Predictive value for fetal outcome of Doppler velocimetry of the ductus venosus between the 11th and the 14th gestation week

PURPOSE: to study the value of Doppler velocimetry of the ductus venosus, between the 11th and 14th weeks of pregnancy, associated to the nuchal translucency thickness measurement, in the detection of adverse fetal outcome. METHODS: a transversal and prospective study in which a total of 1,268 fetuses were studied consecutively. In 56 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus and, in 1,181 cases, the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the ductus venosus. Aiming at prevalence and accuracy indices, sensitivity, specificity, positive predictive value, negative predictive value, probability of false-positive, probability of false-negative, reason of positive probability and reason of negative probability were calculated and analyzed. RESULTS: from the total of 1,268 fetuses, 1,183 cases were selected for analysis. From this number, 1,170 fetuses were normal (98.9%) and 13 fetuses presented adverse outcome at birth (1.1%), including fetal death (trisomy 21 and 22) in two cases; genetic syndrome (Nooman) in one case; two cases of polymalformed fetuses; cardiopathy in three cases; and other structural defects in five cases. The prevalence of the modified ductus venosus (wave A zero/reverse) in the studied population was of 14 cases (1.2%), with a false-positive rate of 0.7%. CONCLUSIONS: there is a significant correlation between the alteration of the ductus venosus Doppler velocimetry and the thickness of the nuchal translucency as an ultrasonographic marker for the first trimester of gestation, in the detection of adverse fetal outcome, especially serious malformations. The ductus venosus was able to diminish the false-positive result in comparison to the isolated use of the nuchal translucency thickness, improving considerably the positive predictive value of the test.OBJETIVO: estudar o valor da dopplervelocimetria do ducto venoso (DV) entre a 11º e a 14º semanas de gestação, associado à medida da translucência nucal (TN), na detecção de resultado fetal adverso. MÉTODOS: foram estudados 1.268 fetos consecutivamente. Em 56 casos, realizou-se estudo citogenético no material obtido, por meio de biópsia de vilosidade coriônica e, em 1.181 casos, o resultado teve como base o fenótipo do recém-nascido. Todos os fetos foram submetidos, além da ultra-sonografia de rotina, à medida da TN e à dopplervelocimetria do DV. Trata-se de um estudo transversal e prospectivo. Foram calculados e analisados, para fins de prevalência e índices de acurácia: sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN), probabilidade de falso-positivo (PFP), probabilidade de falso-negativo (PFN), razão de probabilidade positiva e razão de probabilidade negativa. RESULTADOS: do total de 1.268 fetos, foram selecionados para análise 1.183 casos. Deste total, 1.170 fetos eram normais (98,9%) e 13 fetos tiveram resultado fetal adverso ao nascimento (1,1%) - incluindo morte fetal (trissomia 21 e 22) em dois casos, síndrome genética (Nooman) em um caso, fetos polimalformados em dois casos, cardiopatia em três casos e outros defeitos estruturais em cinco casos. A prevalência do DV alterado (onda A zero/reversa) na população estudada foi de 14 casos (1,2%), com taxa de falso-positivo de 0,7%. CONCLUSÕES: há correlação significativa entre alteração da dopplervelocimetria do DV e a medida da TN, como marcadores ultra-sonográficos de primeiro trimestre, na detecção de resultado fetal adverso, especialmente para malformações graves. O Doppler do DV foi capaz de diminuir o resultado falso-positivo, comparativamente ao uso isolado da TN, melhorando consideravelmente o VPP do teste.Universidade Federal do Espírito SantoUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

SOIL ORGANIC MATTER IN AREAS UNDER YERBA MATE CULTIVATION AND SWINE WASTE APPLICATION

Carbon and nitrogen contents, as well as their chemical fractions (humic acid - HAF, fulvic acid - FAF, humin - HUM) and particle-size fractions (particulate organic carbon - POC, mineral-associated organic carbon - MAOC) of organic matter were evaluated in areas cultivated with yerba mate (Ilex paraguariensis) with 35 (E35) and 45 (E45) consecutive years of cultivation, in addition to a native forest area (NF), taken as reference. The soils of the study area were classified as Cambissolo Háplico (Inceptisol). Soil samples were collected at depths of 0.0-0.05, 0.05-0.10, 0.10-0.20 and 0.20-0.40 cm. A completely randomized design in split plots (3 areas and 4 depths) with 4 replicates was used. The E45 area, due to the longer cultivation time and the addition of organic fertilizer, had higher TOC, N and POC contents in comparison to the E35 area, with similar values of these attributes being observed in the forest area at some depths. The most stable carbon fractions (MAOC and HUM) did not vary between cultivated areas (E35 and E45); however, there were reductions of 25 and 14% (HUM 0-5 cm) and 12 and 21% (MAOC 5-10 cm) in these fractions, respectively, in comparison to the native forest. There was no difference between the evaluated areas for FAF, but HAF values were higher in the native forest area than in the cultivated areas

Safety, Effectiveness, and Hemodynamic Performance of the Bovine Pericardium Organic Valvular Bioprosthesis

ABSTRACT Objective: To assess actual data on the safety, effectiveness, and hemodynamic performance of Bovine Pericardium Organic Valvular Bioprosthesis (BVP). Methods: The BIOPRO Trial is an observational, retrospective, non-comparative, non-randomized, and multicenter study. We collected data from 903 patients with symptomatic, moderate, or severe valve disease who underwent BVP implants in the timeframe from 2013 to 2020 at three Brazilian institutions. Death, valve-related adverse events (AEs), functional recovery, and hemodynamic performance were evaluated at the hospital, at discharge, and six months and one year later. Primary analysis compared late (> 30 days after implant) linearized rates of valve-related AEs, such as thromboembolism, valve thrombosis, major hemorrhage, major paravalvular leak, and endocarditis, following objective performance criteria (OPC). Analysis was performed to include at least 400 valve-years for each valve position (aortic and mitral) for complete comparisons to OPC. Kaplan-Meier survival and major adverse cardiovascular and cerebrovascular event analyses were also performed. Results: This retrospective study analyzed follow-up data collected from 903 patients (834.2 late patient-years) who have undergone surgery for 455 isolated aortic valve replacement (50.4%), 382 isolated mitral valve replacement (42.3%), and 66 combined valve replacement or other intervention (7.3%). The linearized rates of valve-related AEs were < 2 × OPC. One-year survival rates were 95.1% and 92.7% for aortic and mitral valve replacement, respectively. This study demonstrated an improvement in the New York Heart Association classification from baseline and hemodynamic performance within an expected range. Conclusion: According to this analysis, BVP meets world standards for safety and clinical efficacy

Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients

OBJECTIVES: The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS: This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS: In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). CONCLUSION: The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients

Aborto: análise das recentes modificações legais e suas implicações éticas

O aborto é uma questão de saúde pública e a sua discussão abrange aspectos éticos, morais e legais. Apesar das posições contrárias, o abortamento legal propicia acesso seguro e humanizado à assistência, diminuindo a mortalidade materna. Nesse contexto, o objetivo deste trabalho é discutir as recentes modificações no ordenamento jurídico pátrio relacionadas ao aborto e a suas implicações na prática médica. Trata-se de revisão crítica da literatura, realizada nas bases de dados LILACS e SciELO. Evidenciou-se que nas últimas décadas ocorreram várias modificações jurídicas relacionadas ao abortamento. Tais alterações tornaram-se alvo de críticas por violarem a autonomia das pacientes e estarem, em alguns casos, em desacordo com o Código de Ética Médica. Constata-se que, mesmo havendo previsão legal para a prática, muitas mulheres enfrentam a negação de seus direitos.Abortion is a public health issue encompassing ethical, moral, and legal aspects. Despite contrary opinions, legal abortion provides humane and safe access to medical assistance, reducing maternal mortality. This work aimed to discuss the recent modifications in the national legal order related to abortion and their implications for medical practice. A critical literature review was carried out on LILACS and SciELO databases. The results showed that various legal changes related to abortion occurred in the last decades. Such alterations have been the subject of criticism as they violate patient autonomy and are, in some situations, in disagreement with the Code of Medical Ethics. Despite the existence of legal provisions for the procedure, many women have their rights denied

Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis

Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87–0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40–0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60–0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD − 19.44 mg/dL; 95% CI − 21.49 to − 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD − 0,13%; IC 95% − 0.16 to − 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c

Radiodifusão: dispositivo intersetorial na produção de saúde

O artigo trata do cuidado intersetorial na saúde, sendo feito por usuários e trabalhadores participantes de um programa de rádio. A escrita volta-se às memórias dos programas ocorridos, buscando, nesse olhar para trás, um vigor para a discussão. Percorre-se toda uma trajetória de construção do cuidado, inspirado no modo de apresentação do programa de rádio. O artigo tem estrutura semelhante ao programa, contendo subtítulos iguais aos blocos do mesmo. Num primeiro momento apresentaremos o programa, onde está inserido e os atores vinculados. No bloco 1 resgataremos um pouco da história da Reforma Psiquiátrica e as relações com a PNH. No bloco 2 debateremos o cuidado em saúde intersetorial. O terceiro bloco serão memórias do Coletivo loucutor, as quais trarão para o texto pensamentos sobre o fazer radiofônico e o cuidado em saúde. Finalizaremos com as dicas do dia, assim como fazemos no último bloco do programa

MODELAGEM COMPUTACIONAL E MÉTODO DESIGN CONSTRUTAL APLICADOS AO ESTUDO DO COMPORTAMENTO MECÂNICO DE PAINÉIS DE AÇO COM ENRIJECEDORES SUBMETIDOS À FLAMBAGEM

Placas ortotrópicas possuem vigas dispostas longitudinalmente e transversalmente, chamadas de enrijecedores, com o objetivo de aumentar a resistência mecânica. Assim, é necessário obter uma geometria ótima de forma a maximizar a carga crítica de fambagem da placa ortotrópica, quando submetida à flambagem. Empregou-se o Método dos Elementos Finitos, utilizando o software ANSYS®. Inicialmente adotou-se uma placa fina simplesmente apoiada sem enrijecedores, usando como referência o valor da tensão crítica de flambagem da mesma. Enrijecedores foram incorporados à placa. Para isso, a variável fração de volume (Ï•), que representa a relação entre o volume de enrijecedores e o volume total do elemento estrutural placa/enrijecedores, foi adotada, mantendo uma variação nula do volume final da placa. Foram analisadas quatro combinações diferentes de enrijecedores, onde quatro valores de fração volumétrica foram adotados Ï• = 0,1; 0,2; 0,3 e 0,4 em cada situação. Cada análise dos painéis enrijecidos apresentou uma relação hs/ts, relacionando a espessura do enrijecedor e sua altura. Os resultados obtidos foram comparados entre si e com a placa sem enrijecedores, indicando que a variação da configuração geométrica afeta significativamenteo comportamento mecânico sob flambagem dos painéis enrijecidos, sendo possível determinar a geometria ótima que conduz a uma carga crítica maximizada. Palavras-chave: Flambagem, Placa, Enrijecedores, Design Constructal, Simulação Numéric

Evaluation of ichthyofauna in lotic and lentic environments in the Araguaia River basin, Cerrado Biome, Brazil

The Araguaia River is an important watercourse located in Central Brazil and well known for its diversity of fish fauna. Differences between landscape and resources in the distinct environments existing in a floodplain can determine the success of a species. This study presents a list of ichthyofauna species found in lentic and lotic environments in the floodplain of the Araguaia River basin, bordering Mato Grosso and Goiás States. We carried out sampling in July 2019, during the dry season, using diverse fish collection strategies, such as waiting nets, trawl, cast net and fishing rods. Were distributed 12 sampling points between lentic and lotic environments and we captured a total of 168 individuals of 42 species, 19 families and six orders. The predominant orders were Characiformes, Siluriformes and Cichliformes, while the families were Serrasalmidae, Characidae, Triportheidae, Curimatidae and Anostomidae. The genera Triportheus, Psectrogaster and Moenkhausia were the most abundant, while Pimelodus was the most dispersed. Results showed greater abundance and diversity in the lentic environment than in the lotic one, with top-of-the-chain species in both. The variance between environments and the presence of species that are endemic, recently described, of undefined taxonomic status, and bioindicators, highlight the importance of conserving and further studying the ichthyofauna in the Araguaia River basin