Traumatic brain injury (TBI): morbidity, mortality and economic implications

Traumatisms, in general, result in high costs for health systems worldwide. They consist of the leading cause of death in young adults, primarily males. Traumatic brain injury (TBI) represents good part of this spending, reaching globally significant mortality rate, around 1.5 million victims a year. Only in the United States (US) attendances related to traumatic brain injuries in emergency departments revolve around 1.35 million annually, plus about 275,000 hospitalizations and 52,000 deaths. In Brazil, only in 2012 was spent over one billion dollars with hospitalizations related to external causes, including TBI. Mild TBI (Glasgow Coma Scale (GCS) 14-15) occur in about 80% of the total demand, moderate (GCS 9-13) in 10% and serious (GCS 3-8) in 10 %. Regarding mortality rate, this is relatively low compared to the total number, since much of fatal outcomes fits in the moderate to severe groups. One of lesions a valuable prognostic factor related to the TBI is the subdural hematoma (SDH), responsible for complications in up to 45% of cases of TBI, expressing mortality between 60-80% depending on the implemented workup and may even reach 90% when in delay of appropriate treatment. The acute subdural hematoma (ASDH) thus represents a neurosurgical emergency, taking most of these patients to be subjected to urgent evacuation of the hematoma by craniotomy, which also is not without risks, with several reports in literature of new contralateral hematoma formation after craniotomy for evacuation of hematoma, further aggravating the patient's prognosis. For best results of the TBI is needed better understanding of the pathophysiology, identification of newer parameters of brain function and development of innovative therapeutic modalities. According to the Centers for Disease Control and Prevention (CDC), under the Department of Health and Human Services, population data on TBI are fundamental for understanding its impact on the society and know the profile of patients and the mechanisms trauma, to assist in the formulation of prevention strategies and in setting priorities for research and support services to patients living with traumatic brain injury

A utilização de ionômero de vidro e resina composta no selamento de cicatrículas, fóssulas e fissuras dentais: revisão de literatura: The use of glass ionomer and composite resin for sealing cicatriculas, fosculas and dental fissures: a literature review

A cárie dentária é um problema de saúde pública, abordado de forma ampla e buscando métodos preventivos mais eficientes. Os selantes são considerados uma opção terapêutica minimamente invasiva no tratamento de lesões cariosas limitadas à metade externa da dentina, pois o selamento da superfície oclusal elimina as regiões propícias ao acúmulo de bactérias e restos alimentares difíceis de serem removidos pela escovação, impedindo o início do processo carioso. Os selantes podem ser à base de resina, ionômero de vidro, ionômero de vidro modificado por resina ou de resina modificada por poliácidos. Inúmeros artigos e estudos pesquisados nesta revisão de literatura mostram que os selantes de fissuras são eficazes na prevenção da cárie na superfície oclusal, quando aplicados corretamente e em conjunto com outros métodos preventivos. Os dois tipos de materiais selantes mais utilizados, e que são amplamente abordados na literatura, são o cimento de ionômero de vidro e a resina composta, deste modo, este trabalho buscou enfatizar em artigos e pesquisas que comparassem a utilização desses dois materiais, atentando para propriedades como adesão físico-química à estrutura dentária, resistência aos fluidos bucais, resistência à abrasão e forças resultantes da mastigação, afim de esclarecer as vantagens de cada composto selante. Foi evidenciado que, desde o início das pesquisas sobre a temática, os selantes de fóssulas e fissuras a base de resina se mostraram mais eficientes e com maior durabilidade quando comparado com os selantes de ionômero de vidro, principalmente em relação a adesão do material na superfície dentária ao longo do tempo, porém, o primeiro se mostra com melhores resultados na prevenção da cárie

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Biofertilizante bovino, cobertura morta e revestimento lateral dos sulcos na produção de pimentão

The adoption of management practices that reduce water losses is essential to conserve moisture and improve soil temperature, especially in arid and semiarid environments of the Brazilian Northeast, characterized by high evapotranspiration and the adoption of irrigation with saline water, which harms growth and yield of commercial crops. Given these factories, an experiment was conducted in Nova Floresta, Paraiba, from August 2010 to February 2011 in Oxisoil, in order to evaluate the production of bell pepper and soil moisture in grooves with side trim, and application of biofertilizer and mulch cattle. The experimental design was randomized blocks with four replications using a factorial 2 x 2 x 2 for the ground beef with and without biofertilizer, with and without residues of sisal fiber (Agave sisalana), with and without the side facing the grooves, to reduce lateral water losses by infiltration of water with polyethylene plastic film. From the results, the lining of the lateral grooves provided higher values of soil moisture, number of fruits, fruit mass, plant production and productivity, bell pepper plants. It was also found that the combination of biofertilizer and mulch the ground beef remained wetter in the first 15 cm depth.A adoção de práticas de manejo que reduzam as perdas hídricas é imprescindível para a conservação da umidade e melhoramento da temperatura do solo, principalmente em ambientes áridos e semiáridos do Nordeste brasileiro, caracterizado pela alta evapotranspiração e pela adoção da irrigação com água salina, que prejudica o crescimento e rendimento comercial das culturas. Diante desses fatos, foi desenvolvido um experimento no Sítio Estrondo, município de Nova Floresta- PB, no período de agosto de 2010 a fevereiro de 2011 em um LATOSSOLO AMARELO Eutrófico típico, objetivando avaliar a produção das plantas de pimentão, bem como a umidade do solo em sulcos com revestimento lateral, aplicação de biofertilizante bovino e cobertura morta. O delineamento experimental foi em blocos casualizados com quatro repetições, usando o esquema fatorial 2 x 2 x 2, com os fatores referentes ao solo sem e com biofertilizante bovino, sem e com cobertura morta com resíduo de sisal, sem e com revestimento lateral dos sulcos, para redução das perdas hídricas por infiltração lateral da água, com filme plástico de polietileno respectivamente. Pelos resultados, o revestimento lateral dos sulcos proporcionou maiores valores de umidade do solo, número de frutos por planta, massa de frutos, produção por planta e produtividade, em plantas de pimentão. Constatou-se também que a combinação da cobertura morta e biofertilizante bovino manteve o solo mais úmido nos primeiros 15 cm de profundidade

Lipid content and apoptosis of in vitro-produced bovine embryos as determinants of susceptibility to vitrification

The objective was to evaluate supplementation of fetal calf serum (FCS) and phenazine ethosulfate (PES), a metabolic regulator that inhibits fatty acid synthesis, in culture media during in vitro production (IVP) of bovine embryos. Taking oocyte fertilization (n = 4,320) as Day 0, four concentrations of FCS (0, 2.5, 5, and 10%) and three periods of exposure to PES (without addition-Control; after 60 h-PES Day 2.5 of embryo culture; and after 96 h-PES Day 4) were evaluated. Increasing FCS concentration in the culture media enhanced lipid accumulation (P < 0.05), increased apoptosis in fresh (2.5%: 19.1 +/- 1.8 vs 10%: 28.4 +/- 2.3, P < 0.05; mean +/- SEM) and vitrified (2.5%: 42.8 +/- 2.7 vs 10%: 69.2 +/- 3.4, P < 0.05) blastocysts, and reduced blastocoele re-expansion after vitrification (2.5%: 81.6 +/- 2.5 vs 10%: 67.3 +/- 3.5, P < 0.05). The addition of PES in culture media, either from Days 2.5 or 4, reduced lipid accumulation (P < 0.05) and increased blastocoele re-expansion after vitrification (Control: 72.0 +/- 3.0 vs PES Day 2.5: 79.9 +/- 2.8 or PES Day 4: 86.2 +/- 2.4, P < 0.05). However, just the use of PES from D4 reduced apoptosis in vitrified blastocysts (Control: 52.0 +/- 3.0 vs PES Day 4: 39.2 +/- 2.4, P < 0.05). Independent of FCS withdrawal or PES addition to culture media, the in vivo control group had lesser lipid accumulation, a lower apoptosis rate, and greater cryotolerance (P < 0.05). The increased lipid content was moderately correlated with apoptosis in vitrified blastocysts (r = 0.64, P = 0.01). In contrast, the increased apoptosis in fresh blastocysts was strongly correlated with apoptosis in vitrified blastocysts (r = 0.94, P < 0.0001). Therefore, using only 2.5% FCS and the addition of PES from Day 4, increased the survival of IVP embryos after vitrification. Moreover, embryo quality, represented by the fresh apoptosis rate, was better than lipid content for predicting embryo survival after vitrification. (C) 2011 Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

A probiotic has differential effects on allergic airway inflammation in A/J and C57BL/6 mice and is correlated with the gut microbiome

Abstract The phenotypes of allergic airway diseases are influenced by the interplay between host genetics and the gut microbiota, which may be modulated by probiotics. We investigated the probiotic effects on allergic inflammation in A/J and C57BL/6 mice. C57BL/6 mice had increased gut microbiota diversity compared to A/J mice at baseline. Acetate producer probiotics differentially modulated and altered the genus abundance of specific bacteria, such as Akkermansia and Allistipes, in mouse strains. We induced airway inflammation followed by probiotic treatment and found that only A/J mice exhibited decreased inflammation, and the beneficial effects of probiotics in A/J mice were partially due to acetate production. To understand the relevance of microbial composition colonization in the development of allergic diseases, we implanted female C57BL/6 mice with A/J embryos to naturally modulate the microbial composition of A/J mice, which increased gut microbiota diversity and reduced eosinophilic inflammation in A/J. These data demonstrate the central importance of microbiota to allergic phenotype severity. Video Abstrac