RESUMO

The objective of this study was to analyze the effectiveness of the implementation of the lean healthcare system at the emergency room of the Clinical Hospital of the Federal University of Uberlândia, based on a comparison of hospital indicators obtained over the three phases corresponding to the period of one year before the implementation (T1), the year during the implementation (T2) and one year after implementation (T3). The methodology applied through this study can be classified as a case study that is exploratory and descriptive and developed in stages. Based herein on the search for hospital indicators, as occurred in the implementation of a lean process at the Clinical Hospital Emergency Department, along with a description of the implemented lean system. During the collection period of data relevant to the National Emergency Department Overcrowding Score and Length of Stay Indicator, the motivation of the teams grew, but with a notable tension between municipal management and hospital management. It was found that, despite the fluctuations, the patient length of stay in the Emergency Room remained high. With the exception of the variable of female deaths before 24 h of hospitalization, all other variables showed percentage increases before and after the intervention. This study reported the difficulties encountered by HC-UFU in implementing the lean project in an emergency room, thus ensuring that other institutions that intend to implement this project do not make the same types of mistakes.

Assuntos

RESUMO

OBJECTIVES: To evaluate the reliability and reproducibility of an artificial intelligence (AI) software in identifying cephalometric points on lateral cephalometric radiographs considering four settings of brightness and contrast. METHODS AND MATERIALS: Brightness and contrast of 30 lateral cephalometric radiographs were adjusted into four different settings. Then, the control examiner (ECont), the calibrated examiner (ECal), and the CEFBOT AI software (AIs) each marked 19 cephalometric points on all radiographs. Reliability was assessed with a second analysis of the radiographs 15 days after the first one. Statistical significance was set at p < 0.05. RESULTS: Reliability of landmark identification was excellent for the human examiners and the AIs regardless of the type of brightness and contrast setting (mean intraclass correlation coefficient >0.89). When ECont and ECal were compared for reproducibility, there were more cephalometric points with significant differences on the x-axis of the image with the highest contrast and the lowest brightness, namely N(p = 0.033), S(p = 0.030), Po(p < 0.001), and Pog'(p = 0.012). Between ECont and AIs, there were more cephalometric points with significant differences on the image with the highest contrast and the lowest brightness, namely N(p = 0.034), Or(p = 0.048), Po(p < 0.001), A(p = 0.042), Pog'(p = 0.004), Ll(p = 0.005), Ul(p < 0.001), and Sn(p = 0.001). CONCLUSIONS: While the reliability of the AIs for cephalometric landmark identification was rated as excellent, low brightness and high contrast seemed to affect its reproducibility. The experienced human examiner, on the other hand, did not show such faulty reproducibility; therefore, the AIs used in this study is an excellent auxiliary tool for cephalometric analysis, but still depends on human supervision to be clinically reliable.

Assuntos

RESUMO

Resveratrol (RSV), a phytoalexin from grapes and peanuts, has been reported to exhibit antiproliferative effects on various cancer cell lines. In breast cancer, RSV has been demonstrated to exert an antiproliferative effect on both hormone-dependent and hormone-independent breast cancer cell lines. However, RSV is a lipophilic drug, and its therapeutic effect could be improved through nanoencapsulation. Functionalizing polymeric nanoparticles based on polycaprolactone (PCL) with polyethylene glycol 1000 tocopheryl succinate (TPGS) has been reported to prolong drug circulation and reduce drug resistance. However, the effect of TPGS on the physicochemical properties and biological effects of breast cancer cells remains unclear. Therefore, this study aimed to develop RSV-loaded PCL nanoparticles using nanoprecipitation and investigate the effect of TPGS on the nanoparticles' physicochemical characteristics (particle size, zeta potential, encapsulation efficiency, morphology, and release rate) and biological effects on the 4T1 breast cancer cell line (cytotoxicity and cell uptake), in vitro and in vivo. The optimized nanoparticles without TPGS had a size of 138.1 ± 1.8 nm, a polydispersity index (PDI) of 0.182 ± 0.01, a zeta potential of -2.42 ± 0.56 mV, and an encapsulation efficiency of 98.2 ± 0.87%, while nanoparticles with TPGS had a size of 127.5 ± 3.11 nm, PDI of 0.186 ± 0.01, zeta potential of -2.91 ± 0.90 mV, and an encapsulation efficiency of 98.40 ± 0.004%. Scanning electron microscopy revealed spherical nanoparticles with low aggregation tendency. Differential Scanning Calorimetry (DSC) and Fourier Transform Infrared Spectroscopy (FTIR) identified the constituents of the nanoparticles and the presence of drug encapsulation in an amorphous state. In vitro release studies showed that both formulations followed the same dissolution profiles, with no statistical differences. In cytotoxicity tests, IC50 values of 0.12 µM, 0.73 µM, and 4.06 µM were found for the formulation without TPGS, with TPGS, and pure drug, respectively, indicating the potentiation of the cytotoxic effect of resveratrol when encapsulated. Flow cytometry and confocal microscopy tests indicated excellent cellular uptake dependent on the concentration of nanoparticles, with a significant difference between the two formulations, suggesting that TPGS may pose a problem in the endocytosis of nanoparticles. The in vivo study evaluating the antitumor activity of the nanoparticles confirmed the data obtained in the in vitro tests, demonstrating that the nanoparticle without TPGS significantly reduced tumor volume, tumor mass, maintained body weight, and improved survival in mice. Moreover, the biochemical evaluation evidenced possible hepatotoxicity for formulation with TPGS.

RESUMO

Herein, we investigated the effect of fish oil supplementation combined with a strength-training protocol, for 6 weeks, on muscle damage induced by a single bout of strength exercise in untrained young men. Sixteen men were divided into two groups, supplemented or not with fish oil, and they were evaluated at the pre-training period and post-training period. We investigated changes before and 0, 24, and 48 h after a single hypertrophic exercise session. Creatine kinase (CK) and lactate dehydrogenase (LDH) activities, plasma interleukin-6 (IL-6) and C-reactive protein (CRP) levels, and the redox imbalance were increased in response to the single-bout session of hypertrophic exercises at baseline (pre-training period) and decreased during the post-training period in the control group due to the repeated-bout effect (RBE). The fish oil supplementation exacerbated this reduction and improved the redox state. In summary, our findings demonstrate that, in untrained young men submitted to a strength-training protocol, fish oil supplementation is ideal for alleviating the muscle injury, inflammation, and redox imbalance induced by a single session of intense strength exercises, highlighting this supplementation as a beneficial strategy for young men that intend to engage in strength-training programs.

Assuntos

RESUMO

BACKGROUND: Parkinson's disease (PD) can affect hand function since the beginning of the motor symptoms. OBJECTIVE: To compare the ability of different hand function tests to: 1) distinguish individuals with PD from healthy controls; 2) differentiate stages of the disease; and 3) indicate changes over time due to disease progression. METHODS: Twenty-four individuals with PD (Hoehn and Yahr: I-III) and 24 age- and sex-matched controls performed the Jebsen-Taylor Hand Function Test (JTHFT), the Nine-Hole Peg Test (9HPT), and the maximum grip and the maximum pinch strength tests using their right and left hands. Eight individuals with PD (six females and two males) were reassessed after 18 months. The ROC analyses and Mann-Whitney U tests (for disease progression) using the average performance of the hands were done. RESULTS: Individuals with PD presented worse test performances than controls, except for the writing subtest of the JTHFT and the grip strength test. The JTHFT without the writing subtest (JTHFTnoW) was the most accurate to discriminate PD from controls (AUC = 0.899; sensitivity 75% and specificity 95.8%). The 9HPT and the simulated feeding and moving large, light objects JTHFT subtests were sensitive to distinguish stages, while the 9HPT, the moving small, common objects JTHFT subtest, and the grip strength were sensitive to changes with disease progression. CONCLUSION: The JTHFTnoW was highly discriminative of the hand function impairments in PD. TwoJTHFT subtests were the most sensitives to distinguish PD stages (i.e. simulated feeding JTHFT subtest) and disease progression (i.e. moving small, common objects JTHFT subtest).

Assuntos

RESUMO

Prolonged wearing of high heels can cause chronic injury and inflammation. Herein, we investigated the presence of muscle injury, inflammation, and neutrophil function in young women after a single bout of stiletto dance class. Sixteen volunteers (23.4 ± 3.8 years; 61.7 ± 8.1 kg; 23.4 ± 2.3 kg/m2; and 27.2 ± 3.8% body fat) participated in the study. The plasma biomarkers matrix metalloproteinase 3 (MMP-3), muscle damage (myoglobin (Mb), total creatine kinase (CK), and lactate dehydrogenase (LDH)), and inflammation (interleukin 8 (IL-8), tumour necrosis factor-alpha (TNF-α), interleukin (IL]-1ß, and IL-6) were quantified before and immediately after a single stiletto class (60 min) of moderate intensity. After class, our data showed that the plasma concentration of MMP-3, Mb, and CK increased by 56% (p = 0.04; d = 0.8), 113% (p = 0.007; d = 1.1), and 21% (p < 0.001; d = 0.4), respectively. Reactive oxygen species produced by neutrophils and the plasma concentration of IL-8, TNF-α, IL-1ß, and IL-6 were not affected under the study conditions. We concluded that a single bout of stiletto dance class caused muscle damage but did not alter the plasma concentration of proinflammatory cytokines. These findings are crucial in preventing the progress of chronic injuries that are often noted in dancers with synovitis and arthritis.

RESUMO

Objetivou-se com o presente estudo avaliar diferentes ângulos e pontos de vacinação de juvenis de Tilapias-do-Nilo contra streptococose. Foram vacinados 450 juvenis de tilápias-do-nilo (Oreochroimis niloticus). Os animais foram divididos em três grupos (n=150) de acordo com seus pesos (grupo um: 140 g; grupo dois: 225 g e grupo três: 295 g). Os peixes foram vacinados em diferentes ângulos (45° ou 90°) e em diferentes pontos localizados na região intraperitoneal, entre as nadadeiras pélvicas (Ponto 0- meia nadadeira; ponto 1- entre meia nadadeira e a inserção da nadadeira, ponto 2 ­ paralelo a inserção da nadadeira), totalizando 75 peixes para cada ângulo proposto e 25 peixes para cada ponto de vacinação. Utilizou-se vacina comercial inativada com adjuvante oleoso contra Streptococcus agalactiae. Para análise do manejo vacinal elaborou-se um formulário que foi preenchido dividindo os peixes como bem vacinados, pouco vacinados e sem vacina. Os resultados foram obtidos por análise visual e expressos em porcentagem de acordo com os critérios estabelecidos. A vacinação do grupo um (140 g) e do grupo dois (225 g) no ângulo de 90° no ponto 2 possibilitou que 88% dos peixes fossem bem vacinados. O grupo três (295g) também foi melhor vacinado no ângulo de 90° no ponto 2, com 80% dos peixes bem vacinados. O ângulo de 90° no ponto 2 se mostrou mais eficiente para vacinação de juvenis de tilápia-do-Nilo para ambos os grupos de peso estudados.(AU)

The objective of this study was to evaluate different angles and points of vaccination of juvenile Nile Tilapia against streptococcosis. 450 juveniles of Nile tilapia (Oreochromis niloticus) were vaccinated. The animals were divided into three groups (n = 150) according to their weight (group one: 140 g; group two: 225 g and group three: 295 g). The fish were vaccinated at different angles (45 ° or 90 °) and at different points located in the intraperitoneal region, between the pelvic fins (Point 0- half fin; point 1- between half fin and the insertion of the fin, point 2 - parallel inserting the fin), totaling 75 fish for each proposed angle and 25 fish for each vaccination point. Inactivated commercial vaccine with oily adjuvant against Streptococcus agalactiae was used. For the analysis of vaccine management, a form was elaborated that was filled out dividing the fish as well vaccinated, poorly vaccinated and without vaccine. The results were obtained by visual analysis and expressed as a percentage according to the established criteria. The vaccination of group one (140 g) and group two (225 g) at the 90 ° angle at point 2 allowed 88% of the fish to be well vaccinated. Group three (295g) was also better vaccinated at the 90 ° angle at point 2, with 80% of the fish well vaccinated. The 90 ° angle at point 2 was more efficient for vaccinating juvenile Nile tilapia for both weight groups studied.(AU)

El objetivo de este estudio fue evaluar diferentes ángulos y puntos de vacunación de juvenilesde Tilapia del Nilo contra estreptococosis. Se vacunaron 450 juveniles de tilapia del Nilo(Oreochromis niloticus). Los animales se dividieron en tres grupos (n = 150) según supeso(grupo uno: 140 g; grupo dos: 225 gy grupo tres: 295 g). Los peces fueron vacunados endiferentes ángulos (45 ° y 90 °) y en diferentes puntos ubicados en la región intraperitoneal, entre las aletas pélvicas (Punto 0- media aleta; punto 1- entre média aleta y la insercióndelaaleta, punto 2 - paralelo insertando la aleta), totalizando 75 peces por cada ángulo propuestoy 25 peces por cada punto de vacunación. Se utilizó vacuna comercial inactivada conadyuvante oleoso contra Streptococcus agalactiae. Para el análisis del manejo de vacunas seelaboró un formulario que se llenó dividiendo a los peces bien vacunados, mal vacunadosysin vacuna. Los resultados se obtuvieron mediante análisis visual y se expresaronenporcentaje según los criterios establecidos. La vacunación del grupo uno (140 g) y del grupodos (225 g) en el ángulo de 90 ° en el punto 2 permitió que el 88% de los peces estuvieranbien vacunados. El grupo tres (295 g) también se vacunó mejor en el ángulo de 90 ° enel punto 2, con el 80% de los peces bien vacunados. El ángulo de 90 ° en el punto 2 fue máseficiente para vacunar a la tilapia juvenil del Nilo para ambos os grupos de peso estudados.(AU)

Assuntos

RESUMO

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

ABSTRACT Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

RESUMO

Motor synergies, i.e., neural mechanisms that organize multiple motor elements to ensure stability of actions, are affected by several neurological condition. Asymptomatic welders showed impaired synergy controlling the stability of multi-finger action compared to non-welders and this impairment was associated with microstructural damage in the globus pallidus. We further explored the effect of welding-related metal exposure on multi-finger synergy and extended our investigation to posture-stabilizing synergy during a standing task. Occupational, MRI, and performance-stabilizing synergies during multi-finger accurate force production and load releasing while standing were obtained from 29 welders and 19 age- and sex-matched controls. R2* and R1 relaxation rate values were used to estimate brain iron and manganese content, respectively, and diffusion tensor imaging was used to reflect brain microstructural integrity. Associations of brain MRI (caudate, putamen, globus pallidus, and red nucleus), and motor synergy were explored by group status. The results revealed that welders had higher R2* values in the caudate (p = 0.03), putamen (p = 0.01), and red nucleus (p = 0.08, trend) than controls. No group effect was revealed on multi-finger synergy index during steady-state phase of action (ΔVZss). Compared to controls, welders exhibited lower ΔVZss (-0.106 ± 0.084 vs. 0.160 ± 0.092, p = 0.04) and variance that did not affect the performance variable (VUCM, 0.022 ± 0.003 vs. 0.038 ± 0.007, p = 0.03) in the load releasing, postural task. The postural synergy index, ΔVZss, was associated negatively with higher R2* in the red nucleus in welders (r = -0.44, p = 0.03), but not in controls. These results suggest that the synergy index in the load releasing during a standing task may reflect welding-related neurotoxicity in workers with chronic metals exposure. This finding may have important clinical and occupational health implications.

Assuntos

RESUMO

Withajardins, uncommon modified withanolide-type steroids, have been isolated exclusively from plants of the Solanaceae family so far. Two undescribed withajardins and the known tuboanosigenin were isolated from the hexane/EtOAc 1:1 extract from Athenaea velutina leaves. Their structures were established by an extensive analysis of 1D and 2D-NMR and HRMS data. The absolute configuration was determined by X-ray diffraction (withajardin L and tuboanosigenin) and circular dichroism (CD) analyses (withajardin M). The anti-inflammatory activity of compounds was evaluated through the inhibition of the lipopolysaccharide (LPS)-induced nitric oxide (NO), TNF-α, and IL-6 release in RAW264.7 cells. The cell viability effects to RAW 264.7 cells showed IC50 values of 74.4-354.4 µM. The compounds attenuated LPS-induced release of NO and decreased pro-inflammatory cytokines TNF-α and IL-6 in RAW264.7 cells.

Assuntos

RESUMO

This study aimed to compare the thresholds of identification and aesthetic perception of simulated alar base widening among oral and maxillofacial (OMF) surgeons from Brazil and other countries through an online data collection form. Photographs of one male and one female model were digitally manipulated to obtain aesthetically acceptable, symmetrical faces and to gradually widen the alar base to produce six different images from each original photograph. The online questionnaire was sent to OMF surgeons of different nationalities. The results mshowed that the majority of Brazilian (88%) and international (89%) evaluators considered the female faces with 0 to 2 mm of alar base widening as being more pleasant. In turn, Brazilian (93%) and international (94%) respondents agreed that faces with the greatest widening (8 and 10 mm) were less pleasant. As for the male model, Brazilian (93%) and international (85%) OMF surgeons agreed that faces with none or small widening (0 and 2 mm) were more pleasant. The male face with the greatest widening (10 mm) was considered the least attractive by the respondents (93% in both groups). The findings of this study suggest that alar base widening up to the limit of 2 mm did not alter the perception of facial attractiveness. Thus, faces without alar base widening were considered the most attractive, while those with significant alterations were considered less attractive. Most importantly, despite the limitations of this study design, it seems that different cultural and professional contexts have minor influence on aesthetics analysis performed by OMF surgeons. (AU)

Este estudo teve como objetivo comparar os limiares de identificação e percepção estética do alargamento simulado da base alar entre cirurgiões bucomaxilofaciais (BMF) do Brasil e de outros países por meio de um formulário de coleta de dados online. Fotografias de um modelo masculino e de uma modelo feminina foram manipuladas digitalmente para obter faces esteticamente aceitáveis e simétricas e para ampliar gradualmente a base alar produzindo seis imagens diferentes de cada fotografia original. O questionário online foi enviado aos cirurgiões BMF de diferentes nacionalidades. Os resultados mostraram que a maioria dos avaliadores brasileiros (88%) e internacionais (89%) consideraram as faces femininas com 0 a 2 mm de alargamento da base alar como mais agradáveis. Por sua vez, os entrevistados brasileiros (93%) e internacionais (94%) concordaram que os rostos com maior alargamento (8 e 10 mm) foram os menos agradáveis. Quanto ao modelo masculino, os cirurgiões brasileiros (93%) e internacionais (85%) da OMF concordaram que faces com nenhum ou pequeno alargamento (0 e 2 mm) eram mais agradáveis. A face masculina com maior alargamento (10 mm) foi considerada a menos atraente pelos entrevistados (93% em ambos os grupos). Nossos achados sugerem que o alargamento da base alar até o limite de 2 mm não alterou a percepção da atratividade facial. Assim, rostos sem alargamento da base alar foram considerados os mais atraentes, enquanto aqueles com alterações significativas foram considerados menos atraentes. Mais importante ainda, apesar das limitações, parece que diferentes contextos culturais e profissionais têm pouca influência na análise estética realizada pelos cirurgiões da OMF. (AU)

RESUMO

OBJECTIVE: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. METHODS: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. RESULTS: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. CONCLUSION: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

OBJETIVO: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. MÉTODOS: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. RESULTADOS: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). CONCLUSÃO: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

Assuntos

RESUMO

OBJECTIVE: To assess the reliability of CEFBOT, an artificial intelligence (AI)-based cephalometry software, for cephalometric landmark annotation and linear and angular measurements according to Arnett's analysis. METHODS: Thirty lateral cephalometric radiographs acquired with a Carestream CS 9000 3D unit (Carestream Health Inc., Rochester/NY) were used in this study. The 66 landmarks and the 10 selected linear and angular measurements of Arnett's analysis were identified on each radiograph by a trained human examiner (control) and by CEFBOT (RadioMemory Ltd., Belo Horizonte, Brazil). For both methods, landmark annotations and measurements were duplicated with an interval of 15 days between measurements and the intraclass correlation coefficient (ICC) was calculated to determine reliability. The numerical values obtained with the two methods were compared by a t-test for independent variables. RESULTS: CEFBOT was able to perform all but one of the 10 measurements. ICC values > 0.94 were found for the remaining eight measurements, while the Frankfurt horizontal plane - true horizontal line (THL) angular measurement showed the lowest reproducibility (human, ICC = 0.876; CEFBOT, ICC = 0.768). Measurements performed by the human examiner and by CEFBOT were not statistically different. CONCLUSION: Within the limitations of our methodology, we concluded that the AI contained in the CEFBOT software can be considered a promising tool for enhancing the capacities of human radiologists.

Assuntos

RESUMO

This study examined the quality of silage from two cultivars of energy cane (Saccharum spontaneum) produced with different additives. The experiment was laid out in a completely randomized design with a 2×5 factorial arrangement of treatments consisting of two cultivars (VG3, VG1126) and four additives (1% urea; 1% NaOH; 1% CaO; and 1.0 × 1011 CFU g-1 of Lactobacillus plantarum- LP) + control, with eight replicates. Experimental mini-silos were used, which were opened 72 days after ensiling. The dry matter (DM), crude protein (CP), organic matter (OM), mineral matter (MM), ether extract (EE), neutral detergent fiber (NDF) and acid detergent fiber (ADF) contents, and silage degradability were. We identified significant interactions effect between cultivar and type of additive for DM, CP, EE, NDF. ADF. Organic and mineral matter percentage were similar between the two cultivars. LP was the least beneficial additive for DM degradation.After 72 h of fermentation, in vitro NDF degradation of cultivar VG3 increased due to urea, NaOH, and CaO, whereas degradation cultivar VG1126 decreased when inoculated with LP or CaO. The NaOH and CaO improved silage degradability thus improving its quality. The use of LP in the present study did not benefit silage for energy-cane cultivars. The use of NaOH and CaO improves the quality of the silage, two varieties of sugarcane energy VG3 and VG1126, enabling its use with better efficiency for animal feed.

Este estudo avaliou a qualidade da silagem de duas cultivares de cana-de-energia (Saccharumspontaneum) produzidas com diferentes aditivos. O experimento foi instalado em delineamento inteiramente casualizado, com arranjo fatorial 2 × 5 de tratamentos composto por duas cultivares (VG3, VG1126) e quatro aditivos (1% uréia; 1% NaOH; 1% CaO; e 1,0 × 1011 UFC g -1 de Lactobacillus plantarum- LP) + controle, com oito repetições. Foram utilizados minisilos experimentais, os quais foram abertos 72 dias após a ensilagem. Os teores de matéria seca (MS), proteína bruta (PB), matéria orgânica (MO), matéria mineral (MM), extrato etéreo (EE), fibra em detergente neutro (FDN) e fibra em detergente ácido (FDA) e degradabilidade da silagem foram avaliados. Identificou-se efeito de interação significativo entre cultivar e tipo de aditivo para MS, PB, EE, FDN. ADF. As porcentagens de matéria orgânica e mineral foram semelhantes entre as duas cultivares. LP foi o aditivo menos benéfico para a degradação da MS. Após 72 h de fermentação, a degradação in vitro da FDN da cultivar VG3 aumentou devido à uréia, NaOH e CaO, enquanto a degradação da cultivar VG1126 diminuiu quando inoculada com LP ou CaO. O NaOH e o CaO melhoraram a degradabilidade da silagem, melhorando assim sua qualidade. O uso da LP no presente estudo não beneficiou a silagem para cultivares de cana-de-energia. O uso de NaOH e CaO melhora a qualidade da silagem, duas variedades de energia da cana-de-açúcar VG3 e VG1126, possibilitando seu uso com melhor eficiência para ração animal.

Assuntos

RESUMO

ABSTRACT This study examined the quality of silage from two cultivars of energy cane (Saccharum spontaneum) produced with different additives. The experiment was laid out in a completely randomized design with a 2×5 factorial arrangement of treatments consisting of two cultivars (VG3, VG1126) and four additives (1% urea; 1% NaOH; 1% CaO; and 1.0 × 1011 CFU g-1 of Lactobacillus plantarum- LP) + control, with eight replicates. Experimental mini-silos were used, which were opened 72 days after ensiling. The dry matter (DM), crude protein (CP), organic matter (OM), mineral matter (MM), ether extract (EE), neutral detergent fiber (NDF) and acid detergent fiber (ADF) contents, and silage degradability were. We identified significant interactions effect between cultivar and type of additive for DM, CP, EE, NDF. ADF. Organic and mineral matter percentage were similar between the two cultivars. LP was the least beneficial additive for DM degradation.After 72 h of fermentation, in vitro NDF degradation of cultivar VG3 increased due to urea, NaOH, and CaO, whereas degradation cultivar VG1126 decreased when inoculated with LP or CaO. The NaOH and CaO improved silage degradability thus improving its quality. The use of LP in the present study did not benefit silage for energy-cane cultivars. The use of NaOH and CaO improves the quality of the silage, two varieties of sugarcane energy VG3 and VG1126, enabling its use with better efficiency for animal feed.

RESUMO Este estudo avaliou a qualidade da silagem de duas cultivares de cana-de-energia (Saccharumspontaneum) produzidas com diferentes aditivos. O experimento foi instalado em delineamento inteiramente casualizado, com arranjo fatorial 2 × 5 de tratamentos composto por duas cultivares (VG3, VG1126) e quatro aditivos (1% uréia; 1% NaOH; 1% CaO; e 1,0 × 1011 UFC g -1 de Lactobacillus plantarum- LP) + controle, com oito repetições. Foram utilizados minisilos experimentais, os quais foram abertos 72 dias após a ensilagem. Os teores de matéria seca (MS), proteína bruta (PB), matéria orgânica (MO), matéria mineral (MM), extrato etéreo (EE), fibra em detergente neutro (FDN) e fibra em detergente ácido (FDA) e degradabilidade da silagem foram avaliados. Identificou-se efeito de interação significativo entre cultivar e tipo de aditivo para MS, PB, EE, FDN. ADF. As porcentagens de matéria orgânica e mineral foram semelhantes entre as duas cultivares. LP foi o aditivo menos benéfico para a degradação da MS. Após 72 h de fermentação, a degradação in vitro da FDN da cultivar VG3 aumentou devido à uréia, NaOH e CaO, enquanto a degradação da cultivar VG1126 diminuiu quando inoculada com LP ou CaO. O NaOH e o CaO melhoraram a degradabilidade da silagem, melhorando assim sua qualidade. O uso da LP no presente estudo não beneficiou a silagem para cultivares de cana-de-energia. O uso de NaOH e CaO melhora a qualidade da silagem, duas variedades de energia da cana-de-açúcar VG3 e VG1126, possibilitando seu uso com melhor eficiência para ração animal

RESUMO

We investigate the behavior of both pure spin and spin-polarized currents measured with four-probe non-local and two probe local configurations up to room temperature and under an external gate voltage in a lateral graphene transistor, produced using a standard large-scale microfabrication process. The high spin diffusion length of pristine graphene in the channel, measured both directly and by the Hanle effect, and the tuning of the relationship between the electrode resistance areas present in the device architecture allowed us to observe local tunnel magnetoresistance at room temperature, a new finding for this type of device. The results also indicate that while pure spin currents are less sensitive to temperature variations, spin-polarized current switching by an external voltage is more efficient, due to a combination of the Rashba effect and a change in carrier mobility by a Fermi level shift.

