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Brazil has one of the greatest biodiversities on the planet, where various crops play a strategic role in the country's economy. Among the highly appreciated biomasses is babassu, whose oil extraction generates residual babassu mesocarp (BM), which still needs new strategies for valorization. This work aimed to use BM as a support for the immobilization of Thermomyces lanuginosus lipase (TLL) in an 8.83â mL packed-bed reactor, followed by its application as a biocatalyst for the synthesis of hexyl laurate in an integrated process. Initially, the percolation of a solution containing 5â mg of TLL at 25 °C and flows ranging from 1.767 to 0.074â mL min-1 was investigated, where at the lowest flow rate tested (residence time of 2â h), it was possible to obtain an immobilized derivative with hydrolytic activity of 504.7 U g-1 and 31.7 % of recovered activity. Subsequent studies of treatment with n-hexane, as well as the effect of temperature on the immobilization process, were able to improve the activities of the final biocatalyst BM-TLLF, achieving a final hydrolysis activity of 7023â U g-1 and esterification activity of 430â U â g-1 against 142â U g-1 and 113.5â U g-1 respectively presented by the commercial TLIM biocatalyst. Desorption studies showed that the TL IM has 18â mg of protein per gram of support, compared to 4.92â mg presented by BM-TLL. Both biocatalysts were applied to synthesize hexyl laurate, achieving 98 % conversion at 40 °C within 2â h. Notably, BM-TLLF displayed exceptional recyclability, maintaining catalytic efficiency over 12 cycles. This reflects a productivity of 180â mg of product â h-1 U-1 of the enzyme, surpassing 46â mg h-1â U-1 obtained for TLIM. These results demonstrate the efficacy of continuous flow technology in creating a competitive and integrated process offering an exciting alternative for the valorization of residual lignocellulosic biomass.
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Herein, we present a comprehensive total synthesis of cannabidiol integrating both batch and continuous flow conditions. Our approach is planned to streamline the synthesis of olivetolic acid derivatives and utilize an enantiomerically pure monoterpene moiety obtained from naturally occurring (R)-(+)-limonene by photocatalysis. Key reactions, including the synthesis of olivetolic ester and a Friedel-Crafts alkylation, are successfully adapted to continuous flow, resulting in improved yields and selectivities. This study not only offers a scalable and efficient route for cannabidiol synthesis but also contributes to the synthetic approaches to access cannabinoids (diversity synthesis), with potential applications in medicinal and industrial contexts.
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Canabidiol , Canabidiol/química , Canabidiol/síntese química , Estereoisomerismo , Estrutura Molecular , CatáliseRESUMO
PURPOSE: To evaluate glycemic variability (GV) using continuous glucose monitoring (CGM) in individuals with and without type 2 diabetes mellitus (T2DM) undergoing Roux-en-Y gastric bypass (RYGB). METHODS: This prospective cohort study compared the CGM data of fourteen patients with T2DM (n = 7) and without T2DM (n = 7) undergoing RYGB. After 6 months, these patients were compared to a non-operative control group (n = 7) matched by BMI, sex, and age to the T2DM group. RESULTS: Fourteen patients underwent RYGB, with a mean BMI of 46.9 ± 5.3 kg/m2 and an average age of 47.9 ± 8.9 years; 85% were female. After 6 months post-surgery, the total weight loss (TWL) was 27.1 ± 6.3%, with no significant differences between the groups. Patients without diabetes had lower mean interstitial glucose levels (81 vs. 94 and 98 mg/dl, p < 0.01) and lower glucose management indicator (GMI) (5.2 vs. 5.6 and 5.65%, p = 0.01) compared to the control and T2DM groups, respectively. The coefficient of variation (CV) significantly increased only in patients with diabetes (17% vs. 26.7%, p < 0.01). Both groups with (0% vs. 2%, p = 0.03) and without (3% vs. 22%, p = 0.03) T2DM experienced an increased time below range with low glucose (54-69 mg/dL). However, patients without T2DM had significantly less time in rage (70-180 mg/dL) (97% vs. 78%, p = 0.04). CONCLUSION: Significant differences in CGM metrics among RYGB patients suggest an increase in glycemic variability after surgery, with a longer duration of hypoglycemia, especially in patients without T2DM.
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Glicemia , Monitoramento Contínuo da Glicose , Diabetes Mellitus Tipo 2 , Derivação Gástrica , Obesidade Mórbida , Redução de Peso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glicemia/metabolismo , Glicemia/análise , Automonitorização da Glicemia , Monitoramento Contínuo da Glicose/estatística & dados numéricos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/cirurgia , Controle Glicêmico , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Estudos Prospectivos , Redução de Peso/fisiologiaRESUMO
Recognizing user intention in reach-to-grasp motions is a critical challenge in rehabilitation engineering. To address this, a Machine Learning (ML) algorithm based on the Extreme Learning Machine (ELM) was developed for identifying motor actions using surface Electromyography (sEMG) during continuous reach-to-grasp movements, involving multiple Degrees of Freedom (DoFs). This study explores feature extraction methods based on time domain and autoregressive models to evaluate ELM performance under different conditions. The experimental setup encompassed variations in neuron size, time windows, validation with each muscle, increase in the number of features, comparison with five conventional ML-based classifiers, inter-subjects variability, and temporal dynamic response. To evaluate the efficacy of the proposed ELM-based method, an openly available sEMG dataset containing data from 12 participants was used. Results highlight the method's performance, achieving Accuracy above 85%, F-score above 90%, Recall above 85%, Area Under the Curve of approximately 84% and compilation times (computational cost) of less than 1 ms. These metrics significantly outperform standard methods (p < 0.05). Additionally, specific trends were found in increasing and decreasing performance in identifying specific tasks, as well as variations in the continuous transitions in the temporal dynamics response. Thus, the ELM-based method effectively identifies continuous reach-to-grasp motions through myoelectric data. These findings hold promise for practical applications. The method's success prompts future research into implementing it for more reliable and effective Human-Machine Interface (HMI) control. This can revolutionize real-time upper limb rehabilitation, enabling natural and complex Activities of Daily Living (ADLs) like object manipulation. The robust results encourages further research and innovative solutions to improve people's quality of life through more effective interventions.
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Abstract The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the pa tient from invasive mechanical ventilation (iMV) for ap proximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance to mography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effec tively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.
Resumen La prueba de apnea es una técnica diagnóstica am pliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al pacien te de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigena ción mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAP-AT) mitiga eficazmente el colapso pulmonar. Este enfo que resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.
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INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic represented a global public health problem with devastating consequences that have challenged conventional medical treatments. Continuous renal replacement therapy (CRRT), based on a spectrum of modalities and dialysis membranes, can modify cytokine storms, and improve the clearance of inflammatory factors. As severe COVID-19 can lead to acute kidney injury (AKI) requiring RRT, most patients require more than one extracorporeal organ support at this point. This is due to complications that lead to organ dysfunction. The aim of our study was to assess renal recovery and survival while use of the oXiris membrane, as well as a decrease in vasopressors and hemodynamic parameters. METHODS: This was a retrospective, observational study. The population included adult patients (aged >18 years) with a real-time PCR COVID-19 positive test, admitted to the intensive care unit (ICU) with AKI KDIGO 3, which required CRRT, in a hospital in northern Mexico. The primary outcomes were renal recovery and survival, and the secondary outcomes were a decrease in the vasopressor requirements and changes in the hemodynamic parameters. RESULTS: Thirteen patients were included from January 2020 to August 2021, all of whom met the inclusion criteria. oXiris, an AN69-modified membrane, was used for blood purification and cytokine storm control in all the patients. The primary outcome, renal recovery, and survival were observed in 23% of the patients. The secondary outcome was a decrease of 12% in the use of noradrenaline in the first 24 h of CRRT initiation with oXiris, in addition to a decrease in creatinine and C-reactive protein levels in all patients. DISCUSSION: The use of the oXiris membrane in patients with severe COVID-19 improved hemodynamic parameters, with 23% of the patients achieving renal recovery. The decrease on the requirement of vasopressors in the overall patients in the first 24 h of CRRT with oXiris was achieved. The mean decrease was of 12%, accompanied by a decrease in inflammatory markers. There is literature on the benefit of CRRT with a modified AN69 membrane in Mexico; however, studies in this regard are scarce, and our research provides valuable information on our experience in this field.
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Injúria Renal Aguda , COVID-19 , Terapia de Substituição Renal Contínua , Estado Terminal , SARS-CoV-2 , Humanos , COVID-19/terapia , COVID-19/complicações , COVID-19/sangue , COVID-19/mortalidade , México , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Terapia de Substituição Renal Contínua/métodos , Injúria Renal Aguda/terapia , Idoso , Membranas Artificiais , Adulto , Centros de Atenção Terciária , Hemodinâmica , Vasoconstritores/uso terapêutico , Unidades de Terapia Intensiva , Terapia de Substituição Renal/métodosRESUMO
Introduction: There are multiple mechanisms by which HbA1c values can be altered in chronic kidney disease (CKD), which limits its usefulness as a strategy to assess glycemic control in this population. Methods: Concordance and agreement study between two diagnostic tests: HbA1c and glucose management indicator (GMI) measured by intermittently scanned continuous glucose monitoring (isCGM), based in a prospective cohort of patients with diabetes, CKD (glomerular filtration rate between 15 and 60 ml/min/1.73 m²), and anemia. The isCGM was performed for 3 months, and the GMI was compared with the HbA1c levels taken at the end of isCGM. Agreement was evaluated using Bland-Altman graph analysis and Lin's concordance correlation coefficient (CCC). The concordance of the measures with good glycemic control (<7%) was also evaluated. Results: A total of 74 patients were enrolled (median age 68.5 years, 51.3% female, 64.9% with CKD stage 3, hemoglobin 11.1 ± 1.2 g/l). The Bland-Altman analysis shows a mean difference between GMI and HbA1c of 0.757 ± 0.687% (95% limits of agreement: -0.590 and 2.105). Difference was greater as the values of GMI and HbA1c increased. The agreement was poor [CCC 0.477; 95% confidence interval (CI): 0.360-0.594], as well as the concordance of values with good glycemic control according to GMI versus HbA1c (67.5% versus 29.7%, p < 0.001) (Kappa 0.2430; 95% CI: 0.16-0.32). Conclusion: The HbA1c overestimates the GMI values with highly variable ranges of difference, which prevents a precise correction factor. isCGM probably is a safer option for monitoring and decision-making in this population, especially in patients treated with insulin where the risk of hypoglycemia is greater.
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BACKGROUND: We present the first results of the Accreditation System of Medical Schools (Sistema de Acreditação de Escolas Médicas - SAEME) in Brazil. METHODS: We evaluated the results of the accreditation of medical schools from 2015 to 2023. The self-evaluation form of the SAEME is specific for medical education programs and has eighty domains, which results in final decisions that are sufficient or insufficient for each domain. We evaluated the results of the first seventy-six medical schools evaluated by the SAEME. RESULTS: Fifty-five medical schools (72.4%) were accredited, and 21 (27.6%) were not. Seventy-two (94.7%) medical schools were considered sufficient in social accountability, 93.4% in integration with the family health program, 75.0% in faculty development programs and 78.9% in environmental sustainability. There was an emphasis on SAEME in student well-being, with seventeen domains in this area, and 71.7% of these domains were sufficient. The areas with the lowest levels of sufficiency were interprofessional education, mentoring programs, student assessment and weekly distribution of educational activities. CONCLUSION: Medical schools in Brazil are strongly committed to social accountability, integration with the national health system, environmental sustainability and student well-being programs. SAEME is moving from episodic evaluations of medical schools to continuous quality improvement policies.
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Acreditação , Faculdades de Medicina , Brasil , Acreditação/normas , Faculdades de Medicina/normas , Humanos , Educação Médica/normas , Currículo , Responsabilidade SocialRESUMO
BACKGROUND: Continuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America. METHODS: The modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes. RESULTS: Based on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards. CONCLUSIONS: The use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available.
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OBJECTIVE: To assess the outcome of patients with cancer-related sepsis requiring continuous renal replacement therapy (CRRT) in a single-center pediatric intensive care unit (PICU). METHOD: Children with sepsis who necessitate CRRT from January 2017 to December 2021 were enrolled. The patients with leukemia/lymphoma or solid tumors were defined as underlying cancer. Multivariate logistic regression analysis was performed to identify the death risk factors in patients with cancer-related sepsis. RESULTS: A total of 146 patients were qualified for inclusion. Forty-six (31.5%) patients with cancer-related sepsis and 100 (68.5%) non-cancer-related sepsis. The overall PICU mortality was 28.1% (41/146), and mortality was significantly higher in cancer-related sepsis patients compared with non-cancer patients (41.3% vs. 22.0%, p = 0.016). Need mechanical ventilation, p-SOFA, acute liver failure, higher fluid overload at CRRT initiation, hypoalbuminemia, and high inotropic support were associated with PICU mortality in cancer-related sepsis patients. Moreover, levels of IL-6, total bilirubin, creatinine, blood urea nitrogen, and international normalized ratio were significantly higher in non-survivors than survivors. In multivariate logistic regression analysis, pediatric sequential organ failure assessment (p-SOFA) score (OR:1.805 [95%CI: 1.047-3.113]) and serum albumin level (OR: 0.758 [95%CI: 0.581 -0.988]) were death risk factors in cancer-related sepsis receiving CRRT, and the AUC of combined index of p-SOFA and albumin was 0.852 (95% CI: 0.730-0.974). CONCLUSION: The overall PICU mortality is high in cancer-related sepsis necessitating CRRT. Higher p-SOFA and lower albumin were independent risk factors for PICU mortality.
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Terapia de Substituição Renal Contínua , Unidades de Terapia Intensiva Pediátrica , Neoplasias , Sepse , Humanos , Estudos Retrospectivos , Sepse/mortalidade , Sepse/complicações , Sepse/terapia , Masculino , Feminino , Neoplasias/mortalidade , Neoplasias/complicações , Neoplasias/terapia , Criança , Pré-Escolar , Fatores de Risco , Lactente , Mortalidade Hospitalar , AdolescenteRESUMO
OBJECTIVE: To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM. METHODS: An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American. RESULTS: The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM. CONCLUSION: Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.
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We introduce a new class of zero-or-one inflated power logit (IPL) regression models, which serve as a versatile tool for analyzing bounded continuous data with observations at a boundary. These models are applied to explore the effects of climate changes on the distribution of tropical tuna within the North Atlantic Ocean. Our findings suggest that our modeling approach is adequate and capable of handling the outliers in the data. It exhibited superior performance compared to rival models in both diagnostic analysis and regarding the inference robustness. We offer a user-friendly method for fitting IPL regression models in practical applications.
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Clima Tropical , Atum , Animais , Modelos Logísticos , Oceano Atlântico , Biometria/métodosRESUMO
The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the patient from invasive mechanical ventilation (iMV) for approximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance tomography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effectively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.
La prueba de apnea es una técnica diagnóstica ampliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al paciente de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigenación mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO 2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO 2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAPAT) mitiga eficazmente el colapso pulmonar. Este enfoque resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.
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Impedância Elétrica , Medidas de Volume Pulmonar , Humanos , Masculino , Feminino , Medidas de Volume Pulmonar/métodos , Pessoa de Meia-Idade , Apneia/fisiopatologia , Morte Encefálica/fisiopatologia , Morte Encefálica/diagnóstico , Morte Encefálica/diagnóstico por imagem , Adulto , Tomografia/métodos , Pressão Positiva Contínua nas Vias Aéreas , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , IdosoRESUMO
Abstract Objective: To correlate the nasal anatomical characteristics of newborns with the dimensions of short binasal prongs. Method: Observational, cross-sectional study carried out in two hospitals in southern Brazil. The authors evaluated 1620 newborns with neonatal data and nasal dimensions. To measure the dimensions of the nasal region, the authors considered the width of the medial columella, the right nostril diameter, and the left nostril diameter. These data were correlated with the dimensions of two models of short binasal prongs. Results: Of the total newborns evaluated, 807 were female (49.8%), and 813 were male (50.2%). The majority were white (96.2%). The mean gestational age was 37.4 ± 2.9 weeks, ranging from 22 to 42 weeks. The birth weight was 2946.8 ± 699.3 g, ranging from 490.0 to 4740.0 g. Most of the nasal measures were significantly larger than both prong model measurements. Conclusion: The sizes of short binasal prongs available on the Brazilian market do not match the nasal anatomical characteristics of newborns.
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AIM: To evaluate the use of intermittently scanned continuous glucose monitoring (isCGM) in patients with liver cirrhosis (LC). METHODS: Observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without diabetes (DM) (G1), 10 with newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous DM diagnosis (G3). isCGM (FreeStyle Libre Pro) was used for 56 days (four sensors/patient). Blood tests were performed at baseline and after 28 and 56 days. RESULTS: No differences were found in the baseline characteristics, except for higher age in G3. There were significant differences between G1, G2 and G3 in glucose management indicator (GMI) (5.28 ± 0.17, 6.03 ± 0.59, 6.86 ± 1.08%, P < .001), HbA1c (4.82 ± 0.39, 5.34 ± 1.26, 6.97 ± 1.47%, P < .001), average glucose (82.79 ± 7.06, 113.39 ± 24.32, 149.14 ± 45.31mg/dL, P < .001), time in range (TIR) (70.89 ± 9.76, 80.2 ± 13.55, 57.96 ± 17.96%, P = .006), and glucose variability (26.1 ± 5.0, 28.21 ± 5.39, 35.31 ± 6.85%, P = .004). There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0.35% (95% SD 0.17, 0.63). In G1, the mean difference was 0.46% (95% SD 0.19, 0.73) and in G2 0.69% (95% SD 0.45, 1.33). GMI and HbA1c were concordant in G3, with a mean difference of -0.10 % (95% SD [-0.59, 0.38]). CONCLUSION: Disagreements were found between the GMI and HbA1c levels in patients with LC. isCGM was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c, suggesting that isCGM can be useful in assessing glycemic control in patients with LC.
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BACKGROUND: Diabetes Mellitus (DM) is an important chronic disease that occurs worldwide. AIMS: This study aims to investigate how the use of the FreeStyle® Libre system in Unified Health System (SUS) patients impacts diabetes parameters in patients who receive education on proper insulin administration and the use of the continuous monitoring device, as well as how this affects patients without any concomitant multidisciplinary support in Sergipe, Brazil. METHODS: We conducted a prospective randomized study in a diabetes clinic in Sergipe, Brazil, using the flash method FreeStyle® Libre (Abbott). The participants were divided into two groups: one receiving diabetes education on CGM (continuous glucose monitoring), while the other did not. Before the intervention, the patient's treatment motivation and quality of life were assessed using a questionnaire, and baseline levels of glycated hemoglobin were measured using high-performance liquid chromatography (HPLC) and the point of care AlereTM Afinion with boronate fixation. We compared first- and second-phase data with respect to glycated hemoglobin, mean interstitial blood glucose, time on and above target for hypoglycemic and hyperglycemic events, and mean hypoglycemic duration. RESULTS: In group A, which received the diabetes education intervention, there was a significant reduction in average HbA1c levels from 8.6% to 7.9% after 3 months (p = 0.001). However, there was no significant difference in average glycemic values. Time above target decreased significantly from 50.62% to 29.43% (p = 0.0001), while time below target decreased from 22.90% to 20.21% (p = 0.002). There was no significant change in the number of hypoglycemic events, but the duration of hypoglycemia decreased significantly from 130.35 min to 121.18 min after 3 months (p = 0.0001). In Group B, there was no significant difference in mean HbA1c levels before (7.07%) and after (7.28%) sensor installation. This group maintained lower HbA1c levels compared to the other group. Average blood glucose levels also remained similar before (148.37 mg/dL) and after (154.65 mg/dL) the intervention. Although the time above the target glucose level increased significantly from 35.94% to 48.17%, the time at target decreased from 50.40% to 37.97%. No significant changes were observed in the time below target, the number of hypoglycemic events, or the duration of hypoglycemia. CONCLUSIONS: Our findings indicate that utilizing continuous glucose monitoring technology can enhance glycemic control, particularly in motivated, educated, low-income patients dependent on the SUS. To achieve positive results with FreeStyle Libre, it is imperative to allocate resources for multidisciplinary support.
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OBJECTIVE: The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment. METHODS: Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire. RESULTS: The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups. CONCLUSION: Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.
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Background and Objectives: hand hygiene (HH) is a crucial safety practice, but lack of knowledge can hinder compliance. The objective was to measure and assess the knowledge of nursing professionals who provided care during the COVID-19 pandemic regarding HH and to verify the association between HH knowledge and professional category and regions in Brazil. Methods: an observational study was conducted from November 2020 to December 2021 involving 493 nursing professionals from all regions of Brazil. Data collection was carried out using Google Forms® and social media platforms. The Hand Hygiene Knowledge Test for Healthcare Professionals was used, and results were analyzed descriptively. Pearson's chi-square test (x2) and Fisher's exact test were employed to assess associations. Results: among the participants, the majority (74.7%) had limited or subpar knowledge of HH. Nurses had a higher level of knowledge compared to nursing assistants and licensed practical nurses. Associations were found between professional category and correct answers regarding microorganism destruction time and the type of HH to be used. Conclusion: Brazilian nursing professionals had limited knowledge of HH, with nurses displaying a higher level of knowledge compared to nursing assistants and licensed practical nurse. Continuous education and guidance are necessary to improve HH practices among the nursing staff.(AU)
Justificativas e Objetivos: a higiene das mãos (HM) é uma prática crucial para a segurança, mas a falta de conhecimento pode prejudicar a adesão. Este estudo avaliou o conhecimento dos profissionais de enfermagem que prestaram cuidados durante a pandemia de Covid-19 em relação à HM e explorou a associação entre o conhecimento de HM, categoria profissional e regiões no Brasil. Métodos: um estudo observacional foi conduzido de novembro de 2020 a dezembro de 2021 envolvendo 493 profissionais de enfermagem de todas as regiões do Brasil. A coleta de dados foi realizada usando o Google Forms® e plataformas de mídia social. Foi utilizado o Teste de Conhecimento de Higiene das Mãos para Profissionais de Saúde, e os resultados foram analisados descritivamente. O teste qui-quadrado de Pearson (x2) e o teste exato de Fisher foram empregados para avaliar as associações. Resultados: entre os participantes, a maioria (74,7%) tinha conhecimento limitado ou insuficiente sobre HM. Os enfermeiros apresentaram um nível mais elevado de conhecimento em comparação com os auxiliares e técnicos de enfermagem. Foram encontradas associações entre a categoria profissional e respostas corretas sobre o tempo de destruição de microrganismos e o tipo de HM a ser utilizado. Conclusão: os profissionais de enfermagem brasileiros possuíam conhecimento limitado sobre HM, sendo que os enfermeiros apresentaram um nível mais elevado de conhecimento em comparação com os auxiliares e técnicos de enfermagem. Educação contínua e orientação são necessárias para melhorar as práticas de HM entre a equipe de enfermagem.(AU)
Justificación e Objetivos: la higiene de manos (HM) es una práctica de seguridad crucial, pero la falta de conocimiento puede dificultar el cumplimiento. Este estudio evaluó el conocimiento de los profesionales de enfermería que brindaron atención durante la pandemia de Covid-19 en relación con la HM y exploró la asociación entre el conocimiento de HM, la categoría profesional y las regiones en Brasil. Métodos: se realizó un estudio observacional desde noviembre de 2020 hasta diciembre de 2021 que incluyó a 493 profesionales de enfermería de todas las regiones de Brasil. La recopilación de datos se realizó utilizando Google Forms® y plataformas de redes sociales. Se utilizó el Test de Conocimiento de Higiene de Manos para Profesionales de la Salud, y los resultados se analizaron de manera descriptiva. Se emplearon la prueba chi-cuadrado de Pearson (x2) y la prueba exacta de Fisher para evaluar las asociaciones. Resultados: entre los participantes, la mayoría (74,7%) tenía conocimiento limitado o deficiente de HM. Las enfermeras tenían un nivel de conocimiento más alto en comparación con los auxiliares y técnicos de enfermería. Se encontraron asociaciones entre la categoría profesional y las respuestas correctas sobre el tiempo de destrucción de microorganismos y el tipo de HM que debía utilizarse. Conclusión: los profesionales de enfermería brasileños tenían un conocimiento limitado de HM, siendo que las enfermeras mostraban un nivel de conocimiento más alto en comparación con los auxiliares y técnicos de enfermería. Se requiere educación continua y orientación para mejorar las prácticas de HM entre el equipo de enfermería(AU)
Assuntos
Humanos , Brasil , Controle de Infecções , Educação Continuada , Higiene das Mãos , COVID-19 , Profissionais de Enfermagem , Equipe de EnfermagemRESUMO
Significance: Continuous-wave functional near-infrared spectroscopy has proved to be a valuable tool for assessing hemodynamic activity in the human brain in a non-invasively and inexpensive way. However, most of the current processing/analysis methods assume the head is a homogeneous medium, and hence do not appropriately correct for the signal coming from the scalp. This effect can be reduced by considering light propagation in a layered model of the human head, being the Monte Carlo (MC) simulations the gold standard to this end. However, this implies large computation times and demanding hardware capabilities. Aim: In this work, we study the feasibility of replacing the homogeneous model and the MC simulations by means of analytical multilayered models, combining in this way, the speed and simplicity of implementation of the former with the robustness and accuracy of the latter. Approach: Oxy- and deoxyhemoglobin (HbO and HbR, respectively) concentration changes were proposed in two different layers of a magnetic resonance imaging (MRI)-based meshed model of the human head, and then these changes were retrieved by means of (i) a typical homogeneous reconstruction and (ii) a theoretical layered reconstruction. Results: Results suggest that the use of analytical models of light propagation in layered models outperforms the results obtained using traditional homogeneous reconstruction algorithms, providing much more accurate results for both, the extra- and the cerebral tissues. We also compare the analytical layered reconstruction with MC-based reconstructions, achieving similar degrees of accuracy, especially in the gray matter layer, but much faster (between 4 and 5 orders of magnitude). Conclusions: We have successfully developed, implemented, and validated a method for retrieving chromophore concentration changes in the human brain, combining the simplicity and speed of the traditional homogeneous reconstruction algorithms with robustness and accuracy much more similar to those provided by MC simulations.