“AVALIAÇÃO E TRATAMENTO DA DESCOMPENSAÇÃO DE DOENÇAS CRÔNICAS”

    Decompensation of chronic diseases poses a significant challenge in healthcare management, requiring a careful and integrated approach. Precise assessment plays a pivotal role in early identification of signs of decompensation, enabling timely interventions to prevent severe complications. Healthcare professionals should conduct a comprehensive assessment, considering not only the patient’s current symptoms but also their medical history, risk factors, and adherence to treatment. Once decompensation is identified, appropriate treatment is essential to stabilize the patient and improve their health condition. This may include medication adjustments, additional therapies, lifestyle changes, and supportive interventions as needed. Furthermore, ensuring effective communication among healthcare team members and providing patient education on managing their chronic condition and preventing future decompensations are crucial. Addressing decompensation of chronic diseases requires a multidisciplinary approach involving physicians, nurses, pharmacists, therapists, and other healthcare professionals. Collaborative teamwork allows for comprehensive assessment and a variety of perspectives in crafting the most suitable treatment plan for each patient. In conclusion, assessment and treatment of decompensation in chronic diseases demand a holistic and coordinated approach, aiming not only for immediate patient stabilization but also for long-term health promotion and recurrence prevention. This patient-centered approach is essential to ensure positive outcomes and improved quality of life for individuals affected by chronic diseases.  A descompensação de doenças crônicas representa um desafio significativo na gestão da saúde, exigindo uma abordagem cuidadosa e integrada. A avaliação precisa desempenha um papel fundamental na identificação precoce de sinais de descompensação, permitindo intervenções oportunas para prevenir complicações graves. Os profissionais de saúde devem realizar uma avaliação abrangente, considerando não apenas os sintomas atuais do paciente, mas também sua história médica, fatores de risco e adesão ao tratamento. Uma vez identificada a descompensação, o tratamento adequado é essencial para estabilizar o paciente e melhorar sua condição de saúde. Isso pode incluir ajustes na medicação, terapias adicionais, mudanças no estilo de vida e intervenções de suporte, conforme necessário. Além disso, é crucial garantir uma comunicação eficaz entre os membros da equipe de saúde e fornecer educação ao paciente sobre a gestão de sua condição crônica e a prevenção de futuras descompensações. Ao abordar a descompensação de doenças crônicas, é importante adotar uma abordagem multidisciplinar, envolvendo médicos, enfermeiros, farmacêuticos, terapeutas e outros profissionais de saúde. O trabalho em equipe colaborativo permite uma avaliação abrangente e uma variedade de perspectivas na elaboração do plano de tratamento mais adequado para cada paciente. Em conclusão, a avaliação e o tratamento da descompensação de doenças crônicas exigem uma abordagem holística e coordenada, visando não apenas a estabilização imediata do paciente, mas também a promoção da saúde a longo prazo e a prevenção de recorrências. Essa abordagem centrada no paciente é essencial para garantir resultados positivos e uma melhor qualidade de vida para os indivíduos afetados por doenças crônicas

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Where does her mood come from? An organic approach to a once functional patient

Objective: To report the rare development of manic symptoms in a patient with schizophrenia and discuss its differential diagnosis.Case description: Diagnostic criteria were based on the International Classification of Diseases, 10th edition (ICD-10). A 63-year-old female (diagnosed with schizophrenia since she was 28) was brought to the emergency room with symptoms consistent with manic episode and physical examination suggestive of thyrotoxicosis. Graves' disease was confirmed by subsequent laboratory tests. She was treated successfully with radioiodine ablation, leading to full remission of manic symptoms.Comments: Schizophrenia is a chronic disease that affects about 1% of the population worldwide. The main symptoms of the disorder are altered affection, delusions, and hallucinations. Graves' disease is an autoimmune condition in which antibodies increase the production and release of thyroid hormones. There are reports about the development of mood symptoms in patients with Graves' disease that remit with adequate treatment

Doses de composto orgânico comercial na composição de substratos para a produção de mudas de maracujazeiro em diferentes tipos de cultivo protegido Contents of commercial organic compound in the production of passiflora seedlings in different types of protected cultivation

Doses de composto orgânico comercial misturado ao solo foram utilizadas como substrato na produção de mudas de maracujazeiro amarelo. O experimento foi conduzido no Campus de Aquidauana, da Universidade Estadual de Mato Grosso do Sul, de setembro a dezembro de 2007. Utilizaram-se seis ambientes protegidos: estufa plástica com pé-direito de 2,5m; viveiro telado com Sombrite® 50%, com pé-direito de 2,5m; viveiro telado de tela termo-refletora Aluminet® 50%, com pé-direito de 2,5m; viveiro coberto com palha de coqueiro, com pé-direito de 1,8m; estufa plástica com pé-direito de 4,0m, possuindo abertura zenital e tela termo-refletora 50% sob o plástico e, viveiro telado de tela de sombreamento 50%, com pé-direito de 3,5m. Foram utilizados cinco substratos com doses de 0, 7, 14, 21 e 28% de composto orgânico misturado ao solo. Utilizou-se o delineamento em parcelas subdivididas, com dez repetições. As parcelas principais foram os ambientes de cultivo e as subparcelas foram os substratos. Conclui-se que a estufa agrícola com altura de 4,0m, o viveiro agrícola com altura de 3,5m e o viveiro coberto com palha de coqueiro nativo propiciaram melhor desenvolvimento das mudas. As doses de 7%, 14% e 21% de composto orgânico se mostraram viáveis para composição de substratos com solo da região.<br>Contents of commercial organic compound mixed with soil were used as substrate in the production of Passiflora edulis Sims f. flavicarpa Deg. seedlings. The experiment was carried out in the Aquidauana Campus at the State University of Mato Grosso do Sul, from September to December of 2007. Six environments were used: plastic greenhouse with height of 2.5m; nursery with height of 2.5m covered by shade net with black monofilament of 50% shading rate; nursery with height of 2.5m covered by Aluminum shading screen with shading rate of 50%; nursery with height of 1.8m covered by straw of native coconut; plastic greenhouse with height of 4.0m, zenith opened and thermal shade netting from Aluminet® under the roof and nursery with height of 3.5m covered by shade net with black monofilament of 50% shading rate. Five commercial organic compound contents of 0, 7, 14, 21 and 28%, mixed with soil were used. The experiment was carried out in a completely randomized split-plot scheme where the environments were principal plot and substrates were subplots. The greenhouse with height of 4.0 m, the nursery with height of 3.5 m and the nursery covered with coconut fibers showed the best seedlings. The contents of 7%, 14% and 21% of commercial organic compounds were viable for composition of the substrates with local soil

NEOTROPICAL FRESHWATER FISHES: A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

NEOTROPICAL FRESHWATER FISHES: A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

NEOTROPICAL FRESHWATER FISHES: A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications