Perfil das pacientes da fisioterapia pélvica de um hospital público quanto à incontinência urinária e qualidade de vida

Introdução: O assoalho pélvico é formado por músculos e fáscias e tem a função de dar suporte aos órgãos internos. Um assoalho pélvico debilitado e enfraquecido pode resultar em disfunções sexuais, prolapsos urogenitais, incontinência fecal, incontinência urinária entre outros. A incontinência urinária é definida como a queixa de qualquer perda involuntária de urina e pode afetar seriamente a qualidade de vida de quem convive com essa condição. Os maiores problemas decorrentes da incontinência urinária relacionam-se ao bem-estar social e mental, afetando significativamente a qualidade de vida. A fisioterapia pélvica é considerada pela International Continence Society como padrão-ouro no tratamento da incontinência urinária. O objetivo desse estudo é descrever o perfil das pacientes avaliadas no ambulatório de fisioterapia pélvica do Hospital de Clínicas de Porto Alegre, em relação a qualidade de vida e disfunções do assoalho pélvico. Materiais e métodos: Trata-se de um estudo descritivo retrospectivo que foi realizado a partir da análise de prontuários das pacientes atendidas no Ambulatório de Fisioterapia pélvica do Hospital de Clínicas de Porto Alegre, no período de janeiro de 2015 à maio de 2019. A população que foi utilizada no estudo é não intencional probabilística e é composta pelos prontuários das pacientes atendidas no ambulatório. Foram excluídos do estudo prontuários de pacientes que já estejam realizando tratamento pela fisioterapia pélvica. Foram coletadas as seguintes informações: idade, região de procedência, número de gestações, tipo de parto, cirurgias ginecológicas, presença ou não de episiotomia e do uso de fórceps, presença ou não de prolapso urogenital, queixa principal, grau de força da musculatura do assoalho pélvico (MAP), escore do questionário de qualidade de vida International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), presença ou não de constipação intestinal, índice de massa corporal (IMC), menopausa, reposição hormonal, medicamentos de uso e tratamento fisioterapêutico indicado. As informações foram tabeladas em um banco de dados do Excel. Resultados: No total, foram analisados 413 prontuários de pacientes. Entre eles, a mediana da idade foi de 57 anos(17-87), a média do Índice de massa corporal (IMC) foi 30,49 kg/m² (±5,82), 43,6% das pacientes tinham prolapso de órgãos pélvicos, 27,4% pacientes apresentavam grau 3 de força na escala de Oxford modificada, 58,1% prontuários apresentaram como queixa principal a IUM, 58,8% da pacientes haviam sido encaminhadas para o tratamento de exercícios e orientações em grupo e 40% dos prontuários apresentaram escore do ICIQ-SF classificado como severo. Conclusão: Analisando os dados citados foi possível descrever o perfil da população que chega até o ambulatório, enriquecendo a literatura relacionada à área da fisioterapia pélvica e permitindo o delineamento de estratégias de prevenção e tratamento mais eficazes para esse público.Introduction: The pelvic floor is made up of muscles and fascias and has the function of supporting the internal organs. A weakened pelvic floor can result in sexual dysfunction, urogenital prolapses, fecal incontinence, urinary incontinence among others. Urinary incontinence is defined as the complaint of any involuntary loss of urine and can seriously affect the quality of life of those living with this condition. The major problems arising from urinary incontinence are related to social and mental well-being, significantly affecting the quality of life. Pelvic physiotherapy is considered by the International Continence Society as the gold standard in the treatment of urinary incontinence. The aim of this study is to describe the profile of patients evaluated at the pelvic physiotherapy outpatient clinic of the Hospital de Clínicas de Porto Alegre regarding pelvic floor muscle functionality and quality of life. Materials and methods: This is a descriptive retrospective study that will be performed from the analysis of medical records of patients treated at the Pelvic Physiotherapy Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, from january 2015 to may 2019. The population used in this study is unintentional probabilistic and is composed of the medical records of the patients treated at the outpatient clinic. Records of patients already undergoing treatment by pelvic therapy were excluded from the study. The following information were collected: age, region of origin, number of pregnancies, type of birth, gynecological surgeries, presence or absence of episiotomy and use of forceps, presence or absence of urogenital prolapse, main complaint, degree of pelvic floor muscle strength, quality of life score International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), presence or absence of constipation, body mass index, menopause, hormone replacement, medications for use and indicated physiotherapy treatment.. The information were tabulated in an Excel database. Results: In total, 413 patient records were analyzed. Among them, the median age was 57 years (17-87), the average body mass index (BMI) was 30.49 kg/m² (± 5.82), 43.6% of the patients had pelvic organs prolapse, 27.4% of patients had a grade 3 strength on the modified Oxford scale, 58.1% of medical records had as their main complaint the IUM, 58.8% of the patients had been referred for group exercises and guidance and 40% of the medical records had an ICIQ-SF score classified as severe. Conclusion: Analyzing the cited data it was possible to describe the profile of the population that reaches the outpatient clinic, enriching the literature related to the area of pelvic physiotherapy and allowing greater knowledge to the physiotherapists who work in it

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable