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Abstract Background Detailed information about the electromyography practice in Brazil is largely unavailable. Objective To evaluate where and how electromyography is performed in Brazil, as well as regional disparities and the professional and academic credentials of electromyographers. Methods We conducted an internet-based survey of active Brazilian electromyographers. The websites of health insurance companies, professional academies, medical cooperatives, online search engines, and social networks in each Brazilian state were screened and we evaluated the credentials of each electromyographer listed in the Brazilian Federal Medical Board (BFMB) registration website and their online curricula vitae in the Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq, in Portuguese). We also evaluated the same parameters in a control group of non-electromyographer neurologists randomly matched by geographical distribution and gender. Results We found 469 electromyographers (384 neurologists and 85 non-neurologists), with a male predominance. In total, 81.9% were BFMB-certified neurologists, 49.9%, BFMB-certified clinical neurophysiologists, and 10.4%, BFMB-certified physiatrists. Among the non-neurologists, 48.2% were physiatrists. Most electromyographers practiced in states on the Southern and Southeastern regions of Brazil. When adjusted by population, the Federal District and the states of Mato Grosso do Sul and Goiás presented the highest of eletromyographers density. Electromyographers were not more likely to have current/past academic affiliations. Conclusion In Brazil, electromyography is performed predominantly by neurologists, and half of them are BFMB-certified clinical neurophysiologists. The present study highlights regional disparities and may guide government-based initiatives, for instance, to improve the diagnosis of leprosy and the management of neuromuscular disorders within the Brazilian territory.

Resumo Antecedentes Informações detalhadas sobre a prática de eletromiografia no Brasil são em grande parte indisponíveis. Objetivo Avaliar onde e como a eletromiografia é realizada no Brasil, as disparidades regionais, e as credenciais profissionais e acadêmicas dos eletromiografistas. Métodos Realizamos uma enquete via internet de eletromiografistas brasileiros ativos. Foram rastreados sites de operadoras de planos de saúde, academias profissionais médicas, cooperativas médicas, ferramentas de busca online e redes sociais em cada estado brasileiro. Em seguida, avaliamos as credenciais de cada eletromiografista listado no site de registro do Conselho Federal de Medicina (CFM) e seus curricula vitae online no Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Também avaliamos os mesmos parâmetros em um grupo controle de neurologistas não eletromiografistas pareados aleatoriamente por distribuição geográfica e gênero. Resultados Encontramos 469 eletromiografistas (384 neurologistas e 85 não neurologistas), com predominância do sexo masculino. Ao todo, 81,9% eram neurologistas com certificação confirmada pelo site do CFM, 49,9%, neurofisiologistas clínicos com certificação confirmada pelo site do CFM, e 10,4%, fisiatras com certificação confirmada pelo mesmo site. Entre os não neurologistas, 48,2% eram fisiatras. A maioria dos eletromiografistas atuava nos estados do Sul e do Sudeste. Quando ajustados pela população, o Distrito Federal e os estados de Mato Grosso do Sul e Goiás apresentaram a maior densidade de eletromiografistas. Os eletromiografistas não eram mais propensos a ter vínculos acadêmicos atuais/passados. Conclusão No Brasil, a eletromiografia é realizada predominantemente por neurologistas, e metade deles são neurofisiologistas clínicos com certificação confirmada pelo site do CFM. Este estudo destacou as disparidades regionais, e pode orientar ações governamentais para, por exemplo, melhorar o diagnóstico da hanseníase e o manejo das doenças neuromusculares no território brasileiro.

https://doi.org/10.1055/s-0043-1777007

Characterization of intronic SNP located in candidate genes influencing cattle temperament
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Ruiz-De-La-Cruz, Gilberto

; Sifuentes-Rincón, Ana María

; Paredes-Sánchez, Francisco Alejandro

; Parra-Bracamonte, Gaspar Manuel

; Casas, Eduardo

; Welsh Jr., Thomas H.

; Riley, David Greg

; Perry, George

; Randel, Ronald D.

Revista Brasileira de Zootecnia

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2023, Volume 52 elocation e20220057

Resumo: En | Texto: En | PDF: En

ABSTRACT The objective of this study was to evaluate the effect of intronic single nucleotide polymorphisms (SNP) on temperament traits in a Brahman cattle population. The SNP located in CACNG4, EXOC4, NRXN3, and SLC9A4 candidate genes were genotyped in 250 animals with temperament records of exit velocity, pen score, and temperament score. Rs3423464051:G>A in the CACNG4 gene was associated with exit velocity and temperament score. An in silico analysis of the five intronic SNP showed that alternative alleles of CACNG4-rs3423464051, EXOC4-rs109393235, and SLC9A4-rs109722627 SNP could alter branch point sites during splicing, while a protein–protein interaction network analysis demonstrated a GRIA2 gene-mediated interaction between CACNG4 and NRXN3. The present results support previously reported evidence regarding bovine temperament-related candidate genes, particularly CACNG4, which is a confirmed candidate gene in need of more detailed analyses to reveal its role in temperament-related traits.

https://doi.org/10.37496/rbz5220220057

Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
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Zaikos, Thomas Dimitrios

; Yousem, David M.

; Troncoso, Juan C.

; Nix, James Stephen

Autopsy and Case Reports

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2023, Volume 13 elocation e2023448

Resumo: En | Texto: En | PDF: En

ABSTRACT Internal watershed infarcts (IWIs) occur at the junction of the deep and superficial perforating arterial branches of the cerebrum. Despite documentation in the radiology literature, IWIs are rarely encountered at the time of autopsy. Here, we report the case of a 59-year-old incarcerated male who was brought to the emergency department after being found unresponsive on the floor of his jail cell. Initial examination and imaging demonstrated right-sided hemiplegia, aphasia, right facial droop, and severe stenosis of the left middle cerebral artery, respectively. Repeat imaging 4 days after admission and 26 days before death demonstrated advanced stenosis of the intracranial, communicating segment of the right internal carotid artery, a large acute infarct in the right posterior cerebral artery territory, and bilateral deep white matter ischemic changes with a right-sided “rosary-like” pattern of injury that is typical of IWIs. Postmortem gross examination showed that the right deep white matter lesion had progressed to a confluent, “cigar-shaped” subacute IWI involving the right corona radiata. This is the first well-documented case of an IWI with radiologic imaging and photographic gross pathology correlation. This case uniquely highlights a rarely encountered lesion at the time of autopsy and provides an excellent visual representation of internal watershed neuroanatomy.

https://doi.org/10.4322/acr.2023.448

Apoyo social percibido por mujeres gestantes de Santa Marta, Colombia: un análisis comparativo.
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Thomas-Hilarión, Whitne Dayana

; Fuentes-Vanegas, Laura Vanessa

; Gallo-Barrera, Yeison David

; Ramos De la Cruz, Ediltrudis

Revista Cuidarte

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Dez 2022, Volume 13 Nº 3 elocation e2448

Resumo: Es En Pt | Texto: Es En Pt | PDF: Es | PDF: En | PDF: Pt

Resumen Introducción: El apoyo social percibido durante la gestación es importante para la salud mental perinatal. Sin embargo, poco se conoce sobre estas variables en la población colombiana. Objetivo: Comparar el apoyo social percibido según variables sociodemográficas, ginecobstétricas y afecto positivo en mujeres gestantes de Santa Marta, Colombia. Materiales y métodos: Participaron 40 mujeres entre 19 y 41 años (M=26.48; DE=5.03), que se encontraban en su tercer trimestre de embarazo, beneficiarias de un programa de promoción de la lactancia materna exclusiva. Las participantes diligenciaron una ficha de información sociodemográfica y ginecobstétrica, la Escala Multidimensional de Apoyo Social Percibido (a=0.88) y una subescala de la Escala de Afectos Positivos y Negativos (a=0.82). Se aplicó la prueba U de Mann-Whitney para los análisis estadísticos comparativos y se siguieron los lineamientos éticos en investigación con humanos. Resultados: 67% de las participantes fueron de estrato socioeconómico bajo, 87.5% tenía pareja, 67.5% contaba con estudios superiores, 42.5% tenía trabajo y 47.5% eran madres primerizas. Las mujeres de estrato socioeconómico alto percibieron mayor apoyo social por parte de sus amigos (p=0.01). El apoyo social familiar fue significativamente más alto en las madres primerizas (p=0.01) y en las que reportaron mayor afecto positivo (p=0.03). Por último, el apoyo social por parte de personas significativas fue mayor cuando era el primer embarazo de la mujer (p=0.02). Conclusiones: Se encontraron diferencias significativas en algunas dimensiones del apoyo social percibido según el estrato socioeconómico, ser madre primeriza y el afecto positivo. Se recomienda realizar otros estudios con mayor tamaño muestral.

Abstract Introduction: Perceived social support during gestation is important for perinatal mental health. However, little is known about these variables in the Colombian population. Objective: To compare perceived social support with sociodemographic and gynaeco-obstetric variables and positive affect in pregnant women in Santa Marta, Colombia. Materials and Methods: Forty women between 19 and 41 years of age (M=26.48; SD=5.03), in their third trimester of pregnancy and beneficiaries of a program to promote exclusive breastfeeding, participated. The participants filled out a sociodemographic and gynaeco-obstetric form, the Multidimensional Scale of Perceived Social Support (MSPSS) (a=0.88), and a subscale of the Positive and Negative Affect Schedule (PANAS) (a=0.82). The Mann-Whitney U test was used for comparative statistical analyses. Ethical guidelines for human research were followed. Results: 67% of the participants belonged to a low socioeconomic status, 87.5% had a partner, 67.5% had a higher education, 42.5% were employed, and 47.5% were new mothers. Women of higher socioeconomic status perceived greater social support from their friends (p = 0.01). Family social support was significantly higher in first-time mothers (p=0.01) and mothers who reported higher positive affect (p = 0.03). Finally, social support from significant others was higher when it was the woman's first pregnancy (p=0.02). Conclusions: Significant differences were found in some dimensions of perceived social support according to socioeconomic status, being a first-time mother, and positive affect. Further studies with larger sample sizes are recommended.

Resumo Introdujo: O apoio social percebido durante a gravidez é importante para a saúde mental perinatal. No entanto, pouco se sabe sobre essas variáveis na populagáo colombiana. Objetivo: Comparar o apoio social percebido segundo variáveis sociodemográficas, ginecológicas e de afeto positivo em gestantes de Santa Marta, Colombia. Materiais e métodos: Participaram 40 mulheres entre 19 e 41 anos (M=26,48; DP=5,03), que estavam no terceiro trimestre de gestagáo, beneficiárias de um programa de promogáo do aleitamento materno exclusivo. As participantes preencheram uma ficha sociodemográfica e ginecológica, a Escala Multidimensional de Suporte Social Percebido (a=0,88) e uma subescala da Escala de Afetos Positivos e Negativos (a=0,82). O teste U de Mann-Whitney foi aplicado para análise estatística comparativa e foram seguidas as diretrizes éticas para pesquisa em humanos. Resultados: 67% das participantes eram de baixo nível socioeconomico, 87,5% tinham companheiro, 67,5% tinham ensino superior, 42,5% trabalhavam e 47,5% eram máes de primeira viagem. As mulheres de nível socioeconomico alto perceberam maior apoio social dos amigos (p=0,01). O apoio social familiar foi significativamente maior nas novas máes (p=0,01) e naquelas que relataram maior afeto positivo (p=0,03). Por fim, o apoio social de pessoas significativas foi maior quando se tratava da primeira gravidez da mulher (p=0,02). Conclusóes: Foram encontradas diferengas significativas em algumas dimensóes do suporte social percebido de acordo com o nivel socioeconómico, ser máe de primeira viagem e afeto positivo. Outros estudos com tamanho amostral maior sáo recomendados.

https://doi.org/10.15649/cuidarte.2448

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility
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Cohen, Erin Rachel

; Dable, Cortney Lee

; Iglesias, Thomas

; Singh, Eshita

; Ma, Ruixuan

; Rosow, David Edward

International Archives of Otorhinolaryngology

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Dez 2022, Volume 26 Nº 4 Páginas 524 - 532

Resumo: En | Texto: En | PDF: En

Abstract Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053–0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

https://doi.org/10.1055/s-0041-1741435

Evaluation of ultrasound-guided bilateral low thoracic erector spinae plane block for postoperative analgesia in cesarean delivery patients: a prospective, randomized, controlled clinical trial
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Aygun, Hakan

; Ozturk, Nilgun Kavrut

; Ugur, Murside

; Aydin, Yeter

; Celik, Gayem Inayet

; Thomas, David Terence

; Tulgar, Serkan

Brazilian Journal of Anesthesiology

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Jul 2022, Volume 72 Nº 4 Páginas 444 - 449

Resumo: En | Texto: En | PDF: En

Abstract Background: Erector spinae plane block (ESPB) is a recently described block. In many reports, ESPB has been reported to provide effective postoperative analgesia in patients undergoing cesarean delivery (CD). Herein, we compared the effectiveness of ESPB and control group in postoperative analgesia in patients undergoing CD under spinal anesthesia. Method: This assessor-blinded, prospective, randomized, efficiency study was conducted in the postoperative recovery room and ward at a tertiary university hospital. Eighty-six patients ASA II–III were recruited. Following exclusion, 80 patients were randomized into two equal groups (block and control group). Standard multimodal analgesia was performed in the control group while ESPB block was performed in the intervention (ESPB) group. Opioid consumption was measured and pain intensity between groups was compared using Numeric Rating Scores (NRS). Results: NRS was lower in Group ESPB at 3rd and 6th hours. There was no difference between NRS scores at other hours. Opioid consumption was lower in Group ESPB. Conclusion: When added to multimodal analgesia, bilateral ultrasound guided low thoracic ESPB leads to improve the quality of analgesia in the first 24 hours in patients undergoing CD.

https://doi.org/10.1016/j.bjane.2021.07.032

Robotic-assisted nephrectomy with level II IVC thrombectomy using Rummel Tourniquets
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Pulford, Christopher

; Keating, Kevin

; Rohloff, Matthew

; Peifer, David

; Eames, Richard

; Shakuri-Rad, Jaschar

; Maatman, Thomas

International braz j urol

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Jan 2022, Volume 48 Nº 1 Páginas 196 - 197

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Inferior vena cava (IVC) invasion from renal cell carcinoma (RCC) occurs at a rate of 4-10% (1). IVC thrombectomy (IVC-TE) can be an open procedure because of the need for handling of the IVC (2). The first reported series of robotic management of IVC-TE started in 2011 for the management of Level I - II thrombi with subsequent case reports in recent years (2-5). Materials and Methods: The following is a patient in his 50’s with no significant medical history. Magnetic resonance imaging and IR venogram were performed preoperatively. The tumor was clinical stage T3b with a 4.3cm inferior vena cava thrombus. The patient underwent robotic assisted nephrectomy and IVC-TE. Rummel tourniquets were used for the contralateral kidney and the IVC. The tourniquets were created using vessel loops, a 24 French foley catheter and hem-o-lock clips. Results: The patient tolerated the surgical procedure well with no intraoperative complications. Total surgical time was 274 min with 200 minutes of console time and 22 minutes of IVC occlusion. Total blood loss in the surgery was 850cc. The patient was discharged from the hospital on post-operative day 3 without any complications. The final pathology of the specimen was pT3b clear cell renal cell carcinoma Fuhrman grade 2. The patient followed up post-operatively at both four months and six months without disease recurrence. The patient continues annual follow-up with no recurrence. Conclusions: Surgeon experience is a key factor in radical nephrectomy with thrombectomy as patients have a reported 50-65% survival rate after IVC-TE (4).

https://doi.org/10.1590/s1677-5538.ibju.2021.0393

A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas
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Page, Matthew J.

; McKenzie, Joanne E.

; Bossuyt, Patrick M.

; Boutron, Isabelle

; Hoffmann, Tammy C.

; Mulrow, Cynthia D.

; Shamseer, Larissa

; Tetzlaff, Jennifer M.

; Akl, Elie A.

; Brennan, Sue E.

; Chou, Roger

; Glanville, Julie

; Grimshaw, Jeremy M.

; Hróbjartsson, Asbjørn

; Lalu, Manoj M.

; Li, Tianjing

; Loder, Elizabeth W.

; Mayo-Wilson, Evan

; McDonald, Steve

; McGuinness, Luke A.

; Stewart, Lesley A.

; Thomas, James

; Tricco, Andrea C.

; Welch, Vivian A.

; Whiting, Penny

; Moher, David

Revista Panamericana de Salud Pública

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2022, Volume 46 elocation e112

Resumo: En Pt Es | Texto: En Pt Es | PDF: En | PDF: Pt | PDF: Es

ABSTRACT The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

RESUMO A declaração dos Principais Itens para Relatar Revisões Sistemáticas e Meta-análises (PRISMA), publicada em 2009, foi desenvolvida para ajudar revisores sistemáticos a relatar de forma transparente por que a revisão foi feita, os métodos empregados e o que os autores encontraram. Na última década, os avanços na metodologia e terminologia de revisões sistemáticas exigiram a atualização da diretriz. A declaração PRISMA 2020 substitui a declaração de 2009 e inclui novas orientações para relato que refletem os avanços nos métodos para identificar, selecionar, avaliar e sintetizar estudos. A estrutura e apresentação dos itens foram modificadas para facilitar a implementação. Neste artigo, apresentamos a lista de checagem PRISMA 2020 de 27 itens, uma lista de checagem expandida que detalha as recomendações para relato para cada item, a lista de checagem PRISMA 2020 para resumos e os fluxogramas revisados para novas revisões e para atualização de revisões.

RESUMEN La declaración PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), publicada en 2009, se diseñó para ayudar a los autores de revisiones sistemáticas a documentar de manera transparente el porqué de la revisión, qué hicieron los autores y qué encontraron. Durante la última década, ha habido muchos avances en la metodología y terminología de las revisiones sistemáticas, lo que ha requerido una actualización de esta guía. La declaración PRISMA 2020 sustituye a la declaración de 2009 e incluye una nueva guía de presentación de las publicaciones que refleja los avances en los métodos para identificar, seleccionar, evaluar y sintetizar estudios. La estructura y la presentación de los ítems ha sido modificada para facilitar su implementación. En este artículo, presentamos la lista de verificación PRISMA 2020 con 27 ítems, y una lista de verificación ampliada que detalla las recomendaciones en la publicación de cada ítem, la lista de verificación del resumen estructurado PRISMA 2020 y el diagrama de flujo revisado para revisiones sistemáticas.

https://doi.org/10.26633/rpsp.2022.112

Saúde Cardiovascular e Fibrilação ou Flutter Atrial: Um Estudo Transversal do ELSA-Brasil
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Santos, Itamar S.

; Lotufo, Paulo A.

; Goulart, Alessandra C.

; Brant, Luisa C. C.

; Pinto Filho, Marcelo M

; Pereira, Alexandre C.

; Barreto, Sandhi M.

; Ribeiro, Antonio L. P.

; Thomas, G Neil

; Lip, Gregory Y. H.

; Bensenor, Isabela M.

; Arasalingam, Ajini

; Beane, Abi

; Bensenor, Isabela M

; Brocklehurst, Peter

; Cheng, Kar Keung

; El-Bouri, Wahbi

; Feng, Mei

; Goulart, Alessandra C

; Greenfield, Sheila

; Guo, Yutao

; Guruparan, Mahesan

; Gusso, Gustavo

; Gooden, Tiffany E

; Haniffa, Rashan

; Humphreys, Lindsey

; Jolly, Kate

; Jowett, Sue

; Kumarendran, Balachandran

; Lancashire, Emma

; Lane, Deirdre A

; Li, Xuewen

; Lip (Co-PI), Gregory Y.H.

; Li, Yan-guang

; Lobban, Trudie

; Lotufo, Paulo A

; Manseki-Holland, Semira

; Moore, David J

; Nirantharakumar, Krishnarajah

; Olmos, Rodrigo D

; Paschoal, Elisabete

; Pirasanth, Paskaran

; Powsiga, Uruthirakumar

; Romagnolli, Carla

; Santos, Itamar S

; Shantsila, Alena

; Sheron, Vethanayagam Antony

; Shribavan, Kanesamoorthy

; Szmigin, Isabelle

; Subaschandren, Kumaran

; Surenthirakumaran, Rajendra

; Tai, Meihui

; Neil Thomas (Co-PI), G

; Varella, Ana C

; Wang, Hao

; Wang, Jingya

; Zhang, Hui

; Zhong, Jiaoyue

Arquivos Brasileiros de Cardiologia

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2022, Nº ahead

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares. Objetivos Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05. Resultados A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA. Conclusões Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.

Abstract Background The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. Results The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15–0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19–2.98; p=0.007) profiles were significantly associated with AFF diagnosis. Conclusions No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.

https://doi.org/10.36660/abc.20210970

10.

Enacting Contextually Responsive Scholarship: Centring Occupation in Participatory Action Research with Children in India
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Benjamin-Thomas, Tanya Elizabeth

; Rudman, Debbie Laliberte

; Thomas, David Mark

South African Journal of Occupational Therapy

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Dez 2021, Volume 51 Nº 4 Páginas 22 - 31

Resumo: En | Texto: En | PDF: En

Occupation-based scholars are striving to mobilize socially responsive scholarship to address occupational injustices from local to global scales. Moving forward involves expanding beyond Western, Anglophonic, female, able-bodied, adult perspectives on occupation, with critically informed participatory methodologies providing one key means to incorporate diverse perspectives on occupation and occupational justice. Drawing upon a participatory action research project with children with disabilities from rural South India, this paper puts forward an understanding of participatory action research as an occupational process (i.e., embodying a variety of occupations) and an occupation-based process (i.e., informed by an occupational lens). We forefront how 'occupation' was centered and mobilized within the process of this participatory action research. In addition, drawing on select study findings, we illustrate and discuss how participatory action research provided a forum to partner with the child co-researchers and collaboratively identify and critically analyse occupational injustices. Through this illustration and discussion of participatory action research as an occupation-based process and occupational process, we demonstrate its potential to be used to enact contextually responsive scholarship and praxis.

https://doi.org/10.17159/2310-3833/2021/vol51n4a4 33 downloads

11.

How we do it: robotic-assisted distal ureterectomy with ureteral reimplantation
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Pulford, Christopher

; Keating, Kevin

; Rohloff, Matthew

; Peifer, David

; Eames, Richard

; Maatman, Thomas

International braz j urol

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Dez 2021, Volume 47 Nº 6 Páginas 1277 - 1278

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: High risk upper tract urothelial carcinoma (UTUC) is typically managed with radical nephroureterectomy, however, renal preservation can be attempted when UTUC is localized to the distal ureter in the presence of chronic kidney disease (1–3). Distal ureterectomy is typically managed with a ureteral reimplantation and psoas hitch in order to maintain urothelial continuity, to avoid comprising the contralateral ureter, and reducing risk of chronic urinary tract infections and electrolyte abnormalities (4). We present our case of distal ureteral UTUC managed robotically with a distal ureterectomy with ureteral reimplantation. Technique and Follow-Up: Initially, an Orandi needle on a resectoscope circumscribed the left ureteral orifice. Next, robotically, the retroperitoneum was exposed and a left sided pelvic lymphadenectomy was completed. The left ureter was mobilized and the diseased ureteral segment was transected. The mobilized bladder was sutured to psoas fascia. After a cystotomy, the ureter was re-anastomosed to the bladder. The patient was discharged on postoperative day three and re-evaluated one week later with a cystogram. Final pathology was downgraded to non-invasive low-grade papillary urothelial carcinoma with negative lymph nodes and margins. Conclusion: High risk UTUC localized to the distal ureter in the setting of chronic kidney disease can be managed with a distal ureterectomy (3). Robotic distal ureterectomy with ureteral reimplantation can be assisted by an Orandi needle to achieve negative margins. Utilizing a robotic technique can offer challenges with the ureteral spatulation and reanastomosis (5–7). By fixating the ureter to the bladder prior to reanastomosis, our technique offers a solution for these difficulties.

https://doi.org/10.1590/s1677-5538.ibju.2021.0207 65 downloads

12.

Secrecy, Content, and Quantification
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Ferguson, Thomas Macaulay

Análisis filosófico

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Dez 2021, Volume 41 Nº 2 Páginas 285 - 320

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen Mientras participaba en un simposio sobre el libro de David Ripley Uncut, de próxima aparición, sugerí que emplear una interpretación tolerante estricta de las matrices de Kleene débiles proporcionaba una concepción teórica del contenido de los límites de las normas conversacionales que tenía ciertas ventajas sobre la propuesta de Ripley, la cual está basada en matrices de Kleene fuerte. Durante la discusión, utilicé el caso de los secretos como ejemplos de oraciones donde los límites conversacionales en la práctica divergen de la explicación defendida por Ripley. En este artículo, considero la objeción de que mi tratamiento de los cuantificadores era erróneo en virtud de que la confidencialidad de una oración φ(t) puede no afectar la oración ∃xφ(x) y extraigo de esta objeción la conclusión de que en lo que respecta a los cuantificadores, ni la interpretación de fuerte de Kleene ni la débil son suficientes, pero una interpretación novedosa podría serlo.

Abstract While participating in a symposium on Dave Ripley’s forthcoming book Uncut, I had proposed that employing a strict-tolerant interpretation of the weak Kleene matrices provided a content-theoretical conception of the bounds of conversational norms that enjoyed advantages over Ripley’s use of the strong Kleene matrices. During discussion, I used the case of sentences that are taken to be out-of-bounds for being secrets as an example of a case in which the setting of conversational bounds in practice diverged from the account championed by Ripley. In this paper, I consider an objection that my treatment of quantifiers was mistaken insofar as the confidentiality of a sentence φ(t) may not lift to the sentence ∃xφ(x) and draw from this objection that neither the strong nor the weak Kleene interpretation of quantifiers suffices, but that a novel interpretation may do so.

https://doi.org/10.36446/af.2021.457 14 downloads

13.

Establishing targets for advanced HIV disease: A call to action
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Meya, David B.

; Tugume, Lillian

; Nabitaka, Vennie

; Namuwenge, Proscovia

; Phiri, Sam

; Oladele, Rita

; Jibrin, Bilkisu

; Mobolaji-Bello, Mojisola

; Kanyama, Cecilia

; Maokola, Werner

; Mfinanga, Sayoki

; Katureebe, Cordelia

; Amamilo, Ikechukwu

; Ngwatu, Brian

; Jarvis, Joseph N.

; Harrison, Thomas S.

; Shroufi, Amir

; Rajasingham, Radha

; Boulware, David

; Govender, Nelesh P.

; Loyse, Angela

Southern African Journal of HIV Medicine

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2021, Volume 22 Nº 1 Páginas 1 - 5

Resumo: En | Texto: En | PDF: En

The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease.

https://doi.org/10.4102/sajhivmed.v22i1.1266 25 downloads

14.

Glulam connections assembled with screws in different installation angles
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Hanna, David

; Tannert, Thomas

Maderas. Ciencia y tecnología

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2021, Volume 23 elocation 54

Resumo: En | Texto: En | PDF: En

Abstract: Self-tapping screws are the recognized state-of-the-art in fastener technology for timber structures. Combining fasteners of different stiffness, such as self-tapping screws with different installation angles, can be advantageous to simultaneously achieve high connection stiffness and ductility. In this paper, experimental investigations on a total of 65 glued-laminated timber joints assembled with a variety of installation angles including several combinations of self-tapping screws acting axially in withdrawal with self-tapping screws acting laterally are presented. The connection performance was analyzed in terms of the load-carrying capacity, the deformation capacity, the stiffness, and the ductility. The findings demonstrated that joint assemblies with self-tapping screws loaded primarily laterally exhibit low stiffness but high ductility, whereas joint assemblies with self-tapping screws loaded primarily in withdrawal are very stiff but exhibit low ductility. Combining screws in different installation angles created glued-laminated timber connections that combine high stiffness with high ductility. Existing analytical expressions were deemed suitable to estimate load-carrying capacity through simple summation of the different screws’ individual resistances.

https://doi.org/10.4067/s0718-221x2021000100454 320 downloads

15.

Effectiveness of simplified predictive intubation difficulty score and thyromental height in head and neck surgeries: an observational study
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Selvi, Onur

; Kahraman, Seda Tugce

; Tulgar, Serkan

; Senturk, Ozgur

; Serifsoy, Talat Ercan

; Thomas, David

; Cinar, Ayse Surhan

; Ozer, Zeliha

Revista Brasileira de Anestesiologia

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Dez 2020, Volume 70 Nº 6 Páginas 595 - 604

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Justificativa e objetivos: Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço. Método: Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs, determinados. Resultados: Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM. Conclusões: O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.

Abstract Background and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores >10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.

https://doi.org/10.1016/j.bjane.2020.09.007 400 downloads

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