O cuidado farmacêutico na redução do impacto da pandemia de COVID-19 na saúde cardiovascular de pacientes hipertensos e diabéticos

Introdução: A pandemia de COVID-19 impactou na prestação de serviços à saúde aos pacientes portadores de doenças crônicas e o Medication Therapy Management (MTM-PC), parte integrante do cuidado farmacêutico, pode acarretar melhora dos parâmetros clínicos impactados pela pandemia. O objetivo deste estudo foi avaliar o impacto clínico do cuidado farmacêutico na hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) diante às mudanças impostas pela pandemia de COVID-19 no âmbito da atenção primária à saúde. Métodos: Trata-se de um estudo quase-experimental, single arm, do tipo antes e depois, com a coleta de dados de 01 julho de 2019 a 31 de outubro de 2022. Foram incluídos no estudo dados de pacientes do consultório farmacêutico da Farmácia Universitária- UFJF que foram divididos em pré-pandemia e pandemia, considerando o baseline e os dados relativos à reintrodução do atendimento presencial no consultório como endpoint. Foram coletados dados de pressão arterial, perfil lipídico, glicemia capilar, uso de estatinas e ácido acetilsalicílico, risco cardiovascular e dados psicossociais, consequências do isolamento social na saúde mental, prescrição de medicamentos e hábitos de vida. Os dados foramanalisados no software MINITAB v19, considerando o nível de significância de 5%. Resultados: Durante a pandemia sem o MTM-PC verificou-se que a pressão arterial e o HDL aumentaram, PAS 117,5±8,86 e 134,75±12,43; PAD 71,25±3,54 e 83,25±11,65; HDL 45,25± 7,80 e 52,38±12,52. Comparativamente, verificou-se que os valores de pressão arterial se mantiveram e os parâmetros de hemoglobina glicada e HDL melhoraram com o MTM-PC, HbA1c 7,890±1,798, [p=0,028] e 7,325±1,30; HDL48,00±6,00 e 59,00±10,56, [p=0,020]. Consequentemente, refletiu-se no aumento do risco cardiovascular pela pandemia, tanto na escala global 13,69±8,08 para 22,38±7,28, quanto otimizada, 8,35± 6,71 para 16,10±5,83, [p=0,38], havendo a quebra de tendência no aumento do risco com o MTM-PC. A carga terapêutica dos medicamentos utilizados para hipertensão e diabetes se manteve abaixo do valor limite de 75%. Conclusão: Evidenciou-se que a pandemia modificou parâmetros como pressão arterial e risco cardiovascular. E que o MTM-PC foi capaz de reduzir o impacto da pandemia na hemoglobina glicada, melhorar os níveis de colesterol HDL e quebrar uma tendência do aumento do risco cardiovascular.Introduction: The COVID-19 pandemic has impacted the provision of health services to patients with chronic diseases, and the Medication Therapy Management, an integral part of pharmaceutical care can lead to an improvement in clinical parameters impacted by the pandemic. The objective of this study was to assess the clinical impact ofMTM-PC on systemic arterial hypertension and diabetes mellitus (DM) in comparison with the changes imposed by the COVID-19 pandemic in the primary healthcare scope. Methods: This is a quasi-experimental, single-arm, before-and-after study, with data collection from July 1, 2019 to October 31, 2022. Data from patients at the pharmaceuticalservices, of the teaching-Pharmacy of UFJF, were included in the study and were divided into pre-pandemic and pandemic period, considering baseline data and the data related to the reintroduction of face-to-face care in the office as an endpoint.. Data were collected on blood pressure, lipidic profile, glycemia, use of statins and acetylsalicylic acid, cardiovascular risk, and psychosocial data, consequences of social isolation on mental health, medication prescription and life habits. Data were analyzed using the MINITAB v19 software, considering a significance level of 5%. Results: During the pandemic without MTM-PC it was found that blood pressure and HDL increased comparing the pre-pandemic with the pandemic without MTM-PC, respectively, SBP 117.5±8.86 and 134.75±12.43; DBP 71.25±3.54 and 83.25±11.65; HDL 45.25±7.80 and 52.38±12.52. Comparatively, it was verified that the blood pressure values were maintained and, the MTM-PC changed parameters like HbA1c 7.890±1.798, [p=0.028] and 7.325±1.30; HDL48.00±6.00 and 59.00±10.56, [p=0.020]. There was a change in both mean of cardiovascular risk, the global scale 13.69±8.08 to 22.38±7.28 and the optimized scale 8.35±6.71 to 16.10±5.83, [p=0.38], with a break in the trend of increased risk with the MTM-PC. The therapeutic load of drugs used for hypertension and diabetes remained below the limit value of 75%. Conclusion: There was evidence that the pandemic changed parameters such as blood pressure and cardiovascular risk. Additionally, the MTM-PC may be able to reduce the impact of the pandemic on glycated hemoglobin, improve HDL cholesterol levels and break a trend of increased cardiovascular risk

Asociación entre el Sistema de Triage Manchester y el diagnóstico de enfermería

Objetivo: Analisar associações entre discriminadores do Sistema de Triagem de Manchester e Diagnósticos de Enfermagem em pacientes adultos, classificados com prioridade clínica I (emergência) e II (muito urgente). Método: Estudo transversal realizado na unidade de emergência do sul do Brasil, entre abril e agosto de 2014. Amostra de 219 pacientes. Os dados foram coletados no prontuário online e analisados estatisticamente, com teste exato de Fisher ou qui-quadrado. Resultados: Encontrou-se 16 discriminadores e 14 diagnósticos de enfermagem. Houve associação entre sete discriminadores e cin- co diagnósticos de enfermagem do tipo foco no problema, dentre Dor precordial ou cardíaca com o diagnóstico Dor aguda. Também houve associação entre três discriminadores com quatro diagnósticos de enfermagem de risco, dentre Déficit neurológico agudo com o diagnóstico Risco de perfusão tissular cerebral ineficaz. Conclusão: Existem associações significativas entre discriminadores do Sistema de Triagem de Manchester e diagnósticos de enfer- magem mais frequentemente estabelecidos na Unidade de Emergência.Objective: To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). Method: Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher’s exact test or the chi-square test. Results: 16 discriminators and 14 nursing diagnoses were identified. Associations were found between seven discriminators and five problem-focused nursing diagnoses, including the discriminator Cardiac pain and the diagnosis Acute pain. Three discriminators were asso- ciated with four risk nursing diagnoses, among these Acute neurological deficit with the diagnosis Risk of ineffective cerebral tissue perfusion. Conclusion: Significant associations were found between Manchester Triage System discriminators and the nursing diagnoses most frequently established in the emergency department.Objetivo: Analizar asociaciones entre los discernidores del Sistema Triaje de Manchester y los Diagnósticos de Enfermería en pacien- tes adultos con prioridad clínica I (emergencia) y II (muy urgente). Método: Estudio transversal realizado en la unidad de emergencia del sur de Brasil, entre abril y agosto de 2014, con la muestra de 219 pacientes. La colecta de datos fue realizada en el prontuario online de los pacientes. El análisis estadístico fue realizado con el uso del Test Exacto de Fisher o chi-cuadrado. Resultados: Fue identificado el uso de 16 discernidores y 14 diagnósticos de enfermería. Hubo una asociación entre siete discerni- dores y cinco diagnósticos de enfermería del tipo foco en el problema, entre estos Dolor precordial o cardíaca y Dolor agudo. También hubo asociación entre tres discernidores y cuatro diagnósticos de enfermería de riesgo, entre estos Déficit neurológico agudo con el diagnóstico Riesgo de perfusión tisular cerebral ineficaz. Conclusión: Existen asociaciones significativas entre los discernidores del Sistema Triaje de Manchester y los diagnósticos de enfer- mería más frecuente establecidos en la Unidad de Emergencia

Acute consumption of bordo grape juice and wine improves serum antioxidant status in healthy individuals and inhibits reactive oxygen species production in human neuron-like cells

Few studies investigated the biological effects of American grape cultivars. We investigated the metabolic response after acute consumption of grape juice or wine from Bordo grapes (Vitis labrusca) in a placebo-controlled crossover study with fifteen healthy volunteers. Blood samples were collected 1 hour after the intake of 100 mL of water, juice, or wine to measure TBARS, ABTS, FRAP, glucose, and uric acid levels. To evaluate differences in cellular response, intracellular reactive species production (DCFH-DA) and metabolic mitochondrial viability (MTT) were assessed after exposure of human neuron-like cells (SH-SY5Y) to juice or wine. Glycemia was reduced after juice or wine consumption, whereas blood levels of uric acid were reduced after juice consumption but increased after wine consumption. Juice and wine consumption reduced plasma lipid peroxidation and increased plasma antioxidant capacity (ABTS and FRAP assays). Furthermore, juice inhibited H2O2-induced intracellular production of reactive species (RS) and increased the viability of SH-SY5Y cells. In contrast, wine (dealcoholized) exhibited a per se effect by inducing the production of RS and reducing cell viability. )ese results indicate a positive impact of acute consumption of Bordo juice and wine on human oxidative status, whereas only juice had protective effects against oxidative stress-induced cytotoxicity

Acute Consumption of Bordo Grape Juice and Wine Improves Serum Antioxidant Status in Healthy Individuals and Inhibits Reactive Oxygen Species Production in Human Neuron-Like Cells

Few studies investigated the biological effects of American grape cultivars. We investigated the metabolic response after acute consumption of grape juice or wine from Bordo grapes (Vitis labrusca) in a placebo-controlled crossover study with fifteen healthy volunteers. Blood samples were collected 1 hour after the intake of 100 mL of water, juice, or wine to measure TBARS, ABTS, FRAP, glucose, and uric acid levels. To evaluate differences in cellular response, intracellular reactive species production (DCFH-DA) and metabolic mitochondrial viability (MTT) were assessed after exposure of human neuron-like cells (SH-SY5Y) to juice or wine. Glycemia was reduced after juice or wine consumption, whereas blood levels of uric acid were reduced after juice consumption but increased after wine consumption. Juice and wine consumption reduced plasma lipid peroxidation and increased plasma antioxidant capacity (ABTS and FRAP assays). Furthermore, juice inhibited H2O2-induced intracellular production of reactive species (RS) and increased the viability of SH-SY5Y cells. In contrast, wine (dealcoholized) exhibited a per se effect by inducing the production of RS and reducing cell viability. These results indicate a positive impact of acute consumption of Bordo juice and wine on human oxidative status, whereas only juice had protective effects against oxidative stress-induced cytotoxicity

Quality of life in children with cleft lip and palate: pilot study

Objects: The quality of life and oral health of cleft lip and palate children has gain increasingly interest because oral disorders may present negative effect on the quality of life of these individuals. Accordingly, questionnaires aiming to evaluate the impact of oral health on the well-being have been developed and adapted. The present study aimed to evaluate the quality of life and oral health (CPQ8-10) of cleft lip and palate children. Methods and results: Forty-two children were selected, aging from 8 to 10 years-old, at mixed dentition. The children selected were divided into groups according to the type of cleft: Group I - Cleft Lip (n = 7); Group II - Cleft Lip and Palate (n=28); Group III - Cleft Palate (n=7). Each child filled in a questionnaire about the impact of oral disease on quality of life (CPQ8-10). Generally, Group I children affirmed that their teeth are "very good" = 28.57%, and "good" = 42.85%. The participants of Group II and III reported "a little" = 42.5% and 57.14%, respectively, with a greater discomfort with their dental conditions. Concerning to the halitosis perception, Group III exhibited the highest percentage ("sometimes" = 42.85%), followed by Group II ("sometimes" = 32.14%) and Group I ("sometimes" = 14.28%). Conclusion: The pilot study conduction was satisfactorily and the methodology is recommended for a larger sample. To date, it is suggested that the cleft type did not influence on the perception of the patients regarding to the quality of life

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

Extraction of the Muon Signals Recorded with the Surface Detector of the Pierre Auger Observatory Using Recurrent Neural Networks

We present a method based on the use of Recurrent Neural Networks to extract the muon component from the time traces registered with water-Cherenkov detector (WCD) stations of the Surface Detector of the Pierre Auger Observatory. The design of the WCDs does not allow to separate the contribution of muons to the time traces obtained from the WCDs from those of photons, electrons and positrons for all events. Separating the muon and electromagnetic components is crucial for the determination of the nature of the primary cosmic rays and properties of the hadronic interactions at ultra-high energies. We trained a neural network to extract the muon and the electromagnetic components from the WCD traces using a large set of simulated air showers, with around 450 000 simulated events. For training and evaluating the performance of the neural network, simulated events with energies between 1018.5, eV and 1020 eV and zenith angles below 60 degrees were used. We also study the performance of this method on experimental data of the Pierre Auger Observatory and show that our predicted muon lateral distributions agree with the parameterizations obtained by the AGASA collaboration

A search for ultra-high-energy photons at the Pierre Auger Observatory exploiting air-shower universality

The Pierre Auger Observatory is the most sensitive detector to primary photons with energies above ∼0.2 EeV. It measures extensive air showers using a hybrid technique that combines a fluorescence detector (FD) with a ground array of particle detectors (SD). The signatures of a photon-induced air shower are a larger atmospheric depth at the shower maximum (X$_{max}$) and a steeper lateral distribution function, along with a lower number of muons with respect to the bulk of hadron-induced background. Using observables measured by the FD and SD, three photon searches in different energy bands are performed. In particular, between threshold energies of 1-10 EeV, a new analysis technique has been developed by combining the FD-based measurement of X$_{max}$ with the SD signal through a parameter related to its muon content, derived from the universality of the air showers. This technique has led to a better photon/hadron separation and, consequently, to a higher search sensitivity, resulting in a tighter upper limit than before. The outcome of this new analysis is presented here, along with previous results in the energy ranges below 1 EeV and above 10 EeV. From the data collected by the Pierre Auger Observatory in about 15 years of operation, the most stringent constraints on the fraction of photons in the cosmic flux are set over almost three decades in energy