Análise bioético-legal do conhecimento e da conduta de médicos: hemotransfusão em pacientes Testemunhas de Jeová

The doctor-patient relationship has suffered great changes over time, one of the factors that led to such change was the Nuremberg Trials, in which human dignity and autonomy were greatly emphasized. However, there are situations in which doctors are faced with a dilemma: either to perform a procedure that they consider necessary and ignore the patient's refusal, or to stop performing the procedure in respect to the patient's decision, a decision taken in an informed manner and by a civilly capable agent, taking into account the legal bioethical factor. Listing the knowledge and ability of doctors to make use of alternatives to hemotransfusion, made available due to scientific advances. With this in mind, the study aims to analyze the relevant norms and identify the reasons that lead physicians to make decisions in the face of the dilemma posed above, specifically in relation to whole blood transfusions in Jehovah's Witnesses patients. For that, bibliographical research in specialized literature, documental research in internal legislation and relevant jurisprudence as well as International Treaties were used, and the semi-structured interview instrument was applied to the doctors of the Hospital de Clínicas of the Federal University of Uberlândia (HC/UFU) and to surgeons who work in the private healthcare system in the city of Uberlândia, Minas Gerais.Trabalho de Conclusão de Curso (Graduação)O relacionamento entre médico e paciente sofreu modificações ao longo do tempo, e um dos fatores que propiciou tais mudanças foi o Julgamento de Nuremberg, no qual se ressaltavam a dignidade e a autonomia humana. Entretanto, há situações nas quais os médicos se veem diante de um dilema: realizar um procedimento que entendem como necessário e ignorar a recusa do paciente ou deixar de realizar o procedimento em respeito à decisão desse indivíduo. Tal decisão é informada a ele e tomada por um agente civilmente capaz, levando em conta o fator bioético legal. Sendo assim, o presente trabalho elenca o conhecimento e a habilidade dos médicos em fazer uso das alternativas de hemotransfusão, disponibilizadas devido aos avanços científicos. Em vista disso, o estudo objetivou analisar as normas pertinentes e identificar as razões que levam os médicos à tomada de decisão diante do dilema acima colocado, especificamente no tocante à Transfusão de Sangue (TS) total em pacientes Testemunhas de Jeová (TJ). Para tanto, foram empregados a pesquisa bibliográfica na literatura especializada e o estudo documental na legislação interna, na jurisprudência relevante e nos tratados internacionais, além de se recorrer ao instrumento da entrevista semiestruturada que foi aplicada aos médicos do Hospital de Clínicas da Universidade Federal de Uberlândia (HC/UFU) e aos médicos cirurgiões que atendem na rede privada de saúde da cidade de Uberlândia, Minas Gerai

Nutritional profile of newborns with microcephaly and factors associated with worse outcomes

OBJECTIVE: To describe the nutritional profile of newborns with microcephaly and factors associated with worse outcomes during the first 14 days of life. METHODS: This investigation is a longitudinal, descriptive study carried out in 21 full-term neonates exposed vertically to the Zika virus and hospitalized in a neonatal intensive care unit from February to September 2016. Patients receiving parenteral nutrition were excluded. Data analysis was performed using a generalized estimating equation model and Student’s t-test to evaluate the association between worsening weight-for-age z-scores and independent clinical, sociodemographic and nutritional variables during hospitalization, with po0.05 indicating significance. RESULTS: During hospitalization, there was a decrease in the mean values of the weight-for-age z-scores. The factors associated with worse nutritional outcomes were symptomatic exposure to the Zika virus, low maternal schooling, absence of maternal income and consumption of infant formula (po0.05). Calcification and severe microcephaly were also associated with poor nutritional outcomes. Energy and macronutrient consumption remained below the recommendations and had an upward trend during hospitalization. CONCLUSION: The presence of cerebral calcification, the severity of microcephaly and symptomatic maternal exposure to Zika virus affected the nutritional status of newborns. In terms of nutritional factors, human milk intake had a positive impact, reducing weight loss in the first days of life. Other known factors, such as income and maternal schooling, were still associated with a poor nutritional status

lrrigación de colostomia: impacto en la calidad de vida

Objetivo: Relatar o impacto observado na qualidade de vida de usuários em meia idade com esta mia em uso de irrigação e sistema oclusor de colostomia atendidos em um Centro de Referência para atendimento a pessoas com estomias. Métodos: Estudo descritivo, do tipo relato de experiência, realizado por profissionais atuantes em um Centro de Referência para atendimento a pessoas com estomias em uma cidade do sul do Brasil, em janeiro de 2021. Resultados: Analisando a influência na qualidade de vida, a irrigação proporciona uma melhora substancial aos indivíduos. Verifica-se a satisfação com o método empregado, trazendo melhora na autoestima, confiança, melhora no humor, no relacionamento com parceiro, maior liberdade para uso de vestuário e alimentação e retorno das atividades sociais. Conclusão: O uso da irrigação e o oclusor proporciona uma relação mais harmônica do usuário com sua estomia, tornando possível o controle fecal, com melhora da autoestima e da segurança necessária para realizar atividades que haviam sofrido impacto desde o surgimento da nova condição.Objective: Observed on the quality of life of middle-aged users with a colostomy in use of irrigation and colostomy occlusion system served in a Reference Center for care of people with stomas. Methods: a descriptive study, of experience report type, carried out by professionals working in a Reference Center for people with stomas in a city in the south of Brazil, in January 2021. Results: by analyzing the influence on the quality of life, the use of irrigation provides a substantial improvement to in­dividuais. One can verify the satisfaction with the method employed, bringing improvements in self-esteem, confidence, and improvement in mood, in the relationship with their partner, greater freedom to use clothing and food and return to social acti­vities. Conclusion: the use of resources such as irrigation and occlusion provides a more harmonious relationship between the user and his ar her stomach, since fecal contrai becomes possible, leading to improved self-esteem and the safety needed to perform activities that have suffered an impact since the emergence of the new condition.Objectivo: Reportar el impacto observado en la calidad de vida de usuarios de mediana edad con ostomía mediante irrigación y sistema de oclusión de colostomía atendidos en un Centro de Referencia para asistir a personas con ostomía. Métodos: Estu­dio descriptivo, tipo informe de experiencia, realizado por profesionales que laboran en un Centro de Referencia para atender a personas con ostomía en una ciudad dei sur de Brasil, en enero de 2021. Resultados: AI analizar la influencia en la calidad de vida, el uso dei riego proporciona una mejora sustancial a las personas. Se puede comprobar la satisfacción con el método empleado, aportando mejora en la autoestima, confianza, mejora en el estado de ánimo, en la relación con la pareja, mayor libertad para el uso de la rapa y la alimentación y retorno a las actividades sociales. Conclusión: EI uso de recursos como la irrigación y el oclusor proporciona una relación más armoniosa entre el usuario y su ostomía, ya que es posible el contrai fecal, lo que conduce a una mejora de la autoestima y la seguridad necesaria para realizar las actividades que se ven impactadas desde la aparición de la nueva condición

Relação entre a infecção por helmintos gastrintestinais e coccídios nos valores de hematócrito e ganho de peso de caprinos (Capra hircus) da raça Anglo Nubiana em fase de crescimento

O objetivo deste estudo foi acompanhar a correlação entre infecções por helmintos gastrintestinais e coccídeos no ganho de peso e exames de hematócrito de caprinos da raça Anglo Nubiana, em fase de crescimento, criados na Região Metropolitana de Recife. A pesquisa foi conduzida entre maio e outubro de 2011. A análise dos dados foi realizada por meio de técnicas de estatística descritiva: distribuições absolutas, percentuais, e coeficiente de correlação de Spearman. Os resultados encontrados foram infecção por parasitos, predominando ovos tipo Strongyloidea, além de oocistos de Eimeria spp. e ainda correlação significativa entre a presença de oocistos de Eimeria spp. e diminuição do ganho de peso e valores do hematócrito

Interobserver reliability in the classification of pairs of records formed by probabilistic linkage of SISMAMA databases.

INTRODUCTION: The study assessed interobserver reliability in the classification of record pairs formed during probabilistic linkage of health-related databases, a key step in the methodology validation to be used in a larger on-going study on inequalities in the access to breast and cervical cancer control activities in Brazil (DAAC-SIS). METHODOLOGY: The RecLink software was used to link two databases of the Breast Cancer Control Information System (SISMAMA) in the state of Minas Gerais, Brazil: a reference database, which included 301 screening mammograms with probable benign diagnosis (BI-RADS 3 category) recorded in October 2010, and a database comprising 158,517 mammograms registered in 2011. Subsequently, the 215 pairs of records that were not assigned the maximum RecLink score were independently classified as being true or false by ten independent evaluators from four participating centers. RESULTS: The Kappa coefficient ranged from 0.87 to 1.00. Six evaluators were in perfect agreement with one or more evaluators from the other centers. The global Kappa was 0.96 (95% confidence interval - 95%CI 0.94 - 0.99). DISCUSSION: Assessment of interobserver reliability is key to ensuring the quality of the record linkage, and it should be routine practice in studies of this nature. The disclosure of such results contributes to transparency in the conduct of such studies and in the reporting of their findings. CONCLUSION: Interobserver reliability in this study was excellent, indicating satisfactory team consistency in the classification of record pairs

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Avaliação da radiopacidade de materiais de obturação endodônticos utilizando um novo modelo experimental

Objective: To evaluate the radiopacity of endodontic filling materials using a new experimental in vitro model. Methods: To prevent the overlapping of tissues and anatomical structures, a tissue simulator block was created. Gutta-percha, Resilon cones and polyethylene tubes filled with Epiphany, AH Plus and EndoFill (n=5 of each material) were placed inside the root canal of a tooth positioned in the simulator and radiographed after setting. Five sealer samples were prepared in standard discs and radiographed after setting. The films were processed and digitized. The digital images were analyzed using Adobe Photoshop® software; the grayscale values (0 to 256 pixels) were compared using Wilcoxon and Mann-Whitney tests (P<0.05) for the cones and ANOVA, Tukey, independent and dependent t tests (P<0.05) for the sealers. Results: In the simulator, AH Plus and Epiphany behaved similarly, presenting higher gray values than those presented by Endofill. In the standard discs, AH Plus was the most radiopaque, followed by Epiphany and Endofill. Resilon presented with higher radiopacity than did gutta-percha, while both were higher than dentin was. Conclusion: All endodontic filling materials presented higher gray values than dentin did, allowing them to be distinguished from the tooth and its surrounding structures. The proposed methodology can be used for the assessment of the radiopacity of endodontic filling materials.Objetivo: Avaliar a radiopacidade dos materiais de obturação endodônticos usando um novo modelo experimental in vitro. Metodologia: Considerando a sobreposição dos tecidos e estruturas anatômicas, um bloco simulador de tecidos foi criado. Cones de Guta-percha e Resilon e tubos de polietileno preenchidos pelos cimentos Epiphany, AH Plus e Endofill (n=5 de cada material) foram posicionados dentro de um canal radicular de um dente que foi posicionado no simulador e radiografias foram realizadas. Além disso, cinco amostras de cada cimento foram preparadas em discos padronizados e radiografadas. Os filmes foram processados e digitalizados. As imagens digitais foram analisadas pelo programa Adobe Photoshop® e valores de escala de cinza (0 a 256 pixels) foram comparados usando os testes Wilcoxon e Mann-Whitney (P<0,05) para avaliar os cones e ANOVA, Tukey, Testes t independente e dependente (P<0,05) para avaliar os cimentos. Resultados: No simulador de tecidos, o AH Plus e o Epiphany se comportaram semelhantemente, apresentando valores de cinza maiores do que o Endofill. Nos discos padronizados, o AH Plus foi o cimento mais radiopaco, seguido pelo Epiphany e Endofill. Os cones de Resilon se mostraram mais radiopacos do que a guta-percha e ambos mais do que a dentina. Conclusão: Todos os materiais obturadores endodônticos apresentaram valores de cinza maiores do que a dentina, o que permite distingui-los do dente e das estruturas anatômicas em sua volta. A metodologia proposta pode ser usada para avaliação a radiopacidade de materiais obturadores endodônticos