Uso da oxigenoterapia hiperbárica no tratamento da síndrome de fournier / Use of hyperbaric oxygen therapy in the treatment of fournier syndrome

1 INTRODUÇÃOA Síndrome ou Gangrena de Fournier é uma fasciíte necrosante por infecção polimicrobiana que acomete as regiões perineal e genital. Por meio da oxigenoterapia hiperbárica, aumenta-se o transporte de oxigênio e sua disponibilidade, alterando a capacidade de cicatrização em um paciente com Fournier.2 MÉTODOSTrata-se de uma revisão sistemática de literatura que visa identificar os benefícios do uso da oxigenoterapia hiperbárica (OHB) no tratamento da Síndrome de Fournier (SF). Foram utilizadas as bases de dados PubMed, Scielo e Google Acadêmico.  Os descritores foram "Oxigenoterapia Hiperbárica", ‘’Tratamento’’, ‘’Síndrome de Fournier", “Gangrena de Fournier’’. 3 DISCUSSÃOA SF é rara e, geralmente, de etiologia polimicrobiana: por meio da produção de heparinases, ocorre endarterite obliterante, seguida de isquemia e de trombose dos vasos subcutâneos, com subsequente necrose da pele e do tecido celular subcutâneo adjacente. É mais prevalente em homens, entre a segunda e a sexta década de vida e com comorbidades associadas. Diante da alta taxa de morbi-mortalidade, é fundamental que ocorra diagnóstico precoce associado a tratamento efetivo e individualizado. O mecanismo terapêutico da OHB baseia-se, além no estímulo da síntese de colágeno, da angiogênese, da epitelização e da resistência a bactérias, no aumento do transporte de oxigênio plasmático e na sua disponibilidade tecidual. De acordo com a literatura, considerando a hipóxia tecidual e o mecanismo fisiopatológico de Fournier, a OHB é benéfica como tratamento adicional para os pacientes portadores da síndrome, principalmente no que refere-se a capacidade de cicatrização. Mehl et al 2010 desenvolveu um estudo sobre o manejo da SF no Hospital Universitário de Curitiba, onde 26 de 40 pacientes submeteram-se à terapia hiperbárica. A mortalidade global encontrada no estudo foi de 20%. Porém, para os pacientes que associaram câmara hiperbárica ao tratamento clínico-cirúrgico, o índice de mortalidade foi de 11,5%. Assim, a OHB é um fator adjuvante na busca de melhor conduta terapêutica. 4 CONCLUSÃOAo conhecer o alto índice de morbimortalidade, o manejo de pacientes portadores da síndrome de Fournier constitui um desafio na prática clínica. Assim, faz-se necessário o reconhecimento precoce da infecção com objetivo de diminuição da progressão da gangrena. Vale ressaltar a importância da utilização do tratamento clássico associado à medidas adjuvantes, como o uso da oxigenoterapia hiperbárica, a fim de melhor prognóstico e melhora da qualidade de vida do paciente

O retorno do sarampo e a importância do reconhecimento dos achados semiológicos / The return of measles and the importance of recognizing semiological findings

1 INTRODUÇÃOO Sarampo é uma doença infectocontagiosa de etiologia viral, com maior incidência em crianças entre 6 meses e 4 anos e registro similar para ambos os sexos. O atual cenário epidemiológico do Brasil reforça a necessidade da rápida identificação do quadro para tratamento e prevenção de complicações. 2 MÉTODOSTrata-se de uma revisão sistemática de literatura que visa identificar, diante do atual cenário epidemiológico, os principais achados semiológicos do sarampo. Foram utilizadas plataformas PubMed, Scielo, Ministério da Saúde, Organização Mundial de Saúde, Organização Pan-Americana da Saúde e Google Acadêmico. Utilizou-se os termos: sarampo, achados semiológicos, vacinação e retorno.  3 DISCUSSÃONo ano de 2016, o Brasil foi considerado livre do sarampo. Contudo, em 2018, notou-se uma mudança no cenário epidemiológico: 737 casos notificados, sobretudo na região Norte; justificada pela chegada de imigrantes de países com situação socioeconômica vulnerável, sem política de vacinação bem estabelecida, além pelos movimentos anti-vacina. Assim, é importante o reconhecimento do quadro clínico para diagnóstico e prevenção das complicações como otite média aguda e pneumonia. O vírus do sarampo dissemina-se por via oral e, após o período de incubação, a clínica divide-se em: fase catarral, exantemática e descamativa. A fase catarral é caracterizada por sintomas como rinorréia, espirros e conjuntivite, com pródromos de cefaléia, mialgias e febre alta. Surgem, na mucosa oral, lesões patognômicas do sarampo: manchas de Koplik, as quais desaparecem após o início do exantema. Na fase exantemática, ocorre febre elevada e rash maculopapular eritematoso, de caráter crânio caudal. Na fase descamativa, os sintomas diminuem, pode ocorrer escurecimento e descamação do exantema. O diagnóstico baseia-se na suspeita de sarampo ou em indivíduos com rash cutâneo e febre alta; é fundamentalmente clínico em associação a sorologia viral. Não há tratamento específico para o sarampo e a prevenção se dá pela vacina Tríplice Viral, que também protege caxumba e rubéola. 4 CONCLUSÃOAo reconhecer o atual cenário, explicita-se a necessidade de muitos avanços na assistência em saúde. Na busca de soluções, além do rápido reconhecimento do quadro clínico, coberturas de vacinação e de vigilância epidemiológica bem estabelecidas são essenciais, mesmo em áreas consideradas livres do vírus. Assim, além das ações de promoção à saúde visarem à interrupção da transmissão, o tratamento e o manejo adequado serão garantidos para que os pacientes sejam protegidos das complicações

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

Probing effective field theory operators in the associated production of top quarks with a Z boson in multilepton final states at root s=13 TeV

Peer reviewe

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV

Measurements of Higgs boson production cross sections and couplings in the diphoton decay channel at root s=13 TeV

Measurements of Higgs boson production cross sections and couplings in events where the Higgs boson decays into a pair of photons are reported. Events are selected from a sample of proton-proton collisions at root s = 13TeV collected by the CMS detector at the LHC from 2016 to 2018, corresponding to an integrated luminosity of 137 fb(-1). Analysis categories enriched in Higgs boson events produced via gluon fusion, vector boson fusion, vector boson associated production, and production associated with top quarks are constructed. The total Higgs boson signal strength, relative to the standard model (SM) prediction, is measured to be 1.12 +/- 0.09. Other properties of the Higgs boson are measured, including SM signal strength modifiers, production cross sections, and its couplings to other particles. These include the most precise measurements of gluon fusion and vector boson fusion Higgs boson production in several different kinematic regions, the first measurement of Higgs boson production in association with a top quark pair in five regions of the Higgs boson transverse momentum, and an upper limit on the rate of Higgs boson production in association with a single top quark. All results are found to be in agreement with the SM expectations.Peer reviewe

Measurements of the Electroweak Diboson Production Cross Sections in Proton-Proton Collisions at root s=5.02 TeV Using Leptonic Decays

The first measurements of diboson production cross sections in proton-proton interactions at a center-of-mass energy of 5.02 TeV are reported. They are based on data collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 302 pb(-1). Events with two, three, or four charged light leptons (electrons or muons) in the final state are analyzed. The WW, WZ, and ZZ total cross sections are measured as sigma(WW) = 37:0(-5.2)(+5.5) (stat)(-2.6)(+2.7) (syst) pb, sigma(WZ) = 6.4(-2.1)(+2.5) (stat)(-0.3)(+0.5)(syst) pb, and sigma(ZZ) = 5.3(-2.1)(+2.5)(stat)(-0.4)(+0.5) (syst) pb. All measurements are in good agreement with theoretical calculations at combined next-to-next-to-leading order quantum chromodynamics and next-to-leading order electroweak accuracy

Search for lepton-flavor violating decays of the Higgs boson in the mu tau and e tau final states in proton-proton collisions at root s=13 TeV

A search is presented for lepton-flavor violating decays of the Higgs boson to mu t and et. The dataset corresponds to an integrated luminosity of 137 fb(-1) collected at the LHC in proton-proton collisions at a center-of-mass energy of 13 TeV. No significant excess has been found, and the results are interpreted in terms of upper limits on lepton-flavor violating branching fractions of the Higgs boson. The observed (expected) upper limits on the branching fractions are, respectively, B(H -> mu t) e tau) < 0.22(0.16)% at 95% confidence level.Peer reviewe