CORRELAÇÃO ENTRE O ÍNDICE DE MASSA CORPÓREA (IMC), GRAVIDADE E CONTROLE DA ASMA EM PACIENTES PARTICIPANTES DE UM PROGRAMA ESTRUTURADO DE EDUCAÇÃO EM ASMA

O aumento do índice de massa corporal (IMC) tem sido associado a uma maior prevalência da asma em adultos. O presente estudo tem o objetivo de correlacionar o IMC com a gravidade e o nível de controle da asma dos pacientes atendidos em um programa estruturado de educação em asma. 182 pacientes diagnosticados como portadores de asma brônquica foram entrevistados e classificou-se a gravidade da asma através da história clínica, dos resultados da espirometria e da medicação prescrita, segundo a IV Diretriz Brasileira para o Manejo da Asma. O IMC foi calculado e foram considerados obesos os pacientes com IMC ≥ 30 kg/m². Para verificar a existência de associação entre o IMC e a gravidade da asma, bem como entre o IMC e o nível de controle da asma, foi utilizado o teste do qui-quadrado. Com relação à gravidade da doença: 0,5 % apresentavam asma intermitente; 25,8% asma persistente leve; 69,2% asma persistente moderada e 4,4% apresentavam asma persistente grave. A distribuição dos pacientes segundo o IMC mostrou que 20,9 % eram obesos. Quanto ao controle da asma, segundo o Teste de Controle da Asma (ACT), dos pacientes: 15,9% possuíam asma não controlada; 67,6% asma parcialmente controlada e 16,5 % asma controlada. Na amostra estudada notou-se uma associação entre obesidade e gravidade da asma, porém sem significância estatística (p>0,05); notou-se também associação positiva entre obesidade e menor nível de controle da asma, porém o valor de p não foi significativo (p>0,05).Palavras-chave: Asma. IMC. Correlação.CORRELATION BETWEEN BODY MASS INDEX (BMI), GRAVITY AND CONTROL OF ASTHMA IN PATIENTS PARTICIPATING IN A STRUCTURED PROGRAM OF EDUCATION IN ASTHMAAbstract: The Increased of body mass index (BMI) has been associated to a higher prevalence of asthma in adults. The present study aims to correlate the BMI with the severity and the control level of asthma of the patients attended in a structured program of asthma education. 182 patients diagnosed with asthma were interviewed and the severity of asthma was ranked by clinical history, results of spirometry and prescribed medication, according to the IV Brazilian Guidelines for the Management of Asthma. BMI was calculated and were considered obese patients with BMI ≥ 30 kg / m². To verify the existence of an association between BMI and asthma severity, as well as between BMI and the level of asthma control the chi-square test was used. Regarding the severity of the disease: 0.5% had intermittent asthma, 25.8% mild persistent asthma, 69.2% moderate persistent asthma and 4.4% had severe persistent asthma. The distribution  of patients according to BMI showed that 20.9% were obese. Regarding the control of asthma, according to the Asthma Control Test (ACT), patients: 15.9% had uncontrolled asthma, asthma 67.6% and 16.5% partially controlled asthma control. This study noted a correlation between obesity and asthma severity, however without statistical significance (p> 0.05), it was also noted a positive association between obesity  and lower level of asthma control, but the value of p was not significant (p> 0.05).Keywords: Asthma. BMI. Correlation.CORRELACIÓN ENTRE EL ÍNDICE DE MASA CORPORAL (IMC) CON LA GRAVEDAD Y EL CONTROL DEL ASMA EN PACIENTES PARTICIPANTES DE UN PROGRAMA ESTRUCTURADO DE EDUCACIÓN EN ASMAResumen: el aumento del índice de masa corporal (IMC) se ha asociado con una mayor prevalencia de asma en adultos. El presente estudio tiene como objetivo correlacionar con el IMC el nivel de gravedad y de control del asma de los pacientes atendidos en un programa estructurado de educación sobre el asma. 182 pacientes con diagnóstico de asma fueron entrevistados y se clasificó la gravedad del asma mediante la historia clínica, los resultados de la espirometría y la medicación prescrita, de acuerdo con las IV Directrices  Brasileñas para el tratamiento del asma. Se calculó el IMC y se consideraron obesos los pacientes con un IMC ≥ 30 kg / m². Para verificar la existencia de una asociación entre el IMC y la gravedad del asma, así como entre el IMC y el nivel de control del asma se utilizo la prueba de chi-cuadrado. Con respecto a la severidad de la enfermedad: el 0,5% tenian asma intermitente, el 25,8% asma persistente leve, el  69,2% asma persistente moderada y 4.4% tenían asma persistente grave. La distribución de pacientes según el índice de masa corporal mostró que el 20,9% eran obesos. Con relación al control del asma, de acuerdo a la Asthma Control Test (ACT), el 15,9% de los pacientes tenian asma no controlada, 67,6%tenían asma parcialmente controlada y el 16,5% asma controlada. Este estúdio observo una correlación entre la obesidad y la gravedad del asma, pero sin significación estadística (p> 0,05), también se observo una asociación positiva entre la obesidad y un menor nivel de control del asma, pero el valor de p no fue significativo.Palabras clave: Asma. El IMC. La correlación

Prevalência de comorbidades e classificação de nível de controle em pacientes com asma grave / Prevalence of comorbidities and classification of control level in patients with severe asthma

Introdução: Há relatos na literatura mostrando associação entre diversas comorbidades e a asma brônquica, sendo que muitas podem ser vistas como causa e/ou consequência uma da outra. Objetivo: Conhecer a prevalência das comorbidades dos pacientes com asma grave e fazer a classificação quanto ao controle clínico da asma. Métodos: Estudo retrospectivo com pacientes com diagnóstico de asma grave assistidos no Programa de Assistência ao Paciente Asmático do Hospital Universitário da Universidade Federal do Maranhão. Utilizou-se a análise descritiva e o teste qui-quadrado. Resultados: Foram estudados 109 pacientes com asma grave, dos quais 37 (33,9%) apresentavam asma controlada, 38 (34,9%) não controlada e 34 (31,2%) parcialmente controlada, sendo 76 (69,7%) do sexo feminino, idade média de 52,1+/-17 anos. Das comorbidades encontradas em associação à asma grave a rinossinusite foi a mais frequente com 41 (37,6%) além da osteoporose 6 (5,5%), hipertensão arterial sistêmica 20 (18,3%), diabetes mellitus 6 (5,5%) e glaucoma 2 (1,8%). Dos pacientes, 34 (31,2%) não apresentavam comorbidades diagnosticadas, e 75 (68,8%) tinham comorbidades associada. Observou-se que não houve significância estatística (p=0,3924) quando se correlacionou o nível de controle com a presença de comorbidades. Conclusão: A doença mais frequente associada à asma grave foi a rinossinusite. A investigação de comorbidades é imperativa na avaliação de pacientes que apresentam asma grave, porém as comorbidades apresentadas não interferiram no controle da doença.Palavras-chave: Asma grave. Rinossinusite. ComorbidadeAbstractIntroduction: There are studies in the literature showing an association between many comorbidities and asthma. Many of these diseases can be seen as cause and / or consequence of each other. Objective: To determine the prevalence of comorbidities of patients with severe asthma and to sort the asthma according to the its clinical control. Methods: Retrospective study of patients with severe asthma assisted in the Asthmatic Patient Care Program of the University Hospital, FederalUniversity of Maranhão. We used descriptive analysis and chi-square test. Results: 109 patients with severe asthma participated in this study. Of these patients, 37 (33.9%), 38 (34.9%) and 34 (31.2%), had controlled, uncontrolled and partially controlled asthma, respectively. 76 (69.7%) were female with mean age of 52.1 + / -17 years. Regarding the comorbitiesassociated to severe asthma, rhinosinusitis was the most frequent 41 (37.6%). Osteoporosis accounted for six (5.5%), hypertension with 20 (18.3%), diabetes mellitus with 6 (5.5%), glaucoma with 2 (1.8%). Of all patients, 34 (31.2%) had no diagnosed comorbidity. In most cases 75 (68.8%), at least one these diseases was present. It was also observed that there was not statistical significance (p = 0.3924) when we correlated the level of control with presence of comorbidities. Conclusion: Rhinosinusitis was the most common disease associated with severe asthma in the study. The investigation of comorbidities is essential in the evaluation of patients with this form of disease; however, the diagnosed diseases didn't interfere with the disease control.Keywords: Severe asthma. Rhinosinusitis. Comorbidities

OBSTRUÇÃO INTESTINAL POR CORPOS ESTRANHOS EM DOIS INDIVÍDUOS CHELONOIDIS CARBONARIA

Intestinal obstruction in tortoises is very recurrent in the clinic due to the ingestion of foreign bodies. Here, two of these cases are reported in individuals of the species Chelonoidis carbonaria, taken to the clinic with anorexia and intestinal constipation with absence of defecation. The cases were diagnosed after additional tests were carried out, such as radiography, which enabled the definitive diagnosis, as it made it possible to visualize the amorphous content in the gastrointestinal tract of both individuals. The animals underwent emergency celiotomies, opening an access window in the plastron, making it possible to access the cavity for removal of foreign bodies. The postoperative period was different in each case, due to specific complications, such as a possible anemic and/or infectious condition in the postoperative period in one of the animals. It is concluded that enterotomy with removal of foreign bodies is effective in treating severe cases of obstruction, and that rearing reptiles such as pets requires specialized veterinary care to provide adequate management and facilities to avoid the ingestion of foreign bodies by the animals.A obstrução intestinal em jabutis é muito recorrente na clínica devido à ingestão de corpos estranhos. Aqui, são relatados dois destes casos em indivíduos da espécie Chelonoidis carbonaria, levados à clínica apresentando anorexia e constipação intestinal com ausência de defecação. Os casos foram diagnosticados após serem realizados exames complementares, a exemplo da radiografia, que possibilitou o diagnóstico definitivo, já que tornou possível a visualização do conteúdo amorfo no trato gastrointestinal dos dois indivíduos. Os animais foram submetidos a celiotomias de emergência, abrindo uma janela de acesso no plastrão, sendo possível acessar a cavidade para retirada dos corpos estranhos. O pós-cirúrgico foi diferente em cada caso, devido a complicações específicas, a exemplo de um possível quadro anêmico e/ou infeccioso no pós-operatório em um dos animais. Conclui-se que a enterotomia com remoção dos corpos estranhos é eficaz para tratar casos severos de obstrução, e que criação de répteis como pets necessita de acompanhamento veterinário especializado para propiciar manejo e instalações adequadas visando evitar a ingestão de corpos estranhos pelos animais

Primum non nocere e a prevenção quaternária: Revisão sistemática com metanálise / Primum non nocere and quaternary prevention: Systematic review with metanalysis

No decorrer da história da humanidade as concepções do processo saúde-doença foram mudando até desembocar na atualidade no entendimento biopsicossocial. Atravessando compreensões que iam desde conceitos mágicos a compreensão multifatorial do adoecer.  Destarte, as ações dos profissionais de saúde devem ser pautadas por procedimentos, protocolos e sistematizações para que se tragam melhorias para as pessoas e a sociedade no geral. Assim em 1995 foi desenvolvido o conceito de prevenção quaternária que pode ser entendido como a prevenção desenvolvida no que tange aos tratamentos e intervenções desnecessárias e/ou excessivas nos sujeitos causando diversos tipos de iatrogenias. Para chegar ao objetivo do trabalho foi realizado uma revisão sistemática com metanálise sobre a prevenção quaternária, seguindo com rigor todo o protocolo prisma de revisão sistemática, coletando as divulgações cientificas que abordaram o tema. Como resultados encontrou-se poucas publicações sobre o tema que se mostra de grande relevância diante do cenário econômico atual no qual aponta-se como uma alternativa para reduzir gastos. Pois diante da pesquisa mostrou-se de grande valia para diminuir despesas e melhorar a qualidade da saúde

A TECNOLOGIA COMO DISPOSITIVO DO ATENDIMENTO HUMANIZADO NA ATENÇÃO BÁSICA À SAÚDE

Over the years, it has been observed that technology has been advancing more and more and has contributed significantly to people's lives, as well as to important areas such as health, because, based on these tools, it becomes possible to develop care faster and more humanized to patients who seek primary health care to obtain medical assistance. Thus, the research aims to explain the relevance of technology as a device for humanized care in primary health care. The methodology used consisted of the literature review method in order to obtain concise information about the objective of the work, with articles published from 2019 to 2022 available on Scielo, Lilacs and PubMed. Researches that were lower than 2019 were excluded, as well as those whose content was not in Portuguese, which would make the researchers' verification and analysis process difficult. In this way, the results pointed to the benefits caused by technology, enabling better care in terms of medical consultations, exams and guidance to patients, making humanized care in primary health care an essential factor. Concluding on the need to expand technology as a humanized device in all primary health care units, considering that some locations do not have these tools, because, in addition to promoting effectiveness in terms of faster assistance, it enables the minimization queue for appointments and exams.Com o passar dos anos, observa-se que a tecnologia vem avançando cada vez mais e contribuído de forma significativa na vida das pessoas, como também para áreas importantes como a da saúde, pois, a partir dessas ferramentas que torna-se possível desenvolver atendimento mais rápidos e humanizado aos pacientes que buscam atenção básica de saúde para obter assistência médica. Assim, a pesquisa objetiva explicar sobre a relevância da tecnologia como dispositivo do atendimento humanizado na atenção básica à saúde. A metodologia utilizada consistiu no método revisão de literatura com o intuito de obter informações concisas a respeito do objetivo do trabalho, sendo inserido artigos publicados no período de 2019 a 2022 disponíveis na Scielo, Lilacs e PubMed. Sendo excluídas pesquisas que estavam inferior a 2019, bem como aquelas cujo conteúdo não era língua portuguesa, o que dificultaria o processo de verificação e análise dos pesquisadores. Dessa forma, os resultados apontaram sobre os benefícios ocasionados pela tecnologia, possibilitando melhores atendimentos em termos de consultas médicas, exames e orientações aos pacientes, tornando o atendimento humanizado na atenção básica à saúde como um fator imprescindível. Concluindo-se sobre a necessidade de ampliar a tecnologia como dispositivo humanizado em todas as unidades de atenção básica à saúde, tendo em vista que algumas localidades não dispõem dessas ferramentas, pois, além de promover eficácia em termos de assistência mais rápida, possibilita a minimização da fila de espera por atendimentos e exames

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

The xanthomonas citri pv. citri type VI secretion system is induced during epiphytic colonization of citrus

Xanthomonas citri pv. citri (X. citri pv. citri) is the causal agent of Asiatic citrus canker and infects economically important citrus crops. X. citri pv. citri contains one type VI secretion system (T6SS) required for resistance to predation by the soil amoeba Dictyostelium discoideum and induced by the ECF sigma factor EcfK in the presence of amoeba. In this work, we describe the analysis of T6SS gene expression during interaction with host plants. We show that T6SS genes and the cognate positive regulator ecfK are upregulated during growth in the plant surface (epiphytic) and maintain low expression levels during growth inside plant mesophyll. In addition, expression of the virulence-associated T3SS is also induced during epiphytic growth and shows a temporal induction pattern during growth inside plant leaves. The T6SS is not required for adhesion to leaf surface and biofilm formation during the first stages of plant colonization nor for killing of yeasts cells. Since the phyllosphere is colonized by eukaryotic predators of bacteria, induction of the X. citri pv. citri anti-amoeba T6SS during epiphytic growth suggests the presence of an environmental signal that triggers the resistance phenotype761011051111CAPES - Coordenação de Aperfeiçoamento de Pessoal e Nível SuperiorFAPESP – Fundação de Amparo à Pesquisa Do Estado De São Paulonão tem2011/07777-5; 2014/19720-6; 2018/01852-4; 2014/25261-4; 2017/02318-9; 2011/22571-4; 2016/08400-