Concepção dos desafios médicos no diagnóstico de abdome agudo em gestantes: um artigo original

The objective of this study is to expose the main concepts regarding the acute abomen and show its main etiologies in pregnant women. A review of articles was performed in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Directory of Open Access Journals (DOAJ) and PubMed, with the following Health Sciences Descriptors (DeCS): Acute abdomen; Abdominal pain; Diffuse pain; Pregnancy. Selecting articles between the periods 2005 to 2023, in English, Portuguese, German and Spanish. Regarding AA, even though it is a pathology considered to be infrequently recurrent during pregnancy, it is essential that health professionals are prepared to diagnose it accurately and quickly, given the potential risks for pregnancy when the diagnosis is late. It is concluded that the lack of a standard protocol for approaching these patients impairs medical decision-making and contributes to worse prognoses.O objetivo deste estudo é expor os principais conceitos a respeito do abômen agudo e mostrar suas principais etiologias em gestantes. Foi realizada revisão de artigos nas bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Directory of Open Access Journals (DOAJ) e PubMed, com os seguintes Descritores em Ciências da Saúde (DeCS): Abdome agudo; Dor abdominal; Dor difusa; Gravidez. Seleção de artigos entre os períodos de 2005 a 2023, nos idiomas inglês, português, alemão e espanhol. Em relação à AA, mesmo sendo uma patologia considerada pouco recorrente durante a gravidez, é fundamental que os profissionais de saúde estejam preparados para diagnosticá-la com precisão e rapidez, dados os riscos potenciais para a gravidez quando o diagnóstico é tardio. Conclui-se que a falta de um protocolo padrão para abordagem desses pacientes prejudica a tomada de decisão médica e contribui para piores prognósticos.Objetiva-se, neste estudo, expor os principais conceitos no que tange o abomen agudo e mostrar suas etiologias principais em gestantes. Foi realizada uma revisão de artigos nas bases de dados Medical Literature Analysis and Retrievel System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Directory of Open Access Journals (DOAJ) e PubMed, com os seguintes Descritores em Ciências da Saúde (DeCS): Abdome agudo; Dor abdominal; Dor difusa; Gravidez. Selecionando artigos entre os períodos de 2005 a 2023, nos idiomas Inglês, Português, Alemão e Espanhol. Em relação ao AA, mesmo sendo uma patologia considerada pouco recorrente durante a gestação, é essencial que os profissionais da saúde estejam preparados para diagnosticá-la com precisão e rapidez, visto o potencial de riscos para a gestação quando o diagnóstico é tardio. Conclui-se que a falta de um protocolo padrão na abordagem desses pacientes, prejudica a tomada de decisões médicas e corrobora para piores prognósticos

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used