Pilot study of the characteristics of acute stroke events in patients discharged from the Carolina University Hospital, Puerto Rico in 2007

BACKGROUND: Stroke is the third leading cause of death in Puerto Rico. We examined the pre-hospital phase, management and case-fatality-rates (CFR) of patients discharged with acute stroke from the Carolina University of Puerto Rico Hospital during 2007. METHODS: Trained personnel collected information on demographics, delay-time, mode-of-transportation, management, and mortality from all medical records. STATAa was utilized to conduct univariate comparison of demographics, mode-of-transportation, therapeutics and diagnostic characteristics. Logistic regression analysis assessed cohort effect and controlled for confounders. RESULTS: The average age was 69.1 years, and 53% were males. The average delay between onset of symptoms suggestive of stroke and arrival at the emergency department was 4.5 hours. Only 62% of patients utilized Emergency Medical Services (EMS). Intravenous thrombolysis was not administered. Stroke mortality increased with age. Ischemic vs. hemorrhagic CFR was significantly higher (63.9% vs. 36.10%; p = 0.034). CONCLUSIONS: These findings highlight the potential benefit of evidence-based therapeutics and EMS use among stroke patients

Temas para práticas educativas sobre cuidados domiciliares às crianças com leucemia em uso de cateter venoso central semi-implantável

RESUMO OBJETIVO: identificar temas para práticas educativas sobre cuidados domiciliares às crianças com leucemia em uso de cateter semi-implantado na perspectiva de familiares cuidadores. MÉTODO: estudo descritivo com abordagem qualitativa realizado com 11 familiares de crianças com leucemia em uso de cateter venoso semi-implantado. Os dados foram obtidos por meio de entrevista semiestruturada, processados no software IRAMUTEQ e analisados por meio da Classificação Hierárquica Descendente (CHD). RESULTADOS: foram obtidas sete classes da CHD nas quais foram identificados os seguintes temas: higienização das mãos e curativo do cateter, cuidados para manter o curativo do cateter em casa; fixação do cateter; cuidados com o cateter no banho; e sentimentos relacionados a complicações com o cateter. CONCLUSÃO: ao identificar esses temas, o enfermeiro tem a possibilidade de intervir na melhora da assistência domiciliar a essas crianças, pautado nas reais necessidades desses familiares, contribuindo para fornecer-lhes mais segurança na sua vivência

Elaboração e validação de vídeo educativo sobre cuidado de crianças em uso de cateter semi-implantável

Objetivos: Elaborar e validar um vídeo educativo para familiares de crianças com leucemia em uso de cateter semi-implantável.Método: Pesquisa metodológica, realizada de 2018 a 2020 em seis etapas: busca de temas através de entrevista com familiares de crianças com cateter semi-implantável no Instituto de Pediatria do Rio de Janeiro; estudo teórico; desenvolvimento do vídeo; validação com juízes especialistas; adequação do vídeo e validação com familiares. Entrevistas analisadas pelo software Iramuteq e validação com escala Likert, considerando-se validados itens com índices de concordância de 90%. Resultados: Os temas higienização das mãos, curativo e fixação do cateter; cuidados no banho e complicações com o cateter foram abordados em vídeo animado elaborado e validado com índice de concordância de 97% entre juízes e 100% pelos familiares. Conclusão: O estudo valorizou a participação dos familiares em toda concepção do vídeo e criou uma tecnologia educacional validada de alto alcance e fácil utilização. Palavras-chave: Educação em saúde. Tecnologia educacional. Cateteres de demora. Enfermagem pediátrica

Reduction of HIV-1 Reservoir Size and Diversity After 1 Year of cART Among Brazilian Individuals Starting Treatment During Early Stages of Acute Infection

The aim of early combined antiretroviral therapy (cART) of HIV is to limit the seeding of the viral reservoir during the initial phase of infection and, consequently, decrease intrahost viral diversity. Here, we assessed the effect of early cART on size and complexity of the proviral reservoir. Peripheral blood mononuclear cell (PBMC) and plasma samples were obtained from ten HIV-infected Brazilian individuals diagnosed at the acute phase of infection, before (PREART) and 12 months (M12ART) after suppressive cART. HIV proviral reservoir size was determined by quantitative real-time PCR; intrahost viral diversity of the env C2-V3 region was assessed by single genome amplification or next-generation sequencing in PBMC and plasma, respectively. Mean nucleotide diversity (π) and normalized Shannon entropy (HSN) were used to infer the complexity of the viral population. Compared to PREART, M12ART saw an immunological recovery with a gain of ∼200 CD4+ T cells (P = 0.008) and a normalization of the CD4/CD8 ratio [1.0 (IQR: 0.88–1.18), P = 0.016], as well as a significant decrease in HIV-1 RNA (∼4 log, P = 0.004) and DNA (∼1 log, P = 0.002) levels. The median time to achieve viral suppression was 3 months (IQR: 2.8–5.8 months). The high intermixing between sequences from both visits suggests that the HIV-1 DNA reservoir remained remarkably stable under cART. After 1 year of cART, there was a minor reduction in proviral π (PreART = 0.20 vs. M12ART = 0.10; P = 0.156) but a significant decrease in HSN (PreART = 0.41 vs. M12ART = 0.25; P = 0.019). We found no correlation between π or HSN at PreART and the rate of HIV DNA decay, T CD4+ counts, or CD4/CD8 ratio at M12ART. Based on a small cohort of Brazilian infected individuals under early cART and analyses of the env region, 1 year of follow-up suggested a reservoir size reduction, allowed a significant decrease of HIV-1 complexity, and achieved immunological restoration regardless of the initial HIV-1 plasma viral load, CD4+ T cell counts, or HIV-1 subtype. However, further studies in the Brazilian setting aiming a longer follow-up and larger cohort are required in this field

Uso otimizado de marcadores SSR para identificação varietal de algodoeiro herbáceo

The objective of this work was to identify polymorphic simple sequence repeat (SSR) markers for varietal identification of cotton and evaluation of the genetic distance among the varieties. Initially, 92 SSR markers were genotyped in 20 Brazilian cotton cultivars. Of this total, 38 loci were polymorphic, two of which were amplified by one primer pair; the mean number of alleles per locus was 2.2. The values of polymorphic information content (PIC) and discrimination power (DP) were, on average, 0.374 and 0.433, respectively. The mean genetic distance was 0.397 (minimum of 0.092 and maximum of 0.641). A panel of 96 varieties originating from different regions of the world was assessed by 21 polymorphic loci derived from 17 selected primer pairs. Among these varieties, the mean genetic distance was 0.387 (minimum of 0 and maximum of 0.786). The dendrograms generated by the unweighted pair group method with arithmetic average (UPGMA) did not reflect the regions of Brazil (20 genotypes) or around the world (96 genotypes), where the varieties or lines were selected. Bootstrap resampling shows that genotype identification is viable with 19 loci. The polymorphic markers evaluated are useful to perform varietal identification in a large panel of cotton varieties and may be applied in studies of the species diversity.O objetivo deste trabalho foi identificar marcadores polimórficos de sequências simples repetidas (SSR) para identificação varietal de algodão e avaliação da distância genética entre as variedades. Inicialmente, 92 marcadores SSR foram genotipados em 20 cultivares de algodão do Brasil. Desse total, 38 locos foram polimórficos, dos quais dois deles foram amplificados por um único par de iniciadores; o número médio de alelos por loco foi 2,2. Os conteúdos de informação polimórfica (PIC) e de poder de discriminação (DP) foram, em média, 0,374 e 0,433, respectivamente. A distância genética média foi de 0,397 (mínima de 0,092 e máxima de 0,641). Um painel de 96 variedades originárias de diversas regiões do mundo foi avaliado por 21 locos polimórficos derivados a partir de 17 pares de iniciadores selecionados. Entre essas variedades, a distância genética média foi de 0,387 (mínima de 0 e máxima de 0,786). Os dendrogramas elaborados a partir de média aritmética não ponderada (UPGMA) não refletiram as regiões do Brasil (20 genótipos) ou do mundo (96 genótipos), onde as variedades ou linhagens foram selecionadas. O procedimento de reamostragem bootstrap mostra que a identificação dos genótipos é viável com 19 locos. Os marcadores polimórficos avaliados são úteis na identificação varietal de um painel amplo de variedades de algodão e podem ser aplicados em estudos de diversidade da espécie

Incidence of the tympanic foramen in the population of Northeast Brazil

The persistence of the tympanic foramen (or of Huschke) in individuals after second childhood constitutes a failure in the embryological development of the tympanic cavity. When present, it is on the anterior wall of the external acoustic meatus and is associated with important otological complications of the temporomandibular joint and external acoustic meatus. To report on the incidence of tympanic foramen in adult dry skulls, belonging to the population of the Northeast of Brazil, 87 adult skulls obtained from the Human Anatomy Laboratory of 4 universities of the Northeast of Brazil, without knowledge of gender, race and age were analyzed. The 174 temporal bones were examined for presence, morphology and measurements of the longitudinal and transverse diameter of the tympanic foramen. The incidence of tympanic foramen was 24.14%, found in 15 (17.24%) skulls on the right and 18 (20.68%) on the left side. Unilateral tympanic foramen was observed in 10 (11.50%) skulls, bilateral in 9 (10.34%) and multiple in 2 (2.30%). The form of tympanic foramen was mainly irregular. In conclusion, the higher prevalence of tympanic foramen found in the Northeast among other studies carried out in Brazil can be attributed to specific dietary habits in the region that could induce the later foramen occlusion

Recent Region-wide Declines in Caribbean Reef Fish Abundance

Profound ecological changes are occurring on coral reefs throughout the tropics, with marked coral cover losses and concomitant algal increases, particularly in the Caribbean region. Historical declines in the abundance of large Caribbean reef fishes likely reflect centuries of overexploitation. However, effects of drastic recent degradation of reef habitats on reef fish assemblages have yet to be established. By using meta-analysis, we analyzed time series of reef fish density obtained from 48 studies that include 318 reefs across the Caribbean and span the time period 1955–2007. Our analyses show that overall reef fish density has been declining significantly for more than a decade, at rates that are consistent across all subregions of the Caribbean basin (2.7% to 6.0% loss per year) and in three of six trophic groups. Changes in fish density over the past half-century are modest relative to concurrent changes in benthic cover on Caribbean reefs. However, the recent significant decline in overall fish abundance and its consistency across several trophic groups and among both fished and nonfished species indicate that Caribbean fishes have begun to respond negatively to habitat degradation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

DOENÇA TROFOBLÁSTICA GESTACIONAL E SUAS COMPLICAÇÕES: ANÁLISE DE CASOS

Gestational Trophoblastic Disease is a spectrum of disorders characterized by abnormal trophoblastic proliferation, subclassified into hydatidiform mole (complete and partial) and potentially fatal trophoblastic neoplasms with high metastatic potential, such as invasive mole, choriocarcinoma and trophoblastic tumors. Choriocarcinoma is the most common neoplasm secondary to hydatidiform mole, with a high incidence of lung metastasis, whose initial manifestation is hemoptysis. On the other hand, hydatidiform mole originates from villous trophoblasts and is considered a pre-neoplastic condition, whose clinical picture includes vaginal bleeding, hyperemesis and uterine enlargement, with complications such as preeclampsia, anemia and dyspnea. Objective: To analyze cases regarding Gestational Trophoblastic Disease and its complications. Methodology: This is an integrative literature review, of a quantitative nature, whose articles were selected from PubMed, Scientific Electronic Library On-line (SciELO) and Cochrane Library databases, in English. The choice of articles was performed by reading the title, abstract and, finally, reading the article in its entirety, with a careful analysis of the articles based on the inclusion and exclusion criteria. Final considerations: It is concluded that gestational choriocarcinoma is the most common gestational trophoblastic neoplasm, often secondary to hydatidiform mole, and its main metastatic target is the lung parenchyma, the main clinical manifestation being hemoptysis. There is a tendency to increase blood pressure in pregnant women with hydatidiform mole, which can lead to preeclampsia. Thus, it is possible for the fetus to have intrauterine growth restriction, requiring histopathological examination in all cases.La enfermedad trofoblástica gestacional es un espectro de trastornos caracterizados por una proliferación trofoblástica anormal, subclasificados en mola hidatiforme (completa y parcial) y neoplasias trofoblásticas potencialmente mortales con alto potencial metastásico, como la mola invasiva, el coriocarcinoma y los tumores trofoblásticos. El coriocarcinoma es la neoplasia más frecuente secundaria a mola hidatiforme, con alta incidencia de metástasis pulmonares, cuya manifestación inicial es la hemoptisis. Por otro lado, la mola hidatiforme se origina a partir de trofoblastos vellosos y se considera una condición preneoplásica, cuyo cuadro clínico incluye sangrado vaginal, hiperémesis y agrandamiento uterino, con complicaciones como preeclampsia, anemia y disnea. Objetivo: Analizar casos de Enfermedad Trofoblástica Gestacional y sus complicaciones. Metodología: Se trata de una revisión bibliográfica integradora, de carácter cuantitativo, cuyos artículos fueron seleccionados de las bases de datos PubMed, SciELO y Cochrane Library, en inglés. La elección de los artículos se realizó mediante la lectura del título, resumen y, finalmente, lectura del artículo en su totalidad, con un análisis cuidadoso de los artículos a partir de los criterios de inclusión y exclusión. Consideraciones finales: Se concluye que el coriocarcinoma gestacional es la neoplasia trofoblástica gestacional más frecuente, muchas veces secundaria a mola hidatiforme, y su principal diana metastásica es el parénquima pulmonar, siendo la principal manifestación clínica la hemoptisis. Hay una tendencia a aumentar la presión arterial en mujeres embarazadas con mola hidatiforme, lo que puede conducir a la preeclampsia. Así, es posible que el feto tenga restricción del crecimiento intrauterino, requiriendo examen histopatológico en todos los casos.A Doença Trofoblástica Gestacional é um espectro de distúrbios caracterizados por proliferação trofoblástica anormal, subclassificada em mola hidatiforme (completa e parcial) e neoplasias trofoblásticas com alto potencial metastático e potencialmente fatais, como a mola invasora, coriocarcinoma e tumores trofoblásticos. O coriocarcinoma é a neoplasia mais comum e secundária à mola hidatiforme, com alta incidência de metástase pulmonar, cuja manifestação inicial é a hemoptise. Por outro lado, a mola hidatiforme se originam de trofoblastos vilosos e é considerada condição pré-neoplásica, cujo quadro clínico inclui sangramentos vaginais, hiperêmese e aumento uterino e tem como complicações a pré-eclâmpsia, anemia e dispneia. Objetivo: Analisar casos a respeito da Doença Trofoblástica Gestacional e suas complicações. Metodologia: Trata-se de uma revisão bibliográfica integrativa, de natureza quantitativa, cujos artigos foram selecionados das bases de dados PubMed, Scientific Eletronic Library On-line (SciELO) e Cochrane Library, na língua inglesa. A escolha dos artigos foi realizada por meio da leitura do título, resumo e, por fim, da leitura do artigo na íntegra, sendo realizada uma análise criteriosa dos artigos fundamentados nos critérios de inclusão e exclusão. Considerações finais: Conclui-se que o coriocarcinoma gestacional é a neoplasia trofoblástica gestacional mais comum, muitas vezes secundária à mola hidatiforme, e tem como principal alvo metastático o parênquima pulmonar, sendo a principal manifestação clínica a hemoptise. Há uma tendência ao aumento da pressão arterial na gestante com mola hidatiforme, podendo adquirir pré-eclâmpsia. Desse modo, é possível o feto possuir restrição de crescimento intrauterino, sendo necessária a realização do exame histopatológico em todos os casos