DSpace Coleção:

Mobilização muito Precoce após trombolise e exercícios intervalados de alta intensidade no tratamento do acidente vascular cerebral

2022-12-09T00:00:00Z

Título: Mobilização muito Precoce após trombolise e exercícios intervalados de alta intensidade no tratamento do acidente vascular cerebral Autor(es): Anjos, Jorge Luis Motta dos Primeiro Orientador: Durães, André Rodrigues Abstract: Introduction: Stroke is an acute impairment of the neurological system, which has a vascular origin and develops clinical signs due to disturbances in brain function, lasting more than 24 hours. With high prevalence and currently 90% of survivors develop sequelae, making it an important cause of disability in adults. Objective: To examine the effects of high-intensity interval training on functionality and health-related quality of life in patients with post-stroke sequelae and to assess the safety and efficacy of very early mobilization of thrombolyzed post-ischemic stroke patients on the degree of disability and dependence for activities of daily living, balance, functional mobility and complications within 7 days of hospitalization and 90 days after hospital discharge. Methodology: To examine the effects of high-intensity interval training on functionality and quality of life, a systematic review with meta-analysis was performed by searching the following electronic databases: MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials, PEDro database and Scielo by January 2022 for randomized clinical trials investigating the effects of high-intensity interval training in post-stroke patients. Two reviewers independently selected the studies. Study quality was assessed using the PEDro scale. Mean difference (MD), standard mean difference (SMD) and 95% confidence intervals (CIs) were calculated. A randomized clinical trial was also performed comparing very early mobilization after thrombolysis and the usual care of patients with acute ischemic stroke in safety and functional recovery within 7 days of hospitalization and after 90 days of hospital discharge. Results: For the systematic review, nine studies met the study criteria (375 patients). The age of the participants ranged from 55.8 to 72.1 years. The studies ranged from patients within 2 weeks of stroke onset to patients with more than 1 month of stroke. High-intensity interval training resulted in improved cardiorespiratory fitness (peak oxygen consumption) MD (3.8 mL/kg/min, 95% CI: 2.62, 5.01, n=91), balance MD 5 .7 (95% CI: 3.50, 7.91; N = 64) and SMD gait speed (0.2 m/s; 95% CI: 0.05, 0.27; N = 100) in comparison with continuous aerobic training. Health-related quality of life did not differ between groups. Compared with usual care, high-intensity interval training improved SMD cardiorespiratory fitness (0.5 95% CI: 0.14, 0.81, n=239). No serious adverse events were observed. For the randomized clinical trial, a total of 104 patients with ischemic stroke who received thrombolytic treatment between August 2020 and July 2021 were prospectively recruited into the study. Of these, 51 patients received very early mobilization (VEMG) within 24 hours after the ictus and another 53 patients received usual care (UCG) with mobilization 24 hours after the ictus. When comparing the groups within 7 days of hospitalization and after 90 days of discharge, there were no differences in the degree of disability and dependence for activities of daily living (p= 0.44; p=0.15), balance (p=0 .17; p=0.27), functional mobility (p= 0.33; p=0.65), complications (p=0.55; p=0.56) and length of hospital stay (p=0. 69). Conclusion: High-intensity interval training was more efficient than continuous aerobic training for gaining cardiorespiratory fitness, balance and walking speed in patients with post-stroke sequelae and was not superior with regard to health-related quality of life. The very early mobilization strategy after thrombolysis in ischemic stroke was safe, but without evidence of short-term benefit. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Tese

Saliva como amostra biológica na detecção do SARS-CoV-2

2021-12-10T00:00:00Z

Título: Saliva como amostra biológica na detecção do SARS-CoV-2 Autor(es): Vaz, Sara Nunes Primeiro Orientador: Martins Netto, Eduardo Abstract: Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of Coronavirus Disease 2019 (COVID-19). Although Real Time Reverse Transcription Polymerase Chain Reaction (qRT-PCR) of respiratory specimens is the reference standard test for detection of SARS-CoV-2 infection, collecting nasopharyngeal swabs (NPS) and/or oropharyngeal swabs (OPS) causes discomfort to patients and may represent a considerable risk for healthcare workers. The use of saliva as a diagnostic sample has several advantages. Objectives: The aim of this study is to validate the use of saliva as a biological sample for diagnosis of COVID-19 and to evaluate the test performance of the Xpert Xpress SARS-CoV-2 cartridge assay in comparison to a conventional qRT-PCR testing, using saliva as biological specimen. Method: This study was developed at Complexo Hospitalar Professor Edgard Santos (C-HUPES), in Salvador, Brazil. Participants presenting with signs/symptoms suggesting SARS-CoV-2 infection, underwent a NPS and/or OPS, and self-saliva collection. Saliva samples were diluted, RNA isolation and qRT-PCR were performed. Results of conventional versus saliva samples testing were compared. Saliva samples were used to validate the Xpert Xpress SARS-CoV-2 platform. Statistical analyses were performed using Statistical Package for the Social Sciences software (SPSS) version 18.0. Descriptive statistics, Fisher and MannWhitney tests were performed; kappa coefficient, and coefficient of determination and correlation were calculated. Results: One hundred fifty-five participants were recruited, and samples pairs of NPS/OPS and saliva were collected. The sensitivity and specificity of RT-PCR using saliva samples were 94.4% (95% CI 86.4 – 97.8) and 97.6% (95% CI 91.7 – 99.3), respectively. The accuracy of the test using saliva was 96.1%. Forty saliva samples from symptomatic participants were collected. In the Xpert Xpress assay, the median cycle threshold value of the E gene was 29.7, and of the N2 gene was 31.6. In the conventional assay, the median cycle threshold value of the E gene was 34.9, and of the RdRp gene was 38.3. The correlation between Xpert Xpress platform genes was 98%; between conventional PCR genes was 86%; and between E gene from the two assays was 78%. Conclusions: The use of self-collected saliva samples is an easy, convenient, and low-cost alternative to conventional NP swab-based molecular tests. These results can allow a broaden use of molecular tests for management of COVID19 pandemic, especially in resources-limited settings. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Tese

Etnobioética, autonomia universitária e pesquisa em humanos no Brasil do covid-19

