Hospital Universitário - Universidade Federal de Juiz de Fora

BACKGROUND AND AIMS: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. METHODS: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. CONCLUSIONS: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

Sorghum is the fifth most produced cereal in the world and is a source of nutrients and bioactive compounds for the human diet. We summarize the recent findings concerning the nutrients and bioactive compounds of sorghum and its potential impact on human health, analyzing the limitations and positive points of the studies and proposing directions for future research. Sorghum is basically composed of starch, which is more slowly digested than that of other cereals, has low digestibility proteins and unsaturated lipids, and is a source of some minerals and vitamins. Furthermore, most sorghum varieties are rich in phenolic compounds, especially 3-deoxyanthocyanidins and tannins. The results obtained in vitro and in animals have shown that phenolics compounds and fat soluble compounds (polycosanols) isolated from sorghum benefit the gut microbiota and parameters related to obesity, oxidative stress, inflammation, diabetes, dyslipidemia, cancer, and hypertension. The effects of whole sorghum and its fractions on human health need to be evaluated. In conclusion, sorghum is a source of nutrients and bioactive compounds, especially 3-deoxyanthocyanidins, tannins, and polycosanols, which beneficially modulate, in vitro and in animals, parameters related to noncommunicable diseases. Studies should be conducted to evaluate the effects of different processing on protein and starch digestibility of sorghum as well as on the profile and bioavailability of its bioactive compounds, especially 3-deoxyanthocyanidins and tannins. Furthermore, the benefits resulting from the interaction of bioactive compounds in sorghum and human microbiota should be studied.

INTRODUTION: COVID-19 infection may predispose to venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and disseminated intravascular coagulation; however, there are few reports of lower limb ischemia as the main manifestation of the disease. PRESENTATION OF CASE: Male patient, 69 years old, asthmatic, ex-smoker and bearer of systemic arterial hypertension, has been admitted to the emergency department with sudden onset of pain in the right lower limb (RLL), associated with cyanosis and reduced temperature of the limb. He has been tested for COVID-19 in the OR with positive result for IGG and IGM. Computed tomography angiography (AngioCT) was performed, showing signs of arterial embolization to both limbs, right internal iliac artery, and superior mesenteric artery. Faced with the threat of limb loss and the absence of signs and symptoms of visceral ischemia, the patient underwent full anticoagulation and RLL thromboembolectomy and tricompartmental fasciotomy. He was discharged after 7 days of hospitalization and demonstrated no other signs and symptoms of COVID-19, following outpatient follow-up. DISCUSSION: COVID-19 is associated with high risk of thrombotic complications being related to the clinical severity of the patient, with few studies that show symptoms of sudden pain in the lower limb without other complaints. CONCLUSION: Individuals infected with COVID-19 are at risk for arterial thromboembolic events, and knowledge of such cases is essential in order to create specific protocols for prophylaxis of thrombotic events in these patients, in addition to increasing the suspicion of infection in individuals with acute arterial occlusion, mostly during pandemic times.

OBJECTIVE: The aim of this meta-analysis was to summarize the current available evidence on nonoperative management (NOM) with antibiotics for uncomplicated appendicitis, both in adults and children. SUMMARY BACKGROUND DATA: Although earlier meta-analyses demonstrated that NOM with antibiotics may be an acceptable treatment strategy for patients with uncomplicated appendicitis, evidence is limited by conflicting results. METHODS: Systematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized and nonrandomized studies comparing antibiotic therapy (AT) and surgical therapy-appendectomy (ST) for uncomplicated appendicitis. Literature search was completed in August 2018. RESULTS: Twenty studies comparing AT and ST qualified for inclusion in the quantitative synthesis. In total, 3618 patients were allocated to AT (n = 1743) or ST (n = 1875). Higher complication-free treatment success rate (82.3% vs 67.2%; P < 0.00001) and treatment efficacy based on 1-year follow-up rate (93.1% vs 72.6%; P < 0.00001) were reported for ST. Index admission antibiotic treatment failure and rate of recurrence at 1-year follow-up were reported in 8.5% and 19.2% of patients treated with antibiotics, respectively. Rates of complicated appendicitis with peritonitis identified at the time of surgical operation (AT: 21.7% vs ST: 12.8%; P = 0.07) and surgical complications (AT: 12.8% vs ST: 13.6%; P = 0.66) were equivalent. CONCLUSIONS: Antibiotic therapy could represent a feasible treatment option for image-proven uncomplicated appendicitis, although complication-free treatment success rates are higher with ST. There is also evidence that NOM for uncomplicated appendicitis does not statistically increase the perforation rate in adult and pediatric patients receiving antibiotic treatment. NOM with antibiotics may fail during the primary hospitalization in about 8% of cases, and an additional 20% of patients might need a second hospitalization for recurrent appendicitis.

At present, chronic kidney disease (CKD) is broadly defined on the basis of changes in the glomerular filtration rate and/or the presence of parenchymal damage present for at least 3 months. Although the diagnosis of CKD is now quite straightforward, the proportion of patients with end-stage renal disease seen by a nephrologist for the first time immediately before the initiation of dialysis is still unacceptable. Early diagnosis and immediate nephrology referral are key steps in management because enable predialysis education, allow implementation of preventive measures that delay or even halt progression of CKD to end stage renal disease, as well as decrease initial morbidity and mortality. In this review, we discuss the complexity of CKD and the multiplicity of interventions currently recommended in its secondary prevention, different models of healthcare delivery, and examine the rational and outcomes of patients followed in interdisciplinary care clinics.

Sesame oil is widely consumed as nutritious food, cooking oil, and in pharmaceuticals and food. In this study, the antinociceptive and anti-inflammatory properties of the sesame oil and sesamin were investigated. The sesame oil and sesamin reduced the number of abdominal contortions at the doses 100, 200, or 400 mg/kg. The first and second phases of the time paw licking were inhibited by sesame oil and sesamin (100, 200, or 400 mg/kg). After 90 min of treatment, sesame oil and sesamin increased the reaction time on a hot plate (200 or 400 mg/kg). Considering the tail-immersion assay, the sesame oil and sesamin produced significant effect after 60 min at the doses of 100, 200, or 400 mg/kg. After 4 h of application of the carrageenan, the sesame oil and sesamin were effective against the paw edema. The exudate volume and leucocyte migration were also reduced by sesame oil and sesamin. These results suggest that sesamin is one of the active compounds found in sesame oil and justify the antinociceptive and anti-inflammatory properties of this product.

Advances in the technology and improved access to imaging modalities such as Computed Tomography and laparoscopy have changed the contemporary diagnostic and management of acute appendicitis. Complicated appendicitis (phlegmon, abscess and/ or diffuse peritonitis), is now reliably distinguished from uncomplicated cases. Therefore, a new comprehensive grading system for acute appendicitis is necessary. The goal is review and update the laparoscopic grading system of acute appendicitis and to provide a new standardized classification system to allow more uniform patient stratification. During the last World Society of Emergency Surgery Congress in Israel (July, 2015), a panel involving Acute Appendicitis Experts and the author's discussed many current aspects about the acute appendicitis between then, it will be submitted a new comprehensive disease grading system. It was idealized based on three aspect of the disease (clinical and imaging presentation and laparoscopic findings). The new grading system may provide a standardized system to allow more uniform patient stratification for appendicitis research. In addition, may aid in determining optimal management according to grade. Lastly, what we want is to draw a multicenter observational study within the World Society of Emergency Surgery (WSES) based on this design.

<para xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> This paper presents a heuristic constructive algorithm (HCA) for optimal capacitor placement on distribution systems. This is a nonlinear mixed integer optimization problem. In the proposed approach, the integer variables are represented using sigmoid function, thus interior point optimal power flow formulation can be applied to obtain sensitivity indexes based on Lagrange multipliers, reactive power, and bus voltage. The methodology is applied to two power distribution systems, and the results are compared with those obtained using a genetic algorithm approach. </para>

OBJECTIVE: To know the epidemiological profile of maternal mortality in Juiz de Fora, a city in the state of Minas Gerais. Data collection was carried out from April to December 2016. METHOD: Summary of a confidential investigation of maternal mortality on deaths occurred from January 1st, 2005 to December 31, 2015. RESULTS: Eighty-five deaths of women residing in Juiz de Fora were identified and analyzed. The age group was between 20 and 36 years. The women carried out prenatal care (74.1%) with less than six visits (34.0%). Cesarean section was conducted in 38.8% of the childbirths and the obstetric treatment was considered appropriate (32.9%). The first cause of maternal death was hypovolemic shock 12 (14.10%), followed by uterine hypotony 6 (7.0%). CONCLUSION: Cesarean section rates are high and prenatal adherence is lower than that expected, which could justify the number of deaths in the period studied.

Timing of surgical intervention is critical for outcomes of patients diagnosed with surgical emergencies. Facing the challenge of multiple patients requiring emergency surgery, or of limited resource availability, the acute care surgeon must triage patients according to their disease process and physiological state. Emergency operations from all surgical disciplines should be scheduled by an agreed time frame that is based on accumulated data of outcomes related to time elapsed from diagnosis to surgery. Although literature exists regarding the optimal timing of various surgical interventions, implementation of protocols for triage of surgical emergencies is lacking. For institutions of a repetitive triage mechanism, further discussion on optimal timing of surgery in diverse surgical emergencies should be encouraged. Standardizing timing of interventions in surgical emergencies will promote clinical investigation as well as a commitment by administrative authorities to proper operating theater provision for acute care surgery.

The particle swarm optimization (PSO) algorithm is designed to find a single optimal solution and needs some modifications to be able to locate multiple optima on a multimodal function. In parallel with evolutionary computation algorithms, these modifications can be grouped in the framework of niching. In this work, we present a new approach to niching in PSO based on clustering particles to identify niches. The neighborhood structure, on which particles rely for communication, is exploited together with the niche information to locate multiple optima in parallel. Our approach was implemented in the k ‐means‐based PSO ( k PSO), which employs the standard k ‐means clustering algorithm, improved with a mechanism to adaptively identify the number of clusters. k PSO proved to be a competitive solution when compared with other existing algorithms, since it showed better performance on a benchmark set of multimodal functions.

Na realização das tarefas de cuidado e manutenção das famílias de camadas médias no Brasil - desempenhada, na esmagadora maioria das vezes, por mulheres pobres, fora da parentela dos empregadores - assim como nas formas de remuneração e de relacionamento que se desenvolvem entre patrões e empregadas domésticas, reproduz-se um sistema altamente estratificado de gênero, classe e cor. A manutenção desse sistema hierárquico que o serviço doméstico desvela tem sido reforçada, em particular, por uma ambigüidade afetiva entre os empregadores - sobretudo as mulheres e as crianças - e as trabalhadoras domésticas. Ao analisar exemplos tirados de uma pesquisa etnográfica em Vitória (Espírito Santo), comentaremos como essa ambigüidade se revela como instrumento fundamental de uma didática da distância social.

A genetic algorithm (GA) is hybridized with an artificial immune system (AIS) as an alternative to tackle constrained optimization problems in engineering. The AIS is inspired in the clonal selection principle and is embedded into a standard GA search engine in order to help move the population into the feasible region. The procedure is applied to mechanical engineering problems available in the literature and compared to other alternative techniques.

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.

FUNDAMENTAÇÃO: A prática regular de atividades físicas constitui importante fator na promoção da saúde e qualidade de vida da população. Para avaliar o nível de atividade física (NAF) de uma população, vários instrumentos são utilizados, entre eles o IPAQ (International Physical Activity Questionnaire). OBJETIVOS: Avaliar o NAF dos alunos de graduação em Educação Física em relação ao gênero e ao tempo de graduação, assim como comparar o NAF de estudantes de diferentes cursos das áreas saúde/biológica. MÉTODOS: Duzentos e oitenta indivíduos, sendo 194 estudantes de Educação Física (100 homens e 94 mulheres) e 86 estudantes (17 homens e 69 mulheres) de áreas saúde/biológica (Farmácia e Bioquímica, Odontologia e Ciências Biológicas). O instrumento utilizado para medida do nível de atividade física foi o Questionário Internacional de Atividade Física (IPAQ), em sua versão curta. RESULTADOS: No grupo de estudantes de Educação Física, encontrou-se incidência de 92% classificados como Muito Ativos ou Ativos; no entanto, não se observou diferença significativa (p &gt; 0,05) entre os grupos masculino e feminino. Em relação aos outros cursos analisados, constatou-se que a amostra feminina é menos ativa fisicamente que a masculina (p &lt; 0,05). Comparando os diferentes cursos analisados e considerando o valor conjunto das categorias Ativo/Muito Ativo, os estudantes de Biologia (86,9%) e Educação Física (90%) se mostraram mais ativos fisicamente que os da Farmácia (56%) e Odontologia (61,1%). No entanto, essa diferença não foi estatisticamente significativa (p &gt; 0,05). CONCLUSÕES: Homens possuem maior nível de atividade física que as mulheres; os universitários avaliados não possuem padrões semelhantes nos diferentes cursos; e o nível de atividade física mantém-se constante durante o curso de Educação Física.

BACKGROUND AND AIMS: Internal pancreatic fistulas (IPF) are an uncommon but well-recognized complication of chronic pancreatitis (CP) that are associated with significant morbidity and mortality. Because of their low incidence, management is still controversial. The aims of this study are to report the 8-year experience with IPF management in a Brazil University-affiliated hospital and to propose a management algorithm. STUDY: A centralized diagnostic index was used to retrospectively identify all patients with IPF admitted to a teaching hospital from 1995 to 2003. The patient's medical records were reviewed for clinical features, diagnostic work-up, treatment strategies, response to therapy, and the length of hospital stay. All patients underwent contrast-enhanced computed tomography of the abdomen and endoscopic retrograde cholangiopancreatography, to guide the therapeutic modality to be offered. Conservative therapy included withholding of oral feedings in conjunction with total parenteral nutrition, octreotide subcutaneously, and multiple paracentesis or thoracentesis. Interventional therapy was either endoscopic or surgical. RESULTS: IPF was identified in 11 (7.3%) of 150 patients with CP. They ranged in age from 24 to 47 years (mean 36.1), with a male to female ratio of 10:1. All patients had underlying alcoholic CP. The presentation was pancreatic ascites in 9 patients and pleural effusion in 2 cases. Five patients were undergoing the conservative treatment, all presenting main pancreatic duct (MPD) dilatation; endoscopic placement of transpapillary pancreatic duct stent was performed in 4 patients who presented partial MPD stricture or disruption; surgical therapy was performed in 2 patients exhibiting complete MPD obstruction or disruption. Stents were removed 3 to 6 weeks after initial placement. IPF resolved in 10 of 11 patients (90.9%) within 6 weeks. The resolution of IPF was faster (13 +/- 5 vs. 25 +/- 13 days, P < 0.01) and the length of hospital stay was significantly shorter (17.2 +/- 5.6 vs. 31.2 +/- 4.4 days, P < 0.01) in patients subject to interventional treatment compared with those treated conservatively. There was 1 death due to sepsis in a patient managed conservatively; no death was recorded in the interventional therapy group. There was no recurrence of IPF at a mean follow-up of 38 months. CONCLUSIONS: Our results suggest that interventional therapy should be considered the best approach for the management of IPF in patients presenting MPD disruption or obstruction. Conservative therapy must be reserved for those showing MPD dilatation without ductal disruption or stricture. Early interventional therapy reduced hospital stay and convalescence, which likely resulted in lower healthcare overall costs.

Este artigo aborda o letramento digital no interior da discussão sobre a formação de professores, reportando-se às experiências construídas em um grupo de pesquisa orientado pela perspectiva psicológica histórico-cultural. Apresentadas algumas definições de letramento digital, reflete-se sobre os desafios postos à escola pelo confronto com as novas práticas de leitura e escrita propiciadas pelos usos do computador e da internet. Em seguida, analisa-se como, em sua formação inicial e continuada, os professores são preparados para a inserção dessas tecnologias em suas práticas pedagógicas e para compreenderem o letramento digital de seus alunos. Ao final, situa-se o professor na era da internet, em seu lugar insubstituível de mediador e problematizador do conhecimento, que adota uma posição aberta e ao mesmo tempo crítica diante do que essa tecnologia digital oferece.

Supervised exercise has shown benefits for subjects with asthma, but little is known about the effectiveness of unsupervised physical activity on this population. We investigated the effects of a 12-week unsupervised pedometer-based physical activity program on daily steps and on clinical and psychological parameters of adults with asthma. Clinically stable adults with moderate to severe asthma were encouraged to take daily 30-minute walks and were randomized to pedometer and control groups. The pedometer group received pedometers and individualized daily step targets. Changes in daily steps (average of steps taken during six consecutive days), six-minute walk test (6MWT), health-related quality of life, asthma control and anxiety and depression levels were assessed 12 weeks after intervention and 24-28 weeks after randomization. Thirty-seven participants were recruited and 30 completed the intervention. At 12 weeks, the groups differed significantly in daily steps (adjusted average difference, 2488 steps; 95% confidence interval [CI], 803 to 4172; p = 0.005) and in the 6MWT (adjusted average difference, 21.9 m; 95% CI, 6.6 to 37.3; p = 0.006). These differences were not significant 24-28 weeks after randomization. The program was effective in increasing daily steps of adults with moderate to severe asthma 12 weeks after intervention.

Importance: High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) are commonly used respiratory support therapies for patients with acute respiratory failure (ARF). Objective: To assess whether HFNO is noninferior to NIV on the rates of endotracheal intubation or death at 7 days in 5 patient groups with ARF. Design, Setting, and Participants: This noninferiority, randomized clinical trial enrolled hospitalized adults (aged ≥18 years; classified as 5 patient groups with ARF: nonimmunocompromised with hypoxemia, immunocompromised with hypoxemia, chronic obstructive pulmonary disease [COPD] exacerbation with respiratory acidosis, acute cardiogenic pulmonary edema [ACPE], or hypoxemic COVID-19, which was added as a separate group on June 26, 2023) at 33 hospitals in Brazil between November 2019 and November 2023 (final follow-up: April 26, 2024). Interventions: High-flow nasal oxygen (n = 883) or NIV (n = 883). Main Outcomes and Measures: The primary outcome was endotracheal intubation or death within 7 days assessed using a bayesian hierarchical model with dynamic borrowing across patient groups. Noninferiority was defined by a posterior probability of 0.992 or greater for an odds ratio (OR) less than 1.55. Results: Among 1800 patients, 1766 completed the study (mean age, 64 [SD, 17] years; 707 [40%] were women). The primary outcome of endotracheal intubation or death at 7 days occurred in 39% (344/883) in the HFNO group vs 38% (336/883) in the NIV group. In the immunocompromised with hypoxemia patient group, the primary outcome occurred in 57.1% (16/28) in the HFNO group vs 36.4% (8/22) in the NIV group; enrollment was stopped for futility (final OR, 1.07; 95% credible interval [CrI], 0.81-1.39; noninferiority posterior probability [NPP], 0.989). In the nonimmunocompromised with hypoxemia group, the primary outcome occurred in 32.5% (81/249) in the HFNO group vs 33.1% (78/236) in the NIV group (OR, 1.02 [95% CrI, 0.81-1.26]; NPP, 0.999). In the ACPE group, the primary outcome occurred in 10.3% (14/136) in the HFNO group vs 21.3% (29/136) in the NIV group (OR, 0.97 [95% CrI, 0.73-1.23]; NPP, 0.997). In the hypoxemic COVID-19 group, the primary outcome occurred in 51.3% (223/435) in the HFNO group vs 47.0% (210/447) in the NIV group (OR, 1.13 [95% CrI, 0.94-1.38]; NPP, 0.997). In the COPD exacerbation with respiratory acidosis group, the primary outcome occurred in 28.6% (10/35) in the HFNO group vs 26.2% (11/42) in the NIV group (OR, 1.05 [95% CrI, 0.79-1.36]; NPP, 0.992). However, a post hoc analysis without dynamic borrowing across the 5 ARF patient groups revealed some qualitatively different results in patients with COPD, immunocompromised patients, and patients with ACPE. The incidence of serious adverse events was similar (9.4% of patients in HFNO group vs 9.9% in NIV group). Conclusions and Relevance: Compared with NIV, HFNO met prespecified criteria for noninferiority for the primary outcome of endotracheal intubation or death within 7 days in 4 of the 5 patient groups with ARF. However, the small sample sizes in some patient groups and the sensitivity of the findings to the choice of analysis model suggests the need for further study in patients with COPD, immunocompromised patients, and patients with ACPE. Trial Registration: ClinicalTrials.gov Identifier: NCT03643939.