RESUMO

BACKGROUND: This study investigates the marine macroinvertebrate fauna of rhodolith beds (non-geniculated red corallinaceaous algae) in northeast Brazilian. A total of 57 species were identified, belonging to six phyla (Platyhelminthes, Annelida, Sipuncula, Mollusca, Arthropoda and Echinodermata), of which 50 are considered here as new records for the Paraíba State. Annelids (Class Polychaeta) were the most representative taxa in Miramar and Seixas Beaches, while molluscs were dominant in Maceió Beach. NEW INFORMATION: This is the first study that includes an identification key, diagnostic features and distribution patterns worldwide and local (including new records) of the marine invertebrate fauna associated with rhodolith beds in northeast Brazil (State of Paraíba). Sampling events were performed in 2018, at low tide in the intertidal to shallow subtidal zones (1.5 and 4.0 m depth), in Miramar, Seixas and Maceió Beaches. A total of 17 species were found for the first time on Seixas Beach, as well as all identified species for Miramar and Maceió. This study tries to contribute to the knowledge of marine invertebrates in northeast Brazilian shallow habitats, providing a baseline for future environmental studies.

RESUMO

Brain-damaged patients can develop abnormal attitudes towards their deficits. Misoplegia is one such example, involving exaggerated aversion to an impaired limb, sometimes associated with hatred of paresis and verbal or physical abuse directed at the paretic limb. Few studies or reports on this disorder are available in the literature, prompting the present case report of a patient with misoplegia and vascular dementia.

Pacientes com lesões cerebrais podem apresentar atitudes anormais em relação a seus déficits. Um exemplo é a misoplegia, uma aversão excessiva em relação ao membro com déficit, podendo estar associado a ódio à paralisia e maus tratos verbais ou físicos contra os membros paralisados. Ainda há poucos estudos e relatos sobre esse distúrbio na literatura, evidenciando a importância de um relato de caso de um paciente portador de misoplegia e demência vascular.

RESUMO

The study aimed to investigate the control and coordination of grip force (normal component) and load force (tangential component) in three different manipulation tasks in individuals with diabetes with and with no diagnosis of diabetic peripheral neuropathy (DPN) and healthy controls. Twenty-four individuals with type 2 diabetes mellitus, 12 with no (nDPN) and 12 with DPN (wDPN), and 12 healthy controls performed three manipulation tasks (static holding, lifting and holding, and oscillation) with the dominant hand, using an instrumented handle. Relative safety margin (% of GF exerted above the minimum GF needed to hold the object) was measured in all tasks. Individuals with diabetes from the nDPN and wDPN groups set lower relative safety margin than controls only in the static holding task. No other group effect was revealed, except a lower coefficient of friction between skin and object surface in individuals with DPN. The coordination between grip and load force and grip force control was not affected by the diabetes during dynamic manipulation tasks (lifting and holding and oscillation). However, when individuals with diabetes without and with DPN performed a manipulation task in which the inflow of cutaneous information was small and stable (static holding), grip force control was affected by the disease. This finding indicates that individuals with type 2 diabetes mellitus not diagnosed with DPN, already show mild impairments in the nervous system that could affect grip force control and that could be one of the first signs of neuropathy caused by the diabetes.

Assuntos

RESUMO

ABSTRACT. Brain-damaged patients can develop abnormal attitudes towards their deficits. Misoplegia is one such example, involving exaggerated aversion to an impaired limb, sometimes associated with hatred of paresis and verbal or physical abuse directed at the paretic limb. Few studies or reports on this disorder are available in the literature, prompting the present case report of a patient with misoplegia and vascular dementia.

RESUMO. Pacientes com lesões cerebrais podem apresentar atitudes anormais em relação a seus déficits. Um exemplo é a misoplegia, uma aversão excessiva em relação ao membro com déficit, podendo estar associado a ódio à paralisia e maus tratos verbais ou físicos contra os membros paralisados. Ainda há poucos estudos e relatos sobre esse distúrbio na literatura, evidenciando a importância de um relato de caso de um paciente portador de misoplegia e demência vascular.

Assuntos