The Escola Bahiana de Medicina e Saúde Pública (Bahian School of Medicine and Public Health, known simply as Bahiana) is a private and non-profit higher education school of medical sciences and health, established in 1952 in Salvador, Bahia, Brazil. It is one of the most important educational institutions of Northeastern Brazil and has been recognized for its achievements in research and large contribution to public health – with more than 600,000 free care procedures performed in 2012.Bahiana currently offers seven undergraduate courses and post-graduate programs in several fields of health sciences. The school is maintained by the Fundação Bahiana para Desenvolvimento das Ciências (Bahian Foundation for Science Development)..
Introduction: The new corona virus (2019-nCoV OR HCOV-19 or CoV2), has emerged in China as the main cause of viral pneumonia (COVID-19, Coronavirus Disease-19). Objective: To provide evidence-based Physiotherapy and functionality in patients with adult and pediatric COVID-19. Methods: This is an integrative literature review using the MedLine / PubMed databases, library of Latin American and Caribbean Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDRo). Results: Part of the patients with covid 19 show signs of respiratory deficiency with hypoxemia, with low severity in children. Impaired functionality is also expected. Conclusion: COVID-19 causes low pulmonary compliance and important changes in lung function with hypoxemia and cardiovascular repercussions. These changes lead to the need for Physiotherapy and the management of oxygen therapy and ventilatory support (invasive and non-invasive) for these patients.
The Lichtenstein (mesh) and Shouldice (non-mesh) techniques are the main options for open inguinal hernia repair. This systematic review and meta-analysis compared the prevalence of chronic postoperative pain between them. A systematic search was conducted in Medline, Embase and Cochrane databases for studies comparing the prevalence of chronic pain after Shouldice and Lichtenstein techniques in adult patients undergoing inguinal hernia repair. Meta-analysis was performed using RevMan and the effect model was determined based on heterogeneity, assessed by the I² statistic. Subgroup analyses were conducted by mean follow-up duration and study design. Ten studies with 4,122 patients (59.8
BACKGROUND:There is a lack of contemporary studies addressing the prevalence rates and antifungal susceptibility of bloodstream infections (BSI) caused by rare yeasts (RY) from the Saccharomycotina subphylum. OBJECTIVES:This 16-year multicentre study (2007-2023) aimed to assess the prevalence and antifungal susceptibility of rare yeasts isolated from BSIs in 28 Brazilian tertiary care hospitals. METHODS:Yeasts from the Saccharomycotina subphylum, excluding common Candida species and Basidiomycota, were selected from BSI episodes. Species were identified using proteomics and molecular methods. Antifungal susceptibility testing was performed by EUCAST broth microdilution. RESULTS:Among 2655 BSI episodes, 100 (3.76%) involved rare yeasts. Prevalence showed a slight, non-significant increase from 3.16% (2007-2015) to 4.17% (2016-2023; p = 0.183). A total of 11 genera and 20 species were identified, with Clavispora lusitaniae (20%), Wickerhamomyces anomalus (16%), Candida haemulonii (14%) and Candida duobushaemulonii (12%) being the most frequent species. Eight species, including Pichia kluyveri and Kodamaea ohmeri, appeared only in the latter period. Most rare yeasts showed low MICs to amphotericin B and anidulafungin, except for Clavispora lusitaniae, Candida haemulonii and Candida duobushaemulonii, which were less susceptible to amphotericin B. Wickerhamomyces anomalus and Candida duobushaemulonii also showed reduced susceptibility to fluconazole. CONCLUSIONS:This study provides valuable insights into the prevalence rates, species distribution and antifungal susceptibility of rare yeasts causing BSIs in tertiary care hospitals. Our findings highlight the need for continuous surveillance, incorporation of new diagnostic and tailored therapeutic strategies to mitigate morbidity and mortality due to invasive infections caused by emerging fungal pathogens.
Background:Several genes encoding proteins essential for normal bile production have been associated with progressive familial intrahepatic cholestasis in children, but there are few studies evaluating the frequency of variants in these genes among adults with chronic cholestatic disease. The aim of this study was to assess frequency of variants in progressive familial intrahepatic cholestasis-associated genes in adults with idiopathic or episodic cholestatic chronic liver disease (cCLD).Methods:Patients with cCLD of unknown cause followed in 4 different reference centers in Brazil were genotyped for ABCB11, ABCB4, ABCC2, ATP8B1, CFTR, JAG1, KIF12, LSR, MYO5B, NR1H4, PPM1F, SERPINA1, TJP2, USP53, VIPAS39, VPS33B, PEX26, and WDR83OS gene variants using Illumina platforms. Primary biliary cholangitis, primary sclerosing cholangitis, and other causes of cCLD were excluded.Results:Sixty-five patients (40 females; mean +/- SD age at disease onset, 26.8 +/- 13.4 y) were included. Most (65%) had either a family history of cholestatic liver disease or previous signs and symptoms of intrahepatic cholestasis of pregnancy or low phospholipid-associated cholelithiasis. Fifty-seven (88%) had cCLD, whereas 8 (12%) reported recurrent episodic cholestasis. Some had evidence at diagnosis of cirrhosis (n=20) or hepatocellular carcinoma (n=2) or had undergone liver transplantation (n=10). Sequencing revealed 28 variants in ABCB4 (n=25) and ABCB11 (n=3) genes in 42 patients [65%; heterozygous (n=31), homozygous (n=4), and compound heterozygous (n=7)]. Only 17 (61%) were previously reported. Most variants (57%) were classified as pathogenic or likely pathogenic.Conclusions:More than half of the patients with cCLD of unknown cause exhibited pathogenic or likely pathogenic variants in bile transporter genes, particularly ABCB4. Genotyping may identify most of those patients as late-onset patients with multidrug resistance protein 3 deficiency.
BACKGROUND:Infectious intracranial aneurysms (IIAs) are highly morbid vascular lesions, and the comparative effectiveness of medical management (MM), surgery, and endovascular treatment (EVT) remains uncertain. OBJECTIVE:To perform a systematic review and network meta-analysis comparing the three main interventions for IIAs: MM, open surgery, and EVT. METHODS:A systematic review and frequentist network meta-analysis were conducted. Studies comparing MM, open surgery, and EVT in patients with IIAs were included. The primary outcome was treatment success, defined according to study-specific definitions and operationally harmonized as the absence of treatment failure. Secondary outcomes included mortality, rupture or re-rupture, recurrence, neurological deficits, and complications. Random-effects models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using P scores, and heterogeneity was quantified using I². RESULTS:Thirteen observational studies were included. In an exploratory network meta-analysis, both EVT (OR=2.51; 95% CI 1.22 to 5.15) and surgery (OR=7.29; 95% CI 2.00 to 26.55) were associated with higher odds of treatment success compared with MM. EVT was associated with a lower risk of aneurysm rupture or re-rupture compared with MM (OR=0.42; 95% CI 0.18 to 0.96), whereas no statistically significant differences were observed between EVT and surgery. Given the non-randomized nature of the evidence and methodological heterogeneity across studies, these findings should be interpreted with caution. CONCLUSIONS:EVT and surgery were associated with higher odds of treatment success compared with MM, whereas EVT was additionally associated with a lower risk of rupture or re-rupture. These findings should be interpreted cautiously given the observational nature of the available evidence.
