Sistema caixinha de cuidados para auxilio a avaliação de paciente e pesquisa de enfermagem

Orientador: Prof. Dra. Rafaela Mantovani FontanaMonografia (graduação) - Universidade Federal do Paraná, Setor de Educação Profissional e Tecnológica, Curso de Graduação em Tecnologia em Análise e Desenvolvimento de Sistema

Sistema caixinha de cuidados para auxilio a avaliação de paciente e pesquisa de enfermagem

Orientador: Prof. Dra. Rafaela Mantovani FontanaMonografia (graduação) - Universidade Federal do Paraná, Setor de Educação Profissional e Tecnológica, Curso de Graduação em Tecnologia em Análise e Desenvolvimento de Sistema

Non-alcoholic fatty liver disease in overweight children and its relationship with retinol serum levels

Objectives: To evaluate the frequency of non-alcoholic fatty liver disease, the retinol serum levels, lipid profile, and insulin resistance in overweight/obese children. To relate these biochemical variables with the risk of this disease in the population studied.Methods: the study was cross-sectional and prospective, with 46 overweight/obese school children (28 female, 18 male; mean age 8.6 years). the control group consisted of 45 children, paired by age and gender. Hepatic steatosis, evaluated by ultrasound, was classified as normal, mild, moderate, or severe. Also evaluated were serum retinol levels; thiobarbituric acid reactive substances; lipid profile; and fasting glucose and serum insulin levels, used for the calculation of the Homeostasis Model Assessment.Results: Hepatic ultrasound alterations were found in 56.5% and 48,9% of the overweight/obese and control group children, respectively. Presence of obesity was associated with-high levels of triglycerides (OR = 4.6; P 0.002). in the studied children, the risk of steatosis was related to a trend to a higher percentage of retinol inadequacy (OR = 2.8; p = 0.051); there was no association with thiobarbituric acid reactive substances, lipid profile, or insulin resistance.Conclusions: the high frequency of non-alcoholic fatty liver disease in both groups, evaluated by hepatic ultrasound, in low-socioeconomic level children, independent of nutritional condition and without significant association with insulin resistance, emphasizes that especially-in-developing countries, other risk factors such as micronutrient deficiencies (e.g. vitamin A) are involved.Universidade Federal de São Paulo, Paulista Sch Med, Dept Pediat, BR-04023062 São Paulo, BrazilABC Sch Med, Dept Pediat, Santo Andre, SP, BrazilUniv Fed Rio de Janeiro, Dept Nutr, BR-21941 Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Paulista Sch Med, Dept Pediat, BR-04023062 São Paulo, BrazilWeb of Scienc

Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed

OBJETIVO: Avaliar a presença de lipodistrofia clínica em crianças com síndrome da imunodeficiência adquirida e relacioná-la com o esquema antirretroviral utilizado, alterações do perfil lipídico e resistência insulínica. MÉTODOS: Por meio de estudo transversal, foram avaliadas 30 crianças e adolescentes (mediana de idade = 9,1 anos) com síndrome da imunodeficiência adquirida, no período entre 2004 e 2005. As avaliações clínico-laboratoriais incluíram: classificação da infecção pelo HIV, medidas antropométricas (peso e estatura), glicemia e insulina séricas e perfil lipídico (LDL-c, HDL-c, triglicérides). A lipodistrofia foi definida por parâmetros clínicos. O teste do qui-quadrado foi utilizado na análise estatística. RESULTADOS: Todos os pacientes recebiam terapia antirretroviral regularmente (mediana de tempo de uso = 28,4 meses), 80% utilizavam três drogas em associação (terapia fortemente ativa) e 30% usavam inibidores de protease. Lipodistrofia e dislipidemia foram observadas em 53,3 e 60% dos pacientes, respectivamente. Crianças que utilizavam terapia fortemente ativa com inibidor de protease apresentaram maior percentual de lipodistrofia mista, com diferença estatisticamente significante em relação ao grupo com terapia fortemente ativa sem inibidor de protease e ao grupo sem terapia fortemente ativa (44,4 versus 16,7%; p = 0,004). Não se observou diferença estatisticamente significante entre presença de lipodistrofia e gênero, idade (> 10 anos), alterações do perfil lipídico e resistência insulínica. CONCLUSÕES: A elevada prevalência de dislipidemia e lipodistrofia verificada nas crianças com síndrome da imunodeficiência adquirida, mostrando relação com o esquema antirretroviral empregado, pode significar um risco elevado para o desenvolvimento futuro de complicações, especialmente as cardiovasculares.<br>OBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80% were on three drugs in combination (highly active therapy) and 30% were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60% of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7%; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems

Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST)

Background: The impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours.Methods: This was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy-absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy.Results: Some 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures.Conclusion: No difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery

International comparisons of laboratory values from the 4CE collaborative to predict COVID-19 mortality

International audienceAbstract Given the growing number of prediction algorithms developed to predict COVID-19 mortality, we evaluated the transportability of a mortality prediction algorithm using a multi-national network of healthcare systems. We predicted COVID-19 mortality using baseline commonly measured laboratory values and standard demographic and clinical covariates across healthcare systems, countries, and continents. Specifically, we trained a Cox regression model with nine measured laboratory test values, standard demographics at admission, and comorbidity burden pre-admission. These models were compared at site, country, and continent level. Of the 39,969 hospitalized patients with COVID-19 (68.6% male), 5717 (14.3%) died. In the Cox model, age, albumin, AST, creatine, CRP, and white blood cell count are most predictive of mortality. The baseline covariates are more predictive of mortality during the early days of COVID-19 hospitalization. Models trained at healthcare systems with larger cohort size largely retain good transportability performance when porting to different sites. The combination of routine laboratory test values at admission along with basic demographic features can predict mortality in patients hospitalized with COVID-19. Importantly, this potentially deployable model differs from prior work by demonstrating not only consistent performance but also reliable transportability across healthcare systems in the US and Europe, highlighting the generalizability of this model and the overall approach