RESUMO

BACKGROUND: This study was conducted to evaluate the cost-benefit indicators of a vancomycin monitoring protocol based on area under the curve estimation using commercial Bayesian software. METHODS: This quasi-experimental study included patients who were aged >18 years with a vancomycin prescription for >24 hours. Patients who were terminally ill or those with acute kidney injury (AKI) ≤24 hours were excluded. During the preintervention period, doses were adjusted based on the trough concentration target of 15-20 mg/L, whereas the postintervention period target was 400-500 mg × h/L for the area under the curve. The medical team was responsible for deciding to stop the antimicrobial prescription without influence from the therapeutic drug monitoring team. The main outcomes were the incidence of AKI and length of stay. Cost-benefit simulation was performed after statistical analysis. RESULTS: There were 96 patients in the preintervention group and 110 in the postintervention group. The AKI rate decreased from 20% (n = 19) to 6% (n = 6; P = 0.003), whereas the number of vancomycin serum samples decreased from 5 (interquartile range: 2-7) to 2 (interquartile range: 1-3) examinations per patient ( P < 0.001). The mean length of hospital stay for patients was 26.19 days after vancomycin prescription, compared with 17.13 days for those without AKI ( P = 0.003). At our institution, the decrease in AKI rate and reduced length of stay boosted yearly savings of up to US$ 369,000 for 300 patients receiving vancomycin therapy. CONCLUSIONS: Even in resource-limited settings, a commercial Bayesian forecasting-based protocol for vancomycin is important for determining cost-benefit outcomes.

Assuntos

Antibacterianos , Área Sob a Curva , Teorema de Bayes , Análise Custo-Benefício , Monitoramento de Medicamentos , Vancomicina , Humanos , Vancomicina/farmacocinética , Vancomicina/economia , Vancomicina/uso terapêutico , Vancomicina/sangue , Análise Custo-Benefício/métodos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/economia , Masculino , Feminino , Antibacterianos/uso terapêutico , Antibacterianos/economia , Antibacterianos/farmacocinética , Antibacterianos/sangue , Pessoa de Meia-Idade , Idoso , Injúria Renal Aguda , Tempo de Internação , Adulto , Região de Recursos Limitados

RESUMO

Soil salinity is a significant abiotic stress and poses risks to environmental sustainability. Thus, the improvement of the time for recovering the salt-affect soil is crucial for the phytoextraction process using halophytes plants, especially regarding on nutritional management. We evaluated the responses of Atriplex nummularia Lindl. to nitrogen (N) and phosphorus (P) under different salinity levels. The treatments comprised doses of N (N1 = 80 kg ha-1) and P (P1 = 60 kg ha-1): (1) without N and P (N0P0) (control); (2) with N and without P (N1P0); (3) without N and with P (N0P1); and (4) with N and P (N1P1) and five levels of electrical conductivity from irrigation water: 0.08, 1.7, 4.8, 8.6, and 12.5 dS m-1. The. We evaluated dry biomass of leaves, stems, and roots 93 days after transplantation. We also assessed the leaf and osmotic water potential, the osmotic adjustment, and the nutrient contents (N, P, Na, and K). N application increased 22.3, 17.8, and 32.8% the leaf biomass, stem biomass, and osmotic adjustment, respectively; and consequently, boosts Na extraction in 27.8%. Thus, the time of the phytoextraction process can be improved with N fertilizer at a rate of 80 kg ha-1.

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Very few studies have investigated the nutrient dynamics responses in Atriplex species in salt-affected soils; thus, this study represents a novelty. We tested the management of nitrogen (N) and phosphate (P) fertilizers to increase crop yield and optimize the phytoextraction process in salt-affected soils. We believe our results contribute to the improvement of the knowledge of this relevant topic, mainly in terms of the recovery of areas degraded by salinity. There is a paucity of studies associating salinity and nutritional management of soils worldwide.

RESUMO

Hypertrophic cardiomyopathy (HCM) is a heart condition characterized by cellular and metabolic dysfunction, with mitochondrial dysfunction playing a crucial role. Although the direct relationship between genetic mutations and mitochondrial dysfunction remains unclear, targeting mitochondrial dysfunction presents promising opportunities for treatment, as there are currently no effective treatments available for HCM. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. Searches were conducted in databases such as PubMed, Embase, and Scopus up to September 2023 using "MESH terms". Bibliographic references from pertinent articles were also included. Hypertrophic cardiomyopathy (HCM) is influenced by ionic homeostasis, cardiac tissue remodeling, metabolic balance, genetic mutations, reactive oxygen species regulation, and mitochondrial dysfunction. The latter is a common factor regardless of the cause and is linked to intracellular calcium handling, energetic and oxidative stress, and HCM-induced hypertrophy. Hypertrophic cardiomyopathy treatments focus on symptom management and complication prevention. Targeted therapeutic approaches, such as improving mitochondrial bioenergetics, are being explored. This includes coenzyme Q and elamipretide therapies and metabolic strategies like therapeutic ketosis. Understanding the biomolecular, genetic, and mitochondrial mechanisms underlying HCM is crucial for developing new therapeutic modalities.

Assuntos

Cardiomiopatia Hipertrófica , Mutação , Oxirredução , Transdução de Sinais , Humanos , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/metabolismo , Animais , Mitocôndrias/metabolismo , Mitocôndrias/genética , Estresse Oxidativo , Espécies Reativas de Oxigênio/metabolismo

RESUMO

Streptococcosis caused by Streptococcus agalactiae (S. agalactiae) is a major bacterial disease affecting the production of Nile tilapia (Oreochromis niloticus L.), causing significant economic losses due to mortality in the growing phase. Vaccination is the most effective method for preventing streptococcosis on Nile tilapia farms. In Brazil, the major tilapia-producing regions have long production cycles (6-10 months) and harvest tilapias weighing over 900 g for fillet production. Thus, data on the duration of the humoral immune response and protection in farmed tilapia have not been reported or are poorly described. Furthermore, the efficiency of serological testing for the long-term monitoring of immune responses induced by vaccination against S. agalactiae has never been addressed. This study evaluated the duration of protection and humoral immune response induced in Nile tilapia vaccinated against S. agalactiae until 300 days post-vaccination (dpv). The immunization trial was composed of two groups: vaccinated (Vac), vaccinated intraperitoneally with a commercial vaccine, and unvaccinated (NonVac) group, injected fish with sterile saline solution. At 15, 30, 150, 180, 210, and 300 dpv, blood sampling was conducted to detect anti-S. agalactiae IgM antibodies using indirect Enzyme-Linked Immunosorbent Assay (ELISA), and the fish were challenged with pathogenic S. agalactiae to determine the duration of vaccine protection through relative percentage survival (RPS). Spearman's rank correlation was performed between the ELISA optical density (OD) of vaccinated tilapia and the duration of vaccine protection (RPS). The mean cumulative mortality in NonVac and Vac groups ranged from 65 to 90% and less than 35%, respectively. The average RPS was 71, 93, 94, 70, 86, and 67% at 15, 30, 150, 180, 210, and 300 dpv, respectively. RPS revealed that the vaccine provided protection from 15 to 300 dpv. The specific anti-S. agalactiae IgM antibody levels were significantly higher in the Vac group than that non-Vac group up to 180 dpv. The vaccinated fish exhibited significant protection for up to 10 months after vaccination. There was a positive correlation between the antibody response and RPS. This study revealed that a single dose of commercial vaccine administered to Nile tilapia can confer long-term protection against S. agalactiae and that indirect ELISA can monitor the duration of the humoral immune response for up to six months following vaccination. Finally, vaccine protection over six months can be associated with other components of the fish immune system beyond the humoral immune response by IgM antibodies.

RESUMO

The infectious spleen and kidney necrosis virus (ISKNV) is one of the most important emerging viral pathogens for Nile tilapia (Oreochromis niloticus) farming. While prevalent worldwide, it has recently been detected in Brazil. However, despite the importance of the virus and the affected fish species, there are no scientific data on the effects of water temperature on disease pathogenesis in Nile tilapia. In the present study, we conducted two trials using juvenile Nile tilapia over a 15-day period. In trial 1, an experimental infection model was developed based on the intraperitoneal inoculation of active viral homogenates (4.3 × 104 virus fish-1), while control fish were similarly inoculated with inactivated viral homogenates. In trial 2, the fish were maintained at different water temperatures (26, 28, 30, 32, and 34 °C) and then infected with ISKNV. For virus detection, kidney and spleen samples were collected and analyzed by qPCR. Our results show that the disease was successfully reproduced in experimental conditions with active homogenates, with the first signs of the disease appearing on the third day after infection. In addition, a significant reduction in mortality was observed in the groups maintained at higher temperatures (>30 °C). This suggests that a treatment of the disease with non-lethal hyperthermia can be used to control the symptoms and mortality of ISKNV-infected Nile tilapia juveniles.

RESUMO

OBJECTIVES: The objective of this study was to identify Brazil's most critical garbage codes (GCs) reclassified to Chagas disease (ChD) in mortality data and their proportions. We also estimated the potential impact of misclassification on the number of deaths attributed to ChD. STUDY DESIGN: Population-based descriptive study. METHODS: We used the Mortality Information System (SIM; in Portuguese) data before and after routine GC investigation in 2015-2019 to evaluate ChD deaths detected among them. We identified priority GCs, which contributed more than 0.1 % to the percentage of total ChD deaths registered. Spearman's correlation was used to evaluate the association between the reclassification of priority GCs and ChD prevalence. Then, we applied the GC correction factors to estimate the number of deaths attributed to ChD. RESULTS: 22,154 deaths were reported as ChD in the study period. Among them, 1004 deaths originally listed as priority GCs were deaths reclassified to ChD after an investigation in the SIM final database. Unspecific cardiomyopathy (10.2 %), unspecific heart diseases (4.7 %), and heart failure (2.8 %) were GCs with the highest proportions of reclassification to ChD in Brazil. Higher ChD prevalence at the state level was associated with a higher proportion of GC deaths reclassified as ChD. When applying correction factors identified after investigation, we estimated an increase of 26.4 % in registered ChD deaths, mostly in states with higher endemicity. CONCLUSIONS: GCs might conceal deaths due to ChD, particularly in Brazil's states with higher endemicity. The approach suggested in this study may offer an alternative method for estimating ChD-related deaths in endemic countries.

Assuntos

Doença de Chagas , Cardiopatias , Insuficiência Cardíaca , Humanos , Causas de Morte , Brasil/epidemiologia

RESUMO

Older individuals with cancer constitute a high-risk group for COVID-19. Entry of the virus into cells occurs through the binding of the S protein with angiotensin-converting enzyme 2, which is mediated by the TMPRSS2 gene and regulated by androgen receptors. Androgen deprivation therapy in patients with prostate cancer inhibits AR-TMPRSS2 interactions, which in turn inhibits the aggressiveness of the infection. We were unable to prove an association between the use of androgen deprivation therapy and a reduction in factors associated with worse clinical outcomes. Most of the data presented show a tendency to favor the outcomes of patients who do not undergo androgen deprivation therapy, which can be explained by the fact that, in general, their clinical conditions are better and their performance status scores are lower than those of patients who undergo androgen deprivation therapy. Abstract presented to the oncology department of A.C.Camargo Cancer Center as a conclusion of the Scientific Initiation. OBJECTIVE: To describe the epidemiological aspects of COVID-19 in patients with prostate cancer who received androgen deprivation therapy and those who did not. METHODS: We retrospectively analyzed the medical records of patients with prostate cancer undergoing androgen deprivation therapy and those who did not undergo androgen deprivation therapy. These patients were treated at the A.C.Camargo Cancer Center between March 2020 and March 2021. RESULTS: Of the 78 patients with prostate cancer and positive RT-PCR test results, 50% were undergoing androgen deprivation therapy, and 49% were experiencing a non-metastatic biochemical relapse. Of these, 80.6% were symptomatic on the day of examination compared to 97.2% in the Control Group. A total of 82.1% of the patients receiving androgen deprivation therapy required hospitalization, with 30.8% admitted to the intensive care unit compared to 21.6% in the Control Group. There was no statistically significant difference in the use of a high-flow oxygen cannula, the need for orotracheal intubation and mechanical ventilation, the need for dialysis, multiple organ failure, or death. A significant difference was found between the groups in terms of the average length of stay in the intensive care unit. CONCLUSION: Androgen deprivation therapy was not associated with protective factors or potential treatments in patients with prostate cancer and COVID-19. Although the number of patients analyzed was limited, and there may have been a selection bias, this is a unique study that cannot be expanded or replicated in similar (unvaccinated) populations.

Assuntos

COVID-19 , Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/epidemiologia , Antagonistas de Androgênios/uso terapêutico , Androgênios/uso terapêutico , Estudos Retrospectivos , Brasil/epidemiologia , Recidiva Local de Neoplasia/tratamento farmacológico

RESUMO

This study had as general objective to characterize and associate social skills, behavior problems, and academic competence of students with intellectual disabilities in school inclusion and; as specific objectives to verify predictive values for social skills and differences between groups diagnosed with intellectual disability and other associated diagnoses. This was a quantitative, cross-sectional, descriptive, correlational, predictive, and comparative study. Forty-four students with intellectual disability participated (11 of them presented other associated diagnoses), who were evaluated by 42 guardians and 34 teachers. The instruments used were Social Skills Rating System (SSRS-BR) and the Parental Educative Social Skills Interview Script (RE-HSE-P). The evaluation from guardians and teachers were different. Social skills were negatively associated with behavior problems and positively associated with academic competence; behavior problems and diagnosis were negative predictors to social skills. There were significant differences in the groups. The results highlight the importance of intervention programs to develop social skills.(AU)

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O estudo teve como objetivo geral caracterizar e associar habilidades sociais, problemas de comportamento e competência acadêmica de alunos com deficiência intelectual em inclusão educacional e; como objetivos específicos verificar valores preditivos para habilidades sociais e diferenças entre grupos com diagnóstico de deficiência intelectual somente e com outros diagnósticos associados. Trata-se de um estudo quantitativo, transversal, descritivo, correlacional, preditivo e comparativo. Participaram 44 alunos com deficiência (11 apresentavam outros diagnósticos associados), que foram avaliados por 42 responsáveis e 34 professoras. Os instrumentos utilizados foram Social Skills Rating System (SSRS-BR) e Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P). A avaliação de responsáveis e professores foi diferente. Habilidades sociais foram negativamente associadas aos problemas de comportamento e positivamente associadas a competência acadêmica; problemas de comportamento e diagnósticos associados foram preditores negativos de habilidades sociais. Houve diferença significativa entre grupos. Resultados evidenciam a importância de programas para promoção de habilidades sociais.(AU)

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Este estudio tuvo como objetivo general caracterizar y asociar las habilidades sociales, los problemas de conducta y la competencia académica de estudiantes con discapacidad intelectual en la inclusión escolar; y como objetivos específicos verificar los valores predictivos de las habilidades sociales y las diferencias entre grupos diagnosticados con discapacidad intelectual y otros diagnósticos asociados. Se trató de un estudio cuantitativo, transversal, descriptivo, correlacional, predictivo y comparativo. Participaron 44 estudiantes con discapacidad intelectual (11 de ellos presentaban otros diagnósticos asociados), quienes fueron evaluados por 42 tutores y 34 docentes. Los instrumentos utilizados fueron el Sistema de Evaluación de Habilidades Sociales (SSRS-BR) y el Guion de Entrevista de Habilidades Sociales para Educación de los Padres (RE-HSE-P). Las evaluaciones de los tutores y docentes fueron diferentes. Las habilidades sociales se asociaron negativamente con problemas de conducta y positivamente con la competencia académica; los problemas de conducta y el diagnóstico fueron predictores negativos de las habilidades sociales. Hubo diferencias significativas entre los grupos. Los resultados destacan la importancia de los programas de intervención para desarrollar habilidades sociales con la población estudiada.(AU)

Assuntos

Humanos , Masculino , Feminino , Criança , Adulto , Habilidades Sociais , Comportamento Problema/psicologia , Desempenho Acadêmico/psicologia , Deficiência Intelectual/psicologia , Inclusão Escolar , Estudos Transversais , Entrevistas como Assunto , Valor Preditivo dos Testes , Interpretação Estatística de Dados , Correlação de Dados , Fatores Sociodemográficos

RESUMO

CONTEXT: Studies that analyze the temporal trend and spatial clustering of medical education indicators are scarce, especially in developing countries such as Brazil. This analysis is essential to subsidize more equitable policies for the medical workforce in the states and regions of Brazil. Thus, this study aimed to analyze the temporal trend and identify spatial clusters of medical education indicators in Brazil disaggregated by public and private education, states, and regions. METHODS: A time-series ecological study was conducted using data from the Higher Education Census of the Ministry of Education from 2010 to 2021. The study analyzed vacancy density indicators of active and former students/100,000 population, disaggregated by public and private education, 27 states, and 5 regions in Brazil. Prais-Winsten regression was used for trend analyses of indicators. Hot Spot Analysis (Getis-Ord Gi*) was used to identify spatial clusters of indicators. RESULTS: The number of medical schools increased by 102.2% between 2010 and 2021. A total of 366 medical schools offered 54,870 vacancies at the end of 2021. Vacancy density and active and former students increased significantly in the period, but this increase was greater in private institutions. Most states and regions showed an increasing trend in the indicators, with higher increase percentages in private than in public schools. Hot spot spaces changed over time, concentrated in the southeast, center-west, and north at the end of 2021. Medical education remains uneven in Brazil, with a low provision in regions with low socioeconomic development, academic structure, and health services, represented by regions in the north and northeast. CONCLUSIONS: There is a growing trend in medical education indicators in Brazil, especially in the private sector. Spatial clusters were found predominantly in the southeast, center-west, and north. These results indicate the need for more equitable medical education planning between the regions.

Assuntos

Educação Médica , Humanos , Fatores de Tempo , Brasil/epidemiologia , Faculdades de Medicina , Análise por Conglomerados

RESUMO

The aim of this study was to analyze the scenario of medical residency programs (MRPs) in the north region of Brazil as well as the contextual determinants (socioeconomic, structural, and epidemiological) influencing the number of MRPs in this region. An ecological study was conducted using MRPs data from 2022. This study used multiple data sources. MRP indicators were described based on the Brazilian state and specialty. The dependent variable was the number of MRPs. The independent variables included sociodemographic, structural, and epidemiological factors. Poisson regression was performed to analyze the association between contextual variables and the number of MRPs. The results showed that only 3.6% of the municipalities had authorized MRPs. The idleness rate in the region was 46.0%, with family and community medicine as the specialties with the greatest idleness. The total density of authorized vacancies in the MRPs was 14.0 vacancies per 100,000 inhabitants. The models showed that with each increase of one unit of the vulnerability index (Socioeconomic Index in the Geographic Context for Health Studies-GeoSES), the number of MRPs increased, ranging from 8122 (p value < 0.001) to 11,138 (p value < 0.001). With each increase in undergraduate degrees in medicine, the number of MRPs increased by 0.945 (p value < 0.001). With each increase of 1 physician per 1000 population, the number of MRPs increased from 0.537 (p value < 0.001) to 0.845 (p value < 0.001). With each increase of one unit in general hospitals, specialized hospitals, teaching hospitals, and primary healthcare units, the number of MRPs increased by 0.176 (p value < 0.001), 0.168 (p value < 0.001), 0.022 (p value < 0.001) and 0.032 (p value < 0.001), respectively. Finally, with each increase of one death per 100,000 inhabitants, the overall mortality rate increased, ranging from 0.006 (p value < 0.001) to 0.022 (p value < 0.001). The study showed a low supply of MRPs in the northern region, a high rate of idleness, and important socioeconomic, structural, and epidemiological determinants of the number of MRPs.