RESUMO
BACKGROUND: In Brazil, transmission of visceral and cutaneous leishmaniasis has expanded geographically over the last decades, with both clinical forms occurring simultaneously in the same area. OBJECTIVES: This study characterised the clinical, spatial, and temporal distribution, and performed entomological surveillance and natural infection analysis of a leishmaniasis-endemic area. METHODS: In order to characterise the risk of leishmaniasis transmission in Altos, Piauí, we described the clinical and socio-demographic variables and the spatial and temporal distribution of cases of American visceral leishmaniasis (AVL) and American cutaneous leishmaniasis (ACL) cases and identified potential phlebotomine vectors. FINDINGS: The urban area concentrated almost 54% of ACL and 86.8% of AVL cases. The temporal and spatial distribution of AVL and ACL cases in Altos show a reduction in the number of risk areas, but the presence of permanent disease transmission foci is observed especially in the urban area. 3,808 phlebotomine specimens were captured, with Lutzomyia longipalpis as the most frequent species (98.45%). Of the 35 females assessed for natural infection, one specimen of Lu. longipalpis tested positive for the presence of Leishmania infantum and Leishmania braziliensis DNA. MAIN CONCLUSION: Our results indicate the presence of risk areas for ACL and AVL in the municipality of Altos and highlight the importance of entomological surveillance to further understand a possible role of Lu. longipalpis in ACL transmission.
Assuntos
Leishmania infantum , Leishmaniose Cutânea , Leishmaniose Visceral , Animais , Feminino , Brasil/epidemiologia , Insetos Vetores/genética , Leishmaniose Cutânea/epidemiologia , Leishmaniose Visceral/epidemiologia , Leishmania infantum/genética , DNARESUMO
BACKGROUND In Brazil, transmission of visceral and cutaneous leishmaniasis has expanded geographically over the last decades, with both clinical forms occurring simultaneously in the same area. OBJECTIVES This study characterised the clinical, spatial, and temporal distribution, and performed entomological surveillance and natural infection analysis of a leishmaniasis-endemic area. METHODS In order to characterise the risk of leishmaniasis transmission in Altos, Piauí, we described the clinical and socio-demographic variables and the spatial and temporal distribution of cases of American visceral leishmaniasis (AVL) and American cutaneous leishmaniasis (ACL) cases and identified potential phlebotomine vectors. FINDINGS The urban area concentrated almost 54% of ACL and 86.8% of AVL cases. The temporal and spatial distribution of AVL and ACL cases in Altos show a reduction in the number of risk areas, but the presence of permanent disease transmission foci is observed especially in the urban area. 3,808 phlebotomine specimens were captured, with Lutzomyia longipalpis as the most frequent species (98.45%). Of the 35 females assessed for natural infection, one specimen of Lu. longipalpis tested positive for the presence of Leishmania infantum and Leishmania braziliensis DNA. MAIN CONCLUSION Our results indicate the presence of risk areas for ACL and AVL in the municipality of Altos and highlight the importance of entomological surveillance to further understand a possible role of Lu. longipalpis in ACL transmission.
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Tropical forest fragmentation from agricultural expansion alters the microclimatic conditions of the remaining forests, with effects on vegetation structure and function. However, little is known about how the functional trait variability within and among tree species in fragmented landscapes influence and facilitate species' persistence in these new environmental conditions. Here, we assessed potential changes in tree species' functional traits in riparian forests within six riparian forests in cropland catchments (Cropland) and four riparian forests in forested catchments (Forest) in southern Amazonia. We sampled 12 common functional traits of 123 species across all sites: 64 common to both croplands and forests, 33 restricted to croplands, and 26 restricted to forests. We found that forest-restricted species had leaves that were thinner, larger, and with higher phosphorus (P) content, compared to cropland-restricted ones. Tree species common to both environments showed higher intraspecific variability in functional traits, with leaf thickness and leaf P concentration varying the most. Species turnover contributed more to differences between forest and cropland environments only for the stem-specific density trait. We conclude that the intraspecific variability of functional traits (leaf thickness, leaf P, and specific leaf area) facilitates species persistence in riparian forests occurring within catchments cleared for agricultural expansion in Amazonia.
Assuntos
Florestas , Árvores , Agricultura , Fenótipo , Folhas de PlantaRESUMO
BACKGROUND: Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. OBJECTIVES: To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. METHODS: Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. RESULTS: Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. CONCLUSIONS: CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.
FUNDAMENTO: Tem sido observado um grande avanço nas técnicas e nos dispositivos para a realização de intervenções coronárias percutâneas (ICP) em oclusões totais coronarianas crônicas (OTC), mas existem poucos dados da prática do mundo real em países em desenvolvimento. OBJETIVOS: Relatar as características clínicas e angiográficas, os aspectos dos procedimentos e os resultados clínicos da ICP de OTC em centros dedicados a esse procedimento no Brasil. MÉTODOS: Os pacientes incluídos foram submetidos à ICP de OTC em centros participantes do LATAM CTO Registry, um registro multicêntrico latino-americano dedicado à coleta prospectiva desses dados. Os critérios de inclusão foram procedimentos realizados no Brasil, idade acima de 18 anos e presença de OTC com tentativa de ICP. A definição de OTC foi lesão de 100% em uma artéria coronária epicárdica, conhecida ou estimada como tendo pelo menos 3 meses de evolução. RESULTADOS: Foram incluídos dados de 1.196 ICPs de OTC. Os procedimentos foram realizados principalmente para controle da angina (85%) e/ou tratamento de uma grande área isquêmica (24%). A taxa de sucesso técnico foi de 84% e foi alcançada com técnicas de fios anterógrados em 81%, dissecção/reentrada anterógrada em 9% e retrógrada em 10% dos procedimentos. Os eventos cardiovasculares adversos intra-hospitalares ocorreram em 2,3% dos casos, sendo a mortalidade de 0,75%. CONCLUSÕES: As OTC podem ser tratadas no Brasil por intervenção coronária percutânea de forma efetiva e com baixas taxas de complicações. O desenvolvimento científico e tecnológico observado nessa área na última década reflete-se na prática clínica de centros brasileiros dedicados a essa técnica.
Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea , Humanos , Adolescente , Brasil , Oclusão Coronária/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Intervenção Coronária Percutânea/métodos , Doença Crônica , Sistema de RegistrosRESUMO
PURPOSE: Poliomyelitis is an infectious disease that can cause total paralysis. Furthermore, poliomyelitis survivors may develop new signs and symptoms, including muscular weakness and fatigue, years after the acute phase of the disease, i.e., post-polio syndrome (PPS). Thus, the objective was to compare the functional exercise capacity during maximal and submaximal exercises among individuals with polio sequelae (without PPS diagnosis), PPS, and a control group. METHODS: Thirty individuals participated in three groups: a control group (CG, n = 10); a group of individuals with polio sequelae but without PPS diagnosis (PG, n = 10); and a PPS group (PPSG, n = 10). All participants underwent (i) a cardiopulmonary exercise test to determine their maximal oxygen uptake ([Formula: see text]) and (ii) a series of functional field tests (i.e., walking test, sit-to-stand test, and stair climbing test). RESULTS: [Formula: see text]O2max was 30% lower in PPSG than in CG and PG. Regarding functional field tests, walking and stair climbing test performances were significantly different among all groups. The PPSG sit-to-stand performance was lower than CG. CONCLUSION: The sequelae of paralytic poliomyelitis impair functional exercise capacity obtained from maximal and submaximal tests, especially in patients with PPS. Furthermore, submaximal variables appear to be more negatively impacted than maximal variables.
Assuntos
Poliomielite , Síndrome Pós-Poliomielite , Humanos , Síndrome Pós-Poliomielite/complicações , Síndrome Pós-Poliomielite/diagnóstico , Tolerância ao Exercício , Poliomielite/complicações , Exercício Físico , Debilidade MuscularRESUMO
O distanciamento social ocasionado pela pandemia de Covid-19 levou a profundas mudanças na rotina das famílias com crianças pequenas, aumentando o estresse no ambiente doméstico. Este estudo analisou a experiência de planejamento e implementação de um projeto de extensão universitária que ofereceu orientação a pais com filhos de 0 a 11 anos por meio de chamadas de áudio durante a pandemia. O protocolo de atendimento foi desenvolvido para atender às necessidades de famílias de baixa renda e listava problemas específicos relacionados ao confinamento em casa e ao fechamento das escolas seguidos por uma variedade de estratégias de enfrentamento. A análise de 223 queixas relatadas pelos usuários em 130 ligações revelou que 94% dos problemas referidos pelos pais foram contemplados pelo protocolo de atendimento e estavam relacionados aos problemas externalizantes (39%) ou internalizantes (26%) das crianças ou ao declínio do bem-estar subjetivo dos pais (29%). Serviços de apoio devem orientar os pais quanto ao uso de práticas responsivas e assertivas que promovam o bem-estar emocional da criança e estabeleçam expectativas comportamentais em contextos estressantes. A diminuição dos conflitos entre pais e filhos resultante do uso dessas estratégias tende a reduzir o sofrimento dos pais, aumentando sua sensação de bem-estar subjetivo. Recomenda-se ampla divulgação dessas iniciativas e seguimento dos casos.(AU)
The social distancing the COVID-19 pandemic entailed has led to profound changes in the routine of families with young children, increasing stress in the home environment. This study analyzed the experience of planning and implementing a university extension program that offered support to parents with children from 0 to 11 years old via audio calls during the COVID-19 pandemic. The service protocol was developed to meet the needs of low-income families and listed specific problems related to home confinement and school closure followed by a variety of coping strategies. The analysis of 223 complaints reported by users in 130 calls revealed that 94% of the problems reported by parents were addressed by the protocol and were related to children's externalizing (39%) or internalizing (26%) problems or to the decline in parents' subjective well-being (29%). Support services should guide parents on the use of responsive and assertive practices that promote the child's emotional well-being and set behavioral expectations in stressful contexts. The reduction in conflicts between parents and children resulting from the use of these strategies tends to reduce parents' suffering, increasing their sense of subjective well-being. Wide dissemination of these initiatives and case follow-up are recommended.(AU)
La distancia social causada por la pandemia de COVID-19 condujo a cambios profundos en la rutina de las familias con niños pequeños, aumentando el estrés en el entorno del hogar. Este estudio analizó la experiencia de planificar e implementar un proyecto de extensión universitaria que ofreció orientación a los padres con niños de cero a 11 años a través de llamadas de audio durante la pandemia COVID-19. El protocolo de atención se desarrolló para satisfacer las necesidades de las familias de bajos ingresos y enumeró problemas específicos relacionados con el confinamiento en el hogar y el cierre de la escuela, seguido de una variedad de estrategias de afrontamiento. El análisis de 223 quejas informadas por los usuarios en 130 llamadas reveló que el 94% de los problemas informados por los padres fueron abordados por el protocolo de atención y estaban relacionados con los problemas de externalización (39%) o internalización (26%) de los niños o la disminución del bienestar subjetivo de los padres (29%). Los servicios de apoyo deberían aconsejar a los padres sobre el uso de prácticas receptivas y asertivas que promuevan el bienestar emocional del niño y establezcan expectativas de comportamiento en contextos estresantes. La reducción de los conflictos entre padres e hijos como resultado del uso de estas estrategias tiende a reducir el sufrimiento de los padres, aumentando su sensación de bienestar subjetivo. Se recomienda una amplia difusión de estas iniciativas y seguimiento de casos.(AU)
Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Orientação , Pais , Satisfação Pessoal , Criança , Comportamento Problema , COVID-19 , Ansiedade , Relações Pais-Filho , Apetite , Jogos e Brinquedos , Resolução de Problemas , Psicologia , Agitação Psicomotora , Qualidade de Vida , Leitura , Recreação , Ensino de Recuperação , Infecções Respiratórias , Segurança , Salários e Benefícios , Serviços de Saúde Escolar , Autoimagem , Transtorno Autístico , Sono , Ajustamento Social , Condições Sociais , Conformidade Social , Meio Social , Isolamento Social , Problemas Sociais , Socialização , Fatores Socioeconômicos , Análise e Desempenho de Tarefas , Telefone , Temperamento , Terapêutica , Tempo , Desemprego , Violência , Terapia Comportamental , Jornada de Trabalho , Políticas, Planejamento e Administração em Saúde , Abuso Sexual na Infância , Tédio , Neurociências , Viroses , Atividades Cotidianas , Luto , Exercício Físico , Divórcio , Maus-Tratos Infantis , Desenvolvimento Infantil , Saúde Mental , Vacinação em Massa , Terapia de Relaxamento , Imunização , Comportamento Autodestrutivo , Direitos Civis , Poder Familiar , Transtorno de Pânico , Entrevista , Cognição , Violência Doméstica , Transmissão de Doença Infecciosa , Aula , Crianças com Deficiência , Senso de Humor e Humor , Internet , Criatividade , Intervenção em Crise , Choro , Vulnerabilidade a Desastres , Impacto Psicossocial , Autonomia Pessoal , Morte , Amigos , Agressão , Depressão , Impulso (Psicologia) , Economia , Educação Inclusiva , Escolaridade , Emoções , Empatia , Docentes , Conflito Familiar , Relações Familiares , Medo , Consumo Excessivo de Bebidas Alcoólicas , Refeições , Retorno ao Trabalho , Esperança , Otimismo , Pessimismo , Autocontrole , Fobia Social , Sistemas de Apoio Psicossocial , Equilíbrio Trabalho-Vida , Experiências Adversas da Infância , Tempo de Tela , Asco , Tristeza , Solidariedade , Angústia Psicológica , Intervenção Psicossocial , Teletrabalho , Estresse Financeiro , Insegurança Alimentar , Análise de Sentimentos , Fatores Sociodemográficos , Vulnerabilidade Social , Apoio Familiar , Governo , Culpa , Saúde Holística , Homeostase , Hospitalização , Zeladoria , Distúrbios do Início e da Manutenção do Sono , Ira , Aprendizagem , Deficiências da Aprendizagem , Atividades de Lazer , Solidão , Transtornos MentaisRESUMO
Introduction: Community health workers play a prominent role in the primary care context in Brazil. Burnout syndrome is an important work-related condition whose consequences affect job satisfaction. Objectives: To evaluate the extent of burnout syndrome and job satisfaction among community health workers in a city in southern Santa Catarina. Methods: This analytical, individual, cross-sectional study was conducted in Family Health Units. The participants were selected through random probability sampling, with a sampling error of 10%. After sociodemographic data collection, the Maslach Burnout Inventory and a job satisfaction scale were applied. Results: All 66 included workers were women. According to the analyses, there was a moderate positive correlation between satisfaction with colleagues and satisfaction with supervisors. There were weak positive correlations between emotional exhaustion and depersonalization and between professional fulfillment and satisfaction with promotions. However, there was a weak negative correlation between emotional exhaustion and both professional fulfillment and satisfaction with salary. Conclusions: The results indicate that the conditions of these workers are sufficiently satisfactory to deal with the demands of the job. Nevertheless, there was substantial dissatisfaction with salary, which can be a demotivator and trigger work-related depression.
Introdução: Os agentes comunitários de saúde possuem um lugar de evidência na atual proposta da atenção básica. Uma das doenças no meio trabalhista é a síndrome de burnout, e, ao adquirir essa doença, o trabalhador sofre com consequências que afetam a satisfação no trabalho. Objetivos: Avaliar a existência da síndrome de burnout e a satisfação no trabalho dos agentes comunitários de saúde de uma cidade do extremo Sul catarinense. Métodos: Tratou-se de um estudo analítico, individual, transversal realizado nas Estratégias de Saúde da Família. Os participantes foram selecionados por meio de amostragem aleatória probabilística, com erro amostrai de 10%. Foi realizada anamnese de identificação, e os participantes responderam ao Inventário de Burnout de Maslach e à Escala de Satisfação no Trabalho. Resultados: Participaram do estudo 66 agentes comunitárias, todas do sexo feminino. As análises demonstraram correlação positiva moderada entre satisfação com os colegas e com o chefe, e correlações positivas fracas entre exaustão emocional e despersonalização, assim como entre realização profissional e satisfação com promoções. Por outro lado, exaustão emocional, realização profissional e satisfação com a remuneração obtiveram correlação negativa fraca. Conclusões: Os resultados indicam boas condições dos agentes comunitários para lidar com as demandas do trabalho. Destaca-se a insatisfação com a remuneração, podendo ser desmotivante e podendo desencadear doenças relacionadas à saúde mental.
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Resumo Fundamento Tem sido observado um grande avanço nas técnicas e nos dispositivos para a realização de intervenções coronárias percutâneas (ICP) em oclusões totais coronarianas crônicas (OTC), mas existem poucos dados da prática do mundo real em países em desenvolvimento. Objetivos Relatar as características clínicas e angiográficas, os aspectos dos procedimentos e os resultados clínicos da ICP de OTC em centros dedicados a esse procedimento no Brasil. Métodos Os pacientes incluídos foram submetidos à ICP de OTC em centros participantes do LATAM CTO Registry, um registro multicêntrico latino-americano dedicado à coleta prospectiva desses dados. Os critérios de inclusão foram procedimentos realizados no Brasil, idade acima de 18 anos e presença de OTC com tentativa de ICP. A definição de OTC foi lesão de 100% em uma artéria coronária epicárdica, conhecida ou estimada como tendo pelo menos 3 meses de evolução. Resultados Foram incluídos dados de 1.196 ICPs de OTC. Os procedimentos foram realizados principalmente para controle da angina (85%) e/ou tratamento de uma grande área isquêmica (24%). A taxa de sucesso técnico foi de 84% e foi alcançada com técnicas de fios anterógrados em 81%, dissecção/reentrada anterógrada em 9% e retrógrada em 10% dos procedimentos. Os eventos cardiovasculares adversos intra-hospitalares ocorreram em 2,3% dos casos, sendo a mortalidade de 0,75%. Conclusões As OTC podem ser tratadas no Brasil por intervenção coronária percutânea de forma efetiva e com baixas taxas de complicações. O desenvolvimento científico e tecnológico observado nessa área na última década reflete-se na prática clínica de centros brasileiros dedicados a essa técnica.
Abstract Background Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. Objectives To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. Methods Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. Results Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. Conclusions CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.
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RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.
ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
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Objetivo: Caracterizar perfil de pacientes encaminhadas para a UTI materna de um hospital público do Distrito Federal. Método: estudo quantitativo de caráter descritivo, transversal e analítico, pautado em dados secundários retroativos obtidos através do livro de admissões da UTI Materna do Hospital Materno Infantil de Brasília, realizando um comparativo entre o ano de criação junho de 2013-2014 e junho de 2019-2020. A Análise estatística descritiva foi realizada por meio de frequência absoluta e frequência relativa. Resultados: Os dados evidenciaram público atendido é exclusivamente feminino, com maior prevalência da faixa etária entre 20 e 29 anos de idade, com média de 30,27 anos de idade. O diagnóstico prevalente foi de Pré-eclâmpsia (17,12%). A transferência para outros setores do mesmo hospital foi o principal desfecho. Conclusão: As causas obstétricas diretas representam a maior parte das internações no setor. Em geral, são mulheres jovens e com diagnostico prioritário de Síndromes Hipertensivas.(AU)
Objective: To characterize the profile of patients referred to the Maternal ICU of a public hospital in the Federal District. Method: quantitative study of descriptive, cross-sectional and analytical nature, based on retrospective secondary data obtained through the Maternal ICU admissions book of the Materno Infantil Hospital of Brasilia, making a comparison between the year of creation June 2013-2014 and June 2019-2020. Descriptive statistical analysis was performed using absolute frequency and relative frequency. Results: The data evidenced public attended is exclusively female, with a higher prevalence of the age group between 20 and 29 years old, with an average of 30.27 years old. The prevalent diagnosis was preeclampsia (17.12%). Transfer to other sectors of the same hospital was the main outcome. Conclusion: Direct obstetric causes represent most of the hospitalizations in the sector. In general, they are young women and with priority diagnosis of hypertensive syndromes.(AU)
Objetivo: Caracterizar el perfil de las pacientes referidas a la UCI materna de un hospital público del Distrito Federal. Método: estudio cuantitativo de carácter descriptivo, transversal y analítico, basado en datos secundarios retrospectivos obtenidos a través del libro de ingresos de la UCI Materna del Hospital Materno Infantil de Brasilia, realizando una comparación entre el año de creación junio 2013-2014 y junio 2019-2020. El análisis estadístico descriptivo se realizó mediante la frecuencia absoluta y la frecuencia relativa. Resultados: Los datos evidencian que el público atendido es exclusivamente femenino, con una mayor prevalencia del grupo de edad entre 20 y 29 años, con una media de 30,27 años. El diagnóstico más frecuente fue la preeclampsia (17,12%). El traslado a otros sectores del mismo hospital fue el principal resultado. Conclusión: Las causas obstétricas directas representan la mayor parte de las hospitalizaciones del sector. En general, son mujeres jóvenes y con diagnóstico prioritario de Síndromes Hipertensivos.(AU)
Assuntos
Perfil de Saúde , Unidades de Terapia Intensiva , ObstetríciaRESUMO
Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.
Assuntos
Arritmias Cardíacas , Tetralogia de Fallot , Eletrofisiologia CardíacaRESUMO
OBJECTIVES: To compare the efficacy and safety of a new formulation of a fixed dose combination of glucosamine sulfate (GS; 1500 mg) and bovine chondroitin sulfate (CS; 1200 mg) versus the reference product (RP) in patients with knee osteoarthritis (OA). METHODS: In this multicenter, randomized, single-blind trial, 627 patients with knee osteoarthritis (OA)-Kellgren-Lawrence grades 2 or 3 and mean score ≥ 40 mm in the WOMAC pain subscale-were randomized to receive GS/CS or the RP for 24 weeks. The primary efficacy endpoint was the absolute change in WOMAC pain subscale score. The secondary endpoints included the following: WOMAC total and subscale scores, overall assessment of the disease by the patient and the investigator, SF-12 score, OMERACT-OARSI response rate to the treatment, and rescue medication use. RESULTS: Mean reductions of WOMAC pain score were - 35.1 (sd = 23.2) mm in the GS/CS group and - 36.5 (sd = 24.9) mm in the RP group. The difference between the adjusted means of both treatments confirmed the non-inferiority of GS/CS versus the RP. Improvement was observed in pain, stiffness, physical function and total WOMAC score, as well as in overall OA assessment by the patient and the investigator for both groups. No improvement was observed in SF-12. The rate of OMERACT-OARSI responders was 89.4% in GS/CS group and 87.9% in the RP group. Headache and changes in glucose tolerance were the most frequent treatment-related adverse events. CONCLUSIONS: The new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin sulfate was non-inferior to the RP in symptomatic treatment of knee OA, with a high responder rate and good tolerability profile. TRIAL REGISTRATION: ClinicalTrials.gov; Registration number NCT02830919 ; Date of registration: July 13, 2016; First randomization date: December 05, 2016).
Assuntos
Sulfatos de Condroitina/uso terapêutico , Glucosamina/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Brasil , Sulfatos de Condroitina/efeitos adversos , Sulfatos de Condroitina/química , Combinação de Medicamentos , Feminino , Glucosamina/efeitos adversos , Glucosamina/química , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Fatores de TempoRESUMO
OBJECTIVES: To inform about contemporary PCI practice of in-stent (IS) chronic total occlusions (CTO) from a large international registry in Latin America. BACKGROUND: IS-CTO represent a distinctive challenge for PCI, but literature is limited and restricted to high-resource regions of the world. METHODS: Patients undergoing CTO PCI enrolled in the LATAM CTO registry from 42 centers in eight countries were included. We analyzed demographics, angiographic, procedure technique, success and postprocedural outcomes between IS-CTO and non-IS-CTO PCI. RESULTS: From 1,565 patients IS-CTO was present in 181 patients (11.5%). IS-CTO patients had higher prevalence of diabetes and hypertension than patients without IS-CTO. IS-CTOs had less calcification (32.5 vs. 46.7%, p < .001), lower prevalence of a proximal branch (36.3 vs. 50.1%, p < .001), more likely to be ostial (24.4 vs. 18.1%, p = .042), were longer (28.5 vs. 25.2 mm, p = .062), and had less interventional collaterals (49.1 vs. 57.3%, p = .038) compared with non-IS-CTO. CTO complexity scores were similar between both groups. There was no statistically significant difference in the initial or successful strategy between IS-CTO and non-IS-CTO PCI. Technical success rates remained high in IS-CTO (86.7%) and non-IS-CTO (83.1%, p = .230). There was no independent association between IS-CTO and technical success in multivariable analysis. There were no differences between IS-CTO and non-IS-CTO groups for in-hospital clinical outcomes. CONCLUSION: In a contemporary, multicenter, and international registry from Latin America, IS-CTO PCI is frequent and has comparable technical success and safety profile compared to non-IS-CTO PCI.
Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea , Angioplastia , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/terapia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Sistema de Registros , Fatores de Risco , Stents , Resultado do TratamentoRESUMO
Abstract Objectives: To compare the efficacy and safety of a new formulation of a fixed dose combination of glucosamine sulfate (GS; 1500 mg) and bovine chondroitin sulfate (CS; 1200 mg) versus the reference product (RP) in patients with knee osteoarthritis (OA). Methods: In this multicenter, randomized, single-blind trial, 627 patients with knee osteoarthritis (OA)—Kellgren-Lawrence grades 2 or 3 and mean score ≥ 40 mm in the WOMAC pain subscale—were randomized to receive GS/ CS or the RP for 24 weeks. The primary efficacy endpoint was the absolute change in WOMAC pain subscale score. The secondary endpoints included the following: WOMAC total and subscale scores, overall assessment of the disease by the patient and the investigator, SF-12 score, OMERACT-OARSI response rate to the treatment, and rescue medication use. Results: Mean reductions of WOMAC pain score were - 35.1 (sd = 23.2) mm in the GS/CS group and - 36.5 (sd = 24.9) mm in the RP group. The difference between the adjusted means of both treatments confirmed the noninferiority of GS/CS versus the RP. Improvement was observed in pain, stiffness, physical function and total WOMAC score, as well as in overall OA assessment by the patient and the investigator for both groups. No improvement was observed in SF-12. The rate of OMERACT-OARSI responders was 89.4% in GS/CS group and 87.9% in the RP group. Headache and changes in glucose tolerance were the most frequent treatment-related adverse events. Conclusions: The new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin sulfate was non-inferior to the RP in symptomatic treatment of knee OA, with a high responder rate and good tolerability profile. Trial registration: ClinicalTrials.gov; Registration number NCT02830919; Date of registration: July 13, 2016; First randomization date: December 05, 2016).(AU)
Assuntos
Humanos , Condroitina/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Combinação de Medicamentos , Glucosamina/uso terapêutico , Método Simples-Cego , Resultado do TratamentoRESUMO
This study evaluated physical-chemical characteristics of a vacuumed collagen-impregnated bioglass (BG) scaffolds and bone marrow stromal cells (BMSCs) behavior on those composites. scanning electron microscope and energy dispersive x-ray spectroscope demonstrated collagen (Col) was successfully introduced into BG. Vacuum impregnation system has showed efficiency for Col impregnation in BG scaffolds (approximately 20 wt %). Furthermore, mass weight decreasing and more stabilized pH were observed over time for BG/Col upon incubation in phosphate buffered saline compared to plain BG under same conditions. Calcium evaluation (Ca assay) demonstrated higher calcium uptake for BG/Col samples compared to BG. In addition, BG samples presented hydroxyapatite crystals formation on its surface after 14 days in simulated body fluid solution, and signs of initial degradation were observed for BG and BG/Col after 21 days. Fourier transform infrared spectroscopy spectra for both groups indicated peaks for hydroxyapatite formation. Finally, a significant increase of BMSCs viability for both composites was observed compared to control group, but no increase of osteogenic differentiation-related gene expressions were found. In summary, BG/Col scaffolds have improved degradation, pH equilibrium and Ca mineralization over time, accompanied by hydroxyapatite formation. Moreover, both BG and BG/Col scaffolds were biocompatible and noncytotoxic, promoting a higher cell viability compared to control. Future investigations should focus on additional molecular and in vivo studies in order to evaluate biomaterial performance for bone tissue engineering applications. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 211-222, 2019.
Assuntos
Células da Medula Óssea/metabolismo , Diferenciação Celular , Proliferação de Células , Cerâmica/química , Colágeno/química , Células-Tronco Mesenquimais/metabolismo , Alicerces Teciduais/química , Animais , Células da Medula Óssea/citologia , Teste de Materiais , Células-Tronco Mesenquimais/citologia , Ratos , Ratos WistarRESUMO
The efficacy of the vermicomposting and products based on the antagonistic fungus and plant growth promoter trichoderma (Trichoderma spp) is well known and studied in organic agriculture. However, for a better methodological efficiency are necessary studies to evaluate the effect of high doses of these bioproducts in the biology and development of earthworms. Thus, the present work aims to test the use of high commercial biocontrol product (ICB Nutrisolo Trichoderma) doses by evaluating the multiplication and development of Eisenia andrei. Changes in the chemical features of the substrate produced by the vermicomposting process using in natura and sterilized organic cattle manure were also assessed. Each experimental unit consisted of 6 kg of substrate (in multipurpose polypropylene box 20 x 40 x 50 cm) containing 48 clitelate adult Eisenia andrei earthworms. ICB Nutrisolo Trichoderma was used as biological agent along with eight strains of the following species: T. koningiopsis, T. asperellum and T. harzianum. The following treatments were applied at doses of 1011 CFU kg-1 of ICB Nutrisolo Trichoderma in the presence of earthworms: T1 (0.5); T2 (1.0); T3 (2.0); T4 (4.0); T5 (8.0) and T6 (0.0). The T7 treatment was herein used in order to evaluate the chemical features of the vermicompost. It was a completely randomized design with four replications per treatment. The temperature was kept at 28°C and humidity ranged between 60 and 70%. After 60 days, the number of young and adult earthworms, and cocoons was counted; then, their dry biomass was assessed. The results found in the lethality test showed decrease in the number of earthworms treated with 4.0x1011 CFU kg-1 of ICB. The biological product doses up to 1.0x1011 CFU kg-1 did not alter the number of adult earthworms and cocoons, or the multiplication index of E. andrei in cattle waste vermicomposts. There was no influence of the tested doses on earthworms' individual development. However, doses above 2.0x1011 CFU kg-1 decreased their total biomass. The C/N ratio for all treatments indicates maturity within acceptable results for organic compounds.
A eficácia da vermicompostagem e de bioprodutos à base do fungo antagonista e promotor de crescimento vegetal trichoderma (Trichoderma spp) é bem conhecida e estudada na agricultura orgânica. Entretanto, para uma melhor eficiência metodológica, são necessários estudos que possam avaliar a interferência de altas doses desses bioprodutos na biologia e desenvolvimento das minhocas. Baseado nesse contexto, o objetivo deste trabalho foi testar altas doses do produto comercial biológico ICB Nutrisolo Trichoderma (ICB), avaliando-se a multiplicação e desenvolvimento de Eisenia andrei, bem como alterações nas características químicas do substrato produzido no processo de vermicompostagem, a partir do resíduo orgânico esterco bovino. O esterco bovino in natura foi autoclavado a 121°C, por duas vezes, em um intervalo de 24 h. A unidade experimental constituiu-se de 6 kg de substrato condicionados em caixa multiuso de polipropileno, com dimensões 20 x 40 x 50 cm, contendo 48 minhocas adultas e cliteladas da espécie E. andrei. Como agente biológico, utilizou-se o produto comercial ICB na forma de fluído, composto por oito cepas das espécies T. koningiopsis, T. asperellum e T. harzianum, com as seguintes doses nos tratamentos a seguir: T1 (0.5); T2 (1.0); T3 (2.0); T4 (4.0); T5 (8.0); e T6 (0.0), sendo todas as concentrações em 1011 UFC kg-1 do produto em vermicomposto, e, para a avaliação das características químicas do vermicomposto em altas doses do produto ICB, foi utilizado também o T7 (somente substrato). O delineamento foi inteiramente casualizado com quatro repetições por tratamento. A temperatura foi mantida a 28ºC e a umidade entre 60 e 70%. Após 60 dias do início da instalação, fez-se a contagem do número de minhocas adultas, jovens e casulos; posteriormente, avaliou-se o seu peso seco total. Os resultados observados no teste de letalidade mostram que, somente a partir de 4.0x1011 UFC kg-1 de ICB, há decréscimo do número de minhocas. Doses altas até 1.0x1011 UFC kg-1 do produto não alteram o número de minhocas adultas e de casulos de E. andrei em vermicompostagem com esterco bovino, entretanto, o índice de multiplicação foi inferior em todos os tratamentos com o produto. Doses acima de 2.0x1011 UFC kg-1 diminuíram o peso seco total. A relação C/N em todos os tratamentos indica maturidade dentro de resultados aceitáveis para compostos orgânicos.
Assuntos
Oligoquetos , Trichoderma , Produtos Biológicos , Bovinos , Agricultura Orgânica , EstercoRESUMO
Synthetic biomaterials submitted to new structural technologies have become ideal for the recovery of traumatized bone tissues and some bone substitutes such as bioactive glass, ß-Tricalcium phosphate (ß-TCP) and amorphous calcium phosphate (ACP) are being used in areas of tissue defects. For this study, ACP was produced in the form of fibers and then submitted to cytotoxicity testing. A sample of ACP was inserted into the mandibular region of a patient with a lost implant so after removal and curettage, the remaining bone site was filled with the ACP biomaterial. Preliminary cytotoxicity test was negative. After 15 weeks of healing, a titanium implant was inserted at the site. Clinical and radiographic follow-up was conducted for 12 months and sequential radiographic analyses revealed tissue formation resembling spongy bone. Images under immunohistochemistry demonstrated efficient deposition and osteoconduction of the newly deposited tissue. Residual portion of the CaO:P2 O5 outer layers served as a substrate for osteoid matrix deposition, aiding growth, and the results of fiber absorption favored maturation of the new bone tissue.
Assuntos
Materiais Biocompatíveis/farmacologia , Substitutos Ósseos/farmacologia , Fosfatos de Cálcio/farmacologia , Osteogênese/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Apatitas/metabolismo , Implantação Dentária/métodos , Humanos , Osseointegração/fisiologiaRESUMO
Os prejuízos na saúde mental da mãe podem afetar seus comportamentos em interações com o bebê, que são importantes preditores do desenvolvimento infantil no primeiro ano de vida. Este estudo investigou o impacto da depressão pós-parto e da ansiedade na interação mãe-bebê e seus efeitos no desenvolvimento aos três meses de vida. Participaram do estudo 64 díades mãe-bebê que foram filmadas em um episódio de brincadeira livre. As mães responderam ao SRQ-20 e ao BDI para avaliação da saúde mental. O desenvolvimento dos bebês foi avaliado com a EDCC. As análises de regressão confirmaram o poder preditivo da depressão sobre a frequência de sorrisos maternos e também da estimulação tátil ou com objetos sobre os comportamentos motores do bebê. As evidências do impacto da depressão pós-parto sobre os comportamentos sensíveis da mãe e da estimulação não-verbal sobre o desenvolvimento motor nos primeiros meses de vida são discutidas.
Maternal mental health impairments can affect mothers' behavior during interactions with the baby, which are important predictors of childhood development in the first year. This study investigated the impact of postpartum depression and anxiety on motherinfant interaction and its developmental effects at 3 months of age. Participants were 64 mother-baby dyads that were filmed in a free-play episode. Mothers responded to SRQ-20 and BDI for mental health assessment. Babies' development was evaluated with EDCC. Regression analyzes confirmed the predictive power of depression on the frequency of maternal smiles and also of tactile or object stimulation on baby's motor behavior. The evidence of the impact of postpartum depression and nonverbal stimulation during interaction on the mother's sensitive behaviors and motor development in the first months of life are discussed.
Daños en la salud mental de la madre pueden afectar sus comportamientos en las interacciones con el bebé, que son predictores del desarrollo infantil en el primer año de vida. Este estudio investigó el impacto de la depresión postparto y de la ansiedad en la interacción madre-bebé y sus efectos en el desarrollo a los tres meses de vida. Participaron 64 díadas madre-bebé, filmadas en un episodio juego libre. Las madres respondieron al SRQ-20 y al BDI para la evaluación de la salud mental. El desarrollo de los bebés fue evaluado con la EDCC. Análisis de regresión confirmaron el poder predictivo de la depresión sobre la frecuencia de sonrisas maternas y también de la estimulación táctil o con objetos sobre los comportamientos motores del bebé. Evidencias del impacto de la depresión posparto y de la estimulación no verbal durante la interacción sobre comportamientos sensibles de la madre y el desarrollo motor en los primeros meses de vida son discutidas.
Assuntos
Saúde Mental , Psicologia , Desenvolvimento Infantil , Depressão Pós-Parto , Relações Mãe-FilhoRESUMO
O presente estudo objetivou analisar as percepções dos estudantes do Ensino Médio sobre as aulas de Educação Física. Responderam a um questionário 72 estudantes do Ensino Médio, sendo que 14 declararam não participar das aulas ou participar às vezes. Problemas de saúde e vergonha foram as principais justificativas utilizadas por eles. As atividades realizadas esti-mulam a participação de alguns, mas levam ao afastamento de outros. O desejo por atividades diversificadas é comum. O esporte é apreciado por todos, inclusive por aqueles que não parti-cipam das aulas. Entretanto, é importante identificar qual o significado atribuído ao termo, que por vezes parece se confundir com exercício e com jogo. Desta forma, a pesquisa permi-tiu identificar alguns fatores que influenciam as percepções dos alunos sobre as aulas e a for-ma como delas participam.
This study aimed to analyze the perceptions of high school students about the physical educa-tion classes. 72 students answered a questionnaire and 14 said they did not attend classes or participate sometimes. Health problems and shame were the main arguments used by them. The activities encourage the participation of some, but lead to the removal of others. The de-sire for diversified activities is common. The sport is enjoyed by everyone, including those who do not participate in the classes. However, it is important to identify the meaning given to the term, which sometimes seems to be confused with exercise and play. Thus, the research allowed to identify some factors that influence the students' perceptions about the classes and how they participate.
El objetivo de este estudio fue analizar las percepciones de estudiantes de la enseñanza secun-daria sobre las clases de Educación Física. Para eso, 72 estudiantes de la escuela secundaria respondieron un cuestionario y, 14 de ellos dijeron que no participan de las clases o partici-pan poco. Problemas de salud y vergüenza fueron las principales justificativas utilizadas por ellos. Las actividades incentivan la participación de algunos estudiantes, pero, al mismo tiem-po, originan el alejamiento de otros. El deseo de realizar actividades diversificadas es común. El deporte es apreciado por todos, incluso por aquellos que no participan de las clases. Sin embargo, es importante identificar el significado dado a ese término, que a veces parece ser confundido con el ejercicio y con el juego. Por lo tanto, la investigación permitió identificar algunos factores que influyen en las percepciones de los estudiantes acerca de las clases y de su participación en ellas.
RESUMO
OBJECTIVES: To investigate the effects of a strength training program (STP) using rubber band exercises. METHODS: Twenty-five athletes were divided into two groups: muscular imbalance in the dominant (D) and in the non-dominant (ND) upper limbs. Each group was subdivided into experimental and control groups. Experimental groups performed eighteen sessions of STP. Athletes were submitted to ball throwing and isokinetic strength tests to assess the muscular strength of the shoulder rotator muscles and conventional and functional balance ratios. RESULTS: STP improved external rotator peak torque (18.0 ± 0.8 to 21.3 ± 1.0 Nm, p < 0.01) and total work (29.3 ± 0.9 to 34.5 ± 1.5 J, p < 0.01) in the D experimental group, while only total work (34.8 ± 2.5 to 37.6 ± 3.1 J, p < 0.03) improved in the D control group. The ND experimental group also presented significant improvement in external rotator peak torque (18.8 ± 0.8 to 21.1 ± 1.3 Nm, p < 0.01) and total work values (29.0 ± 1.4 to 34.6 to 1.6 J, p < 0.01) while there was no strength improvement in the ND control group. The ND experimental group showed an improvement in conventional (61.5 ± 3.5 to 72.7 ± 3.0%, p = 0.03) and functional (1.0 ± 0.1 to 1.6 ± 0.08, p < 0.01) ratios. STP did not improve the conventional ratio in the D experimental group. However, STP produced a large effect size. The D experimental group presented an improvement in ball velocity (49.0 ± 2.4 to 52.5 ± 2.2 km/h, p = 0.04) in standing position throwing. CONCLUSIONS: STP improves muscular strength of external rotator muscles and muscular balance.