Variabilidade da frequência cardíaca em mulheres com hipermobilidade articular

A hipermobilidade é a capacidade de desempenhar movimentos articulares com amplitude maior que o normal. A prevalência possui variações determinadas pela etnia, sexo, idade, atividade física e variações nos critérios de caracterização. Aproximadamente 30% dos adultos são portadores e apresentam feedback proprioceptivo, sensorial diminuído e espacial alterado da articulação levando a maior frequência de ativação e deformação dos mecanorreceptores nos músculos esqueléticos e na pele. O aumento dos impulsos aferentes dos mecanorreceptores sobre a área cardiovascular no bulbo altera o controle autonômico sobre o coração. O objetivo do estudo foi avaliar o balanço simpatovagal durante manobra de ortostatismo em mulheres com hipermobilidade. Participaram do estudo 27 voluntárias, com 19,97±1,79 anos, índice de massa corpórea abaixo de 25 kg/m², sedentárias e sem uso de medicação. Após diagnóstico da hipermobilidade articular, segundo o escore de Beighton, foram divididas em 2 grupos: 12 hipermóveis (GH) e 15 não hipermóveis (GC). O eletrocardiograma foi realizado durante 10 minutos em supino e em pé para análise da variabilidade da frequência cardíaca. A banda de alta frequência (un) apresentou diminuição da atividade vagal no GH, pJoint hypermobility is the ability to make joint movements greater than normal. The prevalence has large variations determined by race, sex, age, physical activity and variations in characterization criteria. Approximately 30% of adults are considered carriers and present proprioceptive feedback and sensory decreased and joint space positioning altered leading to greater frequency of activation and deformation on the mechanoreceptors in the skeletal muscles and skin. The increase of afferent impulses of the receptors on the bulb cardiovascular area alters the autonomic control on the heart. The objective of the study was to evaluate sympathovagal balance during orthosthatic maneuver in women with hipermobility. Twenty-seven sedentary volunteers participated in this study, with mean age of 19.97±1.79, body mass index below 25 kg/m² and without medication. After the joint hipermobility diagnosis according to Beighton score, they were divided into 2 groups: 12 with hipermobility (HG) and 15 without hipermobility (CG). The electrocardiogram was performed during 10 minutes at supine position and stand for analysis of heart rate variability. The band of high frequency (un) presented reduction in vagal activity in HG, p<0.03. The low frequency increment (un) was higher in HG when compared to CG in orthosthatic maneuver with increased sympathetic activity, p<0.03. The joint hypermobility volunteers presented autonomic cardiac response altered with low vagal responsiveness

MEMBANGUN PENDIDIKAN KARAKTER, PENDIDIKAN KARAKTER SYUKUR

Agama Islam diturunkan di dunia oleh ALLOH SWT, melalui Rosul Muhammad, adalah untuk memberikan pelajaran pada manusia tentang kebesaran dan keagungan NYA. Bentuk kebesaran dan keagungan NYA ini terwujud pada segala benda yang tampak dan tidak tampak di alam semesta. Selayanya manusia sebagai ciptaanNYA yang paling sempurna mensyukurinya. Literasi paling awal di dunia ini adalah ketika ALLOH SWT menurunkan wahyu pertama kepada Rosul Muhammad,melalui malaikat Jibril, berupa Iqro’, yang terangkum dalam surat Al ‘Alaq. Esensi dari surat tersebut adalah tuntunan bagaimana cara-cara mengakses pengetahuan dari ALLOH SWT. Tuhan memberikan bimbingan pada Rosululloh, pada fase awal turunnya wahyu, yang berlangsung di Mekah sebelum hijrah ke Medinah. Saat itu Rosul berumur 40 tahun, dan pada saat itu beliau sudah mencapai kematangan fisik, spiritual dan emosional. Saat proses malaikat Jibril datang membawa wahyu, Rosul Muhamamad bukannya dalam keadaan siap, malah menggigil dan ketakutan. Malaikat Jibril memeluk Rosul sampai tiga kali, baru kemudian Rosul tenang. Dalam keadaan tenang, kemudian Jibril mengulang wahyu ALLOH agar Rosul membaca dengan nama Tuhan ALLOH yang telah menciptakan pengetahuan bagi manusia. Fase pembelajaran yang Alloh tuntunkan kepada Rosul, terdapat dalam Al Qur’an sebanyak 86 surat terkait dengan bimbingan ALLOH. Surat-surat tersebut memberikan penguatan kepada jiwa, menamkan karakteristik iman yang kuat, dan akidah yang kokoh. Gambaran literasi melalui wahyu, kemudian dilanjutkan dalam bentuk hafalan-hafalan, diterjemahkan dalam tulisan-tulisan tangan, dan sampai pada era sekarang tulisan tangan sudah bertransformasi menjadi digital. Pada bab ini, penulis akan menguraikan pendidikan karakter syukur terdiri dari 3 konsep utama : 1) Konsep pendidikan, 2) Konsep karakter, dan 3) Konsep syukur. Tiga diksi yang berbeda namun bila dirangkai menjadi satu, maka akan membentuk diksi bar

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone