Avaliação e manejo de arritmias cardíacas em crianças: uma revisão.

Introduction: Cardiac arrhythmias, such as tachycardia and atrial fibrillation, are common disorders that can lead to serious complications. Risk factors include heart diseases, electrolyte disturbances, medication use, stress, and substance consumption. Objective: Therefore, the present study aims to analyze the evaluation and management of cardiac arrhythmias in pediatric patients. Methodology: In this exploratory literature review, the PMC, LILACS, Google Scholar, and SciELO databases were used to search for scientific articles published between 2014 and 2024 in Portuguese or English on pediatric cardiac arrhythmias. After removing duplicates and analyzing in stages, 52 documents were included for full analysis. Of the 52 documents, 12 were considered relevant for the production of results. The review was conducted according to established guidelines, despite not determining a questioning system. Results: The evaluation and management of cardiac arrhythmias in pediatric patients require a careful and individualized approach. Other diagnostic methods include ECG, electrophysiological study, and cardiac magnetic resonance imaging. Furthermore, treatment varies according to the type and severity of the arrhythmia, and may involve antiarrhythmic drugs, catheter ablation, or pacemaker implantation. Conclusion: The evaluation and management of cardiac arrhythmias in pediatric patients are crucial to ensure the quality of life of these individuals. In this sense, a careful and individualized approach is essential, which includes a detailed initial assessment, complementary exams, and appropriate treatment. Knowledge of the specific characteristics of arrhythmias in children, together with regular monitoring by a pediatric cardiology specialist, is fundamental to avoid unfavorable outcomes. Additionally, further studies and continuous search for updates in guidelines and scientific articles are essential to improve management and early diagnosis, aiming at optimizing treatment and improving the quality of life of these patients. Keywords: Cardiac Arrhythmias; Cardiology; Pediatrics; Management.Introdução: Arritmias cardíacas, como taquicardia e fibrilação atrial, são distúrbios comuns que podem levar a complicações sérias. Fatores de risco incluem doenças cardíacas, distúrbios eletrolíticos, uso de medicamentos, estresse e consumo de substâncias. Objetivo: Sendo assim, o presente trabalho tem como objetivo analisar a avaliação e manejo das arritmias cardíacas em pacientes pediátricos. Metodologia: Nesta revisão de literatura exploratória, foram utilizadas as bases de dados do PMC, LILACS, Google Acadêmico e SciELO para buscar artigos científicos publicados entre 2014 e 2024 em português ou inglês sobre arritmias cardíacas pediátricas. Após a correção de duplicatas e análise em etapas, 52 documentos foram incluídos para análise integral. Dos 52 documentos, 12 foram considerados relevantes para a produção de resultados. A revisão foi conduzida de acordo com as diretrizes estabelecidas, apesar de não determinar uma sistematização por questionamento. Resultados: A avaliação e manejo das arritmias cardíacas em pacientes pediátricos requerem uma abordagem cuidadosa e individualizada. Outros métodos de diagnóstico incluem ECG, estudo eletrofisiológico e ressonância magnética cardíaca. Além disso, o tratamento varia de acordo com o tipo e gravidade da arritmia, podendo envolver medicamentos antiarrítmicos, ablação por cateter ou implante de marcapasso. Conclusão: A avaliação e manejo das arritmias cardíacas em pacientes pediátricos são cruciais para garantir a qualidade de vida desses indivíduos. Nesse sentido, é essencial uma abordagem cuidadosa e individualizada, que inclui uma avaliação inicial detalhada, exames complementares e tratamento adequado. O conhecimento das características específicas das arritmias em crianças, juntamente com o acompanhamento regular por um especialista em cardiologia pediátrica, é fundamental para evitar desfechos desfavoráveis. Além disso, o aprofundamento dos estudos e a busca constante por atualizações nas diretrizes e artigos científicos são essenciais para aprimorar o manejo e a precocidade diagnóstica, visando a otimização do tratamento e a melhoria da qualidade de vida desses pacientes

Uma abordagem acerca da Influenza A-H1N1 e a pandemia de Covid-19 no contexto brasileiro: uma revisão integrativa / An approach to Influenza A-H1N1 in the Brazilian context: an integrative review

O presente estudo tem como objetivo relatar os aspectos da influenza A-H1N1, dentre eles a caracterização viral, diagnóstico e prevenção. Ademais, objetivou-se na abordagem o papel dos suínos na transmissão interespécie e a epidemiologia da doença no Brasil, bem como as semelhanças da doença com a COVID-19, que apresentam um desafio para a saúde pública do país. Trata-se de uma revisão integrativa da literatura realizada através da Biblioteca Virtual em Saúde (BVS), com o auxílio das bases de dados Literatura Latino-Americana e do Caribe em Ciências (LILACS), Scientific Library Eletronic Library Online (SciELO) e Base de Dados de Enfermagem (BDENF), sendo utilizados os descritores: Brasil; COVID-19; Epidemiologia; Patologia e Vírus da influenza A subtipo H1N1, localizados no DeCS. Tais descritores foram cruzados utilizando o operador booleano AND. Foram identificados inicialmente 736 estudos nas bases elencas e, após aplicação dos critérios de inclusão e exclusão, apenas 06 estudos foram selecionados para composição e análise do estudo. Os estudos apontam a sintomatologia ocasionada pelos vírus da Influenza A-H1N1 e COVID-19é semelhante, assim como a forma de transmissão e o agravamento ocasionado pela presença eventual de doenças prévias. A diferenciação se encontra no período de incubação, sendo de 3 a 7 dias no caso da influenza e de 2 a 14 dias na COVID-19. Conclui-se que no contexto pandêmico atual envolvendo o vírus SARS-CoV-2 exige um maior monitoramento, uma vez que as enfermidades possuem semelhanças que podem levar a confusão e dificultar o atendimento

Síndrome de Morgagni-Stewart-Morel: Morgagni-Stewart-Morel syndrome

Introdução: a síndrome de Morgagni Stewart Morel é uma entidade clínica rara. Sua principal característica é a hiperostose frontal interna. Além disso, conta com alterações endócrinas​ metabólicas e psiquiátricas. Pode estar acompanhada de obesidade, diabetes mellitus e hirsutismo. Possui maior prevalência na população feminina. Apresentação do caso: paciente do sexo feminino, 65 anos, obesa em menopausa há 12 anos. Relata em consulta queixa de cefaleia em aperto na região frontal há cerca de 6 anos. A mesma vem se intensificando gradativamente e há 01 semana a dor não é sanada mesmo com o uso de anti-inflamatórios ou analgésicos orais. Discussão: a síndrome de Morgagni-Stewart-Morel consiste em uma condição rara, caracterizada pela presença de Hiperostose Frontal Interna (HFI) associada a alterações metabólicas, psiquiátricas e endócrinas. Sua definição não é uniforme devido a diversidade de sintomas e a sua variabilidade em cada indivíduo. Possui incidência maior no sexo feminino e com idade acima de 50 anos, sua etiologia ainda é pouco conhecida. Algumas teorias buscam elucidar o tema como o aumento da leptina, desordem hormonal de andrógenos e há também defensores de uma síndrome genética, ligada ao X com penetrância variável. Conclusão: diante da raridade de casos da síndrome, o diagnóstico geralmente ocorre de modo incidental, por meio da correlação entre sintomatologia variada e investigação radiológica. Sua abordagem terapêutica é predominantemente sintomática, de modo a se optar por conduta cirúrgica em casos reservados

Avulsão da Espinha Ilíaca anterosuperior pós traumática : Post-traumatic anterosuperior Iliac Spine avulsion

Introdução: As lesões ósseas da pelve e quadril são raras, e ocorrem principalmente na faixa etária de 8 a 14 anos, e estão relacionadas à prática de atividades físicas de alto impacto e repetitivas. As fraturas por avulsão das espinhas ilíacas superior e inferior e tuberosidade isquiática tem maior incidência devido ao aumento da prática de desportos nessa faixa etária. Apresentação do caso: I.P.M, masculino, 17 anos de idade, procurou o serviço do Hospital Geral de Goiás (HGG), referindo dor iniciada há 30 dias na face anterior do quadril esquerdo, durante partida de futebol. Refere aumento da intensidade da dor, e ao exame físico possui equimose local, edema e dor em quadril esquerdo. Ao raio x apresentou fratura da espinha ilíaca ântero superior à esquerda. Discussão: Essa lesão geralmente ocorre como resultado da contração súbita, vigorosa ou repetitiva do músculo sartório e tensor da fascia lata. Os sintomas mais comumente relatados são dor intensa associada a “estalos” na hemipelve afetada, edema, limitação funcional ipsilateral e equimoses. O tratamento é preferencialmente conservador, durando, em média, de 6 a 8 semanas. Já a cirurgia, é indicada para casos em que há desvio de mais de três centímetros ou com lesão neurovascular associada. Conclusão: Seu tratamento adequado, feito precocemente, torna-se importante na prevenção de lesões permanentes e complicações futuras. Na maioria das vezes, o tratamento e conservador, excetuando-se os casos de desvio fragmentário superior a três centímetros

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

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation

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