HSJ

Challenges of maintaining hemodialysis in Brazil

Guilherme de Castro-Santos — Thu, 23 May 2024 00:00:00 -0300

The importance of clinical trial protocols

Melissa Andreia de Moraes Silva — Wed, 19 Jun 2024 09:56:04 -0300

The International Committee of Medical Journal Editors (ICMJE) and the World Health Organization (WHO) define a clinical trial as any research that prospectively assigns participants or groups of human subjects to one or more interventions (medicines, procedures, devices, behavioral treatments, dietary supplements and diets, for example). These trials aim to evaluate the effects of interventions on human health. Prospective clinical research is essential for discovering new knowledge, improving the scientific base, solving challenges, and improving clinical practices. The basic principles for a successful researcher include interest, availability, persistence, and honesty. However, it is essential that, first of all, one has complete and detailed knowledge of scientific writing and preparation of the research protocol.

Adherence to treatment in patients with chronic kidney disease undergoing hemodialysis

Angélica de Cássia Bitencourt, Sandra Marina dos Reis — Wed, 27 Mar 2024 00:00:00 -0300

Objective: To identify the adherence to therapeutic regimens in patients with chronic kidney disease undergoing hemodialysis (HD). Method: This is a descriptive, cross-sectional study using a quantitative approach developed at an HD center in the south of Minas Gerais, Brazil. The study participants were 51 patients undergoing HD. Personal, socioeconomic, and objective data were collected, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was applied. The analysis was performed using simple descriptive statistics. Result: The average age was 56.7 years, and 58% of the patients were male. The percentages of non-adherence were diet (35.4%), hemodialysis (21.6%), fluid intake (15.7%), and medication (13.7%). Conclusion: Therapeutic adherence is a complex process that requires constant monitoring by a multidisciplinary team.

The association between vancomycin trough concentrations and nephrotoxicity in the paediatric intensive care unit

Fri, 03 May 2024 00:00:00 -0300

Objective: To analyze and describe the pharmacokinetic aspects of vancomycin usage in a cohort of critically ill children and to construct a pharmacokinetic model for this population. Method: We conducted an observational study in a pediatric intensive care unit from September 2017 to March 2019. Children receiving vancomycin with at least one serum measurement were included. Variables with a p-value lower than 0.2 in univariate analysis, and biologically plausible for inducing nephrotoxicity and not correlated with other predictors, were incorporated into logistic regression. Additionally, pharmacokinetic modeling was performed using the PMETRICS® package for patients with creatinine clearance (CLCR) > 30 mL/min. Result: The study included 70 children, with an average vancomycin dose of 60 mg/kg/day. Only eleven children achieved vancomycin levels within the target range (15-20 mg/L). No significant differences in doses/mg/kg/day were observed among children above, within, or below the vancomycin target range. In the multivariate model, children above the recommended serum range had an odds ratio of 4.6 [95% CI 1.4 – 17.2] for nephrotoxicity. A pharmacokinetic model was proposed using data from 15 children, estimating PK parameters for CLCR and V as 0.94 L/h and 5.71 L, respectively. Conclusion: Nephrotoxicity was associated with vancomycin plasma concentrations equal to or exceeding 15 mg/L. The developed model enhanced understanding of the drug’s behavior within this population, potentially aiding clinical practice in dose calculations and estimation of the area under the curve – a recommended parameter for vancomycin monitoring.

The use of medications by incarcerated women: an exploratory study

Tue, 14 May 2024 00:00:00 -0300

Objective: To investigate the use of medicines by women deprived of their liberty in a municipality in the east of Minas Gerais. Method: The research was conducted in three stages: (I) documentary investigation, (II) analysis of medical records, and (III) application of semi-structured questionnaires. Women deprived of liberty who were part of the prison system evaluated participated in the study. The research was carried out between June 2020 and June 2021. Result: Seventeen women deprived of their liberty participated in the study, most of them black and brown (88.24%), between 30 and 49 years old (n = 9; 52.9%), and who used a total of 56 different medications, with the psychotropic class being the most prevalent (n = 28; 50%), followed by cardiovascular system drugs (n = 15; 26.8%). Conclusion: The medications most used by study participants belonged to the class of antidepressants and antiepileptics. Furthermore, the women’s medical records lacked crucial information regarding medication use. These data, combined with difficulties in access, highlight the importance of complying with public policies in favor of comprehensive health care for women deprived of their liberty, especially the right to access and rational use of medicines.

Quality of life and strength, but not cytokines, are associated with DAS-28 in active and inactive rheumatoid arthritis

Thu, 16 May 2024 00:00:00 -0300

Objective: Evaluate and correlate data between relevant cytokines, disease progression, and handgrip and quality of life among RA patients at different stages of disease progression. Method: Thirty-three RA patients were recruited for analysis, using comparisons and correlations, between levels of circulating cytokines (IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17, IL-1β, and TNF receptors I and II), activity of the disease (evaluated using the DAS-28), handgrip (Hydraulic dynamometer), and quality of life (SF-36). Result: RA patients in different disease stages showed increases of IL-6 and IL-10 compared control group. Positive correlation between IL-6 with TNF-α, and IL-4 with IL-10 was found. Handgrip strength and quality of life were not related to cytokine levels. However, remission patients had better strength and quality of life indices compared to the active patients. In addition, handgrip of the non-dominant side, physical functions, role limitations physical health, pain, energy/fatigue and social functions have a negative correlation with the DAS28-PCR. Conclusion: High levels of IL-6 and IL-10 were observed in the chronic RA patients, but the values did not show correlation with disease activity, handgrip strength and quality of life. Disease activity show correlation with handgrip strength and quality of life. Furthermore, remission patients had better strength and quality of life indices compared to the active patients.

Impacts of the pandemic on children and adolescents with cancer: scoping review

Mon, 03 Jun 2024 09:44:37 -0300

Objective: To identify the impacts of the COVID-19 pandemic on the health care of children and youth with oncological diseases. Method: Scoping review based on the Joanna Briggs Institute (JBI) methodological framework. To describe the research question, the population, concept, and context (PCC) strategy was used. The searches occurred in September 2022 in the BVS, Cinahl, Scopus, Lilacs, and PubMed databases, with the following descriptors: cancer; children; teenagers; pandemic; Covid; oncology; child; adolescent; and neoplasia. Rayyan software was used to select the studies, following the PRISMA recommendations. The content analysis method proposed by Bardin was used. Result: There were several impacts of the pandemic on care for children and adolescents’ oncology, related to daily life, the need to (re) organize health services, and, in this context, barriers were identified in maintaining treatment, postponing/reducing the offer of care, which impacted the reduction of specialized professionals and the supply of surgeries, and reduction of inputs and medicines. In the emotional sphere, the impacts were related to the intensification of feelings of fear and anxiety. Conclusion: In addition to the impacts caused by the pandemic, the need for awareness raising and support work for children and their families by primary care and specialized care teams became evident when they could not be assisted by other services, in addition to continued care at home.

Food consumption among adolescents and biological and adiposity outcomes

Mon, 03 Jun 2024 10:06:42 -0300

Objective: to investigate the association between macronutrient consumption and biological and adiposity indicators in adolescents. Methods: A total of 77 adolescents were evaluated in relation to anthropometric measurements, sexual maturation, body composition, sociodemographic variables, and food composition. Results: the percentage of lipids in relation to total energy intake was positively related to age (β = 1.33; 95% CI = 0.37 to 2.28), and inversely related to sexual maturation (β = -2.44; 95% CI =-4.68 to – 0.20). Girls had a higher consumption of lipids than boys (β= 4.59; 95% CI = 0.62 to 8.57). Age was positively associated with the consumption of saturated (β = 0.62; 95% CI =0,30 to 0,94) and monounsaturated fatty acids (β=0.48; 95% CI = 0.16 to 0.79). Sexual maturation was inversely associated with the consumption of saturated (β=-1.7; 95% CI = -2.46 to -0.95), monounsaturated (β = -1.59; 95% CI = -2.34 to -0.84), and trans fatty acids (β = -0.32; 95% CI = -0.34 to -0.00). Fat mass showed a positive association with the consumption of saturated (β = 0.18; 95%CI = 0.03 to 0.32) and monounsaturated fatty acids (β = 0.23; 95% CI =0.091 to 0.38). Conclusion: The consumption of lipids was positively related to age and inversely related to sexual maturation; fat mass was positively associated with the consumption of saturated and monounsaturated fatty acids. The findings of this study reinforce the concern regarding a high-fat diet among adolescents, especially older girls.

Quality, reliability, and content of YouTube videos in Portuguese language about dental trauma

Thu, 20 Jun 2024 09:13:09 -0300

Objective: To evaluate the quality, reliability and content of YouTube videos in Portuguese about dental trauma. Method: An infodemiological study was developed in which the first 60 videos found on YouTube with the terms “dental traumatism”, “dental trauma” and “broken tooth” were analyzed. Repeated videos, longer than one hour, in a language other than Portuguese, not intended for the lay public, resolution of questions, songs, interviews, shorts, and other subjects were excluded. The content of the videos was rated using a 23-point scale that classified them into low, moderate, and high content. Reliability was assessed using the modified DISCERN scale and the overall quality was assessed using the Global Quality Score (GQS) scale. The numbers of likes, dislikes, comments and engagement were also accounted. Data were analyzed by Mann-Whitney and Spearman’s correlation test (α= 5%). Result: A total of 55 videos were included in the study. Most were posted by healthcare professionals (92.7%) and just over half (63.7%) were of good overall quality. There were moderate, positive, and statistically significant correlations between DISCERN and GQS scores (r=0.454), duration (r=0.575), and trauma content (r=0.510). Overall quality correlated moderately, positively, and significantly with content scores (r=0.604) and video length (r=0.467). Conclusion: A significant proportion of Portuguese videos on YouTube about dental trauma had low content, quality and reliability information.