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OBJECTIVE: Handgrip strength (HGS) is an indicator of general muscular strength and in cancer patients acts as a relevant marker associated with mortality and health. This study aimed to evaluate the association between peripheral muscle function and health-related quality of life (HRQoL) in breast cancer (BC) survivors. METHODS: Systematic review registered on PROSPERO under number: CRD 42021225206. The searches were carried out on MEDLINE via Pubmed, PEDro, Cochrane Library, Embase, CINAHL via EBSCO and Science Direct databases. Observational studies evaluating the association between handgrip strength (HGS) and HRQoL in adult female BC survivors were included. No linguistic or time restrictions were applied. Two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias using the Newcastle and Ottawa scale (NOS). RESULTS: Five articles were included and involved 587 patients, mean age of 47 to 59 years. The percentage of decreased HGS ranged from 38.3% to 60.3%. HGS was associated with different quality of life measures. From meta-analysis including 220 patients, the correlation coefficient between HGS and HRQoL was 0.26 (95% CI: 0.07-0.35). CONCLUSIONS: Breast cancer survivors face decline of HGS. In this population HGS was correlated with HRQoL. However, more evidence are necessary.

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We correlated clinical, epidemiological, microbiological, and genomic data of an outbreak with polymyxin B (PB)- and carbapenem-resistant Klebsiella pneumoniae during the COVID-19 pandemic. Twenty-six PB- and carbapenem-resistant K. pneumoniae were isolated from patients in the COVID-19 ICU (Intensive Care Unit), non-COVID-19 ICU (Intensive Care Unit), clinical, or surgical ward. Bacterial identification, drug susceptibility tests, and DNA sequencing were performed, followed by in silico resistance genes identification. All isolates showed extensively drug-resistant (XDR) phenotypes. Four different sequence types (ST) were detected: ST16, ST11, ST258, and ST437. Nineteen isolates were responsible for an outbreak in the ICU in September 2020. They belong to ST258 and harbored the 42Kb IncX3plasmid (pKP98M3N42) with the same genomic pattern of two K. pneumoniae identified in 2018. Twenty-four isolates carried bla-KPC-2 gene. No plasmid-mediated colistin (mcr) resistance genes were found. Eight isolates presented mgrB gene mutation. The clonal isolates responsible for the outbreak came from patients submitted to pronation, with high mortality rates in one month. XDR-K. pneumoniae detected during the outbreak presented chromosomal resistance to PB and plasmid-acquired carbapenem resistance due to KPC production in most isolates and 42Kb IncX3(pKP98M3N42) plasmid carrying blaKPC-2 was associated with ST258 isolates. The outbreak followed the collapse of the local healthcare system with high mortality rates.

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Resumen Introducción: El trastorno de la deglución, se denomina disfagia y presenta como complicaciones fundamentales la deshidratación, desnutrición y neumonía por aspiración, situaciones que condicionan desfavorablemente el estado de salud, incrementando la morbimortalidad. En Chile, existen escasas publicaciones a la fecha que den cuenta de antecedentes clínicos que permitan describir a los pacientes con sospecha de disfagia. Objetivo: Describir las características clínicas de pacientes hospitalizados con sospecha de disfagia en el Hospital San Camilo de San Felipe, Chile. Material y Método: Estudio descriptivo de 767 registros de pacientes, entre los años 2017 y 2019. Se revisó información demográfica y antecedentes clínicos. Para variables cualitativas, se utilizaron proporciones y distribuciones frecuenciales, para variables cuantitativas, se usaron medidas de tendencia central. Resultados: El 58,54% de los pacientes era de sexo masculino y el 79,4% correspondió a personas mayores (79,4%). Las patologías neurológicas representaron el diagnóstico de ingreso más frecuente (61,93%). El 14,73% presentó antecedentes de intubación endotraqueal, el 8,34% tenía traqueostomía y el 84,09% era edéntulo parcial o total. En la evaluación con alimentos, las degluciones múltiples y la presencia de tos correspondieron a las alteraciones de eficacia y seguridad más frecuentes. En el 82,01% se diagnosticó disfagia y la mayoría de etiología neurogénica (68,45%). Conclusión: El presente estudio permitió conocer las características clínicas de los pacientes con sospecha de disfagia hospitalizados. En este contexto los pacientes extubados, traqueostomizados y las personas mayores con trastornos neurológicos o patologías respiratorias se presentan como potenciales candidatos para la evaluación de deglución.

Abstract Introduction: The swallowing disorder is called dysphagia and presents complications such as dehydration, malnutrition and aspiration pneumonia, situations that unfavorably condition the state of health, increasing morbidity and mortality. In Chile, there are few publications to date that provide an account of clinical history that allow the description of patients with suspected dysphagia. Aim: To describe the clinical characteristics of hospitalized patients with suspected dysphagia at Hospital San Camilo de San Felipe, Chile. Material and Method: Descriptive study of 767 patient records, between the years 2017 and 2019. Demographic information and clinical history were reviewed. For qualitative variables, proportions and frequency distributions were used, for quantitative variables, measures of central tendency were used. Results: 58.54% of the patients were male and 79.4% corresponded to elderly people (79.4%). Neurological pathologies represented the most frequent admission diagnosis (61.93%). 14.73% had a history of endotracheal intubation, 8.34% had a tracheostomy, and 84.09% were partial or total edentulous. In the evaluation with food, multiple swallows and the presence of cough corresponded to the most frequent alterations in efficacy and safety. In 82.01%, dysphagia was diagnosed and the majority of neurogenic etiology (68.45%). Conclusion: The present study allowed us to describe the clinical characteristics of hospitalized patients with suspected dysphagia. In this context, extubated, tracheostomized patients and the elderly with neurological disorders or respiratory pathologies are presented as potential candidates for swallowing evaluation.

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Background: It is evidenced that migraineurs present balance deficits. However, the balance recovery following unexpected ground perturbations, which reflect conditions of everyday activities, has not been investigated in this population. Aim: We aimed to assess the reactive postural responses among patients with migraine with and without aura, chronic migraine, and controls. We further aimed to assess the factors associated with greater self-report of falls. Methods: Ninety patients diagnosed by headache specialists were equally classified into three migraine subgroups according to the presence of aura and chronic migraine. Thirty controls were also recruited. All participants underwent the motor control test (MCT) and adaptation test (ADT) protocols of dynamic posturography tests (EquiTest®, NeuroCom, USA). Clinical and headache features and information on falls in the previous year, fear of falling, and vestibular symptoms were also assessed. Results: Patients with aura presented a greater sway area in most of the MCT conditions than the other three groups (p = 0.001). The aura group also presented delayed latency responses after perturbations compared with controls and patients without aura (p < 0.03). In the ADT, a greater sway area was observed in patients with aura than in groups without aura, chronic migraine, and controls (p < 0.0001). The MCT and ADT sway area, the frequency of aura, and the fear of falling explained 46% of the falls in the previous 12 months. Conclusion: Patients with aura exhibited greater delay and sway area after unexpected ground perturbations than controls and other migraine subgroups, which are related to the reported number of falls.

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El dolor abdominal es una causa frecuente de consulta ambulatoria, sus causas son múltiples e incluyen patologías de riesgo vital u otras de bajo riesgo que requieren principalmente tratamiento y no requieren mayores estudios. La historia clínica y el examen físico son las herramientas principales para poder sospechar la etiología de la enfermedad que está causando el dolor abdominal. Es por esto que realizar una historia completa, haciendo preguntas dirigidas a confirmar o descartar sospechas diagnósticas, asociado a un examen físico completo y sistemático, es la principal forma de orientar el diagnóstico y estudio posterior del paciente. Conocer el cuadro clínico de las enfermedades que dentro de sus síntomas pueden presentar dolor abdominal, especialmente aquellas que son de riesgo vital permite poder diagnosticarlas con la rapidez que se requiere. Así mismo, es necesario reconocer aquellas enfermedades que son más frecuentes y que no requieren mayores estudios sino tratamiento básico, habitualmente ambulatorio. Existen personas que, por sus condiciones de salud o edad, pueden tener presentaciones atípicas de cuadros habituales o mayores riesgos de tener enfermedades infrecuentes o de mayor riesgo vital, que es importante reconocer al momento de la evaluación.

Abdominal pain is a common complaint in ambulatory medicine. It has multiples causes,including lifethreatening pathologies and other benign in which the need in treatment and no other tests. The clinical history and physical examination are the key to suspect the etiology of the underlying disease. A complete history includes make direct questions to confirm or discard the diagnostic suspects and with a complete and systematic physical examination are the main way to get the diagnosis and treatment of the patient. The clinician must know the syndromes which includes abdominal pain, especially those life-threatening which requires urgent treatment or surgery. Also needs to know the frequent benign syndromes that can be safely treated symptomatically with no further investigation. Older adults or patients with comorbidities may present with unusual causes of abdominal pain or may have an atypical presentation of common disorders. Also, may present more frequent serious etiologies that may require urgent interventions.

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OBJECTIVES: Distinct diseases prevent endangered huemul deer (Hippocamelus bisulcus) recovery. Fundamental etiological factors include nutriments, a mayor component of habitat quality. Undernutrition affects growth, skeletal development, osteopathology, reproduction and immunocompetence: this paper amplifies data corroborating micro-nutrient deficiencies among huemul. RESULTS: In Argentina, 57% huemul cadavers exhibited osteopathology, with new cases reported here. Recently, 86% live huemul had osteopathology: cranial lesions involved antemortem tooth loss, reducing feeding efficiency and body condition, with starvation deaths. This population had tissues well deficient compared to other cervids, averaging 0.28 ppm selenium, 4.98 ppm copper, whereas for manganese 55% were deficient (2.52 ppm) and 45% adequate (42.79 ppm). Recently, lesions in one Chilean huemul were interpreted to stem from parapoxvirus. That population also has cases with cranial osteopathologies, high disease susceptibility (parapoxvirus, parasitism, foot lesions), crippled antlers, and low density, indicative of marginal habitat and primary etiological factors like undernutrition and immunosuppression. The reported atypical symptoms attributed to parapoxvirus may relate to probable diagnostic limitations, but does support presence of nutritional deficiencies. Patagonia has selenium deficient plants and livestock, including severe muscular dystrophy, and soil levels in extant huemul areas considered very deficient. Moreover, 73% of Chilean huemul were selenium deficient and 64% severely deficient with concomitant cranial osteopathology.

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AIM: To validate a model to estimate the nursing workload required by trauma victims on intensive care unit (ICU) discharge. BACKGROUND: Identifying a reliable model of nursing workload measurement that can assist professionals. METHODS: A prospective cohort study conducted in 2010 (first phase) and 2015 (second phase) with 342 trauma victims admitted into the ICU of four hospitals located in São Paulo, Brazil. The original model was created during the first phase and included the Simplified Acute Physiology Score and New Injury Severity Score variables. Coefficients of determination (R2 ) were calculated to identify the reliability. RESULTS: The original model presented high reliability (R2  = 44%) in the hospital of origin, and unsatisfactory performance (R2  < 4%) in the other institutions. An improvement in R2 was observed after adjusting the coefficients for each hospital. CONCLUSION: For the Nursing Activities Score prediction of survivors for ICU discharge, trauma centres must validate the original model with coefficient adjustments for their population, or preferably derive their own models. IMPLICATIONS FOR NURSING MANAGEMENT: Although models are useful in predicting discharge of these ICU patients, for treatment continuity after critical care and for organising services, the study showed that they should be evaluated prior to use for nursing management.

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Introducción El objetivo del estudio fue realizar la traducción, adaptación cultural y validación de una escala de función del miembro superior, denominada DASH, por sus siglas en inglés (discapacidad del brazo, el hombro y la mano). Materiales y métodos Se realizó un estudio metodológico de validación de escalas: traducción (constó de traducciones inglés-español, comité de expertos inicial, dos contratraducciones, un segundo comité de expertos y una traducción definitiva); evaluación de confiabilidad (pruebas de coherencia interna, test-retest y cambio mínimo detectable); respuesta al cambio (mediciones en pacientes antes y después de tratamiento), y estudio de validez (se hicieron pruebas de validez de apariencia, de constructo y de criterio). Resultados La prueba traducida fue aplicada a 338 pacientes con enfermedades de mano y hombro, 311 fueron utilizables. La consistencia interna, mediante alfa de Cronbach, se estimó > 0,96; el resultado del coeficiente de concordancia de Lin fue 0,86. El cambio mínimo detectable fue 15,88, la capacidad de respuesta al cambio mediante la prueba de la t de Student aplicada sobre la diferencia en la puntuación arrojó una p < 0,001; adicionalmente se corrió una correlación no paramétrica de Spearman entre la diferencia en la puntuación DASH y la diferencia en la escala visual analógica de cambio en estado de salud (EVA SALUD) y se obtuvo un r = 0,62 (p < 0,001). Discusión La escala DASH traducida y adaptada al español demostró una buena fiabilidad, estabilidad y capacidad de respuesta al cambio, logró discriminar entre diferentes enfermedades y tiene una validez estimada buena en cuanto a contenido, constructo y criterio.

Introduction The objective of the study was to perform translation, cultural adaptation and validation of a function scale of the upper limb, called DASH, for its acronyms in English (disability of the arm, shoulder and hand). Materials and methods A methodological study of scale validation was performed: translation (consisting of English-Spanish translations, initial expert committee, two backtranslations, a second committee of experts and a definitive translation); reliability assessment (internal consistency tests, test-retest and minimum detectable change); response to change (measurements in patients before and after treatment), and validity study (validity tests of appearance, construct and criteria were performed). Results The translated test was applied to 338 patients with hand and shoulder diseases, 311 were usable. The internal consistency, using Cronbach's alpha, was estimated to be > 0.96; The result of the Lin coefficient of agreement was 0.86. The minimum detectable change was 15.88, the ability to respond to change using the Student t test applied on the difference in score yielded a p <0.001; A nonparametric Spearman correlation was recorded between the difference in the DASH score and the difference in the visual analogue scale of change in health status (EVA HEALTH) with r = 0.62 (p <0.001). Discussion The DASH scale, translated and adapted to Spanish demonstrated good reliability, stability and responsiveness to change, managed to discriminate between different diseases and has an estimated validity in terms of content, construct and criteria.

