ABSTRACT The precise pathogenesis of COVID-19-related multisystem inflammatory syndrome remains largely elusive, despite its rarity. The syndrome symptoms often overlap with those of other infections, posing challenges for prompt diagnosis. A male patient, 34 years old, was admitted with suspicion of severe dengue, rapidly progressing to multiple organ dysfunction. Dengue tests resulted negative, and he passed away after four days. This case occurred approximately four weeks after the initial onset of COVID-19 and met all diagnostic criteria as defined by the Centers for Disease Control and Prevention. This report presents the first documented case of fatal multisystem inflammatory syndrome in adult (MIS-A) in Brazil. Recognizing the significance of suspecting this syndrome and promptly initiating treatment at an early stage are essential for minimizing damage and mortality.

ABSTRACT This study aimed to evaluate the COVID-19 hospitalizations in a tertiary hospital by age group and month, considering the introduction and the advance of the vaccination against the disease. The laboratory-confirmed COVID-19-associated hospitalizations among people aged 20 years or older, that occurred between March 2020 and June 2021, were distributed by month of symptom onset and age group. The proportion of hospitalizations by age group was calculated for the year 2021. The proportions were compared using the chi-square test for trends. The marks of vaccination advances among different age groups were taken from the official website LocalizaSUS. In 2020, hospitalizations among people aged 60–80 years old were the most frequent (39.1%). From January–June 2021, when the vaccination commenced, while hospitalizations of patients aged 20 to < 40 and 40 to 60 years old showed an increasing trend, the older age groups and those with vaccination recommendations (from 60 to < 80 and from 80 or over) showed a downward trend. As of June 2021, with widespread vaccination, a drop in hospitalizations was observed in > 60 years old. At 20 to <40 and 40 to < 60, an increase in hospitalizations was observed. It demonstrates the important role of vaccination in combating the COVID-19 pandemic.

CONTEXTUALIZAÇÃO: A faixa etária que mais cresce no Brasil e no mundo é a de idosos com 80 anos e mais. Entre esses indivíduos, a prevalência de incapacidades e morbidades é maior que em outros grupos. OBJETIVOS: Investigar a influência de fatores socioeconômicos, demográficos, biológicos e de saúde, nutricionais, de relações sociais, além da autoavaliação da saúde sobre a capacidade funcional de idosos longevos (80 anos e mais). MÉTODOS: Trata-se de um estudo transversal, de base populacional, em que os dados foram obtidos por meio de questionários e medidas antropométricas. A capacidade funcional foi avaliada utilizando-se o modelo desenvolvido por Andreotti e Okuma (1999). Foram realizadas análises univariada e multivariada. RESULTADOS: Os fatores independentes associados à pior capacidade funcional foram: ter 85 anos e mais (OR=2,91), ser do gênero feminino (OR=6,09), fazer uso contínuo de cinco ou mais medicamentos (OR=2,67), não visitar parentes e/ou amigos pelo menos uma vez por semana (OR=11,91) e considerar a própria saúde pior que a de seus pares (OR=4,40). CONCLUSÕES: Os resultados sugerem que a capacidade funcional está associada a uma complexa rede de fatores multidimensionais, sendo importante o desenvolvimento de ações relacionadas àqueles fatores que são passíveis de intervenção, visando propiciar melhores condições de saúde e qualidade de vida a esses indivíduos.

BACKGROUND: The fastest-growing age group in Brazil and around the world is the oldest-old group (aged 80 and over). Among these individuals, the prevalence of disability and morbidity is higher than in other groups. OBJECTIVES: To investigate the influence of socioeconomic, demographic, biological, health, nutritional, and social factors, as well as perceived health, on the functional status of the oldest old. METHODS: This was a cross-sectional population-based study in which the data were collected by means of questionnaires and anthropometric measurements. The functional status was evaluated according to the model developed by Andreotti and Okuma (1999). Univariate and multivariate analyses were used. RESULTS: The independent factors associated with worse functional status were: age 85 years and over (OR=2.91), female gender (OR=0.69), continuous use of five or more medications (OR=2.67), no visits to friends and/or relatives at least once a week (OR=11.91), and worse perceived health relative to peers (OR=4.40). CONCLUSIONS: The results suggest that functional status is associated with a complex web of multidimensional factors. Thus, it is important to develop programs related to the factors that are susceptible to intervention in order to provide a better quality of life to the oldest old.

