Perfil epidemiológico das internações por condições sensíveis à atenção primária de saúde no estado de Roraima

Introduction: The Primary Care Sensitive Conditions (CSAP) comprise the health problems that are treated in the first level of health care; if this care is neglected, an evolution of the illness may happen, requiring hospitalization. Objective: Understand the characteristics of hospitalizations due to primary care sensitive conditions that occurred in the Hospitals of Roraima during the period from 2011 to 2015. Methods: This is a population-based ecological study using DATASUS secondary data. Results: During the period under study, 155,063 hospitalizations were detected in HGR, of which 22.79% (35,344) were consequences from Primary Care Sensitive Conditions and 82.19% of the hospitalizations were from patients living in Boa Vista; the bacterial pneumonia was the main cause of hospitalization, followed by skin and subcutaneous tissue infections. Conclusions: : In this study, it was possible to quantify the number of hospitalizations that occurred in the state of Roraima from 2011 to 2015 and to outline a profile of the hospitalizations by CSAP, identifying the main causes that require interventions through programs in primary care.Introdução: As Condições Sensíveis à Atenção Primária (CSAP) compreendem os agravos em saúde que são atendidos no primeiro nível de atenção à saúde, caso esse atendimento seja negligenciado pode haver evolução deste agravo sendo necessária internação hospitalar. Objetivo: Conhecer as características das internações por condições sensíveis à atenção primária que ocorreram nas Instituições Hospitalares do estado de Roraima no período de 2011 à 2015. Métodos: Trata-se de um estudo ecológico de base populacional que utiliza dados secundários do DATASUS. Resultados: No período estudado, evidenciou-se a ocorrência de 155.063 internações no HGR, sendo que 22,79% (35.344) destas foram internações por Condições Sensíveis a Atenção Primária e 82,19% referentes a e pacientes residentes em Boa Vista, visto que as pneumonias bacterianas foram as principais causas de internação, seguido por infecção da pele e tecido subcutâneo. Conclusões: Neste estudo foi possível quantificar as internações ocorridas no estado de Roraima de 2011 à 2015 e traçar um perfil das internações pelas CSAP, identificando as principais causas de internação que necessitam de intervenção por meio de programas dirigidos na atenção primária

Lúpus eritematoso sistêmico: revisão de literatura e atualização dos critérios de classificação

Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that develops inflammatory foci in the most diverse organs and tissues of the body, with a large number of clinical manifestations. This study aims to reinforce the knowledge that exists about the disease and to update on the criteria determined in 2018 by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULA). Methods: The present study was carried out by means of a review of the literature available in the Scientific Electronic Library Online and National Institutes of Medicine of the US National Library of Medicine Health databases. Development: Malfunction of the immune system and consequent production of autoantibodies are of paramount importance in the pathogenesis and presentation of clinical signs and symptoms, but the etiopathogenesis of SLE is not fully elucidated. The diagnosis of SLE is hampered by the wide variety of systemic presentations and the low specificity of various symptoms, which are often mistaken for other diseases. In 2018, updated criteria were developed by the ACR and the EULA. Current treatment regimens consist of antimalarial, corticosteroid and immunobiological drugs. Conclusion: SLE is a disease of considerable complexity due to the lack of complete knowledge of its etiopathogenesis. Its clinical manifestations are confounded with that of several diseases, which hinders its rapid diagnosis and initiation of treatment. Studies on the discovery of new therapies for use in SLE are being carried out worldwide, with the aim of reducing the mortality of these patients.Introdução: O lúpus eritematoso sistêmico (LES) é uma enfermidade autoimune sistêmica que desenvolve focos inflamatórios nos mais diversos órgãos e tecidos do corpo, com um amplo número de manifestações clínicas. Este estudo pretende reforçar o conhecimento que existe sobre a doença e atualizar sobre os critérios determinados em 2018 pelo American College of Rheumatology (ACR) e pela European League Against Rheumatism (EULA). Métodos: O presente estudo foi realizado por meio de uma revisão da literatura disponível na Scientific Eletronic Library Online e Institutos Nacionais de Medicina dos EUA da National Library of Medicine Bancos de dados de Saúde. Desenvolvimento: O mau funcionamento do sistema imunológico e a conseguinte produção de autoanticorpos são de suma importância na patogenia e na apresentação dos sinais e sintomas clínicos, porém a etiopatogenia do LES não está totalmente elucidada. O diagnóstico do LES é dificultado devido à grande variedade de apresentações sistêmicas e à baixa especificidade de vários sintomas, que diversas vezes se confunde com outras doenças. Em 2018, critérios atualizados foram desenvolvidos pelo ACR e pela EULA. Os regimes de tratamento atuais consistem em drogas antimaláricas, corticosteroides e imunobiológicos. Conclusão: O LES é uma doença de importante complexidade, devido ao não conhecimento completo de sua etiopatogenia. Suas manifestações clínicas se confundem com a de diversas doenças, o que dificulta seu rápido diagnóstico e início do tratamento. Estudos para a descoberta de novas terapias para uso no LES estão sendo realizados em todo o mundo, com o intuito de diminuir a mortalidade desses pacientes

Comparative Analyses of Zebrafish Anxiety-Like Behavior Using Conflict-Based Novelty Tests

Modeling of stress and anxiety in adult zebrafish (Danio rerio) is increasingly utilized in neuroscience research and central nervous system (CNS) drug discovery. Representing the most commonly used zebrafish anxiety models, the novel tank test (NTT) focuses on zebrafish diving in response to potentially threatening stimuli, whereas the light-dark test (LDT) is based on fish scototaxis (innate preference for dark vs. bright areas). Here, we systematically evaluate the utility of these two tests, combining meta-analyses of published literature with comparative in vivo behavioral and whole-body endocrine (cortisol) testing. Overall, the NTT and LDT behaviors demonstrate a generally good cross-test correlation in vivo, whereas meta-analyses of published literature show that both tests have similar sensitivity to zebrafish anxiety-like states. Finally, NTT evokes higher levels of cortisol, likely representing a more stressful procedure than LDT. Collectively, our study reappraises NTT and LDT for studying anxiety-like states in zebrafish, and emphasizes their developing utility for neurobehavioral research. These findings can help optimize drug screening procedures by choosing more appropriate models for testing anxiolytic or anxiogenic drugs

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt