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1.
Expert Rev Respir Med ; : 1-13, 2020 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-32902367

RESUMO

INTRODUCTION: The exponential growth of SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on most health systems around the world. The complications derived from the novel coronavirus disease (COVID-19) vary due to comorbidities, sex and age, with more than 50% of the patients requiring some level of intensive care developing acute respiratory distress syndrome (ARDS). The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological, and radiological presentation as well as the current treatment strategies. AREAS COVERED: Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The new treatment strategies are updated, and the analysis of the physiopathology is included in this review. EXPERT OPINION: ARDS is one of the most frequent complications in patients with COVID-19. Information regarding the etiology and physiopathology are still unfolding and for the prevention and amelioration, good clinical management, adequate ventilatory support and the use of systemic corticoids seem to be the most efficient way to reduce mortality and to reduce hospital lengths.

4.
Braz J Psychiatry ; 29(1): 23-5, 2007 03.
Artigo em Inglês | MEDLINE | ID: mdl-17435923

RESUMO

OBJECTIVE: To assess the effectiveness of a manual-based cognitive behavior therapy adapted to a group format in a sample of Brazilian obese subjects with binge-eating disorder. METHOD: In an open trial, 21 obese subjects with binge-eating disorder received a group cognitive-behavioral therapy program. Changes in binge-eating frequency, weight, body shape concerns, and depressive symptoms were compared between baseline and the end of the study. RESULTS: The mean frequency of binge-eating episodes significantly decreased from baseline to post-treatment (p < 0.001), with a binge eating remission rate of 76.1% at the end of the trial. Depressive symptoms and body shape concern also improved (p < 0.001). In addition, weight loss was statistically and clinically significant. CONCLUSION: The use of this adapted manual-based cognitive behavior therapy in this sample resulted in a marked improvement in binge-eating, weight, body shape concern, and depressive symptoms related to binge-eating disorder.


Assuntos
Bulimia Nervosa/terapia , Terapia Cognitivo-Comportamental/métodos , Obesidade/terapia , Adolescente , Adulto , Imagem Corporal , Índice de Massa Corporal , Peso Corporal , Brasil , Bulimia Nervosa/fisiopatologia , Terapia Cognitivo-Comportamental/normas , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Resultado do Tratamento , Perda de Peso
6.
Rev. bras. psiquiatr ; 29(1): 23-25, mar. 2007. tab
Artigo em Inglês | LILACS | ID: lil-448545

RESUMO

OBJECTIVE: To assess the effectiveness of a manual-based cognitive behavior therapy adapted to a group format in a sample of Brazilian obese subjects with binge-eating disorder. METHOD: In an open trial, 21 obese subjects with binge-eating disorder received a group cognitive-behavioral therapy program. Changes in binge-eating frequency, weight, body shape concerns, and depressive symptoms were compared between baseline and the end of the study. RESULTS: The mean frequency of binge-eating episodes significantly decreased from baseline to post-treatment (p < 0.001), with a binge eating remission rate of 76.1 percent at the end of the trial. Depressive symptoms and body shape concern also improved (p < 0.001). In addition, weight loss was statistically and clinically significant. CONCLUSION: The use of this adapted manual-based cognitive behavior therapy in this sample resulted in a marked improvement in binge-eating, weight, body shape concern, and depressive symptoms related to binge-eating disorder.


OBJETIVO: Avaliar a efetividade da terapia cognitivo-comportamental baseada em um manual adaptado para o formato de grupo em uma amostra brasileira de obesos com transtorno da compulsão alimentar periódica. MÉTODO: Em um estudo aberto, 21 pacientes obesos com transtorno da compulsão alimentar periódica participaram de um programa da terapia cognitivo-comportamental em grupo. A freqüência da compulsão alimentar, o peso corporal, o grau de satisfação com a forma corporal e os sintomas depressivos foram avaliados no início do tratamento e no final do estudo. RESULTADOS: Houve uma redução estatisticamente significativa da freqüência média de episódios de compulsão alimentar entre a linha de base e o final do tratamento (p < 0,001), com uma taxa de remissão de episódios no final do estudo de 76,1 por cento. Foi observada, também, uma redução significativa dos sintomas depressivos e da insatisfação com a forma corporal (p < 0,001). Adicionalmente, a perda de peso foi clínica e estatisticamente significativa. CONCLUSÃO: A utilização de terapia cognitivo-comportamental baseada em um manual adaptado para o transtorno da compulsão alimentar periódica resultou em melhora significativa da compulsão alimentar, do peso corporal, da preocupação com a forma corporal e dos sintomas depressivos associados ao transtorno da compulsão alimentar periódica nessa amostra.


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bulimia Nervosa/terapia , Terapia Cognitivo-Comportamental/métodos , Obesidade/terapia , Imagem Corporal , Índice de Massa Corporal , Peso Corporal , Brasil , Bulimia Nervosa/fisiopatologia , Terapia Cognitivo-Comportamental/normas , Transtorno Depressivo/diagnóstico , Obesidade/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Resultado do Tratamento , Perda de Peso
7.
Rev Panam Salud Publica ; 20(1): 39-43, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17018223

RESUMO

OBJECTIVES: Since 1993 dengue has become more frequent in Costa Rica. Adults have been the most affected population, while children have remained virtually unharmed. So far no studies have investigated how many asymptomatic children have been affected by this virus. This pilot study documents the seroprevalence, measured as the presence of IgG antibodies, of dengue virus in asymptomatic children from two different geographical areas. METHODS: This descriptive, prospective epidemiologic study compared the presence of antibodies in children who live in a coastal region of a tropical country where dengue is endemic, and an inland area where dengue is not endemic. An enzyme-linked immunosorbent assay was used to test the serum for dengue virus IgG antibodies. None of the children had a prior history of dengue, fever, immunosuppressive therapy or underlying disease. RESULTS: During the period from July 2002 to July 2003, 103 children were recruited from each area. In the costal region we found a seroprevalence of 36.9%. In the inland area seroprevalence was 2.9%. CONCLUSIONS: We found a substantial number of asymptomatic infections in Costa Rican children. This greatly increases the risk of dengue hemorrhagic fever or dengue shock syndrome in these children, in whom previous dengue infection had gone undetected. Preventive efforts should be targeted at the costal region due to the higher prevalence in this area.


Assuntos
Anticorpos Antivirais/sangue , Vírus da Dengue/imunologia , Imunoglobulina G/sangue , Dengue Grave/sangue , Dengue Grave/epidemiologia , Criança , Pré-Escolar , Costa Rica/epidemiologia , Feminino , Humanos , Lactente , Masculino , Projetos Piloto , Estudos Prospectivos , Estudos Soroepidemiológicos
9.
Rev. panam. salud pública ; 20(1): 39-43, jul. 2006. tab
Artigo em Inglês, Espanhol | LILACS | ID: lil-436412

RESUMO

OBJECTIVES: Since 1993 dengue has become more frequent in Costa Rica. Adults have been the most affected population, while children have remained virtually unharmed. So far no studies have investigated how many asymptomatic children have been affected by this virus. This pilot study documents the seroprevalence, measured as the presence of IgG antibodies, of dengue virus in asymptomatic children from two different geographical areas. METHODS: This descriptive, prospective epidemiologic study compared the presence of antibodies in children who live in a coastal region of a tropical country where dengue is endemic, and an inland area where dengue is not endemic. An enzyme-linked immunosorbent assay was used to test the serum for dengue virus IgG antibodies. None of the children had a prior history of dengue, fever, immunosuppressive therapy or underlying disease. RESULTS: During the period from July 2002 to July 2003, 103 children were recruited from each area. In the costal region we found a seroprevalence of 36.9 percent. In the inland area seroprevalence was 2.9 percent CONCLUSIONS: We found a substantial number of asymptomatic infections in Costa Rican children. This greatly increases the risk of dengue hemorrhagic fever or dengue shock syndrome in these children, in whom previous dengue infection had gone undetected. Preventive efforts should be targeted at the costal region due to the higher prevalence in this area.


OBJETIVOS: Desde 1993, la frecuencia de dengue en Costa Rica ha venido aumentando. La población de adultos ha sido la más afectada, mientras que en los niños apenas se han presentado casos. Hasta el momento no se han realizado estudios para determinar cuántos niños asintomáticos se han visto afectados por el virus de la enfermedad. Este estudio piloto documenta la seroprevalencia de anticuerpos de tipo IgG contra el virus del dengue en niños asintomáticos procedentes de dos zonas geográficas distintas. MÉTODOS: En este estudio epidemiológico descriptivo y prospectivo se comparó la presencia de anticuerpos en niños que vivían en la zona costera de un país tropical donde el dengue es endémico, y en una zona del interior donde no lo es. Se usó inmunoadsorción enzimática para detectar IgG en el suero. Ninguno de los niños tenía antecedentes de dengue, enfermedad febril, tratamiento inmunosupresor o enfermedad subyacente. RESULTADOS: Durante el período transcurrido desde julio de 2003 hasta julio de 2003, se reunió a 103 niños de cada área. En la zona costera encontramos una seroprevalencia de IgG de 36,9 por ciento; en el interior, de 2,9 por ciento. CONCLUSIONES: Encontramos muchos casos de infección asintomática por el virus del dengue en niños costarricenses. Esto conlleva un riesgo elevado de fiebre hemorrágica del dengue o de síndrome de choque por dengue en estos niños en quienes la infección había pasado inadvertida. Es necesario tomar medidas preventivas en la región del litoral debido a la mayor prevalencia de la enfermedad en ella.


