Assuntos
Pré-Eclâmpsia , Feminino , Gravidez , Humanos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controleRESUMO
This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
Esta revisão compreensiva compara protocolos clínicos de entidades importantes em relação ao manejo da restrição de crescimento fetal (RCF), publicados desde 2015. Cinco protocolos foram escolhidos para a extração de dados. Não houve diferenças relevantes quanto ao diagnóstico e classificação da RCF entre os protocolos. Em geral, todos os protocolos sugerem que a avaliação da vitalidade fetal deve ser realizada de forma multimodal, associando parâmetros biofísicos (como cardiotocografia e perfil biofísico fetal) aos parâmetros dopplervelocimétricos da artéria umbilical, artéria cerebral média e ducto venoso. Todos os protocolos reforçam que quanto mais grave a condição fetal, mais frequente essa avaliação deve ser feita. A idade gestacional oportuna e o modo de parto para interromper a gravidez nesses casos podem variar muito entre os protocolos. Portanto, este trabalho apresenta, de forma didática, as particularidades de diferentes protocolos de acompanhamento de RCF, a fim de auxiliar os obstetras no melhor manejo dos casos.
Assuntos
Retardo do Crescimento Fetal , Ultrassonografia Pré-Natal , Feminino , Humanos , Gravidez , Cardiotocografia , Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/terapia , Feto/irrigação sanguínea , Idade Gestacional , Ultrassonografia , Ultrassonografia Doppler , Artérias Umbilicais/diagnóstico por imagemRESUMO
Abstract This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
Resumo Esta revisão compreensiva compara protocolos clínicos de entidades importantes em relação ao manejo da restrição de crescimento fetal (RCF), publicados desde 2015. Cinco protocolos foram escolhidos para a extração de dados. Não houve diferenças relevantes quanto ao diagnóstico e classificação da RCF entre os protocolos. Em geral, todos os protocolos sugerem que a avaliação da vitalidade fetal deve ser realizada de forma multimodal, associando parâmetros biofísicos (como cardiotocografia e perfil biofísico fetal) aos parâmetros dopplervelocimétricos da artéria umbilical, artéria cerebral média e ducto venoso. Todos os protocolos reforçam que quanto mais grave a condição fetal, mais frequente essa avaliação deve ser feita. A idade gestacional oportuna e o modo de parto para interromper a gravidez nesses casos podem variar muito entre os protocolos. Portanto, este trabalho apresenta, de forma didática, as particularidades de diferentes protocolos de acompanhamento de RCF, a fim de auxiliar os obstetras no melhor manejo dos casos.
Assuntos
Humanos , Recém-Nascido , Recém-Nascido Prematuro , Cardiotocografia , Fluxometria por Laser-Doppler , Guias como Assunto , Retardo do Crescimento FetalRESUMO
OBJECTIVES: To evaluate MRI with gadoxetic acid to quantify liver function in cirrhotic patients using the relative enhancement index (REI) compared with Child-Pugh score (CPS), MELD score, and indocyanine green plasma disappearance rate (ICG-PDR) and to establish cutoffs for REI to stratify cirrhotic patients into good and poor liver function groups. METHODS: We prospectively evaluated 60 cirrhotic patients and calculated CPS, MELD score, ICG-PDR, and REI for each patient. Spearman's correlation coefficient was used to assess correlation between REI, CPS, MELD, and ICG-PDR. Good and poor liver function groups were created by k-means clustering algorithm using CPS, MELD, and ICG-PDR. ROC curve analysis was performed and optimal cutoff was identified for group differentiation. RESULTS: Good correlations were found between REI and other liver function biomarkers: REI and CPS (rho = - 0.816; p < 0.001); REI and MELD score (rho = - 0.755; p < 0.001); REI and ICG-PDR (rho = 0.745; p < 0.001)]. REI correlation was stronger for patients with Child-Pugh A (rho = 0.642, p = 0.002) and B (rho = 0.798, p < 0.001) than for those with Child-Pugh C (rho = 0.336, p = 0.148). REI is significantly lower in patients with poor liver function (p < 0.001). ROC curve showed an AUC 0.94 to discriminate patients with poor liver function (REI cutoff < 100; 100% sensitivity; 76% specificity). CONCLUSIONS: REI is a valuable non-invasive index for liver function quantification that has good correlations with other liver function biomarkers. REI can be easily calculated and can be used to estimate liver function in clinical practice in the routine evaluation of cirrhotic patients that undergo MR imaging with gadoxetic acid contrast. KEY POINTS: ⢠REI is a valuable non-invasive index for liver function quantification that has good correlations with other liver function biomarkers. ⢠REI can be easily calculated in the routine evaluation of cirrhotic patients that undergo gadoxetic acid-enhanced MRI. ⢠The REI enables stratification of cirrhotic patients into good and poor liver function groups and can be used as additional information, together with morphological and focal liver lesion evaluation.
Assuntos
Meios de Contraste , Gadolínio DTPA , Humanos , Meios de Contraste/farmacologia , Fígado/diagnóstico por imagem , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Verde de Indocianina/farmacologia , Biomarcadores , Imageamento por Ressonância Magnética/métodos , Estudos RetrospectivosAssuntos
Placenta Acreta , Cesárea , Feminino , Humanos , Histerectomia , Placenta , Placenta Acreta/cirurgia , Gravidez , Estudos RetrospectivosAssuntos
Humanos , Feminino , Gravidez , Placenta Acreta/cirurgia , Placenta , Cesárea , Estudos Retrospectivos , HisterectomiaRESUMO
OBJECTIVES: Rapid on-site evaluation (ROSE) by cytopathologists during endoscopic ultrasound-fine-needle aspiration (EUS-FNA) of solid pancreatic lesions (SPLs) improves adequacy and diagnostic accuracy while reducing the number of needle passes. We evaluated the usefulness of ROSE performed by the endosonographer. METHODS: Patients with an SPL were randomly assigned to EUS-FNA with ROSE or non-ROSE. Procedure duration, number of needle passes, specimen adequacy, and adverse event rates were compared. RESULTS: Sixty-five patients were enrolled (33 in the ROSE vs 32 in the non-ROSE group). Both groups were similar in terms of age, sex, size, and location of the lesion. Specimen adequacy rates were high and similar between groups. Mean (standard deviation) procedure duration was shorter in the ROSE versus non-ROSE group (30.0 [11.3] vs 37.0 [7.2] minutes, P < 0.005), as well as the mean (standard deviation) number of needle passes (2.6 [0.8] vs 3.5 [0.8], P < 0.005). Accuracy parameters as sensitivity and accuracy of ROSE by the endosonographer for malignancy were 93% and 88%, respectively. CONCLUSIONS: After specific training, the endosonographer can accurately evaluate samples during EUS-FNA of SPL, allowing for a shorter procedure duration and a lower number of needle passes.
Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Endossonografia/métodos , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Avaliação Rápida no Local , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
RESUMO O objetivo deste trabalho foi avaliar o potencial do Venturi para a síntese de biodiesel a partir de óleo comestível residual em rota metílica. Para tanto, foi construído em escala de laboratório um aparato experimental constituído de um tanque de 5,2 L e um dispositivo Venturi projetado para produzir o fenômeno de cavitação. A produção de biodiesel foi avaliada em três diferentes pressões de entrada do Venturi: 4,4; 2,9; e 1,4 bar. Os teores de ésteres metílicos foram determinados por cromatografia gasosa. O tempo de síntese de 5,2 L de biodiesel, com o Venturi, foi de 23,2 segundos (ou 4,5 segundos por litro de biodiesel produzido), o que equivale a um único ciclo de passagem pelo sistema a pressão máxima (4,4 bar). Nessa condição, o rendimento dos teores de ésteres foi superior a 98%. Não há na literatura outro caso de síntese tão rápida como a encontrada neste trabalho. A caracterização do biodiesel mostrou que os parâmetros viscosidade cinemática, índice de acidez, ponto de entupimento a frio e massa específica estão dentro dos limites estabelecidos pela Agência Nacional de Petróleo. A comparação com outros estudos da literatura mostrou que o Venturi é superior às placas de orifício na síntese de biodiesel.
Abstract The objective of this work was to evaluate the potential of Venturi in the synthesis of biodiesel from residual edible oil in a methyl route. For this purpose, an experimental apparatus consisting of a 5.2 L tank and a Venturi device designed to produce the cavitation phenomenon was constructed in laboratory scale. Biodiesel production was evaluated at three different Venturi inlet pressures: 4.4; 2.9; and 1.4 bar. Methyl esters contents were determined by gas chromatography. Biodiesel synthesis time with the Venturi device was 23.2 seconds (or 4.5 seconds per liter of biodiesel produced), which is equivalent to a single cycle of the system at maximum pressure (4.4 bar). In this condition, the yield of the ester contents was greater than 98%. There is no other case of synthesis as fast as that found in this work. The biodiesel characterization showed that the parameters kinematic viscosity, acidity index, cold clogging point, and specific mass are within the limits established by National Agency of Petroleum Natural Gas and Biofuels (Agência Nacional de Petróleo). The use of Venturi, as a cavitation device, was shown to be more efficient in biodiesel synthesis than other devices, such as orifice plates.
Assuntos
Humanos , Feminino , Gravidez , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/normas , Técnicas de Diagnóstico Obstétrico e Ginecológico/instrumentação , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , COVID-19/prevenção & controle , COVID-19/epidemiologia , Brasil/epidemiologia , Saúde Ocupacional/normas , Pandemias , Vigilância em Saúde Pública/métodosRESUMO
Embora a maioria das famílias monoparentais seja feminina, vê-se um incremento significativo de homens que vêm ocupando o lugar de genitor exclusivo junto aos filhos. Assim, esse estudo objetivou investigar a experiência de homens de famílias monoparentais masculinas. Para tanto, quatro pais foram entrevistados individualmente, sendo que, após a realização de cada entrevista, foi redigida uma narrativa transferencial, pelo entrevistador, sobre aquele encontro, incluindo suas impressões contratransferenciais. O conjunto das quatro narrativas foi analisado psicanaliticamente, à luz da Teoria dos Campos de Herrmann, sendo identificados os campos "Na tradição", "Segunda chance" e "No improviso". Observou-se que os participantes apresentavam manifestações ancoradas no imaginário patriarcal, mas experienciavam, de modo improvisadamente organizado, a possibilidade de serem pais melhores do que já haviam sido ou do que já haviam tido. Vê-se que a configuração familiar do tipo monoparental revela-se, por excelência, como um campo de investigação que viabiliza reflexões sobre a parentalidade na contemporaneidade.
Although the majority of single-parent families is female, there is an increase in men who have been taking the place of exclusive parent. Thus, this study aimed to investigate the experience of men from male single parent families. Therefore, four parents were interviewed individually. After each interview, a transferential narrative was written by the interviewer, about that meeting, including his countertransference feelings. The set of the four narratives was analyzed psychoanalytically, with the Theory of the Fields of Herrmann. It was identified the fields "In tradition", "Second chance" and "In improvisation". It was observed that the participants had manifestations anchored in the patriarchal imaginary, but they experienced, in an improvised organized way, the possibility of being better parents than they had been or had ever had. In conclusion, the family configuration of the single parent type reveals itself, by excellence, as a field of investigation for the development of reflections on parenting in contemporary times.
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OBJECTIVE: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.
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OBJECTIVES: Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate. AIM: Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard. METHODS: NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2). RESULTS: Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64-0.84) and 0.76 (0.65-0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73-0.90) and 0.82 (0.71-0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71-0.93) and 0.80 (0.69-0.92) (P = 0.66). CONCLUSION: Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.
Assuntos
Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Biópsia , Brasil , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/patologia , Estudos ProspectivosRESUMO
INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in western countries. It is often related to metabolic syndrome, presenting an increased risk of advanced liver disease and cardiovascular-related death. In some etiologies of chronic liver disease, thrombocytopenia has been associated not only with advanced stages of fibrosis but also with autoimmune disease. In NAFLD, however, its prevalence and related factors are still unknown. The aim of this study is to evaluate the prevalence of thrombocytopenia in NAFLD patients without cirrhosis and to investigate its related risk factors. PATIENTS AND METHODS: This was a retrospective study carried out in two tertiary hospitals in the South and Southeast regions of Brazil. Patients diagnosed with NAFLD by liver biopsy were included. Those with other causes of liver disease and/or cirrhosis were excluded. For analysis, patients were divided into two groups, with and without thrombocytopenia. Data was analyzed using a significance level of 5%. RESULTS: 441 non-cirrhotic patients with NAFLD (evaluated by liver biopsy) were included in the study. The prevalence of thrombocytopenia was 3.2% (14/441 patients). In the comparative analysis between groups, thrombocytopenia was associated with male sex (p=0.007) and level of hemoglobin (p=0.023). CONCLUSION: Thrombocytopenia is an infrequent event in NAFLD patients without cirrhosis and is related with male sex and higher hemoglobin levels.
