A influência da pandemia da COVID-19 e do isolamento social sobre os índices de violência doméstica no Brasil: uma mini revisão integrativa de literatura

O distanciamento social, eficaz na prevenção contra a propagação do vírus, contribuiu para que outra pandemia, tão letal quanto o vírus SARS COV2, viesse à tona: a violência contra as mulheres no ambiente doméstico. Dessa maneira, o presente estudo tem por objetivo descrever os dados disponibilizados na literatura sobre as influências que a pandemia da COVID-19 teve no surgimento de novas ocorrências de agressões ocorridas no âmbito domiciliar.  As bases de dados consultadas foram Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Eletronic Library Online (SCIELO) e Google Acadêmico, no período de 2019 a 2022, os descritores utilizados foram “violência doméstica”; pandemia; isolamento social; COVID-19. Como resultados, obteve-se que as principais causas de violência doméstica, durante a pandemia da COVID-19, envolveram questões raciais, sociais e vínculos afetivos. Houve estratégias da imprensa jornalística para o enfrentamento da violência doméstica, mas a falta de investimentos e políticas públicas é fator determinante para o mau funcionamento e sucateamento dos serviços de proteção à saúde da mulher. Conclui-se que a pandemia da COVID-19 foi, de fato, um grande determinante para o aumento dos casos de violência doméstica nos últimos anos, fazendo com que as agressões contra a mulher atinja, de forma mais acentuada, todas as camadas da sociedade, urgindo mudanças de paradigmas

Cognitive impact in children with “benign” childhood focal epilepsy with centrotemporal spikes

Background Cognitive alterations are associated with benign childhood focal epilepsy with centrotemporal spikes (BCECTS) including aspects of executive functions. Objectives This study presents the performance profile on attention and executive function tests of fifty-eight children (BCECTS, n = 30 and controls, n = 28) aged 8-13 years. Methods The following tools were employed: Vocabulary and Block Design subtests from the Wechsler Intelligence Scale for Children III, Stroop Test, Modified Card Sorting Test, Controlled Oral Word Association – FAS and Tower of London. Results Children with BCECTS presented average IQ measure, although their performance was statistically worse when compared to the control group. Children with BCECTS showed significantly lower performance compared to the control group in the following variables: total number of recollected words on the oral fluency test, total number of categories, categorization effect and total number of errors in MCST; and execution time for the Stroop Test Card 1. After controlling for the IQ effect, the total number of errors in the MCST did not show any significant difference between the groups. Discussion Children with BCECTS showed lower performance in attention and executive functions when compared to healthy children. The results suggest that the concept of “benign” BCECTS should be reconsidered

Congenital malformations in neonates: analysis of morbidity and associated factors

Objective: To evaluate the neonatal morbidity due to congenital malformations in the city of Petrolina-PE, from 2008 to 2013. Methods: A descriptive study with data from the Information System on Live Births (Sinasc). The analyzes were carried out through frequency distribution and measures of central tendency and dispersion. The associations were tested by the Pearson and Kruskal Wallis chi-square tests. Significance was set at 5% and 95% confidence. Results: 436 cases of congenital malformations were recorded in the study period, with 2011 being the highest occurrence year. The mothers of the newborns were young (25.2 years old), single, upper level of education and household. In general multiparous, with single gestation, vaginal delivery and performed up to six prenatal visits. The newborns were males, at 39 weeks or more of gestation and with normal weight (> = 2500g). The malformations of the musculoskeletal system were the most frequent followed by the genitourinary system. Congenital malformations were especially associated with neonatal characteristics such as gender and weight. In all causes the mean weight was greater than 2500g (p <0.05). The causes of malformation of greater occurrence in both sexes were osteomuscular (p <0.05). The aspects of the mother did not present significant differences in the present study (p> 0.05). Conclusion: The present study evidenced relevant aspects in the occurrence of morbidities due to congenital malformations, directing to a greater attention the occurrence of these diseases especially in relation to the newborn

Brain activation resulting from associative encoding of face an names in adults with left chronic stroke by functional mangnetic resonance imaging

O estudo do infarto isquêmico causado pelo Acidente Vascular Cerebral Isquêmico (AVCI) permite verificar como a lesão produz alterações em redes neuronais que resultam em um déficit cognitivo. A gravidade do déficit cognitivo irá depender da densidade de conexões que a região lesionada estabelece com outras regiões cerebrais. Permite, também, a verificação de mecanismos de reorganização cerebral adaptativos e desadaptativos relacionados à lesão. O presente estudo tem por objetivo, verificar a relação entre a lesão cerebral isquêmica crônica no Giro Frontal Inferior (GFI) esquerdo e as alterações do padrão de ativação cerebral durante a codificação associativa de pares de faces e nomes (FN) não familiares; bem como, seus respectivos desfechos comportamentais envolvendo a tarefa de memória de reconhecimento para FN (MRFN) e testes neuropsicológicos de memória, atenção e funções executivas. Este perfil de lesão foi escolhido devido à maior densidade de conexões que o GFI esquerdo estabelece com outras áreas cerebrais relacionadas à memória associativa; assim como, o seu envolvimento no processamento de componentes associativos e estratégicos recrutados durante a integração de duas informações que não possuem vínculo contextual. Portanto, para testar a hipótese de que existem diferenças no padrão de ativação na presença, ou não, da lesão no GFI esquerdo que têm impacto na memória associativa, foi utilizado um paradigma de desenho em bloco por Ressonância Magnética Funcional, envolvendo a codificação associativa de FN não familiares. Os grupos foram formados por 25 controles adultos saudáveis, comparados a 24 pacientes AVCIs sem lesão em estruturas hipocampais, mas com lesão em regiões do território carotídeo esquerdo. Destes, 11 pacientes tinham lesão no GFI esquerdo (LGFIe) e 13 pacientes não possuíam lesão nesta região (n-LGFIe). Os três grupos não diferiram quanto ao sexo, à idade, à escolaridade e aos sintomas depressivos no rastreio cognitivo e QI. Os pacientes AVCIs não diferiram quanto ao tempo e volume de lesão, e apresentaram desempenho inferior aos controles na parte A do teste de trilhas. Já os pacientes LGIFe apresentaram pior desempenho que controles na parte B do teste de trilhas, no teste Stroop, na fluência verbal fonêmicaortográfica, no subteste dígitos ordem inversa e na tarefa MRFN. A comparação entre grupos do padrão de ativação ajustado pelo desempenho na MRFN revelou o aumento da ativação em regiões pré-frontais perilesionais e regiões pré-frontais do hemisfério contralesional que são indicativos de mecanismos compensatórios adaptativos à lesão cerebral em pacientes n-LGFIe. Entretanto, foram verificadas correlações negativas entre o aumento da ativação no polo frontal e em parte dos giros frontais superior e inferior do hemisfério contralesional, que podem indicar a presença de desinibição inter-hemisférica desadaptativa em parte destes pacientes. Ambos os grupos de pacientes AVCIs apresentaram redução da ativação no putâmen, tálamo e cápsula interna, que sugerem a presença de diásquise ipsilateral talâmica. Já pacientes LGFIe apresentaram correlações negativas ao aumento da ativação no córtex parietal inferior ipsilesional e correlações positivas ao aumento da ativação no giro frontal médio e córtex précentral esquerdos que demonstram a ocorrência simultânea de mecanismos de reorganização cerebral adaptativa e desadaptativa neste grupo. Entretanto, o aumento em regiões perilesionais, associada à ativação bilateral do hipocampo e amígdala, não foi suficiente para compensar a ineficiência do desempenho na MRFN. Por fim, as diferenças de ativação observadas em pacientes AVCIs refletem sua heterogeneidade clínica e demonstram que mecanismos neuroplásticos compensatórios adaptativos ou desadaptativos podem coexistir em um mesmo grupo de pacientes. Além disso, reforçam a importância do GFI esquerdo nos processos de codificação associativa de FN e podem sugerir um possível déficit de memória associativa em pacientes LGFIeThe study of an Ischemic stroke infarction allows verifying how the lesion produces alterations in the neuronal networks resulting in cognitive deficits. The severity of the cognitive deficit will depend on the density of connections that the lesioned area establishes with other brain regions. It also allows the verification of adaptive and maladaptive cerebral reorganization related to the injury. The present study aims to verify the relationship between chronic ischemic lesion in the left inferior frontal gyrus (IFG) and the changes in the brain activation pattern during associative coding of unfamiliar face and name pairs (FN). As well as their respective behavioral outcomes involving the memory recognition task for FN (MRFN) and neuropsychological tests of memory, attention, and executive functions This lesion profile was chosen given the greater density of connections of the left IFG with other brain areas related to associative memory. Also, due to the involvement of the left IFG in the processing of associative and strategic components, recruited during the integration of two pieces of information that have no contextual link. Therefore, to test the hypothesis that there are differences in the activation pattern in the presence or absence of the lesion in the left IFG that have an impact on associative memory, a block design Functional Magnetic Resonance Imaging FN associative encoding paradigm was used. The group was formed by 25 healthy adult controls, compared to 24 stroke patients without lesions in hippocampal structures, but with lesions in regions of the left carotid territory. Of these, 11 patients had a lesion in the left IFG (LIFG) and 13 patients had no lesion in this region (n-LIFG). The three groups did not differ in terms of sex, age, education, depressive symptoms, cognitive screening, and IQ. Stroke patients did not differ in injury time and volume and performed worse than controls in part A of the trial making test. On the other hand, LIFG patients showed worse performance than controls in part B of the trial making test, in the Stroop test, in the phonemic-orthographic verbal fluency, in the digits backward subtest and in the MRFN task. Comparisons between groups of MRFN performance-adjusted patterns of activation revealed increased activation in perilesional prefrontal areas and prefrontal regions of the contralesional hemisphere that are indicative of compensatory mechanisms adaptive to brain injury in n-LIFG patients. However, negative correlations were found between increased activation in the frontal pole and in part of the superior and inferior frontal gyri of the contralesional hemisphere, which may indicate the presence of maladaptive interhemispheric disinhibition in some of these patients. Both groups of stroke patients showed reduced activation in the left putamen, thalamus and internal capsule that suggest the presence of ipsilateral thalamic diaschisis. On the other hand, LIFG patients showed negative correlations in activations of the ipsilesional inferior parietal cortex and positive correlations in activations of the left middle frontal gyrus and left precentral cortex, which demonstrate the simultaneous occurrence of adaptive and maladaptive brain reorganization mechanisms in this group. However, the increase in perilesional prefrontal regions, associated with bilateral activation of the hippocampus and amygdala, was not enough to compensate for the inefficiency of the MRFN performance. Finally, the differences in activation observed in stroke patients reflect their clinical heterogeneity and demonstrate that adaptive or maladaptive compensatory mechanisms can coexist in the same group of patients. Furthermore, they reinforce the importance of the left IFG in the associative encoding processes of FN and may suggest a possible deficit in associative memory in LIFG patient

Torre de Londres e Torre de Hanói: contribuições distintas para avaliação do funcionamento executivo Tower of London and Tower of Hanoi: distinct contributions to the assessment of executive functioning

OBJETIVO: Realizar um estudo teórico sobre comparações de aspectos cognitivos e metodológicos envolvidos no desempenho das Torres de Hanói e de Londres em indivíduos normais. MÉTODO: Revisão narrativa da literatura. RESULTADOS: O desempenho nesses instrumentos não compartilha a variância esperada em virtude das similaridades aparentes em sua estrutura e demanda de solução. Verificaram-se correlações significativas, porém moderadas, entre o desempenho das duas torres, refletindo em média 75% da variância não compartilhada. CONCLUSÕES: Ambas as torres recrutam diferentes processos executivos para solução da tarefa e não podem ser utilizadas como instrumentos permutáveis.<br>OBJECTIVE: To produce theoretical study about comparisons of cognitive and methodological aspects involved in the performance of Towers of Hanoi and London in normal individuals. METHOD: Narrative review of the literature. RESULTS: The performances in these instruments do not share the expected variance due to the apparent similarities in your structure and solution demand. Correlations significant, however moderate, among the two towers performance, were found reflecting the average of 75% of the nonshared variance. CONCLUSIONS: Both towers recruit different executive processes for task solution and cannot be used as exchangeable instruments

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc