PREVALÊNCIA DE TRAUMA POR ACIDENTE DE MOTO NOS USUÁRIOS ATENDIDOS EM UM HOSPITAL UNIVERSITÁRIO DO MARANHÃO / PREVALENCE OF MOTORCYCLE ACCIDENT TRAUMA AMONG USERS SEEN AT A UNIVERSITY HOSPITAL IN MARANHÃO

Introdução: Os acidentes de trânsito no Brasil, traduz-se em um complexo problema de saúde pública, pois aumentam à proporção em que acontece o desenvolvimento econômico e tecnológico da sociedade moderna, resultando em implicações econômicas e sociais. O Nordeste se destaca com elevado incremento na taxa de morbimortalidade em decorrência de acidentes de moto, sobrecarregando o sistema de saúde, com internações muitas vezes prolongadas. Objetivo: Identificar a prevalência de pacientes que sofreram trauma por acidentes de moto. Método: estudo transversal prospectivo de abordagem quantitativa, realizado no setor de Ortopedia de um Hospital Universitário do Maranhão. Resultados:A faixa etária predominante entre 18 e 35 anos (65%), do sexo masculino (77,50%), solteiros (72,2%), ensino médio completo (35%), moradores do município de São Luís (MA) (57,5%). Estavam na posição de condutor (92,50%), os acidentes tiveram maior ocorrência no turno da noite (37,50%) sendo referido ser a primeira vez (52,50%) relatou ser a primeira vez que sofreu acidente de moto, afirmaram não estar acima do limite de velocidade (70%) e não possuíam Carteira Nacional de Habilitação (55%). O uso do capacete foi referido por 65% e 75% referiram não estar alcoolizados. Conclusão: a prevalência teve como maioria vítimas adultos jovens, do sexo masculino; com ensino médio completo e que não possuem Carteira Nacional de Habilitação.Descritores: Acidente de trânsito. Motocicletas. Prevalência.AbstractIntroduction: Traffic accidents in Brazil translate into a complex public health problem, as they increase as the economic andtechnological development of modern society takes place, resulting in economic and social implications. The Northeast standsout with a high increase in the morbidity and mortality rate due to motorcycle accidents, overloading the health system, withhospitalizations that are often prolonged. Objective: To identify the prevalence of patients who suffered trauma due to motorcycleaccidents. Method: prospective cross-sectional study with a quantitative approach, performed in the Orthopedics sectorof a University Hospital in Maranhão, Brazil. Results: The predominant age group is between 18 and 35 years old (65%), male(77.50%), single (72.2%), complete high school (35%), residents of the capital São Luís-MA (57.5%). They were in the driver'sposition (92.50%), accidents had a higher occurrence during the night shift (37.50%) and it was reported to be the first time(52.50%) reported to be the first time he had a motorcycle accident, said they were not above the speed limit (70%) and did nothave a National Driver's License (55%). The use of the helmet was reported by 65% and 75% reported not being drunk. Conclusion:the prevalence had mostly young adult male victims; complete high school and do not have a National Driver's License.Keywords: Traffic accident. Motorcycles. Prevalence.

Deficiências e incapacidades na hanseníase: do diagnóstico à alta por cura

Objetivou-se comparar o grau de incapacidade física, os sítios corporais afetados, as deficiências e incapacidades presentes e os nervos acometidos no diagnóstico e na alta em pacientes com hanseníase.  Trata-se de um estudo desenvolvido entre 2009 e 2014 em centro de referência para hanseníase na Paraíba. Envolveu 414 prontuários, utilizando formulário estruturado. Os dados foram analisados através de técnicas de estatística descritiva (frequência absoluta e percentagem) e inferencial (Teste de Wilcoxon e Mcnemar). Nota-se decréscimo do acometimento dos sítios corporais (nariz p=0,000), das deficiências (ressecamento p=0,002 e ferida p=0,000 no nariz e úlcera p=0,004 nos pés) e da quantidade de nervos afetados (p=0,000) entre o diagnóstico e a alta por cura. Na análise dos anos 2009-2014 observa-se redução da quantidade de pacientes apresentando grau de incapacidade física 2. Conclui-se, portanto, que mesmo após a alta os pacientes estão propícios a desenvolver ou agravar incapacidades físicas, necessitando de acompanhamento periódico

Análise da viabilidade econômico-financeira da produção de Manihot esculenta (Crantz) em assentamentos rurais no município de Macaíba-RN/ Economic analysis and financial viability the production Manihot esculenta (Crantz) in rural settlements the municipality Macaíba-RN

Manihot esculenta (Crantz) pertence à família Euphorbiaceae, desempenhando um importante papel socioeconômico e cultural na região do Nordeste, tendo em vista, sua relevância e representatividade para a população, principalmente, para aquelas que vivem na base da economia familiar. Visto que o baixo nível de escolaridade entre os mandiocultores implica em um atraso nos avanços tecnológicos no sistema de produção, refletindo no desempenho econômico desta atividade. Para que se possa fazer o diagnóstico na determinação dos lucros ao final do cultivo, é importante determinar a viabilidade econômico-financeira, através de métodos de avaliação de investimentos baseado nos indicadores econômicos. O objetivo do presente trabalho foi analisar a viabilidade econômico-financeira da produção de M. esculenta nos projetos de assentamentos rurais Eldorado dos Carajás e Caracaxá no município de Macaíba-RN. A pesquisa foi realizada nos assentamentos rurais citados acima. Para a coleta de dados, além do procedimento de pesquisa bibliográfica, foram realizadas entrevistas semiestruturadas junto aos produtores de mandioca, as visitas de campo se deram para acompanhar todo o sistema de produção desde o plantio até a colheita. Foi feita a estimativa dos elementos de custos e de receita através de recursos quantitativos, como; tabelas, planilhas e gráficos em programas de computação, e os resultados considerando as previsões de investimento para o estabelecimento da cultura, a receita oriunda da venda da produção, considerando o Período de Retorno – PR, o Valor Presente Líquido – VPL e a Taxa Interna de Retorno – TIR, indicadores estes necessários para obter resultado final. A análise de mercado para o preço da raiz de mandioca observado foi de R$0,40 kg, ou seja, R$ 400,00 a tonelada; os custos de produção dos assentamentos Eldorado dos Carajás e Caracaxá foram de R$5.262,80 e R$ 4.929,00 no primeiro ano, havendo uma redução de 18,72% e 15,72% respectivamente, no ano seguinte, se mantendo estável até o final do período; Os elementos de receita da cultura da mandioca considerando três diferentes cenários de mercado: preço mínimo (R$0,18), médio (R$ 0,29) e máximo (R$0,40); Os valores de mercado destacaram-se no mês de junho de 2018 com o maior valor (R$ 0,40), em abril de 2019 atingiu valor médio (R$0,29) e o menor valor ocorreu no mês de agosto de 2019 (R$ 0,18); O Valor Presente Líquido (VPL), o Período de Retorno (PR), e a Taxa Interna de Retorno (TIR) demonstraram comportamentos semelhantes, visto que no primeiro cenário de mercado (I) apresentaram condições desfavoráveis para o produtor de mandioca assentado no Eldorado dos Carajás e Caracaxá. De acordo com os indicadores financeiros, o segundo cenário (II) exibiu uma situação mediana nos índices obtidos, e o terceiro cenário de mercado (III) apresentou condições favoráveis para o mandiocultor dos assentamentos mediante os resultados dos indicadores, apontando para a viabilidade econômico-financeira na produção de mandioca. De acordo com a análise econômico-financeira, a atividade da mandiocultura é viável considerando as condições ambientais e de cultivo observadas nos assentamentos Eldorado dos Carajás e Caracaxá

Avanços da cirurgia robótica no tratamento de doenças cardiovasculares

Várias cirurgias médicas já utilizaram a tecnologia robótica, tais como: cirurgias no estômago, bexiga, rins, próstata, cérebro e inclusive no coração, o qual proporciona-se a reparação de válvulas cardíacas e até mesmo cirurgias nas artérias. O principal objetivo do presente estudo é discutir por meio da literatura científica acerca dos avanços da cirurgia robótica no tratamento de doenças cardiovasculares. Trata-se de uma revisão sistemática da literatura, dos quais, utilizou-se as bases e biblioteca eletrônica Scielo e Periódico Capes, totalizando 5 artigos elegíveis. A cirurgia robótica tem sido um dos principais métodos utilizados em tratamentos cardiovasculares quando comparados com técnicas convencionais, sobretudo, no que diz respeito, a cirurgia de revascularização do miocárdio

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions