Isquemia mesentérica aguda - etiologia esquecida de abdome agudo cirúrgico

A Isquemia Mesentérica Aguda (IMA) é uma condição rara e potencialmente grave que resulta na súbita falta de irrigação sanguínea para o intestino delgado, causando dor abdominal intensa e podendo levar a complicações sérias, como peritonite e sepse. A etiologia da IMA varia, com embolia arterial mesentérica, trombose arterial mesentérica, isquemia mesentérica não oclusiva e trombose venosa mesentérica sendo causas comuns. A prevalência aumenta com a idade, principalmente acima da sétima década, e a incidência varia entre diferentes regiões. Outrossim, o diagnóstico precoce é desafiador - devido à natureza inespecífica dos sintomas e à baixa incidência da doença - e é frequentemente alcançado por meio de tomografia computadorizada com contraste, auxiliada por uma suspeita clínica robusta. Os sintomas podem variar dependendo da etiologia, destacando-se a dor abdominal como sintoma comum. O exame físico geralmente é pouco específico, e a abordagem diagnóstica deve incluir avaliação laboratorial, como biomarcadores específicos. Ademais, o tratamento da IMA depende da etiologia e condição do paciente. Opções incluem revascularização mesentérica, ressecção intestinal e intervenções endovasculares. Estudos recentes sugerem que abordagens endovasculares podem ter resultados mais favoráveis em comparação com intervenções cirúrgicas abertas, com menor mortalidade e necessidade de ressecção intestinal. Nesse sentido, a escolha da terapia deve considerar fatores como estabilidade hemodinâmica, presença de sinais de peritonite e a extensão do comprometimento intestinal. A sobrevida em 5 anos após o tratamento endovascular foi relatada como superior em comparação com a cirurgia vascular aberta. Diferentes técnicas de restauração do fluxo sanguíneo são aplicadas com base na etiologia da IMA, destacando-se a embolectomia, angioplastia e procedimentos de bypass

Evolução na utilização e nos gastos de uma operadora de saúde

Brazil’s aging population and the rising number of people reliant upon the country’s supplementary healthcare system have elicited the concern of public and private managers regarding the increase in healthcare costs. In this paper, the costs per gender, per type of medical expenses and per age group of a major Brazilian self-managed healthcare provider between 2007 and 2013 were analyzed. This healthcare provider is of interest because, besides portraying a single condition of revenue growth restricted to the existing contributors, it also replicates the demographic profile expected for Brazil in 2050, when approximately one-third of its population will be over 60 years of age. The analyses confirm the current literature as they show an increase in healthcare plan usage by the elderly and the difference between admission rates by gender. They also reveal an increase in average length of stay in hospital and the increase in medical costs far above inflation, especially for materials and medicines. It is hoped that this study will help scholars and others interested in comparisons of medical expense trends, especially by age and sex, and that it encourages further collaboration on the sustainability of health insurance providers in Brazil

Diálogos Insurgentes entre Educação Ambiental e Culturas no Encontro Pesquisa em Educação Ambiental (EPEA)

This article aims to reflect on the theme Environmental Education and Cultures with an emphasis on the works presented since the first Research Meeting in Environmental Education in 2001 until the reflections that occurred in the Research Discussion Group of this research subfield, during the X EPEA of the year 2019. In addition to bringing an account of the discussions, the article focuses on the evolution of the themes of works related to cultures, presented in the first four editions of EPEA (2001-2007), in a modest state of art made using search terms related to the theme, present in their abstracts. We found that, during this period, investigations were, predominantly, linked to the categories of culture and knowledge, which were covered by works in all editions. The themes of Cultural Studies, Inter/multiculturality and Coloniality were not present in the investigations of this subfield presented at the EPEA, in the period, being necessary to deepen the extension of this phenomenon in magazines and databases of dissertations and theses, as well as to evaluate the epistemological and sociopolitical developments of the attention that has been given by the field of research in Environmental Education to the perspectives that recognize and give voice to different cultures, aiming to overcome the silencing processes that prevent full participation in decision-making processes and in social life. Such themes have recently appeared in GDP EA and Culturas that value dialogicity and inter/multiculturality, with criticisms of coloniality and expanding the epistemological, political-methodological and ontological possibilities of Environmental Education Research.Este artículo tiene como objetivo reflexionar sobre el tema Educación Ambiental y Culturas, con énfasis en los trabajos presentados desde la primera Reunión de Investigación en Educación Ambiental, en 2001, hasta las reflexiones que ocurrieron en el Grupo de Discusión de Investigación de este subcampo de investigación, durante el X EPEA del año 2019. Además de dar cuenta de las discusiones, el artículo se centra en la evolución de los temas de las obras relacionadas con las culturas, presentadas en las primeras cuatro ediciones de EPEA (2001-2007), en un estado modesto de arte realizado utilizando términos de búsqueda relacionados con el tema, presente en sus resúmenes. Descubrimos que, durante este período, las investigaciones estaban predominantemente vinculadas a las categorías de cultura y conocimiento, que estaban cubiertas por obras en todas las ediciones. Los temas de Estudios Culturales, Inter/multiculturalidad y Colonialidad no estuvieron presentes en las investigaciones de este subcampo presentado en el EPEA, en el período, siendo necesario profundizar la extensión de este fenómeno en revistas y bases de datos de disertaciones y tesis, así como evaluar los desarrollos epistemológicos y sociopolíticos de la atención que ha brindado el campo de la investigación en Educación Ambiental a las perspectivas que reconocen y dan voz a las diferentes culturas, con el objetivo de superar los procesos de silenciamiento que impiden la plena participación en los procesos de toma de decisiones y en la vida social. Tales temas han aparecido recientemente en GDP EA y Culturas que valoran la dialogicidad y la inter/multiculturalidad, con críticas a la colonialidad y ampliando las posibilidades epistemológicas, político-metodológicas y ontológicas de la Investigación en Educación Ambiental.Este artigo tem por objetivo refletir sobre a temática Educação Ambiental e Culturas, com ênfase nos trabalhos apresentados desde o primeiro Encontro Pesquisa em Educação Ambiental (EPEA), em 2001, até as reflexões ocorridas no Grupo de Discussão de Pesquisas (GDP) desse subcampo de pesquisa, durante o X EPEA, realizado em 2019. Para além de trazer um relato das discussões, o artigo se debruça sobre a evolução das temáticas dos trabalhos relacionados às culturas, apresentados nas quatro primeiras edições do EPEA (2001-2007), em um modesto estado da arte realizado por meio de termos de busca ligados à temática, presentes em seus resumos. Constatamos que, nesse período, as investigações estavam ligadas predominantemente às categorias cultura e saberes, que foram contempladas por trabalhos em todas as edições. Os temas dos Estudos Culturais, Inter/ multiculturalidade e Colonialidade não estiveram presentes nas investigações desse subcampo apresentadas no EPEA, no período, sendo necessário aprofundar a extensão desse fenômeno em revistas e bancos de dissertações e teses, bem como avaliar os desdobramentos epistemológicos e sociopolíticos da atenção que tem sido conferida pelo campo da pesquisa em Educação Ambiental às perspectivas que reconhecem e conferem a voz às diferentes culturas, visando superar os processos de silenciamento que impedem a participação plena nos processos decisórios e na vida social. Temáticas tais que aparecem recentemente no GDP EA e Culturas que valorizam a dialogicidade e a inter/multiculturalidade, com críticas à colonialidade e ampliando as possibilidades epistemológicas, político-metodológicas e ontológicas da Pesquisa em Educação Ambiental

ULTRASTRUCTURAL CHANGES IN Schistosoma mansoni MALE WORMS AFTER in vitro INCUBATION WITH THE ESSENTIAL OIL OF Mentha x villosa Huds

Introduction: The essential oil Mentha x villosa (MVEO) has a wide range of actions, including antibacterial, antifungal, antiprotozoal and schistosomicidal actions. The present study aimed to investigate the ultrastructural changes of MVEO on the tegument of adult Schistosoma mansoni. Materials and Methods: Different concentrations of MVEO were tested on S. mansoni adult worms in vitro. Ultrastructural changes on the tegument of these adult worms were evaluated using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results: The MVEO caused the death of all worms at 500 μg mL-1 after 24 h. After 24h of 500 μg mL-1 MVEO treatment, bubble lesions were observed over the entire body of worms and they presented loss of tubercles in some regions of the ventral portion. In the evaluation by TEM, S. mansoni adult worms treated with MVEO, 500 μg mL-1, presented changes in the tegument and vacuoles in the syncytial matrix region. Glycogen granules close to the muscle fibers were visible. Conclusion: The ability of MVEO to cause extensive ultrastructural damage to S. mansoni adult worms correlates with its schistosomicidal effects and confirms earlier findings with S. mansoni

Enxaqueca em 746 pacientes com esclerose múltipla

Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution