CORRELAÇÃO ENTRE A OBESIDADE E A OSTEOARTRITE

In view of the obesity epidemic that is currently present in the world, this article aims to demonstrate how inflammation resulting from obesity can generate degenerative processes in the cartilage of the joints of patients with a BMI greater than or equal to 30kg/m². This article aims to demonstrate the correlation between obesity and the development of osteoarthritis. This is a literature review, whose result was 282 works found, of which 5 were selected, and the following exclusion criteria were used: title and abstract that did not understand the theme addressed, research projects and articles from paid platforms. From this, it can be seen that central obesity is associated with the early onset of joint pain intensity in patients with osteoarthritis. Therefore, the control of central obesity and visceral fat should be considered a goal for any preventive and pain management program in patients with osteoarthritis. Finally, it is concluded that there is scientific evidence that suggests obesity as a predisposing factor for the onset of osteoarthritis.Ante la epidemia de obesidad que se presenta actualmente en el mundo, este artículo tiene como objetivo demostrar cómo la inflamación resultante de la obesidad puede generar procesos degenerativos en el cartílago de las articulaciones de pacientes con un IMC mayor o igual a 30 kg/m². Este artículo tiene como objetivo demostrar la correlación entre la obesidad y el desarrollo de artrosis. Se trata de una revisión bibliográfica, cuyo resultado fue de 282 trabajos encontrados, de los cuales se seleccionaron 5, y se utilizaron los siguientes criterios de exclusión: título y resumen que no entendían la temática abordada, proyectos de investigación y artículos de plataformas de pago. A partir de esto, se puede observar que la obesidad central se asocia con la aparición temprana de la intensidad del dolor articular en pacientes con artrosis, por lo que el control de la obesidad central y la grasa visceral debe considerarse un objetivo para cualquier programa preventivo y de manejo del dolor en pacientes con artrosis. Finalmente, se concluye que existe evidencia científica que sugiere que la obesidad es un factor predisponente para la aparición de artrosis.Diante da epidemia de obesidade que se apresenta atualmente no mundo, este artigo visa demonstrar como a inflamação advinda da obesidade pode gerar processos degenerativos na cartilagem das articulações dos pacientes com IMC maior ou igual a 30kg/m². O presente artigo tem por objetivo demonstrar a correlação entre a obesidade e o desenvolvimento da osteoartrite. Trata-se de uma revisão de literatura, cujo resultado foi de 282 trabalhos encontrados, destes, foram selecionados 5, sendo utilizados como critérios de exclusão: título e resumo que não compreendessem a temática abordada, projetos de pesquisa e artigos de plataformas pagas. A partir disso, pode-se perceber que a obesidade central está associada ao início precoce da intensidade da dor articular em pacientes com osteoartrite. Portanto, o controle da obesidade central e da gordura visceral deve ser considerado uma meta para qualquer programa preventivo e de manejo da dor em pacientes com osteoartrite. Conclui-se, por fim, que existem evidências científicas que sugerem a obesidade como fator predisponente ao surgimento da osteoartrite.Diante da epidemia de obesidade que se apresenta atualmente no mundo, este artigo visa demonstrar como a inflamação advinda da obesidade pode gerar processos degenerativos na cartilagem das articulações dos pacientes com IMC maior ou igual a 30kg/m². O presente artigo tem por objetivo demonstrar a correlação entre a obesidade e o desenvolvimento da osteoartrite. Trata-se de uma revisão de literatura, cujo resultado foi de 282 trabalhos encontrados, destes, foram selecionados 5, sendo utilizados como critérios de exclusão: título e resumo que não compreendessem a temática abordada, projetos de pesquisa e artigos de plataformas pagas. A partir disso, pode-se perceber que a obesidade central está associada ao início precoce da intensidade da dor articular em pacientes com osteoartrite. Portanto, o controle da obesidade central e da gordura visceral deve ser considerado uma meta para qualquer programa preventivo e de manejo da dor em pacientes com osteoartrite. Conclui-se, por fim, que existem evidências científicas que sugerem a obesidade como fator predisponente ao surgimento da osteoartrite

Cervical cancer tracking in Minas Gerais: assessment of data from Cervical Cancer Information System (SISCOLO)

ObjectiveTo evaluate the indicators related to cervical cytology, quality, frequency of cellular changes and informed follow-up of high-grade lesions in Minas Gerais and its macro-regions of health. Methods a descriptive study based on data from the Cervical Cancer Information System (SISCOLO) from 2006 to 2011. Results The ratio of cervical cytopathologic exams in women aged 25 to 59 years remained stable, but did not reach the goal set by the state. Approximately 75% of the exams were performed in the target population and there was a progressive reduction in the proportion of cervical cytopathologists without previous cytology. On average, 51.2% of the exams were performed within a year. Regarding the quality of the exam, the positivity index was categorized as low throughout the analyzed period. We observed a low percentage of follow-up reported in the state.Conclusion The results evidenced the need to improve the tracking program regarding the quality of the exam, as well as the correct orientation regarding the age group and the periodicity, aiming to guarantee the target population's access and referral for diagnostic investigation and treatment of precursor lesions, when indicated.Objetivo: Avaliar os indicadores relacionados à oferta de exames citopatológicos do colo do útero, sua qualidade, frequência de alterações celulares e seguimento informado de lesões de alto grau, em Minas Gerais e suas macrorregiões de saúde. Métodos: Estudo descritivo com base em dados do Sistema de Informação do Câncer do Colo do Útero (SISCOLO), de 2006 a 2011. Resultados: A razão de exames citopatológicos do colo do útero em mulheres de 25 a 59 anos manteve-se estável, porém sem alcançar a meta estadual pactuada. Aproximadamente 75% dos exames foram realizados na população-alvo e houve progressiva redução na proporção de citopatológicos do colo do útero sem citologia anterior. Em média, 51,2% dos exames foram realizados no período de até um ano. Quanto à qualidade do exame, destaca-se o índice de positividade, categorizado como baixo durante todo o período analisado. Observou-se baixo percentual de seguimento informado no estado. Conclusão: Os resultados evidenciam a necessidade de aprimoramento do programa de rastreamento em relação à oferta e qualidade do exame, bem como ao direcionamento correto quanto à faixa etária e à periodicidade, visando garantir o acesso da população-alvo e o encaminhamento para a investigação diagnóstica e tratamento das lesões precursoras, quando indicado

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Relatório Técnico-Científico Final: Enfrentamento da pandemia de COVID-19: produções, invenções e desafios na gestão do cuidado em rede

Relatório final de projeto de pesquisa: Enfrentamento da pandemia de COVID-19: produções, invenções e desafios na gestão do cuidado em rede. Pesquisador responsável: Ademar Arthur Chioro dos Reis Instituição Sede: Universidade Federal de São Paulo (Unifesp) Processo FAPESP: 2020/12096-6 - Modalidade: Auxílio a Projeto de Pesquisa Linha de fomento: Acordos de Cooperação / PPSUS 2015 – PPSUS 2020 – PPP Período da Vigência: 01/03/2021 a 28/02/2023 (12 meses) Período coberto pelo Relatório Técnico-Científico Final: 28/02/2022 a 28/02/2023 (12 meses)O cenário da emergência sanitária causado pela pandemia da COVID­19 impôs aos gestores do SUS novos e imensos desafios. A rapidez e a alta taxa de transmissão, a produção de casos graves e fatais e o risco de colapso para a rede de saúde exigiram o estabelecimento de planos de contingenciamento. Analisar as experiências dos gestores nas regiões de saúde assume importância ímpar dada as diferenças sanitárias, econômicas, sociais, demográficas e de acesso aos serviços de saúde, em particular no Estado de São Paulo, onde os indicadores da doença foram significativos. Objetivo: analisar as produções, invenções e desafios na gestão do cuidado implementadas pelas redes de atenção à saúde em duas Regiões de Saúde do Estado de São Paulo para o enfrentamento da pandemia da COVID­19, com ênfase na atenção básica, e apresentar proposições que possam aprimorar a capacidade de resposta do SUS. Metodologia: estudo qualitativo, tipo estudo de casos múltiplos, em 3 fases. A primeira, de caráter exploratório, buscou compreender como as 63 regiões de saúde do estado realizaram a gestão do cuidado em rede para enfrentar a COVID­19. Foi desenvolvida por meio de um questionário semiestruturado, preenchido pelos gestores locais e regionais de saúde. A partir de um primeiro plano analítico foram escolhidas, considerando­se relevância, originalidade e resultados preliminares, duas regiões de saúde para estudado em profundidade, uma no interior e outra da Região Metropolitana de São Paulo. A segunda fase teve como objetivo analisar em profundidade as produções, invenções e desafios na gestão do cuidado implementadas nessas duas regiões de saúde, e foi realizada a partir da análise documental e avaliação dos Planos de Contingência e de outros documentos do estado de São Paulo e de municípios de distintos portes que pertençam às duas regiões de saúde. Essa fase do estudo, de caráter qualitativo, foi produzida a partir da realização de 29 entrevistas semiestruturadas (individuais e coletivas). Ao todo foram entrevistados 62 dirigentes municipais e regionais de saúde, no período de maio a novembro de 2022. A partir das entrevistas foi possível identificar e analisar o mapeamento dos arranjos de gestão do cuidado produzidos como resposta à pandemia de COVID­19, caracterizando a participação específica da atenção básica no enfrentamento da COVID­19 e as estratégias implementadas para populações em situação de vulnerabilidade social. Na terceira fase do estudo os resultados da investigação forjaram a proposição de medidas voltados aos gestores do SUS e de caráter geral, visando o aperfeiçoamento do sistema de saúde e da capacidade de resposta à novas emergências sanitárias. A restituição se deu por meio da apresentação de trabalhos e conferências nos 35º e 36º Congressos de Secretários Municipais de Saúde do Estado de São Paulo, artigos científicos e um ebook, que será lançado em oficinas com os gestores estaduais e municipais. O estudo envolveu, em todas as suas fases, pesquisadores vinculados às universidades, a Secretaria Estadual de Saúde de São Paulo (SES­SP), Secretarias Municipais de Saúde e o Conselho dos Secretários Municipais (Cosems­SP), por meio de seus respectivos projetos de apoio – de Atenção Básica (SES­SP) e Apoiadores Regionais (Cosems­SP). Essa estratégia metodológica facilitou a produção da empiria e a almejada construção de proposições efetivas para o enfrentamento da COVID ­19. Contribuições esperadas: qualificação da capacidade de resposta do país para o enfrentamento da pandemia de COVID­19 e o aperfeiçoamento organizacional do SUS. A consolidação do grupo interinstitucional de pesquisa também pode ser considerado um substrato da pesquisa. Foram também desenvolvidos 3 projetos de Iniciação Científica, 1 Mestrado Acadêmico (concluído) e 5 Doutorados (em curso).Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP: 2020/12096-

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

ABC-SPH risk score for in-hospital mortality in COVID-19 patients : development, external validation and comparison with other available scores

The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO/FiO ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19

ABC₂-SPH risk score for in-hospital mortality in COVID-19 patients

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.</p

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

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