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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.

https://doi.org/10.6061/clinics/2021/e3547

Especialismo, especificidade e identidade - as controvérsias em torno do autismo no SUS
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Rios, Clarice

; Camargo Júnior, Kenneth Rochel

Ciência & Saúde Coletiva

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mar 2019, Volume 24 N. 3 Pages 1111 - 1120

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A aprovação da Lei no 12.764/2012 representou uma vitória do ativismo político de familiares de autistas no Brasil, mas também deu visibilidade a um enorme antagonismo entre uma parcela significativa de pais de autistas e a rede de saúde mental. Este artigo analisa o posicionamento dos diferentes atores envolvidos na controvérsia que se sucedeu à aprovação e regulamentação da lei, e procura demonstrar as razões pelas quais essa polêmica antecede à lei e não se resolve com ela. Argumenta-se que a conturbada relação entre o movimento político de pais de autistas e a rede de saúde mental pode ser mais bem entendida se tomarmos a construção e a legitimação de uma rede de “expertise” a respeito dos transtornos do espectro autista como indissociável da construção de uma identidade social e política para os autistas no Brasil. O artigo utiliza como referência teórica os Estudos sobre Expertise e Experiência, que têm como principal pano de fundo uma discussão acerca do novo regime de relações entre a pesquisa científica e a sociedade civil. Entretanto, demonstramos também que a consolidação dessa rede de expertise vem ocorrendo apesar da ausência de uma ampla rede de tratamentos especializados e de uma reconfiguração profunda no regime de pesquisa e de produção de conhecimento sobre autismo no Brasil.

Abstract The passing of federal law 12,764/2012 marked a victory for the political activism of parents of autistic individuals in Brazil, but it also drew attention to the serious antagonism between parents of autistic individuals and the mental health network. This article examines the perspectives of social actors involved in the controversy that took place after the enactment of this law and seeks to show why this controversy precedes the passing of the law and is not resolved by it. The argument is that the troubled relationship between the political movement of parents of autistic individuals and the mental health network can be better understood when the construction and consolidation of a network of expertise around autism spectrum disorders as being inseparable from the construction of a social and political identity for autistic people in Brazil is taken into consideration. The article draws inspiration from the Studies of Expertise and Experience, which discuss the new regime of relations between scientific research and civil society. Nevertheless, it is also seen that the consolidation of this expertise network has arisen despite the absence of a broad specialized treatment network and of a profound reconfiguration in the regime of scientific research and production of knowledge about autism in Brazil.

https://doi.org/10.1590/1413-81232018243.07862017 4105 downloads

Especialismo, especificidade e identidade - as controvérsias em torno do autismo no SUS
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Rios, Clarice

; Camargo Júnior, Kenneth Rochel

Ciência & Saúde Coletiva

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2019, Volume 24 N. 3 Pages 1111 - 1120

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232018243.07862017

High vertical HIV transmission rate in the Midwest region of Brazil
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Matos, Vanessa Terezinha Gubert de

; Batista, Fabiani de Morais

; Versage, Naiara Valera

; Pinto, Clarice Souza

; Oliveira, Vanessa Marcon de

; Vasconcelos-Pereira, Érica Freire de

; Matos, Roberta Barbeta dos Rios de

; Fabbro, Márcia Maria Ferrairo Janini Dal

; Oliveira, Ana Lúcia Lyrio de

Brazilian Journal of Infectious Diseases

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jun 2018, Volume 22 N. 3 Pages 177 - 185

Abstract: En | Text: En | PDF: En

ABSTRACT Objectives To estimate vertical HIV transmission rate in a capital city of the Midwest region of Brazil and describe the factors related to transmission. Methods A descriptive epidemiological study based on the analysis of secondary data from the Notifiable Diseases Information System (SINAN). The analysis considered all HIV-infected pregnant women with delivery in Campo Grande-MS in the years 2007-2013 and their HIV-exposed infants. Results A total of 218 births of 176 HIV-infected pregnant women were identified during the study period, of which 187 infants were exposed and uninfected, 19 seroconverted, and 12 were still inconclusive in July 2015. Therefore, the overall vertical HIV transmission rate in the period was 8.7%. Most (71.6%) of HIV-infected pregnant women were less than 30 years at delivery, housewives (63.6%) and studied up to primary level (61.9%). Prenatal information was described in 75.3% of the notification forms and approximately 80% of pregnant women received antiretroviral prophylaxis. Among infants, 86.2% received prophylaxis, but little more than half received it during the whole period recommended by the Brazilian Ministry of Health. Among the exposed children, 11.3% were breastfed. Conclusion The vertical HIV transmission rate has increased over the years and the recommended interventions have not been fully adopted. HIV-infected pregnant women need adequate prophylactic measures in prenatal, intrapartum and postpartum, requiring greater integration among health professionals.

https://doi.org/10.1016/j.bjid.2018.04.002 605 downloads

“Nada sobre nós, sem nós”? O corpo na construção do autista como sujeito social e político
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Rios, Clarice

Sexualidad, Salud y Sociedad (Rio de Janeiro)

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apr 2017, N. 25 Pages 212 - 230

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo A aprovação da Lei no 12.764, que reconhece os autistas como pessoas com deficiência para todos os efeitos legais, marca também a aliança dos familiares de autistas com um movimento social e político mais amplo, o movimento das pessoas com deficiência. Entretanto, o caso do autismo e o de pessoas com deficiência intelectual grave impõem enormes desafios a esse modelo de ativismo. Este artigo discute a construção do autista como sujeito social e político a partir da observação das diferentes formas de interação entre autistas e pais/cuidadores, com especial atenção aos usos do corpo nessas interações. Para tal, examino dois casos paradigmáticos, observados no trabalho de campo, e proponho que as diferentes dinâmicas relacionais que se estabelecem entre pais/cuidadores e autistas sinalizam diferentes estratégias de ativismo e de construção do sujeito autista.

Abstract The approval of Brazilian federal law 12.764, which recognizes people with autism as persons with a disability for all legal purposes, also points to the alliance between parents of autistic people and the larger political movement of people with disabilities. However, autism and severe intellectual disabilities pose great challenges to this model of activism. This article discusses the construction of autistic people as political and social subjects, based on observations of the different forms of interaction between people with autism and parents/caregivers, with special attention to the uses of the body. Examining two paradigmatic cases, observed during fieldwork, I argue that the different relational dynamics established between parents/caregivers and autistic people index different strategies of activism and of construction of the autistic subject.

Resumen La aprobación de la Ley Nro. 12764, que reconoce los autistas como sujetos con discapacidad para todos los efectos legales, marca también la alianza de los familiares de autistas con un movimiento social más amplio: el movimiento de las personas con discapacidad. Sin embargo, tanto el autismo como otros casos de deficiencia intelectual grave imponen enormes desafíos para este modelo de activismo. El presente artículo discute la construcción de la persona con autismo como sujeto social y político sobre la base de observaciones de diferentes formas de interacción entre autistas y padres/cuidadores, con especial atención en los usos del cuerpo en las interacciones. Con este propósito, examino dos casos paradigmáticos durante recogidos a través de trabajo de campo y propongo que las diferentes dinámicas relacionales que se establecen entre padres/cuidadores e autistas indexan diferentes estrategias de activismo y de construcción del sujeto autista.

https://doi.org/10.1590/1984-6487.sess.2017.25.11.a 4980 downloads

(In)visible Blood: menstrual performances and body art
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Manica, Daniela Tonelli

; Rios, Clarice

Vibrant: Virtual Brazilian Anthropology

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2017, Volume 14 N. 1 elocation e141124

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Embora o potencial simbólico do sangue menstrual venha sendo amplamente explorado no contexto de práticas rituais, esse artigo foca na noção de performance e na dimensão experiencial da ação simbólica associada à menstruação e ao sangue menstrual. O termo performance menstrual refere-se às várias formas pelas quais o sangue menstrual vem sendo empregado como uma expressão estético-política. Esses usos ligam-se frequentemente à esfera da arte, mas também ocorrem em contextos mais mundanos como as redes sociais na Internet. O argumento se estrutura em torno de dois aspectos gerais dessas performances - a ressonância emocional de certas experiências físicas e substâncias corporais, tais como a menstruação e o sangue menstrual; e os dispositivos materiais, tais como o coletor menstrual e a própria Internet, que possibilitam que essas performances envolvendo o sangue menstrual cresçam em número e frequência.

Abstract Although the symbolic potential of menstrual blood has been widely explored in the context of ritual practices, this article focuses on the notion of performance and the experiential dimension of symbolic action associated with menstruation and menstrual blood. The term menstrual performance refers to various ways in which menstrual blood is used as an aesthetic and political expression. These uses are often related to artistic settings, but they also occur in more mundane contexts such as social networks in the Internet. The argument stresses two aspects of these performances: the emotional resonance of certain physical experiences and bodily substances, such as menstruation and menstrual blood; and the material devices, such as the menstrual cup and the internet, that allow these performances involving menstrual blood to grow in number and frequency.

https://doi.org/10.1590/1809-43412017v14n1p124 5642 downloads

Da invisibilidade à epidemia: a construção narrativa do autismo na mídia impressa brasileira
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Rios, Clarice

; Ortega, Francisco

; Zorzanelli, Rafaela

; Nascimento, Leonardo Fernandes

Interface - Comunicação, Saúde, Educação

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jun 2015, Volume 19 N. 53 Pages 325 - 336

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Embora o autismo não seja uma doença contagiosa, fala-se de uma “epidemia de autismo”, em alusão ao aumento vertiginoso do número de casos num período curto de tempo. O artigo traça um panorama das concepções socialmente partilhadas sobre o autismo no Brasil, a partir das narrativas que vêm conferindo visibilidade ao tema na mídia impressa brasileira no período de 2000 a 2012. Entendemos tais narrativas não como representações de uma realidade a priori, mas em sua função estruturante da experiência humana. Por um lado, essas narrativas dão forma e conteúdo às questões e às controvérsias ligadas ao autismo no Brasil, e, por outro, contribuem ativamente para esses debates, pois produzem determinados efeitos de sentido nos leitores.

Although autism is not a contagious disease, the term “autism epidemic” is used in allusion to the dramatic increase in the number of new cases in only a short period of time. This paper provides an overview of the socially shared conceptions surrounding autism in Brazil, through the narratives that have given visibility to this topic in the Brazilian press between 2000 and 2012. We regard these narratives not as representations of a reality a priori, but through their function of structuring human experience. On the one hand, such narratives shape and give content to the issues and controversies that surround autism in Brazil, while on the other hand, they also actively contribute to such debates, given that they affect the meaning that readers place on them.

Aunque el autismo no sea una enfermedad contagiosa, se habla de una “epidemia de autismo”, aludiendo al aumento vertiginoso del número de casos en un corto período de tiempo. El artículo esboza un panorama de las concepciones socialmente compartidas sobre el autismo en Brasil, a partir de las narrativas que otorgan visibilidad al tema en los medios impresos brasileños en el período de 2000 a 2012. Entendemos tales narrativas no como representaciones de una realidad a priori, sino en su función estructuradora de la experiencia humana. Por un lado, esas narrativas dan forma y contenido a las cuestiones y a las controversias vinculadas al autismo en Brasil y, por el otro, contribuyen activamente a esos debates, puesto que producen determinados efectos de sentido en los lectores.

https://doi.org/10.1590/1807-57622014.0146 5315 downloads

Da invisibilidade à epidemia: a construção narrativa do autismo na mídia impressa brasileira
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Rios, Clarice

; Ortega, Francisco

; Zorzanelli, Rafaela

; Nascimento, Leonardo Fernandes

Interface - Comunicação, Saúde, Educação

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jun 2015, Volume 19 N. 53 Pages 325 - 336

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/1807-57622014.0146 1439 downloads

Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volumes
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Oliveira-Costa, Clarice Daniele Alves de

; Friedman, Gilberto

; Vieira, Sílvia Regina Rios

; Fialkow, Léa

Clinics

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jul 2012, Volume 67 N. 7 Pages 773 - 778

Abstract: En | Text: En | PDF: En

OBJECTIVE: To determine the utility of pulse pressure variation (ΔRESP PP) in predicting fluid responsiveness in patients ventilated with low tidal volumes (V T) and to investigate whether a lower ΔRESP PP cut-off value should be used when patients are ventilated with low tidal volumes. METHOD: This cross-sectional observational study included 37 critically ill patients with acute circulatory failure who required fluid challenge. The patients were sedated and mechanically ventilated with a V T of 6-7 ml/kg ideal body weight, which was monitored with a pulmonary artery catheter and an arterial line. The mechanical ventilation and hemodynamic parameters, including ΔRESP PP, were measured before and after fluid challenge with 1,000 ml crystalloids or 500 ml colloids. Fluid responsiveness was defined as an increase in the cardiac index of at least 15%. ClinicalTrial.gov: NCT01569308. RESULTS: A total of 17 patients were classified as responders. Analysis of the area under the ROC curve (AUC) showed that the optimal cut-off point for ΔRESP PP to predict fluid responsiveness was 10% (AUC = 0.74). Adjustment of the ΔRESP PP to account for driving pressure did not improve the accuracy (AUC = 0.76). A ΔRESP PP>10% was a better predictor of fluid responsiveness than central venous pressure (AUC = 0.57) or pulmonary wedge pressure (AUC = 051). Of the 37 patients, 25 were in septic shock. The AUC for ΔRESP PP>10% to predict responsiveness in patients with septic shock was 0.484 (sensitivity, 78%; specificity, 93%). CONCLUSION: The parameter D RESP PP has limited value in predicting fluid responsiveness in patients who are ventilated with low tidal volumes, but a ΔRESP PP>10% is a significant improvement over static parameters. A ΔRESP PP > 10% may be particularly useful for identifying responders in patients with septic shock.

https://doi.org/10.6061/clinics/2012(07)12 2773 downloads

10.

Shunt direita-esquerda através de forame oval patente sem hipertensão pulmonar
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Lisboa, Thiago Costa

; Costa, Clarice Daniele Oliveira

; Furian, Thiago Quedi

; Vieira, Silvia Regina Rios

Arquivos Brasileiros de Cardiologia

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jan 2007, Volume 88 N. 1 Pages e10 - e12

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Este artigo descreve um paciente que se apresentou com quadro de hipoxemia e platipnéia e cujo único achado na investigação foi a presença de um forame oval patente com shunt direita-esquerda sem hipertensão pulmonar, caracterizando uma síndrome rara conhecida como platipnéia-ortodeoxia, de interessantes características fisiopatológicas e com opções terapêuticas ainda não totalmente definidas.

This article describes a patient presenting with dyspnea and platypnea and whose only clinical finding was presence of patent foramen ovale with a right to left shunt, without pulmonary hypertension, characteristic of the rare Platypnea-Orthodeoxya Syndrome, with very interesting pathophysiological findings and with therapeutic alternatives not yet defined.

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