Tuberculose pulmonar: perfil epidemiológico do sertão Pernambucano, Brasil / Pulmonary tuberculosis: epidemiological profile of sertão Pernambucano, Brazil

Atualmente, observa-se que a tuberculose pulmonar constitui um importante problema de Saúde Pública no mundo, uma vez que esse agravo apresentou, em 2015, 10,4 milhões de casos, dos quais, mais de um milhão de pessoas vieram a óbito. Sob essa perspectiva, o presente artigo tem como objetivo traçar um perfil epidemiológico dos casos de Tuberculose Pulmonar notificados no município de Serra Talhada, entre os anos de 2007 a 2017. Foi realizado um estudo de série histórica observacional do tipo transversal, no intervalo de tempo de 2007 a 2017.  No período investigado o número de casos de tuberculose pulmonar foi de 246 casos, o local que teve a maior prevalência foi Serra Talhada, 287 por 100 mil habitantes. Diante dos dados apresentados, é imprescindível concluir, portanto, que esse estudo corrobora o perfil epidemiológico brasileiro para a Tuberculose Pulmonar, o qual indica variabilidade nos índices de acometimento durante o período analisado

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Comparison of strength and muscle fatigability between elderly practitioners and non-practitioners of physical exercise

Objetivo: Analisar aspectos físicos como antropométricos, composição corporal, nível de atividade física, força, Taxa de Desenvolvimento de Força e fatigabilidade, além de aspectos de qualidade de vida entre idosos praticantes e não praticantes de exercício físico. Métodos: O estudo selecionou 32 voluntários do gênero feminino, com idade acima dos 60 anos, sendo divididos em dois grupos, um que pratica exercício físico regular por pelo menos três vezes por semana, de exercício aeróbio e/ou duas vezes/semana - de exercício resistido há no mínimo seis meses e o outro grupo que não realiza exercício físico. Os voluntários executaram tarefas isométricas de Preensão Manual, onde foi investigado a força, Taxa de Desenvolvimento de Força e fatigabilidade do Idoso com uma Célula de Carga e sEMG, e avaliado amplitude e frequências. Resultados: Na Preensão Manual, os valores do grupo que pratica exercício físico apresentaram maiores Taxas de Desenvolvimento de Força (P: 8,76 ± 3,91; NP: 5,72 ± 2,28; P = 0,02), além de maior Pico de Força (P:15,02 ± 5,22; NP 11, 42 ± 2,29; P=0,04), significando maior força rápida, comparado ao grupo que não pratica exercício físico. Na atividade muscular, o grupo que pratica exercício físico apresentou amplitude do sinal eletrofisiológico maior na fase explosiva de produção de força, enquanto que a frequência média foi superior no grupo Não Praticante na fase isométrica, quando comparada ao grupo Praticante. O grupo de idosas não praticante de exercício apresentou melhores resultados nas análises de fatigabilidade comparado ao grupo Praticante, significando menores taxas de perda de força. Conclusão: Pode-se concluir que na tarefa de Preensão Manual houve um aumento no Pico de força e das Taxas de Desenvolvimento de Força na fase explosiva de produção de força, onde sugere-se que a prática de exercício físico contribui para se obter força rápida, e consequentemente uma melhor execução das atividades de vida diária, com mais segurança, proporcionando maior autonomia e qualidade de vida aos idosos que praticam exercício físico.Objective: To analyze physical aspects such as anthropometric, body composition, level of physical activity, strength, Rate of Strength Development and fatigability, in addition to aspects of quality of life among elderly practitioners and non-practitioners of physical exercise. Methods: The study selected 32 female volunteers, aged over 60 years, divided into two groups, one that practices regular physical exercise for at least three times a week, aerobic exercise and / or twice / week - from resistance exercise for at least six months and the other group that does not exercise. The volunteers performed isometric tasks of Handgrip, where strength, Strength Development Rate and fatigue of the Elderly with a Load Cell and sEMG were investigated, and amplitude and frequencies were evaluated. Results: In the Handgrip, the values of the group that practices physical exercise showed higher Strength Development Rates (P: 8.76 ± 3.91; NP: 5.72 ± 2.28; p=0.02), in addition to greater peak strength (P: 15.02 ± 5.22; NP 11, 42 ± 2.29; p=0.04), meaning greater rapid strength, compared to the group that does not practice physical exercise. In muscle activity, the group that practices physical exercise showed a greater amplitude of the electrophysiological signal in the explosive phase of strength production, while the average frequency was higher in the NonPracticing group in the isometric phase, when compared to the Practicing group. The group of elderly women who did not exercise showed better results in the analysis of fatigue compared to the group Practicing, meaning lower rates of loss of strength. Conclusion: It can be concluded that in the Hand Grip task there was an increase in Peak Power and Strength Development Rates in the explosive phase of strength production, where it is suggested that the practice of physical exercise contributes to obtaining rapid strength , and consequently a better execution of activities of daily living, with more security, providing greater autonomy and quality of life to the elderly who practice physical exercise.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Perfil epidemiológico de hanseníase no sertão Pernambucano, Brasil / Epidemiological profile of hanseníase in sertão Pernambucano, Brazil

A Hanseníase é uma doença infecciosa crônica causada por Mycobacterium leprae, considerada um grave problema saúde pública mundial. O presente trabalho tem como objetivo traçar um perfil epidemiológico da Hanseníase no sertão pernambucano, tomando por base os dados eletrônicos do SINAN e DATASUS (ambos ligados ao Ministério da Saúde). A partir dessas fontes, realizou-se um estudo de série histórica observacional do tipo transversal dos casos notificados de Hanseníase entre os anos de 2006 a 2017. De acordo com os dados, observa-se que esse agravo apresentou um decréscimo no número de novos casos, na medida em que se constatava 43.642 casos no ano de 2006 contra 26.875 novos casos em 2017. Essa realidade, embora evidencie uma notável redução no número de novos casos de hanseníase, evoca a responsabilidade dos órgãos públicos de saúde no que tange à manutenção do controle desse agravo, assim como a criação de novas medidas que busquem a prevenção e a erradicação desse enfermo no território nacional.

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London