Avaliação de fatores psicossociais no controle pressórico de pacientes hipertensos durante a pandemia de COVID-19 / Evaluation of psychosocial factors in the pressure control of hypertensive patients during the pandemic of COVID-19

Objetivos: avaliar adesão ao tratamento, controle da pressão arterial (PA) e variáveis psicossociais em indivíduos hipertensos, antes e durante a pandemia de COVID-19. Métodos: estudo de coorte prospectiva com 96 adultos hipertensos para analisar as variáveis (instrumentos): sociodemográficas (entrevista); impacto psicológico da pandemia (questionário IES-R); sintomas de estresse, ansiedade e depressão (questionário EADS-21); adesão ao tratamento farmacológico (questionário BMQ); e controle da pressão arterial (medidas de PA). Para comparar escore BMQ e controle da PA foi utilizado o teste de McNemar’s, já para avaliar associação entre as variáveis: teste qui-quadrado, exato de Fisher, teste T e Mann-whitney. Resultados: houve significativa redução do controle pressórico com início da pandemia (McNemar's qui-quadrado=12,565, p=0.00567) e os fatores de risco associados foram: raça branca (OR=7,765; IC 95%=1,474–40,903, p=0,016), escolaridade menor que quatro anos (OR=7,531, IC 95%=1,200–47,258, p=0,031) e menos horas diárias dedicadas a assuntos relacionados à pandemia (OR=3,852, IC 95%=1,287–11,526, p=0,016). Nível reduzido de sintomas depressivos foi identificado como fator protetor contra descontrole da PA (OR=0,130, IC 95%=0,24 – 0,681, p = 0,018). Não houve variação significativa na adesão ao tratamento medicamentoso (McNemar's chi-squared=4.8979, p=0.557). Conclusão: a pandemia de COVID-19 aumentou a taxa de PA descontrolada, mas não comprometeu adesão ao tratamento

Câncer de mama: ações de prevenção na atenção primária à saúde.

INTRODUCTION: Cancer is characterized as an evident public health problem in the world context. As a result, breast cancer is the main cause of death from cancer in the country, with estimates indicating the occurrence of around 53,000 new cases of the disease per year. OBJECTIVE: To present, in accordance with the scientific literature, the main actions offered in primary care regarding the prevention of breast cancer. METHODOLOGY: This is a qualitative study, it refers to an integrative literature review, presenting a synthesis of the studies analyzed in full, organizing them for the elaboration of the results regarding the established theme, being carried out in the month of August 2023. RESULTS: Actions for the early identification of breast cancer are essential so that control strategies are planned and implemented, since the sooner the tumor is discovered and treatment is started, the greater the patient's chance of cure. In addition, it is essential that actions for the early diagnosis of breast cancer are carried out. FINAL CONSIDERATIONS: Therefore, it is noted that breast cancer is a serious problem for women's health, predisposed to biological risk factors and/or environments, requiring actions for early detection and prevention of injuries.INTRODUÇÃO: O câncer se caracteriza como um problema evidente de saúde pública no contexto mundial. Com isso, a neoplasia mamária se mostra como principal causa de morte por câncer no país, cujas estimativas apontam a ocorrência de cerca de 53 mil novos casos da doença por ano. OBJETIVO: Apresentar, de acordo com a literatura científica, as principais ações ofertadas na atenção primária frente à prevenção do câncer de mama. METODOLOGIA: Trata-se de um estudo qualitativo, refere-se a uma revisão integrativa da literatura, apresentando uma síntese dos estudos analisados na íntegra, organizando-os para a elaboração dos resultados a respeito da temática estabelecida, sendo realizada no mês de agosto de 2023. RESULTADOS: As ações para a identificação precoce do câncer de mama são essenciais para que as estratégias de controle sejam planejadas e executadas, visto que quanto mais cedo o tumor for descoberto e o tratamento iniciado, maior será a chance de cura da paciente. Ademais, é primordial que as ações para o diagnóstico precoce do câncer de mama sejam efetivadas.  CONSIDERAÇÕES FINAIS: Portanto, nota-se que o câncer de mama é um sério problema para a saúde da mulher, predisposto a fatores de risco biológicos e/ou ambientes, necessitando de ações para detecção precoce e prevenção de agravos

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

Colicistite aguda alitiásica condutas que reduzem a taxa de internação em Terapia de Unidade Intensiva: uma revisão sistemática: Acute althiasic cholicistitis conducts that reduce the hospitalization rate in Intensive Unit Therapy: a systematic review

Os cálculos biliares se encontram em mais de 10% da população mundial, sendo que esta incidência se torna maior com o avanço da idade. Sendo assim a colecistite pode ser considerada como uma emergência comum no mundo, sendo que na maior parte dos casos é decorrente da inflamação da parede interna da vesícula devido á impactação do cálculo e decorrente obstrução no ducto cístico, produzindo assim dor repentina e aguda, entretanto a colecistite aguda alitiásica ocorre sem que haja cálculos em seu interior. Esse trabalho possui como sua pergunta de pesquisa qual conduta deve ser adotada para reduzir a taxa de internação em UTI’s em pacientes que apresentem colicistite aguda alitiásica. E assim como seu objetivo geral demonstrar a conduta adequada para manejo de pacientes que apresentem colicistite aguda alitiásica. E como seus objetivos específicos: Identificar do que se trata um quadro de colicistite aguda alitiásica; Auxiliar na tomada de conduta pelos profissionais acerca do tratamento adequado; Disponibilizar informações acerca do assunto. Esse trabalho trata-se de uma revisão sistemática de artigos extraídos das plataformas do PubMed, BVS, Lilacs, Medline, Scielo, esses que possuem datas dos últimos 5 anos e escritos nos seguintes idiomas: português, inglês e espanhol. Com isso conclui-se que ainda são escassos os estudos acerca do tema, portanto é necessário que os médicos consigam de forma significativa o diagnóstico com agilidade, e para isso o conhecimento sobre assunto por uma equipe multidisciplinar deve ser amplamente desenvolvido

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

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.Publisher PDFPeer reviewe

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Relation between alergic diseases, immediate hypersensitivity and socioeconomic/professional factors in a population from Florianópolis, Brasil

TCC(graduação) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Medicina.Fundamentos: Enfermedades alérgicas ocupan un escenario cotidiano de atención en salud y pueden tener diferentes fenotipos y estar influenciado por factores socioeconómicos y ambientales. Objetivo: Identificar el perfil inmunológico de individuos con enfermedades alérgicas y su relación con el perfil socioeconómico/ambiental. Métodos: Estudio populacional transversal, descriptivo, con una muestra final de 83 adultos y 49 niños voluntarios. Se aplicó un cuestionario, adaptado del International Study of Asthma and Allergies in Childhood (ISAAC), un prick-test para alérgenos inhalantes, alimentarios y látex y fue colectada una muestra de sangre para dosis de eosinofilos y IgE total. Se identificaron cuatro grupos de adultos y cuatro de niños y se compararon entre ellos. Resultados: Entre los adultos sintomáticos 12% tenián asma, 53% rinitis, 4,8% dermatitis atópica, 2,4% anafilaxia; 44,6% fueron control. Entre los niños, tenían síntomas: 30,6% asma, 57,1% rinitis, 22,44% dermatitis atópica, 8,2% anafilaxia; 28,6% fueron control. No hubo diferencia significativa en los factores socioeconómicos y ambientales. En los niños los niveles de IgE sérica total y de eosinofilos sanguíneos y la frecuencia de prick-test positivos para aeroalergenos fueron más elevadas en los grupos de niños con al menos una enfermedad alérgica (p<0,05). En los adultos: Niveles de IgE sérico fueron más elevados en los sintomáticos y el grupo control obtuvo el prick-test negativo más frecuentemente (p<0,05). Conclusion: El fenotipo Th-2 fue predominante entre individuos con enfermedades alérgicas en este estudio, sin influencia de factores socioeconómicos o ambientales

Self-Supported Biopolymeric Films Based on Onion Bulb (<i>Allium cepa</i> L.): Gamma-Radiation Effects in Sterilizing Doses

Sterilization is a fundamental step to eliminate microorganisms prior to the application of products, especially in the food and medical industries. γ-irradiation is one of the most recommended and effective methods used for sterilization, but its effect on the properties and performance of bio-based polymers is negligible. This work is aimed at evaluating the influence of γ-radiation at doses of 5, 10, 15, 25, 30, and 40 kGy on the morphology, properties, and performance of bioplastic produced from onion bulb (Allium cepa L.), using two hydrothermal synthesis procedures. These procedures differ in whether the product is washed or not after bioplastic synthesis, and are referred to as the unwashed hydrothermally treated pulp (HTP) and washed hydrothermally treated pulp (W-HTP). The morphological analysis indicated that the film surfaces became progressively rougher and more irregular for doses above 25 kGy, which increases their hydrophobicity, especially for the W-HTP samples. In addition, the FTIR and XRD results indicated that irradiation changed the structural and chemical groups of the samples. There was an increase in the crystallinity index and a predominance of the interaction of radiation with the hydroxyl groups—more susceptible to the oxidative effect—besides the cleavage of chemical bonds depending on the γ-radiation dose. The presence of soluble carbohydrates influenced the mechanical behavior of the samples, in which HTP is more ductile than W-HTP, but γ-radiation did not cause a change in mechanical properties proportionally to the dose. For W-HTP, films there was no mutagenicity or cytotoxicity—even after γ-irradiation at higher doses. In conclusion, the properties of onion-based films varied significantly with the γ-radiation dose. The films were also affected differently by radiation, depending on their chemical composition and the change induced by washing, which influences their use in food packaging or biomedical devices