UNIDADES DE TERAPIA INTENSIVA NEONATAL: FATORES ASSOCIADOS E MÉTODOS CONTRA ERROS DE MEDICAÇÃO

O objetivo deste artigo é discutir os fatores associados e os métodos utilizados contra erros de medicação em unidades de terapia intensiva neonatal. Trata-se de uma revisão integrativa da literatura realizada sobre materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Nacional em Ciências da Saúde da Argentina ( BINACIS), Base de Dados de Enfermagem (BDENF), Index Medicus para o Pacífico Ocidental (WPRIM) e Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em conjunto com o operador booleano AND e OR, sendo: Unidades de Terapia Intensiva Neonatal AND Erros de Medicação AND Newborn OR Prevention. Após aplicação dos critérios de elegibilidade, foram selecionados 10 estudos para compor esta revisão. Concluiu-se que os fatores associados aos erros de medicação em unidades de terapia intensiva neonatal podem variar desde falhas no cálculo de doses, seleção restrita de doses, administração incorreta, problemas de prescrição, bem como desafios associados ao preparo, diluição e armazenamento de medicamentos. Dentre os métodos utilizados para mitigar a ocorrência de erros relacionados ao uso de medicamentos, destacam-se a implantação de tecnologias, como sistemas informatizados de prescrição médica e softwares específicos para neonatos, supervisão direta e indireta, experiência profissional, rotulagem adequada, registros corretos e o comprometimento a atitude da equipe de saúde emergiu como boas práticas na prevenção de erros. Além disso, a comunicação eficaz entre os profissionais de saúde, o desenvolvimento de fórmulas medicamentosas específicas para crianças e a educação continuada dos profissionais foram barreiras para garantir uma assistência mais segura.O objetivo deste artigo é discutir os fatores associados e métodos utilizados contra erros de medicação em unidades de terapia intensiva neonatal. Trata-se de uma revisão bibliográfica integrativa realizada sobre materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Nacional em Ciências da Saúde da Argentina (BINACIS), Base de Dados de Enfermagem (BDENF), Index Medicus para o Pacífico Ocidental (WPRIM) e Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em conjunto com o operador booleano AND e OR, sendo: Unidades de Terapia Intensiva Neonatal AND Erros de Medicação AND Newborn OR Prevention. Após aplicação dos critérios de elegibilidade, foram selecionados 10 estudos para compor esta revisão. Concluiu-se que os fatores associados aos erros de medicação em unidades de terapia intensiva neonatal podem variar desde erros no cálculo de doses, seleção restrita de doses, administração incorreta, problemas de prescrição, bem como dificuldades associadas ao preparo, diluição e armazenamento de medicamentos. Dentre os métodos utilizados para mitigar a ocorrência de erros relacionados ao uso de medicamentos, destacam-se a implantação de tecnologias, como sistemas informatizados de prescrição médica e programas de computador específicos para neonatos, supervisão direta e indireta, experiência profissional, rotulagem adequada, registros corretos e a a atitude comprometida da equipe de saúde emergiu como boas práticas na prevenção de erros. Por outro lado, a comunicação eficaz entre os profissionais de saúde, o desenvolvimento de fórmulas farmacológicas específicas para crianças e a formação continuada dos profissionais foram obstáculos para garantir cuidados mais seguros.Este artigo tem por objetivo abordar os fatores associados e métodos utilizados contra erros de medicação nas unidades de terapia intensiva neonatal. Trata-se de uma revisão integrativa da literatura realizada nos materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS),  Bibliografia Nacional em Ciências da Saúde da Argentina (BINACIS), Base de dados de Enfermagem (BDENF),  Index Medicus para o Pacífico Ocidental (WPRIM) e o Índice Bibliográfico Español en Ciencias de la Salud (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em cruzamento com o operador booleano AND e OR, da seguinte forma: Unidades de Terapia Intensiva Neonatal AND Erros de Medicação AND Recém-Nascido OR Prevenção. Após a aplicação dos critérios de elegibilidade foram selecionados 10 estudos para compor essa revisão. Conclui-se que os fatores associados a erros de medicação nas unidades de terapia intensiva neonatal podem ocorrer, desde falhas no cálculo da dose, seleção restrita da dose, administração incorreta, problemas na prescrição, além de desafios associados à preparação, diluição e armazenamento dos medicamentos. Dentre as métodos utilizados para mitigar a ocorrência de erros relacionados ao uso de medicações, observou-se a  implementação de tecnologias, como sistemas informatizados de pedidos médicos e softwares específicos para neonatos, supervisão direta e indireta, experiência profissional, rotulagem adequada, registros corretos e a atitude comprometida da equipe de saúde emergiram como boas práticas na prevenção de erros. Além disso, a comunicação eficaz entre profissionais de saúde, desenvolvimento de fórmulas de medicamentos específicos para crianças e a educação continuada dos profissionais constituíram-se como barreiras para a garantia de uma assistência mais segura

ENDOCRINOLOGIA PEDIÁTRICA: ATUALIZAÇÕES EM DISTÚRBIOS HORMONAIS NA INFÂNCIA

  Pediatric endocrinology is a vital area of medicine that requires constant updating and research. By studying hormonal disorders in childhood and pediatric endocrinology, we can hope to improve the quality of life and care of children affected by these disorders. The aim of this study was to look at the latest updates on hormonal disorders in childhood, with a focus on pediatric endocrinology. To this end, a systematic literature review was carried out, selecting scientific studies published between 2019 and 2024, available in the Scielo, Medline and Lilacs databases. After analyzing the results, the main conclusion is that recent advances in genetic research have provided a deeper understanding of the molecular basis of pediatric hormonal disorders, such as Kallmann syndrome and Prader-Willi syndrome, paving the way for more targeted and effective therapies in the future.  A endocrinologia pediátrica é uma área vital da medicina que requer constante atualização e pesquisa. Por meio do estudo dos distúrbios hormonais na infância e da endocrinologia pediátrica, é possível esperar a melhoria da qualidade de vida e o cuidado das crianças afetadas por esses distúrbios. Trata-se de um estudo cujo objetivo foi estudar atualizações mais recentes em distúrbios hormonais na infância, com foco na endocrinologia pediátrica. Nesse sentido, realizou-se uma revisão sistemática de literatura, com a seleção de estudos científicos publicados entre os anos de 2019 e 2024, disponíveis nas bases de dados Scielo, Medline e Lilacs. Após análise dos resultados, a principal conclusão é que avanços recentes na pesquisa genética têm proporcionado uma compreensão mais profunda das bases moleculares de distúrbios hormonais pediátricos, como a síndrome de Kallmann e a Síndrome de Prader-Willi, abrindo caminho para terapias mais direcionadas e eficazes no futuro

Anomalia de Ebstein com comunicação interatrial em paciente gestante com pré-eclâmpsia: um raro relato de caso

A Anomalia de Ebstein (AE) é uma cardiopatia congênita rara, ocorre em apenas 1% das más formações cardíacas. É uma alteração da implantação dos folhetos da valva tricúspide, ocorre o aumento do volume do átrio direito e a atrialização do ventrículo direito. Geralmente, possui uma evolução clínica lenta, com sintomas aparecendo em idade avançada. A comunicação interatrial (CIA), também consiste em uma cardiopatia congênita, do tipo acianótica, comumente assintomática, com prevalência de 5 a 10% de todas as cardiopatias, mais comum em mulheres. Baseia-se na formação de um “shunt” esquerdo-direito, podendo causar hiperfluxo da veia pulmonar. Por outro lado, a pré-eclâmpsia é uma complicação gestacional detectada na vigésima semana. É uma disfunção materno/placentária responsável por elevação da pressão arterial (> 140/90 mmHg), associada a lesão de órgão alvo, proteinúria ou disfunção útero/placentária. Neste estudo, o objetivo é relatar as complicações desenvolvidas durante a gestação em paciente que possuía essa rara associação de comorbidades. Paciente feminina, 20 anos, primigesta com 30 semanas e 4 dias, vista em USG obstétrico, com descontrole pressórico desde de o início da gestação. Cardiopata, sem acompanhamento, apresentando EA e IA (diagnóstico em laudo de 2008). Foi admitida em Unidade de Terapia Intensiva (UTI) com dispneia, saturação de O2 de 91%, pressão de 150/100 mmHg. Após estabilização, solicitados pareceres para cardiologia, obstetrícia e risco anestésico. USG obstétrico mostrou compartimento fetal alterado e relação cérebro/placentária alterada. No 2º dia, após corticoterapia, paciente retorna do centro-cirúrgico após cesariana, acoplada à ventilação mecânica invasiva, devido à descompensação. Radiografia pós-cirurgia mostrou pequeno derrame pleural bilateral. Mantida Cefalotina por mais 2 dias. No dia 3, TC de tórax revelou derrame persistente e consolidações, iniciando Ceftriaxone e Clindamicina. Noradrenalina iniciada após descompensação hemodinâmica. No dia 6, após teste de respiração espontânea bem-sucedido, o ecocardiograma evidenciou AE, insuficiência tricúspide acentuada e mitral leve. Sem critérios graves, a paciente foi transferida para a enfermaria para seguimento e término da antibioticoterapia. A gestação pode agravar riscos em pacientes com comorbidades raras como anomalias cardíacas congênitas. O acompanhamento específico é crucial e, em casos graves, a gravidez deve ser evitada

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world’s oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and non-breeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging species

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

A social and ecological assessment of tropical land uses at multiple scales: the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far.Keywords: Social–ecological systems, Tropical forests, Land use, Interdisciplinary research, Sustainability, Trade-off

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world’s oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and non-breeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging species

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world's oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and non-breeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging species.B.L.C., C.H., and A.M. were funded by the Cambridge Conservation Initiative’s Collaborative Fund sponsored by the Prince Albert II of Monaco Foundation. E.J.P. was supported by the Natural Environment Research Council C-CLEAR doctoral training programme (Grant no. NE/S007164/1). We are grateful to all those who assisted with the collection and curation of tracking data. Further details are provided in the Supplementary Acknowledgements. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government.Peer reviewe

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others