Carcinoma basocelular: métodos diagnósticos e condutas terapêuticas

O carcinoma basocelular (CBC) consiste na neoplasia de pele mais comum, representando cerca de 80% dos cânceres de pele não melanoma, sendo mais incidente em homens caucasianos acima dos 50 anos. Sua patogênese envolve uma complexa interação entre a exposição aos fatores de risco e os fatores genéticos e imunes do hospedeiro. Todavia, sabe-se que consiste em um tumor de células basalóides, dispostas em massas, com característica paliçada na periferia, sendo localizados, mais frequentemente, em regiões expostas ao sol (raios ultravioletas), como face, orelhas, pescoço, couro cabeludo, ombros e costas. Há diversos subtipos descritos e não há uma classificação universalmente definida. Contudo, sabe-se que o mais comum é o CBC nodular. As manifestações clínicas decorrentes do CBC são muito amplas e variam de paciente para paciente, conforme a apresentação e gravidade da doença. Além disso, cada subtipo possui sua lesão característica. No que tange ao diagnóstico, este, é clínico, baseado na história de evolução e características clínicas das lesões (dermatoscopia), além da realização de biópsia para análise histopatológica da lesão. O manejo terapêutico é imprescindível, a fim de evitar evolução do quadro. Em caso de doença localizada, a excisão padrão com margem de segurança é o tratamento mais comum para todos os tipos de CBCs. Sendo que, ultimamente, a cirurgia micrográfica de Mohs mostrou-se uma abordagem cirúrgica especializada que remove menos pele sadia adjacente ao tumor, podendo ser considerada uma técnica mais refinada e precisa. Em lesões com critérios de baixo risco, pode ser tentado tratamentos conservadores. Contudo, a excisão consiste na técnica mais segura, sendo associada a altos índices de cura. Vale ressaltar que a exposição solar controlada e o uso de protetor solar devem ser indicados em associação a qualquer modalidade terapêutica

O ACOLHIMENTO DA FAMÍLIA EM UNIDADE DE TERAPIA INTENSIVA NEONATAL E PEDIÁTRICA

The neonatal intensive care unit (NICU) is an essential environment for the treatment of high-risk and stressful neonates for patients and their families. The implementation of family-centered care, such as the implementation of humanistic embracement, requires understanding the experiences of fear, anxiety and anguish experienced by family members and addressing care needs that transcend the technical scope and condition the patient's clinical experience. Qualitative review systematic review of the perception of welcoming by nursing professionals and their families during admission to the neonatal intensive care unit. This is a qualitative systematic review with a metasynthesis approach, developed according to the guidelines of the Joanna Briggs Institute. The guiding question is: What is the opinion of nurses and family members regarding hospitalized newborns at risk of admission to the neonatal intensive care unit? The inclusion criteria were: participants (nurses and family members), design (admission), location (neonatal intensive care unit) and type of study: original qualitative study. The searches were carried out in the Scientific Electronic Libraries Online (SciELO), SciVerse Scopus (SCOPUS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL), using the plural term: understanding of cure. . Or kiss and neonatal intensive care unit at home. Language (English, Portuguese, Spanish), publication period (last five years) and total availability were defined as search limitations. The search returned 698 works. Among them, 12 articles were selected as a review set. In terms of methodological quality, the majority of studies met all criteria listed in the JBI Qualitative Research Critical Appraisal Checklist, with 3 studies meeting 7 criteria, 1 study meeting 8 criteria, and 1 study meeting 8 criteria. . 9 out of 10 criteria. The meta-analysis allowed the construction of 4 thematic categories representing the meaning and definition of reception, the necessary conditions, the difficulties and needs necessary to implement reception, and the consequences and consequences associated with (non)receptive practices. The results showed that there are still many gaps in the reception process due to the lack of professionals with the qualifications and equipment necessary to provide more sensitive care, as well as families' understanding of the medical team's workflow Interact and find out more obstacle The complexity of environments such as the neonatal intensive care unit raises issues that need to be addressed, including family leadership, caregiving relationships, and collaboration. Understanding the main meanings of the welcome that caregivers and families receive during the newborn's stay in the NICU is crucial to clarify gaps between experiences and expectations, identify differences and converge meanings to achieve mutual understanding.  A unidade de terapia intensiva neonatal (UTIN) é um ambiente essencial para o tratamento de neonatos de alto risco e estressante para os pacientes e seus familiares. A implementação do cuidado centrado na família, como a implantação do acolhimento humanístico, requer a compreensão das experiências de medo, ansiedade e angústia vivenciadas pelos familiares e a abordagem de necessidades de cuidado que transcendem o âmbito técnico e condicionam a clínica do paciente.Revisão qualitativa sistemática sobre a percepção do acolhimento pelos profissionais de enfermagem e seus familiares durante a admissão na unidade de terapia intensiva neonatal. Trata-se de uma revisão sistemática qualitativa com abordagem de metassíntese, desenvolvida segundo as diretrizes do Instituto Joanna Briggs. A questão norteadora é: Qual a opinião dos enfermeiros e familiares em relação aos recém-nascidos hospitalizados com risco de internação na unidade de terapia intensiva neonatal? Os critérios de inclusão foram: participantes (enfermeiros e familiares), desenho (admissão), local (unidade de terapia intensiva neonatal) e tipo de estudo: estudo qualitativo original. As buscas foram realizadas nas bases Scientific Electronic Libraries Online (SciELO), SciVerse Scopus (SCOPUS), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), utilizando o termo plural: compreensão da cura. . Ou beijo e unidade de terapia intensiva neonatal em casa. Idioma (inglês, português, espanhol), período de publicação (últimos cinco anos) e disponibilidade total foram definidos como limitações da busca. A busca retornou 698 trabalhos. Dentre eles, 12 artigos foram selecionados como conjunto de revisão. Em termos de qualidade metodológica, a maioria dos estudosatendeu a todos os critérios listados na lista de verificação de avaliação crítica de pesquisa qualitativa do JBI, com 3 estudos atendendo a 7 critérios, 1 estudo que atendeu a 8 critérios e 1 estudo atendeu a 8 critérios. 9 de 10 critérios. A meta-análise permitiu a construção de 4 categorias temáticas representativas do significado e definição do acolhimento, das condições necessárias, das dificuldades e necessidades necessárias à implementação do acolhimento, e das consequências e consequências associadas às práticas (não)receptivas. Os resultados mostraram que ainda existem muitas lacunas no processo de acolhimento devido à falta de profissionais com qualificação e equipamentos necessários para prestar um cuidado mais sensível, bem como a compreensão das famílias sobre o fluxo de trabalho da equipe médica Interaja e saiba mais obstáculo A complexidade de ambientes como a unidade de cuidados intensivos neonatais levanta questões que precisam de ser abordadas, incluindo a liderança familiar, as relações de prestação de cuidados e a colaboração. Compreender os principais significados do acolhimento que cuidadores e famílias recebem durante a permanência do recém-nascido na UTIN é crucial para esclarecer lacunas entre experiências e expectativas, identificar diferenças e convergir significados para alcançar o entendimento mútuo

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Search for anomalous production of events with three or more leptons in pp collisions at √s = 8TeV

Published by the American Physical Society under the terms of the Creative Commons Attribution 3.0 License. Further distribution of this work must maintain attribution to the author(s) and the published articles title, journal citation, and DOI.A search for physics beyond the standard model in events with at least three leptons is presented. The data sample, corresponding to an integrated luminosity of 19.5fb-1 of proton-proton collisions with center-of-mass energy s=8TeV, was collected by the CMS experiment at the LHC during 2012. The data are divided into exclusive categories based on the number of leptons and their flavor, the presence or absence of an opposite-sign, same-flavor lepton pair (OSSF), the invariant mass of the OSSF pair, the presence or absence of a tagged bottom-quark jet, the number of identified hadronically decaying τ leptons, and the magnitude of the missing transverse energy and of the scalar sum of jet transverse momenta. The numbers of observed events are found to be consistent with the expected numbers from standard model processes, and limits are placed on new-physics scenarios that yield multilepton final states. In particular, scenarios that predict Higgs boson production in the context of supersymmetric decay chains are examined. We also place a 95% confidence level upper limit of 1.3% on the branching fraction for the decay of a top quark to a charm quark and a Higgs boson (t→cH), which translates to a bound on the left- and right-handed top-charm flavor-violating Higgs Yukawa couplings, λtcH and λctH, respectively, of |λtcH|2+|λctH|2<0.21

Measurement of associated W plus charm production in pp collisions at √s=7 TeV

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