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Implementation of a High-Risk Outpatient Clinic for Children with Complex Congenital Heart Disease in a Reference Service in Brazil

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Congenital Heart Disease 2023年第6期18卷 649-656页

作者： Gustavo Foronda Vanessa Ferreira Amorim de Melo Claudia Regina pinheiro de Castro Grau Ingrid Magatti Piva Glaucia Maria Penha Tavares ana Cristina Sayuri Tanaka Nana Miura Department of Pediatric Cardiology and Adult Congenital Heart Diseases Heart Institute of the University of São PauloSão PauloBrazil Foronda Clinic São PauloBrazil Institute of Orthopedics and Traumatology University of São PauloSão PauloBrazil Department of Echocardiography Heart Institute of the University of São PauloSão PauloBrazil

Background:Children with congenital heart disease(CHD),even after surgical approaches,and especially those who undergo staged procedures in theﬁrst months of life,remain vulnerable to readmissions and complications,requiring very close monitoring and differentiated intervention ***:Descriptive and exploratory study,of the experience report type,which presents the process of building the high-risk outpatient clinic for complex congenital heart diseases(AAR)at the Instituto do Coração(InCor).Results:Report of the path taken to structure the AAR,demonstrating the organization,interface with the multidisciplinary team,admission and discharge criteria,training,and patient proﬁ*** theseﬁve years of care,275 patients were treated,59.65%with biventricular interstage physiology,followed by univentricular interstage physiology(34.55%),residual defects after surgical procedures(3.63%),tumors with risk of mechanical obstruction(1.45%)and patients with an intrauterine approach(0.72%).The signiﬁcant number of critical patients who were successfully discharged from hospital(44.72%),the low mortality rate due to sudden deaths at home and the high adherence to follow-up cor-roborate the impact of this specialized ***:Despite the limitations of the study,this experi-ence report showed that with few resources,there is the possibility of organizing an AAR with differentiated care,with the objective of early detection and treatment of residual injuries,identiﬁcation of early interventions,edu-cation of parents for follow-up of their children,resulting in individualized treatment,promoting a better quality of life for this population.

关键词： Congenital heart defects ambulatory care heart defects

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Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level:A case report

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World Journal of Clinical Cases 2021年第13期9卷 3219-3226页

作者： ana Lorena Sousa de Vasconcelos Garate Thiara Barcelos Rocha Luciana Rocha Almeida Rodrigo Quera Jaqueline Ribeiro Barros Julio pinheiro Baima Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine São Paulo State University(Unesp)Medical SchoolBotucatu 18618687São PauloBrazil Inflammatory Bowel Disease Program GastroenterologyMedicine DepartmentClínica Universidad de los AndesSantiago 7550000Chile

BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitisassociated with high levels of circulating tumor necrosis factor alpha, due to theintense inflammation and faster stool clearance of anti-tumor necrosis factordrugs. Dose-intensified infliximab treatment can be beneficial and is associatedwith lower rates of colectomy. The aim of the study was to present a case of apatient with ASUC and megacolon, treated with hydrocortisone and acceleratedscheme of infliximab that was monitored by drug trough *** SUMMARYA 22-year-old female patient diagnosed with ulcerative colitis, presented withdiarrhea, rectal bleeding, abdominal pain, vomiting, and distended *** investigation, a positive toxin for Clostridium difficile and colonic dilatationof 7 cm consistent with megacolon were observed. She was treated with oralvancomycin for pseudomembranous colitis and intravenous hydrocortisone forsevere colitis, which led to the resolution of megacolon. Due to the persistentsevere colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drugtrough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (< 30 μg/g). Based onthe low infliximab trough level after one week from the first infliximab dose, thepatient received a second infusion at week 1, consistent with the acceleratedregimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical andendoscopic response after 6 mo of therapy, without the need for a *** accelerated infusions can be beneficial in ASUC unresponsive to thetreatment with intravenous corticosteroids. Longitudinal studies are necessary todefine the best therapeutic drug monitoring and treatment regimen for thesepatients.

关键词： Infliximab Acute severe ulcerative colitis Toxic megacolon Ulcerative colitis Inflammatory bowel disease Case report

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Health 2014年第18期6卷 2375-2387页

作者： Cinthia Gondim Pereira Calou ana Karina Bezerra pinheiro Régia Christina Moura barbosa Castro Mirna Fontenele de Oliveira Priscila de Souza Aquino Franz Janco Antezana Departamento de Enfermagen Universidade Regional do Cariri Ceará Brasil Department of Nursing Federal University of Ceará Fortaleza Brazil

Objective: The objectives were to characterize the scientific production on Health-Related Quality of Life of pregnant women, identify the areas that are most affected during pregnancy and puerperal period and identify the instruments used to assess quality of life related to health in pregnant women. Methods: For the integrative review, 11 articles published from 2006 to 2013 in the PUBMED, MEDLINE, CINAHL, SCOPUS and SCIELO were selected. Result: Data showed scarce publication from nursing professionals, prevalence of non-experimental studies conducted mainly in Brazil. The most commonly instruments used were the WHOQOL-BREF and SF-12. The presence of pain, nausea and vomiting, depression, low education, younger age and absence of partner negatively affect the quality of life of pregnant women. Practicing physical activity and being socially supported during pregnancy favour a better quality of life. In the domain of social relations, sexuality was the only affected facet. Conclusion: Gaps in the level of evidence considered weak were identified. We suggest bigger role of nurses in research on the subject so that there will be the development of effective interventions to support nursing practice and ensure quality care and consequently improve the quality of life of women in pregnancy and childbirth.

关键词： Prenatal Quality of Life Nursing

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Difficulties Faced by Physicians in the Diagnosis of Endometriosis in the Brazilian Public Health System

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Health 2023年第7期15卷 788-795页

作者： Carla Patrícia Alves barbosa Tayná Maria Dantas Carozo Calumby ana Paula Portela Andrade Júlia de Araújo Gomes Maria Renata Suyane Silva de Farias Maria Eduarda Dantas Donald Gabrielly pinheiro Marinho Antônia Iva Sampaio Bisneta Francisco Expedito Ramos Aguiar Sobrinho Elizabeth Bacha Centro Universitário Tiradentes (UNIT) Maceió Brasil Universidade de Pernambuco (UPE) Recife Brasil

Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.

关键词： Endometriosis Diagnosis Public Health System

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Knowledge of Female Prisoners in a City of Ceará, Brazil, about Sexually Transmitted Diseases

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Open Journal of Nursing 2014年第9期4卷 630-636页

作者： Cinthia Gondim Pereira Calou Camila Fonseca Wasidi Maria de Fátima Esmeraldo Ramos de Figueiredo ana Izabel Oliveira Nicolau ana Karina Bezerra pinheiro Régia Christina Moura barbosa Castro Priscila de Souza Aquino Universidade Federal do Ceará Fortaleza Brazil Universidade Federal do Ceará Fortaleza Brazil Universidade Regional do Cariri Crato Brazil Universidade Regional do Cariri Crato Brazil

Exploratory study was conducted in the Crato Public Prison, State of Ceará, Brazil, aiming to understand the knowledge and experiences related to the preventive aspects of Sexually Transmitted Diseases (STDs) in the prison context. The target population of the study consisted of 14 female inmates, 10 of whom agreed to participate. Data collection occurred in June 2012 through recorded semi-structured individual interviews. We investigated quantitative, socio-demographic and sexual variables. In qualitative data analysis, we applied the Meaning Interpretation Method. The female vulnerability was aggravated by the early onset of sexual activity, lack of knowledge about STDs, non-adoption of preventive measures and history of prostitution. The following categories emerged from the qualitative assessment: Knowledge about STD/AIDS versus Personal Experience;Use of contraception as STD/AIDS prevention within the Public Jail;Habits of inmates: alcohol and tobacco;and Characterization of the conjugal visit area.

关键词： Prisoners Nursing Women’s Health Sexual and Reproductive Health

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analysis of Risk Factors Sociodemographic for the Functional Dependence of Adults with Spinal Cord Injury

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Journal of Biomedical Science and Engineering 2015年第4期8卷 287-294页

作者： Roberta de Araújo e Silva Priscila Alencar Mendes Reis Zuila Maria de Figueiredo Carvalho ana Karina Bezerra pinheiro Lorena barbosa Ximenes Maria Aparecida Alves de Oliveira Federal University of Ceará FortalezaBrazil Federal University of Maranhao ImperatrizBrazil

Objective: To evaluate the odds ratio of risk factors of sociodemographic and functional capacity of adults with spinal cord injury. Methods: analytical, cross-sectional, quantitative study accomplished with a group of 47 people with spinal cord injury in hospitals and 27 in the household. The data were collected through a structured instrument composed of independent variables related to epidemiological and clinical data on spinal cord injury and dependent variables corresponding to the scale of the Barthel Index (BI). The data were analysed with the two-tailed chi-square or Fisher’s exact tests using the Statistical Package for the Social Sciences version 20.0 (SPSS Inc., USA). Odds ratio (OR) and 95% confidence intervals (CI) were used as an estimate of the risk. The level of significance was set at a p value ≤0.05. Results: It was found that males (OR = 4.804, p = 0.041), the education less than ten years (OR = 3.000, p = 0.036), the hospital care (OR = 5.250, p = 0.002) and injury time less than six months (OR = 5.250, p = 0.002) are sociodemographic factors that are associated with the functional capacity of individuals with spinal cord injury. Moreover, the total dependence (p < 0.001) and severe dependence (p = 0.019) are associated with quadricplegia. It was found that males (p = 0.041), the education less than ten years (p = 0.036), attention to hospital health (p = 0.002) and minor injury time less than six months (p = 0.002) are sociode-mographic factors associated with functional capacity of subjects. Conclusion: As a result, it was found that knowing the epidemiological and clinical factors of people with spinal cord injury is relevant to plan the nursing care. In other words, knowing the epidemiological and clinical factors of people with spinal cord injury is relevant to achieve the functional independence of these people, and it was demonstrated that the social determinants of health are interrelated and interdependent of chronic health conditions,

关键词： Spinal Cord Injury Health Promotion Social Determinants of Health Nursing

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Sweet syndrome as a paraneoplastic manifestation of cholangiocarcinoma:A case report

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World Journal of Clinical Cases 2020年第18期8卷 4122-4127页

作者： Camille Carneiro Lemaire ana Luisa Carvalho Portilho Luciana V pinheiro Rafael Alves Vivas Maíra Britto Melaine Montenegro Luiz Felipe de Farias Rodrigues Sérgio Arruda AndréCastro Lyra Lourianne Nascimento Cavalcante Department of Internal Medicine Escola Bahiana de Medicina e Saúde PúblicaSalvador 40290-000BahiaBrazil Department of Internal Medicine Hospital Geral Roberto SantosSalvador 41180-780BahiaBrazil Department of Surgery Hospital Geral Roberto SantosSalvador 41180-780BahiaBrazil Department of Gastroenterology and Hepatology Hospital Geral Roberto SantosSalvador 41180-780BahiaBrazil Department of Radiology Hospital Geral Roberto SantosSalvador 41180-780BahiaBrazil Pathological anatomy Fiocruz-BahiaUniversidade Estadual da BahiaSalvador 40000-000BahiaBrazil Department of Medicine Division of Gastroenterology and HepatologyFederal University of Bahia and Gastro-Hepatology ServiceSalvador 40295-050BahiaBrazil Department of Medicine Division of Gastroenterology and HepatologyFederal University of Bahia and SED-CHD Hospital Geral Roberto SantosSalvador 40295-050BahiaBrazil

BACKGROUND Sweet’s syndrome,also known as acute febrile neutrophilic dermatosis,is a rare skin disorder that may be associated with *** SUMMARY A 58-year-old female presented with a cholestatic syndrome and significant weight loss three months before *** months earlier,she had abruptly developed skin lesions with erythematous papules that evolved to erythematous *** evaluation and laboratory tests confirmed hepatic *** lesions histopathological findings showed neutrophilic dermatosis,massive edema,fibrin,necrosis,and *** results,in association with the macroscopic aspects of the findings,led to the diagnosis of paraneoplastic Sweet’s syndrome due to *** staging was consistent with an advanced tumor without a cure perspective,we opted to perform percutaneous biliary drainage,and subsequently,palliative ***,after a few weeks,the patient *** In conclusion,the diagnosis of the underlying disease-causing Sweet’s syndrome must be accurate,and patients need to be followed-up,as neoplasia such as cholangiocarcinoma may be a later manifestation.

关键词： Cholangiocarcinoma Paraneoplastic syndrome Sweet syndrome Case report Bullous lesions Cholestasis

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Consequences of Different Hysterectomy Techniques in Sexual Behavior——A Systematic Review

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Open Journal of Obstetrics and Gynecology 2014年第6期4卷 333-341页

作者： ana Fátima Fernandes ana Izabel Nicolau Camila Vasconcelos Pricilla Alves ana Karina pinheiro Namie Sawada Cristina Maria Galvao Camila Moreira Department of Nursing Federal University of CearáFortalezaBrazil

We conducted a systematic review of the literature to determine the influence of different hysterectomy techniques in the sexual behavior of women who underwent. We searched CENTRAL (The Cochrane Library), PubMed, SCOPUS, CINAHL and LILACS for studies between the years 1998 and 2010 that prospectively examined the sexuality after hysterectomy. Those that were not randomized controlled clinical trials were excluded. It was not available electronically, it was not related with the outcomes determined, it was not research, but publications before 1998 and study which women realized chemotherapy and radiotherapy. From the 455 identified studies, 9 met inclusion criteria. There was variability in how hysterectomies influence in the sexual behavior. Most of studies considered women who underwent vaginal hysterectomy had fewer changes in sexual behavior. Sexual desire, intercourse frequency and orgasm are the sexual aspects reported by women as more changes experimented after surgery. Findings from this study have implications for healthcare providers and policymakers. Each woman needs an individualized care plan that fits within the context of her life, and there are basic interventions that every woman who underwent hysterectomy should receive. This review draws attention to the need for different care plans for women who underwent different hysterectomy techniques.

关键词： Hysterectomy Sexual Behavior Sistematic Review

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Determinant Factors in Maintaining the Exclusive Breastfeeding and Premature Weaning in Postpartum Mothers in the Brazilian Semiarid

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Health 2015年第3期7卷 355-364页

作者： Hellen Lívia Oliveira Catunda Elizian Braga Rodrigues Bernardo Lara Leite de Oliveira Mirna Fontenele de Oliveira Régia Christina Moura barbosa Castro Priscila de Souza Aquino ana Karina Bezerra pinheiro Department of Nursing Federal University of Ceará Fortaleza Brazil Department of Nursing Federal University of Cariri Juazeiro do Norte Brazil

This is a cross-sectional, correlational and quantitative study conducted on 210 postpartum women from January to July 2013 at the breastfeeding outpatient clinic of a public maternity. The study was carried out in order to assess the determining factors in maintaining an exclusive breastfeeding in the first month of the newborn’s life, the participation of the nurse in encouraging this process, and the reasons leading to a premature weaning. Prior births proved to be a positive factor for exclusive breastfeeding (Odds Ratio (OR) 0.359;CI 95% 0.137 - 0.941;p = 0.031). The absence of a nurse in the medical appointments resulted in a threefold risk to have no prenatal exclusive breastfeeding guidance whatsoever (OR 3.025;CI 95% 1.567 - 5.840;p = 0.001). The reported reasons for a premature weaning were difficulty latching-on, cracked nipples, poor milk that does not satiate the baby’s hunger, and production of little or no milk at all. The results provide information for the adoption of strategies during pregnancy and the postpartum period aimed to promote an exclusive breastfeeding, checking for the possible influence of the woman’s personal circumstances in her choosing exclusive breastfeeding, as well as the participation of the nurse in the mother’s decision.

关键词： Breastfeeding Weaning Health Promotion Nursing

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Acute heart failure as an adverse event of tumor necrosis factor inhibitor therapy in inflammatory bowel disease:A review of the literature

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World Journal of Cardiology 2023年第5期15卷 217-228页

作者： Thais Gagno Grillo Caroline Ferreira da Silva Mazeto Pupo Silveira ana Elisa Valencise Quaglio Renata de Medeiros Dutra Julio pinheiro Baima Silmeia Garcia Zanati Bazan Ligia Yukie Sassaki Department of Internal Medicine Medical SchoolSão Paulo State UniversityBotucatuBotucatu 18618686Brazil Department of Biophysics and Pharmacology Institute of BiosciencesSão Paulo State UniversityBotucatuBotucatu 18618689Brazil

Tumor necrosis factor inhibitors(anti-TNFs)are widely used therapies for the treatment of inflammatory bowel diseases(IBD);however,their administration is not *** failure(HF),although rare,is a potential adverse event related to administration of these ***,the exact mechanism of development of HF remains ***αis found in both healthy and damaged *** effects are concentration-and receptor-dependent,promoting either cardio-protection or cardiomyocyte *** rat models with TNFαreceptor knockout showed increased survival rates,less reactive oxygen species formation,and improved diastolic left ventricle ***,clinical trials employing anti-TNF therapy to treat HF had disappointing results,suggesting abolishment of the cardioprotective properties of TNFα,making cardiomyocytes susceptible to apoptosis and ***,patients with IBD who have risk factors should be screened for HF before initiating anti-TNF *** review aims to discuss adverse events associated with the administration of anti-TNF therapy,with a focus on HF,and propose some approaches to avoid cardiac adverse events in patients with IBD.

关键词： Tumor necrosis factor inhibitors Inflammatory bowel disease Heart failure Adverse event TNFαreceptor

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