Uso de jogos eletrônicos por adolescentes em Patos de Minas: Um retrato dos efeitos em estudantes do Ensino Médio / Use of electronic games by adolescents in Patos de Minas: A portrait of the effects on high school students

Objetivo: Com o objetivo de identificar a prevalência e correlatos do uso abusivo de jogos eletrônicos em adolescentes foi realizada a pesquisa com alunos do ensino médio de escolas públicas selecionadas por sorteio na zona urbana do município de Patos de Minas, cidade de porte médio da região do Alto Paranaíba em Minas Gerais. Metodologia: Este trabalho caracteriza-se por ser analítico, quantitativo e transversal com a amostragem de 300 estudantes. Os jovens receberam um questionário de autopreenchimento, com questões que abordavam dados sociodemográficos, o uso de games e perguntas que compõem a escala PVP (Problem Videogame Playing) para medir o uso problemático de jogos eletrônicos. Resultados: Como resultados identificou-se uma prevalência elevada de uso abusivo de jogos eletrônicos (24%), com predominância no sexo masculino, associação com mal rendimento escolar e com interferência no tempo dedicado a relacionamentos afetivos. Conclusão: Tais resultados demonstram que o uso excessivo desses jogos pode alterar de forma nociva o cotidiano do usuário. Diante disso, a inclusão do uso abusivo dos games como um transtorno de saúde mental na 11ª revisão da Classificação Internacional de Doenças (CID-11) é pertinente.  

CIRURGIA AMBULATORIAL: DO CONCEITO À ORGANIZAÇÃO DE SERVIÇOS E SEUS RESULTADOS

The progress of videoendoscopic surgery, the introduction of short-acting anesthetic drugs with fewer side-effects, as well as the need to teach and provide healthcare, in a scenario which mandates the rational use of available hospital beds has contributed to stretching the limits of outpatient surgery. This is a report on the fundamental conceptual aspects of outpatient surgery, including the technical, ethical and legal issues. The process for the implantation of minor and major outpatient surgical services along with its results are presented. And finally, the technical and political aspects, according to the principles of the Brazilian Unified Health System, of consolidating a network for outpatient surgery involving the Centro de Saúde Escola (Primary), Hospital Estadual (Secondary) and the Hospital das Clínicas (Tertiary), with the cooperation of the Faculdade de Medicina de Ribeirão Preto da Unversidade de São Paulo, is discussed.O desenvolvimento da cirurgia videoendoscópica, a introdução de drogas anestésicas de duração curta com efeitos colaterais reduzidos e as necessidades didáticas e assistenciais associadas à imperativa gestão racional dos leitos hospitalares têm contribuído para a expansão dos limites da cirurgia ambulatorial, em nosso meio. Esse trabalho traz os fundamentos da cirurgia ambulatorial nos seus aspectos conceituais, técnicos, éticos e legais. Nesse contexto, o processo de implantação de serviços de cirurgia ambulatorial de pequeno e grande porte e a evolução dos seus resultados são descritos. Finalmente, destaca-se o papel desse movimento técnico e político em sintonia com as diretrizes do Sistema Único de Saúde para a consolidação de uma rede de serviços de cirurgia ambulatorial que integra o Centro de Saúde Escola, o Hospital Estadual e o Hospital das Clínicas e conta com a cooperação da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

Gastrostomia e jejunostomia: aspectos da evolução técnica e da ampliação das indicações

O acesso à luz do estômago e do jejuno proximal por meio de gastrostomia e jejunostomia, respectivamente, de forma temporária ou definitiva, está indicado diante da necessidade prolongada de descompressão digestiva ou de suporte alimentar. O emprego desses procedimentos expandiu-se nos últimos25 anos com a introdução da gastrostomia endoscópica, especialmente em pacientes com afecçõesneurológicas de evolução progressiva e neoplasias avançadas. Este artigo aborda aspectos conceituaisda gastrostomia e jejunostomia, as principais indicações, as vias de acesso preferenciais em diferentes cenários clínicos e as modalidades técnicas frequentemente empregadas. O manejo dessasestomias, os resultados e as potenciais complicações também são enfatizados. Finalmente, os fundamentos éticos e legais da ampliação da indicação da gastrostomia e da jejunostomia como procedimentos paliativos são discutidos.A temporary or permanent access to the stomach or jejunum, through a gastrostomy or jejunostomy, isindicated whenever nutritional support or prolonged decompression of the upper alimentary tract isneeded.  With the introduction of endoscopic gastrostomy, the utilization of these procedures has increased in the last 25 years, specially in patients with progressive neurologic diseases and in those withadvanced cancer.  This article deals with the conceptual aspects of gastrostomies and jejunostomies, itsprimary indications, the preferential means of access in different clinical scenarios as well as the technical modalities most frequently used.  The management of the stomas, the results and potential complications are also highlighted. Finally, the ethical and legal implications of greater utilization of theseprocedures in a palliative setting are also discussed

Incidência das doenças exantemáticas infantis nas regiões brasileiras/Incidence of child exanthematic diseases in brazilian regions

As doenças exantemáticas são consideradas infecções por vírus ou bactérias que apresentam como característica dominante erupções cutâneas geralmente acompanhadas com outras manifestações clínicas. O presente artigo tem como objetivo identificar as regiões brasileiras com maior incidência de rubéola e sarampo. Trata-se de um estudo transversal, quantitativo e descritivo. Foram analisados por meio da plataforma de dados DATASUS que disponibiliza o Tabnet, nele se encontram os casos confirmados de sarampo e rubéola nas cinco regiões brasileiras entre 2010 a 2014. Dessa forma, após a análise dos dados disponíveis pelo sistema, identificou-se 427 casos confirmados na faixa etária entre zero a nove anos, sendo o Nordeste e o Sudeste com as maiores incidências, 87,12% (N=372) e 7,96% (N=34), respectivamente. Diante da porcentagem de casos confirmados das doenças em pauta, a região Nordeste apresentou os maiores índices; dessa forma, afirma-se como a região com maior incidência, seguida pelo Sudeste, Norte, Centro-Oeste e Sul

Orientações para Realização de Exames de Ressonância Magnética Nuclear em Pacientes com Dispositivos Eletrônicos Cardíacos

Estima-se que até 75% dos pacientes com dispositivos cardíacos eletrônicos implantáveis (DCEIs) terão indicação de exame de ressonância nuclear magnética (RNM) ao longo da vida. Pelas características dos dispositivos, esses foram excluídos historicamente do rol de pacientes considerados elegíveis ao exame

De novo transcriptome analysis of Hevea brasiliensis tissues by RNA-seq and screening for molecular markers

Abstract\ud \ud Background\ud The rubber tree, Hevea brasiliensis, is a species native to the Brazilian Amazon region and it supplies almost all the world’s natural rubber, a strategic raw material for a variety of products. One of the major challenges for developing rubber tree plantations is adapting the plant to biotic and abiotic stress. Transcriptome analysis is one of the main approaches for identifying the complete set of active genes in a cell or tissue for a specific developmental stage or physiological condition.\ud \ud \ud Results\ud Here, we report on the sequencing, assembling, annotation and screening for molecular markers from a pool of H. brasiliensis tissues. A total of 17,166 contigs were successfully annotated. Then, 2,191 Single Nucleotide Variation (SNV) and 1.397 Simple Sequence Repeat (SSR) loci were discriminated from the sequences. From 306 putative, mainly non-synonymous SNVs located in CDS sequences, 191 were checked for their ability to characterize 23 Hevea genotypes by an allele-specific amplification technology. For 172 (90%), the nucleotide variation at the predicted genomic location was confirmed, thus validating the different steps from sequencing to the in silico detection of the SNVs.\ud \ud \ud Conclusions\ud This is the first study of the H. brasiliensis transcriptome, covering a wide range of tissues and organs, leading to the production of the first developed SNP markers. This process could be amplified to a larger set of in silico detected SNVs in expressed genes in order to increase the marker density in available and future genetic maps. The results obtained in this study will contribute to the H. brasiliensis genetic breeding program focused on improving of disease resistance and latex yield.CNPqPROSULCAPESFUNDHER

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Clinical Predictors of Different Grades of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is one of the comorbidities related to obesity. Liver biopsy has been used as the "gold standard" for the diagnosis, grading, and prognosis of obese patients. The objective of the present study was to evaluate clinical predictors of more advanced stages of NAFLD. In this retrospective study we assessed several physical and laboratorial factors, including some cytokines, in morbidly obese patients submitted to Roux-en-Y gastric bypass that could be related to the diagnosis and staging of NAFLD. Fragments of the livers were obtained from wedge biopsies during operation. The medical records of 259 patients were studied. The patients were divided into four groups: normal hepatic biopsy, steatosis, mild nonalcoholic steatohepatitis (NASH), and moderate and severe NASH. There were no differences in cytokine levels among groups. The triglyceride levels were the only variable that could stratify the grades of NAFLD and also differentiate from normal livers in the female patients. Also in this group, the aminotransferases and GGT levels and fasting glucose were predictors of the more advanced stages of NASH, while BMI and weight were predictors of the more advanced stages of NASH in male patients. There are no available markers in clinical practice to detect the initial stages of NAFLD. It is very important to perform a liver biopsy in all patients submitted to bariatric surgery and in obese patients with no indication to be operated in the presence of elevated blood levels of aminotransferases, GGT, and fasting glucose