Complicações da colecistectomia laparoscopica

As complicações graves da colecistectomia laparoscópicas se resumem na maioria dos casos a lesão do canal biliar, liberação da bile, hemorragia e lesões intestinais. as complicações resultam em parte de variantes anatómicas, doenças e comorbilidades inerentes ao paciente, e os constrangimentos técnicos da abordagem minimamente invasiva. O médico assistente deve suspeitar de extravasamento biliar quando os pacientes apresentam após a colecistectomia febre, dor abdominal e/ou ascites biliares. Casos de sangramento pode ocorrer a partir do fígado, fontes arteriais ou locais de inserção da porta, nesses casos a abordagem da complicação é definida pelo cenário clínico e nível de gravidade. Outra lesão que pode ocorrer são as intestinais que é um risco em toda cirurgia laparoscópica. Dessa forma é necessário o conhecimento a respeito das complicações com o objetivo de minimizá-las durante os procedimentos

CONSEQUÊNCIAS QUANTO À ADOÇÃO DE REGIME ALIMENTAR VEGETARIANO NA GESTAÇÃO: UMA ANÁLISE NARRATIVA

Pregnancy is an interval in which feeding requires an adequate nutritional matrix, which becomes essential for proper fetal growth. An unbalanced nutritional state has been correlated with adverse pregnancy and childbirth outcomes. At present, vegetarian diets are on the rise, but they can lead to an increase in nutritional and energy deficiencies. This study seeks to examine the data available in the scientific literature and determine whether a vegetarian diet has repercussions on pregnancy.  This is a descriptive analysis of the scientific literature, with bibliographic research on research platforms such as: Pubmed, Scielo, Lilacs, BVS among others with studies published between the years 2010 to 2021. The following descriptors were used as inclusion criteria: "Vegetarian Diet in Pregnancy", "Vegan Diet", "Macronutrients and Micronutrients", "Nutritional Deficiency" and "Fetal Development", with a search for articles available in Portuguese, English and Spanish. Therefore, to ensure that the needs of pregnant women are met, the adoption of a vegetarian diet must be planned and adjusted to the physiological demands of the pregnant woman and to proper fetal development. Appropriate prenatal counseling is essential. In addition, the literature suggests a relationship between nutritional deficiencies and possible complications in the mother's health, although the scientific evidence is inconclusive.A gestação é um intervalo no qual a alimentação necessita de uma matriz nutricional adequada, que se torna essencial para o devido crescimento fetal. Um estado nutricional desequilibrado tem sido correlacionado com adversidades na gestação e parto. No presente, as dietas vegetarianas estão em ascensão, entretanto, podem acarretar em incrementos de deficiências nutricionais e energéticas. Este estudo busca examinar os dados disponíveis na literatura científica e determinar se o regime alimentar vegetariano tem repercussões na gestação.  Esta é uma análise descritiva da literatura científica, com investigação bibliográfica em plataformas de pesquisa quais sejam: Pubmed, Scielo, Lilacs, BVS entre outros com estudos publicados entre os anos de 2010 a 2021. Foram utilizados critérios de inclusão os seguintes Descritores: “Dieta Vegetariana na Gravidez”, “Dieta Vegana”, “Macronutrientes e Micronutrientes”, “Deficiência Nutricional” e “Desenvolvimento Fetal”, com busca de artigos disponíveis nas línguas portuguesa, inglesa e em espanhol. Portanto, para garantir que as necessidades da mulher grávida sejam atendidas, a adoção de uma dieta vegetariana deve ser planejada e ajustada às demandas fisiológicas da gestante e ao desenvolvimento fetal adequado. É essencial um aconselhamento pré-natal apropriado. Além disso, a literatura sugere uma relação entre deficiências nutricionais e possíveis complicações na saúde da mãe, embora as evidências científicas sejam inconclusivas

O PAPEL DA CIRURGIA BARIÁTRICA NA REDUÇÃO DA OBESIDADE E NA REMISSÃO DE DOENÇAS METABÓLICAS

This literature review investigates the impact of bariatric surgery on obesity reduction and remission of associated metabolic diseases, such as type 2 diabetes, arterial hypertension, and sleep apnea. Through a comprehensive analysis of clinical and observational studies, we identified consistent evidence of the benefits of bariatric surgery in promoting sustained weight loss and improving metabolic comorbidities in obese patients. The results indicate that bariatric surgery can lead to remission of type 2 diabetes, reduction in blood pressure, and improvement of sleep apnea symptoms. However, careful assessment of individual risks and benefits is warranted before recommending this procedure. This review highlights the importance of bariatric surgery as an effective tool in the treatment of obesity and its metabolic complications, offering new perspectives for the management of these chronic conditions.Esta revisão da literatura investiga o impacto da cirurgia bariátrica na redução da obesidade e na remissão de doenças metabólicas associadas, como diabetes tipo 2, hipertensão arterial e apneia do sono. A partir de uma análise abrangente de estudos clínicos e observacionais, identificamos consistentes evidências dos benefícios da cirurgia bariátrica na promoção da perda de peso sustentada e na melhoria das comorbidades metabólicas em pacientes obesos. Os resultados indicam que a cirurgia bariátrica pode levar à remissão do diabetes tipo 2, redução da pressão arterial e melhoria dos sintomas da apneia do sono. No entanto, ressalta-se a necessidade de uma avaliação cuidadosa dos riscos e benefícios individuais antes da indicação desse procedimento. Esta revisão destaca a importância da cirurgia bariátrica como uma ferramenta eficaz no tratamento da obesidade e suas complicações metabólicas, oferecendo novas perspectivas para a gestão dessas condições crônicas

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units

ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Datasheet1_Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units.pdf

ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied.</p

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved