O IMPACTO DA CAMPANHA DE COMBATE À SÍFILIS CONGÊNITA SOBRE DIAGNÓSTICO E TRATAMENTO DE SÍFILIS EM MULHERES ADMITIDAS EM UMA MATERNIDADE MUNICIPAL DO RIO DE JANEIRO

Abstract Objective: to describe the time of diagnosis and treatment of syphilis in women who had their children screened for congenital syphilis in a maternity of the State of do Rio de Janeiro during the campaign to combat congenital syphilis, (1999 to 2001). Methods: this was a descriptive, retrospective epidemiological. Results: 479 records were analyzed to investigate SC in 1999 on the first Campaign for Elimination of SC, and 2001, on the second. It was found that more than half of these mothers were diagnosed during prenatal care (54.3% to 71.9%) and there was a progressive increase in anticipation of provision of treatment (33.8% to 62.5%). Conclusions: the practice of the campaigns reflected positively in the fight against congenital syphilis, however, the number of missing data, especially for variables co-infection HIV and syphilis-in screening of partners, affects the reliability of data and expressed the need to consider new strategies to increase epidemiological surveillance. Descriptors: nursing; congenital syphilis; surveillance epidemiology.Resumo Objetivo: descrever o momento de diagnóstico e tratamento de sífilis nas mulheres que tiveram seus filhos investigados para Sífilis Congênita (SC) em uma maternidade municipal do Rio de Janeiro, no período da campanha de combate a SC (1999 a 2001). Métodos: pesquisa descritiva, retrospectiva, de levantamento epidemiológico. Resultados: foram analisadas 479 fichas de investigação de SC nos anos de 1999, referente à primeira Campanha de Eliminação da SC, e 2001, referente à segunda. Identificou-se que mais da metade dessas mães foram diagnosticadas no pré-natal (54,3% à 71,9%) e houve um aumento progressivo da antecipação de oferta de tratamento (33,8% à 62,5%). Conclusão: as práticas das campanhas refletiram positivamente no combate a SC, contudo, o número de dados ignorados, principalmente nas variáveis referentes a co-infecção sífilis-HIV e no rastreamento dos parceiros, afeta a confiabilidade dos dados e expressa a necessidade de se pensar em novas estratégias a fim de aumentar a vigilância epidemiológica. Descritores: enfermagem; sífilis congênita; vigilância epidemiologia

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

O IMPACTO DA CAMPANHA DE COMBATE À SÍFILIS CONGÊNITA SOBRE DIAGNÓSTICO E TRATAMENTO DE SÍFILIS EM MULHERES ADMITIDAS EM UMA MATERNIDADE MUNICIPAL DO RIO DE JANEIRO

Resumo Objetivo: descrever o momento de diagnóstico e tratamento de sífilis nas mulheres que tiveram seus filhos investigados para Sífilis Congênita (SC) em uma maternidade municipal do Rio de Janeiro, no período da campanha de combate a SC (1999 a 2001). Métodos: pesquisa descritiva, retrospectiva, de levantamento epidemiológico. Resultados: foram analisadas 479 fichas de investigação de SC nos anos de 1999, referente à primeira Campanha de Eliminação da SC, e 2001, referente à segunda. Identificou-se que mais da metade dessas mães foram diagnosticadas no pré-natal (54,3% à 71,9%) e houve um aumento progressivo da antecipação de oferta de tratamento (33,8% à 62,5%). Conclusão: as práticas das campanhas refletiram positivamente no combate a SC, contudo, o número de dados ignorados, principalmente nas variáveis referentes a co-infecção sífilis-HIV e no rastreamento dos parceiros, afeta a confiabilidade dos dados e expressa a necessidade de se pensar em novas estratégias a fim de aumentar a vigilância epidemiológica. Descritores: enfermagem; sífilis congênita; vigilância epidemiologia

O IMPACTO DA CAMPANHA DE COMBATE À SÍFILIS CONGÊNITA SOBRE DIAGNÓSTICO E TRATAMENTO DE SÍFILIS EM MULHERES ADMITIDAS EM UMA MATERNIDADE MUNICIPAL DO RIO DE JANEIRO

Resumo Objetivo: descrever o momento de diagnóstico e tratamento de sífilis nas mulheres que tiveram seus filhos investigados para Sífilis Congênita (SC) em uma maternidade municipal do Rio de Janeiro, no período da campanha de combate a SC (1999 a 2001). Métodos: pesquisa descritiva, retrospectiva, de levantamento epidemiológico. Resultados: foram analisadas 479 fichas de investigação de SC nos anos de 1999, referente à primeira Campanha de Eliminação da SC, e 2001, referente à segunda. Identificou-se que mais da metade dessas mães foram diagnosticadas no pré-natal (54,3% à 71,9%) e houve um aumento progressivo da antecipação de oferta de tratamento (33,8% à 62,5%). Conclusão: as práticas das campanhas refletiram positivamente no combate a SC, contudo, o número de dados ignorados, principalmente nas variáveis referentes a co-infecção sífilis-HIV e no rastreamento dos parceiros, afeta a confiabilidade dos dados e expressa a necessidade de se pensar em novas estratégias a fim de aumentar a vigilância epidemiológica. Descritores: enfermagem; sífilis congênita; vigilância epidemiologia

O impacto da campanha de combate à sífilis congênita sobre diagnóstico e tratamento de sífilis em mulheres admitidas em uma maternidade municipal do Rio de Janeiro

Objetivo: descrever o momento de diagnóstico e tratamento de sífilis nas mulheres que tiveram seus filhos investigados para Sífilis Congênita (SC) em uma maternidade municipal do Rio de Janeiro, no período da campanha de combate a SC (1999 a 2001). Métodos: pesquisa descritiva, retrospectiva, de levantamento epidemiológico. Resultados: foram analisadas 479 fichas de investigação de SC nos anos de 1999, referente à primeira Campanha de Eliminação da SC, e 2001, referente à segunda. Identificou-se que mais da metade dessas mães foram diagnosticadas no pré-natal (54,3% à 71,9%) e houve um aumento progressivo da antecipação de oferta de tratamento (33,8% à 62,5%). Conclusão: as práticas das campanhas refletiram positivamente no combate a SC, contudo, o número de dados ignorados, principalmente nas variáveis referentes a co-infecção sífilis-HIV e no rastreamento dos parceiros, afeta a confiabilidade dos dados e expressa a necessidade de se pensar em novas estratégias a fim de aumentar a vigilância epidemiológica.Objetivo: describir el momento del diagnóstico y el tratamiento de la sífilis en mujeres que habían tenido sus niños para detectar la sífilis congénita en un Maternidad del Estado de Río de Janeiro durante la campaña de lucha contra la sífilis congénita, (1999 a 2001). Métodos: se realizó un estudio descriptivo, estudio epidemiológico retrospectivo. Resultados: 479 registros fueron analizados para investigar SC en 1999 en la primera Campaña para la Eliminación de la SC, y 2001, en el segundo. Se encontró que más de la mitad de estas madres fueron diagnosticados durante la atención prenatal (54,3% a 71,9%) y hubo un aumento progresivo de la previsión de suministro de tratamiento (33,8% a 62,5%). Conclusiones: la práctica de las campañas se refleja positivamente en la lucha contra la sífilis congénita, sin embargo, el número de datos que faltan, especialmente para las variables de co-infección por el VIH y la sífilis en el cribado de la los socios, afecta a la fiabilidad de los datos, y expresó la necesidad de considerar nuevas estrategias para aumentar la vigilancia epidemiológica.Objective: to describe the time of diagnosis and treatment of syphilis in women who had their children screened for congenital syphilis in a maternity of the State of do Rio de Janeiro during the campaign to combat congenital syphilis, (1999 to 2001). Methods: this was a descriptive, retrospective epidemiological. Results: 479 records were analyzed to investigate SC in 1999 on the first Campaign for Elimination of SC, and 2001, on the second. It was found that more than half of these mothers were diagnosed during prenatal care (54.3% to 71.9%) and there was a progressive increase in anticipation of provision of treatment (33.8% to 62.5%).Conclusions: the practice of the campaigns reflected positively in the fight against congenital syphilis, however, the number of missing data, especially for variables co-infection HIV and syphilis-in screening of partners, affects the reliability of data and expressed the need to consider new strategies to increase epidemiological surveillanc

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field