Avaliação da qualidade de vida de idosos com hipertensão arterial sistêmica atendidos em Unidades Básicas de Saúde

A hipertensão arterial (HAS) é um problema grave de saúde pública pela sua alta predominância e morbimortalidade. Este estudo teve por objetivo avaliar a qualidade de vida de idosos com hipertensão arterial sistêmica atendidos emunidades básicas de saúde, do município de Caucaia, Ceará. Trata-se de estudo transversal, descritivo, exploratório, com abordagem quantitativa. A coleta de dados foi realizada em cinco unidades básicas de saúde por meio da aplicação de um questionário sócio demográfico e um questionário específico para a hipertensão arterial, MINICHAL-BRASIL. A amostra foi composta por 73 idosos. Dos participantes avaliados, a maioria era mulheres com idade média de 70 anos, casada, com baixa escolaridade, baixa renda familiar, na faixa de sobrepeso ou obesidade, com risco muito aumentado de complicações metabólicas, dieta controlada, não etilista, história familiar de doenças cardiovasculares, portadoras de diabetes e dislipidemia e pressão arterial entre controlada e estágio I e II. Esses dados sugerem a necessidade de efetivar ações de promoção à saúde, dirigidas para a educação e prática na prevenção dos fatores de risco, proporcionando uma melhora na qualidade de vida da população. Neste contexto, salienta-se a importância da equipe multiprofissional no controle da HAS e na prevenção das complicações crônicas

The spectral evolution of AT 2018dyb and the presence of metal lines in tidal disruption events

We present light curves and spectra of the tidal disruption event (TDE) ASASSN-18pg / AT 2018dyb spanning a period of one year. The event shows a plethora of strong emission lines, including the Balmer series, He II, He I and metal lines of O III $\lambda$3760 and N III $\lambda\lambda$ 4100, 4640 (blended with He II). The latter lines are consistent with originating from the Bowen fluorescence mechanism. By analyzing literature spectra of past events, we conclude that these lines are common in TDEs. The spectral diversity of optical TDEs is thus larger than previously thought and includes N-rich events besides H- and He-rich events. We study how the spectral lines evolve with time, by means of their width, relative strength, and velocity offsets. The velocity width of the lines starts at $\sim$ 13000 km s$^{-1}$ and decreases with time. The ratio of He II to N III increases with time. The same is true for ASASSN-14li, which has a very similar spectrum to AT 2018dyb but its lines are narrower by a factor of $>$2. We estimate a black hole mass of $M_{\rm BH}$ = $3.3^{+5.0}_{-2.0}\times 10^6$ $M_{\odot}$ by using the $M$-$\sigma$ relation. This is consistent with the black hole mass derived using the MOSFiT transient fitting code. The detection of strong Bowen lines in the optical spectrum is an indirect proof for extreme ultraviolet and (reprocessed) X-ray radiation and favors an accretion origin for the TDE optical luminosity. A model where photons escape after multiple scatterings through a super-Eddington thick disk and its optically thick wind, viewed at an angle close to the disk plane, is consistent with the observations.Comment: Accepted version. Updated with new photometry and spectra, including an X-shooter spectrum used to determine the BH mass. Two more figures added and line measurements tabulated. No significant scientific updates and the conclusions remain unaffecte

Uso de álcool durante tratamento medicamentoso

Introdução: Este trabalho aborda a combinação delicada de álcool e medicamentos, destacando os efeitos prejudiciais do álcool no sistema nervoso central e nos órgãos do corpo. O álcool passa por um complexo processo metabólico após a ingestão, afetando a absorção, distribuição, metabolismo e excreção de medicamentos. Essas interações podem comprometer a eficácia do tratamento e aumentar os riscos à saúde, enfatizando a necessidade de conscientização entre profissionais de saúde e pacientes. Evitar o álcool durante o uso de medicamentos é uma escolha sensata e protetora. Metodologia: Este trabalho é uma revisão de literatura com base em artigos de 2019 a 2023, em português, espanhol e inglês, obtidos das plataformas SciELO e PubMed. Foram incluídos textos completos, teses, dissertações, capítulos de livros, monografias e artigos em revistas e periódicos científicos. Foram utilizados descritores em saúde (DeCS) como "Álcool", "Tratamento" e "Medicamento" para avaliação dos textos. Resultados: O álcool tem efeitos prejudiciais no sistema nervoso central e nos órgãos, variando entre indivíduos. Sua absorção ocorre no intestino delgado e no estômago. O álcool afeta diversos órgãos, contribuindo para doenças ou interferindo nos efeitos dos medicamentos. No cérebro, estimula a liberação de serotonina, afetando o humor. No estômago, altera a mucosa e aumenta a produção de ácido gástrico. O álcool também pode inibir a ação do hormônio antidiurético (ADH), aumentando o volume urinário. As interações entre álcool e medicamentos podem ser farmacocinéticas, absortivas, biotransformativas, excretoras ou hipoglicemiantes. Elas impactam a absorção, distribuição, metabolismo e excreção de medicamentos, podendo resultar em efeitos indesejados. Conclusão: O uso combinado de álcool e medicamentos representa um sério risco à saúde e à vida. O álcool tem efeitos prejudiciais e interage de várias maneiras com medicamentos. Profissionais de saúde e pacientes precisam estar cientes desses perigos. Consultas médicas e uso responsável de medicamentos são fundamentais para a eficácia do tratamento e a proteção dos pacientes. Evitar o álcool durante o tratamento é a decisão mais segura e prudente para preservar a vida e o bem-estar

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Genetic contributors to risk of schizophrenia in the presence of a 22q11.2 deletion

Schizophrenia occurs in about one in four individuals with 22q11.2 deletion syndrome (22q11.2DS). The aim of this International Brain and Behavior 22q11.2DS Consortium (IBBC) study was to identify genetic factors that contribute to schizophrenia, in addition to the ~20-fold increased risk conveyed by the 22q11.2 deletion. Using whole-genome sequencing data from 519 unrelated individuals with 22q11.2DS, we conducted genome-wide comparisons of common and rare variants between those with schizophrenia and those with no psychotic disorder at age ≥25 years. Available microarray data enabled direct comparison of polygenic risk for schizophrenia between 22q11.2DS and independent population samples with no 22q11.2 deletion, with and without schizophrenia (total n = 35,182). Polygenic risk for schizophrenia within 22q11.2DS was significantly greater for those with schizophrenia (padj = 6.73 × 10−6). Novel reciprocal case–control comparisons between the 22q11.2DS and population-based cohorts showed that polygenic risk score was significantly greater in individuals with psychotic illness, regardless of the presence of the 22q11.2 deletion. Within the 22q11.2DS cohort, results of gene-set analyses showed some support for rare variants affecting synaptic genes. No common or rare variants within the 22q11.2 deletion region were significantly associated with schizophrenia. These findings suggest that in addition to the deletion conferring a greatly increased risk to schizophrenia, the risk is higher when the 22q11.2 deletion and common polygenic risk factors that contribute to schizophrenia in the general population are both present

A cationic near infrared fluorescent agent and ethyl-cinnamate tissue clearing protocol for vascular staining and imaging

Understanding vascular structures and dysfunction is a fundamental challenge. This task has been approached by using traditional methodologies such as microscopic computed tomography and magnetic resonance imaging. Both techniques are not only expensive but also time-consuming. Here, we present a new method for visualizing vascular structures in different organs in an efficient manner. A cationic near infrared (NIR) fluorescent dye was developed with attractive features to specifically stain blood vessels. Furthermore, we refined the process of organ staining and harvesting by retrograde perfusion and optimized the subsequent dehydration and clearing process by the use of an automatic tissue processor and a non-toxic substance, ethyl-cinnamate. Using this approach, the time interval between organ harvesting and microscopic analysis can be reduced from day(s) or weeks to 4 hours. Finally, we have demonstrated that the new NIR fluorescent agent in combination with confocal or light-sheet microscopy can be efficiently used for visualization of vascular structures, such as the blood vessels in different organs e.g. glomeruli in kidneys, with an extremely high resolution. Our approach facilitates the development of automatic image processing and the quantitative analysis to study vascular and kidney diseases