Saúde e Nutrição de Crianças Internadas em Unidades Neonatais e sua Relação com a Alimentação Recebida

Some newborns are subject to clinical complications that may lead them to experience periods of hospitalization soon after birth in which they will receive intensive care to recover their health in neonatal units. However, its proper development depends on the balance between the support of biological needs, the environment and the family, the use of anthropometric parameters are extremely important for monitoring development, as well as the provision of adequate and healthy food that provides health recovery. prevent further health problems. The objective of this study was to relate the anthropometric nutritional status of newborns admitted to neonatal care units to the type of food received during hospitalization. Retrospective observational study composed of 242 neonates who were admitted to the intensive care and conventional intermediate care units of the Dona Regina Siqueira Campos maternity hospital in Palmas, Tocantins. The data were collected from the Human Milk Bank recipients registration form from February to September 2017 and the following variables were evaluated: gestational age, birth and discharge weight, length and cephalic perimeter during birth. length of stay and at discharge, daily weight gain, length of stay and diet received. Numerical variables were evaluated for normality by Skewness, Kurtosis and Shapiro-Wilk and were compared by analysis of variance, Chi-square test, student t-test, Mc Neimar, Mann-Whitney, Fischer exact and Pearson correlation. Significant differences were observed in the analysis of newborns when separated by groups in preterm and term infants and inpatient units for the following characteristics: length of stay, birth weight, discharge weight, length at birth. hospitalization and discharge, head circumference at birth, during hospitalization and discharge, nutritional classification at birth and discharge, and predominant diet. There was a predominance of premature and male babies, those born with higher weight tended to have the highest weight at discharge leading to compensatory growth, there was a decline in the nutritional status of the population studied at discharge regardless of the hospitalization unit but those who passed Intermediate care units presented better mean birth length, weight gain among preterm and full-term infants did not show statistical differences during hospitalization, with predominance of breast milk supply to preterm infants admitted to intensive care units, while among those who received preterm infants. commercial formulas predominated those born at term. We concluded that children who received infant formula possibly had conditions of breastfeeding and had greater weight gain at discharge, preterm infants remained hospitalized longer and showed less evolution of anthropometric profile and weight. We emphasize the importance of adequate and quality nutritional support in view of the impacts of prematurity and neonatal hospitalization on infant mortality.Alguns recém-nascidos estão sujeitos a passar por intercorrências clínicas que podem determinar sua internação, logo após o nascimento, para cuidados intensivos de recuperação da saúde. O desenvolvimento adequado desses bebês depende diretamente do equilíbrio entre o suporte das necessidades biológicas, o ambiente e a família. Nesse sentido, o monitoramento dos parâmetros antropométricos refletirá o desenvolvimento e a oferta de nutrição adequados, bem como propiciará mais rápida recuperação da saúde e prevenção de novos agravos. O presente trabalho buscou relacionar o estado nutricional antropométrico de recém-nascidos internados em unidades de cuidados neonatais, ao tipo de alimentação recebida durante a internação. Tratou-se de um estudo observacional retrospectivo, com amostra de 242 neonatos, que estiveram internados nas unidades de terapia intensiva e cuidados intermediários convencionais do Hospital e Maternidade Dona Regina Siqueira Campos, em Palmas, Tocantins. Os dados foram coletados das fichas de cadastro de receptores do Banco de Leite Humano, durante os meses de fevereiro a setembro de 2017 e avaliadas as seguintes variáveis: idade gestacional, peso ao nascer e na alta, comprimento e o perímetro cefálico ao nascer, durante o período de internação e na alta, ganho de peso diário, tempo de internação e dieta recebida. As variáveis numéricas foram avaliadas quanto a normalidade por Skewness, Kurtosis e Shapiro-Wilk e foram comparadas por análise de variância. Os testes de Qui-quadrado, t-Student, Mc Neimar, Mann-Whitney, Exato de Fischer e correlação de Pearson foram utilizados. Observaram-se diferenças significativas entre os grupos de neonatos prematuros e a termo e entre os grupos separados por unidade de internação, para as seguintes variáveis: período de internação, peso ao nascer, peso na alta, comprimento ao nascer, durante a internação e na alta, perímetro cefálico ao nascer, durante a internação e na alta, classificação do estado nutricional ao nascer e na alta, e dieta predominante. Houve predominância de bebês prematuros e do sexo masculino, os que nasceram com maior peso tenderam também a ter o peso mais elevado na alta, remetendo ao crescimento compensatório. Houve declínio do estado nutricional da população estudada, na alta hospitalar, independentemente da unidade de internação. No entanto, aqueles internados na unidade de cuidados intermediários apresentaram melhores médias de comprimento ao nascer. O ganho de peso durante a internação não apresentou diferença estatística, quando comparados prematuros e a termo. Houve predominância da oferta de leite materno aos prematuros internados em unidades de terapia intensiva, enquanto dentre os que receberam fórmulas comerciais predominavam as nascidas a termo. Os neonatos que receberam fórmula infantil obtiveram maior ganho de peso na alta. Os prematuros permaneceram mais tempo internados e apresentaram pior evolução do perfil antropométrico. Ressalta-se a importância do suporte nutricional adequado e de qualidade, diante dos impactos da prematuridade e da internação neonatal na mortalidade infantil

Prematuridade e sua relação com o estado nutricional e o tipo de nutrição durante a internação hospitalar

Introdução: fatores de risco gestacionais podem culminar na prematuridade neonatal, que constitui um grande desafio para a saúde pública em todo o mundo, sendo uma das principais causas de mortes neonatais. Objetivo: analisar uma população de prematuros, internados em unidades neonatais em relação ao estado nutricional e à alimentação recebida. Metodologia: delineamento observacional retrospectivo, com 125 recém-nascidos prematuros de uma maternidade pública do Tocantins. Sexo, idade gestacional ao nascer, peso, comprimento e perímetro cefálico ao nascer, durante a internação e na alta, ganho de peso diário, tempo de internação e tipo de dieta recebida foram analisados por meio dos testes de Mann-Whitney, Qui-quadrado, Exato de Fisher e t-Student, Mc Nemar, Wilcoxon e Friedman, a 5% de significância, no Statistical Package for Social Sciences 20.0. Resultados: houve predomínio do sexo masculino na amostra. A prevalência de crianças muito prematuras foi maior na unidade de cuidados convencionais (UcinCo), enquanto a prevalência de crianças com muito baixo peso ao nascer foi maior na unidade de terapia intensiva (UTIN). O tempo de internação foi menor na UcinCo, sendo este menos da metade do tempo de internação na UTIN. O peso à alta e o ganho de peso foram maiores na UTIN. Observou-se declínio do estado nutricional nas duas unidades. A utilização de fórmulas comerciais foi maior na UcinCo, enquanto predominou a oferta de leite humano na UTIN. Conclusão: independentemente do tipo de dieta recebida e da unidade de terapia, as crianças declinaram de estado nutricional durante a internação.

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

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

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq