KETAMINA NO MANEJO FARMACOLÓGICO AGUDO DA IDEAÇÃO SUICIDA

ABSTRACT Objective: Suicide ideation is the most often psychiatric emergency found in the emergency context. However, because of the complex interaction between their risk factors, patient discomfort in addressing the issue, clinical individuality of episodes and deficits in pharmacological interventions, there are few protocols that provide algorithms for the management of the entity. Although the efficacy of Ketamine in the management of depression has recently been demonstrated, little is known about its efficacy in managing suicidal ideation. In this review, were evaluated clinical trials that discussed the use of ketamine in the acute treatment of suicidal ideation associated or not with depressive disorders, in order to determine if the use of the drug is safe and effective in the management of this psychiatric emergency. Data sources: Searches were performed in PubMed, SciELO, Web of Science, Bireme and Scopus databases with the MeSH terms "Ketamine" and "Suicide ideation". Data synthesis:  After selection of randomized clinical trials and exclusion of duplicates, 10 studies were included in this review.  Conclusions: Studies have shown that ketamine is a fast-acting drug and possibly sustained in suicidal ideation, as well as mild and self-limiting adverse effects. However, such results should be replicated in a larger number of patients, especially regarding the use of maintenance doses.Objetivo: A ideação suicida é a emergência psiquiátrica mais frequentemente encontrada no contexto emergencial. Entretanto, devido à complexa interação entre seus fatores de risco, desconforto do paciente em abordar a temática, individualidade clínica dos episódios e déficit de intervenções farmacológicas eficazes, são escassos os protocolos que forneçam algoritmos para o manejo da entidade. Apesar de recentemente ter sido demonstrada a eficácia do uso de Ketamina no manejo da depressão, pouco se sabe sobre sua eficácia no manejo da ideação suicida. Nesta revisão foram avaliados ensaios clínicos que versam sobre o uso da ketamina no tratamento agudo da ideação suicida associada ou não a transtornos depressivos, de forma a determinar se o uso do fármaco é seguro e eficaz no manejo dessa emergência psiquiátrica. Fontes de dados: Foram realizadas buscas nas bases de dados PubMed, SciELO, Web of Science, Bireme e Scopus com os termos MeSH “Ketamine” e “Suicide ideation”. Síntese dos dados: Após a seleção, sem limites temporais, de ensaios clínicos randomizados e exclusão das duplicatas, foram incluídos 10 estudos nesta revisão. Conclusões: Os trabalhos demonstraram que a Ketamina é um fármaco de ação rápida e possivelmente sustentada na ideação suicida, bem como de efeitos adversos leves e auto-limitados. Entretanto, tais resultados devem ser reproduzidos em um maior número de pacientes, principalmente no que diz respeito ao uso de doses de manutenção

Sustainability Agenda for the Pantanal Wetland: Perspectives on a Collaborative Interface for Science, Policy, and Decision-Making

International audienceBuilding bridges between environmental and political agendas is essential nowadays in face of the increasing human pressure on natural environments, including wetlands. Wetlands provide critical ecosystem services for humanity and can generate a considerable direct or indirect income to the local communities. To meet many of the sustainable development goals, we need to move our trajectory from the current environmental destructive development to a wiser wetland use. The current article contain a proposed agenda for the Pantanal aiming the improvement of public policy for conservation in the Pantanal, one of the largest, most diverse, and continuous inland wetland in the world. We suggest and discuss a list of 11 essential interfaces between science, policy, and development in region linked to the proposed agenda. We believe that a functional science network can booster the collaborative capability to generate creative ideas and solutions to address the big challenges faced by the Pantanal wetland

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care