EXPOSIÇÃO SOLAR E ENVELHECIMENTO PRECOCE EM TRABALHADORES PRAIANOS DO MUNICÍPIO DE SALINÓPOLIS/PA

Objetivo: Identificar a presença do envelhecimento precoce de pele em pescadores de Salinópolis/PA. Métodos: A pesquisa foi realizada com 275 pescadores, de 18 a 59 anos, no período de março a maio de 2016, sendo aplicados dois questionários: “Protocolo de Avaliação Facial – PAF” e “Hábitos de exposição e fotoproteção solar”, ambos modificados pelas pesquisadoras. Resultados: Foi observada prevalência de trabalhadores praianos de 26 a 35 anos (36%), pele parda (70%), fototipo III (64%) e com a presença de fotoenvelhecimento (61%), que se expunham diariamente ao sol (97%), não possuíam cuidados com a pele (91%) e não usavam protetor solar (92%). Os voluntários relataram que não gostavam de aplicar protetor solar (59%) e desconheciam que a radiação ultravioleta causava envelhecimento da pele (60%), manchas na pele (54%) ou câncer (56%). Conclusão: A maioria dos pescadores não utilizavam fotoprotetores e apresentavam fotoenvelhecimento com predisposição a desenvolver câncer de pele

Early mobilization in children with pneumonia in mechanical ventilation: randomized clinical trial

Immobility in the bed of pediatric patients in intensive care units increases the risk of morbidities such as pneumonia, with consequences for autonomic function. Physiotherapy based on physical exercise is part of the rehabilitation process and can modify autonomic function. To compare the effects of two physical therapy protocols, one conventional and the other based on physical exercise, on heart rate variability, length of stay and invasive mechanical ventilation in children with ventilator-associated pneumonia. This is a randomized clinical trial, the volunteers were divided into a control group (submitted to a physiotherapy protocol with only breathing exercises and passive mobilization) and an experimental group (submitted to a physiotherapy protocol based on physical exercise). Patients aged 1 to 8 years, on invasive mechanical ventilation, with pneumonia were included. The rehabilitation protocol took place for 4 consecutive days. The collection of heart rate variability occurred in the pre-protocol period, on the 2nd day, 1 day after the end of the protocol. 25 patients completed the study. There was a reduction in the time of invasive mechanical ventilation in the experimental group (p = 0.01). There was an improvement in the heart rate variability of the experimental group in all indices (p < 0.01). The post-protocol analysis of the groups showed significant values in all variables (p < 0.05). Exercise-based physical therapy protocol improved autonomic heart rate modulation and reduced IMV time in children with ventilator-associated pneumonia

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

Avanços da cirurgia robótica no tratamento de doenças cardiovasculares

Várias cirurgias médicas já utilizaram a tecnologia robótica, tais como: cirurgias no estômago, bexiga, rins, próstata, cérebro e inclusive no coração, o qual proporciona-se a reparação de válvulas cardíacas e até mesmo cirurgias nas artérias. O principal objetivo do presente estudo é discutir por meio da literatura científica acerca dos avanços da cirurgia robótica no tratamento de doenças cardiovasculares. Trata-se de uma revisão sistemática da literatura, dos quais, utilizou-se as bases e biblioteca eletrônica Scielo e Periódico Capes, totalizando 5 artigos elegíveis. A cirurgia robótica tem sido um dos principais métodos utilizados em tratamentos cardiovasculares quando comparados com técnicas convencionais, sobretudo, no que diz respeito, a cirurgia de revascularização do miocárdio

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 &lt;= 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

EXPOSIÇÃO SOLAR E ENVELHECIMENTO PRECOCE EM TRABALHADORES PRAIANOS DO MUNICÍPIO DE SALINÓPOLIS/PA

Objetivo: Identificar a presença do envelhecimento precoce de pele em pescadores de Salinópolis/PA. Métodos: A pesquisa foi realizada com 275 pescadores, de 18 a 59 anos, no período de março a maio de 2016, sendo aplicados dois questionários: “Protocolo de Avaliação Facial – PAF” e “Hábitos de exposição e fotoproteção solar”, ambos modificados pelas pesquisadoras. Resultados: Foi observada prevalência de trabalhadores praianos de 26 a 35 anos (36%), pele parda (70%), fototipo III (64%) e com a presença de fotoenvelhecimento (61%), que se expunham diariamente ao sol (97%), não possuíam cuidados com a pele (91%) e não usavam protetor solar (92%). Os voluntários relataram que não gostavam de aplicar protetor solar (59%) e desconheciam que a radiação ultravioleta causava envelhecimento da pele (60%), manchas na pele (54%) ou câncer (56%). Conclusão: A maioria dos pescadores não utilizavam fotoprotetores e apresentavam fotoenvelhecimento com predisposição a desenvolver câncer de pele

Estresse oxidativo na interrupção da ventilação mecânica em pacientes vítimas de traumatismo cranioencefálico: um estudo randomizado e cego

Introdução: Os efeitos tóxicos do oxigênio não estão bem estabelecidos em seres humanos. Objetivo: Analisar os níveis de estresse oxidativo (EOx) na interrupção da ventilação mecânica (VM) em pacientes vítimas de TCE. Métodos: Estudo prospectivo, longitudinal, analítico, randomizado e cego. Participaram 12 pacientes: PSV (n=6) e grupo Tubo-T (n=6). A interrupção da VM deu-se em: PSV- (Δ 7 cmH2O) e PEEP (5 cmH2O) durante 30 minutos; Tubo-T - o paciente foi conectado ao tubo T com FiO2 a 0,4 durante 30 minutos. Realizou-se avaliação morfológica do EOx no plasma sanguíneo pelo Dry layer oxidative test. A coleta foi realizada: com 24h de VM, antes do teste, em 15’ de teste e após o teste PSV ou Tubo-T. Para análise da normalidade utilizou-se o teste de Shapiro-Wilk para análise intragrupo e intergrupos, o teste ANOVA seguido de Tukey; para correlação-Correlação de Spearman (p valor 5%). Resultados: Não houve aumento estatisticamente significativo na descontinuidade da matriz extracelular nos grupos (p>0,05). Os níveis de EOx encontraram-se elevados (grau III–moderado) nas primeiras avaliações. Não foi encontrada correlação significativa entre os parâmetros de VM com o EOx. O grupo PSV permaneceu em média 12.33 dias sob VM, tendo EOx de 29.02 (grau III/ moderado) – r=0.8, p=0.01; o grupo Tubo T em média 12.83±2.2 dias, tendo EOx de 31.03±5.41 (grau IV/grave)- r=0.9, p=0.07. Conclusão: Não houve diferença no comportamento do EOx entre os métodos de interrupção da VM. No entanto, o EOx aumentou com o tempo de VM