Protection of social rights of transgender persons: the impacts of the sentence of the Federal Supreme Court in the direct action of unconstitutionality 4,275 in Brazil

A questão dos direitos sociais dos transgêneros brasileiros ganha destaque no contexto de proteção à minorias. Principalmente, a partir do momento em que o Supremo Tribunal Federal julgou procedente no dia 1º de março de 2018 a Ação Direta de Inconstitucionalidade n. 4.275 para dar interpretação conforme a Constituição e o Pacto de São José da Costa Rica ao art. 58 da Lei n. 6.015/73, permitindo aos transgêneros, que são aqueles que não se identificam com o seu gênero biológico, alterarem no cartório (via administrativa) o prenome e gênero diretamente no registro civil e sem a obrigatoriedade de ter realizado a cirurgia de transgenitalização. Por meio de uma pesquisa exploratória, com referenciais teóricos e um estudo realizado sobre as histórias de vida, será possível conhecer os impactos positivos e negativos dessa decisão, bem como, os enfrentamentos do dia a dia da população trans. Pode-se inferir que houve um avanço na história do Brasil com a Ação Direta de Inconstitucionalidade n. 4.275, pois apesar dos impactos negativos mencionados é perceptível que já estamos um passo à frente da desconstrução da cultura transfóbica.The issue of social rights of Brazilian transgender persons is highlighted in the context of protecting minorities. Mainly, from the moment the Supreme Federal Court judged on March 1, 2018 the Direct Action of Unconstitutionality No. 4,275 to interpret article 58 of Law No. 6,015/73 according to the Brazilian Constitution and the Pact of San José, Costa Rica, allowing transgender persons, who are those who do not identify with their biological gender, to change the first name and gender in the registry office (administrative route) directly and without the obligation to have undergone transgenitalization surgery. Through an exploratory research, with theoretical references and a study carried out on life histories, it will be possible to know the positive and negative impacts of this sentence, as well as the daily confrontations of the transgender people. It can be inferred that there was an advance in the history of Brazil with the Direct Action of Unconstitutionality No. 4,275, because despite its negative impacts mentioned, this sentence was one step towards the deconstruction of the transphobic culture

Alterações gastrointestinais no Diabetes mellitus: revisão sistemática: Gastrointestinal alterations in Diabetes mellitus: a systematic review

Introdução: O diabetes mellitus pode levar a diversas alterações. Dentre elas, aquelas gastrointestinais, que acarretam inúmeros problemas ao indivíduo e sua qualidade de vida. Destaca-se, então, que compreender essas alterações constitui-se como de grande importância para que auxilie o indivíduo em sua vida cotidiana. Assim, questionando acerca das alterações gastrointestinais no diabetes mellitus, realizou-se o estudo. Objetivo: analisar através da literatura atual as alterações gastrointestinais no diabetes mellitus. Método: revisão sistemática de literatura, através da busca nas bases de dados National Library of Medicine (Medline) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), utilizando-se os descritores em Saúde (DeCS), Medical Subject Headings (MeSH) e Biblioteca Virtual da Saúde (BVS), como: Diabetes Mellitus, Complications of Diabetes Mellitus, Diabetes Mellitus type 1, Diabetes Mellitus type 2, Gastrointestinal Microbiome, Gut Microbiota, Gastrointestinal Tract, GI Tract, Lower Gastrointestinal Tract, Upper Gastrointestinal Tract. Resultado: A amostra final do estudo foi composta por 10 artigos científicos, nos quais se evidenciou que além de afetar a qualidade de vida dos indivíduos, as alterações gastrointestinais no diabetes ocasiona diversas complicações. Assim, para auxílio deste indivíduo torna-se fundamental a manutenção de um bom controle glicêmico. Conclusão: Os artigos remeteram a necessidade de novos estudos sobre a temática, principalmente quanto a fisiopatologia, diagnóstico e tratamento das alterações gastrointestinais

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status