Fatores de risco para hipotermia pós-operatória em sala de recuperação pós-anestésica : estudo piloto prospectivo de prognóstico

Justificativa: A hipotermia ocorre em até 20% dos pacientes no perioperatório. A monitoração sistemática pós-operatória da temperatura não é um padrão de atendimento no Brasil e há poucas publicações sobre recuperação da temperatura na sala de recuperação pós-anestésica. Desenho e cenário: Estudo multicêntrico, observacional, transversal, conduzido no Hospital de Base do Distrito Federal e no Hospital Materno Infantil de Brasília. Métodos: Na admissão e alta da sala de recuperação pós-anestesia, os pacientes submetidos a procedimentos cirúrgicos eletivos ou de urgência foram avaliados de acordo com a temperatura timpânica, sinais vitais, eventos adversos perioperatórios, tempo de permanência na sala de recuperação pós-anestesia e tempo de internação hospitalar. Resultados: Setenta e oito pacientes com idades entre 18 e 85 anos foram avaliados. A incidência de temperatura <36 ºC na admissão à sala de recuperação pós-anestesia foi de 69,2%. Raquianestesia (p < 0,0001), cesariana (p = 0,03) e os pacientes que receberam morfina (p = 0,005) e sufentanil (p = 0,003) apresentaram temperaturas significativamente menores ao longo do tempo. Durante a permanência na sala de recuperação pós-anestesia, os pacientes idosos apresentaram uma tendência maior a apresentarem hipotermia e menor capacidade de recuperação dessa condição, em comparação com os pacientes jovens (p < 0,001). Anestesia combinada também foi associada a taxas mais altas de hipotermia, seguida pelas anestesias regional e geral isoladas (p < 0,001). Conclusão: Em conclusão, este estudo piloto mostrou que a hipotermia perioperatória ainda é um problema prevalente em nossa prática anestésica. Mais de metade dos pacientes analisados apresentaram hipotermia durante a admissão à sala de recuperação pós-anestésica. Demonstramos a viabilidade de um grande estudo multicêntrico, transversal, de hipotermia pós-operatória em sala de recuperação pós-anestésica.Background: Hypothermia occurs in up to 20% of perioperative patients. Systematic postoperative temperature monitoring is not a standard of care in Brazil and there are few publications about temperature recovery in the postoperative care unit. Design and setting: Multicenter, observational, cross-sectional study, at Hospital de Base do Distrito Federal and Hospital Materno Infantil de Brasília. Methods: At admission and discharge from postoperative care unit, patients undergoing elective or urgent surgical procedures were evaluated according to tympanic temperature, vital signs, perioperative adverse events, and length of stay in postoperative care unit and length of hospital stay. Results: 78 patients, from 18 to 85 years old, were assessed. The incidence of temperatures <36 ºC at postoperative care unit admission was 69.2%. Spinal anesthesia (p < 0.0001), cesarean section (p = 0.03), and patients who received morphine (p = 0.005) and sufentanil (p = 0.003) had significantly lower temperatures through time. During postoperative care unit stay, the elderly presented a greater tendency to hypothermia and lower recovery ability from this condition when compared to young patients (p < 0.001). Combined anesthesia was also associated to higher rates of hypothermia, followed by regional and general anesthesia alone (p < 0.001). Conclusion: In conclusion, this pilot study showed that perioperative hypothermia is still a prevalent problem in our anesthetic practice. More than half of the analyzed patients presented hypothermia through postoperative care unit admission. We have demonstrated the feasibility of a large, multicenter, cross-sectional study of postoperative hypothermia in the post-anesthetic care unit

The KISS principle in Software-Defined Networking: An architecture for Keeping It Simple and Secure

Security is an increasingly fundamental requirement in Software-Defined Networking (SDN). However, the pace of adoption of secure mechanisms has been slow, which we estimate to be a consequence of the performance overhead of traditional solutions and of the complexity of the support infrastructure required. As a first step to addressing these problems, we propose a modular secure SDN control plane communications architecture, KISS, with innovative solutions in the context of key distribution and secure channel support. A comparative analysis of the performance impact of essential security primitives guided our selection of basic primitives for KISS. We further propose iDVV, the integrated device verification value, a deterministic but indistinguishable-from-random secret code generation protocol, allowing the local but synchronized generation/verification of keys at both ends of the channel, even on a per-message basis. iDVV is expected to give an important contribution both to the robustness and simplification of the authentication and secure communication problems in SDN. We show that our solution, while offering the same security properties, outperforms reference alternatives, with performance improvements up to 30% over OpenSSL, and improvement in robustness based on a code footprint one order of magnitude smaller. Finally, we also prove and test randomness of the proposed algorithms

The KISS principle in Software-Defined Networking: An architecture for Keeping It Simple and Secure

Security is an increasingly fundamental requirement in Software-Defined Networking (SDN). However, the pace of adoption of secure mechanisms has been slow, which we estimate to be a consequence of the performance overhead of traditional solutions and of the complexity of the support infrastructure required. As a first step to addressing these problems, we propose a modular secure SDN control plane communications architecture, KISS, with innovative solutions in the context of key distribution and secure channel support. A comparative analysis of the performance impact of essential security primitives guided our selection of basic primitives for KISS. We further propose iDVV, the integrated device verification value, a deterministic but indistinguishable-from-random secret code generation protocol, allowing the local but synchronized generation/verification of keys at both ends of the channel, even on a per-message basis. iDVV is expected to give an important contribution both to the robustness and simplification of the authentication and secure communication problems in SDN. We show that our solution, while offering the same security properties, outperforms reference alternatives, with performance improvements up to 30% over OpenSSL, and improvement in robustness based on a code footprint one order of magnitude smaller. Finally, we also prove and test randomness of the proposed algorithms

Probiotics mitigate thermal stress- and pathogen-driven impacts on coral skeleton

Threats leading to a reduction in coral populations are apparent worldwide. Several different approaches have been tested to accelerate the adaptation of corals to a changing climate. Here, we evaluated the skeleton structure, crystal habit, and chemical changes of the coral Pocillopora damicornis in response to the pathogen (Vibrio coralliilyticus) and probiotic (Beneficial Microorganisms for Corals, BMCs) inoculation under ambient conditions (26 °C) and thermal stress (30 °C) during a 50-day mesocosm experiment. The skeletons were analyzed using microtomography, energy-dispersive x-ray spectroscopy (EDX/SEM), and densitometry to investigate the skeleto-physico-chemical micro-morphological changes in porosity, median pore-size diameter, crystal habit, Mg/Ca, Sr/Ca, the skeleton mineral density (g/cm2) and skeleton mineral content (g–2). The results indicate considerable changes in the coral skeleton caused by both temperature and microbial inoculation. Most importantly, lower density (to ∼ x̄ 0.5 g/cm2) and higher porosity (up to ∼ x̄ 47%) were correlated with inoculation of V. coralliilyticus and mitigated by probiotics. BMCs also substantially increased calcification, as evidenced by Mg/Ca in the skeleton of thermally stressed corals. At the micron scale, aragonite crystal fibbers precipitated during the experiments showed an acicular habit in thermally stressed and pathogen-inoculated corals kept at 30 °C. In contrast, a spherulitic habit, characteristic of high growth rates, was observed in corals inoculated with both BMCs and V. coralliilyticus. Our findings reveal that pathogen inoculation and thermal stress had notable impacts on coral skeleton properties, including porosity, density, and crystal morphology, in a short period of time, which highlights the potential impacts of shifts in climate warming and environmental quality. Interestingly, BMCs played a role in maintaining the properties of skeleton calcification

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Risk factors for postoperative hypothermia in the post-anesthetic care unit: a prospective prognostic pilot study

Background: Hypothermia occurs in up to 20% of perioperative patients. Systematic postoperative temperature monitoring is not a standard of care in Brazil and there are few publications about temperature recovery in the postoperative care unit. Design and setting: Multicenter, observational, cross-sectional study, at Hospital de Base do Distrito Federal and Hospital Materno Infantil de Brasília. Methods: At admission and discharge from postoperative care unit, patients undergoing elective or urgent surgical procedures were evaluated according to tympanic temperature, vital signs, perioperative adverse events, and length of stay in postoperative care unit and length of hospital stay. Results: 78 patients, from 18 to 85 years old, were assessed. The incidence of temperatures <36 °C at postoperative care unit admission was 69.2%. Spinal anesthesia (p < 0.0001), cesarean section (p = 0.03), and patients who received morphine (p = 0.005) and sufentanil (p = 0.003) had significantly lower temperatures through time. During postoperative care unit stay, the elderly presented a greater tendency to hypothermia and lower recovery ability from this condition when compared to young patients (p < 0.001). Combined anesthesia was also associated to higher rates of hypothermia, followed by regional and general anesthesia alone (p < 0.001). Conclusion: In conclusion, this pilot study showed that perioperative hypothermia is still a prevalent problem in our anesthetic practice. More than half of the analyzed patients presented hypothermia through postoperative care unit admission. We have demonstrated the feasibility of a large, multicenter, cross-sectional study of postoperative hypothermia in the post-anesthetic care unit. Resumo: Justificativa: A hipotermia ocorre em até 20% dos pacientes no perioperatório. A monitorização sistemática pós-operatória da temperatura não é um padrão de atendimento no Brasil e há poucas publicações sobre recuperação da temperatura na sala de recuperação pós-anestésica. Desenho e cenário: Estudo multicêntrico, observacional, transversal, conduzido no Hospital de Base do Distrito Federal e no Hospital Materno Infantil de Brasília. Métodos: Na admissão e alta da sala de recuperação pós-anestesia, os pacientes submetidos a procedimentos cirúrgicos eletivos ou de urgência foram avaliados de acordo com a temperatura timpânica, sinais vitais, eventos adversos perioperatórios, tempo de permanência na sala de recuperação pós-anestesia e tempo de internação hospitalar. Resultados: Setenta e oito pacientes com idades entre 18 e 85 anos foram avaliados. A incidência de temperatura <36 °C na admissão à sala de recuperação pós-anestesia foi de 69,2%. Raquianestesia (p < 0,0001), cesariana (p = 0,03) e os pacientes que receberam morfina (p = 0,005) e sufentanil (p = 0,003) apresentaram temperaturas significativamente menores ao longo do tempo. Durante a permanência na sala de recuperação pós-anestesia, os pacientes idosos apresentaram uma tendência maior a apresentarem hipotermia e menor capacidade de recuperação dessa condição, em comparação com os pacientes jovens (p < 0,001). Anestesia combinada também foi associada a taxas mais altas de hipotermia, seguida pelas anestesias regional e geral isoladas (p < 0,001). Conclusão: Em conclusão, este estudo piloto mostrou que a hipotermia perioperatória ainda é um problema prevalente em nossa prática anestésica. Mais de metade dos pacientes analisados apresentaram hipotermia durante a admissão à sala de recuperação pós-anestésica. Demonstramos a viabilidade de um grande estudo multicêntrico, transversal, de hipotermia pós-operatória em sala de recuperação pós-anestésica. Keywords: Body temperature, Hypothermia, Anesthesia, Postoperative care, Palavras-chave: Temperatura corporal, Hipotermia, Anestesia, Cuidados pós-operatório

FIND: A Feedback Initiated Narrative Development Protocol to elicit resources in psychotherapy

The FIND (Feedback Initiated Narrative Development) protocol was designed to foster the availability of clients' resources in psychotherapy. This protocol consists of two brief interviews and an observation of an early psychotherapy session, centered on the elicitation of the client's personal resources. The contents of both the interviews and the observed session are summarized for clients and therapists in the form of therapeutic letters. The theoretical background of this protocol is presented in this paper, which focuses on the first part of the protocol, illustrating it with clinical vignettes. The FIND protocol was developed after more than 10 years of research on innovative moments in psychotherapy and is based on narrative therapy practices and dialogical self theory tenets. Other research and models further contributed to the development of this protocol, such as the hypothesis of capitalization of resources; studies that emphasize clients ' active role in their own change; and research on autobiographical memories and narrative construction of identity. Drawing on these models, the FIND protocol attempts to prime and activate the client ' s resources (i.e., potential innovative moments) from the beginning of therapy, with the aim of improving psychotherapy efficacy.This study was conducted at Psychology Research Center (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology (FCT) and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653)

In Vitro Schistosomicidal Activity of Balsaminol F and Karavilagenin C

Five cucurbitane-type triterpenes (1-5), previously isolated from the African medicinal plant Momordica balsamina, along with five ester derivatives (6-10) of karavilagenin C (2), were evaluated for their potential schistosomicidal activity against Schistosoma mansoni adult worms. The natural compounds were isolated from the ethyl acetate-soluble fraction of the methanol extract of the aerial parts of M. balsamina. In a preliminary study, a significant schistosomicidal activity was observed for both the crude methanol extract and the ethyl acetate fraction. The compounds responsible for the activity were found to be balsaminol F (1) and karavilagenin C (2) with LC50 values of 14.7 +/- 1.5 and 28.9 +/- 1.8 mu M, respectively, after 24 h of incubation (positive control praziquantel, LC50 = 1.2 +/- 0.1 mu M). Both compounds (1, 2), at 10-50 mu M, induced significant reductions in the motor activity of the worms and significantly decreased the egg production. Furthermore, they were able (at 10-100 mu M) to separate the adult worm pairs into male and female after 24 h. Compounds 3-5, bearing a sugar moiety as a substituent, and the acylated derivatives of karavilagenin C (6-10) were inactive, suggesting that the presence of free hydroxyl groups in the tetracyclic skeleton might be important for the activity. A correlation between activity and the molecular volume/weight of compounds was also found.FCT, Portugal [BD/22321/2005, PEst-OE/SAU/UI4013/2011]FCT (Portugal)FAPEMIG [APQ 00171/11]FAPEMIGFAPESP (Brazil)FAPESP, Brazil [06/60132-4

Innovative moments in recovered cases treated with the unified protocol for transdiagnostic treatment of emotional disorders

Objective Innovative moments (IMs) are moments in which the previous problematic pattern of meaning is challenged. Studies have shown that IMs are associated with good psychotherapy outcomes. A three-level hierarchy of IMs was observed in recent studies, with level 1 IMs being more elementary and levels 2 and 3 being more complex and associated with treatment success. However, studies with manualized protocol treatments are thus far lacking. This study analyzed the longitudinal progression of IMs in the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) and explored its associations with changes in psychological distress. Methods Data were collected from a Portuguese university-based outpatient clinic and included 18 cases with positive outcomes. Nine sessions of each case were coded with the IM coding system (N=162). Results Multilevel analyses showed a significant increase in all IM levels across treatments. The decrease in psychological distress predicted an increase in level 2 IMs in the same session. Conclusion The evolution of IMs is similar to what was found previously in other studies. Contrary to what was found in previous studies, IMs did not predict outcomes in the following session, whereas the reduction in psychological distress predicted the emergence of level 2 IMs.This work was supported by Fundacao para a Ciencia e a Tecnologia: [Grant Number UID/PSI/01662/2019].This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through national funds (PIDDAC). Dr. Batista, Dr. Braga and Dr. Oliveira were also supported by the Portuguese Foundation for Science and Technol ogy and the Portuguese Ministry of Science, Tech nology and Higher Education, through national funds, within the scope of the Transitory Disposition of Decree No. 57/2016, of 29 August, amended by Law No. 57/2017 of 19 July