O uso contínuo de anti-inflamatórios não esteroidais em idosos e a insuficiência renal aguda: levantamento bibliográfico / The continuous use of non-steroidal anti-inflammatory drugs in the elderly and acute renal insufficiency: a bibliographic survey

Devido a comercialização de fármacos de forma livre, sem a necessidade de uma receita médica e as recentes alterações na comercialização de antibióticos pelo Ministério da Saúde. Este artigo tem por objetivo analisar os possíveis prejuízos causados pelos anti-inflamatórios não esteroidais (AINE’s), que são os mais consumidos de forma geral, sobre a população idosa. Que devido sua fisiologia necessitam de maior cuidado no uso de drogas. A metodologia utilizada se baseia na revisão narrativa de artigos publicados em revistas especializadas. A pesquisa mostra um real comprometimento da estrutura e função renal causada pelos uso continuo e inadequado desses medicamentos. Ao final trabalho mostrou como e porque os AINE’s desenvolvem quadros de insuficiência renal aguda, que se não tratado evolui para danos severos sobre os rins e demais órgãos

Doença arterial obstrutiva periférica e neuropatia em paciente diabético tipo II: relato de caso / Peripheral obstructive arterial disease and neuropathy in type II diabetic patient: case report

Diabetes Mellitus é caracterizado pela presença de distúrbios metabólicos. A complicação mais comum é a neuropatia diabética que designa-se por um conjunto de sinais e sintomas clínicos ou subclínicos que comprometem o sistema nervoso periférico. A neuropatia diabética é uma condição de risco que acarreta o comprometimento da perfusão  sanguínea e/ou  amputação de membros inferiores, deformidades e complicações microvasculares. Além disso, o paciente com diabetes pode desenvolver a Doença Arterial Obstrutiva Periférica. Essa doença um tipo de aterosclerose que possui a claudicação intermitente como sinal patognomônico e em pacientes descompensados e/ou associado ao tabagismo, a obstrução periférica leva à desestabilização da isquemia. O presente relato de caso apresenta um paciente diabético tipo II descompensado que evoluiu com neuropatia e doença arterial obstrutiva periférica, as quais resultaram em uma má perfusão que exigiu procedimento cirúrgico para atenuação do quadro clínico

Gender Differences in COVID-19 Among Liver Transplant Recipients: Results from a Multicenter Brazilian Cohort

Introduction: Existing literature presents varying perspectives on the impact of COVID-19 on liver transplant recipients.However, no research has specifically investigated the role of gender differences in the manifestation of COVID-19 among liver transplant recipients. This study aims to examine the effects of COVID-19 on liver transplant recipients, with a focus on gender differences in disease presentation and progression. Methods: Conducted as a multicenter historical cohort study, this research collected patient records through an online questionnaire. Assessing COVID-related mortality was the main objective. Additionally, demographic, clinical, and laboratory data pertaining to disease presentation and progression werecollected. Results: The study included a total of 283 patients, of whom 76 were female and 206 were male. The median follow-up period for males was 99 days (IQR 38-283), while for females, it was 126 days (IQR 44-291). A higher prevalence of cardiovascular disease was observed in males (p=0.002). Females frequently experienced a loss of smell (p=0.021), whereas males commonly exhibited fever (p=0.031). Levels of ALT and gamma-glutamyl transferase were significantly elevated in males (p=0.008 and 0.004, respectively). Although there was a trend towards increased mortality in males, it did not reach statistical significance. Conclusion: This study is the first attempt to investigate gender differences in COVID-19 among liver transplant recipients. Our findings highlight the need for a comprehensive and personalised approach to treating this patient population and underscore the importance of further elucidating the disease presentation in these individuals

International Society of Human and Animal Mycology (ISHAM)-ITS reference DNA barcoding database - the quality controlled standard tool for routine identification of human and animal pathogenic fungi

Human and animal fungal pathogens are a growing threat worldwide leading to emerging infections and creating new risks for established ones. There is a growing need for a rapid and accurate identification of pathogens to enable early diagnosis and targeted antifungal therapy. Morphological and biochemical identification methods are time-consuming and require trained experts. Alternatively, molecular methods, such as DNA barcoding, a powerful and easy tool for rapid monophasic identification, offer a practical approach for species identification and less demanding in terms of taxonomical expertise. However, its wide-spread use is still limited by a lack of quality-controlled reference databases and the evolving recognition and definition of new fungal species/complexes. An international consortium of medical mycology laboratories was formed aiming to establish a quality controlled ITS database under the umbrella of the ISHAM working group on "DNA barcoding of human and animal pathogenic fungi." A new database, containing 2800 ITS sequences representing 421 fungal species, providing the medical community with a freely accessible tool at http://www.isham.org and http://its.mycologylab.org/ to rapidly and reliably identify most agents of mycoses, was established. The generated sequences included in the new database were used to evaluate the variation and overall utility of the ITS region for the identification of pathogenic fungi at intra-and interspecies level. The average intraspecies variation ranged from 0 to 2.25%. This highlighted selected pathogenic fungal species, such as the dermatophytes and emerging yeast, for which additional molecular methods/genetic markers are required for their reliable identification from clinical and veterinary specimens.This study was supported by an National Health and Medical Research Council of Australia (NH&MRC) grant [#APP1031952] to W Meyer, S Chen, V Robert, and D Ellis; CNPq [350338/2000-0] and FAPERJ [E-26/103.157/2011] grants to RM Zancope-Oliveira; CNPq [308011/2010-4] and FAPESP [2007/08575-1] Fundacao de Amparo Pesquisa do Estado de So Paulo (FAPESP) grants to AL Colombo; PEst-OE/BIA/UI4050/2014 from Fundacao para a Ciencia e Tecnologia (FCT) to C Pais; the Belgian Science Policy Office (Belspo) to BCCM/IHEM; the MEXBOL program of CONACyT-Mexico, [ref. number: 1228961 to ML Taylor and [122481] to C Toriello; the Institut Pasteur and Institut de Veil le Sanitaire to F Dromer and D Garcia-Hermoso; and the grants from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and the Fundacao de Amparo a Pesquisa do Estado de Goias (FAPEG) to CM de Almeida Soares and JA Parente Rocha. I Arthur would like to thank G Cherian, A Higgins and the staff of the Molecular Diagnostics Laboratory, Division of Microbiology and Infectious Diseases, Path West, QEII Medial Centre. Dromer would like to thank for the technical help of the sequencing facility and specifically that of I, Diancourt, A-S Delannoy-Vieillard, J-M Thiberge (Genotyping of Pathogens and Public Health, Institut Pasteur). RM Zancope-Oliveira would like to thank the Genomic/DNA Sequencing Platform at Fundacao Oswaldo Cruz-PDTIS/FIOCRUZ [RPT01A], Brazil for the sequencing. B Robbertse and CL Schoch acknowledge support from the Intramural Research Program of the NIH, National Library of Medicine. T Sorrell's work is funded by the NH&MRC of Australia; she is a Sydney Medical School Foundation Fellow.info:eu-repo/semantics/publishedVersio

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Behavioral, electroacoustic and electrophysiological hearing assessment of malnourished children

Introdução: A desnutrição energético-protéica é um dos maiores problemas de saúde pública no Brasil, ocorrendo mais frequentemente em pré-escolares e determinando o comprometimento do crescimento. A desnutrição pode provocar alterações no sistema nervoso central, dependendo da intensidade, da época de incidência e da duração da doença, comprometendo irreversivelmente as funções intelectuais. Levando-se em consideração a importância da integridade do Sistema Auditivo Periférico e Central na aquisição e desenvolvimento de fala, linguagem e aprendizado, torna-se imprescindível que anormalidades auditivas tanto periféricas como centrais sejam identificadas e tratadas precocemente nesta população. Objetivo: Caracterizar os achados das avaliações comportamentais, eletroacústicas e eletrofisiológicas da audição em crianças com desnutrição, bem como compará-los aos obtidos em crianças saudáveis da mesma faixa etária. Métodos: Foram realizados exames de audiometria tonal, logoaudiometria, teste dicótico de dígitos, imitanciometria, potencial evocado auditivo de tronco encefálico (PEATE) e potencial evocado auditivo de longa latência (PEALL) em 31 crianças desnutridas (grupo estudo) e 34 crianças saudáveis (grupo controle), com idade entre 7 e 12 anos, de ambos os gêneros. Resultados: Na análise dos dados quantitativos da audiometria tonal foi observada uma diferença estatisticamente significante entre os grupos para os limiares auditivos nas frequências de 250 e 8000 Hz, tendo o grupo estudo apresentado limiares auditivos mais elevados. Na análise qualitativa, não houve diferença estatisticamente significante entre os grupos, apesar de duas crianças do grupo estudo apresentarem perda auditiva discreta. Na análise dos dados qualitativos, não foram encontradas alterações na logoaudiometria para os dois grupos. No teste dicótico de dígitos, houve diferença estatisticamente significante entre os grupos, sendo observada uma maior proporção de crianças com alteração no grupo estudo. Ambos os grupos apresentaram resultados alterados na imitanciometria, não havendo diferença estatisticamente significante entre os grupos. Ambos os grupos apresentaram resultados normais do PEATE. Na análise dos dados quantitativos dos PEALL, verificou-se diferença estatisticamente significante entre os grupos para as latências dos componentes P1, N1 e P300, sendo que o grupo estudo apresentou latências maiores para todos os componentes. Na avaliação da amplitude do P300, houve diferença estatisticamente significante entre as orelhas direita e esquerda do grupo controle, sendo a amplitude do P300 maior na orelha direita. Por sua vez, no grupo estudo, não houve diferença significativa entre as orelhas direita e esquerda. Tanto o grupo controle quanto o grupo estudo apresentaram alterações nos resultados do PEALL, havendo diferença estatisticamente significante entre os grupos para os componentes P1, N1 e P300, sendo que o grupo estudo apresentou maior ocorrência de alterações. O tipo de alteração predominante nos componentes P1 e P300 foi o aumento de latência e, para o componente N1, foi a ausência de resposta no grupo estudo; para o grupo controle, o tipo de alteração predominante nos componentes P1, N1 e P300 foi o aumento de latência. Devido ao predomínio de crianças desnutridas de grau leve (58,1%), não foi possível estabelecer uma correlação entre o grau da desnutrição e a alteração dos PEALL. Conclusão: Crianças com desnutrição apresentaram mais alterações na avaliação comportamental da audição (audiometria tonal e teste dicótico de dígitos) e nos PEALL do que as crianças saudáveis, sugerindo déficit na via auditiva central e alteração no processamento da informação acústica. Há a necessidade de mais estudos para melhor caracterizar as alterações fonoaudiológicas e audiológicas desta população.Introduction: Protein-energy malnutrition is a major public health problem in Brazil. It is more frequent among pre-school aged children and it compromises growth. Malnutrition may cause changes to the central nervous system depending on its intensity, time of incidence and duration, irreversibly compromising intellectual functions. Considering the importance of Peripheral and Central Auditory System integrity to the acquisition and development of speech, language and learning, it is crucial that both peripheral and central auditory abnormalities are identified and treated early in this population. Objective: To describe the findings of behavioral, electroacoustic and electrophysiological auditory assessments of malnourished children, as well as comparing them with findings from healthy children within the same age group. Methods: The following tests were performed in 31 malnourished children (study group) and 34 healthy children (control group), aged 7 to 12, from both genders: pure tone audiometry, speech audiometry, dichotic digit test, immittance measures, brainstem auditory evoked potential (BAEP) and long-latency auditory evoked potential (LLAEP). Results: While analyzing quantitative data from pure tone audiometry we observed statistically significant differences between groups for hearing thresholds at frequencies of 250 and 8000 Hz; the study group had higher hearing thresholds. As for quantitative analysis, there was no statistically significant difference between groups, although two children in the study group showed slight hearing loss. While analyzing qualitative data we did not find any changes in speech audiometry in any of the groups. As for the dichotic digit test, there was a statistically significant difference between groups, with a higher proportion of abnormal children in the study group. Both groups showed abnormal immittance measures results, although there was no statistically significant difference between the groups. Both showed normal BAEP results. When analyzing quantitative LLAEP data we observed a statistically significant difference between groups in terms of latency of components P1, N1 and P300; the study group had higher latencies for all components. When analyzing P300 amplitudes, there was a statistically significant difference between the right and left ears in the control group; P300 amplitudes was wider for the right ear. On the other hand, the study group did not show any statistically significant difference between the right and left ears. Both the control and study group shoed abnormal LLAEP results. There was a statistically significant difference between groups for components P1, N1 and P300; abnormalities were more frequent in the study group. The type of predominant abnormality in components P1 and P300 was increased latency and for component N1 it was lack of response in the study group; for the control group the type of predominant abnormality in components P1, N1 and P300 was increased latency. Because most children were only slightly malnourished (58.1%), it was not possible to establish a correlation between the level of malnutrition and LLAEP abnormalities. Conclusion: Malnourished children showed more abnormalities in auditory behavioral assessment (pure tone audiometry and dichotic digit test) and LLAEP than healthy children. This suggests a deficit in central auditory pathways and abnormalities in the processing of acoustic information. Further studies are necessary to better describe speech and language and hearing abnormalities in this population