O checklist de cirurgia segura da Organização Mundial da Saúde é uma ferramenta útil para diminuir eventos adversos em hospitais, porém sua implantação efetiva ainda é um desafio. Este estudo objetiva avaliar a adesão ao checklist em cirurgias urológicas e ginecológicas de dois hospitais de ensino em Natal, Rio Grande do Norte, Brasil. O desenho foi observacional transversal; selecionaram-se cirurgias eletivas, e a coleta se deu por meio de revisão de prontuários. Descreveu-se a adesão mediante a existência e qualidade do preenchimento do checklist, e analisou-se a associação de fatores estruturais e socioprofissionais valendo-se de análise de regressão múltipla. Das 375 cirurgias revisadas, 61% tinham checklist, e 4% estavam totalmente preenchidos. A existência do checklist se associou às cirurgias ginecológicas (maternidade) (OR = 130,18) e à maior duração da cirurgia (OR = 2,13), enquanto a qualidade do preenchimento se relacionou com as cirurgias urológicas (hospital geral) (β = 26,36). A adesão ao checklist precisa ser aprimorada, e as diferenças sugerem a influência das distintas estratégias de implantação utilizadas em cada instituição.

Syphilis still remains a major health concern worldwide because of the possibility of serious medical and psychological consequences, long-term disability, and death. Neurosyphilis (NS) may occur at any stage of infection. Its clinical presentation has been changing over recent years including­ psychiatric and neurocognitive symptoms. Several recent studies have described cases with these symptoms as the principal signs of NS. We present the case of neurosyphilis with a psychiatric presentation characterized by mood disturbance and auditory and visual hallucinations.

Background: Alzheimer’s disease (AD) is the main cause of dementia worldwide. The definitive diagnosis of AD is clinicopathological and based on the identification of cerebral deposition of amyloid β (Aβ) plaques and neurofibrillary tangles. However, the link between amyloid cascade and depositions of phosphorylated tau (p-tau) is still missing. In this scenario, inflammasomes might play a relevant role. Experimental models of AD have suggested that Aβ accumulation induces, through microglia, activation of the NLRP3 inflammasome. This activation contributes to the dissemination of Aβ and p-tau, as well as to hyperphosphorylation of tau. Also in experimental models, NLPR1 promoted neuronal pyroptosis. There are neither comprehensive neuropathologic characterization, nor clinicopathologic studies evaluating the NLRP1 and NLRP3 inflammasomes in subjects with AD. Objective: The current mini-review aims to summarize recent and promising findings on the role of NLRP1 and NLRP3 signaling in the pathophysiology of AD. We also sought to highlight the knowledge gap in patients with AD, mainly the lack of clinicopathologic studies on the interaction among inflammasomes, Aβ/tau pathology, and cognitive decline.

ABSTRACT. Dementia is a cause of disability among older adults. Accessing advanced dementia prognosis is a challenge. Objective: The objective of this study was to evaluate the accuracy of the Charlson and Carey indexes in predicting 3-year survival of older adults with advanced dementia. Methods: This is a retrospective cohort study of 238 patients aged ≥60 years with advanced dementia from an outpatient clinic and classified as stage ≥6A by using the Functional Assessment Staging scale. We excluded patients with missing data. We reviewed the semi-structured interview (clinical, sociodemographic, and functional data) from the baseline visit. This information was used to calculate 3-year mortality risks according to the Charlson and Carey indexes. We used Cox proportional hazard models to evaluate the associations of all-cause mortality with both indexes, adjusted for sociodemographic variables. We used Harrell’s C measure to determine the discrimination. We calculated the absolute differences between observed and predicted 3-year mortality risks for each index for calibration. Results: In 238 patients, the average age was 80.5±7.8 years, with 36% being men. The median follow-up time was 1.8 years (0.05–3.0). The 3-year all-cause mortality rate was 50% (119 deaths). The Carey index was associated with mortality, with one point increase related to a 15% increase in the mortality risk (hazard ratio [HR]=1.15, 95% confidence interval (95%CI) 1.06–1.25, p=0.001), even after adjustment. Accuracy for the Charlson index and Carey index was 0.55 (95%CI 0.49–0.60) and 0.60 (95%CI 0.52–0.62), respectively, with no difference between them (p=0.44). Conclusions: Both indexes had poor discrimination and calibration performances in predicting 3-year mortality in patients with advanced dementia.

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