Na busca de um alimento de fácil preparo, com melhor valor nutritivo e sendo a promoção da germinação um processo simples, econômico e que melhora o valor nutricional dos grãos, objetivou-se com este trabalho estudar três espécies de Fabaceae baseado nas características químicas. Grãos e brotos foram analisados quanto à composição química, minerais e vitamina C. O delineamento experimental foi em blocos casualizados, em fatorial 6x3, com três repetições. O mungo-preto apresentou valores mais elevados que as demais espécies de feijões estudadas quanto aos teores de sódio e ferro, tanto para os grãos quantos para os brotos. O mungo-verde se destacou quanto aos teores de proteínas, tanto no grão quanto no broto, e quanto aos teores de fibra e vitamina C (4,9 vezes mais elevado que o do grão). O feijão guandu-anão apresentou, o maior teor de vitamina C no sexto dia de germinação (3,6 vezes mais elevado que o do grão) e elevados teores de potássio e sódio. Observou-se que, seis dias mostrou-se como o período mais indicado, para a germinação das três espécies de Fabaceae, para a obtenção dos brotos.

In the search for a food of easy preparation, with a better nutrition value, and germination being an easy and economic process that improves the nutritional value of grains, this work was aimed at studying three Fabaceae species based on chemical characteristics. Grains and sprouts were analyzed for the chemical composition, minerals and vitamin C. The experimental design was in randomized blacks, in a 6x3 factorial structure, with three replications. The black mungo bean presented higher values than the other species of bean studied, concerning the contents of sodium and iron, both in grains and sprouts. The green mungo bean has distinguished itself for its protein contents both in grains and sprouts, and for its fiber and vitamin C contents (4.9 times higher than the contents of the grains). The dwarf guandu bean presented the highest content of vitamin C at the sixth day of germination (3.6 times higher than the grains) and high contents of potassium and sodium. It was observed that the six-day period was the most indicated for the germination of the three Fabaceae species in order to obtain sprouts.

JUSTIFICATIVA E OBJETIVOS: Não existe consenso sobre qual modelo prognóstico deva ser utilizado em pacientes com disfunção renal aguda (DRA). O objetivo deste estudo foi avaliar o desempenho de seis escores de prognóstico em pacientes que necessitaram de suporte renal. MÉTODO: Coorte prospectiva de pacientes internados nas unidades de terapia intensiva (UTI) de três hospitais terciários que necessitaram de suporte renal por DRA durante 32 meses. Foram excluídos os pacientes crônicos em programa de diálise ou com < 24h de internação na UTI. Os dados das primeiras 24h de UTI foram utilizados no cálculo do SAPS II e do APACHE II, e os dados das primeiras 24h de suporte renal foram utilizados no cálculo dos escores LOD, ODIN, Liaño e Mehta. A discriminação foi avaliada através da área sobre a curva ROC (AUROC) e a calibração através do teste do goodness-of-fit de Hosmer-Lemeshow. A letalidade hospitalar foi o desfecho de interesse. RESULTADOS: Quatrocentos e sesseta e sete pacientes foram incluídos e a letalidade hospitalar foi 75%. Os valores dos escores SAPS II, APACHE II e LOD foram 48,5 ± 11,2, 27,4 ± 6,3, 7 (5-8) pontos, respectivamente. A calibração foi adequada para todos os escores, com exceção do Mehta (p = 0,001). Entretanto, a discriminação foi ruim para todos os modelos, com AUROC variando entre 0,60 para o ODIN e 0,72 para o SAPS II e Mehta. Com exceção do Mehta, todos os modelos subestimaram a letalidade. CONCLUSÕES: Todos os seis modelos estudados foram inadequados na predição prognóstica de pacientes graves com DRA e necessidade de suporte renal.

BACKGROUND AND OBJECTIVES: There is no consensus about prognostic scores for use in patients with acute kidney injury (AKI). The aim of this study was to evaluate the performance of six prognostic scores in predicting hospital mortality in patients with AKI and need for renal replacement therapy (RRT). METHODS: Prospective cohort of patients admitted to the intensive care units (ICU) of three tertiary care hospitals that required RRT for AKI over a 32-month period. Patients with end-stage renal disease and those with ICU stay < 24h were excluded. Data from the first 24h of ICU admission were used to calculate SAPS II and APACHE II scores, and data from the first 24h of RRT were used in the calculation of LOD, ODIN, Liaño and Mehta scores. Discrimination was evaluated using the area under ROC curve (AUROC) and calibration using the Hosmer-Lemeshow goodness-of-fit test. The hospital mortality was the end-point of interest. RESULTS: 467 patients were evaluated. Hospital mortality rate was 75%. Mean SAPS II and APACHE II scores were 48.5 ±11.2 and 27.4 ± 6.3 points, and median LOD score was 7 (5-8) points. Except for Mehta score (p = 0.001), calibration was appropriate in all models. However, discrimination was uniformly unsatisfactory; AUROC ranged from 0.60 for ODIN to 0.72 for SAPS II and Mehta scores. In addition, except for Mehta, all models tended to underestimate hospital mortality. CONCLUSIONS: Organ dysfunction, general and renal-specific severity-of-illness scores were inaccurate in predicting outcome in ICU patients in need for RRT.

INTRODUCTION: Acute kidney injury usually develops in critically ill patients in the context of multiple organ dysfunctions. OBJECTIVE: To evaluate the effect of changes in associated organ dysfunctions over the first three days of renal replacement therapy on the outcomes of patients with acute kidney injury. METHODS: Over a 19-month period, we evaluated 260 patients admitted to the intensive care units of three tertiary-care hospitals who required renal replacement therapy for > 48 h. Organ dysfunctions were evaluated by SOFA score (excluding renal points) on the first (D1) and third (D3) days of renal replacement therapy. Absolute (A-SOFA) and relative (D-SOFA) changes in SOFA scores were also calculated. RESULTS: Hospital mortality rate was 75%. Organ dysfunctions worsened (A-SOFA>0) in 53%, remained unchanged (A-SOFA=0) in 17% and improved (A-SOFA<0) in 30% of patients; and mortality was lower in the last group (80% vs. 84% vs. 61%, p=0.003). SOFA on D1 (p<0.001), SOFA on D3 (p<0.001), A-SOFA (p=0.019) and D-SOFA (p=0.016) were higher in non-survivors. However, neither A-SOFA nor D-SOFA discriminated survivors from non-survivors on an individual basis. Adjusting for other covariates (including SOFA on D1), A-SOFA and D-SOFA were associated with increased mortality, and patients in whom SOFA scores worsened or remained unchanged had poorer outcomes. CONCLUSIONS: In addition to baseline values, early changes in SOFA score after the start of renal replacement therapy were associated with hospital mortality. However, no prognostic score should be used as the only parameter to predict individual outcomes.

The present study aims at comprehending the retired people through a group experience as well as allowing them to reflect about their condition. The authors utilized the research-action methodology, with 25 retired subjects who worked in the University, aging from 51 to 79 years old. The narratives related to their experiences were obtained through verbal interaction, group discussions and interviews. From the analysis of the experiences emerged questions associated to the retired-elderly interests, their physical and mental health, relationship, learning process, social environment and leisure.

Este estudio se propone comprender la situación del jubilado, a través de la vivencia en grupo, y permitir que los jubilados refleccionen con respecto a su condición. Se ha utilizado la metodologia de la investigación - acción, con 25 sujetos jubilados de la Universidad, con edad entre 51 y 79 años. Las narraciones respecto de las vivencias fueron obtenidas por medio de interacción verbal, discusión en grupo y entrevista. En el análisis de las vivencias han emergido cuestiones relacionadas a los intereses de los jubilados ancianos, cuanto a la salud física y mental, relacionamiento, aprendizaje, ambiente social y ocio.

The present study aims at comprehending the retired people through a group experience as well as allowing them to reflect about their condition. The authors utilized the research-action methodology, with 25 retired subjects who worked in the University, aging from 51 to 79 years old. The narratives related to their experiences were obtained through verbal interaction, group discussions and interviews. From the analysis of the experiences emerged questions associated to the retired-elderly interests, their physical and mental health, relationship, learning process, social environment and leisure.

Este estudio se propone comprender la situación del jubilado, a través de la vivencia en grupo, y permitir que los jubilados refleccionen con respecto a su condición. Se ha utilizado la metodologia de la investigación - acción, con 25 sujetos jubilados de la Universidad, con edad entre 51 y 79 años. Las narraciones respecto de las vivencias fueron obtenidas por medio de interacción verbal, discusión en grupo y entrevista. En el análisis de las vivencias han emergido cuestiones relacionadas a los intereses de los jubilados ancianos, cuanto a la salud física y mental, relacionamiento, aprendizaje, ambiente social y ocio.