Análise sobre a taxa de cesáreas ocorridas na 15ª regional de saúde do Paraná e um breve comparativo com macrorregiões brasileiras: Analysis of cesarean rates in the 15th regional health region of Paraná and a brief comparison with brazilian macroregions

Sabe-se que, com o passar do tempo, e com a evolução das técnicas operatórias, a taxa de cesáreas feitas em todo o mundo aumentou consideravelmente, inclusive no Brasil. Essa cirurgia é uma alternativa ao parto normal, indicada em casos específicos, dentre eles quando há possíveis riscos para a mãe ou para o bebê. Contudo, no cenário atual, dos partos realizados, a quantidade de cesáreas ultrapassa os números sugeridos pela OMS - Organização Mundial da Saúde, assim, pode-se dizer que há uma epidemia de cesáreas. O presente estudo teve como método quantitativo, epidemiológico, documental e observacional da ocorrência de partos vaginais e cesarianos no estado do Paraná e distritos e macrorregiões brasileiras. Foi considerada a variável denominada como Grupo de Robson, sendo criada para reduzir as taxas de cesariana em hospitais, nos dados extraídos do SINASC - Sistema de Informações sobre Nascidos Vivos. A realização dos gráficos e a análise dos dados ocorreu por meio de estatística simples, comparando a taxa de incidência do parto cesáreo entre 1996-2019 na 15ª Regional de Saúde do Paraná, bem como a taxa de cesáreas nas cinco macrorregiões brasileiras no período de 2000 a 2014. Foi possível constatar que na 15ª Regional de Saúde do Estado do Paraná a alta taxa de cesáreas no período analisado (1996 - 2019), teve prevalência em mulheres de faixa etária entre 25 e 29 anos, classificadas no grupo 5 de Robson. Assim, o tema deve ser discutido entre profissionais e pacientes para que a “epidemia” de cesáreas seja contida

The ARIA-MASK-air® approach

Funding Information: The authors thank Ms Véronique Pretschner for submitting the paper. MASK‐air has been supported by Charité Universitätsmedizin Berlin, EU grants (EU Structural and Development Funds Languedoc Roussillon and Region PACA; POLLAR: EIT Health; Twinning: EIP on AHA; Twinning DHE: H2020; Catalyse: Horizon Europe) and educational grants from Mylan‐Viatris, ALK, GSK, Novartis, Stallergènes‐Greer and Uriach. None for the study. ® Publisher Copyright: © 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.MASK-air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.publishersversionpublishe

ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.Peer reviewe

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

Perfil de acidentes envolvendo risco biológico em profissionais de saúde de Araçatuba-SP: uma caracterização dos envolvidos

Each year individuals have sought a better quality of life and work, in this case, the science of Bio-insurance needs to keep up with technological advances and the needs of society to minimize or eliminate the risks of accidents. This study evaluated the most common accidents involving health staff from 2007 to 2011 in Araçatuba-SP. 478 accidents were recorded, and 78.7% with percutaneous involvement, 9% with intact skin, 4% with no skin intact, with 7.3 mucous and 1.05% other types of exposures. Most accidents were caused by needles with lumen (68.0%), followed by other agents (14.1%), accidents with blades (8.5%) or needles without lumen (5.5%); 3.7% did not answer and 0.2% were accidents with glasses. When checking the condition in which the accident occurred, 26.0% did not specify, 25.1% occurred in the disposal and / or handling sharp objects, 12.0% at the time of drug administration, 6.9% puncture, 3.7% occurred during recapping the needle. These data show that the most common accidents are those involving needles with lumen and / or sharp objects and due to these factors, the industry of health materials have sought alternatives to minimize such accidents as needles with protective, vacuum collection . Thus, it appears that reporting accidents is important for the development of technical and / or safer materials for patients and health workers.A cada ano os indivíduos têm buscado por melhor qualidade de vida e de trabalho, nesse sentido, a ciência da Biossegurança precisa acompanhar os avanços tecnológicos e as necessidades da sociedade para tentar minimizar ou eliminar os riscos de acidentes. Este estudo avaliou os acidentes mais frequentes com agentes da saúde no período de 2007 a 2011 em Araçatuba-SP. Foram registrados 478 acidentes, sendo 78,7% com envolvimento percutâneo, 9% com pele íntegra, 4,% com pele não íntegra, 7,3% com mucosas e 1,1% outros tipos de exposições. A maioria dos acidentes foi causada por agulhas com lúmen (68,0%), seguidos de outros agentes (14,1%), acidentes com lancetas ou lâminas (8,5%), agulhas sem lúmen (5,5%); 3,7% não responderam e 0,2% foram acidentes com vidros. Quando se verifica a circunstância em que o acidente ocorreu, 26,0% não especificaram, 25,1% ocorreram no descarte e/ou manipulação de material perfuro-cortante, 12,0 % na hora da administração da medicação, 6,9% na punção, 3,7% ocorreram durante o reencape da agulha. Esses dados mostram que os acidentes mais comuns são aqueles que envolvem agulhas com lúmen e/ou material perfuro-cortante e devido a esses fatores, a indústria de materiais de saúde têm buscado alternativas para minimizar esses acidentes, como agulhas com protetores, coleta a vácuo. Desta forma, verifica-se que a notificação de acidentes é importante para o desenvolvimento de técnicas e/ou materiais mais seguros para os pacientes e agentes de saúde

MANIFESTACIÓN BUCAL DE PARACOCCIDIOIDOMICOSIS ASOCIADA A ASPERGILOSIS. PRESENTACIÓN DE CASO

Paracoccidioidomicosis y Aspergilosis son micosis causadas respectivamente por los hongos Paracoccidioides brasiliensis y Aspergillus fumigatus, que afectan con mayor frecuencia los pulmones y posteriormente se propagan para otras regiones del cuerpo. La asociaci&oacute;n de estas dos micosis en pacientes que no presentaban inmunosupresi&oacute;n es poco com&uacute;n. Descripci&oacute;n de caso cl&iacute;nico resaltadas: Paciente de sexo masculino de 49 a&ntilde;os, present&oacute; lesi&oacute;n en el paladar, orofaringe y regi&oacute;n retromolar. Los ex&aacute;menes histol&oacute;gicos, citopatol&oacute;gicos y microbiol&oacute;gicos confirmaron el diagn&oacute;stico de paracoccidioidomicosis asociada a aspergilosis. Hist&oacute;ricamente los hongos se han considerado como la causa de infecciones de relativa significancia; sin embargo, en los &uacute;ltimos a&ntilde;os se ha visto un aumento importante de las enfermedades que causan. El reconocimiento del agente etiol&oacute;gico en cultivos es importante para poder implementar el tratamiento adecuado, ya que &eacute;stos pueden producir da&ntilde;os irreversibles o llevar a la muerte del paciente. El objetivo de este trabajo fue mostrar por medio del caso cl&iacute;nico de un paciente que presentaba las dos mucosis asociadas em mucosa bucal y orofaringe la necesidad de ex&aacute;menes complementares para el diagn&oacute;stico de las enfermedades bucales cuando los ex&aacute;menes de laboratorioABSTRACTParacoccidioidomycosis and aspergillosis are, respectively, mycosis caused by Paracoccidioides brasiliensis and Aspergillus fumigatus fungi, which, most frequently, attack the lungs and later spread to other body regions. The association between both mycosis is rare in patients that do not present immunosuppression. A 49-year-old man presented with oral lesion, besides lesions on palatum, retromolar and oropharyngeal regions. Histopathological and microbiological exams confirmed the diagnosis of paracoccidioidomycosis associated to aspergillosis. Historically, fungi have been considered as the cause of relatively important infections, but, in the last years, a significant increase of diseases caused by fungi is evidenced. The recognition of the etiological agent in culture is important for the suitable treatment, once these fungi can cause irreversible damages or even death. The purpose of this study was to demonstrate, through the case of a patient who presented both mycosis associated, the need of complementary exams for the diagnosis of oral diseases, when routine laboratorial exams indicate the presence of another disease associated. de rutina indican la presencia de enfermedades asociadas