Diabetes Mellitus Gestacional com ênfase nas Gestantes de Alto Risco / Gestational Diabetes Mellitus with an emphasis on High-Risk Pregnant Women

Resumo: Considerando o Diabetes Mellitus um problema de saúde pública e sendo um dos principais fatores de morbimortalidade no Brasil, torna-se relevante destacar o aumento de casos ocorridos do DMG em gestantes de alto risco. Esta pesquisa teve por objetivo: investigar o perfil clínico do diabetes mellitus gestacional (DMG) e como o mesmo pode levar a uma gravidez de alto risco, sua associação aos fatores de riscos e suas principais complicações. Quanto à metodologia é exclusivamente de caráter bibliográfico. Foi feita uma pesquisa de revisão bibliográfica, a qual utilizou fontes de internet, onde foram aplicados critérios de inclusão e exclusão, chegando a um total de 12 artigos selecionados. A partir desses artigos, a pesquisa verificou que os fatores de riscos associados ao DMG e suas complicações, fazem correlação com a gravidez de alto risco. Assim, se faz necessário o rastreamento e monitoramento, a prevenção, o diagnóstico e tratamento do DMG tanto para a mãe quanto para o feto. Logo é fundamental a atuação do farmacêutico na equipe multidisciplinar, pois contribui desde a gestão, aquisição até a dispensação eficiente dos medicamentos auxiliando de forma a reduzir os riscos, promovendo atenção, cuidado e uma saúde de qualidade às gestantes. Palavras Chave: Diabetes Mellitus. Diabetes Mellitus Gestacional. Gravidez de Alto Risco. Abstract: Considering Diabetes Mellitus a public health problem and one of the main morbidity and mortality factors in Brazil, it is relevant to highlight the increase in cases of GDM in high-risk pregnant women. This research aimed to: investigate the clinical profile of gestacional diabetes mellitus (GDM) and how it can lead to a high-risk pregnancy, its association with risk factors and its main complications. As for the methodology, it is exclusively bibliographic in nature. A bibliographic review research was carried out, using internet sources, where inclusion and exclusion criteria were applied, reaching a total of 12 selected articles. From these articles, the research found that the risk factors associated with GDM and its complications are correlated with high-risk pregnancy. Thus, it is necessary the tracking and monitoring, prevention, diagnosis and treatment of GDM for both mother and fetus. Therefore, the role of the pharmacist in the multidisciplinary team is essential, as he contributes from the management, acquisition to the efficient dispensing of medicines, helping to reduce risks, promoting attention, care and quality health for pregnant women. Keywords: Diabetes Mellitus. Gestational Diabetes Mellitus. High-risk Pregnancy.

Exposure to ambient gaseous air pollutants and adult lung function: a systematic review

Exposure to hazardous air pollutants is identified as most obvious premature mortality factors in the world. Numerous epidemiological studies have estimated exposure to air pollutants may cause pulmonary toxicity and the incidence of respiratory diseases including chronic obstructive pulmonary disease (COPD), chronic bronchitis and asthma. The currently research was performed to evaluation the association between gaseous pollutants and lung function in healthy adults. Articles related to this study were selected from researches of Scopus, PubMed, and Web of Science databases. A total of 2,644 articles were retrieved and 39 records were reviewed after removing duplicates and excluding irrelevant studies. The result of this systematic review indicated that there is some evidence on decreasing lung function with exposure to gaseous air pollutants (NO2, SO2, and O3) which can have negative effects on human health. Although according to the evidence changes in lung function are mostly linked to the exposure to environmental pollutants including CO, O3, NO2 and SO2, the results should be interpreted with caution considering some following issues discussed in this review. Therefore, further studies are required considering well-designed studies in large scales to strengthen the evidence.

Nanotechnology as a Novel Approach in Combating Microbes Providing an Alternative to Antibiotics

The emergence of infectious diseases promises to be one of the leading mortality factors in the healthcare sector. Although several drugs are available on the market, newly found microorganisms carrying multidrug resistance (MDR) against which existing drugs cannot function effectively, giving rise to escalated antibiotic dosage therapies and the need to develop novel drugs, which require time, money, and manpower. Thus, the exploitation of antimicrobials has led to the production of MDR bacteria, and their prevalence and growth are a major concern. Novel approaches to prevent antimicrobial drug resistance are in practice. Nanotechnology-based innovation provides physicians and patients the opportunity to overcome the crisis of drug resistance. Nanoparticles have promising potential in the healthcare sector. Recently, nanoparticles have been designed to address pathogenic microorganisms. A multitude of processes that can vary with various traits, including size, morphology, electrical charge, and surface coatings, allow researchers to develop novel composite antimicrobial substances for use in different applications performing antimicrobial activities. The antimicrobial activity of inorganic and carbon-based nanoparticles can be applied to various research, medical, and industrial uses in the future and offer a solution to the crisis of antimicrobial resistance to traditional approaches. Metal-based nanoparticles have also been extensively studied for many biomedical applications. In addition to reduced size and selectivity for bacteria, metal-based nanoparticles have proven effective against pathogens listed as a priority, according to the World Health Organization (WHO). Moreover, antimicrobial studies of nanoparticles were carried out not only in vitro but in vivo as well in order to investigate their efficacy. In addition, nanomaterials provide numerous opportunities for infection prevention, diagnosis, treatment, and biofilm control. This study emphasizes the antimicrobial effects of nanoparticles and contrasts nanoparticles’ with antibiotics’ role in the fight against pathogenic microorganisms. Future prospects revolve around developing new strategies and products to prevent, control, and treat microbial infections in humans and other animals, including viral infections seen in the current pandemic scenarios.

Machine Learning Algorithms For Understanding The Determinants of Under-Five Mortality

Background: The death rate of under-five children in India declined last few decades, but few bigger states have poor performance. This is a matter of serious concern for the child's health as well as social development. Nowadays, machine learning techniques play a crucial role in the smart health care system to capture the hidden factors and patterns of outcomes. In this paper, we used machine learning techniques to predict the important factors of under-five mortality.This study aims to explore the importance of machine learning techniques to predict under-five mortality and to find the important factors that cause under-five mortality.The data was taken from the National Family Health Survey-IV of Uttar Pradesh. We used four machine learning techniques like decision tree, support vector machine, random forest, and logistic regression to predict under-five mortality factors and model accuracy of each model. We have also used information gain to rank to know the important variables for accurate predictions in under-five mortality data.Result: Random Forest (RF) predicts the child mortality factors with the highest accuracy of 97.5 %, and the number of living children, births in the last five years, educational level, birth order, total children ever born, currently breastfeeding, and size of child at birth that identifying as essential factors for under-five mortality.Conclusion: The study focuses on machine learning techniques to predict and identify important factors for under-five mortality. The random forest model provides an excellent predictive result for estimating the risk factors of under-five mortality. Based on the resulting outcome, policymakers can make policies and plans to reduce under-five mortality.

Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Cardiac Arrest in Adult Patients in the United States

Background Factors associated with poor prognosis following receipt of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest remain unclear. We aimed to identify predictors of mortality in adults with cardiac arrest receiving ECMO in a nationally representative sample. Methods and Results The US Healthcare Cost and Utilization Project's National Inpatient Sample was used to identify 782 adults hospitalized with cardiac arrest who received ECMO between 2006 and 2014. The primary outcome of interest was all‐cause in‐hospital mortality. Factors associated with mortality were analyzed using multivariable logistic regression. The overall in‐hospital mortality rate was 60.4% (n=472). Patients who died were older and more often men, of non‐White race, and with lower household income than those surviving to discharge. In the risk‐adjusted analysis, independent predictors of mortality included older age, male sex, lower annual income, absence of ventricular arrhythmia, absence of percutaneous coronary intervention, and presence of therapeutic hypothermia. Conclusions Demographic and therapeutic factors are independently associated with mortality in patients with cardiac arrest receiving ECMO. Identification of which patients with cardiac arrest may receive the utmost benefit from ECMO may aid with decision‐making regarding its implementation. Larger‐scale studies are warranted to assess the appropriate candidates for ECMO in cardiac arrest.

The impact of parasitoids on diamondback moth in Europe: a life table approach

Diamondback moth, Plutella xylostella (Linnaeus) (Lepidoptera: Plutellidae), was first recorded in North America from Europe about 150 years ago and can be a significant pest of canola in Western Canada. Because parasitism of P. xylostella in Canada is generally low, the introduction of one or more additional exotic parasitoids from Europe is being considered to increase the suppression of P. xylostella populations. Life table studies to determine the impact of parasitoids on diamondback moth populations in Europe were conducted in northwestern Switzerland in 2014–2016. Net reproductive rates were found to be less than one in seven out of eight life tables, suggesting that P. xylostella populations in Switzerland are mostly driven by immigration and recolonisation. In total, seven primary parasitoid species and one hyperparasitoid were associated with diamondback moth. Pupal parasitism by D. collaris reached up to 30%, but because generational mortality was mainly driven by abiotic mortality factors and predation of larvae, the overall contribution of pupal parasitism was low (< 6%). In regions of Canada, where P. xylostella may have increasing populations and low larval mortality, the addition of D. collaris may be a promising approach. Life table studies across Canada are necessary to determine the need for such intervention.

Challenges to Generating Reliable COVID Statistics: Domestic and International Experience

The article discusses specifc issues of the reliability of statistics on the spread of the coronavirus pandemic and the comparability of similar statistics across different countries. All countries faced challenges, regardless of the level of well-being and social system. However, the examples outlined in the article refer mainly to large economies, each of which for at least one year from 1980 to 2019 produced more than 1% of the global GDP. The organization of the health care system in these countries is different, and only the general requirements of WHO could provide information on the spread of the pandemic in comparable formats.The authors formulated the problems of identifying those infected with Covid-19 and mortality statistics, indicating the various impact of the pandemic on deaths. It has been shown that the formal application of the WHO recommendations to the identifcation of infected persons and differences in the practical use of these recommendations in different countries can give poorly comparable results. The example of Russian statistics illustrates that it is possible to compare the operational data on the mortality of those infected with the coronavirus with the data on the total mortality in the country. Attention is drawn to the example of statistics from Germany, demonstrating the possibility of practical overlapping of the excess mortality rate and the operational data on the mortality of those infected with Covid-19.Data on daily increments of infected, dead, and recovered per million people allows one to see the nature and prevalence rate of the pandemic in different countries in a comparable format. The largest single-day increase in coronavirus cases in some countries in 2020–2021 reached 2–3 thousand per 1 million population, while in others – it was less than 30. In most countries under review, daily deaths' peaks amounted to less than 40 cases, but there were other countries for which these peaks did not exceed 10 cases or less per 1 million population.In conclusion, the report identifes six all-cause mortality factors associated with the pandemic and social distancing demands formulated by the American Institute for Health Metrics and Evaluation. According to the authors, it would be interesting to learn the experts' assessment of how realistic and benefcial it is to know how to keep track of these factors. It would improve the quality of international comparative analysis of socio-demographic indicators.

Toward a better comprehension of external environment factors and life cycle stages importance on SME failure in Brazil

Although importance of small and medium-sized enterprises (SME) is relatively well established in the literature, little research exists on life cycle stage at the time of SME failure or closure. This exploratory research builds a comprehensive description of SME mortality factors related to the external environment to analyse the changing importance of these factors throughout the SME’s organization life cycle stages (OLC). Seven case studies are used to develop a more complete understanding of the relationship between external environment and mortality factors. Data were collected through interviews and analysed based on inductive content analysis technique. The results indicate that failure SME did not adequately assimilate nine main factors: non-payment of the clients, competition with big business, seasonality of sells during the year, minimum amount of purchase required by suppliers, tributary load, government economic plans, national economy crisis, and headquarter/office robbery and asymmetric relationship with the franchisor. Regarding SME’s OLC, environmental factors’ relevance changed throughout the SME life cycle. Additional result suggests that exists more stages than discussed in the literature, reported by sample SME owner-managers studied.

Mortality Associated Factors of Patients with Mechanical Ventilation Treated at the Intensive Care Unit of a Second Level Hospital at Piedras Negras Coahuila Mexico

Introduction: The mechanical ventilation is the cornerstone of treatment for patients with acute respiratory failure and is one of the pivotal therapies in critical care medicine. The epidemiology of mechanical ventilation in México is scarce and usually a transpolated of the information in high specialty centers. The mechanical ventilation has the aim of assisting in the elimination of CO2 (carbon dioxide) and / or favoring the adequate exchange of oxygen while the patient is unable to do so or due to conditions external to the respiratory system. Quality indicators of attention are a quantitative measure that are used to assess important aspects of clinical practice. Objective: Describe the epidemiology and mortality factors in mechanically ventilated patients treated at second level ICU in Piedras Negras, Coahuila México. Material and Methods: retrospective study from December 2016 to December 2019 all patients treated with MV. We collected general demographic characteristics, quality indicators and complications, severity of disease and mortality. Results: 164 patients were enrolled. Female 54.8%, main diagnoses Sepsis 30.5%, and DKA 13.4%, mean age 44.1 SD ± mean SOFA 7.2 SD ± 6.2, mean SAPS3 50.6 SD ± 20.2, ICU LOS 4.5 SD ± 5.1, Hospital LOS 11.7 SD ± 10.2 p<0.0001. ICU and Hospital mortality 14 % and 23.8%. The factors associated with ICU mortality were: Age, MV hours, Respiratory SOFA, and Hepatic SOFA and with Hospital mortality: Age, Neurological SOFA, Unstable at admission, SOFA and SAPS 3. Conclusions: MV is a primordial need of critical care patients, our mortality was reported lower than expected but quality of attention indicators most be improved in order to maintain this trend. This study has several limitations in population and applicability but contributes with primordial information about MV critical care patients treated at México.