Intervenção educacional para empoderamento das famílias no tratamento de crianças com diabetes Mellitus / Educational intervention for family empowerment in the treatment of children with diabetes Mellitus

Diabetes mellitus é uma doença crônica, caracterizados por defeitos na ação da insulina, na secreção de insulina ou em ambas, resultando em hiperglicemia. Para seu tratamento são necessárias ações farmacológicas individualizadas e medidas não farmacológicas que incluem um planejamento familiar adequado, mudanças no estilo de vida e atividade física regular, em específico as crianças por serem um grupo vulnerável, necessitando ainda mais do auxílio familiar. Nesse contexto, o estudo visou orientar as competências familiares no cuidado às crianças com diabetes mellitus. A metodologia utilizada foi de pesquisa-ação, sendo essa uma primeira fase de investigação e finalizada por outra de programação-ação. A amostra foi composta por 42 familiares. No que se refere a aceitação do trabalho, 71,8% dos familiares que foram beneficiados com a pesquisa-ação consideraram ótima a intervenção. Outro dado relevante foi relacionado ao aprendizado que 85,7% dos familiares considerou que o trabalho acrescentou conhecimento. O presente estudo apresentou benefícios aos pacientes e familiares, pois houve a oportunidade de conhecer mais sobre o diabetes mellitus tipo 1 devido aos materiais de intervenção educacional utilizados folder, vídeo e a entrevista semiestruturada

Orientações para Realização de Exames de Ressonância Magnética Nuclear em Pacientes com Dispositivos Eletrônicos Cardíacos

Estima-se que até 75% dos pacientes com dispositivos cardíacos eletrônicos implantáveis (DCEIs) terão indicação de exame de ressonância nuclear magnética (RNM) ao longo da vida. Pelas características dos dispositivos, esses foram excluídos historicamente do rol de pacientes considerados elegíveis ao exame

Síndrome de DiGeorge (deleção do cromossomo 22q11.2): manejo e prognóstico

A síndrome de DiGeorge (SDG), também conhecida como síndrome velocardiofacial, é uma condição neurogenética autossômica dominante de interesse global caracterizada pela microdeleção do cromossomo 22q11.2, na qual não há predileção por gênero ou raça. A doença é conhecida pela tríade clássica as cardiopatias congênitas, timo hipoplásico – ou aplásico – e hipocalcemia decorrente da hipoplasia paratireoidiana O diagnóstico da síndrome baseia-se em dois exames laboratoriais, a Hibridização Genômica Comparativa baseada em microarray (aCGH) e a Hibridização por Fluorescência in situ (FISH), ambas com a finalidade de investigar o distúrbio genético e o tratamento consiste em tratar as alterações decorrentes da patologia. O objetivo estudo é analisar o manejo e o prognóstico da síndrome de DiGeorge por meio de um apanhado de casos clínicos. Trata-se de uma revisão bibliográfica integrativa, de natureza quantitativa, que utilizou as plataformas PubMed (Medline), Scientific Eletronic Library On-line (SciELO) e Cochrane Library como bases de dados para a seleção dos artigos, todos na língua inglesa. Foram utilizadas literaturas publicadas com recorte temporal de 2017 a 2022. De acordo com as literaturas analisadas, foi observado que a SDG requer diligência por parte dos profissionais da saúde no que concerne ao seu manejo, vide os vários fenótipos, desde leves a graves, da patologia. Por ter envolvimento multissistêmico, é essencial que, mesmo antes do diagnóstico, os distúrbios inerentes à síndrome sejam tratados e sujeitos à suspeição por intermédio da equipe, a qual necessita ter conhecimento acerca dessa possibilidade, haja vista a eventualidade de um pior prognóstico aos pacientes portadores

AVALIAÇÃO NEUROBIOLOGICA DO USO DA RITALINA EM PACIENTES NÃO PORTADORES DE TDHA

The non-therapeutic use of Ritalin, or methylphenidate, among individuals without Attention Deficit Hyperactivity Disorder (ADHD) has increased, especially in academic settings, due to its potential to improve attention and cognitive performance. This study reviews the neurobiological effects of this use in individuals without ADHD. Changes in brain activity, especially in the prefrontal cortex and limbic system, were compared, alterations in dopaminergic neurotransmission were investigated, and differences in neuropsychological performance before and after the use of Ritalin were assessed. The review included articles published between 2011 and 2024 in the PubMed, SciELO, LILACS, and Google Scholar databases, focusing on the neurobiological effects of Ritalin in individuals without ADHD. Results indicate that, despite temporary improvements in concentration and working memory, prolonged use may cause anxiety, tachycardia, changes in appetite, and dependence, as well as reduce the effectiveness of the medication due to tolerance. It is concluded that the risks to physical and mental health outweigh the short-term cognitive benefits. It is essential to raise awareness about the dangers of non-prescribed use of Ritalin and to promote healthy alternatives for cognitive enhancement, as well as to develop evidence-based guidelines to minimize the risks of unsupervised stimulant use.O uso não terapêutico da Ritalina, ou metilfenidato, entre indivíduos sem Transtorno de Déficit de Atenção e Hiperatividade (TDAH) tem aumentado, principalmente em ambientes acadêmicos, devido ao seu potencial para melhorar a atenção e o desempenho cognitivo. Este estudo revisa os efeitos neurobiológicos desse uso em indivíduos sem TDAH. Foram comparadas as alterações na atividade cerebral, especialmente no córtex pré-frontal e sistema límbico, investigadas mudanças na neurotransmissão dopaminérgica e avaliadas as diferenças no desempenho neuropsicológico antes e após o uso da Ritalina.    A revisão incluiu artigos publicados entre 2011 e 2024 nas bases PubMed, SciELO, LILACS e Google Scholar, focando nos efeitos neurobiológicos da Ritalina em indivíduos sem TDAH. Resultados indicam que, apesar de melhorias temporárias na concentração e memória de trabalho, o uso prolongado pode causar ansiedade, taquicardia, alterações no apetite e dependência, além de reduzir a eficácia do medicamento devido à tolerância.    Conclui-se que os riscos à saúde física e mental superam os benefícios cognitivos de curto prazo. É essencial conscientizar sobre os perigos do uso não prescrito da Ritalina e promover alternativas saudáveis para o aprimoramento cognitivo, além de desenvolver diretrizes baseadas em evidências para minimizar os riscos do uso não supervisionado de estimulantes

Comparative Genomic Analysis of Human Fungal Pathogens Causing Paracoccidioidomycosis

Paracoccidioides is a fungal pathogen and the cause of paracoccidioidomycosis, a health-threatening human systemic mycosis endemic to Latin America. Infection by Paracoccidioides, a dimorphic fungus in the order Onygenales, is coupled with a thermally regulated transition from a soil-dwelling filamentous form to a yeast-like pathogenic form. To better understand the genetic basis of growth and pathogenicity in Paracoccidioides, we sequenced the genomes of two strains of Paracoccidioides brasiliensis (Pb03 and Pb18) and one strain of Paracoccidioides lutzii (Pb01). These genomes range in size from 29.1 Mb to 32.9 Mb and encode 7,610 to 8,130 genes. To enable genetic studies, we mapped 94% of the P. brasiliensis Pb18 assembly onto five chromosomes. We characterized gene family content across Onygenales and related fungi, and within Paracoccidioides we found expansions of the fungal-specific kinase family FunK1. Additionally, the Onygenales have lost many genes involved in carbohydrate metabolism and fewer genes involved in protein metabolism, resulting in a higher ratio of proteases to carbohydrate active enzymes in the Onygenales than their relatives. To determine if gene content correlated with growth on different substrates, we screened the non-pathogenic onygenale Uncinocarpus reesii, which has orthologs for 91% of Paracoccidioides metabolic genes, for growth on 190 carbon sources. U. reesii showed growth on a limited range of carbohydrates, primarily basic plant sugars and cell wall components; this suggests that Onygenales, including dimorphic fungi, can degrade cellulosic plant material in the soil. In addition, U. reesii grew on gelatin and a wide range of dipeptides and amino acids, indicating a preference for proteinaceous growth substrates over carbohydrates, which may enable these fungi to also degrade animal biomass. These capabilities for degrading plant and animal substrates suggest a duality in lifestyle that could enable pathogenic species of Onygenales to transfer from soil to animal hosts.National Institute of Allergy and Infectious Diseases (U.S.)National Institutes of Health. Department of Health and Human Services (contract HHSN266200400001C)National Institutes of Health. Department of Health and Human Services(contract HHSN2722009000018C)Brazil. National Council for Scientific and Technological Developmen

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

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives