Non-invasive hemodynamic evaluation by Doppler echocardiography

The approach for treating a hemodynamically unstable patient remains a diagnostic and therapeutic challenge. Stabilization of the patient should be rapid and effective, but there is not much room for error. This narrow window of intervention makes it necessary to use rapid and accurate hemodynamic evaluation methods. Echocardiography is the method of choice for the bedside evaluation of patients in circulatory shock. In fact, it was intensive care physicians who recognized the potential of Doppler echocardiography for the initial approach to patients in circulatory failure. An echocardiogram allows rapid anatomical and functional cardiac evaluation, which may include non-invasive hemodynamic evaluation using a Doppler study. Such an integrated study may provide data of extreme importance for understanding the mechanisms underlying the hemodynamic instability of the patient to allow the rapid institution of appropriate therapeutic measures. In the present article, we describe the most relevant echocardiographic findings using a practical approach for critical patients with hemodynamic instability.info:eu-repo/semantics/publishedVersio

Abordagens familiares face ao autismo

Este trabalho resulta de uma perspectiva psicodinâmica na abordagem das atitudes maternas face à criança com perturbação do spectrum autista. No caso clínico apresentado, uma mãe recebeu suporte psico-social e integração num grupo terapêutico na Unidade da Primeira Infância. A abordagem familiar foi complementada com um trabalho social em rede, através do qual os pais participaram como parceiros no processo terapêutico

Recent evidences in the management of acute diverticulitis

Nas últimas décadas a incidência da moléstia diverticular do cólon e de suas complicações tem aumentado. Durante esse período o número de publicações a respeito do tema se expandiu, bem como as opções terapêuticas. Apesar disso, muitas dúvidas persistem e as decisões terapêuticas continuam relativamente imutadas, baseadas muitas vezes em dados antigos e de baixo poder estatístico. Nesta revisão apresentamos as evidências científicas atuais acerca da terapêutica desta complexa patologia.During the past decades the incidence of diverticular disease of the colon and its complications has increased as well as the therapeutic options have expanded. However, there are still remaining doubts about the timing of surgery indication, the access (open vs laparoscopic) and the best approach to complicated diverticulitis. The current decisions are mostly based in old data of poor statistic strength. This review shows the present-day evidence about the treatment of diverticular disease

Atratividade organizacional como fator da intenção de saída nas firmas de auditoria

Mestrado Bolonha em Ciências EmpresariaisAudit firms are organizations characterized by high employee turnover, particularly visible at the junior levels of the audit career. Consequently, identifying the factors that influence employee turnover is a main aspect to effective human capital management in audit firms. Organizational attractiveness has a positive impact on talent attraction and retention in organizations. However, this is a concept that varies from employee to employee, as perceptions of what is considered attractive vary according to personal and professional goals. Attractiveness also affects the satisfaction and happiness that the employee feels in performing their tasks, as well as their job performance. The present study has a twofold objective. First, it seeks to examine whether organizational attractiveness is related to employees' intention to leave audit firms. Secondly, the study examines the mediating effect of job satisfaction and job performance on the former relationship. For this purpose, using a survey research strategy, the analysis focuses on a sample of 117 auditors and the research hypotheses tested using the Partial Least Squares - Structural Equation Model method. The results show that organizational attractiveness and job satisfaction have a significant relationship with the intention to leave, because an increase in these two factors reduces the predisposition of employees to leave the audit firm.As firmas de auditoria são organizações caracterizadas por uma elevada rotatividade de colaboradores, particularmente visível nos níveis hierárquicos inferiores da carreira de auditor. Consequentemente, a identificação dos fatores que influenciam a saída dos colaboradores, é um aspeto central para uma gestão eficaz do capital humano nas firmas de auditoria. A atratividade organizacional impacta positivamente na atração e retenção do talento nas organizações, contudo, trata-se de um conceito que varia consoante o colaborador, pois a perceção do que é considerado atrativo varia em função dos objetivos pessoais e profissionais. A atratividade afeta igualmente a satisfação e felicidade que o colaborador sente enquanto desenvolve as suas tarefas, bem como na sua performance profissional. O presente estudo tem um duplo objetivo. Em primeiro lugar, procura analisar se a atratividade organizacional está relacionada com a intenção de saída dos colaboradores das firmas de auditoria. Em segundo lugar, o estudo analisa o efeito mediador da satisfação no trabalho e do desempenho no trabalho sobre a relação anterior. Para esse efeito, o estudo utiliza a estratégia de investigação do Survey, a análise incide sobre uma amostra de 117 auditores e as hipóteses de investigação testadas através do método Partial Least Squares – Structural Equation Model. Os resultados evidenciam que a atratividade organizacional e a satisfação no trabalho têm uma relação significativa com a intenção de saída, pois um aumento das mesmas, reduz a predisposição dos colaboradores em sair da firma de auditoria.info:eu-repo/semantics/publishedVersio

Dyslipidaemia and mortality in COVID-19 patients - a meta-analysis

Background: The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear. Aim: To assess the prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia. Design: Systematic review and meta-Analysis. Methods: Preferred reporting items for systematic reviews and meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 31 January 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random-effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random-effect models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. Results: Of about 18 studies, enrolling 74 132 COVID-19 patients (mean age 70.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3-24.3%, P < 0.0001), with high heterogeneity (I2 = 98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-Term death (OR: 1.69, 95% CI: 1.19-2.41, P = 0.003), with high heterogeneity (I2 = 88.7%). Due to publication bias, according to the Trim-And-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13-2.28, P < 0.0001 (one studies trimmed). Conclusion: Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-Term mortality risk

Differential right and left ventricular diastolic tolerance to acute afterload and NCX gene expression in Wistar rats

This study evaluated right ventricular (RV) and left ventricular (LV) diastolic tolerance to afterload and SERCA2a, phospholamban and sodium-calcium exchanger (NCX) gene expression in Wistar rats. Time constant tau and end-diastolic pressure-dimension relation (EDPDR) were analyzed in response to progressive RV or LV afterload elevations, induced by beat-to-beat pulmonary trunk or aortic root constrictions, respectively. Afterload elevations decreased LV-tau, but increased RV-tau. Whereas LV-tau analyzed the major course of pressure fall, RV-tau only assessed the last fourth. Furthermore, RV afterload elevations progressively upward shifted RV-EDPDR, whilst LV afterload elevations did not change LV-EDPDR. SERCA2a and phospholamban mRNA were similar in both ventricles. NCX-mRNA was almost 50% lower in RV than in LV. Left ventricular afterload elevations, therefore, accelerated the pressure fall and did not induce diastolic dysfunction, indicating high LV diastolic tolerance to afterload. On the contrary, RV afterload elevations decelerated the late RV pressure fall and induced diastolic dysfunction, indicating small RV diastolic tolerance to afterload. These results support previous findings relating NCX with late Ca2+ reuptake, late relaxation and diastolic dysfunction

Differential right and left ventricular diastolic tolerance to acute afterload and NCX gene expression in Wistar rats

This study evaluated right ventricular (RV) and left ventricular (LV) diastolic tolerance to afterload and SERCA2a, phospholamban and sodium-calcium exchanger (NCX) gene expression in Wistar rats. Time constant tau and end-diastolic pressure-dimension relation (EDPDR) were analyzed in response to progressive RV or LV afterload elevations, induced by beat-to-beat pulmonary trunk or aortic root constrictions, respectively. Afterload elevations decreased LV-tau, but increased RV-tau. Whereas LV-tau analyzed the major course of pressure fall, RV-tau only assessed the last fourth. Furthermore, RV afterload elevations progressively upward shifted RV-EDPDR, whilst LV afterload elevations did not change LV-EDPDR. SERCA2a and phospholamban mRNA were similar in both ventricles. NCX-mRNA was almost 50% lower in RV than in LV. Left ventricular afterload elevations, therefore, accelerated the pressure fall and did not induce diastolic dysfunction, indicating high LV diastolic tolerance to afterload. On the contrary, RV afterload elevations decelerated the late RV pressure fall and induced diastolic dysfunction, indicating small RV diastolic tolerance to afterload. These results support previous findings relating NCX with late Ca2+ reuptake, late relaxation and diastolic dysfunction