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1.
Lipids Health Dis ; 24(1): 37, 2025 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-39905430

RESUMO

BACKGROUND: The impact of a healthy diet on the secondary prevention of ischemic stroke (IS) remains uncertain. Levels of low-density lipoprotein cholesterol (LDL-C) are inversely associated with the risk of IS recurrence. A Mediterranean diet (MeDi), consisting of a preference for fish/poultry, monosaturated fats from olive oil, fruit, vegetables, whole grains, legumes/nuts and limited red meats, animal fats and sweetened beverages, reduces metabolic syndrome, LDL-C levels and stroke risk. Avocados also reduce metabolic syndrome and LDL-C levels but are not part of the traditional MeDi diet. The effects of an avocado-based Mediterranean diet on LDL-C were investigated and compared to those of a low-fat diet in patients with previous IS. METHODS: The Avocado-Based Mediterranean Diet on Serum Lipids for Secondary Prevention after Ischemic Stroke (ADD-SPISE) was a prospective, randomized, open-label, blinded outcome assessment, phase 2, clinical trial. The participants were adults with an IS in the previous month who were randomly assigned at a 1:1 ratio to a MeDi or a low-fat diet for three months. Outcome assessors of laboratory results and data analysts were masked. The primary outcome was the mean difference in LDL-C between groups at 90 days, adjusted by statin use. Safety, feasibility and acceptability (assessed through a 14-item questionnaire administered to all patients who completed the follow-up) were also evaluated. RESULTS: From August 2018 to October 2022, 200 participants were enrolled (97 randomized to the low-fat diet and 103 to the MeDi), with 189 (94.5%) completing the study. There were no significant differences in LDL-C levels between the MeDi group and the low-fat group at 90 days: 66.5 mg/dL (95% confidence interval [CI] 59.6, 73.4) in the MeDi group and 69.9 mg/dL (62.6, 77.2) in the low-fat group at the end of follow-up. The adjusted difference was - 3.4 mg/dL (-13.4, -6.62); P = 0.50. The intervention group showed significant improvements in Mediterranean diet adherence (P < 0.01). Moreover, no significant differences in adverse events were observed between the groups. CONCLUSION: Compared with a low-fat diet, the avocado-based MeDi did not significantly lower LDL-C in IS patients after three months. The intervention was safe, feasible, and well accepted. Larger trials should establish whether longer dietary interventions could yield clinically significant benefits in these patients. The study is registered under ADD-SPISE at www. CLINICALTRIALS: gov . Identifier: NCT03524742.


Assuntos
LDL-Colesterol , Dieta Mediterrânea , AVC Isquêmico , Persea , Prevenção Secundária , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Prevenção Secundária/métodos , AVC Isquêmico/prevenção & controle , AVC Isquêmico/sangue , AVC Isquêmico/dietoterapia , LDL-Colesterol/sangue , Projetos Piloto , Dieta com Restrição de Gorduras , Lipídeos/sangue , Estudos Prospectivos
2.
Rev Lat Am Enfermagem ; 33: e4443, 2025.
Artigo em Inglês, Espanhol, Português | MEDLINE | ID: mdl-39907389

RESUMO

OBJECTIVE: to identify the main factors related to complications of the invasive blood pressure system. METHOD: prospective study conducted with patients over 18 years of age admitted to intensive care, using a device for measuring invasive blood pressure. Participants were monitored during the catheter dwell-time and sociodemographic, clinical and device data were collected. The outcome analyzed was removal due to non-indication of use or due to complications. Student's t-test, Mann-Whitney U test, chi-square test and Fisher's exact test were used for the analyses. RESULTS: 50 participants were included and monitored, and most devices were installed in the radial artery (86%), with a 20-gauge catheter (50%), all with a flexible catheter. Each patient remained, on average, 4.36 days (SD: 3.504) with the device. Regarding the outcomes, 60.0% of the devices were removed due to non-indication of use and 40.0% due to complications. Phlebitis was the most prevalent complication, and pressure in the bag was the factor associated with catheter removal before the time of indication (p=0.046). CONCLUSION: the main complications associated with this device were obstruction and phlebitis, while pressure in the bag was the factor related to catheter removal before indication. BACKGROUND: (1) Phlebitis was the most prevalent complication. (2) Pressure in the bag was associated with catheter removal before indication. (3) Length of stay and use of sedation were related to the onset of phlebitis.


Assuntos
Determinação da Pressão Arterial , Humanos , Estudos Prospectivos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Determinação da Pressão Arterial/instrumentação , Adulto , Idoso de 80 Anos ou mais , Flebite/etiologia , Flebite/epidemiologia
3.
Braz J Med Biol Res ; 58: e14103, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39907425

RESUMO

Frailty is a significant risk factor for adverse outcomes in elderly surgical patients. Gait speed assessment is a new tool recently used to stratify risk for these pre-operative adverse outcomes. In this prospective study of 392 frail elderly patients undergoing abdominal surgery, we investigated the predictive value of preoperative gait speed for postoperative outcomes. Patients were divided into two groups based on their 6-meter gait speed: normal (≥0.8 m/s, n=184) and slow (<0.8 m/s, n=208). The slow group was older, had more comorbidities, and higher American Society of Anesthesiologists (ASA) grades (P<0.05). They also had significantly higher rates of 30-day overall complications (38.9 vs 18.5%, P<0.01), severe complications (12.0 vs 4.3%, P<0.01), and 1-year mortality (15.4 vs 6.5%, P=0.008) compared to the normal group. Pulmonary infection, wound infection, and delirium were the most common complications. Multivariate logistic regression confirmed slow gait speed as an independent risk factor for 30-day complications (OR=2.38, 95%CI: 1.41-4.01) and 1-year mortality (OR=2.19, 95%CI: 1.07-4.48). Our findings demonstrated that preoperative 6-meter gait speed effectively predicted short-term complications and mid-term mortality in frail elderly patients undergoing abdominal surgery. This suggests the need for individualized perioperative management strategies for high-risk patients with slow gait speed to potentially improve their prognosis.


Assuntos
Idoso Fragilizado , Avaliação Geriátrica , Complicações Pós-Operatórias , Velocidade de Caminhada , Humanos , Estudos Prospectivos , Idoso , Feminino , Masculino , Velocidade de Caminhada/fisiologia , Complicações Pós-Operatórias/mortalidade , Prognóstico , Idoso de 80 Anos ou mais , Fatores de Risco , Avaliação Geriátrica/métodos , Abdome/cirurgia , Medição de Risco/métodos , Valor Preditivo dos Testes , Período Pré-Operatório
4.
Braz J Med Biol Res ; 58: e13965, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39907423

RESUMO

This systematic review of inception prospective cohort studies aimed to investigate whether autoantibodies are potential prognostic factors for short- and long-term clinical outcomes of COVID-19. Searches were conducted in MEDLINE, EMBASE, AMED, GLOBAL HEALTH, and COCHRANE databases from 2019 to 2022. When possible, meta-analysis was conducted, otherwise findings from individual studies were reported using odds ratios (OR) with 95% confidence intervals (CI). Quality of evidence was summarized using the GRADE criteria. We identified 2292 references, 18 inception prospective cohort studies (3178 patients) were included in the systematic review, and 12 studies reached criteria for meta-analysis. Studies achieved, in general, low to moderate risk of bias. Moderate quality of evidence showed that anti-interferon (IFN) was associated with increased risk of severity (OR=7.75; CI=1.79-33.61) and mechanical ventilation (OR=4.19; CI=2.06-8.53), but not with COVID-19 mortality (OR=1.68; CI=0.63-4.44). Antiphospholipids were not associated with COVID-19 mortality (OR=1.42; CI=0.85-2.37; P=0.18; I2=3.21) nor with thrombosis risk (OR=1.41; CI: 0.71-2.8; P=0.33). Antinuclear antibody level was not associated with risk of mortality or severity (risk for mortality: OR=3.8; CI=0.78-18.6; P=0.1; I2: 32.3; severity: OR=1.74; CI=0.96-3.16; P=0.07). Evidence currently available is insufficient for a quantitative analysis of autoantibodies association with long COVID-19. Anti-IFN measurement should be considered in COVID-19 follow-up. In a population-based rational, optimized vaccination strategies should be considered for individuals with anti-IFN antibodies since it could represent a risk for a worse prognosis. High-quality prospective studies for short- and long-term disease effects and autoantibody evaluation are still needed.


Assuntos
Autoanticorpos , COVID-19 , SARS-CoV-2 , Humanos , COVID-19/imunologia , COVID-19/mortalidade , Autoanticorpos/sangue , Prognóstico , SARS-CoV-2/imunologia , Estudos Prospectivos
5.
BMC Ophthalmol ; 25(1): 57, 2025 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-39901127

RESUMO

BACKGROUND: Multifocal intraocular lenses (IOLs) are designed to reduce dependence on spectacles by providing multiple focal points. However, they are associated with photic phenomena such as halos and glare, and may reduce contrast sensitivity. The BIOS Trifocal is a single-piece acrylic diffractive IOL with a closed-loop haptic design, optimized for centration and stability. It features an aspheric, aberration-neutral surface and a precisely engineered diffraction grating for effective energy distribution across multiple distances. This study aims to evaluate the visual, clinical, and quality of life outcomes of the BIOS Trifocal IOL for treatment of cataract and presbyopia. METHODS: Participants who met the inclusion criteria underwent implantation of the BIOS Trifocal IOL and were assessed at 30 and 90 days post-surgery. The evaluations included measurements of patient-reported outcomes using the NEI-VFQ 25 at postoperative day 30 and uncorrected and corrected distance visual acuity and defocus curves at postoperative day 90. Additionally, intraoperative and postoperative complications were documented. Visual acuity assessments were performed under photopic conditions, with a range of defocus from + 1.5 D to -3.0 D. RESULTS: Significant improvements were observed in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and near visual acuity (UNVA) at both 30 and 90 days post-surgery (p < 0.001). The defocus curve demonstrated functional vision from + 1.5 D to -3.0 D, supporting the lens's efficacy for near, intermediate, and far distances. Quality of life, as assessed by the NEI-VFQ 25, showed marked improvement across all domains (p < 0.05), with no significant complications directly attributable to the IOL. CONCLUSIONS: The BIOS Trifocal IOL presented satisfactory effectivity in the treatment of cataract and presbyopia, providing functional vision across near, intermediate and far distances and maintaining good patient satisfaction. TRIAL REGISTRATION: This trial was registered at the ReBEC (Registro Brasileiro de Ensaios Clínicos - Brazilian Registry of Clinical Trials)database under the registration code RBR-772s6y at April 6th, 2020.


Assuntos
Lentes Intraoculares Multifocais , Desenho de Prótese , Qualidade de Vida , Acuidade Visual , Humanos , Acuidade Visual/fisiologia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Pseudofacia/fisiopatologia , Presbiopia/cirurgia , Presbiopia/fisiopatologia , Implante de Lente Intraocular/métodos , Refração Ocular/fisiologia , Satisfação do Paciente , Estudos Prospectivos , Facoemulsificação , Sensibilidades de Contraste/fisiologia , Lentes Intraoculares
6.
Sci Rep ; 15(1): 4239, 2025 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-39905083

RESUMO

Preoperative anemia is associated with poor outcomes, but less is known about its impact on quality of life (QoL). This study investigates the association between preoperative anemia and QoL in elderly undergoing major abdominal surgery. This prospective observational study was conducted from 2017 to 2021 in a tertiary hospital's preoperative anesthesia clinic. QoL outcomes were assessed using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) and the EuroQol-Visual Analogue Scale (EQ-VAS). Data was collected at baseline, 1-, 3-, and 6-month postoperatively. Patients were included if they were 65 years or older, could provide written informed consent and were planned for elective major abdominal surgery. Patients were excluded if they were going for organ transplant surgery. A total of 469 patients were analyzed, of which 176 (38%) had anemia. There was no significant difference across varying anemia severity in EQ-5D-3L dimensions of mobility, self-care, usual activities, and pain/discomfort. Moderate-to-severe anemic patients generally have more issues across EQ-5D-3L dimensions. At baseline, these patients exhibited more issues with self-care (3%), pain/discomfort (13%), and anxiety/depression (19%), along with a lower mean EQ-VAS score of 77. However, there was a significant improvement in mobility, usual activities, and pain/discomfort over time. EQ-VAS score significantly improved for all groups of patients over time. The dimensions of EQ-5D-3L and EQ-VAS scores improved as the severity of anemia decreased. Preoperative anemia is associated with a significant decrease in QoL based on EQ-VAS. Recognizing and managing preoperative anemia may improve the recovery of elderly patients undergoing major abdominal surgery.


Assuntos
Abdome , Anemia , Complicações Pós-Operatórias , Qualidade de Vida , Humanos , Idoso , Anemia/epidemiologia , Masculino , Feminino , Estudos Prospectivos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Idoso de 80 Anos ou mais , Abdome/cirurgia , Período Pré-Operatório
7.
Arq Bras Cardiol ; 122(1): e20240249, 2025 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-39907376

RESUMO

BACKGROUND: Previous studies have shown that women with coronary artery disease (CAD) are less likely to undergo angiography and have less favorable outcomes after percutaneous coronary intervention (PCI). OBJECTIVES: Assess the outcomes of women with acute coronary syndrome (ACS) and stable CAD (lesion>50%) treated with contemporary PCI using DES. METHODS: Observational, longitudinal cohort study with prospective follow-up included all female patients ≥ 18 years admitted at a tertiary public cardiovascular center in Brazil from January 2019 to December 2020. The level of significance adopted in the statistical analysis was 5%. RESULTS: 1146 women (average age 65 years) underwent guideline-recommended PCI. Risk factors were frequent (hypertension: 88%, dyslipidemia: 85%, diabetes: 47.5%), and 69% were admitted due to ACS. Radial access was used in 59% of patients; 1516 vessels were treated with 1725 stents implanted (1.5 stents/patient). PCI was successful in 97.7%, in-hospital death occurred in 1.2%, peri-procedural MI in 3.6%, and TIA in 0.4%. Predictors of in-hospital major adverse cardiac and cerebrovascular events (MACCE): previous stroke (OR: 2.97; CI: 1.06-7.15; p= 0.023), CKD (OR: 3.11; CI: 1.49-6.20; p= 0.002), and at least one procedural failure during PCI (OR: 10.2; CI: 1.17-5.9; p<0.001). The average follow-up was 576.2 days in 1047 patients. All-cause mortality occurred in 5.3%, cardiac death in 3.5%, recurrent ACS in 8%, and additional revascularization procedures in 5.5%. The predictors for MACCE during FU were hospital admission for ACS for the index PCI (OR: 1.58; HR: 1.06-2.35; p=0.023) and the presence of MACCE during hospitalization (OR: 6.66; HR: 2.42- 18.3; p< 0.001). CONCLUSION: In this pioneering study involving 1146 patients treated by contemporary PCI and followed for almost 2 years, we obtained very encouraging in-hospital and mid-term results.


FUNDAMENTO: Estudos prévios demonstram que mulheres com doença arterial coronariana (DAC) são menos submetidas a angiografia e apresentam resultados menos favoráveis após intervenção coronariana percutânea (ICP). OBJETIVOS: Avaliar os resultados de mulheres com síndrome coronariana aguda (SCA) e DAC estável (lesão>50%) tratadas com ICP contemporânea usando stents liberadores de drogas. MÉTODOS: Estudo de coorte observacional, longitudinal, com acompanhamento prospectivo, que incluiu todas as pacientes do sexo feminino > 18 anos admitidas em centro cardiológico público terciário no Brasil, no período de janeiro de 2019 a dezembro de 2020. RESULTADOS: 1146 mulheres (idade média de 65 anos) foram submetidas à ICP recomendada pela diretriz. Os fatores de risco foram frequentes (hipertensão: 88%, dislipidemia: 85%, diabetes: 47,5%) e 69% foram internadas devido à SCA. O acesso radial foi usado em 59% das pacientes; 1516 vasos foram tratados com 1725 stents implantados (1,5 stents/paciente). A ICP foi bem-sucedida em 97,7%, a morte intra-hospitalar ocorreu em 1,2%, IM periprocedimento em 3,6% e ataque isquêmico transitório em 0,4%. Preditores de eventos adversos cardíacos e cerebrovasculares maiores (ECCAM) intra-hospitalares: acidente vascular cerebral prévio (OR: 2,97; IC: 1,06-7,15; p = 0,023), DRC (OR: 3,11; IC: 1,49-6,20; p = 0,002) e pelo menos uma falha de procedimento durante ICP (OR: 10,2; IC: 1,17-5,9; p < 0,001). O acompanhamento médio foi de 576,2 dias em 1.047 pacientes. Mortalidade por todas as causas ocorreu em 5,3%, morte cardíaca em 3,5%, nova SCA em 8% e necessidade de nova revascularização em 5,5%. Os preditores de ECCM durante o seguimento foram admissão por SCA (retirar índice ICP) e a presença de ECCM durante a hospitalização (OR: 6,66; HR: 2,42-18,3; p< 0,001). CONCLUSÃO: Neste estudo pioneiro envolvendo 1146 pacientes tratados por ICP contemporânea e acompanhados por quase 2 anos, obtivemos resultados hospitalares e de médio prazo muito encorajadores.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Humanos , Feminino , Idoso , Estudos Longitudinais , Pessoa de Meia-Idade , Doença da Artéria Coronariana/cirurgia , Fatores de Risco , Resultado do Tratamento , Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/cirurgia , Estudos Prospectivos , Brasil , Guias de Prática Clínica como Assunto , Mortalidade Hospitalar , Stents Farmacológicos
8.
Clinics (Sao Paulo) ; 80: 100572, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39864315

RESUMO

PURPOSE: This study aimed to evaluate the accuracy and quality of healing of main corneal incisions in femtosecond laser procedures in cataract surgery. METHODS: It was a prospective, non-randomized, investigator-masked study. A total of 37 eyes of 37 patients with indication for cataract surgery were separated into two groups in this prospective, nonrandomized study: Femto group, with incisions automated by femtosecond laser (18 eyes), and Phaco group, with incisions made using a keratome (19 eyes). The planned incisions were 2.2 mm wide and 1.65 mm long. The length of the incision and prevalence of endothelial gap, endothelial misalignment, and localized Descemet Membrane Detachment (DMD) were compared. RESULTS: The mean incision length was statistically higher in the Femto group in two examinations: 1.64 mm ± 0.16 vs. 1.43 mm ± 0.30 (p = 0.001) in Exam 1 (between 2 and 4 days) and 1.58 mm ± 0.22 vs. 1.27 mm ± 0.34 (p < 0.0001) in Exam 2 (between 1 and 3 months). No eye presented an endothelial gap in Exam 2. The endothelial gap was higher in the Femto group in Exam 1. In the two examinations, endothelial misalignment was lower in the Femto group, whereas the incidence of DMD was lower in the Femto group in the two examinations. CONCLUSIONS: Automated incisions with femtolaser presented a higher mean length and lower DMD prevalence compared to manual incisions with a keratome.


Assuntos
Córnea , Terapia a Laser , Facoemulsificação , Cicatrização , Humanos , Facoemulsificação/métodos , Facoemulsificação/efeitos adversos , Estudos Prospectivos , Feminino , Masculino , Idoso , Córnea/cirurgia , Pessoa de Meia-Idade , Terapia a Laser/métodos , Fatores de Tempo , Resultado do Tratamento , Idoso de 80 Anos ou mais , Endotélio Corneano/patologia , Reprodutibilidade dos Testes
9.
Clinics (Sao Paulo) ; 80: 100584, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39879907

RESUMO

BACKGROUND: Post-acute COVID-19 Syndrome (PACS) occurs in some COVID-19 patients long after acute infection and significantly affects patients' health. However, the mechanism by which PACS develops is unknown. Myosin light chain 9 (Myl9), produced by activated platelets, plays a role in immune dysregulation and microthrombi formation during acute COVID-19. However, in the PACS phase, the association between Myl9 and residual symptoms remains unclear, and further investigation is needed. METHODS: In this prospective cohort study, serum Myl9 concentrations were measured in 195 COVID-19 patients during hospitalization and at 3- and 6-month follow-up visits. Gaussian mixture modeling was used to identify groups on the basis of Myl9 levels. Relationships between Myl9 levels and residual symptoms were evaluated. Clinical characteristics influencing Myl9 levels were analyzed via logistic regression. RESULTS: A total of 304 serum samples from 195 patients were collected. Two distinct groups were identified in the Myl9 distribution with a cutoff of 386 ng/mL by Gaussian mixture modeling in this cohort. The high-Myl9 group presented significant residual respiratory symptoms at 6 months post-infection (p < 0.05). Elevated Myl9 levels at 6 months were correlated with increased neutrophil counts (p < 0.01) and respiratory comorbidities at diagnosis (p < 0.05) according to univariate regression analysis. Multivariate regression analysis confirmed the relationship between the neutrophil count and high Myl9 levels. CONCLUSION: Prolonged high Myl9 levels are associated with respiratory symptoms, suggesting the potential involvement of prolonged inflammation or endothelial damage in PACS.


Assuntos
COVID-19 , Cadeias Leves de Miosina , Síndrome de COVID-19 Pós-Aguda , Humanos , COVID-19/sangue , COVID-19/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Seguimentos , Cadeias Leves de Miosina/sangue , Adulto , SARS-CoV-2 , Fatores de Tempo , Idoso , Biomarcadores/sangue
10.
Pediatrics ; 155(2)2025 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-39814049

RESUMO

BACKGROUND: Zika virus (ZIKV) infection during pregnancy can lead to congenital Zika syndrome (CZS) and may result in neurodevelopmental alterations in exposed children, with and without CZS. This study aimed to evaluate ZIKV infection during pregnancy as a risk factor for early and long-term adverse outcomes. METHODS: This retrospective-prospective, matched cohort study was conducted in Mato Grosso do Sul, Brazil. Mother-infant pairs exposed and unexposed to ZIKV during pregnancy were enrolled in the study from 2018 to 2022. Clinical and epidemiological data from the gestational period and neonatal evaluations were obtained from the Brazilian health surveillance system. Children were assessed for early (congenital anomalies) and long-term adverse outcomes (neurodevelopmental delay). Incidence risk ratio (IRR) and crude odds ratio (OR) were used to assess associations. RESULTS: The risk of adverse outcomes in exposed children was nearly 3-fold higher (IRR, 2.7; 95% CI, 1.4-5.1) compared with the control group. The risk of motor (IRR, 3.4; 95% CI, 1.2-9.6) and cognitive delay (IRR, 4.7; 95% CI, 1.7-13.0) was significantly higher in exposed children. In 44% of pregnancies wherein maternal infection occurred in the first trimester, at least 1 adverse event was identified in the child, with 11.2-fold greater odds of adverse outcomes (OR, 11.2; 95% CI, 3.6-35.0) compared with children of mothers infected in the third trimester. CONCLUSIONS: Children exposed to ZIKV in utero, even without CZS, demonstrate a greater risk for neurodevelopmental delay in early childhood, with the timing of maternal infection being a significant predictive risk factor.


Assuntos
Complicações Infecciosas na Gravidez , Infecção por Zika virus , Humanos , Feminino , Gravidez , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/complicações , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Brasil/epidemiologia , Estudos Prospectivos , Recém-Nascido , Masculino , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Lactente , Fatores de Risco , Pré-Escolar , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/etiologia , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia
11.
Crim Behav Ment Health ; 35(1): 31-40, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39833993

RESUMO

BACKGROUND: Many studies have found that a small group of chronic offenders is responsible for the majority of crimes and tend to be particularly violent. However, there is a major lack of evidence on chronic offending in low- and middle-income countries; understanding these patterns is especially important in settings with very high levels of serious violence, such as Brazil. AIMS: To identify the extent that crime is concentrated in chronic offenders and linked to violence and homicide in a Brazilian cohort. METHODS: The 1982 Pelotas Birth Cohort includes 5623 participants followed from birth in 1982 with complete crime records up to age 30. Chronic offenders were defined as individuals who committed five or more offences and, in aggregate, over 50% of all crimes. Key offending characteristics including age of onset, violent and homicide offending, and incarceration rates were compared across three different offender groups (one-timers, below-chronic and chronic offenders). RESULTS: Approximately 27% of participants had a record for at least one crime by age 30, and 5% were chronic offenders. Chronic offenders were responsible for 57% of all crimes, 54% of violent crimes and 68% of homicides. Chronic offenders exhibited more severe patterns of offending on all characteristics examined compared to non-chronic offenders. Homicides committed by chronic offenders were more likely to involve firearms than those by non-chronic offenders. DISCUSSION: This is the first study to analyse chronic offending within a large prospective cohort in a low- and middle-income country. Chronic offending patterns in this Brazilian setting resemble those in high-income country studies and are highly related to homicides.


Assuntos
Criminosos , Homicídio , Violência , Humanos , Homicídio/estatística & dados numéricos , Brasil/epidemiologia , Masculino , Adulto , Criminosos/estatística & dados numéricos , Criminosos/psicologia , Feminino , Estudos Prospectivos , Violência/estatística & dados numéricos , Adulto Jovem , Adolescente , Crime/estatística & dados numéricos
12.
Child Care Health Dev ; 51(1): e70033, 2025 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-39778873

RESUMO

BACKGROUND: Screen use has become nearly universal, especially in children. Therefore, it is important not only to comprehend its effects on health but also to understand its patterns of use. We aim to describe screen use patterns among children assessed at 2, 4, and 6-7 years, based on device, period of the day, and child/family characteristics. METHODS: Longitudinal study, with participants of the 2015 Pelotas (Brazil) Birth Cohort, a population-based study including all living newborns in the city of Pelotas between 1 January and 31 December 2015. Child/family characteristics used in the study were sex, skin color, family income, and maternal education. Screen time at 2 years was evaluated by TV time. At age 4, TV time and other screens (computer and videogames) was assesed. At 6-7 years, screen use was collected for each device (TV, smartphone, tablet/iPad, computer, and videogames). RESULTS: At 2, 4, and 6-7 years, 1420, 3963, and 3857 had valid screen time data, respectively. Mean total screen time ranged from ~ 2.5 h per day at age 2 to ~ 5.5 h per day at age 6-7. At 2 years, no difference in screen time was found according to child/family characteristics. In general, boys presented higher screen time values at 4 and 6-7 years. No differences for ethnicity were observed. For family income and maternal education, the extreme groups presented higher use. Higher values of screen time were also observed during the evening and for children who did not attend school nor had home activities during the Covid-19 pandemic. CONCLUSIONS: The results suggest that children are exceeding current screen time guidelines, with different patterns of use according to child/family characteristics. The high use of screens and more concentrated use during the evenings raise concern considering its possible negative effects on health.


Assuntos
Tempo de Tela , Humanos , Brasil/epidemiologia , Feminino , Masculino , Pré-Escolar , Criança , Estudos Prospectivos , Estudos Longitudinais , Televisão/estatística & dados numéricos , Jogos de Vídeo/estatística & dados numéricos , Comportamento Infantil , COVID-19/epidemiologia , Computadores/estatística & dados numéricos , Fatores Socioeconômicos
13.
Support Care Cancer ; 33(2): 108, 2025 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-39820523

RESUMO

OBJECTIVES: To analyze the presence of nutritional impact symptoms (NIS) throughout radiotherapy treatment in the head and neck, thorax, abdomen, and pelvis areas. METHODS: A prospective cohort study was conducted with individuals undergoing radiotherapy for cancer. Three assessments were carried out: at the start of radiotherapy, midway through, and in the last week of treatment. Clinical, anthropometric data, and the Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess symptoms. RESULTS: A total of 254 participants were evaluated at the start, 165 at the midpoint, and 120 at the end of the treatment. More than half of the participants at all stages were elderly. At the start, 51.6% were women, while at the end, 57.5% were men. Pelvic tumors were the most common, followed by tumors in the head and neck and thorax. The prevalence of NIS increased from 58.2% at the beginning to 76.9% at the midpoint (RR 1.32; 95% CI 1.17-1.48; p = < 0.001) and 78.3% at the end of treatment (RR 1.34; 95% CI 1.18-1.52; p = < 0.001). Odynophagia was the most reported symptom among patients with head and neck tumors, increasing from 24.5 to 66.6%, and from 3.0 to 22.2% by the end of treatment in patients with thoracic tumors. Diarrhea was common at the end of treatment among those with abdominal (69.2%) and pelvic (35.8%) tumors. CONCLUSION: NIS increased during radiotherapy. The location of tumors influences symptom prevalence, highlighting the need for continuous nutritional support.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias , Humanos , Feminino , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Idoso , Neoplasias/radioterapia , Neoplasias/complicações , Neoplasias de Cabeça e Pescoço/radioterapia , Estado Nutricional , Adulto , Estudos de Coortes , Neoplasias Pélvicas/radioterapia , Desnutrição/etiologia , Desnutrição/epidemiologia , Idoso de 80 Anos ou mais
14.
J Neurol ; 272(2): 157, 2025 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-39821642

RESUMO

BACKGROUND: The presence of diffuse brain damage in normal-appearing white matter (NAWM) and gray matter (NAGM) in neuromyelitis optica spectrum disorder (NMOSD) remains controversial. We aimed to address this controversy by applying a multiparametric MRI approach. Additionally, the association between MRI metrics and clinical variables was explored. METHODS: In this cross-sectional study, we prospectively evaluated aquaporin-4-IgG positive NMOSD patients and healthy controls (HC) matched for age and sex. The clinical variables of interest were collected for each participant. The mean values of T1-w/T2-w ratio, magnetization transfer ratio (MTR), fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were obtained in NAWM, NAGM, as well as in global and hypointense lesion masks. Global lesions refer to those typically associated with aquaporin-4-IgG positive NMOSD. Hypointense lesions were defined as areas of hypointense signal in both T1-w and fluid-attenuated inversion recovery (FLAIR) images. RESULTS: In total, we included 105 participants (59 NMOSD patients and 46 HC). T1-w/T2-w ratio was lower in NAWM of NMOSD patients versus HC (1.83 ± 0.14 vs 1.89 ± 0.14; p = 0.029), while no significant differences were found in NAWM or NAGM across the other metrics: (p range: 0.079 to 0.973). Hypointense lesions showed lower T1-w/T2-w ratio, MTR, and FA, and higher diffusivity metrics as compared to global lesion masks (p < 0.001). T1-w/T2-w ratio in NAWM was inversely correlated with time to start immunosuppressive therapy (r = - 0.278; p = 0.036) and with MD (r = - 0.325; p = 0.014). CONCLUSION: Microstructural integrity loss seems to be confined to focal tissue damage in NMOSD. Decreased T1-w/T2-w ratio in NAWM may reflect subclinical water accumulation due to astrocyte and blood-brain barrier dysfunction. Hypointense lesions have shown a severe degree of microstructural damage.


Assuntos
Encéfalo , Imagem de Tensor de Difusão , Neuromielite Óptica , Humanos , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/patologia , Feminino , Masculino , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Aquaporina 4/imunologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Estudos Prospectivos , Imageamento por Ressonância Magnética , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Adulto Jovem , Anisotropia
15.
Eur J Pediatr ; 184(2): 144, 2025 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-39825155

RESUMO

To evaluate the accuracy of the lung ultrasound score (LUS) in predicting ventilatory weaning failure during neonatal hospitalization in the NICU and to identify factors associated with weaning failure, including corrected gestational age (CGA). This prospective, longitudinal, pragmatic and observational cohort study included neonates on mechanical ventilation for at least 48 h. The primary outcome was the accuracy of lung ultrasound in predicting 3-day weaning failure, with the ROC curve used to determine the best LUS cutoff (sensitivity and specificity). Among 55 neonates, the pre-extubation LUS did not show statistical significance in predicting weaning failure (AUC 0.61; 95% CI: 0.46-0.76, p = 0,169). In the subgroup analysis, a score ≥ 4 suggests the need for ventilatory support after extubation (area under the curve [AUC] = 0.91, 95% CI: 0.80-1.0, p < 0.001) in neonates with GA ≥ 28 weeks. In extremely preterm infants, the pre-extubation LUS was not statistically significant in predicting weaning failure (AUC = 0.38, 95% CI: 0-0.77, p = 0.535). In contrast, CGA ≥ 28.7 weeks at extubation was predictor of successful weaning within 3 days (AUC = 0.95, 95% CI: 0.85-1.0, p < 0.001). CONCLUSION: LUS show promise in predicting weaning failure, though its accuracy may be limited in extremely preterm infants, highlighting the need for further well-powered studies. CGA at extubation also emerges as a key consideration in this population, warranting confirmation through robust future research. WHAT IS KNOWN: • Identifying the optimal timing for extubation is crucial, as both prolonged mechanical ventilation and failed extubation are linked to increased morbidity. • Lung ultrasound plays a well-established role in diagnosing various neonatal lung pathologies, allowing clinicians to make rapid, bedside decisions for the treatment of newborns. WHAT IS NEW: • LUS appears to be accurate in predicting weaning failure, though its accuracy may be lower in extremely preterm infants. • In extremely preterm infants, CGA may play an important role in extubation decision-making. • These findings are hypothesis-generating and warrant further investigation in future studies.


Assuntos
Extubação , Idade Gestacional , Unidades de Terapia Intensiva Neonatal , Pulmão , Ultrassonografia , Desmame do Respirador , Humanos , Recém-Nascido , Desmame do Respirador/métodos , Feminino , Masculino , Estudos Prospectivos , Ultrassonografia/métodos , Pulmão/diagnóstico por imagem , Falha de Tratamento , Estudos Longitudinais , Lactente Extremamente Prematuro , Valor Preditivo dos Testes , Curva ROC , Recém-Nascido Prematuro
16.
Lasers Med Sci ; 40(1): 21, 2025 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-39825978

RESUMO

PURPOSE: RVVC is defined as four or more episodes of candidiasis in a 12-month period. Conventional treatment is complex and often involves long-term medication use or multiple treatments. ABL therapy is a promising treatment option as it is acceptable to women and has only rare side effects. We conducted a prospective study with the objective of assessing the effects of antimicrobial blue light (ABL) therapy for recurrent vulvovaginal candidiasis (RVVC) in drug-resistant women. METHODS: Our study enrolled RVVC drug-resistant women (defined based on clinical non-response to standard azole therapies confirmed through culture or persistence of VVC symptoms (oedema, erythema, pruritus, burning, dysuria and leucorrhea)), who received ABL through 10 sessions for 20 min once a week from January 2023 to January 2024. The symptoms of Recurent VVC were assessed after 10 treatment sections and after 6 months. RESULTS: We included 62 patients. The overall symptoms improvement were 79% immediately after treatment and 58% after 6 months, respectively. There was an improvement in the symptoms of pruritus, burning, oedema, erythema and leucorrhoea. CONCLUSION: ABL was an effective therapy to be employed in drug-resistant women suffering from RVVC.


Assuntos
Candidíase Vulvovaginal , Recidiva , Humanos , Feminino , Candidíase Vulvovaginal/terapia , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/radioterapia , Adulto , Estudos Prospectivos , Brasil , Adulto Jovem , Resultado do Tratamento , Fototerapia/métodos , Pessoa de Meia-Idade , Lasers Semicondutores/uso terapêutico , Luz Azul
17.
J Bras Nefrol ; 47(1): e20240054, 2025.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39776148

RESUMO

INTRODUCTION: Pediatric patients with chronic kidney disease (CKD) develop mineral and bone disorders (MBD). We do not have Brazilian data that evaluate these outcomes, which can be obtained through epidemiological records. OBJECTIVE: To present the DOMINÓ study, which aims to describe CKD-MBD characteristics in Brazilian pediatric patients. METHODS: Retrospective and prospective, multicenter, observational cohort. The retrospective study will analyze data from prevalent patients in 2024, and the prospective study will analyze data from 2025 onwards. Demographic, clinical, laboratory, imaging, and bone biopsy data will be collected from pediatric patients with CKD-MBD < 18 years old with CKD stage 3-5D and kidney transplant recipients. The Ethics Committees of the participating centers approved the study. DISCUSSION/CONCLUSION: The DOMINÓ study will provide information on the incidence, prevalence, morbidity, treatment results, and mortality of this pediatric disease in Brazil. Future analyses will allow us to identify predictors of response to treatment and improve the care for these patients.


Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica , Sistema de Registros , Humanos , Brasil/epidemiologia , Criança , Estudos Prospectivos , Estudos Retrospectivos , Adolescente , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Masculino , Feminino , Prevalência , Pré-Escolar , Incidência
18.
Ann Card Anaesth ; 28(1): 25-32, 2025 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-39851147

RESUMO

BACKGROUND: The role of left ventricular global longitudinal strain (LVGLS) in coronary artery bypass grafting (CABG) and outcomes such as low cardiac output syndrome (LCOS) is not well established. The authors investigated the relationship between LVGLS before and after induction of anesthesia, their differences, and their relationship with LCOS and other outcomes. METHODOLOGY: A prospective observational study was conducted in a public/private hospital with 50 adult patients scheduled for on-pump CABG with normal left ventricular ejection fraction (LVEF). Acoustic windows necessary to obtain the 2D-LVGLS were acquired with transthoracic echocardiography (TTE) before induction of anesthesia (LVGLSBI) and after with mechanical ventilation (LVGLSAI) using transesophageal echocardiography (TEE). LCOS was defined as the use of epinephrine, dobutamine, and/or milrinone at minimum IV doses of 1 µg/min-1, 2.5 µg/kg-1/min-1, and 0.375 µg/kg-1/min-1, respectively, for a minimum of 24 h after cardiopulmonary bypass. RESULTS: A dedicated workstation (EchoPAC Software v203, GE) was used for offline calculation of LVGLS. LVGLSBI did not have a significant correlation with LCOS (mean difference, 1.66; 95% CI, --3.63 to 3.05; P = 0.862), nevertheless, it was an independent risk factor of in-hospital mortality (OR, 0.74; 95% CI, 0.57-0.95; P = 0.02), 3-month mortality (OR, 0.80; 95% CI, 0.64-0.99; P = 0.05), and delirium (OR, 0.65; 95% CI, 0.43-0.97; P = 0.03) in the multivariate analysis. LVGLSAI was also an independent risk factor for 3-month mortality (OR, 0.78; 95% CI, 0.62-0.99; P = 0.04). CONCLUSIONS: In CABG surgeries, LVGLS was a predictor of adverse outcomes in both awake and anesthetized patients with normal LVEF.


Assuntos
Ponte de Artéria Coronária , Humanos , Estudos Prospectivos , Masculino , Feminino , Ponte de Artéria Coronária/métodos , Pessoa de Meia-Idade , Idoso , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Função Ventricular Esquerda/fisiologia , Ecocardiografia Transesofagiana/métodos , Ecocardiografia , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Baixo Débito Cardíaco/fisiopatologia , Volume Sistólico/fisiologia , Cognição/fisiologia , Cognição/efeitos dos fármacos , Deformação Longitudinal Global
19.
Acta Ortop Mex ; 39(1): 19-26, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39855903

RESUMO

INTRODUCTION: anterior cruciate ligament rupture has evolved to be one of the most common sports injuries with a remarkable increase in its incidence in the last two decades, with Return-To-Sport being a crucial approach in the choice of autologous graft for its surgical repair, the most commonly used being hamstring and quadriceps tendon graft. MATERIAL AND METHODS: a prospective randomized study was performed with 32 patients divided into two groups, one for each type of graft, with 13 patients in each. They were evaluated before surgery, at 30, 180 and 360 days after the procedure using scales such as Lysholm, mCKRS and ACL-RSI, and their previous activity level was considered using the Tegner score. RESULTS: it was observed that, at 30 and 180 days after surgery, there were significant differences in pain assessment using the VAS scale between the groups, while at 360 days no significant differences were observed. No significant differences were found in Lysholm and mCKRS scale scores in either group at days 30, 180, and 360, but significant differences were found in ACL-RSI scale scores at 30 and 180 days between the two groups, which did not hold at 360 days. CONCLUSION: despite the difference in postoperative pain, Return-To-Sport times and overall recovery showed no significant differences between the two types of grafts in this study.


INTRODUCCIÓN: la ruptura del ligamento cruzado anterior ha evolucionado a ser una de las lesiones deportivas más comunes con un aumento notable en su incidencia en las últimas dos décadas, siendo el Return-To-Sport un enfoque crucial en la elección del injerto autólogo para su reparación quirúrgica; los más utilizados son el injerto de isquiotibiales y el de tendón de cuádriceps. MATERIAL Y MÉTODOS: se realizó un estudio prospectivo aleatorizado con 32 pacientes divididos en dos grupos, uno para cada tipo de injerto, con 13 pacientes en cada uno. Se evaluaron antes de la cirugía, a los 30, 180 y 360 días después del procedimiento utilizando escalas como Lysholm, mCKRS y ACL-RSI y se consideró su nivel de actividad previo mediante la puntuación de Tegner. RESULTADOS: se observó que, a los 30 y 180 días posteriores a la cirugía, hubo diferencias significativas en la evaluación del dolor utilizando la escala visual análoga de dolor (EVA) entre los grupos, mientras que a los 360 días no se observaron diferencias significativas. No se encontraron diferencias significativas en las puntuaciones de las escalas Lysholm y mCKRS en ninguno de los grupos en los días 30, 180 y 360, pero se encontraron diferencias significativas en las puntuaciones de la escala ACL-RSI a los 30 y 180 días entre los dos grupos, que no se mantuvieron a los 360 días. CONCLUSIÓN: a pesar de la diferencia en el dolor postoperatorio, los tiempos de retorno al deporte y la recuperación general no mostraron diferencias significativas entre los dos tipos de injertos en este estudio.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Músculo Quadríceps , Volta ao Esporte , Humanos , Masculino , Estudos Prospectivos , Adulto , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Adulto Jovem , Lesões do Ligamento Cruzado Anterior/cirurgia , Tendões dos Músculos Isquiotibiais/transplante , Músculos Isquiossurais/transplante , Transplante Autólogo/métodos , Adolescente , Tendões/transplante
20.
Acta Ortop Mex ; 39(1): 8-12, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39855901

RESUMO

INTRODUCTION: transfusion-related complications are a major concern for surgeons performing total hip and knee arthroplasty (THA and TKA). Several strategies have been implemented to reduce transfusion rates, including the use of tranexamic acid (TXA), whose optimal dosage remains a matter of debate. OBJECTIVE: to evaluate the efficacy and safety of a single pre-surgical dose of TXA in reducing blood loss in THA and TKA. MATERIAL AND METHODS: sixty patients were enrolled. Patients were randomly assigned to either a control group (no TXA) or an experimental group (1 g TXA 30 minutes before surgery). Blood loss, blood transfusion rate and volume, and hemoglobin levels were analyzed. RESULTS: hemoglobin loss in the control group was 3.5 ± 1.4 g/dl compared to 2.5 ± 1.5 g/dl in the experimental group (p = 0.006). Hematocrit loss was 10.6% ± 3.5 in the control group and 8% ± 4.9 in the experimental group (p = 0.02). Blood transfusion was only required in 3 patients (5%): 2 in the control group and 1 in the experimental group (p = 0.4). CONCLUSIONS: a single pre-surgical intravenous dose of 1 g TXA reduces hemoglobin loss in patients undergoing THA and TKA.


INTRODUCCIÓN: el sangrado trans y postquirúrgico en las artroplastías totales de cadera y rodilla es la preocupación más frecuente del cirujano. Existen múltiples estrategias para disminuir esta tasa de transfusión, como son el empleo de ácido tranexámico, del cual aún no existe un consenso establecido de la dosis idónea. OBJETIVO: evaluar la eficacia y seguridad de una dosis única de ácido tranexámico prequirúrgica para reducir la pérdida de sangre en la artroplastía total de cadera y rodilla. MATERIAL Y MÉTODOS: se analizó un total de 60 pacientes. Los participantes fueron distribuidos de forma aleatoria en dos grupos: grupo control al cual no se le administro ácido tranexámico y un grupo experimental al que se le administró 1 g de ácido tranexámico 30 minutos antes de iniciar el evento quirúrgico. Se analizó la pérdida de sangre, la velocidad y el volumen de transfusión de sangre, así como el nivel de hemoglobina. RESULTADOS: la pérdida de hemoglobina en el grupo control fue 3.5 ± 1.4 g/dl, en comparación con el grupo experimental, donde fue 2.5 ± 1.5 g/dl; p = 0.006. La pérdida del hematocrito fue de 10.6% ± 3.5 para el grupo control, en comparación con 8% ± 4.9 para el grupo experimental; p = 0.02. La transfusión sanguínea sólo se realizó en tres pacientes (5%), dos del grupo control y uno del grupo experimental (p = 0.4). CONCLUSIÓN: la dosis intravenosa de 1 g prequirúrgico de ácido tranexámico disminuye la pérdida de hemoglobina de pacientes sometidos a reemplazo total articular de cadera y rodilla.


Assuntos
Antifibrinolíticos , Artroplastia de Quadril , Artroplastia do Joelho , Perda Sanguínea Cirúrgica , Ácido Tranexâmico , Humanos , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Feminino , Masculino , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Idoso , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Transfusão de Sangue/estatística & dados numéricos
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