Deformidades e incapacidades dos hemofílicos do Centro de Hemoterapia e Hematologia do Espírito Santo, Brasil

Hemophilia is a severe hereditary disorder that affects blood clotting; it can cause several permanent or transitory deformities and disabilities as well as psychosocial disorders on those affected. The proposition of this is study is not only to identify the main complications found on hemophilic individuals served by Espírito Santo´s Hemotherapy and Hematology Centre (HEMOES), but also discuss the necessity of insertion of a Occupational Therapy service as an everyday practice on the integral treatment of those diagnosed with hemophilia. 161 medical records of patients served by HEMOES from 2001 to 2004 were analyzed and complications related to hemophilia were extracted according to a previously defined protocol. The 161 medical records analyzed represent 40% of the total hemophiliacs registered at Espirito Santo state. Most of them were male (98%) and the most common type of disorder was TYPE A (77%). As for severeness levels, the highly and moderately severe prevailed, adding up to 43% of the cases, the least severe cases represented 16%. Deformities and disabilities of the articulatory system corresponded to 89% of the complications while the muscular system had 11%. It can be concluded that the profile of hemophiliac patients taken care by HEMOES is marked by high percents of deformities and disabilities. This situation urges for professional follow up from the biological up to the psychosocial levels and highlights the importance of insertion of the occupational therapist on the multiprofessional staff that cares for hemophiliacs, so that they can be treated integrally.A hemofilia é um grave distúrbio hereditário da coagulação sanguínea que pode resultar em diversas deformidades e incapacidades no corpo, permanentes ou transitórias, além das conseqüências psicossociais nos indivíduos afetados. A proposição do presente estudo é identificar quais as principais seqüelas e incapacidades que acometem os portadores de hemofilia do Centro de Hemoterapia e Hematologia do Espírito Santo (HEMOES). Além de discutir a importância da inserção do serviço de terapia ocupacional como parte integrante do atendimento integral à saúde desses pacientes. Foram analisados 161 prontuários de pacientes atendidos no HEMOES de 2001 a 2004 anotando-se os acometimentos à hemofilia por um roteiro de pesquisa estruturado. Os 161 prontuários corresponderam a cerca de 40% do total de hemofílicos cadastrados no estado. A maioria era do sexo masculino 98% e o tipo de coagulopatia mais comum foi hemofilia A (77%). Quanto aos níveis de severidade, predominaram dos tipos de deficiência grave e moderada que somados totalizaram 43% dos casos, enquanto o tipo leve representou 16% dos casos. As incapacidades e deformidades em regiões articulares do corpo corresponderam a 89% de acometimentos, enquanto as regiões musculares 11%. Conclui-se que o perfil dos pacientes hemofílicos atendidos no HEMOES destaca-se pelo alto percentual de seqüelas e incapacidades, gerando a necessidade de atuação profissional desde o nível biológico até o nível psicossocial. Isso ressalta a importância da implantação, junto à equipe multiprofissional, do serviço de Terapia Ocupacional para atendimento integral à saúde

The Novo Progresso Formation, Tapajós Gold Province, Amazonian Craton: zircon U-Pb and Lu-Hf constraints on the maximum depositional age, reconnaissance provenance study, and tectonic implications

The Novo Progresso Formation, located in southeastern Tapajós Gold Province, at its boundary with the Iriri-Xingu Domain, south of the Amazonian Craton, is composed of quartz- and lithic-arenites and siltstones with volcanic/volcanoclastic contributions, and was deposited in fluvial and lake systems. Reconnaissance detrital zircon U-Pb LA-ICP-MS data on a lithic arenite indicate maximum depositional age around 1840 Ma, whereas structural relationships suggest a minimum age of 1780 Ma. The zircon age spectrum shows two well-defined peaks at 1846 and 1968 Ma, and statistically secondary peaks ranging from 2185 Ma to 2973 Ma. εHf values vary from +8.1 to -14.5 (TDM = 2.13 to 3.95 Ga), whereas the εNd values range from -2.5 to -3.3 (TDM = 2.31 to 3.21 Ga), with one positive value of +4.5 (TDM = 1.81 Ga). These data and the lithological composition indicate that surrounding Orosirian rocks from Tapajós and Iriri-Xingu were the main sources for the sediments, with subordinate contributions from older and more distant domains of the Amazonian Craton. In addition, the Hf systematics suggest a ~2.50 Ga-old crustal growth event and a ~3.95 Ga-old hidden component in the eastern portion of the Amazonian Craton. The deposition of the Novo Progresso Formation is related to the development of the large Orosirian intracratonic rift system known as Uatumã Silicic Large Igneous Province (1.89-1.80 Ga), which cut across the Amazonian Craton, following the final stages of magmatism in the Tapajós Gold Province

Sinais e sintomas, manifestação clínica e diagnóstico do miocárdio não compactado: uma revisão sistemática

O objetivo desta revisão bibliográfica foi relatar o conhecimento atual sobre o miocárdio não compactado e fornecer uma análise crítica sobre as manifestações e os métodos diagnósticos.   Para o desenvolvimento dessa pesquisa foi elaborada uma questão norteadora:  ‘’Quais são os principais sinais e sintomas da  Não Compactação do Ventrículo Esquerdo (NCVE), bem como quais são os métodos utilizados no diagnóstico e qual recurso terapêutico é utilizado na prática clínica? As buscas foram realizadas na base de dados PubMed Central (PMC) . Foram utilizados 5 descritores em combinação com o termo booleano “AND”: Isolated Noncompaction of the Ventricular Myocardium , Thrombosis, Signs and Symptoms, Pathological Conditions e Cardiomyopathies. Dessa forma, encontrados um total de 32 artigos, e que após a aplicação dos critérios de inclusão e exclusão foram selecionados 9 estudos para compor o estudo. A NCVE é caracterizada por insuficiência cardíaca, arritmias e alto risco de eventos embólicos. A prevalência de fibrilação atrial e taquiarritmias ventriculares é notável. O diagnóstico depende de critérios morfológicos específicos, sendo a ecocardiografia transtorácica e a ressonância magnética cardíaca as ferramentas diagnósticas principais. Há variações na identificação da NCVE entre os critérios ecocardiográficos, sugerindo a necessidade de um consenso diagnóstico mais padronizado. A identificação correta da NCVE é essencial para o manejo apropriado dos pacientes, visando reduzir complicações e melhorar a qualidade de vida

Deformities and disabilities of hemophilics undergoing treatment at the Hemoterapy and Hematology Centre of Espirito Santo, Brazil

A hemofilia é um grave distúrbio hereditário da coagulação sanguínea que pode resultar em diversas deformidades e incapacidades no corpo, permanentes ou transitórias, além das conseqüências psicossociais nos indivíduos afetados. A proposição do presente estudo é identificar quais as principais seqüelas e incapacidades que acometem os portadores de hemofilia do Centro de Hemoterapia e Hematologia do Espírito Santo (HEMOES). Além de discutir a importância da inserção do serviço de terapia ocupacional como parte integrante do atendimento integral à saúde desses pacientes. Foram analisados 161 prontuários de pacientes atendidos no HEMOES de 2001 a 2004 anotando-se os acometimentos à hemofilia por um roteiro de pesquisa estruturado. Os 161 prontuários corresponderam a cerca de 40% do total de hemofílicos cadastrados no estado. A maioria era do sexo masculino 98% e o tipo de coagulopatia mais comum foi hemofilia A (77%). Quanto aos níveis de severidade, predominaram dos tipos de deficiência grave e moderada que somados totalizaram 43% dos casos, enquanto o tipo leve representou 16% dos casos. As incapacidades e deformidades em regiões articulares do corpo corresponderam a 89% de acometimentos, enquanto as regiões musculares 11%. Conclui-se que o perfil dos pacientes hemofílicos atendidos no HEMOES destaca-se pelo alto percentual de seqüelas e incapacidades, gerando a necessidade de atuação profissional desde o nível biológico até o nível psicossocial. Isso ressalta a importância da implantação, junto à equipe multiprofissional, do serviço de Terapia Ocupacional para atendimento integral à saúde.Hemophilia is a severe hereditary disorder that affects blood clotting; it can cause several permanent or transitory deformities and disabilities as well as psychosocial disorders on those affected. The proposition of this is study is not only to identify the main complications found on hemophilic individuals served by Espírito Santo´s Hemotherapy and Hematology Centre (HEMOES), but also discuss the necessity of insertion of a Occupational Therapy service as an everyday practice on the integral treatment of those diagnosed with hemophilia. 161 medical records of patients served by HEMOES from 2001 to 2004 were analyzed and complications related to hemophilia were extracted according to a previously defined protocol. The 161 medical records analyzed represent 40% of the total hemophiliacs registered at Espirito Santo state. Most of them were male (98%) and the most common type of disorder was TYPE A (77%). As for severeness levels, the highly and moderately severe prevailed, adding up to 43% of the cases, the least severe cases represented 16%. Deformities and disabilities of the articulatory system corresponded to 89% of the complications while the muscular system had 11%. It can be concluded that the profile of hemophiliac patients taken care by HEMOES is marked by high percents of deformities and disabilities. This situation urges for professional follow up from the biological up to the psychosocial levels and highlights the importance of insertion of the occupational therapist on the multiprofessional staff that cares for hemophiliacs, so that they can be treated integrally

Tentativas de suicídio e suicídio em município de cultura pomerana no interior do estado do Espírito Santo

OBJETIVO: Descrever o perfil das tentativas de suicídio e mortalidade por suicídio no município de Santa Maria de Jetibá, interior do Espírito Santo, no período de 2001 a 2007. MÉTODO: Estudo descritivo, observacional e de abordagem quantitativa. A identificação dos casos de tentativas de suicídio e suicídios ocorreu por meio dos Boletins de Ocorrência Policial da Polícia Militar do Município, onde foram selecionados todos os casos. Para análise dos dados, foram utilizadas tabelas de frequência e os testes de hipótese t Student e Qui-quadrado. RESULTADOS: O coeficiente médio de mortalidade por suicídio foi de 12,9/100.000. Verificou-se que as mulheres realizam mais tentativas de suicídio, enquanto os homens foram mais eficientes, cometendo mais suicídio (p = 0,008). A média de idade para as vítimas de tentativas de suicídio foi de 30 ± 10,1 anos e de suicídio 42 ± 14,9 anos (p = 0,001). Os meios mais utilizados para os casos de suicídio foi o enforcamento (57,1%), enquanto para as tentativas foi o envenenamento por agrotóxico (42,5%). CONCLUSÃO: Verificou-se que o perfil dos suicidas se diferencia dos que tentam, especialmente segundo o sexo, a idade e os meios utilizados, enfatizando a necessidade de se desencadear discussões acerca de programas, tratamento e prevenção para os grupos mais vulneráveis

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