Aims: This study aims to investigate the efficacy of transcutaneous tibial nerve home stimulation for overactive bladder (OAB) in women with Parkinson's disease (PD). Methods: The current study is a prospective, randomized, double-blind, sham-controlled trial. Home intervention was carried out and assessments were conducted at a tertiary hospital in South Brazil. Women with PD and OAB symptoms were included in the study. Patients were randomly divided into two groups: (1) stimulation and (2) sham. Both groups underwent intervention at home for 12 weeks. Patients were evaluated at baseline and at 12 weeks (end of intervention), 30-and 90-day follow-up. The primary outcome was the mean reduction in the number of urgency incontinence episodes, and secondary outcomes included daytime and nighttime urinary frequency, urinary urgency episodes, use of pad (reported in a 24-h bladder diary), OAB-V8 and King's Health Questionnaire scores, and maintenance of symptom relief after discontinuation of the intervention. Results: In total, 30 consecutive patients completed the study (15/group). The stimulation group showed a reduction in nighttime urinary frequency (0.9 ± 0.6), urinary urgency (1.0 ± 1.2), urgency incontinence episodes (0.5 ± 0.6), use of pads (1.3 ± 1.2), and OAB-V8 (1.3 ± 1.2) and King's Health Questionnaire scores. In a 30-day and 90-day follow-up, 8 (53.3%) and 5 (33.3%) stimulation patients, respectively, reported full maintenance of symptom relief after discontinuation of the intervention. Stimulation patients presented a statistically significant improvement of symptoms as compared with sham patients (p = .001). Conclusions: Transcutaneous tibial nerve home stimulation can be used in clinical practice as an effective nonpharmacological resource for the reduction

ObjectivesIdentify patients at risk for intensive care unit readmission, the reasons for and rates of readmission, and mortality after their stay in the intensive care unit; describe the sensitivity and specificity of the Stability and Workload Index for Transfer scale as a criterion for discharge from the intensive care unit. Methods Adult, critical patients from intensive care units from two public hospitals in Porto Alegre, Brazil, comprised the sample. The patients' clinical and demographic characteristics were collected within 24 hours of admission. They were monitored until their final outcome on the intensive care unit (death or discharge) to apply the Stability and Workload Index for Transfer. The deaths during the first intensive care unit admission were disregarded, and we continued monitoring the other patients using the hospitals' electronic systems to identify the discharges, deaths, and readmissions. ResultsReadmission rates were 13.7% in intensive care unit 1 (medical-surgical, ICU1) and 9.3% in intensive care unit 2 (trauma and neurosurgery, ICU2). The death rate following discharge was 12.5% from ICU1 and 4.2% from ICU2. There was a statistically significant difference in Stability and Workload Index for Transfer (p<0.05) regarding the ICU1 patients' outcome, which was not found in the ICU2 patients. In ICU1, 46.5% (N=20) of patients were readmitted very early (within 48 hours of discharge). Mortality was high among those readmitted: 69.7% in ICU1 and 48.5% in ICU2. ConclusionsThe Stability and Workload Index for Transfer scale showed greater efficacy in identifying patients more prone to readmission and death following discharge from a medical-surgical intensive care unit. The patients' intensive care unit readmission during the same hospitalization resulted in increased morbidity, mortality, length of stay, and total costs.

In the last few years the understanding of mechanisms and, consequently, the diagnosis of neuropathic pain (NP) has becoming progressively clearer in clinical practice. However, the treatment of such condition remains challenging so far. One of the reasons for such difficulty is the diversity of mechanisms involved in NP generation and its persistency. In the present review we discuss several treatment modalities for NP that are scantily applied in daily clinical practice. For that, we collected positive clinical evidence of unusual and SECS (Safe, Easy, Cheap, and Sensible) approaches for NP. The aim of this review is not to establish the "state of the art" or rigid guidelines for NP treatment. In a different way, we only want bring new possibilities of treatment to the readers and also to motivate investigators to confirm those positive preliminary but promising results for NP reliev.Keywords: neuropathic pain, treatment, unconventional, alternative, evidence-based medicine. RESUMONos últimos anos, a compreensão dos mecanismos e consequentemente do diagnóstico da dor neuropática (DN) têm se tornado cada vez mais claros na prática clínica. Entretanto, o tratamento desta condição continua sendo um desafio. Uma das razões para tal dificuldade é diversidade de mecanismos envolvidos na geração e perpetuação da DN. Na presente revisão, os autores discutem várias modalidades de tratamento para DN pouco utilizadas na prática clínica diária. Para isso, selecionamos evidências clínicas positivas de abordagens para DN consideradas não-convencionais e do tipo "SFBR" (Seguro, Fácil, Barato e Racional). O objetivo desta revisão não é estabelecer o "estado da arte" ou diretrizes rígidas para o tratamento da DN. Diferente disso, pretendemos apenas trazer aos leitores novas possibilidades de tratamento assim como motivar pesquisadores a confirmar estes resultados preliminares, mas promissores para o alívio da DN.Palavras-chave: dor neuropática, tratamento, alternativo, medicina baseada em evidência.Neuropathic pain is defined as pain caused by lesion or dysfunction of the somatosensory system 1 and is most commonly consequence from several clinical conditions, such as diabetes, chemotherapy, herpes zoster infection, chronic alcohol abuse and other idiopathic conditions, such as idiopathic small fiber neuropathy and trigeminal pain. Patients with NP usually complain of burning and tingling sensations over the skin that almost always correspond to a plausible body distribution. Antidepressants and antiepileptic drugs are the mainstay of therapy, but they usually relieve only 40-50% of the pain 2 . Since the diagnosis of NP has becoming clearer in the last few years with the advent of new neurophysiological and histological tools, it is believed that the diversity of pathophysiological mechanism might explain the refractoriness of NP to the conventional therapeutic approaches. Therefore, several lines of investigation have been developed in parallel with the sophistication of usual drugs used in NP patients. Some of these...

The Bayesian approach in regression models has shown good results in parameter estimations, where it can increase accuracy and precision. The objective of the current study was to analyze the application of Bayesian statistics to the modeling yield for leaf dry matter (LM) and stem (SM), in kg ha-1, leaf ratio (LR), crude protein content for leaves (CPL) and stem (CPS) (%) of Brachiaria grass as a function of varying N doses (0; 100; 200 and 300 kg ha-1 yr-1). Simple and two degree polynomial linear regression models were analyzed. Information for a priori distributions was obtained from the literature. A posteriori distribution was generated using a Monte Carlo method via Markov chains. Parameters significance was assyed with HPD (Highest Posteriori Density) with a 95% interval. Model selections was performed using DIC (Deviance Information Criterion); and adjustment quality estimated with means and 95% HPD for Bayesian R2 distribution ranges. The models selected for the variables LM, SM and CPS were linear, while for LR and CPL, they were second level polynomial. The lowest doses that maximize response variables were: LM: 274 ha-1yr-1, SM: 280 ha-1yr-1, LR: 113 ha-1yr-1, CPL: 265 ha-1yr-1, CPS: 289 ha-1yr-1. The Bayesian approach allowed the inclusion of literatureverified a priori information, and the identification of evidence optimization range intervals.

A gravidez e puerpério são períodos da vida da mulher marcados por frequentes dificuldades sexuais. Inúmeros fatores interferem na função sexual nesse período, incluindo alterações hormonais, anatômicas, psicológicas e sociais. Objetivos: discutir as funções e disfunções sexuais femininas na gestação epuerpério, os principais fatores associados, além da avaliação e manejo multiprofissional. Métodos: a estratégia desta revisão foi a busca de artigos revelantes nas bases de dados PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (SciELO), teses no banco de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), no perído dode 1966 a 2019. Os artigos foram selecionados utilizando os seguintes descritores isolados e combinados:(1) função sexual, (2) disfunção sexual, (3) sexualidade, (4) gestação e (5) puerpério. Resultados: a partir darevisão de literatura realizada, foi escrito o presente artigo, que abordou a sexualidade feminina no períodogravídico-puerperal, concentrando o assunto em três grandes eixos: (1) função sexual feminina na gestaçãoe puerpério, (2) disfunção sexual feminina na gestação e puerpério e (3) abordagem da função e disfunçãosexual feminina na gestação e puerpério. Conclusão: a vida sexual da mulher no ciclo gravídico-puerperalconstitui um desafio adaptativo que exige profissionais de saúde preparados para falar abertamente sobre sexualidade com o casal, um tema ainda atualmente pouco discutido.

Bladder training and biofeedback are equivalent for patients with stress urinary incontinence, considering general quality-of-life, sexual function, symptoms, and measures of muscle strength.

O Brasil é um dos maiores produtores mundiais de leite bovino, sendo que grande parte é destinada para fabricação de queijos. Para que a indústria queijei ra se mantenha, o leite, sua principal matéria-prima, deve ser de qualidade. Sendo a qualidade do leite avaliada por diversas variáveis em fluxo contínuo, o controle estatístico de processo (CEP) pode ser uma ferramenta para monitorá-la. Neste trabalho foram utilizadas cartas de controle paramétricas e não paramétricas para verificar se o processo de recebimento de leite em uma queijaria da cidade de São Luís de Montes Belos, Goiás, estava sob controle estatístico. Foram verificadas normalidade e simetria dos dados, e como esperado, o CEP paramétrico se mostrou aparentemente mais poderoso. Os autores sugerem a utilização de CEP como ferramenta para assegurar a qualidade de laticínios, mas sempre verificando se as pressuposições de cada metodologia são atendidas. Em específico, se verificada normalidade, as cartas paramétricas são mais poderosas e por isso, são aconselhadas.

Resumo: A garantia da qualidade da água para consumo humano está inclusa em leis federais brasileiras. Em Minas Gerais, a Companhia de Saneamento de Minas Gerais é a responsável pelo abastecimento de diversos municípios e precisa garantir a qualidade de seus serviços e produtos. Nesse trabalho, foi utilizado controle estatístico de processo multivariado para proporção, indicando uma sugestão de ferramenta para controle das variáveis que descrevem a qualidade da água. Foram utilizados dados de relatórios da COPASA das cidades de Alfenas e Belo Horizonte de 2012 a 2016 (60 meses), para as sete variáveis controladas pela empresa em proporção de violação dos limites legais, sendo elas: cloro, coliformes totais, cor, Escherichia coli, fluoreto, pH e turbidez. Com a ferramenta, verificou-se pontos fora de controle para ambas cidades, e para diferentes variáveis. Esta ferramenta pode ser utilizada em processo de triagem, embasando gestores em tomadas de decisão, como, por exemplo, para onde devem ser voltadas as atenções, decidindo quais partes do processo deve-se realizar estudos mais detalhados.