AS QUESTÕES SOCIOJURÍDICAS NO BRASIL: A RELAÇÃO ENTRE A DESIGUALDADE SOCIAL, A CRIMINALIDADE E O DIREITO

O presente artigo tem por objetivo tratar da relação entre Desigualdade Social e Criminalidade à luz do Direito. A princípio, procuramos identificar as raízes das desigualdades sociais brasileiras, entre elas: a colonização exploratória e escravocrata, e a falta de planejamento nos processos de urbanização e industrialização. Em consonância com esses fatos, buscamos elucidar as linhas de pensamento desenvolvidas por estudiosos que atribuem a desigualdade social, ao desarmamento civil e a impunidade como consequentes fomentadores da Criminalidade. Ademais, a partir da hipótese de que a negação dos direitos básicos fundamentais, com ênfase na pobreza extrema, são propulsores para os delitos, entendemos que o Estado deve promover equidade, através de políticas públicas objetivando a Justiça Social. &nbsp

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

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

Decreased Premotor Cortex Volume in Victims of Urban Violence with Posttraumatic Stress Disorder

Background: Studies addressing posttraumatic stress disorder (PTSD) have demonstrated that PTSD patients exhibit structural abnormalities in brain regions that relate to stress regulation and fear responses, such as the hippocampus, amygdala, anterior cingulate cortex, and ventromedial prefrontal cortex. Premotor cortical areas are involved in preparing to respond to a threatening situation and in representing the peripersonal space. Urban violence is an important and pervasive cause of human suffering, especially in large urban centers in the developing world. Violent events, such as armed robbery, are very frequent in certain cities, and these episodes increase the risk of PTSD. Assaultive trauma is characterized by forceful invasion of the peripersonal space; therefore, could this traumatic event be associated with structural alteration of premotor areas in PTSD?Methodology/Principal Findings: Structural magnetic resonance imaging scans were acquired from a sample of individuals that had been exposed to urban violence. This sample consisted of 16 PTSD patients and 16 age-and gender-matched controls. Psychometric questionnaires differentiated PTSD patients from trauma-exposed controls with regard to PTSD symptoms, affective, and resilience predispositions. Voxel-based morphometric analysis revealed that, compared with controls, the PTSD patients presented significant reductions in gray matter volume in the ventral premotor cortex and in the pregenual anterior cingulate cortex.Conclusions: Volume reduction in the premotor cortex that is observed in victims of urban violence with PTSD may be associated with a disruption in the dynamical modulation of the safe space around the body. the finding that PTSD patients presented a smaller volume of pregenual anterior cingulate cortex is consistent with the results of other PTSD neuroimaging studies that investigated different types of traumatic events

ESCORE MMCD PARA PREDIÇÃO DE TERAPIA RENAL SUBSTITUTIVA E MORTALIDADE INTRA-HOSPITALAR EM PACIENTES HOSPITALIZADOS COM COVID-19 DE 2020 A 2022

Introdução: A lesão renal aguda (LRA) com necessidade de terapia renal substitutiva (TRS) em suas formas mais graves é uma complicação importante de pacientes com covid-19. O desenvolvimento de um escore de risco para predizer a necessidade de TRS pode ser muito útil, para melhor alocação de recursos de saúde. Assim, este estudo teve como objetivo desenvolver e validar um escore para predição de necessidade de TRS, em pacientes hospitalizados com covid-19, entre 2020 e 2022. Métodos: Trata-se de uma coorte retrospectiva multicêntrica de pacientes consecutivos internados por covid-19, confirmada laboratorialmente, em 40 hospitais brasileiros, entre março de 2020 e julho de 2022. Foram excluídos do estudo pacientes menores de 18 anos, grávidas, em cuidados paliativos ou terapia dialítica à admissão. A seleção de variáveis preditoras foi realizada utilizando modelos aditivos generalizados (GAM). Enquanto, a regressão do operador de seleção e contração mínima absoluta (LASSO) foi usada para derivação de pontuação. O escore foi desenvolvido no período de março a julho de 2020, com validação temporal e geográfica de julho a setembro de 2020 e nova validação temporal no período de março de 2021 a julho de 2022. O desempenho do MMCD foi avaliado pela área sob a curva da característica de operação do receptor (AUROC, com intervalo de confiança de 95%), análise gráfica com teste de intercepto e inclinação e escore de Brier. Resultados: Foram incluídos 3.680 pacientes na amostra de desenvolvimento, 1.532 na validação temporal 2020, 1.378 na validação geográfica e 9.473 na validação temporal 2021-2022. Quatro preditores da necessidade de TRS foram identificados: ventilação mecânica a qualquer momento da internação, sexo masculino, creatinina à admissão e diabetes mellitus. O escore nomeado como MMCD apresentou excelente discriminação, calibração e desempenho geral nas coortes de derivação e validações (desenvolvimento: AUROC: 0.929; IC95%: 0.918–0.939, escore de Brier: 0.057; validação temporal 2020: AUROC 0.927, IC95% 0.911–0.941, escore de Brier 0.056; validação geográfica 2020: AUROC: 0.819, IC95% 0.792–0.845, escore de Brier 0.122; validação temporal 2021/2022: AUROC 0.916, IC95% 0.909-0.924, escore de Brier 0.057). Conclusão: O MMCD apresentou excelente capacidade preditiva para TRS nas diferentes fases da pandemia, o que pode contribuir para subsidiar decisões mais assertivas na alocação de recursos assistenciais

Statistical parametric mapping (SPM) showing clusters in the left pregenual anterior cingulate cortex and the right ventral premotor cortex.

<p>There are significant differences in gray matter volume between the PTSD and control groups.</p

Characteristics of the sample population.

<p>Characteristics of the sample population.</p