Raciocínio Baseado em Casos

The paper presents an approach of Case Based Reasoning, where it was born from the problems of human memory solution model, thus inspiring the creation of programs to address current problems. It is a technique that aims to solve a problem from the knowledge of past problems, comparing them with the new problem, and adapting well to a new solution. This will cover, from its definition, the techniques used, the stages of its development, as well as its advantages and disadvantages

Raciocínio Baseado em Casos

The paper presents an approach of Case Based Reasoning, where it was born from the problems of human memory solution model, thus inspiring the creation of programs to address current problems. It is a technique that aims to solve a problem from the knowledge of past problems, comparing them with the new problem, and adapting well to a new solution. This will cover, from its definition, the techniques used, the stages of its development, as well as its advantages and disadvantages

Central auditory processing and migraine: a controlled study

This study aimed to verify and compare central auditory processing (CAP) performance in migraine with and without aura patients and healthy controls.Forty-one volunteers of both genders, aged between 18 and 40 years, diagnosed with migraine with and without aura by the criteria of the International Classification of Headache Disorders (ICDH-3 beta) and a control group of the same age range and with no headache history, were included. Gaps-in-noise (GIN), Duration Pattern test (DPT) and Dichotic Digits Test (DDT) tests were used to assess central auditory processing performance.The volunteers were divided into 3 groups: Migraine with aura (11), migraine without aura (15), and control group (15), matched by age and schooling. Subjects with aura and without aura performed significantly worse in GIN test for right ear (p = .006), for left ear (p = .005) and for DPT test (p < .001) when compared with controls without headache, however no significant differences were found in the DDT test for the right ear (p = .362) and for the left ear (p = .190).Subjects with migraine performed worsened in auditory gap detection, in the discrimination of short and long duration. They also presented impairment in the physiological mechanism of temporal processing, especially in temporal resolution and temporal ordering when compared with controls. Migraine could be related to an impaired central auditory processing.Research Ethics Committee (CEP 0480.10) - UNIFESP.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, UNIFESP, Neurol & Neurosurg Dept, DITH, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Speech Pathol & Audiol Dept, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Neurol & Neurosurg Dept, DITH, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Speech Pathol & Audiol Dept, São Paulo, BrazilWeb of Scienc

EVENTOS ADVERSOS PÓS-VACINAIS DA VACINA CONTRA O HPV NO MUNICÍPIO DE ANÁPOLIS, GOIÁS POST-VACCINE ADVERSE EVENTS OF THE HPV VACCINE IN ANÁPOLIS, GOIÁS

ResumoObjetivo: Identificar a ocorrência de eventos adversos pós-vacinais da vacina contra o Papiloma Vírus Humano, no município de Anápolis, no ano de 2014. Métodos: Foram analisadas as fichas de Notificação dos Eventos Adversos Pós-Vacinais da vacina contra o Papiloma Vírus Humano e as variáveis: idade do paciente, dose da vacina, lote da vacina, tipo de evento adverso (sistêmico ou local), o tempo decorrido entre a aplicação do imunobiológico e o aparecimento do evento adverso, e as ações realizadas em casos de ocorrência de eventos adversos. Resultados: Foram analisadas sete fichas de Notificação de Eventos Adversos Pós-vacina, representando 0,0829% das adolescentes vacinadas. Sete meninas apresentaram eventos sistêmicos como palidez, síncope, cefaleia, vômitos, náuseas, hipotensão, espirros, rinorreia, sonolência, dor lombar, fraqueza, dor abdominal, parestesia e placas avermelhadas na região abdominal. Já em relação aos eventos adversos pós-vacinais locais, 03 adolescentes apresentaram dor e calor local e placas avermelhadas no braço. Conclusão: Apesar do pequeno intervalo de tempo estudado, os resultados desse trabalho se aproximam dos resultados encontrados por outros estudos. Palavras-chave:HPV. Vacina. Notificação. AbstractObjective: To analyze the occurrence of post-vaccine adverse events of the human papillomavirus vaccine, in the city of Anápolis, in the year 2014. Methods: he records of the Notification of Adverse Events after Vaccine of the Human Papilloma Virus Vaccine were analyzed and variables as patient age , vaccine dose,  vaccine lot, kind of adverse event (systemic or local), the time between the application of immunobiological and the onset of the adverse event, and the actions taken in case of occurrence of adverse events were considered. Results: Seven Post-Vaccine Adverse Events Notification sheets were analyzed, representing 0.0829% of the adolescents vaccinated.  Seven girls had systemic events such as pallor, syncope, headache, vomiting, nausea, hypotension, sneezing, rhinorrhea, drowsiness, back pain, weakness, abdominal pain, paresthesia, reddish plaques in the abdominal region. Concerning local post-vaccine adverse events, 03 girls presented  pain and local heat and red plaques in the arm. Conclusion: The results of our study are in agreement with that expected for the vaccine and approach with other studies in the literature. Keyword:HPV. Vaccine. Notification

Sexual Dimorphism in Red-Eared Sliders (Trachemys scripta elegans) from the Wild Animal Triage Center of the Tiete Ecological Park, São Paulo, Brazil

Background: Trachemys scripta elegans is an aquatic turtle native to North America and distributed geographically from the eastern United States to northeastern Mexico. In Brazil, it is an exotic and invasive species and the most illegally traded pet animal. When these turtles grow and they cease to be attractive as pets, they are released clandestinely in lakes, ponds, rivers, and other bodies of water, where they threaten biodiversity and native populations. The present study aimed to characterize specimens of T. s. elegans from the Centro de Triagem de Animais Silvestres do Parque Ecológico do Tiete by analyzing body biometrics, sexual dimorphism, and structure of specimens for sex ratio and size classes.Materials, Methods &amp; Results: Trachemys scripta elegans turtles (39 females and 30 males) were anesthetized, euthanized and frozen. After being thawed, the turtles were sexed according to measurements on secondary sex characters such as claw length (CWL) of the third finger of the right forearm and length of the tail from the tip to the beginning of the cloacal opening (postcloacal tail length, PTL); subsequently, sex was confirmed through dissection. Subsequently, body mass (BM, g) and maximum carapace length (MCL, cm), maximum carapace width (MCW, cm), maximum plastron length (MPL, cm), maximum plastron width (MPW) and shell height (HGT, cm, measured laterally until obtaining the greatest value) were evaluated and the sexual dimorphism index (SDI) was also calculated. All analyses were performed using SAS v. 9.4 software. The results indicate a sex ratio of 1.3 females per male. The identification of males by secondary sex characteristics was performed using only claw length (CWL), which was related to sex and not to maximum carapace length (MCL). The most discriminatory variables were CWL in males and body mass (BM) in females. With the exception of CWL, the sexual dimorphism index (SDI) values all favored females and varied from 1.21 to 2.49, with the greatest value for BM and the lowest value for postcloacal tail length (PTL). Males exhibited a unimodal tendency at a classification interval of 15.0 cm MCL, and females exhibited a bimodal tendency at 21.0- and 22.0 cm MCL. Sexual maturity was identified at 12.0 cm MCL in males and at 12.5 cm MCL in females. The rate of CWL growth in males was higher at the beginning of sexual maturity and subsequently decreased, whereas in females, the rate of CWL escalated after 19.0 cm MCL. In both sexes, principal component 1 (PC1) was composed of the variables related to size and BM, and principal component 2 (PC2) and principal component 3 (PC3) were composed of variables related to secondary sex characteristics (CWL and PTL).Discussion: In members of the genus Trachemys, several secondary sex characteristics can be used to differentiate between the sexes, however, in the present study, recognition of males was performed only by claw length, as it was confirmed by the discriminate analysis and the principal components analysis (PCA) which showed that CWL was the variable that was most discriminatory in males (approximately 76.0%), followed by BM (approximately 50%) in females. The results reinforcing the claim that the degree of development of secondary sex characteristics varies between species as well as between distinct populations of the same species and establish that even under unnatural habitat, sexual dimorphism of size in favor of females is maintained for variables related to mass and size

Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review

This paper presents a rapid review of the literature for the components, benefits, barriers, and facilitators of pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) people in-home and community-based settings. seventy-six studies were included: 57 home-based pulmonary rehabilitation (HBPR) studies and 19 community-based pulmonary rehabilitation (CBPR) studies. The benefits of HBPR on exercise capacity and health-related quality of life were observed in one-group studies, studies comparing HBPR to usual care, and studies comparing to hospital-based pulmonary rehabilitation, although the benefits were less pronounced in the latter. HBPR reduced hospital admissions compared to usual care and was more cost-effective than hospital pulmonary rehabilitation. Most HBPRs were designed with low-density or customized equipment, are minimally supervised, and have a low intensity of training. Although the HBPR has flexibility and no travel burden, participants with severe disease, physical frailty, and complex comorbidities had barriers to complying with HBPR. The telerehabilitation program, a facilitator for HBPR, is feasible and safe. CBPR was offered in-person supervision, despite being limited to physical therapists in most studies. Benefits in exercise capacity were shown in almost all studies, but the improvement in health-related quality of life was controversial. Patients reported the benefits that facilities where they attended the CBPR including social support and the presence of an instructor. They also reported barriers, such as poor physical condition, transport difficulties, and family commitments. Despite the minimal infrastructure offered, HBPR and CBPR are feasible, safe, and provide clinical benefits to patients with COPD. Home and community settings are excellent opportunities to expand the offer of pulmonary rehabilitation programs, as long as they follow protocols that ensure quality and safety following current guidelines

4-aminopyridyl-based lead compounds targeting CYP51 prevent spontaneous parasite relapse in a chronic model and improve cardiac pathology in an acute model of Trypanosoma cruzi infection.

BackgroundChagas disease, caused by the protozoan Trypanosoma cruzi, is the leading cause of heart failure in Latin America. The clinical treatment of Chagas disease is limited to two 60 year-old drugs, nifurtimox and benznidazole, that have variable efficacy against different strains of the parasite and may lead to severe side effects. CYP51 is an enzyme in the sterol biosynthesis pathway that has been exploited for the development of therapeutics for fungal and parasitic infections. In a target-based drug discovery program guided by x-ray crystallography, we identified the 4-aminopyridyl-based series of CYP51 inhibitors as being efficacious versus T.cruzi in vitro; two of the most potent leads, 9 and 12, have now been evaluated for toxicity and efficacy in mice.Methodology/principal findingsBoth acute and chronic animal models infected with wild type or transgenic T. cruzi strains were evaluated. There was no evidence of toxicity in the 28-day dosing study of uninfected animals, as judged by the monitoring of multiple serum and histological parameters. In two acute models of Chagas disease, 9 and 12 drastically reduced parasitemia, increased survival of mice, and prevented liver and heart injury. None of the compounds produced long term sterile cure. In the less severe acute model using the transgenic CL-Brenner strain of T.cruzi, parasitemia relapsed upon drug withdrawal. In the chronic model, parasitemia fell to a background level and, as evidenced by the bioluminescence detection of T. cruzi expressing the red-shifted luciferase marker, mice remained negative for 4 weeks after drug withdrawal. Two immunosuppression cycles with cyclophosphamide were required to re-activate the parasites. Although no sterile cure was achieved, the suppression of parasitemia in acutely infected mice resulted in drastically reduced inflammation in the heart.Conclusions/significanceThe positive outcomes achieved in the absence of sterile cure suggest that the target product profile in anti-Chagasic drug discovery should be revised in favor of safe re-administration of the medication during the lifespan of a Chagas disease patient. A medication that reduces parasite burden may halt or slow progression of cardiomyopathy and therefore improve both life expectancy and quality of life

A violência domiciliar contra crianças e adolescentes e a responsabilidade dos profissionais de saúde: uma revisão bibliográfica

Objetivos: Discutir a violência contra crianças e adolescentes e a responsabilidade dos profissionais de saúde na identificação e notificação desses eventos. Fonte de dados: Foi realizado um levantamento bibliográfico no portal da Biblioteca Virtual em Saúde, de modo a identificar as publicações sobre o tema da violência contra crianças e adolescentes, incluindo termos relacionados à notificação de casos de maus-tratos. A pesquisa foi realizada de agosto a novembro de 2012 e foram selecionadas publicações no período de 2001 a 2012, além de material institucional do Ministério da Saúde e legislações pertinentes à temática pesquisada. Síntese de dados: O estudo demonstrou que a Política Nacional de Redução da Morbimortalidade por Acidentes e Violência tornou compulsória a notificação de todos os casos, suspeitos ou confirmados, de maus tratos, no intuito de desencadear um processo que visa interromper atitudes e comportamentos violentos por parte de qualquer agressor, além de promover cuidados sócio-sanitários voltados à proteção das vítimas. Contudo, por despreparo em lidar com tais situações, muitos profissionais deixam de realizar a notificação por acreditarem que a violência é um fato jurídico e de segurança pública, não caracterizando um problema de saúde. Conclusão: Conclui-se que há uma lacuna nas notificações e identificações desses casos pelos profissionais de saúde sendo, portanto, imprescindível a implementação de programas de educação permanente nos serviços

Validation of a quick and effective method for determining nitrate and nitrite in meat products / Validação de método rápido e eficaz para determinação de nitrato e nitrito em produtos cárneos

A fim de implementar ensaios rápidos e de baixo resíduo, métodos de refletometria para quantificação de nitrato e nitrito em produtos cárneos foram validados. As incertezas de medição foram estimadas e os métodos aplicados em amostras comerciais. O intervalo de trabalho estabelecido para a determinação de nitrato foi de 0,007 a 0,188 g / 100g expresso em NaNO2. Os limites de detecção e quantificação foram 0,0042 e 0,0067 g / 100g, respectivamente. Os resultados de recuperação ficaram entre 90 e 115% e a precisão entre 4,1 e 12,8%. O método revelou-se seletivo na presença de interferentes, exceto para nitritos, o que tornou necessária sua eliminação prévia. A incerteza relativa expandida variou entre 5,3 e 14,2%. A repetibilidade do método foi a maior fonte de contribuição para a incerteza. O intervalo de trabalho estabelecido para determinação de nitrito foi 0. 0056 a 0,028g / 100g expresso em NaNO2. Os limites de detecção e quantificação foram 0,0009 e 0,0056 g / 100g. Os resultados de recuperação ficaram entre 81 e 85% e a precisão entre 4,4 e 10,8%. Fosfatos (0,5 g / 100g) e ácido ascórbico (0,01 g / 100g) foram avaliados como interferentes. A incerteza relativa expandida variou entre 2,9 e 4,9%. Os métodos resultaram simples, rápidos e adequados para a quantificação do analito. Aplicando os métodos em amostras comerciais, foram obtidos resultados satisfatórios de acordo com os limites máximos estabelecidos pela legislação. A incerteza relativa expandida variou entre 2,9 e 4,9%. Os métodos resultaram simples, rápidos e adequados para a quantificação do analito. Aplicando os métodos em amostras comerciais, foram obtidos resultados satisfatórios de acordo com os limites máximos estabelecidos pela legislação. A incerteza relativa expandida variou entre 2,9 e 4,9%. Os métodos resultaram simples, rápidos e adequados para a quantificação do analito. Aplicando os métodos em amostras comerciais, foram obtidos resultados satisfatórios de acordo com os limites máximos estabelecidos pela legislação

Efectos de la práctica mental asociada a la fisioterapia motora sobre la marcha y el riesgo de caídas en la enfermedad de Parkinson: estudio piloto

El objetivo de este estudio piloto, realizado en un hospital universitario de referencia en Pernambuco, fue el de evaluar los efectos de la práctica mental asociada a la fisioterapia motora sobre la marcha y el riesgo de caída en personas con enfermedad de Parkinson. La muestra de la investigación fue compuesta por 18 sujetos, de ambos sexos, con enfermedad de Parkinson idiopática, divididos en grupo experimental (8 individuos) y de control (10 individuos). Ambos grupos realizaron 15 sesiones de 40 minutos de fisioterapia motora, dos veces por semana. En el grupo de intervención, la fisioterapia se asoció a la práctica mental (15 minutos). En cuanto a las variables de desenlace primario, el tiempo de ejecución del timed up and go y de la prueba de caminata de 10 metros se redujo, pero la diferencia no fue significativa. En cuanto a la velocidad, cadencia y puntaje del dynamic gait index, hubo aumento después de la intervención en el grupo experimental, con diferencia significativa (p= 0,02). El número de pasos se ha mantenido en ambos grupos. Los resultados sugieren que la práctica mental asociada a la fisioterapia motora reduce el riesgo de caídas en comparación con la fisioterapia motora aplicada aisladamente.O objetivo deste estudo piloto, realizado em um hospital universitário de referência em Pernambuco, foi avaliar os efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de queda em pessoas com doença de Parkinson. A amostra da pesquisa foi composta por 18 sujeitos, de ambos os sexos, com doença de Parkinson idiopática, divididos em grupo experimental (8 indivíduos) e controle (10 indivíduos). Ambos os grupos realizaram 15 sessões de 40 minutos de fisioterapia motora, duas vezes por semana. No grupo de intervenção, a fisioterapia foi associada a prática mental (15 minutos). Em relação às variáveis de desfecho primário, o tempo de execução do timed up and go e do teste de caminhada de 10 metros reduziu, mas a diferença não foi significativa. Em relação à velocidade, cadência e escore do dynamic gait index, houve aumento após a intervenção no grupo experimental, com diferença significativa (p=0,02). O número de passos foi mantido em ambos os grupos. Os resultados sugerem que a prática mental associada à fisioterapia motora reduz o risco de quedas em comparação com a fisioterapia motora aplicada isoladamente.The objective of this pilot study, carried out in a university hospital of reference in Pernambuco, was to assess the effects of mental practice associated with motor physical therapy on gait and the risk of falls in people with Parkinson’s disease. The study sample consisted of 18 subjects, of both sexes, with idiopathic Parkinson’s disease, divided into experimental group (8 individuals) and control group (10 individuals). Both groups performed fifteen 40-minute sessions of motor physical therapy twice a week. In the intervention group, physical therapy was associated with mental practice (15 minutes). Regarding the primary outcome variables, the duration of the timed up and go test and of the 10-meter walking test reduced, but the difference was not significant. Speed, cadence and dynamic gait index increased after the intervention in the experimental group, with a significant difference (p=0.02). The number of steps was maintained in both groups. The results suggest that the mental practice associated with motor physical therapy reduces the risk of falls compared with applied motor physical therapy alone