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BACKGROUND: Chronic kidney disease (CKD) is a global health problem with rising prevalence, morbidity, mortality, and associated costs. Early identification and risk stratification are key to preventing progression to kidney failure. However, there is a paucity of data on practice patterns of kidney function assessment to guide the development of improvement strategies, particularly in lower-income countries. METHODS: A retrospective observational analysis was conducted in a nationwide laboratory database in Brazil. We included all adult patients with at least one serum creatinine assessment between June 2018 and May 2021. Our primary objective was to determine the proportion of patients with estimated glomerular filtration rate (eGFR) evaluations accompanied by predicted levels of urinary albumin-to-creatinine ratio (pACR) assessments within 12 months. RESULTS: Out of 4,5323,332 serum creatinine measurements, 42% lacked pACR measurements within 12 months. Approximately 10.8% of tests suggested CKD, mostly at stage 3a. The proportion of serum creatinine exams paired with pACR assessment varied according to the CKD stage. Internal Medicine, Cardiology, and Obstetrics/Gynecology were the specialties requesting most of the creatinine tests. Nephrology contributed with only 1.1% of serum creatinine requests for testing. CONCLUSION: Our findings reveal that a significant proportion of individuals with a creatinine test lack an accompanying urinary albuminuria measurement in Brazil, contrary to the recommendations of the international guidelines. Non-Nephrologists perform most kidney function evaluations, even among patients with presumable advanced CKD. This highlights the urge to incorporate in clinical practice the early detection of CKD and to encourage more collaborative multidisciplinary care to improve CKD management.
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Albuminúria , Creatinina , Taxa de Filtração Glomerular , Insuficiência Renal Crônica , Humanos , Brasil/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Creatinina/sangue , Estudos Retrospectivos , Feminino , Masculino , Medição de Risco/métodos , Pessoa de Meia-Idade , Bases de Dados Factuais , Adulto , Testes de Função Renal/métodos , IdosoRESUMO
To find novel antibiotic drugs, six 1-thiocarbamoyl-3,5-diaryl-4,5-dihydro-1H derivatives named 1b, 1d (pyrazoles), 2a, 2b, 2c, and 2d (thiazoles) were evaluated in silico and in vitro. The in silico analyses were based on ADME pharmacokinetic parameters (absorption, distribution, metabolism, and excretion). The in vitro antibacterial activity was evaluated in Gram-positive and Gram-negative species (Staphylococcus aureus ATCC® 25904, Staphylococcus epidermidis ATCC® 35984, Klebsiella pneumoniae ATCC® 700603, and Acinetobacter baumannii ATCC® 19606), by determination of minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), kinetics curve, and antibiofilm assays. As results, the azoles have activity against the Gram-negative species K. pneumoniae ATCC® 700603 and A. baumannii ATCC® 19606. No antibacterial activity was observed for the Gram-positive bacteria evaluated. Thus, the azoles were evaluated against clinical isolates of K. pneumoniae carbapenemase (KPC) and A. baumannii multidrug-resistant (Ab-MDR). All azoles have antibacterial activity against Ab-MDR isolates (Gram-negative) with MIC values between 512 µg/mL and 1,024 µg/mL. Against KPC isolates the azoles 1b, 1d, and 2d present antibacterial activity (MIC = 1,024 µg/mL). In the kinetics curve assay, the 1b and 1d pyrazoles reduced significantly viable cells of Ab-MDR isolates and additionally inhibited 86.6 to 95.8% of the biofilm formation. The in silico results indicate high possibility to permeate the blood-brain barrier (2b) and was predict human gastrointestinal absorption (all evaluated azoles). Considering that the research and development of new antibiotics is a priority for drug-resistant pathogens, our study revealed the antibacterial and antibiofilm activity of novel azoles against K. pneumoniae and A. baumannii pathogens.
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Antibacterianos , Tiazóis , Humanos , Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana , Pirazóis/farmacologia , BiofilmesRESUMO
Sporting events were cancelled, and sports training was banned to prevent the spread of COVID-19. These changes during the COVID-19 pandemic decreased the physical activity levels, increased sedentary time, and also impaired the mental health of elite and sub-elite athletes. The impact on body composition and physical performance is not clear, however, especially considering a systematic review with meta-analysis. Thus, our objective was to conduct a review in accordance with the PRISMA Statement studies published in scientific journals (PubMed, Web of Science, or Scopus databases) that investigated the effect that social distancing during the COVID-19 pandemic had on the physical performance (muscle power, cardiorespiratory capacity, and sprint) or body composition (body weight, percentage of fat, fat mass, and fat-free mass) of athletes. Data from 24 studies indicate that, throughout the global lockdown, the athletes maintained muscle power, cardiorespiratory capacity, and sprint, and prevented significant changes in fat mass and fat-free mass. However, the total body weight (meta-analysis with 18 studies), showed a significant increase (p = 0.006), with a small ES = 0.12; 95% CI = 0.04 to 0.21. Furthermore, the time of follow-up, level of training, and the age of the athletes were possible moderators of these effects. The data reinforce the importance of general strength and endurance exercises sessions to maintain physical fitness during non-competitive periods or due to the mandatory lockdown.
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BACKGROUND: the study determined the validity and reliability of measurements obtained using the portable traction dynamometer (PTD) (E-Lastic, E-Sports Solutions, Brazil) and the reproducibility between evaluators (precision) in the evaluation of the isometric muscle strength of the knee extensors of healthy male adults, compared to measurements obtained with the "gold standard" computerized dynamometer (CD) (Biodex System 3, Nova York, NY, USA). METHODS: we evaluated sixteen recreationally active men (29.50 ± 7.26 years). The test-retest reliability of both equipment to determine quadriceps strength, agreement analysis, and the minimal important difference were verified. RESULTS: excellent test-retest interrater reliability was observed for absolute and relative measurements, with a low absolute error for both sets of equipment and excellent validity of the PTD against the CD, as verified by linear regression and Pearson's correlation coefficient. CONCLUSIONS: PTD is a valid and reliable instrument for assessing the isometric strength of knee extensors, with results similar to the isometric CD "gold standard".
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This study aimed to assess the effects of different spray-dried plasma (SDP) feeding programmes to pigs on performance, intestinal histomorphology and faecal bacterial shedding after an Escherichia coli K88 challenge. A total of 96 piglets (5.77 ± 0.01 kg) were weaned at 21 days of age (Day 0) and challenged with 3 ml of 1 × 1010 CFU of E. coli K88 in total 3.0 × 1010 CFU/animal on Days 0, 2 and 4. Pigs were fed nursery diets containing 0.0%, 3.0%, 6.0% or 9.0% SDP from weaning to 35 days of age; 0.0%, 1.5%, 3.0% or 4.5% SDP from 36 to 49 days; and the same control diet (without SDP), for the last 10 days of the experiment (50-59 days of age). Performance was measured from 35 to 59 days of age and faecal bacterial shedding and intestinal histomorphometry were evaluated at Days 28 and 49 of age respectively. From 21 to 35 days of age, there was a linear effect for body weight (BW) and average daily gain (ADG), a trend of linear effect for average daily feed intake (ADFI) and a quadratic effect for feed:gain ratio (FG). From 21 to 49 days, the 9.0:4.5% and 6.0:3.0% SDP feeding programmes improved BW, ADG and FG when compared to the other treatments. At 59 days of age, BW and ADG were increased by the two highest SDP feeding programmes. The 9.0:4.5% SDP feeding programme increased ADFI from 21 to 59 days of age, with 6.0:3.0% being intermediate and the other two treatments being lowest. The CFU counts of E. coli/g of faeces decreased linearly with increasing addition of SDP. These results indicate that an extended inclusion of increased SDP levels in post-weaning diets can improve growth potential and decrease bacterial shedding induced by E. coli K88.
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Escherichia coli Enterotoxigênica , Infecções por Escherichia coli , Doenças dos Suínos , Animais , Suínos , Derrame de Bactérias , Dieta , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/veterinária , Desmame , Fezes/microbiologia , Ração Animal/análise , Doenças dos Suínos/microbiologiaRESUMO
Objectives: The purpose of this study was to compare the effects of two acute doses of Capsiate (CAP; 6 vs. 12 mg) on upper body resistance exercise performance in trained men. Methods: Using a randomized, crossover and double-blind design, 20 resistance-trained males were supplemented with low-dose CAP (6 mg), high-dose CAP (12 mg) or placebo 45 minutes before exercise. Subjects performed 4 sets of bench press with repetitions to failure at 70% 1 repetition maximum (1RM) and 2 minutes of rest between each set. The ratings of perceived exertion (RPE) and blood lactate were analyzed at baseline and after exercise. Results: Total weight lifted was greater in the low CAP (2,454.6 ± 448.6 kg) compared to placebo (2,354.7 ± 458.6 kg, p = 0.039) and high CAP (2,309.3 ± 428.1 kg, p = 0.001). There was no significant difference between conditions for RPE (p = 0.155) and blood lactate (p = 0.434). Conclusion: In summary, 6 mg CAP increased total weight lifted and repetitions to failure on bench press exercise in trained men, while 12 mg did not present any effect.
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Heterobaric leaves have bundle sheath extensions (BSEs) that compartmentalize the parenchyma, whereas homobaric leaves do not. The presence of BSEs affects leaf hydraulics and photosynthetic rate. The tomato (Solanum lycopersicum) obscuravenosa (obv) mutant lacks BSEs. Here, we identify the obv gene and the causative mutation, a nonsynonymous amino acid change that disrupts a C2H2 zinc finger motif in a putative transcription factor. This mutation exists as a polymorphism in the natural range of wild tomatoes but has increased in frequency in domesticated tomatoes, suggesting that the latter diversified into heterobaric and homobaric leaf types. The obv mutant displays reduced vein density, leaf hydraulic conductance and photosynthetic assimilation rate. We show that these and other pleiotropic effects on plant development, including changes in leaf insertion angle, leaf margin serration, minor vein density, and fruit shape, are controlled by OBV via changes in auxin signaling. Loss of function of the transcriptional regulator AUXIN RESPONSE FACTOR 4 (ARF4) also results in defective BSE development, revealing an additional component of a genetic module controlling aspects of leaf development important for ecological adaptation and subject to breeding selection.
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Solanum lycopersicum , Ácidos Indolacéticos/metabolismo , Solanum lycopersicum/metabolismo , Fotossíntese/genética , Melhoramento Vegetal , Folhas de Planta/metabolismo , Proteínas de Plantas/metabolismoRESUMO
COVID-19 pandemic, has led to several countries adopting the use of masks in public spaces. Mask used during physical exercise it may induce early fatigue. However, despite the results with aerobic exercise, as far as we know, no studies have been carried out on wearing a mask during resistance exercise.This randomized, crossover study verified the acute effect of an FFP2/N95 face mask on moderate- and high-load upper body resistance exercise performance in recreational weight lifters.The FFP2/N95 face mask impacted performance, evaluated with bar velocity, in the high-intensity resistance bench press exercise until movement failure but decreased oxygen saturation and increased rate of perceived effort only in the moderate-intensity exercise.
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COVID-19 , Treinamento Resistido , Estudos Cross-Over , Exercício Físico , Humanos , Respiradores N95 , Pandemias , SARS-CoV-2RESUMO
Latent fingermarks are important trace evidence found in crime scenes mainly used for identification purposes. Once deposited, the composition of samples changes over time influencing the efficacy of latent fingermark development methods. In this sense, the aims of this work were to characterize the fatty acid (FA) profile of sebaceous latent fingermarks by GC-FID and to preliminarily evaluate the development efficiency of enhancement methods (powder dusting, iodine fuming and silver nitrate method) in a 30-day period of aging under controlled parameters of temperature, photoperiod and humidity. Results showed that myristic (7.51 ± 0.76% - 13.39 ± 1.26%), palmitic (35.91 ± 1.07% - 40.81 ± 2.52%), stearic (6.67 ± 0.36% - 9.13 ± 0.36%) and oleic (18.08 ± 0.25% - 20.93 ± 0.26%) acid varied significantly (p < 0.05) over the 30-day period of analysis. Regarding development efficiency, fluorescent orange powder and the silver nitrate method also increased their efficacy to develop latent fingermarks over time while the iodine fuming method decreased its efficiency. Silver black powder had constant efficacy in the tested period. Changes in the constitution of sebaceous marks possibly influenced the development efficiency of enhancement techniques. This knowledge is important to better understand the kinetic of aging and its influence on the development method.
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Iodo , Nitrato de Prata , Idoso , Corantes , Dermatoglifia , Humanos , PósRESUMO
The irrational use of medications has increased the incidence of microbial infections, which are a major threat to public health. Moreover, conventional therapeutic strategies are starting to become ineffective to treat these infections. Hence, there is a need to develop and characterize novel antimicrobial compounds. Phytochemicals are emerging as a safe and accessible alternative to conventional therapeutics for treating infectious diseases. Curcumin is extracted from the dried rhizome of the spice turmeric (Curcuma longa (Zingiberaceae)). However, the bioavailability of curcumin is low owing to its lipophilic property and thus has a low therapeutic efficacy in the host. A previous study synthesized structural variants of curcumin, which are called monocurcuminoids (CNs). CNs are synthesized based on the chemical structure of curcumin with only one methyl bridge. The biological activities of four previously synthesized CNs (CN59, CN63, CN67, and CN77), curcumin, and turmeric powder were examined in this study. Gas chromatography-tandem mass spectrometry analysis of curcumin and turmeric powder revealed similar peaks, which indicated the presence of curcumin in turmeric powder. The antioxidant activity of the test compounds was evaluated using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) assays. The ABTS radical scavenging activities of the test compounds were similar to those of vitamin C. The minimum inhibitory concentration (MIC) values of the test compounds against seven microbial strains were in the range of 4.06-150⯵g/mL. The MIC value was equal to minimum bactericidal concentration value for CN63 (150⯵g/mL) and CN67 (120⯵g/mL) against Staphylococcus aureus. The treatment combination of CN77 (8.75 or 4.37⯵g/mL) and turmeric powder (9.37 or 4.68⯵g/mL) exerted synergistic growth-inhibiting effects on Aeromonas hydrophila, Candida albicans, and Pseudomonas aeruginosa. Photodynamic therapy using 2X MIC of CN59 decreased the growth of Enterococcus faecalis by 4.18-fold compared to the control group and completely inhibited the growth of Escherichia coli. The results of the hemolytic assay revealed that the test compounds were not cytotoxic with half-maximal inhibitory concentration values ranging from 49.65-130.9 µM. The anticoagulant activity of most compounds was comparable to that of warfarin but higher than that of heparin. This indicated that these compounds target the intrinsic coagulation pathway. These results demonstrated that these CNs are a safe and promising alternative for curcumin.
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Anti-Infecciosos/farmacologia , Antioxidantes/farmacologia , Bactérias/efeitos dos fármacos , Bioprospecção , Candida albicans/efeitos dos fármacos , Diarileptanoides/farmacologia , Fotoquimioterapia , Fármacos Fotossensibilizantes/farmacologia , Animais , Anti-Infecciosos/síntese química , Anti-Infecciosos/toxicidade , Antioxidantes/síntese química , Antioxidantes/toxicidade , Bactérias/crescimento & desenvolvimento , Benzotiazóis/química , Compostos de Bifenilo/química , Coagulação Sanguínea/efeitos dos fármacos , Candida albicans/crescimento & desenvolvimento , Diarileptanoides/síntese química , Diarileptanoides/toxicidade , Resistência Microbiana a Medicamentos , Hemólise/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Fármacos Fotossensibilizantes/síntese química , Fármacos Fotossensibilizantes/toxicidade , Picratos/química , Carneiro Doméstico , Ácidos Sulfônicos/químicaRESUMO
Abstract Objective: Using a wide and representative sample of adolescents from 37 countries, this study aimed to analyze how age changes adolescents' healthy lifestyle. Methods: The study included 148,839 adolescents who participated in the Health Behavior in School-aged Children 2010 survey. A composite score of a healthy lifestyle was created using the combination of daily physical activity, daily fruit and vegetable consumption, <2 h daily on screen-based behaviors, abstinence from alcohol, and abstinence from tobacco products. Healthy lifestyle measures were based on self-report. Results: 4.7% of boys and 4.4% of girls aged 11 years, 3% of boys and 2% of girls aged 13 years, and 1.5% of boys and 0.8% of girls aged 15 scored perfectly on the healthy lifestyle score. As age increased, the prevalence of adolescents with a healthy lifestyle decreased. In 37 countries and regions, the prevalence of healthy behaviors decreased linearly between early adolescence and the age of 15 years. Conclusions: In general, adolescents do not have a healthy lifestyle. Results from this study highlight that there is still much work to be done in promoting healthy lifestyles and to raise awareness among adolescents of the potential risk to their health status.
Resumo Objetivo Com o uso de uma amostra ampla e representativa de adolescentes de 37 países, analisar como a idade muda o estilo de vida saudável dos adolescentes. Métodos Participaram 148.839 adolescentes provenientes da pesquisa Health Behavior in School-aged Children, de 2010. Foi elaborado um escore composto de um estilo de vida saudável, com a combinação de atividade física diária, consumo diário de frutas e vegetais, menos de duas horas diárias de comportamento sedentário baseado em tempo de tela, abstinência de álcool e abstinência de produtos de tabaco. As medidas do estilo de vida saudável foram baseadas em autorrelato. Resultados Obtiveram um escore perfeito no estilo de vida saudável 4,7% dos meninos e 4,4% das meninas de 11 anos, 3% dos meninos e 2% das meninas de 13 anos e 1,5% dos meninos e 0,8% das meninas de 15 anos. Com o aumento da idade, a prevalência de adolescentes com estilo de vida saudável diminuiu. Em 37 países e regiões, a prevalência de comportamentos saudáveis diminuiu linearmente entre o início da adolescência e os 15 anos. Conclusões Em geral, os adolescentes não têm um estilo de vida saudável. Os resultados deste estudo destacam que ainda há muito trabalho a ser feito na promoção de estilos de vida saudáveis e na conscientização dos adolescentes sobre os riscos potenciais para o seu estado de saúde.
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Humanos , Masculino , Feminino , Criança , Adolescente , Comportamento do Adolescente , Estilo de Vida Saudável , Verduras , Exercício Físico , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Using a wide and representative sample of adolescents from 37 countries, this study aimed to analyze how age changes adolescents' healthy lifestyle. METHODS: The study included 148,839 adolescents who participated in the Health Behavior in School-aged Children 2010 survey. A composite score of a healthy lifestyle was created using the combination of daily physical activity, daily fruit and vegetable consumption, <2h daily on screen-based behaviors, abstinence from alcohol, and abstinence from tobacco products. Healthy lifestyle measures were based on self-report. RESULTS: 4.7% of boys and 4.4% of girls aged 11 years, 3% of boys and 2% of girls aged 13 years, and 1.5% of boys and 0.8% of girls aged 15 scored perfectly on the healthy lifestyle score. As age increased, the prevalence of adolescents with a healthy lifestyle decreased. In 37 countries and regions, the prevalence of healthy behaviors decreased linearly between early adolescence and the age of 15 years. CONCLUSIONS: In general, adolescents do not have a healthy lifestyle. Results from this study highlight that there is still much work to be done in promoting healthy lifestyles and to raise awareness among adolescents of the potential risk to their health status.
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Comportamento do Adolescente , Estilo de Vida Saudável , Adolescente , Criança , Estudos Transversais , Exercício Físico , Feminino , Humanos , Masculino , Inquéritos e Questionários , VerdurasRESUMO
BACKGROUND: Randomised controlled trials have evaluated the recombinant tetravalent dengue vaccine (CYD-TDV). However, individual results may have little power to identify differences among the populations studied. OBJECTIVE: To evaluate efficacy, immunogenicity and safety of CYD-TDV in the prevention of dengue in children aged 2-17 years. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE (from 1950 to 5 December 2018), EMBASE (from 1947 to 5 December 2018) and Cochrane (from 1993 to 5 December 2018). ELIGIBILITY CRITERIA OF STUDIES: Randomised trials comparing efficacy, immunogenicity and safety of CYD-TDV with placebo or other vaccines for preventing dengue cases in children aged 2-17 years. OUTCOME MEASURES: Efficacy, immunogenicity and safety of CYD-TDV. STUDY APPRAISAL AND METHODS: Calculations were made of relative risk (RR) and mean difference (MD) for dichotomous and continuous outcomes, respectively. All estimates were calculated considering a 95% CI estimate. A p<0.05 was considered statistically significant. RESULTS: Nine studies involving 34 248 participants were included. The overall efficacy of CYD-TDV was 60% (RR 0.40 (0.30 to 0.54)). Serotype-specific efficacy of the vaccine was 51% for dengue virus type-1 (DENV-1) (RR 0.49 (0.39 to 0.63)); 34% for DENV-2 (RR 0.66 (0.50 to 0.86)); 75% for DENV-3 (RR 0.25 (0.18 to 0.35)) and 77% for DENV-4 (RR 0.23 (0.15 to 0.34)). Overall immunogenicity (MD) of CYD-TDV was 225.13 (190.34 to 259.93). Serotype-specific immunogenicity was: DENV-1: 176.59 (123.36 to 229.83); DENV-2: 294.21 (181.98 to 406.45); DENV-3: 258.78 (146.72 to 370.84) and DENV-4: 189.35 (141.11 to 237.59). The most common adverse events were headache and pain at the injection site. LIMITATIONS: The main limitation of this study was unclear or incomplete data. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: CYD-TDV is considered safe and able to partially protect children and adolescents against four serotypes of DENV for a 1-year period. Despite this, research should prioritise improvements in vaccine efficacy, thus proving higher long-term protection against all virus serotypes. PROSPERO REGISTRATION NUMBER: CRD42016043628.
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Vacinas contra Dengue/uso terapêutico , Dengue , Imunogenicidade da Vacina , Adolescente , Criança , Pré-Escolar , Dengue/imunologia , Dengue/prevenção & controle , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Vacinação/métodosRESUMO
A novel bio-based polyurethane/chitosan foam (PU/chitosan) was synthesized using a polyol derived from castor oil and applied to remove Food Red 17 dye (FR17) from aqueous solutions. PU/chitosan foam presented better characteristics and adsorption potential than polyurethane foam (PU). PU/chitosan foam showed a semi-crystalline structure, with several functional groups, high porosity and good mechanical properties. These characteristics are adequate for adsorptive separations. Using identical adsorption conditions, PU/chitosan was able to remove >98% of FR17 dye from the solution, while, PU removed only 40%. The adsorption of FR17 on PU/chitosan composite foam was favored at pHâ¯2. Pseudo-second order model was the most adequate to represent the kinetic data. The equilibrium data followed the Sips model, with a maximum adsorption capacity of 267.24â¯mgâ¯g-1. The adsorption process was spontaneous, favorable and endothermic. The results showed that polyurethane foams are capable to support chitosan, generating an adsorbent with better mechanical characteristics and high potential to remove anionic dyes from aqueous media.
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Compostos Azo/química , Compostos Azo/isolamento & purificação , Quitosana/química , Poliuretanos/química , Poliuretanos/síntese química , Ácidos Ricinoleicos/química , Adsorção , Óleo de Rícino/química , Técnicas de Química Sintética , Concentração de Íons de Hidrogênio , Cinética , Polímeros/química , Termodinâmica , Água/química , Poluentes Químicos da Água/química , Poluentes Químicos da Água/isolamento & purificaçãoRESUMO
ABSTRACT Objective to evaluate the effectiveness of the 3D virtual anatomical table as a complementary resource to the learning of the hepatobiliary anatomy by undergraduate medical students. Method A randomized controlled study comparing the anatomical learning of hepatobiliary structures, supported by a real model versus a virtual model, both three-dimensional (3D), by undergraduate medical students. The students' perception of the resources used to teach anatomy was also evaluated. The students were submitted to a pre-test and to two evaluations after the interventions were applied. Results Overall, both the 3D virtual anatomical table and the real liver increased students' knowledge of the hepatobiliary anatomy in relation to their previous knowledge (p = 0.001 and p = 0.01, respectively for second and third evaluations). In the longitudinal comparison between the pre-test and the second evaluation (hepatobiliary anatomy and Couinaud's segmentation), this increase was significantly higher in the group allocated to the real liver (p = 0.002); in the comparison of the pre-test with the third evaluation (inclusion of adjacent organs in the anatomical table or in the real liver), the increase in knowledge was significantly higher in the group allocated to the anatomical table (p = 0.04). The perception of participants' satisfaction regarding the learning resources was considered very good, with a minimum percentage of satisfaction of 80%. Conclusion the 3D virtual anatomical table provided more hepatobiliary anatomy knowledge than a real liver for undergraduate medical students, in comparison to their previous knowledge about these structures. In the cross-sectional comparison of the post-instruction evaluations, there was no difference between the two interventions. Moreover, the 3D platform had a positive impact on the level of satisfaction of study participants. This study shows that the 3D virtual anatomical table has the potential to improve both medical students' understanding and interest in anatomy. It is recommended, however, that future protocols such as this be carried out with larger samples and exploring other anatomical structures.
RESUMO Objetivo Avaliar a eficácia da mesa anatômica virtual 3D como recurso complementar ao aprendizado da anatomia hepatobiliar por estudantes de graduação em Medicina. Metodologia Trata-se de estudo randomizado e controlado que comparou a aprendizagem anatômica de estruturas hepatobiliares, apoiada por um modelo real versus por um modelo virtual, ambos tridimensionais (3D), por parte de estudantes de medicina. Avaliou-se também a percepção dos estudantes quanto aos recursos utilizados para o ensino da anatomia. Os alunos foram submetidos a um pré-teste e a duas avaliações após a aplicação das intervenções. Resultados Globalmente, tanto a mesa anatômica virtual 3D quanto o fígado real aumentaram o conhecimento dos estudantes sobre a anatomia hepatobiliar em relação ao conhecimento prévio deles (p = 0,001 e p = 0,01, respectivamente para a segunda e terceira avaliação). Na comparação longitudinal entre o pré-teste e a segunda avaliação (anatomia hepatobiliar e segmentação de Couinaud), esse aumento foi significantemente maior no grupo alocado para o fígado real (p = 0,002); já na comparação do pré-teste com a terceira avaliação (inclusão de órgãos anexos na mesa anatômica ou no fígado real), o aumento do conhecimento foi significantemente maior no grupo alocado para a mesa anatômica (p = 0,04). A percepção de satisfação dos participantes quanto aos recursos de aprendizagem foi considerada muito boa, com percentual mínimo de satisfação de 80%. Conclusão A mesa anatômica virtual 3D forneceu mais conhecimento de anatomia hepatobiliar que um fígado real para estudantes de medicina, em relação ao conhecimento prévio deles sobre essas estruturas. Na comparação transversal das avaliações pós-instrução, não houve diferença entre as duas intervenções. Além disso, a plataforma 3D teve um impacto positivo no nível de satisfação dos participantes do estudo. Este estudo mostra que a mesa anatômica virtual 3D tem potencial para melhorar tanto a compreensão quanto o interesse dos estudantes de medicina pela anatomia. Recomenda-se, no entanto, que futuros protocolos como este sejam realizados com amostras maiores e explorando outras estruturas anatômicas.
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BACKGROUND: Iron deficiency anemia remains one of the main indications to perform small bowel capsule endoscopy. Literature suggests that diagnostic yield is influenced by patient's age but with conflicting results regarding age cutoff. OBJECTIVE: We aimed to clarify the differences in diagnostic yield and incidence of specific findings according to age. METHODS: Retrospective single-center study including 118 patients performing small bowel capsule endoscopy in the study of iron deficiency anemia. Videos were reviewed and small bowel findings that may account for anemia were reported. Incomplete examinations were excluded. Findings were compared between patients ≤60 and >60 years. RESULTS: Patients had a mean age of 58 years old (SD ±17.9) with 69.5% females (n=82). The overall diagnostic yield was 49% (58/118), being higher among patients >60 years (36/60, diagnostic yield 60%) than those ≤60 years (20/58, diagnostic yield 34%), (P<0.01). Angioectasias were more frequent in patients >60 years (45% vs 9%, P<0.01). Patients ≤60 years presented more frequently significant inflammation (Lewis score >135 in 10.3% vs 1.7%, P<0.05) and other non-vascular lesions (24% vs 10%, P=0.04). CONCLUSION: In our cohort small bowel capsule endoscopy diagnosed clinically relevant findings in the setting of iron deficiency anemia in almost half the patients. Diagnostic yield was higher in patients older than 60 years (60%), with vascular lesions being more frequent in this age group. Despite the lower diagnostic yield in patients ≤60 years, significant pathology was also found in this age group, mainly of inflammatory type.
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Anemia Ferropriva/etiologia , Endoscopia por Cápsula/métodos , Gastroenteropatias/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastroenteropatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
ABSTRACT Objectives: This study is aimed at evaluating whether core decompression of the femoral head in the early stages of femoral head osteonecrosis improves patients' subjective perception of pain and avoids the progression of the disease to a femoral head collapse and a final indication of total hip arthroplasty. Methods: Eighteen patients (30 hips) in the early stages of the disease (Ficat and Arlet 1 and 2A) were evaluated through clinical, radiological, risk factor maintenance, and by the functional Merle D'Aubigné, and Postel score before and after core decompression of the femoral head. Results: There was an improvement of symptoms up to the sixth month in 83.3% of the hips evaluated through the Merle D'Aubigné and Postel score. However, 73.3% of the cases evolved with femoral head collapse, and in 50%, total hip arthroplasty was indicated regardless of whether or not the risk factors were maintained. Conclusions: Core decompression of the femoral head improves patients' pain early in the initial stages of the pathology. However, it does not alter the prognosis and the ultimate indication of total hip arthroplasty in the final stages of the disease.
RESUMO Objetivos: O presente estudo tem como objetivo avaliar se a descompressão simples da cabeça femoral nos estágios iniciais da osteonecrose da cabeça femoral melhora a percepção subjetiva da dor dos pacientes e se evita a progressão da doença para o colapso da cabeça femoral e a indicação final de artroplastia total do quadril. Métodos: Foram avaliados 18 pacientes (30 quadris) em estágios iniciais da doença (Ficat e Arlet 1 e 2 A) por critérios clínicos, radiológicos, manutenção dos fatores de risco e pela escala funcional de Merle D'Aubigné e Postel antes e após a descompressão simples da cabeça femoral. Resultados: Houve melhoria dos sintomas precocemente (até o sexto mês) em 83,3% dos quadris avaliados pela escala de Merle D'Aubigné e Postel. No entanto, 73,3% dos casos evoluíram com colapso da cabeça femoral e em 50% deles foi indicada artroplastia total do quadril, independentemente da manutenção ou não dos fatores de risco. Conclusões: A descompressão simples da cabeça femoral melhora a dor dos pacientes precocemente nos estágios iniciais da patologia. Entretanto, não altera o prognóstico da doença e a indicação final de artroplastia total do quadril nos estágios finais da doença.
Assuntos
Humanos , Masculino , Feminino , Resultado do Tratamento , Necrose da Cabeça do Fêmur/diagnóstico , Necrose da Cabeça do Fêmur/fisiopatologia , Necrose da Cabeça do Fêmur/patologiaRESUMO
OBJECTIVES: This study is aimed at evaluating whether core decompression of the femoral head in the early stages of femoral head osteonecrosis improves patients' subjective perception of pain and avoids the progression of the disease to a femoral head collapse and a final indication of total hip arthroplasty. METHODS: Eighteen patients (30 hips) in the early stages of the disease (Ficat and Arlet 1 and 2A) were evaluated through clinical, radiological, risk factor maintenance, and by the functional Merle D'Aubigné, and Postel score before and after core decompression of the femoral head. RESULTS: There was an improvement of symptoms up to the sixth month in 83.3% of the hips evaluated through the Merle D'Aubigné and Postel score. However, 73.3% of the cases evolved with femoral head collapse, and in 50%, total hip arthroplasty was indicated regardless of whether or not the risk factors were maintained. CONCLUSIONS: Core decompression of the femoral head improves patients' pain early in the initial stages of the pathology. However, it does not alter the prognosis and the ultimate indication of total hip arthroplasty in the final stages of the disease.
OBJETIVOS: O presente estudo tem como objetivo avaliar se a descompressão simples da cabeça femoral nos estágios iniciais da osteonecrose da cabeça femoral melhora a percepção subjetiva da dor dos pacientes e se evita a progressão da doença para o colapso da cabeça femoral e a indicação final de artroplastia total do quadril. MÉTODOS: Foram avaliados 18 pacientes (30 quadris) em estágios iniciais da doença (Ficat e Arlet 1 e 2A) por critérios clínicos, radiológicos, manutenção dos fatores de risco e pela escala funcional de Merle D'Aubigné e Postel antes e após a descompressão simples da cabeça femoral. RESULTADOS: Houve melhoria dos sintomas precocemente (até o sexto mês) em 83,3% dos quadris avaliados pela escala de Merle D'Aubigné e Postel. No entanto, 73,3% dos casos evoluíram com colapso da cabeça femoral e em 50% deles foi indicada artroplastia total do quadril, independentemente da manutenção ou não dos fatores de risco. CONCLUSÕES: A descompressão simples da cabeça femoral melhora a dor dos pacientes precocemente nos estágios iniciais da patologia. Entretanto, não altera o prognóstico da doença e a indicação final de artroplastia total do quadril nos estágios finais da doença.