Assuntos
Hepatopatia Gordurosa não Alcoólica/epidemiologia , Trombocitopenia/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hemoglobinas/metabolismo , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/patologia , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Trombocitopenia/sangueRESUMO
O tromboembolismo pulmonar é um grave problema de saúde pública devido ao subdiagnóstico e às elevadas morbidade e mortalidade. Quando a embolia pulmonar é maciça com repercussão hemodinâmica importante e a terapia adequada não ocorre nas primeiras horas, a mortalidade é superior a 85%. Na suspeita clínica de tromboembolismo pulmonar, a avaliação ecocardiográfica pode ter papel fundamental na avaliação da mobilidade e da estrutura do ventrículo direito, presença de hipertensão pulmonar e documentação da presença de trombo. A detecção ecocardiográfica de trombo móvel nas câmaras cardíacas direitas permite identificar um grupo de pacientes de alto risco, com mortalidade muito elevada, quando comparada ao tromboembolismo pulmonar em geral. Além da terapia clínica clássica, com heparinas e trombolíticos, as terapêuticas endovascular e cirúrgica devem ser consideradas e podem contribuir para o prognóstico desses pacientes. Relata-se um caso de uma paciente de 33 anos de idade admitida em uma unidade de emergência da no 8o dia de pós-operatório de apendicectomia, com queixas de dor torácica e dispneia de início súbito. Ecocardiograma transtorácico evidenciou presença de trombo serpiginoso solto em átrio direito, que ocluía intermitentemente a valva tricúspide durante o ciclo cardíaco. Diante das características ecocardiográficas atípicas do trombo e da significativa chance de embolização maciça, optou-se por intervenção cirúrgica de emergência.
Pulmonary thromboembolism is a serious public health problem due to misdiagnosis and high morbidity and mortality. When pulmonary embolism is massive with important hemodynamic repercussion, and the appropriate therapy does not take place in the early hours, mortality is higher than 85%. If there is clinical suspicion of pulmonary thromboembolism, an echocardiographic evaluation may have a key role in the evaluation of mobility and structure of the right ventricle, presence of pulmonary hypertension, and documentation of the presence of thrombus. Echocardiographic detection of mobile thrombus in right cardiac chambers allows the identification of a group of high-risk patients with very high mortality when compared to pulmonary thromboembolism in general . In addition to the classical clinical therapy with heparins and thrombolytics, endovascular and surgical therapy should be considered and may contribute to these patients' prognosis. A case is reported of a 33-year-old female patient admitted to an Emergency Unit at 8th postoperative day (POD) of appendectomy, with complaints of chest pain and dyspnea of sudden onset. Transthoracic echocardiography showed the presence of a floating serpiginous thrombus in the right atrium, which intermittently occluded the tricuspid valve during the cardiac cycle. Due to the atypical echocardiographic features of the thrombus, and significant chance of massive embolization, an emergency surgery was chosen.
Assuntos
Humanos , Feminino , Adulto , Embolia Pulmonar/diagnóstico por imagem , Ecocardiografia , Disfunção Ventricular Direita/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Taquicardia/etiologia , Vasoconstritores/uso terapêutico , Varfarina/uso terapêutico , Dor no Peito/etiologia , Radiografia , Norepinefrina/uso terapêutico , Enoxaparina/uso terapêutico , Disfunção Ventricular Direita/cirurgia , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/tratamento farmacológico , Dispneia/etiologia , Eletroencefalografia , Taquipneia/etiologia , Índice de Perfusão , Hipotensão/etiologia , Hipóxia/etiologia , Anticoagulantes/uso terapêuticoRESUMO
Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepato-logy (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.