Comitê de prevenção da mortalidade materna, Infantil e fetal no município de castanhal / Committee for the prevention of maternal mortality, children and fetal in the municipality of castanhal

A Secretaria Municipal de Saúde de Castanhal (PA) instituiu, em outubro de 2015, o Comitê Municipal de Prevenção do Óbito Materno, Infantil e Fetal (CMPOMIF), constituindo o segundo comitê municipal no estado. O objetivo do trabalho é conhecer o número e o perfil dos óbitos maternos, infantis e fetais do município, bem como seus determinantes e o potencial de evitabilidade. O projeto pretende garantir a melhoria da informação através da visibilidade dos principais problemas identificados, além de subsidiar a implantação de medidas que promovam a redução da mortalidade. Outro propósito é monitorar a qualidade da assistência de saúde através da educação. As principais variáveis analisadas pelo comitê corresponderam à qualidade do atendimento da mãe no pré-natal e parto, do recém-nascido na maternidade e da criança na atenção básica, na urgência e emergência e no hospital, bem como a organização do serviço de saúde, no qual é verificado se houve falhas no acesso e na assistência. Através do trabalho realizado pelo comitê foi possível identificar algumas falhas no sistema em relação ao atendimento da mulher no pré-natal, no parto e no puerpério, levando a equipe de profissionais a observar uma maior necessidade de sensibilização de todos os atores envolvidos na assistência a esse público. 

Adesão ao tratamento dietético e evolução nutricional e clínica de pacientes com diabetes mellitus tipo 2.

O Diabetes Mellitus (DM) acomete em média 300 milhões de pessoas no mundo. O conhecimento a cerca das características da doença e sobre a adesão ao tratamento nutricional em pacientes ambulatoriais é fundamental para um melhor controle da patologia. Esse estudo teve como objetivo avaliar a adesão ao tratamento dietético e a evolução do estado nutricional e clínico de pacientes diabéticos assistidos pelo Ambulatório de Nutrição do Hospital Universitário de Sergipe. Participaram do estudo 30 pacientes, sendo avaliados os momentos da primeira consulta e depois de 6 ± 2 meses de tratamento nutricional. Foram coletados dos protocolos de atendimento do ambulatório de nutrição dados antropométricos, bioquímicos, história clínica dos mesmos e da adesão ao consumo alimentar. Analisou-se peso, IMC, colesterol total e frações, glicemia de jejum, glicemia pós-prandial, triglicérides, prevalência de comorbidades e percentual de adesão à dieta. Foi encontrada uma prevalência de 40% de pacientes obesos. As comorbidades mais prevalentes no estudo foram hipertensão (80%) e dislipidemia (36%). Quanto ao tratamento nutricional, observou-se que apenas 13,3% da amostra aderiram ao plano alimentar proposto e que não houve evolução significativa do perfil antropométrico e bioquímico dos pacientes participantes do estudo

Pontas de pulverização e horários de aplicação no controle químico de ferrugem asiática da soja

Spray nozzles were evaluated at two different spraying times (14h and 17h 30m), in Mato Grosso do Sul, Brazil regarding Asian soybean rust control (Phakopsora pachyrhizi Sidow). Four spray nozzles were evaluated: deflector plain tips, double deflector plain tips, extended range flat spray tips and double plain tips. A commercial formulation of epoxiconazole and pyraclostrobin (0,5 L ha-1) was sprayed in the plots. Soybean leaves were collected at the top, middle and lower canopy, for assessment of the number of lesions and uredinias. In addition, leaf area affected by P. pachyrhizi was estimated. Plots sprayed with double deflector plain tips had lower uredinia counts in the lower canopy compared to the other tips tested. Sprays done early in the afternoon with double deflector plain nozzles had lower uredinia counts compared to the other treatments. Smaller defoliation and greater a-thousand grain mass were detected in plots sprayed with fungicide using a double deflector plain tip compared to the deflector plain nozzle. Soybean yield was not affected by nozzles and time of fungicide spray.O trabalho foi desenvolvido em Dourados-MS, com o objetivo de estudar o efeito de pontas de pulverização e horários de aplicação de fungicida no controle químico da ferrugem asiática da soja (Phakopsora pachyrhizi Sidow). Avaliaram-se quatro pontas de pulverização: jato plano defletor, jato plano defletor duplo, já to plano de faixa ampliada, jato plano duplo. As aplicações ocorreram nos horários de 14h e 17h 30min com pulverizador costal à pressão constante. O fungicida utilizado foi uma formulação comercial de epoxiconazol e piraclostrobina (0,5 L ha-1). Foram coletados folíolos nos terços superior, médio e inferior para avaliação do número de lesões, urédias, e área foliar lesionada. Menor número de urédias no terço inferior foi observado em plantas que receberam aplicação de fungicida às 14h via ponta jato plano defletor duplo em relação às demais pontas. A aplicação de fungicida, independente do tipo de ponta, não resultou em alterações nos níveis de controle da ferrugem asiática nos terços superior e médio. Menor desfolha e maior massa de mil grãos foram detectadas quando a aplicação foi realizada com a ponta jato plano defletor duplo em relação à jato plano defletor. A produtividade não foi afetada pelo uso de diferentes pontas e horários de aplicação do fungicida

Activity of phenolic compounds from plant origin against Candida species

Candida albicans and other Candida species have been highly associated with several opportunistic fungal infections. Their ability to develop host infections is incited by different determinants, being virulence factors the most highlighted. Molecular targets of the antifungal drugs are crucial components for determination of yeast survival. Ergosterol, nucleic acids and glucan are the most studied molecular targets to destroy Candida species, being considered the basis of the development of new antifungal drugs. However, increasing levels of resistant Candida species to the current antifungal drugs have been observed, making ineffective those agents. Thus, other therapies more effective and safer than the current ones, are being studied, namely the use plant of extracts enriched in phenolic compounds. In this sense, this manuscript provide an historical perspective of the opportunistic fungal infections, molecular targets of the current anti-Candida drugs, as well as a general description of the active principles present in plants, focused on the antifungal potential of whole plant extracts and isolated phenolic compounds, against Candida species.Foundation for Science and Technology (FCT, Portugal) grant (SFRH/BD/87658/2012), “Programa Compromisso com Ciência – 2008” and financial support to the Research Centre CIMO (strategic project PEst-OE/AGR/UI0690/2011). This work was also supported by the Programa Operacional, Fatores de competitividade – COMPETE and by national funds through FCT – Fundação para a Ciência e a Tecnologia on the scope of the projects FCT PTDC/SAU-MIC/119069/2010, RECI/EBB-EBI/0179/2012 and PEst-OE/EQB/LA0023/2013. Project “BioHealth – Biotechnology and Bioengineering approaches to improve health quality”, Ref. NORTE-07-0124-FEDER-000027, co-funded by the Programa Operacional Regional do Norte (ON.2-O Novo Norte), QREN, FEDER

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age >= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients >= 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those >= 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI < 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI > 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 & PLUSMN; 24.4 Kgs and 43.03 & PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = < 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially