Qualidade de vida e autopercepção de saúde de pacientes submetidos à prostatectomia radical e os determinantes sociais de saúde

Introduction: The self-perception of health and quality of life in men subjected to radical prostatectomy can be influenced by the Social Determinants of Health (SDHs); therefore, exploring this relationship contributes to the development of health care measures.Objective: To identify associations between the SDHs and quality of life and self-perceived health in men subjected to radical prostatectomy.Method: A cross-sectional study with quantitative analysis, which had men subjected to radical prostatectomy as participants, interviewed using instruments to characterize the SDHs, Quality of Life (QoL) and self-perceived health. The data were analyzed using descriptive and correlational statistics. The study was approved by the Research Ethics Committee.Results: The participants were 33 men with a mean age of 66.8 years old, mostly white-skinned, with a spouse, professing some religion and with complete or incomplete Elementary School. They presented preserved levels of QoL and self-perception of health. Self-perceived health was associated with religion and with owning a house; QoL was associated with religion, type of surgical approach, marital status, having someone in the family with prostate cancer and schooling.Conclusion: There was an association between the SDHs and QoL and self-perceived health in men subjected to radical prostatectomy.Introducción: La autopercepción de salud y calidad de vida de los hombres sometidos a prostatectomía radical puede ser influenciada por los determinantes sociales de la salud (DSS), por lo tanto, explorar esa relación contribuye al desarrollo de medidas de atención a la salud.Objetivo: Identificar asociaciones entre DSS y calidad de vida y autopercepción de salud en hombres sometidos a prostatectomía radical.Método: Estudio transversal, con análisis cuantitativo, tuvo como participantes hombres sometidos a prostatectomía radical, entrevistados mediante instrumentos para caracterizar el DSS, Calidad de Vida (CV) y autopercepción de salud. Los datos se analizaron mediante estadística descriptiva y correlacional. El estudio fue aprobado por el Comité de Ética en Investigación.Resultados: Participaron 33 hombres, con una edad media de 66,8 años, en su mayoría blancos, con cónyuge, religión y primaria completa o incompleta. Presentaron niveles conservados de CV y autopercepción de salud. La autopercepción de salud se asoció con la religión y la posesión de vivienda, la CV se asoció con la religión, tipo de abordaje quirúrgico, estado civil, tener algún familiar con cáncer de próstata y escolaridad. Conclusión: Hubo una asociación entre DSS y QoL y la salud autopercibida de los hombres sometidos a prostatectomía radical.Introdução: A autopercepção de saúde e a qualidade de vida de homens submetidos a prostatectomia radical podem ser influenciadas pelos determinantes sociais de saúde (DSS), portanto, explorar esta essa relação contribui para desenvolver medidas de cuidado em saúde. Objetivo: Identificar as associações dos DSS com a qualidade de vida e autopercepção de saúde de homens submetidos a prostatectomia radical. Método: Estudo transversal, de análise quantitativa, teve como participantes homens submetidos a prostatectomia radical, entrevistados por meio de instrumentos para caracterização dos DSS, Qualidade de Vida (QV) e autopercepção de Saúde. Os dados foram analisados pela estatística descritiva e correlacional. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Participaram 33 homens, com média de idade de 66,8 anos, a maioria brancos, com cônjuge, religião e ensino fundamental completo ou incompleto. Apresentaram níveis preservados de QV e autopercepção de Saúde. A autopercepção de saúde foi associada a religião e possuir casa própria, a QV foi associada a religião, tipo de abordagem cirúrgica, estado civil, possuir alguém na família com câncer de próstata e escolaridade. Conclusão: Houve associação dos DSS na QV e autopercepção de saúde de homens submetidos a prostatectomia radical

Efetividade de intervenções de enfermagem preventivas de respostas adversas a meio de contraste iodado: protocolo de revisão sistemática

This review aimed to identify evidence available in the literature about nursing interventions to prevent adverse reactions to iodinated contrast media. The research question for this study – “How effective are nursing actions at preventing adverse reactions in patients who will receive iodinated contrast?” – is based on issues that involve patient safety regarding the risk of adverse events. Method: systematic review based on the Joanna Briggs Institute protocol, which provides for the formulation of a guiding question, definition of descriptors, participation of two reviewers, definition of inclusion and exclusion criteria for studies, definition of electronic databases, selection of studies , critical analysis of the articles and synthesis of the data with the recommendation of the degree of evidence. Expected results: survey of scientific evidence to prevent adverse responses to the iodinated contrast medium, as well as provide means for the safety of radiological nursing care.El objetivo de esta revisión es identificar la evidencia disponible en la literatura sobre intervenciones preventivas de enfermería para las respuestas adversas a los medios de contraste yodados. La pregunta de investigación para este estudio es la siguiente: “¿Qué tan efectivas son las acciones de enfermería preventiva para las reacciones adversas desarrolladas por pacientes que recibirán contraste yodado?” Basado en cuestiones que involucran la seguridad del paciente a riesgo de un evento adverso. Método: revisión sistemática basada en el protocolo del Instituto Joanna Briggs, que prevé la formulación de una pregunta guía, definición de descriptores, participación de dos revisores, definición de criterios de inclusión y exclusión para estudios, definición de bases de datos electrónicas, selección de estúdios, análisis crítico de los artículos y síntesis de los datos con la recomendación del grado de evidencia. Resultados esperados: encuesta de evidencia científica para prevenir respuestas adversas al medio de contraste yodado, así como proporcionar medios para la seguridad de la atención radiológica de enfermería.O objetivo desta revisão é identificar evidências disponíveis na literatura sobre intervenções de enfermagem preventivas de respostas adversas ao meio de contraste iodado. A questão de pesquisa para esse estudo é a seguinte: “Qual a eficácia das ações de enfermagem preventivas de reações adversas desenvolvidas por pacientes que receberão contraste iodado? ” Baseada nas questões que envolvem a segurança do paciente ao risco de evento adverso. Método: revisão sistemática baseada no protocolo do Joanna Briggs Institute, que prevê a formulação de uma questão norteadora, definição de descritores, participação de dois revisores, definição de critérios de inclusão e exclusão dos estudos, definição de bases de dados eletrônicas, seleção dos estudos, análise crítica dos artigos e síntese dos dados com a recomendação do grau de evidência. Resultados esperados: levantamento de evidências científicas para prevenção de respostas adversas ao meio de contraste iodado, bem como fornecer meios para segurança da assistência de enfermagem radiológica

Quality of life and self-perceived health of patients subjected to radical prostatectomy and the social determinants of health

Introducción: La autopercepción de salud y calidad de vida de los hombres sometidos a prostatectomía radical puede ser influenciada por los determinantes sociales de la salud (DSS), por lo tanto, explorar esa relación contribuye al desarrollo de medidas de atención a la salud. Objetivo: Identificar asociaciones entre DSS y calidad de vida y autopercepción de salud en hombres sometidos a prostatectomía radical. Método: Estudio transversal, con análisis cuantitativo, tuvo como participantes hombres sometidos a prostatectomía radical, entrevistados mediante instrumentos para caracterizar el DSS, Calidad de Vida (CV) y autopercepción de salud. Los datos se analizaron mediante estadística descriptiva y correlacional. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: Participaron 33 hombres, con una edad media de 66,8 años, en su mayoría blancos, con cónyuge, religión y primaria completa o incompleta. Presentaron niveles conservados de CV y autopercepción de salud. La autopercepción de salud se asoció con la religión y la posesión de vivienda, la CV se asoció con la religión, tipo de abordaje quirúrgico, estado civil, tener algún familiar con cáncer de próstata y escolaridad. Conclusión: Hubo una asociación entre DSS y QoL y la salud autopercibida de los hombres sometidos a prostatectomía radical.Introdução: A autopercepção de saúde e a qualidade de vida de homens submetidos a prostatectomia radical podem ser influenciadas pelos determinantes sociais de saúde (DSS), portanto, explorar esta essa relação contribui para desenvolver medidas de cuidado em saúde. Objetivo: Identificar as associações dos DSS com a qualidade de vida e autopercepção de saúde de homens submetidos a prostatectomia radical. Método: Estudo transversal, de análise quantitativa, teve como participantes homens submetidos a prostatectomia radical, entrevistados por meio de instrumentos para caracterização dos DSS, Qualidade de Vida (QV) e autopercepção de Saúde. Os dados foram analisados pela estatística descritiva e correlacional. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Participaram 33 homens, com média de idade de 66,8 anos, a maioria brancos, com cônjuge, religião e ensino fundamental completo ou incompleto. Apresentaram níveis preservados de QV e autopercepção de Saúde. A autopercepção de saúde foi associada a religião e possuir casa própria, a QV foi associada a religião, tipo de abordagem cirúrgica, estado civil, possuir alguém na família com câncer de próstata e escolaridade. Conclusão: Houve associação dos DSS na QV e autopercepção de saúde de homens submetidos a prostatectomia radicalIntroduction: The self-perception of health and quality of life in men subjected to radical prostatectomy can be influenced by the Social Determinants of Health (SDHs); therefore, exploring this relationship contributes to the development of health care measures. Objective: To identify associations between the SDHs and quality of life and self-perceived health in men subjected to radical prostatectomy. Method: A cross-sectional study with quantitative analysis, which had men subjected to radical prostatectomy as participants, interviewed using instruments to characterize the SDHs, Quality of Life (QoL) and self-perceived health. The data were analyzed using descriptive and correlational statistics. The study was approved by the Research Ethics Committee. Results: The participants were 33 men with a mean age of 66.8 years old, mostly white-skinned, with a spouse, professing some religion and with complete or incomplete Elementary School. They presented preserved levels of QoL and self-perception of health. Self-perceived health was associated with religion and with owning a house; QoL was associated with religion, type of surgical approach, marital status, having someone in the family with prostate cancer and schooling. Conclusion: There was an association between the SDHs and QoL and self-perceived health in men subjected to radical prostatectomy

Type 2 Diabetes Variants Disrupt Function of SLC16A11 through Two Distinct Mechanisms

Type 2 diabetes (T2D) affects Latinos at twice the rate seen in populations of European descent. We recently identified a risk haplotype spanning SLC16A11 that explains ∼20% of the increased T2D prevalence in Mexico. Here, through genetic fine-mapping, we define a set of tightly linked variants likely to contain the causal allele(s). We show that variants on the T2D-associated haplotype have two distinct effects: (1) decreasing SLC16A11 expression in liver and (2) disrupting a key interaction with basigin, thereby reducing cell-surface localization. Both independent mechanisms reduce SLC16A11 function and suggest SLC16A11 is the causal gene at this locus. To gain insight into how SLC16A11 disruption impacts T2D risk, we demonstrate that SLC16A11 is a proton-coupled monocarboxylate transporter and that genetic perturbation of SLC16A11 induces changes in fatty acid and lipid metabolism that are associated with increased T2D risk. Our findings suggest that increasing SLC16A11 function could be therapeutically beneficial for T2D. Video Abstract [Figure presented] Keywords: type 2 diabetes (T2D); genetics; disease mechanism; SLC16A11; MCT11; solute carrier (SLC); monocarboxylates; fatty acid metabolism; lipid metabolism; precision medicin

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research