Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Acometimento renal em modelo murino imunocompetente BALB/c na infecção pelo vírus dengue 2: aspectos histopatológicos e ultraestruturais

Os vírus dengue (DENV) são arbovírus pertencentes ao gênero Flavivirus, da família Flaviviridae e são divididos em quatro sorotipos antigenicamente distintos (DENV-1, -2, -3 e -4). A infecção por esses arbovírus resulta na doença mundialmente conhecida como dengue (DEN). A DEN é considerada um dos maiores problemas de saúde pública no mundo, e estima-se que anualmente 390 milhões de pessoas são infectadas pelos DENV. No Brasil, em 2022, até a semana epidemiológica 43, 1.374.019 casos prováveis de DEN foram notificados. A doença apresenta amplo espectro de manifestações clínicas, com evolução imprevisível, podendo ser observado o envolvimento de diferentes órgãos. De acordo com a literatura, o comprometimento renal em casos de DEN não é bem estabelecido. Algumas alterações renais já foram descritas em decorrência da infecção pelos DENV, dentre elas lesão renal aguda, proteinúria, hematúria, glomerulonefrite, síndrome nefrótica e até mesmo falência renal. Dentre as alterações histopatológicas observadas em casos de DEN, estão: necrose aguda tubular, danos circulatórios e do parênquima e perda da membrana basal de túbulos contorcidos proximais. Nesse contexto, a caracterização de um modelo experimental animal para o melhor entendimento do acometimento do rim durante a infecção pelos DENV é de grande relevância. Assim sendo, este trabalho tem como objetivo verificar alterações morfológicas em rim de camundongos BALB/c infectados experimentalmente com duas Linhagens distintas de DENV-2. Para tal, camundongos BALB/c machos, de 2 meses de idade foram infectados com 2 cepas epidêmicas e não-neuroadaptadas, representativas das Linhagens (I e II) de DENV-2 e eutanasiados 72 horas pós-infecção (hpi). Para detecção do antígeno viral foi realizado um ensaio imuno-histoquímico. Foi realizada morfometria para quantificar o número de corpúsculos renais e a área ocupada por glomérulos. Para análises histopatológicas e ultraestruturais, os camundongos foram eutanasiados 72 hpi. As amostras foram coletadas e processadas de acordo com protocolos padrão para observação em microscópio de campo claro e microscópio eletrônico de transmissão. O antígeno de DENV foi detectado em amostras infectadas com a Linhagem II de DENV-2. A Histomorfometria mostrou uma diminuição estatisticamente significativa do número de corpúsculos renais dos animais infectados. Apesar disso, a área média ocupada pelos glomérulos dos camundongos infectados se mostrou maior que as observadas no grupo controle negativo. As alterações histopatológicas mais observadas foram: necrose tubular, infiltrado mononuclear, perda citoplasmática, congestão capilar, atrofia glomerular e perda de cromatina. Achados ultraestruturais corroboram os vistos na histopatologia. Perante o exposto, podemos concluir que a infecção por duas Linhagens de DENV-2 causa alterações em rim de camundongos BALB/c infectados experimentalmente tais como observadas em casos humanos de DEN e que este modelo pode ser aplicado em estudo que visem o entendimento do envolvimento deste órgão na DENDengue viruses (DENV) are arboviruses belonging to the genus Flavivirus, family Flaviviridae and are divided into four antigenically distinct serotypes (DENV-1, -2, -3 and -4). Infection by these arboviruses results in the disease known worldwide as dengue fever (DEN). DENV is considered one of the biggest public health problems in the world, and it is estimated that annually 390 million people are infected with DENV. In Brazil, in 2022, until epidemiological week 43, 1,374,019 probable cases of DEN were reported. The disease has a wide spectrum of clinical manifestations, with unpredictable evolution, and the involvement of different organs can be observed. According to the literature, renal impairment in cases of DEN is not well established. Some renal alterations have already been described as a result of DENV infection, including acute kidney injury, proteinuria, hematuria, glomerulonephritis, nephrotic syndrome and even renal failure. Among the histopathological changes observed in cases of DEN are: acute tubular necrosis, circulatory and parenchymal damage, and loss of basement membrane of proximal convoluted tubules. In this context, the characterization of an experimental animal model for a better understanding of the involvement of the kidney during DENV infection is of great relevance. Therefore, this work aims to verify morphological alterations in the kidney of BALB/c mice experimentally infected with two different strains of DENV-2. For this purpose, 2-month-old male BALB/c mice were infected with 2 epidemic and non-neuroadapted strains, representative of DENV-2 Lineages (I and II) and euthanized 72 hours post-infection (hpi). To detect the viral antigen, an immunohistochemical assay was performed. Morphometry was performed to quantify the number of renal corpuscles and the area occupied by glomeruli. For histopathological and ultrastructural analyses, mice were euthanized at 72 hpi. Samples were collected and processed according to standard protocols for brightfield and transmission electron microscope observation. DENV antigen was detected in samples infected with DENV-2 Lineage II. Histomorphometry showed a statistically significant decrease in the number of renal corpuscles in infected animals. Despite this, the average area occupied by the glomeruli of infected mice was larger than those observed in the negative control group. The most observed histopathological alterations were: tubular necrosis, mononuclear infiltrate, cytoplasmic loss, capillary congestion, glomerular atrophy and chromatin loss. Ultrastructural findings corroborate those seen in histopathology. In view of the above, we can conclude that infection by two strains of DENV-2 causes alterations in the kidney of experimentally infected BALB/c mice such as observed in human cases of DEN and that this model can be applied in studies aimed at understanding the involvement of this organ in DEN71 f

Immunocompetent Mice Infected by Two Lineages of Dengue Virus Type 2: Observations on the Pathology of the Lung, Heart and Skeletal Muscle

Dengue virus (DENV) infection by one of the four serotypes (DENV-1 to 4) may result in a wide spectrum of clinical manifestations, with unpredictable evolution and organ involvement. Due to its association with severe epidemics and clinical manifestations, DENV-2 has been substantially investigated. In fact, the first emergence of a new lineage of the DENV-2 Asian/American genotype in Brazil (Lineage II) in 2008 was associated with severe cases and increased mortality related to organ involvement. A major challenge for dengue pathogenesis studies has been a suitable animal model, but the use of immune-competent mice, although sometimes controversial, has proven to be useful, as histological observations in infected animals reveal tissue alterations consistent to those observed in dengue human cases. Here, we aimed to investigate the outcomes caused by two distinct lineages of the DENV-2 Asian/American genotype in the lung, heart and skeletal muscle tissues of infected BALB/c mice. Tissues were submitted to histopathology, immunohistochemistry, histomorphometry and transmission electron microscopy (TEM) analysis. The viral genome was detected in heart and skeletal muscle samples. The viral antigen was detected in cardiomyocytes and endothelial cells of heart tissue. Heart and lung tissue samples presented morphological alterations comparable to those seen in dengue human cases. Creatine kinase serum levels were higher in mice infected with both lineages of DENV-2. Additionally, statistically significant differences, concerning alveolar septa thickening and heart weight, were observed between BALB/c mice infected with both DENV-2 lineages, which was demonstrated to be an appropriate experimental model for dengue pathogenesis studies on lung, heart and skeletal muscle tissues

Normal nutrient ranges and nutritional monitoring of 'Pêra' orange trees based on the CND method in different fruiting stages

O objetivo deste trabalho foi determinar valores de referência para avaliação do estado nutricional de laranjeiras 'Pêra' (Citrus sinensis) em diferentes estádios de frutificação, com uso do método de diagnose da composição nutricional (CND). Foram utilizadas 243 amostras foliares, provenientes de 81 glebas, com coletas em plantas com frutos de três e seis meses de idade e, também, na colheita principal (nove meses). Glebas com produtividade superior a 30 Mg ha-1 foram selecionadas para o estabelecimento dos padrões de referência. Foram avaliadas três faixas normais para cada nutriente, na população de referência, abrangidas entre o intervalo de confiança (IC) das médias dos teores foliares, a média±desvio-padrão (±DP) e a média±⅔DP. Independentemente da faixa normal de nutrientes utilizada, a época de amostragem foliar interferiu no estado nutricional da laranjeira 'Pêra'. As faixas normais obtidas a partir dos critérios IC e ±⅔DP dos teores nutricionais observados na população de referência proporcionaram diagnósticos nutricionais frequentemente semelhantes. Zn, Ca e Fe são os elementos que mais frequentemente limitam a produção da laranja 'Pêra' no Amazonas.The objective of this work was to determine reference values for evaluating the nutritional status of 'Pêra' orange (Citrus sinensis) trees in different fruiting stages, using the compositional nutrient diagnosis (CND) method. The study used 243 leaf samples from 81 plots, with samplings performed in plants bearing fruits with three and six months of age, and also in the main harvest (nine months). Plots with productivity higher than 30 Mg ha-1 were selected for the establishment of reference standards. Three normal ranges were evaluated for each nutrient in the reference population, comprehended by the confidence interval (CI) of the foliar content averages, by the mean±standard deviation (±SD), and by the mean±⅔SD. Regardless of the normal range of nutrients used, the leaf sampling periods interfered with the nutritional status of 'Pêra' orange tree. The normal ranges obtained from the criteria CI and ±⅔SD of the nutrient contents observed in the reference population frequently provided similar nutritional diagnoses. Zn, Ca, and Fe are the elements that most often limit the production of 'Pêra' orange in the state of Amazonas, Brazil

Effectiveness of Whole-Body Vibration Combined with Multicomponent Training on the Risk of Falls and Quality of Life in Elderly Women with Osteoporosis: Study Protocol for a Randomized Controlled Clinical Trial

Osteoporosis and the risk of falls increase the risk of fractures and events of falls. Prescriptions and programs for different forms of exercise have different impacts on the risk of falls, and exercises from multiple categories of whole-body vibration can be effective. This study aims to evaluate the effectiveness of whole-body vibration (WBV) protocol combined with multicomponent training (MCT) in elderly women with osteoporosis and their history of falls. Our proposal is a protocol for a randomized clinical trial, divided into two stages: First, development of a protocol for WVB combined with MCT for elderly women with osteoporosis and a history of falls, under the Guidelines of the American College of Sports Medicine, and following the recommendations of the Standard Protocol Items Recommendations for Interventional Trials (SPIRIT), and second, a randomized controlled clinical trial following the Consolidated Standards of Reporting Trials (CONSORT). This trial will have implications for the effectiveness of a vibration protocol combined with multicomponent exercise on the risk of falls and quality of life for older women with osteoporosis. We expect that adding full-body vibration to an exercise protocol will decrease the risk of falls and improve participants’ quality of life, as well as their strength, balance, and functional capacity

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians

ABSTRACT: Objectives: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. Methods: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. Results: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. Conclusion: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

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