Complicações respiratórias pós-operatórias em cirurgia bariátrica: revisão da literatura

Obesity is a public health problem worldwide because of the high rates of morbimortality. Bariatric surgery has been the most often treatment and attracts attention on its development and results. However, there is no review about the incidence of respiratory complications in this population. The aim of this study was to review the literature on respiratory complications in conventional bariatric surgery utilizing the databases PubMed, Scielo and Cochrane. The terms searched were complications, pulmonary, postoperative care and bariatric surgery, and the limits, the last ten years, adults, English and Spanish. We found 69 articles, and used 21, showing that the most common respiratory complications in bariatric surgery are pulmonary embolism, atelectasis and pneumonia, being related to age and the presence of hypoventilation. Morbid obesity is associated with respiratory dysfunction, including decreased cardiorespiratory endurance and dyspnea, being the most common changes: the decrease in ventilation and chest wall compliance, and tachypnea and respiratory muscle workload, with high rates of hypoxemia and respiratory fatigue. Our results suggest that pulmonary embolism, atelectasis and pneumonia are the pulmonary complications with the highest incidences in conventional bariatric surgery, and elderly and patients with hypoventilation or syndrome and obstructive sleep apnea have higher risk of developing postoperative pulmonary complications.Obesidade é um problema de saúde pública mundial com altos índices de morbi-mortalidade. A cirurgia bariátrica tem sido o tratamento mais usado e desperta atenção para seu desenvolvimento e resultados. Porém, até o momento, não há revisão sobre a incidência de complicações respiratórias nesta população. O objetivo deste estudo foi revisar a literatura sobre as complicações respiratórias após cirurgias bariátricas convencionais com a utilização das bases de dados PubMed, Cochrane e Scielo buscando os termos: complicações, pulmonar, pós-operatório e cirurgia bariátrica. Os limites foram os últimos dez anos, adultos, inglês e espanhol. Encontramos 69 artigos e utilizamos 21. As complicações respiratórias mais observadas em cirurgia bariátrica são: embolia pulmonar, atelectasias e pneumonia, estando relacionadas à idade e à hipoventilação. A obesidade mórbida está associada a disfunções respiratórias, incluindo diminuição da resistência cardiorrespiratória e dispneia, sendo as alterações mais comuns: diminuição da ventilação e da complacência torácica, taquipneia e aumento do trabalho muscular respiratório, com altos índices de hipoxemia e fadiga respiratória. Nossos resultados mostram que embolia pulmonar, atelectasias e pneumonias são as complicações respiratórias mais incidentes em cirurgias bariátricas convencionais, sendo os idosos ou portadores de síndrome da hipoventilação e apneia obstrutiva do sono os que apresentam maior risco de desenvolvê-las

Correlation between Moberg Pick-Up test and sensation threshold test after median nerve reconstruction

Functional assessment of sensitivity is essential to analyzing the status, recovery, and effectiveness of the treatment program for patients who have suffered losses due to physical and/or sensory disability after peripheral nerve injuries. Such losses of sensation lead to a significant loss of hand function. Objective: The purpose of the present study was to establish a correlation between functional and sensory threshold tests after a peripheral nerve lesion in the hand. Method: Fourteen men aged 18 to 40 years, who had bruises and cut injuries at the volar region of the wrist resulting in median nerve lesion, were selected for study. All the subjects were at least 1-year post-surgery. An esthesiometer SORRI® and a modified Moberg pick-up test were used. The test was divided into two phases, one with eyes open and the other with eyes closed. Also, the same test was performed by two different examiners. It was a “blinded” test that was performed three times, being repeated by the examiners according to a random sequence kept during the entire evaluation. Mean age and standard deviation were obtained during analysis in which Pearson’s coefficient was calculated and the non-parametric Mann-Whitney test was applied at 5% significance. Results: The mean age was 27.14 years with a standard deviation of 6.43 years, with the lesions being more frequently seen in men aged 21 to 30 years. Also, 64% of the cases involved lesion of the dominant hand. Pearson’s coefficient (r) regarding the correlation between sensory threshold test and Moberg pick-up test ranged from 0.5 to 0.7, which was statistically significant. Confidence intervals and p-values obtained from the Mann-Whitney test showed no statistically significant differences. Conclusion: One can conclude, therefore, that despite lacking standardized measures, the Moberg pick-up test correlated with the functional test. However, further studies are needed to support validation and reliability of the two methods.A avaliação funcional da sensibilidade é essencial para analisar o estado, recuperação, e efetividade do programa de tratamento em pacientes que sofreram perdas decorrentes de deficiência motora e/ou sensitiva, após lesões nervosas periféricas. Estas lesões geram a interrupção das sensações ocasionando a perda da sensibilidade e uma significante perda funcional da mão. Objetivo: O objetivo deste estudo foi correlacionar o teste funcional Pick-Up de Moberg com o teste de limiar sensitivo Estesiômetro SORRI® na reconstrução do nervo mediano. Método: Foram analisados 14 homens com idade entre 18 e 40 anos que sofreram ferimento corto-contuso na região volar do punho e tratamento cirúrgico há pelo menos um ano de pós-operatório. Foram utilizados para a avaliação da sensibilidade cutânea o Estesiômetro SORRI® e o teste Pick-Up de Moberg modificado, no qual a avaliação foi dividida em duas fases, olhos abertos e fechados, ambas realizadas com a mão dominante e não dominante, e em duas etapas com diferentes avaliadores, sendo repetidas três vezes em cada mão. A sequência dos avaliadores foi sorteada e mantida durante toda a avaliação. Na análise dos dados foi utilizado o coeficiente de Pearson e aplicado o teste não-paramétrico de Mann-Whitney com o nível de significância α = 0,05. Resultados: A média da idade foi de 27,14 anos (± 6,43), com maior frequência entre 21 a 30 anos sendo que 64% apresentaram lesão na mão dominante. O coeficiente de Pearson (r) entre o Estesiômetro e o Pick-Up foi entre 0,5 e 0,7, com p-valor < 0,05. Os intervalos de confiança e p-valores dos testes de Mann-Whitney não indicaram diferenças estatisticamente significantes. Conclusão: Apesar do teste Pick-Up de Moberg não possuir medidas padronizadas, na amostra estudada pode-se concluir que existe correlação entre o teste funcional e o teste de limiar sensitivo. Novos estudos são necessários para a validação e confiabilidade de ambos os métodos

Health-related quality of life and functionality in primary caregiver of surviving pediatric COVID-19

ObjectivesTo prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19.MethodsA longitudinal observational study was carried out on primary caregivers of surviving pediatric post-COVID-19 patients (n = 51) and subjects without COVID-19 (n = 60). EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 12-question WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) were answered for both groups. The univariate regression analysis was carried out using SPSS (v 20) and significance was established at 5%.ResultsThe median duration between COVID-19 diagnosis in children and adolescents and longitudinal follow-up visits was 4.4 months (0.8–10.7). The median age of children and adolescents caregivers with laboratory-confirmed COVID-19 was similar to primary caregivers of subjects without laboratory-confirmed COVID-19 [43.2 (31.6–60.9) vs. 41.5 (21.6–54.8) years, p = 0.08], as well as similar female sex (p = 1.00), level of schooling (p = 0.11), social assistance program (p = 0.28), family income/month U$ (p = 0.25) and the number of household’s members in the residence (p = 0.68). The frequency of slight to extreme problems (level ≥ 2) of the pain/discomfort domain according to EQ-5D-5L score was significantly higher in the former group [74% vs. 52.5%, p = 0.03, OR = 2.57 (1.14–5.96)]. The frequency of disability according to WHODAS 2.0 total score was similar to those without disability and unknown (p = 0.79); however, with a very high disability in both groups (72.5% and 78.3%). Further analysis of primary caregivers of children and adolescents with post-COVID-19 condition (PCC) [n = 12/51 (23%)] compared to those without PCC [n = 39/51(77%)] revealed no differences between demographic data, EQ-5D-5L and WHODAS 2.0 scores in both groups (p > 0.05).ConclusionWe longitudinally demonstrated that pain/discomfort were predominantly reported in approximately 75% of primary caregiver of COVID-19 patients, with high disability in approximately three-quarters of both caregiver groups. These data emphasized the prospective and systematic caregiver burden evaluation relevance of pediatric COVID-19

Estudos Artísticos

Há um compromisso entre o artista e a sociedade. Não é possível retirar a arte do seu contexto social. Neste projecto, em que se desafiam os criadores a pesquisar a obra de outros criadores, reúnem-se aqueles artigos que melhor demonstram a responsabilidade e a solidariedade entre os criadores e os seus pares sociais. São obras, artistas, projetos, plataformas de intervenção, projetos que enfatizam as relações sociais como suporte. Sob esta temática geral foram reunidos 25 artigos para este número 6 da Revista Croma, em linhas de exploração variadas e mantendo a elevada internacionalização da revista: mais de noventa por cento das publicações são exógenas à Faculdade de Belas-Artes da Universidade de Lisboa ou do CIEBA, a sua unidade de investigação. Este é um indicador procurado e atingido de modo consistente em todos os exemplares publicados até hoje, e que se espera poder afirmar com continuidade. As diferentes perspetivas apresentadas nos variados artigos expõe a obra de autores que exploram dimensões relacionais ou perante as quais o espectador é convocado a deslocar o seu posicionamento, a desassossegar-se. A implicação surge como resultado da articulação expressiva dos recursos mais variados, em constante mistura, exibindo o modo como as dimensões materiais e ideais são fundadoras das diversas propostas. Nesta revista não há indiferença, há diferenças.info:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Entre la procédure et le fonds : la participation politique et les sens de la démocratie

Dentre os estudos de cultura política e experiências participativas, a participação política comumente tem sido relacionada a valores democráticos e ao aprofundamento da democracia. No entanto, ainda existe uma lacuna explicativa sobre como ativistas de diferentes setores da sociedade civil pensam e concebem a democracia. Ancorado na pergunta: “Como pessoas com diferentes trajetórias de ativismo entendem a democracia?”, este artigo visa fornecer subsídios teóricos e empíricos sobre como cidadãs e cidadãos com experiências participativas diversas compreendem a democracia e, alternativamente, como concebem regimes não democráticos. A partir de análises das conversas produzidas por grupo focais realizados em Belo Horizonte, Porto Alegre e Montes Claros, entre os meses de março e setembro de 2019, o artigo demonstra como os entendimentos sobre democracia variam a depender do perfil e dos vínculos dos participantes.Among the literature on political culture and participatory experiences, participation has commonly been related to democratic values and the deepening of democracy. However, there is still an explanatory gap regarding how activists from different sectors of civil society think about and conceive democracy. Anchored in the question, “How do people with different trajectories of activism understand democracy?”, this article aims to provide a theoretical and empirical explanation of how citizens with different participatory experiences understand democracy and, alternatively, how they conceive non-democratic regimes. Based on analysis of the conversations produced by focus groups held in Belo Horizonte, Porto Alegre, and Montes Claros, from March to September 2019, the article will demonstrate how understandings about democracy vary depending on the profile and the links of the participants.Entre los estudios de cultura política y experiencias participativas, la participación se ha relacionado comúnmente con los valores democráticos y la profundización de la democracia. Sin embargo, todavía existe una brecha explicativa sobre cómo los activistas de diferentes sectores de la sociedad civil piensan y conciben la democracia. Anclado en la pregunta: “¿Cómo entienden la democracia las personas con diferentes trayectorias de activismo?”, este artículo tiene como objetivo brindar subsidios teóricos y empíricos sobre cómo los ciudadanos con diversas experiencias participativas entienden la democracia y, alternativamente, cómo conciben regímenes no democráticos. A partir del análisis de las conversaciones producidas a través de grupos focales realizados en Belo Horizonte, Puerto Alegre y Montes Claros, entre marzo y septiembre de 2019, el artículo demostrará cómo los entendimientos sobre la democracia varían en función del perfil y los vínculos de los participantes.Parmi les études sur la culture politique et les expériences participatives, la participation a généralement été liée aux valeurs démocratiques et à l'approfondissement de la démocratie. Cependant, il existe encore un écart explicatif sur la façon dont les militants de différents secteurs de la société civile pensent et conçoivent la démocratie. Ancré dans la question “Comment les personnes ayant des trajectoires d'activisme différentes comprennent-elles la démocratie ?”, cet article vise à fournir un soutien théorique et empirique sur la façon dont les citoyens ayant différentes expériences participatives comprennent la démocratie et, alternativement, comment ils conçoivent les régimes non démocratiques. A partir de l'analyse des conversations réalisées par des groupes de discussion tenus à Belo Horizonte, Porto Alegre et Montes Claros, entre mars et septembre 2019, l'article démontrera comment les compréhensions de la démocratie varient en fonction du profil et des liens des participants

Guia Prefeito + Brasil - Volume 2

Este guia foi desenvolvido pela Enap, em parceria com a Secretaria de Assuntos Federativos da Presidência da República (SEAF), para proporcionar uma visão sistêmica sobre Políticas Públicas Municipais.v. 2, 762 páginasPolíticas PúblicasGuia Prefeito + Brasil - Volume 1 está disponível aqui: http://repositorio.enap.gov.br/handle/1/702