 20% of patients had relapses at 2 years (annualized relapse rate: 0.190). Few patients had disability progression. PROs (fatigue, depression, impairment in work/social activities), QoL, and most of neuropsychological tests significantly improved vs. baseline. The 2-year treatment with DMF was associated with slowing of cognitive impairment and with significant improvements in QoL and psychosocial function.

Introdução: Diabetes Mellitus (DM) representa um grupo de doenças caracterizadas por hiperglicemia. Objetivo: foi demonstrar a importância da extensão, da atuação interprossional e multiprofissional para a resolução de um caso clínico dentro de um Projeto de extensão interprofissional na perspectiva de clínica ampliada. Metodologia: foi realizado relato da atuação da extensão universitária em um caso de uma criança de 11 anos de idade com Diabetes mellitus tipo 1 (DMT1) não controlada, apresentando um quadro de hiperplasia gengival, além de fratura incisal no dente 21. Resultados: O protocolo de atendimento foi preventivo e terapêutico e incluiu: aferição da glicemia capilar, antibioticoterapia profilática, atendimento interprofissional e multiprofissional e controle do quadro de hipoglicemia. O apoio dos familiares foi fundamental para o sucesso do tratamento. Conclusão: Conclui-se que a atuação interprofissional e multiprofissional no planejamento e no desenvolvimento das atividades, favoreceram a interlocução de conhecimentos e experiências para ajudar na resolução das situações vivenciadas, promovendo, assim, melhores condições para o paciente lidar com sua saúde geral e bucal.

Background To report the use of the Oscor Destino steerable sheath in challenging target visceral vessel (TVV) cannulation/bridging stenting in fenestrated and branched endovascular aneurysm repair (FB-EVAR). Methods Between 2016 and 2018, patients undergoing FB-EVAR for juxtarenal/pararenal aneurysms (j/p-AAAs) and thoracoabdominal aortic aneurysms (TAAAs) were recorded. Cases requiring the use of the steerable sheath as planned or unplanned maneuvers were analyzed. Technical success, freedom from reinterventions, and TVV patency were assessed. Results Two hundred sixty patients underwent FB-EVAR to treat j/p-AAAs and TAAAs, for an overall of 956 TVVs. Among these, the Oscor Destino steerable sheath was used in 33 (13%) cases to cannulate a total of 62 (7%) TVVs. FB-EVAR was performed for 7 (21%) j-AAAs, 4 (12%) p-AAAs, 11 (61%) TAAAs, and 2 (6%) previously failed EVAR. The TVVs were 37 (60%) renal arteries, 9 (15%) superior mesenteric arteries, and 16 (25%) celiac trunks. The Oscor Destino steerable sheath was used as the primary cannulation approach in 29 (47%) cases and after failure of the standard cannulation technique in 33 (53%) cases. Technical success was achieved in 61/62 (98%) TVVs. There was no 30-day mortality or bowel ischemia. At the discharge, there were no type I/III endoleaks, whereas 4 type II endoleaks were detected. The median follow-up was 12 months (interquartile range: 8). One patient died at 6 months because of aneurysm-unrelated cause. No TVV occlusion or TVV-related reinterventions occurred. There were no type I–III endoleaks. Conclusions The use of the steerable sheath could be an effective adjunctive tool and can be used primarily as a planned technique or in case of failure of the standard cannulation technique in challenging TVV anatomy during FB-EVAR.

Due to the global financial and societal crisis, a societal or business transformation project is important. A well-designed financial services automation process is the need of the hour. This automation process depends on measurable critical success factors (CSF) which characterize the progress and evaluation of societal or organizational transformation processes. This chapter discussed in detail the concept of an applied tech-based enterprise control and audit for financial crimes (ECAFC) framework, which is significant for the detection of financial crimes. In the context of financial crimes analysis (FCA), a strategic vision is required for the integration of financial engineering related to risk and controls. This analysis is fundamental for the enterprise's long-term business longevity and to avoid/combat state organized global financial predators (SOGFP). Moreover, the chapter also highlighted that the detection mechanisms are essential for the enterprise, in order to integrate the local and global economies in a sustainable, controlled, and iterative manner.

Importance: Cognitive impairment is a common and disabling feature of multiple sclerosis (MS), but a precise characterization of cognitive phenotypes in patients with MS is lacking. Objectives: To identify cognitive phenotypes in a clinical cohort of patients with MS and to characterize their clinical and magnetic resonance imaging (MRI) features. Design, Setting, and Participants: This multicenter cross-sectional study consecutively screened clinically stable patients with MS and healthy control individuals at 8 MS centers in Italy from January 1, 2010, to October 31, 2019. Patients with MS and healthy control individuals who were not using psychoactive drugs and had no history of other neurological or medical disorders, learning disability, severe head trauma, and alcohol or drug abuse were enrolled. Main Outcomes and Measures: Participants underwent a neurological examination and a cognitive evaluation with the Rao Brief Repeatable Battery and Stroop Color and Word Test. A subgroup of participants also underwent a brain MRI examination. Latent profile analysis was used on cognitive test z scores to identify cognitive phenotypes. Linear regression and mixed-effects models were used to define clinical and MRI features of each phenotype. Results: A total of 1212 patients with MS (mean [SD] age, 41.1 [11.1] years; 784 women [64.7%]) and 196 healthy control individuals (mean [SD] age, 40.4 [8.6] years; 130 women [66.3%]) were analyzed in this study. Five cognitive phenotypes were identified: Preserved cognition (n = 235 patients [19.4%]), mild-verbal memory/semantic fluency (n = 362 patients [29.9%]), mild-multidomain (n = 236 patients [19.5%]), severe-executive/attention (n = 167 patients [13.8%]), and severe-multidomain (n = 212 patients [17.5%]) involvement. Patients with preserved cognition and mild-verbal memory/semantic fluency were younger (mean [SD] age, 36.5 [9.8] years and 38.2 [11.1] years) and had shorter disease duration (mean [SD] 8.0 [7.3] years and 8.3 [7.6] years) compared with patients with mild-multidomain (mean [SD] age, 42.6 [11.2] years; mean [SD] disease duration, 12.8 [9.6] years; P

Background The endovascular treatment of peripheral artery obstructive disease in Trans-Atlantic Inter-Society (TASC) C and D lesions involving the aortic bifurcation is a matter of debate. The aim of this study is to evaluate the technical and clinical success of kissing stenting in this context and to analyze predictors of outcome. Methods All patients treated for aortoiliac TASC C and D lesions with kissing stenting (from 2012 to 2017) in a 6-year period were retrospectively analyzed. Preoperative anatomical features were evaluated by reviewing computed tomography angiography images to identify severe iliac calcifications (SICs) versus not SIC (NSICs). Primary end points were as follows: technical success (TS), procedural success, primary patency (PP), and clinical success (CS). Secondary end points were as follows: secondary patency, assisted patency, survival, mid-term procedure-related complications, and risk factors that affected TS and mid-term results. Results In a 6-year period, 51 patients fulfilled the inclusion criteria. TS was achieved in 49 (96.1%) cases. Thirty-one patients (60.8%) received a dual antiplatelet therapy (DAPT) for at least 1 month after the procedure. 30-day CS was 94.1%. Median follow-up was 45.7 months (IQR: 24.5, 8–86 range). The CS was 92.6% at 3 years, with a PP of 86.8% and a secondary patency of 93.2% at 3 years. Six (13.2%) iliac axis occluded during the first follow-up year. NSIC was statistically and independently associated with a lower PP (73% vs. 96%, P = 0.03); DAPT was statistically and independently associated with higher PP than single antiplatelet therapy (96% vs. 75%, P = 0.03); these results were confirmed by Cox regression analysis (HR: 0.14, 95%, IC: 0.01–0.89, P = 0.05 for DAPT analysis; HR: 6.8, 95%, IC: 1.21–59, P = 0.05 for NSIC analysis). Conclusions Endovascular treatment for TASC C–D is an effective technique. Postoperative stent occlusion is higher in patients with no DAPT and it usually occurs during the first postoperative year. Preoperative NSIC lesions are associated with reduced PP at 3 years of follow-up.

Paracoccidioidomycosis (PCM) is an endemic fungal infection in Latin America, which manifests as an acute or chronic form and is more frequent in adult males. It is caused by Paracoccidioides brasiliensis or Paracoccidioides lutzii, which are thermodimorphic fungi. The disease can present as a severe and disseminated form involving the lungs, skin, lymph nodes, spleen, liver, and lymphoid organs of the gastrointestinal tract. Most of the primary infections are subclinical, and the cell-mediated immune response contains the infection. It is rare in transplant patients, and there are few cases described in the literature. In solid organ transplant patients, it usually results from the reactivation of a latent infection, manifesting itself after a few years of transplantation with frequent pulmonary and skin involvement. PCM is an endemic infection in Brazil; however, as it is not classified as a notifiable disease, there is no accurate database on its incidence, and case reports are important sources of information. Clinical disease in kidney transplant patients is rare and has a high mortality rate. In this scope, the present clinical case reports the challenges of the clinical management of disseminated PCM caused by Paracoccidioides brasiliensis in a kidney transplant recipient who used immunosuppressive drugs and was treated with Itraconazole.

We present the first steps to develop radiation sensors based on the graphene field effect transistor technology. Such a sensor exploits the ambipolar behavior of graphene near its Dirac point and it is not dependent on collecting charges, but it senses ionizing radiation trough the change in conductivity of the graphene layer induced by changes of the electric field. We designed the layout of the sensors with the help of Sentaurs TCAD. We simulated static operations and the dynamic response to radiation and calculated the source–drain current through the graphene layer with a quasi-analytical model. The transistors were produced at the National Enterprise for nanoScience and nanoTechnology by depositing high quality graphene on silicon chips manufactured by the Fondazione Bruno Kessler foundry. To reduce the high contact resistance between graphene and aluminum contacts caused by oxidation of the aluminum surface, we used gold/chromium interfaces. We investigated the sensors behavior by mean of electrical measurements, extracting the graphene properties, such as mobility and doping. We observed modulation of the source–drain current, determined the Dirac point and found the optimal voltage levels to be sensitive to pulsed IR laser light and β -particles.

Growing evidence supports the positive impact of antimicrobial stewardship programs (ASPs) on antimicrobial use, including pediatrics.1 Although short of the level of acceptance these have reached in the United States, the implementation of pediatric ASPs in European hospitals has increased over the last few years.1 It has been suggested that the ASP should be helpful in the preparation for and response to the SARS-CoV-2/COVID-19 outbreak, 2 but no formal recommendations have been published. Whether pediatric ASP remains an essential activity or not during the COVID-19 pandemic has yet to be clarified. Here, we describe how the COVID-19 pandemic has impacted antimicrobial use in a referral pediatric hospital, and we propose a supporting role for ASP teams in the local management of the outbreak. The first COVID-19 case in Catalonia, Spain, was reported on February 25, 2020. By mid-March, most pediatric and obstetrics departments in the region were shut to increase the capacity for adult COVID-19 patients. Hospital Sant Joan de Déu Barcelona (SJD) remained the largest pediatric and maternal referral center in the region. COVID-19 and non-COVID-19 pediatric and young adult patients were transferred to our wards and pediatric ICU (PICU), and the number of daily deliveries tripled, whereas all nonemergency clinical, teaching, and research activities were postponed. Compared to the same months in 2019, in March 2020, total hospital stays decreased by 0.8% in the PICU and 15.2% in non-PICU areas, and in April 2020, total hospital stays decreased by 23.7% in the PICU and 22.2% in non-PICU areas.

Introduction The aim of this study was to compare the colonization rates of central venous catheter (CVC) and arterial catheter (ArtC) hubs fitted with two types of needleless connectors (NCs). Methods We designed a prospective randomized study to compare rates of catheter hub colonization of CVC and ArtC hubs fitted with two types of needleless connectors: neutral-pressure NCs (NP-NCs) and positive-pressure NCs (PP-NCs) in critically ill patients. All NCs were replaced every 7 days of use. Results We obtained 326 cultures from 146 catheters (81 CVC and 65 ArtC) in 70 patients. The total cumulative days of risk were 1250 catheter-days. Global swab cultures were positive in NP-NCs in 29/198 (14.6%) versus 17/128 (13.3%) in PP-NCs during catheter use. We did not observe any cases of CRBSI. Conclusions In our experience, the use of PP-NCs did not result in significantly more frequent hub colonization with respect to NP-NCs.

Aims The hallmarks of type 2 diabetes (T2D) are hyperglycaemia and insulin resistance. These factors, at the cellular level, are associated with mitochondrial dysfunction and increased glucose uptake. Such events are poorly explored in the context of the salivary glands. In this study, we present a series of eight cases of a distinct salivary gland lesion characterised by multiple oncocytic cysts, and we provide new pathological insights regarding its pathogenesis. Methods and results Seven patients (87.5%) had confirmed T2D, and obesity was identified in five (62.5%) patients. Clinically, the patients showed bilateral parotid gland swelling with recurrent episodes of pain and enlargement. Imaging examination revealed multiple cystic lesions in both parotid glands. Microscopically, the parotid glands showed multiple cysts of different sizes, lined by oncocytic epithelial cells. Intraluminally, strongly eosinophilic glass-like crystalloid material was observed. Immunohistochemical studies were performed, and the most notable finding was glucose transporter 1 (GLUT1) overexpression in the oncocytic cysts which is not observed in any other oncocytic lesion of patients without T2D. In addition, high expressions of mitochondrial antigen, fission 1 protein and mitofusin-2 were observed in the oncocytic epithelium of the cysts. Furthermore, most of the oncocytic cysts showed a pattern of cytokeratin expression consistent with striated ducts. Conclusions These results strongly suggest that T2D is associated with alterations in GLUT1 expression in the cells of striated ducts with mitochondrial dysfunction, causing a hyperplastic process characterised by multiple oncocytic cysts. For this lesion, the designation of 'diabetes-associated-bilateral multiple oncocytic cysts of the parotid gland' is proposed.

The media play an essential role of informing and mobilising voters as well as facilitating a two-way communication process between citizens and those vying for electoral offices during elections. This allows citizens to get information on various issues from the contenders, which largely informs their electoral decisions. In most less democratic societies however, this media function is increasingly becoming difficult to fulfil due to challenges journalists encounter during electoral processes. Using Uganda’s last general elections in 2016 as a case study, this article discusses the safety of journalists during elections basing on findings from a bigger study on the media coverage of the 2016 elections, supplemented by in-depth interviews with 10 journalists who covered the elections. In addition, the analysis makes reference to the 2016 Uganda Press Freedom Index. Findings of this research show that journalists face more safety and security risks during elections particularly perpetuated by state security agencies. Compared to previous elections, the 2016 elections also recorded the highest number of victims who were female journalists. This article highlights key challenges journalists face during elections, which include: state harassment and intimidation, arrest of those considered critical to the state, and denial of access to important information. Due to concerns of their own safety, journalists have responded to the insecure work environment by engaging in self-censorship, thereby giving biased or limited information to the public. The article identifies gaps that media development agencies can help to close if the media are to play their rightful role in a democratic society, especially during the electoral process.

Objetivo: Avaliar o estado nutricional e consumo alimentar de gestantes diabeticas tipo 2 e diabetes gestacional. Metodos : Estudo observacional, do tipo serie de casos com gestantes diabeticas atendidas em nivel ambulatorial e em internamento hospitalar. Dados socioeconomicos, antropometricos, bioquimicos, clinicos e estilo de vida foram analisados. O consumo alimentar foi analisado atraves do metodo do recordatorio alimentar de 24 h. Resultados : Foram avaliadas 57 gestantes diabeticas. A maior parte da amostra encontrava-se em excesso de peso de acordo com a circunferencia do braco (56,1%) e Indice de Massa Corporal (80,7%). A relacao entre ingestao alimentar e variaveis sociodemograficas revelou que nas gestantes que concluiram apenas o Ensino fundamental, a proteina (p=0,002) e os carboidratos (p=0,004) foram os mais consumidos. As sedentarias demonstraram ingestao elevada em todos os macronutrientes (p>0,05). As internadas, maiores ingestoes de energia e demais macronutrientes (p