988 resultados para Evidência
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
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Objectives: Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results. Methods: Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries. Results: The majority of the cases were young men. The most common injury was to the thumbs. The surgical techniques and tactics used were: nerve grafting, vein grafting, transposition of the digital vessels, limb shortening, and heterotopic replantation. The most commonly used technique was vein graft. The limb survival rate was high (93%), as was patient satisfaction. Conclusion: Replantation after avulsion injury depends on the correct diagnosis of the limb viability and the use of appropriate surgical techniques and tactics for each case. The experience of the team of surgeons and a good hospital structure are essential for good results. There are few articles in medical literature about the indications, techniques and results of limb replantation after avulsion injuries. We believe that this retrospective evaluation can bring new information and contributions to the correct management of this highly complex situation. Level of evidence IV, Case Series.
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Objective: To analyze the shear forces on the vertebral body L4 when submitted to a compression force by means of transmission photoelasticity. Methods: Twelve photoelastic models were divided into three groups, with four models per group, according to the positioning of the sagittal section vertebrae L4-L5 (sections A, B and C). The simulation was performed using a 15N compression force, and the fringe orders were evaluated in the vertebral body L4 by the Tardy compensation method. Results: Photoelastic analysis showed, in general, a homogeneous distribution in the vertebral bodies. The shear forces were higher in section C than B, and higher in B than A. Conclusion: The posterior area of L4, mainly in section C, showed higher shear concentrations, corresponding to a more susceptible area for bone fracture and spondylolisthesis. Economic and Decision Analyses Development of an Economic or Decision Model. Level I
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Schizophrenia is a severe psychiatric disorder with frequent recurrent psychotic relapses and progressive functional impairment. It results from a poorly understood gene-environment interaction. The gene encoding catechol-O-methyltransferase (COMT) is a likely candidate for schizophrenia. Its rs165599 (A/G) polymorphism has been shown to be associated with alteration of COMT gene expression. Therefore, the present study aimed to investigate a possible association between schizophrenia and this polymorphism. The distribution of the alleles and genotypes of this polymorphism was investigated in a Brazilian sample of 245 patients and 834 controls. The genotypic frequencies were in Hardy-Weinberg equilibrium and no statistically significant differences were found between cases and controls when analyzed according to gender or schizophrenia subtypes. There was also no difference in homozygosis between cases and controls. Thus, in the sample studied, there was no evidence of any association between schizophrenia and rs165599 (A/G) polymorphism in the non-coding region 3' of the COMT gene.
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Background: The anomalous experiences are often an explanatory challenge for psychiatry and psychology about how and why they occur, in addition to signaling gaps in knowledge about human psychological functioning, as hallucinations in non-clinical populations. Objective: It aims to investigate possible psychopathological dimensions of Brazilian samples of persons who claim distinctively contemporary anomalous experiences. Methods: It was used the Mini International Neuropsychiatric Interview, detailed version (MINI PLUS) and the nine diagnostic criteria for the distinction between spiritual experiences and mental disorders with religious content developed by Menezes Junior and Moreira-Almeida. Results: There was evidence that the experiences are typically healthy, although there are indicators of pre-morbid characteristics in the childhood and adolescence of the protagonists of the more complex experiments. There is profitable intersections with healthy squizotype profile, which is still poorly understood. Discussion: The absence of formal mental disorders does not exhaust the possible relations between contemporary anomalous experiences and the mental health field, but reveals complexities that characterize the everyday culture. Martins LB, Zangari W / Rev Psiq Clin. 2012; 39(6): 198-202
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PURPOSE: Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad (c); 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". RESULTS: There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.
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Neuromyelitis optica (NMO) has been traditionally described as the association of recurrent or bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM). Identification of aquaporin-4 antibody (AQP4-IgG) has deeply changed the concept of NMO. A spectrum of NMO disorders (NMOSD) has been formulated comprising conditions which include both AQP4-IgG seropositivity and one of the index events of the disease (recurrent or bilateral optic neuritis and LETM). Most NMO patients harbor asymptomatic brain MRI lesions, some of them considered as typical of NMO. Some patients with aquaporin-4 autoimmunity present brainstem, hypothalamic or encephalopathy symptoms either preceding an index event or occurring isolatedly with no evidence of optic nerve or spinal involvement. On the opposite way, other patients have optic neuritis or LETM in association with typical lesions of NMO on brain MRI and yet are AQP4-IgG seronegative. An expanded spectrum of NMO disorders is proposed to include these cases.
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Objetives: Determine the stability of tibial and femoral components of 20 cementless knee arthroplasties with rotating platform. Methods: The 20 patients (20 knees) underwent an analysis of dynamic radiographs with an image amplifier and maneuvers of varus and valgus which were compared to static frontal and lateral radiographs of the knees and analyzed by two experienced surgeons in a double-blind way. Results: We could observe in this study that both methods showed very similar results for the stability of the tibial and femoral components (p<0.001) using the Kappa method for comparison. Conclusion: The tibial component was more unstable in relation to the femoral component in both static and dynamic studies. Level of Evidence IV, Case Series.
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In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.
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INTRODUCTION: The symptoms of Brazilian borreliosis resemble the clinical manifestations of Lyme disease (LD). However, there are differences between the two in terms of epidemiological and laboratory findings. Primers usually employed to diagnose LD have failed to detect Borrelia strains in Brazil. OBJECTIVE: We aimed to identify the Brazilian Borrelia using a conserved gene that synthesizes the flagellar hook (flgE) of Borrelia burgdorferi sensu lato. METHOD: Three patients presenting with erythema migrans and positive epidemiological histories were recruited for the study. Blood samples were collected, and the DNA was extracted by commercial kits. RESULTS: The gene flgE was amplified from DNA of all selected patients. Upon sequencing, these positive samples revealed 99% homology to B. burgdorferi flgE. CONCLUSION: These results support the existence of borreliosis in Brazil. However, it is unclear whether this borreliosis is caused by a genetically modified B. burgdorferi sensu stricto or by a new species of Borrelia spp.
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Pesquisa fundamentada na fenomenologia de Martin Heidegger que objetivou compreender as necessidades de cuidados das mulheres infectadas pelo Papilomavírus Humanos. Participaram catorze mulheres que haviam recebido o diagnóstico dessa infecção. As questões norteadoras foram: como é, para você, estar com este diagnóstico? Conte-me sua experiência, desde que soube do diagnóstico até hoje. Como está sendo a assistência que você tem recebido? O desvelamento do tema - buscando o cuidado como solicitude - mostrou a importância do suporte dos familiares e de amigos. A presença da infecção como motivo de conflitos e separação conjugal foi outro aspecto ressaltado. Os depoimentos deixam em evidência a resignação após a tentativa frustrada de busca por informações precisas e esclarecedoras para a tomada de decisões assertivas. As ações de saúde à mulher infectada necessitam ultrapassar os modelos tradicionais de cuidado, incluindo ações de promoção e prevenção à saúde, com profissionais capacitados, sensíveis à dimensão subjetiva.
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CONTEXTO: As experiências anômalas se constituem em desafio explicativo para a psiquiatria e para a psicologia a respeito de como e por que ocorrem. Podem indicar aspectos desconhecidos do funcionamento psicológico humano, por exemplo, alucinações em populações não clínicas. OBJETIVO: Investigar amostras brasileiras de pessoas que alegam experiências anômalas caracteristicamente contemporâneas quanto a dimensões psicopatológicas. MÉTODOS: Comparando grupos experimentais e controle, foram utilizados o instrumento diagnóstico Mini International Neuropsychiatric Interview, versão detalhada (MINI PLUS), e os nove critérios diagnósticos para distinção entre experiências espirituais e transtornos mentais de conteúdo religioso elaborados por Menezes Júnior e Moreira-Almeida. RESULTADOS: Houve evidência de que as experiências são tipicamente saudáveis, embora haja indicadores de características pré-mórbidas na infância e na adolescência dos protagonistas das experiências mais complexas. Além disso, encontrou-se certa correlação com o perfil "esquizotípico saudável", que ainda é pouco compreendido. CONCLUSÃO: Apesar de não terem sido encontradas evidências de transtornos mentais nas amostras investigadas, foram discutidos alguns temas que tocam nas complexas relações entre as experiências investidas e a cultura em que emergem.
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OBJETIVO: Identificar as escalas utilizadas para avaliação funcional na doença de Pompe (DP) e descrever seu nível de evidência e recomendação. FONTES DE DADOS: Revisão sistemática sobre as escalas de avaliação funcional na DP. Pesquisa realizada nos bancos de dados Medline, Lilacs, Registro Cochrane de Ensaios Controlados Central (CCTR) e SciELO com artigos (exceto artigos de revisão) publicados entre 2000 e 2010. As palavras-chave utilizadas nos idiomas português e inglês foram: doença de depósito de glicogênio tipo II, atividades cotidianas, avaliação. Os artigos foram classificados em nível de evidência e recomendação. SÍNTESE DOS DADOS: Foram incluídos 14 estudos que avaliaram desde recém-nascidos a adultos (amostra total=449). Foram encontradas as seguintes escalas na literatura: Pediatric Evaluation of Disability Inventory (PEDI) e sua forma adaptada para DP (Pompe-PEDI), Alberta Infant Motor Scale (AIMS), Rotterdam Handiscap Scale (RHS), Functional Independence Measure (FIM), Gross Motor Function Measure (GMFM) e Peabody Developmental Motor Scales (PDMS-II). A maioria dos estudos apresentou nível de evidência III, por serem não randomizados. Grau de recomendação das escalas: C para AIMS e Pompe-PEDI; D para GMFM e PDMS-II; E para RHS e FIM. CONCLUSÕES: A maioria das escalas utilizadas para avaliação funcional na DP apresenta baixo nível de evidência e recomendação. As que apresentam melhor grau de recomendação (C) são as escalas AIMS e Pompe-PEDI aplicadas em Pediatria.
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Ancorada na perspectiva teórica da Análise do Discurso, na interface com a Filosofia e as Ciências Sociais, meu propósito, neste artigo, é pensar a circulação dos discursos sobre a leitura na internet. O corpus analisado se constitui de alguns excertos de relatos escritos por alunos de três cursos de graduação do Ensino Superior (Ciências Biológicas, Matemática, Pedagogia), os quais colocam em evidência a produção de discursividades sobre a leitura do texto-papel para o texto-tela, bem como a relação do sujeito-aluno-leitor com as "novas" tecnologias digitais no mundo contemporâneo e globalizado.