Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects

Moderate or severe pain are important sources of complications as well as morbidity and mortality in the postoperative period after surgical procedures. Patient‐controlled analgesia (PCA) is an effective strategy for postoperative analgesia, since it may provide suitable analgesic dose just after system activation, with reduced periods of pain and an increase in patients’ satisfaction. Although intravenous and epidural routes are the typical approaches used for PCA, regional patient‐controlled analgesia has been shown to be an effective alternative providing a higher standard of analgesia with lower incidence of adverse effects. New devices and routes of PCA administration (transdermal, sublingual, inhalation, and oral routes) have shown to be promising alternatives in clinical studies. Nowadays, there is still no consensus regarding which is the best route or drug used since clinical efficacy/safety depends on the complex comprehension of the drugs pharmacokinetic profile through different routes of administration. Additionally, pharmacoeconomic studies are needed to evaluate the cost‐effectiveness of these approaches

A labelling strategy to define airtightness performance ranges of naturally ventilated dwellings: An application in southern Europe

Energy efficiency and indoor air quality are frequently-two conflicting objectives when establishing the air change rate (ACH) of a dwelling. In Europe, the northern countries have a clear focus on energy conservation, leading to an obvious awareness of the importance of airtightness, which translates into a high level of regulation and implementation. Meanwhile, the southern counterparts experience a more com-plex challenge by having predominantly passive ventilation strategies and milder climates, which often results in a more permissive approach. This work proposes an innovative labelling methodology to classify the performance of naturally ventilated dwellings. A representative sample of a southern European national built stock is used in a stochastic process to create a pool of 43,200 unique dwellings. The simulation period refers to a month of the typical heating season in the southern European mild conditions. The results test the labelling methodology. With feature selection, ACH limits, and a labelling strategy, dwellings classify according to their ability to provide adequate ACHs. The terrain was the best splitter of the dataset from the applied categorical variables. Regarding continuous variables, the airtightness was the one explaining most of the variability of the outputted ACHs, followed by the floor area. From the best performing dwellings labelled as compliant (Com), the average airtightness level was 5.3 h(-1), with 4.9 h(-1) and 5.8 h(-1) in rural and urban locations. (C) 2022 Elsevier B.V. All rights reserved.This work was financially supported by: Base Funding - UIDB/04708/2020 and Programmatic Funding - UIDP/04708/2020 of the CONSTRUCT - Instituto de I&D em Estruturas e Construcoes - funded by national funds through the FCT/MCTES (PIDDAC). The author would like to acknowledge the support of FCT - Fundacao para a Ciencia e a Tecnologia, the funding of the Doctoral Grant PD/BD/135162/2017, through the Doctoral Programme EcoCoRe. This work is supported by the European Social Fund (ESF), through the North Portugal Regional Operational Programme (Norte 2020) [Funding Reference: NORTE-06-3559-FSE-000176]. The authors also acknowledge Dr. Ricardo Deus and the Portuguese Institute for Sea and Atmosphere, I.P. (IPMA, IP) for providing the meteorological dataset for this work

Towards an airtightness compliance tool based on machine learning models for naturally ventilated dwellings

Physical models and probabilistic applications often guide the study and characterization of natural phenomena in engineering. Such is the case of the study of air change rates (ACHs) in buildings for their complex mechanisms and high variability. It is not uncommon for the referred applications to be costly and impractical in both time and computation, resulting in the use of simplified methodologies and setups. The incorporation of airtightness limits to quantify adequate ACHs in national transpositions of the Energy Performance Building Directive (EPBD) exemplifies the issue. This research presents a roadmap for developing an alternative instrument, a compliance tool built with a Machine Learning (ML) framework, that overcomes some simplification issues regarding policy implementation while fulfilling practitioners' needs and general societal use. It relies on dwellings' terrain, geometric and airtightness characteristics, and meteorological data. Results from previous work on a region with a mild heating season in southern Europe apply in training and testing the proposed tool. The tool outputs numerical information on the air change rates performance of the building envelope, and a label, accordingly. On the test set, the best regressor showed mean absolute errors (MAE) below 1.02% for all the response variables, while the best classifier presented an average accuracy of 97.32%. These results are promising for the generalization of this methodology, with potential for application at regional, national, and European Union levels. The developed tool could be a complementary asset to energy certification programmes of either public or private initiatives. (c) 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).This work was financially supported by: Base Funding - UIDB/04708/2020 and Programmatic Funding - UIDP/04708/2020 of the CONSTRUCT - Instituto de I & D em Estruturas e Construcoes - funded by national funds through the FCT/MCTES (PIDDAC). The author would like to acknowledge the support of FCT - Fundacao para a Ciencia e a Tecnologia, the funding of the Doctoral Grant PD/BD/135162/2017, through the Doctoral Programme EcoCoRe. This work is supported by the European Social Fund (ESF), through the North Portugal Regional Operational Programme (Norte 2020) [Funding Reference: NORTE-06-3559-FSE-000176]

A abordagem semiótica dos conceitos de modelos atômicos na análise de livros didáticos adotados por escolas públicas no município de Goiás / The semiotic approach to the concepts of atomic models in the analysis of textbooks adopted by public schools in the municipality of Goiás

A pesquisa apresentada corresponde a um estudo que teve como objetivo depreender como os modelos atômicos estão apresentados nos livros didáticos (LD) adotados pelas escolas públicas da cidade de Goiás. As quatro principais escolas do município participantes da pesquisa nos revelaram que o LD utilizado em três delas era o mesmo – Coleção Química Cidadã. A partir desse dado a investigação se direcionou para a leitura de como o modelo atômico era abordado no LD. Observou-se que há um exercício abstrato que antecede e se constrói organicamente até a apresentação do conceito atômico. Isso permitiu compreender como elementos semióticos são dimensionados para elaborar uma representação dos signos químicos de forma dialógica formatando uma compreensão dos conceitos químicos afastada do realismo interpretativo. Compreendemos que essa abordagem exige do estudante uma estruturação complexa do pensamento e que sem a mediação do professor a aprendizagem do conceito atômico pode se configurar como um obstáculo

Death due to bicycle accidents in the northeast region of Brazil

Objective: To evaluate the death prevalence due to bicycle accidents in the northeast region of Brazil between 2001 and 2010. Methodology: This study was conducted with a descriptive quantitative and analytical approach through secondary data. The sample consisted of all Death Certificates (DC) registered over the Mortality Information System (MIS) of the Unified Health System Data Base that reported bicycle accidents between 2001 and 2010. Descriptive measures were determined to all variables. The sociodemographic variables were intersected with the basic cause of death to search a statistical correlation. Results: Over the considered period of time, 2763 Death Certificates were brought up, where the deaths that occurred over the northeast region of Brazil were due to bicycle accidents, being evidenced a higher frequency to men, between 25-39 and 40-59 years old, with brown skin color, single and with 1-3 scholarity years. The victims mean age was 38,49 (DP = 18,322). Conclusion: The increase in the numbers of fatal bicycle accidents show that a restructuration of the traffic infrastructure is needed, an increase on the cycling paths offer and effective legal changes to the reduction of this kind of accident.Objetivo: Evaluar la prevalencia de la mortalidad por accidentes de bicicletas en el Nordeste entre 2001 y 2010. Metodología: Este estudio se realizó en un enfoque cuantitativo descriptivo y analítico a través de datos secundarios. La muestra estuvo constituida por todas las declaraciones de la Muerte (DO) registrados en el Sistema de Informaciones sobre Mortalidad (SIM), Base de datos del Sistema Nacional de Salud (DATASUS), quienes reportaron accidentes de bicicleta entre 2001 y 2010. Medidas descriptivas fueron determinadas para todas las variables. Las variables sociodemográficas se cruzaron con la causa básica de defunción en busca de correlación estadística. Resultados: En el período que se examina se plantearon 2.763 declaraciones de muertes en las que ocurrieron en el noreste de Brasil se debieron a accidentes de bicicleta, lo que evidencia una mayor frecuencia en el sexo masculino, entre los 25-59 años, marrón, único y escolaridad 1-3 años. La edad promedio de las víctimas era 38,49 años (DE = 18.322). Conclusiones: El aumento en el número de accidentes mortales con señales bicicleta a la necesaria mejora de la infraestructura de transporte, el aumento de la oferta de ciclos de punto y los cambios legales eficaces para reducir este tipo de accidentes

Infarto agudo do miocárdio secundário à dissecção espontânea de artéria coronária: um relato de caso

Relata-se um caso de uma mulher de meia idade, sem fatores de risco cardiovasculares, apresentando um quadro de Infarto Agudo do Miocárdio Sem Supra de Segmento ST. Após a realização de um cateterismo, evidenciou imagem compatível com Dissecção Espontânea de Artéria Coronária

Vascular dementia: neurological assessment and cardiovascular manifestations

Vascular dementia is a form of dementia caused by brain damage resulting from problems with blood flow to the brain. It is often associated with risk factors and cardiovascular manifestations, such as high blood pressure, diabetes mellitus, ischemic heart disease, stroke, atrial fibrillation, among others. These factors may contribute to the development and progression of vascular dementia, as well as increase the risk of complications and mortality. Objective: to evaluate the relationship between vascular dementia and neurological and cardiovascular changes, as well as to identify the main strategies for prevention, diagnosis and treatment of this condition. Methodology: followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, which consists of a set of recommendations to guarantee the quality and transparency of systematic reviews. Searches were carried out in the PubMed, Scielo and Web of Science databases, using the following descriptors: “vascular dementia”, “neurological assessment”, “cardiovascular manifestations”, “risk factors” and “treatment”. Only articles published in the last 10 years (from 2013 to 2023), in English or Portuguese, that addressed the topic of vascular dementia and its neurological and cardiovascular implications were included. Articles that were not original (reviews, editorials, letters to the editor, etc.), that did not present sufficient or reliable data, that had an inadequate methodology or that were not relevant to the objective of the review were excluded. Results: 17 studies were selected. The neurological evaluation of vascular dementia should include a detailed anamnesis, a complete physical examination, a cognitive and functional assessment, as well as complementary exams such as computed tomography or magnetic resonance imaging of the skull. The cardiovascular assessment of vascular dementia must consider modifiable and non-modifiable risk factors, clinical manifestations, and laboratory and imaging findings. Pharmacological interventions may include medications to improve cognitive function (such as cholinesterase inhibitors or NMDA receptor antagonists), to control cardiovascular risk factors (such as antihypertensives, hypoglycemic agents, or anticoagulants), or to prevent complications (such as anti-inflammatories). or antidepressants). Conclusion: Vascular dementia is a serious and prevalent disease that affects both the central nervous system and the cardiovascular system. Its prevention, diagnosis and treatment require an integrated and multidimensional approach, which considers the neurological and cardiovascular aspects involved. Carrying out more studies on this topic is essential to expand scientific knowledge and improve the quality of life of patients with vascular dementia.Vascular dementia is a form of dementia caused by brain damage resulting from problems with blood flow to the brain. It is often associated with risk factors and cardiovascular manifestations, such as high blood pressure, diabetes mellitus, ischemic heart disease, stroke, atrial fibrillation, among others. These factors may contribute to the development and progression of vascular dementia, as well as increase the risk of complications and mortality. Objective: to evaluate the relationship between vascular dementia and neurological and cardiovascular changes, as well as to identify the main strategies for prevention, diagnosis and treatment of this condition. Methodology: followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, which consists of a set of recommendations to guarantee the quality and transparency of systematic reviews. Searches were carried out in the PubMed, Scielo and Web of Science databases, using the following descriptors: “vascular dementia”, “neurological assessment”, “cardiovascular manifestations”, “risk factors” and “treatment”. Only articles published in the last 10 years (from 2013 to 2023), in English or Portuguese, that addressed the topic of vascular dementia and its neurological and cardiovascular implications were included. Articles that were not original (reviews, editorials, letters to the editor, etc.), that did not present sufficient or reliable data, that had an inadequate methodology or that were not relevant to the objective of the review were excluded. Results: 17 studies were selected. The neurological evaluation of vascular dementia should include a detailed anamnesis, a complete physical examination, a cognitive and functional assessment, as well as complementary exams such as computed tomography or magnetic resonance imaging of the skull. The cardiovascular assessment of vascular dementia must consider modifiable and non-modifiable risk factors, clinical manifestations, and laboratory and imaging findings. Pharmacological interventions may include medications to improve cognitive function (such as cholinesterase inhibitors or NMDA receptor antagonists), to control cardiovascular risk factors (such as antihypertensives, hypoglycemic agents, or anticoagulants), or to prevent complications (such as anti-inflammatories). or antidepressants). Conclusion: Vascular dementia is a serious and prevalent disease that affects both the central nervous system and the cardiovascular system. Its prevention, diagnosis and treatment require an integrated and multidimensional approach, which considers the neurological and cardiovascular aspects involved. Carrying out more studies on this topic is essential to expand scientific knowledge and improve the quality of life of patients with vascular dementia

Caso clinico de hirschsprug e suas abordagens / Hirschsprug's clinical case and its approaches

O megacólon é a dilatação do intestino grosso, acompanhada de dificuldade para eliminar fezes e gases, causado por lesões nas terminações nervosas do intestino. Ele pode ser consequência de uma doença congênita do bebê, conhecida como doença de Hirschsprung. Com a perda das contrações e movimentos intestinais nesta doença, surgem sinais e sintomas como prisão de ventre que piora ao longo do tempo, vômitos, inchaço e dor abdominal. Dessa forma na maioria das vezes a abordaem cirúrgica é a mais adequada visando aumentar a qualidade de vida desse paciente. O presente estudo tem como objetivo abordar as principais técnicas e suas principais complicações

A acurácia da circunferência da panturrilha na identificação da gravidade de pacientes com insuficiência venosa crônica / The accuracy of calf circumference in identifying the severity of chronic venous insufficiency patients

Introdução: A insuficiência venosa crônica (IVC) é uma doença de alta prevalência que cursa com acometimento funcional dos membros inferiores, sendo necessário estabelecer medidas simples de acompanhamento da gravidade da doença. Objetivo: Verificar o papel da circunferência da panturrilha na identificação dos pacientes com IVC grave. Métodos: Foram avaliados 73 pacientes (68 do sexo feminino, 49,2±13,2 anos) com IVC. Os pacientes foram estratificados em IVC leve (pacientes sem sinais visíveis de IVC e/ou com presença de veias reticulares e telangiectasias, n=48), e IVC grave (pacientes com edema, alterações tróficas e/ou úlcera venosa, n=25). Todos os pacientes foram submetidos à perimetria dos membros inferiores como instrumento de avalição da circunferência da panturrilha. A acurácia de circunferência da panturrilha na identificação dos pacientes graves foi realizada pela Receiver Operating Characteristic (Curva ROC). Resultados: A circunferência da panturrilha foi eficaz em identificar os pacientes com IVC grave (área sob a curva = 0,71; intervalo de confiança 95%: 0,58 – 0,85). O ponto de corte ótimo da circunferência da panturrilha para identificar os pacientes com IVC grave foi de 37 cm, com sensibilidade de 60% e especificidade 83%. O valor preditivo negativo do ponto de corte foi de 80%. Sendo assim, o paciente com IVC que apresentar circunferência da panturrilha inferior a 37 cm possui 80% de chance de ter IVC leve. Conclusão: O ponto de corte da circunferência da panturrilha pode ser útil para tentar identificar os pacientes mais graves com IVC, e o ponto de corte de 37 cm pode ser utilizado como referência.