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2.
Artigo em Inglês | MEDLINE | ID: mdl-38655581

RESUMO

INTRODUCTION: This systematic review and meta-analysis aimed to compare the efficacy of dynamic versus standard bougies to achieve tracheal intubation. METHODS: We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus and Google Scholar on 10 October 2023. We included clinical trials comparing both devices. The primary outcome was the first-attempt intubation success rate. The secondary outcome was the time required for tracheal intubation. RESULTS: Eighteen studies were included. Dynamic bougies do not increase first-attempt success rate (RR 1.11; p = 0.06) or shorten tracheal intubation time (MD -0.30 sec; p = 0.84) in clinical trials in humans. In difficult airways, first-attempt success intubation rate was greater for dynamic bougies (RR 1.17; p = 0.002); Additionally, they reduced the time required for intubation (MD -4.80 sec; p = 0.001). First-attempt intubation success rate was higher (RR 1.15; p = 0.01) and time to achieve intubation was shorter when using Macintosh blades combined with dynamic bougies (MD -5.38 sec; p < 0.00001). Heterogeneity was high. CONCLUSION: Dynamic bougies do not increase the overall first-pass success rate or shorten tracheal intubation time. However, dynamic bougies seem to improve first-attempt tracheal intubation rate in patients with difficult airways and in those intubated with a Macintosh blade. Further research is needed for definitive conclusions. REGISTRATION OF PROSPERO: CRD42023472122.

3.
Artigo em Inglês | MEDLINE | ID: mdl-38492988

RESUMO

INTRODUCTION: There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening models in order to optimise the follow-up. METHODOLOGY: A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR). RESULTS: The overall CI by quarterly screening was 8.3 (95% CI: 7.6-9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68-0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5-0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73-0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32-0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25-0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24-0.42). CONCLUSIONS: The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.

4.
Artigo em Inglês | MEDLINE | ID: mdl-38340790

RESUMO

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

6.
Drug Des Devel Ther ; 18: 71-80, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38229917

RESUMO

Introduction: Nicotine is a major component of cigarette smoke with various detrimental cardiovascular effects, including increased oxidative stress in the heart. Agonism of α2-adrenergic receptors (ARs), such as with dexmedetomidine, has been documented to exert cardioprotective effects against oxidative stress and related apoptosis and necroptosis. α2-ARs are membrane-residing G protein-coupled receptors (GPCRs) that primarily activate Gi/o proteins. They are also subjected to GPCR-kinase (GRK)-2-dependent desensitization, which entails phosphorylation of the agonist-activated receptor by GRK2 to induce its decoupling from G proteins, thus terminating α2AR-mediated G protein signaling. Objective: In the present study, we sought to examine the effects of nicotine on α2AR signaling and effects in H9c2 cardiomyocytes exposed to H2O2 to induce oxidative cellular damage. Methods and Results: As expected, treatment of H9c2 cardiomyocytes with H2O2 significantly decreased cell viability and increased oxidative stress, as assessed by reactive oxygen species (ROS)-associated fluorescence levels (DCF assay) and superoxide dismutase activity. Both H2O2 effects were partly rescued by α2AR activation with brimonidine in control cardiomyocytes but not in cells pretreated with nicotine for 24 hours, in which brimonidine was unable to reduce H2O2-induced cell death and oxidative stress. This was due to severe α2AR desensitization, manifested as very low Gi protein activation by brimonidine, and accompanied by GRK2 upregulation in nicotine-treated cardiomyocytes. Finally, pharmacological inhibition of adenylyl cyclase (AC) blocked H2O2-dependent oxidative damage in nicotine-pretreated H9c2 cardiomyocytes, indicating that α2AR activation protects against oxidative injury via its classic coupling to Gai-mediated AC inhibition. Discussion/Conclusions: Nicotine can negate the cardioprotective effects of α2AR agonists against oxidative injury, which may have important implications for patients treated with this class of drugs that are chronic tobacco smokers.


Assuntos
Miócitos Cardíacos , Nicotina , Humanos , Nicotina/farmacologia , Nicotina/metabolismo , Peróxido de Hidrogênio/farmacologia , Peróxido de Hidrogênio/metabolismo , Receptores Adrenérgicos alfa 2/metabolismo , Estresse Oxidativo , Apoptose , Tartarato de Brimonidina/metabolismo , Tartarato de Brimonidina/farmacologia
7.
JACC Heart Fail ; 12(1): 67-78, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37897456

RESUMO

BACKGROUND: Certain antineoplastic therapies are associated with an increased risk of cardiomyopathy and heart failure (HF). Sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF. OBJECTIVES: This study aims to examine the efficacy of SGLT2 inhibitors in patients with cancer therapy-related cardiac dysfunction (CTRCD) or HF. METHODS: The authors conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Patients aged ≥18 years with a history of type 2 diabetes mellitus, cancer, and exposure to potentially cardiotoxic antineoplastic therapies, with a subsequent diagnosis of cardiomyopathy or HF between January 1, 2013, and April 30, 2020, were identified. Patients with ischemic heart disease were excluded. Patients receiving guideline-directed medical therapy were divided into 2 groups based on SGLT2 inhibitor use. After propensity score matching, odds ratios (ORs) and Cox proportional HRs were used to compare outcomes over a 2-year follow-up period. RESULTS: The study cohort included 1,280 patients with CTRCD/HF (n = 640 per group; mean age: 67.6 years; 41.6% female; 68% White). Patients on SGLT2 inhibitors in addition to conventional guideline-directed medical therapy had a lower risk of acute HF exacerbation (OR: 0.483 [95% CI: 0.36-0.65]; P < 0.001) and all-cause mortality (OR: 0.296 [95% CI: 0.22-0.40]; P = 0.001). All-cause hospitalizations or emergency department visits (OR: 0.479; 95% CI: 0.383-0.599; P < 0.001), atrial fibrillation/flutter (OR: 0.397 [95% CI: 0.213-0.737]; P = 0.003), acute kidney injury (OR: 0.486 [95% CI: 0.382-0.619]; P < 0.001), and need for renal replacement therapy (OR: 0.398 [95% CI: 0.189-0.839]; P = 0.012) were also less frequent in patients on SGLT2 inhibitors. CONCLUSIONS: SGLT2 inhibitor use is associated with improved outcomes in patients with CTRCD/HF.


Assuntos
Antineoplásicos , Cardiomiopatias , Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Neoplasias , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Feminino , Adolescente , Adulto , Idoso , Masculino , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/complicações , Estudos Retrospectivos , Cardiomiopatias/complicações , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico
8.
Ecol Appl ; 34(2): e2933, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37983735

RESUMO

Areas used for livestock production and dominated by native grasses represent a unique opportunity to reconcile biodiversity conservation and livestock production. However, limited knowledge of individual species' responses to rangeland management restricts our capacity to design grazing practices that favor endangered species and other priority birds. In this work, we applied Hierarchical Modelling of Species Communities (HMSC) to study individual species responses, as well as the influence of traits on such responses, to variables related to rangeland management using birds of the Rio de la Plata Grasslands as a case study. Based on presence-absence data collected in 454 paddocks across 46 ranches we inferred the response of 69 species considering imperfect detection. This degree of detail fills a major gap in rangeland management, as species-level responses can be used to achieve targeted conservation goals other than maximizing richness or abundance. We found that artificial pastures had an overall negative impact on many bird species, whereas the presence of tussocks had a positive effect, including all threatened species. Grassland specialists were in general sensitive to grass height and tended to respond positively to tussocks but negatively to tree cover. Controlling grass height via adjustments in stocking rate can be a useful tool to favor grassland specialists. To favor a wide range of bird species in ranches, a mosaic of short and tall native grasslands with patches of tussocks and trees is desirable. We also found that species-specific responses were modulated by their traits: small-sized birds responded positively to tussocks and tree cover while large species responded negatively to increasing grass height. Ground foragers preferred short grass while birds that scarcely use this stratum were not affected by grass height. Results on the influence of traits on bird responses are an important novelty in relation to previous work in rangelands and potentially increase our predicting capacity and model transferability across grassland regions.


Assuntos
Biodiversidade , Pradaria , Animais , Aves , Espécies em Perigo de Extinção , Gado , Poaceae , Árvores
9.
Australas J Dermatol ; 64(4): 537-543, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37823565

RESUMO

The terminology surrounding the clinical syndrome characterized by acute mucositis with minimal skin involvement has been a subject of debate over time. In recent years, terms such as mycoplasma-induced rash and mucositis and reactive infectious mucocutaneous eruption (RIME) have been introduced to encompass milder mucocutaneous diseases associated with respiratory infections, with implications for management and prognosis. We report the first case of recurrent RIME associated with Chlamydophila pneumoniae infection in an adult patient. RIME is likely underreported due to misclassification and a lack of testing for potential pathogens. Early recognition of recurrent RIME is of particular interest from the patient's perspective to reduce the frequency and duration of hospital admissions.


Assuntos
Chlamydophila pneumoniae , Exantema , Mucosite , Pneumonia por Mycoplasma , Humanos , Adulto , Mycoplasma pneumoniae , Mucosite/complicações , Exantema/etiologia , Síndrome , Pneumonia por Mycoplasma/complicações
10.
Biomolecules ; 13(9)2023 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-37759689

RESUMO

N-nitrosodiethylamine (NDEA) is a potential carcinogen known to cause liver tumors and chronic inflammation, diabetes, cognitive problems, and signs like Alzheimer's disease (AD) in animals. This compound is classified as probably carcinogenic to humans. Usual sources of exposure include food, beer, tobacco, personal care products, water, and medications. AD is characterized by cognitive decline, amyloid-ß (Aß) deposit, tau hyperphosphorylation, and cell loss. This is accompanied by neuroinflammation, which involves release of microglial cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin 1ß (IL-1ß), by nuclear factor kappa B (NF-κB) upregulation; each are linked to AD progression. Weak PI3K/Akt insulin-signaling inhibits IRS-1 phosphorylation, activates GSK3ß and promotes tau hyperphosphorylation. Metformin, an antihyperglycemic agent, has potent anti-inflammatory efficacy. It reduces proinflammatory cytokines such as IL-6, IL-1ß, and TNF-α via NF-κB inhibition. Metformin also reduces reactive oxidative species (ROS) and modulates cognitive disorders reported due to brain insulin resistance links. Our study examined how NDEA affects spatial memory in Wistar rats. We found that all NDEA doses tested impaired memory. The 80 µg/kg dose of NDEA increased levels of Aß1-42, TNF-α, and IL-6 in the hippocampus, which correlated with memory loss. Nonetheless, treatment with 100 mg/kg of metformin attenuated the levels of pro-inflammatory cytokines and Aß1-42, and enhanced memory. It suggests that metformin may protect against NDEA-triggered memory issues and brain inflammation.


Assuntos
Doença de Alzheimer , Metformina , Animais , Ratos , Doença de Alzheimer/induzido quimicamente , Doença de Alzheimer/tratamento farmacológico , Peptídeos beta-Amiloides , Carcinógenos , Citocinas , Dietilnitrosamina , Hipocampo , Interleucina-6 , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/tratamento farmacológico , Metformina/farmacologia , Metformina/uso terapêutico , NF-kappa B , Fosfatidilinositol 3-Quinases , Ratos Wistar , Fator de Necrose Tumoral alfa
11.
Ther Adv Cardiovasc Dis ; 17: 17539447231199350, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37724539

RESUMO

G protein-coupled receptors (GPCRs) play pivotal roles in regulation of cardiac function and homeostasis. To function properly, every cell needs these receptors to be stimulated only when a specific extracellular stimulus is present, and to be silenced the moment that stimulus is removed. The regulator of G protein signaling (RGS) proteins are crucial for the latter to occur at the cell membrane, where the GPCR normally resides. Perturbations in both activation and termination of G protein signaling underlie numerous heart pathologies. Although more than 30 mammalian RGS proteins have been identified, each RGS protein seems to interact only with a specific set of G protein subunits and GPCR types/subtypes in any given tissue or cell type, and this applies to the myocardium as well. A large number of studies have provided substantial evidence for the roles various RGS proteins expressed in cardiomyocytes play in cardiac physiology and heart disease pathophysiology. This review summarizes the current understanding of the functional roles of cardiac RGS proteins and their implications for the treatment of specific heart diseases, such as heart failure and atrial fibrillation. We focus on cardiac RGS4 in particular, since this isoform appears to be selectively (among the RGS protein family) upregulated in human heart failure and is also the target of ongoing drug discovery efforts for the treatment of a variety of diseases.


Assuntos
Cardiopatias , Insuficiência Cardíaca , Proteínas RGS , Animais , Humanos , Proteínas RGS/genética , Proteínas RGS/metabolismo , Transdução de Sinais , Coração , Proteínas de Ligação ao GTP/metabolismo , Cardiopatias/tratamento farmacológico , Mamíferos/metabolismo
12.
Healthcare (Basel) ; 11(18)2023 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-37761667

RESUMO

A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.

13.
Rev. osteoporos. metab. miner. (Internet) ; 15(3): 100-105, Juli-Sep. 2023. tab
Artigo em Inglês, Espanhol | IBECS | ID: ibc-226994

RESUMO

Introducción y objetivo: el objetivo fue valorar la relevancia de variables no contenidas en el FRAX sobre la incidencia de fractura osteoporótica. Material y métodos: participaron 316 mujeres > 50 años seguidas 8 años. Se evaluaron variables que recoge FRAX (edad, IMC, fractura previa, antecedentes parentales de fractura de cadera, hábito tabáquico, glucocorticoides, DMO cuello femoral) y que no recoge (edad de menarquia, menopausia, años fértiles y nuliparidad). Resultados: edad y antecedentes parentales de fractura de cadera se asociaron con fractura de cadera, pero también edad de menopausia y años fértiles. La edad [odds ratio (OR) = 1,09, Intervalo de confianza del 95 % (IC 95 %) = (1,01-1,17)] y edad de menopausia [OR = 0,90, IC 95 % = (0,82-0,99)] se asociaron con fractura de cadera tras análisis multivariante ajustado por edad e IMC. IMC, DMO en cuello femoral y nuliparidad se asociaron con fractura de Colles. En el análisis multivariante, solo nuliparidad se asoció con fractura de Colles [OR = 4,59, IC 95 % = (1,59-13,26)]. La fractura mayor osteoporótica se asoció significativamente con antecedentes parentales de fractura de cadera, nuliparidad y años fértiles. En el análisis multivariante, antecedentes parentales de fractura de cadera [OR = 3,26, IC 95 % = (1,23-8,61)], nuliparidad [OR = 3,07; IC 95 % = (1,48-6,37)] y años fértiles [OR = 0,92, IC 95 % = (0,87-0,98)] se asociaron con fractura mayor osteoporótica. Conclusiones: de las variables del FRAX, edad y antecedentes parentales de fractura de cadera se asociaron con incidencia de fractura mayor osteoporótica y de cadera, pero otras variables ginecológicas tuvieron un peso similar, lo que sugiere que deben ser tenidas muy en cuenta a la hora de realizar la anamnesis de las pacientes.(AU)


Introduction and objective: the objective of this study was to assess the significance of variables not included in the FRAXtool regarding the incidence of osteoporotic fractures.Materials and methods: a total of 316 women older than 50 years were followed for 8 years. The variables collected (age,BMI, previous fracture, parental history of hip fracture, smoking habit, use of glucocorticoids, femoral neck BMD) and thosenot collected by the FRAX tool (age at menarche, menopause, fertile years, nulliparity) were studied.Results: age and parental history of hip fracture were associated with hip fractures, but so were age at menopause andfertile years. Age [odds ratio (OR), 1.09; 95 % confidence interval (CI), 1.01-1.17] and age at menopause [OR, 0.90; 95 %CI,0.82-0.99] were associated with hip fractures after the multivariate analysis adjusted for age and BMI. BMI, femoral neckBMD and nulliparity were associated with the occurrence of Colles fractures. According to the multivariate analysis, onlynulliparity was associated with Colles fractures [OR, 4.59; 95 %CI, 1.59-13.26)]. Major osteoporotic fractures were signifi-cantly associated with parental history of hip fracture, nulliparity, and fertile years. According to the multivariate analysis,the parental history of hip fracture [OR, 3.26; 95 %CI, 1.23-8.61], nulliparity [OR, 3.07; 95 %CI, 1.48-6.37], and fertile years[OR, 0.92; 95 %CI, 0.87-0.98] were associated with the occurrence of major osteoporotic fractures.Conclusions: among the FRAX variables, age and parental history of hip fracture were associated with the incidence ofmajor osteoporotic and hip fractures. However, the significance of other gynecological variables was similar, which is indic-ative that they should certainlay be taken into consideration during patient history assessment.(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Fraturas por Osteoporose/cirurgia , Fragilidade , Fraturas do Quadril , Fratura de Colles/diagnóstico , Densitometria , Fraturas Ósseas , Osteoporose , Incidência , Estudos Prospectivos , Estudos de Coortes , Inquéritos e Questionários
14.
Healthcare (Basel) ; 11(8)2023 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-37107952

RESUMO

Airway device-associated infections resulting from the cross-contamination of reusable laryngoscopes are one of the main causes of healthcare-associated infections. Laryngoscope blades are highly contaminated with various pathogens, including Gram-negative bacilli, which can cause prolonged hospitalization, high morbidity and mortality risks, the development of antibiotic-resistant microorganisms, and significant costs. Despite the Centers for Disease Control and Prevention and the American Society of Anesthesiologists' recommendations, this national survey of 248 Spanish anesthesiologists showed that there is great variability in the processing of reusable laryngoscopes in Spain. Nearly a third of the respondents did not have an institutional disinfection protocol, and 45% of them did not know the disinfection procedure used. Good practices for the prevention and control of cross-contamination can be ensured through compliance with evidence-based guidelines, education of healthcare providers, and audits of clinical practices.

15.
Psicothema ; 35(2): 119-128, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37096406

RESUMO

BACKGROUND: After the lockdown, schools adopted measures to avoid infection, which changed pre-pandemic routines. We evaluated whether the new school conditions constituted a stress factor for children or contributed to their recovery after the impact of the lockdown period. METHOD: Participants included 291 families with children between 3 and 11 years of age. The children were assessed by parents through the Child and Adolescent Assessment System (SENA) at three time points: T1 (before COVID-19 confinement), T2 (after the children had spent between 4 and 6 weeks confined), and T3 (one year after the beginning of the pandemic). RESULTS: For Preschoolers, no statistical differences were found in any scale or time point. For primary-school children, the differences between T1 and T3 were not significant. Comparisons between T2 and T3 showed significant differences in Willingness to study, Emotional regulation and Hyperactivity and impulsivity. CONCLUSIONS: Our results suggest that returning to school might have improved some dimensions of primary-school children's well-being. However, it seems that neither the confinement nor the restrictive measures have had a negative effect on our sample. To interpret these findings, we discuss the psychological factors of protection and vulnerability.


Assuntos
COVID-19 , Pandemias , Humanos , Criança , Estudos Retrospectivos
16.
Children (Basel) ; 10(2)2023 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-36832534

RESUMO

Here, we aim to describe mental health (MH) in a cohort of children, adolescents, and young adults living with perinatally acquired HIV (PHIV) in Spain and explore the treatment gap for mental disorders. We also aim to analyze the potential association between MH issues to psychosocial risk factors (PSRFs) and identify management priorities. We conducted a descriptive transversal study that included all cases of PHIV under follow-up in a reference hospital in Madrid. The study included patients undergoing follow-up in the pediatric outpatient clinic and youths transferred from pediatric to adult care units after 1997. Epidemiological, clinical, immunovirological, and treatment-related data were collected, including PSRF and adverse childhood experiences (ACEs). Of the 72 patients undergoing follow-up, 43 (59.7%) had already been transferred to the adult outpatient clinic. The patients' median age was 25 years (IQR 18-29), and 54.2% were women. Most patients were undergoing treatment (94.6%) and were virologically suppressed (84.7%). Although MH issues were present in 30 patients (41.7%), only 17 (56.7%) had been referred for evaluation to the Department of Mental Health, and only 9 (30%) had received a MH diagnosis. PSRFs were common (32% of participants had at least one PSRF) and were associated with MH issues and adherence issues (all p < 0.05). A multidisciplinary approach to address the psychological factors and social determinants of health is urgently needed, particularly during important life development stages, such as adolescence.

17.
Perfusion ; 38(3): 580-590, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35133212

RESUMO

INTRODUCTION: Patients undergoing cardiac surgery can experience significant thermal changes during the perioperative period and, for that reason, it is essential to monitor temperatures with adequate accuracy and precision during cardiopulmonary bypass (CPB). The primary aim of the current study was to measure the discrepancies between temperatures at different body sites during normothermic or mild hypothermic CPB. METHODS: 48 patients undergoing cardiac surgery participated in our study. Simultaneous temperatures were measured at nasopharynx, pulmonary artery, arterial outlet, venous inlet, forehead using a heat flux sensor, and urinary bladder at 5-min intervals throughout surgery. The Bland-Altman plot for repeated measures was used to assess concordance between methods. RESULTS: The duration of surgery was 360 min (interquartile range (IQR) 300-412), while the median cross-clamp time was 135 min (IQR 101-169). During the CPB time, the average difference between arterial outlet and nasopharyngeal temperature was -0.16°C (95% limits of agreement of ±0.93). The bias between arterial outlet and the venous inflow was 0.16°C and the 95% limits of agreement were -0.63 to 0.95°C. The Bland-Altman analysis showed an average difference between oxigenator arterial outlet and bladder probe of -0.62 (95% limits of agreement of ±1.3). The average difference between arterial outlet and Tcore™ temperatures was 0.08°C (95% limits of agreement of ±1.46). 25 patients (52.08%) presented nasopharyngeal temperatures higher than 37°C in the post-CPB period, but none of them exceeded 38°C. CONCLUSIONS: Perfusionists should be cautious when using the nasopharyngeal site as the only surrogate of brain temperature, even in normothermic cardiac surgery because the precision of measurements is not entirely adequate.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Hipotermia Induzida , Humanos , Temperatura Corporal , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Artéria Pulmonar , Hipotermia Induzida/métodos , Temperatura
18.
Educ Inf Technol (Dordr) ; 28(5): 5297-5312, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36373040

RESUMO

Different reasons may hinder the right to education of children with a disability and/or from vulnerable families; for example, living in rural areas where they do not have access to public transport, restriction of opportunities to access schools, precarious economic situations, lack of minimum services that meet the needs of hygiene and personal care, among other reasons. This has made it necessary to implement changes in traditional education systems. For this reason, the objective of this study is to build a theoretical base that facilitates the understanding of the requirements of these children in terms of distance education. To do this, the authors interviewed primary education teachers who work with children with a disability and/or from vulnerable families. A qualitative research methodology was used with the focus group as a technique for collecting information. Ten primary school teachers participated in an interview made up of a set of open-ended questions that facilitated their narratives regarding education strategies used for students with a disability and/or those living in vulnerable families, which were later grouped into categories. As a result of this research, the following strategies used by the participating teachers were collected: recreating the feeling of the physical classroom in the virtual classroom, fostering friendship and companionship among students, designing engagement strategies, and considering the socio-cultural variables that influence learning. The teachers assured that distance education is a perfectly viable alternative for children with a disability and/or from vulnerable families.

19.
Communic Res ; 50(2): 205-229, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38603413

RESUMO

We analyze short-term media trust changes during the COVID-19 pandemic, their ideological drivers and consequences based on panel data in German-speaking Switzerland. We thereby differentiate trust in political information from different types of traditional and non-traditional media. COVID-19 serves as a natural experiment, in which citizens' media trust at the outbreak of the crisis is compared with the same variables after the severe lockdown measures were lifted. Our data reveal that (1) media trust is consequential as it is associated with people's willingness to follow Covid-19 regulations; (2) media trust changes during the pandemic, with trust levels for most media decreasing, with the exception of public service broadcasting; (3) trust losses are hardly connected to ideological divides in Switzerland. Our findings highlight that public service broadcasting plays an exceptional role in the fight against a pandemic and that contrary to the US, no partisan trust divide occurs.

20.
Psicothema (Oviedo) ; 35(2): 119-128, 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-219692

RESUMO

Background: After the lockdown, schools adopted measures to avoid infection, which changed pre-pandemic routines.We evaluated whether the new school conditions constituted a stress factor for children or contributed to their recoveryafter the impact of the lockdown period. Method: Participants included 291 families with children between 3 and 11years of age. The children were assessed by parents through the Child and Adolescent Assessment System (SENA)at three time points: T1 (before COVID-19 confinement), T2 (after the children had spent between 4 and 6 weeksconfined), and T3 (one year after the beginning of the pandemic). Results: For Preschoolers, no statistical differenceswere found in any scale or time point. For primary-school children, the differences between T1 and T3 were notsignificant. Comparisons between T2 and T3 showed significant differences in Willingness to study, Emotionalregulation and Hyperactivity and impulsivity. Conclusions: Our results suggest that returning to school might haveimproved some dimensions of primary-school children’s well-being. However, it seems that neither the confinementnor the restrictive measures have had a negative effect on our sample. To interpret these findings, we discuss thepsychological factors of protection and vulnerability.(AU)


Antecedentes: Tras el confinamiento, la escuela se adaptó a las restricciones para controlar el COVID-19. Evaluamos si elregreso al colegio constituyó un estresor para los niños o contribuyó a su recuperación tras el impacto del confinamiento.Método: Participaron 291 familias con niños entre 3 y 11 años. Los padres evaluaron a los niños a través del Sistemade Evaluación de Niños y Adolescentes (SENA) en tres momentos: T1 (unas semanas antes del confinamiento), T2(después de estar entre 4 y 6 semanas confinados) y T3 (un año después del inicio de la pandemia). Resultados: Paralos niños de Infantil, las comparaciones no mostraron diferencias en ninguna de las escalas y ninguno de los tiemposevaluados. Para los niños de Primaria, no se hallaron diferencias entre T1 y T3. La comparación entre T2 y T3 indicóuna mejora en las escalas Disposición al estudio, Regulación emocional e Hiperactividad e impulsividad. Conclusiones:La vuelta al colegio contribuyó a mejorar algunas dimensiones en los niños de Primaria. Sin embargo, parece que ni elconfinamiento ni las posteriores medidas restrictivas han tenido un impacto negativo en los niños de esta muestra. Parainterpretar estos resultados discutimos los factores de protección y vulnerabilidad psicológica.(AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Pandemias , Isolamento Social , Estudantes , Ensino Fundamental e Médio , Psicologia da Criança , Esgotamento Psicológico , Infecções por Coronavirus/epidemiologia , Psicologia Social , Estudos Longitudinais
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