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Anticorpos Antivirais/sangue , Dengue Grave/sangue , Dengue Grave/epidemiologia , Vírus da Dengue/imunologia , Imunoglobulina G/sangue , Costa Rica/epidemiologia , Projetos Piloto , Estudos Prospectivos , Estudos Soroepidemiológicos
10.
J Adolesc ; 29(2): 313-7, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15998536

RESUMO

A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an 'at-risk' group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison group for body mass index (BMI) and socio-economic status (SES). The prevalence of young people at risk for eating disorders was 1.4% (higher in females and rising with age). 'At-risk' individuals did not differ from controls in BMI but were of higher SES. In Brazil, the link between symptoms of eating disorders and higher SES is not just a referral artefact but is evident in a representative community sample. This might reflect a stronger preference for thinness among more westernized social groups.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Adolescente , Índice de Massa Corporal , Brasil/epidemiologia , Área Programática de Saúde , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Humanos , Prevalência , Fatores de Risco , Inquéritos e Questionários
12.
São Paulo; s.n; 2006. [105] p. ilus, tab, graf.
Tese em Português | LILACS | ID: lil-443952

RESUMO

Esta tese teve por objetivo validar e pesquisar a confiabilidade da Sessão de Transtornos Alimentares do DAWBA (Development and Well-Being Assessment), um pacote de entrevistas e técnicas de avaliação aplicável por entrevistadores sem experiência clínica prévia, para rastrear e diagnosticar transtornos alimentares em crianças e adolescentes do sexo feminino, de 7 a 17 anos, em estudos epidemiológicos. Participaram deste estudo 174 meninas de 8 a 17 anos, de três grupos: (1) 48 com transtornos alimentares; (2) 55 controles clínicos - em tratamento para depressão unipolar, para transtorno obsessivo-compulsivo ou para doença gastrointestinal – e (3) 71 controles comunitários. A Sessão de Transtornos Alimentares do DAWBA apresentou boa validade e confiabilidade...


This thesis concerns the validation and investigation of the reliability of The Eating Disorders Section of The Development and Well-Being Assessment (DAWBA), a package of interviews and assessment techniques designed to be administered by trained interviewers without previous experience in eating disorders, for screening and diagnosis in epidemiological studies of eating disorders in female children and adolescents, from 7 to 17 years old. This study was carried out with the participation of 174 girls, from 8 to 17 years old, from three groups: (1) 48 with eating disorders; (2) 55 clinical controls – in treatment for unipolar depression, for obsessive compulsive disorder or for gastrointestinal disease – and (3) 71 community controls. The Eating Disorders Section of the DAWBA presented good validity and reliability...


Assuntos
Feminino , Criança , Adolescente , Humanos , Anorexia Nervosa/diagnóstico , Bulimia/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Adolescente , Anorexia Nervosa/epidemiologia , Bulimia/epidemiologia , Criança , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Comportamento Alimentar , Inquéritos e Questionários
14.
Braz J Psychiatry ; 27(1): 25-31, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15867980

RESUMO

OBJECTIVE: Development and validation of the Eating Disorders Section of the Development and Well-Being Assessment (DAWBA). It is a package of questionnaires, interviews and evaluation techniques, designed to generate DSM-IV and ICD-10 based diagnoses of anorexia, bulimia nervosa and the respective partial syndromes in epidemiological studies, in subjects who are 7 to 17 years old. The parents are interviewed in all cases, as are young people aged 11 or more. METHODS: 174 girls, divided into three groups, were assessed with the Eating Disorders Section of the Development and Well-Being Assessment: 48 with eating disorders, 55 clinical controls (with depression, obsessive-compulsive disorder or gastrointestinal disease) and 71 community controls. The sensitivity, specificity and predictive values of the assessment were investigated by comparing the Development and Well-Being Assessment diagnoses with independent psychiatric diagnoses. The test-retest reliability was investigated by reapplying the measure on 55 subjects after 2 or 3 weeks. RESULTS: For the detection of any DSM-IV and ICD-10 eating disorder, the final Development and Well-Being Assessment diagnosis had a sensitivity of 100%, specificity of 94%, positive predictive value of 88%, and a negative predictive value of 100%; there was 95% agreement between the initial and repeat diagnoses (a kappa of 0.81). CONCLUSION: The Eating Disorders Section of the Development and Well-Being Assessment has suitable psychometric properties for use in clinical and epidemiological studies.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Escalas de Graduação Psiquiátrica , Adolescente , Anorexia Nervosa/diagnóstico , Bulimia Nervosa/diagnóstico , Criança , Feminino , Humanos , Entrevista Psicológica/métodos , Sensibilidade e Especificidade , Inquéritos e Questionários
15.
Rev. bras. psiquiatr ; 27(1): 25-31, Mar. 2005. tab
Artigo em Inglês | LILACS | ID: lil-398143

RESUMO

OBJETIVOS: Desenvolvimento e validação da Sessão de Transtornos Alimentares do Development and Well-Being Assessment (DAWBA). Essa sessão é um pacote de questionários, entrevistas e técnicas de avaliação, desenvolvido para gerar diagnósticos baseados no DSM-IV e CID-10 de anorexia, bulimia nervosa e as respectivas síndromes parciais em estudos epidemiológicos, em jovens de 7 a 17 anos. Os pais são entrevistados em todos os casos, assim como as jovens de 11 anos ou mais. MÉTODOS: 174 meninas, divididas em três grupos, foram avaliadas com a Sessão de Transtornos Alimentares do Development and Well-Being Assessment: 48 jovens com transtornos alimentares, 55 controles clínicos (com depressão, transtorno obsessivo-compulsivo ou doença gastrintestinal) e 71 controles da comunidade. Sensibilidade, especificidade e valores preditivos do instrumento foram pesquisados pela comparação dos diagnósticos pelo Development and Well-Being Assessment com diagnósticos psiquiátricos independentes. A confiabilidade teste-reteste foi investigada reaplicando-se o instrumento em 55 sujeitos após duas ou três semanas. RESULTADOS: Para a detecção de qualquer transtorno alimentar segundo o DSM-IV e o CID-10, o diagnóstico final pelo Development and Well-Being Assessment apresentou sensibilidade de 100%, especificidade de 94%, valor preditivo positivo de 88%, valor preditivo negativo de 100% e 95% de concordância entre testes e retestes (Kappa de 0,81). CONCLUSAO: A Sessão de Transtornos Alimentares do Development and Well-Being Assessment tem boas propriedades psicométricas para o uso em estudos clínicos e epidemiológicos.


Assuntos
Humanos , Feminino , Criança , Adolescente , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Escalas de Graduação Psiquiátrica , Anorexia Nervosa/diagnóstico , Bulimia/diagnóstico , Entrevista Psicológica/métodos , Sensibilidade e Especificidade , Inquéritos e Questionários
20.
Am J Clin Pathol ; 121(1): 78-86, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14750244

RESUMO

We report immunohistochemical staining results for cyclooxygenase (COX)-2 and matrix metalloproteinase (MMP)-9 in primary tumors of 117 patients with resected adenocarcinoma of the lung (median follow-up, 20 months). For COX-2, we graded the degree of tumor staining according to the sum of staining intensity and the proportion of cells staining. For MMP-9, we used morphometry to quantify cytoplasmic staining. We used the Cox proportional hazards model to analyze overall survival. With only 29 patients censored at last follow-up, after controlling for the effect of pathologic stage, staining for COX-2 and MMP-9 and subtype of tumor were related significantly to survival (P < 6 x 10(-5)). The effects of COX-2 and MMP-9 were opposite. Whereas any staining for COX-2 decreased the hazard and increased survival time, increased staining for MMP-9 increased the hazard and decreased survival time. The results also suggested that staining for COX-2 decreases with dedifferentiation. Our results suggest that staining for the combination of COX-2 and MMP-9 and categorizing tumors into papillary and nonpapillary types may provide important prognostic information for patients with resected adenocarcinoma of the lung; it is possible that these 3 variables could aid decisions about postoperative adjuvant treatment.


Assuntos
Adenocarcinoma/enzimologia , Isoenzimas/metabolismo , Neoplasias Pulmonares/enzimologia , Metaloproteinase 9 da Matriz/metabolismo , Prostaglandina-Endoperóxido Sintases/metabolismo , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Brasil/epidemiologia , Ciclo-Oxigenase 2 , Intervalo Livre de Doença , Feminino , Humanos , Técnicas Imunoenzimáticas , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Proteínas de Membrana , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Análise de Sobrevida , Taxa de Sobrevida
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