A importância do laudo pericial médico na formação do entendimento do juízo: análise de casos de suposta má prática médica em cirurgia geral

Currently, in Brazil, legal demands filed by patients against their doctors have enormously increased. Medical malpractice is defined as improper conduct, which involves a technical failure, capable of producing damage to life or harm to health of others. The lack of expertise in medicine makes the judicial authority require an expert opinion to determine the liability of those involved. The aim of this study was to assess the importance of medical expert opinion in shaping the understanding of judges in cases of alleged medical malpractice in general surgery and to evaluate the impact of medical expertise in the formation of his decision. We have studied the official forensic reports and court decisions of the year 2009 of 100 civil cases related to medical malpractice in general surgery, proposed in the state of São Paulo, in first instance. We have observed elements of the expert report and the reasons for the sentence. We have determined agreement and disagreement between the medical and legal understandings in each case. In all decisions judges have mentioned the forensic evidence exposed by the expert. In 96% of cases the forensic report influenced the decision. 80% of the sentences were unfavorable to the authors. In 84% of cases, the expert did not establish the cause-effect relationship. In 16%, elements related to medical malpractice were well qualified. The agreement took place, specifically, in 75% for the inadequate medical management and 100% when the expert considered the assistance appropriate. Thus, medical examination with expert opinion is the primary means of proof in actions that deal with medical malpractice. The results confirm the strong influence of expert opinion in the merits or otherwise of the actions. The adequate supply to the competent authority for clarification on the matter at hand, based on scientific knowledge, is responsible for the formation of the magistrate’s conviction, contributing to justice.Atualmente, no Brasil, têm aumentado enormemente as demandas jurídicas impetradas por paciente contra seus médicos. A má prática médica é conceituada como a conduta inadequada, que supõe inobservância técnica, capaz de produzir dano à vida ou agravo à saúde de outrém, mediante imperícia, imprudência ou negligência. A ausência de conhecimento técnico em medicina faz com que a autoridade judicial se utilize da perícia médica para apuração da responsabilidade civil dos envolvidos. O objetivo deste trabalho foi avaliar a importância do laudo pericial médico na formação do entendimento da autoridade judicial em casos de alegada má prática médica na especialidade de cirurgia geral e verificar o impacto da perícia médica na formação de seu convencimento. Estudaram-se os laudos oficiais e as decisões judiciais do ano de 2009 de 100 processos cíveis referentes à má prática médica na especialidade de cirurgia geral, propostas no estado de São Paulo, até a primeira instância. Observaram-se os elementos do laudo pericial e a fundamentação da sentença. Determinaram-se a concordância e a discordância entre os entendimentos médico e jurídico em cada caso. Em todos os julgados mencionou-se a prova pericial médica. Em 96% dos casos o laudo médico-legal influenciou a decisão judicial. 80% das sentenças foi desfavorável aos autores. Em 84% dos casos, o perito não estabeleceu nexo de causalidade. Houve, em 16% das perícias realizadas, elementos que permitiram concluir pela ocorrência de má prática médica. A concordância deu-se, especificamente, em 75% quanto à conduta médica inadequada e em 100% quando se considerou a assistência prestada adequada. Constatou-se que a perícia médica é o principal meio de prova nas ações que versam sobre má prática médica. Demonstrou-se a grande influência do laudo pericial na decisão pela procedência, ou não, das ações. O fornecimento adequado à autoridade competente de esclarecimentos sobre a matéria em tela, com base em conhecimentos científicos, é responsável pela formação do convencimento do magistrado, contribuindo para que se faça justiça

Valoração Médico-Pericial do Dano Estético

The expert assessment of damage constitutes a technical activity, to which apply the rules of the Medical Art, within the context of the law. The medical report must be comprehensive and allow understanding the actual situation of the individual. The evaluation of the expert should ensure clarification of the judgment, thus contributing to justice. It is fundamental that personal injury is identified, described, and valued according to a rigorous scientific method. This article takes into account the experience of the Institute of Social Medicine and Criminology of the State of São Paulo (IMESC) to discuss Aesthetic Damage, both in its diagnosis and in its assessment within the Brazilian legal framework. The assessment method employed is based on a quantitative-descriptive scale, aiming for harmonization in its consideration, within the general principle of integral reparation of damages, in a contextualized and grounded manner.O exame pericial de avaliação de danos constitui uma atividade técnica, à qual se aplicam as regras da Arte Médica, considerando-se o âmbito do Direito em que se insere. O laudo médico deve ser completo e fazer compreender a situação real do indivíduo. A avaliação do experto deve assegurar o esclarecimento do juízo, contribuindo para que se promova a Justiça. É fundamental que o dano pessoal seja identificado, descrito e valorado de acordo com rigoroso método científico. Este artigo discorre sobre o Dano Estético e reflete a experiência do Instituto de Medicina Social e de Criminologia do Estado de São Paulo (IMESC) tanto em seu diagnóstico quanto em sua valoração dentro do arcabouço legal brasileiro, de acordo com método de avaliação baseado em escala quantitativa-descritiva, buscando-se harmonização em sua ponderação, dentro do princípio geral da reparação integral dos danos, de modo contextualizado e fundamentado

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

Repercussões Da Interposição Ileal Isolada Em Ratos Com Dismetabolismo Glicídico Induzido Por Dieta

INTRODUCTION: The clinical management of type 2 diabetes mellitus (T2DM) is complex and permanent. In this moment, it is necessary a surgical procedure considered effective for the treatment of this disease among individuals with body mass index above morbid obesity. The isolated ileal transposition (III) could become an alternative therapy in selected non-obese diabetic patients. There are no reports of III performed in wistar rats in an experimental model of diet-induced disglycemia without genetic or drug influences, nor its pancreas morphology evaluation. OBJECTIVE: This study aims to contribute to the treatment of T2DM, evaluating the physiological effects of III on glucose metabolism and investigating histological changes of the pancreas in an experimental model of diet-induced disglycemia. METHODS: Seventy two 12-week-old male Wistar rats were distributed into four groups - ileal transposition, sham-operated, diabetic controls and non-diabetic controls (NG). The NG group received usual rat feeding while the other groups received hypercaloric-hyperlipidic diets. III was carried out in obese disglycemic rats at the 30-week. All groups maintained their diets untill the 48-week. Glucose tolerance, insulin resistance, food-intake, body weight, adiposity, serum substances and pancreas morphology were evaluated. RESULTS: After a postoperative period of 18 weeks, the III improved glucose tolerance and insulin sensitivity in diet-induced disglycemic rats. III did not induced weight loss or food intake decrease, and did not affected fat mass. It did not promoted morphological pancreatic alterations. CONCLUSIONS: In rats with diet-induced disglycemia, III promotes beneficial changes in glucose metabolism and does not modify the morphology of the endocrine pancreas.INTRODUÇÃO: O tratamento clínico do diabetes mellitus tipo 2 (DM2) é complexo. Atualmente, busca-se procedimento cirúrgico que seja eficaz no tratamento do DM2 em indivíduos eutróficos e com sobrepeso. A interposição ileal isolada (III) pode vir a constituir-se numa alternativa terapêutica para indivíduos selecionados. Não há relatos da realização de III em modelo experimental de dismetabolismo glicídico induzido por dieta, mimetizando a condição humana, sem influências genéticas nem farmacológicas. A análise histológica do pâncreas desses animais também ainda não foi realizada. OBJETIVOS: O objetivo deste estudo é contribuir para o tratamento do DM2, avaliando-se os efeitos ponderais, metabólicos e morfológicos pancreáticos após a III em modelo experimental de dismetabolismo glicídico induzido por dieta. MATERIAL E MÉTODOS: 72 ratos Wistar machos, com 12 semanas de vida, foram distribuídos em quatro grupos - Grupo Padrão (GP), Grupo Interposição Ileal Isolada, Grupo Sham e Grupo Controle. O GP consumiu ração padrão ao passo que os demais receberam dietas hiperenergéticas-hiperlipídicas durante todo o procedimento. As intervenções cirúrgicas foram realizadas na 30ª semana de vida, nos animais que desenvolveram obesidade, hiperglicemia, intolerância à glicose e resistência insulínica induzidos por dieta. Análises biométricas e bioquímicas foram realizadas, além de avaliação morfológica do pâncreas. RESULTADOS: Na 18ª semana de pós-operatório, a III melhorou a tolerância à glicose e a sensibilidade das células-alvo à insulina em ratos com disglicemia induzida por dieta. A III não implicou em perda de peso, não promoveu diminuição da ingesta de ração nem não afetou o depósito de gordura visceral. A III não promoveu alterações histológicas estruturais no pâncreas. CONCLUSÃO: Em ratos Wistar com disglicemia induzida por dieta, a III promove alterações benéficas no metabolismo da glicose e não altera a morfologia do pâncreas endócrino.Dados abertos - Sucupira - Teses e dissertações (2017

AGE AND GENDER MAY INFLUENCE THE RESULTS OF ROUX-EN-Y GASTRIC BYPASS? Metabolic syndrome parameters

Context Severe obesity affects the body favoring the development of serious diseases, including hypertension, diabetes mellitus, atherosclerosis and non alcoholic fatty liver disease. Bariatric procedures increased in Brazil in the last decade. Objectives The purpose of this study was to verify if gender and age in date of procedure resulted significant differences in metabolic syndrome parameters after surgery. Methods The study involved 205 medical records of adult patients undergoing Roux-en-Y gastric bypass, stratified by gender and age groups and followed one year by a multidisciplinary team. Results It was observed significant decrease in body mass index, fasting glucose and insulin at all ages and both genders. Lipid profile showed significant improvements except high density lipoprotein cholesterol. Ectopic fat in the liver has decreased after 6 months in patients classified with steatosis at baseline. Patients classified as hypertensive blood pressure levels decreased 6 months after surgical intervention. Conclusions Roux-en-Y gastric bypass proved to be an important tool in remission of metabolic syndrome parameters. The reduction of body mass accompanied to decrease in insulin resistance resulted in lower prevalence of comorbidities associated with obesity. The benefits were similar and extended both genders and all age groups between 18 and 65 years old

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data