A oxigenoterapia hiperbárica enquanto terapêutica complementar do pé diabético: útil ou inútil?

Introdução: O pé diabético constitui uma complicação grave da diabetes mellitus com repercussões económicas e biopsicossociais relevantes, exigindo dos prestadores de cuidados de saúde uma otimização da abordagem terapêutica. Foi definido como objetivo principal a revisão da literatura acerca do tratamento do pé diabético, com especial enfoque na utilidade clínica e perspetivas futuras sobre o uso da oxigenoterapia hiperbárica neste contexto. Material e Métodos: Pesquisa de revisões sistemáticas no motor de busca Pubmed, em língua inglesa, que incluem uma análise de pelo menos dois dos seguintes termos: amputação major, amputação minor, taxa e/ou tempo de cicatrização, redução da área da úlcera, saturação de oxigénio transcutânea, efeitos adversos, impacto na qualidade de vida e custo-efetividade. Na pesquisa inicial foram obtidas 27 publicações desde 2005 (inclusive). Após revisão manual dos resumos e aplicação dos critérios definidos anteriormente, foram incluídos 6 artigos. Resultados: A análise da literatura perscrutada revela um perfil favorável de segurança pela baixa incidência de efeitos adversos, a utilidade clínica da oxigenoterapia hiperbárica na cicatrização para um período de seguimento de 6 meses e, possivelmente, até para além dos 12 meses. A saturação de oxigénio transcutânea do pé foi maior nos grupos de doentes tratados com esta terapêutica complementar. Verificou-se a diminuição da necessidade de amputação major dos membros inferiores. Conclusões: A evidência atual sugere o benefício clínico da oxigenoterapia hiperbárica no pé diabético, particularmente no que concerne à cicatrização e à menor taxa de amputação. No entanto, são necessários mais estudos de caráter prospetivo, aleatorizado e controlado que consubstanciem o referido.Introduction: Diabetic foot is one of the most serious complications of diabetes mellitus with relevant economic and psychosocial repercussions, which requires an optimization of therapeutic approach from health care providers. The main purpose was to review the literature on the treatment of diabetic foot, with special focus on the clinical utility and future perspectives of hyperbaric oxygen therapy in this context. Material and Methods: Pubmed search of systematic reviews, written in English, with an analysis of at least two of the following results: major amputation, minor amputation, rate and / or healing time, ulcer area reduction, transcutaneous oxygen saturation, adverse effects, impact on quality of life and cost-effectiveness. 27 publications were obtained since 2005 (inclusive). The abstracts were manually revised and 6 articles were included according to previously defined criteria. Results: The literature review reveals the favourable safety profile due to low incidence of side effects, the clinical benefit of hyperbaric oxygen therapy in the healing process in follow-up periods up to 6 months and probably for a follow-up equal to or greater than 12 months. The transcutaneous oxygen saturation of the foot was greater in the groups of patients treated with this complementary therapy. There was a decrease in the need for major amputation of the lower limbs. Conclusions: Current evidence points to the clinical utility of hyperbaric oxygen therapy, especially in the amputation and healing outcomes. However, more prospective, randomized and controlled studies are needed to overcome the limitations of existing publications

Prevalence of symptoms of temporomandibular disorders, oral behaviors, anxiety, and depression in Dentistry students during the period of social isolation due to COVID-19

Temporomandibular dysfunction (TMD), anxiety, and depression are disorders that, due to the current lifestyle, are affecting an increasing portion of the population. Investigating the prevalence of the symptoms of these disorders during the quarantine due to the coronavirus 2019 pandemic (COVID-19) is important to outline clinical strategies for patient care. Objective: This study assessed the prevalence of TMD symptoms, anxiety, depression, and oral behaviors and their associations during the social isolation due to COVID-19. Methodology: Questionnaires were used to assess TMD symptoms in accordance with the Diagnostic Criteria for Temporomandibular Disorders: clinical protocol and assessment instruments, a questionnaire to verify oral behaviors and Hospital Anxiety and Depression Scale to assess symptoms of anxiety and depression in students of dentistry at the Faculty of Health Sciences of the University of Brasília in May 2020. Qualitative data were subjected to descriptive statistics and chi-squared analysis (p<0.05). The relationship between quantitative and qualitative data was evaluated using Spearman's rho correlation (p<0.05). Results: There was a high prevalence of TMD symptoms, anxiety, and depression in the participants, resulting in association between gender and anxiety symptoms (p=0.029). There was a positive correlation between oral behaviors and TMD symptoms (r=0.364; p<0.001), between oral behaviors and anxiety symptoms (r=0.312; p=0.001), and between oral behaviors and symptoms of depression (r=0.216; p=0.021). Conclusion: Social isolation due to the COVID-19 pandemic has an impact on the prevalence of TMD symptoms, anxiety, and depression

