ANSIEDADE, DEPRESSÃO E ESTRESSE EM MULHERES COM DOR PÉLVICA CRÔNICA / ANXIETY, DEPRESSION AND STRESS IN WOMEN WITH CHRONIC PELVIC PAIN

Introdução: A dor pélvica crônica é uma condição clínica prevalente e, frequentemente associada à ansiedade, depressão e estresse. Objetivos: Estimar a prevalência de transtornos em mulheres com dor pélvica crônica e verificar a associação com o tempo e intensidade da dor. Métodos: Estudo caso-controle realizado no município de São Luís (MA), com 200 mulheres, sendo 50 casos e 150 controles. As variáveis avaliadas foram: tempo de dor, intensidade da dor e escores de ansiedade, depressão e estresse aferidos respectivamente por questionário semi-estruturado, escala visual analógica da dor, BAI (Beck Anxiety Inventory), BDI (Beck Depression Inventory) e o Inventário de Sintomas de Estresse para Adultos de Lipp (ISSL). Para estabelecer a prevalência desses transtornos, foi considerado como presente a partir do nível moderado, tanto para o BAI como para o BDI. Resultados: A prevalência de estresse no grupo de mulheres com Doença Pélvica Crônica foi de 59,3%, enquanto ansiedade e depressão foram 37,04% e 25,92%, respectivamente. No grupo controle, ansiedade e depressão estiveram presentes em 8,0% e 5,33%, respectivamente, sendo o estresse prevalente em 36%. Observou-se uma correlação positiva (r=0,1275) entre a intensidade da dor e depressão. Conclusões: Mulheres com Dor Pélvica Crônica apresentam escores mais elevados de ansiedade, depressão e estresse em relação ao grupo controle, sendo a depressão positivamente relacionada com a intensidade da dor.Palavras-chave: Dor pélvica. Ansiedade. Transtornos de Adaptação.AbstractIntroduction: Chronic pelvic pain (CPP) is a prevalent clinical condition that is often associated with anxiety, depression and stress. Objectives: To estimate the prevalence of these disorders in women with CPP and to check for associations with time and intensity of pain. Methods: Case-control study conducted in the municipality of São Luís, Maranhão, Brazil, in the period from March 2010 to May 2011, in a group of 200 women, where 50 had CPP diagnostic and 150 were in the control group. Variables were, as follows: pain time, pain intensity and anxiety, depression and stress scores, which were measured, respectively, by semi-structured questionnaire, visual analogue scale for pain, BAI (Beck Anxiety Inventory), BDI (Beck Depression Inventory) and Lipp's Adult Stress Symptoms Inventory (ISSL). In order to establish the prevalence of these disorders, they were considered present from the moderate level, for both BAI and BDI. Results: Stress prevalence in the group of women with CPP was of 59.3%, while anxiety and depression were identified in 37.04% and 25.92% of women, respectively. In the control group, anxiety and depression were present in 8.0% and 5.33% of women, respectively, and stress was present in 36%. There was positive correlation (r = 0.1275) between the intensity of pain and depression. Conclusions: Women with CPP have higher scores of anxiety, depression and stress than women without CPP, and depression is positively related to the intensity of pain.Keywords: Pelvic pain. Anxiety. Adjustment Disorders

VAGINOSE BACTERIANA RECORRENTE: ATUALIDADES NO MANEJO TERAPÊUTICO / RECURRENT BACTERIAL VAGINOSIS: UPDATES IN THERAPEUTIC MANAGEMENT

Introdução: A Vaginose Bacteriana (VB) é uma enfermidade comum e muito prevalente. Decorre do desequilíbrio da flora vaginal, com redução populacional de Lactobacilos e colonização por bactérias patogênicas. Apresenta recorrência significativa com o tratamento convencional monoterápico e necessita de maior compreensão fisiopatogênica para melhor terapêutica. Objetivo: Demonstrar os principais regimes terapêuticos para o tratamento da vaginose bacteriana, enfocando as terapias mais recentes para o controle da recorrência. Métodos: Estudo bibliográfico a partir dos termos: vaginose bacteriana, vaginose bacteriana recorrente e tratamento da Vaginose Bacteriana. Resultados: Apesar dos regimes terapêuticos confiáveis com antibióticos, como Metronidazol® e Clindamicina®, percebe-se falha importante no controle da enfermidade, atribuída ao desenvolvimento de resistência bacteriana. Outros fatores podem ser incluídos, como predisposição genética, hábitos sexuais, mas nenhum é suficientemente convincente para explicar a fisiopatogênese da doença. A maioria das terapias combinadas com os antibióticos tradicionais apresenta bons resultados na diminuição da recorrência. Os probióticos, em especial Lactobacillus, mostraram-se eficazes na prevenção da Vaginose Bacteriana recorrente quando em associação ao antibiótico tradicional. Os prebióticos também são substâncias que podem melhorar o sucesso na terapia de casos recorrentes. Conclusão: Não obstante a recomendação de monoterapia para o tratamento a utilização de outras substâncias, como os probióticos, é recomendada para adição ao arsenal terapêutico, considerando a diminuição significativa da recorrência de Vaginose Bacteriana em pacientes tratadas com terapia combinada.Palavras-chave: Vaginose bacteriana. Antibióticos. Terapêutica. Probióticos.AbstractIntroduction: Bacterial vaginosis (BV) is a common and very prevalent disease. It is an imbalance of the vaginal flora with a reduction of Lactobacilli concentration and colonization by pathogenic bacteria. It presents significant recurrence with conventional monotherapy and that is why its physiopathogenicity needs to be more understood for a better therapy. Objective: To demonstrate the main therapeutic approaches for the treatment of Bacterial vaginosis, focusing on newer therapies for the control of recurrence. Methods: A literature review using the terms: bacterial vaginosis, recurrent bacterial vaginosis and treatment of bacterial vaginosis. Results: Despite the reliable therapeutic approaches with antibiotics such as metronidazole and clindamycin, it is still seen failure in controlling this disease because of bacterial resistance. Other factors may be included, such as genetic predisposition, sexual habits. However, none of these factors is sufficiently convincing to explain the pathophysiology of the disease. The majority of combined therapy with traditional antibiotics presents good results in the reduction of recurrence. The probiotics, especially lactobacillus, were effective in preventing recurrent BV when in combination with traditional antibiotics. The prebiotics are also substances that can improve the success of therapy in recurrent BV. Conclusion: Despite the recommendation of monotherapy for the treatment of Bacterial vaginosis, the use of other substances, such as probiotics, is recommended for addition to the therapeutic arsenal because of the significant reduction in the recurrence of BV in patients treated with combined therapy.Keywords: Bacterial vaginosis. Antibiotics. Therapeutics. Probiotics

SÍNDROME DOS OVÁRIOS POLICÍSTICOS EM UM SERVIÇO DE REFERÊNCIA: PREVALÊNCIA E RISCO CARDIOVASCULAR ASSOCIADO / POLYCYSTIC OVARY SYNDROME IN A REFERENCE SERVICE: PREVALENCE AND ASSOCIATED CARDIOVASCULAR RISK

Introdução: A Síndrome dos Ovários Policísticos (SOP) é um distúrbio endócrino heterogêneo, que engloba vários critérios diagnósticos. Dentre suas repercussões sistêmicas, as alterações metabólicas podem destacar-se como fatores de risco para doenças cardiovasculares. Objetivo: Identificar a prevalência da SOP de acordo com os consensos diagnósticos vigentes, as características clínicas e a prevalência de fatores de risco cardiovascular nas mulheres diagnosticadas com essa síndrome. Métodos: Estudo transversal com 215 mulheres, entre 20 e 45 anos, atendidas no ambulatório de ginecologia do Hospital Universitário Unidade Materno-Infantil, no período de 2008 a 2010. As mulheres foram submetidas à avaliação para diagnóstico de SOP segundo os consensos, posteriormente, submetidas a exame clínico e laboratorial (pressão arterial, colesterol total, LDL-colesterol, HDL-colesterol, triglicerídeos e glicemia em jejum). Resultados: A prevalência de SOP correspondeu a 47,4% das mulheres avaliadas, sendo caracterizada por mulheres com idade entre 20 e 25 anos (41,2%), cor parda (50%), solteiras (52,9%), com ensino médio (44,1%) e estudantes (27,4%). O consenso de Rotterdam apreendeu todas as mulheres com SOP, seguido do desenvolvido pela Androgen Excess Society (68,6%). A disfunção ovulatória ocorreu em 90,2% da amostra, caracterizada principalmente por oligomenorréia. Quanto aos fatores de risco cardiovascular, identificaram-se as alterações mais prevalentes no perfil lipídico, destacando-se o HDL-colesterol com 23,5% e colesterol total com 22,5%. Conclusão: Reafirma-se que a SOP consiste em uma endocrinopatia comum entre as mulheres na idade reprodutiva e que estas mulheres apresentam uma prevalência importante de fatores de risco cardiovascular, sobretudo relacionados à alteração no perfil lipídico.Palavras-chave: Síndrome do Ovário Policístico. Consenso. Fatores de Risco. Doenças Cardiovasculares.AbstractIntroduction: Polycystic Ovary Syndrome (PCOS) is a heterogeneous endocrine disorder that comprises several diagnostic criteria. Among its systemic repercussions, metabolic changes stand out as risk factors for cardiovascular disease. Objective: To identify the prevalence of PCOS according to the current consensus of diagnoses, the clinical characteristics and the prevalence of cardiovascular risk factors in women diagnosed with this syndrome. Methods: Cross-sectional study with 215 women of 20 to 45 years age and assisted at the gynecology clinic of the University Hospital - Maternal Child Unit from 2008 to 2010. These women underwent evaluation for diagnosis of PCOS according to the consensus. Thus, they were subjected to clinical examination and laboratory tests (blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and fasting glucose). Results: The prevalence of PCOS corresponded to 47.4% of all women evaluated. Of these women, mostly were between 20 and 25 years (41.2%), brown (50%), single (52.9%), high school graduate (44.1%) and students (27.4%). The consensus of Rotterdam involved all women with PCOS, followed by the developed criterion of the Androgen Excess Society (68.6%). The ovulatory dysfunction occurred in 90.2% of the sample, mainly characterized by oligomenorrhea. Regarding cardiovascular risk factors, the most frequent changes were identified in the lipid profile, especially in the HDL-cholesterol (23.5%) and the total cholesterol (22.5%). Conclusion: It is noteworthy to say that the PCOS is a common endocrine disorder among women in reproductive age and that these women have a high prevalence of cardiovascular risk factors, particularly related to changes in lipid profile.Keywords: Polycystic Ovary Syndrome. Consensus. Risk Factors. Cardiovascular Disease

Habilidades e Competências requeridas pelo Mercado de Trabalho para o Profissional de Contabilidade em Minas Gerais

O presente estudo objetiva investigar as competências e habilidades requeridas pelo mercado de trabalho para o profissional de Contabilidade, no Estado de Minas Gerais, nos níveis operacional, gerencial e estratégico, na óptica dos empregadores. A classificação da pesquisa é de caráter descritivo, com abordagem qualitativa e utilizou-se a pesquisa documental para a coleta de dados. A amostra é composta por 172 anúncios de quatro sites especializados de empresas de recrutamento e seleção: Michael Page, Catho, InfoJobs.com e Manager. Os resultados obtidos demonstram que, nos anúncios analisados, predomina a busca por profissionais para nível auxiliar, estando esses anúncios voltados para quem está iniciando a carreira. Além disso, verificou-se uma baixa representatividade no nível gerencial se comparada com os outros níveis.  Também, foi identificado um percentual relevante de demanda por experiência prévia na área contábil. Dentre os grupos de conhecimento mais exigidos aos profissionais da contabilidade, destacam-se “experiência profissional”, “tecnologia de informação” e “áreas não específicas da contabilidade”; já o grupo “normas contábeis internacionais e convergência das normas brasileiras” foi aquele que obteve menor frequência de exigência. Espera-se, com este trabalho, que os discentes de Ciências Contábeis conheçam as habilidades requeridas pelo mercado de trabalho, instigando-os a buscar mais informações sobre o perfil exigido do profissional contábil, estimulando, desse modo, que os futuros profissionais da área se qualifiquem no decorrer do curso de graduação

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status