Implantação do programa 5s em unidade de hospital de ensino / Implementation of the 5s program in a teaching hospital unit

A ferramenta 5S é um recurso de manejo assertivo quanto a sua implementação e com resultados eficazes, assegurando que os investimentos realizados com tal ferramenta gerem, quando corretamente aplicados, retorno institucional positivo ao longo do tempo. O objetivo do estudo foi relatar o processo de implantação da ferramenta 5S em uma unidade de clínica médica e cirúrgica de um hospital público de ensino localizado no oeste paranaense, que tem capacidade para 30 leitos destinados à neurologia, ginecologia, ortopedia e vascular e conta com uma equipe de enfermagem composta por 30 profissionais distribuídos nos três turnos de trabalho. A implantação da ferramenta 5S na referida unidade teve início na segunda quinzena de abril de 2019. O estudo foi avaliado pelo Comitê de Ética em Pesquisa, sendo aprovado pelo parecer nº 3.323.244 de 13/05/2019. Com a implementação da ferramenta 5S, materiais e equipamentos danificados ou em desuso foram retirados do setor. Materiais e equipamentos localizados no arsenal, posto de enfermagem, expurgo e corredores foram identificados e dispostos em locais previamente demarcados para essa finalidade. Ao término desse processo foi possível observar um setor organizado e funcional. Com o auxílio de funcionários, pacientes e acompanhantes, que aderiram e colaboraram para a manutenção da ordem do setor, o mesmo permanece organizado

Compilação de dados referentes à Síndrome de Fabry – uma exposição de evidências / Fabry Syndrome data Compilation - an exposition of evidence

INTRODUÇÃO: O presente trabalho tem como objetivo resumir a etiopatogenia, a epidemiologia, a apresentação clínica, o diagnóstico, o tratamento e o prognóstico da Síndrome de Fabry (SF). Não existe conflito de interesses neste trabalho.METODOLOGIA: Foi feita uma revisão de literatura com busca no PubMed, LILACS e SciELO. Utilizou-se os descritores (“Fabry's disease”) pesquisados no MeSH e DeCS. Foram pesquisados artigos que configuraram metanálises e revisões sistemáticas, nos idiomas inglês, espanhol e português, publicados entre 2014 e 2020. Na busca encontrou-se 171 artigos que foram restringidos para um total de 8 artigos.DISCUSSÃO: A SF é conhecida como uma desordem do armazenamento lipídico. É um distúrbio raro recessivo ligado ao cromossomo X, que causa uma deficiência na atividade da enzima alfa-galactosidase e promove mais sintomas em homens do que em mulheres. Esse defeito provoca um acúmulo lisossômico progressivo da globotriaosilceramida nas células. O acúmulo de Gb3 e o de glicosfingolipídeos ocasiona lesões teciduais que afetam os sistemas cardiovascular, renal, gastrointestinal, cerebrovascular, neurológico, auditivo, ocular e cutâneo. Os homens são mais afetados comparados com mulheres heterozigóticas. Adiporfose e angioqueratoma, opacidade corneana, perda auditiva e dor abdominal. Além disso, apresentam anormalidades dismórficas leves típicas:  plenitude periorbitária, lóbulos proeminentes das orelhas, testa encravada, ângulo nasal pronunciado, cristas supraorbitais proeminentes, face mediana rasa, orelhas rotacionadas posteriormente e prognatismo. O diagnóstico inicia-se com o suspeito clínico com avaliação multidisciplinar, a maioria dos casos de SF é diagnosticada no contexto de investigação genética, sobretudo no gene GLA, na imagem por ressonância magnética ou na ecocardiografia transtorácica. O tratamento é baseado na administração da terapia de reposição enzimática e requer acompanhamento com equipe multidisciplinar.CONCLUSÃO: Apesar da SF ser uma síndrome rara algumas informações possibilitam melhora na qualidade de vida do paciente. Podendo assim, proporcionar medidas de prevenção adequadas a cada caso. Sendo que ainda, muitas das suas facetas não estão completamente compreendidas e o conhecimento para orientar políticas de saúde específicas ainda é limitado

MANEJO DA ESQUIZOFRENIA RESISTENTE AO TRATAMENTO: REVISÃO SISTEMÁTICA DE ESTRATÉGIAS FARMACOLÓGICAS E PSICOSSOCIAIS

A esquizofrenia é um transtorno psiquiátrico severo, frequentemente tratado com antipsicóticos, mas alguns pacientes não respondem adequadamente a essas medicações, resultando em esquizofrenia resistente ao tratamento. Este estudo revisa o manejo dessa condição, com foco na definição de resistência e nas abordagens terapêuticas disponíveis. A resistência ao tratamento é identificada com base em critérios específicos, incluindo falha em dois tratamentos antipsicóticos adequados e persistência dos sintomas. A clozapina é considerada a principal opção para pacientes com esquizofrenia resistente, sendo necessário um monitoramento rigoroso devido aos possíveis efeitos colaterais graves. Para iniciar o tratamento com clozapina, é essencial que o paciente tenha contagens hematológicas adequadas e esteja disposto a seguir o protocolo de monitoramento. Além da clozapina, outras abordagens podem incluir terapias psicossociais e, em alguns casos, eletroconvulsoterapia (ECT) ou outros medicamentos. A escolha do tratamento deve ser adaptada às necessidades individuais do paciente e ao perfil de resposta ao tratamento. Em resumo, o manejo da esquizofrenia resistente ao tratamento requer uma combinação de estratégias farmacológicas e psicossociais, com o objetivo de melhorar a eficácia do tratamento e a qualidade de vida dos pacientes. &nbsp

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Síndrome doença Celíaca, Epilepsia e Calcificação Cerebral (CEC): um relato de caso

A Síndrome Doença Celíaca, Epilepsia e Calcificação Cerebral (CEC) é uma patologia rara e pouco conhecida que pode ser confundida com outras condições neurológicas. Os exames de imagem são fundamentais para o diagnóstico correto e preciso, os quais permitem a escolha do tratamento mais adequado. O objetivo deste trabalho é relatar um caso de síndrome CEC em um paciente com diagnóstico prévio de doença celíaca e epilepsia, ao destacar a importância dos exames de imagem no diagnóstico e no tratamento dessa patologia. Um paciente de 29 anos, sexo masculino, apresentou quadro de migrânea crônica e amaurose há 5 anos, além de histórico de doença celíaca (DC) e epilepsia. O paciente foi admitido no centro de neurorradiologia de um hospital de referência na capital paulista para investigação diagnóstica. Foram realizados exames de imagens: ressonância magnética (RM) do crânio e tomografia computadorizada (TC). A RM evidenciou extensos focos de hipossinal associados a áreas de encefalomalácia e gliose, os quais acometeram a substância branca dos lobos occipitais, com extensão aos lobos temporais e parietais. A TC evidenciou extensas calcificações grosseiras que acometeram as regiões parieto-temporo-occipitais, associadas a uma área hipoatenuante no parênquima encefálico adjacente sugestivo de gliose. Frente à análise dos resultados dos exames de imagens realizados, confirmou-se o diagnóstico de síndrome CEC, tendo em vista o diagnóstico prévio de DC e a associação com o histórico de crises convulsivas e os achados imagenológicos relativos às calcificações subcorticais occipitais, bilaterais e simétricas presentes, além da ausência de efeito expansivo e realce pelo meio de contraste. A síndrome CEC é uma patologia rara e pouco conhecida que pode apresentar sintomas semelhantes a outras doenças neurológicas. O diagnóstico correto e preciso é essencial para o tratamento adequado e para a prevenção de complicações futuras. Os exames de imagem, como a ressonância magnética e a tomografia computadorizada, são fundamentais para o diagnóstico e a escolha do tratamento mais adequado. No caso descrito, o uso do levetiracetam foi eficaz para o controle das crises epilépticas e para a melhora da qualidade de vida do paciente. É importante que os profissionais de saúde estejam atentos aos sintomas e ao histórico do paciente para um diagnóstico precoce e preciso da patologia

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research