Red Blood Cell Transfusion Strategy for Upper Gastrointestinal Bleeding

Acute upper gastrointestinal bleeding (UGIB) is a potentially lethal and frequent digestive disease. It is mainly divided into the nonvariceal UGIB and variceal bleeding according to the source of bleeding. Red blood cell transfusion is the core therapeutic option for the management of acute UGIB. In this chapter, we reviewed the primary evidence from meta‐analyses and large‐scale randomized controlled trials regarding red blood cell transfusion strategy for acute UGIB

Tratamento interdisciplinar das hepatites virais no Hospital Estadual Bauru: relato de experiência

Este trabalho apresenta a experiência de uma abordagem interdisciplinar, desenvolvida na modalidade de pesquisa-ação, no atendimento ambulatorial a um grupo de 20 pacientes em tratamento da hepatite C. As especialidades envolvidas no projeto foram: assistência social, enfermagem, gastroenterologia, infectologia, nutrição e psicologia. Os objetivos do atendimento interdisciplinar foram manter a qualidade de vida do portador da doença, diante dos efeitos colaterais das medicações prescritas, reduzir os índices de abandono do tratamento, promover a participação do paciente no processo saúde-doença e na intervenção desse processo. Os métodos utilizados foram atendimentos individuais e grupo de apoio para os pacientes, com a integração cooperativa da equipe interdisciplinar. Como resultado dessa abordagem no primeiro ano de implantação obteve-se 100% de adesão dos pacientes ao tratamento, com relatos de experiências incentivadoras à continuidade de ações interdisciplinares. Ressalta-se a constatação de alto índice de cura dos pacientes, superior aos obtidos em outros centros de referência.

Association between phase angle, anthropometric measurements, and lipid profile in HCV-infected patients

OBJECTIVE: The objective of this study was to investigate the associations between phase angle, anthropometric measurements, and lipid profile in patients chronically infected with the hepatitis C virus. METHODS: A total of 160 consecutive patients chronically infected with the hepatitis C virus and who received treatment at the hepatitis C outpatient unit of our hospital from April 2010 to May 2011 were prospectively evaluated. Bioelectrical impedance analysis, anthropometric measurements, and serum lipid profile analysis were performed. RESULTS: Twenty-five patients were excluded. A total of 135 patients with a mean age of 49.8¡11.4 years were studied. Among these patients, 60% were male. The phase angle and BMI means were 6.5¡0.8°and 26.5¡4.8 kg/ m2, respectively. Regarding anthropometric variables, mid-arm circumference, mid-arm muscle circumference, and arm muscle area had a positive correlation with phase angle. In contrast, when analyzing the lipid profile, only HDL was inversely correlated with phase angle. However, in multiple regression models adjusted for age and gender, only mid-arm circumference (p = 0.005), mid-arm muscle circumference (p = 0.003), and arm muscle circumference (p = 0.001) were associated with phase angle in hepatitis C virus-infected patients.CONCLUSIONS: In conclusion, phase angle is positively correlated with anthropometric measures in our study. However, there is no association between phase angle and lipid profile in these patients. Our results suggest that phase angle is related to lean body mass in patients chronically infected with hepatitis C virus

Influência de Publicidade no Comportamento do Consumidor Infantil

Studies have noted the influence of commercials aired by the electronic media consumption behavior of children, especially television. Thus, this work proposes to study the behavior of the child consumer in Brazil, analyzing how the actions of marketing and media may influence the behavior of early consumption of children aged between six and nine years. We used a mixed approach, with the application of an instrument with open and closed questions and multiple choice, about consumer preferences applied to 141 children six to nine years old. It was found that going to the mall and watching television is part of everyday life that the consumer market, the survey also revealed that the most consumed products are toys for children (71.63%), the largest source of product knowledge that arouse desire are the advertisements on television (80.85%) and the infant admiring the appearance of these cartoon television advertisements (36.99%). It appears that the marketing and the media influence the behavior of the child consumer through advertisements on TV, advertisements on Internet and showcase the stores, especially if they are inserted in the malls, once consisting of a tour of great enjoyment for children. Key words: Marketing, Consumer market, Consumer behavior, Child consumer.    

Modelagem Dinâmica do Uso e Cobertura das Terras para o Controle da Erosão na Bacia Hidrográfica do Rio Mogi-Guaçú e Pardo - São Paulo - Brasil

O objetivo deste artigo é a modelagem da dinâmica do uso e cobertura das terras na Bacia-Hidrográfica dos Rios Mogi-Guaçú e Pardo no Estado de São Paulo. Ele foca a restauração dos serviços ecossistêmicos do controle da erosão. São descritos e analisados a dinâmica do uso e cobertura das terras, focados nas suas principais forças direcionadoras, tais como a legislação ambiental do país e as mudanças nos preços relativos favorecendo uma forte expansão do cultivo da cana-de-açúcar na região. Esta dinâmica tem importante impacto nas taxas de erosão cujas medidas metodológicas são apresentadas com os resultados obtidos. Para simular esta dinâmica foi desenvolvido um modelo seguindo a metodologia do MIMES. O algoritmo desenvolvido modela as mudanças do uso e cobertura das terras baseado principalmente na força das leis ambientais. Espera-se que esta dinâmica contribua para a restauração dos serviços ecossistêmicos da Bacia HidrográficaThis paper aims at modeling the land use and land cover dynamics in a watershed in São Paulo State, Brazil. It focuses on the potential restoration of the ecosystem service erosion control. The studied watershed is described and its land use and land cover dynamics analyzed, focusing on its main driving forces such as the legislation enforcement and crop relative price changes favoring a very strong expansion of sugar-cane in the region. This dynamics has important impacts on erosion rates whose measurement methodology is presented along with the results obtained. To simulate this dynamics a model was built following MIMES. The algorithms developed deal with a process of forest recovery, modeling land use/land cover changes pushed mainly by legislation enforcement and environmental price movements and measuring their impacts on the erosion process. It is expected that this dynamics would lead to a restoration of the ecosystem service erosion contro

Case report: Biliobronchial fistula after biliary tract stenosis

Biliobronchial fistula (BBF) is a rare abnormality resulting from congenital or acquired communication between the bile ducts and the bronchial tree. Patients often suffer from chronic cough, dyspnea, and bilioptysis, a pathognomonic symptom of this condition. Conservative methods such as less-invasive procedures are gradually consolidating. Nonetheless, surgery remains the primary treatment, especially in more complex cases. We present the case of a 44-year-old woman with a chronic cough, no verified periods of fever, cyclic jaundice, and episodes of yellowish sputum. She had undergone cholecystectomy in 2018 and had been hospitalized several times since for pneumonia treatment. All consequent investigations for mycobacteriosis were negative. When referred to our hospital, she had cyclic jaundice and parenchymal consolidation in the right lower lobe. Suspected bilioptysis motivated the search for a biliobronchial fistula. Magnetic resonance cholangiography (MRC) confirmed stenosis of the biliary tract and fistulous path, and sputum analysis indicated high bilirubin levels. External biliary bypass was performed as an initial conservative and definitive therapy due to the presence of liver cirrhosis. Although BBF is a rare condition when bilioptysis is suspected, a diagnostic investigation should be initiated. Our case study proposes two criteria for diagnosis: an imaging exam demonstrating the fistulous path and confirmation of bilirubin in the sputum or bronchoalveolar lavage (BAL). When diagnosed, surgical correction should be performed

Modelagem Dinâmica do Uso e Cobertura das Terras para o Controle da Erosão na Bacia Hidrográfica do Rio Mogi-Guaçú e Pardo – São Paulo – Brasil

O objetivo deste artigo é a modelagem da dinâmica do uso e cobertura das terras na Bacia-Hidrográfica dos Rios Mogi-Guaçú e Pardo no Estado de São Paulo. Ele foca a restauração dos serviços ecossistêmicos do controle da erosão. São descritos e analisados a dinâmica do uso e cobertura das terras, focados nas suas principais forças direcionadoras, tais como a legislação ambiental do país e as mudanças nos preços relativos favorecendo uma forte expansão do cultivo da cana-de-açúcar na região. Esta dinâmica tem importante impacto nas taxas de erosão cujas medidas metodológicas são apresentadas com os resultados obtidos. Para simular esta dinâmica foi desenvolvido um modelo seguindo a metodologia do MIMES. O algoritmo desenvolvido modela as mudanças do uso e cobertura das terras baseado principalmente na força das leis ambientais. Espera-se que esta dinâmica contribua para a restauração dos serviços ecossistêmicos da Bacia Hidrográfica.Modelo de mudanças do uso das terras; valoração dos serviços ecossistêmicos; controle da erosão de solos; modelo dinâmico integrado multi-escala.

Modelagem dinâmica do uso e cobertura das terras para o controle da erosão na bacia hidrográfica do Rio Mogi-Guaçú e Pardo – São Paulo – Brasil

sem informaçãoO objetivo deste artigo é a modelagem da dinâmica do uso e cobertura das terras na Bacia-Hidrográfica dos Rios MogiGuaçú e Pardo no Estado de São Paulo. Ele foca a restauração dos serviços ecossistêmicos do controle da erosão. São descritos e analisados a14112sem informaçãosem informaçãosem informaçã

Use of albumin infusion for cirrhosis-related complications: An international position statement

BACKGROUND & AIMS: Numerous studies have evaluated the role of human albumin (HA) in managing various liver cirrhosis-related complications. However, their conclusions remain partially controversial, probably because HA was evaluated in different settings, including indications, patient characteristics, and dosage and duration of therapy. METHODS: Thirty-three investigators from 19 countries with expertise in the management of liver cirrhosis-related complications were invited to organise an International Special Interest Group. A three-round Delphi consensus process was conducted to complete the international position statement on the use of HA for treatment of liver cirrhosis-related complications. RESULTS: Twelve clinically significant position statements were proposed. Short-term infusion of HA should be recommended for the management of hepatorenal syndrome, large volume paracentesis, and spontaneous bacterial peritonitis in liver cirrhosis. Its effects on the prevention or treatment of other liver cirrhosis-related complications should be further elucidated. Long-term HA administration can be considered in specific settings. Pulmonary oedema should be closely monitored as a potential adverse effect in cirrhotic patients receiving HA infusion. CONCLUSIONS: Based on the currently available evidence, the international position statement suggests the potential benefits of HA for the management of multiple liver cirrhosis-related complications and summarises its safety profile. However, its optimal timing and infusion strategy remain to be further elucidated. IMPACT AND IMPLICATIONS: Thirty-three investigators from 19 countries proposed 12 position statements on the use of human albumin (HA) infusion in liver cirrhosis-related complications. Based on current evidence, short-term HA infusion should be recommended for the management of HRS, LVP, and SBP; whereas, long-term HA administration can be considered in the setting where budget and logistical issues can be resolved. However, pulmonary oedema should be closely monitored in cirrhotic patients who receive HA infusion