Pré-dimensionamento de válvulas de alívio a partir do cálculo de volume expulso de água durante transitório hidráulico

Este trabalho tem por objetivo verificar a viabilidade da adoção de determinados diâmetros de válvula de alívio para algumas configurações de adutora durante eventos de parada de bomba e posterior golpe de aríete. Para isso, adotou-se a modelagem computacional do transiente hidráulico a partir do UFC 7, que utiliza o Método das Características e o modelo de Cavidade de Gás Livre Discreto com celeridade variável, e da válvula de alívio por meio do uso da equação da vazão através do orifício e das curvas de abertura e fechamento da válvula proposta por Bell et al. (2020), com adaptações para evitar sobrepressões secundárias. Os resultados obtidos foram ilustrados por meio de três configurações distintas de adutoras, em que foram exibidas as envoltórias de pressão e os gráficos de volume disponível nas tubulações ao longo do tempo. A partir destes, verificou-se que diâmetros elevados de válvula de alívio promovem o esvaziamento total da água existente na adutora, o que na prática é impossível de ocorrer. Assim, pode-se propor a adoção de diâmetros ideais para cada caso, também sendo observado o critério de geração de sobrepressões secundárias. Ademais, foram testados mais oito casos e, a partir de algumas combinações dos dados de entrada destas adutoras, foi proposta uma equação para pré-dimensionamento da válvula de alívio. Sugere-se, então, que essa equação seja testada em casos distintos para averiguar se, de fato, cumpre a função pretendida

Jejum intermitente no emagrecimento: uma revisão sistemática

Among the various nutritional strategies that exist to facilitate weight loss, one of the most popular is the Intermittent Fasting (JI) diet. Typically, JI is defined as a total or partial restriction in energy intake between one to three days per week, or a complete restriction on energy intake for a defined period of the day. This study is a review article that aimed at the broad view of the intermittent fasting diets and evidenced the effects of the evaluation process of the nutritional strategy. A search was carried out in the Pubmed, Lilacs, Medline and the Scielo e-libraries to identify scientific papers published between 2007 and 2017. A total of 44 articles were selected, containing the descriptors in Portuguese and English: "fasting", "Calorie restriction" and "weight loss". Overall, many of the studies reviewed suggest that JI is effective for weight reduction, including benefits such as improved glucose metabolism, cardiovascular health, and maintenance of lean mass. However, it can be verified that of the studies developed in humans, published in the timeframe of the research, involved mainly short-term JI and groups with small numbers of individuals, thus questioning possible biological adaptations and future effects on The risk of diseases that may occur in individuals who practice this diet.Dentre as várias estratégias nutricionais que existem para faciltiar a perda de peso, uma das mais populares é a dieta do Jejum Intermitente (JI). Normalmente, JI é definido por uma restrição total ou parcial na ingestão de energia entre um a três dias por semana, ou uma restrição completa na ingestão de energia por um período definido do dia. Este estudo trata-se de um artigo de revisão que objetivou fornecer visão ampla das dietas de jejum intermitentes e evidenciar os possíveis efeitos no processo de emagrecimento por meio dessa estratégia nutricional. Foi realizada uma busca nas bases de dados Pubmed, Lilacs, Medline e a biblioteca eletrônica Scielo a fim de identificar artigos científicos publicados no período de 2007 a 2017. Foram selecionados 44 artigos, contendo os descritores, em português e inglês: “jejumâ€, “restrição calórica†e “emagrecimento’’. De forma geral, muitos dos estudos analisados sugerem que o JI é eficiente para redução de peso, incluindo benefícios como, melhora do metabolismo da glicose, saúde cardiovascular e manutenção de massa magra. No entanto, pode ser verificado que dos estudos desenvolvidos em humanos, publicados no intervalo de tempo foco da pesquisa, envolveram principalmente JI de curto prazo e grupos com número reduzido de indivíduos, ficando, desta forma, questionamento sobre possíveis adaptações biológicas e efeitos futuros sobre o risco de doenças que possam ocorrer em indivíduos que praticam essa dieta

Impact of COVID-19 In-hospital Mortality in Chagas Disease Patients

The COVID-19 virus infection caused by the new SARS-CoV-2 was first identified in Rio de Janeiro (RJ), Brazil, in March 2020. Until the end of 2021, 504,399 COVID-19 cases were confirmed in RJ, and the total death toll reached 68,347. The Evandro Chagas National Institute of Infectious Diseases from Oswaldo Cruz Foundation (INI-Fiocruz) is a referral center for treatment and research of several infectious diseases, including COVID-19 and Chagas disease (CD). The present study aimed to evaluate the impact of COVID-19 on in-hospital mortality of patients with CD during the COVID-19 pandemic period. This observational, retrospective, longitudinal study evaluated all patients with CD hospitalized at INI-Fiocruz from May 1, 2020, to November 30, 2021. One hundred ten hospitalizations from 81 patients with CD (58% women; 68 ± 11 years) were evaluated. Death was the study's main outcome, which occurred in 20 cases. The mixed-effects logistic regression was performed with the following variables to test whether patients admitted to the hospital with a COVID-19 diagnosis would be more likely to die than those admitted with other diagnoses: admission diagnosis, sex, age, COVID-19 vaccination status, CD clinical classification, and the number of comorbidities. Results from multiple logistic regression analysis showed a higher risk of in-hospital mortality in patients diagnosed with COVID-19 (OR 6.37; 95% CI 1.78–22.86) compared to other causes of admissions. In conclusion, COVID-19 infection had a significant impact on the mortality risk of INI-Fiocruz CD patients, accounting for one-third of deaths overall. COVID-19 presented the highest percentage of death significantly higher than those admitted due to other causes during the COVID-19 pandemic

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030