A longitudinalidade e a integralidade no cuidado às crianças menores de um ano: avaliação de cuidadores

Objective: This study aimed to evaluate the attributes longitudinality and comprehensive care in Family Health Units in Vitória da Conquista, Bahia, Brazil. Method: quantitative, cross-sectional study with data collected through the use of the Brazilian version of Primary Care Assessment Tool. This instrument covers the essential attributes of the Primary Health Care, including longitudinality and comprehensive care. We interviewed 271 caretakers of children under one year old who use the health facilities, from January to June 2012. Results: longitudinality scores were high (3.07±0.53), demonstrating good experience of caretakers regarding the actions derived from this attribute. On the other hand, the scores for comprehensive care related to available services and services provided were low (2.83±0.36 and 2.81±0.98). Such results demonstrate little awareness of caretakers related to available services, as well as services provided to children by health facilities. Conclusions: Family Health Strategy is a reference for most health needs of the child; it promotes the relationship between caretakers and health professionals, and enables the knowledge about children health status. However, despite the high coverage of the Family Health Strategy in the county, some children´s health actions are not experienced by caretakers. Managers and health professionals should have the priorities for child health in their agendas, as well as planning and implementation of actions which are related to the child health needs.Objetivo: avaliar os atributos longitudinalidade e integralidade da atenção em Unidades de Saúde da Família em Vitória da Conquista, Bahia, Brasil. Método: pesquisa quantitativa, transversal com dados coletados mediante uso do Instrumento de Avaliação da Atenção Primária, versão nacional Primary Care Assessment Tool. Este instrumento contempla os atributos essenciais da APS, dentre eles a longitudinalidade e a integralidade da atenção. Foram entrevistados 271 cuidadores de crianças menores de um ano, usuários dos serviços, no período de janeiro a junho de 2012. Resultados: a longitudinalidade apresentou escore elevado (3,07±0,53), demonstrando boa experiência dos cuidadores com as ações derivadas desse atributo. Por outro lado, os escores para integralidade, tanto para serviços disponíveis quanto para serviços prestados, foram baixos (2,83±0,36 e 2,81±0,98). Tais resultados apontam pouca percepção dos cuidadores sobre serviços disponíveis, como também serviços prestados à criança pelas unidades de saúde. Conclusões: A ESF constitui referência para a maioria das necessidades de saúde da criança, favorece a relação entre cuidadores e profissionais, além de possibilitar o conhecimento da situação de saúde desse público. Entretanto, apesar da alta cobertura da estratégia no município, algumas ações em saúde voltadas às crianças não são vivenciadas pelos cuidadores. Aos gestores e profissionais de saúde que atuam com esta clientela, cabe a sensibilização sobre as prioridades dentro de suas agendas, como também o planejamento e a implementação de ações que estejam dentro das necessidades de saúde da população infantil

Draft genome sequence of Wickerhamomyces anomalus LBCM1105, isolated from cachaça fermentation

Wickerhamomyces anomalus LBCM1105 is a yeast isolated from cachaça distillery fermentation vats, notable for exceptional glycerol consumption ability. We report its draft genome with 20.5x in-depth coverage and around 90% extension and completeness. It harbors the sequences of proteins involved in glycerol transport and metabolism.The authors gratefully acknowledge Laboratorio Nacional de Ciencia e Tecnologia do Bioetanol (CTBE) and the Centro Nacional de Pesquisa em Energia e Materiais (CNPEM) for support with the sequencing of LBCM1105. This work was supported by CAPES/Brazil (PNPD 2755/2011; PCF-PVE 021/2012), by CNPq (Brazil), processes 304815/2012 (research grant) and 305135/2015-5, and by AUXPE-PVES 1801/2012 (Process 23038.015294/2016-18) from Brazilian Government and by UFOP. C.L. is supported by the strategic program UID/BIA/04050/2013 [POCI-01-0145-FEDER-007569] funded by national funds through the FCT I.P. and by the ERDF through the COMPETE2020 - Programa Operacional de Competitividade e Internacionalizacao (POCI). DMRP is a fellow from the CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico) - Brazil (310080/2018-5)

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Carotid endarterectomy in the awake patient: safety, tolerability and results

Objective: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). Conclusion: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates

Renal osteodystrophy in the obesity era: Is metabolic syndrome relevant?

<div><p>Background</p><p>Observational studies have shown a beneficial effect of obesity on bone health; however, most of those studies were not based on bone biopsies. Metabolic syndrome (MetS) could have an effect on bone remodeling. However, there are no data on the effects of MetS in the presence of renal osteodystrophy.</p><p>Objective</p><p>The aim of this study was to investigate associations between MetS and renal osteodystrophy using the bone histomorphometric turnover-mineralization-volume (TMV) classification.</p><p>Design, setting, participants & measurements</p><p>This observational cross-sectional study included 55 hemodialysis patients (28 women/27 men) who were evaluated for MetS and bone histomorphometry. Biochemical parameters included calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, free serum leptin, fibroblast growth factor 23 (FGF23), intact osteocalcin, sclerostin (Scl), glucose, insulin, and thyroid hormones. Robust models of multivariate linear regressions were used for the statistical analyses.</p><p>Results</p><p>Females had higher iPTH levels (1,143 <i>vs</i>. 358, p = 0.02). Patients with normal bone volume (BV/TV) had a higher prevalence of MetS (73.6% <i>vs</i>. 41.7%, p = 0.02) and higher serum phosphorus, C-terminal FGF23 and insulin levels. The multivariate regression analysis showed that low-density lipoprotein cholesterol (LDL) was positively correlated with bone formation rate (BFR/BS) and negatively associated with mineralization lag time. Bone volume was negatively associated with age but positively associated with MetS. Body mass index (BMI) was not correlated with any of the bone histomorphometric parameters.</p><p>Conclusion</p><p>Our results suggest that MetS is not a risk factor for low bone volume in hemodialysis patients. Furthermore, BMI alone was not related to bone volume in this population.</p></div

Rural Triatoma rubrovaria from Southern Brazil harbors Trypanosoma cruzi of lineage IIc

Triatoma infestans, the main vector of Chagas disease, has nearly been eliminated from Brazil. Nevertheless, other triatominae species are involved in the domiciliation process, including Triatoma rubrovaria in Rio Grande do Sul State (RS). Previous studies showed that 1.6% of the T rubrovaria specimens collected at the rural district of Quarai, RS, were naturally infected by Trypanosoma cruzi. In this study, five T. cruzi isolates obtained from infected triatomines were characterized molecularly and biologically. Genotyping of the T cruzi isolates showed that they belong to lineage IIc of T cruzi (TCIIc). Biological characterization showed miotropism and myositis during acute and chronic phases of infection, respectively. Virulence and mortality rates were variable among isolates. To our knowledge, this study corresponds to the first characterization of T cruzi isolates from T rubrovaria and the first description of TCIIc in the sylvatic cycle of T cruzi from the southern region of Brazil.Fundação para o Desenvolvimento da UNESP (FUNDUNESP)Fundacao para o Desenvolvimento da UNESP (FUNDUNESP)Secretaria de Saude do Estado do Rio Grande do SulSecretaria de Saude do Estado do Rio Grande do SulCNPqConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESPFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Characteristics of the population distributed according to the diagnosis of metabolic syndrome.

<p>Characteristics of the population distributed according to the diagnosis of metabolic syndrome.</p

Percentage of low or normal BV/TV on biopsy according to presence or absence of MetS.

<p>Percentage of low or normal BV/TV on biopsy according to presence or absence of MetS.</p

Characteristics of the population distributed according to bone volume.

<p>Characteristics of the population distributed according to bone volume.</p