Nevin Manimala

Arq Bras Cardiol. 2022 Apr;118(4):694-700. doi: 10.36660/abc.20210050.

ABSTRACT

BACKGROUND: The prognostic importance of the classification ‘heart failure (HF) with mid-range ejection fraction (EF)’ remains uncertain.

OBJECTIVE: To analyze the clinical characteristics, comorbidities, complications, and in-hospital and late mortality of patients classified as having HF with mid-range EF (HFmrEF – EF: 40%-49%), and to compare them to those of patients with HF with preserved EF (HFpEF – EF > 50%) and with HF with reduced EF (HFrEF – EF < 40%) on admission for decompensated HF.

METHODS: Ambispective cohort of patients admitted to the cardiac intensive care unit due to decompensated HF. Clinical characteristics, comorbidities, complications, and in-hospital and late mortality were assessed. The software R was used, with a 5% significance, for the tests chi-square, analysis of variance, Cox multivariate, and Kaplan-Meier survival curve, in addition to machine-learning techniques (Elastic Net and survival tree).

RESULTS: 519 individuals were included between September 2011 and June 2019 (mean age, 74.87 ± 13.56 years; 57.6% were men). The frequencies of HFpEF, HFmrEF and HFrEF were 25.4%, 27% and 47.6%, respectively. Previous infarction was more frequent in HFmrEF. The mean follow-up time was 2.94 ± 2.55 years, with no statistical difference in mortality between the groups (53.8%, 52.1%, 57.9%). In the survival curve, there was difference between neither the HFpEF and HFmrEF groups, nor the HFpEF and HFrEF groups, but between the HFmrEF and HFrEF groups. Age over 77 years, previous HF, history of readmission, dementia and need for vasopressors were associated with higher late mortality in the survival tree.

CONCLUSION: The EF was not selected as a variable associated with mortality in patients with decompensated HF.

PMID:35508046 | DOI:10.36660/abc.20210050

Braz Dent J. 2022 Mar-Apr;33(2):61-67. doi: 10.1590/0103-6440202204929.

ABSTRACT

To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the ‘Child Impact’ section in the LAC was 4.0(±8.3), in the ‘Family Impact’ section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the ‘Child Impact’ section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the ‘Family Impact’ section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children’s age and parents’ report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

PMID:35508037 | DOI:10.1590/0103-6440202204929

Braz Dent J. 2022 Mar-Apr;33(2):12-21. doi: 10.1590/0103-6440202204772.

ABSTRACT

The purpose of this in vitro study was to evaluate the shaping ability of reciprocating and continuous rotary systems after root canal retreatment. After preparation and root canal filling, mesial canals of 54 mandibular molars were distributed into 3 groups (n=18), according to the filling material removal and re-instrumentation protocols: WOG group – WaveOne Gold system; PTN group – ProTaper Next system; and PTU group – ProTaper Universal system. Cone-beam computed tomographic (CBCT) images acquisition of the mesial root canals was performed at different moments: (1) before instrumentation (unprepared root canals), (2) after preparation and filling, (3) after filling material removal and (4) re-instrumentation. The apical transportation (AT), centering ability (CA) and change in root canal diameter were assessed by CBCT analysis. The remaining filling material quantification was performed by radiographic examination. The statistical analyses were performed using the 3-way ANOVA, Tukey-Kramer, Kruskal-Wallis and Dunn multiple Comparison tests (p<0.05). The tested instruments did not show full CA (=1.0). PTN group had greater AT at the 5th mm in comparison with the WOG group (p<0.05). After re-instrumentation, WOG group had greater root canal diameter change at the 1st and 5th mm than PTN and PTU groups (p<0.05). There was no significant difference among groups when comparing the amount of remaining filling material after re-instrumentation (p>0.05). The tested systems provided minimal alteration in root canal morphology at the apical portion after root canal retreatment. However, WOG promoted greater change in root canal diameter.

PMID:35508032 | DOI:10.1590/0103-6440202204772

Braz Dent J. 2022 Mar-Apr;33(2):1-11. doi: 10.1590/0103-6440202204567.

ABSTRACT

The aim was to assess the physicochemical properties and the penetration into dentinal tubules of calcium hypochlorite solution [Ca(OCl)2], with or without surfactants. The surfactants benzalkonium chloride, cetrimide, Tween 80 and Triton X-100 were mixed at different concentrations with sodium hypochlorite solution (NaOCl), Ca(OCl)2 and distilled water (control). Once the critical micellar concentration (CMC) of the surfactants in Ca(OCl)2 and NaOCl was determined, pH, free chlorine, surface tension and free calcium ions were evaluated. The penetration into dentinal tubules of NaOCl and Ca(OCl)2, with or without benzalkonium chloride and Triton X-100 [surfactants that promoted the lowest surface tension of Ca(OCl)2], was assessed using human premolars stained with crystal violet. The statistical tests were one-way ANOVA and Tukey’s post-test, Kruskal-Wallis and Dunn’s post-test, two-way ANOVA and Bonferroni’s post-test, and t-test; depending on the assay. The addition of surfactants reduced the surface tension of NaOCl and Ca(OCl)2, and did not alter the pH or the free available chlorine of either solution. The addition of all surfactants increased the availability of free calcium ions in Ca(OCl)2, especially benzalkonium chloride. Ca(OCl)2 exhibited lower penetration into dentinal tubules than NaOCl, and the addition of surfactants did not improve the penetration of Ca(OCl)2, but did increase the penetration of NaOCl. It can be concluded that the addition of surfactants to Ca(OCl)2 did not increase the penetration into dentinal tubules, but it did promote lower surface tension, without changing the pH or free available chlorine values, and higher availability of free calcium ions in Ca(OCl)2.

PMID:35508031 | DOI:10.1590/0103-6440202204567

Cad Saude Publica. 2022 Apr 29;38(4):EN230621. doi: 10.1590/0102-311XEN230621. eCollection 2022.

ABSTRACT

This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks – Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

PMID:35508025 | DOI:10.1590/0102-311XEN230621

Sao Paulo Med J. 2022 May 2:S1516-31802022005010201. doi: 10.1590/1516-3180.2021.0659.R2.13102021. Online ahead of print.

ABSTRACT

BACKGROUND: Stroke is one of the main causes of death worldwide. Educational interventions on stroke are potentially effective in reducing the period between the onset of symptoms and the initial emergency medical assistance.

OBJECTIVES: To assess high school students’ knowledge of stroke.

DESIGN AND SETTING: Cross-sectional study conducted in high schools in northeastern Brazil.

METHODS: A self-structured questionnaire survey regarding stroke awareness was applied among high school students in northeastern Brazil. Data were collected between 2018 and 2019. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression.

RESULTS: A total of 1,788 students were analyzed. Eighty percent (n = 1430) of them did not have the minimum knowledge on how to act in a stroke situation. Only 10% (n = 179) presented the ideal knowledge on how to act. Males presented lower levels of knowledge on risk factors (odds ratio, OR: 0.62%; 95% confidence interval, CI: 0.49-0.79) and signs and symptoms of stroke (OR: 0.63%; 95% CI: 0.52-0.77). Students with ≥ 10 years of schooling (OR: 1.64%; 95% CI: 1.30-2.07) demonstrated greater knowledge of signs and symptoms of stroke. Students aged 18 years (OR: 1.70%; 95% CI: 1.14-2.52) demonstrated greater knowledge than other ages regarding the telephone number of the emergency medical services.

CONCLUSIONS: There was a knowledge deficit with regard to recognizing stroke and activating the emergency medical services. The findings apply to the sample investigated and suggest that there is a need for stroke educational interventions, starting in high school.

PMID:35508010 | DOI:10.1590/1516-3180.2021.0659.R2.13102021

Sao Paulo Med J. 2022 May 2:S1516-31802022005009203. doi: 10.1590/1516-3180.2021.0209.R1.25082021. Online ahead of print.

ABSTRACT

BACKGROUND: Reduced antioxidant defenses may reflect a poor protective response against oxidative stress and this may be implicated in progression of gestational diabetes mellitus (GDM). Oxidative stress induced by hyperglycemia plays a major role in micro and macrovascular complications, which imply endothelial dysfunction.

OBJECTIVE: Our aim in this study was to investigate the association between GDM and oxidative stress markers measured in plasma, with regard to revealing changes to total antioxidant capacity (TAC) and total oxidant status (TOS) among mothers showing impairments in oral glucose tolerance tests (OGTTs).

DESIGN AND SETTING: Prospective study at a university hospital in Turkey.

METHODS: The study group consisted of 50 mothers with GDM, and 59 healthy mothers served as controls. Umbilical cord blood samples were taken from all mothers during delivery and breast milk samples on the fifth day after delivery. TAC, TOS, thiol and disulfide levels were measured.

RESULTS: No statistically significant relationship between the blood and milk samples could be found. An analysis on correlations between TAC, TOS and certain parameters revealed that there were negative correlations between TOS and total thiol (r = -0.386; P < 0.001) and between TOS and disulfide (r = -0.388; P < 0.001) in milk in the control group. However, these findings were not observed in the study group.

CONCLUSION: Our findings suggested that a compensatory mechanism of oxidative stress was expected to be present in gestational diabetes mellitus and that this might be ameliorated through good glycemic regulation and antioxidant supplementation.

PMID:35508001 | DOI:10.1590/1516-3180.2021.0209.R1.25082021

Sao Paulo Med J. 2022 May 2:S1516-31802022005009201. doi: 10.1590/1516-3180.2021.0066.R2.16082021. Online ahead of print.

ABSTRACT

BACKGROUND: Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated.

OBJECTIVES: To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19.

DESIGN AND SETTING: Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey.

METHODS: Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded.

RESULTS: Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05).

CONCLUSIONS: Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.

PMID:35507997 | DOI:10.1590/1516-3180.2021.0066.R2.16082021

Sao Paulo Med J. 2022 Apr 29:S1516-31802022005007206. doi: 10.1590/1516-3180.2021.0492.R1.15092021. Online ahead of print.

ABSTRACT

BACKGROUND: Epidemiological studies involving large samples usually face financial and operational challenges.

OBJECTIVES: To describe the planning and execution of ADHERE Brazil, an epidemiological study on 1,105 kidney transplant patients, and report on how the study was structured, difficulties faced and solutions found.

DESIGN AND SETTING: Cross-sectional multicenter study in 20 Brazilian kidney transplantation centers.

METHODS: Actions developed in each phase of implementation were described, with emphasis on innovations used within the logistics of this study, aimed at estimating the prevalence of nonadherence to treatment.

RESULTS: Coordination of activities was divided into four areas: general, regulatory, data collection and statistics. Weekly meetings were held for action planning. The general coordination team was in charge of project elaboration, choice of participating centers, definition of publication policy and monitoring other coordination teams. The regulatory team provided support to centers for submitting the project to ethics committees. The data collection team prepared a manual on the electronic collection system, scheduled web meetings and was available to respond to queries. It also monitored the data quality and reported any inadequacies found. Communication with the centers was through monthly reports via e-mail and distribution of exclusive material. The statistical team acted in all phases of the study, especially in creating the data analysis plan and data bank, generation of randomization lists and data extraction.

CONCLUSIONS: Through these logistics, we collected high-quality data and built a local research infrastructure for further studies. We present supporting alternatives for conducting similar studies.

CLINICAL TRIAL ANNOTATION: http://clinicaltrials.gov/ on October 10, 2013; NCT02066935.

PMID:35507993 | DOI:10.1590/1516-3180.2021.0492.R1.15092021

Sao Paulo Med J. 2022 Apr 29:S1516-31802022005007201. doi: 10.1590/1516-3180.2021.0062.21092021. Online ahead of print.

ABSTRACT

BACKGROUND: For critically ill patients, physicians tend to administer sufficient or even excessive oxygen to maintain oxygen saturation at a high level. However, the credibility of the evidence for this practice is unclear.

OBJECTIVE: To determine the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated intensive care unit (ICU) patients.

DESIGN AND SETTING: Systematic review of the literature and meta-analysis conducted at Jiangxi Provincial People’s Hospital, Affiliated to Nanchang University, Nanchang, China.

METHODS: We systematically searched electronic databases such as PubMed and Embase for relevant articles and performed meta-analyses on the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated ICU patients.

RESULTS: A total of 1802 patients from five studies were included. There were equal numbers of patients in the conservative and liberal groups (n = 910 in each group). There was no significant difference between the conservative and liberal groups with regard to 28-day mortality (risk ratio, RR = 0.88; 95% confidence interval, CI = 0.59-1.32; P = 0.55; I2 = 63%). Ninety-day mortality, infection rates, ICU length of stay, mechanical ventilation-free days up to day 28 and vasopressor-free days up to day 28 were comparable between the two strategies.

CONCLUSIONS: It is not necessary to use liberal oxygen therapy strategies to pursue a higher level of peripheral oxygen saturation for mechanically ventilated ICU patients. Conservative oxygen therapy was not associated with any statistically significant reduction in mortality.

PMID:35507988 | DOI:10.1590/1516-3180.2021.0062.21092021