Measures for the prevention of COVID-19 transmission for prehospital care workers

Objective: to identify measures to prevent transmission of COVID-19 for prehospital care health care workers. Methods: integrative review using LILACS and BDENF databases via the Virtual Health Library, CINAHL, MEDLINE/PubMed, Web of Science, EMBASE, Cochrane Library, and SCOPUS. Results: eight publications were included that presented recommendations regarding the use of safety equipment by healthcare professionals and ambulance drivers and measures to prevent the risk of infection during invasive airborne procedures in suspected or contaminated COVID-19 patients. Conclusion: the preventive measures directed to prehospital care professionals were proper use of personal protective equipment and changes in the management of suspected/contaminated patients by COVID-19 and in invasive procedures or transportation of these patients. In addition, it is essential the cleaning and disinfection of the ambulances and their equipment

IMPACTOS AMBIENTAIS NA ÁREA DE PRESERVAÇÃO PERMANENTE (APP) DO RIO GURGUÉIA NO PERÍMETRO URBANO DO MUNICÍPIO DE SÃO GONÇALO DO GURGUÉIA – PI

O crescimento populacional ocasionou inúmeros problemas ao meio ambiente, intensificada pela superexploração dos recursos naturais de forma desordenada. O objetivo da pesquisa foi identificar os impactos ambientais na Área de Preservação Permanente (APP) do rio e propor medidas mitigadoras. A pesquisa foi realizada no perímetro urbano de São Gonçalo do Gurguéia – PI às margens do rio Gurguéia. O método para a avaliação dos impactos ambientais foi a Matriz de avaliação de impactos derivada de Leopold. Neste, os impactos ambientais foram identificados mediante visita in loco para obtenção dos dados, percorrendo as margens do rio. A maioria dos impactos identificados na APP foram classificados como de caráter negativo, sendo estes relacionados aos aspectos ambientais: disposição de resíduos sólidos diversos, lançamento de efluentes domésticos, ausência de canais de escoamento de águas pluviais, supressão da vegetação. Estudos relatam que a cobertura vegetal possui papel relevante por auxiliar na redução dos impactos ambientais. O diagnóstico permitiu constatar que a área se encontra em estágio de degradação ambiental devido aos impactos que afetam o meio físico, biótico e antrópico. Com isso, é possível propor medidas mitigadoras para serem adotadas pelos órgãos competentes para a adoção de ações preventivas e corretivas para a recuperação da APP

Tratamento com simbióticos em mulheres com constipação intestinal: estudo de caso comparativo / Symbotic treatment in women with intestinal constipation: a comparative case study

A Constipação Intestinal Funcional, queixa comum nos consultórios médicos, é de caráter multifatorial e estudos recentes sugerem que a perturbação da microbiota (disbiose) do aparelho gastrintestinal poderia se relacionar com o seu surgimento. Pesquisas sugerem diminuição das bactérias do gênero Lactobacillus e Bifidobacterium, bem como aumento de bactérias patogênicas em tal distúrbio. Nosso estudo trata-se de um ensaio clínico randomizado duplo-cego, em que foram selecionadas alunas da Universidade Vila Velha (UVV), de idade entre 20 a 30 anos, com queixas de constipação intestinal. As voluntárias foram divididas em dois grupos aleatoriamente, recebendo cápsulas idênticas, sendo que um grupo recebeu simbióticos e o outro placebo por 3 meses. Ao longo do estudo, pode-se perceber uma tendência a melhora dos sintomas abordados pelo ROMA IV no grupo intervenção, o que poderia ser explicado pela imunomodulação dos simbióticos influenciado pelo tempo de tratamento

Síndrome de fraser : Fraser syndrome

Introdução: a Síndrome de Fraser é caracterizada por presença de criptoftalmo, sindactilia, anormalidades da genitália e outras malformações congênitas do nariz, ouvido ou laringe, defeitos esqueléticos, hérnia umbilical, agenesia renal e retardo mental. É uma expressão fenotípica que depende da consanguinidade dos pais. Apresentação do caso: paciente do sexo feminino, três meses de idade, em acompanhamento no centro de referência oftalmológica da Faculdade de Medicina da Universidade São Paulo. Na ultrassonografia de abdome total, foi apenas evidenciada presença de hérnia umbilical simples. Discussão: a prevalência é igual entre os sexos e a doença pode ser diagnosticada à ultrassonografia pré-natal e fetoscopia ou no momento do nascimento frente às alterações apresentadas pelo paciente, por critérios maiores e menores. O tratamento é multidisciplinar e dependente das malformações presentes, assim como o prognóstico, que é pior em casos de malformações urogenitais e laríngeas graves. Conclusão: os médicos devem estar atentos, para as manifestações clínicas e o diagnóstico preciso, oferecendo tratamento adequado e aconselhamento genético aos casais

Sarcoma ósseo secundário da Doença de Paget: Secondary bone sarcoma of Paget's disease

Resumo INTRODUÇÃO: A Doença de Paget é uma doença crônica inflamatória do osso. A degeneração sarcomatosa dessa doença é rara, chegando a 1% e o tipo histológico mais comum é o osteossarcoma. APRESENTAÇÃO DO CASO: Paciente com 66 anos, masculino, com diagnóstico de Doença de Paget há 20 anos, apresenta deformidade em fêmur direito, relata piora da dor há 5 meses. Radiografia com sinais de malignidade confirmados na RNM, na qual havia expansão das partes moles, ruptura da cortical óssea com osteólise agressiva. Histopatológico confirmando osteossarcoma. DISCUSSÃO: A Doença de Paget é um distúrbio ósseo crônico que resulta na renovação óssea acelerada e desordenada, acomete, principalmente, o esqueleto axial, o crânio, os fêmures e as tíbias. A maioria dos pacientes com Doença de Paget é assintomática, sendo o diagnóstico, muitas vezes, tardio e acidental. É a segunda doença osteometabólica mais comum, ficando atrás da osteoporose. A doença de Paget afeta cerca de 3-4% da população acima dos 40 anos de idade, sendo que sua prevalência aumenta com a idade. O osteossarcoma secundário à doença de Paget é raro, estima-se que ocorra em menos de 1% das pessoas com doença óssea de Paget. Dor, edema e fratura são manifestações iniciais. Achados radiográficos iniciais geralmente mostram uma lesão lítica em expansão no osso. O tratamento do osteossarcoma secundário à Doença de Paget é principalmente cirúrgico que pode envolver a combinação de quimioterapia. A presença de comorbidades em idosos limita o uso da quimioterapia. Quando indicada, a quimioterapia geralmente é neoadjuvante e em terapia adjuvante CONCLUSÃO: Compreende-se que a Doença de Paget acomete principalmente idosos e que o prognóstico é ruim tanto em pacientes sintomáticos como em assintomáticos, devido a inflamação óssea e risco de evolução para osteossarcoma, porém o diagnóstico precoce pode trazer benefícios aos pacientes no controle da dor e com tratamentos mais conservadores, evitando a necessidade de amputações, com melhoria na qualidade de vida

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

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation