PANORAMA DA ASMA NA INFÂNCIA: EPIDEMIOLOGIA E ESTRATÉGIAS TERAPÊUTICAS

Asthma in children is a complex respiratory condition that requires a comprehensive understanding to provide effective management and improve children's quality of life. This condition, characterized by hyperreactive airways and chronic inflammation, is one of the most common chronic childhood illnesses, affecting millions of children around the world. The peculiarity of asthma in children lies not only in its clinical manifestations, such as wheezing, coughing and difficulty breathing, but also in the variety of factors that trigger and influence its expression. From genetic factors to environmental influences such as exposure to allergens and air pollutants, childhood asthma is an intricate intertwining of genetic predisposition and environmental interactions. This study proposes a literature review with the aim of analyzing and synthesizing information on the epidemiology and treatment of childhood asthma. With a special emphasis on Brazilian peculiarities and challenges, the research is based on reliable sources, such as PubMed, Scielo and data from the Brazilian Ministry of Health. Official reports, guidelines and information related to the epidemiology and treatment of childhood asthma were obtained from the official website of the Brazilian Ministry of Health, including bulletins, treatment guides and strategies for controlling this condition in the country. Asthma continues to be a public health concern, with marked variations in prevalence between countries and ethnic groups. Prevention and intervention strategies are essential to mitigate the social and economic impacts associated with asthma. As for treatment, we have seen notable developments in recent decades. Personalized therapeutic approaches have gained prominence, recognizing the heterogeneity of the disease. Inhaled corticosteroids remain a cornerstone of long-term control, while bronchodilators and leukotriene antagonists provide symptomatic relief. The significant prevalence of childhood asthma highlights the importance of effective measures to improve management and reduce the impact of the disease. It is imperative to implement preventive strategies that address environmental factors, such as reducing exposure to allergens and pollutants, contributing to the prevention of the development of asthma in predisposed children. Furthermore, promoting smoke-free environments and raising awareness about associated risks are crucial to protecting children's respiratory health.A asma em crianças é uma condição respiratória complexa que exige uma compreensão abrangente para proporcionar um manejo eficaz e melhorar a qualidade de vida dos pequenos. Essa condição, caracterizada por vias respiratórias hiperreativas e inflamação crônica, é uma das doenças crônicas mais comuns na infância, afetando milhões de crianças em todo o mundo. A peculiaridade da asma em crianças reside não apenas em suas manifestações clínicas, como sibilos, tosse e dificuldade respiratória, mas também na variedade de fatores que desencadeiam e influenciam sua expressão. Desde fatores genéticos até influências ambientais, como exposição a alérgenos e poluentes do ar, a asma infantil é um intricado entrelaçamento de predisposição genética e interações ambientais. Este estudo propõe uma revisão de literatura com o objetivo de analisar e sintetizar informações sobre a epidemiologia e tratamento da asma na infância. Com uma ênfase especial nas peculiaridades e desafios brasileiros, a pesquisa fundamenta-se em fontes confiáveis, como PubMed, Scielo e dados do Ministério da Saúde do Brasil. Relatórios, diretrizes e informações oficiais relacionadas à epidemiologia e tratamento da asma na infância foram obtidos no site oficial do Ministério da Saúde do Brasil, incluindo boletins, guias de tratamento e estratégias de controle dessa condição no país. A asma continua a ser uma preocupação de saúde pública, com variações marcantes na prevalência entre países e grupos étnicos. Estratégias de prevenção e intervenção são fundamentais para mitigar os impactos sociais e econômicos associados à asma. Quanto ao tratamento, observamos uma evolução notável nas últimas décadas. Abordagens terapêuticas personalizadas ganharam destaque, reconhecendo a heterogeneidade da doença. Corticosteroides inalatórios permanecem uma pedra angular no controle a longo prazo, enquanto broncodilatadores e antagonistas de leucotrienos proporcionam alívio sintomático. A prevalência significativa da asma infantil destaca a importância de medidas efetivas para melhorar o manejo e reduzir o impacto da doença. É imperativo implementar estratégias preventivas que abordem fatores ambientais, como a redução da exposição a alérgenos e poluentes, contribuindo para a prevenção do desenvolvimento da asma em crianças predispostas. Além disso, a promoção de ambientes livres de fumo e a conscientização sobre os riscos associados são cruciais para proteger a saúde respiratória infantil

EVALUACIÓN MICROBIOLÓGICA DE LECHE CRUDA COMERCIALIZADA EN LA CIUDAD DE CASTANHAL, ESTADO DE PARÁ, BRASIL

Este estudo visa verificar a qualidade microbiológica do leite cru comercializado no município de Castanhal, no estado do Pará.  Foram coletadas 14 amostras de leite cru, em feiras-livres, padarias e de vendedores ambulantes e encaminhadas para a realização das análises, para Contagem de Bactérias Aeróbias Mesófilas, contagem de Staphylococcus coagulase positiva, contagem de Enterobacteriaceae, contagem de bolores e leveduras, por fim, a enumeração provável de coliformes a 35ºC e 45ºC. Os resultados da contagem de bactérias, variaram entre 1,2×10⁴ e 2,5×10⁷ UFC/mL. A contagem de Staphylococcus coagulase positiva, variou entre 1,0×10⁴ a 1,2×108 UFC/mL. Os resultados da contagem de Enterobactérias os resultados apresentaram-se entre 3,0×10³ e 7,0×107 UFC/mL. Quanto os resultados obtidos para contagem de bolores e leveduras foram entre 6,0×10³ e 4,5x10⁵ UFC/mL. Nas determinações de Números Mais Prováveis de Coliformes a 35ºC e 45ºC, os valores variaram de 11 a <1100 NMP/mL. Todos os resultados obtidos nas análises apontaram contaminações que podem desencadear danos à saúde pública e eventuais casos de Doenças Transmitidas por Alimentos (DTA). Desta forma, faz-se necessário um controle mais rígido por parte dos agentes de fiscalização de modo a se garantir a qualidade e segurança do produto.This study aims to verify the microbiological quality of raw milk sold in the municipality of Castanhal in the state of Pará. 14 samples of raw milk were collected at street markets, bakeries and street vendors and sent for analysis, for Mesophilic Aerobic Bacteria Counting, coagulase positive Staphylococcus count, Enterobacteriaceae count, mold and yeast count, by end the probable enumeration of coliforms at 35°C and 45°C. Bacterial count results varied between 1.2×10⁴ and 2.5×10⁷ UFC/mL. Staphylococcus coagulase positive count ranged from 1.0×10⁴ to 1.2×108 UFC/mL. The results of the Enterobacteriaceae count were between 3.0×10³ and 7.0×107 UFC/mL. The results obtained for counting molds and yeasts were between 6.0×10³ and 4.5x10⁵ UFC/mL. In the Most Likely Numbers of Coliform determinations at 35°C and 45°C, values ​​ranged from 11 to <1100 MNP/mL. All results obtained in the analyzes pointed to contamination that could trigger damage to public health and possible cases of Foodborne Diseases (DTA). In this way, it is necessary a stricter control by the inspection agents in order to guarantee the quality and safety of the product.Este estudo visa verificar a qualidade microbiológica do leite cru comercializado no município de Castanhal, no estado do Pará.  Foram coletadas 14 amostras de leite cru, em feiras-livres, padarias e de vendedores ambulantes e encaminhadas para a realização das análises, para Contagem de Bactérias Aeróbias Mesófilas, contagem de Staphylococcus coagulase positiva, contagem de Enterobacteriaceae, contagem de bolores e leveduras, por fim, a enumeração provável de coliformes a 35ºC e 45ºC. Os resultados da contagem de bactérias, variaram entre 1,2×10⁴ e 2,5×10⁷ UFC/mL. A contagem de Staphylococcus coagulase positiva, variou entre 1,0×10⁴ a 1,2×108 UFC/mL. Os resultados da contagem de Enterobactérias os resultados apresentaram-se entre 3,0×10³ e 7,0×107 UFC/mL. Quanto os resultados obtidos para contagem de bolores e leveduras foram entre 6,0×10³ e 4,5x10⁵ UFC/mL. Nas determinações de Números Mais Prováveis de Coliformes a 35ºC e 45ºC, os valores variaram de 11 a <1100 NMP/mL. Todos os resultados obtidos nas análises apontaram contaminações que podem desencadear danos à saúde pública e eventuais casos de Doenças Transmitidas por Alimentos (DTA). Desta forma, faz-se necessário um controle mais rígido por parte dos agentes de fiscalização de modo a se garantir a qualidade e segurança do produto.Este estudio tiene como objetivo verificar la calidad microbiológica de la leche cruda comercializada en el municipio de Castanhal en el estado de Pará.  Se recogieron un total de 14 muestras de leche cruda de mercados abiertos, panaderías y vendedores ambulantes y se enviaron para su análisis, para el recuento de bacterias aeróbicas mesófilas, el recuento de Staphylococcus coagulasa positivo, el recuento de enterobacteriaceae, el recuento de moho y levaduras, poniendo fin a la probable enumeración de coliformes a 35ºC y 45ºC. varió de 1,2×10⁴ a 2,5×10⁷ UFC/ml. El recuento de Staphylococcus coagulasa positivo varió de 1,0×10⁴ a 1,2×108 UFC/ml. Los resultados del recuento de enterobacterias estuvieron entre 3,0×10³ y 7,0×107 UFC/ml. Los resultados obtenidos para los recuentos de moho y levadura estuvieron entre 6.0×10³ y 4.5x10⁵ UFC/mL. En las determinaciones del número más probable de coliformes a 35ºC y 45ºC, los valores variaron de 11 a <1100 NMP/mL. Todos los resultados obtenidos en los análisis apuntaron a contaminaciones que pueden desencadenar daños a la salud pública y eventuales casos de Enfermedades Transmitidas por los Alimentos (DTA). De esta manera, es necesario un control más rígido por parte de los agentes de inspección con el fin de garantizar la calidad y seguridad del producto

Alterações neurológicas associadas a SARS-CoV-2: uma revisão de literatura: Associated neurological changes the SARS-CoV-2: a literature review

Introdução. A doença comumente conhecida por COVID-19 é capaz de ser encontrada em todos os órgãos e sistemas. Contudo o SNC pode ser afetado de forma que cause danos significativos aos que foram acometidos pela mesma. Desta forma, este trabalho é uma revisão acerca dos achados e suas manifestações para que possamos no futuro triar, buscar e analisar fatores neurologicamente afetados. Objetivo. Analisar e revisar matérias que possam auxiliar no detalhamento acerca de alterações neurológicas oriundas da COVID-19. Método. A estratégia utilizada contou com estudos, tendo por base uma análise em plataformas como o Google Acadêmico, PubMed, SciELO, Medical Subject Heading (MeSH), nas quais cada fonte de dados contou com um estudo acerca dos títulos, assuntos e tipos específicos na língua portuguesa e inglesa. Resultados. Foi possível ao longo de 16 artigos analisados, observar que grande parte da população analisada teve alterações, sejam elas leves como mialgia, disfunções de olfato e paladar, podendo a ter alterações graves como o Acidente Vascular Cerebral (AVC). Além disso, foi possível observar que pacientes com morbidades como a DM e a HAS tiveram maiores propensões a doenças cerebrovasculares. Conclusão. Este estudo oferece uma nova forma de pensar e analisar as alterações causadas pela COVID-19, associado com as alterações neurológicas. Com isso, podemos ajudar a identificar e classificar as possíveis alterações, a fim de auxiliar no combate a alterações severas

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good