Patologia Psiquiátrica nos Cuidados Primários de Saúde

É consensual a alta prevalência de patologia psiquiátrica ao nível dos Cuidados Primários Saúde. Consensual será também o papel fulcral que estes mesmos Cuidados desempenham enquanto primeiro filtro na abordagem dos problemas psiquiátricos, reconhecendo-se que, frequentemente, o Clínico Geral é o agente melhor posicionado para uma correcta abordagem diagnóstica e terapêutica deste tipo de problemas. Assume-se assim como necessidade objectiva que o Clínico Geral tome a seu cargo a maioria destes doentes e proceda à referenciação criteriosa duma minoria verdadeiramente necessitada de cuidados mais especializados. Em termos práticos, configura-se como prioritária uma progressiva melhoria da capacidade de actuação dos Clínicos Gerais, na área da Saúde Mental. É portanto neste contexto que surge a importância da articulação dos Serviços de Psiquiatria com os Centros de Saúde e a relevância do trabalho Consiliar e de Ligação do Psiquiatra junto dos Clínicos Gerais. No presente artigo os autores tecem algumas considerações e lançam diversas questões sobre o tema em apreço, procurando abordar determinados aspectos centrais, nomeadamente, as particularidades de apresentação da patologia psiquiátrica nos Cuidados de Saúde Primários, em particular da “depressão”, e decorrendo deste facto, as dificuldades na avaliação e abordagem das perturbações mentais neste setting particular

Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study

Objective. SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares.Methods. This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score ≥4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation.Results. A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors.Conclusion. Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention

Left Atrial Appendage Volume As a New Predictor of Atrial Fibrillation Recurrence After Catheter Ablation

PURPOSE: Recurrence of atrial fibrillation (AF) after catheter ablation is common, being clinically relevant to identify predictors of recurrence. The left atrial appendage (LAA) role as an AF trigger is scarcely explored. Our aim was to identify if LAA volume is an independent predictor of AF recurrence after catheter ablation. METHODS: We analysed 52 patients (aged 54 ± 10 years, 58% male) with paroxysmal and persistent AF who underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure. RESULTS: The mean left atrial and LAA volumes measured by cardiac CT were 98.9 ± 31.8 and 9.3 ± 3.5 mL, respectively. All patients received successful pulmonary vein isolation and were followed up for 24 months. AF recurrence occurred in 17 patients (33%). LAA volume was significantly greater in patients with AF recurrence than in those without recurrence (11.3 ± 2.9 vs. 8.2 ± 3.4 mL; p = 0.002). Multivariable analysis using Cox regression revealed that LAA volume (hazard ratio 1.32; 95% confidence interval 1.12-1.55; p = 0.001) and persistent AF (hazard ratio 4.22; 95% confidence interval 1.48-12.07; p = 0.007) were independent predictors for AF recurrence. An LAA volume greater than 8.825 mL predicted AF recurrence with 94% sensitivity and 66% specificity. The Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with an LAA volume >8.825 mL (p < 0.001). CONCLUSIONS: Larger LAA volume was associated with AF recurrence after catheter ablation in patients with paroxysmal and persistent AF.info:eu-repo/semantics/publishedVersio

The Influence of Thermal Comfort on the Quality of Life of Nursing Home Residents

Thermal comfort (TC) parameters were measured in 130 rooms from nursing homes (NH), following ISO 7730:2005 in order to evaluate the influence of winter season TC indices on quality of life (QoL) in older individuals. Mean radiant temperature (mrT), predicted mean vote (PMV) and predicted percent of dissatisfied people (PPD) indices, and the respective measurement uncertainties were calculated using Monte Carlo Method. The WHOQOL-BREF questionnaire was conducted from September 2012 to April 2013, during the winter season TC sampling campaign. Winter PMV and PPD indices showed significant differences between seasons in median values for comfort. There were also significant differences between seasons for air temperature, air velocity, mrT, and relative humidity. The winter PMV index displayed a “slightly cool” [≤−1] to “cool” [≤−2] in thermal sensation scale [−3 to 3]. PPD index reflected this discomfort as evidenced by a high rate of predicted dissatisfied occupants (64%). The influence of winter season TC on older individual QoL results demonstrated that values of PMV above −0.7 had higher mean score of QoL (coefficient estimate: 11.13 units) compared with values of PMV below −0.7. These findings are of relevance to public health and may be useful for understanding NH indoor environment variables thus implementing preventive policies in terms of standards and guidelines for these susceptible populations.This work was supported by GERIA Project (www.geria.webnode.com): PTDC/SAU-SAP/116563/2010 and a PhD Grant (SFRH/BD/72399/2010) from Foundation for Science and Technology (Fundação para a Ciência e Tecnologia - FCT) through Operational Competitiveness Programme (COMPETE) as part of the National Strategic Reference Framework. SB work was supported by a grant funded by AIRC (Associazione Italiana per la Ricerca sul Cancro)

Cytokine Production but Lack of Proliferation in Peripheral Blood Mononuclear Cells from Chronic Chagas' Disease Cardiomyopathy Patients in Response to T. cruzi Ribosomal P Proteins

Background:Trypanosoma cruzi ribosomal P proteins, P2β and P0, induce high levels of antibodies in patients with chronic Chagas' disease Cardiomyopathy (CCC). It is well known that these antibodies alter the beating rate of cardiomyocytes and provoke apoptosis by their interaction with β1-adrenergic and M2-muscarinic cardiac receptors. Based on these findings, we decided to study the cellular immune response to these proteins in CCC patients compared to non-infected individuals.Methodology/Principal findings:We evaluated proliferation, presence of surface activation markers and cytokine production in peripheral blood mononuclear cells (PBMC) stimulated with P2β, the C-terminal portion of P0 (CP0) proteins and T. cruzi lysate from CCC patients predominantly infected with TcVI lineage. PBMC from CCC patients cultured with P2β or CP0 proteins, failed to proliferate and express CD25 and HLA-DR on T cell populations. However, multiplex cytokine assays showed that these antigens triggered higher secretion of IL-10, TNF-α and GM-CSF by PBMC as well as both CD4+ and CD8+ T cells subsets of CCC subjects. Upon T. cruzi lysate stimulation, PBMC from CCC patients not only proliferated but also became activated within the context of Th1 response. Interestingly, T. cruzi lysate was also able to induce the secretion of GM-CSF by CD4+ or CD8+ T cells.Conclusions/Significance:Our results showed that although the lack of PBMC proliferation in CCC patients in response to ribosomal P proteins, the detection of IL-10, TNF-α and GM-CSF suggests that specific T cells could have both immunoregulatory and pro-inflammatory potential, which might modulate the immune response in Chagas' disease. Furthermore, it was possible to demonstrate for the first time that GM-CSF was produced by PBMC of CCC patients in response not only to recombinant ribosomal P proteins but also to parasite lysate, suggesting the value of this cytokine to evaluate T cells responses in T. cruzi infection.Fil: Longhi, Silvia Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Atienza, Augusto. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Perez Prados, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Buying, Alcinette. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Balouz, Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas; ArgentinaFil: Buscaglia, Carlos Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas; ArgentinaFil: Santos, Radleigh. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Tasso, Laura Mónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Bonato, Ricardo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Chiale, Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Pinilla, Clemencia. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Judkowski, Valeria A.. Torrey Pines Institute for Molecular Studies; Estados UnidosFil: Gomez, Karina Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin

Myeloid Sirtuin 2 expression does not impact long-term Mycobacterium tuberculosis control

Sirtuins (Sirts) regulate several cellular mechanisms through deacetylation of several transcription factors and enzymes. Recently, Sirt2 was shown to prevent the development of inflammatory processes and its expression favors acute Listeria monocytogenes infection. The impact of this molecule in the context of chronic infections remains unknown. We found that specific Sirt2 deletion in the myeloid lineage transiently increased Mycobacterium tuberculosis load in the lungs and liver of conditional mice. Sirt2 did not affect long-term infection since no significant differences were observed in the bacterial burden at days 60 and 120 post-infection. The initial increase in M. tuberculosis growth was not due to differences in inflammatory cell infiltrates in the lung, myeloid or CD4+ T cells. The transcription levels of IFN-?, IL-17, TNF, IL-6 and NOS2 were also not affected in the lungs by Sirt2-myeloid specific deletion. Overall, our results demonstrate that Sirt2 expression has a transitory effect in M. tuberculosis infection. Thus, modulation of Sirt2 activity in vivo is not expected to affect chronic infection with M. tuberculosis.Fundação para a Ciência e Tecnologia, Portugal and cofunded by Programa Operacional Regional do Norte (ON.2–O Novo Norte), Quadro de Referência Estratégico Nacional (QREN), through the Fundo Europeu de Desenvolvimento Regional (FEDER). Project grants: PTDC/SAU-MII/101977/2008 (to AGC) and PTDC/BIA-BCM/102776/2008 (to MS). LMT was supported by FCT Grant SFRH/BPD/77399/20

Desenvolvimento de um sistema para compara??o de pre?os em supermercados na cidade de Te?filo Otoni

Diante do per?odo de crise econ?mica em que o pa?s se encontra o que se busca s?o pre?os baixos e ofertas promocionais. Ao se analisar os supermercados existentes na cidade de Te?filo Otoni - MG, p?de-se perceber que, apesar de divulgarem seus pre?os atrav?s de redes sociais como o Facebook, os principais meios pelos quais se faz essa divulga??o de pre?os de produtos e ofertas promocionais s?o an?ncios em r?dio e televis?o al?m de se utilizar banners e panfletos, os quais trazem consigo impedimentos no quesito facilidade de acesso ? informa??o. O objetivo desse estudo ? desenvolver um sistema para compara??o de pre?os em supermercados na cidade de Te?filo Otoni que, com base em uma lista de compras incrementada pelo pr?prio usu?rio, indique onde comprar cada item com o menor pre?o, bem como realizar uma compra ?nica com o melhor custo benef?cio, al?m de indicar promo??es em tempo real, tudo em prol da economia e facilidade ao realizar as compras. Levando em considera??o a dissemina??o da internet e a populariza??o dos smartphones, optou-se pelo desenvolvimento de um sistema web para compara??o de pre?os em supermercados. O banco de dados desse sistema possui informa??es de c?digos de barras de produtos comercializados no Brasil, com funcionalidades criadas para trazer economia e mitigar o tempo gasto em pesquisa de pre?os. Durante a fase inicial do projeto atentou-se para a parte visual do produto, investindo-se em interfaces intuitivas que por serem amig?veis e f?ceis de utilizar diminuem significativamente a curva de aprendizado, capazes de se adaptar a qualquer tipo de tela de dispositivos m?veis ou n?o. Foram aplicados algoritmos inteligentes capazes de otimizar o processo de busca e compara??o de pre?os, tornando a experi?ncia de uso bastante agrad?vel. ? v?lido lembrar que esse projeto contou com a experi?ncia de empres?rios donos de supermercados, os quais contribu?ram com informa??es relevantes agregando muito mais valor ? pesquisa. Ap?s a implementa??o do sistema e de v?rios testes realizados, observou-se que tal ferramenta ser? sim importante se inserida no contexto do objeto de estudo diante do per?odo de crise e recess?o que o pa?s enfrenta, trazendo vantagens financeiras tanto para o empres?rio que poder? dar mais visibilidade ao seu neg?cio quanto ao consumidor em agilidade, praticidade e economia no processo de compra. Durante os testes observou-se que o sistema de compara??o de pre?os em supermercados mostrou ser tamb?m uma ferramenta capaz de coletar informa??es de h?bitos alimentares dos usu?rios e varia??es de pre?os de alimentos, podendo essas informa??es serem ?teis para profissionais da ?rea da sa?de nutricional e ?rg?os estat?sticos como IBGE e DIEESE.Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Tecnologia, Sa?de e Sociedade, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017.Faced with the period of economic crisis in which the country is located, centralization and variety of products is not enough, now we are looking for low prices and promotional offers. When analyzing the existing supermarkets in the city of Te?filo Otoni - MG, despite spreading their prices through social networks such as Facebook, it can be seen that the main means by which product prices and promotional offers are advertised are radio and television advertisements, besides the use of banners and pamphlets, which carry with them impediments in the modus operandi, especially in the question of ease of access to information. The goal of this study is to develop a price comparison system in supermarkets in the city of Te?filo Otoni, which, based on a user-supplied shopping list, indicates where to buy each item with the lowest price, where to make a single purchase with the better costeffectiveness besides indicating promotions in real time, all for the sake of economy and ease when making purchases. Taking into account the spread of the internet and the popularization of smartphones, we opted for the development of a web system to compare prices in supermarkets. The database of this system has information of barcodes of products commercialized in Brazil, with features designed to bring savings and mitigate time spent on price research. During the initial phase of the project we looked at the visual part of the product, investing in intuitive interfaces, able to adapt to any type of screen of mobile devices or not. Intelligent algorithms capable of optimizing the search process and price comparison were applied, making the use experience quite pleasant. It is worth remembering that this project relied on the experience of entrepreneurs who owned supermarkets, who contributed with relevant information adding much more value to the research. After the implementation of the system and several tests carried out, it was concluded that such a tool will be important if inserted in the context of the object of study in the period of crisis and recession that the country faces, bringing financial advantages to both the entrepreneur who can to give more visibility to your business regarding the consumer in agility, practicality and economy in the process of purchase. During the tests, it was observed that the system of comparison of prices in supermarkets was also a tool capable of collecting information on users eating habits and variations in food prices, and this information could be useful for professionals in the area of nutritional health and organs such as IBGE and DIEESE

Measurement of the inclusive and dijet cross-sections of b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

The inclusive and dijet production cross-sections have been measured for jets containing b-hadrons (b-jets) in proton-proton collisions at a centre-of-mass energy of sqrt(s) = 7 TeV, using the ATLAS detector at the LHC. The measurements use data corresponding to an integrated luminosity of 34 pb^-1. The b-jets are identified using either a lifetime-based method, where secondary decay vertices of b-hadrons in jets are reconstructed using information from the tracking detectors, or a muon-based method where the presence of a muon is used to identify semileptonic decays of b-hadrons inside jets. The inclusive b-jet cross-section is measured as a function of transverse momentum in the range 20 < pT < 400 GeV and rapidity in the range |y| < 2.1. The bbbar-dijet cross-section is measured as a function of the dijet invariant mass in the range 110 < m_jj < 760 GeV, the azimuthal angle difference between the two jets and the angular variable chi in two dijet mass regions. The results are compared with next-to-leading-order QCD predictions. Good agreement is observed between the measured cross-sections and the predictions obtained using POWHEG + Pythia. MC@NLO + Herwig shows good agreement with the measured bbbar-dijet cross-section. However, it does not reproduce the measured inclusive cross-section well, particularly for central b-jets with large transverse momenta.Comment: 10 pages plus author list (21 pages total), 8 figures, 1 table, final version published in European Physical Journal