Uterine Artery Embolization Versus Hysterectomy in Postpartum Hemorrhage: A Systematic Review With Meta-Analysis.

PURPOSE: The objective of this study is to perform a meta-analysis comparing the effectiveness of uterine artery embolization (UAE) versus peripartum hysterectomy for acute refractory postpartum hemorrhage (PPH) control. MATERIALS AND METHODS: We systematically searched 6 medical databases for studies comparing UAE and hysterectomy in PPH. Outcomes examined were mortality, hospitalization duration (HD) in days, and red blood cells (RBC) units utilization. Statistical analysis used RevMan 5.1.7 and random-effects models. Odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. RESULTS: We included 833 patients from 4 cohort studies, with 583 (70%) undergoing UAE. The UAE population required fewer RBC units (MD: -7.39; 95% CI: -14.73 to -0.04; p=0.05) and had shorter HD (MD: -3.22; 95% CI: -5.42 to -1.02; p=0.004). Lower mortality rates were noted for UAE in the pooled analysis, but no statistical significance. Uterine artery embolization demonstrated lower procedural complications (16.45% vs. 28.8%), in which UAE had less ureter and bladder lesions (OR: 0.05; 95% CI: 0.01-0.38; p=0.004 and OR: 0.02; 95% CI: 0.00-0.15; p<0.001, respectively). Only 35 (6%) required conversion to hysterectomy, while 27 (4.6%) underwent re-embolization with 100% bleeding control. Uterine artery embolization did not hinder fertility, with normal menstruation restored in 19 patients with postoligomenorrhea. CONCLUSION: Uterine artery embolization for the control of PPH is associated with lower use of RBC units and HD, but similar rates of mortality are noted when compared to hysterectomy. These results associated with uterine preservation could support its importance for refractory PPH management. CLINICAL IMPACT: Uterine Artery Embolization is associated with a shorter hospitalization duration and reduced use of red blood cell units when compared with hysterectomy in refractory postpartum hemorrhage. Although demonstrating similar mortality rates, these findings, together with fertility preservation, support the method incorporation as a valuable option in obstetric services.

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge.

Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.

Association between the degree of iliac venous outflow obstruction by intravascular ultrasound and lower limb venous reflux.

OBJECTIVE: The present study aims to evaluate the association between the degree of iliac venous outflow obstruction (IVOO) identified by intravascular ultrasound (IVUS) and venous reflux presentation in the lower limbs on duplex ultrasound (DU). METHODS: Patients with bilateral chronic venous insufficiency, CEAP (clinical-etiology-anatomy-pathophysiology) C3 to C6, and a visual analog scale score for pain >5 underwent DU for reflux evaluation of the deep venous system (reflux ≥1 second); superficial system, great saphenous vein, and small saphenous vein (reflux ≥0.5 second); and perforator system (reflux ≥0.35 second). All patients underwent IVUS in the iliac venous territory. The area of the impaired venous segments was categorized as obstruction <50% (category 1), 50% to 79% (category 2), and ≥80% (category 3). The venous clinical severity score and reflux multisegment score (RMS) were assessed. RESULTS: A total of 51 patients (n = 102 limbs; age, 50.53 ± 14.5 years; 6 men) were included. The predominant clinical severity CEAP class was C3 in 54 of 102 limbs (52.9%). The mean VCSS was 14.3 ± 6.7. A severe RMS (≥3) was registered in 63.4% of the limbs. Of the 102 limbs, 51 (50%) presented with category 1, 27 (26.5%) with category 2, and 24 (23.5%) with category 3. Previous deep vein thrombosis (DVT) was associated with critical obstruction (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.29-10.38; P = .015). The superficial and perforator venous systems had no association with the degree of IVOO. Deep venous reflux (DVR) had a significant association with significant IVOO (obstruction ≥50%; OR, 6.44; 95% CI, 2.19-18.93; P = .001) and critical IVOO (obstruction ≥80%; OR, 4.57; 95% CI, 1.70-12.27; P = .003) and a significant linear association with the IVOO degree and reflux in the femoral veins (P < .001) and popliteal vein (P = .008). Significant lesions were significantly more likely to develop in the left limb (OR, 5.76; 95% CI, 2.46-13.50; P < .001). After multivariate analysis, DVR remained a predictor for significant and critical obstruction (P < .003 and P < .012, respectively). Left limb and previous DVT remained as predictors for IVOO of ≥50% and ≥80% (P < .001 and P = .043, respectively). CONCLUSIONS: We found a significant linear association between the degree of IVOO and reflux in the deep venous system on DU. Limbs with DVR, a severe RMS, loss of respiratory variation on DU, and previous DVT were more likely to be affected by IVOO of ≥50%, especially with left leg involvement.

Association between the degree of iliac venous outflow obstruction by intravascular ultrasound and lower limbs venous reflux

OBJECTIVE: This study aims to evaluate the association between the degree of iliac venous outflow obstruction (IVOO) identified by Intravascular Ultrasound (IVUS) and venous reflux presentation in lower limbs on Duplex Ultrasound (DU). METHODS: Patients with bilateral chronic venous insufficiency, CEAP C3-6 (Clinical-Etiology-Anatomy-Pathophysiology classification), and with Visual Analogic Scale score for pain > 5, underwent DU for reflux evaluation: deep venous system (reflux ≥ 1 s); superficial system, great saphenous vein (GSV) and small saphenous vein (SSV) (reflux ≥ 0.5 s); perforator system (reflux ≥ 0.35s). All patients underwent IVUS in the iliac venous territory. The area of the impaired venous segments was categorized as obstructions< 50% (Cat. 1); 50-79% (Cat. 2), and ≥ 80% (Cat. 3). Venous clinical severity scale (VCSS) and reflux multisegment score (RMS) were assessed. RESULTS: 51 patients (n=102 limbs; 50.53 ± 14.5 years, 6 men) were included. The predominant clinical severity CEAP class was C3 in 54/102 (52.9%) limbs. VCSS mean was 14.3 ± 6.7. Severe RMS (≥ 3) was registered in 63,4% of the limbs. In 51/102 limbs (50%) presented cat. 1, 27/102 (26.5%) cat. 2, and 24/102 (23.5%) cat. 3. Previous DVT was associated with critical obstruction (OR 3.65; 95% CI: 1.29-10.38; p=0.015). Superficial and perforator venous systems had no association with the degree of iliac obstruction. Deep venous reflux (DVR) had a significant association with significative IVOO (obstruction ≥ 50%) (OR 6.44; 95% CI: 2.19-18.93; p=0.001) and critical IVOO (obstruction ≥ 80%) (OR 4.57; 95% CI: 1.70-12.27; p=0.003), and significant linear association with IVOO degree and reflux in femoral veins (p<0.001) and popliteal vein (p=0.008). Significant lesions had 5.76 (95% CI: 2.46-13.50; p<0.001) more odds of happening in the left limb. After a multivariate analysis, DVR remained as predictor for significant and critical obstruction (p<0.003, p< 0.012; respectively). Left limb and previous DVT remained as predictors for IVOO ≥50% and IVOO≥ 80% (p<0.001, p=0.043; respectively) CONCLUSIONS: There is a significant linear association between the degree of iliac venous outflow obstruction and reflux in the deep venous system on DU. Limbs with DVR, severe RMS, loss of respiratory variation on DU, and previous DVT, were more likely to be affected by IVOO ≥ 50%, especially with the left leg involvement.

Ensino da pesquisa científica na graduação médica: há interesse e envolvimento dos estudantes? / Teaching scientific research in medical graduation: is there interest and involvement of the students?

Resumo: Introdução: O conhecimento sobre pesquisa científica e a compreensão dela são habilidades que devem ser desenvolvidas por todos os profissionais de saúde. Especificamente na Medicina, essas habilidades compõem uma parcela importante da graduação e da educação médica continuada. Considerando que a formação médica possui estreita relação com a compreensão sobre evidências científicas, torna-se relevante analisar o envolvimento dos estudantes de Medicina com as atividades científicas durante o curso. Objetivo: Este estudo teve como objetivos verificar o interesse e o envolvimento em pesquisas científicas entre os estudantes de Medicina por meio da análise do perfil acadêmico e das atividades extracurriculares realizadas, avaliar a produção científica e identificar as motivações e dificuldades enfrentadas. Método: Trata-se de um estudo transversal, realizado com estudantes de Medicina de Salvador, na Bahia, maiores de 18 anos. Aplicou-se, por meio do Microsoft Forms, um questionário virtual, estruturado e anônimo contendo 21 perguntas acerca do perfil acadêmico e das atividades extracurriculares realizadas, além de dados sobre a produção científica e as motivações e dificuldades enfrentadas pelos estudantes. Resultado: Dos 460 estudantes participantes, houve predominância de mulheres (63,3%), com idade de 24,1+6,1 anos, cursando os ciclos básico (45,4%) e clínico (46,7%), que não possuem desejo prévio de trabalhar com pesquisa (54,8%). Dentre os participantes, 54,6% integraram ligas acadêmicas, 31,1% possuem envolvimento com grupos de pesquisa e 29,1% participaram de monitoria. Verificou-se que apenas 33,9% dos estudantes possuem resumos publicados em congressos, 12,2% são coautores de artigos científicos e 7,4% são autores principais. O interesse em trabalhar com pesquisa aumenta durante a graduação (p = 0,010), estando os estudantes motivados para produzir cientificamente (66,1%). A experiência em pesquisa (27,4%) e o interesse genuíno na descoberta científica (20,9%) foram os principais fatores motivadores. Entretanto, 81,1% dos discentes identificaram dificuldades para produzir conteúdo científico e apontaram como empecilhos a orientação inadequada (16,0%) e a falta de tempo (15,5%). Não foi observada relação entre a motivação e a dificuldade para produzir cientificamente e o ciclo acadêmico em curso. Conclusão: Os estudantes de Medicina demonstram interesse e participação em pesquisa científica, entretanto aqueles que, de fato, estão envolvidos com atividades científicas representam a minoria.

Abstract: Introduction: Knowledge and understanding of scientific research are skills that must be developed by all health professionals. Specifically in Medicine, these skills make up an important part of undergraduate and continuing medical education. Considering that medical training is closely related to the understanding of scientific evidence, it becomes relevant to analyze the involvement of medical students with scientific activities during the course. Objective: This study aimed to investigate the interest and involvement in scientific research among medical students, analyzing the academic profile and the extracurricular activities carried out, in addition to evaluating the scientific production and identifying the motivations and difficulties faced. Method: A cross-sectional study carried out with medical students from Salvador/Bahia, over 18 years of age. A virtual, structured, anonymous questionnaire was applied through Microsoft Forms, containing 21 questions about the academic profile and extracurricular activities carried out, in addition to data on scientific production and the motivations and difficulties faced by students. Result: Of the 460 participating students, there was a predominance of women (63.3%), aged 24.1+6.1 years, attending the basic (45.4%) and clinical (46.7%) cycles, who have no previous desire to work with research (54.8%). Among the participants, 54.6% were part of academic leagues, 31.1% were involved in research groups and 29.1% participated in monitoring. It was found that only 33.9% of students have abstracts published in congresses, 12.2% are co-authors of scientific articles and 7.4% are main authors. Interest in working with research increases during graduation (p = 0.010), with students motivated to produce scientifically (66.1%). Research experience (27.4%) and genuine interest in scientific discovery (20.9%) were the main motivating factors. However, 81.1% of students identify difficulties in producing scientific content, with inadequate guidance (16.0%) and lack of time (15.5%) being the main obstacles. No relationship was observed between motivation and difficulty to produce scientifically and the current academic cycle. Conclusion: Medical students show interest and participation in scientific research, however those who are actually involved in scientific activities represent the minority.

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge / Manejo de pseudoaneurisma do arco palmar superficial traumático: desafio terapêutico

Abstract Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

Resumo O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.

Annular pancreas in neonate patients Vomiting and weight loss in a 13-day newborn / Pâncreas Anular no período neonatal Vômitos e perda de peso em neonato com 13 dias de vida

Objective: Reinforce that, despite being a rare condition, the annular pancreas must be considered a differential diagnosis for intestinal obstructions in the newborn period. Case description: This case report refers to a 13-days newborn admitted to the emergency room presenting with postprandial vomiting and progressive weight loss since maternity discharge. The patient did not respond to initial interventions that included IV antibiotics and nasogastric tube insertion. A contrast study of the upper digestive tract (esophagus, stomach, and duodenum) found a luminal narrowing on the second duodenal portion. The patient was submitted to an exploratory laparotomy which found a pancreatic-tissue ring involving the second part of the duodenum. Despite rare, we reinforce that the annular pancreas must be considered a differential diagnosis for intestinal obstructions in the newborn period. Comments: Annular pancreas is a rare congenital defect in which a ring of pancreatic tissue encircles the duodenum, causing different degrees of intestinal obstruction. (AU)

Objetivo: Evidenciar que, apesar de condição rara, o pâncreas anular deve se firmar como diagnóstico dife-rencial das obstruções intestinais no período neonatal. Descrição do caso: Este relato aborda o caso de uma paciente de 13 dias de vida admitida no pronto atendimento com queixa de volumosos vômitos pós-prandiais e perda de peso progressiva desde a alta da maternidade. Apesar das medidas iniciais, com ressuscitação volêmica, antibioticoterapia e passagem de sonda nasogástrica para descompressão, a paciente evolui sem melhora. Exame contrastado de esôfago-estômago-duodeno detectou estreitamento luminal da segunda porção duodenal. Paciente submetida à laparotomia exploradora, que evidenciou anel de tecido pancreático estreitando o trânsito intestinal na região. Comentários: O pâncreas anular é uma anomalia congênita rara na qual um anel de tecido pancreático envolve a porção descendente do duodeno, causando graus variados de obstrução intestinal extrínseca. (AU)

Delirium in the intensive care unit: identifying difficulties in applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

BACKGROUND: Delirium is an underdiagnosed condition and this may be related, among other causes, to the incorrect use of assessment tools due to lack of knowledge about cognitive assessment and lack of training of the care team. The aim of this study was to investigate the difficulties encountered by the nursing team in the application of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in patients on mechanical ventilation. METHODS: This is descriptive study with a qualitative approach in a private tertiary hospital located in northeast Brazil. Data collection took place from July 2018 to January 2019. We included 32 nurses and used face-to-face semi-structured interviews. The recorded data were analysed using content analysis. This study followed the recommendations of the Standards for Reporting Qualitative Research (SRQR). RESULTS: We identified three major categories: lack of knowledge of professionals, subdivided into deficit in academic formation, difficulty in the differential diagnosis of delirium and delusion, and lack of knowledge about the steps of the CAM-ICU; difficulty in patient cooperation; and lack of adequate training to apply the CAM-ICU. CONCLUSION: Nurses have a deficit in academic formation on delirium and need adequate training for the correct and frequent use of the CAM-ICU.

Estratégias de prevenção de lesões por pressão facial ocasionadas pelo uso da posição prona / Strategies for the prevention of facial pressure injuries caused by the use of the prone position / Estrategias de prevención de lesiones por presión facial ocasionadas por el uso de la posición prona

Objetivo:Identificar as principais estratégias para prevenção de lesões por pressão faciais ocasionadas pelo uso de posição prona. Métodos:Revisão integrativa de literatura, realizada durante o mês de março de 2021. Foram pesquisados artigos nas bases de dados da MEDLINE, LILACS, BDENF e IBECS. Os artigos selecionados foram redigidos nos idiomas inglês, português e espanhol, entre 2016 e 2021. Foram excluídos os duplicados e os que não incluíam a temática abordada. Inicialmente, foram identificados 29 artigos. Após a aplicação dos critérios de inclusão e exclusão, resultaram 10 artigos para análise. Resultados: Das complicações relacionadas ao uso de posição prona, 10 (100%) dos estudos abordam a lesão por pressão como a principal complicação dessa manobra terapêutica. Quanto às estratégias de prevenção, os estudos analisados citam a mudança de decúbito associada ao uso de coxim e hidrocolóides como principais métodos preventivos. Conclusão: Foram identificadas as seguintes estratégias de prevenção de lesão por pressão facial pelo uso de posição prona: mudança de decúbito em tempos pré-estabelecidos; uso de dispositivos que proporcionam alívio de pontos de pressão, tais como os coxins e hidrocolóides; e a utilização de materiais de baixo custo e fácil acesso, como esponjas cirúrgicas adaptadas, respeitando as estruturas anatômicas de cada paciente.

Objective:Identify the main strategies for preventing facial pressure injuries caused by the use of the prone position. Methods: Integrative literature review, carried out during the month of March 2021. Articles were searched in the MEDLINE, LILACS, BDENF and IBECS databases. The selected articles were written in English, Portuguese and Spanish, between 2016 and 2021. Duplicates and those that did not include the topic addressed were excluded. Initially, 29 articles were identified. After applying the inclusion and exclusion criteria, 10 articles resulted for analysis. Results: Of the complications related to the use of the prone position, 10 (100%) of the studies address the pressure injury as the main complication of this therapeutic maneuver. As for prevention strategies, the studies analyzed cite the change in position associated with the use of pads and hydrocolloids as the main preventive methods. Conclusion: The following strategies to prevent facial pressure injury by using the prone position were identified: change of decubitus at pre-established times; use of devices that provide relief from pressure points, such as pads and hydrocolloids; and the use of low-cost and easily accessible materials, such as adapted surgical sponges, respecting the anatomical structures of each patient.

Objetivo:Identificar las principales estrategias para la prevención de lesiones por presión faciales ocasionadas por el uso de posición prona. Métodos: Revisión integrativa de literatura, realizada durante el mes de marzo del 2021. Fueron investigados artículos en las bases de datos de MEDLINE, LILACS, BDENF e IBECS. Los artículos seleccionados fueron redactados en los idiomas inglés, portugués y español, entre el 2016 y el 2021. Fueron excluidos los duplicados y los que no incluían la temática abordada. Inicialmente, fueron identificados 29 artículos. Después de la aplicación de los criterios de inclusión y exclusión, resultaron 10 artículos para análisis. Resultados: De las complicaciones relacionadas al uso de la posición prona, 10 (100%) de los estudios abordan la lesión por presión como la principal complicación de esta maniobra terapéutica. Con respecto a las estrategias de prevención, los estudios analizados citan el cambio de decúbito asociada al uso de apoyo e hidrocoloides como principales métodos preventivos. Conclusión: Fueron identificadas las siguientes estrategias de prevención de lesión por presión facial por el uso de posición prona: cambio de decúbito en tiempos preestablecidos; uso de dispositivos que proporcionan alivio de puntos de presión, tales como los apoyos e hidrocoloides; y la utilización de materiales de bajo costo y fácil acceso, como esponjas quirúrgicas adaptadas, respetando las estructuras anatómicas de cada paciente.

Os desafios bioéticos da interrupção voluntária de hidratação e nutrição em fim de vida no ordenamento jurídico brasileiro / The Bioethical Challenges of the End-of-Life Voluntary Interruption of Hydration and Nutrition in the Brazilian Legal Syste / Los retos bioéticos de la interrupción voluntaria de hidratación y nutrición en el final de vida en el ordenamiento jurídico brasileño

Resumo: O presente artigo, por meio de pesquisa teórica de natureza exploratória, aborda como o direito de morrer é tratado no ordenamento jurídico brasileiro; assim, destaca suas principais nomenclaturas, a saber: distanásia, ortotanásia, cuidados paliativos, diretivas antecipadas de vontade e morte medicamente assistida. Destarte, o objetivo principal é tratar da interrupção voluntária de comer e beber, como possibilidade de antecipar a morte e, por conseguinte, discutir se é um meio viável ou não para se alcançar uma morte digna. Ressalta-se que o procedimento não está previsto de forma explícita nas normas brasileiras e inexistem pesquisas sobre a sua legitimidade no ordenamento pátrio como meio de se alcançar a morte digna, razão pela qual o presente artigo se justifica.

Abstract: Through theoretical research of an exploratory nature, this article addresses how the right to die is treated in the Brazilian legal system; thus, it highlights its main nomenclatures: dysthanasia, orthothanasia, palliative care, advance directives of will, and medically assisted death. The primary purpose is to deal with the voluntary interruption of eating and drinking as a possibility to hasten death and, therefore, discuss whether it is a viable means to have a dignified death. We emphasize that the procedure is not explicitly provided for in the Brazilian regulations and that there are no studies into its legitimacy as a means to achieve a dignified death in the national system, which justifies this article.

Resumen: El presente artículo, mediante investigación teórica de naturaleza exploratoria, aborda cómo el derecho de morir es tratado en el ordenamiento jurídico brasileño; así, destaca sus principales nomenclaturas: distanasia, ortotanasia, cuidados paliativos, directivas anticipadas de voluntad y muerte médicamente asistida. De este modo, el propósito principal es ocuparse de la interrupción voluntaria de comer y beber, como posibilidad de adelantar la muerte y, por ende, discutir si es un medio viable o no para lograr una muerte digna. Se resalta que el procedimiento no está previsto de forma explícita en las normas brasileñas y no existen investigaciones sobre su legitimidad en el ordenamiento patrio como medio de alcanzar la muerte digna, por lo cual el artículo se justifica.

Space-time filter for SSVEP brain-computer interface based on the minimum variance distortionless response.

Brain-computer interfaces (BCI) based on steady-state visually evoked potentials (SSVEP) have been increasingly used in different applications, ranging from entertainment to rehabilitation. Filtering techniques are crucial to detect the SSVEP response since they can increase the accuracy of the system. Here, we present an analysis of a space-time filter based on the Minimum Variance Distortionless Response (MVDR). We have compared the performance of a BCI-SSVEP using the MVDR filter to other classical approaches: Common Average Reference (CAR) and Canonical Correlation Analysis (CCA). Moreover, we combined the CAR and MVDR techniques, totalling four filtering scenarios. Feature extraction was performed using Welch periodogram, Fast Fourier transform, and CCA (as extractor) with one and two harmonics. Feature selection was performed by forward wrappers, and a linear classifier was employed for discrimination. The main analyses were carried out over a database of ten volunteers, considering two cases: four and six visual stimuli. The results show that the BCI-SSVEP using the MVDR filter achieves the best performance among the analysed scenarios. Interestingly, the system's accuracy using the MVDR filter is practically constant even when the number of visual stimuli was increased, whereas degradation was observed for the other techniques.

Correlation between baropodometric variables, disability, and intensity of low back pain in pregnant women in the third trimester.

BACKGROUND: Growth of uterus, enlargement of breasts and weight gain result from the development and growth of the fetus during pregnancy. The posture and the displacement of the center of gravity change. OBJECTIVE: Correlate baropodometric variables with low back pain in pregnant women in the third trimester of pregnancy. METHODS: This is a cross-sectional analytical study conducted in São Luís (MA, Brazil). For data collection, we used a form containing sociodemographic and clinical data, Oswestry Disability Questionnaire for disability evaluation of the lumbar spine, Numerical Rating Scale to measure pain intensity, and baropodometric evaluation. RESULTS: Twenty-five pregnant women took part in the study. There was a significant and positive correlation (r = 0.404, p = 0.045) between functional disability and hindfoot pressure and a significant and negative correlation (r = -0.404, p = 0.045) between functional disability and plantar pressure in the forefoot of the right foot. In addition, there was a positive and significant correlation between the intensity of pain and the contact area on the left (r = 0.504, p = 0.010) and right (r = 0.509, p = 0.009) foot. CONCLUSION: There is a relation between disability and plantar pressure and between pain intensity and area of contact of feet in pregnant women.

Hepatorenal syndrome in children: a review.

Hepatorenal syndrome (HRS) occurs in patients with cirrhosis or fulminant hepatic failure and is a kind of pre-renal failure due to intense reduction of kidney perfusion induced by severe hepatic injury. While other causes of pre-renal acute kidney injury (AKI) respond to fluid infusion, HRS does not. HRS incidence is 5% in children with chronic liver conditions before liver transplantation. Type 1 HRS is an acute and rapidly progressive form that often develops after a precipitating factor, including gastrointestinal bleeding or spontaneous bacterial peritonitis, while type 2 is considered a slowly progressive form of kidney failure that often occurs spontaneously in chronic ascites settings. HRS pathogenesis is multifactorial. Cirrhosis causes portal hypertension; therefore, stasis and release of vasodilator substances occur in the hepatic vascular bed, leading to vasodilatation of splanchnic arteries and systemic hypotension. Many mechanisms seem to work together to cause this imbalance: splanchnic vasodilatation; vasoactive mediators; hyperdynamic circulation states and subsequent cardiac dysfunction; neuro-hormonal mechanisms; changes in sympathetic nervous system, renin-angiotensin system, and vasopressin. In patients with AKI and cirrhosis, fluid expansion therapy needs to be initiated as soon as possible and nephrotoxic drugs discontinued. Once HRS is diagnosed, pharmacological treatment with vasoconstrictors, mainly terlipressin plus albumin, should be initiated. If there is no response, other options can include surgical venous shunts and kidney replacement therapy. In this regard, extracorporeal liver support can be a bridge for liver transplantation, which remains as the ideal treatment. Further studies are necessary to investigate early biomarkers and alternative treatments for HRS.

COVID-19 and Renal Diseases: An Update.

BACKGROUND: It becomes increasingly evident that the SARS-CoV-2 infection is not limited to the respiratory system. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease. METHODS: Data was obtained by a comprehensive and non-systematic search in the PubMed, Cochrane, Scopus and SciELO databases, using mainly the terms "SARS-CoV-2", "COVID-19", "chronic kidney disease", "renal transplantation", acute kidney injury" and "renal dysfunction" Discussion: The membrane-bound angiotensin-converting enzyme 2 is the receptor for SARS-CoV- -2, and this interaction may lead to an imbalance of the Renin-Angiotensin System (RAS), associated with worse clinical presentations of COVID-19, including acute pulmonary injury, hyperinflammatory state and hematological alterations. In the framework of renal diseases, the development of acute kidney injury is associated mostly with immune alterations and direct cytopathic lesions by the virus, leading to higher mortality. As for chronic kidney disease, the patients at a non-terminal stage have a worse prognosis, while the hemodialysis patients appear to have mild courses of COVID-19, probably due to lower chances of being affected by the cytokine storm. Furthermore, the current scenario is unfavorable to kidney donation and transplantation. The relationship between COVID-19 and immunosuppression in kidney transplantation recipients has been greatly discussed to determine whether it increases mortality and how it interacts with immunosuppressive medications. CONCLUSION: The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection, and more research is required to have a complete understanding of the repercussions caused by COVID-19 in renal diseases.

Acolhimento de familiares de pacientes com COVID-19 em unidades de terapia intensiva / Accommodation of families of patients with COVID-19 in intensive care units

Objetivo: Relatar e refletir a experiência de discentes de enfermagem sobre a prática do acolhimento de familiares de pacientes com COVID-19 em uma Unidades de Terapia Intensiva.Método: Trata-se de um relato de experiênciacom subsídio teórico-reflexivo,desenvolvido em um hospital privado de Teresina-PI, no período entre abril e maio de 2021. Adotou-se os pressupostos de Peplau na Teoria das Relações Interpessoais como arcabouço teórico.Resultados: Foi possível a identificação das quatro fases preconizadas por Pepalu no acolhimento realizado pelas discentes, visto que a teoria prioriza a melhorias terapêuticas do ser cuidado, ressaltando assim queum acolhimento de forma humanizadapotencializa o fortalecimento dos fatores de enfrentamento do processo de adoecimento. Conclusão: Foi percebido os frutos positivos do vínculo terapêutico entre a família e a equipe assistencial.O que sugere o impacto deste estudo, no sentido de direcionar boas práticas em saúde, endossadas pelas de Humanização.

Objective: To report and reflect the experience of nursing students on the practice of welcoming family members of patients with COVID-19 in an Intensive Care Unit. Method:This is an experience report with theoretical-reflective subsidy, developed in a private hospital in Teresina-PI, inthe period between April and May 2021. Peplau's assumptions in the Theory of Interpersonal Relations were adopted as a theoretical framework . Results:It was possible to identify the four phases recommended by Pepalu in the embracement performed by the students, as the theory prioritizes therapeutic improvements of the person being cared for, thus emphasizing that a humanized embracement enhances the strengthening of the factors for coping with the illness process. Conclusion:The positive results of the therapeutic bond between the family and the care team were perceived. Which suggests the impact of this study, in the sense of directing good practices in health, endorsed by those of Humanization.

Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study.

BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes. OBJECTIVE: To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese. DESIGN AND SETTING: Questionnaire validity study conducted at a private university. METHODS: The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study. RESULTS: For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found. CONCLUSION: The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study

ABSTRACT BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes. OBJECTIVE: To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese. DESIGN AND SETTING: Questionnaire validity study conducted at a private university. METHODS: The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study. RESULTS: For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found. CONCLUSION: The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

Channel capacity in brain-computer interfaces.

OBJECTIVE: Adapted from the concept of channel capacity, the information transfer rate (ITR) has been widely used to evaluate the performance of a brain-computer interface (BCI). However, its traditional formula considers the model of a discrete memoryless channel in which the transition matrix presents very particular symmetries. As an alternative to compute the ITR, this work indicates a more general closed-form expression-also based on that channel model, but with less restrictive assumptions-and, with the aid of a selection heuristic based on a wrapper algorithm, extends such formula to detect classes that deteriorate the operation of a BCI system. APPROACH: The benchmark is a steady-state visually evoked potential (SSVEP)-based BCI dataset with 40 frequencies/classes, in which two scenarios are tested: (1) our proposed formula is used and the classes are gradually evaluated in the order of the class labels provided with the dataset; and (2) the same formula is used but with the classes evaluated progressively by a wrapper algorithm. In both scenarios, the canonical correlation analysis (CCA) is the tool to detect SSVEPs. MAIN RESULTS: Before and after class selection using this alternative ITR, the average capacity among all subjects goes from 3.71 [Formula: see text] 1.68 to 4.79 [Formula: see text] 0.70 bits per symbol, with p -value <0.01, and, for a supposedly BCI-illiterate subject, her/his capacity goes from 1.53 to 3.90 bits per symbol. SIGNIFICANCE: Besides indicating a consistent formula to compute ITR, this work provides an efficient method to perform channel assessment in the context of a BCI experiment and argues that such method can be used to study BCI illiteracy.

Impact of lung expansion therapy using positive end-expiratory pressure in mechanically ventilated patients submitted to coronary artery bypass grafting

Abstract Objective: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). Methods: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. Results: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. Conclusion: It is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting.

OBJECTIVE: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). METHODS: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. RESULTS: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. CONCLUSION: It is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.