Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction

This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI). A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fisher's exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38%), musculoskeletal (29.7%), food and/or medication poisoning (8.5%) and arising from the respiratory apparatus (6.3%). The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.Esta serie de casos tuvo el objetivo de evaluar las conductas adoptadas por los pacientes durante la fase prehospitalaria del infarto agudo del miocardio (IAM). Se evaluaron 115 individuos portadores de IAM con el segmento ST supradesnivelado. Fue aplicada la prueba Chi-cuadrado y la prueba exacta de Fisher. Los individuos que no asociaron los síntomas a la enfermedad cardiovascular la atribuyeron más frecuentemente a los siguientes orígenes: gastrointestinal (38%), osteomuscular (29,7%), intoxicación alimentar y/o medicamentosa (8,5%) y provenientes del aparato respiratorio (6,3%). La proporción de resultados más graves y de pacientes que llegaron a la emergencia después de 12 horas fue más elevada entre mujeres, individuos con renta mensual de hasta un salario mínimo, que usaron analgésicos y no asociaron los síntomas a la enfermedad cardiovascular. Se constató que individuos en condiciones socioeconómicas desfavorables, que interpretaron los síntomas de forma incorrecta, llegaron más tarde a la emergencia y presentaron peores resultados intrahospitalarios.Esta série de casos teve o objetivo de avaliar as condutas adotadas pelos pacientes, durante a fase pré-hospitalar do infarto agudo do miocárdio (IAM). Avaliaram-se 115 indivíduos portadores de IAM, com supradesnivelamento do segmento ST. Foi aplicado o teste qui-quadrado e o teste exato de Fisher. Os indivíduos que não associaram os sintomas à doença cardiovascular atribuíram, mais frequentemente, às seguintes origens: gastrointestinal (38%), osteomuscular (29,7%), intoxicação alimentar e/ou medicamentosa (8,5%) e decorrentes do aparelho respiratório (6,3%). A proporção de desfechos maiores e de pacientes que chegaram à emergência após 12 horas foi mais elevada entre mulheres, indivíduos com renda mensal de até um salário mínimo, que usaram analgésicos e não associaram os sintomas à doença cardiovascular. Constatou-se que indivíduos em condições socio-conômicas desfavoráveis, que interpretaram os sintomas de forma incorreta, chegaram mais tardiamente à emergência e apresentaram piores desfechos intra-hospitalares

Eflúvio Telógeno e COVID-19: um caso e uma breve revisão de literatura

COVID-19 es una nueva enfermedad que ha tenido un gran impacto en la morbilidad y mortalidad global. En los últimos meses, ha habido reportes cada vez más frecuentes de síntomas persistentes y / o manifestaciones clínicas atribuidas al COVID-19, que no se presentaron durante la fase aguda de la enfermedad. En este artículo presentamos el caso de un paciente que manifestó efluvio telógeno tras un COVID-19 agudo. Se trata de un paciente hipertenso y obeso, de 39 años, que buscó atención médica porque hace un mes se quejaba de una caída masiva del cabello. Hace cuatro meses, le habían diagnosticado COVID-19 moderado. Después de investigar y excluir otras causas más comunes de efluvio telógeno y bien establecidas en la literatura, como la sífilis y la anemia ferropénica, la condición se correlacionó con el episodio anterior de COVID-19. Es posible que la fiebre persistente, la tormenta de citocinas y toda la cascada inmune puedan conducir a la apoptosis de los queratinocitos en los folículos pilosos, comenzando así la fase catágena seguida por la telógena con liberación capilar precoz. La manifestación de síntomas tardíos posiblemente secundarios a COVID-19 debe ser objeto de atención e interés de la comunidad científica. Como se trata de una enfermedad nueva, cuyas consecuencias tardías aún no se conocen por completo, es necesario observar de cerca y controlar a los pacientes.A COVID-19 é uma doença nova que vem provocando grande impacto na morbimortalidade mundial. Relatos de persistência de sintomas e/ou manifestações clínicas atribuídas à COVID-19 após a fase aguda da doença tem sido cada vez mais frequentes. Neste artigo, apresentamos um caso de eflúvio telógeno pós COVID-19 em um paciente de 39 anos, hipertenso e obeso, que procurou atendimento médico devido à queda volumosa de cabelos. Histórico prévio de COVID-19 moderada há 4 meses. Após investigação e exclusão de outras possíveis causas de eflúvio telógeno bem estabelecidas na literatura o quadro foi atribuído ao episódio prévio de COVID-19. É possível que a febre persistente, a tempestade de citocinas e toda a cascata imunológica da COVID-19 possam levar à apoptose dos queratinócitos dos folículos capilares, iniciando, assim, precocemente a fase catágena seguida pela fase telógena com consequente liberação capilar. Sintomas tardios possivelmente secundários à COVID-19 devem ser alvo de atenção e interesse da comunidade médica e científica. Por se tratar de uma doença nova, cujas consequências tardias ainda não se encontram completamente conhecidas/ elucidadas, recomenda-se a observação atenta e o seguimento clínico criterioso desses pacientes.COVID-19 is a new disease that has brought a great impact on global morbidity and mortality. There have been increasingly frequent reports of persistent symptoms and/or clinical manifestations attributed to COVID-19 after the acute phase of the disease. In this article, we present a case of post-COVID-19 telogen effluvium in a 39-year-old hypertensive and obese patient who looked for medical attention due to massive hair loss. Previous history of moderate COVID-19 4 months ago. After investigation and exclusion of other possible causes of telogen effluvium well established in the literature, the condition was attributed to the previous episodeof COVID-19. Persistent fever, the cytokine storm, and the entire immunological cascade of COVID-19 canlead to apoptosis of the keratinocytes of the hair follicles, initiating the catagen phase early followed by the telogen phase with a consequent capillary release. Late symptoms possibly secondary to COVID-19 should receive attention and interest from the medical and scientific community. As it is a new disease, whose late consequences are not yet fully known/elucidated, careful observation and careful clinical follow-up of these patients are recommended

Construction of a low-cost mobile embedded system for computer numerical control and educational purpose

This article describes the construction of a low-cost, mobile, CNC (Computerized Numerical Command) mini machine, bringing as its objective the gain of experience in relation to machining knowledge, where the device executes a list of movements written in the programming language G. For the development of the project, the Arduino Nano embedded system, two CD / DVD players and two H bridges (L293D) were used. Afterward, the assembly, programming and results of the project in question are described

Fatores prognósticos associados ao SAPS 3 e APACHE II em pacientes idosos admitidos em unidade de terapia intensiva

Study design: a descriptive, prospective cohort study. Objectives: identify the risk factors associated with SAPS 3 and APACHE II score to improve mortality prediction in elderly admitted in the intensive care unit (ICU). Methodology: a cohort study with 174 elderly patients admitted in ICU from July 2016 to June 2017. The primary independent variables analyzed were: presence of stress hyperglycemia, the need for invasive mechanical ventilation (IMV), acute renal failure, level of consciousness and use of vasopressors. The outcomes studied were death and hospital discharge. Results: ICU and hospital mortality were 17.8% and 29.8%, respectively. The multivariate analysis of factors associated with hospital death not contemplated in the obtaining of SAPS 3 demonstrated that IMV, Chronic Obstructive Pulmonary Disease (COPD) and Mean Arterial Pressure (MAP) <70 mmHg improved the prediction of mortality. The Hosmer-Lemeshow test (p=0.472) and area under ROC curve=0.80 (CI95%:0.731-0.872) confirmed, respectively, an appropriate calibration and acceptable-to-excellent discriminatory power for this model. IMV and COPD were also factors associated with the APACHE II score in prediction of mortality with appropriated calibration (p=0.471) and acceptable-to-excellent discriminatory power (area under ROC curve=0.80 [CI95%:0.730-0.868]). Conclusion: IMV, COPD, and MAP <70 mmHg were associated with SAPS3 and APACHE II to predict mortality in elderly admitted to ICU.Modelo de estudo: estudo descritivo, coorte prospectiva. Objetivos: identificar os fatores de risco associados ao escore SAPS 3 e APACHE II para melhorar a predição de mortalidade em idosos internados em unidade de terapia intensiva (UTI). Metodologia: estudo de coorte com 174 idosos internados em UTI no período de julho de 2016 a junho de 2017. As principais variáveis ​​independentes analisadas foram: presença de hiperglicemia de estresse, necessidade de ventilação mecânica invasiva (VMI), insuficiência renal aguda, nível de consciência e uso de vasopressores. Os desfechos estudados foram morte e alta hospitalar. Resultados: A mortalidade na UTI e hospitalar foi de 17,8% e 29,8%, respectivamente. A análise multivariada de fatores associados à morte hospitalar não contemplada na obtenção do SAPS 3 demonstrou que a VMI, Doença Pulmonar Obstrutiva Crônica (DPOC) e Pressão Arterial Média (PAM) <70 mmHg melhoraram a predição de mortalidade. O teste de Hosmer-Lemeshow (p = 0,472) e a área sob curva ROC = 0,80 (IC95%: 0,731-0,872) confirmaram, respectivamente, calibração adequada e poder discriminatório aceitável a excelente para este modelo. VMI e DPOC também foram fatores associados ao escore APACHE II na predição de mortalidade com calibração adequada (p = 0,471) e poder discriminatório aceitável-a-excelente (área sob curva ROC = 0,80 [IC95%: 0,730-0,868]). Conclusão: VMI, DPOC e PAM <70 mmHg foram associados ao SAPS3 e ao APACHE II para predizer mortalidade em idosos internados em UTI.&nbsp

Experience report from an epidemiology and cardiology research group

A formação de grupos acadêmicos durante o curso de medicina é importante para a construção e compartilhamento de conhecimentos e habilidades fundamentais para a prática médica. O presente trabalho relata a experiência de um ano de atividades (2017-2018) de um grupo de pesquisa em epidemiologia e cardiologia. Apresentamos os principais pontos de motivação, objetivos e funcionamento do grupo, no intuito de fornecer um modelo estrutural que possa servir de inspiração e debate para a formação de outros grupos de pesquisa constituídos por estudantes de medicina ao redor do país. Ao longo de um ano foram apresentados em eventos científicos os resultados das pesquisas do grupo, além da publicação de artigos em periódicos científicos na área da saúde, totalizando 12 trabalhos acadêmicos. Como meio de fornecer uma ferramenta de avaliação quantitativa de análise das atividades do grupo, foram apresentados os resultados da autoavaliação desenvolvida pelos membros acadêmicos após um ano de atividades. Considerando o elevado número de publicações biomédicas e o aumento na exigência de conhecimentos em pesquisa e medicina baseada em evidências nos últimos anos, a formação de grupos de pesquisa apresenta-se como uma alternativa para complementação de conhecimentos teóricos e práticos para a formação médica, permitindo aos futuros profissionais uma visão crítica da produção do conhecimento científico, uma prática médica baseada em evidências, um melhor enfretamento das exigências de mercado e dos interesses econômicos na área de saúde.The establishment of academic groups during medical school is important for the construction and sharing of knowledge and fundamental skills to good medical practice. This paper reports a one-year experience of activities (2017-2018) of a research group in epidemiology and cardiology. The presentation of the motivation reasons, objectives, and performance of the group to provide a structural model that could serve as inspiration and debate for the establishment of other research groups made up from and for medical students from all over the world. During one year of activity, the findings of the group research were presented in scientific events, as well as the publication of articles in scientific journals in the health area, totaling 12 academic papers.  As a means of providing a quantitative evaluation tool for the analysis of the group's activities, the results of the self-assessment developed by the academic members after one year of activities were presented. Considering the high number of biomedical publications and the increase in the demand for knowledge in research and evidence-based medicine in recent years, the establishment of research groups is an alternative to complement theoretical and practical knowledge for medical education, allowing to future professionals a critical view of the production of scientific knowledge, evidence-based medical practice, a better understanding of market demands, and economic interests in health

Estoques de carbono do solo e nas frações lábeis da matéria orgânica sob sistema agroflorestal em brejo de altitude pernambucano

Intense soil preparation and disturbance in crops, over time, reduces the quantity and quality of soil organic matter. Given this context, this work aimed to determine soil carbon stocks and labile fractions under agroforestry system (AFS) and toposequences in an altitude marsh, Taquaritinga do Norte, Pernambuco, Brazil. The study was carried out at the Yaguara farm, and the areas studied were native forest with 4.57 ha and coffee plantation in shade with native forest with 25.59 ha. Soil samples were collected in four trenches measuring 1.5 x 1.5 x 0.60 m, with a distance of 50 meters. Soils were collected at depths of 0–20, 20–40 and 40-60 cm, followed by chemical, physical and density analyzes to determine soil carbon stocks and labile fractions. The area with shaded coffee showed higher values ​​of soil carbon stocks at depths of 0-20 cm and 20-40 cm. At a depth of 40-60 cm, the AFS top toposequence showed the highest carbon stock with 11.73 Mg ha-1, followed by the area with native vegetation with 10.6 Mg ha-1, slope with 9.23 Mg ha-1 and pediment with 7.00 Mg ha-1. It was found that the top toposequence with shaded coffee exhibited a greater stock of labile carbon at depth 0-20 cm with a value of 1.06 Mg ha-1, followed by the bedding areas (SAF) with 0.88 Mg ha-1, native forest with 0.79 Mg ha-1 and slope with 0.67 g kg-1. However, the area of native vegetation showed the highest value of labile carbon at a depth of 40-60 cm. It was concluded that the area with shaded coffee in the top toposequence showed great capacity to increase total carbon stocks and labile carbon stocks of soil organic matter.O intenso preparo e revolvimento do solo em cultivos, com o tempo, reduz a quantidade e a qualidade da matéria orgânica do solo. Diante desse contexto, este trabalho teve como objetivo determinar os estoques de carbono do solo e frações lábeis sob sistema agroflorestal (SAF) e topossequências em brejo de altitude, em Taquaritinga do Norte, Pernambuco, Brasil. O estudo foi desenvolvido na fazenda Yaguara, e as áreas estudadas foram mata nativa com 4,57 ha e plantio de café sombreado com mata nativa com 25,59 ha. As amostras de solos foram coletadas em quatro trincheiras 1,5 x 1,5 x 0,60 m, com distância de 50 metros. Foram coletados solos nas profundidades de 0–20, 20–40 e 40-60 cm, seguido de análises químicas, físicas e densidade para determinação dos estoques de carbono no solo e frações lábeis. A área com café sombreado apresentou maiores valores de estoques de carbono no solo nas profundidades de 0-20 cm e 20-40 cm. Na profundidade de 40-60 cm, a topossequência de topo do SAF apresentou maior estoque de carbono com 11,73 Mg ha-1, seguido da área com vegetação nativa com 10,6 Mg ha-1 , encosta com 9,23 Mg ha-1 e pedimento com 7,00 Mg ha-1. Verificou-se que a topossequência de topo com café sombreado exibiu maior estoque de carbono lábil na profundidade 0-20 cm com o valor de 1,06 Mg ha-1, sucedido das áreas de pedimento (SAF) com 0,88 Mg ha-1, mata nativa com 0,79 Mg ha-1e encosta com 0,67 Mg ha-1. No entanto, a área de vegetação nativa apresentou o maior valor de carbono lábil na profundidade de 40-60 cm. Concluiu-se que a área com café sombreado na topossequência topo mostrou grande capacidade para elevar os estoques de carbono total e estoques de carbono lábil da matéria orgânica do solo

Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital

Objective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method: This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results: Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them during admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitalization, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more critical, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion: Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged