Risk of Orthopedic Surgical Site Infections in Patients with Rheumatoid Arthritis Treated with Antitumor Necrosis Factor Alfa Therapy

Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue

Risk of Orthopedic Surgical Site Infections in Patients with Rheumatoid Arthritis Treated with Antitumor Necrosis Factor Alfa Therapy

Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue

AVALIAÇÃO DA QUALIDADE DE SERVIÇOS EDUCACIONAIS EM UMA INSTITUIÇÃO PÚBLICA DE ENSINO SUPERIOR E SUAS CONSEQUÊNCIAS

O objetivo deste trabalho foi medir a qualidade percebida pelos estudantes de uma IES pública e suas consequências, utilizando uma escala ECSI estendida adaptada para o ensino superior. Foi aplicado um questionário para uma amostra dos alunos da IES, totalizando 502 questionários válidos. Imagem Percebida e Expectativas dos alunos foram os construtos que apresentaram as maiores notas em relação à média de avaliação de todos os itens. Qualidade Percebida e Valor Percebido obtiveram notas pouco acima da média, enquanto que Comunicação boca a boca obteve uma média regular. Satisfação e Confiança tiveram avaliações pouco abaixo da média geral. Também foram calculadas as correlações entre os oito construtos do modelo utilizado e verificou-se que essas correlações entre os construtos que possuem relações de causalidade apresentaram altos valores e correlações significativas em nível de 0.01. Os resultados indicam a possibilidade de que o modelo possui validade em sua cadeia nomológica

Correction of a Complication of the Use of a Nasoesophageal Feeding Tube in a Southern Tiger Cat (Leopardus guttulus)

Background: The southern tiger cat (Leopardus guttulus) is a vulnerable wild felid whose occurrence is restricted to the Atlantic Forest biome of Brazilian South and Southwest regions. Various strategies must be used to improve the conservation of species of felids, including preservation of forests and greater therapeutic support for animals in poor health condition. Enteral nutrition through a nasoesophageal tube is an option for patients in poor or critical condition; however, this procedure carries the risk of accidental ingestion of the tube. The objective of this work is to describe a conservative approach for the management of ingestion of a linear foreign body in a Leopardus guttulus patient.Case: A young female southern tiger cat was taken for veterinary treatment. The patient had an estimated age of nine weeks, 0.846 kg of body weight, and exhibited cachexia, hypothermia, severe dehydration, and apathy. During the examination, blood samples were taken, and initial treatment commenced with fluid therapy, antibiotic therapy, and anti-inflammatory therapy along with administration of analgesics and a gastric protector. Since the patient did not want to eat, it received a nasoesophageal feeding tube under mild sedation. The patient was positioned in sternal recumbency, its head was tilted up, and a no. 6 nasoesophageal tube was ventromedially inserted through the right nostril. The tube was later confirmed to be correctly positioned at the ninth intercostal space by a radiographic study. The feeding tube allowed administration of drugs and microenteral nutrition with a hypercaloric diet; this minimized handling of the patient, which preserved its wild behavior. After the seventh day of treatment, a piece of the tube was found lying at the bottom of the cage. Since ingestion of the remainder of the tube by the patient was suspected, it was taken to the diagnostic imaging division. At the ultrasonographic exam, the stomach exhibited hypermotility and was filled with a moderate amount of mucous content. The stomach wall was thin, and its stratified structure was preserved. Ultrasound imaging did not reveal any alterations suggestive of obstruction or inflammation such as free liquid, thickened wall, or loss of the stratified structure of the layers of the stomach. A hyperechoic tubular structure compatible with the feeding tube used was detected in the fundus of the stomach. After verification of the presence of the tube-derived material in the digestive system, the medical team opted for a conservative therapy consisting of administration of fibers, to increase intestinal motility. The patient was followed up daily by means of imaging exams. The patient did not exhibit signs of intestinal obstruction during the follow-up period. Two days after commencement of the conservative therapy, the remnant of the feeding tube that had been ingested by the patient was expelled along with the feces.Discussion: In spite of the accidental ingestion of the feeding tube by the patient, the use of this device was effective to provide nutritional and pharmacological support to the Leopardus guttulus cub, leading to its recovery. Managing malnutrition is fundamental for the recovery of any patient. Inappetence is alarming especially in felines, which quickly develop hepatic lipidosis during extended periods of anorexia. The conservative approach used, with the aid of serial imaging exams, was enough to treat ingestion of the linear foreign body by the patient

Low dynamic muscle strength and its associations with fatigue, functional performance, and quality of life in premenopausal patients with systemic lupus erythematosus and low disease activity : a case–control study

