Thromboembolic and/or Bleeding Complications in Patients Under Oral Anticoagulation Followed at a Tertiary Hospital

A consulta de hipocoagulação de um hospital central contempla uma população bastante diversificada, pelo que uma melhor compreensão das características da mesma, poderá levar à melhoria da prestação de cuidados de saúde e à diminuição do número de complicações tromboembólicas (resultantes da patologia base) e hemorrágicas [resultantes da própria terapêutica anticoagulante (ACO)]. Objectivos: Avaliar as características da população que frequenta a consulta de hipocoagulação e analisar quais podem predizer um maior risco de complicações. Métodos: Utilizaram-se os dados colhidos por um médico através de um questionário colocado a doentes durante a consulta de hipocoagulação. Foram efectuados 101 questionários e avaliaram-se as características demográficas (sexo, idade, escolaridade, grau de analfabetismo), os factores de risco clássicos para doença coronária, o diagnóstico que levou ao início da ACO, a duração da ACO, a periodicidade da determinação e valores mínimos, máximos e à data do questionário de INR e as complicações desta terapêutica. Consideraram-se como complicações o aparecimento de fenómenos hemorrágicos e/ou tromboembólicos, no decurso da terapêutica hipocoagulante. Resultados: Foram estudados 101 doentes, 74 do sexo feminino (73,3%), com idade média de 6410 anos (21-85). A população analisada tinha 4,5 ± 3,5 anos de escolaridade, com 15% de analfabetismo. A maioria dos doentes iniciou ACO após colocação de prótese valvular mecânica (56,4%). Em cada doente existia em média 1 factor de risco para doença coronária. O número de meses de ACO era de 99,489 (1-360). Sessenta e seis doentes (65,3%) conheciam o motivo pelo qual iniciaram esta terapêutica. Cada doente tinha efectuado 1,20,6 determinações de INR por mês e tinha, em média, um tempo máximo sem verificação do mesmo de 6,210,4 semanas. Quarenta e cinco doentes sofreram alguma complicação tromboembólica e/ou hemorrágica no decurso da terapêutica ACO. Ocorreram 50 complicações hemorrágicas, em 41 doentes, das quais 7 motivaram internamento. Detectaram-se 7 episódios de tromboembolismo central ou periférico, em 7 doentes. Posteriormente, dividiu-se a população em dois grupos: grupo I – com complicações (GI) e grupo II – sem complicações (GII). GI – 45 doentes, idade média 63,59,1 anos (39-80) e GII – 56 doentes, idade média 64,711,3 anos (21-85). Nos doentes que iniciaram ACO por prótese mitral detectou-se um maior número de complicações (60,6% no GI e 39,4% no GII, p=0,024). Também nos doentes com INR máximo recomendado > 3 (55,2% no GI e 44,8% no GII, p=0,013) e nos que tinham sido sujeitos a terapêutica estomatológica (68,3% no GI e 31,7% no GII, p<0,001) se verificou um maior número de complicações. A duração da ACO foi o factor mais significativo para o aparecimento de complicações (GI – 138,196,5 meses, GII – 67,868,2 meses, p <0,00005). Na análise multivariada apenas a duração da ACO se manteve como factor preditivo independente. Conclusões: Na população existe uma percentagem importante de doentes com baixa escolaridade, que se poderá repercutir sobre a compreensão desta terapêutica específica, não tendo contudo, neste estudo, revelado influência significativa na taxa de complicações. O aparecimento de complicações durante a terapêutica anticoagulante é dependente da duração desta, do valor do INR máximo recomendado e da realização ou não de procedimentos estomatológicos, sendo o primeiro factor o mais significativo

Agronomic biofortification of cowpea with selenium: effects of selenate and selenite applications on selenium and phytate concentrations in seeds

BACKGROUNDSelenium (Se) is a nutrient for animals and humans, and is considered beneficial to higher plants. Selenium concentrations are low in most soils, which can result in a lack of Se in plants, and consequently in human diets. Phytic acid (PA) is the main storage form of phosphorus in seeds, and it is able to form insoluble complexes with essential minerals in the monogastric gut. This study aimed to establish optimal levels of Se application to cowpea, with the aim of increasing Se concentrations. The efficiency of agronomic biofortification was evaluated by the application of seven levels of Se (0, 2.5, 5, 10, 20, 40, and 60 g ha−1) from two sources (selenate and selenite) to the soil under field conditions in 2016 and 2017.RESULTSApplication of Se as selenate led to greater plant Se concentrations than application as selenite in both leaves and grains. Assuming human cowpea consumption of 54.2 g day−1, Se application of 20 g ha−1 in 2016 or 10 g ha−1 in 2017 as selenate would have provided a suitable daily intake of Se (between 20 and 55 μg day−1) for humans. Phytic acid showed no direct response to Se application.CONCLUSIONSelenate provides greater phytoavailability than selenite. The application of 10 g Se ha−1 of selenate to cowpea plants could provide sufficient seed Se to increase daily human intake by 13–14 μg d−1. © 2019 Society of Chemical Industr

Copy number variants prioritization after array-CGH analysis - a cohort of 1000 patients

Array-based comparative genomic hybridization has been assumed to be the first genetic test offered to detect genomic imbalances in patients with unexplained intellectual disability with or without dysmorphisms, multiple congenital anomalies, learning difficulties and autism spectrum disorders. Our study contributes to the genotype/phenotype correlation with the delineation of laboratory criteria which help to classify the different copy number variants (CNVs) detected. We clustered our findings into five classes ranging from an imbalance detected in a microdeletion/duplication syndrome region (class I) to imbalances that had previously been reported in normal subjects in the Database of Genomic Variants (DGV) and thus considered common variants (class IV).info:eu-repo/semantics/publishedVersio

Validation of control of allergic rhinitis and asthma test for children (CARATKids)--a prospective multicenter study

BACKGROUND: Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross-sectional validity, and longitudinal validity. METHODS: A prospective observational study was conducted in 11 Portuguese centers. During two visits separated by 6 wk, CARATKids, visual analog scale scales and childhood asthma control test were completed, and participant's asthma and rhinitis were evaluated by his/her physician without knowing the questionnaires' results. Data-driven item reduction was conducted, and internal consistency, responsiveness analysis, and associations with external measures of disease status were assessed. RESULTS: Of the 113 children included, 101 completed both visits. After item reduction, the final version of the questionnaire has 13 items, eight to be answered by the child and five by the caregiver. Its Cronbach's alpha was 0.80, the Guyatt's responsiveness index was -1.51, and a significant (p < 0.001) within-patient change of CARATKids score in clinical unstable patients was observed. Regarding cross-sectional validity, correlation coefficients of CARATKids with the external measures of control were between 0.45 and -0.69 and met the a priori predictions. In the longitudinal validity assessment, the correlation coefficients between the score changes of CARATKids and those of external measures of control ranged from 0.34 to 0.46

Does the cognitive reflection test measure cognitive reflection? A mathematical modeling approach

We used a mathematical modeling approach, based on a sample of 2,019 participants, to better understand what the cognitive reflection test (CRT; Frederick In Journal of Economic Perspectives, 19, 25–42, 2005) measures. This test, which is typically completed in less than 10 min, contains three problems and aims to measure the ability or disposition to resist reporting the response that first comes to mind. However, since the test contains three mathematically based problems, it is possible that the test only measures mathematical abilities, and not cognitive reflection. We found that the models that included an inhibition parameter (i.e., the probability of inhibiting an intuitive response), as well as a mathematical parameter (i.e., the probability of using an adequate mathematical procedure), fitted the data better than a model that only included a mathematical parameter. We also found that the inhibition parameter in males is best explained by both rational thinking ability and the disposition toward actively open-minded thinking, whereas in females this parameter was better explained by rational thinking only. With these findings, this study contributes to the understanding of the processes involved in solving the CRT, and will be particularly useful for researchers who are considering using this test in their research

Lateral adhesion drives reintegration of misplaced cells into epithelial monolayers.

Cells in simple epithelia orient their mitotic spindles in the plane of the epithelium so that both daughter cells are born within the epithelial sheet. This is assumed to be important to maintain epithelial integrity and prevent hyperplasia, because misaligned divisions give rise to cells outside the epithelium. Here we test this assumption in three types of Drosophila epithelium; the cuboidal follicle epithelium, the columnar early embryonic ectoderm, and the pseudostratified neuroepithelium. Ectopic expression of Inscuteable in these tissues reorients mitotic spindles, resulting in one daughter cell being born outside the epithelial layer. Live imaging reveals that these misplaced cells reintegrate into the tissue. Reducing the levels of the lateral homophilic adhesion molecules Neuroglian or Fasciclin 2 disrupts reintegration, giving rise to extra-epithelial cells, whereas disruption of adherens junctions has no effect. Thus, the reinsertion of misplaced cells seems to be driven by lateral adhesion, which pulls cells born outside the epithelial layer back into it. Our findings reveal a robust mechanism that protects epithelia against the consequences of misoriented divisions.The authors are grateful to R. Nieuwburg, the St Johnston group, and other Gurdon Institute members for suggestions. We thank the Bloomington Stock Center, J. Knoblich, and the TRiP at Harvard Medical School (NIH/NIGMS R01-GM084947) for fly stocks. We thank N. Lowe for technical assistance. This work was supported by a Wellcome Trust Principal Fellowship to D.St.J. (080007), and by core support from the Wellcome Trust (092096) and Cancer Research UK (A14492). D.T.B. was supported by a Marie Curie Fellowship and the Wellcome Trust. H.E.L. was supported by a Herchel Smith Studentship.This is the author accepted manuscript. The final version is available from NPG via http://dx.doi.org/10.1038/ncb324

Performance evaluation of primary care services for the treatment of tuberculosis

Objective Evaluating the performance of primary care services for the treatment of tuberculosis according to the assessment referential of health services (structure/process) in Cabedelo, a port city in the state of Paraíba. Method An evaluation quantitative, cross-sectional study, in which were carried out 117 interviews with health professionals using a structured instrument. The analysis was based on the construction of indicators using a standardized value for the reduced variable (z=1). Results The structural indicators showed regular performance for the following variables: professional training, access to record instruments and coordination with other services. The process indicators related to external actions and information about the disease had unsatisfactory performance. The directly observed treatment and the flows of reference/counter-reference had regular performance. Conclusion The focused professional qualification, the fragmentation of practices and the unsystematic home care constitute obstacles for carrying out actions aimed at providing expanded, continuous and resolute care

Health services performance for TB treatment in Brazil: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.</p> <p>Methods</p> <p>This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the <it>Primary Care Assessment Tool </it>adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.</p> <p>Results</p> <p>"Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.</p> <p>Conclusions</p> <p>Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.</p