226 research outputs found
É possível desvirtuar a participação social na gestão dos recursos hídricos? : análise espacial aplicada ao Comitê de Bacia Hidrográfica do rio Paraguaçu (BA)
O trabalho produziu uma análise espacial do quantitativo de membros representantes do Comitê de Bacia Hidrográfica do rio Paraguaçu (CBHP), Bahia, no período de 2006/2009, e suas implicações para a gestão participativa e dos conflitos em torno dos usos múltiplos dos recursos hídricos. A partir do domicílio de cada representante, foi quantificado o número de representantes no CBHP por município e feita a cartografia desse quantitativo. O resultado revelou a existência de uma superrepresentação no CBHP dos irrigantes do trecho alto da bacia do rio Paraguaçu. A consequência é a hegemonia política de uma região sobre as demais, que configura uma geometria de poder conformada pela existência de pólos concentradores de poder político, que possivelmente expresse polarização econômica. Com base nos resultados, problematiza-se os critérios de composição dos comitês de bacia hidrográfica, baseados na representação por setor de usuários, sem levar em consideração a origem geográfica e a vinculação regional ao território.This paper produced a spatial analysis of the quantitative of representative members of the Water basin Committee of Paraguaçu river (CBHP), Bahia, in the period 2006/2009, and its implication for participatory and conflict management around the multiple uses of water resources. From the home address of each representative in CBHP, it has been quantified the number of representatives per municipalities and it was made the mapping of this quantitative. The result showed the existence of an overrepresentation
of irrigators from the upper portion of water basin. The consequence is a political hegemony of one region over the others ones that constitutes a geometry of power conformed by the existence of hubs poles of political power, possibly expressing the economic polarization in the territory. Based on the results, it was discussed the criteria for the composition of the water basin committees, based on representation by users of water resources, regardless of geographic origin and linkage to the regional territory
Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome
AbstractObjectivesTo describe the epidemiological, clinical, and laboratory profile of infective endocarditis (IE) at a Brazilian tertiary care center, and to identify the predictors of in-hospital mortality.MethodsData from 62 patients who fulfilled the modified Duke's criteria for IE during a seven-year period were gathered prospectively. The Cox proportional hazards model was used to identify predictive factors for death.ResultsThe mean age of patients was 45 years, and 39 patients (63%) were male. The median time from admission to diagnosis was 15 days. Rheumatic heart disease was the predominant underlying heart condition (39%), followed by valvular prosthesis (31%). Neurological complications were observed in 12 patients (19%). Echocardiography demonstrated one or more vegetations in 84% of cases. The infective agent was identified in 65% of cases, and the most frequent causative agents were staphylococci (48%), followed by streptococci (20%). The median duration of hospitalization was 39 days. Surgery was performed during the acute phase of the IE in 53% of cases. The overall in-hospital mortality was 31%. On multivariate analysis, vegetation length >13mm remained the only independent predictor of in-hospital mortality (hazard ratio 1.05 per millimeter, 95% confidence interval 1.003–1.110, p=0.038).ConclusionsIE remains a severe disease affecting the young population in Brazil, and rheumatic heart disease continues to be the most common underlying heart condition. Large vegetation size, assessed early in the course of IE by transesophageal echocardiography, along with the clinical and microbiological features, may predict in-hospital death
É POSSÍVEL DESVIRTUAR A PARTICIPAÇÃO SOCIAL NA GESTÃO DOS RECURSOS HÍDRICOS? ANÁLISE ESPACIAL APLICADA AO COMITÊ DE BACIA HIDROGRÁFICA DO RIO PARAGUAÇU (BA)
This paper produced a spatial analysis of the quantitative of representative members of the Water basin Committee of Paraguaçu river (CBHP), Bahia, in the period 2006/2009, and its implication for participatory and conflict management around the multiple uses of water resources. From the home address of each representative in CBHP, it has been quantified the number of representatives per municipalities and it was made the mapping of this quantitative. The result showed the existence of an overrepresentation of irrigators from the upper portion of water basin. The consequence is a political hegemony of one region over the others ones that constitutes a geometry of power conformed by the existence of hubs poles of political power, possibly expressing the economic polarization in the territory. Based on the results, it was discussed the criteria for the composition of the water basin committees, based on representation by users of water resources, regardless of geographic origin and linkage to the regional territory.O trabalho produziu uma análise espacial do quantitativo de membros representantes do Comitê de Bacia Hidrográfica do rio Paraguaçu (CBHP), Bahia, no período de 2006/2009, e suas implicações para a gestão participativa e dos conflitos em torno dos usos múltiplos dos recursos hídricos. A partir do domicílio de cada representante, foi quantificado o número de representantes no CBHP por município e feita a cartografia desse quantitativo. O resultado revelou a existência de uma superrepresentação no CBHP dos irrigantes do trecho alto da bacia do rio Paraguaçu. A consequência é a hegemonia política de uma região sobre as demais, que configura uma geometria de poder conformada pela existência de pólos concentradores de poder político, que possivelmente expresse polarização econômica. Com base nos resultados, problematiza-se os critérios de composição dos comitês de bacia hidrográfica, baseados na representação por setor de usuários, sem levar em consideração a origem geográfica e a vinculação regional ao território
Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes
Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confrmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confrmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64–80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fbrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p< 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fbrillation and chronic heart failure compared with non-CD controls, with no diferences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation
Evaluation of fucoxanthin contents in seaweed biomass by vortex-assisted solid-liquid microextraction using high-performance liquid chromatography with photodiode array detection
Fucoxanthin is considered an important marine bioactive compound with biological properties with promising effects, namely on health. A simple and efficient
analytical methodology is proposed for its quantification in seaweed biomass by using vortex-assisted solid-liquid microextraction (VASLME) followed by reversed
phase high-performance liquid chromatography (RP-HPLC) photodiode array detection (PDA) analysis. This microextraction uses reduced quantities of sample
(25 mg) and solvent (300 μL of ethanol) to efficiently extract this high-valued xanthophyll, in a vortex time of 15 min. These extraction parameters were optimized
performing a Central Composite Design (CCD) analysis, running 32 individual experiments. In turn, the method validation was assessed. The linearity of the method
was confirmed (R2 = 0.99998) in a concentration range from 12 to 3600 μg·g−1 dw. Also, good sensitivity and accuracy results were observed through the LOD
(3.33 μg·g−1
), LOQ (10.09 μg·g−1
) and recovery (varied from 95 to 97%) assessments. Good precision was also verified, with intra-day variation within 2.0–3.3%,
and inter-day within 1.0–3.8%. Matrix effect was also evaluated and an acceptable variation of 3.4% was found. The method applicability was confirmed by the
analysis of 22 seaweed biomass samples and fucoxanthin content was found to vary from about 10 to 853 μg·g−1 dw. This method demonstrated a good performance
and can be successfully implemented for a rapid, reliable and accurate screening of fucoxanthin in seaweed biomass.info:eu-repo/semantics/publishedVersio
Role of coronary artery calcium score for risk stratification in patients with non significant perfusion defects by myocardial perfusion single photon emission computed tomography
Background: Myocardial perfusion scintigraphy (MPS) is an important diagnostic tool in the management of patients with suspected coronary artery disease (CAD). However, the presence of mild-moderate perfusion defects can be challenging and may lead to unnecessary cardiac catheterization. The coronary artery calcium (CAC) score is a method with excellent negative predictive value in the evaluation of CAD, but its role in this setting of patients has not been fully defined. This study aims to assess the potential of CAC in the prediction of cardiac adverse events in patients with suspected CAD with mild-moderate perfusion by MPS.
Methods and results: We conducted a cohort study in 292 patients presenting with mild-moderate perfusion defects by MPS undergoing a CAC measurement. The patients were followed for a mean of 34 months for occurrence of major cardiac adverse events (MACE). The majority of the patients (64.7%) were male, mean age of 57.9 ± 12.6 years. During the follow-up there were 37 MACE. In multivariate Cox proportional hazards model, hypertension and CAC were independent predictors of MACE. The patients who presented a CAC score of ≥ 400 had a high risk of MACE (HR 20.9; 95% CI 4.79–91.42; p < 0.001). Kaplan-Meier curve showed a significant difference (log-rank c2; p< 0.001) using CAC scores in predicting MACE.
Conclusions: CAC score carries a powerful prognostic value in predicting adverse events in patients with suspected CAD and MPS with mild-moderate perfusion defects and may be useful in risk stratification of these patients
Relação entre capacidade funcional e função diastólica no infarto recente
La relación entre la capacidad funcional (CF) y la función diastólica (FD) del ventrículo izquierdo (VI) no es clara en condiciones cardíacas agudas, como el infarto agudo de miocardio (IAM). El objetivo de este estudio fue evaluar la relación entre la CF, evaluada por medio de la distancia recorrida en el test de marcha de seis minutos (DTM6) y la FD del VI evaluada por medio de ecocardiografía Doppler después del IAM reciente. Cincuenta y seis pacientes con IAM no complicado fueron seleccionados después del alta de la unidad coronaria y fueron luego sometidos a los tests. Fue realizado el análisis estadístico considerando todos los pacientes y por grupos, de acuerdo a la clasificación de la FD del VI. Fue observada una correlación entre la onda a' lateral (referente a la diástole tardía) y la DTM6 (r=-0,320; p=0,023). Sin embargo, no hubo asociación entre la CF y la FD del VI en el análisis por grupos. La correlación entre la DTM6 y la onda a´ lateral indica asociación entre la diástole tardía y la CF en estos pacientes, sugiriendo una mayor contribución de la contracción auricular para la promoción del llenado del VI en esta población. Estos datos proporcionan una asignación adicional para la utilización del TM6 en la evaluación de la CF después de un IAM reciente.O infarto do miocárdio (IM) altera a função diastólica (FD) do ventrículo esquerdo (VE) em diferentes graus, o que pode refletir na capacidade funcional (CF). O objetivo deste estudo foi avaliar, após IM recente, a relação entre a FD do VE por meio de ecocardiografia Doppler e a CF estimada por meio da distância percorrida no teste de caminhada de seis minutos (DP6). Cinquenta e seis pacientes com IM não complicado foram selecionados após a alta da unidade coronariana e submetidos aos testes. Foi realizada análise de correlação considerando todos os pacientes e de comparação entre grupos definidos de acordo com a classificação da FD do VE. Foi observada correlação entre a onda a' lateral (referente à diástole tardia) e a DP6 (r=-0,320; p=0,023) e não houve diferença entre a CF dos grupos classificados conforme a FD do VE. As respostas de pressão arterial e frequência cardíaca ao teste foram fisiológicas. A correlação encontrada indica que o comprometimento da diástole precoce amplia o papel da contração atrial na CF, reforçando a necessidade de avaliação desses pacientes ainda no hospital. A resposta fisiológica ao TC6 reforça a viabilidade de sua utilização após IM recente.The myocardial infarction (MI) alters left ventricle diastolic function (LVDF) in different grades, which may reflect on functional capacity (FC). This study aimed to assess, in patients with recent MI, the relation between LVDF and FC evaluated by the distance covered during the six minute walking test (6MWT). Fifty-six uncomplicated MI inpatients were selected after discharge from the coronary care unit and submitted to tests. Statistic analyses were carried out considering all patients for correlations and groups according to the classification of LVDF to comparison. It was found correlation between lateral wave a' (later diastole) and 6MWD (r=-0.320; p=0.023) and no difference between FC and LVDF between groups. Blood pressure and heart rate had physiologic responses. The correlation indicates that the impairment of early diastole expands the role of atrial contraction in CF, reinforcing the need for evaluation of these patients still in the hospital. The physiological responses related to the six minute walking test reinforce the feasibility of its use after recent MI
Democratização da saúde: desafios da municipalização e descentralização administrativa relacionado a participação e controle social/ Health democratization: challenges of municipalization and administrative decentralization related to participation and social control
“Democratização da saúde: desafios da municipalização e descentralização administrativa relacionado a participação e controle social” teve como objetivo: propor uma reflexão crítica sobre o papel desempenhado pelo Conselho Municipal de Saúde, enquanto arena de discussão e proposição de políticas públicas de saúde, procurando analisar, sobretudo, o processo de participação social do grupo usuário na constituição do controle social, a fim de verificar as suas potencialidades e fragilidades na gestão local das políticas públicas de saúde. Metodologia: Tratou-se de estudo de abordagem qualitativa. Adotou-se a revisão integrativa da literatura. Resultados: identificação dos desafios que interferem na descentralização administrativa e municipalização através da participação e controle social. Conclusão: Essa experiência subsidiou a apreensão de conhecimentos e o aprofundamento de categorias teórico-analíticas. A matriz teórico-conceitual que norteia as reflexões produzidas no referido estudo se fundamenta nas concepções e diretrizes propostas pela Constituição Federal de 1988, conhecida também como a Constituição Cidadã, à qual proporcionou ao povo brasileiro uma nova tessitura no contexto da seguridade social, assim como as leis complementares e as normas operacionais básicas que regulamentam a gestão e o funcionamento o SUS e dos Conselhos de Saúde
Postoperative pain in patients submitted to elective craniotomy
Artigo disponível em português e inglêsJUSTIFICATIVA E OBJETIVOS: A dor é uma experiência subjetiva e multidimensional, comum em pacientes submetidos a operações. Os objetivos do estudo foram identificar a intensidade e verificar o registro da dor em prontuário, de pacientes submetidos à craniotomia eletiva.
MÉTODO: Estudo descritivo, quantitativo. Foram estudados 100 pacientes submetidos à craniotomia. As variáveis pesquisadas foram idade, sexo, tipo de operação, presença e intensidade da dor, registro da dor e uso de analgésicos no pós-operatório. Realizou-se a análise descritiva das variáveis estudadas, utilizando-se medidas de tendência central, dispersão e análise de proporções.
RESULTADOS: Os dados deste estudo demonstram que 59% dos pacientes submetidos à craniotomia eram do sexo feminino, com média de idade 44,6 ± 14,5 anos, 57% eram solteiros, e tiveram uma média de internação na unidade de terapia intensiva (UTI) e no hospital de 2,8 ± 2,4 e 21,8 ± 16,9 dias, respectivamente. Em 55% dos casos o diagnóstico médico foi de tumor cerebral, e o tipo de operação foi supratentorial em 90% dos pacientes. A cefaleia foi a principal queixa no pós-operatório, classificada na maioria das vezes como moderada, do tipo contínua. A maioria dos pacientes não recebeu qualquer tipo de medicação analgésica. Na maior parte dos prontuários não havia registro da dor pela equipe de saúde.
CONCLUSÃO: Os dados demonstram a necessidade de aperfeiçoamento dos profissionais da saúde para o tratamento e a avaliação da dor de maneira sistemática._________________________________________________________________________________________ ABSTRACT: BACKGROUND AND OBJECTIVES: Pain is subjective and multidimensional and is common in the postoperative period. This study aimed at identifying intensity and at checking pain records of patients submitted to elective craniotomy.
METHOD: This is a descriptive and quantitative study involving 100 patients submitted to craniotomy. Studied variables were age, gender, type of surgery, pain and pain intensity, pain records and the use of analgesics in the postoperative period. Studied variables were submitted to descriptive analysis using central trend measurements, dispersion and ratio analysis.
RESULTS: Our study has shown that 59% of patients submitted to craniotomy were females, with mean age of 44.6 ± 14.5 years, 57% were single and had mean ICU and hospital stay of 2.8 ± 2.4 e 21.8 ± 16.9 days, respectively. Brain tumor was diagnosed in 55% of cases and surgery was supratentorial in 90% of patients. Headache was the major postoperative complaint, classified as moderate and continuous by most patients. Most patients had no analgesic medication. Most medical records had no pain recorded by the health team.
CONCLUSION: Data show the need for health professionals' improvement to systematically treat and evaluate pain
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