Background: The purpose of the present study was to compare dynamic muscle strength, functional performance, fatigue, and quality of life in premenopausal systemic lupus erythematosus (SLE) patients with low disease activity versus matched-healthy controls and to determine the association of dynamic muscle strength with fatigue, functional performance, and quality of life in SLE patients. Methods: We evaluated premenopausal (18–45 years) SLE patients with low disease activity (Systemic lupus erythematosus disease activity index [SLEDAI]: mean 1.5 ± 1.2). The control (n = 25) and patient (n = 25) groups were matched by age, physical characteristics, and the level of physical activities in daily life (International Physical Activity Questionnaire IPAQ). Both groups had not participated in regular exercise programs for at least six months prior to the study. Dynamic muscle strength was assessed by one-repetition maximum (1-RM) tests. Functional performance was assessed by the Timed Up and Go (TUG), in 30-s test a chair stand and arm curl using a 2-kg dumbbell and balance test, handgrip strength and a sit-and-reach flexibility test. Quality of life (SF-36) and fatigue were also measured. Results: The SLE patients showed significantly lower dynamic muscle strength in all exercises (leg press 25.63%, leg extension 11.19%, leg curl 15.71%, chest press 18.33%, lat pulldown 13.56%, 1-RM total load 18.12%, P < 0.001-0.02) compared to the controls. The SLE patients also had lower functional performance, greater fatigue and poorer quality of life. In addition, fatigue, SF-36 and functional performance accounted for 52% of the variance in dynamic muscle strength in the SLE patients. Conclusions: Premenopausal SLE patients with low disease activity showed lower dynamic muscle strength, along with increased fatigue, reduced functional performance, and poorer quality of life when compared to matched controls

Polymeric micelles containing resveratrol: development, characterization, cytotoxicity on tumor cells and antimicrobial activity

Antimicrobial and antitumor activities of resveratrol, a compound found mainly in grapes, have already been demonstrated. However, its low bioavailability is a limiting factor for therapeutic application. Polymeric micelles can be an approach to solve this problem since they can encapsulate hydrophobic substances. We developed and characterized micellar formulations containing resveratrol and evaluated their cytotoxic and antimicrobial effects. The formulations were prepared by the cold dispersion method with different concentrations of F127 (5 or 10% w/w) and resveratrol (500 or 5000 µM). The formulations were characterized according to size, polydispersity index, pH, encapsulation rate and in vitro release. Cytotoxic effect was evaluated on a bladder cancer cell line and antimicrobial effect was evaluated on E. coli, S. aureus and C. albicans. One of the formulations (10% w/w of F127 and 5000 µM of resveratrol) was a monodispersed solution with high encapsulation rate, thus it was chosen for the cytotoxicity and antimicrobial assays. MS10+RES-3 was able to preserve the antimicrobial and cytotoxic activity of resveratrol. This is the first study that evaluated antimicrobial potential and cytotoxicity of micelles containing resveratrol on bladder cancer cells and the results showed that micellar nanostructures could ensure the maintenance of the biological activity of resveratrol

In vitro antileishmanial and antitrypanosomal activities of flavanones from Baccharis retusa DC. (Asteraceae)

Leishmaniasis and Chagas' are parasitic protozoan diseases that affect the poorest population in the world, causing a high mortality and morbidity. As a result of highly toxic and long-term treatments, novel, safe and more efficacious drugs are essential. in this work, the CH2Cl2 phase from MeOH extract from the leaves of Baccharis retusa DC. (Asteraceae) was fractioned to afford two flavonoids: naringenin (1) and sakuranetin (2). These compounds were in vitro tested against Leishmania spp. promastigotes and amastigotes and Ttypanosoma cruzi trypomastigotes and amastigotes. Compound 2 presented activity against Leishmania (L) amazonensis, Leishmania (V.) braziliensis, Leishmania (L) major, and Leishmania (L) chagasi with IC50 values in the range between 43 and 52 mu g/mL and against T. cruzi trypomastigotes (IC50= 20.17 mu g/mL). Despite of the chemical similarity, compound 1 did not show antiparasitic activity. Additionally, compound 2 was subjected to a methylation procedure to give sakuranetin-4'-methyl ether (3), which resulted in an inactive compound against both Leishmania spp. and T. cnizi. the obtained results indicated that the presence of one hydroxyl group at C-4' associated to one methoxyl group at C-7 is important to the antiparasitic activity. Further drug design studies aiming derivatives could be a promising tool for the development of new therapeutic agents for Leishmaniasis and Chagas' disease. (C) 2011 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Pesquisa e DesenvolvimentoUniversidade Federal de São Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Diadema, SP, BrazilInst Adolfo Lutz Registro, Dept Parasitol, São Paulo, BrazilUniv Fed ABC, Ctr Ciencias Nat & Humanas, Santo Andre, SP, BrazilUniv Presbiteriana Mackenzie, Ctr Ciencias & Humanidades, São Paulo, BrazilUniversidade Federal de São Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Diadema, SP, BrazilFAPESP: 06/57626-5FAPESP: 08/11496-9Conselho Nacional de Pesquisa e Desenvolvimento: 473405/2008-3Conselho Nacional de Pesquisa e Desenvolvimento: 477422/2009-8Web of Scienc

Protótipo acessível de um filtro com materiais reutilizáveis para captação de água da chuva em calhas residenciais e industriais / Affordable prototype of a filter with reusable materials for rainwater harvesting in residential and industrial gutters

O objetivo desse projeto é a elaboração da prototipagem de um filtro com materiais financeiramente acessíveis, captando água da chuva através de calhas no telhado. A água captada e tratada pelo filtro, poderá ser utilizada para diversos fins, salientando que o método de filtragem proposto não contempla a capacidade de ingestão da água filtrada. O insumo terá um objetivo de ser empregado nos ambientes industriais e residenciais. O filtro se apresenta como uma proposta inicial de sustentabilidade simples e eficiente, com aspectos de utilização do insumo tratado, por exemplo: lavagem de quintal, carro, moto, louça, roupas e irrigação de hortas entre outras funcionalidades, apresentando como vantagem o custo benefício atrelado ao padrão sustentável, viável e econômico ao usuário. Compreendendo a escassez de água nas diversas regiões, o protótipo torna-se uma excelente opção para sustentabilidade da água, logo o serviço doméstico economizará água e os processos industriais utilizarão da água coletada pelo filtro empregando no processo fabril, não necessitando de utilizar a água principalmente potável. A região municipal onde ocorreu o desenvolvimento da pesquisa, a precipitação atmosférica municipal apresentou valores relevantes no âmbito municipal, regional, estadual e nacional. Outro fator relevante que contribui para a continuidade das pesquisas e aperfeiçoamento do protótipo é que o município, situa-se na região do Vale do Paraíba, localizado no estado de São Paulo, consistindo em um cenário fértil e relevante de indústrias regionais, nacionais, internacionais e multinacionais, concluindo assim a eficácia para os habitantes e indústrias. Os resultados obtidos foram satisfatórios, a capacidade volumétrica do filtro foi de aproximadamente vinte litros de água e o valor monetário para o desenvolvimento do filtro e instalação na residência ou indústria, no ano de 2018 que foi desenvolvido, não ultrapassou o valor de cem reais

Experimentation with psychoactive substances by public school students

OBJECTIVE To analyze the prevalence of exposure to psychoactive substances in public students of basic education and its association with sociodemographic characteristics. METHODS This is a cross-sectional survey conducted from March to September 2015, involving 1,009 students of the basic and high school education in 20 public schools in the municipality of Aracaju, State of Sergipe, Brazil. The data have been compiled using questionnaires previously applied in national studies of the Brazilian Center for Psychotropic Drugs. The variables have been dichotomized for later logistic regression using the Chi-square test to analyze associations between experimentation with psychoactive substances and other sociodemographic variables; odds ratio and confidence intervals have also been calculated. The level of significance adopted was 5%. RESULTS We have identified that 69.6% of the students have experimented alcohol and 12.4% cigarettes. Age (≥ 15 years) has shown a significant association with experimentation with alcohol (p < 0.001) and cigarettes (p = 0.02), acting as risk factor in both cases (OR = 2.34 and 1, 78, respectively), but it acted as a protective factor for the use of inhalants (p = 0.03 and OR = 0.58) and weight loss medication (p = 0.006 and OR = 0.44). Religious practice had a significant association with experimentation with alcohol (p = 0.01), functioning as a protective factor (OR = 0.56). CONCLUSIONS We have concluded that the psychoactive substance most experienced by students was alcohol, followed by cigarettes, and chance for experimentation increases after the age of 15. Religious practice, in turn, acts as a protective factor for experimentation with alcohol.OBJETIVO Analisar a prevalência de exposição a substâncias psicoativas em estudantes do ensino básico de escolas públicas e sua associação com características sociodemográficas. MÉTODOS Trata-se de um inquérito transversal realizado de março a setembro de 2015, envolvendo 1.009 alunos do ensino fundamental e médio em 20 escolas públicas de Aracaju, São Cristóvão e Nossa Senhora do Socorro. Os dados foram compilados por meio de questionários aplicados anteriormente em estudos nacionais do Centro Brasileiro de Drogas Psicotrópicas. As variáveis foram dicotomizadas para posterior regressão logística com aplicação do teste Qui-quadrado para analisar associações entre a experimentação de substâncias psicoativas e outras variáveis sociodemográficas, e calculada a razão de chances e seus intervalos de confiança. O nível de significância adotado foi de 5%. RESULTADOS Identificamos que 69,6% dos estudantes têm experimentado álcool e 12,4% cigarro. A idade dos alunos (≥ 15 anos) mostrou associação significativa com a experimentação de álcool (p < 0,001) e cigarros (p = 0,02), atuando como fator de risco em ambos os casos (OR = 2,34 e 1,78, respectivamente), mas atuando como fator de proteção para o uso de inalantes (p = 0,03 e OR = 0,58) e remédios para emagrecer (p = 0,006 e OR = 0,44). A prática religiosa apresentou associação significativa com a experimentação de álcool (p = 0,01), funcionando como um fator de proteção (OR = 0,56). CONCLUSÕES Conclui-se que a substância psicoativa mais experimentada pelos estudantes foi o álcool, seguida do cigarro, e que a chance de experimentação aumenta a partir dos 15 anos. A prática religiosa, por sua vez, atua como fator de proteção à experimentação do álcool