Substituição transcateter da valva aórtica: uma revisão integrativa

Introdução: A estenose da válvula aórtica (EA) é a cardiopatia valvar mais comum em países desenvolvidos, o que representa um forte impacto na saúde pública. As três causas principais de EA são: valvopatia reumática, esclerose e anomalia congênita. Ao diagnóstico precoce por ecocardiografia, usualmente os pacientes relatam dispnéia e angina aos esforços e pré-síncope. Classicamente, em casos avançados, as manifestações incluem angina, síncope e insuficiência cardíaca (IC). A substituição valvar é a primeira linha de tratamento da EA grave sintomática. Nesse sentido, considerando a crescente evolução técnica e melhoria dos dispositivos implantáveis, destaca-se o implante transcateter de valva aórtica (TAVR) como alternativa à substituição cirúrgica da valva aórtica (SAVR).  Objetivo: Analisar as evidências atuais acerca da TAVR e comparar os desfechos clínicos dos pacientes submetidos a esse procedimento e à SAVR. Métodos: Revisão integrativa de 20 estudos encontrados na base de dados PubMed, a partir dos descritores “aortic stenosis” e “transcatheter aortic valve replacement”, utilizando os filtros idioma inglês, publicação nos últimos 10 anos e estudos dos tipos ensaio clínico, meta-análise e revisão sistemática. Resultados:  Os estudos mostraram, em geral, maior necessidade de implante de marcapasso permanente em pacientes submetidos à TAVR, bem como maior regurgitação paravalvar em comparação com aqueles que passaram pela SAVR. Ambos os grupos apresentaram melhora similar na classe funcional NYHA. Além disso, os dados não mostraram diferença significativa de deterioração estrutural valvar (SVD) a médio prazo nos dois grupos, tampouco de mortalidade e de acidente vascular encefálico (AVE) incapacitante em até 8 anos. Conclusão: Foi possível compreender que, para pacientes de alto e médio risco cirúrgico, as evidências suportam a TAVR como alternativa à SAVR devido ao perfil de segurança e aos desfechos clínicos semelhantes. Contudo, ainda faltam estudos para indicar assertivamente o procedimento aos pacientes de baixo risco. Vale salientar a necessidade de mais pesquisas envolvendo as novas gerações das biopróteses valvares e o seguimento de pacientes a longo prazo a fim de determinar precisamente a SVD

SUPLEMENTAÇÃO DE CÁLCIO NA PREVENÇÃO DOS DISTÚRBIOS HIPERTENSIVOS DA GESTAÇÃO: REVISÃO INTEGRATIVA

This article aims to highlight calcium supplementation in the prevention of gestational hypertensive disorders. This is an integrative review, using the databases indexed in the Virtual Health Library (VHL): MEDLINE, SciELO, BDENF-Enfermagem and LILACS, using the descriptors: “Calcium supplementation”, “prevention”, “disorders hypertensive disorders during pregnancy” and “gestational hypertension”, in order to answer the question “What is the relevance of calcium supplementation in the prevention of gestational hypertensive disorders?”. As a result, calcium supplementation during pregnancy has shown promise for implementation in prenatal care protocols in view of the vulnerable population with low calcium nutritional intake, thus seeking to promote the prevention of hypertensive disorders in the perinatal period. . Concluding that through literature that supplementation in a guided manner and accompanied by trained health professionals, age reduces maternal gestational hypertension and, consequently, the risk of pre-eclampsia, in women with low previous calcium deficiency. However, although calcium supplementation appears to reduce blood pressure directly, it does not prevent endothelial damage associated with preeclampsia.Este artigo tem por visa evidenciar a suplementação de cálcio na prevenção dos distúrbios hipertensivos gestacional. Trata-se de uma revisão integrativa, foram utilizadas as bases de dados indexadas na Biblioteca Virtual em Saúde (BVS): MEDLINE, SciELO, BDENF-Enfermagem e LILACS, através dos descritores: “Suplementação de cálcio”, “prevenção”, “distúrbios hipertensivos na gravidez” e “hipertensão gestacional”, afim de alcançar a respota do questionamento” Qual a relevância da suplementação do cálcio na prevenção de distúrbios hipertensivos gestacional?”. Resultando em que a suplemntação de cálcio na gestacação vem mostrando-se promissor para a implementação em protocolos de atenção ao pré-natal tendo em vista a população vulnerável com baixa ingesta de nutricional de cálcio, buscando assim promover a prevenção de distúrbios hipertensivos no período perinatal. Concluindo que mediante a literatura que a suplementação de forma orientada e acompanhada por profissionais de saúde capacitados age reduzindo hipertensão gestacional materna e, consequentemente, o risco de pré-eclâmpsia, em mulheres com baixa ingestão de cálcio prévia. Entretanto, apesar de a suplementação de cálcio parecer reduzir a pressão sanguínea diretamente, não impede a lesão endotelial associada à pré-eclâmpsia

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

MAPPING LOCAL PATTERNS OF CHILDHOOD OVERWEIGHT AND WASTING IN LOW- AND MIDDLE-INCOME COUNTRIES BETWEEN 2000 AND 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic