Comment on "Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review''

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O adoecer psíquico no trabalho do professor de ensino fundamental e médio da rede pública no Estado de Minas Gerais

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia de Produção.Análise do ambiente e a pressão sobre determinadas tarefas que têm alterado experiências de trabalho e seus significados, fatos que afetam a estrutura psíquica dos indivíduos. Investiga que tipo de relação o trabalho do professor tem com sua saúde. Busca verificar se a prática do professor afeta sua saúde física e mental, essencialmente se este desgaste é mais psíquico que físico

Performance of prognostic risk scores in chronic heart failure patients enrolled in the European Society of Cardiology Heart Failure long-term registry

[Abstract] Objectives. This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Background. Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited. Methods. This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final sample of 6,161 patients. Results. At 1-year follow-up, 5,653 of 6,161 patients (91.8%) were alive. The observed-to-predicted survival ratios (CHARM: 1.10, GISSI-HF: 1.08, MAGGIC: 1.03, and SHFM: 0.98) suggested some overestimation of mortality by all scores except the SHFM. Overprediction occurred steadily across levels of risk using both the CHARM and the GISSI-HF, whereas the SHFM underpredicted mortality in all risk groups except the highest. The MAGGIC showed the best overall accuracy (area under the curve [AUC] = 0.743), similar to the GISSI-HF (AUC = 0.739; p = 0.419) but better than the CHARM (AUC = 0.729; p = 0.068) and particularly better than the SHFM (AUC = 0.714; p = 0.018). Less than 1% of patients received a prognostic estimate from their enrolling physician. Conclusions. Performance of prognostic risk scores is still limited and physicians are reluctant to use them in daily practice. The need for contemporary, more precise prognostic tools should be considered

Evaluation of antitumoral and antimicrobial activity of Morinda lcitrifolia L. grown in Southeast Brazil

PURPOSE: To evaluate the antitumor and antimicrobial activity of ethanolic extract of Morinda citrifolia L. fruit cultivated in southeastern Brazil.METHODS: Preparation ethanolic extract of the fruit of Morinda citrifolia L. Culture of melanoma cells B16-F10 for treatment with ethanolic extract of Morinda citrifolia L. fruit to determine cell viability by MTT and determination temporal effect of ethanolic extract fruit on the cell growth B16-F10 for 8 days. Evaluation of antimicrobial activity of ethanolic extract fruit against Staphylococcus aureus and Escherichia coli by determination of Minimum Inhibitory Concentration (MIC).RESULTS: the ethanolic extract of Morinda citrifolia L. fruit (10mg/mL) decreased cellular activity and inhibited 45% the rate of cell proliferation of B16-F10 melanoma treated during period studied. the ethanolic extract of Morinda citrifolia L. fruit demonstrated antimicrobial activity inhibiting the growth of both microorganisms studied. Staphylococcus aureus was less resistant to ethanolic extract of Morinda citrifolia L. fruit than Escherichia coli, 1 mg/mL and 10 mg/mL, respectively.CONCLUSION: What these results indicate that the ethanolic extract of the fruit of Morinda citrifolia L. showed antitumor activity with inhibition of viability and growth of B16-F10 cells and also showed antibacterial activity as induced inhibition of growth of Staphylococcus aureus and Escherichia coli.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Bahia Research Foundation (FAPESB)Univ Estadual Santa Cruz UESC, Dept Ciencias Biol, BR-45662900 Ilheus, BA, BrazilUniv Estadual Santa Cruz, Dept Agr & Environm Sci, BR-45662900 Ilheus, BA, BrazilUniversidade Federal de São Paulo, Div Plast Surg, São Paulo, Brazil1A CNPq, São Paulo, BrazilMed III CAPES, São Paulo, BrazilUniversidade Federal de São Paulo, Div Plast Surg, São Paulo, BrazilWeb of Scienc

Influence of diabetes on sacubitril/valsartan titration and clinical outcomes in patients hospitalized for heart failure.

Diabetes mellitus is associated with worse outcomes and lower attainment of disease-modifying therapies in patients with heart failure with reduced ejection fraction (HFrEF). This post hoc analysis of TRANSITION compared the patterns of tolerability and uptitration of sacubitril/valsartan in patients with HFrEF stabilized after hospital admission due to acute decompensated HF depending on the presence or absence of diabetes as a co-morbidity. TRANSITION, a randomized, open-label study compared sacubitril/valsartan initiation pre-discharge vs. post-discharge (up to14 days) in 991 patients hospitalized for acutely decompensated HFrEF. The impact of diabetes status on tolerability and safety was studied at 10-week and 26-week post-randomization. Among the 991 patients analysed at baseline, 460 (46.4%) had diabetes and exhibited a higher risk profile. At 10 weeks, sacubitril/valsartan target dose (97/103 mg bid) was achieved in a similar proportion of patients in each subgroup, when initiated pre-discharge or post-discharge respectively [diabetes subgroup: 47% (n = 105/226) vs. 50% (n = 115/228); relative risk ratio (RRR), 0.923; P = 0.412; non-diabetes subgroup: 45% (n = 119/267) vs. 51% (n = 133/261); RRR, 0.878; P = 0.155]. The proportions of patients achieving and maintaining either 49/51 mg or 97/103 mg bid [diabetes subgroup: 61.1% (n = 138/226) vs. 67.5% (n = 154/228); RRR, 0.909; P = 0.175; non-diabetes subgroup: 62.9% [n = 168/267] vs 69.3% [n = 181/261]; RRR, 0.906; P = 0.118] or any dose for ≥2 weeks leading to Week 10 [diabetes subgroup: 85% (n = 192/226) vs. 88.2% (n = 201/228); RRR, 0.966; P = 0.356; non-diabetes subgroup: 86.9% (n = 232/267) vs. 90.8% (n = 237/261); RRR, 0.963; P = 0.215] were also similar in each subgroup, when initiated pre-discharge or post-discharge, respectively. At 10 weeks, hypotension and renal dysfunction rates were similar, although hyperkalaemia was higher among patients with diabetes (15.9% vs. 9.5%). The rate of permanent discontinuation due to adverse events was similar in the diabetes and non-diabetes subgroups at 10 weeks, respectively: pre-discharge (7.5% vs. 7.1%) or post-discharge (5.7% vs. 4.2%). Similar patterns of uptitration and tolerability were observed at 26 weeks. Cardiac biomarkers including NT-proBNP (P < 0.005) and hs-TnT (P < 0.005) reduced significantly from baseline levels in both subgroups at Weeks 4 and 10; however, the response was greater among patients without diabetes. Mortality (diabetes vs. non-diabetes subgroups: 3.3% vs 4.0%; P = 0.438) and HF rehospitalization (diabetes vs. non-diabetes subgroups: 36.3% vs. 33.0%; P = 0.295) did not differ between the groups at 26 weeks. Despite a higher risk profile among patients with diabetes, sacubitril/valsartan initiation either before or shortly after discharge in hospitalized patients with HFrEF resulted in comparable rates of dose up-titration and tolerability as in those without diabetes.The study was funded by Novartis Pharma AG, Basel,Switzerland.S

The current and future burden of heart failure in Portugal

© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. ESC HEART FAILURE ESC Heart Failure (2019) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/ehf2.12399 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.AIMS: Heart failure (HF) is a clinical syndrome with significant social and economic burden. We aimed to estimate the burden of HF in mainland Portugal over a 22-year time horizon, between 2014 and 2036. METHODS AND RESULTS: Heart failure burden was measured in disability-adjusted life years (DALYs), resulting from the sum of years of life lost (YLL) due to premature death and years lost due to disability (YLD). YLL were estimated based on the Portuguese mortality rates reported by the European Detailed Mortality Database. For YLD, disease duration and the overall incidence were estimated using an epidemiological model developed by the World Health Organization (DISMOD II). Disability weights were retrieved from published literature. The impact of ageing was estimated with a shift-share analysis using official demographic projections. In 2014, 4688 deaths were attributed to HF, corresponding to 4.7% of the total deaths in mainland Portugal. DALYs totalled 21 162, 53.9% due to premature death (YLL: 11 398) and 46.1% due to disability (YLD: 9765). Considering only population ageing over a 22-year horizon, the deaths and burden of HF are expected to increase by 73.0% and 27.9%, respectively, reaching 8112 deaths and 27 059 DALYs lost due to HF in 2036. DALY's growth is mainly driven by the increase of YLL, whose contribution to overall burden will increase to 62.0%. CONCLUSIONS: Heart failure is an emerging and growing health problem where significant health gains may be obtained. The projected significant increase of HF burden highlights the need to set HF as a priority for healthcare system.This study was supported by Novartis Farma, Produtos Farmacêuticos SA through an unrestricted grant to the Research and Development Association of Lisbon University School of Medicine (AIDFM). Funding was independent of the study outcomes. The promoter did not participate in any phase of the study.info:eu-repo/semantics/publishedVersio

Programa de Farmacovigilancia para Droguerias Independientes Minoristas

GráficasEl presente documento presenta un programa de farmacovigilancia, con una perspectiva técnicamente planeada que permite llevar a cabo actividades de identificación, cuantificación, prevención de gestión del riesgo; además cuenta con un procedimiento, y un protocolo de manejo de eventos o incidentes adversos que ayudan a identificar las causas de esta situación, que puedan presentar los pacientes atendidos en esta Droguería durante o después de tomar o utilizar un medicamento. Los formatos de reporte, el proceso de divulgación de información y capacitación cuenta con guías internas y formatos de diligenciamiento, este contribuye para el buen uso y la seguridad delos pacientes atendidos. El programa de fármaco vigilancia en estas Droguerías Independientes se encontrara a cargo del Químico Farmacéutico o Regente de Farmacia, dando lugar al cumplimiento de lo estipulado dentro de la normatividad vigente en el sistema de saludThis document presents a pharmacovigilance program, with a technically planned perspective that allows carrying out activities of identification, quantification, prevention of risk management; It also has a procedure, and a protocol for handling adverse events or incidents that help identify the causes of this situation, which may be presented by patients treated in this Drugstore during or after taking or using a medication. Report formats, information dissemination process and training have internal guidelines and forms of completion, this contributes to the proper use and safety of the patients served. The drug monitoring program in these Independent Drugstores will be in charge of the Pharmaceutical Chemist or Regent of Pharmacy, giving rise to compliance with what is stipulated in the current regulations in the health system

LAMA DE BENEFICIAMENTO DE ROCHAS ORNAMENTAIS PROCESSADAS NO ESPÍRITO SANTO: COMPOSIÇÃO E APROVEITAMENTO: Dimension stone processing sludge from the state of Espírito Santo: composition and utilization

The production of dimension stones for coating generates a thin-grained residue from the discarding of the Dimension Stone Processing Sludge (DSPS), whose composition indicates potential use in several productive sectors. Here, we describe the compositional variability of the DSPS and different types of rocks, aiming to identify the factors that control the composition of the wastes generated by block sawing. Thirty-five samples of rocks were collected, together with the DSPS produced during the cutting of these rocks. The samples were collected directly at the loom discharge point in companies of Cachoeiro de Itapemirim County (ES), which is the main production pole in the State of Espírito Santo. The mapping of the companies' production process allowed to measure the amount of waste generated by each block sawed and showed the relevance of a stricter loss control. The comparison between rocks and DSPS revealed a strong similarity between these matrices, except for some elements such as iron and calcium, which are added as an input in the processing through conventional looms. The samples were grouped into five sets with potential uses in cosmetics, soil applications, ceramics manufacture, building or simply as a filler.A produção de rochas ornamentais para revestimento gera um resíduo de granulação muito fina, a partir do descarte da Lama de Beneficiamento de Rochas Ornamentais (LBRO), cuja composição indica potencial de utilização em diversos setores produtivos. Neste trabalho, apresenta-se um estudo da variabilidade composicional da LBRO e de diferentes tipos de rocha, com o objetivo de identificar os fatores controladores da composição dos resíduos gerados pela serragem de blocos. Foram coletadas 35 amostras de rocha e da LBRO produzida durante a serragem dessas rochas. As amostras foram coletadas diretamente da descarga do tear em empresas de Cachoeiro de Itapemirim (ES), um dos principais polos produtores do Estado do Espírito Santo. O mapeamento do processo produtivo das empresas permitiu dimensionar a quantidade de resíduos que é gerada por bloco serrado e mostrou a importância do controle de perdas. A comparação entre rochas e LBRO evidenciou íntima semelhança entre a composição química dessas matrizes, com exceção de alguns elementos como ferro e cálcio, que são acrescentados a partir dos insumos de beneficiamento em teares convencionais. As amostras foram agrupadas em cinco conjuntos com potencial de uso em cosméticos, aplicação no solo, fabricação de cerâmica, uso na construção civil ou simplesmente como filler

Remdesivir and corticosteroids in the treatment of hospitalized COVID-19 patients

okCoronavirus disease 2019 (COVID-19) is a pandemic infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2. Remdesivir (RDV) and corticosteroids are used mainly in COVID-19 patients with acute respiratory failure. The main objective of the study was to assess the effectiveness of remdesivir with and without corticosteroids in the treatment of COVID-19 patients. We conducted a prospective observational study, including adult patients consecutively hospitalized with confirmed COVID-19 and acute respiratory failure. Patients were divided according to treatment strategy: RDV alone versus RDV with corticosteroids. The primary outcome was the time to recovery in both treatment groups. We included 374 COVID-19 adult patients, 184 were treated with RDV, and 190 were treated with RDV and corticosteroid. Patients in the RDV group had a shorter time to recovery in comparison with patients in the RDV plus corticosteroids group at 28 days after admission [11 vs. 16 days (95% confidence Interval 9.7-12.8; 14.9-17.1; p = .016)]. Patients treated with RDV alone had a shorter length of hospital stay. The use of corticosteroids as adjunctive therapy of RDV was not associated with improvement in mortality of COVID-19 patients.publishersversionpublishe