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Efeito de uma estratégia de transição do cuidado baseada em videomonitoramento, teach-back e entrevista motivacional no autocuidado de pacientes com insuficiência cardíaca: ensaio clínico randomizado

2026-02-27T00:00:00Z

Title: Efeito de uma estratégia de transição do cuidado baseada em videomonitoramento, teach-back e entrevista motivacional no autocuidado de pacientes com insuficiência cardíaca: ensaio clínico randomizado Abstract: Introduction: Heart failure (HF) is a complex clinical syndrome associated with high rates of hospitalization, mortality, and readmissions, often related to poor therapeutic adherence, fragmentation of care, and weaknesses during the transition between levels of the healthcare system. Structured care transition strategies, combined with the use of technologies such as video monitoring and behavior change methodologies, have been proposed as alternatives to strengthen self-care and reduce adverse outcomes. Objective: To evaluate the effectiveness of a structured hospital-to-primary care transition strategy, combined with remote clinical followup via video monitoring, grounded in motivational interviewing (MI) and teach-back (TB), on self-care in patients with HF, compared to usual care, over a 180-day follow-up period. Materials and Methods: This was a single-center randomized clinical trial with blinded outcome assessment, conducted with patients with decompensated HF and reduced ejection fraction (LVEF <40%), treated at the Hospital de Clínicas of the Federal University of Uberlândia. Participants were randomized into an intervention group (IG) and a control group (CG). At hospital discharge, the IG received an educational booklet, sharing of the discharge summary with primary care, and nursing consultations via video monitoring through WhatsApp® at 7, 30, 60, and 180 days post-discharge, using MI and TB, while the CG received usual care. The primary outcome was self-care, assessed using the European Self-Care Scale. Longitudinal analysis was performed using Generalized Estimating Equations (GEE), with models adjusted for age, sex, ejection fraction, and NYHA functional class, and analyses were conducted using R software. Results: A total of 140 patients were included (CG = 73; IG = 67), with a mean age of 65.59 ± 13.72 years in the CG and 63.94 ± 14.28 years in the IG, predominantly NYHA functional class II (n = 60; 42.9%), and a mean LVEF of 30.49 ± 6.49%. The GEE model adjusted for age, sex, LVEF, and NYHA functional class showed a significant interaction between group and time (χ² = 27.22; p < 0.001). Adjusted mean total self-care scores remained stable in the CG over time, whereas a progressive reduction in scores was observed in the IG (29.07 ± 0.92 at baseline, 24.38 ± 1.08 at 30 days, 19.84 ± 0.75 at 60 days, and 19.92 ± 0.90 at 180 days). Adjusted between-group differences (IG − CG) were −0.78 at baseline, −6.28 at 30 days, −9.32 at 60 days, and −10.09 points at 180 days, indicating a clinically and statistically significant improvement in self-care in the IG. Lower rates of readmission (32.14% vs. 11.76%) and mortality (5.36% vs. 1.96%) were also observed in the IG. Conclusions: The nurse-led care transition intervention, combining MI, TB, and clinical video monitoring, significantly improved self-care in patients with HF over 180 days, in addition to reducing readmissions and mortality, supporting the incorporation of these strategies into care transition models to enhance patient engagement and sustain self-care

Avaliação do potencial antioxidante e hipolipemiante do extrato bruto de Monteverdia ilicifolia em modelo experimental de dislipidemia induzida

2026-02-24T00:00:00Z

Title: Avaliação do potencial antioxidante e hipolipemiante do extrato bruto de Monteverdia ilicifolia em modelo experimental de dislipidemia induzida Abstract: Non-communicable chronic diseases (NCDs) represent a significant global health burden, with dyslipidemia being a primary risk factor for their associated complications. Conventional treatments, although effective, present certain limitations and adverse effects, driving the exploration for novel phytotherapeutic alternatives using natural products. This study aimed to investigate the hypolipidemic and antioxidant potential of the crude ethanolic extract of Monteverdia ilicifolia leaves (EEBT-MI) using an induced in vivo model of hyperlipidemia. Hyperlipidemia was induced in C57BL/6 mice via intraperitoneal administration of Tyloxapol (400 mg/kg). The animals were administered with three doses of the extract (100, 200, and 400 mg/kg) or with Simvastatin (20 mg/kg). Serum biochemical parameters evaluated included hepatic oxidative stress markers, fecal lipid excretion, and histopathological analyses of the liver. The results demonstrated that Tyloxapol drastically elevated total cholesterol and triglyceride levels in the vehicle group (HL). Conversely, treatment with EEBT-MI, particularly at the 200 mg/kg dose (HM200) (p<0.05), promoted a significant reduction in these markers, bringing them closer to the levels observed in the healthy control group. Notably, multivariate cluster analysis confirmed that the 200 mg/kg dose was the most effective, exhibiting the highest metabolic similarity to healthy animals. Regarding the mechanism of action. It was observed that the extract may inhibit intestinal lipid absorption, as evidenced by increased fecal excretion, possibly by inhibiting key enzymes of lipid metabolism. Assessment of oxidative stress markers revealed that hyperlipidemia in the vehicle group caused significant damage, reducing the activity of antioxidant enzymes (SOD, CAT, GPx). In contrast, the HM200 group restored the activity of these enzymes and increased total antioxidant capacity (FRAP), suggesting activation of the Nrf2 pathway. This differed from Simvastatin, which showed signs of hepatotoxicity through elevated ALT and AST transaminases, whereas EEBT-MI demonstrated hepatoprotective action (p<0.5). The Histopathological analyses confirmed these findings, showing that the extract-treated groups exhibited lower cytoplasmic vacuolization and better hepatic preservation compared to the HL group. In conclusion, these results support the therapeutic potential of M. ilicifolia extract as a natural alternative for managing hyperlipidemia, however, further clinical studies are recommended to confirm its efficacy as a hypolipidemic intervention.

Aplicação da espectroscopia ATR-FTIR combinada a algoritmos de aprendizado de máquina para identificação da doença renal crônica em amostras de saliva

2025-10-30T00:00:00Z

Title: Aplicação da espectroscopia ATR-FTIR combinada a algoritmos de aprendizado de máquina para identificação da doença renal crônica em amostras de saliva Abstract: Introduction: Chronic Kidney Disease (CKD) is a progressive condition that presents nonspecific symptoms in its early stages, making diagnosis difficult. This highlights the need for noninvasive, accessible, and effective diagnostic methods for CKD detection. Objectives: This study aimed to investigate the potential of attenuated total reflection- Fourier transform infrared (ATR-FTIR) spectroscopy of saliva, combined with machine learning algorithms, to discriminate patients with CKD from healthy individuals. Materials and Methods: Samples were collected at the Hemodialysis Unit of the Hospital das Clínicas at UFU. Participants followed prior restrictions on eating, drinking, smoking, and the use of oral products. Unstimulated whole saliva was collected in sterile tubes under standardized conditions, in accordance with international protocols for salivary biomarker studies. Spectra were acquired by ATR- FTIR and subjected to spectral preprocessing. Machine learning algorithms, including Principal Component Analysis (PCA), Support Vector Machine (SVM), Random Forest, AdaBoost, and Neural Networks, were used for statistical and predictive analysis. Results: Twenty-nine patients with CKD diagnosed according to the NKF criteria and 24 healthy controls, matched for age and sex, with no history of renal, systemic, or oral diseases, were included. The study identified ten salivary spectral biomarkers associated with CKD, mainly related to proteins, carbohydrates, lipids, and nucleic acids. One of the protein markers stood out in the amide III region, involving vibrations of the N–H and C–N bonds. Spectral classification achieved 98% accuracy, 100% sensitivity, and 96% specificity. Conclusion: This study demonstrated the potential of ATR-FTIR spectroscopy applied to saliva samples, combined with machine learning algorithms, as a promising approach for the non-invasive diagnosis of Chronic Kidney Disease (CKD). Keywords: Chronic kidney disease, Spectroscopy, Fourier Transform Infrared, Saliva

Aplicabilidade do Weight Loss Grading System (WLGS) na avaliação da caquexia e sobrevida em pacientes com câncer avançado

2025-10-24T00:00:00Z

Title: Aplicabilidade do Weight Loss Grading System (WLGS) na avaliação da caquexia e sobrevida em pacientes com câncer avançado Abstract: Introduction: Advanced cancer represents a major challenge in oncologic care due to clinical complications that impair functionality and worsen patients' overall condition. In this context, cancer cachexia, a multifactorial and progressive syndrome characterized by involuntary weight loss and systemic inflammation that leads to a decline in nutritional status and negatively affects prognosis. Given the lack of simple and effective tools for cachexia staging and clinical risk stratification, the Weight Loss Grading System (WLGS) has emerged as a promising alternative. Objective: This prospective study aimed to evaluate the applicability of the WLGS in predicting cachexia stages and estimating survival in patients with advanced cancer. Methods: The study was conducted from 2021 to 2024 at the Hospital das Clínicas of the Federal University of Uberlândia and included 100 patients with advanced cancer receiving palliative care. Sociodemographic, clinical, and anthropometric data were collected, and the WLGS was applied. The association between WLGS and cachexia stages was analyzed using Pearson’s chi-square test. Median survival across WLGS categories was estimated using the Kaplan–Meier method, and mortality prediction was assessed using binary logistic regression. Results: A significant association of the WLGS with cachexia stages was found, with more advanced stages of the syndrome being associated with higher grades of the system (p < 0.001). The WLGS was identified as an independent predictor of 180-day mortality (OR = 1.374; p = 0.038), indicating an approximately 37.4% increase in the risk of death for each additional point in the system. Furthermore, median survival decreased with increasing WLGS scores, with significant differences observed between the Grade 0 and Grade 4 groups (p < 0.049). Conclusion: These findings suggest that the WLGS is a valuable tool for risk stratification in patients with advanced cancer, as it is associated with both the severity of cachexia and overall survival. Its integration into clinical practice may support more personalized and effective interventions.