Gestão do doente hipocondríaco

Introdução: O doente hipocondríaco, segundo o Manual de Diagnóstico e Estatística de Transtornos Mentais-4ª edição, é um indivíduo que tem uma crença inabalável de possuir ou vir a desenvolver uma patologia grave. Com a atualização do “Manual de Diagnóstico e Estatística de Transtornos Mentais-4ª edição”, para o “Manual de Diagnóstico e Estatística de Transtornos Mentais-5ª edição”, a Hipocondria foi dividida em “Distúrbio de Ansiedade da Doença”” e “Distúrbio do Sintoma Somático”, observando-se, nos dois casos, elevados níveis de ansiedade relacionados com a saúde. A maior diferença entre os dois distúrbios, é a presença de sintomas somáticos no Distúrbio do Sintoma Somático, sendo que no Distúrbio de Ansiedade da Doença não há sintomas somáticos, ou quando há, são de leve intensidade. Como tal, por ser uma patologia subdiagnosticada e com alterações recentes na sua definição, é importante que os médicos vão atualizando os seus conhecimentos acerca da Hipocondria, verificando os critérios de diagnóstico recomendados, e fazendo um correto diagnóstico diferencial e tratamento (é igualmente importante entender a postura e forma mais correta de comunicar com o doente hipocondríaco). Com esta revisão bibliográfica, pretende-se clarificar e esclarecer a forma mais correta de gerir um doente hipocondríaco, desde o momento em que há uma suspeita diagnóstica de Hipocondria. Métodos: A realização desta monografia baseou-se na leitura de artigos científicos. Desta forma, usando os motores de busca “PubMed”, selecionei preferencialmente artigos em inglês a partir do ano 2010 (contudo sem restrições de data de publicação), usando múltiplas associações entre os termos “Hypochondriasis”, “Illness Anxiety Disorder”, “Somatic Symptoms Disorder”, “Management”, “Diagnosis” e “Treatment”. Usei também, livros de referência na área da Psiquiatria, nomeadamente o “Manual de Diagnóstico e Estatística de Transtornos Mentais-4ª edição” e o “Manual de Diagnóstico e Estatística de Transtornos Mentai-5ª edição”. Conclusão: Foram já comprovados os benefícios, tanto dos Inibidores Seletivos da Recaptação de Serotonina, como da Terapia Cognitivo-Comportamental, nos doentes hipocondríacos, contudo continua a ser necessário a realização de mais estudos, para se tornarem os tratamentos mais eficazes, sobretudo a longo prazo. Após a leitura de vários artigos científicos relacionados com a Hipocondria, concluí que mais estudos têm de ser efetuados para clarificar e tornar mais unânime o seu conceito. Alguns autores defendem mesmo que, tanto o Distúrbio de Ansiedade da Doença, como o Distúrbio do Sintoma Somático, deveriam ser considerados Transtornos de Ansiedade, e não pertencerem à secção “Sintomas Somáticos e Distúrbios Relacionados”, mais uma prova da necessidade de continuar a clarificar o conceito de Hipocondria.Introduction: The hypochondriac patient, according to the “Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition”, is an individual who has an unwavering belief of possessing or developing a severe pathology. With the update of the “Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition” for “Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition”, the word hypochondriasis was divided into "Illness Anxiety Disorder" and "Somatic Symptom Disorder”, observing, both in one disorder and in the other, high health-related anxiety. The biggest difference between the two disorders is the presence of somatic symptoms in the Somatic Symptom Disorder, and in the Illness Anxiety Disorder there are no somatic symptoms, or when there are, are of mild intensity. As such, because it is an underdiagnosed pathology and with recent changes in the definition, it is important that doctors update their knowledge about Hypochondriasis, verifying the recommended diagnostic criteria, and making the right differential diagnoses and treatment (it is equally important to understand the posture and the most correct way to communicate with the hypochondriac patient). With this literature review, it is intended to clarify a correct way to manage a hypochondriac patient, from the moment there is a diagnostic suspicion of Hypochondriasis, to its treatment. Methods: This monograph was based on the reading of scientific articles. Thus, using the search engines "PubMed", I preferably selected articles in English from the year 2010 (however without restrictions of publication date), using multiple associations between the terms "Hypochondriasis", "Illness Anxiety Disorder", "Somatic Symptoms Disorder", "Management", "Diagnosis" and "Treatment". I also used reference books in psychiatry, namely the “Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition” and “Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition”. Results/Conclusion: The benefits of both Seletive Serotonin Reuptake Inhibitors and Cognitive-Behavioral Therapy in hypochondriac patients have already been proven, but further studies are still needed to become the most effective treatments, especially in the long term. After reading several scientific articles related to Hypochondriasis, more studies are required to clarify and make his concept more unanimous. Some authors even argue, that both Illness Anxiety Disorder and Somatic Symptoms Disorder, should be considered Anxiety Disorders, instead of being part of the section "Somatic Symptoms and Related Disorders", further proof of the need to clarify the concept of Hypochondriasi

Práticas artísticas no ensino básico e secundário

A mediação entre os conteúdos culturais e a Educação Artística formal tem emergido como uma distinta área de inovação e de intervenção, como o mostram os 18 artigos selecionados nesta nona edição da revista Matéria-Prima.Entre a identidade, fundada nos focos de conhecimento local, e uma inserção integrada nos problemas e conteúdos globais joga-se a problematização da Educação Artística. As propostas articulam quer discursos curatoriais (museu, bienal, exposição), como ações de mediação visando uma expansão das atividades, a que se juntam as reflexões sobre a realidade da formação de professores, nas suas diversas modalidades, em diversas realidades sociais.Propiciam-se oportunidades de ações de intervenção, concertadas ou não, entre os agentes artísticos e os educadores. O resultado pode ser potenciado se se conseguir uma perspetiva informada e integrada das realidades artísticas: pede-se a todos os intervenientes mais integração e disponibilidade para um conhecimento mútuo consequente.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

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

Image_1_Retrospective cohort study to evaluate the continuous use of anticholesterolemics and diuretics in patients with COVID-19.TIF

PurposeThe purpose of this study is to evaluate the interference of the continuous use of drug classes in the expression of biomarkers during the first week of hospitalization and in the prognosis of patients with COVID-19.MethodsThe patients diagnosed with COVID-19 and confirmed with SARS-CoV-2 by RT-qPCR assay underwent the collection of fasting whole blood samples for further analysis. Other data also extracted for this study included age, sex, clinical symptoms, related comorbidities, smoking status, and classes of continuous use. Routine serum biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, N-terminal fragment of B-type natriuretic peptide, and cardiac troponin, were measured.ResultsIn this cross-sectional study, a total of 176 patients with COVID-19 hospitalizations were included. Among them, 155 patients were discharged (88.5%), and 21 patients died (12%). Among the drug classes evaluated, we verified that the continuous use of diuretic 4.800 (1.853–11.67) (p = 0.0007) and antihypercholesterolemic 3.188 (1.215–7.997) (p = 0.0171) drug classes presented a significant relative risk of death as an outcome when compared to the group of patients who were discharged. We evaluated biomarkers in patients who used continuous antihypercholesterolemic and diuretic drug classes in the first week of hospitalization. We observed significant positive correlations between the levels of CRP with cardiac troponin (r = 0.714), IL-6 (r = 0.600), and IL-10 (r = 0.900) in patients who used continuous anticholesterolemic and diuretic drug classes and were deceased. In these patients, we also evaluated the possible correlations between the biomarkers AST, NT-ProBNP, cardiac troponin, IL-6, IL-8, and IL-10. We observed a significantly negative correlations in AST levels with NT-ProBNP (r = −0.500), cardiac troponin (r = −1.00), IL-6 (r = −1.00), and IL-10 (r = −1.00) and a positive correlation with IL-8 (r = 0.500). We also observed significant negative correlation in the levels of NT-ProBNP with IL-10 (r = −0.800) and a positive correlation with cardiac troponin (r = 0.800). IL-6 levels exhibited positive correlations with cardiac troponin (r = 0.800) and IL-10 (r = 0.700).ConclusionIn this study, we observed that hospitalized COVID-19 patients who continued using anticholesterolemic and diuretic medications showed a higher number of correlations between biomarkers, indicating a poorer clinical prognosis. These correlations suggest an imbalanced immune response to injuries caused by SARS-CoV-2.</p

Table_1_Retrospective cohort study to evaluate the continuous use of anticholesterolemics and diuretics in patients with COVID-19.DOCX

PurposeThe purpose of this study is to evaluate the interference of the continuous use of drug classes in the expression of biomarkers during the first week of hospitalization and in the prognosis of patients with COVID-19.MethodsThe patients diagnosed with COVID-19 and confirmed with SARS-CoV-2 by RT-qPCR assay underwent the collection of fasting whole blood samples for further analysis. Other data also extracted for this study included age, sex, clinical symptoms, related comorbidities, smoking status, and classes of continuous use. Routine serum biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, N-terminal fragment of B-type natriuretic peptide, and cardiac troponin, were measured.ResultsIn this cross-sectional study, a total of 176 patients with COVID-19 hospitalizations were included. Among them, 155 patients were discharged (88.5%), and 21 patients died (12%). Among the drug classes evaluated, we verified that the continuous use of diuretic 4.800 (1.853–11.67) (p = 0.0007) and antihypercholesterolemic 3.188 (1.215–7.997) (p = 0.0171) drug classes presented a significant relative risk of death as an outcome when compared to the group of patients who were discharged. We evaluated biomarkers in patients who used continuous antihypercholesterolemic and diuretic drug classes in the first week of hospitalization. We observed significant positive correlations between the levels of CRP with cardiac troponin (r = 0.714), IL-6 (r = 0.600), and IL-10 (r = 0.900) in patients who used continuous anticholesterolemic and diuretic drug classes and were deceased. In these patients, we also evaluated the possible correlations between the biomarkers AST, NT-ProBNP, cardiac troponin, IL-6, IL-8, and IL-10. We observed a significantly negative correlations in AST levels with NT-ProBNP (r = −0.500), cardiac troponin (r = −1.00), IL-6 (r = −1.00), and IL-10 (r = −1.00) and a positive correlation with IL-8 (r = 0.500). We also observed significant negative correlation in the levels of NT-ProBNP with IL-10 (r = −0.800) and a positive correlation with cardiac troponin (r = 0.800). IL-6 levels exhibited positive correlations with cardiac troponin (r = 0.800) and IL-10 (r = 0.700).ConclusionIn this study, we observed that hospitalized COVID-19 patients who continued using anticholesterolemic and diuretic medications showed a higher number of correlations between biomarkers, indicating a poorer clinical prognosis. These correlations suggest an imbalanced immune response to injuries caused by SARS-CoV-2.</p

Table_2_Retrospective cohort study to evaluate the continuous use of anticholesterolemics and diuretics in patients with COVID-19.DOCX

PurposeThe purpose of this study is to evaluate the interference of the continuous use of drug classes in the expression of biomarkers during the first week of hospitalization and in the prognosis of patients with COVID-19.MethodsThe patients diagnosed with COVID-19 and confirmed with SARS-CoV-2 by RT-qPCR assay underwent the collection of fasting whole blood samples for further analysis. Other data also extracted for this study included age, sex, clinical symptoms, related comorbidities, smoking status, and classes of continuous use. Routine serum biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, N-terminal fragment of B-type natriuretic peptide, and cardiac troponin, were measured.ResultsIn this cross-sectional study, a total of 176 patients with COVID-19 hospitalizations were included. Among them, 155 patients were discharged (88.5%), and 21 patients died (12%). Among the drug classes evaluated, we verified that the continuous use of diuretic 4.800 (1.853–11.67) (p = 0.0007) and antihypercholesterolemic 3.188 (1.215–7.997) (p = 0.0171) drug classes presented a significant relative risk of death as an outcome when compared to the group of patients who were discharged. We evaluated biomarkers in patients who used continuous antihypercholesterolemic and diuretic drug classes in the first week of hospitalization. We observed significant positive correlations between the levels of CRP with cardiac troponin (r = 0.714), IL-6 (r = 0.600), and IL-10 (r = 0.900) in patients who used continuous anticholesterolemic and diuretic drug classes and were deceased. In these patients, we also evaluated the possible correlations between the biomarkers AST, NT-ProBNP, cardiac troponin, IL-6, IL-8, and IL-10. We observed a significantly negative correlations in AST levels with NT-ProBNP (r = −0.500), cardiac troponin (r = −1.00), IL-6 (r = −1.00), and IL-10 (r = −1.00) and a positive correlation with IL-8 (r = 0.500). We also observed significant negative correlation in the levels of NT-ProBNP with IL-10 (r = −0.800) and a positive correlation with cardiac troponin (r = 0.800). IL-6 levels exhibited positive correlations with cardiac troponin (r = 0.800) and IL-10 (r = 0.700).ConclusionIn this study, we observed that hospitalized COVID-19 patients who continued using anticholesterolemic and diuretic medications showed a higher number of correlations between biomarkers, indicating a poorer clinical prognosis. These correlations suggest an imbalanced immune response to injuries caused by SARS-CoV-2.</p

COVID-19 Computed tomography patterns in renal replacement therapy patients

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12–84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19