Diferenças entre os sexos na esquizofrenia

UNIFESP-EPM Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

First episode psychosis: a window of treatment opportunity?

BACKGROUND: Specific first episode programs were developed around the world aiming to: early detection, intensive crises care and relapse prevention. OBJECTIVE: This article intends to outline this new first episode psychosis approach. METHOD: To review study findings from international and national centers. RESULTS: Early education programs can lower the duration of untreated psychosis and interventions in first episode psychosis should include patient and family intensive care. CONCLUSION: In some countries these services have already been incorporated in the health system. There are few research and services in our country, showing the need to develop research in this area.CONTEXTO: Programas específicos para a pesquisa e assistência ao primeiro episódio psicótico foram desenvolvidos ao redor do mundo cujos pressupostos básicos são: identificação precoce do episódio psicótico, tratamento intensivo da crise e prevenção de recaídas. OBJETIVO: Este artigo pretende dar uma visão sobre a abordagem atual do paciente no primeiro episódio psicótico. MÉTODO: Revisão de pesquisas sobre primeiro episódio psicótico em centros internacionais e nacionais. RESULTADOS: Programas para identificação precoce do episódio psicótico podem diminuir o tempo de psicose não tratada e intervenções intensivas no primeiro episódio psicótico devem incluir tratamento intensivo do paciente e de seus familiares. CONCLUSÃO: Em alguns países os serviços já foram incorporados à rede de saúde pública. Existem poucas pesquisas e serviços especializados para primeiro episódio em nosso meio mostrando a necessidade de desenvolvimento de novas pesquisas nessa área.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Management consulting skills: Towards an integrative matrix

Management consultant’s competencies have been a fragmented field of research where many proposals abound, but convergence is still pending. This research aims to offer such an integrative competency framework by critically analyzing extant models, conducting a documental content analysis to extract a list of competencies, which was subjected to empirical scrutiny via two different consensus seeking techniques: Swarm analysis and Delphi technique. Counting on three groups of participants from postgraduate studies, independent judgments were collected on the relative importance of competencies for management consultancy. These were contrasted to validate its scores and ranking, and interrater agreement indicators were applied to judge its convergence. Findings show that there is wide consensus and that a valid core competency framework to be used in management consultancy is deployable. Complementarily, findings prove that Swarm and Delphi mostly converge, and that Swarm analysis brings more efficiency to the process and opens up new analytical possibilities.As competências dos consultores de gestão têm sido um campo de investigação fragmentado onde muitas propostas abundam, porém, ainda sem que haja convergência entre si. Esta investigação visa encontrar um quadro integrador de competências através da análise crítica dos modelos existentes, conduzindo uma análise de conteúdo documental para extrair uma lista de competências, depois submetida a um escrutínio empírico através de duas técnicas diferentes de procura de consenso: a análise Swarm e a técnica Delphi. Contando com três grupos de participantes provindos de estudos pós-graduados, foram recolhidos julgamentos independentes sobre a importância relativa das competências para a consultoria de gestão. Estes foram contrastados para validar as suas pontuações e classificações, e foram usados indicadores de concordância para avaliar a sua convergência. As conclusões mostram que existe um amplo consenso e que é viável obter um quadro válido de competências centrais na consultoria de gestão. Complementarmente, os resultados mostram que o Swarm e o Delphi convergem fortemente, e que a análise Swarm traz mais eficiência ao processo e abre novas possibilidades analíticas

Wine Quality Assessment under the Eindhoven Classification Method

The identification, classification and recording of events leading to deterioration of wine quality is essential for developing appropriate strategies to avoid them. This work introduces an adverse event reporting and learning system that can help preventing hazards and ensure the quality of the wines. The Eindhoven Classification Method (ECM) has been extended and adapted to the incidents of the wine industry. Logic Programming (LP) was used for Knowledge Representation and Reasoning (KRR) in order to model the universe of discourse, even in the presence of incomplete data, information or knowledge. On the other hand, the evolutionary process of the body of knowledge is to be understood as a process of energy devaluation, enabling the automatic extraction of knowledge and the generation of reports to identify the most relevant causes of errors that can lead to a poor wine quality. In addition, the answers to the problem are object of formal evidence through theorem proving

Major clinical outcomes of melatonin use in COVID-19 patients: a systematic review

Introduction: In the context of the Sars-Cov-2 (COVID-19) pandemic, as well as other viral infections, these viruses can lead to significant morbidity and mortality. Thus, in the context of melatonin science in viral infections such as influenza and COVID-19, there is a growing realization that the regulation of melatonin pathways, both pineal and systemic, may be an important aspect of the regulation of viruses in cellular functions. Objective: It was to list the main results of clinical studies of the use of melatonin in patients infected with Sars-Cov-2 through a systematic review. Methods: The rules of the Systematic Review-PRISMA Platform. The search was carried out from December 2021 to April 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: It was found 164 articles. A total of 86 articles were fully evaluated and 30 studies were developed in a systematic review. Melatonin is known as an anti-inflammatory agent and immune modulator that may address the progressive pathophysiology of coronavirus disease 2019 (COVID-19). According to the objective and results obtained in the present study that evaluated the treatment in patients with COVID-19, the use of melatonin can help reduce thrombosis, sepsis and mortality. Furthermore, the combination of 3.0 mg oral melatonin tablets and standard care can substantially improve sleep quality and blood oxygen saturation in hospitalized patients. Clinical symptoms such as cough, dyspnea and fatigue, as well as the polymerase chain reaction (PCR) level and lung involvement in patients receiving melatonin can improve significantly. Also, the mean time of patients' hospital discharge and return to initial health was significantly shorter in patients who received melatonin compared to the control group. There was evidence of benefit of sustained-release melatonin 2 mg in therapy in patients, as well as evidence that the use of melatonin was associated with a reduced probability of a positive SARS-CoV-2 test result compared to the use of blockers of the angiotensin II receptor or angiotensin-converting enzyme inhibitors

COVID-19: Major Metabolic and Immunological Relationships in Obesity

Introduction: In the scenario of chronic non-communicable diseases, obesity stands out as a multifactorial disease that can cause several public health problems. Currently, about 30% of the world's population is overweight or obese. Estimates suggest that the prevalence of severe obesity in 2030 will be 11%, approximately twice the current prevalence. By 2025, Brazil will be in fifth place in the world ranking, with an estimated 18.0 million people. The appearance of the new coronavirus (SARS-CoV-2), which causes the disease COVID-19, has worsened the comorbidities of obesity. Objective: to explore, through a concise systematic review, the main metabolic and immunological relationships in obesity, especially in the presence of COVID-19. Methods: The present study followed a concise systematic review model (PRISMA). The search strategy was carried out in the databases PubMed, Embase, Ovid and Cochrane Library, Web of Science, and Scopus. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 76 studies were found that were submitted to the eligibility analysis, and, after that, 15 studies of high to medium quality and with risks of bias were selected that do not compromise the scientific basis of the studies, we found that obesity is an important predictor of worsening SARS-CoV-2 pathology. There is a complex interaction between multiple metabolic, immunological and inflammatory factors that result in meta-inflammation. It has been shown that obesity causes dysfunction in the immune system, increasing susceptibility to infections and death from sepsis, and increased oxidative stress in the body. SARS-CoV-2 amplifies the inflammatory response, enabling greater propensity to alveolar thrombotic microangiopathy and pulmonary thromboembolism. Meta-inflammation and insulin resistance with hyperinsulinemia is the main baseline changes in obesity. Conclusion: In the COVID-19 scenario, obesity is an important predictor of the worsening of SARS-CoV-2 pathology, mainly due to the worsening of met inflammation

Tratamento e controlo sintomático nas feridas malignas

As lesões malignas cutâneas podem ocorrer em cerca de 5% dos doentes com cancro e 10% dos doentes que apresentam metástases e surgem frequente nos seus últimos seis meses de vida, sendo neste contexto que surge a ferida maligna, associada a progressão da doença e agravamento do prognóstico. As feridas neoplásicas constituem uma temática pouco abordada na literatura nacional e internacional quando comparadas com outro tipo de feridas, principalmente devido à falta de publicação de trabalhos de investigação nesta área. Existem, essencialmente, estudos de casos particulares. Objetivo: identificar medidas eficazes de tratamento e controlo sintomático da ferida maligna. Método: realizou-se uma revisão sistemática da literatura em dois momentos distintos, nomeadamente em Outubro e em Dezembro de 2011. A pesquisa efetuou-se através do sistema Medline e PubMed, utilizando o descritor “fungating wounds”. Para este artigo foram selecionados como critérios de inclusão a data compreendida entre 2000 e 2011 e a descrição ao longo do artigo das intervenções para tratamento e controlo sintomático da ferida maligna, tenso sido incluídos 13 artigos. Conclusões: A abordagem à ferida passa, não só, pelo controlo dos eventos físicos, mas está, sim, intimamente interligada com o apoio psicológico. O tratamento das feridas malignas deverá estar associado ao tratamento da neoplasia. Se o tumor responder a tratamentos adjuvantes como a radioterapia ou a quimioterapia, A ferida poderá evoluir para a cura ou reduzir o seu tamanho. As neoplasias nem sempre respondem aos tratamentos, e, muitas das vezes este tipo de tratamentos é meramente paliativo. E sendo assim, o tratamento local da ferida tem como principal objetivo: o controlo da sintomatologia presente, através de intervenções como a escolha de material de penso adequado ou a utilização de agentes tópicos que promovam a hemóstase, assim como a utilização de medidas sistémicas para controlar a dor e a infeção

La liquidación del impuesto sobre sucesiones y donaciones. Ventajas y desventajas de la autoliquidación

En el Impuesto sobre sucesiones y donaciones el sujeto pasivo puede optar por presentar a la AdministraciónTributaria los documentos acreditativos del hecho imponible para que la misma le notifique la liquidación correspondiente o por presentar autoliquidación, en la que el propio contribuyente realiza la cuantificación de la cuota tributaria y procede a su ingreso. En principio, salvo en los caso en los que es obligatoria la autoliquidación, al sujeto pasivo le convendría optar por el régimen de presentación de documentos, salvo que le interese inscribir en el Registro de la Propiedad los inmuebles trasnmitidos o disponer de determinados bienes sometidos a la resposabilidad subsidiaria del depositario.In the inheritance and gift tax the taxpayer may choose to submit to the tax authorities the documents of the fact that the same amount for it notifies the appropriate disposition or present self, in which the taxpayer conducts the quantification of the quota and proceeds to its tax income. In principie, except in cases where it is compulsory self, the taxpayer should you opt for the scheme to submit documents, except that he was interested to enroll in the Land Registry buildings transmitted or dispose of certain assets subject to liability subsidiary of the depositary

La eficacia del poder de representación de los administradores mancomunados

Los administradores mancomunados de una sociedad mercantil, en general, y los de una sociedad de responsabilidad limitada, en particular, ejercen el poder de representación de dicha sociedad conjuntamente, es decir, siendo necesaria la intervención de dos de ellos, al menos, en la forma determinada en los Estatutos sociales. Pero esta limitación, impuesta legalmente y que debe constar inscrita en el Registro Mercantil, no siempre alcanza al tercero de buena fe que contrata con la sociedad a través de uno sólo de los administradores mancomunados. La jurisprudencia otorga validez a estos contratos, sobre la base de la doctrina del Tribunal Supremo sobre el factor notorio. A la sociedad le cabe defenderse probando que el tercero conocía la existencia del órgano de administración mancomunado y, en caso de que esto no sea posible, exigiendo responsabilidades al administrador mancomunado que ha actuado en solitarioThe joint administrators of a mercantile society in general and a limited society, in particular, together represent the company so it is necessary two of them for the representation. This representation not always reachs the third good faith that hires with the company through one of them. It is nececessary to prove it that the society shows the knowledge of the existence of the joint administration for the third person or demanding him responsabilites for his lonely activities