Considerações acerca da relativização atípica da coisa julgada no âmbito cível

A relativização da coisa julgada é um dos temas de maior discussão no Direito Processual Civil contemporâneo. O fenômeno da relativização da coisa julgada, de acordo com a doutrina, pode ocorrer de maneira típica (prevista no ordenamento jurídico) ou atípica (não prevista no ordenamento jurídico). O objetivo do presente trabalho monográfico é concluir pela possibilidade ou impossibilidade da relativização da res judicata por meios atípicos. Para solução desta problemática utiliza-se o método jurídico-dogmático-instrumental e, subsidiariamente, o Jurídico- Epistemológico. Nesse sentido, após analisar os fundamentos epistemológicos do caso julgado, apresentam-se importantes teses doutrinárias acerca do tema, para, ao final, chegar a uma conclusão sobre a viabilidade da relativização atípica da coisa julgada quando em conflito com outros direitos e garantias fundamentais ou quando inexistente juridicamente. Sendo assim, por não existir direito absoluto, as decisões judiciais transitadas em julgado eivadas por vício de inconstitucionalidade podem ser impugnadas por ação autônoma denominada de querela nullitatis, a partir da técnica da ponderação de bens. De outro lado, as decisões judiciais das quais não caibam mais recursos eivadas com vício de inexistência podem ser superadas pela propositura de uma nova demanda de igual teor, dispensando-se a necessidade de ação de impugnação.The relativization of res judicata is one of the most discussed topics in contemporary civil procedure law. The phenomenon of relativization of res judicata according to the doctrine, can occur in a typical (under law) or atypical way (not provided for by law). The objective of this monograph is to conclude either for possibility or for the impossibility of relativizing the res judicata by atypical means. For solving this problem we use the legal-instrumental-dogmatic method and, secondarily, the legalepistemological method. Accordingly, after reviewing the epistemological bases of res judicata, we present important doctrinal arguments about the theme, in order to reach a conclusion on the feasibility of atypical relativization of res judicata when it’s in conflict with other fundamental rights and guarantees or when it’s legally absent. Therefore, since there is no absolute right, final judicial decisions ridden by vice of unconstitutionality may be challenged by autonomous lawsuit called querela nullitatis, derived from technique of balancing values. On the other hand, judicial decisions which do not admit further appeals, but have the vice of legal absence can be overcome by the filing of a new lawsuit with the same subject, eliminating the need for querela nulillitatis

S-ketamine’s effect changes the cortical electrophysiological activity related to semantic affective dimension of pain : a placebo- controlled study in healthy male individuals

Background: Previous studies using the electroencephalogram (EEG) technique pointed out that ketamine decreases the amplitude of cortical electrophysiological signal during cognitive tasks, although its effects on the perception and emotional-valence judgment of stimuli are still unknown. Objective: We evaluated the effect of S-ketamine on affective dimension of pain using EEG and behavioral measures. The hypothesis was that S-ketamine would be more effective than placebo, both within and between groups, to attenuate the EEG signal elicited by target and non-target words. Methods: This double-blind parallel placebo-controlled study enrolled 24 healthy male volunteers between 19 and 40 years old. They were randomized to receive intravenous S-ketamine (n = 12) at a plasmatic concentration of 60 ng/ml or placebo (n = 12). Participants completed a computerized oddball paradigm containing written words semantically related to pain (targets), and non-pain related words (standard). The volunteers had to classify the words either as “positive,” “negative” or “neutral” (emotional valence judgment). The paradigm consisted in 6 blocks of 50 words each with a fixed 4:1 target/non-target rate presented in a single run. Infusion started during the interval between the 3rd and 4th blocks, for both groups. EEG signal was registered using four channels (Fz, Pz, Pz, and Oz, according to the 10–20 EEG system) with a linked-earlobe reference. The area under the curve (AUC) of the N200 (interval of 100–200 ms) and P300 (300–500 ms) components of event-related potentials (ERPs) was measured for each channel. Results: S-ketamine produced substantial difference (delta) in the AUC of grand average ERP components N200 (P = 0.05) and P300 (P = 0.02) at Pz during infusion period when compared to placebo infusion for both targets and non-targets. S-ketamine was also associated with a decrease in the amount of pain-related words judged as negative from before to after infusion [mean = 0.83 (SD = 0.09) vs. mean = 0.73 (SD = 0.11), respectively; P = 0.04]. Conclusion: Our findings suggest that S-ketamine actively changed the semantic processing of written words. There was an increase in electrophysiological response for pain-related stimuli and a decrease for standard stimuli, as evidenced by the increased delta of AUCs. Behaviorally, S-ketamine seems to have produced an emotional and discrimination blunting effect for pain-related words

Sequential Organ Failure Assessment (SOFA) Score and Mortality Prediction in Patients With Severe Respiratory Distress Secondary to COVID-19

Background: This study looks at the validity of the sequential organ failure assessment score (SOFA) in detecting mortality in patients with Coronavirus disease of 2019 (COVID-19) pneumonia. Also, it is looking to determine the optimal SOFA score that will discriminate between mortality and survival. Methods: It is a retrospective chart review of the patients admitted to Henry Ford Hospital from March 2020 to December 2020 with COVID-19 pneumonia who developed severe respiratory distress. We collected the following information; patient demographics (age, sex, body mass index), co-morbidities (history of diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, or cancer), SOFA scores (the ratio of arterial oxygen tension (PaO(2)) to the fraction of inspired oxygen, Glasgow Coma Scale (GCS) score, mean arterial pressure, serum creatinine level, bilirubin level, and platelet count) as well as inpatient mortality. Results: There were 320 patients; out of these, 111 were intubated. The receiver operating characteristic (ROC) curve for SOFA at the moment of inclusion in the study had an area under the curve of 0.883. The optimal point for discrimination between mortality and survival is SOFA of 5. A SOFA score of less than two is associated with 100% survival, while a score of more than 11 is associated with 100% mortality. Conclusions: SOFA score in COVID-19 patients with severe respiratory distress strongly correlates with the initial SOFA score. It is a valuable tool for predicting mortality in COVID-19 patients

THE EFFECT OF A PERIPHERAL NOREPINEPHRINE PROTOCOL ON CENTRAL LINE UTILIZATION IN A SURGICAL ICU

INTRODUCTION: Central venous catheters (CVC) are associated with various complications. In several studies, the use of vasopressors through peripheral venous catheters (PVC) obviated the need for CVC insertion in 34-87% of patients. Although evidence indicates that the peripheral administration of vasopressors is safe, most health systems currently use protocols that favor the use of CVC over PVC. We proposed a quality improvement study evaluating the use of a protocol for the peripheral administration of a dilute norepinephrine solution (16 mcg/ml) in the surgical intensive care unit (SICU). METHODS: This was a retrospective quality improvement study conducted at Henry Ford Hospital in Detroit, MI. We included 100 patients that were admitted to the SICU between June and December 2021 and received dilute norepinephrine for any cause through a PVC under our prespecified protocol. Guidelines for CVC insertion were present in the protocol to assist clinicians. An extravasation protocol was instituted which included application of 2% nitroglycerin ointment. The primary endpoint evaluated was the number of patients in which a CVC was placed, regardless of the cause, within 24 hours of discontinuation of norepinephrine through the PVC. Secondary endpoints included the indication for central line placement, dose of norepinephrine infused, duration of norepinephrine infusions, gauge and location of the PVC, frequency of extravasation events, and tissue injury. RESULTS: Out of the 100 included in the study 51 patients (51%) did not receive a CVC, and 60 patients (60%) did not receive a CVC within the first 24 hours of discontinuation of peripheral norepinephrine. Norepinephrine extravasation was noted in 6 patients (6%). These incidents were successfully managed with nitroglycerin (2%) ointment. CONCLUSIONS: We demonstrated that administration of diluted norepinephrine through a PVC following a protocol in the SICU was associated with a reduction in CVC placement. The incidence of extravasation of norepinephrine was rare. Careful assessment of the PVC allowed for early treatment with topical nitroglycerine and no harm was identified to any patient

Effect of Intubation Timing on the Outcome of Patients With Severe Respiratory Distress Secondary to COVID-19 Pneumonia.

Background: The optimal timing of intubation for critically ill patients with severe respiratory illness remains controversial among healthcare providers. The coronavirus disease 2019 (COVID-19) pandemic has raised even more questions about when to implement this life-saving therapy. While one group of providers prefers early intubation for patients with respiratory distress because these patients may deteriorate rapidly without it, other providers believe that intubation should be delayed or avoided because of its associated risks including worse outcomes. Research question: Our objective was to assess whether the timing of intubation in patients with severe COVID-19 pneumonia was associated with differences in mortality or other outcomes. Study design and methods: This was a single-center retrospective observational cohort study. We analyzed outcomes of patients who were intubated secondary to COVID-19 pneumonia between March 13, 2020, and December 12, 2020, at Henry Ford Hospital in Detroit, Michigan. Patients were categorized into two groups: early intubated (intubated within 24 hours of the onset of severe respiratory distress) and late intubated (intubated after 24 hours of the onset of severe respiratory distress). Demographics, comorbidities, respiratory rate oxygenation (ROX) index, sequential organ failure assessment (SOFA) score, and treatment received were compared between groups. The primary outcome was mortality. Secondary outcomes were ventilation time, intensive care unit stay, hospital length of stay, and discharge disposition. Post hoc and Kaplan-Meier survival analyses were performed. Results: A total of 110 patients were included: 55 early intubated and 55 late intubated. We did not observe a significant difference in overall mortality between the early intubated (43%) and the late intubated groups (53%) (p = 0.34). There was no statistically significant difference in patients\u27 baseline characteristics including SOFA scores (the early intubation group had a mean score of 7.5 compared to 6.7 in the late intubation group). Based on the ROX index, the early intubation group had significantly more patients with a reduced risk of intubation (45%) than the late group (27%) (p = 0.029). The early intubation group was treated with a high-flow nasal cannula at a significantly lower rate (47%) than the late intubation group (83%) (p \u3c 0.001). Significant differences in patient baseline characteristics, treatment received, and other outcomes were not observed. Post hoc analysis adjusting for SOFA score between 0 and 9 revealed significantly higher mortality in the late intubation group (49%) than in the early intubation group (26%) (p = 0.03). Patients in the 0 to 9 SOFA group who were intubated later had 2.7 times the odds of dying during hospital admission compared to patients who were intubated early (CI, 1.09-6.67). Interpretation: The timing of intubation for patients with severe COVID-19 pneumonia was not significantly associated with overall mortality or other patient outcomes. However, within the subgroup of patients with SOFA scores of 9 or lower at the time of intubation, patients intubated after 24 hours of the onset of respiratory distress had a higher risk of death than those who were intubated within 24 hours of respiratory distress. Thus, patients with COVID-19 pneumonia who are not at a high level of organ dysfunction may benefit from early mechanical ventilation

Prevalência e fatores associados aos níveis de ansiedade durante a pandemia da COVID-19: Prevalence and factors associated with anxiety levels during the COVID-19 pandemic

A pandemia e a inerente alteração de comportamentos, a par da pouca previsibilidade, conceberam maiores níveis de sintomas de ansiedade na população. O isolamento social foi proposto pelos governos locais como medida de saúde pública fundamental para controle da disseminação do Covid-19. Apesar de ser uma das medidas mais eficazes no combate à propagação da pandemia, o distanciamento pode ter influências sociais e psicológicas diretas e indiretas na saúde mental da população. Investigar os sintomas de ansiedade e fatores associados na população adulta durante a pandemia da Covid-19 no estado do Ceará, Nordeste do Brasil. Trata-se de um estudo descritivo com caráter retrospectivo, no qual participaram da pesquisa 214 sujeitos (44,4% residentes de Fortaleza, 43,9% da Região Metropolitana e 11,7% residentes de outras cidades). Para a coleta de dados foi utilizado o Inventario de Beck - BAI, disponibilizado de forma eletrônica através do Google Forms® e analisados pela estatística descritiva e regressão logística. Identificou-se que a maioria (58,87%) dos entrevistados apresentavam sintomas de ansiedade. Os sintomas de ansiedade mostraram-se relacionados aos indivíduos mais jovens 18-23 anos (OR = 3,03; IC: 1,17-7,80), que não praticavam atividade física (OR = 2,14; IC: 1,14- 4,02) e que pararam de praticar atividade física durante o lockdown (OR = 2.38; IC: 1,20 - 4,71). Os participantes do presente estudo apresentaram sintomas de ansiedade leve, moderado e severo e os fatores associados foram idade, não praticar atividade física e ter parado de praticar atividade física durante o período de lockdown

A diabetes como fator agravante da infecção por COVID-19

O Coronavírus-2 (SARS-CoV-2) é uma síndrome respiratória grave, que apareceu no final de 2019 em uma província na China e espalhou-se por todo o mundo. Essa doença agressiva, frequentemente, teve seus sintomas agravados por condições associadas, como a diabetes. Essa condição metabólica de origem múltipla é considerada uma das comorbidades mais comuns em pessoas com COVID-19. A maioria das evidências disponíveis também revela que a doença tem uma ligação intrínseca com o aumento da gravidade e mortalidade, especialmente em relação a pacientes com níveis glicêmicos descompensados. Este presente estudo tem como objetivo analisar a associação da Diabetes como agravante dos quadros de COVID-19. A pesquisa envolveu a análise de artigos relevantes publicados entre 2020 e 2023, selecionados em bases renomadas como SCIELO, MEDLINE/PubMed e RBAC, analisando descritores específicos correlacionados à Diabetes e ao COVID-19, principalmente tomando como base as duas patologias simultâneas.  Os resultados indicam que o indivíduo com diabetes tem uma grande prevalência de óbito e um aumento de chances de caso severo quando infectado pelo SARS-CoV-2. Isso porque, enquanto uma doença crônica, a diabetes altera as funções metabólicas e, com isso, as respostas imunológicas. Ademais, a diabetes aumenta o risco de fibrose pulmonar, distúrbios pulmonares obstrutivos e redução da função respiratória, que podem também diminuir a oxigenação dos órgãos. Diante dessa próxima interação entre as enfermidades, torna-se necessário o desenvolvimento de mais pesquisas no ramo científico acerca da temática para proporcionar um maior conhecimento na área da saúde, consequentemente provocando um aumento da prevenção, além de um manejo mais específico e um maior zelo por pacientes acometidos, com o intuito de evitar complicações maiores provocadas por essas alterações, melhorando o prognóstico e avançando nesse âmbito

Os aspectos semiológicos do acidente vascular encefálico: uma abordagem neurológica

O Acidente Vascular Encefálico (AVC) é um evento neurológico súbito, com um foco de isquemia ou hemorragia. Ambos, qualificados pelo déficit neurológico focal abrupto. Ressaltando, que estes déficits podem ocorrer, sendo a ocorrência espontânea, perduração de 15 minutos, autoresolutiva é denominada como Ataque Isquêmico Transitório (AIT), no entanto, toda insuficiência neural que não melhorar pós esse período deve ser manejado como AVC. O artigo objetivou descrever os principais aspectos clínicos do AVC. O AVC é uma emergência para a saúde pública, em razão de ser um potencial em gerar morbimortalidades para os portadores e prejuízos para os sistemas de saúde. O AVC do tipo isquêmico representa a maioria das ocorrências, o quadro clínico do paciente é correspondente ao tecido neural afetado, inicialmente a tomografia computadorizada sem contraste é o primeiro exame, por ser crucial para descartar a etiologia hemorrágica, a condução terapêutica se baseia em medidas neuroprotetoras através da estabilização da glicemia, temperatura e sódio, adequar os níveis pressóricos, mediante o prazo estipulado impor terapia antitrombótica. A manifestação hemorrágica, pode ocorrer por torção de aneurisma sacular originando o sangramento subaracnóideo ou por hipertensão gerando o sangramento intraparenquimatoso. A partir da análise das informações coletadas, elucida-se que o diagnóstico precoce e o período transcorrido até o manejo terapêutico são cruciais para o desfecho clínico do portador, ou seja, é possível a normalização ou ocorrer sequelas neurais e óbito

Evidências sobre o uso de leite materno no tratamento dermatológico da pele do recém-nascido: Evidence on the use of breast milk in the dermatological treatment of newborn skin

O presente estudo tem como objetivo analisar as evidências sobre o uso de leite materno no tratamento dermatológico da pele do recém-nascido. A pesquisa foi desenvolvida com base em uma Revisão Sistemática da Literatura (RSL). A pesquisa foi realizada na Biblioteca Virtual do Ministério da Saúde (BVS) que indexa artigos de diferentes bases de dados como Scielo, Lilacs e MedLine e na PubMed.  Como critérios de inclusão foi considerado ser disponível em formato completo e publicado nos últimos dez anos (2012-2022). Foram excluídos estudos que não respondessem o tema de pesquisa ou que estivessem duplicados nas bases de dados. O uso do leite materno como tratamento dermatológico de pele é potencial, porém, os estudos ainda são escassos e inconclusivos, fazendo-se importante que estudos sejam realizados para que se possa sanar dúvidas sobre o uso do leite materno, considerando ser um tratamento natural e de baixo custo

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality