Aspectos clínicos e epidemiológicos da tuberculose associada a diabetes em alagoas entre 2013 e 2022

A tuberculose (TB) é uma doença infectocontagiosa causada pela Mycobacterium tuberculosis, é um problema muito associado a aspectos socioeconômicos, como desnutrição e habitação inadequada, e também a um elemento muito importante que é a existência de comorbidades, por exemplo, infecção pelo HIV e a diabetes. Estudos mostraram que pacientes com Diabetes Mellitus (DM) podem ter de 2,44 a 8,33 vezes mais chances de contrair a infecção e que em 2014, 15% dos casos de TB tinham DM associada. Este estudo objetivou analisar os aspectos clínicos e epidemiológicos da tuberculose associados a diabetes em Alagoas entre 2013-2022. Trata-se de um estudo epidemiológico analítico transversal, onde foram incluídos todos os casos de TB com agravamento associado do DM registrados no Sistema de Informação de Agravos de Notificação (SINAN) no período de janeiro de 2013 a dezembro de 2022 no estado de Alagoas. Para a análise das características epidemiológicas, foram selecionadas as variáveis: como idade, sexo e raça/cor, as informações sobre a residência, como a zona em que se encontram, e dados adicionais sobre o caso, incluindo a forma clínica e situação de encerramento.  Foi identificado alguns aspectos relevantes sobre o perfil dos casos de comorbidade tuberculose/diabetes mellitus no estado de Alagoas, incluindo a maior prevalência em homens de meia-idade com baixa escolaridade e pertencimento étnico-racial pardo, com predomínio da forma pulmonar e um maior índice de cura. A TB-DM ainda representa um grande problema de saúde pública, evidenciando a importância do preenchimento adequado das plataformas de saúde para o estado. Assim, destaca-se a importância de aprimorar as políticas públicas de saúde e garantir um tratamento mais efetivo e equitativo para a população afetada por essa comorbidade

INTERAÇÕES MEDICAMENTOSAS RELACIONADAS AO USO DE ANTIMICROBIANO EM HOSPITAIS

Os antimicrobianos constituem numa das principais classes prescritas e responsáveis pela ocorrência dos eventos adversos no âmbito hospitalar, isso ocorre, às vezes, por uso irracional e por associá-lo a terapias medicamentosas, resultando no acentuado número de problemas relacionados aos medicamentos. Esta pesquisa teve como objetivo realizar levantamento epidemiológico das prescrições, identificando as principais interações medicamentosas. O presente estudo, de caráter quantitativo e descritivo, foi desenvolvido no Hospital Universitário Alcides Carneiro – HUAC, em Campina Grande, durante um período de um ano, com pacientes internos na alas C e D(endócrinas) e UTI’s (adulto e infantil). As interações medicamentosas foram identificadas através do Micromedex® e classificadas segundo a sua gravidade. Foram estudados 537 prescrições, sendo 141 da Ala C, 206 da Ala D, 130 UTI adulto e 60 UTI infantil, destas, 398 continham pelo menos um antibiótico associado a uma terapia polimedicamentosa. A média de medicamentos, foi de 12 por prescrição nas Alas C, D e UTI adulto de 7 medicamentos para UTI infantil.Apresentaram interações medicamentosas com antimicrobianos: Ala C(141 pacientes); Ala D:(70 pacientes); UTI infantil: (44 pacientes); UTI adulto: (113 pacientes). Com relação às formas farmacêuticas mais empregadas nas Alas C, D e UTI Adulto foram as soluções e pós para injetáveis, todas pela via endovenosa. Conclui-se que, uma terapia segura contribui de forma efetiva para a integridade e manutenção da saúde do indivíduo, aumentando sua resolutibilidade, através de alternativas terapêuticas mais seguras e racionais que priorize o cuidado maior ao paciente

O uso do paracetamol na gestação associado ao risco de desenvolvimento do espectro autista em crianças: uma revisão de literatura

Popularmente conhecido como autismo, Transtorno do Espectro Autista (TEA), é uma síndrome que tem diversas origens que afetam o comportamento e tem influência direta na evolução da criança, afetando o seu desenvolvimento neurológico. Por décadas, o TEA tinha como principal diagnóstico um tipo de ‘’esquizofrenia infantil’’, porém como o avanço da medicina, começou a diferir este transtorno entre distúrbios metais. Utilizam-se também os termos ASDs ou DEA para referenciar as Desordens do Espectro Autista, onde estes são empregados para referir 3 de 5 transtornos do desenvolvimento que são invasivos. Nos últimos anos, tem sido notado um aumento considerável de nascimentos de crianças com TEA ao redor de todo o mundo. O paracetamol (acetaminofeno), como é conhecido popularmente, são responsáveis por inibir a síntese de prostaglandinas por meio do ácido araquidônico, inibindo a cicloxigenase (COX), gerando ação anestésica e antipirética, por ocorrerem a nível do sistema nervoso central, este medicamento ao ser ingerido por gestantes, ultrapassa a barreira placentária, é muito utilizado no período gestacional para o combate de febre, desta forma, tornou-se o objeto importante de estudo, quando relacionado à pesquisa de TEA. O objetivo do trabalho é apresentar uma possível hipótese do uso do paracetamol durante a gestação, onde este uso pode interferir no desenvolvimento neurológico da criança, gerando o Transtorno do Espectro Autista, em crianças com predisposições genéticas e imunológicas

Malformações Arteriovenosa Cerebrais: uma revisão bibliográfica / Cerebral Arteriovenous Malformations: a bibliographic review

Esse estudo foi realizado com o intuito de realizar uma revisão sistemática dentro da literatura cientifica para poder melhor organizar o raciocínio clínicos quanto ao diagnóstico, tratamento e consequências de pacientes portadores de Malformações Arteriovenosa Cerebrais (MAV), uma vez que seu diagnóstico não é fácil de se realizar e a abordagem terapêutica varia de individuo em indivíduo. Contudo, entende-se que o MAV pode ser um dos diagnósticos diferenciais para tratamento de outras patologias através da apresentação da sintomatologia apresentadas pelo paciente admitidos em pronto atendimentos e que procuram clínicas de neurologia e/ou neurocirurgia para tratamento das sintomatologias mais brandas

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030