Efeito protetor do pré-tratamento com ácido ascóbico em modelo experimental de isquemia-reperfusão intestinal: um estudo histomorfométrico

BACKGROUND: Ascorbic acid has shown promise in attenuation of intestinal ischemia-reperfusion (I/R) injury. The aim of this study was to determine the protective effects of ascorbic acid on intestinal morphology during IR injury in rats. MATERIALS AND METHODS: We examined morphological changes in the small intestine of Wistar rats after (i) 40 minutes of ischemia (I), (ii) ischemia followed by 30 min of reperfusion (IR), (iii) ischemia with ascorbic acid (IA), (iv) ischemia followed by reperfusion and ascorbic acid (IRA) and (v) in a sham group (S). We used morphometry to evaluate the amount of villous architecture, crypts, necrosis, hemorrhagic infarcts and inflammatory cells at the mesenteric and antimesenteric borders of the small intestine. RESULTS: Ascorbic acid caused a significant reduction of antimesenteric villous hemorrhagic infarction (pINTRODUÇÃO: O ácido ascórbico tem se mostrado como um agente promissor na atenuação da lesão causada pela isquemia/reperfusão (IR). O objetivo deste estudo foi determinar os efeitos protetores do ácido ascórbico na morfologia intestinal durante a IR em ratos. MATERIAL E MÉTODOS: Examinamos alterações morfológicas no intestino delgado de ratos do tipo Wistar. Após 40 minutos de isquemia (I), isquemia seguida de reperfusão (IR), isquemia com tratamento com ácido ascórbico (IA), isquemia seguida por 30 minutos de reperfusão e tratamento com ácido ascórbico (IRA) e do grupo sham (S). Utilizamos a morfometria para avaliar quantitativamente a arquitetura dos vilos da mucosa intestinal, criptas intestinais, necrose, hemorragia, células inflamatórias nas bordas mesentéricas e antimesentéricas do intestino delgado. RESULTADOS: O ácido ascórbico causou uma redução significativa (

Nebulized Recombinant Tissue Plasminogen Activator (rt-PA) for Acute COVID-19-Induced Respiratory Failure : An Exploratory Proof-of-Concept Trial

Acknowledgments We would like to extend our sincerest gratitude to all the colleagues and hospital staff who worked tirelessly throughout the pandemic and without whom this work would not have been possible. Firstly, we would like to thank our colleagues in the intensive care unit (ICU), in particular the matrons, Sean Carroll and Sinead Hanton, and research nurses, Filipe Helder and Amitaa Maharajh for their support, and bedside nurses who bore the responsibility of drug administration. We would also like to extend our thanks to ICU consultants who acted as professional legal consultees on behalf of critical care patients. Equally, we would like to thank colleagues within the respiratory team. Their expertise was instrumental to our role in treating patients on 8N and 8E wards. A special mention to lead Nurse Mary Emerson; we were grateful for her knowledge, support and for facilitating the training for the nebulizer and drug administration on the wards. We would like to thank Aarti Nandani and all the staff in the Royal Free clinical trials pharmacy for their immense support throughout the whole pandemic, especially considering their ever-increasing workload at the time. Thanks also to the HSL coagulation laboratory, the Trust R&D department and all the staff working to cover during a very challenging time. We are also very grateful to the Royal Free charity for funding this study. Finally, we would like to thank all the clinical nurses, physiotherapists, research data managers and healthcare professionals within the Haemophilia department (and wider hospital) for all their many efforts in supporting this study. This trial was overseen by an independent data monitoring committee, chaired by Najib Rahman, Director of the Oxford Respiratory Trials Unit, University of Oxford and comprises the following committee members: Mike Makris, Jonathan Silversides and Henry Watson. Funding Royal Free Charity Trust Fund 35 provided funding for this study. The study drug was provided by Boehringer Ingelheim (BI). BI had no role in the design, analysis, or interpretation of the results. They were given the opportunity to review the manuscript for medical and scientific accuracy since it relates to BI substances and intellectual property considerations.Peer reviewedPublisher PD

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Vetenskaplig grund i specialpedagogens arbete En studie om några specialpedagogers uppfattning om vetenskaplig grund

Syftet med vårt arbete är att ta reda på och bidra med kunskap om hur några specialpedagoger uppfattar skolans vetenskapliga grund samt hur de i sin yrkesroll förverkligar den. Vi vill belysa vikten av att vetenskaplig grund omsätts i praktiken. Vi tror att det är viktigt att bygga kunskap och i förlängningen ett samhälle på vetenskaplig grund, inte minst med tanke på den senaste tidens diskussion om bland annat fake news, nättroll och desinformation. Vi vill bidra med att ge en inblick i hur och om man arbetar med vetenskaplig grund i verksamheter där specialpedagoger arbetar. Det är ett till synes outforskat område vilket gjort att vi fått tänka både högt och brett i undersökningen för att hitta begynnelsen till skrivelsen vetenskaplig grund. Den teoretiska utgångspunkten i arbetet har varit fenomenografi. Fenomenografin studerar människors uppfattningar om olika fenomen. Den grundläggande distinktionen inom denna ansats är att hur något är och hur något uppfattas vara. Eftersom fenomenografi handlar om att identifiera människors uppfattningar om olika fenomen i sin omvärld, har denna metodansats använts i vår undersökning för att ta reda på hur specialpedagoger uppfattar begreppet vetenskaplig grund i skolans verksamhet. En kvalitativ ansats har använts som metod i detta arbete. Vi har genomfört sju intervjuer som transkriberats, bearbetats och analyserats flera gånger för att hitta gemensamma teman men även se på skillnader i uppfattningar. Intervjuerna har varit semistrukturerade för att ge respondenterna möjlighet att beskriva sin uppfattning med egna ord. I arbetet har endast ett urval av svaren valts ut från de olika respondenterna. Detta för att få en variation av uppfattningar. Samtidigt har vissa av citaten valts ut när de bäst representerat vad majoriteten av respondenterna har uttryckt om en fråga. Dessa utplockade citat utgör på så sätt en gemensam röst inom denna frågeställning. Resultatet visar på att respondenterna uppfattade den vetenskapliga grunden såsom den beskrivs av Skolverket och Skolinspektionen. Vidare visade resultatet att det bland specialpedagogerna i undersökningen fanns kunskap och medvetenhet om vad vetenskaplig grund är, men den utgjorde inte ett naturligt inslag i deras arbete ute i verksamheterna

Vetenskaplig grund i specialpedagogens arbete En studie om några specialpedagogers uppfattning om vetenskaplig grund

Syftet med vårt arbete är att ta reda på och bidra med kunskap om hur några specialpedagoger uppfattar skolans vetenskapliga grund samt hur de i sin yrkesroll förverkligar den. Vi vill belysa vikten av att vetenskaplig grund omsätts i praktiken. Vi tror att det är viktigt att bygga kunskap och i förlängningen ett samhälle på vetenskaplig grund, inte minst med tanke på den senaste tidens diskussion om bland annat fake news, nättroll och desinformation. Vi vill bidra med att ge en inblick i hur och om man arbetar med vetenskaplig grund i verksamheter där specialpedagoger arbetar. Det är ett till synes outforskat område vilket gjort att vi fått tänka både högt och brett i undersökningen för att hitta begynnelsen till skrivelsen vetenskaplig grund. Den teoretiska utgångspunkten i arbetet har varit fenomenografi. Fenomenografin studerar människors uppfattningar om olika fenomen. Den grundläggande distinktionen inom denna ansats är att hur något är och hur något uppfattas vara. Eftersom fenomenografi handlar om att identifiera människors uppfattningar om olika fenomen i sin omvärld, har denna metodansats använts i vår undersökning för att ta reda på hur specialpedagoger uppfattar begreppet vetenskaplig grund i skolans verksamhet.En kvalitativ ansats har använts som metod i detta arbete. Vi har genomfört sju intervjuer som transkriberats, bearbetats och analyserats flera gånger för att hitta gemensamma teman men även se på skillnader i uppfattningar. Intervjuerna har varit semistrukturerade för att ge respondenterna möjlighet att beskriva sin uppfattning med egna ord. I arbetet har endast ett urval av svaren valts ut från de olika respondenterna. Detta för att få en variation av uppfattningar. Samtidigt har vissa av citaten valts ut när de bäst representerat vad majoriteten av respondenterna har uttryckt om en fråga. Dessa utplockade citat utgör på så sätt en gemensam röst inom denna frågeställning. Resultatet visar på att respondenterna uppfattade den vetenskapliga grunden såsom den beskrivs av Skolverket och Skolinspektionen. Vidare visade resultatet att det bland specialpedagogerna i undersökningen fanns kunskap och medvetenhet om vad vetenskaplig grund är, men den utgjorde inte ett naturligt inslag i deras arbete ute i verksamheterna

Vetenskaplig grund i specialpedagogens arbete En studie om några specialpedagogers uppfattning om vetenskaplig grund

Syftet med vårt arbete är att ta reda på och bidra med kunskap om hur några specialpedagoger uppfattar skolans vetenskapliga grund samt hur de i sin yrkesroll förverkligar den. Vi vill belysa vikten av att vetenskaplig grund omsätts i praktiken. Vi tror att det är viktigt att bygga kunskap och i förlängningen ett samhälle på vetenskaplig grund, inte minst med tanke på den senaste tidens diskussion om bland annat fake news, nättroll och desinformation. Vi vill bidra med att ge en inblick i hur och om man arbetar med vetenskaplig grund i verksamheter där specialpedagoger arbetar. Det är ett till synes outforskat område vilket gjort att vi fått tänka både högt och brett i undersökningen för att hitta begynnelsen till skrivelsen vetenskaplig grund. Den teoretiska utgångspunkten i arbetet har varit fenomenografi. Fenomenografin studerar människors uppfattningar om olika fenomen. Den grundläggande distinktionen inom denna ansats är att hur något är och hur något uppfattas vara. Eftersom fenomenografi handlar om att identifiera människors uppfattningar om olika fenomen i sin omvärld, har denna metodansats använts i vår undersökning för att ta reda på hur specialpedagoger uppfattar begreppet vetenskaplig grund i skolans verksamhet.En kvalitativ ansats har använts som metod i detta arbete. Vi har genomfört sju intervjuer som transkriberats, bearbetats och analyserats flera gånger för att hitta gemensamma teman men även se på skillnader i uppfattningar. Intervjuerna har varit semistrukturerade för att ge respondenterna möjlighet att beskriva sin uppfattning med egna ord. I arbetet har endast ett urval av svaren valts ut från de olika respondenterna. Detta för att få en variation av uppfattningar. Samtidigt har vissa av citaten valts ut när de bäst representerat vad majoriteten av respondenterna har uttryckt om en fråga. Dessa utplockade citat utgör på så sätt en gemensam röst inom denna frågeställning. Resultatet visar på att respondenterna uppfattade den vetenskapliga grunden såsom den beskrivs av Skolverket och Skolinspektionen. Vidare visade resultatet att det bland specialpedagogerna i undersökningen fanns kunskap och medvetenhet om vad vetenskaplig grund är, men den utgjorde inte ett naturligt inslag i deras arbete ute i verksamheterna

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Este trabalho tem por objetivo apresentar a análise de ajuste de modelos de regressão logística. Inicialmente, dedicamo-nos ao estudo de técnicas que propiciam uma análise global do ajuste do modelo. Numa etapa seguinte, introduzimos as principais medidas de diagnóstico para a detecção de pontos discrepantes e um estudo dos principais gráficos para esse tipo de análise. Concluímos o trabalho com a aplicação das técnicas descritas a um conjunto de dados reaisnot availabl

Empatía : la capacidad de iluminar las relaciones Interpersonales : un estudio entre niños de escuelas públicas de São Paulo

Abstract: This article presents a descriptive research that included the participation of children, students from two directorates of the São Paulo state public education network: the DRE “Leste 3” in the metropolitan region of São Paulo, with 824 respondents, and the DRE of Taquaritinga, in São Paulo’s countryside, with 225 children who responded to the survey, totaling 1049 participants. The objective was to identify the levels of empathy pointed out by students in the initial years. For this, we used a questionnaire with closed questions, divided into two parts: in the first, containing 13 questions, we seek to identify the student's profile and, in the second, with eight questions, we aim to visualize the levels of empathy. The questionnaire was built by members of the GEPEM - Group of Studies and Research in Moral Education from the current literature. The students responded online, through a Google Forms form. The results indicated how much children indicate that they are able to be sensitized to the feelings of their peers and show that self-control is still under construction at this stage of development among the children participating in the investigation.Resumo: Este artigo apresenta uma pesquisa descritiva que contou com a participação de crianças, estudantes de duas diretorias da rede de ensino público estadual paulista: a DRE “Leste 3” na região metropolitana de São Paulo, com 824 respondentes, e a DRE de Taquaritinga, no interior paulista, com 225 crianças que responderam à pesquisa, totalizando 1049 participantes. O objetivo foi identificar os níveis de empatia apontados por estudantes dos anos iniciais. Para isso, utilizamos um questionário com perguntas fechadas, dividido em duas partes: na primeira, contendo 13 perguntas, buscamos identificar o perfil do estudante e, na segunda, com oito questões, objetivamos visualizar os níveis de empatia. O questionário foi construído por membros do GEPEM - Grupo de Estudos e Pesquisas em Educação Moral a partir da literatura atual. As alunas e os alunos responderam de maneira online, por meio de um formulário do Google Forms. Os resultados indicaram o quanto as crianças sinalizam conseguirem se sensibilizar com o sentimento dos colegas e mostra que o autocontrole ainda está em construção nesta etapa do desenvolvimento entre as crianças participantes da investigação.Resumen: Este artículo presenta una investigación descriptiva que contó con la participación de niños, estudiantes de dos juntas directivas de la red de educación pública del estado de São Paulo: la DRE "Leste 3" en la región metropolitana de São Paulo, con 824 encuestados, y la DRE de Taquaritinga, en el interior de São Paulo, con 225 niños que respondieron a la encuesta, totalizando 1049 participantes. El objetivo fue identificar los niveles de empatía señalados por los estudiantes desde los primeros años. Para ello, utilizamos un cuestionario con preguntas cerradas, dividido en dos partes: en la primera, que contiene 13 preguntas, se intentó identificar el perfil del alumno y, en la segunda, con ocho preguntas, se pretendió visualizar los niveles de empatía. El cuestionario fue construido por miembros del GEPEM - Grupo de Estudios e Investigación en Educación Moral a partir de la literatura actual. Los estudiantes respondieron en línea a través de un formulario de Google Forms. Los resultados indicaron cuánto señalan los niños para sensibilizarse con el sentimiento de sus colegas y muestran que el autocontrol aún está en construcción en esta etapa del desarrollo entre los niños que participan de la investigación