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1.
Rev. Bras. Odontol. Leg. RBOL ; 10(3): 12-22, 2023-12-30.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1532854

RESUMO

Introdução: Atualmente no Brasil têm-se evidenciado um número elevado de profissionais da Odontologia que utilizam diversas estratégias de marketing para garantir e atrair clientela, como as publicações nas redes sociais, que tem ocasionado um aumento significativo de infrações éticas cometidas por cirurgiões-dentistas. Objetivo: Analisar infrações éticas atreladas à publicidade e propaganda em perfis de cirurgiões-dentistas e clínicas odontológicas do estado da Paraíba na rede social Instagram®. Metodologia: O estudo observacional, transversal, descritivo foi realizado a partir da análise de 572 perfis. Foram avaliadas postagens públicas à luz do Código de Ética Odontológico (CEO) e da Resolução CFO nº 196/2019. Buscaram-se perfis abertos por meio dos termos chaves: "clínica odontológica", "dental", "dentista", "Odontologia" combinados com: "Paraíba", "PB". Resultados: A partir da análise dos itens de investigação verificou-se algum tipo de violação ética ao CEO e/ou Resolução na maioria dos perfis. Os itens com maiores índices de infração estiveram relacionados a postagens com a exibição do termo "diagnóstico x conclusão" sem menção do Termo de Consentimento Livre e Esclarecido e de vídeos e/ou imagens com conteúdo relativo ao transcurso do procedimento. Conclusão: É evidente que a maioria dos perfis analisados no presente estudo infringiu de alguma forma a ética quanto à publicidade e propaganda. Nessa perspectiva, é necessário que haja uma maior orientação e fiscalização por parte do conselho, bem como que os profissionais estejam atentos e façam cumprir os preceitos éticos estabelecidos pelo CEO, zelando assim, pelo bom prestígio da profissão


Introduction: Currently in Brazil, it has been evidenced a high number of dental professionals who use various marketing strategies to ensure and attract customers, such as publications on social networks, which has caused a significant increase in ethical violations committed by dentists. Objective: To analyze ethical violations linked to advertising and propaganda in profiles of dentists and dental clinics in the state of Paraíba in the social network Instagram®. Methodology: The observational, cross-sectional, descriptive study was conducted from the analysis of 572 profiles. Public posts were evaluated in the light of the Code of Dental Ethics (CEO) and CFO Resolution No. 196/2019. Open profiles were searched using the key terms: "dental clinic", "dental", "dentist", "Dentistry" combined with: "Paraíba", "PB". Results: From the analysis of the research items there was some type of ethical violation of the CEO and/or Resolution in most of the profiles. The items with the highest rates of violation were related to posts with the display of the term "diagnosis x conclusion" without mention of the Informed Consent Form and videos and/or images with content related to the course of the procedure. Conclusion: It is clear that most of the profiles analyzed in this study have somehow infringed ethics regarding advertising and propaganda. In this perspective, it is necessary that there is greater guidance and supervision by the council and those professionals are aware and enforce the ethical precepts established by the CEO, thus ensuring the good prestige of the profession.

2.
Life (Basel) ; 13(5)2023 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-37240820

RESUMO

INTRODUCTION: Intestinal neuronal dysplasia type B (IND-B) is a controversial entity that affects the submucosal nerve plexus of the distal intestine. The lack of definition of the causal relationship between histological findings and clinical symptoms has been identified as the primary point to be elucidated in the scientific investigation related to IND-B, which is essential for it to be considered a disease. OBJECTIVE: To investigate the relationship between histopathological findings and symptoms in a series of patients with IND-B. METHODS: Twenty-seven patients with histopathological diagnosis of IND-B, according to the Frankfurt Consensus (1990), who underwent surgical treatment through colorectal resections were included. Data from medical records regarding the clinical picture of the patients at the time of diagnosis, including the intestinal symptom index (ISI) and a detailed histopathological analysis of the rectal specimens, were retrieved. Exploratory factor analysis was performed, applying the principal components method for clusters with Varimax rotation. RESULTS: Two factors were determined: the first, determined by histopathological and clinical variables, and the second, composed of the main symptoms presented in patients with IND-B, including ISI. Factorial rotation showed the association between the two factors and, through a graph, demonstrated the proximity between ISI values and histopathological alterations. CONCLUSION: There was evidence of an association between the clinical features presented by patients with IND-B and the histopathological findings of the rectal samples. These results support the understanding of IND-B as a disease.

3.
J Intensive Care Med ; 38(8): 751-759, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36939479

RESUMO

BACKGROUND: It is known that patients with COVID-19 are at high risk of developing delirium. The aim of the study was to compare the incidence of delirium between critically ill patients with and without a diagnosis of COVID-19. METHODS: This is a retrospective study conducted in a southern Brazilian hospital from March 2020 to January 2021. Patients were divided into two groups: the COVID-19 group consisted of patients with a diagnosis of COVID-19 confirmed by reverse transcription-polymerase chain reaction (RT-PCR) or serological tests who were admitted to specific ICUs. The non-COVID-19 group consisted of patients with other surgical and medical diagnoses who were admitted to non-COVID ICUs. All patients were evaluated daily using the Intensive Care Delirium Screening Checklist (ICDSC). The two cohorts were compared in terms of the diagnosis of delirium. RESULTS: Of the 649 patients who remained more than 48 h in the ICU, 523 were eligible for the study (COVID-19 group: 292, non-COVID-19 group: 231). There were 119 (22.7%) patients who had at least one episode of delirium, including 96 (32.9%) in the COVID-19 group and 23 (10.0%) in the non-COVID-19 group (odds ratio [OR] 4.42; 95% confidence interval [CI], 2.69 to 7.26; p < 0.001). Among patients mechanically ventilated for two days or more, the incidence of delirium did not differ between groups (COVID-19: 89/211, 42.1% vs non-COVID-19: 19/47, 40.4%; p = 0.82). Logistic regression showed that the duration of mechanical ventilation was the only independent factor associated with delirium (p = 0.001). CONCLUSION: COVID-19 can be associated with a higher incidence of delirium among critically ill patients, but there was no difference in this incidence between groups when mechanical ventilation lasted two days or more.


Assuntos
COVID-19 , Delírio , Humanos , Delírio/epidemiologia , Delírio/etiologia , Delírio/diagnóstico , Estudos Retrospectivos , Estado Terminal , Incidência , COVID-19/complicações , COVID-19/epidemiologia , Unidades de Terapia Intensiva , Respiração Artificial
4.
Cureus ; 15(12): e50618, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38226135

RESUMO

BACKGROUND: Although the signs and symptoms that comprise the clinical presentation of Hirschsprung disease (HD) and intestinal neuronal dysplasia type B (IND-B) are well established, no studies have specifically compared the clinical characteristics presented by patients with these diseases. We compared the clinical pictures of patients with HD and IND-B at the time of histopathological diagnosis. METHODS: This was a single-center, retrospective, analytical, and comparative study. We included 119 patients aged 0-15 years diagnosed with HD or IND-B. Information from the medical records of these patients was retrieved to obtain demographic and clinical information at the time of diagnosis. The data were compared statistically according to the characteristics of the variables. RESULTS: Sixty-nine patients (58.0%) were diagnosed with HD, and 50 (42.0%) had IND-B. The HD group had significantly more individuals with symptom onset in the neonatal period (p = 0.001), delayed meconium clearance (p < 0.001), failure to thrive (p = 0.02), and acute complications, such as enterocolitis (p = 0.049) or acute abdominal obstruction (p = 0.031), more commonly requiring emergency surgery (p < 0.001). Patients with IND-B were diagnosed at a significantly older age (p = 0.002). They more commonly had chronic constipation as their main symptom (p = 0.004), with local complications, such as evacuation bleeding (p = 0.007). CONCLUSION: There were significant differences between the clinical pictures of patients with HD and IND-B. Knowledge of each disease's most common signs and symptoms can help direct diagnostic susception and initial management.

5.
World J Gastroenterol ; 27(44): 7649-7660, 2021 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-34908804

RESUMO

Intestinal neuronal dysplasia type B (IND-B) is a controversial condition among gastrointestinal neuromuscular disorders. Constipation is its most common clinical manifestation in patients. Despite intense scientific research, there are still knowledge gaps regarding the diagnostic criteria for IND-B in the histopathological analysis of rectal biopsies. The guidelines published in the past three decades have directed diagnostic criteria for quantifying the number of ganglion cells in the nervous plexus of the enteric nervous system. However, it is very complex to distinguish numerically what is pathological from what is normal, mainly because of the difficulty in determining a reliable control group composed of healthy children without intestinal symptoms. Thus, a series of immunohistochemical markers have been proposed to assist in the histopathological analysis of the enteric nervous system. Several of these markers facilitate the identification of other structures of the enteric nervous system, in addition to ganglion cells. These structures may be related to the etiopathogenesis of IND-B and represent new possibilities for the histopathological diagnosis of this disease, providing a view beyond the number of ganglion cells. This review critically discusses the aspects related to the disease definitions and diagnostic criteria of this organic cause of constipation.


Assuntos
Sistema Nervoso Entérico , Doença de Hirschsprung , Enteropatias , Constipação Intestinal/etiologia , Humanos , Intestinos
6.
BMC Infect Dis ; 21(1): 1022, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587909

RESUMO

BACKGROUND: Cardiac autonomic dysfunction in HIV+ patients on different antiretroviral therapy (ART) regimens has been described. We aimed to characterize parameters of heart rate variability (HRV) and correlate with different classes of ART in HIV+ patients in three experimental conditions: rest, cold face, and tilt tests. METHODS: Cross-sectional study with three groups of age- and gender-matched individuals: group 1, 44 HIV+ patients undergoing combination therapy, with two nucleoside reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI); group 2, 42 HIV+ patients using two NRTI and protease inhibitors (PI's); and group 3, 35 healthy volunteers with negative HIV serology (control group). Autonomic function at rest and during cold face- and tilt-tests was assessed through computerized analysis of HRV, via quantification of time- and frequency domains by linear and non-linear parameters in the three groups. RESULTS: Anthropometric and clinical parameters were similar between both HIV groups, except CD4+ T lymphocytes, which were significantly lower in group 2 (p = 0.039). At baseline, time-domain linear HRV parameters, RMSSD and pNN50, and the correlation dimension, a non-linear HRV parameter (p < 0.001; p = 0.018; p = 0.019, respectively), as well as response of RMSSD to cold face test were also lower in the HIV+ group than in the control individuals (p < 0.001), while no differences among groups were detected in HRV parameters during the tilt test. CONCLUSIONS: Despite ART regimens, HIV+ patients presented lower cardiac vagal modulation than controls, whereas no difference was observed among the HIV groups, suggesting that higher cardiovascular risk linked to PIs may be associated with factors other than autonomic dysfunction.


Assuntos
Infecções por HIV , Sistema Nervoso Autônomo , Estudos Transversais , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Frequência Cardíaca , Humanos , Inibidores da Transcriptase Reversa/uso terapêutico
7.
Rev Bras Ter Intensiva ; 33(1): 1-11, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33886849

RESUMO

OBJECTIVE: To contribute to updating the recommendations for brain-dead potential organ donor management. METHODS: A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, answered questions related to the following topics were divided into mechanical ventilation, hemodynamics, endocrine-metabolic management, infection, body temperature, blood transfusion, and checklists use. The outcomes considered were cardiac arrests, number of organs removed or transplanted as well as function / survival of transplanted organs. The quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system to classify the recommendations. RESULTS: A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong, 11 as weak and 1 was considered a good clinical practice. CONCLUSION: Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak.


OBJETIVO: Fornecer recomendações para nortear o manejo clínico do potencial doador em morte encefálica. MÉTODOS: O presente documento foi formulado em dois painéis compostos por uma força tarefa integrada por 27 especialistas de diferentes áreas que responderam a questões dirigidas aos seguintes temas: ventilação mecânica, hemodinâmica, suporte endócrino-metabólico, infecção, temperatura corporal, transfusão sanguínea, e uso de checklists. Os desfechos considerados foram: parada cardíaca, número de órgãos retirados ou transplantados e função/sobrevida dos órgãos transplantados. A qualidade das evidências das recomendações foi avaliada pelo sistema Grading of Recommendations Assessment, Development, and Evaluation. RESULTADOS: Foram geradas 19 recomendações a partir do painel de especialistas. Dessas, 7 foram classificadas como fortes, 11 fracas e uma foi considerada boa prática clínica. CONCLUSÃO: Apesar da concordância entre os membros do painel em relação à maior parte das recomendações, o grau de recomendação é fraco em sua maioria.


Assuntos
Morte Encefálica , Cuidados Críticos , Encéfalo , Humanos , Respiração Artificial , Doadores de Tecidos
8.
Chest ; 160(1): 148-156, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33676997

RESUMO

BACKGROUND: The resting of the respiratory musculature after undergoing the spontaneous breathing trial (SBT) to prevent extubation failures in critically ill patients needs to be studied further. RESEARCH QUESTION: Is the reconnection to mechanical ventilation (MV) for 1 h after a successful SBT able to reduce the risk of reintubation? STUDY DESIGN AND METHODS: Randomized clinical trial conducted in four ICUs between August 2018 and July 2019. Candidates for tracheal extubation who met all screening criteria for weaning were included. After achieving success in the SBT using a T-tube, the patients were randomized to the following groups: direct extubation (DE) or extubation after reconnection to MV for 1 h (R1h). The primary outcome was reintubation within 48 h. RESULTS: Among the 336 patients studied (women, 41.1%; median age, 59 years [interquartile range, 45-70 years]), 12.9% (22/171) in the R1h group required reintubation within 48 h vs 18.2% (30/165) in the DE group (risk difference, 5.3 [95% CI, -2.49 to 13.12]; P = .18). No differences were found in mortality, length of ICU or hospital stay, causes of reintubation, or signs of extubation failure. A prespecified exploratory analysis showed that among the 233 patients (69.3%) who were ventilated for more than 72 h, the incidence of reintubation was 12.7% (15/118) in the R1h group compared with 22.6% (26/115) observed in the DE group (P = .04). INTERPRETATION: Reconnection to MV after a successful SBT, compared with DE, did not result in a statistically significant reduction in the risk of reintubation in mechanically ventilated patients. Subgroup exploratory findings suggest that the strategy may benefit patients who were ventilated for more than 72 h, which should be confirmed in further studies. TRIAL REGISTRY: Brazilian Clinical Trials Registry; No.: RBR-3x8nxn; URL: www.ensaiosclinicos.gov.br.


Assuntos
Extubação/métodos , Estado Terminal/terapia , Intubação Intratraqueal/métodos , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Desmame do Respirador/métodos , Adulto , Idoso , Brasil/epidemiologia , Estado Terminal/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/fisiopatologia , Fatores de Tempo
9.
Rev. bras. ter. intensiva ; 33(1): 1-11, jan.-mar. 2021. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1289064

RESUMO

RESUMO Objetivo: Fornecer recomendações para nortear o manejo clínico do potencial doador em morte encefálica. Métodos: O presente documento foi formulado em dois painéis compostos por uma força tarefa integrada por 27 especialistas de diferentes áreas que responderam a questões dirigidas aos seguintes temas: ventilação mecânica, hemodinâmica, suporte endócrino-metabólico, infecção, temperatura corporal, transfusão sanguínea, e uso de checklists. Os desfechos considerados foram: parada cardíaca, número de órgãos retirados ou transplantados e função/sobrevida dos órgãos transplantados. A qualidade das evidências das recomendações foi avaliada pelo sistema Grading of Recommendations Assessment, Development, and Evaluation. Resultados: Foram geradas 19 recomendações a partir do painel de especialistas. Dessas, 7 foram classificadas como fortes, 11 fracas e uma foi considerada boa prática clínica. Conclusão: Apesar da concordância entre os membros do painel em relação à maior parte das recomendações, o grau de recomendação é fraco em sua maioria.


Abstract Objective: To contribute to updating the recommendations for brain-dead potential organ donor management. Methods: A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, answered questions related to the following topics were divided into mechanical ventilation, hemodynamics, endocrine-metabolic management, infection, body temperature, blood transfusion, and checklists use. The outcomes considered were cardiac arrests, number of organs removed or transplanted as well as function / survival of transplanted organs. The quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system to classify the recommendations. Results: A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong, 11 as weak and 1 was considered a good clinical practice. Conclusion: Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak.


Assuntos
Humanos , Morte Encefálica , Cuidados Críticos , Respiração Artificial , Doadores de Tecidos , Encéfalo
10.
Ann Intensive Care ; 10(1): 169, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33315161

RESUMO

OBJECTIVE: To contribute to updating the recommendations for brain-dead potential organ donor management. METHOD: A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, joined a task force formed by the General Coordination Office of the National Transplant System/Brazilian Ministry of Health (CGSNT-MS), the Brazilian Association of Intensive Care Medicine (AMIB), the Brazilian Association of Organ Transplantation (ABTO), and the Brazilian Research in Intensive Care Network (BRICNet). The questions were developed within the scope of the 2011 Brazilian Guidelines for Management of Adult Potential Multiple-Organ Deceased Donors. The topics were divided into mechanical ventilation, hemodynamic support, endocrine-metabolic management, infection, body temperature, blood transfusion, and use of checklists. The outcomes considered for decision-making were cardiac arrest, number of organs recovered or transplanted per donor, and graft function/survival. Rapid systematic reviews were conducted, and the quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Two expert panels were held in November 2016 and February 2017 to classify the recommendations. A systematic review update was performed in June 2020, and the recommendations were reviewed through a Delphi process with the panelists between June and July 2020. RESULTS: A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong (lung-protective ventilation strategy, vasopressors and combining arginine vasopressin to control blood pressure, antidiuretic hormones to control polyuria, serum potassium and magnesium control, and antibiotic use), 11 as weak (alveolar recruitment maneuvers, low-dose dopamine, low-dose corticosteroids, thyroid hormones, glycemic and serum sodium control, nutritional support, body temperature control or hypothermia, red blood cell transfusion, and goal-directed protocols), and 1 was considered a good clinical practice (volemic expansion). CONCLUSION: Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak. The observed lack of robust evidence on the topic highlights the importance of the present guideline to improve the management of brain-dead potential organ donors.

11.
Rev. bras. cir. plást ; 35(4): 420-426, out.dez.2020. ilus
Artigo em Inglês, Português | LILACS-Express | LILACS | ID: biblio-1367924

RESUMO

Introdução: As queimaduras são um grave problema de saúde pública. O conhecimento dos principais dados epidemiológicos dos pacientes acometidos é de suma importância para a prevenção e instituição do melhor tratamento clínico a esses indivíduos. Objetivou-se realizar um levantamento sobre o perfil epidemiológico das queimaduras, os principais mecanismos envolvidos, tratamentos e desfechos destes casos no Hospital de Clínicas da UFTM. Métodos: Trata-se de um estudo retrospectivo e transversal, das internações por queimadura no HC- UFTM, de janeiro de 2015 a dezembro de 2019. Foram avaliados: gênero, idade, profundidade das queimaduras, localização, etiologia, utilização de opioides, tempo de internação hospitalar, desfecho (alta hospitalar ou óbito) e extensão das áreas queimadas (SCQ%). Resultados: Este estudo foi composto por 138 pacientes, divididos em 3 grupos: grupo 1 (G1), 39 pacientes; o grupo 2 (G2), 89 participantes, dos quais 5 foram a óbito; e o grupo 3 (G3), 10 participantes, sendo que 4 vieram a óbito. Quanto ao mecanismo do trauma, o mais comum foi por escaldadura (17,39%), seguida pela queimadura térmica (13,76%), pelo álcool (8,69%) e queimaduras elétricas (5,79%). Conclusão: Houve uma maior prevalência de queimaduras de segundo grau em pacientes do gênero masculino. O mecanismo de trauma mais prevalente foi escaldadura e a SQC teve média de 23,9%. A face e o pescoço foram os segmentos mais acometidos e 61,59% dos pacientes necessitaram com uso de opioides na internação. Com relação ao desfecho, 91,30% dos pacientes receberam alta hospitalar e 6,52% vieram a óbito, com a maioria dos casos no G2.


Introduction: Burns are a serious public health problem. Knowledge of the main epidemiological data of affected patients is paramount for preventing and establishing the best clinical treatment for these individuals. The objective was to survey the epidemiological profile of burns, the main mechanisms involved, treatments, and outcomes of these cases at the Hospital de Clínicas da UFTM. Methods: This is a retrospective and cross-sectional study of hospitalizations for burns at HC-UFTM from January 2015 to December 2019. Gender, age, depth of burns, location, etiology, use of opioids, hospitalization duration, outcome (hospital discharge or death), and extent of burned areas (EBA%). Results: This study was composed of 138 patients, divided into three groups: group 1 (G1), 39 patients; group 2 (G2), 89 participants, of which 5 died; and group 3 (G3), 10 participants, 4 of whom died. As for the trauma mechanism, the most common was scald (17.39%), followed by thermal burn (13.76%), alcohol (8.69%), and electric burns (5.79%). Conclusion: There was a higher prevalence of second-degree burns in male patients. The most prevalent mechanism of trauma was scald, and the EBA had an average of 23.9%. The face and neck were the most affected segments, and 61.59% of the patients required opioids during hospitalization. Regarding the outcome, 91.30% of patients were discharged from the hospital, and 6.52% died, with most cases in G2.

12.
J Bras Nefrol ; 42(2 suppl 1): 22-31, 2020 08 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877495

RESUMO

We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.


Assuntos
Injúria Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/normas , Dispositivos de Acesso Vascular/normas , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Brasil/epidemiologia , COVID-19 , Tomada de Decisão Clínica , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos , Humanos , Rim/efeitos dos fármacos , Nefrologia/normas , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/prevenção & controle , Recuperação de Função Fisiológica , Terapia de Substituição Renal/métodos , Respiração Artificial/efeitos adversos , SARS-CoV-2 , Sociedades Médicas
13.
EBioMedicine ; 51: 102571, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31911274

RESUMO

BACKGROUND: A pathophysiological link exists between dysregulation of MEF2C transcription factors and heart failure (HF), but the underlying mechanisms remain elusive. Alternative splicing of MEF2C exons α, ß and γ provides transcript diversity with gene activation or repression functionalities. METHODS: Neonatal and adult rat ventricular myocytes were used to overexpress MEF2C splicing variants γ+ (repressor) or γ-, or the inactive MEF2Cγ+23/24 (K23T/R24L). Phenotypic alterations in cardiomyocytes were determined by confocal and electron microscopy, flow cytometry and DNA microarray. We used transgenic mice with cardiac-specific overexpression of MEF2Cγ+ or MEF2Cγ- to explore the impact of MEF2C variants in cardiac phenotype. Samples of non-infarcted areas of the left ventricle from patients and mouse model of myocardial infarction were used to detect the expression of MEF2Cγ+ in failing hearts. FINDINGS: We demonstrate a previously unrealized upregulation of the transrepressor MEF2Cγ+ isoform in human and mouse failing hearts. We show that adenovirus-mediated overexpression of MEF2Cγ+ downregulates multiple MEF2-target genes, and drives incomplete cell-cycle reentry, partial dedifferentiation and apoptosis in the neonatal and adult rat. None of these changes was observed in cardiomyocytes overexpressing MEF2Cγ-. Transgenic mice overexpressing MEF2Cγ+, but not the MEF2Cγ-, developed dilated cardiomyopathy, correlated to cell-cycle reentry and apoptosis of cardiomyocytes. INTERPRETATION: Our results provide a mechanistic link between MEF2Cγ+ and deleterious abnormalities in cardiomyocytes, supporting the notion that splicing dysregulation in MEF2C towards the selection of the MEF2Cγ+ variant contributes to the pathogenesis of HF by promoting cardiomyocyte dropout. FUNDING: São Paulo Research Foundation (FAPESP); Brazilian National Research Council (CNPq).


Assuntos
Ciclo Celular/genética , Regulação da Expressão Gênica , Predisposição Genética para Doença , Variação Genética , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/metabolismo , Processamento Alternativo , Animais , Apoptose/genética , Modelos Animais de Doenças , Estudos de Associação Genética , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Fatores de Transcrição MEF2/genética , Camundongos , Camundongos Transgênicos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/ultraestrutura , Ratos
14.
Rev Col Bras Cir ; 46(2): e2104, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31017178

RESUMO

OBJECTIVE: to investigate the main causes and most common risk situations related to childhood accidents, in our local reality. METHODS: an observational, cross-sectional, retrospective, descriptive, and analytical study from the medical records of patients attended in the pediatric emergency services of the hospital complex of Hospital das Clínicas, Botucatu Medical School - UNESP, in 2016. We included patients from zero to 15 years old who had received medical care related to accidents, determining age, gender, type of accident, period of the day, accident place, and history of previous accidents. RESULTS: considering all consultations with appropriate medical records, 936 (27.5%) were related to accidents: 588 (62.8%) in male patients and 348 (37.2%) in female patients. As to age, 490 (52.3%) happened with children from zero to five years, 245 (26.2%) with children from six to ten years, and 201 (21.5%) with children over ten years. Falls and local traumas were the most common types of accidents in all analyzed age groups. Most accidents occurred in the afternoon (46.1%), at home (60.7%), and 26.6% of the patients had a history of previous accidents. CONCLUSION: accidents were responsible for a large portion of urgent care. The high rate of patients with previous accident records indicated the repeated exposure of these children to risk situations.


OBJETIVO: investigar as principais causas e situações de risco mais comuns relacionadas aos acidentes na infância, em nossa realidade local. MÉTODOS: estudo observacional, transversal, retrospectivo, descritivo e analítico, a partir dos prontuários médicos de pacientes atendidos nos serviços de urgências pediátricas do complexo hospitalar do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP, no ano de 2016. Foram incluídos os atendimentos de pacientes de zero a 15 anos de idade que haviam recebido atendimento médico relacionado a acidentes, determinando-se idade, sexo, tipo de acidente, período do dia e ambiente onde aconteceu o acidente e histórico de acidentes pregressos. RESULTADOS: do total de atendimentos com registros adequados no prontuário, 936 (27,5%) estavam relacionados a acidentes: 588 (62,8%) em pacientes do sexo masculino e 348 (37,2%) em pacientes do sexo feminino. Quanto à idade, 490 (52,3%) acidentes ocorreram com crianças de zero a cinco anos, 245 (26,2%) com crianças de seis a dez anos e 201 (21,5%) com crianças com mais de dez anos de idade. Quedas e traumas locais foram os tipos de acidentes mais comuns em todas as faixas etárias analisadas. A maior parte dos acidentes ocorreu à tarde (46,1%), em casa (60,7%), e 26,6% dos pacientes apresentavam antecedentes de acidentes prévios. CONCLUSÃO: os acidentes foram responsáveis por grande parcela dos atendimentos de urgência. A elevada taxa de pacientes com registros de acidentes prévios indica a exposição repetida destas crianças às situações de risco.


Assuntos
Acidentes/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Distribuição por Idade , Brasil/epidemiologia , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Registros Médicos , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Centros de Atenção Terciária/estatística & dados numéricos
15.
Rev. Col. Bras. Cir ; 46(2): e2104, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1003085

RESUMO

RESUMO Objetivo: investigar as principais causas e situações de risco mais comuns relacionadas aos acidentes na infância, em nossa realidade local. Métodos: estudo observacional, transversal, retrospectivo, descritivo e analítico, a partir dos prontuários médicos de pacientes atendidos nos serviços de urgências pediátricas do complexo hospitalar do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP, no ano de 2016. Foram incluídos os atendimentos de pacientes de zero a 15 anos de idade que haviam recebido atendimento médico relacionado a acidentes, determinando-se idade, sexo, tipo de acidente, período do dia e ambiente onde aconteceu o acidente e histórico de acidentes pregressos. Resultados: do total de atendimentos com registros adequados no prontuário, 936 (27,5%) estavam relacionados a acidentes: 588 (62,8%) em pacientes do sexo masculino e 348 (37,2%) em pacientes do sexo feminino. Quanto à idade, 490 (52,3%) acidentes ocorreram com crianças de zero a cinco anos, 245 (26,2%) com crianças de seis a dez anos e 201 (21,5%) com crianças com mais de dez anos de idade. Quedas e traumas locais foram os tipos de acidentes mais comuns em todas as faixas etárias analisadas. A maior parte dos acidentes ocorreu à tarde (46,1%), em casa (60,7%), e 26,6% dos pacientes apresentavam antecedentes de acidentes prévios. Conclusão: os acidentes foram responsáveis por grande parcela dos atendimentos de urgência. A elevada taxa de pacientes com registros de acidentes prévios indica a exposição repetida destas crianças às situações de risco.


ABSTRACT Objective: to investigate the main causes and most common risk situations related to childhood accidents, in our local reality. Methods: an observational, cross-sectional, retrospective, descriptive, and analytical study from the medical records of patients attended in the pediatric emergency services of the hospital complex of Hospital das Clínicas, Botucatu Medical School - UNESP, in 2016. We included patients from zero to 15 years old who had received medical care related to accidents, determining age, gender, type of accident, period of the day, accident place, and history of previous accidents. Results: considering all consultations with appropriate medical records, 936 (27.5%) were related to accidents: 588 (62.8%) in male patients and 348 (37.2%) in female patients. As to age, 490 (52.3%) happened with children from zero to five years, 245 (26.2%) with children from six to ten years, and 201 (21.5%) with children over ten years. Falls and local traumas were the most common types of accidents in all analyzed age groups. Most accidents occurred in the afternoon (46.1%), at home (60.7%), and 26.6% of the patients had a history of previous accidents. Conclusion: accidents were responsible for a large portion of urgent care. The high rate of patients with previous accident records indicated the repeated exposure of these children to risk situations.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Ferimentos e Lesões/epidemiologia , Acidentes/estatística & dados numéricos , Brasil/epidemiologia , Maus-Tratos Infantis/estatística & dados numéricos , Registros Médicos , Estudos Transversais , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Distribuição por Idade , Estatísticas não Paramétricas , Serviços Médicos de Emergência/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos
16.
Textos contextos (Porto Alegre) ; 18(2): 348-361, 2019.
Artigo em Português | LILACS | ID: biblio-1087827

RESUMO

As projeções demográficas têm sinalizado a tendência nacional de ampliação no número relativo e absoluto de idosos. Nesse contexto, surgem diferentes abordagens políticas para justificar reformas do Estado brasileiro: por um lado, utiliza-se de argumentos estritamente quantitativos para justificar a redução das responsabilidades do Estado diante do envelhecimento e aumentar a responsabilização individual. Por outra perspectiva, a sustentabilidade é observada para além da questão puramente fiscal, inserindo a população idosa na agenda pública, como cidadã de direito e demandante de novas políticas públicas para o desenvolvimento na dimensão social. O objetivo deste artigo é oferecer elementos para a análise destas diferentes posições políticas acerca da sustentabilidade no Sistema de Seguridade Social brasileiro. Para tanto, além da breve revisão bibliográfica acerca do termo sustentabilidade, o estudo apresenta a trajetória e as perspectivas para a proteção social voltada aos idosos no Brasil.


Demographic projections have signaled the national tendency to increase the relative and absolute number of the elderly. In this context, different political approaches emerge to justify reforms of the Brazilian State: on one side strictly quantitative arguments are used to justify the reduction of state responsibilities face of aging and to increase individual accountability. On the other, the sustainability is observed beyond the purely fiscal issue, including the elderly population into the public agenda as citizen and demander of new public policies for development in the social dimension. The purpose of this article is to provide elements for the analysis of these different political positions on sustainability in the Brazilian Social Security System. Therefore, in addition to the brief bibliographical review about the term sustainability, the study presents the trajectory and perspectives for social protection aimed at the elderly in Brazil.


Assuntos
Humanos , Idoso , Assistência a Idosos , Previdência Social , Serviço Social , Envelhecimento , Reforma dos Serviços de Saúde , Política de Saúde
17.
Rev. bras. ter. intensiva ; 28(3): 220-255, jul.-set. 2016. tab
Artigo em Português | LILACS | ID: lil-796152

RESUMO

RESUMO O transplante de órgãos é a única alternativa para muitos pacientes portadores de algumas doenças terminais. Ao mesmo tempo, é preocupante a crescente desproporção entre a alta demanda por transplantes de órgãos e o baixo índice de transplantes efetivados. Dentre as diferentes causas que alimentam essa desproporção, estão os equívocos na identificação do potencial doador de órgãos e as contraindicações mal atribuídas pela equipe assistente. Assim, o presente documento pretende fornecer subsídios à equipe multiprofissional da terapia intensiva para o reconhecimento, a avaliação e a validação do potencial doador de órgãos.


ABSTRACT Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.


Assuntos
Humanos , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/métodos , Morte Encefálica , Transplante de Órgãos/métodos , Unidades de Terapia Intensiva
18.
Neuroepidemiology ; 46(4): 273-81, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27064414

RESUMO

BACKGROUND: Temporal trends on the incidence of stroke and its subtypes could help assess on-going public health policies and point to further targets for action among middle- and low-income countries, where the stroke burden is very high. This study aimed at evaluating longitudinal trends of stroke incidence in Joinville, Brazil. METHODS: We ascertained the incidence of all first-ever strokes occurred in 1995, 2005-2006 and 2012-2013, which were extracted from Joinville Stroke Registry, a prospective epidemiological data bank, launched in 1995. RESULTS: From 1995 to 2013, the age-adjusted incidence of all strokes decreased 37% (95% CI 32-42). From 2005 to 2013, the haemorrhagic stroke (HS) incidence decreased 60% (95% CI 13-86), ischemic stroke (IS) incidence decreased 15% (95% CI 1-28), and subarachnoid haemorrhage incidence remained stable. The proportion of IS and HS patients with regularly treated hypertension increased by 60% (p = 0.01) and 33% (p = 0.01), respectively. The proportion of IS and HS patients that quit smoking increased 8% (p = 0.03) and 17% (p = 0.03), respectively. CONCLUSIONS: Stroke incidence has been decreasing in Joinville over the last 18 years, more so for HS than IS. Better control of hypertension and tobacco use might explain these findings.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Adulto Jovem
19.
eNeurologicalSci ; 5: 1-6, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29430550

RESUMO

Groundbreaking results concerning ischemic stroke (IS) hyperacute treatment worldwide were published in 2014 and 2015. We aimed to compare functional status after 3 months in patients treated with intra-arterial thrombectomy (IAT) and those treated with intravenous thrombolysis (IVT) alone in Joinville, Brazil. From the Joinville Stroke Registry, we extracted and compared all consecutive IVT patients treated with r-tPA within 4.5 h in the period 2009-2011 versus all consecutive IAT treated within 6 h with the Solitaire FR device plus IVT in the period 2012-2014. We registered 82 patients in the IVT group and 31 patients in the IAT group. At hospital admission, patients in the IAT group were significantly younger (p < 0.001), had a higher educational level (p = 0.001), had a slightly higher prevalence of atrial fibrillation (p = 0.057) and had more severe strokes measured by the NIH stroke scale (p = 0.011). After 90 days, 45% of patients in the IAT group and 27% in the IVT group were independent (0-1 points) according to the modified Rankin scale (adjusted odds ratio: 4.53; 95% CI: 1.22 to 16.75). Symptomatic hemorrhage was diagnosed in 10% of patients in both groups (p = 1.0). The 90-day case-fatality was 39% (32/82) in the IVT group and 26% (8/31) in the IAT group (p = 0.27). In this small cohort, a greater rate of functional independence was achieved in patients treated with IAT plus IVT, compared with patients treated with IVT lysis alone. Our "real-world" findings are consistent with results of controlled, randomized clinical trials.

20.
Ciênc. cogn ; 20(2): 331-343, set. 2015. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1017174

RESUMO

Os diálogos produtivos ajudam significativamente no fomento da criatividade, que é requisitada pela indústria e muito relevante e evidente nos processos de projeto de interface. Assim, ensinar a ser criativo é um esforço importante na educação dos alunos envolvidos no estudo de interação humano- computador. Este trabalho destaca a importância da criatividade verbal, fornecendo evidências empíricas de que, quando os alunos se envolvem em discussões produtivas com outros estudantes, novas ideias, novos conhecimentos surgem, e se aprofundam. Neste trabalho foram realizados dois estudos de caso. No primeiro foram investigadas três turmas envolvidas no curso de computação gráfica. Os padrões de discurso produtivo que descrevem avanço do conhecimento quando os estudantes criticaram, mas também criaram a partir de ideias alheias. O segundo estudo de caso foi executado em seis turmas de um curso de interação humano-computador. Resultados de análise das mensagens online mostraram que alunos que fizeram uma melhor avaliação crítica, mas também criativa, relacionaram ideias e buscaram novas interpretações. Além disso, as interfaces desenvolvidas pelos alunos foram mais criativas


Productive dialogues help significantly in fostering creativity, which is required by the industry and very relevant and evident in the process of interfacedesign. Thus, taught to be creative is an important effort in educating the students involved in the study of human computer interaction. This work highlights the importance of verbal creativity, providing empirical evidence that when students engage in productive discussions with other students, new ideas, new knowledge emerge and deepen. In this paper two case studies were conducted. In the first three classes involved were investi gated in the course of computer graphics. Patterns of discourse production depicting the advancement of knowledge when students were involved critically, but creativelly on others' ideas. The second case study was performed in six classes involved in the course of human-computer interaction. Results from discourse analysis showed that students did critical but creative evaluation, also related new ideas and searched for new interpretations. Besiades, the interfaces developed by the students were more creative


Assuntos
Humanos , Criatividade , Aprendizagem
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