A espécie Moringa oleífera Lam. E suas propriedades na fitocosmética: Uma revisão de literatura

As plantas medicinais são utilizadas tradicionalmente pelo homem através das gerações, e na atualidade estão presentes também na produção industrial em cuidados com a saúde e na fitocosmética. Esse artigo tem por objetivo descrever a importância da Moringa oleífera Lam. nos produtos cosméticos através de uma revisão bibliográfica. Estudos demonstram que a moringa é rica em compostos fenólicos, flavonoides, óleos essenciais e glicosídeos livres, como os flavônicos e terpênicos, que conferem as ações antioxidante, hidratante e fotoprotetora, justificando o seu uso cosmético e medicinal em cápsulas, chás, óleos, sabonetes, cremes, suplementos, medicamentos e outros. Devido ao seu baixo custo de produção, fácil cultivo e alto rendimento, a Moringa oleífera L. é uma excelente aliada para a dermocosmética

A ESTRUTURA DE CAPITAL E A GOVERNANÇA: ANÁLISE DOS CONSELHOS ADMINISTRAÇÃO E ESTRUTURA DE PROPRIEDADE NAS EMPRESAS LISTADAS NO IBRX-100

Desde os resultados de Modigliani e Miller (1958) que a estrutura de capital é um dos temas mais discutido em finanças, e não são poucos os estudos que investigam como as empresas definem sua estrutura de capital. A presente pesquisa analisou a luz da teoria da pecking order se existe uma relação entre as variáveis que compõem o conselho de administração, a estrutura de propriedade e a estrutura de capital das empresas, buscando contribuir com evidências empíricas acerca das relações destas variáveis com o endividamento. Para tanto, foram analisadas as empresas não financeiras do IBRX-100, com títulos negociados na BM&FBOVESPA entre os anos de 2010 a 2014, totalizando 406 observações. Os resultados indicam que não existe relação entre as características da composição do Conselho de Administração e a estrutura de capital, divergindo do corpo de evidências já existente na literatura. Sugere-se, para futuras pesquisas, a utilização de outra amostra para fins comparativos e da inclusão de variáveis de mercado ao modelo

Prevalence of symptoms of temporomandibular disorders, oral behaviors, anxiety, and depression in dentistry students during the period of social isolation due to COVID-19

Temporomandibular dysfunction (TMD), anxiety, and depression are disorders that, due to the current lifestyle, are affecting an increasing portion of the population. Investigating the prevalence of the symptoms of these disorders during the quarantine due to the coronavirus 2019 pandemic (COVID-19) is important to outline clinical strategies for patient care. Objective: This study assessed the prevalence of TMD symptoms, anxiety, depression, and oral behaviors and their associations during the social isolation due to COVID-19. Methodology: Questionnaires were used to assess TMD symptoms in accordance with the Diagnostic Criteria for Temporomandibular Disorders: clinical protocol and assessment instruments, a questionnaire to verify oral behaviors and Hospital Anxiety and Depression Scale to assess symptoms of anxiety and depression in students of dentistry at the Faculty of Health Sciences of the University of Brasília in May 2020. Qualitative data were subjected to descriptive statistics and chi-squared analysis (p<0.05). The relationship between quantitative and qualitative data was evaluated using Spearman's rho correlation (p<0.05). Results: There was a high prevalence of TMD symptoms, anxiety, and depression in the participants, resulting in association between gender and anxiety symptoms (p=0.029). There was a positive correlation between oral behaviors and TMD symptoms (r=0.364; p<0.001), between oral behaviors and anxiety symptoms (r=0.312; p=0.001), and between oral behaviors and symptoms of depression (r=0.216; p=0.021). Conclusion: Social isolation due to the COVID-19 pandemic has an impact on the prevalence of TMD symptoms, anxiety, and depression

A dor é total e não apenas um sintoma físico - acerca de um caso clínico em cuidados paliativos

info:eu-repo/semantics/publishedVersio

Enhancing soil vapor extraction with EKSF for the removal of HCHs

This paper evaluates the combination of electrokinetic soil flushing (EKSF) with soil vapor extraction (SVE) for the removal of four hexachlorocyclohexane (HCH) isomers contained in a real matrix. Results demonstrate that the combination of EKSF and SVE can be positive, but it is required the application of high electric fields (3 V cm−1) in order to promote a higher temperature in the system, which improves the volatilization of the HCH contained in the system. Electrokinetic transport is also enhanced with the application of higher electric gradients, but these transport processes are slower than the volatilization processes, which are the primary in this system. Hence collection of species in the electrolyte wells is negligible as compared to the compound dragged with air by the SVE but the temperature increase demonstrates a good performance. Combination of EKSF with SVE can efficiently exhaust the four HCH isomers reaching a removal of more than 90% after 15 days of treatment (20% more than values attained by SVE) but it is required the application of high electric fields to promote a higher temperature in the system (to improve the volatilization) and EK transport (to improve the dragging). 1-D transport model can be easily used to estimate the average pore water velocity and the effective diffusion of each compound under the different experimental conditions tested.Este artículo evalúa la combinación de lavado electrocinético del suelo (EKSF) con extracción de vapor del suelo (SVE) para la eliminación de cuatro isómeros de hexaclorociclohexano (HCH) contenidos en una matriz real. Los resultados demuestran que la combinación de EKSF y SVE puede ser positiva, pero se requiere la aplicación de campos eléctricos elevados (3 V cm −1) con el fin de promover una mayor temperatura en el sistema, lo que mejora la volatilización del HCH contenido en el sistema. El transporte electrocinético también mejora con la aplicación de gradientes eléctricos más altos, pero estos procesos de transporte son más lentos que los procesos de volatilización, que son los principales en este sistema. Por lo tanto, la recolección de especies en los pozos de electrolito es insignificante en comparación con el compuesto arrastrado con aire por el SVE, pero el aumento de temperatura demuestra un buen desempeño. La combinación de EKSF con SVE puede agotar eficientemente los cuatro isómeros de HCH alcanzando una eliminación de más del 90 % después de 15 días de tratamiento (20 % más que los valores alcanzados por SVE) pero se requiere la aplicación de campos eléctricos elevados para promover una temperatura más alta en el sistema (para mejorar la volatilización) y transporte EK (para mejorar el arrastre). El modelo de transporte 1-D se puede usar fácilmente para estimar el promediola velocidad intersticial del agua y la difusión efectiva de cada compuesto bajo las diferentes condiciones experimentales probadas

Digital twinning of the human ventricular activation sequence to clinical 12-lead ECGs and magnetic resonance imaging using realistic Purkinje networks for in silico clinical trials

Cardiac in silico clinical trials can virtually assess the safety and efficacy of therapies using human-based modelling and simulation. These technologies can provide mechanistic explanations for clinically observed pathological behaviour. Designing virtual cohorts for in silico trials requires exploiting clinical data to capture the physiological variability in the human population. The clinical characterisation of ventricular activation and the Purkinje network is challenging, especially non-invasively. Our study aims to present a novel digital twinning pipeline that can efficiently generate and integrate Purkinje networks into human multiscale biventricular models based on subject-specific clinical 12-lead electrocardiogram and magnetic resonance recordings. Essential novel features of the pipeline are the human-based Purkinje network generation method, personalisation considering ECG R wave progression as well as QRS morphology, and translation from reduced-order Eikonal models to equivalent biophysically-detailed monodomain ones. We demonstrate ECG simulations in line with clinical data with clinical image-based multiscale models with Purkinje in four control subjects and two hypertrophic cardiomyopathy patients (simulated and clinical QRS complexes with Pearson's correlation coefficients > 0.7). Our methods also considered possible differences in the density of Purkinje myocardial junctions in the Eikonal-based inference as regional conduction velocities. These differences translated into regional coupling effects between Purkinje and myocardial models in the monodomain formulation. In summary, we demonstrate a digital twin pipeline enabling simulations yielding clinically consistent ECGs with clinical CMR image-based biventricular multiscale models, including personalised Purkinje in healthy and cardiac disease conditions

Factors associated with the delay in seeking legal abortion for pregnancy resulting from rape

AbstractBackground: about 7% of rape cases in Brazil result in pregnancy. Brazilian  women generally are unaware of the right to legal interruption of pregnancy  after rape and try to end abortion in an unsafe manner or last to request the  procedure. Objective: to analyse factors associated with the time of seeking  legal abortion after rape in a public hospital. Methods: this is an observational,  analytical, and cross-sectional study. Data are from medical records of 1,270  women who complained of rape and have requested legal abortion in a public  hospital in São Paulo between 1994 and 2013. The variables age, education,  race, marital status, religion, form of intimidation, vulnerable condition,  perpetrator of sexual violence, number of perpetrators, and police report were analysed in relation to gestational age, according to multiple multinomial logistic  regression models. Results: the delay in requesting abortion at intermediate  gestational age is associated to when a woman is vulnerable (p=0.015), late  gestational age is associated with the presence of a police report (p=0.029) and 48 marital status as ngle (p=0.05). Be a relative of the aggressor is associated with  both intermediate (p=0.016) and late gestational age (p=0.002). Conclusions:  women without partners, who suffered intimidation with threats, in a vulnerable  condition, who made a police report and, above all, who were raped by relatives,  composed the group who took longer to get the health service.Keywords: sexual violence; rape; unwanted pregnancy; legal abortio