Efectividad de la heparina y el suero fisiológico para mantener la permeabilidad de los catéteres venosos centrales: revisión sistemática

OBJETIVO Determinar qual é a solução (flush heparina comparado com oflushde soro fisiológico 0.9%) mais eficaz na redução do risco de oclusões de cateteres venosos centrais (CVC) em adultos. MÉTODO A revisão sistemática seguiu os princípios propostos pelo Cochrane Handbook; a análise crítica, a extração e a síntese dos dados foram realizadas por dois investigadores, isoladamente; e a análise estatística efetuada com recurso ao programa RevMan 5.2.8. RESULTADOS Foram incluídos oito estudos randomizados controlados e um estudo de coorte e os resultados da meta-análise mostram não existir diferenças (RR=0.68, IC 95%=0.41-1.10; p=0.12). A análise por subgrupos mostra que nos CVC totalmente implantados não se verificaram diferenças (RR=1.09, IC 95%=0.53-2.22; p=0.82); nos CVC com vários lúmens existiu um efeito benéfico no grupo da heparina (RR=0.53, IC 95%=0.29-0.95;p=0.03); nos CVC de duplo lúmen para hemodiálise (RR=1.18, IC 95%=0.08-17.82; p=0.90) e nos CVC de inserção periférica (RR=0.14, IC 95%=0.01-2.60; p=0.19) também não se verificaram diferenças. CONCLUSÃO O soro fisiológico é suficiente para manter a permeabilidade dos cateteres venosos centrais, prevenindo os riscos associados à administração da heparina.OBJETIVO Determinar cuál es la solución (flush con heparina comparado con el de suero fisiológico al 0,9%) más eficaz en la reducción del riesgo de oclusiones de catéteres venosos centrales (CVC) en adultos. MÉTODO La revisión sistemática siguió los principios propuestos por elCochrane Handbook; el análisis crítico, la extracción y la síntesis de los datos fueron realizados por dos investigadores, aisladamente; y el análisis estadístico fue llevado a cabo con recurso al programa RevMan 5.2.8. RESULTADOS Se incluyeron ocho estudios randomizados controlados y un estudio de cohorte, y los resultados del metaanálisis muestran no existir diferencias (RR=0.68, IC 95%=0.41-1.10; p=0.12). El análisis por subgrupos muestra que en los CVC totalmente implantados no se verificaron diferencias (RR=1.09, IC 95%=0.53-2.22; p=0.82); en los CVC con varios lúmenes existió un efecto benéfico en el grupo de la heparina (RR=0.53, IC 95%=0.29-0.95; p=0.03); en los CVC de doble lumen para hemodiálisis (RR=1.18, IC 95%=0.08-17.82; p=0.90) y en los CVC de inserción periférica (RR=0.14, IC 95%=0.01-2.60;p=0.19) tampoco se verificaron diferencias. CONCLUSIÓN El suero fisiológico es suficiente para mantener la permeabilidad de los catéteres venosos centrales, previniendo los riesgos asociados con la administración de la heparina.OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration

Critérios de diagnóstico de anomalias da homeostasia da glicose da ADA e da IDF: Haverá diferenças?

[Resumo][Abstract

Up-Mind: um programa de treino para otimização de competências de grupos de operacionais de polícia

Sendo a atividade policial uma profissão reconhecida como uma das mais stressantes e com exposição a eventos potencialmente traumáticos, é fundamental preparar os operacionais de modo a minimizar este impacto emocional que prejudica a saúde física e psicológica. Baseado nos princípios da gestão do stresse, psicologia do desporto e neuropsicologia, foi desenvolvido um programa de treino de competências de auto-regulação com recurso ao biofeedback (BFB), designado Up-Mind. Sendo inovador no panorama português, foi desenvolvido por uma equipa multidisciplinar que integrou psicólogos, investigadores e elementos policiais. Pretende-se descrever os pressupostos de construção do programa, composto por quatro fases: apresentação e formação, avaliação inicial, intervenção individual e grupal e, avaliação final. Destina-se aos operacionais da polícia, tendo como objetivo a redução do stresse psicológico e psicofisiológico, bem como a otimização do desempenho policial. Numa época em que está demonstrado o impacto psicológico da pandemia COVID-19 nos elementos policiais, o programa Up-Mind pode ser aplicado a diversas forças policiais para promoção da saúde física e psicológica, contribuindo para a relação estabelecida entre o procedimento operacional e a resposta psicofisiológica.Since police activity is a profession recognized as one of the most stressful ones, with exposure to potentially traumatic events, it is essential to prepare police officers in order to minimize this emotional impact that harms physical and psychological health. Based on the principles of stress management, sports psychology and neuropsychology, a self-regulatory skills training program was developed using biofeedback (BFB), called Up-Mind. Being innovative in the Portuguese context, it was developed by a multidisciplinary team that integrated psychologists, researchers, and police elements. We aim to describe the assumptions of developing the program, composed of four phases: presentation and training, initial evaluation, individual and group intervention, and final evaluation. The program is for police officers, aiming at reducing psychological and psychophysiological stress, as well as optimizing police performance. At a time when the psychological impact of the COVID-19 pandemic on police elements is demonstrated, the Up-Mind program can be applied to various police forces to promote physical and psychological health, contributing to the relationship established between the operational procedure and the psychophysiological response.Dado que la actividad policial es una profesión reconocida como una de las más estresantes y con exposición a eventos potencialmente traumáticos, es esencial preparar a los policías para minimizar este impacto emocional que perjudica la salud física y psicológica. Basado en los principios del manejo del estrés, la psicología del deporte y la neuropsicología, se desarrolló un programa de entrenamiento de habilidades autorreguladoras utilizando biofeedback (BFB), llamado Up-Mind. Siendo innovador en el contexto portugués, fue desarrollado por un equipo multidisciplinario que integró psicólogos, investigadores y elementos policiales. Se pretende describir los supuestos de construcción del programa, compuesto por cuatro fases: presentación y formación, evaluación inicial, intervención individual y grupal y evaluación final. Está destinado a agentes de policía, con el objetivo de reducir el estrés psicológico y psicofisiológico, así como optimizar el rendimiento policial. En un momento en que se demuestra el impacto psicológico de la pandemia de COVID-19 en los elementos policiales, el programa Up-Mind se puede aplicar a diversas fuerzas policiales para promover la salud física y psicológica, contribuyendo a la relación establecida entre el procedimiento operativo y la respuesta psicofisiológica.info:eu-repo/semantics/publishedVersio

Manual de referência FPN para o ensino e aperfeiçoamento em natação: um modelo multidisciplinar

ligadas à prática da natação e pretende, com a sua experiência na missão de melhorar as condições de prática das disciplinas competitivas, estender a todas as entidades e praticantes de atividades aquáticas os benefícios duma organização de âmbito nacional, com abrangência insular, regional e local. No âmbito do PEFPN_2014-2024, e da análise dos fatores de competitividade, da missão e visão institucionais da FPN, decorreram quatro vetores estratégicos: (i) massificar a prática da natação; (ii) desenvolver a prática desportiva; (iii) render e competir ao alto nível; (iv) sustentar a atividade: estrutural e funcional (transversal a todos os restantes).info:eu-repo/semantics/publishedVersio

Abnormal NK cell lymphocytosis detected after splenectomy: association with repeated infections, relapsing neutropenia, and persistent polyclonal B-cell proliferation

Abnormal NK cell lymphocytosis detected after splenectomy: association with repeated infections, relapsing neutropenia, and persistent polyclonal B-cell proliferation. Granjo E, Lima M, Fraga M, Santos F, Magalhães C, Queirós ML, Moreira I, Rocha S, Silva AS, Rebelo I, Quintanilha A, Ribeiro ML, Candeias J, Orfão A. Department of Hematology, Hospital S. João, Porto, Portugal. [email protected] Abstract We report the case of a boy with hereditary spherocytosis who presented with mild microcytic hypochromic anemia and recurrent leg ulcers that had been present since childhood. Chronic natural killer (NK) cell and B-cell lymphocytosis was detected 1 year after therapeutic splenectomy during investigation of recurrent episodes of neutropenia and persistent lymphocytosis. NK cells proved to be abnormal at immunophenotyping studies, and B-cells were polyclonal and displayed a normal immunophenotype. Genotypic analysis of T-cell receptor (TCR)-beta and TCR-gamma genes showed a germ-line pattern. The clinical course of this patient was characterized by multiple pulmonary infections and amygdalitis. We discuss the potential roles of persistent immune stimulation due to chronic hemolysis and severe leg ulcers and of splenectomy in the origin of NK cell lymphocytosis and the relationship between NK cells and recurrent infections, relapsing neutropenia, and polyclonal B-cell response

Association between Elevated Iodine Intake and IQ among School Children in Portugal

Funding Information: This project was funded through grants by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009–2014, and supported by FEDER through the operation POCI-01-0145-FEDER-007746 funded by the Programa Operacional Competitividade e Internacionalização—COMPETE2020 and by National Funds through FCT—Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020) and within the scope of the project RISE, Associated Laboratory (reference LA/P/0053/2020). DP and VCF also received individual funding from Fundação para a Ciência e a Tecnologia (SFRH/BPD/109158/2015 in the first case; SFRH/BPD/109153/2015, UIDB/50006/2020, UIDP/50006/2020, and LA/P/0008/2020 in the second case).The goal of this work was to examine whether elevated iodine intake was associated with adverse effects on IQ among school-age children in Portugal. In a representative sample of children from the north of the country, IQ percentiles by age (assessed with Raven’s Colored Progressive Matrices) were dichotomized to <50 (“below-average” IQs) and ≥50. Morning urine iodine concentrations, corrected for creatinine, were dichotomized to <250 µg/g and ≥250 µg/g, according to the European Commission/Scientific Committee on Food’s tolerable upper level of daily iodine intake for young children. Data were examined with Chi-square tests, logistic regression, and GLM univariate analysis. The sample (N = 1965) was classified as generally iodine-adequate (median urinary iodine concentration = 129 µg/L; median iodine-to-creatinine ratio = 126 µg/g) according to the WHO’s criteria. A greater proportion of children in the ≥250 µg/g group had below-average IQs, compared to children with less than 250 µg/g (p = 0.037), despite a sizable (though non-significant) proportion of children in the less-than-250 µg/g group also presenting below-average IQs, at the bottom of the iodine distribution (<50 µg/g). The proportion of below-average IQs increased with increasingly elevated iodine concentrations (p = 0.047). The association remained significant after the adjustment for confounders, with the elevated iodine group showing increased odds of having below-average IQs when compared with the non-elevated iodine group (OR 1.55; 95% CI 1.11–2.17; p = 0.011). Consistently, the former group presented a lower mean IQ than the latter (p = 0.006). High iodine intake was associated with lower IQs even in a population classified as iodine-adequate. These results bear on child cognition and on initiatives involving iodine supplementation.publishersversionpublishe

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio