16 research outputs found
Acute traumatic subdural haematomas : study of 110 cases
Apresentamos uma sĂ©rie consecutiva de 110 pacientes com hematoma subdural agudo traumático (HSDA) admitidos no serviço de emergĂŞncia do HBDF no perĂodo de 1°-janeiro a 1°-dezembro-1994. Todos os pacientes foram atendidos de acordo com o mesmo protocolo. Houve predominância do sexo masculino (79%), com idade variando entre 14 e 70 anos, sendo os atropelamentos (34%) e os acidentes automobilĂsticos (20%) as causas mais comuns. A maioria dos pacientes (85,7%) foi admitida muito grave, com 8 pontos ou menos na Escala de Coma Glasgow (ECG), o que influenciou diretamente na mortalidade. A tomografia computadorizada de crânio foi o exame diagnĂłstico de escolha que mostrou serem as contusões e o inchaço cerebral ("swelling") as lesões intracranianas associadas mais freqĂĽentes. A cirurgia foi realizada em 45,1% dos pacientes, e, em sua maioria, atravĂ©s de craniotomia fronto-tĂŞmporo-parietal ampla, com drenagem do hematoma, seguida de plástica da dura-mater. Em 54,9% as condições clĂnicas nĂŁo permitiram a realização da cirurgia; neste grupo, cerca de 69,6% estavam em coma profundo Ă admissĂŁo, com 3 pontos na ECG. A letalidade cirĂşrgica foi de 61,2% e esteve diretamente relacionada Ă condição clĂnica inicial e Ă idade do paciente. A letalidade, incluindo todos os pacientes cirĂşrgicos e nĂŁo cirĂşrgicos com HSDA, mesmo aqueles admitidos já com sinais de falĂŞncia de tronco cerebral, foi de 79,5%. AlĂ©m destes pacientes que faleceram, cerca de 7% evoluĂram sem seqĂĽelas ou com seqĂĽelas mĂnimas; outros 11,4% com seqĂĽelas de moderadas a paves e 2,1 % permaneceram em estado vegetativo persistente. Nossos dados estĂŁo de acordo com os da literatura no que se refere a elevada taxa de morbidade e mortalidade dos pacientes com HSDA.We report a series of 110 patients with acute traumatic subdural hematoma (ASDH) admitted at HBDF emergency within 1994 (January Is1 to December PJ.All patients were treated according to the same protocol. There was a predominance of males (79%), with ages ranging from 14 to 70, being car accidents (20%) and car-pedestrian accidents (34%) the most frequent causes The majority of patients (85.7%) was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS) or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6
Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases
Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.As doenças pulmonares intersticiais (DPIs) sĂŁo afecções heterogĂŞneas, envolvendo um elevado nĂşmero de condições, cuja abordagem ainda Ă© um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critĂ©rios utilizados para a definição diagnĂłstica das diferentes condições, alĂ©m de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes.Universidade de SĂŁo Paulo Faculdade de Medicina Hospital das ClĂnicasUniversidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de Medicina Curso de PĂłs-Graduação de Doenças Pulmonares IntersticiaisUniversidade Federal de CiĂŞncias da SaĂşde de Porto AlegreSanta Casa de Porto Alegre AmbulatĂłrio de Doenças IntersticiaisSES Hospital Regional da Asa Norte Serviço de Doenças TorácicasFundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho Serviço de MedicinaUniversidade Estadual de Campinas Faculdade de CiĂŞncias MĂ©dicas Departamento de ClĂnica MĂ©dicaUniversidade Federal do Estado do Rio de JaneiroUniversidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PatologiaHospital do Servidor PĂşblico Estadual de SĂŁo Paulo Serviço de Anatomia PatolĂłgicaUniversidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade de SĂŁo Paulo Faculdade de Medicina de RibeirĂŁo Preto DivisĂŁo de PneumologiaUniversidade Federal de Santa Catarina Departamento de ClĂnica MĂ©dicaUniversidade Federal de Santa Catarina Hospital UniversitárioHospital de Messejana AmbulatĂłrio de Doenças IntersticiaisHospital do Servidor PĂşblico Estadual de SĂŁo Paulo AmbulatĂłrio de Doenças IntersticiaisUniversidade de SĂŁo Paulo Faculdade de Medicina Instituto do CoraçãoUniversidade Federal FluminenseUniversidade de SĂŁo Paulo Faculdade de MedicinaHospital SĂrio LibanĂŞs NĂşcleo Avançado de TĂłraxUniversidade Federal da BahiaHospital do Servidor PĂşblico Estadual de SĂŁo PauloHospital do Câncer AntĂ´nio Cândido CamargoUNIFESP, EPM, Curso de PĂłs-Graduação de Doenças Pulmonares IntersticiaisUNIFESP, EPM, Depto. de PatologiaUNIFESP, EPMSciEL
Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases
Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes.28229
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
Canagliflozin and renal outcomes in type 2 diabetes and nephropathy
BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years
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
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
Medida da diferença artério-venosa de oxigênio na monitorização de pacientes com hemorragia subaracnóidea por aneurisma cerebral Measurement of arteriovenous oxygen difference in the monitoring of patients with subarachnoid haemorrhage due to cerebral aneurysm
A diferença artĂ©rio-venosa de oxigĂŞnio (DAVO2), pelo fato de estar relacionada com o metabolismo cerebral, reflete alterações que ocorrem em determinadas situações patolĂłgicas, entre elas as causadas pela hemorragia subaracnĂłidea espontânea (HSAE). Com a finalidade de avaliar a relação entre alterações na DAVO2 com o quadro clĂnico e a evolução de pacientes com HSAE, devido Ă ruptura de aneurisma cerebral, este mĂ©todo foi utilizado em 30 pacientes portadores desta patologia, admitidos na Unidade de Neurocirurgia do HBDF. A HSAE foi confirmada por CT de crânio em 17 pacientes e por punção lombar em 13. Dezoito pacientes foram admitidos com Hunt & Hess (H&H) I ou II, sete com H&H III e cinco com H&H IV ou V. A medida da DAVO2 baseou-se na equação de Fick e os resultados clĂnicos foram avaliados pela escala de seqĂĽelas de Glasgow. Dezenove pacientes apresentaram DAVO2 normais (inicialmente e durante a evolução), sendo que trĂŞs faleceram; cinco tiveram valores de DAVO2 sempre baixos e trĂŞs faleceram; os restantes seis pacientes tiveram valores da DAVO2 sempre elevados e dois faleceram. Os pacientes com DAVO2 normais tiveram melhor evolução clĂnica e Ăndice de mortalidade menor, quando comparados com os pacientes com valores anormais da DAVO2 (p<0,05). O diagnĂłstico de vasoespasmo foi feito, em sua maioria, pela avaliação clĂnica, sendo confirmado radiologicamente em oito pacientes, mas estes Ăşltimos tiveram DAVO2 normais. A medida isolada da DAVO2 nĂŁo foi suficiente para o diagnĂłstico do vasoespasmo, porĂ©m refletiu alterações metabĂłlicas precoces. Baseada nestes resultados, a DAVO2 pode ser usada como parâmetro importante na monitorização da evolução dos pacientes com HSAE.<br>The arterious venous oxygen difference (AVDO2) due to the close relationship with cerebral metabolic rate of oxygen and cerebral blood flow shows metabolic alterations that occur in some pathological situations in the brain including subarachnoid haemorrhage. The AVDO2 was calculated by the Fick equation and the results evaluated by the Glasgow outcome scale. Measurements of arteriojugular oxygen difference were carried out in 30 patients with subarachnoid haemorrhage due to rupture of intracranial aneurysms, as an attempt to monitor the relationship between changes in AVDO2, clinical picture, and evolution of the patients. The subarachnoid haemorrhage was diagnosed by CT scan in 17 patients and by lumbar punction in 13 and the diagnosis of arterial vasospasm was carried out by clinical evaluation and confirmed by four vessels angiogram in only eight patients. Eighteen patients were admitted with Hunt & Hess (H&H) I/II, seven with H&H III and five with H&H IV/V. Nineteen patients had AVDO2 normal and this group had three deaths; five patients had AVD02 continuously low with three deaths; and six patients had AVDO2 continuously high with two deaths. The patients with normal AVDO2 had better prognosis and clinical evolution than the patients with abnormal values of AVDO2. In conclusion, AVDO2 measurements could not be correlated with the diagnosis of vasospasm, but was useful in the early identification of metabolic changes that occur after subarachnoid haemorrhage and could be used as an supplementary monitoring in the clinical evaluation of patients with this pathology
Jornal Brasileiro de Pneumologia
p. 282-291As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer
aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes