Trauma em gestantes: condutas quanto ao uso diagnóstico de exames com radiação ionizante

Introdução: Trauma é a principal causa de morte em mulheres gestantes excluindo as causas obstétricas. Os estudos por imagem fornecem complementação às informações trazidas pelo exame clínico nesses casos. Porém, haja vista a exposição à radiação ionizante provocada por exames como a tomografia computadorizada (TC), seu uso deve ser sempre discutido de forma particular em cada caso. Objetivo: avaliar quais os fatores influenciam na tomada de decisão a respeito do uso de exames a base de radiação ionizante. Metodologia: Trata-se de uma revisão integrativa na base de dados PUBMED utilizando os descritores “Pregnancy And Radiation And (Trauma Or Emergency)’’ para artigos publicados entre 2018 e 2023. DISCUSSÃO: A exposição fetal pode ocasionar efeitos deletérios como a perda espontânea da gravidez e efeitos teratogênicos, porém, a dose relacionada ao aborto é de 50 a 100 mGy ou superior. Assim, entende-se que a preocupação sobre a radiação a que o feto será exposto nunca deverá anteceder a atenção ao cuidado prestado à mãe no acolhimento inicial pós trauma. Conclusão: A garantia de vida ao feto está condicionada à manutenção da vida materna. Se possível, exames de imagem feitos por equipamento modernos que exponha a mãe e o feto a menores doses de radiação, devem ser utilizados. A RM pode ser uma alternativa para pacientes estáveis em que quer se evitar a exposição à radiação apresentada pela TC

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Conhecimento dos agentes comunitários de saúde sobre a tuberculose, suas medidas de controle e tratamento diretamente observado

Trata-se de estudo de corte transversal, realizado mediante a aplicação de questionário em uma amostra aleatória e representativa de 489 agentes comunitários de saúde (ACS) a respeito da tuberculose (TB), suas medidas de controle e o tratamento diretamente observado (TDO), em Belo Horizonte, Minas Gerais, Brasil. A proporção média de itens acertados foi de 74,6%. A proporção média de acertos no domínio TB foi 81%; no domínio medidas de controle, 84,1%; e sobre TDO, 59,4%. Verificou-se uma lacuna no conhecimento sobre a identificação de pacientes com TB pulmonar, o público-alvo do TDO, e a técnica adequada para supervisão do tratamento. Foi observada associação entre maior conhecimento e tempo de atuação igual ou superior a três anos (RC = 2,3) e acompanhamento de casos nos 12 meses anteriores à entrevista (RC = 1,7). Este trabalho apresentou informações inéditas na literatura científica sobre o nível de conhecimento dos ACS sobre TDO, e poderá subsidiar estratégias destinadas ao aperfeiçoamento das atividades de controle da tuberculose

Prenatal exposure to a mixture of different phthalates increases the risk of mammary carcinogenesis in F1 female offspring

Phthalates metabolites have been detected in the urine of pregnant and breastfeeding women. Thus, this study evaluated the adverse effects of maternal exposure to a mixture of six phthalates (Pth mix) on the mammary gland development and carcinogenesis in F1 female offspring. Pregnant female Sprague-Dawley rats were exposed daily to vehicle or Pth mix (35.22% diethyl-phthalate, 21.03% di-(2-ethylhexyl)-phthalate, 14.91% dibutyl-phthalate, 15.10% diisononyl-phthalate, 8.61% diisobutyl-phthalate, and 5.13% benzylbutyl-phthalate) by gavage at 20 μg/kg, 200 μg/kg or 200 mg/kg during gestational day 10 (GD 10) to postnatal day 21 (PND 21). After weaning (PND 22), some female offspring were euthanized for mammary gland analyses while other females received a single dose of N-methyl-N-nitrosourea (MNU, 50 mg/kg) or vehicle and then tumor incidence and multiplicity were recorded until PND 180. Maternal Pth mix exposure increased the number of Ki-67 and progesterone receptor-positive epithelial cells in the mammary gland from Pth mix 200 at μg/kg and 200 mg/kg groups. In addition, tumor incidence and mean number were higher only in Pth mix at 200 mg/kg when compared to the vehicle-treated group, and percentage of tumor-free animals was lower in Pth mix at 200 μg/kg and 200 mg/kg groups. The findings indicate that perinatal Pth mixture exposure increased susceptibility to MNU-induced mammary carcinogenesis in adult F1 female offspring.Fil: de Freitas, Thiago. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Zapaterini, Joyce R.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Moreira, Cristiane M.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: de Aquino, Ariana M.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Alonso Costa, Luiz G.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Bidinotto, Lucas T.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Kass, Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Salud y Ambiente del Litoral. Universidad Nacional del Litoral. Instituto de Salud y Ambiente del Litoral; ArgentinaFil: Flaws, Jodi A.. University of Illinois. Urbana - Champaign; Estados UnidosFil: Scarano, Wellerson R.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Barbisan, Luis F.. Universidade Estadual Paulista Julio de Mesquita Filho; Brasi

Prevalência do Transtorno Dismórfico corporal em pacientes candidatos e/ou submetidos a procedimentos estéticos na especialidade da cirurgia plástica: uma revisão sistemática

O transtorno dismórfico corporal (TDC) é um transtorno psiquiátrico caracterizado pela preocupação excessiva e distorcida com a aparência física. Na especialidade da cirurgia plástica, é comum que pacientes busquem procedimentos estéticos para corrigir supostas imperfeições corporais decorrentes do TDC. O objetivo desta revisão sistemática é avaliar a prevalência do TDC em pacientes candidatos e/ou submetidos a procedimentos estéticos na especialidade da cirurgia plástica. Foram selecionados estudos que abordam a prevalência do TDC em pacientes submetidos a procedimentos estéticos, publicados entre 2010 e 2022. Os resultados indicam uma prevalência elevada de TDC em pacientes que buscam procedimentos estéticos na cirurgia plástica. A revisão também destaca a importância da avaliação psicológica pré-operatória e do tratamento adequado para pacientes com TDC ou outras condições mentais que possam interferir no resultado da cirurgia e na satisfação do paciente. Uma abordagem multidisciplinar envolvendo cirurgiões plásticos e profissionais de saúde mental é fundamental para garantir a segurança e a satisfação dos pacientes submetidos a procedimentos estéticos