O perfil semiológico do paciente portador de hemorragia digestiva alta

OBJETIVO: O seguinte estudo objetivou descrever a semiologia do paciente portador de hemorragia digestiva alta, considerando como determinante na avaliação de potencias focos hemorrágicos. METODOLOGIA: Foram realizadas buscas nas plataformas do SciELO, LILACS, PubMed, Scopus e Google Scholar,utilizando os descritores gastrointestinal bleeding, peptic ulcerous disease e varicose hemorrhage, sendo identificados 35 estudos, dos quais foram incluídos 13 artigos completos. Desses estudos, 5 avaliaram as principais etiologias, 2 o surgimento de novos testes diagnósticos, 2 analisaram os aspectos epidemiológicos e 1 a sintomatologia apresentada pelo acometimento da hemorragia digestiva alta. Observou-se inicialmente a abundâncias de informações conceituais sobre o sangramento, como um transtorno clínico comum, acompanhada de inúmeras manifestações, considerando que o foco hemorrágico pode ocorrer em qualquer porção do trato gastrointestinal. Neste estudo, todas as publicações eleitas apresentaram o quadro semiológico composto por algia abdominal, indícios de choque hipovolêmico e taquicardia, alguns exibiram quedas abruptas da pressão arterial, odinofagia, êmese, náuseas e estado ictérico. Os pacientes implicados, cronicamente, já manifestaram ocorrências prévias, devido ao caráter recidivante torna-se essencial investigar a existência de varizes, fístula aorto-entérica, angiodisplasia e doença ulcerosa. CONCLUSÃO: Elucida-se que a hemorragia digestiva alta representa a principal causa de sangramento do trato gastrointestinal, majoritamente manifesta-se como hematêmese ou melena e cursam com o quadro sintomatológico que auxilia na avaliação da gravidade deste e o embasamento de potenciais focos de sangramento e que contribuam para disseminação de informações e intervenções futuras

Relation between visceral fat and coronary artery disease evaluated by multidetector computed tomography

INTRODUÇÃO: A gordura visceral abdominal tem sido associada com os fatores de risco cardiovasculares e com a doença arterial coronária (DAC). A maior parte dos estudos delineados para avaliar o risco atribuído à distribuição da gordura corporal utilizaram as medidas antropométricas para estimar a gordura visceral. Entretanto, quando comparada com as medidas antropométricas tradicionais (circunferência do quadril e relação das medidas da cintura e quadril), a gordura visceral avaliada pela tomografia computadorizada (TC) foi mais intensamente associada aos fatores de risco para DAC. A angiografia por TC com múltiplos detectores é um método diagnóstico em ascensão, permitindo a detecção de DAC obstrutiva e não obstrutiva, acrescentando informação para a estratificação de risco cardiovascular. O objetivo desse estudo foi avaliar a associação entre DAC e as medidas de adiposidade por métodos clínicos e tomográficos. MÉTODOS: Nós avaliamos prospectivamente 125 indivíduos consecutivos (57% eram homens, idade média de 56 ± 12 anos) referenciados para realizar angiografia coronária por TC. As variáveis clínicas e laboratoriais foram determinadas e tomografias cardíacas e abdominais foram realizadas em um tomógrafo com 64 fileiras de detectores. A DAC foi definida pela presença de qualquer placa coronária, calcificada ou não, identificada pela angiografia por TC. As artérias coronárias foram classificadas de acordo com a presença ou não de estenoses significativas (obstrução do diâmetro luminal 50%). As calcificações coronárias foram determinadas pelo escore de cálcio. As medidas de gordura visceral e subcutâneas foram realizadas em diferentes níveis do espaço intervertebral. RESULTADOS: A angiografia por TC detectou DAC em 70 participantes (56%) e nenhuma associação foi encontrada com as medidas antropométricas usuais (circunferências de cintura e quadril e índice de massa corpórea). Entretanto, as medidas das áreas de gordura visceral abdominal (GVA) foram significativamente associadas ao diagnóstico de DAC. As médias das áreas de GVA no espaço intervertebral L1-T12 (GVA L1-T12) e L4-L5 (GVA L4-L5) foram 151,2 cm2 e 167,2 cm2, respectivamente. Valores de GVA L1-T12 145 cm2 apresentaram odds ratio de 2,85 (1,3 6,26, IC95%) para o diagnóstico de DAC e a GVA L4-L5 150 cm2 apresentou odds ratio de 2,87 (1,31 6,3, IC 95%) para DAC. As medidas de adiposidade não mostraram associação com o grau de estenose coronária, nem com a presença de calcificações coronárias identificadas pelo escore de cálcio. A análise multivariada determinou a idade e a GVAL1-T12 como as únicas variáveis independentemente associadas ao diagnóstico de DAC. CONCLUSÃO: A gordura visceral avaliada pela TC é um marcador independente de DAC diagnosticada pela angiografia coronária por TC. A avaliação da gordura visceral pela TC em diferentes sítios abdominais foi fortemente associada à DAC, e não se associou às tradicionais variáveis antropométricas e clínicas utilizadas para estimar o risco cardiovascular. A utilização das medidas de adiposidade pela TC na prática clínica pode agregar valor à estratificação de risco da DACINTRODUCTION: Visceral abdominal fat has been associated with cardiovascular risk factors and coronary artery disease (CAD). Visceral fat is frequently estimated using anthropometric measurements, but computed tomography (CT) studies have shown stronger association with CAD risk than anthropometric variables (waist circumference, waist-to-hip ratio). CT angiography is an emerging technology allowing detection of both obstructive and nonobstructive CAD adding information to clinical risk stratification. The aim of this study was to evaluate the association between CAD and adiposity measurements assessed clinically and by CT. METHODS: We prospectively evaluated 125 consecutive subjects (57% men, age 56.0 ± 12 years) referred to perform CT angiography. Clinical and laboratory data were determined. Cardiac CT and abdominal CT were performed in a 64- slice scanner. CAD was defined as the presence of any plaque detected by CT angiography and stenosis were graded as significant (greater than 50% of luminal narrowing) or nonsiginificant (less than 50%). The presence of coronary calcification was determined by calcium score. Visceral and subcutaneous adiposity measurements were determined at different intervertebral levels. RESULTS: CT angiography detected CAD in 70 (56%) subjects, and no association was found with usual anthropometric adiposity measurements. Nevertheless CT visceral fat area (VFA) was significantly associated to CAD. The mean VFA at the intervertebral locations T12-L1 (VFA L1-T12) and L4-L5 (VFA L4-L5) were 151.2 cm2 and 167.2 cm2, respectively. VFA L1-T12 values 145 cm2 had an odds ratio of 2.85 (95% CI - 1.30 6.26) to CAD and VFA L4-L5 150 cm2 had a 2.87-fold (95% CI - 1.31-6.30) CAD risk. Adiposity measurement was not related to stenosis severity and neither to the presence of coronary calcification. The multivariate analysis determined age and VFA L1-T12 as the only independent variables associated to CAD. CONCLUSION: Visceral fat as assessed by CT angiography is an independent marker of CAD. VFA in different abdominal sites was strongly related to CAD but this relation was not found using anthropometric measurements and clinical variables. The use of these CT adiposity measurements in the clinical practice may improve the risk stratification to CA

GOING OUT NORMALLY DURING COVID-19 PANDEMIC: INSIGHTS ABOUT THE LACK OF ADHESION TO SOCIAL DISTANCING

The population's adhesion to measures to ensure social distancing represents a great management challenge. Evidence has shown that social distancing is effective. However, it is challenging to separate government measures from social distancing driven by personal initiatives. Theory: It is possible that the output of protective behaviors, such as adherence to protective measures and staying in social isolation, is influenced by individual characteristics, such as personality traits or symptoms of mental distress of anxiogenic nature. We hypothesized that individuals with more expressive symptoms of fear or anxiety would have a more protective behavioral tendency in terms of risk exposure, leaving less home during the pandemic. In contrast, individuals with greater emotional stability, as they feel more secure and with a lower perception of risk, could go out more often. Material and Methods: A total of 2709 individuals from all regions of Brazil participated in the study (mean age = 42 years; 2134 women). Correlation analysis was performed to investigate the relationships between personality traits according to the big five model and Psychopathological Symptoms (BSI). Then investigate how people that go out usually differ from people that stay at home, in both symptoms and personality traits. Finally, to investigate the predictors for going out usually, we use multiple regression analysis, using gender, marital status, level of education, and personality traits. Results: During the second wave of COVID-19 in Brazil, individuals with higher emotional stability tended to leave home more than those with more expressive levels of anxiogenic dysregulation. These results reinforce the role of both personality traits and psychopathological symptoms in prophylactic behavior during COVID-19 pandemics

Video_4_High-dimensional intravital microscopy reveals major changes in splenic immune system during postnatal development.mp4

Spleen is a key organ for immunologic surveillance, acting as a firewall for antigens and parasites that spread through the blood. However, how spleen leukocytes evolve across the developmental phase, and how they spatially organize and interact in vivo is still poorly understood. Using a novel combination of selected antibodies and fluorophores to image in vivo the spleen immune environment, we described for the first time the dynamics of immune development across postnatal period. We found that spleens from adults and infants had similar numbers and arrangement of lymphoid cells. In contrast, splenic immune environment in newborns is sharply different from adults in almost all parameters analysed. Using this in vivo approach, B cells were the most frequent subtype throughout the development. Also, we revealed how infections – using a model of malaria - can change the spleen immune profile in adults and infants, which could become the key to understanding different severity grades of infection. Our new imaging solutions can be extremely useful for different groups in all areas of biological investigation, paving a way for new intravital approaches and advances.</p

Video_1_High-dimensional intravital microscopy reveals major changes in splenic immune system during postnatal development.mp4

Spleen is a key organ for immunologic surveillance, acting as a firewall for antigens and parasites that spread through the blood. However, how spleen leukocytes evolve across the developmental phase, and how they spatially organize and interact in vivo is still poorly understood. Using a novel combination of selected antibodies and fluorophores to image in vivo the spleen immune environment, we described for the first time the dynamics of immune development across postnatal period. We found that spleens from adults and infants had similar numbers and arrangement of lymphoid cells. In contrast, splenic immune environment in newborns is sharply different from adults in almost all parameters analysed. Using this in vivo approach, B cells were the most frequent subtype throughout the development. Also, we revealed how infections – using a model of malaria - can change the spleen immune profile in adults and infants, which could become the key to understanding different severity grades of infection. Our new imaging solutions can be extremely useful for different groups in all areas of biological investigation, paving a way for new intravital approaches and advances.</p

Video_5_High-dimensional intravital microscopy reveals major changes in splenic immune system during postnatal development.mp4

Spleen is a key organ for immunologic surveillance, acting as a firewall for antigens and parasites that spread through the blood. However, how spleen leukocytes evolve across the developmental phase, and how they spatially organize and interact in vivo is still poorly understood. Using a novel combination of selected antibodies and fluorophores to image in vivo the spleen immune environment, we described for the first time the dynamics of immune development across postnatal period. We found that spleens from adults and infants had similar numbers and arrangement of lymphoid cells. In contrast, splenic immune environment in newborns is sharply different from adults in almost all parameters analysed. Using this in vivo approach, B cells were the most frequent subtype throughout the development. Also, we revealed how infections – using a model of malaria - can change the spleen immune profile in adults and infants, which could become the key to understanding different severity grades of infection. Our new imaging solutions can be extremely useful for different groups in all areas of biological investigation, paving a way for new intravital approaches and advances.</p

Video_3_High-dimensional intravital microscopy reveals major changes in splenic immune system during postnatal development.mp4

Spleen is a key organ for immunologic surveillance, acting as a firewall for antigens and parasites that spread through the blood. However, how spleen leukocytes evolve across the developmental phase, and how they spatially organize and interact in vivo is still poorly understood. Using a novel combination of selected antibodies and fluorophores to image in vivo the spleen immune environment, we described for the first time the dynamics of immune development across postnatal period. We found that spleens from adults and infants had similar numbers and arrangement of lymphoid cells. In contrast, splenic immune environment in newborns is sharply different from adults in almost all parameters analysed. Using this in vivo approach, B cells were the most frequent subtype throughout the development. Also, we revealed how infections – using a model of malaria - can change the spleen immune profile in adults and infants, which could become the key to understanding different severity grades of infection. Our new imaging solutions can be extremely useful for different groups in all areas of biological investigation, paving a way for new intravital approaches and advances.</p

Video_2_High-dimensional intravital microscopy reveals major changes in splenic immune system during postnatal development.mp4

Spleen is a key organ for immunologic surveillance, acting as a firewall for antigens and parasites that spread through the blood. However, how spleen leukocytes evolve across the developmental phase, and how they spatially organize and interact in vivo is still poorly understood. Using a novel combination of selected antibodies and fluorophores to image in vivo the spleen immune environment, we described for the first time the dynamics of immune development across postnatal period. We found that spleens from adults and infants had similar numbers and arrangement of lymphoid cells. In contrast, splenic immune environment in newborns is sharply different from adults in almost all parameters analysed. Using this in vivo approach, B cells were the most frequent subtype throughout the development. Also, we revealed how infections – using a model of malaria - can change the spleen immune profile in adults and infants, which could become the key to understanding different severity grades of infection. Our new imaging solutions can be extremely useful for different groups in all areas of biological investigation, paving a way for new intravital approaches and advances.</p