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Introduction: The purpose of this clinical report was to describe an unprecedented case of bilateral pressure-induced stromal keratopathy (PISK) following corneal photorefractive keratectomy, associated with presumed herpetic keratitis, and to present tomographic and biomechanical findings before and after appropriate treatment. Case Presentation: A 33-year-old male patient was referred to our clinic with suspected delayed corneal epithelial healing 3 weeks after an uncomplicated PRK. A central layer of corneal opacity with a presumed fluid-filled interface area was observed upon slit lamp biomicroscopy. Scheimpflug images from the Pentacam® revealed a hyperreflective area beneath the central cornea. Scheimpflug-based corneal tomography, biomechanical assessment using the Pentacam® AXL Wave, and the Corvis ST® were conducted. Goldmann applanation tonometry measured 23/13 mm Hg, while noncontact tonometry intraocular pressure measured with the Corvis ST® (Corvis ST IOPnct) was 40.5/43.5 mm Hg. Treatment with oral valacyclovir, combined with ocular hypotensive therapy, led to a significant reduction in IOP and improved corneal deformation parameters after 1 month. Conclusion: Surgeons should be aware of the inaccuracy of Goldmann applanation tonometry in PISK, which can occur after LASIK or surface ablation.
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This study analyzed a total of 260 confirmed scorpion stings reported in the city of Manaus, in the Brazilian Amazon, from 1990 to 2020. Cases were mapped according to the GPS location of their occurrence and plotted on a satellite image of the city. The stings generally occurred close to green areas, and the hotspots of stings moved north as city grew into that direction over time. Spatial analysis shows that scorpion stings mostly occur in poor, recently urbanized areas. The rapid and unplanned urbanization of originally forested areas, without offering adequate infrastructure and services, creates favorable conditions for infestation by scorpions and increases the risk of scorpion stings.
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Picadas de Escorpião , Escorpiões , Urbanização , Brasil/epidemiologia , Picadas de Escorpião/epidemiologia , Humanos , Animais , Cidades , Masculino , Adulto , Feminino , Criança , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Pré-EscolarRESUMO
PURPOSE: To identify the risk factors for the nursing diagnosis of fall risk in adults (00303) in elderly people in the community-dwelling. METHOD: This is a methodological study, with a quantitative approach, carried out with elderly people living in the city of Ribeirão Preto, SP, Brazil, from February to December 2018. For data collection, the demographic profile, Mini-Mental State Examination, diseases self-reported, functional independence measure, Lawton and Brody scale, geriatric depression scale, and self-perception of gait instruments were used. Tests of accuracy and association of risk factors with p ≤ 0.05 were performed. FINDINGS: A total of 262 elderly people, aged over 80 years (55.7%), 71% of which were female and 42.7% were widowed, were included in the sample. A total of 82.1% had vascular diseases, 72.1% had diabetes, and 20.6% had depression. The predominant risk factors were difficulty performing instrumental activities of daily living (58.8%), cognitive dysfunction (43.5%), and depressive symptoms (26.3%). Difficulty performing instrumental activities of daily living had a sensitivity greater than 60%. The positive and negative predictive values were mostly greater than 50%. In the regression analysis, it was found that the elderly have a higher risk of suffering a fall if they present anxiety (p = 0.05), impaired physical mobility (p = 0.02), and difficulty to perform instrumental activities of daily living as risk factors (p = 0.03). CONCLUSION: It was possible to identify the presence of risk factors for the diagnosis fall risk in adults (00303) in the clinical context of the elderly in home settings and contribute to the clinical validation of the taxonomy, increase the evidence and importance of the diagnosis, and generate new knowledge for gerontological nursing. IMPLICATIONS FOR NURSING PRACTICE: To help nurses identify risk factors that lead elderly people to suffer falls at home and to implement preventive actions in their community with the support of their families.