2023-05-05T00:00:00Z

Título: Etnobioética, autonomia universitária e pesquisa em humanos no Brasil do covid-19 Autor(es): Araújo, Antonio Fábio Medrado de Primeiro Orientador: Martins Netto, Eduardo Abstract: OBJECTIVES. To discuss the elements of a bioethics of research (with technological innovation) on humans in Brazil from COVID-19. And, particularly: a) speculate on the integrity of bioethics at its birth, in light of the similarities that permeate the primordial writing of Paul Max Fritz Jahr and that of van Rensselaer Potter; b) review ethics applied to human research in Brazil, under the prism of the transition between Resolutions (CNS) No. 196/96 and No. 466/12, and the threat of extinction of the CEP/CONEP system; c) understand the ethnobioethical resistance, expression of the autonomy of Brazilian public universities and related entities against the official negationism throughout the coronacrisis (2020-2022); d) discuss suborbital tourism as an analytical reference to the risks of human research without a bioethical control such as the REC/CONEP system; e) punctuate the federal and anti-scientific decision to continue investing in “early treatment” based on chloroquine, after February 2021, to the detriment of the MMR vaccine; f) explain how the doubt about the origin of the SARSCoV-2 virus puts in check the innovation/patenting of specific vaccines. METHODS. From the reading and critical updating of the basic text of the bioethicist Maria da Gloria Gomes, we revisit not only the primordial writing of Jahr and Potter, in an archeology of their equivalences, but also the plot of the transition between Resolutions (CNS) No. 196/96 and No. 466/12, which coexists, since the PL No. 200/2015, with the anti-democratic threat of extinction of the CEP/CONEP network. Continuous act, by autofictional strategy, of Camusian inspiration, we elect speeches/actions delator of presidential negationism and of agents of the first echelon (2018-2022 quadrennium), to underline the policing to university autonomy and democracy during the pandemic zoonosis, imagining places (Pequi, folkloric successor of Brazil; Tijuca River; Kubitschek District), characters (Obtusus-Queen, Obtusus-Operaries) and landscape (academic front) that mirror a dramatization of national reality. A combination of the methods “content analysis” and “discourse analysis” permeated the thesis, both being options that harmonize with the conjunctural demands of the objectives. RESULTS. The situation of the preferred object of the Brazilian school of bioethics — protocol involving humans — was verified. It is weakened by the threat of extinction of the CEP/CONEP system. The historical conditions identified were the hypothesis that bioethics was born under the plagiarism of Potter to Jahr’s writings, and also the transition from Resolution (CNS) No. 196/96 to No. 466/12. Being at the forefront of both science and ethics applied to human research, the transversality of topics such as suborbital travel, triple viral vaccine against COVID-19 and the origin of SARS-CoV-2 served as a reference to the assertive role that bioethics can assume, even under the judgment of denialism/antiscientificism. DISCUSSION AND CONCLUSION. Public universities account for more than 95% of all Brazilian scientific production. Such prominence made state universities collaborate decisively to make the CEP/CONEP system viable. And the radicalization, in the previous government, of the attempts to extinguish it aimed at the publicuniversity autonomy, target of retaliations during the premeditated exasperation of COVID-19. The final considerations are: the hypothesis that Potter would have plagiarized Jahr’s bioethical imperative is valid; the transition between Resolutions No. 196/1996 and No. 466/2012 sedimented the social control over scientific research on humans, via the CEP/CONEP system; the threat of extinction of the CEP/CONEP network hovers over the Brazilian State, in tow of PL No. 7082/2017; the denialism and anti-scientificism of the previous government sought to undermine the public-university autonomy, responsible for more than 95% of scientific production in the country; the (premeditated) exasperation of COVID-19 franchised a state genocide against indigenous and quilombolas; all bioethics is ethnobioethics and in Brazil, to democratize is to academize; space tourism, in its research dimension, disregarded elementary precepts of bioethics, risking the individual and socio-environmental dignity of the participants; the weak support of the last government for studies capable of evaluating MMR as a protection factor against COVID-19 may have aggravated its lethality; it is possible that SARS-CoV-2 is an invention (artificial origin), which would make it illegal to patent vaccines specifically to combat COVID-19. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Tese

Tecnologias da informação e métodos computacionais para gerenciamento, otimização e medicina de precisão em departamentos de imagens médicas

2023-01-13T00:00:00Z

Título: Tecnologias da informação e métodos computacionais para gerenciamento, otimização e medicina de precisão em departamentos de imagens médicas Autor(es): Machado, Marcos Antônio Dórea Primeiro Orientador: Martins Netto, Eduardo Abstract: The healthcare industry demands information technologies and computational methods to improve productivity and offer personalized assistance to patients. This work aimed to develop and explore information systems and computational methods to improve the management, optimize the exams, and provide new biomarkers and artificial intelligence signatures for decision making in medical imaging facilities. We developed softwares based on Workflow Based Approach (WBA) concept and computational methods using Python language to improve the management and optimize the exam protocols. A framework to access new biomarkers and artificial intelligence (AI) signatures was developed and validated in COVID-19 CT patients, 18F-FDG-PET/CT cervical cancer and 18F-FDG-PET/CT Hodgkin lymphoma patients. This framework was feasible for robustness analysis: repetitivity (error < 5%), reproducibility (intraclass correlation coefficient, ICC > 90%) and clinical correlation (p < 0.05). The overall performance of predictive models was AUC=0.74 and AUC=0.96 for 18F-FDG-PET/CT cervical cancer and 18F-FDG-PET/CT Hodgkin lymphoma, respectively. A new AI software to support thorax CT COVID-19 diagnoses was implemented and validated within PACS/Viewer. Without the support of software, physicians performed with mean sensitivity and specificity of 83.4% and 64.3%, respectively. When they were assisted with AI software, mean sensitivity and specificity were 87.1% and 91.1%, respectively. In addition, AI software improved the inter-rater reliability from moderate to substantial agreement in a Cohen’s Kappa scale. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Tese