Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis

There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper?s title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54?14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30?28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery

Attitudes and behaviors of diabetics about the diabetes clinical prevention and control strategies

Introdução: O Diabetes Mellitus (DM) constitui um dos principais agravos de saúde pública das doenças crônicas não transmissíveis no mundo. Atitudes adequadas dos diabéticos frente às recomendações dos profissionais da saúde são imprescindíveis para sucesso terapêutico. Ademais, o nível de conhecimento sobre a doença constitui um dos pontos principais para prevenção de complicações do diabetes. Objetivo: Avaliar atitudes e comportamentos dos diabéticos acerca das estratégias de prevenção e suas influências no controle clínico do diabetes. Casuística e Métodos: Estudo transversal descritivo e exploratório realizado em duas Unidades Básicas de Saúde no interior do estado de Sergipe. A coleta de dados se deu através de questionários e realização do exame clínico. Resultados: Ao total, foram aplicados 82 questionários onde todos possuíam o DM tipo 2. A maioria dos pacientes era do sexo feminino (75,6%) com média de idade de 61,74 ± 13,06 anos, 39% analfabetos e apenas 15% trabalham. Foi observado excesso de peso em 66% e sedentarismo em 74% dos pacientes. Cerca de 10% apresentam alguma complicação do diabetes, 8% afirmaram não fazer tratamento conforme recomendado e 5% apresentam algum grau de amputação de membros inferiores associado ao DM. Mais de 90% desconheciam sinais, causas e manejo da hipoglicemia e apenas 18,29% participaram de alguma atividade educativa sobre o cuidado com o pé diabético. Conclusão: Os resultados remetem à necessidade da realização de estratégias preventivas, objetivando a educação em saúde e promoção, para aumentar o conhecimento, e melhorar atitudes e comportamento dos pacientes diabéticos.Introduction: Diabetes Mellitus (DM) is one of the main problem of public health among the chronic non transmissible diseases in several countries. The diabetic’s attitudes to the health professionals’ recommendations are essential for the success therapeutic. In addition, the knowledge about some disease aspects is one of the main points for the prevention diabetes complications. Objective: Evaluate attitudes and behaviors towards prevention strategies adopted and their influence on the clinical control of diabetes. Patients and Methods: Descriptive and exploratory cross-sectional study developed on two Public Basic Health Units in the interior of the state of Sergipe. The collection of data was done through a questionnaire and the clinical exam. Results: A total of 82 questionnaires were applied and all patients had DM type 2. The most of them were female (75.6%) with mean age of 61,74 ± 13,06 years, 39% are illiterate and only 15% are economically active. Overweight was observed in 66% of diabetics and sedentary lifestyle in 74% of them. About 10% had some type of diabetes complication, 8% referred do not follow treatment properly and 5% already presents some level of lower limb amputation associated with diabetes. More than 90% not had enough knowledge about the signs, causes and management of hypoglycemia, and only 18.29% participated of educational activities about diabetic foot care. Conclusion: The results show the necessity to develop preventive strategies focused on health education and promotions to increase knowledge, attitudes and behaviors of diabetic patients

Anthropometry and lifestyle of children and adolescent in inland of Northeastern Brazil

Introduction: Brazil is going through a nutritional transition, which is observed decrease in malnutrition and increased excess weight.Objective: To evaluate the nutritional status and lifestyle of school children and adolescents from 4 to 17 years old resident in the interior of the Brazilian Northeast.Methods: This is a longitudinal study performed in two stages. The first stage took place during the School Health Program and anthropometric data were collected from 975 schoolchildren. In the second stage, it was used a questionnaire to assess lifestyle and diet. Participants were classified into “not overweight” and “overweight”. The significant level for the statistical tests was set at 5%.Results: In the first stage, less than 2% of students had low height for age. The prevalence of overweight and malnutrition was 22.15% and 5.23%, respectively.  Of the 134 participants of the second stage, 47.76% were not overweight and 52.24% overweight. Regarding the lifestyle, the not overweight group had a higher percentage of insufficiently active members (p = 0.017) and a lower intake of vegetables and salads (p=0.015).Conclusions: The results revealed low short stature in the population studied and overweight was more prevalent than malnutrition. Children and adolescents had sedentary habits that associated with inappropriate dietary practices favor the occurrence of overweight.

Atitudes, conhecimento e barreiras científicas entre estudantes de medicina de uma universidade em Sergipe: estudo longitudinal

Introduction: Extracurricular activities participation such as research and extension allow students to develop skills. However, the literature reports the existence of barriers to the development of scientific practice in undergraduate courses. Previous studies were able to assess the target population only in a single moment. Objectives: To evaluate longitudinally the levels of knowledge, attitudes and scientific barriers of medical students. Casuistics and Methods: Longitudinal observational study carried out with medical students from Campus Prof. Antônio Garcia Filho of the Federal University of Sergipe. A questionnaire was applied to 23 students at two different times, 2015 and 2017, with 4 sections: Demographic, Scientific Knowledge, Favorable Attitudes to Scientific Practice and Barriers to Scientific experience. Results: In the analyzed period, there was an increase of more than 300% (p <0.0001) in the participation of students in Academic Leagues, as well as with regard to their scientific attitudes (increase of 21.80%; p <0, 01). When assessing knowledge scores and scientific barriers, no difference was observed between the two periods. Although, in the analysis of barriers alone, there was a significant increase (p <0.05) in dedication to curricular activities, lack of familiarity with statistics, and there was also an increase in the percentage of students who did not see the application of research in their future profession. Conclusion: Despite the improvement in attitudes, there was an increase in scientific barriers. Thus, there is a need to reduce the difficulties encountered by students and further encourage scientific practice.Introdução: A participação em atividades extracurriculares como a pesquisa e extensão permitem o desenvolvimento de habilidades nos estudantes. Entretanto, a literatura relata a existência de barreiras para o desenvolvimento da prática científica na graduação. Estudos anteriores conseguiram avaliar a população alvo apenas em um único momento. Objetivos: Avaliar longitudinalmente os níveis de conhecimento, atitudes e barreiras científicas de estudantes de medicina. Casuística e Métodos: Estudo observacional longitudinal realizado com acadêmicos de medicina do Campus Prof. Antônio Garcia Filho da Universidade Federal de Sergipe. Aplicou-se um questionário a 23 discentes em dois momentos diferentes, 2015 e 2017, possuindo 4 seções: Demográfica, Conhecimento Científico, Atitudes Favoráveis a Prática Científica e Barreiras para vivência Científica. Resultados: No período analisado, ocorreu crescimento de mais de 300% (p < 0,0001) na participação de estudantes em Ligas Acadêmicas, bem como no que diz respeito às suas atitudes científicas (aumento de 21,80%; p < 0,01). Ao avaliar os escores de conhecimento e barreiras científicas não foi observado diferença entre os dois períodos avaliados. Na análise das barreiras isoladamente, no entanto, constatou-se aumento significativo (p < 0,05) da dedicação nas atividades curriculares e falta de familiaridade com estatística, também houve aumento da porcentagem de alunos que não viam aplicação da pesquisa em sua futura profissão. Conclusão: Apesar da melhora das atitudes, houve aumento das barreiras científicas. Sendo assim, percebe-se a necessidade de reduzir as dificuldades encontradas pelos estudantes e estimular ainda mais a prática científica.                                                                                                                                                                                                                                                                                                                                                                                       

Increased thiol levels in antimony-resistant Leishmania infantum isolated from treatment-refractory visceral leishmaniasis in Brazil

BACKGROUND Treatment-refractory visceral leishmaniasis (VL) has become an important problem in many countries. OBJECTIVES We evaluated the antimony-resistance mechanisms of Leishmania infantum isolated from VL patients refractory or responsive to treatment with pentavalent antimony. METHODS Strains isolated from antimony-refractory patients (in vitro antimony-resistant isolates) and antimony-responsive patients (in vitro antimony-sensitive isolates) were examined. Morphological changes were evaluated by transmission electron microscopy after trivalent antimony exposure. P-glycoprotein (P-gp) efflux pump activity was evaluated using the pump-specific inhibitor verapamil hydrochloride, and the role of thiol in trivalent antimony resistance was investigated using the enzymatic inhibitor L-buthionine sulfoximine. FINDINGS Antimony treatment induced fewer alterations in the cellular structure of L. infantum resistant isolates than in that of sensitive isolates. P-gp efflux activity was not involved in antimony resistance in these isolates. Importantly, the resistant isolates contained higher levels of thiol compared to the sensitive isolates, and inhibition of thiol synthesis in the resistant isolates recovered their sensitivity to trivalent antimony treatment, and enhanced the production of reactive oxygen species in promastigotes exposed to the drug. MAIN CONCLUSIONS Our results demonstrate that isolates from patients with antimony-refractory VL exhibited higher thiol levels than antimony-sensitive isolates. This indicates that redox metabolism plays an important role in the antimony-resistance of New World VL isolates

Leishmania infantum Induces the Release of sTREM-1 in Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a systemic transmissible disease that remains to be a major global health problem. The inflammatory response during VL is characterized by the release of several cytokines and other pro-inflammatory mediators. Triggering Receptor Expressed on Myeloid Cells (TREM) are a group of evolutionarily conserved membrane-bound surface receptors expressed on neutrophils and monocytes. Engagement of TREM-1 directs intracellular signaling events that drive cytokine production, degranulation, and phagocytosis. In certain inflammatory-associated diseases, TREM-1 can also be found as a soluble form (sTREM-1), which can negatively regulate TREM-1 receptor signaling. In these studies, we now find that high levels of circulating sTREM-1 correlate directly with VL disease severity. In particular, high levels of sTREM-1 were observed in non-survivor VL patients. Furthermore, these levels of sTREM-1 positively correlated with liver size and negatively correlated with leukocyte counts and hemoglobin concentration. Moreover, we found that neutrophils exposure in vitro to Leishmania infantum modulates TREM-1, DAP12, and IL-8 gene expression, while also increasing release of sTREM-1. Finally, results revealed that higher sTREM-1 levels are associated with increasing parasite ratio. Taken together, these studies suggest that L. infantum may modulate TREM-1 in neutrophils and high levels of this molecule is associated with severe VL

Increased thiol levels in antimony-resistant Leishmania infantum isolated from treatment-refractory visceral leishmaniasis in Brazil

<div><p> BACKGROUND Treatment-refractory visceral leishmaniasis (VL) has become an important problem in many countries. OBJECTIVES We evaluated the antimony-resistance mechanisms of Leishmania infantum isolated from VL patients refractory or responsive to treatment with pentavalent antimony. METHODS Strains isolated from antimony-refractory patients (in vitro antimony-resistant isolates) and antimony-responsive patients (in vitro antimony-sensitive isolates) were examined. Morphological changes were evaluated by transmission electron microscopy after trivalent antimony exposure. P-glycoprotein (P-gp) efflux pump activity was evaluated using the pump-specific inhibitor verapamil hydrochloride, and the role of thiol in trivalent antimony resistance was investigated using the enzymatic inhibitor L-buthionine sulfoximine. FINDINGS Antimony treatment induced fewer alterations in the cellular structure of L. infantum resistant isolates than in that of sensitive isolates. P-gp efflux activity was not involved in antimony resistance in these isolates. Importantly, the resistant isolates contained higher levels of thiol compared to the sensitive isolates, and inhibition of thiol synthesis in the resistant isolates recovered their sensitivity to trivalent antimony treatment, and enhanced the production of reactive oxygen species in promastigotes exposed to the drug. MAIN CONCLUSIONS Our results demonstrate that isolates from patients with antimony-refractory VL exhibited higher thiol levels than antimony-sensitive isolates. This indicates that redox metabolism plays an important role in the antimony-resistance of New World VL isolates.</p></div