OBJETIVO: Identificar os fatores de risco para o diagnóstico de enfermagem Risco de Quedas em adultos (00303) em idosos do domicílio. MÉTODO: Tratase de um estudo metodológico, com abordagem quantitativa, realizado com idosos residentes na cidade de Ribeirão Preto, SP, Brasil, no período de fevereiro a dezembro de 2018. Para coleta de dados foram utilizados instrumentos de perfil sociodemográfico, Mini exame do Estado Mental, doenças autorreferidas, Medida de Independência Funcional, Escala de Lawton e Brody, Escala de Depressão Geriátrica e autopercepção da marcha. Foram realizados testes de acurácia e associação de fatores de risco com p ≤ 0,05. RESULTADOS: Participaram 262 idosos, com idade superior a 80 anos (55,7%), sendo 71% do sexo feminino e 42,7% viúvos. Um total de 82,1% tinha doenças vasculares, 72,1% tinham diabetes e 20,6% tinham depressão. Os fatores de risco predominantes foram dificuldade para realizar atividades instrumentais de vida diária (58,8%), déficit cognitivo (43,5%) e sintomas depressivos (26,3%). A dificuldade para realizar atividades instrumentais da vida diária apresentou sensibilidade superior a 60%. Os valores preditivos positivos e negativos foram em sua maioria superiores a 50%. Na análise de regressão constatouse que os idosos apresentam maior risco de sofrer queda se apresentarem Ansiedade (p = 0,05), Mobilidade física prejudicada (p = 0,02) e Dificuldade para realizar atividades instrumentais de vida diária (p = 0,03). CONCLUSÃO: Foi possível identificar a presença de fatores de risco para o diagnóstico Risco de queda em adultos (00303) no contexto clínico do idoso em ambiente domiciliar e contribuir para a validação clínica da taxonomia, aumentar a evidência e a importância do diagnóstico e gerar novos conhecimentos para a enfermagem gerontológica. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Ajudar os enfermeiros a identificar os fatores de risco que levam os idosos a sofrer quedas no domicílio e a implementar ações preventivas na sua comunidade com o apoio dos seus familiares.
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This study aimed to determine the pars plana length in postmortem human eyes using advanced morphometric techniques and correlate demographics to ocular metrics such as age, sex, ethnicity, and axial length. Between February and July 2005, we conducted a cross-sectional observational study on 46 human cadaver eyes deemed unsuitable for transplant by the SBO Eye Bank. The morphometric analysis was performed on projected images using a surgical microscope and a video-microscopy system with a 20.5:1 correction factor. The pars plana length was measured three times per quadrant, with the final value being the mean of these measurements. Of the 46 eyes collected, 9 were unsuitable for the study due to technical constraints in conducting intraocular measurements. Overall, the average axial length was 25.20 mm. The average pars plana length was 3.8 mm in all quadrants, with no measurements below 2.8 mm or above 4.9 mm. There were no statistically significant variations across quadrants or with age, sex, axial length, or laterality. Accurately defining the pars plana dimensions is crucial for safely accessing the posterior segment of the eye and minimizing complications during intraocular procedures, such as intravitreal injections and vitreoretinal surgeries.
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The impact of Covid-19 on envenomations by venomous animals in countries heavily affected by both conditions has not been quantified yet. Brazil shows high incidence of envenomations by scorpions, spiders and snakes and was heavily affected by waves of Covid-19. To determine how the pandemic impacted the epidemiology of envenomations by those three groups of venomous animals, we used online databases from two surveillance sources on number of cases and mortality. During the years before and during the pandemic, scorpion stings typically occurred in adults of both sexes in urban zones in the Southeast and Northeast regions. Spider bites occurred mainly in the South region, in adults of both sexes in urban zone. Snakebites affected mainly rural adult men in the Amazon. Between 2007 and 2021, overall incidence of cases by scorpions, spiders and snakes decreased after the beginning of the pandemic, snakebites did not show changes after the pandemic started in Brazil, but cases by scorpions and spiders decreased. No changes in the incidence of deaths were observed. On national level, Covid-19 affected some demographic, clinical and epidemiological aspects in cases by scorpions, spiders and snakes.
