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The aim of this study is to identify the factors associated with mortality in patients with COVID-19 undergoing invasive mechanical ventilation at a university hospital in Northeastern Brazil. This is a retrospective cohort from April to August 2020 through an analysis of medical records, considering the demographic profile, comorbidities, complications, supports, respiratory and laboratory parameters. A total of 65 patients required invasive mechanical ventilation, of which 64.6% died in the ICU. They were older, had more comorbidities, shorter length of stay in the intensive care unit, received more support such as palliative care and two vasopressors simultaneously, showed lower levels of pH, hemoglobin and calcium, and higher levels of bicarbonate, lactate, prothrombin time, international normalized ratio, troponin and ferritin at the start of invasive mechanical ventilation. Furthermore, the time course of pH, arterial oxygen partial pressure to fractional inspired oxygen ratio, arterial carbon dioxide partial pressure, lactate, hemoglobin, platelets, lymphocytes, neutrophil-to-lymphocyte ratio, coagulation parameters, calcium, urea, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, ferritin, static compliance, airway resistance, tidal volume, and noradrenaline doses showed association with mortality. There was a high mortality rate in invasively mechanically ventilated COVID-19 patients, with some associated factors identified at the start of invasive mechanical ventilation and others identified over time.
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COVID-19 , Hospitais Universitários , Respiração Artificial , Humanos , COVID-19/mortalidade , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Brasil/epidemiologia , Respiração Artificial/estatística & dados numéricos , Idoso , SARS-CoV-2 , Unidades de Terapia Intensiva/estatística & dados numéricos , Mortalidade Hospitalar , Fatores de Risco , Adulto , Comorbidade , Tempo de Internação/estatística & dados numéricosRESUMO
BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.
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Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Brasil/epidemiologia , Adulto , Recém-Nascido , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado da Gravidez , Doenças Fetais/cirurgia , Complicações na Gravidez/cirurgia , Idade Gestacional , Adulto Jovem , Mortalidade PerinatalRESUMO
OBJETIVO: Verificar qual o tratamento mais indicado para a prevenção e redução dos sinais e sintomas de abstinência em crianças criticamente doentes por meio de uma revisão sistemática da literatura mundial. MÉTODO: A revisão sistemática será conduzida conforme a metodologia PRISMA e Cochrane, com registro no PROSPERO, sob o número de ID CRD42021274670, nas respectivas bases de dados PubMed, LILACS, Embase, Web of Science, Cochrane, CINAHL, Cochrane Database Systematic Review e CENTRAL. As buscas serão realizadas por dois avaliadores independentes, um terceiro realizará o intermédio se necessário. Os dados serão inseridos no programa de software Zotero que irá excluir os artigos duplicados, após o material selecionado será transferido para planilha Excel em instrumento próprio. Os estudos serão classificados quanto ao seu nível de evidência, viés e fator de risco. Os resultados serão analisados e tabulados e discutidos a fim de melhor compreensão dos resultados. Se possível, serão realizadas meta-análises para os resultados agregados.
OBEJECTIVE: To verify the most appropriate treatment for the prevention and reduction of the signs and symptoms of abstinence in critically ill children through a systematic review of the world literature. METHOD: The systematic review will be conducted according to the PRISMA and Cochrane methodology, with registration at PROSPERO, under the ID number CRD42021274670, in the respective databases, PUBMed, LILACS, Embase, Web of Science, Cochrane, CINAHL, Cochrane Database Systematic Review, and CENTRAL, searches will be carried out by two independent evaluators, and a third party will perform the intermediate if necessary. The data will be entered into the Zotero software program that will delete duplicate articles after the selected material is transferred to an Excel spreadsheet on its instrument. The studies will be classified according to their level of evidence, bias, and risk factors. The results will be analyzed, tabulated, and discussed to understand the results better. If possible, meta-analyzes will be carried out for the aggregated results.
Assuntos
Humanos , Criança , Síndrome de Abstinência a Substâncias , Unidades de Terapia Intensiva Pediátrica , Saúde da Criança , Estado Terminal , Revisões Sistemáticas como Assunto , AnalgesiaRESUMO
ABSTRACT Introduction: HIV/AIDS is considered one of the great cases of public health, but it is seen that patients who use antiretroviral therapy (ART) and practice strength training promote a promotion of their health. Objectives: Assess the impact of strength and resistance training on cytokines and body composition in people living with HIV/AIDS. Methods: Randomized clinical trial, the sample consisted of 12 patients, 7 from the Strength Group (GF) and 5 from Group 2, Muscular Resistance (MGR). We compared the levels of IL-2, IL-4, IL-6, IL-10 and TNF-α cytokines and body composition in the first and last sessions. The patients completed 36 strength and resistance training sessions over 12 weeks. Results: After 36 sessions of GRM resistance training, there was a significant increase from 4,734 pg/mL to 5,050 pg/mL of IL-10 (p=0.002). Regarding the GFR, no significant results were found. For body composition, there were significant differences in GFR due to the increase in lean mass of the arms from 6,441g to 7,014g (p=0.04), legs from 16,379g to 17,281g (p=0.02) and whole body of 45,640g to 47,343g (p=0.01). In G2 there was a significant decrease in the percentage of fat in the arms from 23,160% to 20,750% (p = 0.04). To assess quality of life, the WHOQOL-HIV-Bref questionnaire was used, where significant improvement was found in all domains, except for the level of independence domain. Conclusion: We conclude that muscular resistance training is effective in increasing IL-10 and decreasing the percentage of fat in the arms, whereas strength training increases lean mass in arms, legs, and the whole body. Level of Evidence I; Randomized Clinical Trial.
RESUMEN Introducción: El VIH/SIDA es considerado uno de los grandes casos de salud pública, sin embargo, está comprobado que pacientes que hacen uso de la terapia antirretroviral (TARV) y practican entrenamiento de fuerza provoca una promoción de su salud. Objetivos: Evaluar el impacto del entrenamiento de fuerza en la resistencia a las citoquinas y en la composición corporal de las personas que viven con VIH/SIDA. Métodos: Ensayo clínico aleatorizado, la muestra estuvo compuesta por 12 pacientes, siete del Grupo de Fuerza (TFG) y cinco del Grupo de Resistencia Muscular (GRM). Se compararon los niveles de las citocinas IL-2, IL-4, IL-6, IL-10 y TNF-α y la composición corporal en la primera y la última sesión. Los pacientes completaron 36 sesiones de entrenamiento de fuerza y resistencia durante 12 semanas. Resultados: Tras 36 sesiones de entrenamiento de resistencia GRM, se produjo un aumento significativo de 4.734 pg/mL a 5.050 pg/mL de IL-10 (p=0,002). En cuanto a la TFG, no se encontraron resultados significativos. En cuanto a la composición corporal, hubo diferencias significativas en la TFG debido al aumento de la masa magra en brazos de 6.441g a 7.014g (p=0,04), piernas de 16.379g a 17.281g (p=0,02) y cuerpo entero de 45.640g a 47.343g (p=0,01). En el GRM hubo una disminución significativa del porcentaje de grasa en los brazos de 23.160% a 20.750% (p = 0,04). Para la evaluación de la calidad de vida se utilizó el cuestionario WHOQOL-HIV-Bref, donde se encontró una mejoría significativa en todos los dominios, excepto en el dominio nivel de independencia. Conclusión: Concluimos que el entrenamiento de resistencia muscular es eficaz para aumentar la IL-10 y disminuir el porcentaje de grasa en los brazos, mientras que el entrenamiento de fuerza aumenta la masa magra total. Nivel de Evidencia I; Ensayo clínico aleatorizado.
RESUMO Introdução: O HIV/AIDS é considerado um dos grandes casos de saúde pública, porém verifica-se que pacientes que fazem uso de terapia antirretroviral (TARV) e praticam treinamento de força provocam uma promoção de sua saúde. Objetivos: Avaliar o impacto do treinamento de força sobre a resistência nas citocinas e a composição corporal de pessoas vivendo com HIV/AIDS. Métodos: Ensaio clínico randomizado, a amostra foi composta por 12 pacientes, sendo sete do Grupo Força (TFG) e cinco do Grupo Resistência Muscular (GRM). Comparou-se os níveis das citocinas IL-2, IL-4, IL-6, IL-10 e TNF-α e a composição corporal na primeira e na última sessão. Os pacientes completaram 36 sessões de treinamento de força e resistência ao longo de 12 semanas. Resultados: Após 36 sessões de treinamento resistido GRM, houve um aumento significativo de 4.734 pg/mL para 5.050 pg/mL de IL-10 (p=0,002). Em relação à TFG, não foram encontrados resultados significativos. Para composição corporal, houve diferenças significativas na TFG devido ao aumento da massa magra dos braços de 6.441g para 7.014g (p=0,04), pernas de 16.379g para 17.281g (p=0,02) e corpo inteiro de 45.640g para 47.343g (p=0,01). No GRM houve diminuição significativa do percentual de gordura nos braços de 23.160% para 20.750% (p = 0,04). Para avaliação da qualidade de vida foi utilizado o questionário WHOQOL-HIV-Bref, onde foi encontrada uma melhora significativa em todos os domínios, exceto no domínio nível de independência. Conclusão: Conclui-se que o treinamento de resistência muscular é eficaz em aumentar a IL-10 e diminuir o percentual de gordura nos braços, enquanto o treinamento de força aumenta a massa magra geral. Nível de Evidência I; Ensaio Clínico Randomizado.
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OBJECTIVE: This study aims to describe and compare the prevalence of perceived barriers to physical activity (PBPA) in pre- and post-metabolic and bariatric surgery (MBS) patients and assess the association of these barriers with their physical activity levels. METHODS: A cross-sectional study included pre-operative (n = 63) and post-operative (n = 119) groups. Sociodemographic characteristics, leisure-time physical activity levels, and PBPA data were collected. Descriptive statistics, chi-square, and Fisher's exact tests, and binomial logistic regression analyses were used for comparisons and associations. RESULTS: Compared to the pre-operative group, the post-operative group had a lower prevalence of barriers in the physical domain (p = 0.036) and the behavioral domain (p = 0.004). However, there were no significant differences in the environmental (p = 0.531) or social (p = 0.597) domains. Pre-MBS patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.048) and behavioral (p = 0.048) domains. In contrast, post-surgical patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.027), social (p = 0.020), and behavioral (p = 0.037) domains. CONCLUSION: The results show that individuals who underwent metabolic and bariatric surgery have a lower prevalence of behavioral and physical PBPA compared to those awaiting the procedure. The perception of barriers to physical activity in the environmental and behavioral domains increases the likelihood of physical inactivity in both pre- and post-MBS patients, while in the social domain, it was only associated with physical activity in post-MBS patients.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Humanos , Estudos Transversais , Prevalência , Obesidade Mórbida/cirurgia , Exercício FísicoRESUMO
ABSTRACT BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.
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Objectives: Evaluate the efficacy and effects of releasing the muscles of subluxated hips of patients with SCZ. Methods: This is a retrospective study with 29 patients with subluxation of the hip, corresponding to 55 hips operated in a public hospital in Recife, Brazil. Preoperative femoral head migration (PM) percentages were evaluated and compared with 6- and 12-month postoperative results. Results: Twenty-nine patients were eligible, representing 55 hips evaluated. 19 were female (65.5%), with a mean age of 31.45 months (ranging from 23 to 42 years). 19 patients were GMFCS level V (65.5%), 34.5% were level IV, and 20 of the 29 patients (69%) had no complications. The PM had an absolute reduction of 11.6% (GMFCS IV) and 13.31% (GMFCS V) in the first six months. After 12 months, there was a regression of MP of 7.14% (GMFCS V) and 11.25% (GMFCS IV) compared to preoperative values, with no significant statistical difference among MP values presented between 6 and 12 months after surgery. Conclusions: The surgery was effective in PM regression during the analyzed period and presented a low complication rate. Level of Evidence III; Comparative retrospective study.
Objetivos: Avaliar a eficácia e os efeitos da liberação das musculaturas de quadris subluxados de pacientes com SCZ. Métodos: Trata-se de um estudo do tipo retrospectivo com 29 pacientes CZS com subluxação do quadril, correspondendo a 55 quadris operados em um hospital público de Recife, Brasil. Foram avaliados os percentuais migratórios da cabeça femoral (PM) no pré-operatório e comparados com os resultados pós-operatórios de 6 e 12 meses. Resultados: Foram elegíveis 29 pacientes, representando 55 quadris avaliados. 19 eram do sexo feminino (65,5%), com média de idade de 31,45 meses (variando de 23 a 42 anos). 19 pacientes eram GMFCS nível V (65,5%), 34,5% eram nível IV e 20 dos 29 pacientes (69%) não apresentaram complicações. O PM teve redução absoluta de 11,6% (GMFCS IV) e de 13,31% (GMFCS V), nos primeiros seis meses. Após 12 meses, houve regressão do PM de 7,14% (GMFCS V) e de 11,25% (GMFCS IV) em relação aos valores pré-operatórios, sem diferença estatística entre os valores do PM apresentados entre 6 e 12 meses da cirurgia. Conclusões: A cirurgia foi eficaz em regredir o PM no período analisado e apresentou uma baixa taxa de complicações. Nível de Evidência III; Estudo retrospectivo comparativo.
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OBJECTIVE: To reveal the experience of family members after learning their child would adopt palliative care. METHOD: Phenomenological research on Heidegger's perspective. The participants were eleven family members of children who were recommended palliative care in the Pediatric Intensive Care Unit from a university hospital in southern Brazil. The statements were obtained in a semi-structured interview, from January to November/2017, and submitted to Heidegger's theoretical-philosophical analysis. Research approved by the institution's Ethical Committee. RESULTS: The communication of palliative care triggers the perception of the child's existencial facticity in the Family, revealing reactions explained in the thematic dimensions: "Coping with the finiteness of the child when confronted with the proposal of adopting palliative care" and "The need for compassionate and attentive care". FINAL CONSIDERATIONS: Phenomenology allows us to understand the parent's existential purpose. An understanding perspective can help interdisciplinary teams to communicate the adoption of palliative care in a sensitive and ethical way, focusing on the best interest of the child.
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Família , Cuidados Paliativos , Criança , Humanos , Adaptação Psicológica , Comunicação , Existencialismo , Pesquisa QualitativaRESUMO
Estudos acerca dos riscos socioambientais são frequentes. Diante deles, cientistas alertam que, caso não sejam tomadas providências, é a própria vida no planeta que estará em perigo. Esta pesquisa objetivou identificar e analisar, sob o enfoque da Psicologia Social e da Filosofia da Diferença, experiências de sustentabilidade afetiva no espaço urbano diante da emergência da pandemia. Adotando a estratégia metodológica da história oral, buscou-se acompanhar o relato de participantes vinculados a uma Instituição de Ensino Superior que se dispuseram a compartilhar os impactos afetivos da relação com a cidade em estado pandêmico. Os relatos foram analiticamente organizados em dois eixos: 1. Desterritorializações e medos; 2. Frustrações narcísicas e restrições biopolíticas. Os resultados mostraram que as percepções iniciais diante do contato com a pandemia foram marcadas por afetos de surpresa, angústia e medo. Concluiu-se que sustentar afetivamente esta experiência comportou desafios relacionais colocados à coletividade em sua interface com as cidades.
Studies on the socio-environmental risks are frequents. Scientists warn that if no immediate action is taken, it is life itself on the planet that will be in danger. This research aimed to identify and analyze, under the focus of Social Psychology and the Philosophy of Difference, experiences of affective sustainability in the urban space. Adopting a methodology strategy of oral history, we sought to follow the reports of participants linked a Superior Institution of Studies who were willing to share the affective impacts resulting from your urban relation in pandemic station. The reports were analytically organized in two axes: 1. Deterritorialization and fears; 2. Narcissistic frustrations and biopolitical restrictions. The results show that the first perceptions were marked by surprise, anguish and fear. It concluded that affectively sustaining this experience is still a challenge posed for collectivity in its interface with the cities.
Son frecuentes los estudios sobre los riesgos socio ambientales. Ante ellos, científicos advierten que, si no se toman medidas inmediatas, es la vida del planeta la que estará en peligro. Esta investigación tuvo como objetivo identificar y analizar, bajo el enfoque de la Psicología Social y la Filosofía de la Diferencia, experiencias de sostenibilidad afectiva en el espacio urbano ante la emergencia de la pandemia. Adoptando una estrategia metodológica de la historia oral, se buscó seguir los informes de participantes vinculados a un Instituto de Enseñanza Superior que estaban dispuestos a compartir los impactos afectivos de la relación con la ciudad en estado de pandemia. Los relatos fueran organizados en dos ejes: 1 Deterritorialization e miedo; 2. Frustraciones narcisos e restricciones biopolíticas. Los resultados muestran que las primeras percepciones del contacto con la pandemia fueron marcadas por la sorpresa, la angustia y el miedo. Se concluye que sostener afectivamente esta experiencia comporto desafíos a la colectividad en su interface con la ciudad.
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Humanos , Filosofia , Psicologia Social , Cidades , Pandemias , Ansiedade , Pesquisa Qualitativa , Indicadores de Desenvolvimento SustentávelRESUMO
Bisphosphonates are drugs used to treat bone disorders. The chronic use of bisphosphonates is associated with the occurrence of medication-related osteonecrosis of the jaw (MRONJ). Previous data reported the positive effects of Geranylgeraniol on different cell types treated with Bisphosphonates. Foregoing work done by our research group demonstrated the wound healing capacity of Fridericia chica (Bonpl.) L.G.Lohmann standardized ethanol extract. Herein in vitro cytoprotective synergistic effect of the association of F. chica extract associated with an enriched geranylgeraniol fraction on keratinocytes exposed to zoledronic acid is reported. An association of F. chica at 1 and 5 µg/mL with geranylgeraniol at 15 µg/mL, increased cell viability by 73.5% and 71.1%, respectively. This treatment did not increase tumor cells viability; whereas the clonogenic potential assessment showed that, the association with F. chica (5 µg/mL) reversed the effects of zoledronic acid on the cells. This study provides data for a potential treatment for MRONJ.
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ABSTRACT Objectives: Evaluate the efficacy and effects of releasing the muscles of subluxated hips of patients with SCZ. Methods: This is a retrospective study with 29 patients with subluxation of the hip, corresponding to 55 hips operated in a public hospital in Recife, Brazil. Preoperative femoral head migration (PM) percentages were evaluated and compared with 6- and 12-month postoperative results. Results: Twenty-nine patients were eligible, representing 55 hips evaluated. 19 were female (65.5%), with a mean age of 31.45 months (ranging from 23 to 42 years). 19 patients were GMFCS level V (65.5%), 34.5% were level IV, and 20 of the 29 patients (69%) had no complications. The PM had an absolute reduction of 11.6% (GMFCS IV) and 13.31% (GMFCS V) in the first six months. After 12 months, there was a regression of MP of 7.14% (GMFCS V) and 11.25% (GMFCS IV) compared to preoperative values, with no significant statistical difference among MP values presented between 6 and 12 months after surgery. Conclusions: The surgery was effective in PM regression during the analyzed period and presented a low complication rate. Level of Evidence III; Comparative retrospective study.
RESUMO Objetivos: Avaliar a eficácia e os efeitos da liberação das musculaturas de quadris subluxados de pacientes com SCZ. Métodos: Trata-se de um estudo do tipo retrospectivo com 29 pacientes CZS com subluxação do quadril, correspondendo a 55 quadris operados em um hospital público de Recife, Brasil. Foram avaliados os percentuais migratórios da cabeça femoral (PM) no pré-operatório e comparados com os resultados pós-operatórios de 6 e 12 meses. Resultados: Foram elegíveis 29 pacientes, representando 55 quadris avaliados. 19 eram do sexo feminino (65,5%), com média de idade de 31,45 meses (variando de 23 a 42 anos). 19 pacientes eram GMFCS nível V (65,5%), 34,5% eram nível IV e 20 dos 29 pacientes (69%) não apresentaram complicações. O PM teve redução absoluta de 11,6% (GMFCS IV) e de 13,31% (GMFCS V), nos primeiros seis meses. Após 12 meses, houve regressão do PM de 7,14% (GMFCS V) e de 11,25% (GMFCS IV) em relação aos valores pré-operatórios, sem diferença estatística entre os valores do PM apresentados entre 6 e 12 meses da cirurgia. Conclusões: A cirurgia foi eficaz em regredir o PM no período analisado e apresentou uma baixa taxa de complicações. Nível de Evidência III; Estudo retrospectivo comparativo.
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Abstract Obesity is considered a risk factor to health and besides generating metabolic and cardiovascular alterations, it is related to mechanical complications. Since stability may be altered due to anthropometric and biomechanical factors, studies investigating the relationship of excess weight on the mobility and balance of obese adults are still scarce. The research aimed to evaluate the postural balance and mobility of obese individuals who are waiting for bariatric surgery. This is a cross-sectional and descriptive study, conducted at the Hospital das Clínicas of the Universidade Federal de Pernambuco. The sample consisted of 97 individuals, 81 women, 16 men, age 38.39 ± 10.60 years and body mass index 47.5 ± 6.9 kg/m2. The Timed Up and Go test, which evaluates the mobility, resulted in 7.6 ± 1.7 seconds as the average of the longest times spent to perform the test. Regarding the evaluation of dynamic balance and mobility, it was found that the domains of anticipatory postural adjustments, necessary to prevent postural disturbances (median 5, 95%CI 5-6) and the domain of dynamic movement, which corresponds to the balance necessary to walk (median 8, 95%CI 7-9) are the most impaired in the subjects with obesity. Positive correlations were found between weight and dynamic balance. The findings indicate that excess body fat interferes with dynamic balance.
Resumo A obesidade é considerada fator de risco à saúde e além de gerar alterações metabólicas e cardiovasculares, está relacionada a complicações mecânicas. Uma vez que a estabilidade pode estar alterada em função de fatores antropométricos e biomecânicos, ainda são escassos os estudos que investigam a relação do excesso de peso sobre a modilidade e equilíbrio dos adultos obesos. A pesquisa teve como objetivo avaliar o equilíbrio postural e a mobilidade dos indivíduos com obesidade que estão aguardando a realização da Cirurgia Bariátrica. Trata-se de um estudo transversal e descritivo, realizado no Hospital das Clínicas da Universidade Federal de Pernambuco. A amostra foi composta por 97 indivíduos, sendo 81 mulheres, 16 homens, idade 38,39 ± 10,60 anos e índice de massa corporal 47,5 ± 6,9 kg/m2. O teste Timed Up and Go, que avalia a mobilidade, teve como resultado 7,6 ± 1,7 segundos como a média dos maiores tempos gastos para a execução do teste. A respeito da avaliação do equilíbrio dinâmico e da mobilidade, verificou-se que os domínios de ajustes posturais antecipatórios, necessários para prevenir perturbações posturais (mediana 5, IC95% 5-6) e o domínio de movimentação dinâmica, que corresponde ao equilíbrio necessário para a realização da marcha (mediana 8; IC95% 7-9) são os mais prejudicados nos sujeitos com obesidade avaliados. Foram constatadas correlações positiva entre peso e equilíbrio dinâmico. Os achados indicam que o excesso de gordura corporal interfere no equilíbrio dinâmico.
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Perante um contexto de rápida disseminação do novo coronavírus, inúmeras secretarias municipais e estaduais de saúde adotaram medidas cautelares para diminuir a contaminação. Tais medidas ocasionaram o fechamento de espaços públicos e, igualmente, os ambientes típicos de prática de atividade física foram limitados. Além disso, o isolamento ressoou na população, acarretando diferentes sentimentos que provocaram medos e incertezas, que, adicionado a um frequente estado de luto, atingiram a saúde mental da população. Desse modo, diferentes estratégias e ações intersetoriais foram utilizadas nesse período, visando amenizar os efeitos prejudiciais do isolamento e superar as barreiras para a manutenção de um estilo de vida saudável. Assim, o objetivo desta pesquisa é relatar uma experiência de desenvolvimento de estratégias e ações de cuidado realizadas com usuários de um programa de promoção à saúde com ajuda das práticas corporais em Recife, Pernambuco.
Faced with a context of rapid spread of the new coronavirus, numerous municipal and state health departments have adopted precautionary measures to reduce contamination. Such measures resulted in the closing of public spaces and the typical environments for physical activity were limited as well. In addition, isolation resonated with the population, resulting in different feelings that caused fears and uncertainties, which, added to a frequent state of mourning, affected the mental health of the population. Thus, different intersectoral strategies and actions were used in this period, aiming to mitigate the harmful effects of isolation and overcome barriers to maintaining a healthy lifestyle. Thus, the objective of this research is to report an experience of developing strategies and care actions carried out with users of a health promotion program with the help of body practices in Recife, Pernambuco.
Ante un contexto de rápida propagación del nuevo coronavirus, muchas secretarías de salud municipales y estaduales han adoptado medidas de precaución para reducir la contaminación. Tales medidas dieron como resultado el cierre de espacios públicos y limitaron los ambientes para la actividad física. Además, el aislamiento tuvo impacto en la población al generar diferentes sentimientos relacionados a temores e incertidumbres, a lo cual se sumó a un estado de duelo frecuente, afectándole su salud mental. Así, en este período se utilizaron diferentes estrategias y acciones intersectoriales, con el objetivo de mitigar los efectos nocivos del aislamiento y superar las barreras para mantener un estilo de vida saludable. Por lo tanto, el objetivo de este estudio es relatar una experiencia de desarrollo de estrategias y acciones de cuidado realizadas con usuarios de un programa de promoción de la salud de prácticas corporales en Recife, Pernambuco (Brasil).
Assuntos
Atenção Primária à Saúde , Exercício Físico , Atenção à Saúde , COVID-19RESUMO
RESUMO Objetivo: Verificar as estratégias de prevenção e tratamento da síndrome de abstinência em unidade de terapia intensiva pediátrica. Métodos: Trata-se de revisão sistemática nas bases de dados PubMed®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review e CENTRAL. Uma estratégia de busca em três etapas foi utilizada para esta revisão. O protocolo da revisão foi aprovado no PROSPERO (CRD42021274670). Resultados: Foram incluídos na análise 12 artigos. Observou-se grande heterogeneidade entre os estudos incluídos, principalmente em se tratando de esquemas terapêuticos utilizados na sedação e na analgesia. As doses de midazolam variaram de 0,05mg/kg/hora a 0,3mg/kg/hora. A morfina também variou consideravelmente, de 10mcg/kg/hora a 30mcg/kg/hora entre os estudos. A escala mais utilizada para identificação da síndrome de abstinência, entre os 12 estudos selecionados, foi a Sophia Observational Widrawal Symptoms Scale. Em três estudos, houve diferença estatística relevante na prevenção e no manejo da síndrome de abstinência com a implantação de protocolos (p < 0,01 e p < 0,001). Conclusão: Observou-se grande variação entre o regime de sedoanalgesia utilizado entre os estudos e o método de desmame e avaliação de síndrome de abstinência. São necessários mais estudos para fornecer evidências mais robustas acerca do tratamento mais indicado para prevenção e redução dos sinais e sintomas de abstinência em crianças criticamente doentes. Registro PROSPERO:CRD 42021274670
ABSTRACT Objective: To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit. Methods: This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670). Results: Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001). Conclusion: There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children. PROSPERO register: CRD 42021274670
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RESUMO Objetivo: Avaliar os efeitos da doença crítica no status funcional de crianças de zero a 4 anos com e sem histórico de prematuridade após a alta da unidade de terapia intensiva pediátrica. Métodos: Estudo transversal secundário aninhado a uma coorte de caráter observacional de sobreviventes de uma unidade de terapia intensiva pediátrica. A avaliação funcional aconteceu por meio da Functional Status Scale no período de até 48 horas após a alta da unidade de terapia intensiva pediátrica. Resultados: Participaram do estudo 126 pacientes, sendo 75 prematuros e 51 nascidos a termo. Na comparação entre o status funcional basal e o status funcional da alta da unidade de terapia intensiva pediátrica, ambos os grupos apresentaram diferenças significativas (p < 0,001). Na alta da unidade de terapia intensiva pediátrica, as alterações funcionais aumentaram significativamente em ambos os grupos (p < 0,001). Os pacientes prematuros apresentaram maior declínio funcional na alta da unidade de terapia intensiva pediátrica (61%). Nos pacientes nascidos a termo, houve correlação significativa entre Pediatric Index of Mortality, tempo de sedação, tempo de ventilação mecânica e tempo de internação com os desfechos funcionais (p = 0,05). Conclusão: A maior parte dos pacientes estudados apresentou declínio funcional na alta da unidade de terapia intensiva pediátrica. Apesar de os pacientes prematuros apresentarem maior declínio funcional na alta, os pacientes nascidos a termo apresentaram influência do tempo de sedação e do tempo de uso de ventilação mecânica nos seus status funcionais.
ABSTRACT Objective: To evaluate the effects of critical illness on the functional status of children aged zero to 4 years with or without a history of prematurity after discharge from the pediatric intensive care unit. Methods: This was a secondary cross-sectional study nested in an observational cohort of survivors from a pediatric intensive care unit. Functional assessment was performed using the Functional Status Scale within 48 hours after discharge from the pediatric intensive care unit. Results: A total of 126 patients participated in the study, 75 of whom were premature, and 51 of whom were born at term. Comparing the baseline and functional status at pediatric intensive care unit discharge, both groups showed significant differences (p < 0.001). Preterm patients exhibited greater functional decline at discharge from the pediatric intensive care unit (61%). Among patients born at term, there was a significant correlation between the Pediatric Index of Mortality, duration of sedation, duration of mechanical ventilation and length of hospital stay with the functional outcomes (p = 0.05). Conclusion: Most patients showed a functional decline at discharge from the pediatric intensive care unit. Although preterm patients had a greater functional decline at discharge, sedation and mechanical ventilation duration influenced functional status among patients born at term.
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O presente estudo teórico tem por objetivo problematizar uma prática consolidada no contemporâneo: o consumo. Longe de responder à satisfação de necessidades básicas, as práticas de consumo são engendradas por uma série de enquetes realizadas por áreas como o marketing, a publicidade e o design. Elas visam não apenas conhecer as expectativas dos consumidores, mas também incutir neles o prazer de consumir, valendo-se de elementos simbólicos, afetivos e subjetivos. A argumentação teórica deste estudo, pautada na Psicologia Social, percorre o seguinte trajeto: primeiro, busca-se compreender o processo de colonização pela via do consumo atentando para como elas incidem sobre os corpos e os afetos. Na sequência, é colocada em análise a complexa relação com o que chamamos de estrangeiro, que pode tomar contornos colonizadores, mas também engendrar outras sensibilidades e maneiras de se vincular ao mundo. Ao final do estudo constata-se o quanto o sujeito contemporâneo deixa-se colonizar pelas promessas midiáticas de felicidade, satisfação e prazer que são proclamadas de maneira idealizada nas campanhas publicitárias em favor do consumo. Isso coloca à Psicologia Social o desafio de dar visibilidade aos processos de colonização, analisando criticamente os efeitos estéticos, afetivos, econômicos e políticos gerados para a população e para o planeta.
The present theoretical study aims to analyze a consolidated practice in the contemporary: consumption. Far from responding to the satisfaction of basic needs, consumer practices are engendered through surveys conducted by areas such as marketing, advertising and design. They aim not only to know the expectations of consumers, but also to instill in them the pleasure of consuming, using symbolic, affective and subjective elements. The theoretical argumentation of this study, based on Social Psychology, follows the following path: first, we seek to understand the process of colonization through consumption by looking at how they affect bodies and affections. Next, the complex relationship with what we call the alien, which can take colonizing contours, but also engender other sensitivities and ways of linking to the world, is put into analysis. At the end of the study, it is verified how much the contemporary subject is colonized by the media promises of happiness, satisfaction and pleasure that are proclaimed in an idealized way in advertising campaigns in favor of consumption. This gives social psychology the challenge of giving visibility to colonization processes, critically analyzing the aesthetic, affective, economic and political effects generated for the population and for the planet.
El presente estudio teórico pretende problematizar una práctica consolidada en lo contemporáneo: el consumo. Lejos de responder a la satisfacción de las necesidades básicas, las prácticas de consumo se engendran a través de encuestas realizadas por áreas como el marketing, la publicidad y el diseño. Su objetivo no es solo conocer las expectativas de los consumidores, sino también inculcarles el placer de consumir, utilizando elementos simbólicos, afectivos y subjetivos. La argumentación teórica de este estudio, basada en la Psicología Social, sigue el siguiente camino: en primer lugar, busca comprender el proceso de colonización a través del consumo observando cómo afectan a los cuerpos y a las afecciones. A continuación, se analiza la compleja relación con lo que llamamos el extranjero, que puede tomar contornos colonizadores, pero también engendrar otras sensibilidades y formas de vincularse con el mundo. Al final del estudio, se verifica hasta qué punto el sujeto contemporáneo está colonizado por las promesas mediáticas de felicidad, satisfacción y placer que se proclaman de manera idealizada en las campañas publicitarias a favor del consumo. Esto pone a la Psicología Social el desafío de dar visibilidad a los procesos de colonización, analizando críticamente los efectos estéticos, afectivos, económicos y políticos generados para la población y para el planeta.
Assuntos
Humanos , Psicologia Social , Fatores Socioeconômicos , Corpo Humano , Comportamento do Consumidor , Capitalismo , Política , AfetoRESUMO
Background: Sarcopenia is related to morbidity and mortality in non-dialysis Chronic Kidney Disease (ND-CKD) patients; however, the pathophysiology of sarcopenia remains unclear. The study aimed to assess the prevalence and factors associated with sarcopenia in ND-CKD individuals. Methods: We cross-sectionally evaluated 139 prevalent ND-CKD patients attending our outpatient clinic at Hospital das Clínicas of the Federal University of Pernambuco, between April and October 2019. Patients older than 18 years old and at G3-G5 CKD stages were included. Hand grip strength, Muscle Mass appendicular Index, and Gait Speed (GS) were defined by the standards of the European Working Group on Sarcopenia in Older People 2 guideline. Results: Sarcopenia prevalence was 20.9% and severe sarcopenia 2.9%. Sarcopenic were mostly found in elderly ones (64.8 ± 13.5 years vs. 54.9 ± 12.8 years, p < 0.001), revealing lower body mass index [26.1 (6.8) vs. 28.6 (6.2), p = 0.023], lower phase angle (PhA) [4.50 (1.10) vs. 5.60 (1.20), p < 0.001] and lower GS [1.00 (0.50) vs. 1.40 (0.4), p < 0.001]. They also presented lower serum creatinine levels [2.40 (1.50) vs. 3.0 (1.8), p = 0.032], lower Albumin-to-Creatinine Ratio [72.60 (1008.30) vs. 342.30 (1172.1), p = 0.039] and Hemoglobin levels [11.45 (1.8) vs. 12.60 (2.40), p = 0.003], and higher levels of C-reactive protein [0.2 (0.80) vs. 0.03 (0.3), p = 0.045] compared to non-sarcopenic. Under Poisson Multivariate Model, PhA [Relative precision (RP): 0.364, Confidence Interval (CI) (95%):0.259-0.511, p < 0.001], Interleukin six (IL-6) [RP: 1.006, CI (95%):1.001-1.01, p = 0.02] and serum creatinine levels [RP: 0.788, CI (95%): 0.641-0.969, p = 0.024] were associated with sarcopenia. Conclusions: Sarcopenia predominance was identified in our ND-CKD population, and was associated with lower PhA values, higher IL-6 levels, and lower serum creatinine levels.
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Abstract Objective To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Methods Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic's medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children's data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. Results Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. Conclusion Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.
Resumo Objetivo Analisar os resultados clínicos históricos de crianças commielomeningocele (MMC) com critérios para cirurgia fetal,mas que foram submetidas a cirurgia pós-natal. Métodos Dados de crianças submetidas à correção deMMCpós-natal entre janeiro de 1995 e janeiro de 2015 foram coletados nos prontuários do Ambulatório de Neurocirurgia. Foram incluídas crianças se tivessem ≥ 1 ano de acompanhamento pósoperatório e atendessem os critérios para cirurgia fetal. As informações dessas crianças foram então estratificadas de acordo com se receberam ou não derivação do líquido cefalorraquidiano. O desfecho primário foi a mortalidade e os desfechos secundários foram atrasos educacionais, hospitalização, infecções recorrentes do trato urinário einsuficiência renal. Resultados Durante o período de 20 anos, 231 crianças com MMC foram acompanhadas. Com base nos dados clínicos registrados no momento do nascimento, 165 (71,4%) atendiam critérios para a cirurgia fetal. Dos 165 pacientes, 136 (82,4%) foram submetidos à colocação de derivação do líquido cefalorraquidiano. A taxa de mortalidade foi de 5,1% no grupo com derivação do líquido cefalorraquidiano e 0% no grupo sem risco relativo (RR) 3,28 (intervalo de confiança 95%, IC 95%, 0,19-55,9). Os RRs estatisticamente significativos para resultados adversos no grupo com derivação do líquido cefalorraquidiano foram 1,86 (IC 95%, 1,01-3,44) para infecção do trato urinário, 30 (IC 95%, 1,01-537) para insuficiência renal e 1,77 (IC 95%, 1,09-2,87) para hospitalizações. Conclusão Crianças com MMC com critérios para cirurgia fetal submetidas à colocação de derivação do líquido cefalorraquidiano eram mais propensas a ter infecções recorrentes do trato urinário, desenvolver insuficiência renal e serem hospitalizadas. Como aproximadamente metade dos procedimentos de derivação poderiam ser evitados por cirurgia fetal, há um benefício clínico e um possível benefício financeiro com a implementação dessa tecnologia em nosso meio.
Assuntos
Humanos , Pré-Escolar , Derivações do Líquido Cefalorraquidiano , Disrafismo Espinal , Meningomielocele , Feto/cirurgiaRESUMO
OBJECTIVE: To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. METHODS: Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic's medical records. Children were included if they had ≥ 1 year of postoperative follow-up and met the criteria for fetal surgery. The children's data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. RESULTS: Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. CONCLUSION: Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.
OBJETIVO: Analisar os resultados clínicos históricos de crianças com mielomeningocele (MMC) com critérios para cirurgia fetal, mas que foram submetidas a cirurgia pós-natal. MéTODOS: Dados de crianças submetidas à correção de MMC pós-natal entre janeiro de 1995 e janeiro de 2015 foram coletados nos prontuários do Ambulatório de Neurocirurgia. Foram incluídas crianças se tivessem ≥ 1 ano de acompanhamento pós-operatório e atendessem os critérios para cirurgia fetal. As informações dessas crianças foram então estratificadas de acordo com se receberam ou não derivação do líquido cefalorraquidiano. O desfecho primário foi a mortalidade e os desfechos secundários foram atrasos educacionais, hospitalização, infecções recorrentes do trato urinário e insuficiência renal. RESULTADOS: Durante o período de 20 anos, 231 crianças com MMC foram acompanhadas. Com base nos dados clínicos registrados no momento do nascimento, 165 (71,4%) atendiam critérios para a cirurgia fetal. Dos 165 pacientes, 136 (82,4%) foram submetidos à colocação de derivação do líquido cefalorraquidiano. A taxa de mortalidade foi de 5,1% no grupo com derivação do líquido cefalorraquidiano e 0% no grupo sem risco relativo (RR) 3,28 (intervalo de confiança 95%, IC 95%, 0,1955,9). Os RRs estatisticamente significativos para resultados adversos no grupo com derivação do líquido cefalorraquidiano foram 1,86 (IC 95%, 1,013,44) para infecção do trato urinário, 30 (IC 95%, 1,01537) para insuficiência renal e 1,77 (IC 95%, 1,092,87) para hospitalizações. CONCLUSãO: Crianças com MMC com critérios para cirurgia fetal submetidas à colocação de derivação do líquido cefalorraquidiano eram mais propensas a ter infecções recorrentes do trato urinário, desenvolver insuficiência renal e serem hospitalizadas. Como aproximadamente metade dos procedimentos de derivação poderiam ser evitados por cirurgia fetal, há um benefício clínico e um possível benefício financeiro com a implementação dessa tecnologia em nosso meio.
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Hidrocefalia , Meningomielocele , Insuficiência Renal , Brasil , Criança , Feminino , Humanos , Hidrocefalia/complicações , Masculino , Meningomielocele/cirurgia , Estudos RetrospectivosRESUMO
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, which induces a high release of pro-inflammatory chemokines and cytokines, leading to severe systemic disorders. Further, evidence has shown that recovered COVID-19 patients still have some symptoms and disorders from COVID-19. Physical exercise can have many health benefits. It is known to be a potent regulator of the immune system, which includes frequency, intensity, duration, and supervised by a professional. Given the confinement and social isolation or hospitalization of COVID-19 patients, the population became sedentary or opted for physical exercise at home, assuming the guarantee of the beneficial effects of physical exercise and reducing exposure to SARS-CoV-2. This study aimed to investigate the effects of a supervised exercise protocol and a home-based unsupervised exercise protocol on chemokine and cytokine serum levels in recovered COVID-19 patients. This study was a prospective, parallel, two-arm clinical trial. Twenty-four patients who had moderate to severe COVID-19 concluded the intervention protocols of this study. Participants were submitted to either supervised exercise protocol at the Clinical Hospital of the Federal University of Pernambuco or home-based unsupervised exercise for 12 weeks. We analyzed serum levels of chemokines (CXCL8/IL-8, CCL5/RANTES, CXCL9/MIG, CCL2/MCP-1, and CXCL10/IP-10) and cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, TNF-α, and IFN-γ). Before the interventions, no significant differences were observed in the serum levels of chemokines and cytokines between the supervised and home-based unsupervised exercise groups. The CXCL8/IL-8 (p = 0.04), CCL2/MCP-1 (p = 0.03), and IFN-γ (p = 0.004) levels decreased after 12 weeks of supervised exercise. In parallel, an increase in IL-2 (p = 0.02), IL-6 (p = 0.03), IL-4 (p = 0.006), and IL-10 (p = 0.04) was observed after the supervised protocol compared to pre-intervention levels. No significant differences in all the chemokines and cytokines were found after 12 weeks of the home-based unsupervised exercise protocol. Given the results, the present study observed that supervised exercise was able to modulate the immune response in individuals with post-COVID-19, suggesting that supervised exercise can mitigate the inflammatory process associated with COVID-19 and its disorders. Clinical trial registration: https://ensaiosclinicos.gov.br/rg/RBR-7z3kxjk, identifier U1111-1272-4730.