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Glioblastoma (GBM) is the most lethal form of brain tumor, being characterized by the rapid growth and invasion of the surrounding tissue. The current standard treatment for glioblastoma is surgery, followed by radiotherapy and concurrent chemotherapy, typically with temozolomide. Although extensive research has been carried out over the past years to develop a more effective therapeutic strategy for the treatment of GBM, efforts have not provided major improvements in terms of the overall survival of patients. Consequently, new therapeutic approaches are urgently needed. Overcoming the blood-brain barrier (BBB) is a major challenge in the development of therapies for central nervous system (CNS) disorders. In this context, the intranasal route of drug administration has been proposed as a non-invasive alternative route for directly targeting the CNS. This route of drug administration bypasses the BBB and reduces the systemic side effects. Recently, several formulations have been developed for further enhancing nose-to-brain transport, mainly with the use of nano-sized and nanostructured drug delivery systems. The focus of this review is to provide an overview of the strategies that have been developed for delivering anticancer compounds for the treatment of GBM while using nasal administration. In particular, the specific properties of nanomedicines proposed for nose-to-brain delivery will be critically evaluated. The preclinical and clinical data considered supporting the idea that nasal delivery of anticancer drugs may represent a breakthrough advancement in the fight against GBM.

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Clinical and metabolic evaluation is necessary for the monitoring of pregnant and lactating mares, as they reflect the health of the animal. The body condition of the mare is an indicator of reproductive efficiency. The study aimed to determine the possible variations in body and metabolic condition in Mangalarga Marchador mares during the transition period. Forty-eight mares distributed in two groups were used: Maintenance Group (MG), composed of non-pregnant and non-lactating mares, and Transition Group (TG), formed by pregnant mares and who after delivery became lactating. Analyzes were performed in the times T-60, T-30 and T-15 before delivery, first six hours (T0) after delivery and T15, T30 and T60 days after delivery. MG was evaluated only at one time (T-60). Body weight and fat-free mass differed (P<0.05) between the groups. The percentage of fat was lower in MG. Mares had a higher fat percentage in TG at T-60 and T-30 times. There was a difference (P<0.05) in the amount of cholesterol between MG and TG (T0, T15 and T30). Triglycerides were different between the groups. TG showed higher concentrations of non-esterified fatty acids (P<0.05). There was a higher amount of glucose in TG (delivery and lactation) when compared to mares in MG. Changes in body condition and metabolic constituents occurred in the animals resulting from physiological adaptations of the transition period. The energetic components are the most affected from the transition period, with intense fat mobilization to supply the body demands.(AU)

Avaliações clínicas e metabólicas são necessárias para o monitoramento de éguas gestantes e lactantes, pois refletem a saúde do animal. A condição corporal da égua pode ser um indicador da eficiência reprodutiva. O estudo objetivou determinar as possíveis variações na condição corporal e metabólica em éguas Mangalarga Marchador durante o período de transição. Foram utilizadas 48 éguas distribuídas em dois grupos: Grupo em Manutenção (GM) composto por éguas não gestantes e não lactantes; Grupo em Transição (GT) formado por éguas gestantes e que após o parto tornaram-se lactantes. As análises foram realizadas nos tempos T-60, T-30 e T-15 antes do parto, primeiras seis horas (T0) após o parto e T15, T30 e T60 dias após o parto. O GM foi avaliado apenas uma vez (T-60). O peso corporal e a massa livre de gordura diferiram (P<0,05) entre os grupos. O percentual de gordura foi menor em GM. As éguas apresentaram maior porcentagem de gordura no GT no T-60 e no T-30. Houve diferença (P<0,05) na quantidade de colesterol entre GM e GT (T0, T15 e T30). Triglicérides foram diferentes entre os grupos. GT apresentou maiores concentrações de ácidos graxos não esterificados (P<0,05). Houve maior quantidade de glicose no GT (parto e lactação) quando comparada às éguas no GM. Mudanças na condição corporal e nos constituintes metabólicos ocorreram nos animais resultantes de adaptações fisiológicas do período de transição. Os componentes energéticos são os mais afetados neste período, existindo intensa mobilização de gordura para suprir demandas corporais.(AU)

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