Background
A local increase in angiotensin 2 after inactivation of angiotensin-converting enzyme 2 by SARS-CoV-2 may induce a redox imbalance in alveolar epithelium cells, causing apoptosis, increased inflammation and, consequently, impaired gas exchange. We hypothesized that N-acetylcysteine (NAC) administration could restore this redox homeostasis and suppress unfavorable evolution in Covid-19 patients.
Objective
To determine whether NAC in high doses can avoid respiratory failure in patients with Covid-19.
Methods
It was a double-blind, randomized, placebo-controlled, unicentric trial, conducted at the Emergency Department of Hospital das Clínicas, São Paulo, Brazil. We enrolled 135 patients with severe Covid-19 (confirmed or suspected), with an oxyhemoglobin saturation of less than 94% or respiratory rate higher than 24 breaths/min. Patients were randomized to receive NAC 21 g (approximately 300 mg/kg) for 20 hours, or dextrose 5%. Primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to ICU, time in ICU, and mortality.
Results
Baseline characteristics were very similar in the two groups, with no significant difference in age, sex, comorbidities, medicines taken, and disease severity. Also, groups were similar in laboratory tests and chest CT scan findings. Sixteen patients (23.9%) in the Placebo group were submitted to endotracheal intubation and mechanical ventilation, compared to 14 patients (20.6%) in the NAC group (p=0.675). No difference was observed in secondary endpoints.
Conclusion
Administration of NAC in high doses did not affect the evolution of severe Covid-19.
Objective: To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus. Methods: PubMed ® , Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in metaanalysis. Results: Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I 2 >97%; p<0.001), reduction in glycated hemoglobin (-1.
-Context-One of the limitations of 13 C-urea breath test for Helicobacter pylori infection diagnosis in Brazil is the substrate acquisition in capsule presentation. Objectives-The purpose of this study was to evaluate a capsule-based 13 C-urea, manipulated by the Pharmacy Division, for the clinical practice. Methods-Fifty patients underwent the conventional and the capsule breath test. Samples were collected at the baseline and after 10, 20 and 30 minutes of 13 C-urea ingestion. Urease and histology were used as gold standard in 83 patients. Results-In a total of 50 patients, 17 were positive with the conventional 13 C-urea (75 mg) breath test at 10, 20 and 30 minutes. When these patients repeated breath test with capsule (50 mg), 17 were positive at 20 minutes and 15 at 10 and 30 minutes. The relative sensitivity of 13 C-urea with capsule was 100% at 20 minutes and 88.24% at 10 and at 30 minutes. The relative specificity was 100% at all time intervals. Among 83 patients that underwent capsule breath test and endoscopy the capsule breath test presented 100% of sensitivity and specificity. Conclusion-Capsule based breath test with 50 mg 13 C-urea at twenty minutes was found highly sensitive and specific for the clinical setting. HEADINGS-Helicobacter pylori. Breath Test. Urea, analysis.
Esta revisão integrativa analisa aspectos da identidade profissional (IP) em equipes multiprofissionais da saúde, desde a graduação. Foram estudados vinte e dois artigos, no período de cinco anos, das bases de dados Embase, Scopus e Web of Science, classificados em onze categorias profissionais, resultando em seis artigos com alunos de graduação, cinco com estágios profissionalizantes e onze com profissionais da saúde. Analisou-se o processo de construção da IP de residentes e profissionais que atuam no ambiente hospitalar, observando-se que, para a profissão médica é necessária a mudança de paradigma sobre IP e trabalho em equipe, enquanto que para os demais profissionais faz-se necessário desenvolver o processo de IP no ambiente de trabalho, como fator importante para a gestão de conflitos entre os integrantes das equipes de saúde.
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