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COVID-19 , Picadas de Escorpião , Mordeduras de Serpentes , Brasil/epidemiologia , COVID-19/epidemiologia , Humanos , Mordeduras de Serpentes/epidemiologia , Animais , Masculino , Feminino , Adulto , Incidência , Picadas de Escorpião/epidemiologia , Picada de Aranha/epidemiologia , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Criança , SARS-CoV-2 , Escorpiões , Serpentes , Pandemias , IdosoRESUMO
OBJECTIVE: to map scientific knowledge on nursing students' attitudes and perceptions regarding ageism. METHOD: scoping review according to the recommendations of the Joanna Briggs Institute. The study question was: What are scientific evidence available on the attitudes and perceptions of nursing students regarding ageism? The search was conducted in 12 databases using the Rayyan application and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The studies were selected by two reviewers using a data extraction tool. RESULTS: of the 4,595 files, 46 that were published between 1984 and 2022 were selected, and the quantitative method was the most used. The most commonly used instrument was the Kogan's Attitudes Toward Old People Scale. Positive, negative, mixed, neutral, and inconclusive attitudes and perceptions were identified. CONCLUSION: attitudes and perceptions about ageism are diverse and not conclusive. Future intervention studies are recommended to detect changes in the behavior of nursing students in the face of ageism. BACKGROUND: (1) Attitudes and perceptions about ageism are diverse and not conclusive. BACKGROUND: (2) Importance of discussing ageism in the training of nursing students. BACKGROUND: (3) Intervention studies to identify paradigm shifts in nursing students.
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Etarismo , Atitude do Pessoal de Saúde , Estudantes de Enfermagem , Etarismo/psicologia , Estudantes de Enfermagem/psicologia , HumanosRESUMO
INTRODUCTION: The deaths from and morbidities associated with snakebites - amputations, loss of function in the limb, visible scarring or tissue damage - have a vast economic, social, and psychological impact on indigenous communities in the Brazilian Amazon, especially children, and represent a real and pressing health crisis in this population. Snakebite clinical and research experts have therefore proposed expanding antivenom access from only hospitals to include the community health centers (CHC) located near and within indigenous communities. However, there are no studies examining the capacity of CHCs to store, administer, and manage antivenom treatment. In response to this gap, the research team calling for antivenom decentralization developed and validated an expert-based checklist outlining the minimum requirements for a CHC to provide antivenom. METHODS: The objective of this study was thus to survey a sample of CHCs in indigenous territories and evaluate their capacity to provide antivenom treatment according to this accredited checklist. The checklist was administered to nurses and doctors from 16 CHCs, two per indigenous district in Amazonas/Roraima states. RESULTS: Our results can be conceptualized into three central findings: 1) most CHCs have the capacity to provide antivenom treatment, 2) challenges to capacity are human resources and specialized items, and 3) antivenom decentralization is feasible and appropriate in indigenous communities. CONCLUSION: Decentralization would provide culturally and contextually appropriate care accessibility to a historically marginalized and underserved population of the Brazilian Amazon. Future studies should examine optimal resource allocation in indigenous territories and develop an implementation strategy in partnership with indigenous leaders. Beyond the indigenous population, the checklist utilized could be applied to community health centers treating the general population and/or adapted to other low-resource settings.
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Mordeduras de Serpentes , Criança , Humanos , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/epidemiologia , Antivenenos/uso terapêutico , Brasil/epidemiologia , Inquéritos e Questionários , Centros Comunitários de SaúdeRESUMO
Acute kidney injury (AKI) is a critical systemic complication caused by Bothrops envenoming, a neglected health problem in the Brazilian Amazon. Understanding the underlying mechanisms leading to AKI is crucial for effectively mitigating the burden of this complication. This study aimed to characterize the urinary protein profile of Bothrops atrox snakebite victims who developed AKI. We analyzed three groups of samples collected on admission: healthy subjects (controls, n = 10), snakebite victims who developed AKI (AKI, n = 10), and those who did not evolve to AKI (No-AKI, n = 10). Using liquid-chromatography tandem mass spectrometry, we identified and quantified (label-free) 1190 proteins. A panel of 65 proteins was identified exclusively in the urine of snakebite victims, with 32 exclusives to the AKI condition. Proteins more abundant or exclusive in AKI's urine were associated with acute phase response, endopeptidase inhibition, complement cascade, and inflammation. Notable proteins include serotransferrin, SERPINA-1, alpha-1B-glycoprotein, and NHL repeat-containing protein 3. Furthermore, evaluating previously reported biomarkers candidates for AKI and renal injury, we found retinol-binding protein, beta-2-microglobulin, cystatin-C, and hepcidin to be significant in cases of AKI induced by Bothrops envenoming. This work sheds light on physiological disturbances caused by Bothrops envenoming, highlighting potential biological processes contributing to AKI. Such insights may aid in better understanding and managing this life-threatening complication.
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Injúria Renal Aguda , Fenômenos Biológicos , Bothrops , Mordeduras de Serpentes , Animais , Humanos , Mordeduras de Serpentes/complicações , Bothrops atrox , Proteômica , Injúria Renal Aguda/etiologiaRESUMO
Objective: to map scientific knowledge on nursing students' attitudes and perceptions regarding ageism. Method: scoping review according to the recommendations of the Joanna Briggs Institute. The study question was: What are scientific evidence available on the attitudes and perceptions of nursing students regarding ageism? The search was conducted in 12 databases using the Rayyan application and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The studies were selected by two reviewers using a data extraction tool. Results: of the 4,595 files, 46 that were published between 1984 and 2022 were selected, and the quantitative method was the most used. The most commonly used instrument was the Kogan's Attitudes Toward Old People Scale. Positive, negative, mixed, neutral, and inconclusive attitudes and perceptions were identified. Conclusion: attitudes and perceptions about ageism are diverse and not conclusive. Future intervention studies are recommended to detect changes in the behavior of nursing students in the face of ageism.
Objetivo: mapear el conocimiento científico sobre las actitudes y percepciones de los estudiantes de enfermería respecto al edadismo. Método: La pregunta del estudio fue: ¿Qué evidencia científica está disponible sobre las actitudes y percepciones de los estudiantes de enfermería respecto al edadismo? La búsqueda se realizó en 12 bases de datos utilizando la aplicación Rayyan y la Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews . Los estudios fueron seleccionados por dos revisores mediante una herramienta de extracción de datos. Resultados: de los 4.595 artículos, se seleccionaron 46 publicados entre 1984 y 2022, siendo el método cuantitativo el más utilizado. La herramienta más utilizada fue el Kogan's Attitudes Toward Old People Scale . Se identificaron actitudes y percepciones positivas, negativas, mixtas, neutras y no concluyentes. Conclusión: las actitudes y percepciones sobre la discriminación por edad son diversas y no concluyentes. Se recomiendan futuros estudios de intervención para detectar cambios en el comportamiento de los estudiantes de enfermería ante el edadismo.
Objetivo: mapear o conhecimento científico sobre as atitudes e percepções dos estudantes de enfermagem em relação ao idadismo. Método: revisão de escopo segundo as recomendações do Joanna Briggs Institute . A pergunta de estudo foi: Quais são as evidências científicas disponíveis sobre as atitudes e percepções dos estudantes de enfermagem no que diz respeito ao idadismo? A busca foi realizada em 12 bases de dados utilizando o aplicativo Rayyan e o Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews . Realizou-se a seleção dos estudos por dois revisores, com uso de um instrumento para a extração dos dados. Resultados: dos 4.595 arquivos, selecionaram-se 46 publicados entre 1984 e 2022, sendo que a maioria utilizou o método quantitativo. O instrumento mais utilizado foi o Kogan's Attitudes Toward Old People Scale e os estudos mostraram que os estudantes apresentaram atitudes e percepções positivas, negativas, mistas, neutras e não conclusivas. Conclusão: as atitudes e percepções sobre idadismo são diversificadas e não conclusivas. Recomenda-se estudos futuros de intervenção para detecção de mudanças de comportamento dos estudantes de enfermagem frente ao idadismo.
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Humanos , Idoso , Percepção , Estudantes de Enfermagem , Atitude , EtarismoRESUMO
ABSTRACT Objective: To study vertex-optical distance variation and estimate its impact on manifest refraction. Methods: Prospective study in a private clinic using the Vision-S™ 700 with five forehead positions. Forehead on the third position showed the closest vertex-optical distance of 12mm. Results: Analysis of 52 eyes from 26 patients revealed mean differences in vertex-optical distance of 12.25mm (right eye) and 11.75mm (left eye). A 2mm change in vertex-optical distance resulted in a 0.05D change for a 5D spherical equivalent and 0.20D for a 10D equivalent. Conclusion: Vertex-optical distance varies among patients and is influenced by forehead adjustment. These variations impact refraction accuracy and treatment evaluation. Adjusting the forehead to the third position on the Vision-S™ 700 is recommended.
RESUMO Objetivo: Estudar a variação da distância vértice-óptico, de acordo com o ajuste da testa, e estimar seu impacto na refração manifesta. Métodos: Estudo prospectivo realizado em clínica privada. A refração foi realizada utilizando cinco posições preestabelecidas com o Vision-Sa 700. A testa disposta na terceira posição apresentou distância vértice do refrator mais próxima de 12mm. Resultados: Foram analisados 52 olhos de 26 pacientes. A diferença média da distância vértice do refrator no olho direito foi de 12,25mm (variação de 11,50mm) e, no olho esquerdo, 11,75mm (variação de 12,00mm). O impacto foi de 2mm na distância vértice do refrator, fomentando em uma mudança de 0,05D para um equivalente esférico de 5D e 0,20D para um equivalente de 10D. Conclusão: A distância vértice do refrator varia entre pacientes, estando relacionada ao ajuste da testa. As variações afetam a precisão da refração, impactando no ajuste dos óculos, das lentes de contato e na avaliação pós-operatória de cirurgia refrativa. Sugerimos ajustar a posição da testa para terceira posição no Vision-S™ 700, se a distância vértice do refrator não for medida em todos os pacientes.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Optometria/instrumentação , Optometria/métodos , Refração Ocular/fisiologia , Testes Visuais/instrumentação , Testes Visuais/métodos , Lentes , Postura , Erros de Refração , Cefalometria , Estudos Prospectivos , Procedimentos Cirúrgicos Refrativos , Óptica e Fotônica , Posicionamento do PacienteRESUMO
Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.
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Zika virus (ZIKV) and yellow fever virus (YFV) originated in Africa and expanded to the Americas, where both are co-circulated. It is hypothesized that in areas of high circulation and vaccination coverage against YFV, children of pregnant women have a lower risk of microcephaly. We evaluated the presence and titers of antibodies and outcomes in women who had ZIKV infection during pregnancy. Pregnancy outcomes were classified as severe, moderate, and without any important outcome. An outcome was defined as severe if miscarriage, stillbirth, or microcephaly occurred, and moderate if low birth weight and/or preterm delivery occurred. If none of these events were identified, the pregnancy was defined as having no adverse effects. A sample of 172 pregnant women with an acute ZIKV infection confirmed during pregnancy were collected throughout 2016. About 89% (150 of 169) of them presented immunity against YFV, including 100% (09 of 09) of those who had severe outcomes, 84% (16 of 19) of those who had moderate outcomes, and 89% (125 of 141) of those who had non-outcomes. There was no difference between groups regarding the presence of anti-YFV antibodies (p = 0.65) and YFV titers (p = 0.6). We were unable to demonstrate a protective association between the presence or titers of YFV antibodies and protection against serious adverse outcomes from exposure to ZIKV in utero.
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Microcefalia , Infecção por Zika virus , Zika virus , Criança , Recém-Nascido , Feminino , Humanos , Gravidez , Vírus da Febre Amarela , Resultado da Gravidez , Anticorpos AntiviraisRESUMO
BACKGROUND: The indigenous populations of Brazil present poor health indicators and a disproportionate prevalence and case-fatality rate of neglected tropical diseases, including snakebite envenomations (SBEs). This study aims to estimate access to medical care for SBEs and analyze the barriers that prevent victims from accessing healthcare in indigenous communities in two health districts located in the Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study used semi-structured interviews to collect data from individuals who experienced SBEs in the Upper Rio Solimões and Upper Rio Negro indigenous health districts. Of the 187 participants, 164 (87.7%) reported that they had access to healthcare and received assistance in a hospital in the urban area of the municipalities. Frequency was 95.4% in the Upper Rio Solimões SIHD, and 69.6% in the Upper Rio Negro SIHD (P<0.0001). The study found that the availability of indigenous medicine as the only choice in the village was the main reason for not accessing healthcare (75%), followed by a lack of financial resources and means of transportation (28.1%). Four deaths were reported from SBEs, resulting in a case-fatality rate of 2.1%. CONCLUSIONS/SIGNIFICANCE: In the study areas, there are records of SBE patients who did not receive medical attention. Availability of pre-hospital emergency transport using motorboats, a greater number of hospitals and better navigability of the Solimões River and its tributaries would make access easier for indigenous people living in the region of the Upper Solimões River. The implementation of cross-cultural hospital care needs to be considered in order to reduce the resistance of indigenous populations in relation to seeking treatment for SBEs.
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Mordeduras de Serpentes , Humanos , Mordeduras de Serpentes/terapia , Brasil/epidemiologia , Estudos Transversais , Medicina Tradicional , Acessibilidade aos Serviços de SaúdeRESUMO
Zika virus (ZIKV) is an RNA flavivirus (Flaviviridae family) endemic in tropical and subtropical regions that is transmitted to humans by Aedes (Stegomyia) species mosquitoes. The two main urban vectors of ZIKV are Aedes aegypti and Aedes albopictus, which can be found throughout Brazil. This study investigated ZIKV infection in mosquito species sampled from urban forest fragments in Manaus (Brazilian Amazon). A total of 905 non-engorged female Ae. aegypti (22 specimens) and Ae. albopictus (883 specimens) were collected using BG-Sentinel traps, entomological hand nets, and Prokopack aspirators during the rainy and dry seasons between 2018 and 2021. All pools were macerated and used to inoculate C6/36 culture cells. Overall, 3/20 (15%) Ae. aegypti and 5/241 (2%) Ae. albopictus pools screened using RT-qPCR were positive for ZIKV. No supernatants from Ae. aegypti were positive for ZIKV (0%), and 15 out of 241 (6.2%) Ae. albopictus pools were positive. In this study, we provide the first-ever evidence of Ae. albopictus naturally infected with ZIKV in the Amazon region.
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Aedes , Infecção por Zika virus , Zika virus , Humanos , Animais , Feminino , Zika virus/genética , Brasil/epidemiologia , Mosquitos VetoresRESUMO
The shortage of physicians in rural and underserved areas is an obstacle to the implementation of Universal Health Coverage (UHC). We carried out a systematic review to analyze the effectiveness of initiatives in medical education aimed to increase the supply of physicians in rural or underserved areas. We searched for studies published between 1999 and 2019 in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Interventional or observational controlled studies were defined as inclusion criteria. A total of 955 relevant unique records were selected for inclusion, which resulted in the identification of 17 articles for analysis. The admission of students from rural areas associated with a rural curriculum represented 52.95% of the interventions. Medical practice after graduation in rural or underserved areas was the most evaluated outcome, representing 12 publications (70.59%). Participants of these educational initiatives were more likely to work in rural or underserved areas or to choose family medicine, with significant differences between the groups in 82.35% of the studies. Educational strategies in undergraduate and medical residencies are effective. However, it is necessary to expand these interventions to ensure the supply of physicians in rural or urban underserved areas.
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Médicos , Serviços de Saúde Rural , Humanos , Área Carente de Assistência Médica , Medicina de Família e Comunidade , Currículo , EstudantesRESUMO
Halitosis affects all populations worldwide. The presence of chronic halitosis may be related to a health problem. Patients with bad breath usually seek a gastroenterologist and, in some cases, invasive and expensive exams, such as digestive endoscopy, are performed to investigate the etiology of halitosis. This study aimed to investigate whether the prevalence of bad breath in patients diagnosed with dyspepsia (any pain or discomfort in the upper abdomen) is higher than or equivalent to that in non-dyspeptic patients. This is a cross-sectional study that included 312 patients from university hospitals in the city of Rio de Janeiro (141 dyspeptic patients and 171 non-dyspeptic ones). The presence of halitosis was defined based on different cutoff points. Association analyses were performed using a log-binomial model and 95% confidence intervals were calculated for the coefficients, adjusting for sex and age. The equivalence test (Westlake) was used to test the hypothesis of equivalence between the proportions of patients with bad breath in the two groups (dyspeptic vs. non-dyspeptic), considering an equivalence band of ± 15%. The prevalence of bad breath ranged from 30% to 64% according to the definition of bad breath. Dyspepsia was not associated with bad breath in any of the three definitions of bad breath (two specific ones and a sensitive one). The proportion of patients with marked bad breath was equivalent in patients with and without dyspepsia.
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Dispepsia , Halitose , Infecções por Helicobacter , Helicobacter pylori , Humanos , Halitose/etiologia , Halitose/complicações , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Estudos Transversais , Brasil/epidemiologia , Dispepsia/complicações , Dispepsia/epidemiologiaRESUMO
This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter® (Interscan Corporation) and information obtained from a close person (ICP). Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points. The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%. VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.
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Halitose , Compostos de Enxofre , Humanos , Halitose/diagnóstico , Halitose/epidemiologia , Boca , Sensibilidade e EspecificidadeRESUMO
Envenomation caused by venomous animals may trigger significant local complications such as pain, edema, localized hemorrhage, and tissue necrosis, in addition to complications such as dermonecrosis, myonecrosis, and even amputations. This systematic review aims to evaluate scientific evidence on therapies used to target local effects caused by envenomation. The PubMed, MEDLINE, and LILACS databases were used to perform a literature search on the topic. The review was based on studies that cited procedures performed on local injuries following envenomation with the aim of being an adjuvant therapeutic strategy. The literature regarding local treatments used following envenomation reports the use of several alternative methods and/or therapies. The venomous animals found in the search were snakes (82.05%), insects (2.56%), spiders (2.56%), scorpions (2.56%), and others (jellyfish, centipede, sea urchin-10.26%). In regard to the treatments, the use of tourniquets, corticosteroids, antihistamines, and cryotherapy is questionable, as well as the use of plants and oils. Low-intensity lasers stand out as a possible therapeutic tool for these injuries. Local complications can progress to serious conditions and may result in physical disabilities and sequelae. This study compiled information on adjuvant therapeutic measures and underscores the importance of more robust scientific evidence for recommendations that act on local effects together with the antivenom.
Assuntos
Mordeduras de Serpentes , Aranhas , Animais , Antivenenos/uso terapêutico , Serpentes , Escorpiões , Insetos , Mordeduras de Serpentes/tratamento farmacológicoRESUMO
With the aging process, elderly people present changes in their bodies that can lead them to suffer several geriatric syndromes. The present study aimed to analyze and synthesize the literature produced concerning the association of sarcopenia with falls in elderly people with cognitive impairment. This is a systematic review study on etiology and risk, conducted according to the JBI methodology using the Medline (Pubmed), Cinahl, Embase, Scopus, and Web of Science databases. The gray literature search was conducted in the CAPES Brazilian Digital Library of Theses and Dissertations, Google Scholar, Networked Digital Library of Theses and Dissertations (NDLTD), EBSCO Open Dissertations, DART-e, and ACS Guide to Scholarly Communication. The identification of the association between the variables was extracted from the articles themselves (Odds Ratio and the 95% Confidence Intervals). Four articles published between 2012 and 2021 were included in this review. A prevalence of falls was identified, ranging from 14.2% to 23.1%, of cognitive impairment ranging from 24.1% to 60.8%, and of sarcopenia ranging from 6.1 to 26.6%. The meta-analysis found that elderly people with cognitive impairment who suffer falls are at a 1.88 times greater risk of presenting sarcopenia (p = 0.01). There is evidence of an association between the variables, but it is necessary to conduct follow-up studies to support this association as well as other factors that may influence the senescence and senility process.
Assuntos
Disfunção Cognitiva , Sarcopenia , Idoso , Humanos , Acidentes por Quedas , Brasil , Disfunção Cognitiva/complicações , Seguimentos , Sarcopenia/complicaçõesRESUMO
Species of the genus Acanthamoeba are free-living protozoans that occasionally act as parasites, causing a severe, progressive corneal infection termed Acanthamoeba keratitis (AK). The variable pathogenic potential among Acanthamoeba lineages has been shown by in vitro assays, but little is known about the behavior of different strains in animal models of AK. This work aimed to evaluate the infectivity of Acanthamoeba from distinct morphological groups and genotypes in a rat model of AK and apply an immunohistochemical technique for histological characterization of the lesions. Only a strain classified as group I/genotype T17, isolated from a soil source, caused ulcerated corneal lesions in two Wistar rats (n = 9) subjected to intrastromal inoculation. Two strains derived from AK human cases (group II/genotype T4 and group III/genotype T5) did not induce corneal lesions in the rats. A previous association of group II/genotype T4 trophozoites with lethally irradiated Escherichia coli did not influence the infectivity. A hyperimmune serum produced in Wistar rats was validated by an immunocytochemical technique using the three distinct strains and then applied for immunohistochemistry. The abundance of antigenic residues was observed in both corneas with keratitis, suggesting that the infectious process tended to resolve. Despite the low infection rate of the AK Wistar rat model, we produced an immunochemical tool with a potential diagnostic application. We also showed for the first time the ability of Acanthamoeba from T17 genotype to cause AK in experimental conditions.